Elderly residents at the Royal Freemasons - Ballarat aged care home in Canadian were placed at "serious risk" by failings in personal and clinical care according to the Aged Care Quality and Safety Commissioner.
Following a site audit which took place from September 18 to 20 last year, the commissioner said the failure to meet one quality standard "has placed the safety, health or well-being of aged care consumers of the service at serious risk".
Despite the failure, the Commission decided on October 22 that the service met seven of the eight Aged Care Quality Standards and re-accredited the service until November 26, 2021.
"The organisation was not able to demonstrate that each consumer gets safe and effective personal and clinical care that is best practice, tailored to their needs and optimising their health and wellbeing," assessors wrote in the report, published on the Aged Care Quality Standards Commission website.
According to the report, the care failures stem from poor procedures around catheter management, medication delivery and paperwork.
"The service has not ensured catheter management is effective, safe and delivered according to directives," the report stated.
"Medication delivery is not available after hours, resulting in a consumers' medication management being compromised. Incident reports for clinical event have not been consistently completed as required by the service."
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The Department of Health was notified of the risk.
The assessment team said care in all other clinical areas including end of life care, wound management, mobility, dietary needs and diabetic management were safely and effectively delivered.
"Except for catheter management, the service demonstrated the ongoing reviews are conducted in consultation with the consumer or representative and ensure personal and or clinical care is safe and right for each consumer," they found.
During a further assessment on January 22 to monitor the service's progress in meeting the standards, Royal Freemasons - Ballarat was found to comply with all aged care quality standards.
Management of the Royal Freemasons aged care home were approached for comment but did not respond before deadline.
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