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Report of an inspection of a Designated Centre for Disabilities (Adults) Issued by the Chief Inspector Name of designated centre:

Mullingar Centre 2

Name of provider: Muiríosa Foundation

Address of centre: Westmeath

Type of inspection: Announced

Date of inspection:

10 March 2020

Centre ID: OSV-0004083

Fieldwork ID: MON-0023006

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About the designated centre

The following information has been submitted by the registered provider and describes the service they provide. The statement of purpose outlined that the service provides full time residential care to four male adults, with a primary diagnoses of moderate to severe intellectual disability, autism and behaviours of concern. Allied support service including social work, occupational therapy, speech and language, psychology and behaviour supports are available within the organisation. The service is staffed by social care staff with nursing oversight available. There are staff on duty at all times with both waking and sleep over staff at night. The residents are supported to avail of community based services which are important to them. The designated centre comprises two single story, detached community houses in close proximity to a small town in Co Westmeath where each resident has their own bedroom, adequate communal living space and suitably equipped bathroom and recreational facilities. The following information outlines some additional data on this centre.

Number of residents on the

date of inspection:

4

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How we inspect

This inspection was carried out to assess compliance with the Health Act 2007 (as amended), the Health Act 2007 (Care and Support of Residents in Designated Centres for Persons (Children and Adults) with Disabilities) Regulations 2013, and the Health Act 2007 (Registration of Designated Centres for Persons (Children and Adults with Disabilities) Regulations 2013 - 2015 as amended. To prepare for this inspection the inspector of social services (hereafter referred to as inspectors) reviewed all information about this centre. This included any previous inspection findings, registration information, information submitted by the provider or person in charge and other unsolicited information since the last inspection.

As part of our inspection, where possible, we:

speak with residents and the people who visit them to find out their

experience of the service,

talk with staff and management to find out how they plan, deliver and monitor

the care and support services that are provided to people who live in the

centre,

observe practice and daily life to see if it reflects what people tell us,

review documents to see if appropriate records are kept and that they reflect

practice and what people tell us.

In order to summarise our inspection findings and to describe how well a service is

doing, we group and report on the regulations under two dimensions of:

1. Capacity and capability of the service:

This section describes the leadership and management of the centre and how

effective it is in ensuring that a good quality and safe service is being provided. It

outlines how people who work in the centre are recruited and trained and whether

there are appropriate systems and processes in place to underpin the safe delivery

and oversight of the service.

2. Quality and safety of the service:

This section describes the care and support people receive and if it was of a good

quality and ensured people were safe. It includes information about the care and

supports available for people and the environment in which they live.

A full list of all regulations and the dimension they are reported under can be seen in

Appendix 1.

This inspection was carried out during the following times:

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Date Times of

Inspection

Inspector Role

Tuesday 10 March 2020

08:30hrs to 18:00hrs

Noelene Dowling Lead

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What residents told us and what inspectors observed

The inspector met with the four residents in their home at different times during the day and observed some of their daily live. Some of the residents communicated with the support of staff, sat with the inspector as the process was going on and were happy for the inspector to join them for lunch.

It was clear that they were very much at home in their house and liked having their own treasured possessions, The houses were laid out in a manner which allowed for the residents to have space to move around comfortably and also to have the quiet environment when they preferred. The porch in one house was seen to be a favourite bright space to sit, to watch the garden and the road. A resident was also observed sitting comfortably in the kitchen with the staff as they prepared the meals.

It was clear that their preferences were respected and that they were comfortable and happy in their home. During the day, they went out for various activities such as walks or cycling. The inspector observed that the interactions with staff were warm, comfortable and that staff were very attentive to the residents. Communication received from parents, indicated that they were very happy with the service and complimented the life skills and personal developments which had been supported, which resulted in significant enhancement to their relatives lives.

Capacity and capability

This monitoring inspection was undertaken to inform the decision following the provider’s application to renew the registration of the centre. The centre was last inspected in January 2019 and had been first granted registration in August 2017.

This inspection found good management systems in place, which supported the welfare and quality of life of the residents living in the centre. The person in charge was a qualified nurse, with significant management experience and demonstrated very good knowledge of the responsibilities of the post and a commitment to the residents. They were responsible for two designated centres, but the management structures were such that this arrangement was effective. There were also effective reporting and support systems evident with clear lines of accountability for various areas of service provision.

There were good systems for quality assurance implemented, which included

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unannounced quality and safety reviews, audits, regular unannounced visits by the person in charge. Detailed reports were submitted monthly to the relevant manager. These systems were thorough and effective, focused on the residents’ care, safety, and identified various areas for improvement which were addressed by the person in charge.

Additionally, a detailed and transparent annual review of the quality and safety of care for 2018/2019 had been completed.

The provider had ensured that the staffing levels and skill mix were appropriate and flexible to the residents’ assessed needs for support, both day and night time. While the residents did not require nursing care, this oversight was available via the person in charge.

These arrangements, and a small consistent core group of staff, ensured that the residents had the supports they needed for their lives and their individual care. The staff spoken with were very familiar with, and obviously very supportive of the individual residents.

The records reviewed by the inspector indicated that mandatory training was up-to-date for the staff with further schedules planned. However, staff also had additional training in the administration of emergency medicines, autism, and dysphagia and received regular guidance from psychology and behaviour supports specialist. This training was relevantt to the residents who live in the centre.

There were good quality ongoing staff support and supervision systems implemented and monthly team meetings, which addressed pertinent matters and ensured the residents’ care was being monitored and appropriately supported. There was an appropriate lone working policy implemented where this was necessary. As the personnel files for the staff were stored in a different location they will be reviewed at a later stage to ascertain the provider’s compliance with Regulation 15. The provider will be informed of the outcome of that review.

The service was sufficiently resourced with adequate staff, suitable premises, equipment and transport. The provider had submitted all of the required documentation including evidence of insurance for the renewal of the registration and had done so in a timely manner. The statement of purpose was detailed and contained all of the information required. Care practices were found to be congruent with this statement. There was a detailed contract of care signed on behalf of the residents and the policies required under schedule five, were available and updated. From a review of accident and incident reports, the inspector was satisfied that the provider and person in charge were submitting the required notifications to the Chief Inspector.

While there are a number of minor actions identified in the quality and safety section of this report, this centre was generally well managed and responsive to the residents’ needs

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Registration Regulation 5: Application for registration or renewal of registration

The provider had submitted all of the required documentation for the renewal of the registration and had done so in a timely manner.

Judgment: Compliant

Registration Regulation 9: Annual fee to be paid by the registered provider of a designated centre for persons with disabilities

The required fee was submitted by the provider.

Judgment: Compliant

Regulation 14: Persons in charge

The person in charge was a qualified nurse, with significant management experience, who demonstrated very good knowledge of the responsibilities of the post and a commitment to the residents.

Judgment: Compliant

Regulation 15: Staffing

The provider had ensured that the staffing levels and skill mix were appropriate and flexible to the residents’ assessed needs for support, both day and night time. While the residents did not require nursing care, this oversight was available via the person in charge.

Judgment: Compliant

Regulation 16: Training and staff development

The records reviewed by the inspector indicated that mandatory training was up-to-date for the staff with further schedules planned. However, staff also had additional training in the administration of emergency medicines, autism, and dysphagia and

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received regular guidance from psychology and behaviour supports specialist.

Judgment: Compliant

Regulation 21: Records

All of the records required by the regulations were maintained.

Judgment: Compliant

Regulation 22: Insurance

Evidence of up to date insurance was forwarded by the provider.

Judgment: Compliant

Regulation 23: Governance and management

The provider had effective management structures and oversight systems in place which promoted the quality and safety of the residents lives.

Judgment: Compliant

Regulation 24: Admissions and contract for the provision of services

There was a suitable contract for service signed on behalf of the residents and admission decisions took due consideration of the need to ensure compatibility and safeguarding of the residents.

Judgment: Compliant

Regulation 3: Statement of purpose

The statement of purpose was detailed and contained all of the information

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required. Care practices were found to be congruent with this statement.

Judgment: Compliant

Regulation 31: Notification of incidents

From a review of accident and incident reports, the inspector was satisfied that the provider and person in charge were submitting the required notifications to the Chief Inspector.

Judgment: Compliant

Regulation 33: Notifications of procedures and arrangements for periods when the person in charge is absent

There were suitable procedures in place for any absence of the person in charge and the provider had submitted these tot he Chief Inspector.

Judgment: Compliant

Regulation 34: Complaints procedure

There were suitable systems in place for the management of any complaints or concerns raised on behalf of the residents.

Judgment: Compliant

Regulation 4: Written policies and procedures

The policies required under schedule five, were available and updated by the provider.

Judgment: Compliant

Quality and safety

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There was evidence that the provider was committed to providing a safe and person-centred service, based on the individual resident’s assessed needs and preference’s as they expressed them. The residents had complex needs including mental health and these were very well understood and supported.

Comprehensive and frequent multidisciplinary assessments, including speech and language, physiotherapy, dietitians, neurology, medical and psychiatric reviews, were undertaken. Very detailed and pertinent support plans were implemented to reflect these needs and the supports required for their personal development, health and social care needs. The personal plans and goals were reviewed frequently by the multidisciplinary team, the resident and family representatives.

The staff were familiar with the residents’ preferences and their therapeutic needs. For example, a resident liked to play classical music as a soothing mechanism. These systems helped to ensure that the resident’s quality of life was prioritised.

The arrangements for the residents daily lives and social activities were based on thoughtful consideration of the resident’s capacities, preferences and support needs. The residents had access, with staff supports, to ordinary recreation and social activities of their own choosing. They did not attend formal day service but had a wrap-around service from their homes. The inspector observed that the staff were very flexible in their approach to this. For instance, although the routines were in place, it was the resident who decided on the day what they wished to do. The staff also trialled various activities such as swimming, and were attentive to the resident’s response to these.

Some residents did arts and crafts as part of their therapeutic care while others did reflexology , gardening or some up-cycled furniture. Their works were utilised in various local community festivals. They went out for lunch and helped with shopping and also did small routine tasks in their homes. However, these activities were seen to be carefully planned so as to ensure they did not cause anxiety or distress for the residents. There was also evidence that the residents’ personal and familial relationships were being nurtured and maintained.

There were good systems for consultation with the residents’ regarding their wishes, primarily via key worker supports and house meetings. The staff used a range of mediums including pictures to ensure that the residents had knowledge of the routines and also had choices.

The residents’ healthcare needs, some of which were complex, were found to be very well attended to, monitored by staff, with frequent clinical review and evidence of follow-up referrals. They were provided with a nutritious and appetising diet, regularly reviewed by dietitians and speech and language therapists where required.

The residents had very good communication plans implemented and were supported by staff with a large variety of pictorial images, objects and sign language, where the residents were responsive to this.

The residents were protected by the systems in place to prevent and respond to any

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incidents or allegations of concern. Any legal requirements in place in relation to the residents’ care and decision making were understood and adhered to by the person in charge. The good staffing levels,individualised support plans and regular oversight by the person in charge also helped to ensure the residents were safeguarded in the service.

The residents monies were managed by the organisation, but the inspector saw that that there were detailed accounts maintained to ensure the monies were used appropriately. The systems for monitoring and oversight of this were robust.

The residents complex mental health needs were supported by good access to guidance from behaviours support specialist and psychiatry. Staff outlined the changes these supports had made to the residents well being and quality of life. The low numbers of residents in each house and compatibility of needs also supported this. Restrictive practices were not a feature of this service and those that were in place, had been carefully considered and frequently reviewed.

Medicines management systems were safe and from the records seen, it was apparent that these were reviewed regularly. Medicines audits took place regularly.

The systems for the management of risk were balanced and proportionate to the environment and the residents assessed needs. Each resident had pertinent risk management plans implemented for their identified individual risks, whether falls, seizure activity or personal safety. There was “live” risk register implemented and updated to ensure this process was effective and responsive. Systems for learning from any adverse events were also evident. For example, changes had been made promptly when a resident suffered a fall.

Overall,fire safety systems were good with suitable alarms, containment systems and evacuation systems in place. Regular practice drills were held with the residents. However, the records seen demonstrated that servicing of the fire alarms was somewhat irregular and not in accordance with the requirements or the contractual arrangements. It was however, tested by staff regularly and was in working order. Additionally, one door required review to ensure it provided suitable containment.

There was a suitable emergency plan devised and a signed and current health and safety statement available. Infection control practices were implemented and the provider was actively making contingency plans to deal with possible additional risks. There was evidence of regular maintenance of the heating systems and all vehicles used for the residents.

Both houses were very homely, comfortable, and spacious and suited the needs for the residents very well. They had their own bedrooms and suitably equipped bathrooms and their own favourite places to spend time. The back door and steps down to the garden in one of the houses did require some adjustments however, so the residents could use this easily, given their risk of falls.

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Regulation 10: Communication

The residents had very good communication plans implemented and were supported by staff with a large variety of pictorial images, objects and sign language, where the residents were responsive to this.

Judgment: Compliant

Regulation 12: Personal possessions

The residents had full access to all of their treasured personal possessions and accounts of these were maintained.

Judgment: Compliant

Regulation 13: General welfare and development

The residents had access, with staff supports, to ordinary recreation and social activities of their own choosing. They did not attend formal day service but had a wrap-around service from their homes. The inspector observed that the staff were very flexible in their approach to this and also supported the residents to develop and maintain fundamental life skills appropriate to their capacities.

Judgment: Compliant

Regulation 17: Premises

The premises were very homely, comfortable, spacious and suited the needs for the residents very well. They had their own bedrooms and suitably equipped bathrooms and their own favourite places to spend time. The back door and steps down to the garden in one of the houses did require some adjustments however, so the residents could use this easily, given their risk of falls.

Judgment: Substantially compliant

Regulation 26: Risk management procedures

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The systems for the management of risk were balanced and proportionate to the environment and the residents assessed needs.Systems for learning from any adverse events were also evident. There was a suitable emergency plan available and contingency plans being devised to deal with any untoward events.

Judgment: Compliant

Regulation 27: Protection against infection

There were good infection control procedures implemented to protect the residents .

Judgment: Compliant

Regulation 28: Fire precautions

Overall, fire safety systems were good with suitable alarms and containment systems and evacuation systems in place. Regular practice drills were held with the residents. However, the records seen demonstrated that servicing of the fire alarms was somewhat irregular and not in accordance with the requirements or the contractual arrangements in place. It was however, tested by staff regularly and was in working order. Additionally, one door required review to ensure it provided suitable containment.

Judgment: Substantially compliant

Regulation 29: Medicines and pharmaceutical services

Medicines management systems were safe and from the records seen, it was apparent that these were reviewed regularly. Medicines audits took place regularly.

Judgment: Compliant

Regulation 5: Individual assessment and personal plan

Comprehensive and frequent multidisciplinary assessments, including speech and language, physiotherapy, dietitians, neurology, medical and psychiatric reviews, were available to the residents.Their care and support needs were

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were frequently reviewed and were tailored to their own preferences and wishes.

Judgment: Compliant

Regulation 6: Health care

The residents’ healthcare needs, some of which were complex, were found to be very well attended to, monitored by staff, with frequent clinical review and evidence of follow-up referrals.

Judgment: Compliant

Regulation 7: Positive behavioural support

The residents complex mental health, emotional and behaviour support needs were supported by good access to guidance from behaviours support specialist and psychiatry. Restrictive practices were not a feature of this service and those that were in place, had been carefully considered and frequently reviewed.

Judgment: Compliant

Regulation 8: Protection

The residents were protected by the systems in place to prevent and respond to any incidents or allegations of abuse.

Judgment: Compliant

Regulation 9: Residents' rights

The residents own preferences for their daily lives were seen to supported by the provider, with appropriate supports, and their privacy and personal dignity was found to be respected.

Judgment: Compliant

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Appendix 1 - Full list of regulations considered under each dimension This inspection was carried out to assess compliance with the Health Act 2007 (as amended), the Health Act 2007 (Care and Support of Residents in Designated Centres for Persons (Children and Adults) with Disabilities) Regulations 2013, and the Health Act 2007 (Registration of Designated Centres for Persons (Children and Adults with Disabilities) Regulations 2013 - 2015 as amended and the regulations considered on this inspection were:

Regulation Title Judgment

Capacity and capability

Registration Regulation 5: Application for registration or renewal of registration

Compliant

Registration Regulation 9: Annual fee to be paid by the registered provider of a designated centre for persons with disabilities

Compliant

Regulation 14: Persons in charge Compliant

Regulation 15: Staffing Compliant

Regulation 16: Training and staff development Compliant

Regulation 21: Records Compliant

Regulation 22: Insurance Compliant

Regulation 23: Governance and management Compliant

Regulation 24: Admissions and contract for the provision of services

Compliant

Regulation 3: Statement of purpose Compliant

Regulation 31: Notification of incidents Compliant

Regulation 33: Notifications of procedures and arrangements for periods when the person in charge is absent

Compliant

Regulation 34: Complaints procedure Compliant

Regulation 4: Written policies and procedures Compliant

Quality and safety

Regulation 10: Communication Compliant

Regulation 12: Personal possessions Compliant

Regulation 13: General welfare and development Compliant

Regulation 17: Premises Substantially compliant

Regulation 26: Risk management procedures Compliant

Regulation 27: Protection against infection Compliant

Regulation 28: Fire precautions Substantially compliant

Regulation 29: Medicines and pharmaceutical services Compliant

Regulation 5: Individual assessment and personal plan Compliant

Regulation 6: Health care Compliant

Regulation 7: Positive behavioural support Compliant

Regulation 8: Protection Compliant

Regulation 9: Residents' rights Compliant

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Compliance Plan for Mullingar Centre 2 OSV-0004083 Inspection ID: MON-0023006

Date of inspection: 10/03/2020 Introduction and instruction This document sets out the regulations where it has been assessed that the provider or person in charge are not compliant with the Health Act 2007 (Care and Support of Residents in Designated Centres for Persons (Children And Adults) With Disabilities) Regulations 2013, Health Act 2007 (Registration of Designated Centres for Persons (Children and Adults with Disabilities) Regulations 2013 and the National Standards for Residential Services for Children and Adults with Disabilities. This document is divided into two sections: Section 1 is the compliance plan. It outlines which regulations the provider or person in charge must take action on to comply. In this section the provider or person in charge must consider the overall regulation when responding and not just the individual non compliances as listed section 2. Section 2 is the list of all regulations where it has been assessed the provider or person in charge is not compliant. Each regulation is risk assessed as to the impact of the non-compliance on the safety, health and welfare of residents using the service. A finding of:

Substantially compliant - A judgment of substantially compliant means that the provider or person in charge has generally met the requirements of the regulation but some action is required to be fully compliant. This finding will have a risk rating of yellow which is low risk.

Not compliant - A judgment of not compliant means the provider or person in charge has not complied with a regulation and considerable action is required to come into compliance. Continued non-compliance or where the non-compliance poses a significant risk to the safety, health and welfare of residents using the service will be risk rated red (high risk) and the inspector have identified the date by which the provider must comply. Where the non-compliance does not pose a risk to the safety, health and welfare of residents using the service it is risk rated orange (moderate risk) and the provider must take action within a reasonable timeframe to come into compliance.

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Section 1 The provider and or the person in charge is required to set out what action they have taken or intend to take to comply with the regulation in order to bring the centre back into compliance. The plan should be SMART in nature. Specific to that regulation, Measurable so that they can monitor progress, Achievable and Realistic, and Time bound. The response must consider the details and risk rating of each regulation set out in section 2 when making the response. It is the provider’s responsibility to ensure they implement the actions within the timeframe. Compliance plan provider’s response:

Regulation Heading Judgment

Regulation 17: Premises

Substantially Compliant

Outline how you are going to come into compliance with Regulation 17: Premises: The PIC consulted with the Operation Manager who has arranged for the works below to commence. The steps at the back door and the step leading to the garden will be adjusted to ensure it is a safe and accessible height so that all individuals in the designated centre may safely access the garden and back of the house.

Regulation 28: Fire precautions

Substantially Compliant

Outline how you are going to come into compliance with Regulation 28: Fire precautions: The registered provider shall ensure that effective fire safety management systems are in place which includes the servicing of the fire alarms in line with the organisations contractural arrangements. The Operations Manager has advised that the company has given assurance that the fire alarm and emergency lightening is serviced every quarter. The PIC will audit the Fire Register to ensure that servicing of the fire alarm and lightening is consistence. One door will be replaced to ensure suitable containment in the event of a fire.

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Section 2: Regulations to be complied with The provider or person in charge must consider the details and risk rating of the following regulations when completing the compliance plan in section 1. Where a regulation has been risk rated red (high risk) the inspector has set out the date by which the provider or person in charge must comply. Where a regulation has been risk rated yellow (low risk) or orange (moderate risk) the provider must include a date (DD Month YY) of when they will be compliant. The registered provider or person in charge has failed to comply with the following regulation(s).

Regulation Regulatory requirement

Judgment Risk rating

Date to be complied with

Regulation 17(6) The registered provider shall ensure that the designated centre adheres to best practice in achieving and promoting accessibility. He. she, regularly reviews its accessibility with reference to the statement of purpose and carries out any required alterations to the premises of the designated centre to ensure it is accessible to all.

Substantially Compliant

Yellow

24/04/2020

Regulation 28(2)(b)(i)

The registered provider shall make adequate arrangements for maintaining of all fire equipment, means of escape, building fabric and building services.

Substantially Compliant

Yellow

31/05/2020

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