Ultimate Care Mount Victoria

Profile & contact details

Premises details
Premises nameUltimate Care Mount Victoria
Address 135 Constable Street Newtown Wellington 6021
Total beds50
Service typesGeriatric, Medical, Rest home care
Certification/licence details
Certification/licence nameThe Ultimate Care Group Limited - Mount Victoria Lifecare
Current auditorThe DAA Group Limited
End date of current certificate/licence06 August 2018
Certification period48 months
Provider details
Provider nameThe Ultimate Care Group Limited
Street addressLevel 2 111 Johnsonville Road Johnsonville Wellington 6037
Post addressPO Box 13120 Johnsonville Wellington 6440
Websitewww.ultimatecare.co.nz/

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: 17 October 2016

Outcome requiredFound at auditAction requiredRisk ratingAction statusDate action reported complete
Information is entered into the consumer information management system in an accurate and timely manner, appropriate to the service type and setting. Currently there is no management system for records which are archived on site. Provide evidence of an appropriate system to manage archived records. PA NegligibleReporting Complete09/09/2014
A medicines management system is implemented to manage the safe and appropriate prescribing, dispensing, administration, review, storage, disposal, and medicine reconciliation in order to comply with legislation, protocols, and guidelines.Medications are being signed for prior to the drug being administered. A prescribed nutritional supplement had not been administered, since being prescribed. A safe medication management system is implemented. PA ModerateReporting Complete21/02/2017
New service providers receive an orientation/induction programme that covers the essential components of the service provided.Not all of the orientation programme had been completed by all staff as required with the relevant sign off processes evident. Review staff files to ensure they have completed all sections of the orientation programme and these are signed off to reflect this. PA LowReporting Complete23/05/2017
A system to identify, plan, facilitate, and record ongoing education for service providers to provide safe and effective services to consumers.Records of staff training and ongoing education programmes reviewed do not demonstrate sufficient numbers are attending to provide evidence that all care staff are being adequately trained as required. Work with staff to ensure that the training sessions that are provided are attended by as many staff as possible to maintain competency levels. PA LowReporting Complete23/05/2017
Food, fluid, and nutritional needs of consumers are provided in line with recognised nutritional guidelines appropriate to the consumer group.Decanted items in the pantry had no record of when the items should be used by. Food items are used within their use by dates PA LowReporting Complete23/05/2017
Each stage of service provision (assessment, planning, provision, evaluation, review, and exit) is provided within time frames that safely meet the needs of the consumer.The residents of Ultimate Care Mt Victoria have an interRAI assessment completed within three weeks of admission, however these were not consistently reviewed every six months. Residents are required to have an interRAI assessment every six months, or as needs change. PA LowReporting Complete24/05/2017

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: 17 October 2016

Audit type:Surveillance Audit

Audit date: 05 June 2014

Audit type:Certification Audit

Audit date: 18 February 2013

Audit type:Surveillance Audit

Audit date: 29 June 2011

Audit type:Certification Audit

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