Health Information and Quality Authority. Designated centres for older people (DCOP)
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1 DCOP NF39 m Health Information and Quality Authority Designated centres for older people (DCOP) Quarterly notification of incidents * Section 1. Centre details Centre name Centre ID (OSV) Unit or ward name (if applicable) Please tick the applicable quarter and state the year. Quarter 1 (January, February, March) Year Quarter 2 (April, May, June) Year Quarter 3 (July, August, September) Year Quarter 4 (October, vember, December) Year * Please complete this form with HIQA s notification guidance. You can download the guidance at Page 1 of 11 V1.0
2 Section 2. Restraints Details of any occasion where a restraint was d. Have physical restraints been d in the quarter? If yes, please state the type of physical restraint. Type of physical restraint Bed rail. of occasions. of residents Bed bumpers Lap belt Chair Heavy table Laptop table Limiting his or her freedom If you have ticked other, please provide details. Have environmental restraints been d in the quarter? If yes, please state the type of environmental restraint. As per the Health Act 2007 and regulations thereunder, the person in charge shall ensure that a written report is provided to the Chief Inspector at the end of each quarter in relation to any occasion when restraint was d. Page 2 of 11 V1.0
3 Section 2. Restraints Details of any occasion where a restraint was d. Type of environmental restraint Door lock. of occasions. of residents Window lock Seclusion If you have ticked other, please provide details: Have chemical restraints been d in the quarter? If yes, please state the number of occasions and residents.. of occasions. of residents Please include any additional information relevant to this section. Page 3 of 11 V1.0
4 Section 3. Fire alarm equipment activated Any occasion other than for the purpose of fire practice, drill or test of equipment. Has the fire alarm equipment been operated in the quarter? If yes, please state the reason. Reason fire alarm equipment was activated Automatic detection of fire. of occasions Automatic detection of smoke False alarm or malicious activation Fire alarm malfunction Manual call point activation such as a red break glass unit If you have ticked other, please provide details. Please provide details for each occasion fire alarm equipment was activated. Page 4 of 11 V1.0
5 Section 3. Fire alarm equipment activated Any occasion other than for the purpose of fire practice, drill or test of equipment. Please include any additional information relevant to this section. Page 5 of 11 V1.0
6 Section 4. Recurring pattern of theft or burglary Two or more occasions of theft or burglary at the designated centre. Have there been two or more instances of theft or burglary in the quarter? If yes, please state the number of instances. What is the total number of instances in the quarter? Resident Staff member Who is the injured party? Please tick the relevant box or boxes. Registered provider Relative or friend of a resident Visiting consultant If other, please provide details. Cash What is the missing item? Please tick the relevant box or boxes. Personal belongings Property If other, please provide details. Page 6 of 11 V1.0
7 Section 4. Recurring pattern of theft or burglary Two or more occasions of theft or burglary at the designated centre. What actions have been taken to address the pattern of theft or burglary? Please include any additional information relevant to this section. Page 7 of 11 V1.0
8 Section 5. Death of a resident including ca of death Any occasion that does not require an NF01 Has the death of a resident or residents occurred in the quarter? If yes, please state how many. How many deaths have occurred in the quarter? Please provide the following information for each death that has occurred Residents unique identifier Ca of death Date Time (am or pm) other than a death notified under an NF01 notification Page 8 of 11 V1.0
9 Section 5. Death of a resident including ca of death Any occasion that does not require an NF01 Residents unique identifier Ca of death Date Time (am or pm) Please continue on a separate photocopy of section 5 if necessary. Please include any additional information relevant to this section. Page 9 of 11 V1.0
10 Section 6. Pressure ulcer (grade 2 or higher) sustained by a resident or residents How many residents have sustained a pressure ulcer, grade 2 or higher, in the quarter? Please state the number of instances of grade 2 pressure ulcer. Please state the number of instances of grade 3 pressure ulcer. Please state the number of instances of grade 4 pressure ulcer. Please state how many of the grade 2 or higher pressure sores you have identified were sustained in each of these locations. Designated centre Hospital If you have ticked other, please provide details. How many pressure ulcers (grade 2 or higher) required medical or hospital treatment? Medical treatment Hospital treatment Please include any additional information relevant to this section. Page 10 of 11 V1.0
11 Section 7. Declaration I, the undersigned, declare that the information I have provided in this notification form is true to the best of my knowledge and belief. Name (print) Position Person in charge Authorised person Signed Date Contact number (during office hours) Please return the completed signed form by to rst@hiqa.ie or by post to: Regulatory Support Team Health Information and Quality Authority Dublin Regional Office George s Court George s Lane Smithfield Dublin 7 Tel: Page 11 of 11 V1.0
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PPFP responded candles removed from room student informed of rules on candles PPFD responded burnt popcorn in microwave Alarm re-set
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GEORGIA DEPARTMENT OF CORRECTIONS Standard Operating Procedures
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2018-2019 ALABAMA SAFE APPLIANCE INSTALLATION PROGRAM GUIDELINES This program is available on purchases on or after October 1, 2018 until September 30, 2019 or funds are depleted, whichever comes first.
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