Recently there have been some emerging themes from site visits by Aged Care Quality and Safety Commission (ACQSC) assessors. Based on our clients’ experiences, we would like to share some of these themes along with examples of the kinds of questions that have been asked by ACQSC assessors.
This article has been updated from it's previous post published on July 16, 2019. Click here to read the original post.
The Shift from Triangulation of Evidence to Conversation
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 by conversing with staff, management or other consumers. The assessor does necessarily not need a third piece of evidence to confirm the identified issue.
The general approach now is for ACQSC assessors to question the 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.
Here are some of the particular areas that ACQSC assessors appear to be focusing on, accompanied by some tips on how to ensure your approach to these areas is appropriate and up to standard:
Restraints and Restrictive Practices
1. Ensure you have recently reviewed your Restraint and Restrictive Practices Policy, Procedures and related forms to ensure you are meeting all requirements of the Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019.
2. Ensure processes around the Psychotropic Self-Assessment are updated.
Infection Prevention and Control
Ensure you have evidence of:
1. an operational Antimicrobial Stewardship Program
2. education and related competency assessment programs for all relevant staff, particularly Clinical Managers and Registered Nurses, and covering all relevant topics, including the Antimicrobial Stewardship Program
3. communication processes with Medical Practitioners and other Health Specialists that align to your infection control reporting and support timely notification and accessing of support
4. outbreak management systems and availability of appropriate resources to manage such events.
1. Ensure you have evidence that staff, contractors, volunteers, contractors and the board have been educated on the new Aged Care Quality standards.
1. Ensure you have current examples and evidence of what has been achieved, the results of your quality activities and your ongoing planned actions. Unless there is a good reason, continuous quality improvement initiatives should not be delayed.
Support for consumers following an allegation of sexual assault
1. Ensure you can evidence through policy and procedures that staff are directed to offer counselling and support services to consumers following these events.
Knowledge of the Aged Care Quality Standards
1. Managers and staff can utilise the standards guidance document (Guidance and Resources for Providers to Support the Aged Care Quality Standards) available at https://www.agedcarequality.gov.au/providers/standards to ensure that they have the appropriate knowledge of the Aged Care Quality Standards.
Sample Themes and Questions
Wherever possible when answering questions from the assessors try to refer to consumers by name and use specific examples.
Theme – Privacy and Dignity
How do you support the privacy and dignity of consumers?
Staff response could be: Some of the things I do to support the privacy and dignity of consumers include:
- Knock prior to entering the consumer’s room.
- If the door is open, announce myself and check to ensure the consumer is happy for me to enter.
- Where this is not possible, e.g. if a consumer is 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.
Theme – Cultural Safety
What do you understand by the term ‘cultural safety’?
Staff response could be: 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.
Theme – Consumer Independence
Are consumers able to independently go outside if they choose?
Staff response could be: 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, according to their wants and needs.
Theme – Consumer Dignity and Choice
Can consumers personalise their environment?
Staff response could be: 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. This is usually discussed with the manager to ensure that these furnishings are safe for both the consumer and staff and support independent movement, where possible, in the size and space of 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.
Theme – Restraint and Restrictive Practices
Can you tell me about how the Home is reducing the use of physical, environmental and chemical restraints? What types of behaviour management strategies are implemented?
Staff response could be: 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.
Theme – Hydration and Nutrition
Is food and drinks available and accessible to consumers at any time day or night? For example, if a consumer wakes up hungry and asks for something to eat, as a carer what would you do?
Staff response could be: Yes – food is available for our consumers, and we can provide them with some different drinks, 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 can access anytime.
Theme – Education and Training Programs
Can you tell me some of the learning areas that your orientation and mandatory training programs cover?
Staff response could be: Yes. We have mandatory training every year and I last attended this [insert date]. We learned about a range of areas including:
- Our organisation
- Consumer Rights
- Elder Abuse
- Missing Residents
- Fire and emergency management
- Manual handling
- Infection prevention and control and associated work practices, including handwashing
My Manager can show you a copy of the orientation and mandatory training program.
Theme – Human Resources
How do you identify agency staff working within the Home? How do you know if they have the appropriate skills and knowledge to do the job?
Staff response could be: 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.
Theme – Lifestyle Program
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 consumer challenging behaviours?
Staff response could be: We provide a range of lifestyle activities and support within our Home both during the day as well as in the evening. I can show you our current calendar of activities.
We use different behaviour strategies depending on each consumer’s individual needs and their preferences. These are in each consumer’s care plan. I will take you to the RN on duty to discuss further your question.
Theme – Infection Control
How do you control the spread of infections in the Home?
Staff response could include the following:
- We make sure we wash our hands. This is before we start and throughout the shift. We are competency assessed on our handwashing practices every year.
- We do not come to work when we are sick.
- We make sure we report to the RN straight away if there are any changes in a consumer’s condition or health that may indicate that they are unwell, for example, coughing or feeling nauseous.
- We have the flu vaccination annually (every year).
Theme – Consumer Care
What are some of your high clinical risks or high prevalence of clinical issues?
Staff response could be: 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.
Registered Nurse response could be: I can show you a copy of the clinical indicator report from last month. A summary of 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
Theme – Strategic, Diversity and Risk Management
Can you access a copy of the Home’s Strategic, Diversity and Risk Management Plans?
Staff response could be: Our Home’s important plans are accessible on our corporate network drive and discussed with us at our meetings. Some examples of things we are working on: [provide 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.