S.I. No. 226/1993:

NURSING HOMES (CARE AND WELFARE) REGULATIONS, 1993.

NURSING HOMES (CARE AND WELFARE) REGULATIONS, 1993.

The Minister for Health, in exercise of the powers conferred on him by Section 6 of the Health (Nursing Homes) Act, 1990 (No. 23 of 1990) hereby makes the following Regulations:--

1. These Regulations may be cited as the Nursing Homes (Care and Welfare) Regulations, 1993.

2. These Regulations shall come into operation on the first day of September 1993.

3. The Homes for Incapacitated Persons Regulations, 1985 ( S.I. No. 317 of 1985 ) are hereby revoked.

4. In these Regulations:--

"the Act" means the Health (Nursing Homes) Act, 1990 (No. 23 of 1990),

"competent person" means a chartered engineer with experience in fire safety engineering and fire safety management,

"dependent person" has the meaning given to it in Section 1 (1) of the Act,

"designated officers" means officers of health boards authorised by the chief executive officer or the deputy chief executive officer of a health board to carry out functions under the Act and these Regulations,

"health board" in relation to a nursing home, means a health board within the meaning of the Health Act, 1970 (No. 1 of 1970 ) in whose functional area the home is situated,

"medical practitioner" means a person registered in the general register of medical practitioners established under Section 26 of the Medical Practitioners Act, 1978 (No. 4 of 1978),

"medical record" means a record under article 19.1 (d) of these Regulations,

"the Minister" means the Minister for Health,

"nursing home" has the meaning given to it in Section 2 of the Act,

"nurse" means a person registered in the register of nurses established under the Nurses Act, 1985 (No. 18 of 1985),

"person in charge" means the person in charge of the care and welfare of patients in a nursing home,

"record" means any record kept or retained in pursuance of articles 19-22 of these Regulations including any book, card, form, tape, computerised record, film or notes,

"registration" has the meaning given to it in Section 1 (1) of the Act,

"registered proprietor" has the meaning given to it in Section 1 (1) of the Act.

5. The registered proprietor and the person in charge shall ensure that there is provided for dependent persons maintained in a nursing home:--

( a ) suitable and sufficient care to maintain the person's welfare and well-being, having regard to the nature and extent of the person's dependency;

( b ) a high standard of nursing care;

( c ) appropriate medical care by a medical practitioner of the person's choice or acceptable to the person;

( d ) facilities for the occupation and recreation of persons;

( e ) opportunities to participate in activities appropriate to his or her interests and capacities;

(f) freedom to exercise choice to the extent that such freedom does not infringe on the rights of other persons;

( g ) privacy to the extent that the person is able to undertake personal activities in private;

( h ) information concerning current affairs, local matters, voluntary groups, community resources and events;

( i) adequate arrangements to facilitate a person in the practice of his or her religion.

6. The registered proprietor and the person in charge of a nursing home shall:--

( a ) encourage dependent persons to maintain contact with persons of their choice;

( b ) allow reasonable times during which persons in the nursing home may receive visits;

( c ) provide adequate arrangements for the care of the dying,

( d ) ensure respect for the remains of deceased persons and make arrangements for the removal of remains.

7.1 Within two months of the registration of a nursing home, the registered proprietor or person in charge shall execute a contract with each dependent person and/or a person acting on his or her behalf.

7.2 In the year following the commencement of the Act, the registered proprietor or person in charge shall execute a contract with a dependent person and/or a person acting on his or her behalf within two months of the admission of that dependent person to the nursing home.

7.3 Such contract shall deal with the care and welfare of that person in the nursing home and shall include details of the services to be provided for that person and the fees to be charged.

8. The registered proprietor and person in charge of the nursing home shall ensure that:--

( a ) provision is made for the safe keeping of the personal belongings of a dependent person and a record kept of valuables signed by the person or a person acting on his or her behalf;

( b ) adequate space is provided for a reasonable number of personal possessions.

9. Where the registered proprietor or the person in charge intends discharging a dependent person, they shall inform the person and the person nominated to act on the person's behalf of the date of the proposed discharge, the reasons for the discharge and give fourteen days notice to make alternative arrangements.

10.1 There shall be a person in charge of a nursing home.

10.2 Subject to article 10.3, the post of person in charge shall be full-time and the person in charge shall be a nurse with a minimum of three years appropriate post registration experience within the previous six years.

10.3 Where the registered proprietor is a registered medical practitioner, solely employed in the carrying on of a nursing home and has a minimum of three years experience carrying on a nursing home under the Health (Homes for Incapacitated Persons) Regulations, 1985 or as a registered proprietor of a nursing home, the registered proprietor may be the person in charge, provided that at all times there is a nurse on duty in the home.

10.4 The registered proprietor shall notify the health board in writing if the person in charge on the date of registration ceases to be the person in charge during the period of registration and shall notify the health board in writing of the name of the new person in charge within one month of the appointment.

10.5 The registered proprietor and the person in charge of the nursing home shall ensure that:--

( a ) a medical practitioner of the dependent person's choice or acceptable to that person is available to ensure that he or she receives appropriate medical care;

( b ) a medical practitioner is available to attend the person in the nursing home and to be on call for emergencies;

( c ) a nurse is on duty at all times;

( d ) a sufficient number of competent staff are on duty at all times having regard to the number of person maintained therein and the nature and extent of their dependency.

11.1 The registered proprietor and the person in charge of the nursing home shall ensure that the maximum number of persons to be maintained in the home and the maximum number of persons to be accommodated in shared rooms in the nursing home shall not exceed a number for which the nursing home is registered by the health board.

11.2 In every nursing home there shall be provided suitable and sufficient accommodation which meets the minimum standards as follows:--

( a ) adequate accommodation and space in single and shared sleeping rooms and portable screens or screening curtains to ensure privacy for individual persons;

( b ) adequate day space for each person in an area separate from the circulation and sleeping areas and adequate dining and sitting space for mobile persons;

( c ) doorways and corridors which allow for easy use of wheelchairs and walking aids and access ramps where appropriate;

( d ) a visitors reception area and adequate facilities for persons to receive visitors in private;

( e ) an office or station for staff and general use;

( f ) suitable and sufficient equipment and facilities having regard to the nature and extent of the dependency of the persons maintained in the nursing home;

( g ) bed and bedding appropriate to the dependency of each person and suitable and sufficient furniture and other necessary fittings and equipment;

( h ) suitable and sufficient lighting and ventilation, with natural lighting and ventilation in rooms which are regularly occupied by dependent persons;

( i ) over-bed lamps at each bed accessible to the person and permanent night lighting with dimming facilities;

( j ) emergency call facilities are provided at each bed;

( k ) suitable and sufficient heating with a minimum heating of 65 degrees F (18 degrees C) in bedroom areas and 70 degrees F (21 degrees C) in day areas.

12. The registered proprietor and the person in charge of the nursing home shall:--

( a ) take precautions against the risk of accidents to any dependent person in the nursing home and in the grounds of the nursing home;

( b ) ensure that handrails are provided in circulation areas and that grab-rails are provided in bath, shower and toilet areas;

( c ) ensure that handrails are on both sides of stair cases except where a stairlift is provided;

( d ) ensure that, where dependent persons are maintained on more than two floors and the health board so requires, a lift is provided;

( e ) ensure that safe floor covering is provided.

13. In every nursing home there shall be:--

( a ) a separate kitchen with suitable and sufficient cooking facilities, kitchen equipment and tableware;

( b ) provision for the storage of food in hygienic conditions.

14. The registered proprietor and the person in charge of the nursing home shall:--

( a ) ensure that the nursing home and its curtilage is maintained in a proper state of repair and in a clean and hygienic condition;

( b ) make adequate arrangements for the prevention of infection, infestation, toxic conditions, or spread of infection and infestation at the nursing home;

( c ) ensure that there are adequate arrangements for the laundering at regular intervals, and as occasion may require, of linen, clothing and other articles belonging or used by dependent persons maintained in the nursing home;

( d ) ensure that a separate well ventilated room is provided for sluicing and for the storage of dirty linen;

( e ) maintain a high standard of hygiene in relation to the storage and preparation of food and the disposal of domestic refuse.

15. The registered proprietor and the person in charge of the nursing home shall ensure that:--

( a ) there is a sufficient supply of piped hot and cold water and that wash-hand basins are provided in each bedroom;

( b ) there is a sufficient number of toilets having regard to the number of dependent persons in the home and that a sufficient number of toilets are designed to provide access for dependent persons in wheelchairs, having regard to the number of persons using wheelchairs in the nursing home;

( c ) a sufficient number of commodes is provided;

( d ) there is a sufficient number of baths and showers having regard to the number of persons in the nursing home and that a sufficient number of assisted baths and showers are provided, having regard to the dependency of persons in the nursing home;

( e ) where items such as disposable sheets and incontinence pads are necessary, they are available in sufficient quantity;

( f ) bed linen, disposable sheets and incontinence pads are changed as frequently as may be required for the comfort and well-being of the person;

( g ) adequate arrangements are made for the proper disposal of swabs, soiled dressings, instruments, disposable syringes and sheets, incontinence pads and other similar substances and materials.

16.1 The registered proprietor and person in charge of the nursing home shall ensure that suitable, sufficient, nutritious and varied food, properly prepared, cooked and served is provided.

16.2 Any dietary restriction on medical or religious grounds shall be respected.

16.3 Fresh drinking water shall be provided on each floor of the nursing home.

17. The registered proprietor and the person in charge of the nursing home shall have a brochure available with information about the nursing home, including the name and address of the home, the name of the registered proprietor, the admissions policy, accommodation provided and special facilities and services.

18.1 In every nursing home there shall be kept in a safe place a bound register of all dependent persons resident in the home, which shall include the following particulars in respect of each person:--

( a ) the first name, surname, address, date of birth, marital status and religious denomination of the person;

( b ) the name, address and telephone number, if any, of the person's relative or other person nominated to act on the person's behalf as a person to be notified in the event of a change in the person's health or circumstances;

( c ) the name, address and telephone number of the person's medical practitioner;

( d ) the date on which the person was last admitted to the nursing home;

( e ) where the person has left the nursing home, the date on which he or she left and a forwarding address;

( f ) where the person is admitted to hospital, the date of and reasons for the admission and the name of the hospital;

( g ) where the person dies in the nursing home, the date, time and the certified cause of death.

18.2 Each part of the register kept under article 18.1 shall be retained for a period of not less than five years, beginning with the date on which the last entry was made.

19.1 In every nursing home the following particulars shall be kept in a safe place in respect of each dependent person:--

( a ) where the person is in receipt of a health board subvention, a summary of the assessment of the person's level of dependency on admission and on review;

( b ) a copy of the contract which the registered proprietor or person in charge executed with the dependent person or a person acting on his or her behalf in accordance with article 7.1 or 7.2;

( c ) a record of the medical and nursing condition of the person at the time of admission;

( d ) an adequate nursing record of the person's health and condition and treatment given, completed on a daily basis and signed and dated by the nurse on duty;

( e ) a medical record with details of investigations made, diagnosis and treatment given, and a record of all drugs and medicines prescribed, signed and dated by a medical practitioner;

(f) a record of drugs and medicines administered giving the date of the prescription, dosage, name of the drug or medicine, method of administration, signed and dated by a medical practitioner and the nurse administering the drugs and medicines;

( g ) a record of any accident or fall involving a dependent person;

( h ) a record of any occasion on which physical or chemical restraint is used, the nature of the restraint and its duration;

( i) a record of any substantial complaint made by the dependent person or a person acting on his or her behalf and of the outcome of the investigation.

19.2 Records kept under article 19.1 shall be retained for a period of not less than five years after the dependent person to whom they relate ceases to be resident in the home.

20. The registered proprietor and the person in charge shall ensure that all records pertaining to a dependent person are treated with confidentiality, subject to the requirements of article 23.2.

21. In every nursing home there shall be kept in a safe place a record of:--

( a ) the name, date of birth and details of position and dates of employment at the nursing home of each member of the nursing and ancillary staff;

( b ) details of the qualifications and a copy of the certificate of current registration of each member of the nursing staff employed;

( c ) appropriate weekly duty rosters covering 24 hour periods.

22. When a dependent person dies in a nursing home, the registered proprietor or the person in charge shall send a notice in writing of the date and time of death to the Medical Officer of Health for the area in which the nursing home is situated, not later than forty eight hours after it occurs and the certified cause of death as soon as possible thereafter.

23.1 The registered proprietor and any member of staff of the nursing home shall:--

( a ) permit designated officers to enter and inspect the nursing home and shall afford the said officers such facilities and information as they require for that purpose;

( b ) subject to article 23.3, permit designated officers to examine records kept by the nursing home and to obtain copies of any such records or of extracts therefrom;

( c ) subject to article 23.3, permit designated officers to conduct interviews (including interviews in private) with persons (including staff) in the home and to examine any dependent person in the home, where the officer has reasonable cause to believe that a person in the nursing home is not or has not been receiving proper care, maintenance or medical or other treatment;

( d ) provide facilities for the conducting of interviews and the carrying out of examinations by designated officers.

23.2 Nothing in article 23.1 authorises any person other than a designated officer who is a medical practitioner to inspect any medical record relating to a person in a nursing home.

23.3 Nothing in article 23.1 authorises any person other than a designated officer who is a medical practitioner or a registered nurse to carry out an examination of a person in a nursing home.

23.4 In carrying out inspections a designated officer shall have regard to the religious beliefs or principles of dependent persons and the religious ethos of the home.

23.5 In carrying out inspections a designated officer shall act with due courtesy towards dependent persons and staff.

24. Inspections of a nursing home pursuant to article 23.1 shall be made by designated officers not less than once in every period of six months.

25.1 Where a designated officer has reason to believe that more than two dependent persons are being maintained in a premises in respect of which there is not for the time being in force a certificate of registration, the owner or person responsible for the premises shall:--

( a ) permit designated officers to enter and inspect the premises;

( b ) subject to article 25.2, permit designated officers to examine records kept by the home and to permit designated officers to obtain copies of any such records or of extracts therefrom;

( c ) subject to article 25.3, permit designated officers to conduct interviews (including interviews in private) with persons (including staff) in the home and to carry out such examinations of persons being maintained in the premises as are necessary to establish the dependency of such persons;

( d ) provide facilities for the conduct of interviews and the carrying out of examinations by designated officers.

25.2 Nothing in article 25.1 authorises any person, other than a designated officer who is a medical practitioner, to inspect any medical record relating to a person being maintained in the premises.

25.3 Nothing in article 25.1 authorises any person, other than a designated officer who is a medical practitioner or a registered nurse, to carry out an examination of persons being maintained in the premises.

26.1 A dependent person being maintained in a nursing home or a person acting on his or her behalf may make a complaint to the chief executive officer or a designated officer of the health board.

26.2 A complaint shall be made in writing, save as provided in article 26.3.

26.3 A chief executive officer may cause a verbal complaint to be considered and investigated, where he or she is satisfied that it is not possible to make a written complaint and that the complainant is acting in good faith.

26.4 A complaint may be made in relation to any matter concerning the nursing home or the maintenance, care, welfare and well being of a dependent person while being so maintained.

26.5 The chief executive officer shall cause a designated officer of the health board to consider and investigate any complaint made by or on behalf of a dependent person being maintained in a nursing home.

26.6 The chief executive officer shall cause a designated officer of the health board to inform the registered proprietor or person in charge of the nursing home of the complaint that is being investigated and shall give the registered proprietor or person in charge the opportunity to make his or her case.

26.7 Where a complaint is upheld by a chief executive officer following consideration and investigation, the chief executive officer may issue a direction to the registered proprietor of the nursing home concerned, requiring such proprietor to take specified action in relation to the matter complained of.

26.8 A registered proprietor of a nursing home shall comply with a direction of a chief executive officer under article 26.7.

26.9 A chief executive officer, following consideration and investigation of a complaint under this article, shall inform the complainant of the outcome of the consideration and investigation.

27. The registered proprietor and the person in charge of the nursing home shall:--

( a ) take adequate precautions against the risk of fire, including the provision of adequate means of escape in the event of fire and make adequate arrangements for detecting, containing and extinguishing fires, for the giving of warnings and for the evacuation of all persons in the nursing home in the event of fire, and for the maintenance of fire fighting equipment;

( b ) make adequate arrangements to secure by means of fire drills and practices that the staff, and so far as is practicable, dependent persons in the nursing homes, know the procedure to be followed in the case of fire;

( c ) ensure that materials contained in bedding and the internal furnishings of the nursing home have adequate fire retardancy properties and have low levels of toxicity when on fire;

( d ) ensure that emergency lighting is provided in the home;

( e ) supply to the health board with the application for registration of the nursing home, written confirmation from a competent person that all the requirements of the statutory fire authority have been complied with;

(f) a written confirmation provided in accordance with article 27 ( e ) shall suffice on any subsequent registration of the nursing home, save where structural alterations to the home have been carried out, in which case, a new written confirmation of fire safety from a competent person that all the requirements of the statutory fire authority have been complied with, shall be required to be produced to the health board.

28.1 In every nursing home there shall be kept in a safe place a record of:--

( a ) all fire practices which take place at the home;

( b ) all fire alarm tests carried out at the home together with the result of any such test and the action taken to remedy defects;

( c ) the number, type and maintenance record of fire-fighting equipment.

28.2 In every nursing home the procedure to be followed in the event of fire shall be displayed in a prominent place in the nursing home.

29. The registered proprietor and the person in charge of the nursing home shall:--

( a ) make adequate arrangements for the recording, safekeeping, administering and disposal of drugs and medicines;

( b ) ensure that the treatment and medication prescribed by the medical practitioner of a dependent person is correctly administered and recorded.

30. The registered proprietor and the person in charge of the nursing home shall ensure that:--

( a ) where medical treatment is recommended and agreed to by a dependent person or the person acting on his or her behalf that it is carried out;

( b ) when a person requires physiotherapy, chiropody, occupational therapy or other health service, such service is made available by the registered proprietor or by arrangement with the health board;

( c ) a person's right to refuse treatment shall be respected and documented and the matter brought to the attention of the person's medical practitioner and the person acting on his or her behalf.

31. A health board may provide services (being services of a kind provided by or on behalf of health boards for the purposes of their functions) to a nursing home at the request of the registered proprietor or person in charge upon such terms, charges and conditions and to such extent as the health board may determine, following discussion with the registered proprietor of the home.

32. A health board may provide training facilities for staff of nursing homes by agreement with the registered proprietor or person in charge upon such terms, charges and conditions and to such extent as the health board may determine following discussion with the registered proprietor of the home.

33. The registered proprietor and person in charge shall ensure that the current registration certificate is displayed in a prominent place in the nursing home at all times.

34. The registered proprietor shall ensure that dependent persons are adequately insured against injury while being maintained in the home.

35. These regulations shall be enforced and executed in the functional area of each health board by the chief executive officer or deputy chief executive officer of that health board.

GIVEN under the Official Seal of the Minister for Health, this 30th day of July 1993.

BRENDAN HOWLIN,

Minister for Health.

EXPLANATORY NOTE.

These Regulations contain provisions for the purposes of ensuring that adequate and suitable care and accommodation are provided for dependent persons in nursing homes. The Regulations also contain requirements in relation to facilities for patients, safety, staffing levels, record keeping and also provide for the regular inspection of nursing homes by designated officers of health boards.