Summary of attainment The following table summarises the number of standards and criteria audited and the ratings they were awarded. Attainment Rating Continuous Improvement (CI) Fully Attained (FA) Partially Attained Negligible Risk (PA Negligible) Partially Attained Low Risk (PA Low) Partially Attained Moderate Risk (PA Moderate) Partially Attained High Risk (PA High) Partially Attained Critical Risk (PA Critical) Standards 0 34 0 3 6 2 0 Criteria 0 79 0 8 4 2 0 Attainment Rating Unattained Negligible Risk (UA Negligible) Unattained Low Risk (UA Low) Unattained Moderate Risk (UA Moderate) Unattained High Risk (UA High) Unattained Critical Risk (UA Critical) Standards 0 0 0 0 0 Criteria 0 0 0 0 0
Consumers' service delivery plans are evaluated in a comprehensive and timely manner. been formally reviewed by a registered nurse within the last three months in the dementia service and six months in the rest home area. There is a need for the reviews of personal goals in short and long term care plans and activity plans to be more reflective of the person’s goals, for interRAI to be used at six monthly review timeframes and for short term care plan problems to be evaluated in an ongoing manner as long as the problem exists, rather than just closed out. There was good evidence in long term care plans that where changes have been identified through review processes or through progress recording that the care plan interventions had been changed accordingly. Standard 1.3.9: Referral To Other Health And Disability Services (Internal And External) Consumer support for access or referral to other health and/or disability service providers is appropriately facilitated, or provided to meet consumer choice/needs. FA Residents are being referred to other health and/or disability providers. This is mostly done in conjunction with the GP. Examples on files that were reviewed included referrals to older person’s health, psychiatric services for the elderly and dental services. Residents and family members are linked into the Alzheimer’s Society and the Foundation for the Blind has recently also provided advice and assistance. A family member expressed gratitude on how the service had put them onto the Alzheimer’s Society and useful they had found that. Residents’ records include consultation and follow-up correspondence of referrals made. Standard 1.4.1: Management Of Waste And Hazardous Substances Consumers, visitors, and service providers are protected from harm as a result of exposure to waste, infectious or hazardous substances, generated during service delivery. FA There are guidelines for the management of waste and hazardous substances, which are followed by staff. These include directions for housekeeping and laundry. Laundry is managed onsite and cleaning products are provided by an external contractor. This provider has material safety data sheets for all their products and these were current and matched all products used on site. All cleaning and laundry chemicals, and those used by the maintenance person, are stored in locked storage areas. Staff have access to cleaning chemicals in labelled containers with instructions for use. Staff have regular training in the use of the chemical products and in the management of waste and hazardous substances. This was evident in the review of personnel files and at interview with staff.