Premise details
- Address
- 194 Nixon Street Hamilton East Hamilton 3216
- Total beds
- 47
- Service types
- Dementia care, Rest home care
Certification/licence details
- Certification/licence name
- Kaylex Care Limited - Eastcare Residential Home
- Current auditor
- The DAA Group Limited
- End date of current certificate/licence
- Certification period
- 36 months
Provider details
- Provider name
- Kaylex Care Limited
- Street address
- 194 Nixon Street Hamilton East Hamilton 3216
- Postal address
Progress on issues from the last audit
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.
| Outcome required | Found at audit | Action required | Risk rating | Action status | Date action reported complete |
|---|---|---|---|---|---|
| The purpose, values, scope, direction, and goals of the organisation are clearly identified and regularly reviewed. | There was no auditable record of reports related to operational and service delivery matters such as quality and risk, staffing or progress toward meeting quality goals. Without this governance cannot ensure services are planned, coordinated and suitable for residents. | Provide evidence that governance (GM) is kept fully informed about all aspects of service delivery at Eastcare including emerging risks, and improvements. | PA Moderate | Reporting Complete | |
| Quality improvement data are collected, analysed, and evaluated and the results communicated to service providers and, where appropriate, consumers. | There is insufficient analysis or comparison of incident/accident data to assist in identifying trends | Implement an effective system for analysing and reporting trends in adverse events. | PA Low | Reporting Complete | |
| All aspects of food procurement, production, preparation, storage, transportation, delivery, and disposal comply with current legislation, and guidelines. | The surfaces in the kitchen (cupboards and benches) are degraded and pose a risk of contamination. | Ensure all kitchen surfaces are intact. | PA Low | Reporting Complete | |
| Service providers shall develop and implement a quality management framework using a risk-based approach to improve service delivery and care. | There is insufficient documented evidence of analysis or comparison of incident/accident data to assist in identifying trends. | Provide documented evidence of analysing and reporting trends in adverse events. Provide documented evidence of analysing and reporting trends in adverse events. | PA Moderate | Reporting Complete | |
| Professional qualifications shall be validated prior to employment, including evidence of registration and scope of practice for health care and support workers. | Residents assessed as requiring dementia level of care do not have oversight of a qualified diversional therapist. | Provide evidence that a qualified diversional therapist has oversight of residents that have been assessed as requiring dementia level care as per contractual requirement. | PA Low | Reporting Complete | |
| Service providers ensure competent health care and support workers manage medication including: receiving, storage, administration, monitoring, safe disposal, or returning to pharmacy. | Not all care staff administering medication have an up-to-date medication competency. | Provide evidence that all care staff administering medication have an up-to-date medication competency. | PA Low | Reporting Complete | |
| Surveillance methods, tools, documentation, analysis, and assignment of responsibilities shall be described and documented using standardised surveillance definitions. Surveillance includes ethnicity data. | Surveillance of healthcare-associated infections was not including ethnicity data. | Ensure surveillance of infections includes ethnicity data. | PA Low | Reporting Complete | |
| Planned review of a person’s care or support plan shall: (a) Be undertaken at defined intervals in collaboration with the person and whānau, together with wider service providers; (b) Include the use of a range of outcome measurements; (c) Record the degree of achievement against the person’s agreed goals and aspiration as well as whānau goals and aspirations; (d) Identify changes to the person’s care or support plan, which are agreed collaboratively through the ongoing re-assessment and review | (i) Four of six long-term care plans reviewed were not reviewed following interRAI assessments. (ii) Two residents’ files reviewed had no specific management plans for the residents’ current conditions. (iii) Neurological observations were not completed following unwitnessed falls or head injuries in four residents’ files reviewed. | (i) Ensure long-term care plans are reviewed following interRAI assessments. (ii)Develop specific management plans for residents’ current conditions. (iii)Ensure neurological observations are completed for residents post unwitnessed falls or head injuries. | PA Low | Reporting Complete | |
| The following aspects of the system shall be performed and communicated to people by registered health professionals operating within their role and scope of practice: prescribing, dispensing, reconciliation, and review. | i) Six of twelve medication charts reviewed were overdue for review with timeframes ranging from one to two months overdue. (ii) Expired PRN medications were still being administered to residents. | Ensure medication charts are reviewed three monthly and PRN medications are current. | PA Moderate | Reporting Complete |
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
About audit reports
Audit reports for this rest home’s latest audits can be downloaded below.
Before you begin
Before you download the audit reports, please read our guide to rest home certification and audits. The guide gives an overview of the auditing process and explains what the audit reports mean.
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.
From 1 June 2009 to 28 February 2022 rest homes were audited against the Health and Disability Services Standards NZS 8134:2008. These standards have been updated, and from 28 February 2022 rest homes are audited against Ngā Paerewa Health and Disability Services Standard NZS 8134:2021.
Before 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 Ngā Paerewa Health and Disability Services Standard.
Note: From November 2013, as rest homes are audited, any issues from their latest audit (the corrective actions required by the auditor) appear on the rest home’s page. As the rest home completes the required actions, the status on the website updates.
Audit date:
Audit type: Surveillance Audit
Audit date:
Audit type: Certification Audit
Audit date:
Audit type: Surveillance Audit
Audit date:
Audit type: Certification Audit
Audit date:
Audit type: Surveillance Audit
