Alpine Retirement Group Limited - Alpine View Lodge

Alpine Retirement Group Limited - Alpine View Lodge

Introduction

This report records the results of a Partial Provisional Audit of a provider of aged residential care services against the Health and Disability Services Standards (NZS8134.1:2008; NZS8134.2:2008 and NZS8134.3:2008).

The audit has been conducted by Health and Disability Auditing New Zealand Limited, an auditing agency designated under section 32 of the Health and Disability Services (Safety) Act 2001, for submission to the Ministry of Health.

The abbreviations used in this report are the same as those specified in section 10 of the Health and Disability Services (General) Standards (NZS8134.0:2008).

You can view a full copy of the standards on the Ministry of Health’s website by clicking here.

The specifics of this audit included:

Legal entity:Alpine Retirement Group Limited

Premises audited:Alpine View Lodge

Services audited:Rest home care (excluding dementia care)

Dates of audit:Start date: 15 July 2015End date: 15 July 2015

Proposed changes to current services (if any):Reconfigure the current certified services to include 40 apartments as rest home level beds.

Total beds occupied across all premises included in the audit on the first day of the audit:47

Executive summary of the audit

Introduction

This section contains a summary of the auditors’ findings for this audit. The information is grouped into the six outcome areas contained within the Health and Disability Services Standards:

• consumer rights
• organisational management
• continuum of service delivery (the provision of services)
• safe and appropriate environment
• restraint minimisation and safe practice
• infection prevention and control.

General overview of the audit

Alpine View retirement village complex has recently opened a newly built Lodge which includes 40 one bedroom serviced apartments, a café and restaurant, community centre, movie room, chapel and swimming pool. The Alpine View complex also includes a 47 bed care centre providing rest home level care, with full occupancy on the day of audit. The care centre is managed by a nurse manager with support from a clinical director and care staff. The retirement village, including the Lodge, is managed by a village manager with support from the clinical director, kitchen staff, care givers and cleaning and maintenance staff. The clinical director (registered nurse) was appointed in November 2014 to oversee the care of both the care centre and the Lodge. The clinical director reports to the village manager, directors and the board. Alpine View retirement village and care centre is guided by a comprehensive quality and risk management system.

This partial provisional audit was conducted to assess the service’s ability to provide rest home level care within the 40 bed serviced apartments at the Lodge. This would increase certified bed numbers from 47 rest home to 87 rest home level beds. This audit verified that the service has appropriate processes, facilities and staffing to provide rest home level care within the Lodge. Audit processes included a tour of the facility, review of documentation, medication management and food service, and interviews with directors, management and staff.

Improvements are required prior to occupancy around provision of a medication management system, dietitian review of the menu, monitoring of hot water temperatures, and provision of appropriate equipment.

Previous surveillance audit findings were reviewed in respect to part 3 (continuum of service delivery) of the health and disability service standards. Improvements continue to be required for rest home residents at the care centre around: inclusion of resident and family in care planning, aspects of assessments, care planning and evaluation, medication management and safe food management.

Consumer rights

Not Audited

Organisational management

The Alpine View board of directors and management team of the retirement village provide governance and support to the village manager. The clinical director acts as village manager in his absence. Human resources processes are managed in accordance with good employment practice, meeting legislative requirements. The induction and education and training programmes for the staff ensure staff are competent to provide care for rest home residents. There are staff employed to provide care for the existing retirement village residents with further recruitment planned as assessed residents are admitted. The clinical director is based at the Lodge and is an experienced nurse educator and health and safety advisor. Existing care staff have completed aged care standards qualifications. A roster is in place for staff cover in the Lodge and will be increased in line with occupancy. Another registered nurse will be employed as and when required.

Continuum of service delivery

Medication policies and procedures align with current standards and guidelines. Staff responsible for medicine administration are trained and have current medication competencies. Food service at the Lodge is provided on site by experienced kitchen staff. The service is equipped to manage the provision of rest home level residents at the Lodge. Kitchen staff have completed food safety training. Residents' individual needs are identified, documented and reviewed on a regular basis.

Safe and appropriate environment

Alpine View has documented processes for waste management. The service has a policy for investigating, recording and reporting incidents involving infectious material or hazardous substances. Chemical safety training has been provided to staff. There is a current building warrant of fitness. The maintenance role entails checks for safety of the facility and implementing requests from the maintenance book. Annual testing and tagging of electrical equipment and calibration and service of medical equipment will be conducted when required as currently all equipment is new. Within the Lodge there is a large atrium, a restaurant, café, bar, two lounges, a movie theatre and a swimming pool. All apartments have full bathroom facilities. The service has implemented policies and procedures for fire, civil defence and other emergencies and training has been conducted. There are staff on duty with a current first aid certificate. General living areas and apartments are appropriately heated and ventilated. The rest home residents will have access to communal areas for entertainment, recreation and dining. Residents will be provided with safe and hygienic cleaning and laundry services, which are appropriate to the setting.

Restraint minimisation and safe practice

Not Audited

Infection prevention and control

Infection control management systems are in place to minimise the risk of infection to consumers, service providers and visitors. Documented policies and procedures are in place for the prevention and control of infection and reflect current accepted good practice and legislative requirements. These reflect the needs of the service and are readily available for staff access. Documentation evidences that relevant infection control education is provided to all service providers as part of their orientation and also as part of the on-going in-service education programme.

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 / 12 / 0 / 1 / 5 / 0 / 0
Criteria / 0 / 30 / 0 / 2 / 6 / 0 / 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

Attainment against the Health and Disability Services Standards

The following table contains the results of all the standards assessed by the auditors at this audit. Depending on the services they provide, not all standards are relevant to all providers and not all standards are assessed at every audit.

Please note that Standard 1.3.3: Service Provision Requirements has been removed from this report, as it includes information specific to the healthcare of individual residents. Any corrective actions required relating to this standard, as a result of this audit, are retained and displayed in the next section.

For more information on the standards, please click here.

For more information on the different types of audits and what they cover please click here.

Standard with desired outcome / Attainment Rating / Audit Evidence
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 Alpine View retirement village board of directors provide governance and support to the village manager and clinical director. The village manager is also a director. The clinical director is a registered nurse with experience in education, practice nursing, operating theatre and health and safety management systems. The clinical director was appointed in November 2014. The service is certified to provide rest home level care for up to 47 residents at the care centre with full occupancy on the day of audit. There were no respite residents. A nurse manager oversees the care centre. The Lodge is a newly built facility which is part of the new retirement village complex and includes 40 one bedroom apartments.
The organisation has a current strategic plan, business plan and quality plan. The quality programme is managed by the clinical director and nurse manager. The service has a comprehensive suite of policies and procedures which have been developed by an external consultant. Quality improvement activities are identified from audits, meetings, staff and resident feedback and incidents/accidents. There are clearly defined and measurable goals developed for the strategic plan and quality plan. The service has developed a plan around the provision of rest home level care in the Lodge serviced apartments and includes engagement of stakeholders, physical environment, recruitment of staff, staff education, a marketing plan, and assessment of residents and management of a waiting list.
The clinical director and nurse manager have maintained at least eight hours annually of professional development activities related to managing the service including InterRAI training and palliative care.
Standard 1.2.2: Service Management
The organisation ensures the day-to-day operation of the service is managed in an efficient and effective manner which ensures the provision of timely, appropriate, and safe services to consumers. / FA / In the village manager’s absence, the clinical director is responsible for the running of the facility. A review of the documentation, policies and procedures and from discussions with staff identifies the service's operational management strategies, and quality and risk programme are in place to minimise the risk of unwanted events and enhance quality.
Standard 1.2.7: Human Resource Management
Human resource management processes are conducted in accordance with good employment practice and meet the requirements of legislation. / FA / The recruitment and staff selection process requires that relevant checks are completed to validate the individual’s qualifications, experience and veracity. A copy of practising certificates including the registered nurses, general practitioners, physiotherapist and pharmacist is kept. There are comprehensive human resources policies including recruitment, selection, orientation and staff training and development. Reference checks are completed before employment is offered. The service has a comprehensive orientation programme in place that provides new staff with relevant information for safe work practice. Six staff files were reviewed and included the clinical director, three caregivers, one enrolled nurse and one kitchen hand.
Discussion with the clinical director confirms that a comprehensive in-service training programme is in place that covers relevant aspects of care and support and meets requirements. There is an in-service calendar for 2015. Training has been provided for Lodge staff around emergency management, civil defence response, and first aid, medication competencies for caregivers, fire training and fire evacuation drills. Caregivers’ orientation will include completion of a level two qualification. Caregivers who do not have formal qualifications will be encouraged to complete training to level three and four. The clinical director is qualified to teach adult education. Registered nurses (RN’s) and caregivers will complete medication competencies. Care staff currently employed are medication competent.
Standard 1.2.8: Service Provider Availability
Consumers receive timely, appropriate, and safe service from suitably qualified/skilled and/or experienced service providers. / FA / Human resource management policies include a staff rationale and skill mix policy. Sufficient staff are currently rostered on to manage the care requirements of the rest home residents at the care centre. The Lodge is currently staffed by the clinical director who works full time and there is one caregiver rostered on for morning, afternoon and night shift. The clinical director provides on call cover. The Lodge also employs cleaning staff, a food services manager, cooks and kitchen hands and a maintenance person and gardeners. The clinical director has developed a proposed roster for staffing the Lodge when rest home residents are accommodated. With 10 rest home residents there will be one RN and one caregiver on duty on the morning shift, one caregiver on the afternoon shift and one caregiver on duty overnight. Staffing will be increased in increments of five – ten residents. Activities are to be provided Monday to Friday and an activity programme is currently underway for retirement village residents. The intention is to employ a registered nurse to cover Monday to Friday when rest home resident numbers demand this.
Standard 1.3.12: Medicine Management
Consumers receive medicines in a safe and timely manner that complies with current legislative requirements and safe practice guidelines. / PA Moderate / Partial Provisional audit: There are comprehensive medication management policies and procedures in place, which have been provided by an external consultant. A medicines management system will be implemented to manage the safe and appropriate prescribing, dispensing, administration, review, storage, disposal, and medicine reconciliation in order to comply with legislation, protocols, and guidelines. The service will use four weekly blister dose medication packs for all rest home residents at the Lodge. There is a signed agreement with a supplying pharmacy. Medication packs will be checked and reconciled against medication charts upon arrival to the facility.
Caregivers who are deemed to be medication competent will administer medications to rest home residents in the serviced apartments. Medication competencies were current for two caregiver staff files reviewed. Corrective actions, where appropriate, following medication errors will be discussed at the weekly management meetings and staff meetings.
The service has a policy and procedure for residents who wish to self-medicate that advises three monthly assessments by GP of the resident's on-going ability to safely self-medicate and a resident competency review form.
Care Centre: Previous audit identified shortfalls around no medication chart for a respite resident, insecure controlled drug storage and infrequent controlled drugs checking, expired medications, staff administration procedures, self-medicating residents competence and storage of medications. A medicines management system is implemented to manage the safe and appropriate prescribing, dispensing, review, disposal, and medicine reconciliation in order to comply with legislation, protocols, and guidelines. The service uses four weekly blister dose medication packs for all residents at the care centre. Medication charts for 10 residents were reviewed and evidence that photo identification and allergies were recorded.
There is a signed agreement with the supplying pharmacy. Medication packs are checked and reconciled against medication charts upon arrival to the facility.
Medication fridge temperatures are monitored.
Caregivers administer medications in the rest home care centre. The service records all medication errors as incidents/accidents and these are followed up on a monthly basis.
The service has a policy and procedure on residents who wish to self-medicate that eludes three monthly assessments by GP of the resident's on-going ability to safely self-medicate and a resident competency review form, however, this has not been reviewed for one resident who self-administers medications.
There is a locked treatment room and two medication trolleys in the care centre. A medication round was not observed during the audit.
Standard 1.3.13: Nutrition, Safe Food, And Fluid Management
A consumer's individual food, fluids and nutritional needs are met where this service is a component of service delivery. / PA Moderate / Partial Provisional: The service has employed a food services manager who works full time at the Lodge. The food service manager is a cook with many years of experience and is responsible for menu planning, training of staff and all cleaning and audits. One other qualified chef and kitchen hands are employed. All staff working in the kitchen at the Lodge have food safety qualifications. Fridge and freezer temperatures are monitored daily in the kitchen. Food temperatures are recorded and also food on delivery to the service is recorded. Meals are served directly from the kitchen to the restaurant.