The Aged Care Quality and Safety Commission (ACQSC) is stepping up its program of infection control spot checks of residential aged care homes.
What is a spot check and what does it involve on the day? What sort of things are the ACQSC Assessors looking for? To answer these questions, we’ve draw on the ACQSC’s report and feedback from providers who have experienced spot checks first-hand.
What is an infection control spot check?
According to the ACQSC’s Infection Control Spot Checks resource, an infection control spot check is an unannounced monitoring visit.
The purpose of the visit is to “observe infection control defences at the service to prevent transmission and to recognise and respond to symptoms of COVID-19; this is to ensure that everyone is adhering to infection control arrangements including safe PPE protocols.”
As an unannounced visit, a spot check could happen without warning at any time, day or night. The ACQSC will not conduct a spot check on a facility where there is a known case of COVID-19.
What happens on the day of a spot check?
The Assessor will arrive unannounced. They will run through these questions on the Infection Control Monitoring Checklist before entering the home:
- Is the service in lockdown?
- Are any of the consumers at the service COVID-19 positive?
- Are any of the staff at the service COVID-19 positive?
- Are you screening consumers daily for COVID-19 symptoms?
- What tool are you using for COVID-19 screening?
- Do you have any consumers or staff with flu like symptoms at present?
- Are any consumers or staff waiting on any tests related to Covid-19?
- Are these tests related to suspected symptoms, suspected flu like symptoms?
- Are these tests related to exposure or possible exposure to a Covid-19 positive person?
- Are these tests related to voluntary or proactive tests as available to consumers and/or health care workers?
Assessors may also ask additional questions to understand how the provider is applying the public health directives relating to infection control applicable in their state or territory.
The Assessors will then enter and inspect the premises. The ACQSC advises that “officers conducting the visits use a range of tools including a review against best practice based on the Communicable Diseases Network Australia (CDNA) guidelines for COVID-19 Outbreaks in Aged Care Facilities”.
In most cases, the infection control monitoring checklist is used to guide and record the outcomes of the monitoring visit.
The Assessors have extensive information gathering powers, including the power to:
- interview consumers, visitors, staff and anyone else who is involved with the service
- search the premises and anything on the premises
- examine or observe any activity on the premises
- take photographs or make any recording of the premises or anything on the premises
- inspect, examine, take measurements of, or conduct tests on, anything on the premises
- inspect any document on the premises
- take extracts from, or make copies of, any such document.
What are the ACQSC Assessors Looking for?
Observe Infection Prevention and Control Practices
While the monitoring contact occurs Assessors will observe:
- for appropriate signage and communication of information. This could include the currency and location of key information about hand hygiene, cough etiquette, social distancing, density signage and COVID -19 advice
- the practices of staff throughout the Home, including the appropriate use of PPE and infection control measures eg. hand hygiene, cleaning practices both environment and for equipment, and the use of preventative strategies such as social distancing protocols, staff and resident screening practices
- Consumer care and services being provided including supporting Consumers to freely move outside of their rooms, mealtime arrangements and support of visitors in line with the Home’s policies and procedures.
Outbreak Management Plans
- Does the provider have an Outbreak Management Plan (OMP) in place?
- Does the OMP contain all relevant information in an easy-to-read format? Relevant information includes maps that clearly identify service cohorting zones/rooms where PPE donning and doffing stations are, or should be, located.
- Is the OMP reviewed regularly? Can it easily be updated and redistributed?
- Does the provider conduct drills using the OMP?
Staff and PPE
- Does the provider have sufficient PPE for the first 48 hours in the event of an outbreak?
- Staff Are staff practising correct PPE etiquette? Are they wearing masks correctly? Are they refraining from touching their face/mask? Are they observing social distancing?
- Are donning and doffing stations clearly identified and used by staff?
- Are hand washing/alcohol-based hand sanitiser stations and disinfectant wipes readily available?
- Is shared equipment, such as phones or computers, wiped down between users?
- Does the provider have clear signage to identify the permissible number of staff in common areas such as offices, break and changing rooms?
- What are the PPE disposal systems, including how clinical waste is managed and details of the contractor services that the Home has available?
COVID-19 Testing and Isolating
- What is the current COVID-19 status of staff and consumers?
- What is the strategy for COVID-19 testing?
- What is the strategy for isolating staff and consumers while they await COVID-19 test results?
- Is there a clearly documented process for clinical handover and lockdown?
- Is there a centralised, readily-available list of consumer Medicare numbers?
- Does the provider have prepared signage that could be used immediately to identify areas that are active COVID-19 zones?
- Is there a surge contingency staffing plan? Does this include resource cleaning staff and supplies?
- Is there orientation, induction and training in PPE and infection control measures? Does this include for a surge workforce if they were to be used?
- What are the handover arrangements in relation for consumers including their individual risks, care needs, social needs and monitoring requirements?
What happens after a spot check?
The ACQSC advises that “A record of the regulatory official’s observations of the service environment, consumers and staff practices will be emailed to the provider of the service following the site visit.”
The ACQSC also notes that a spot check is a “monitoring visit, not a performance assessment”. This means that a spot check will not result in findings of “met” or “not met” in regard to the Aged Care Quality Standards. However, a spot check can lead to sanctions or further regulatory action such as the imposition of a performance assessment.
Webinar Recording: “Understanding the Gaps in Infection Control that put Residential Aged Care Facilities at Risk”
The Aged Care Quality and Safety Commission is increasing its unannounced infection control spot checks so we have extended access to this webinar recording. Click here to learn more and request the recording and audit tools.