St Margaret's Hospital and Rest Home

Profile & contact details

Premises details
Premises nameSt Margaret's Hospital and Rest Home
Address 52 Beach Road Te Atatu Peninsula Auckland 0610
Total beds89
Service typesPhysical, Dementia care, Rest home care, Geriatric, Medical
Certification/licence details
Certification/licence nameCHT Healthcare Trust - St Margaret's Hospital and Rest Home
Current auditorHealth and Disability Auditing New Zealand Limited
End date of current certificate/licence11 December 2019
Certification period36 months
Provider details
Provider nameCHT Healthcare Trust
Street address 97 Great South Rd Market Road Auckland 1543
Post addressPO Box 74341 Market Road Auckland 1543
Websitewww.cht.co.nz/index.php

Progress on issues from the last audit

What’s on this page?

This rest home has been audited against the Health and Disability Services Standards. During the last audit, the auditors identified some areas for improvement.

Issues from their last audit are listed in the corrective actions table below, along with the action required to fix the issue, its risk level, and whether or not the issue has been reported as fixed.

A guide to the table is available below.

Details of corrective actions

Date of last audit: 29 September 2016

Outcome requiredFound at auditAction requiredRisk ratingAction statusDate action reported complete
Service delivery plans describe the required support and/or intervention to achieve the desired outcomes identified by the ongoing assessment process.Six of ten resident files (three hospital and three from the dementia unit) had identified issues that were not documented in the long-term care plan. One resident (hospital level) did not have a short-term care plan developed on return from hospital. Ensure all identified needs are documented on a care plan. PA LowReporting Complete12/04/2017
Each episode of restraint is evaluated in collaboration with the consumer and shall consider: (a) Future options to avoid the use of restraint; (b) Whether the consumer's service delivery plan (or crisis plan) was followed; (c) Any review or modification required to the consumer's service delivery plan (or crisis plan); (d) Whether the desired outcome was achieved; (e) Whether the restraint was the least restrictive option to achieve the desired outcome; (f) The duration of the restraint episode… (this text has been trimmed due to space limits).Restraint use is scheduled to be evaluated six-monthly (at a minimum). Two residents’ files reviewed indicated that the evaluations for both residents were last completed in December 2015. Ensure the use of restraint is evaluated as per CHT policy. PA LowReporting Complete12/04/2017
The provision of services and/or interventions are consistent with, and contribute to, meeting the consumers' assessed needs, and desired outcomes.(i) Thirteen wounds did not have a comprehensive assessment and four wounds did not have a documented wound management plan. (ii) Two turning charts (hospital level) had occasions where they had not been completed. (iii) One resident (rest home level) requiring weekly blood pressure readings had not had these documented for the previous two weeks. (i) Ensure every wound has a comprehensive assessment and a wound management plan. (ii) Ensure that turning charts are documented when completed. (iii) Ensure that the GPs instructions are followed. PA ModerateReporting Complete10/07/2017

Guide to table

Outcome required

The outcome required by the Health and Disability Services Standards.

Found at audit

The issue that was found when the rest home was audited.

Action required

The action necessary to fix the issue, as decided by the auditor.

Risk level

Whether the required outcome was partially attained (PA) or unattained (UA), and what the risk level of the issue is.

The outcome is partially attained when:

  • there is evidence that the rest home has the appropriate process in place, but not the required documentation
  • when the rest home has the required documentation, but is unable to show that the process is being implemented.

The outcome is unattained when the rest home cannot show that they have the needed processes, systems or structures in place.

The risk level is determined by two things: how likely the issue is to happen and how serious the consequences of it happening would be.

The risk levels are:

  • negligible – this issue requires no additional action or planning.
  • low – this issue requires a negotiated plan in order to fix the issue within a specified and agreed time frame, such as one year.
  • moderate – this issue requires a negotiated plan in order to fix the issue within a specific and agreed time frame, such as six months.
  • high – this issue requires a negotiated plan in order to fix the issue within one month or as agreed between the service and auditor.
  • critical – This issue requires immediate corrective action in order to fix the identified issue including documentation and sign off by the auditor within 24 hours to ensure consumer safety.

The risk level may be downgraded once the rest home reports the issue is fixed.

Action status

Whether the necessary action is still in progress or if it is complete, as reported by the rest home to the relevant district health board.

Date action reported complete

The date that the district health board was told the issue was fixed.

Audit reports

Before you begin
Before you download the audit reports, please read our guide to rest home certification and audits which gives an overview of the auditing process and explains what the audit reports mean.

What’s on this page?

Audit reports for this rest home’s latest audits can be downloaded below.

Full audit reports are provided for audits processed and approved after 29 August 2013.  Note that the format for the full audit reports was streamlined from 16 December 2014.  Full audit reports between 29 August 2013 and 16 December 2014 are therefore in a different format. 

Prior to 29 August 2013, only audit summaries are available.

Both the recent full audit reports and previous audit summaries include:

  • an overview of the rest home’s performance, and
  • coloured indicators showing how well the rest home performed against the different aspects of the Health and Disability Services Standards.

Note: From November 2013, as rest homes are audited, any issues from their latest audit (the corrective actions required by the auditor) will appear on the rest home’s page. As the rest home completes the required actions, the status on the web site will update.

Audit reports

Audit date: 29 September 2016

Audit type:Certification Audit

Audit date: 11 November 2015

Audit type:Surveillance Audit

Audit date: 01 October 2014

Audit type:Certification Audit

Audit date: 26 October 2011

Audit type:Certification Audit

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