Recently there have been some emerging themes from Aged Care Quality and Safety Commission (ACQSC) assessors conducting accreditation audits and visits.
ACQSC assessors are questioning Board, management, staff and relevant others on current aged care industry developments, their knowledge of these areas and what has been implemented to effect change. From these conversations and investigations, assessors are then determining compliance or non-compliance on standards outcomes.
Triangulation of Evidence
At a recent Department of Health Reform Webinar (6 June 2019), advice was provided that assessors do not have to triangulate evidence for every issue they identify. For example, if the assessor converses with a consumer regarding meals and the consumer is dissatisfied, the assessor may seek to understand the issues further, for e.g. by conversing with staff, management or other consumers. The assessor does necessarily not need a third piece of evidence to confirm the identified issue.
Based on our clients’ experiences, we would like to share some of the questions that have been recently repeatedly asked by ASCQC assessors and suggested responses.
Other considerations for Management:
- Restraints – ensure you have recently reviewed your Restraint Policy and Procedures to ensure all requirements of the Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019 and to ensure processes around the Psychotropic Self-Assessment are updated.
- Infection control –ensure you have evidence of: Antimicrobial Stewardship Program in place, education provided to RN’s and Clinical Managers and communication to GPs, specialists etc.
- Education –ensure evidence of new standards education for staff, contractors, volunteers, contractors and Board.
- Continuous improvement –ensure you have current examples are required of what has been achieved and planned. Unless there is a good reason, CQI initiatives should not be delayed.
- The system to support consumers emotionally following an allegation of sexual assault – this needs to be evidenced through policy and procedures that direct staff to offer counselling and support services to consumers following these events.
- Knowledge of the Aged Care Quality Standards – managers and staff can utilise the standards guidance document https://www.agedcarequality.gov.au/resources/guidance-and-resources-aged-care-quality-standards-providers including understanding and application of the standards and terms in the glossary or the fact sheet https://www.agedcarequality.gov.au/providers/standards.
Assessor: What is the role of Aged Care Quality and Safety Commission role is and how it was formed?
Management: The role of the Aged Care Quality and Safety Commission (Commission) is to protect and enhance the safety, health, well-being and quality of life of people receiving aged care. The Commission promotes high quality care and services to safeguard everyone who is receiving Australian Government funded aged care. The Commission replaces the Australian Aged Care Quality Agency and the Aged Care Complaints Commissioner.
Staff: The Commission sends assessors to ensure we are complying with the ACQS and to make sure all consumers have safe and quality care. The Commission also supports us through accreditation.
Assessor: How do you allow your consumers to have privacy and dignity?
Staff: Examples might include:
- Knock prior to entering the (consumer)’s room.
- If the door is open, announce ourselves and check to ensure the (consumer)s is happy for me to enter.
- Where this is not possible, e.g. (consumer)s living with dementia, I announce myself and greet the (consumer) and explain the purpose of the visit.
- Check on the (consumer)’s preference for having doors/ curtain opened or closed when leaving the room.
- Store all consumer files securely and away from public access.
- Ensure I use passwords for electronic information.
Assessor: What do you understand by the term ‘cultural safety’?
Staff: The consumer tells us what cultural safety is. It’s their experience of the care and services they are given and how able they feel to raise concerns. Cultural safety is about understanding a consumer’s culture, acknowledging differences and being actively aware and respectful of these differences in planning and delivering care and services.
Assessor: Are consumers able to get outside independently?
Staff: Yes - all consumers have access to the outside garden and courtyard areas of the Home. We ask all consumers about their plan for the day and assist them to go outside if they choose. For those consumers who like to go out every day, we follow their care and services plan and support them to go outside, as needed.
Assessor: Can consumers personalise their environment?
Staff: Yes – definitely. Consumers can personalise their rooms by having familiar photos, religious symbols and pictures and paintings on the wall, as well as some familiar furnishings. They may also be able to bring some items of furniture with them, but it is important that these furnishings are safe for both the consumer and staff and are not cluttering their room. If a consumer wants a change in room layout or needs help to hang a picture, we can help or call the maintenance officer to help with this.
Assessor: What can you tell me about how the Home is reducing physical, environmental and psychotropic restraints and conducting behaviour management strategies?
Staff: I understand that the Home takes these things very seriously and we have policies and procedures on these. We try to not use restraint wherever possible and only as a last resort. For example, we don’t use bedrails any more or very rarely. We always try to understand the consumer's wants and needs using behaviour techniques to support the consumer.
My manager can also tell you more about this.
Assessor: Is food available to the consumers at any time day or night? For example, if a consumer wakes up hungry and asks for food, as a carer what do you do?
Staff: Yes - food is available to our consumers anywhere at any time. If the consumer wakes at night and is hungry we have drinks, fruit and snacks that we can bring to their room. Many consumers also have a refrigerator in their room which stores food and refreshments that they access anytime.
Assessor: Can you tell me some of the topic areas that your orientation and mandatory training programs cover?
Staff: Yes. We have mandatory training every year and I attended this on (month) or year. We learned about:
- Our organisation
- Consumer Rights
- Elder Abuse
- Missing Residents
- Manual handling
My Manager can show you a copy of the orientation and mandatory training program.
Assessor: Can you tell me who are agency staff and do you know if they have the appropriate skills and knowledge to do the job?
Staff: Yes. All agency staff have orientation before starting their shift if they haven’t worked here before. The RN places their name on the roster when they are due to work. Agency staff wear a different uninform to ours and we work closely with them on the floor. Please speak to my Manager for more information about their knowledge and skills.
Assessor: I have arrived after business hours to observe lifestyle support for afternoon and evening – can you show me what strategies and activities you have in place to manage challenging behaviours?
Staff: We have lifestyle activities and support during waking hours and I can show you our calendar of activities. We use different behaviour strategies depending on each resident. These are in the resident’s care plan.
I will take you to the RN on duty to discuss further your question.
Assessor: How do you control the spread of infections in the Home?
- We make sure we wash our hands. This is before we start and throughout the shift. We are checked on our handwashing every year.
- We make sure we do not come to work when we are sick.
- We make sure we report to the RN straight away if a resident is unwell, for example, coughing or sneezing.
- We have the flu shot every year.
Assessor: What are some of your high clinical risks or high prevalence of clinical issues?
Staff: You will need to discuss this with the Director of Care or our senior member of the Leadership Team on duty. I will take you to them now to discuss your question further.
RN: I can show you a copy of the clinical indicator report from last month. I'll just get this. However, our clinical risks and high prevalence areas are:
- Managing hydration and nutrition
- Managing risks of choking
- Managing medications safely
- Minimising restrictive practices
- Managing delirium
- Managing pressure injuries
- Managing hearing loss
Assessor: Can you access a copy of the Home’s Strategic, Diversity and Risk Management Plans?
Staff: Our Home’s important plans are accessible on our corporate network drive or everyone can see them in the foyer. These plans are discussed with us at our meetings and these are some of things we are working on: enter examples.
I will take you to the Director of Care or our senior member of the Leadership Team on duty to discuss further your question.
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