Golden Bay Community Health
Profile & contact details
|Premises name||Golden Bay Community Health|
|Address||10 Central Takaka Road Takaka 7183|
|Service types||Rest home care, Geriatric, Maternity, Medical|
|Certification/licence name||Nelson Bays Primary Health Trust - Golden Bay Community Health|
|Current auditor||Health and Disability Auditing New Zealand Limited|
|End date of current certificate/licence||21 May 2022|
|Certification period||36 months|
|Provider name||Nelson Bays Primary Health Trust|
|Street address||10 Central Takaka Road Takaka 7183|
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: 14 March 2019
|Outcome required||Found at audit||Action required||Risk rating||Action status||Date action reported complete|
|Service delivery plans describe the required support and/or intervention to achieve the desired outcomes identified by the ongoing assessment process.||(i) There was no pain management plan or behaviour management plan as triggered in the interRAI assessment. There was no bowel management plan for the resident on a regular analgesic known to cause constipation. (ii) There was no hydration, fluid or dietary plan for one resident with unintentional weight loss. (iii) There was no diabetic management plan in place for an insulin dependent resident.||(i)-(iii) Ensure care plans reflect the resident’s current health status.||PA Low||In Progress|
|New service providers receive an orientation/induction programme that covers the essential components of the service provided.||Three midwives (employed) have not completed a facility orientation.||Ensure midwives complete a facility orientation on employment.||PA Low||In Progress|
|Information is entered into the consumer information management system in an accurate and timely manner, appropriate to the service type and setting.||Maternity Services: (i). Two of five files reviewed included illegible clinical entries. (ii) Two of five files reviewed had time of clinical entry missing. (iii) Four of five files reviewed identified clinical pages that did not have the midwifes designation and printed last name at least once on each page. (iv) One of five files reviewed identified there was no labour and birth summary.||Ensure documentation if fully completed.||PA Low||In Progress|
|Quality improvement data are collected, analysed, and evaluated and the results communicated to service providers and, where appropriate, consumers.||(i) Internal audits had not been completed as scheduled and corrective actions had not been signed off as completed on some audits. (ii) The resident survey had not been collated to identify any opportunities for improvement. The survey results had not been communicated to the participants.||(i) Complete internal audits as scheduled and ensure corrective actions are signed off when completed. (ii) Ensure survey results are collated and communicated to participants.||PA Low||In Progress|
|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.||1) The standing orders for the acute bed residents had not been reviewed by the GP since July 2017. 2) Maternity service: Review of 10 clinical files identified three medications administered had not been prescribed on the medication chart. 3) Current emergency flow charts, guidelines, policies and procedures (Golden Bay and Nelson/Marlborough DHB) support this remote rural primary unit to have the following emergency pieces of equipment, due to long stabilisation time and transfer of babie… (this text has been trimmed due to space limits).||1) Ensure standing orders are reviewed annually for the acute bed residents. 2) Ensure all medications administered to clients are prescribed on the facility medication chart. 3) Ensure all pieces of emergency equipment is made available.||PA Moderate||In Progress|
The outcome required by the Health and Disability Services Standards.
Found at audit
The issue that was found when the rest home was audited.
The action necessary to fix the issue, as decided by the auditor.
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.
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.
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 reportsAudit date: 14 March 2019
Audit type:Certification Audit
- Golden Bay Community Health - Mar 2019 (docx, 51.15 KB)
- Golden Bay Community Health - Mar 2019 (pdf, 197.2 KB)
Audit type:Surveillance Audit
- Golden Bay Community Health - Sep 2017 (docx, 36.71 KB)
- Golden Bay Community Health - Sep 2017 (pdf, 144.46 KB)
Audit type:Certification Audit
- Golden Bay Community Health - Apr 2016 (docx, 53.08 KB)
- Golden Bay Community Health - Apr 2016 (pdf, 204.53 KB)
Audit type:Verification Audit
Audit type:Verification Audit
Audit type:Certification Audit; Verification Audit
Audit type:Provisional Audit