Full Response by Aged Care Quality and Safety Commission (ACQSC)
Background Briefing: Does the regulator stand by its 2019 accreditation of St Basil’s?
ACQSC Response: The Aged Care Quality and Safety Commission made a decision in August 2019 to re-accredit St Basil’s Home for the Aged in Victoria for a period of 3 years. This decision was informed by a re-accreditation site audit conducted on 18 and 19 July 2019.
This audit included observations at the service, a review of documents and interviews with staff, consumers/representatives and others at the time. The performance report resulting from this site audit can be found on the Commission’s website here.
It is widely recognised that the compliance status of a service is not static, and can be affected by a variety of factors. The Commission uses a range of regulatory tools to monitor risk and detect possible non-compliance with the Aged Care Quality Standards.
Background Briefing: Can you please explain the discrepancies between the 2019 accreditation and the most recent audit report which failed St Basil’s on almost every criteria? What changed in that time?
ACQSC Response: The Commission has been closely monitoring the quality of care and services at St Basil’s Home for the Aged in Victoria since the COVID-19 outbreak at the service in July 2020.
The Commission initially took regulatory action on 26 July 2020, in relation concerns about the serious impact of the outbreak on residents and staff at the service. The Notice of Requirement to Agree to Certain Matters (Notice to Agree) issued at that time secured the service’s agreement to a number of specified requirements. The COVID-19 outbreak at the service totally disrupted the delivery of “normal” care for St Basil’s residents and the service required very significant support from external agencies, including health services, for a period extending beyond the end of the outbreak at the facility. Commission staff made a number of unannounced visits to the facility over successive months to assess the service’s efforts to recover from the outbreak.
In December 2020, the Commission undertook a comprehensive review audit at St Basil’s and the service was found not to comply with 21 of 42 requirements, across six of the eight Aged Care Quality Standards. The performance report resulting from this review audit can be found on the Commission’s website here.
Additional regulatory action was taken on 24 December 2020 with a Sanction and a Notice to Agree being issued that required the provider to immediately take further steps to manage risks associated with identified non-compliance with the Aged Care Quality Standards.
Also arising from this audit, in January 2021, the Commission decided on a shortened period (12 months) of accreditation for St Basil’s, and included strict conditions requiring the service to rectify areas where it is non-compliant with the Aged Care Quality Standards. St Basil’s acknowledged the identified deficiencies and has confirmed that it is paying close attention to addressing these issues.
The approved provider is required to apply for re-accreditation of St Basil’s prior to its current period of accreditation expiring on 19 January 2022. This process will include an unannounced site audit in which quality assessors will assess the service against all 42 requirements of the Aged Care Quality Standards.
Background Briefing: Can you please explain why St Basil’s was deemed to have adequate infection control procedures (ie hand washing basins and sanitisters) in 2019 yet by the end of 2020 it was failed on this standard? What had changed in that time?
ACQSC Response: In the context of the Australian Government’s early declaration of COVID-19 as a pandemic, the Australian Health Protection Principal Committee moved quickly in early 2020 to issue advice to Australians generally, and to the health care and aged care sectors specifically, on a range of precautionary measures to strengthen infection prevention and control (IPC). The Communicable Diseases Network Australia published specific guidance on this matter for residential aged care services, and the Aged Care Quality and Safety Commission assisted with the drafting of that document.
From March 2020, the Commission proactively and frequently communicated with the sector to urge providers to access and implement the growing body of guidance and advice in relation to IPC measures in aged care. This advice was specific to COVID-19 which, based on growing international evidence, was known to be a highly infectious virus that could be transmitted between people in particular ways. In its communications with the sector and interactions with individual providers and services, the Commission made clear that assessment of compliance with relevant IPC requirements in the Aged Care Quality Standards would take into account a service’s precautionary IPC measures specifically aimed at minimising the risk and impact of COVID-19.
With respect to St Basil’s Home for the Aged in Victoria, the Commission has been closely monitoring the quality of care and services at this service, and especially since the COVID-19 outbreak at the facility in July 2020.
In relation to the review audit conducted in December 2020, the Commission’s assessment team observed inconsistent infection control practices while on site, including:
• There were no readily available handwashing stations for staff use when providing care delivery to consumers. There were no wall mounted sanitiser stations set up in corridors where care staff deliver direct care to consumers.
• There was no available supply of sanitiser wipes at each lifting machine for cleaning of equipment between each use.
• Staff were observed to be wearing PPE incorrectly and not always using infection control practices such as hand hygiene during donning/doffing.
• Donning and doffing stations were observed to be inappropriately placed without facilities for waste disposal.
Background Briefing: Given these discrepancies, can consumers trust the commission to provide accurate information about the safety and quality of an aged care provider?
ACQSC Response: The Commission publishes performance information about individual aged care services, including performance reports resulting from site assessments, decisions relating to accreditation of residential services and other historical performance information on its website. The My Aged Care website also features compliance ratings for every residential service.
At a system level, the Commission publishes a quarterly sector performance report which provides an overview of the Commission’s regulatory activities and outcomes in relation to a range of its functions, including quality assessment and monitoring, compliance and enforcement, complaints resolution, compulsory reporting (now serious incident reporting), and provider approvals.
Where an approved aged care provider is found to be non-compliant with the Aged Care Quality Standards, the Commission decides on a regulatory response that is proportionate to the level of assessed risk.
Background Briefing: St Basil’s was given three months to rectify the concerns and a pause was placed on funding for new residents – has this now been lifted? Has St Basil’s Notice to Agree been withdrawn? If so, why and on what basis?
ACQSC Response: Following a review audit undertaken of St Basil’s in December 2020, on 24 December 2020, a Sanction and Notice of Requirement to Agree to Certain Matters (Notice to Agree) was issued to the approved provider by the Commission in relation to the St Basil’s service.
The terms of the Sanction and Notice to Agree apply for a period of 6 months, until 24 June 2021.
The terms of this notice still apply, subject to the Commission’s consideration of special circumstances pertaining to an individual seeking admission to the service. Commission executives have had a number of meetings with the Board Chair of St Basil’s to ensure that the Board is fully aware of the seriousness of the current Sanction and Notice, and is overseeing the necessary improvements at the service.
Background Briefing: Are aged care providers now notified of an inspection and/or an audit?
ACQSC Response: Re-accreditation site audits conducted by the Commission are unannounced. This arrangement was introduced by the former Australian Aged Care Quality Agency in 2018. Unannounced site visits were replaced by short-notice visits for a short period in 2020 when expert clinical advice cautioned against them.
The Commission may also conduct other site visits at a service, both announced and unannounced.
Background Briefing: A former assessor has described the process as “superficial” and that providers are able to “gloss over” issues – do you dispute this? If so, what is done to ensure the inspections and audits are thorough?
ACQSC Response: The Commission uses a proportionate, risk-based approach in delivering its regulatory functions.
The Commission’s on-site audit methodology is comprehensive and includes interviewing staff and residents at a service and collecting a range of other evidence relating to the requirements of the Aged Care Quality Standards.
The Commission’s reaccreditation site audits are typically undertaken over a number of days and with a minimum team of 2 but usually 3 or 4 quality assessors to ensure maximum evidence collection when on site.
Under the Commission Rules (subordinate legislation), providers are required to notify their residents that they are expecting an unannounced site audit in the months leading up to accreditation expiry. The purpose of this notification is to ensure that residents and their families have the opportunity to contact the Commission (by phone or email) and provide feedback about care and services prior to the team commencing the audit on site. When on site, Quality Assessors will interview a range of residents and talk to family members if present as a formal part of their assessment, and any resident or family member can approach a quality assessor on site to share their thoughts about the service.
All quality assessors are required to be registered by the Commission, which requires them to undergo a formal training program. Registration is renewable annually and is dependent on a quality assessor undertaking a minimum number of assessments and participating in approved continuing professional development.
The Commission uses a range of regulatory tools to monitor compliance and detect possible non-compliance. The Commission is not restricted to evidence from a particular source and considers all relevant available evidence to allow it to make decisions.
Evidence may include information from:
• performance assessments against the Aged Care Quality Standards undertaken during site audits, review audits or assessment contacts
• assessment contacts for the purpose of monitoring quality of care and services monitoring and investigating providers’ compliance