The royal commission has questioned aged care regulators how an approved provider with a history of poor compliance and several “red flags” could continue to operate.
This week’s hearing of the aged care royal commission in Brisbane is looking into the regulation of aged care by the Aged Care Quality and Safety Commission, and its predecessor the Australian Aged Care Quality Agency, and the Department of Health.
Evidence presented this week may lead to questions about whether the current regulatory regime attaches sufficient weight to protecting the quality and safety of care, Senior Counsel Assisting Peter Gray said in his opening address.
It may also raise questions over whether the emphasis on managing a provider back to compliance is the right approach when standards are not met, he said.
Day one of the hearing featured a case study on the two aged care homes at the Earle Haven Retirement Village in Nerang on the Gold Coast, which closed on 11 July, sparking an emergency operation to relocate 68 residents (read our backgrounder).
The commission first heard from the emergency responder and key staff of both the approved provider People Care and HelpStreet, which had been contracted to provide care services since April 2018, and the deteriorating relationship between the two organisations (read our report here).
It then looked into the extent the Commonwealth bodies responsible for the regulation of safety and quality of aged care were adequately monitoring and appropriately responding over the months and years leading to the event.
Numerous red flags
The commission heard about a long-history of poor compliance for People Care, a siloed approach to the various areas of regulation, and a lack of cohesion of all the relevant information to make an informed decision about the organisation retaining its approved provider status.
“From its approval in 2006 as a provider of community, flexible and residential care, People Care appears to have had a poor compliance record, raising potential red flags about governance and management capacity,” Mr Gray told the hearing.
Mr Gray detailed “red flag” matters from 2015 about the provider’s inability to deliver aged care and periods of intense regulatory scrutiny by the quality bodies and the department, including for financial issues.
There were multiple instances of unmet quality standards, serious risk decisions, variations to accreditation and sanctions at the facility as well as complaints about the operator and defaults in financial reporting and engagement with inquiries, the commission heard.
The commission also heard that HelpStreet Global CEO Kristofer Bunker had become disqualified to manage companies or corporations in Australia in 2018.
Limited processes for sharing information
Mr Gray asked Tracey Rees, regional director for Queensland of the quality and monitoring group of the quality and safety commission, whether in 2015 there was scope within the agency for referring information that raises questions about the suitability of an approved provider to the department.
Ms Rees said there was and is a process for providing a report to the compliance area of the department where a service was non-compliant, but no process for communicating directly with the approved-provider area.
She said compliance issues were handled through a process aimed at managing the approved provider back to compliance, unless accreditation was revoked.
The quality agency and now commission could make a decision to revoke accreditation, but there were or are no circumstances it would question the suitability of the corporate entity to be an approved provider, the commission heard.
Mr Gray said the red flags pointed to the logical conclusion that People Care was not suitable to be an approved provider and he suggested the agency and department should have been working on a phased process of managing the approved provider out of the industry.
“The agency’s responsibility at the time was to monitor compliance with the accreditation standards and make decisions about accreditation. It was the department’s responsibility in relation to approved provider. We didn’t have a joint approach,” Ms Rees said.
No follow up on outsourcing arrangement
Ms Rees said in retrospect they should have looked further into the trial-contract arrangement between People Care and HelpStreet, such as about the demarcation of roles and responsibilities between the two, rather than just noting the agreement in the record when the details came to light following a compliance visit.
Anthony Speed, the acting assistant secretary for the aged care compliance branch in the aged care reform and compliance division of the department, told the inquiry that with the benefit of hindsight, the department had an opportunity to investigate this contractual arrangement and it should have done.
The commission heard there were divisions at the time within the department including between operational compliance relating to quality and prudential compliance relating financial matters, but they have subsequently been merged into a single branch managed by Mr Speed.
However, the suitability of approved providers continues to be maintained in a different division of the department in a separate branch, he said.
“The compliance branch has a role in revocation of approved provider status but not in the assessment of approved provider status,” Mr Speed said.
The commission heard about an investigation into People Care’s finances that was limited to a financial-management issue that made no reference of the poor compliance history in residential and home aged care.
Mr Gray said the policies and procedures of the department seemed to be overly narrow and suggested a broader perspective should have been taken that combined all the issues related to People Care and its subcontractor HelpStreet in a coherent consideration of whether the approved provider was suitable to be an approved provider.
Mr Speed agreed.
“I’d agree that the opportunity to consider all information and all risk triggers in decision-making processes would be ideal and that’s a matter that was recognised in the Carnell and Paterson review and recommendations were put forward and accepted by government in relation to that matter.”
Improved sharing from 2020
Mr Speed said there were some arrangements in place now to support engagement and information sharing between aged care’s regulatory bodies.
Mechanisms will be strengthened and allow for more holistic consideration when the compliance and compulsory-reporting functions of department are transferred to the commission on 1 January 2020, he said.
To stay up to date on the latest about the Royal Commission into Aged Care and Quality go to our special coverage.
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