The Local Paper has compiled a special report about failure after failure at St John’s Retirement Village Nursing Home at Wangaratta … the centre that Bishop John Parkes wants to merge with Alexandra’s Kellock Lodge. The findings of the Australian Aged Care Quality Agency are scathing.

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Anglican Bishop John Parkes wants to merge Alexandra’s Kellock Lodge aged residential care centre with his organisation’s St John’s Village at Wangaratta.
Mergers and acquisitions, and business takeovers, are almost always accompanied by ‘due diligence’ studies.

“Due diligence” is defined as “a comprehensive appraisal of a business undertaken by a prospective buyer, especially to establish its assets and liabilities and evaluate its commercial potential”.
In July last year year a proposed merger between St John’s Village with Anglican Aged Care Service’s Benetas failed after both parties “mutually agreed” not to proceed after agreement could not be reached on “commercial terms”, the Wangaratta Chronicle reported.

In December 2016 Bishop John Parkes had told residents the merger was necessary “to ensure the long-term viability of our services”, the Wangaratta newspaper reported.

The Australian Aged Care Quality Agency conducts regular appraisals of centres around the nation.

In an accreditation review conducted late last year, AACQA found that St John’s Retirement Village Nursing Home failed to meet 13 of the 44 expected outcomes of the Accreditation Standards.
St John’s is operated by the “approved provider”, Trustees of the Anglican Diocese of Wangaratta.

ACQA says a number of areas of performance at St John’s were “not met”:

Management systems, staffing
and organisational development
• Continuous improvement,
• Regulatory compliance,
• Comments and complaints,
• Human resource management,

Health and personal care
• Continuous improvement,
• Regulatory compliance,
• Clinical care,

Care recipient lifestyle
n Regulatory compliance,

Physical environment
and safe systems
• Continuous improvement,

Health and personal care
• Regulatory compliance,
• Education and staff development,
• Infection control,
• Catering, cleaning and laundry services.

The damning 30-page report says that managers under the supervision of Trustees of the Anglican Diocese of Wangaratta (headed by Bishop Parkes) were not clear they had responsibility for quality systems.
The AACQA report said staff generally did not know how to use a new electronic risk management program.

“Management did not identify the issues with documenting improvement suggestions and were not actively engaged with the continuous improvement system.”
AACQA was scathing about the St John’s leadership:
“The organisation’s management does not have an effective system to identify and promote compliance with all relevant legislation, regulatory requirements, professional standards and guidelines.
“Regulatory compliance across the Accreditation Standards was not effectively monitored.

“Management and staff did not ensure the home was actively pursuing continuous improvement across the Accreditation Standards. “Management were not aware staff were working outside their scope of practice in relation to verification of death, management of syringe drivers and controlled medication.
“Management did not ensure staff reported allegations of elder abuse in a timely manner.
“Management did not ensure the respiratory outbreak case list was complete and reflected all deaths and hospitalisations.

“Management did not ensure all deaths and hospitalisations related to the influenza and respiratory outbreak of August 2017 and September 2017 were consistently notified to the Department of Health and Human Services in a timely manner within 24 hours.
“Management did not have systems to ensure management and staff followed all relevant guidelines in identifying, actioning and monitoring the influenza and respiratory outbreak in a timely manner from the onset of symptoms,” the Agency said of St John’s.
“Management and staff cannot demonstrate they had the appropriate knowledge and skills to identify, contain and manage the influenza and respiratory outbreak of August 2017 and September 2017.
“These skill and knowledge deficits impacted negatively on care recipients.

“Management and staff were not consistently prepared or equipped with the appropriate knowledge and skills in relation to use of the home’s electronic risk management system. “Management and staff knowledge and skills were inconsistent in relation to reporting or actioning incidents and infections and communicating about the health status of care recipients.
“While the home has an onsite registered training organisation that provides staff education, the program does not always identify and respond to staff training needs.
“Staff said management did not provide timely information and education to support the containment and management of the respiratory outbreak.

“During the review audit, stakeholders raised concerns about staffing levels, skin care, pain management, continence and clinical care during the influenza and respiratory outbreak in August 2017 and September 2017.
“In addition, they raised concerns about infection control, cleaning and the level of communication during that time.
“A representative of a deceased care recipient who contracted respiratory illness said they did not receive a call to inform them of the outbreak.
“They received a letter about the outbreak after their relative had died.

“The organisation did not maintain a sufficient number of appropriately skilled and qualified staff during the influenza and respiratory outbreak of August 2017 and September 2017.
“A total of 58 staff across the organisation were affected during the outbreak and were absent from work at various periods.
“There was no staffing contingency plan for the outbreak to ensure types and numbers of staff were maintained
“Replacement staff were not always able to be sourced from permanent staff, the staff pool or a nursing agency. No additional staff worked during the outbreak,” the Agency found.
The Australain Aged Care Quality Agency continued with its detailed criticisms of the deficient standards at St John’s Retirement Village Nursing Home under the providers, the Trusteesof the Anglican Diocese of Wangaratta:

“There was not always a registered nurse on duty and the on call nurse did not always come in when requested after hours.
“The infection control coordinator was on planned leave during the outbreak and the role was not replaced.
“The leisure and lifestyle coordinator supervised environmental services staff during the outbreak when their supervisor was on approved leave.

“Management did not effectively monitor and action staffing levels and skill mix during the outbreak and did not monitor staff knowledge, skills and staff practice.
“Management did not effectively identify the services and actions to be provided by staff during the outbreak and communicate them to staff in a timely manner.
“Management said they were not satisfied with staffing levels during the outbreak.

“Staff were not satisfied staffing numbers, types and skills during the outbreak were sufficient and said they did not have adequate time to attend to care recipients’ clinical care needs.
“Staff said they were not adequately supported by management during the outbreak and they are dissatisfied with the level of current support.
“Replacement staff were not always able to be sourced from permanent staff, the staff pool or a nursing agency.

“No additional staff worked during the outbreak and staff worked short on many shifts resulting in care recipients not consistently receiving appropriate clinical and personal care.
“Over half of care recipients and representatives interviewed were not satisfied the home was adequately staffed during the respiratory outbreak.
“Not all care recipients and representatives were satisfied there are sufficient, appropriately qualified and responsive staff to meet care and service needs,” the Agency said.
AACQA said St John’s Village failed to meet standards regarding information systems:

“The home does not meet this expected outcome
“The organisation cannot demonstrate their information systems during the recent respiratory outbreak of August 2017 and September 2017 were effective.
“The home’s policies and procedures do not assist management and staff in identifying and responding to an outbreak.
“The policies, procedures and flowchart do not reflect current Australian Government and Victorian Government infection control guidelines.
“Organisational outbreak policies and procedures define an outbreak as three or more care recipients and/or staff showing newly acquired respiratory symptoms within a seven day period.
“This is not in line with current infection control guidelines that define a respiratory outbreak as three or more care recipients and/or staff showing symptoms within the same three day period.
“Management did not provide timely information about the influenza and respiratory outbreak to care recipients and representatives. Seventeen of 35 care recipients and representatives were dissatisfied with the level of communication they received during the outbreak.

“Thirteen staff were not satisfied with information provision in relation to the respiratory and influenza outbreak and said they were not always informed about who was affected with respiratory illness.
“The respiratory outbreak case list used to provide accurate information to the Department of Health and Human Services was incomplete and did not reflect all care recipients’ hospitalisations and deaths. “Clinical care documentation was not updated to reflect the health status and increasing needs of care recipients who contracted influenza and respiratory illness.
“The documentation did not include current pain management and skin care needs and wound dressing requirements.
“Staff and representatives said they were not provided with updated clinical information when care recipients clinically deteriorated.

“Staff could not consistently operate the risk management system in recording infections and incidents, including follow up actions, evaluations and closing off incidents.
Of Health and Personal Care outcomes, St John’s Village failed to meet continuous improvement requirements, according to the Accreditation Team:
“The organisation does not have an effective system to identify ongoing improvement opportunities related to Standard 2 Health and personal care.
“New improvement processes were implemented in April 2017 and consistent processes for gathering improvement suggestions from stakeholders in relation to health and personal care are not established. “Clinical monitoring and reporting mechanisms are ineffective and management cannot show key performance data that exceeded specified risk thresholds has been actioned, for example, falls, hydration status and number of medications prescribed.

“Management cannot interpret clinical monitoring data or explain how it is used to improve care and service provision. Incidents are not consistently documented, investigated, actioned and closed.
“For example, a care recipient who showed symptoms of respiratory illness and passed away during the outbreak had a fall five days before their death.
“Staff were unable to determine any head strike but noted the care recipient had difficulty straightening their knee and they were unable to stand. No incident form is on file. “Data from incidents is not effectively collated and analysed for trends to minimise preventable recurrences.
“:Management and staff could not show ongoing improved results in Standard 2 Health and personal care,” AACQA concluded.

St John’s Village failed regulatory compliance standards:
“The home does not have an effective system to identify regulatory compliance obligations and to ensure compliance with regulations, guidelines and professional standards in relation to health and personal care. “Management did not ensure qualified staff were always available and responsible for assessing and monitoring care recipients’ clinical care needs during the influenza and respiratory outbreak of August 2017 and September 2017.
“Staff did not always work according to legislative requirements or within their scope of practice in relation to verification of death, management of syringe drivers and controlled medication.
“For example, we identified that on two occasions the enrolled nurses worked outside their scope of practice by assessing and verifying the deaths of two care recipients.
“On one occasion, staff said they contacted the on call nurse three times about a care recipient who was dying but they were unavailable.

“The care services manager working as the on call registered nurse was called about a death however, they came to the home hours after a care recipient’s body had been taken by the undertaker.
“Management said personal care assistants are permitted only to record if the battery light is flashing on a syringe driver, which indicates the machine is working.
However, we identified a personal care assistant recorded monitoring information that is the responsibility of an endorsed enrolled or registered nurse.
“Management said two registered nurses or one registered nurse and an endorsed enrolled nurse have authority to take telephone medication orders.
“However, we noted a telephone order for controlled medication was taken and the medication was administered on August 22, 2017, by an endorsed enrolled nurse and a personal care assistant. This order was not signed by the medical officer.”

AACQA said St John’s failed clinical care standards:

“During the influenza and respiratory outbreak in August 2017 and September 2017 a number of care recipients did not receive appropriate clinical care.
“Three of 10 care recipients who died with influenza or respiratory illness were not referred to a medical officer at the onset of their illness. “Care recipients with influenza or respiratory illness were reported as displaying symptoms of fever, lethargy, loss of appetite, pain, cough and breathing difficulties.
“Management cannot demonstrate they received timely notification of care recipients who were identified as having symptoms of influenza or respiratory illness.
“Staff said they were not always able to attend to care recipients’ hygiene, pain relief, skin care and hydration needs, due to the increased acuity and extended care needs of care recipients.
“We identified between April 6, 2017, and September 22, 2017, a total of 290 incidents entered in the risk management system have not been followed up by management and are unresolved.
“This includes but is not limited to, medication, skin trauma, pressure areas, behaviours and falls.

“Not all representatives said staff contacted them in a timely manner when informing them about their relatives’ declining conditions.”
There were deficiencies in the pain management standards at St John’s Village:
“Care recipients’ pain was not effectively managed during the respiratory and influenza outbreak of August 2017 and September 2017. “Staff said care recipients who were unwell during the outbreak died in pain because they could not provide timely repositioning and pain management resources were not always available.

“Pain relief medication was not always available for care recipients and pain charting was not always completed in order to evaluate the effectiveness of pain relief measures.
“Care plans were not always updated to reflect the increasing pain experience and management strategies as care recipients deteriorated, to guide appropriate staff practice. “Five care recipients and several staff said care recipients’ pain is not effectively managed.”
There were deficiencies with skin care management:
“During the influenza and respiratory outbreak of August 2017 and September 2017 a number of care recipients did not receive appropriate skin care. Seven of ten care recipients who died with respiratory illness had outdated information in assessments and care plans impacting on the delivery of care recipients’ skin care needs,” the report said ”

10 deaths
at St John’s
“A fatal flu outbreak at a Wangaratta nursing home, where 10 residents died of influenza and two others from respiratory illness, was worsened by serious management failures, a scathing government audit has found,” was how The Age late last year reported on St John’s Village at Wangaratta.
Three of the 10 residents who died were not referred to a doctor when they first started showing symptoms, and others had to wait five days for swabs to be taken, the report by the Aged Care Quality Agency found, The Age said.
“Management were not aware of their responsibilities in relation to the reporting of the hospitalisation of care recipients with influenza or respiratory illness within 24 hours and did not comply with these requirements,” the agency said.
“On occasions there was no registered nurse on duty and the nurse manager on call was not always available to come in when requested after hours.”
“Except for hand hygiene training prior to the outbreak, management could not show broader infection control practices training for all staff.”
“The home’s infection control co-ordinator was on planned leave from August 31, 2017 until September 25, 2017”.
“The ‘environmental services supervisor’, who was in charge of cleaning, also went on leave, which left the home’s ‘leisure and lifestyle co-ordinator’, who had no recent infection control training, in charge of the cleaners.
“A number of cleaning staff were home sick, and “existing numbers … were not increased to undertake infectious cleaning processes,” The Age said.

Turnover
of managers
St John’s Village Chief Executive Officer Glenn Phelps resigned last year in the wake of an investigation into the influenza deaths at the facility.
Care manager Neale Morris was also stood aside, the Wang-aratta Chronicle reported.
Mr Phelps was the fourth CEO or acting CEO at the aged care centre in less than three years.
Previously, Rob Hankins decided not to extend his contract in that position after just six months in the role.
Peter Hill left St John’s in February 2015 after two years in the job.
In November 2016 St John’s had to repay a couple at the retirement village their share of at least $300,000 wrongly charged to residents for more than a decade.
Bishop John Parkes was Acting CEO for a time, the Wangaratta Chronicle said.