Safe and appropriate environment Includes 8 standards that support an outcome where services are provided in a clean, safe environment that is appropriate to the age/needs of the consumer, ensure physical privacy is maintained, has adequate space and amenities to facilitate independence, is in a setting appropriate to the consumer group and meets the needs of people with disabilities. Standards applicable to this service attained. is a current building warrant of fitness. There have been no changes to the building since the previous audit. Electrical and functional testing of equipment is undertaken. Restraint minimisation and safe practice Includes 3 standards that support outcomes where consumers receive and experience services in the least restrictive and safe manner through restraint minimisation. Standards applicable to this service fully attained. Talbot Park is a secure environment. One resident uses restraint for short periods during the day and there are no enablers in use. Infection prevention and control Includes 6 standards that support an outcome which minimises the risk of infection to consumers, service providers and visitors. Infection control policies and procedures are practical, safe and appropriate for the type of service provided and reflect current accepted good practice and legislative requirements. The organisation provides relevant education on infection control to all service providers and consumers. Surveillance for infection is carried out as specified in the infection control programme. Standards applicable to this service fully attained.
Standard 1.2.1: Governance The governing body of the organisation ensures services are planned, coordinated, and appropriate to the needs of consumers. FA The strategic direction for the organisation includes the intention to exit all services provided in the facility. This process is continuing, with closure of the hospital care component of the service occurring on May 18th 2017 after transfer of the few remaining residents to other facilities. This strategy has involved two rounds of redundancy for the existing staff. The remaining psychogeriatric service of twenty-five beds is expected to transfer to a private provider in the next two years, resulting in full closure of the facility at that point. The goal has been to support residents and families through the closure process. There has been extensive consultation with staff, families and the wider community, however there is acknowledgement that it has been a stressful and uncertain time for all involved. Staff have been offered access to confidential employee assistance. The new arrangements have also involved a restructure of the remaining service. It now comes under the oversight of the manager of mental health and addictions at the DHB, with the day to day operation undertaken by an experienced charge nurse manager on the Talbot Park site. She holds relevant qualifications in nursing and has undertaken post graduate papers in nursing, delirium and dementia, leadership and management and has recently completed the “Leading the walk” workshop which can link/compliment the “Spark of Life” programme she has previously completed. A structured reporting programme ensures key performance indicators are reported to the DHB each month. Adequate information to monitor performance is provided. Back of house functions provided by the DHB include financial services and human resources management. The service continues to utilise the DHB contracted providers for food and household services. The service contracts with the DHB for aged residential care services. Twenty-three residents were receiving services under the contract at the time of audit. Standard 1.2.3: Quality And Risk Management Systems The organisation has an established, documented, and maintained quality and risk management FA Talbot Park has a planned quality and risk system linked to the framework that reflects the principles of continuous quality improvement which is documented in the Quality and Risk Plan 2016-2017. This includes management of adverse events, near misses and complaints using an electronic reporting system, internal audit activities, an annual
members and groups. Activities for residents in this secure dementia unit are specific to the needs and abilities of the people living there. One on one activities are undertaken and built into the schedule. Staff, including caregivers, were observed encouraging residents, to move around, go outside, cuddle a toy animal or doll (as applicable for the person) or use the fiddle boards as they moved around. Family members informed that overall residents are well occupied and noted there is a wide range of ways families/visitors can be involved. A comprehensive social assessment and history is undertaken when a resident is admitted to ascertain their needs, interests, abilities and social requirements. A 24 hour diversional therapy plan is then developed on a template that requires eight different goals and sets of interventions. Participation in various activities are recorded in an individualised tick sheet. Improvements are required related to activity reports and evaluations as these were not current nor reflected personal goals. Standard 1.3.8: Evaluation Consumers' service delivery are evaluated in a comprehensive and timely manner. FA Resident care is evaluated on each shift and reported in the progress notes. If any change is noted, it is reported to a registered nurse who is responsible for taking appropriate action. A multidisciplinary team meeting is undertaken every month and a brief summary of the discussion about each resident is documented all of the resident’s files that were reviewed. Formal care plan evaluations, occur every six months in conjunction with the six-monthly interRAI reassessment and as resident’s needs change. Where progress is different from expected, the service responds by initiating changes to the plan of care and examples if updates were evident in all resident files sighted. There was a gap in the evaluations and reviews of diversional therapy plans and this has been noted in section standard 1.3.7 (Planned Activities) in this report. Examples of short term care plans being consistently reviewed and progress evaluated as clinically indicated were noted for infections, skin tears and wounds. When necessary, and for unresolved problems, long term care plans are added to and/or updated. Family members stated they believe their feedback is valued by staff and contributes to how their relative is cared for.