Published_decision_(SA_and_RA) - Aged Care Quality …



The Ritz Nursing HomeRACS ID:2539Approved provider:Milstern Health Care Pty LtdHome address:203 Leura Mall LEURA NSW 2780Following an audit, an authorised delegate decided that this home does not meet 37 of the 44 expected outcomes of the Accreditation Standards. The review audit was conducted on 15 November 2017 to 20 November 2017. The assessment team’s report is attached.An authorised delegate of the CEO of the Australian Aged Care Quality Agency made a decision on 29 November 2017 to revoke the accreditation of the service. The period of accreditation of the service will expire on 18 December 2017.Serious risk decisionOn 22 November 2017 a delegate of the CEO of the Australian Aged Care Quality Agency made a decision that?Milstern Health Care Pty Ltd failed to meet one or more expected outcomes in the Accreditation?Standards in relation to?The Ritz Nursing Home and that this failure has placed, or may place, the safety, health or wellbeing of a care recipient of the service at serious risk.The Department of Health has been notified of the risk.Most recent decision concerning performance against the Accreditation StandardsStandard 1: Management systems, staffing and organisational developmentPrinciple:Within the philosophy and level of care offered in the residential care service, management systems are responsive to the needs of care recipients, their representatives, staff and stakeholders, and the changing environment in which the service operates.1.1Continuous improvementNot met1.2Regulatory complianceMet1.3Education and staff developmentNot met1.4Comments and complaintsNot met1.5Planning and leadershipNot met1.6Human resource managementNot met1.7Inventory and equipmentMet1.8Information systemsNot met1.9External servicesNot metStandard 2: Health and personal carePrinciple:Care recipients’ physical and mental health will be promoted and achieved at the optimum level in partnership between each care recipient (or his or her representative) and the health care team.2.1Continuous improvementNot met2.2Regulatory complianceNot met2.3Education and staff developmentNot met2.4Clinical careNot met2.5Specialised nursing care needsNot met2.6Other health and related servicesMet2.7Medication managementNot met2.8Pain managementNot met2.9Palliative careNot met2.10Nutrition and hydrationNot met2.11Skin careNot met2.12Continence managementNot met2.13Behavioural managementNot met2.14Mobility, dexterity and rehabilitationNot met2.15Oral and dental careNot met2.16Sensory lossMet2.17SleepNot metStandard 3: Care recipient lifestylePrinciple:Care recipients retain their personal, civic, legal and consumer rights, and are assisted to achieve active control of their own lives within the residential care services and in the community.3.1Continuous improvementNot met3.2Regulatory complianceNot met3.3Education and staff developmentNot met3.4Emotional SupportNot met3.5IndependenceMet3.6Privacy and dignityNot met3.7Leisure interests and activitiesNot met3.8Cultural and spiritual lifeNot met3.9Choice and decision-makingNot met3.10Care recipient security of tenure and responsibilitiesMetStandard 4: Physical environment and safe systemsPrinciple:Care recipients live in a safe and comfortable environment that ensures the quality of life and welfare of care recipients, staff and visitors4.1Continuous improvementNot met4.2Regulatory complianceMet4.3Education and staff developmentNot met4.4Living environmentNot met4.5Occupational health and safetyNot met4.6Fire, security and other emergenciesNot met4.7Infection controlNot met4.8Catering, cleaning and laundry servicesNot metAudit ReportName of home: The Ritz Nursing HomeRACS ID: 2539Approved provider: Milstern Health Care Pty LtdIntroductionThis is the report of a Review Audit from 15 November 2017 to 20 November 2017 submitted to the Quality Agency.Accredited residential aged care homes receive Australian Government subsidies to provide quality care and services to care recipients in accordance with the Accreditation Standards.To remain accredited and continue to receive the subsidy, each home must demonstrate that it meets the Standards. There are four Standards covering management systems, health and personal care, care recipient lifestyle, and the physical environment and there are 44 expected outcomes such as human resource management, clinical care, medication management, privacy and dignity, leisure interests, cultural and spiritual life, choice and decision-making and the living environment.Each home applies for re-accreditation before its accreditation period expires and an assessment team visits the home to conduct an audit. The team assesses the quality of care and services at the home and reports its findings about whether the home meets or does not meet the Standards. The Quality Agency then decides whether the home has met the Standards and whether to re-accredit or not to re-accredit the home.During a home’s period of accreditation there may be a review audit where an assessment team visits the home to reassess the quality of care and services and reports its findings about whether the home meets or does not meet the Standards.Assessment team’s findings regarding performance against the Accreditation StandardsThe information obtained through the audit of the home indicates the home meets:7 expected outcomesThe information obtained through the audit of the home indicates the home does not meet the following expected outcomes:1.1Continuous improvement1.3Education and staff development1.4Comments and complaints1.5Planning and leadership1.6Human resource management1.8Information systems1.9External services2.1Continuous improvement2.2Regulatory compliance2.3Education and staff development2.4Clinical care2.5Specialised nursing care needs2.7Medication management2.8Pain management2.9Palliative care2.10Nutrition and hydration2.11Skin care2.12Continence management2.13Behavioural management2.14Mobility, dexterity and rehabilitation2.15Oral and dental care2.17Sleep3.1Continuous improvement3.2Regulatory compliance3.3Education and staff development3.4Emotional support 3.6Privacy and dignity3.7Leisure interests and activities3.8Cultural and spiritual life3.9Choice and decision-making4.1Continuous improvement4.3Education and staff development4.4Living environment4.5Occupational health and safety4.6Fire, security and other emergencies4.7Infection control4.8Catering, cleaning and laundry servicesScope of this documentAn assessment team appointed by the Quality Agency conducted the Review Audit from 15 November 2017 to 20 November 2017.The audit was conducted in accordance with the Quality Agency Principles 2013 and the Accountability Principles 2014. The assessment team consisted of two registered aged care quality assessors.The audit was against the Accreditation Standards as set out in the Quality of Care Principles 2014.Details of homeTotal number of allocated places: 148Number of care recipients during audit: 138Number of care recipients receiving high care during audit: 138Special needs catered for: N/AAudit trailThe assessment team spent three days on site and gathered information from the following:InterviewsPosition titleNumberAdministrator1Nurse advisor1Acting director of nursing1Systems manager 1Educator1Registered nurses and enrolled nurses4Lifestyle staff1Catering staff3Care recipients and/or representatives21Administration staff1Care staff10Transport nurse1Hairdresser1Cleaning contractor1Cleaning staff3Laundry staff1Maintenance staff2Sampled documentsDocument typeNumberCare recipients’ files16Medication charts14Personnel files3Other documents reviewedThe team also reviewed:Accident/incident reports and medication incident reportsCase conference scheduleClinical documentation including: assessments, RN (registered nurse) directives, blood glucose level (BGL) monitoring, wound documentation, weight records, clinical observations, dietician reviews, bowel charts, restraint authorisation Complaint folderContractor agreements, contractor orientationEducation: Staff training education survey 2018, education attendance records, assessments in manual handling techniques sheets, education report September/October 2017, education calendarEmails regarding arrangements for major repairs to liftsExternal maintenance reportsHazard formsHospitality services: Cleaning schedule, catering temperature monitoring forms, calibration records, catering cleaning schedule, menu, Human resource management: police check system, advertisement for registered nurseInformation systems: pre-entry enquiry form (blank), staff hand book, care recipient handbook, meeting minutes (inaugural clinical care meeting, registered nurses/enrolled nurse, care recipient action group)Lifestyle: cultural assessments, leisure and lifestyle ability assessments, leisure and recreation assessment, social and emotional needs assessments, spiritual assessments, care recipient religion list, ethnic origin listMandatory reporting registerQuality system: review audit action plan, continuous improvement logs, Audits (bed, fire safety, privacy and dignity, lifter) commercial auditing system folderSmoking risk assessmentsObservationsThe team observed the following:Activities in progressCharter of Care Recipient Right and Responsibilities displayedChemical storageCleaning operationsClinical suppliesEmergency flip charts available for staffEquipment and supply storage areas Fire equipment available throughout the homeFood preparation and storage areasHand washing facilitiesInteractions between staff and care recipientsInternal and external complaints mechanisms availableKeypad/fob access to various areas and gates Living environmentLunch and dinner meal servicesManual handling and mobility aids available throughout Menu on displayMission, vision and values on displaySmoking area in useQuality Agency review audit notice on displaySafety data sheets available Short observation in smoker’s areaSign in/sign out registersStorage of medicationsSuggestion box at front entranceAssessment informationThis section covers information about the home’s performance against each of the expected outcomes of the Accreditation Standards.Standard 1 – Management systems, staffing and organisational developmentPrinciple:Within the philosophy and level of care offered in the residential care services, management systems are responsive to the needs of care recipients, their representatives, staff and stakeholders, and the changing environment in which the service operates.1.1Continuous improvementThis expected outcome requires that “the organisation actively pursues continuous improvement”.Team’s findingsThe home does not meet this expected outcomeThe home does not adequately monitor systems and processes across all four Accreditation Standards. Whilst the home has processes to monitor the home’s activities, these systems have not been effective in identifying deficiencies which exist across all four Accreditation Standards. Improvement initiatives are not evaluated to ensure they are effective. Stakeholders do not have input into the continuous improvement system. 1.2Regulatory complianceThis expected outcome requires that “the organisation’s management has systems in place to identify and ensure compliance with all relevant legislation, regulatory requirements, professional standards and guidelines”.Team’s findingsThe home meets this expected outcomeThe home has systems to identify relevant legislation, regulatory requirements, and guidelines. The home receives updates and information pertaining to regulatory compliance from government departments and agencies. The home has a subscription to a legislation monitoring program. The systems manager is responsible for reviewing this information and making any changes to policies and procedures. Staff are informed of regulatory requirements and changes to legislation primarily via staff meetings, memoranda, shift handovers, and staff notice boards. Examples of regulatory compliance relevant to Accreditation standard one include:- A system for managing criminal record checks/statutory declarations for all staffInformation about staff and care recipients were observed to be securely stored1.3Education and staff developmentThis expected outcome requires that “management and staff have appropriate knowledge and skills to perform their roles effectively”.Team’s findingsThe home does not meet this expected outcome The home does not have an effective system to ensure staff have the appropriate knowledge and skills to perform their roles. Numerous issues were identified during review audit 18 to 24 September 2017 which indicated deficits in staff knowledge Review of documentation, interviews and observations shows these deficiencies continue.1.4Comments and complaintsThis expected outcome requires that "each care recipient (or his or her representative) and other interested parties have access to internal and external complaints mechanisms".Team’s findingsThe home does not meet this expected outcomeWhilst the home has a system in place for care recipients and their representatives to have access to internal and external complaint mechanisms to raise complaints, review audit report 18 to 24 September 2017 identified the home’s system is not effective in resolving complaints.1.5Planning and leadershipThis expected outcome requires that "the organisation has documented the residential care service’s vision, values, philosophy, objectives and commitment to quality throughout the service".Team’s findingsThe home does not meet this expected outcomeWhilst the organisation has documented the residential care service’s vision, values, philosophy, objectives and commitment to quality in the service, the organisation has not demonstrated a commitment to that quality. A review audit undertaken 18 to 24 September 2017 identified significant deficiencies across all four accreditation standards. Minimal actions have been undertaken to address deficiencies and ensure the delivery of quality care and services. Further deficiencies in care and services were identified during this review audit.1.6Human resource managementThis expected outcome requires that "there are appropriately skilled and qualified staff sufficient to ensure that services are delivered in accordance with these standards and the residential care service’s philosophy and objectives".Team’s findingsThe home does not meet this expected outcomeThe organisation does not have a system to ensure staff have appropriate knowledge and skills to perform their roles. Numerous issues were identified during a review audit 16 to 24 September 2017 which indicate deficits in staff knowledge and the monitoring of staff skills. Review of documentation, interviews and observations shows these deficiencies continue.1.7Inventory and equipmentThis expected outcome requires that "stocks of appropriate goods and equipment for quality service delivery are available".Team’s findingsThe home meets this expected outcome There are systems to ensure that appropriate stocks of goods and equipment are available. clinical supplies, catering supplies and other stores were observed to be well stocked and appropriately stored. Regular orders for medical supplies and groceries are in place with suppliers. Reactive maintenance requirements can be, and are, raised by staff verbally to maintenance staff or via a maintenance book. Maintenance staff stated all requests are prioritised and addressed as soon as possible. Maintenance staff said requests are completed in a timely manner. Staff indicated they have adequate levels of stock to perform their roles.1.8Information systemsThis expected outcome requires that "effective information management systems are in place".Team’s findingsThe home does not meet this expected outcomeThe home does not have effective information systems. Clinical documentation does not provide adequate information to support staff in their work. The clinical information and documentation system is fragmented, inconsistent and not sufficiently monitored. Information about care recipient’s dietary needs and preferences is not effectively maintained and is not easily accessible. Accidents/incidents including medication incidents are not consistently documented or monitored. Lifestyle and cultural and spiritual assessments and documentation is incomplete.1.9External servicesThis expected outcome requires that "all externally sourced services are provided in a way that meets the residential care service’s needs and service quality goals".Team’s findingsThe home does not meet this expected outcomeThe home does not ensure that all externally sourced services are provided in a way that meets the residential care service’s needs and service quality goals. Management has not ensured that contracted cleaning services have been clearly specified and that the contractor has the skills and experience to delivery appropriate services. Arrangements were not made to plan the orderly introduction of the new cleaning contractor. Observations and interviews demonstrate cleaning services are not delivered to an acceptable standard.Standard 2 – Health and personal carePrinciple:Care recipients’ physical and mental health will be promoted and achieved at the optimum level in partnership between each care recipient (or his or her representative) and the health care team.2.1Continuous improvementThis expected outcome requires that “the organisation actively pursues continuous improvement”.Team’s findingsThe home does not meet this expected outcomeThe home does not have an effective continuous improvement system in place to monitor performance and identify issues relevant to the health and personal care for care recipients. Whilst the home participates in a commercial benchmarking audit program, these audits do not comprehensively cover clinical care. As a result management has not identified deficiencies in performance against the Accreditation Standards in a timely manner. Deficiencies identified in review audit report 18 to 24 September 2017 have not been addressed.2.2Regulatory complianceThis expected outcome requires that “the organisation’s management has systems in place to identify and ensure compliance with all relevant legislation, regulatory requirements, professional standards and guidelines, about health and personal care”.Team’s findingsThe home does not meet this expected outcomeThe home does not have an effective system to ensure compliance with all aspects of Accreditation Standard two, health and personal care. Review audit report 18-24 September 2017 identified that management of the home did not demonstrate a clear understanding of their obligations regarding missing care recipients. Whilst improvements have been made in relations to staff knowledge and skills the home’s system has not demonstrated it is sustainable.2.3Education and staff developmentThis expected outcome requires that “management and staff have appropriate knowledge and skills to perform their roles effectively”.Team’s findingsThe home does not meet this expected outcomeThe home does not have an effective system to ensure staff have the appropriate knowledge and skills with regard to Standard Two Health and personal care. Review audit report 18 to 24 September 2017 identified deficits exist in staff knowledge and skills demonstrating that the education system is not effective. Whilst some improvements have been made deficiencies continue and new deficiencies were identified during this review audit. 2.4Clinical careThis expected outcome requires that “care recipients receive appropriate clinical care”.Team’s findingsThe home does not meet this expected outcomeManagement are not able to demonstrate care recipients receive appropriate clinical care. Clinical assessments are not always completed or updated as needed. Care plans do not always include sufficient information and are not always updated to reflect the changing care needs and preferences of care recipients. Care recipient accidents/incidents do not result in review of care and strategies to prevent or minimise future occurrences. Staff do not always respond to care recipients’ care needs.2.5Specialised nursing care needsThis expected outcome requires that “care recipients’ specialised nursing care needs are identified and met by appropriately qualified nursing staff”.Team’s findingsThe home does not meet this expected outcomeManagement does not demonstrate that care recipients’ specialised nursing care needs are identified and met by appropriately qualified nursing staff. The home does not undertake assessments of care recipients specialised nursing care needs and does not develop plans of care to ensure specialised nursing care needs are met. Staff are not aware of care recipients’ specialised nursing care needs.2.6Other health and related servicesThis expected outcome requires that “care recipients are referred to appropriate health specialists in accordance with the care recipient’s needs and preferences”.Team’s findingsThe home meets this expected outcome Documentation shows the home refers care recipients to external health professionals. Several allied health professionals visit the home on a regular basis including pathology services, a podiatrist and the physiotherapist. Care recipients and representatives are generally satisfied with the way referrals are made and the way changes to care are implemented.2.7Medication managementThis expected outcome requires that “care recipients’ medication is managed safely and correctly”.Team’s findingsThe home does not meet this expected outcomeThe review audit of 18-24 September 2017 identified management are not able to ensure medications are managed safely and correctly. Medication incidents are not routinely recorded and audits do not sufficiently identify gaps in medication management. Medication charts are regularly not signed as the medication given. Improvements have not been made to ensure safe medication management. Staff operate outside their scope of practice.2.8Pain managementThis expected outcome requires that “all care recipients are as free as possible from pain”.Team’s findingsThe home does not meet this expected outcomeThe home is not able to demonstrate all care recipients are as free from pain as possible. There are limited interventions to manage pain. Pain monitoring is limited. Feedback indicates some care recipients experience pain.2.9Palliative careThis expected outcome requires that “the comfort and dignity of terminally ill care recipients is maintained”.Team’s findingsThe home does not meet this expected outcomeThe review audit of 18-24 September 2017 identifies management does not ensure the comfort and dignity of terminally ill care recipients is maintained. Whilst the home consults with, and uses the services of palliative care services, the home does not holistically respond to the care needs of terminally ill care recipients. Plans for care have not been reviewed and updated in response to changing care needs of terminally ill care recipients.2.10Nutrition and hydrationThis expected outcome requires that “care recipients receive adequate nourishment and hydration”.Team’s findingsThe home does not meet this expected outcomeThe review audit of 18-24 September 2017 found “the home is unable to demonstrate care recipients receive adequate nourishment and hydration. The home does not consistently monitor care recipient weight and does not take action in response to weight loss or gain. Care recipients are not referred to allied health professionals when their condition indicates it would be appropriate. Staff do not have appropriate knowledge and skills about specialised diets and do not have system to ensure care recipients consistently receive the appropriate meals. Care recipients are not satisfied with the variety, presentation and taste of meals”. Document review, observations and interviews demonstrate gaps in nutrition and hydration systems continue. 2.11Skin careThis expected outcome requires that “care recipients’ skin integrity is consistent with their general health”.Team’s findingsThe home does not meet this expected outcomeThe home does not have systems and processes to ensure care recipients’ skin integrity is consistent with their general health. Treatment plans are not developed and followed to guide staff in the treatment of wounds. The home does not have records of the wounds in the home and no specific registered nurse is responsible for wound management plans. 2.12Continence managementThis expected outcome requires that “care recipients’ continence is managed effectively”.Team’s findingsThe home does not meet this expected outcomeThe review audit of 18-24 September 2017 identified care recipients’ continence is not managed effectively. Policies and procedures do not direct staff in continence management. We observed bowel management is not documented according to the home’s documentation system. Staff availability impacts on care recipients being toileted when they request to be. Care recipients provided feedback about dissatisfaction with continence management”. These deficiencies continue. 2.13Behavioural managementThis expected outcome requires that “the needs of care recipients with challenging behaviours are managed effectively”.Team’s findingsThe home does not meet this expected outcomeThe home does not effectively manage the needs of care recipients with challenging behaviours. Trends in behaviour incidents are not responded to, reducing incidence. Staff do not have the knowledge and skills to effectively respond to the needs of care recipients with aggressive behaviours. Individualized behavioural care plans to meet the needs of care recipients with complex behaviours are not developed. Investigation of incidents of aggression and sexual disinhibition are minimal do not result in changes to care. Care recipients said they are not safe and are subjected to assaults by other care recipients.2.14Mobility, dexterity and rehabilitationThis expected outcome requires that “optimum levels of mobility and dexterity are achieved for all care recipients”.Team’s findingsThe home does not meet this expected outcomeThe review audit of 18-24 September 2017 identified “home does not ensure that optimum levels of mobility and dexterity are achieved for all care recipients. Comprehensive assessments of care recipients’ falls risk and mobility assessments are not completed. The home does not provide mobility programs to ensure care recipients’ ability to achieve maximum mobility and dexterity is maintained. Environmental hazards are not addressed. Care recipients are not always reviewed by the physiotherapist following falls, as required by the home’s procedures. Actions to prevent falls are not considered”. Document review, observations and interviews demonstrate gaps in mobility and dexterity systems continue. 2.15Oral and dental careThis expected outcome requires that “care recipients’ oral and dental health is maintained”.Team’s findingsThe home does not meet this expected outcomeThere are gaps in the home has systems for maintaining care recipients’ oral and dental health. Oral and dental health is not maintained. There is minimal information about care recipient oral and dental care. There are long waits for dental services when indicated through assessments or care recipient reports of dental issues.2.16Sensory lossThis expected outcome requires that “care recipients’ sensory losses are identified and managed effectively”.Team’s findingsThe home meets this expected outcome Care recipients’ sensory losses are identified and managed by staff at the home. Hearing and vision loss is identified and referrals to appropriate specialists are made where required. Staff demonstrate an understanding of individual care recipients’ sensory needs. Care recipients report general satisfaction with the assistance provided by staff in relation to care recipients’ sensory losses.2.17SleepThis expected outcome requires that “care recipients are able to achieve natural sleep patterns”.Team’s findingsThe home does not meet this expected outcome The living environment does not support care recipients achieving natural sleep patterns. Shared bedrooms and bathrooms and noisy, wandering care recipients impact on care recipient’s ability to achieve natural sleep. Standard 3 – Care recipient lifestylePrinciple:Care recipients retain their personal, civic, legal and consumer rights, and are assisted to achieve control of their own lives within the residential care service and in the community.3.1Continuous improvementThis expected outcome requires that “the organisation actively pursues continuous improvement”.Team’s findingsThe home does not meet this expected outcomeThe home does not have an effective continuous improvement system in place to monitor performance and identify issues relevant to care recipient lifestyle. Management systems have not identified deficiencies in review audit report 18 to 24 September 2017 or those identified during this audit.3.2Regulatory complianceThis expected outcome requires that “the organisation’s management has systems in place to identify and ensure compliance with all relevant legislation, regulatory requirements, professional standards and guidelines, about care recipient lifestyle”.Team’s findingsThe home does not meet this expected outcomeThe home does not have an effective system to ensure compliance with all aspects of Accreditation Standard Three, Care recipient lifestyle. Review audit report 18-24 September 2017 identified management of the home did not demonstrate a clear understanding of their obligations regarding reportable assaults. Whilst improvements have been made in relations to staff knowledge and skills the home’s system has not demonstrated it is sustainable.3.3Education and staff developmentThis expected outcome requires that “management and staff have appropriate knowledge and skills to perform their roles effectively”.Team’s findingsThe home does not meet this expected outcomeThe home does not have an effective system to ensure staff have the appropriate knowledge and skills with regard to Standard Three Care recipient lifestyle. Review audit report 18 to 24 September 2017 identified deficits exist in staff knowledge and skills demonstrating that the education system is not effective. Whilst some improvements have been made deficiencies continue. 3.4Emotional support This expected outcome requires that "each care recipient receives support in adjusting to life in the new environment and on an ongoing basis".Team’s findingsThe home does not meet this expected outcomeReview audit report 18 to 24 September 2017 identified management does not ensure each care recipient receives support in adjusting to life in the new environment and on an ongoing basis. Care recipients’ emotional status is not assessed ongoing and interventions are not put in place to ensure their emotional needs are meet. Staff do not demonstrate an awareness of care recipients’ emotional needs. Whilst some improvements have been made they have not been effective in ensuring care recipients’ emotional needs are met.3.5IndependenceThis expected outcome requires that "care recipients are assisted to achieve maximum independence, maintain friendships and participate in the life of the community within and outside the residential care service".Team’s findingsThe home meets this expected outcomeThe home has systems to assist care recipients achieve maximum independence, and enables some care recipients access the community. Care recipients are free to access the large grounds of the home and move freely through the home and grounds. 3.6Privacy and dignityThis expected outcome requires that "each care recipient’s right to privacy, dignity and confidentiality is recognised and respected".Team’s findingsThe home does not meet this expected outcomeReview audit report 18-24 September 2017 identified management does not ensure that each care recipient’s right to privacy, dignity and confidentiality is recognised and respected. Feedback from care recipients, review of documents and observation showed the delivery of care and services at times does not respect care recipients and compromises their dignity. Whilst some improvements have been made further improvements are needed. 3.7Leisure interests and activitiesThis expected outcome requires that "care recipients are encouraged and supported to participate in a wide range of interests and activities of interest to them".Team’s findingsThe home does not meet this expected outcomeReview audit report 18 to 24 September 2017 identified the home does not ensure care recipients are encouraged and supported to participate in a wide range of interests and activities of interest to them. Interviews, observations and review of documentation demonstrated these deficiencies continue. Whilst some care recipients are able to access the community, this has decreased since the last review audit as care recipients are no longer able to volunteer with a local charity shop. The home has limited resources and ability to provide stimulation and activities for care recipients within the grounds of the home. Observations, interviews and documentation demonstrate there is very limited participation in individual and group activities for care recipients. Care recipients continue to express dissatisfaction with the activities provided by the home and indicated they are bored.3.8Cultural and spiritual lifeThis expected outcome requires that "individual interests, customs, beliefs and cultural and ethnic backgrounds are valued and fostered".Team’s findingsThe home does not meet this expected outcomeThe home does not demonstrate that the individual interests, customs, beliefs and cultural and ethnic backgrounds are valued and fostered. The home does not collect information to enable care recipients’ interests, customs, beliefs and cultural practices to be fostered and supported. The home does not have any resources to support the interests of care recipients from culturally and linguistically diverse backgrounds. There are no practices in the home to foster and value care recipients’ cultural and ethnic backgrounds.3.9Choice and decision-makingThis expected outcome requires that "each care recipient (or his or her representative) participates in decisions about the services the care recipient receives, and is enabled to exercise choice and control over his or her lifestyle while not infringing on the rights of other people".Team’s findingsThe home does not meet this expected outcome Review audit report 18 to 24 September 2017 identified the home does not have systems to ensure each care recipient is supported to make decisions about their daily life. While management of the home explained they have an open door policy, care recipients were noted to have limited input into their care and in general regarding what happens in the home. The menu was noted to be limited with regard to meal choices. Many care recipients said they would like to exercise choice not to live at the home. While some improvements have been made care recipients continue to exercise limited choice.3.10Care recipient security of tenure and responsibilitiesThis expected outcome requires that “care recipients have secure tenure within the residential care service, and understand their rights and responsibilities”.Team’s findingsThe home meets this expected outcome The home is able to demonstrate care recipients have secure tenure within the home and understand their rights and responsibilities. Relevant information about security of tenure and care recipients’ rights and responsibilities is provided and discussed with prospective care recipients and their representatives when entering the home. The care recipient care agreement contains information for care recipients and their representatives about security of tenure, care recipients’ rights and responsibilities and rules of occupancy. The Charter of Care Recipients’ Rights and Responsibilities is displayed in the home and in key documents. Care recipients confirm awareness of their rights and responsibilities in regard to security of tenure.Standard 4 – Physical environment and safe systemsPrinciple:Care recipients live in a safe and comfortable environment that ensures the quality of life and welfare of care recipients, staff and visitors.4.1Continuous improvementThis expected outcome requires that “the organisation actively pursues continuous improvement”.Team’s findingsThe home does not meet this expected outcomeThe home does not have an effective continuous improvement system in place to monitor performance and identify issues relevant to the physical environment and safe systems. Whilst the home participates in a commercial benchmarking audit program, these audits do not comprehensively cover the physical environment and safety. As a result management was not alerted to deficiencies in performance against the Accreditation Standards in a timely manner. 4.2Regulatory complianceThis expected outcome requires that “the organisation’s management has systems in place to identify and ensure compliance with all relevant legislation, regulatory requirements, professional standards and guidelines, about physical environment and safe systems”.Team’s findingsThe home meets this expected outcomeThe home has systems to identify and ensure compliance with relevant legislation, regulatory requirements and professional standards and guidelines. For further information relating to the home’s regulatory compliance system, please see expected outcome 1.2 Regulatory compliance. Examples of regulatory compliance relevant to Accreditation Standard Four include:All chemicals purchased by the home have current safety data sheets.The home has a current Annual Fire Safety Statement displayed.4.3Education and staff developmentThis expected outcome requires that “management and staff have appropriate knowledge and skills to perform their roles effectively”.Team’s findingsThe home does not meet this expected outcomeThe home does not have an effective system to ensure staff have the appropriate knowledge and skills with regard to Standard Four Living environment and safe systems. Review audit report 18 to 24 September 2017 identified deficits exist in staff knowledge and skills demonstrating that the education system is not effective. Whilst limited improvements have been made deficiencies continue. 4.4Living environmentThis expected outcome requires that "management of the residential care service is actively working to provide a safe and comfortable environment consistent with care recipients’ care needs".Team’s findingsThe home does not meet this expected outcomeReview audit report 18 to 24 September 2017 identified the home does not have effective systems to provide care recipients with a safe and comfortable environment consistent with their care needs. Both the interior and exterior of the home have not been well maintained. The home does not provide a safe and secure environment for care recipients. Our observations, interviews and review of documentation show that improvements have not been made to the living environment and some aspects of the living environment have deteriorated further.4.5Occupational health and safetyThis expected outcome requires that "management is actively working to provide a safe working environment that meets regulatory requirements".Team’s findingsThe home does not meet this expected outcomeReview audit report 18-24 September 2017 identified the home does not demonstrate that it is actively working to provide a safe working environment that meets regulatory requirements. Observations, interviews and documentation demonstrates this continues to be the case. The home does not have a system of risk assessments and does not record hazards or take action when accidents and incidents occur to prevent future occurrences. The home does not effectively monitor the working environment. Staff and care recipients report they do not feel safe in the home.4.6Fire, security and other emergenciesThis expected outcome requires that "management and staff are actively working to provide an environment and safe systems of work that minimise fire, security and emergency risks".Team’s findingsThe home does not meet this expected outcomeReview audit report identified the home is not actively working to provide a safe environment for care recipients. The Ritz nursing home has a challenging population of the care recipients, many of which present with aggressive behaviours; these behaviours are not being managed effectively which is resulting in other care recipients feeling not safe. These identified issues have not been addressed. Lack of disposal of unused item and poor environmental management practices present a fire hazard.4.7Infection controlThis expected outcome requires that there is "an effective infection control program".Team’s findingsThe home does not meet this expected outcomeDocumentation, staff interviews and observation shows the home does not have an effective infection control program. Cleaning contractors do not have knowledge of infection control practices. Observations of cleaning practice and interviews with cleaners demonstrate that they do not have knowledge of, or implement, appropriate practices to maintain infection control.4.8Catering, cleaning and laundry servicesThis expected outcome requires that "hospitality services are provided in a way that enhances care recipients’ quality of life and the staff’s working environment".Team’s findingsThe home does not meet this expected outcomeReview audit report 18-24 September 2017 identified the home has effective laundry processes, catering and cleaning in the home are substandard. Observations, interviews and review of documentation demonstrates identified deficiencies have not been addressed. Catering service in the home remains limited in choice and is not satisfactory to care recipients. The home was observed to be poorly maintained and dirty with many malodours throughout the home. ................
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