Ultimate Care Aroha

Profile & contact details

Premises details
Premises nameUltimate Care Aroha
Address 128 Monrad Street Highbury Palmerston North 4412
Total beds46
Service typesGeriatric, Medical, Dementia care, Rest home care
Certification/licence details
Certification/licence nameThe Ultimate Care Group Limited - Ultimate Care Aroha
Current auditorCentral Region's Technical Advisory Services Limited
End date of current certificate/licence07 March 2024
Certification period48 months
Provider details
Provider nameThe Ultimate Care Group Limited
Street addressLevel 2 111 Johnsonville Road Johnsonville Wellington 6037
Post addressPO Box 425 Waterloo Quay Wellington 6140
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: 27 January 2022

Outcome requiredFound at auditAction requiredRisk ratingAction statusDate action reported complete
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.Timeframes for neurological observations after unobserved falls, do not meet good practice. Ensure timeframes for neurological observations to meet accepted good practice standards. PA ModerateReporting Complete17/03/2020
The physical environment minimises risk of harm, promotes safe mobility, aids independence and is appropriate to the needs of the consumer/group.i) There are no privacy signs on the dementia unit toilets and showers and also on two showers in the hospital wing. ii) The sluices and laundry tubs and hoses did not give staff protection from splash back, with either a splash guard or face shield provided. iii) The cleaner’s trolley had chemicals stored in an unsafe manner. i) Ensure privacy signs are installed for all toilets and showers ii) Ensure that staff have adequate protection when handling soiled items iii) Ensure that chemicals are stored securely on the cleaner’s trolley. PA LowReporting Complete31/03/2022
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.i. The effectiveness of PRN medications administered is not consistently documented. ii. The temperature of the medication rooms is not recorded as per UCG policy. i. Ensure that the effectiveness of all PRN medication administered is documented. ii. Ensure that the temperature of the medication rooms is monitored and recorded in accordance with UCG policy. PA ModerateReporting Complete21/06/2022
A corrective action plan addressing areas requiring improvement in order to meet the specified Standard or requirements is developed and implemented.(i) Outcomes for corrective actions are not documented, inclusive of evaluations prior to sign off. (ii) Quality, health and safety, and staff meetings do not fully inform staff of evaluations and outcomes for corrective actions raised. (i) Outcomes and evaluations of corrective actions should be documented. (ii)) Quality, health and safety, and staff meetings should clearly outline corrective actions and improvements. PA LowReporting Complete21/06/2022
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.LTCPs are not consistently evaluated within the required timeframe. Ensure that all LTCPs are evaluated within the required timeframe. PA LowReporting Complete22/06/2022

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. 

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.

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 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) 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: 27 January 2022

Audit type:Surveillance Audit

Audit date: 10 December 2019

Audit type:Certification Audit

Audit date: 13 September 2018

Audit type:Surveillance Audit

Audit date: 13 December 2016

Audit type:Certification Audit

Audit date: 26 May 2016

Audit type:Surveillance Audit

Audit date: 17 September 2015

Audit type:Surveillance Audit

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