Nursing Home Standards

Table of Contents

Standards Types

National quality standards for residential care settings for older persons were launched in 2009. There are now 32 standards under a number of groupings, namely:

health and social needs,
quality of life,
staffing,
care environment,
governance and management,
rights protection.

The Health Act 2007 Registration of Designated Centres) Regulation and The Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulation provide, respectively, for registration with the Chief Inspector and for the underpinning of standards.

Statement

The registered provider is to compile, in relation to the designated centre, a written statement consisting of the aims, objects and ethos of the centre, particulars of the facilities to be provided and a statement of matters listed in the schedule. The registered provider must make a copy available to the Chief Inspector and available on request to a resident.

The statement is to be retained. A Chief Inspector is to be notified of any changes in the statement of purpose which affect the purpose or function of the designated centre.

Residents I

The physical environment is to enhance the quality of life. There are provisions in relation to the premises and its grounds. There must be a safe outdoor space with seating, which is maintained in an attractive way. If there is no garden area, there must still be access to outdoor activity.

Residents are to exercise choice and control and are encouraged to maximise independence in accordance with their wishes. Their lifestyle is to match insofar as possible before entering the care setting, and their social, cultural, religious and recreational interests are to be satisfied in accordance with their wishes.

Residents are to receive a varied and nutritious diet. Special dietary needs are to be catered for. Friends, family and others are entitled to visit and are encouraged to be in contact with residents.

Residents are entitled to see visitors in private. Where residents have special behavioural needs, they are to be managed and responded to in an environment that effectively promotes well-being with the least restriction.

Residents II

A directory of residents must be established and maintained. It must contain specific records. The maximum number of residents to be maintained shall not exceed the number designated by the Chief Inspector.

The residential care must be run in a way that protects residents from avoidable harm, including physical harm and infection. Premises must be kept clean, hygienic, and free from offensive odours. Systems must be in place to control the spread of the infection.

Residents are entitled to bring personal belongings and may provide some of their own furnishings. They are to have a lockable storage space for personal belongings and valuables.

Their bedroom is to have a lock which can be used by the resident. The staff may access it in an event of an emergency. If a room is shared, there is to be screening to ensure personal privacy.

Treatment

The patient must not suffer or be subjected to unnecessary or inappropriate medicine consumption. He or she may decide on physical, personal and spiritual care they would prefer including in respect of end of life.

The registered provider must ensure that the centre has written operational policies and procedures for end-of-life care. The provider shall ensure that when a resident is approaching the end of his or her life,

that appropriate care and comfort are given to address physical, emotional, psychological and spiritual needs,
that his religious and cultural practices are insofar as practicable facilitated;
that resident’s family and friends are, insofar as reasonably practicable, facilitated to be with the resident when they are dying, and overnight facilities are provided whenever possible at each resident’s place of death choice, including the option of a single room as identified and facilitated.

Anti-Abuse

The registered provider shall ensure that all reasonable measures are taken to protect the resident from all forms of abuse and that there is a policy and procedure sin place for the prevention, detection and response to abuse.

The person in charge shall make all necessary arrangements by training staff or by other measures that are aimed at preventing residents from being harmed, suffering abuse or being placed at risk of abuse. It must record incidents and take appropriate action where a resident is harmed or suffers abuse.

There are provisions for protection from bullying, harassment, neglect and discrimination. There are provisions to protect the financial interests of residents. Any involvement by staff in finances must be carefully recorded and should generally be signed.

Welfare Obligations

The registered provider must ensure that there is provided for residents in a centre suitable and sufficient care to maintain their welfare and well-being, having regard to the nature and extent of their resident’s dependency and their needs are set out in their care plan. A high standard of evidence-based nursing practice must be implemented.

Appropriate medical care by medical practitioners of the resident’s choice and acceptable to the person must be provided. A resident must be given the opportunity to participate in activities appropriate to his interests and capacities.

The registered provider must ensure that the centre has written operational policies and procedures relating to the resident’s personal property and possession. A person in charge is to keep a record of each person\’s property, signed by the resident and the records must be kept up to date. Adequate space must be provided for a reasonable number of personal possessions, and each resident must retain control over his or her personal possessions.

Care Plan

The person in charge must ensure that each resident\’s needs are set out in an individual care plan agreed upon with each resident. The plan is to be made available to the resident and kept under a formal review in accordance with the resident’s changing needs or circumstances.

This must be at no less frequent than three monthly intervals. The resident’s care plan must be revised after consultation unless it is impracticable to carry it out. The resident must be notified of any review.

Consent & Decision Making

Residents have a right to easily accessible information in clear language to assist in decision-making. They are encouraged to express their views on any aspect of the residential care setting. They are to be consulted in relation to the organisation of the care setting and are given the option to participate in the organisation of the care setting if they wish.

Residents must consent to treatment and care. Their privacy and dignity must be respected. They must be helped in the exercise of their political, civil and religious rights in accordance with their wishes.

A resident is to receive a written contract from the provider of the residential care service that sets out what will be provided, including fees and additional costs. A complaint made by the resident or family member must be acted on. There must be an effective appeals procedure in the event of disagreement as to whether the complaint has been resolved.

Manager

The person in charge is to be a nurse with professional training experience in managing the residential care setting. There must be policies and procedures covering a range of issues to ensure the safety and well-being of residents. This includes areas such as medication, health and safety, fire safety, staff training, managing risk, record keeping and complaints.

The person in charge must ensure that the staff knows the details of policies and procedures and the manner in which they are implemented. There is to be a written statement which sets out the services to be provided in a residential care setting and describes the manner in which they are to be provided. It covers matters such as the number of residents that the Centre can accommodate and the services and facilities it has to provide.

Managers must work together in a way that supports and promotes the delivery of quality care service. The service must be reviewed so that it is continuously developed and improved.

Staff

The person in charge must ensure that there is, at all times, the number of staff and skill needs appropriate to the assessed needs of the residents and the size and layout of the centre. They shall ensure that an appropriate qualified general registered nurse is on duty and in charge of the designated centre.

The person in charge is to ensure that there is a planned and actual staff rota showing staff on duty at any time during the day and night and that it is maintained. A person in charge must ensure that the staff members have access to education and training and are appropriately supervised. They must be made aware of the provisions of the Act and their roles and responsibilities.

There must be appropriate procedures in respect of the recruitment, selection and vetting of staff. Persons may not be employed unless they are fit to work, they have obtained the requisite proof of capacity and ability, and there is no doubt about their authenticity. A person is not fit to work unless he is of good character and integrity, has suitable qualifications, is mentally and physically fit for the work and has provided full and satisfactory information.

Staff are to be suitably qualified and verified to ensure that they are safe to work in the residential care environment. Staff providing support and care must have knowledge and skills gained from experience and must have appropriate training. There must be enough staff on duty day and night to ensure that the needs of all residents are met.

Staff must receive ongoing professional development to ensure their skills and qualifications are up to date. They must be supported in their work by receiving regular supervision.

Premises

The registered provider shall not use premises unless they are suitable for the purpose of achieving the aims and objectives set out and the location is appropriate to the needs of residents. A designated centre must comply with Planning and Development Acts and Building Regulations rules.

The registered provider shall having regard to the number and needs of residents, ensure that

the physical design and layout meet those needs;
that it is soundly constructed and in a good state of repair externally and internally;
that equipment is in good working order
that all parts are kept clean, tidy, and suitably decorated;
that there is adequate private and communal accommodations;
that the size and layout of rooms are suitable;
that there is adequate seating, recreational and dining space;
that the communal space provided is suitable for social, cultural, and religious activities;
that there are suitable facilities for residents to meet visitors and communal accommodation and, insofar as practicable, a suitable private area which is separate from the residents’ own private rooms;
that there are appropriate facilities in the premises, a sufficient number of lavatories and wash basins, baths and showers fitted with hot and cold water with thermostatic control valves and suitable anti-scalding protection with necessary sluicing facilities;
that suitable provision is made for storage and for storage facilities;
that suitable adaptations are made, including passenger lifts to meet the requirements of residents;
that the external grounds are suitable for and safe for use by residents and are appropriately maintained;
that ventilation, heating and lighting are suitable for residents and are provided in all parts of the designated centre which are used by residents.

There must be fire safety training with plans and preparations for what is to be done in an emergency. There are provisions applicable to existing buildings and new buildings. They include provisions in relation to room size, toilets and bathrooms.

Facilities

The registered provider must provide suitable facilities and accommodation for staff, including suitable changing, storage and sleeping facilities. In every designated centre, there should be separate cooking and kitchen facilities and proper provisions made for the storage of foods in hygienic conditions.

There must be a sufficient supply of hot and cold water; a sufficient number of toilets having regard to the number of dependent persons, including in particular wheelchair accessible toilets; a sufficient number of commodes, sufficient baths, showers, sufficient incontinence care, bed linen and adequate arrangements for disposals of soiled dressings, instruments, syringes, sheets etc.

They are detailed provisions in respect of food and nutrition. Dietary restrictions on medical or religious grounds must be facilitated. The person in charge must give appropriate assistance to those who would require assistance with eating and drinking.

The person in charge of an institution shall arrange regular laundering of linen and clothes. They shall provide adequate facilities for residents to wash and iron their own clothes if they so wish and, for that purpose, make arrangements for clothes to be sorted or kept separately.