Criterion 1.2.4.3 PA Low Policy includes that whenever a incidents where neuro Ensure neuro resident has a potential or actual observations were required observations are The service provider documents adverse, knock to the head, neuro did not have completed completed and unplanned, or untoward events including service observations are to be completed. neuro observation forms documented when a shortfalls in order to identify opportunities to Three incident forms sampled where available to confirm these resident has a improve service delivery, and to identify and the resident had experienced a had occurred. potential head manage risk. potential or actual knock to the head injury. documented on the incident form that these had been completed but no observation records were available to 60 days support this. Criterion 1.2.7.5 PA CHT has documented requirements Education provided has not Ensure all Moderate to be included in the education covered most required receive training in all A system to identify, plan, facilitate, and record programme that includes all required topics or providing support required areas ongoing education for service providers to training. Carnarvon has a to all residents included including providing provide safe and effective services to consumers. documented 2016/2017 training plan younger people. support to meet the that does not include all required needs of all trainings and several sessions of residents. required training that had been planned had been cancelled. Staff, including registered nurses and 90 days healthcare assistants, have attended external training provided by the DHB or hospice, either as small groups or as individuals, depending on spaces available and staff numbers that could be released. Staff training (in required areas) has been provided for the full staff around fire safety, medication management, infection control and health and safety. Criterion 1.3.12.1 PA Low All medications are stored safely. There were six imprest stock Ensure all There are regular checks in place for medications that had medications in stock A medicines management system is implemented imprest stock, required’ expired. are checked for ‘as to manage the safe and appropriate prescribing, medications, medication fridge expiry dates. dispensing, administration, review, storage, temperatures, emergency trolley,
Criterion 1.2.4.3 The service provider documents adverse, unplanned, or untoward events including service shortfalls in order to identify opportunities to improve service delivery, and to identify and manage risk. PA Low Policy includes that whenever a resident has a potential or actual knock to the head, neuro observations are to be completed. Three incident forms sampled where the resident had experienced a potential or actual knock to the head documented on the incident form that these had been completed but no observation records were available to support this. incidents where neuro observations were required did not have completed neuro observation forms available to confirm these had occurred. Ensure neuro observations are completed and documented when a resident has a potential head injury. 60 days Criterion 1.2.7.5 A system to identify, plan, facilitate, and record ongoing education for service providers to provide safe and effective services to consumers. PA Moderate CHT has documented requirements to be included in the education programme that includes all required training. Carnarvon has a documented 2016/2017 training plan that does not include all required trainings and several sessions of required training that had been planned had been cancelled. Staff, including registered nurses and healthcare assistants, have attended external training provided by the DHB or hospice, either as small groups or as individuals, depending on spaces available and staff numbers that could be released. Staff training (in required areas) has been provided for the full staff around fire safety, medication management, infection control and health and safety. Education provided has not covered most required topics or providing support to all residents included younger people. Ensure all receive training in all required areas including providing support to meet the needs of all residents. 90 days Criterion 1.3.12.1 A medicines management system is implemented to manage the safe and appropriate prescribing, dispensing, administration, review, storage, PA Low All medications are stored safely. There are regular checks in place for imprest stock, ‘as required’ medications, medication fridge temperatures, emergency trolley, There were six imprest stock medications that had expired. Ensure all medications in stock are checked for expiry dates.
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