Audits, assessments, reviews: the different ways the Quality Commission assesses nursing homes

The aged care sector has been under unprecedented scrutiny over the last few years in the wake of the Oakden scandal and under the sharp focus of the royal commission.

Across the nation, stories of inadequate care, abuse and scandal are fuelling concern about the way we care for some of the most vulnerable members of our society.

In a rapidly ageing population, addressing these concerns is particularly pressing.

The Aged Care Quality and Safety Commission is the government body that regulates the quality of aged care services in Australia, monitoring operators, measuring performance against the standards, addressing concerns, and helping providers get back to compliance.

Representatives from the Quality Commission go into aged care facilities, and monitor performance in a number of different ways and in response to a range of circumstances. It conducts reviews, audits and assessments.

In this article, we take a look at the different types of reviews it can do.

In the three months to 31 March 2019, the Quality Commission completed 249 site audits, 1,096 assessment contacts, and 30 review audits. What happens in each of these types of reviews?

What is a site audit?

Site audits are conducted as part of the re-accreditation process.

Providers are not given any notification ahead of a site audit to ensure the ‘Assessment Team’ captures an accurate snapshot of the day-to-day operations.

During a site audit, the Commission will compare the provider’s everyday performance against the Quality Standards which came into effect on 1 July 2019.

When the Assessment Team arrives at the facility, they must ask for consent to enter the premises. The Assessment Team has search powers it can use for regulatory purposes.

During a site audit, the Assessment Team will interview a range of people, including residents, their families, staff, management, allied health professionals, volunteers, suppliers and contractors.

The Assessment Team will observe how the staff interact with residents, their practices, and the physical environment. The Assessment Team will also review documents to ensure that what the provider says it does, is what actually takes place in practice.

The Team also conducts consumer experience interviews with at least 10 per cent of residents to capture the consumers’ experience of the facility. A consumer experience report is compiled to accompany the audit report.

On the last day of the site audit, the Assessment Team will meet with the facility manager to discuss any issues that arise during the visit.

Within seven days of the site audit, the Assessment Team will provide a report to the Commissioner. After the report is reviewed by a delegate of the Commissioner, it is passed to the provider as soon as possible. The provider has 14 days to respond.

The Commissioner will make a decision about compliance with the standards and whether to re-accredit the aged care facility within 28 days of receiving the site audit report. The period of accreditation is also part of this decision.

What is an assessment contact?

Assessment contacts are the tool the Commission uses to assess risk and monitor quality among aged care providers. 

Providers can either be given notice ahead of an assessment contact, or the Commission’s team may arrive unannounced.

Assessment contacts will assess a service’s performance against the new quality standards. However, performance may be assessed against the old standards if the provider is on a ‘timetable for improvement’ (TFI) under transition arrangements.

Assessment contacts may be conducted for one or more of the following reasons:

• to assess the provider against the Quality Standards,
• to help the provider along a process of continuous improvement,
• to find out if a more detailed review is needed, or
• to give the provider information or additional education.

At an unannounced assessment contact, the Assessment Team will ask the manager of the service seven questions to identify key areas of risk. These include:

1. Have there been any adverse findings by another regulatory agency or oversight body in the last 12 months?
2. What trends do your complaints data show you?
3. How many consumers are receiving pressure area care?
4. Have there been any medication incidents in the past 6 months where a consumer required hospitalisation or attention by a medical officer?
5. How many consumers have had falls and required medical attention in the past 3 months?
6. How many consumers at the service are currently receiving psychotropic medications? 

How many consumers are restrained in order to manage risks to themselves or others at the service? 

1. Can you tell me about incidents in the past 6 months where a consumer or staff member has required medical attention as a result of challenging behaviour from a consumer?

The provider will be notified of the outcomes of an assessment contact within 21 days.

What is a review audit?

Review audits are usually undertaken when the Commission has concerns about an aged care service.

A review audit may be conducted for the following reasons:

• the Commissioner believes the approved provider is not meeting the Quality Standards,
• the Commissioner believes the approved provider has not complied with assessment contact arrangements,
• the provider has asked for a review of a regulatory decision, or
• the Department of Health has asked the Commission to review a facility. 

Review audits are conducted by at least two assessors, and may be announced or unannounced.

The Assessment Team will provide a review audit report to the Commissioner within 14 days of the audit, after which it will be given to the provider as soon as possible for a response.

Following a review audit where non-compliance is identified, the Commissioner may decide to place a service on a timetable for improvement, vary the facility’s period of accreditation or revoke accreditation from a prescribed date.