Waimarie Private Hospital
Profile & contact details
|Premises name||Waimarie Private Hospital|
|Address||Waimarie 9 Waiatarua Road Remuera Auckland 1050|
|Service types||Rest home care, Geriatric, Medical|
|Certification/licence name||Care Alliance 2016 Limited - Waimarie Private Hospital|
|Current auditor||The DAA Group Limited|
|End date of current certificate/licence||01 March 2021|
|Certification period||36 months|
|Provider name||Care Alliance 2016 Limited|
|Street address||Waimarie Hospital 9 Waiatarua Road Remuera Auckland 1050|
|Post address||PO Box 21633 Henderson Auckland 0612|
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: 23 September 2019
|Outcome required||Found at audit||Action required||Risk rating||Action status||Date action reported complete|
|All aspects of food procurement, production, preparation, storage, transportation, delivery, and disposal comply with current legislation, and guidelines.||Over a 31-day period for December 2017, six days did not have completed food temperatures. The freezer in the kitchen did not have food labelled and dated. There was no evidence of the documented cleaning schedule being signed of as completed. Dry stores (potatoes) were sitting directly on the floor. Kitchen walls, ceiling (above head height) require cleaning and some maintenance. The oven and chip fryer require cleaning. The extractor fan above the oven is not working and the dishwasher is not… (this text has been trimmed due to space limits).||Provide evidence that all aspects of food storage, cleaning and maintenance of the kitchen environment and equipment meets current legislation and guidelines.||PA Moderate||Reporting Complete||03/04/2018|
|All buildings, plant, and equipment comply with legislation.||1. A Waitara Ave toilet window frame is rotten and needs to be repaired. 2. The power plug in room 76 needs fixing as it is loose. 3. The bathroom hand basin cabinet in room 69 has water damage and cannot be cleaned to meet infection control standards.||Provide evidence that all maintenance repairs required are identified and undertaken.||PA Low||Reporting Complete||03/04/2018|
|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.||Ten interRAI assessments are overdue. Four of the ten are awaiting transfer of files from NASC to the facility. One resident admitted from home was assessed by the facility GP five days after admission. One resident admitted from home on the 29 December 2017 has not been assessed by a GP at the time of audit, with GP documented notes stating ‘new admission, awaiting old notes’.||Provide evidence that all interRAI assessments are up to date and that all residents are seen by a GP within the required timeframes to meet contractual requirements.||PA Low||Reporting Complete||10/04/2018|
|The needs, outcomes, and/or goals of consumers are identified via the assessment process and are documented to serve as the basis for service delivery planning.||At time of audit, one resident admitted on the 20th November 2017 has not had an initial nursing assessment or care plan developed.||Provide evidence that all residents have a nursing assessment undertaken.||PA Low||Reporting Complete||10/04/2018|
|Key components of service delivery shall be explicitly linked to the quality management system.||The only key components of service delivery which are clearly documented and reported are related to incidents and accidents and health and safety.||Provide evidence that all key components of service delivery are reported to the business manager to show how they are linked to the quality management system described in policy.||PA Low||In Progress|
|A system to identify, plan, facilitate, and record ongoing education for service providers to provide safe and effective services to consumers.||There is no education plan in place which identifies ongoing education. Documentation in staff files does not identify what training and education each staff member has attended for 2018-2019.||Provide evidence of documented planned, appropriate ongoing staff training and education and that attendance is documented in each staff member’s file.||PA Low||In Progress|
|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 previous finding in the last audit has not been addressed. One resident admitted in July 2019 has not had the interRAI assessment completed in the required timeframe of three weeks post admission. Currently eight interRAI re-assessments are overdue. Care plans have not been signed off by the resident and/or family when updated.||Provide evidence that all interRAI assessments are up to date and that care plans reflect that the resident/family/representative have been involved with the development and implementation of the care plan.||PA Low||In Progress|
|A process to measure achievement against the quality and risk management plan is implemented.||The internal audit requirements set out in policy are not being followed so it is difficult to ascertain a true measure of achievement against the quality and risk plan.||Provide evidence that the internal audit plan shown in policy is being maintained.||PA Low||In Progress|
|Quality improvement data are collected, analysed, and evaluated and the results communicated to service providers and, where appropriate, consumers.||Meeting minutes showed that the only quality results reported at staff meetings related to incidents and accidents and challenging behaviour. Quality data results are computerised on a monthly basis but there is no evaluation identified and no trending against previously collected data is undertaken.||Provide evidence that all quality data is evaluated and trended and that information is communicated to all service providers.||PA Low||In Progress|
|Service providers responsible for medicine management are competent to perform the function for each stage they manage.||Staff who administer medicines have not completed the required annual competency questionnaire and practicum for medication administration.||Provide evidence that all staff who administer medicines have completed the annual medication competencies required to perform the function for each stage they manage.||PA Moderate||Reporting Complete||29/10/2019|
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: 23 September 2019
Audit type:Surveillance Audit
- Waimarie Private Hospital - Sep 2019 (docx, 35.26 KB)
- Waimarie Private Hospital - Sep 2019 (pdf, 137.35 KB)
Audit type:Certification Audit
- Waimarie Private Hospital - Jan 2018 (docx, 50.62 KB)
- Waimarie Private Hospital - Jan 2018 (pdf, 184.43 KB)
Audit type:Provisional Audit