Nursing Home Regulation

Table of Contents

Regulators

The Health Act 2007 provided for the establishment of HIQA. Part of its functions includes the registration and inspection of all nursing homes by the Chief Inspector of Social Services. This replaced the previous Health (Nursing Homes) Act, under which the HSE registered and inspected private nursing homes only.

The Health Act 2007 Registration of Designated Centres for Older Persons Regulations provides for the registration of nursing homes and other designated centres for older persons. The Chief Inspector is to maintain a register of each category of designated centres for older persons referred to in the Regulations.

The Chief Inspector is to enter the maximum number of residents who will be accommodated in the Centre and other particulars relating to the designated centre deemed relevant by the inspector.

Registration

The individual partners are listed when you enter the name of the registered provider. Where the provider is a company, details of directors and controllers are to be entered.

The managers must be detailed. Where is a statutory body under the health legislation, other appropriate particulars, including particulars of managers and the controlling authority, are to be entered.

There is provision for amending the register as required due to changes, provision of additional conditions, cessation of registration and other changes. The legislation sets out a form of application for registration. It must include the scheduled information.

The registration must be renewed in a similar manner with a similar form. An application for renewal must include full and satisfactory information in relation to all matters specified in the schedule to the regulations relating to the provider.

Evidence that the premises comply with planning permission and building regulations must be furnished. Copy of the insurance contract, written guidance for residents and a statement of the maximum number of residents must be provided.

There is a fee is set by the regulations for initial registration. An annual fee is payable by the registered provider of a designated centre for all the persons.

If satisfied that the application is properly made and that the registration should be granted, a certificate is issued with particulars of the premises and the applicant/ operator is issued. It sets out the maximum number of residents who can be accommodated and the period of registration. The certificate may be amended as circumstances require.

Changes

As soon as possible, information must be given in respect of any change of identity of the person in charge. Equivalent information in respect of the substituted person must be immediately furnished.

The Chief Inspector must be notified where the person in charge of a designated centre has ceased to be in charge and full particulars of the new substitute person in charge must be furnished. The change of identity of persons participating in management other than persons in charge must be furnished within 28 days.

At least eight weeks’ notice in writing is required of any of the following:

Change in ownership of the company,
change in the identity of any senior officers,
change of name and address

Equivalent procedures apply in respect of changes in the composition of a partnership or other organisation.

At least six months’ notice must be given of the intention to cease trading and operations.

Registered providers may apply for variations or removal of conditions on registration. The reason for variation or removal must be specified. This may arise from such matters as structural changes to the premises, changes in management, additional staff, etc. Approval must be sought for the variation. A fee is payable.

Information & Records

There are provisions in respect of information to be kept or provided to residents and others. A resident’s guide must be prepared in writing and contain detailed information on specified matters. A copy is to be given to the Chief Inspector and to residents.

Registered providers must keep detailed records which must be up to date and in good order. They must be kept in a safe and secure place and made available to the residents to whom they refer. They must be made available for inspection by the Inspectors. There must be written records in relation to access to policies. They must be retained for not less than seven years after the resident ceases to reside. All documentation of inspections relating to food, safety, health and fire inspections must be maintained.

Staffing

Detailed staffing records are required to include particulars of each staff member, details of qualifications, applicable registrations and weekly working rosters.

Volunteer workers must have a written agreement in relation to their role. They must be vetted and must receive supervision and support.

Medicines

The centre must have appropriate and suitable practices in relation to ordering, prescribing, storing and administration of medicines. The person in charge must ensure all parties are familiar with the procedures. They must comply with current regulations and guidelines relating to medicines.

Detailed medical records must be kept for each resident. This is to include details of medical nursing or psychiatric condition, adequate nursing records, medical records, records in relation to drugs and medicine, records of any occasion the drugs are administered, particulars of prescriptions, records of occasions when residents are refused treatment, records of adverse reactions, medication errors or use of restraints.

Insurance

There are provisions in respect of insurance. The registered provider must ensure that insurance coverage is put in place in respect to loss or damage to a patient’s personal property, which need not exceed €1,000 per item except where the property is expressly designated for safekeeping.

The provider must have appropriate operating policies and procedures. They are set out in detail in the schedule to the regulation.

Residents

A contract must be provided to residents within one month of admission. It is to detail the care and welfare of the resident in the centre and includes details of the services to be provided and fees charged.

There are duties in respect of temporary absences and discharge of residents. Relevant information must be retained regarding information where the resident is absent, including, in particular, other designated centres and hospitals.

Information must be obtained from the other institution etc., regarding the period of absence and manner of treatment etc. There must be a systematic plan for the safe discharge of residents.

Safety Procedures

There must be written policies and procedures in relation to health and safety, including the safety of residents, visitors and staff. The registered provider must have comprehensive written risk management policies that are implemented.

It must identify risks and specify precautions to be taken. In particular, particular risks and precautions, including absence without leave, assault, accidental injury, self-harm, aggression and violence, must be the subject of specific policies.

There are detailed provisions in respect of fire precautions and records. There must be adequate fire safety equipment, means of escape and fire detection devices. There must be arrangements for evacuation procedures, maintenance of fire equipment, review etc.

Employees must receive suitable training. There must be fire drills at suitable intervals. Records of fire practices, alarm tests, records, etc., must be kept.

Quality of Care

The registered provider must establish and maintain systems for reviewing the quality of care and the quality of life of residents in designated centres. It must provide a system for improving the quality of care. The system must provide for consultation with residents.

Records must be kept of all incidents. Certain incidents, including deaths of residents under 70, outbreaks of infectious diseases, serious injuries, unexplained absences, and allegations of abuse or misconduct, must be notified to the Chief Inspector without delay. If made verbally, it must be confirmed in writing within three days.

A written report must be provided to the Chief Inspector quarterly in relation to any recurring pattern of theft, accidents, fire, loss of power, heating, incidents requiring evacuation or other prescribed incidents. Records must be kept for seven years after the event.

Contingencies

There are provisions for notifications when the person in charge is absent from a designated centre. Notice of the proposed absence is to be given to the chief inspector. This must happen at least one month in advance.

Where the absence occurs in an emergency, notice must be given to the Chief Inspector within three days. Procedures and arrangements must be put in place, and notified when the person in charge is absent.

The notice is to specify the arrangements that are in place. Provisions must be made for appointing another person in charge to manage a designated centre during the absence.

Complaints

The registered provider must have a written policy regarding procedures for handling, making and investigating complaints about any aspect of service, care or treatment. It is to contain an independent appeals process, which is to be included in the statutory policy.

Residents are to be made aware of the complaints procedure as soon as practicable after admission. The complaints procedure is to be displayed in a prominent place in the centre. The nominated person is to be available to deal with all complaints. They must be properly investigated. Records of a complaint and the outcome of the complaint must be kept.

The results of all complaints must be fully and properly recorded so that records are kept in addition to the individual\’s care plan. A resident must not be adversely affected by the reason for having complained. Records must be kept for seven years after the complaint and investigation and when the resident is informed of the outcome.