Sanction Management 50+ Bed Aged Care Facility in Metro Adelaide
In March 2019, Virginia Matthews and Vitish Guddoy, Principal Consultants at Quality Compliance and Innovation Pty Ltd (QCI Consulting) were appointed as Nurse advisor and Administrator to a 50+ bed aged care facility in metropolitan Adelaide. The home had been sanctioned with 9 “Not Met Expected Outcomes” (Not Mets) under the Accreditation Standards with immediate and severe risks having been identified by the Department of Health.
Ms. Matthews first task at the home was to conduct consumer care and wellbeing risk profiling in the clinical and lifestyle areas. This allowed identification of individual consumer risks and the way the home had been managing these risks. The risk profiling was vital as this allowed us to address all issues identified by the ACQSC and additional issues that were not identified by the ACQSC. Based on the issues identified a comprehensive training plan was put in place for all the staff.
Post-consumer care and wellbeing risk profiling a plan for continuous improvement was revised to include all deficit areas. The consumer care and wellbeing risk profiling was instrumental in addressing all clinical deficits both for individual consumers and for the home in general. Ms Matthews took a holistic approach to assist the home to achieve compliance and went well above only addressing the areas identified by the ACQSC as deficits, including comprehensive assessment of all consumers receiving psychotropic medications, leading to a significant decrease in use of this type of medication. Ms Matthews also addressed polypharmacy practices at the home and implemented actions to reduce this practice.
Mr Guddoy’s first task at the home was to undertake a consumer survey using the Aged Care Quality and Safety Commission (ACQSC) consumer experience survey. This allowed for an understanding of where the areas of concern were from a consumer and representatives perspective.
Apart from the not met expected outcomes identified by the ACQSC, the consumer survey identified there was a significant issue with consumers and relatives not trusting the home or corporate organisation to address their concerns. Ms Matthews and Mr Guddoy spent a significant amount of time with consumers and representatives and involved them in helping to address the not met areas. Decisions to implement new processes were discussed with and results and outcomes communicated to consumers and their representatives ensuring transparency and building trust.
The QCI team took a holistic approach to quality and implemented a culture of innovation that leads to compliance for the consumers and service provider. One of the most significant areas of concern at the home was malnutrition. Significant weight loss was identified among several consumers in the home. Consumers had been losing weight despite being on supplements as per their care plan.
Ms Matthews’s consumer care and wellbeing risk profiling had identified the significant weight losses and Mr Guddoy further investigated the reason for the weight loss and identified that consumers were not always receiving their supplements, many did not like the supplements, and there were no other means for increasing nutrition being implemented other than supplements.
Mr Guddoy implemented a “food first approach” to address the issue of malnutrition in the home. This included a “food first approach” campaign across the home focusing on a culture of collaboration between clinical staff, catering staff, dietitian and speech pathologist.
Offering consumers nutritionally fortified snacks, main meals and taking into consideration individual likes, dislikes and preferences resulted in an overall improvement in consumer weights. One consumer who was on a texture modified diet had a significant weight loss of 9kgs over three months and was continuing to lose weight. Mr Guddoy spent time with the consumer and his representative and found out the consumer’s preferences. The implementation of the “food first approach” resulted in significant weight gain for the consumer within a short period. The consumer after a few days on real food fortification was able to sit out of bed and attend the dining room for meals, something he had not had the strength to do for some time, he also recommenced attended some activities.
This consumer, unfortunately, had a medical incident that he was not to recover from, he was placed on palliative care, including nil by mouth. Mr Guddoy in consultation with the consumer and his wife implemented food foaming to allow the consumer to enjoy the sensation of taste without swallowing. The consumer being able to have fruit juices foamed, as per his preferences and likes, giving him and his family much pleasure in the last few days of his life.
The home’s dietitian was very impressed with the work that Mr Guddoy had undertaken to address the issue of malnutrition and weight management through the implementation of the “food first approach” and weight tracker tool. The dietitian commented on Mr Guddoy’s work as follows:
“The home has recently implemented a new weight tracking spreadsheet. This enables weekly-monthly weight tracking (comparing with previous weights and highlighting changes) for consumers at risk of malnutrition. This new tool is allowing staff to identify changes and take proactive steps to prevent malnutrition including offering additional snacks, high protein foods, and close monitoring and encouragement of consumers. These are important changes which show dedication to improving the health of the consumers at the home, and useful tools in completing dietetic assessments for consumers that need further personalized nutrition interventions. Really appreciate all the work you and the staff at the home are doing for consumer nutrition.”
Ms Matthews and Mr Guddoy undertook a comprehensive staffing review and analysis against industry standards, changes were made to staffing models to ensure that care and services are in line with industry best practice and at the same time the changes are stainable for the organisation. One of the changes to the staffing structure was the introduction of the engagement shift. The engagement shift person was assigned to work with consumers who required additional support to prevent social isolation and boredom that had previously led to behaviours of concern. The engagement shift had a significant impact on reducing behaviour and falls incidents at the home.
The QCI Consulting team received positive feedback from the consumers, management, and staff at the home.
Staff and management commented “Thank you very much for your help and guidance during your time at the home”
In June 2019 Mr Guddoy undertook a follow-up consumer experience survey with consumers and representatives that demonstrated a significant improvement in all areas. Some of the comments from consumers and representatives were: – “Things are getting better”, and “Things have improved in the last few months”.
Ms Matthews and Mr Guddoy worked with consumers, their representatives, staff, and management at the home, and as a collective team, they managed to achieve compliance with the Accreditation Standards in May 2019, four months before the initial sanctions date. This resulted in the early lifting of the sanctions.
If you are an approved provider looking to appoint a nurse advisor or administrator you need look no further than QCI consulting. We can assist your service to understand your consumers’ needs by undertaking consumer experience surveys, undertake the consumer care and wellbeing risk profiling, and using the information gathered through these processes and information from ACQSC reports to implement real, and sustainable changes that not only will your assist services to achieve compliance but to maintain it as well.
For QCI consulting, it is all about building confidence in the aged care industry (https://qciconsulting.com.au)
By Virginia .M and Vitish .G