Provider information form

Please fill out this form with the information related to the nursing home you manage, ensuring that the information provided is correct and up to date.

Please note that fields marked with a red square are required fields.

Details
Fill in details of nursing home
(Required)
State Name of Nursing Home as reqistered with HIQA (HEALTH INFORMATION QUALITY AUTHORITY)
(Required)
State Name of Person in Charge as registered with HIQA
(Required)
(Required)
State Address - Street, Town
(Required)
(Required)
(Required)
(Required)
Attachments
Upload information booklet and image of nursing home.
Type of home
(Required)
Select appropriate option:
Tick box if your Nursing Home is a member of Nursing Home Ireland - NHI Ireland Logo will be included on your individual web page.
Service Types
Tick appropriate boxes if Nursing Home provides service:
List any additional services provided
Bed capacity
(Required)
State Total Number of Beds Registered with Health Information Quality Authority (enter a whole number)
State Total Bed Capacity of Nursing Home - if higher than total number of registered beds (enter a whole number)
How many of each room type are within the residence (enter a whole number for each, enter 0 for none)
(Required)
(Required)
(Required)
(Required)
(Required)
(Required)
Transport
(Required)
State number of car ports available for visitors
State Train or Bus Routes available
Quality Provision
Tick appropriate boxes if residents can participate in:
Tick box if residents can avail of flu vaccine
State % of residents who received the flu vaccine during the period 1st October 2008 to 31st March 2009
Quality Programmes
Tick appropriate boxes if Nursing Home is involved in developing the following quality programmes:
List other Quality Programmes Nursing Home is involved in
Religion
Does the home have a particular religious ethos?
Language
Tick appropriate boxes if applicable to Nursing Home:
Environment
Tick appropriate boxes if applicable to Nursing Home:
Tick only if car parking is specifically allocated to visitors
Tick only if public transportation is reachable within a 10-15 minute walk
Tick only if (shops, church and pub) are reachable within 10-15 minutes by public or provided transport
Tick only if residents can access an outside garden safely by themselves or with family/friends assistance
Tick only if residents with limited mobility can access all areas safely by themselves
Tick only if temperature can be individually controlled in personal rooms and with agreement in shared areas
Privacy & Safety
Tick appropriate boxes if applicable to Nursing Home:
Tick only if residents with personal rooms have and are permited to lock the door
Tick only if the lockable place for resident's belongings is within their personal space
Tick only if the Nursing Home's insurance policy has a provision that specifically covers residents belongings
Tick only if there is a written policy that outlines how residents can access and manage personal finances
Care Provision and Services
Tick appropriate boxes if applicable to Nursing Home:
Tick only if there is a written policy that outlines how residents (as appropriate) can manage their own medication
Tick only if residents have flexibility in daily routines and individual preferences are facilitated where appropriate
General Options
Tick appropriate boxes if applicable to Nursing Home:
Tick only if there is a written programme outline that is available on request
Tick only if information on the council and its activities is available on request
Tick only if there is a written policy that outlines what furniture or personal items are permissible
Tick only if there is a written policy on residents wearing their own clothes and on-site laundry arrangements
Tick only if there is a written policy covering open visiting by children and pets
Tick only if residents have access to a designated quiet room to meet with visitors
Tick only if residents visitors can be accommodate overnight on request
(Required)
The name of the person to contact about this data
(Required)
Email address to use as contact regarding any queries about submitted information

Before submitting form please ensure you have completed all sections fully and attached the nursing home's information booklet and photograph (if applicable).