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An established Western Australian retirement
company recently acquired by more commercial
interests and expanding into nursing homes. This
expansion was accompanied by multiple accreditation
failures in nursing homes in 2006.
Keith Pix founded Craigmore as a private West Australian company 28 years ago and it prospered in nursing homes and retirement villages. In 2003 it was acquired by Sauve Enterprises. Sauve was formed by an executive who had left Moran Health Care. He received backing from Westpac's Hastings Private Equity Fund. Westpac wanted to enter the aged care sector. The cashed up company was in a position to bid for the Salvation Army’s nursing homes. This Westpac funded vehicle was pipped by the Macquarie/Tricare consortium.
It is using its new wealth to expand rapidly into other states. Its nursing homes are listed under the name of Glenn-Craig Villages Pty Ltd
A NEWCOMER to the WA aged-care market has snapped up the Craigcare group of companies in a $25 million-plus deal.
Sept 2003 Sauve buys Craigcare
Suave Enterprises, which settled on the Craigcare deal on Wednesday, was formed 12 months ago by former Moran Health Care Group executive John Gillett as an acquisition vehicle and has secured Westpac-backed Hastings Private Equity Fund as a financial backer.
The Craigcare group, which consists of five nursing homes and four retirement villages in WA, pulls in more than $26 million a year in revenue.
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Suave acquired the group, which was established in 1972, from interests associated with founder Keith Pix.
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Mr Gillett said Hastings, which was "effectively an equity partner", was keen to invest in the aged-care sector but would not comment on the amount of funds available for acquisitions.
Suave picks up Craigcare for $25m. The West Australian September 26, 2003
The nation's biggest listed aged-care company, DCA Group, and a private operator based in Perth called Craigcare are among bidders for the Salvation Army's 15 aged-care facilities worth as much as $70 million.
July 2004 Bidding for Salvation Army homes
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Craigcare has been providing residential accommodation services for seniors in Western Australia for more than 30 years and has begun an expansion into other states. It recently set up a national office in Sydney. It owns five aged-care facilities in WA.
DCA bids for Salvos' age facilities Australian Financial Review July 8. 2004
Part of homeliness in nursing homes is the presence of pets. There have been many reports documenting the beneficial effects of dogs on the elderly and most homes welcome them. Quite apart from dogs there are also issues of hygiene, risks in kitchen activities and other areas where safety and legal risk conflict with the provision of the ordinary amenities of life in nursing homes.
With the advent of accreditation and corporate consciousness a far stricter approach is taken. This must impact on residents lives and their sense of homeliness. An interesting case in point is a valued Great Dane in a home purchased by the new Westpac backed Craigmore. When taken over by Sauve Enterprises and Westpac the pet was forbidden and residents protests ignored. It was too big and its slobber unhygienic. Another company Primelife also had protests from residents who wanted pets.
ELDERLY residents of a Mt Martha nursing home are devastated after the centre's new owner gave their beloved pet dog the boot.
Oct 2005 A Great Dane story
For more than two years Ryleigh the great dane had been a much-loved fixture at the Mornington Private Nursing Home, spending every day there with his owner, director of nursing Jill Bell.
The Leader reported last year that six-year-old Ryleigh was a friend to most of the home's 124 residents, tucking into bacon and eggs with them at breakfast and popping into their rooms each day to say hello.
Some families had even told staff the dog had been the deciding factor in their choice of home.
However, about six weeks ago the home's new operator, Craigcare, deemed Ryleigh to be a health risk and ordered Ms Bell to keep him away.
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According to one staff member, who asked not to be named, residents and staff were horrified at the decision."There was an overwhelming protest and even a petition from residents and staff but to no avail," the staff member said.
"He is sadly missed and the place doesn't feel like a home any more.
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Ms Goldsmith said although there had not been a problem in the two-and-a-half years Ryleigh had been at the home, there was a potential for one of the residents to be hurt.
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Ms Goldsmith said Ryleigh also had a problem with drooling."He shook his head a lot and the slobber would go everywhere," she said.
"The auditors were there one day and one of them stepped in it.
Best friend dumped Elderlies sad over loss of great dane Mornington Peninsular Leader October 25, 2005
The Sauve takeover and Westpacs drive for profits has given this company a new commercial focus. It has expanded rapidly into other states including Victoria. This has been accompanied by a spate of failures to meet accreditation standards. The reports suggest that management has lost its focus on care. Its attention to staff morale, education and clinical processes has gone out of the window. Staff morale seems to have plummeted with a high turnover in nursing home managers, staff shortages and increased reliance on agency staff. I have described elsewhere how motivated staff become dissillusioned by the adverse impact of a strong commercial focus on care and are replaced by staff who will do what the market demands.. The consequence for care are predictable and are illustrated in the assessments on the Victorian homes.
That Craigcare has the capacity and skills to monitor care in its own homes and prevent problems developing is illustrated by the rapidity with which it fixed the problems when its financial interests were threatened by a loss of accreditation.
There is something seriously amiss when the monitoring and oversight by an organisation the size of Craigcare is so poor that something like this can develop. They have many years experience in the business. One wonders about their committment to care. Without a suitably large fiscal penalty commercially focussed entities will not change their profitable wrinkle ranching practices.
Instead of acting to penalise this group the industry friendly accreditation agency has once again overruled the decision of its own assessors to grant accreditation and the minister has publicly supported this. He even denied the findings about inadequate staffing made by the assessors. The minister's earlier claims to have reformed the system to make it stricter and more effective are shown to be so much pie in the sky. It is back to the business of supporting the big moneyed companies whose support keeps the government in power.
TWO Victorian nursing homes owned by the same company will continue to take in residents, despite failing several basic standards of accreditation.
Aug 2006 Multiple failures
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But Federal Minister for Ageing Santo Santoro told The Age last week that there was no proof that staff shortages were a problem in homes.
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Senator Santoro said "the Government doesn't adopt a deliberate policy of shutting them down or depriving them of the capacity to expand".
Nursing homes fall short The Age August 29, 2006
The decision comes after two other homes run by the same company -- Glenn-Craig Villages -- were also accredited despite major failings.
Oct 2006 Multiple failures
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But the Aged Care Standards and Accreditation Agency said the home's management had taken action to address the problems.The only penalty imposed was a reduction in the home's accreditation period by five months, which now expires in June next year.
Opposition aged care spokeswoman Jan McLucas said Elizabeth House was one of the worst centres she had heard of.
"I haven't seen in my time a facility that has failed 30 out of 44 expected outcomes, and I am astonished there have been no sanctions applied," Senator McLucas said.
Failed home to stay open Herald-Sun October 11, 2006
The case created uproar in a stormy Senate question time in Canberra yesterday as Minister for Ageing Santo Santoro accused Labor counterpart Jan McLucas of attempting to frighten the elderly with "psychological abuse".
Oct 2006 "Debate" in the senate
But Senator McLucas questioned whether the community could have any confidence in a system in which a home was allowed to operate despite having been found unable meet basic standards.
Care home failed tests The Australian October 19, 2006
Elizabeth House Private Nursing Home
The Elizabeth House Private Nursing Home in Victoria was a chronic offender under previous owners in 2001. It was on a list of critical homes. Its new owner seems to have compounded the problems. It was never as bad as this.
In August 2006 it was non-compliant with 30 of the 44 criteria - a truly dreadful finding. Assessors advised that accreditation be denied. In spite of this all the agency did was to reduce the period of accreditation. The reason offered for this was that the home was making efforts to correct the problems.
All were found by assessment teams to be in a critical or unacceptable condition during the past 13 months.
Aug 2001 On a list of critical homes
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The most current published agency assessment team reports list the following Victorian homes as being in a CRITICAL condition, - - - - - .
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Elizabeth House Private Nursing Home. Lower Plenty Rd, Heidelberg.
Ratings under review. Herald-Sun August 20, 2001
A MELBOURNE nursing home has been allowed to remain open despite failing to comply with basic standards.
Oct 2006 Failed 30 out of 44
Auditors called for West Heidelberg's Elizabeth House private nursing home to be shut after it failed 30 out of 44 checks.
But federal aged care authorities said the 30-bed home should keep its accreditation, and did not impose official sanctions.
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In the latest case, auditors were concerned the home's high-care residents were not getting enough food and fluids, and those showing unexpected weight loss were not referred to medical professionals.Auditors found medications were "not managed safely or correctly", while residents may have been left in unnecessary pain.
Residents often missed out on exercise and physiotherapy, and those with challenging behaviour did not get psychiatric help.
Staff at the home were also found to have inadequate training and patients' files were often incomplete.
The audit team that examined the home said its accreditation should be revoked.
Failed home to stay open Herald-Sun October 11, 2006
Assessment team's recommendation
August 2006 Elizabeth House Private Nursing Home --- Accreditation findings
The assessment team recommends that The Aged Care Standards and Accreditation Agency Ltd revoke the accreditation of Elizabeth House Private Nursing Home.The assessment team considers that the information obtained through audit of the home indicates that the home complies with. 14 expected outcomes.
The assessment team considers that the information obtained through the audit of the home indicates that the home does not comply with the following expected outcomes:
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Management systems, staffing and organisational development
Continuous improvement:-
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Regulatory compliance:- Management cannot demonstrate that there are systems in place to identify and ensure compliance with legislative and regulatory requirements.
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Education and staff development:- The home cannot demonstrate that management and staff have the knowledge andskills to perform their roles effectively.
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Comments and complaints:- Residents, their representatives and staff spoke of inappropriate verbal responses to complaints they had raised, to feeling intimidated, and being unable to complain.
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Human resource management:- Residents' clinical and care needs are not being met by appropriately skilled and qualified staff. - - - - there has been a high turnover of staff in the last few months, and management have been relying on casual agency staff to fill vacancies. - - - - - Residents, their representatives and staff all stated that there was not enough staff, that there were too many agency staff being used and some questioned the clinical and communication skills of the casual agency staff.
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Information systems:-
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Health and personal care
Continuous improvement:-
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Regulatory compliance:- Management cannot demonstrate that there are systems in place to identify and ensure compliance with legislative and regulatory requirements.
---------------------------------
Education and staff development:- The team identified widespread non-compliance in relation to residents' health and personal care, much of which is attributed to lack of knowledge and skills, or education not being provided to staff. Staff do not have the required knowledge to ensure current clinical care is provided,
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Clinical care:- Residents do not always receive appropriate care interventions. Incidents are not always documented and incidents are not monitored or actioned.
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Specialised nursing care needs:- The home has no processes or systems in place to ensure residents requiring specialised care receive this care.
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Medication management:- There is no system in place to ensure that residents' medications are managed safely and correctly. Management have not conducted medication management audits for some time.
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Pain management:- Management cannot demonstrate that they are assisting residents to be as free as possible from pain.
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Nutrition and hydration:- Residents' nutrition and hydration needs are not monitored. Residents identified with unexpected weight gain or loss are not referred to appropriate health professionals. A speech pathologist or dietitian does not routinely review residents receiving enteral feeding.
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Continence management:- Residents' continence needs are not always met. Continence assessments are not always completed or information transferred to care plans.
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Behavioural management:- Residents with challenging behaviours are not being managed effectively. - - - - - Staff do not have the knowledge or skills to manage residents with challenging behaviours - - - .
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Mobility, dexterity and rehabilitation:- Residents are not assisted to achieve optimum levels of mobility and dexterity. - - - - - and staff told the team they do not have the level of skills and knowledge required to effectively manage all the resident's mobility needs.
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Resident lifestyle
Continuous improvement:- Management cannot demonstrate that it systematically pursues continuous improvement. - - - - Suggested improvements from residents and their representatives, meetings and other sources are not used to inform the plan. There have been no resident surveys conducted in 2006,
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Regulatory compliance:- Management cannot demonstrate that there are systems in place to identify and ensure compliance with legislative and regulatory requirements.
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Education and staff development:- Staff practices demonstrate a lack of knowledge and understanding in relation to residents' privacy, dignity and choice. Some staff volunteered that they were unaware for residents' need for privacy and dignity.
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Privacy and dignity:- The home does not have systems and processes in place to ensure that residents' privacy and dignity is recognised and respected at all times.
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Leisure interests and activities:- Information documented about the activity and lifestyle preferences of residents is either undated or not current and is not consistently followed, resulting in many residents sitting in their rooms for lengthy periods of time. - - - - - However, feedback from residents and representatives indicated dissatisfaction with the activities offered and many said they are bored.
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Choice and decision-making:- Residents stated they do not have the opportunity to have choice in their daily lives because they feel they have to do what staff want, because "the staff are so busy".
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Resident security of tenure and responsibilities:- Residents are not supported to understand their rights and responsibilities. - - - - - said senior management will not respond to their concerns about what is to happen which have been raised at meetings and by correspondence.
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Physical environment and safe systems
Continuous improvement:- In relation to the physical environment and safe systems the team identified non-compliance in relation to key expected outcomes in this standard. - - - The facility manager, who was appointed four months ago, said that she has had no input into the home's plan for continuous improvement. Trending and analysis of quality indicators appears to have ceased at the end of 2005.
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Regulatory compliance:- Management cannot demonstrate that there are systems in place to identify and ensure compliance with legislative and regulatory requirements
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Education and staff development:- Management has conducted minimal education in relation to this standard. There is not currently a trained occupational health and safety representative on site.
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Living environment:- Residents are not accommodated in a safe and secure environment. - - - - - The building does not meet building certification requirements for 2008. - - - Security arrangements are poor, and residents safety is further compromised by lack of access to call bells or similar means of alerting staff. Contact with the home is compromised because of an inadequate telephone system. The external environment is poorly maintained, and some areas represent a risk to residents' safety.
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Fire, security and other emergencies:- Management do not have systems in place to ensure that residents and staff are accommodated and work in a safe environment. One designated fire exit is sometimes locked which potentially severely compromises the safety of residents and staff in the event of a fire or evacuation. - - - - - - Fire evacuation and security procedures are not clearly understood by staff, and there has been no fire and emergency training for nearly twelve months. During this time there has been a high turnover of staff, and there are a number of new and agency staff working at the home.
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Infection control:- Elizabeth House does not currently have processes or systems in place to ensure staff carry out an effective infection control program. - - - - No audits, surveys or staff competencies are carried out and no analysis of the number of infections recorded each month occurs. The home does not have an infection control officer or an infection control committee.Accreditation agency inspection report August 2006
Plumpton Villa Aged Care Facility
The Plumpton Villa Aged Care Facility in Victoria was another chronic offender under previous owners. It struggled to gain accreditation in 2000 and was given an exemption when it failed to meet the deadline set for 2001.
In June 2006 assessors found the facility was not compliant with 25 (over half) of the 44 items assessed. The agency overruled three of these and merely reduced the period of accreditation. It supervised the home until it was fully compliant with all items when the material was placed on the web site. Plumpton has clearly gone backwards under its new owners.
Bellhaven Hostel, Preston
Oct 2000 Problems in the home
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No official sanctions; agency to conduct regular visits.Diabetic residents not properly managed with insulin injections administered by unqualified staff or at inappropriate times.
NURSING HOMES UNDER THE MICROSCOPE. Herald-Sun October 23, 2000
Preston's Bellhaven Hostel, Braybrook's Howard Kingham Lodge Hostel and the United Church's Moorfields Community appear on the Aged Care Standards and Accreditation Agency's website as "serious risk".
Oct 2003 "Serious risk"
Nursing homes run closure risk. Herald-Sun October 23, 2000
According to an audit conducted in October, Bellhaven was rated a ``critical'' risk to the health and personal care of residents. A report by the standards and accreditation agency said residents' medication was not managed safely and correctly, and the hostel could not be sure residents received adequate nourishment and hydration.
Jan 2001 Critical risk
Nurse Homes Fail Test The Age January 1, 2001
``In addition to the 20 that failed accreditation and were given an exemption, it now appears that up to 300 nursing homes failed to meet standards but were given one-year accreditation,'' he said.
Jan 2001 Given exemption
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Facilities granted extensions
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* Bellhaven Hostel, Preston
Nursing Homes Fail To Make The Grade The Age January 2, 2001
In one of the homes, medicines had been administered incorrectly or not at all, residents were not assured of getting the medical care they needed and had been kept out of one another's rooms with chains.
Aug 2006 Fails 22 (half) of 44 standards
This home - the Plumpton Villa Aged Care Facility in Glenroy - did not have enough qualified staff "to ensure that the residents receive appropriate clinical and lifestyle care". In all it failed 22 standards.
Nursing homes fall short The Age August 29, 2006
The assessment team considers that the information obtained through the audit of the home indicates that the home does not comply with the following expected outcomes:
June 2006 Plumpton Villa Aged Care Facility --- Accreditation findings
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Management systems, staffing and organisational development
Continuous improvement:- The acting facility manager had just commenced in the position on the first day of the audit and was unable to provide the team with any examples of quality activities that had occurred since the accreditation audit in September 2005 - - - - - There is no evidence of any other system in place to monitor and evaluate actions arising from quality activities. - - - There was no evidence that any resident or staff surveys had taken place in the past twelve months. - - - Staff interviewed said they have never received feedback on any suggestions they had raised
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Regulatory compliance:- - - - there is no system in place to advise staff of changes to their work practice. - - - - The administration officer was not aware of any legal requirements pertaining to the archiving of resident files, and was not aware of the location of the hard copies of regulatory and legislative requirements.
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Education and staff development:- Management does not have a system in place to identify that staff have the knowledge and skills to perform their roles effectively. There has been limited education delivered to all staff, - - -
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Comments and complaints:- Residents and staff interviewed expressed concern regarding complaints processes and the lack of action taken regarding their complaint, and a resident and their relative spoke of being fearful of recrimination if they followed up a complaint. The administration officer was unaware of complaints procedures - - - .
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Human resource management:- There is insufficient qualified staff to ensure that the residents receive appropriate clinical and lifestyle care. Staff levels during the afternoon in the 30-bed low care area are minimal. Staff have not received ongoing or adequate training to preform their duties
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Information systems:- Plumpton Villa does not have effective information systems in place. Data is not collected and updated in a consistent manner, which does not assist management to perform their roles. There is no system in place to ensure that information pertaining to residents is accurate and up to date and reviewed in a timely manner.
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Health and personal care
Continuous improvement:- The acting facility manager had just commenced in the position on the first day of the audit - - - - - but there is no system in place to monitor if any of the actions taken had occurred, and if so, if they had been effective.
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Regulatory compliance:- Care staff interviewed were not aware of a system in place to advise them of changes to legislative and regulatory requirements.
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Education and staff development:- Staff do not receive sufficient ongoing clinical training to perform their roles in a consistent and effective manner. No education program has been developed for the staff. No performance appraisals have been conducted - - - .
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Clinical care:- Residents' files do not provide sufficient information to ensure that they receive appropriate clinical care. High care residents in the hostel have not been assessed or have had care plans developed by appropriately qualified nursing staff. - - - - . The team noted residents calling out for long periods of time before receiving staff attention.
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Medication management:- Residents' medications are not always distributed in accordance with the attending medical practitioners' orders. Residents' morning medications are often distributed late and there have been incidents of 'cardiac patches' either not being applied or removed as ordered and drugs not being given when ordered. The medication trolleys in the high care area were sticky to touch, unclean and cumbersome to manoeuvre throughout the different levels in the home. The team observed that the trolleys were not always kept locked.
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Pain management (Agency changed this):- Residents in the high care area are not being assessed adequately or are kept as pain free as possible. - - - - - Residents and representatives stated that often the staff take 'forever' to respond to their buzzers when they need pain relief. A resident was overheard moaning at various times throughout the days on site.
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Nutrition and hydration (Agency changed this):- Residents are not assured of receiving their required dietary needs. - - - - - Residents are not always appropriately positioned to partake of meals. Some residents said there is little to no choice at meal times.
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Skin care (Agency changed this):- There is insufficient information documented for staff to provide the appropriate skin care to residents. Unlabelled skin preparations were seen on a dressing trolley. There were virtually no progress reports regarding the healing process of residents' wounds. There has been a high incidence of residents' fall resulting in skin breaks.
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Behavioural management:- Residents identified with challenging behaviours are typically not being managed in an effective manner. There is a lack of assessment information and care plans are generic.
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Resident lifestyle
Continuous improvement:- The acting facility manager had just commenced acting in the position on the first day of the audit and was unable to provide the team with any examples of quality activities relative to standard three that had occurred since the accreditation audit in September 2005.
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Regulatory compliance:- Information contained in the residents' handbook does not always reflect their entitlements under specified care and services. - - - However, the team was unable to find any discussions relating to legislative or regulatory requirements in minutes of meetings reviewed, nor was there any information documented in memos held in the memos and staff notices folder 2005- 2006.
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Education and staff development:- Staff do not receive sufficient ongoing lifestyle training to perform their roles in a consistent and effective manner. No education program has been developed for the staff. - - - One unqualified diversional therapist works four day a week and is responsible for providing activities for all 90 residents. This does not meet the needs of the residents.
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Privacy and dignity:- Information provided in minutes of meetings relating to residents' clinical and care issues is not monitored to ensure that the resident cannot be identified.
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Leisure interests and activities:- Residents receive limited support to participate in a limited range of activities that are of interest to them. Only two activity sessions are conducted on weekdays and there is no weekend program. - - - Residents and relatives' representatives said that there is not a lot to do during the day.
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Physical environment and safe systems
Continuous improvement:- - - - - there is no system in place to monitor that that these activities are actioned, reviewed and evaluated in a systematic manner. In addition, there have been no standard four audits conducted that are provided under the external package used by the home. - - - - Resident information held for emergency transfer purposes and catering preferences is not accurate and up to date and there is no system to ensure that the information is reviewed in a systematic manner.
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Education and staff development:- The regional catering manager said she had identified that ongoing training has not been provided to all catering staff and there were gaps in general knowledge.
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Living environment:- A family member raised concerns regarding ease of access to the service during these hours, and the team noted that there have been three incidents of residents absconding in 2006. Residents and relatives raised concerns about having to wait for quite a long time to be attended to when they used their call bells. - - - - The team was unable to locate any staff on some occasions, and in one instance heard a pager buzzing. The pager was found to be in a drawer at the nurses' station.
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Fire, security and other emergencies:- There is an emergency transfer folder located at the main entrance, however the resident details are not accurate nor up to date, and there is no system in place to ensure that the information is updated on a regular basis.
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Infection control:- The service does not have an effective infection control program. There are no audits being conducted or staff education for infection control.Accreditation agency inspection report June 2006
Berwick Village Supportive Care Hostel
Assessors found the Berwick Village Supportive Care Hostel in Victoria non-compliant in Clinical Care, Behavioural management, and Mobility, dexterity and rehabilitation in April 2006. The agency reversed the decision on Clinical care on additional information and the hostel was found to be fully compliant at a follow up support inspection. Accreditation was reduced to 2 years.
Berwick Residential Aged Care, which failed nine standards, was expecting an accreditation visit next week, he (John Gillett, chief executive of Craigcare)said.
Aug 2006 Failed 9 standards
Nursing homes fall short The Age August 29, 2006
The Ravenswood Court Hostel in Victoria had poor and confusing information systems for staff and patients due to the rapid turnover of managers at the facility. The problem was corrected with follow up visits and accreditation was not affected.
The Craigcare web site is at http://www.craigcare.com.au/indexNS.html
For Updates:- A good way to check for recent developments in aged care is to go to the aged care crisis group's search page and enter the name of the company, nursing home or key words relating to any other matter in the search box. Most significant press reports are flagged there. The aged care crisis web site has recently been restructured and some of the older links used from this site may not work.
Web Page
History
This page created Sept 2006 by
Michael
Wynne
Updated Dec 2006
