What ACE Readers had to Say: The Aged Care Quality Standards One Year On

Last week CompliSpace released the Aged Care Impact Report – One Year On. The Report revealed that the burden of adjusting to the new Aged Care Quality Standards and also coping with a once in 100-year pandemic are straining the aged care sector, putting staff retention at risk and pointing to reduced capacity to care for residents.

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How to Manage Aged Care Assessment Contacts Part 1: Preparing for the Entry Meeting

Assessment Contacts are one of the most important tools that the Aged Care Quality and Safety Commission (ACQSC) uses to monitor the quality of aged care services. Through Assessment Contacts the ACQSC Assessors collect and evaluate evidence to determine how well an Aged Care Home has complied with the Aged Care Quality Standards (Quality Standards).

Assessment Contacts can happen announced or unannounced, any time, any day of the week, and can cover any of the requirements in the Quality Standards. The prospect can be daunting and stressful, but these tips can help you feel a little more cool and confident.

This first part of our “How to Manage Aged Care Assessment Contacts” series will cover the first stage of the Assessment Contact process: the entry meeting.

 

Recap on Definitions

Assessment Contacts, Site Audits, Review Audits – what’s the difference? All this terminology can take a while to grasp so let’s start with a brief recap.

Quality Audit

  • Applies specifically to Home Services
  • Occurs at least once every three years

Review Audit 

  • Is an onsite assessment
  • Comprehensively assesses the provider’s performance against all the Quality Standards
  • Can be announced or unannounced

Site Audit

  • An onsite assessment conducted when a service that is currently providing care to consumers applies for re-accreditation

Assessment Contact

  • Could be a site visit or some other form of contact such as phone call or email
  • Can involve:
    • Performance Assessment, which assesses performance against one or more of the Quality Standards and results in a report; or
    • Monitoring, which does not explicitly involve assessment and won’t result in a report, but can lead to a decision to conduct a Performance Assessment
  • Can be announced or unannounced

 

This article will focus on Assessment Contacts that involve Performance Assessments, as opposed to Assessment Contacts that only involve monitoring. For more general information on how aged care assessments work, see our article: The Aged Care Quality Standards: How Will Compliance Be Assessed in 2020?

 

Arrival and Entry Meeting: An Overview

When they arrive on site, the ACQSC assessment team will show their identification and request consent to enter the premises. The request for consent is mostly a formality as Providers have a legal duty to co-operate with the Assessors and probably can’t refuse entry without a very good reason.

The Assessors will then conduct an entry meeting with the person in charge of the aged care service. At the entry meeting the Assessors will:

  • ask you to produce key documents
  • ask you seven “risk screening questions” to determine the focus of the Assessment Contact (unless the focus has already been determined).

The Assessors may also consider the four “Evidence Domains” when determining the focus of the Assessment Contact.

 

Key Documents that the Assessors Will Request at the Entry Meeting

Certain key documents must be provided to the Assessors at the entry meeting or within an hour afterwards. You can see a detailed list of the documents here, but in sum they are:

  • a complete list of consumers in the service
  • record of consumers who are receiving psychotropic medications or are subject to physical restraint
  • the contact information for consumer representatives
  • clinical incident management information records and any trends analysis
  • complaints register for the previous six months, including consumer/representative name
  • consolidated records of incidents involving allegations or suspicions of reportable assaults for the previous six months, and
  • for Site Audits only, personnel information for service staffing in the week prior to the assessment.

Practical Tips for Managing Your Key Documents

  • Have the key documents pre-prepared and stored together in a specific location. There should be a system for ensuring that the key documents are updated as key things change within the Home, or new data is available.
  • Ensure all management staff (including out of hours managers) are aware of the location of these documents, their purpose and how to discuss them with the Assessors.
  • Also prepare a list of ancillary key documents, that don’t form part of the assessment but could be helpful for the Assessment Team e.g. map of the facility, codes for accessing key areas, list/map of facility amenities, and emergency plans and exits.

 

Seven Risk Screening Questions to Determine the Scope/Focus of the Assessment Contact

With over 40 separate requirements in the Quality Standards, the ACQSC Assessors probably won’t cover every requirement in a single Assessment Contact. Instead, they will focus on particular areas. This is what the ACQSC means by the “focus” or “scope” of the assessment (the ACQSC uses the two terms interchangeably).

To determine the focus of the assessment, the Assessors may consider general areas of concern in the aged care sector (such as infection control) or the compliance history of the particular Provider. But, most importantly, they will also determine the focus by asking these seven questions during the entry meeting:

  1. Have there been any adverse findings by another regulatory agency or oversight body in the last 12 months?  (e.g. Healthcare complaints commission or similar, Food safety authority, Workcover, etc).
  2. What trends do your complaints data show you?
  3. How many consumers are receiving pressure area care?
  4. Have there been any medication incidents in the past 6 months where a consumer required hospitalisation or attention by a medical officer?
  5. How many consumers have had falls and required medical attention in the past 3 months?
  6. How many consumers at the service are currently receiving psychotropic medications? (To be captured as a rate or percent of total consumers at the service.) How many consumers are restrained in order to manage risks to themselves or others at the service? (To be captured as a rate or percent of total consumers at the service.)
  7. Can you tell me about incidents in the past 6 months where a consumer or staff member has required medical attention as a result of challenging behaviour from a consumer?

 

Practical Tips for Dealing with the Seven Questions

  • There is a clear overlap between the seven questions and the key documents. This means you can use your key documents to answer the seven questions.
  • Conversely, you can use the seven questions to improve the quality of your key documents. When prepping your key documents, test how well they answer the seven questions and then fill any gaps accordingly.
  • The ACQSC Assessors are not required to inform you of the focus of their Assessment Contact. It would, however, be enormously helpful to you if they did. So, if they don’t tell you – ask. As early as possible, ask the ACQSC Assessors to identify the scope of their assessment in as much detail as possible. Then ensure that appropriate staff receive this information.

 

The Four “Evidence Domains” 

The ACQSC’s recently-introduced “Evidence Domains” may also affect the focus of the Assessment Contact. According to the ACQSC’s revised Assessment Methodology, “An assessment contact will include one or more of the four evidence domains”, which are:

  1. Dignity, respect, choice and complaints (Standards 1 and 6)
  2. Care planning and personal and clinical care (Standards 2 and 3)
  3. Lifestyle and service environment (Standards 4 and 5)
  4. Governance and human resources (Standards 7 and 8)

What does this mean for Providers in practice? Effectively it means that there is now a “minimum scope” for Assessment Contacts. That is, you won’t be assessed on your compliance with just one Standard – at minimum, you will be assessed on your compliance with a pair of Standards.

 

Conclusion

Preparation is the key to a successful entry meeting. But how do you prepare for something that could happen at any moment without warning? The simple, but difficult answer is that you always need to be prepared. The practical tips in this article can help with this, but the process also involves a shift in mindset. To sustainably manage Assessment Contacts you need to change your thinking from reactive to proactive; from the panicked “compliance scramble” done every now and then to the steady “compliance system” maintained every day.

 

About the Authors

Ruth GreeneRuth Greene-1

As a Registered Nurse with over 30 years’ experience across the healthcare industry, Ruth has been employed in a range of management and clinical positions, and for several years worked as a consultant in residential aged care. Understanding organisational governance, risk and related quality standards has been a pivotal part of her work practices and has included maintaining and monitoring of legislative and regulatory requirements, as well as developing linked policy documents. Ruth is Principal Consultant – Aged Care, at CompliSpace.

Jennifer MaJennifer

Jennifer is a content development assistant in our Sydney Office. She recently graduated from the Juris Doctor, from the University of Sydney and completed her final semester at the University of Vienna. After completing an undergraduate degree in the field of medical sciences at Sydney University, and commencing an honours in neuroscience, she decided that path wasn’t for her. She is now convinced about her passion for the law, and has experience assisting in a variety of legal matters from commercial law, including litigation, to family law.

ACE Editorial Team
ABOUT THE AUTHOR | ACE Editorial Team
ACE is published by CompliSpace and Critical Success Solutions. CompliSpace is an Australian company that specialises in helping organisations manage their legal and regulatory obligations. Critical Success Solutions is an Australian company that specialises in helping Aged Care and Disability Services manage their regulatory and legal requirements.

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