Woodlands Of Palmerston North
Profile & contact details
|Premises name||Woodlands Of Palmerston North|
|Address||Karaka Court Trust 544 Featherston Street Roslyn Palmerston North 4414|
|Service types||Dementia care, Rest home care|
|Certification/licence name||Karaka Court Limited - Woodlands of Palmerston North|
|Current auditor||Health and Disability Auditing New Zealand Limited|
|End date of current certificate/licence||18 October 2018|
|Certification period||36 months|
|Provider name||Karaka Court Limited|
|Street address||544 Featherston Street Roslyn Palmerston North 4414|
|Post address||PO Box 100 Feilding 4740|
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 February 2017
|Outcome required||Found at audit||Action required||Risk rating||Action status||Date action reported complete|
|Food, fluid, and nutritional needs of consumers are provided in line with recognised nutritional guidelines appropriate to the consumer group.||Review of two diabetic nutritional profiles showed that sugar-free marmalade, jam, cakes, ice-cream and fruit juices be included in their food preferences. One of these residents was an insulin dependent diabetic. The kitchen did not have sugar-free food cakes, jam or other foods.||Ensure that residents’ dietary needs are catered for.||PA Low||Reporting Complete||01/11/2017|
|The service is able to demonstrate that written consent is obtained where required.||One resident’s admission agreement was not available on day of audit, and one resident’s admission agreement was not signed on or before admission.||Ensure that all residents have a signed admission agreement on file signed for before or on admission.||PA Low||Reporting Complete||19/10/2015|
|An appropriate 'call system' is available to summon assistance when required.||Three call bells in the shower/toilet areas were tested and were not working. The director immediately contacted an electrician who arrived during the audit to fix these calls bells and check all of the others. (It was discovered one resident is removing and stashing call bells with personal belongings. At the time of the audit they plugged other call bell in place that were not compatible with this area).||Ensure call bells are in working order at all times.||PA Low||Reporting Complete||19/10/2015|
|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) Three of seventeen medication charts reviewed (one dementia and two rest home) did not identify any resident allergies or nil known allergies. (ii) Four of seventeen medication charts reviewed (two rest home and two dementia) did not identify indication for use for ‘as required’ medication (PRN).||i) Ensure any resident allergies or nil known allergies are identified on the medication chart. (ii) Ensure that indications for use are identified for all as required medication (PRN).||PA Moderate||Reporting Complete||19/10/2015|
|Activities are planned and provided/facilitated to develop and maintain strengths (skills, resources, and interests) that are meaningful to the consumer.||On the day of audit there were no activities taking place in the dementia unit as per an activity programme. Two staff interviewed in the dementia unit stated that they did not know what the ‘individual’ activity identified on the activity programme was.||Ensure that there are appropriate activities organised in the dementia unit and that caregivers working in the dementia unit are fully aware of their role in providing these activities.||PA Moderate||Reporting Complete||19/10/2015|
|The organisation is managed by a suitably qualified and/or experienced person with authority, accountability, and responsibility for the provision of services.||The manager’s professional development related to managing an aged care service does not meet contractual requirements.||Ensure the manager attends a minimum of eight hours annually of professional development relating to managing an aged care facility.||PA Low||Reporting Complete||19/10/2015|
|There is a document control system to manage the policies and procedures. This system shall ensure documents are approved, up to date, available to service providers and managed to preclude the use of obsolete documents.||The document control system does not provide specific information about when policies and procedures were last reviewed. Policies and procedures are not linked to InterRAI.||Ensure that a system is in place to manage policies and procedures to verify that documents are approved, up-to-date and reflect evidence of regular reviews. Ensure that the policy manual is updated to reflect the implementation of InterRAI.||PA Low||Reporting Complete||19/10/2015|
|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.||Review of the controlled drug register showed that a controlled drug entry was documented five times in one day as a ‘prn controlled drug’, but it was only signed twice in the electronic medication records. Progress notes also only had one record regarding administration of prn medication. The CD register has been checked by an RN after these recordings; however, the issue was not identified at the time.||Ensure safe administration of controlled drugs and recording is completed according to policies and procedures.||PA Moderate||Reporting Complete||08/06/2017|
|The provision of services and/or interventions are consistent with, and contribute to, meeting the consumers' assessed needs, and desired outcomes.||Review of five resident’s files identified gaps around service delivery interventions in three of five files; (i) One rest home resident with diabetes required podiatry services and has an ingrown toenail. This was identified in the resident progress notes as an issue but the resident has not been referred or seen by a podiatrist yet. Review of resident’s notes and interview with the resident confirmed bleeding of the toenail at times and the most recently, his/her toenails were trimmed by a ca… (this text has been trimmed due to space limits).||(i) Ensure that access to podiatry services are facilitated as required. (ii) Ensure that care plan interventions are updated following a significant change. (iii) Ensure that RN input is documented as required.||PA Moderate||Reporting Complete||21/08/2017|
|A system to identify, plan, facilitate, and record ongoing education for service providers to provide safe and effective services to consumers.||(i) There was no documented evidence of training in the last 2 years for the following topics; challenging behaviour, health and safety, cultural safety, falls prevention, end of life, skin management/pressure area. (ii) Annual performance appraisals have not been completed for the manager and the clinical leader/RN within the last 12 months.||(i) Ensure that training is completed and documented for the following topics; restraint, challenging behaviour, health and safety, cultural safety, treaty of Waitangi, complaints, open disclosure, falls prevention, end of life, nutrition/hydration, pain management, privacy/dignity, skin management/pressure area, sexuality/intimacy and spirituality/counselling. (ii) Ensure that performance appraisals are completed for the manager and the clinical leader/RN annually.||PA Moderate||Reporting Complete||28/09/2017|
|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.||(i) Two of five InterRAI assessments (one rest home, one dementia) were overdue. (ii) Care plan interventions are reviewed/updated prior to the InterRAI reassessment in two files reviewed (one dementia and one rest home).||(i) Ensure that InterRAI assessments are completed within required timeframes. (ii) Ensure that care plan interventions are updated/reviewed following an InterRAI assessment.||PA Low||Reporting Complete||08/11/2017|
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: 17 February 2017
Audit type:Surveillance Audit
- Woodlands Of Palmerston North - Feb 2017 (docx, 33.64 KB)
- Woodlands Of Palmerston North - Feb 2017 (pdf, 133.33 KB)
Audit type:Certification Audit
- Woodlands Of Palmerston North - Aug 2015 (docx, 41.96 KB)
- Woodlands Of Palmerston North - Aug 2015 (pdf, 161.27 KB)
Audit type:Surveillance Audit
- Woodlands Of Palmerston North - Jun 2014 (docx, 67.62 KB)
- Woodlands Of Palmerston North - Jun 2014 (pdf, 462.94 KB)
Audit type:Certification Audit
Audit type:Surveillance Audit