Gaps in audit documentation and a lack of transparency in accreditation and sanction procedures at a Victorian facility have been under the spotlight of the royal commission this week.
On Tuesday, the Royal Commission into Aged Care Quality and Safety continued its investigation into MiCare Avondrust Lodge in Victoria, less than a month after it investigated the poor care provided to Bertha Aalberts, who passed away three months after entering the facility in May 2018 (read more here).
A week after Ms Aalberts entered Avondrust, the quality regulator re-accredited the facility for the maximum three-year period following a successful audit in April, the inquiry heard. However, a complaint by Ms Aalberts’ daughter triggered an audit on 29 August, Counsel Assisting Richard Knowles told the royal commission.
In evidence to the royal commission, MiCare CEO and executive director Petronella Neeleman said there were no significant changes to the rosters or the number of staff between 17 April and 30 August.
All 44 expected outcomes were met at a review audit conducted 17-18 April found, however it failed to meet 13 of the expected outcomes in an audit conducted between 16-27 August, seven of which related to clinical care. By 29 August, the Department of Health had imposed a sanction on Avondrust, the commission heard.
A February 2018 resident survey showed concerns about staffing levels, however the auditors were not given this information in April, the inquiry heard.
Aged Care Quality and Safety Commission quality surveyor Gilda D’Rozario, who was team leader of the April 2018 audit, said review audits were based on interviews the team conducted and documentation available to surveyors on the day.
“At the time of our audit, documentation that we had requested management at the time were provided to us, so we based our findings on those documentation that was available to us on the day,” Ms D’Rozario said.
She said while they received some feedback from residents regarding delays in call bell responses, management at Avondrust told them they would review processes and ensure residents were satisfied.
The inquiry also heard that computer-generated templates are used to write the findings of reviews.
Mr Knowles pointed out contradictory information in the reports as a result of this approach.
Avondrust’s April audit report stated: “care recipients and representatives interviewed are satisfied with the availability of skilled and qualified staff and the quality of care and services provided,” while a subsequent comment from a surveyors added “majority of care recipients and representatives interviewed are satisfied.”
“One relates to the majority; the other one suggests that all care recipients and representatives were satisfied who were interviewed,” Mr Knowles said.
Ms D’Rozario said there was no justification for the inconsistency and agreed when Mr Knowles suggested surveyors might not add to the template report at all.
Aged Care Quality and Safety Commission regional director for Victoria and Tasmania in the quality assessment and monitoring group Catherine Rosenbrock said it was usual practice to use computer-generated reports at the time, but hasn’t been since the establishment of the quality commission.
“Under the current methodology that has been applied, and the report writing process under the new quality standards, we no longer use computer-generated reporting. All reports are written from scratch,” Ms Rosenbrock said.
Aged care royal commissioner Richard Tracey said he did not understand how a decision can be made knowing that the report was “simply template writing.”
“The output of the audit tool was based upon assessors validating, within the software, that they had considered the relevant information to support their finding,” Ms Rosenbrock said.
She said as a decision-maker, the computer-generated reports made her feel uncomfortable.
Improving regulatory processes
Avondrust engaged a nurse advisor from aged care advisory firm Ansell Strategic in September 2018 following its sanction, the inquiry heard.
Ansell was required to report to the department on a fortnightly basis throughout Avondrust’s three-month timetable for improvement.
Quality surveyors at a re-accreditation audit on 6 December were unaware that a nurse advisor was on site at the time of the audit and were not given Ansell’s reports. A nurse advisor is not someone surveyors are interested in interviewing, the inquiry heard.
Department of Health director for the Compliance Centre East Elsy Brammesan, who lifted Avondrust’s sanction on 11 January 2019, also failed to contact Ansell.
Ms Brammesan said while Ansell’s report would have been of interest and hearing from the nurse advisor and administrator would be preferable, the information would be viewed as an opinion.
“A commonwealth agency has… gone back and assessed that those areas were addressed, and I did have information from the provider to tell me what measures they were putting in place going forward,” Ms Brammesan said.
She said she was also aware that a re-accreditation visit would take place within three months, which would be a test if the measures were sustained.
Lack of transparency
Elsewhere, aged care royal commissioner Lynelle Briggs said there were issues with transparency around the accreditation and sanction process for approved providers.
Ms Briggs said she did not understand how a provider was able to appear to have done serious things to families, and be accredited with all 44 expected outcomes, and then quite quickly have another review state they were not meeting all the expected outcomes.
“The issue is that the community at large doesn’t see the system as responsive to people making complaints, doesn’t see them providing feedback to those people and certainly doesn’t see it as transparent to them in terms of a fair process of review, sanctioning and so on following,” Ms Briggs said.
Ms Brammesan agreed there was more to do to create further transparency.
“We can go a step further and, possibly at the end of a process, we could have another meeting with the same family members to say what has been done and is there remaining issues. And so I think that is something that we should absolutely consider doing,” Ms Brammesan said.
The Royal Commission into Aged Care Quality and Safety hearing in Brisbane wraps up today. The next hearing takes place from 9-11 September and 13 September in Melbourne and will focus on younger people in residential aged care.
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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