Lyndoch Living has defended two audits from the Aged Care Quality and Safety Commission, which found both its nursing home and hostel services failed at least half the national quality standards.
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The Lyndoch Nursing Home was non-compliant for five out of eight standards, while the Lyndoch Hostel was non-compliant for four out of eight.
A Lyndoch spokeswoman emphasised both services were re-accredited "for the maximum three-year period" despite the failures, welcoming the "positive decisions".
Lyndoch Living chief executive officer Doreen Power told The Standard "this great outcome is a tribute to our hard-working staff".
"I cannot stress enough how grateful I am to our staff for the exceptional work they do every day," she said.
Ms Power also said she welcomed the fact Lyndoch had not been sanctioned for its failure to comply with the aged care standards, saying this showed there were no major concerns.
Slipping standards?
In terms of non-compliance, the recent audits were the worst on record for Lyndoch.
As recently as last year, the Lyndoch Hostel passed every one of the aged care standards, but this time it failed half of them.
The nursing home received a damning audit in 2021, with its pain and wound management practices deemed inadequate. And while it fixed those issues in the recent audit, it failed five out of eight standards this time around compared to just three in 2021.
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Each of the eight national aged care standards is composed of a number of sub-standards called requirements.
For example, Standard One, which relates to the dignity and choice of residents, has six requirements. If the service fails one of the requirements it must be found non-compliant for the whole standard.
Nursing home woes
The nursing home failed one requirement across five different standards: dignity and choice, personal and clinical care, services and supports, human resources, and governance.
Under Standard One, the nursing home did not comply with the requirement to provide residents with accurate, clear information when it limited visiting hours during the COVID-19 pandemic.
The nursing home reduced visitations to between 10am and 2pm, claiming it was a "government requirement", but the government guidelines said the service needed to discuss the change with each resident to work out alternative arrangements if the limited hours were preventing contact with loved ones. Lyndoch did not do this, and conceded the restrictions had an impact on residents.
The nursing home also failed Standard Three - personal and clinical care of residents - because it didn't comply with the requirement to effectively manage "high impact or high prevalence risks" for residents.
The audit found "the service did not adequately demonstrate that incidents of falls, weight loss and swallowing difficulty were consistently identified and actioned with the consideration of risk mitigation and prevention of possible harm".
It said the majority of staff and residents "expressed concerns" about staffing shortages preventing effective management of risks.
"In relation to managing risks of choking, a consumer (the audit's term for resident) identified as requiring an easy to chew and cut up diet and thin fluids experienced a choking episode while having lunch... the (resident) was not assessed by the registered nurse after the choking episode," the audit said.
It also found the resident's swallowing was not properly investigated after the incident, nor was the episode reported to the medical practitioner as required, and that Lyndoch took action after the failures were pointed out by the audit assessment team.
The audit made a point of emphasising the nursing home also failed the risk requirement at the previous assessment team visit in September 2021, but had failed to fix the problems.
The nursing home also failed Standard four, which ensured residents got adequate services and supports to be happy and healthy.
Specifically, the nursing home failed the requirement to provide "safe and effective services and supports for daily living that meet the (resident's) needs, goals and preferences and optimise the independence, health, well-being and quality of life".
The audit said residents "provided negative feedback", saying there was "a lack of stimulating and appropriate activities provided by the service".
"Care staff explained there have been several resignations and extended unplanned leave that (had) impacted on the delivery of the lifestyle program."
The audit said Lyndoch disputed the findings, but said it "did not provide sufficient information" to substantiate its objection.
Hostel concerns
The Lyndoch Hostel was non-compliant in several of the same areas as the nursing home, failing to provide accurate clear information about COVID-19 visiting hours and failing to demonstrate adequate risk management.
Overall, the hostel failed to comply with seven requirements across four aged care standards, a substantial slip after it passed every single requirement in its previous audit.
One area of non-compliance related to the requirement that residents get safe and effective personal and clinical care. The audit found that while wound and pain management was up to scratch, the hostel's management of chemical restraint - using medication to control a resident's behaviour - was "not effective".
"Not all consumers who require the use of restrictive practices are assessed, monitored and reviewed according to requirements, and informed consent with substitute decision-makers did not always occur," the audit said.
The use of drugs to subdue a resident is generally seen as a measure of last resort because it removes a person's agency and there is a risk it could be inappropriately used. Yet the audit found some residents were chemically restrained even though staff hadn't created a behaviour management plan for them and without any evidence other less invasive methods had been considered.
"One consumer was administered an 'as required' (PRN) psychotropic medication by a personal care worker for being 'agitated, anxious and paranoid'. Consultation with a registered nurse prior to the administration of the psychotropic medication was not documented nor was there any documentation showing any non-pharmacological strategies were trialled prior to the administration of the medication," the audit said.
It said Lyndoch had "acknowledged the gaps" in its processes and had "taken action to address the deficits identified in relation to restrictive practices".
The audit also expressed concerns about poor management of a "high risk" resident at the hostel, "which resulted in overall increased risk and anxiety for other (residents)".
"The (resident) had episodes of responsive behaviours documented in progress notes from January 2022 but no behaviour support plan in place," the audit said. The report said staff couldn't explain what triggered the poor behaviour and had no strategies to control it.
"The family of the (resident) expressed frustration they were not called upon to assist to manage the behaviours. They also said medication to sedate the (resident) was utilised prior to referring the consumer to a medical officer," the audit said.
Lyndoch said it was in the process of creating a behaviour management plan for the resident, but the audit said assessors saw no evidence of proactive management of the resident's behaviour.
Short staffed
The Lyndoch spokeswoman described the above failures affecting "low risk areas" of the service, while Ms Power said they were about "paperwork" rather than "outcomes" for residents.
Many of the failures identified across the nursing home and hostel were directly related to a chronic lack of staff at Lyndoch Living.
Ms Power said Lyndoch had hired 15 nurses over the past six months, however South West Coast MP Roma Britnell said more than 200 staff had left in the past two years, a figure Lyndoch did not dispute.
"Our recruitment campaign is ongoing," Ms Power said.
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