1. health and fitness

Promoting the human rights,
interests and dignity of
Victorians with a disability
or mental illness
Community Visitors
Annual Report
2011-2012
Mental Health
Disability Services
Health Services
Community Visitors Annual Report 2011-2012
© 2012 Office of the Public Advocate
ISSN 1836-3296
Cover: The cover of this annual report is a photo of an art installation
by University of Melbourne student Amelia Mellor. Amelia folded 660
origami boats in a rainbow of colors and launched them in the university
quadrangle moat one autumn day in 2012. The photo was taken by her
cousin. The boats are as diverse as the many Victorians with a disability
whose circumstances make them vulnerable to abuse, neglect and
exploitation, the theme of this year’s Community Visitors annual report.
The Honourable Mary Wooldridge MP
Minister for Community Services,
Mental Health and Senior Victorians
Level 22, 50 Lonsdale Street
MELBOURNE VIC 3000
20 September 2012
Dear Minister
RE: COMMUNITY VISITORS ANNUAL REPORT 2011-2012
In accordance with the Mental Health Act 1986, the Disability Act 2006 and the
Health Services Act 1988 please find enclosed the 2011-2012 annual report
of the Community Visitors Mental Health Board, Disability Services Board and
Health Services Board.
The focus of this year’s report reflects the findings in relation to the disturbing
propensity of reports in relation to the abuse, neglect and exploitation of
residents and consumers when in the care of others – in this case, service
providers.
The findings have been drawn from 5104 visits by 360 Community Visitors
across the state.
The Community Visitors Boards commend the report to you and thank you for
your support of the program to date.
According to Community Visitors, there is critical work to be done to prevent
fellow Victorians with a disability from being abused, neglected and exploited.
They look forward to continuing to work with you to prevent this deeply
concerning matter.
Yours sincerely,
Colleen Pearce
Public Advocate and Chairperson of the Combined Board
Office of the Public Advocate
Level 1, 204 Lygon Street, Carlton, 3053.
DX 210293
Local Call: 1300 309 337 TTY: 1300 305 612 Fax: 1300 787 510
www.publicadvocate.vic.gov.au
Community Visitors Annual Report 2012
1
Ordered to be printed
Victorian Government Printer
Palimentary Paper No 168, Session 2010-12
Contents
1
Letter of transmission
4Message from the Public Advocate
and Chairperson
8Introducing the Community
Visitors Boards
10
Introducing Community Visitors
11
Reporting Regions
12Mental Health Statewide themes
and recommendations
14
Mental Health Regional Reports
20
21
23
23
24
26
29
35
37
Barwon-South Western Region
Eastern Metropolitan Region
Gippsland Region
Grampians Region
Hume Region
Lodden-Mallee Region
North and West
Metropolitan Region (North)
North and West
Metropolitan Region (West)
Southern Metropolitan Region
42Disability Services statewide themes
and recommendations
44
Disability Services regional reports
50 Barwon-South Western Region
57 Eastern Metropolitan Region
70 Gippsland Region
71 Grampians Region
75 Hume Region
77 Lodden-Mallee Region
79 North and West
Metropolitan Region (North)
83 North and West
Metropolitan Region (West)
86 Southern Metropolitan Region
92Health Services statewide themes
and recommendations
94
Health Services regional reports
99
101
104
106
106
108
111
112
114
Barwon-South Western Region
Eastern Metropolitan Region
Gippsland Region
Grampians Region
Hume Region
Lodden-Mallee Region
North and West
Metropolitan Region (North)
North and West
Metropolitan Region (West)
Southern Metropolitan Region
Appendices
117Facilities visited by Community
Visitors 2011-12
119
Community Visitors 2011-2012
121Acronyms
Message from the
Public Advocate and Chairperson
“The desire for dignity is universal and powerful. It is a motivating
force behind all human interaction – in families, in communities, in
the business world, and in relationships at the international level.
When dignity is violated, the response is likely to involve
aggression, even violence, hatred, and vengeance. On the
other hand, when people treat one another with dignity, they
become more connected and are able to create more meaningful
relationships”
Donna Hicks, Dignity –­The Essential Role it Plays in Resolving Conflict
Abuse and violence
Addressing the abuse, neglect and exploitation
of people with a disability or a mental illness is
a pressing human rights issue, and a key priority
area for both my office and Community Visitors.
While many people are given caring support by
dedicated staff, Community Visitors are encountering
an increasing number of people who are victims of
abuse, violence including sexual assault, and neglect.
The figure on page 5 shows Community Visitor
reports of these matters have more than doubled in
three years. Government and service providers must
act immediately to stop the suffering of vulnerable
people with a disability and their families who are
being irreparably damaged by abuse.
They must also do everything possible to prevent
abuse from occurring in the first place and respond
with care, concern and immediate action when
allegations of abuse are made.
This year, Community Visitors reported numerous
very troubling cases of assault by staff, serious and
unexplained injuries, and people living in fear of
violence. In 30 instances, Community Visitors were
so concerned for the immediate safety and wellbeing
of individuals, I received formal written notifications
of these cases.
A review of Community Visitors reports and the
increasing number of formal notifications reinforces
to me, the urgent need for service providers to foster
a culture that is alert to signs of abuse, neglect and
exploitation, where abuse is not tolerated, where
victims and their families are supported without
hesitation and incidents are reported immediately
and appropriately.
Community Visitors have reported allegations of
sexual assault in mental health services, Supported
Residential Services (SRS) and in group homes for
people with a disability. The Health Services Board,
so disturbed by allegations of sexual assault in SRS,
reported their concerns directly to the Community
Services Minister, Mary Wooldridge.
4
In mental health, most services have developed
gender-specific areas but Community Visitors still
report serious difficulties. At one adult acute unit,
the gender-specific area is generally locked at night
as it is out-of-sight of the nurses’ station. In other
settings, the mix of residents and the pressure on
beds makes it hard to justify keeping a separate
area available. Not surprisingly, women continue to
fear for their safety in many mental health services
and SRS where staff struggle to support large
numbers of people with a variety of complex needs.
In disability services, there have been several wellpublicised cases of sexual assault of residents by
staff and other acts of violence against residents.
Resident incompatibility and the heightened risk
of abuse between residents, continues to be of
concern for Community Visitors. In some facilities,
people with very different needs are forced to
share confined spaces and staff constantly manage
potentially volatile situations, resulting in safety
concerns or in unnecessary restrictions on an
individual’s freedom. Again, this year, Community
Visitors cite services where people with violent
and challenging behaviours have assaulted other
residents and staff. Community Visitors reported
multiple incidents of residents being threatened with
knives, and of other physical and verbal abuse. In
one case, a resident of an SRS murdered another
resident. In a mental health facility, a consumer who
had been in care for an extended period of time
– ‘long-stay’ – was repeatedly assaulted by other
consumers, up to three times in a month.
Individuals, staff, families and friends, concerned
about safety and desperate for help in dealing with
challenging situations have accessed OPA’s Advice
Service 316 times for advice, support or to request
a visit from a Community Visitor.
Of particular concern is an increase in reports of
significant, unexplained injuries consistent with being
caused by assault or trauma. In one case, a forensic
physician’s independent review stated that
200
183
180
number of issues identified
160
69
140
120
110
100
91
80
26
27
87
60
66
40
55
20
0
10
17
2009-2010
2010-2011
27
2011-2012
stream
Health
Disability
Mental Health
Figure 1. Abuse, Neglect and Assaults across all Community Visitor streams, 2009-2012
ams, 2009-2012
a resident’s injury “does not necessarily require
a fall. It does, however, require inappropriate and
rough handling as a minimum”. In a different case,
the same physician stated, “it is hard to see how
such severe injuries could have gone unwitnessed
and unrecorded.” If a service provider cannot identify
the cause of an injury, how can it guarantee that the
person concerned has not been a victim of assault?
Moreover, if it is an assault, how will that person be
protected from further injury?
Neglect
Disturbingly, Community Visitors reported cases
where fractures and other serious injuries were
identified and reported only after bruising, swelling
and pain was noted by a third party. While staff report
to Community Visitors their struggle in identifying
pain in those who are unable to speak, evidencebased, reliable and easy-to-use tools are available to
measure and assess pain in such circumstances. It
seems these tools are rarely used by staff to assess
people with a disability, the consequence being that
pain management is minimal, or non-existant causing
unnecessary suffering.
Poor manual handling practices by staff led to
a resident in the Grampians Region nearly having
her leg amputated. Comprehensive staff training
on manual handling can help prevent injuries
to residents with compromised bone density.
Community Visitors identified cases where multiple
health assessments had been undertaken before
fractures were identified. Health professionals
often struggle to assess people with a disability
who have difficulty communicating, yet Community
Visitors report instances where residents are sent
alone by ambulance, with no written summary of
their communication or health issues and no staff
to advocate on their behalf. Consequently, they
receive inadequate healthcare that compounds
their suffering. Incidences such as these highlight
that significant communication and sensory issues
may prevent a person raising concerns, and it is
imperative that these individuals have access
to communication aids.
Responding to abuse, violence and neglect
The lack of staff training on recognising indicators
of abuse and neglect can have dire consequences,
with abuse continuing unabated, undetected and
unreported. This year’s report highlights an incident
where staff witnessed a resident being physically
abused by a family member. Staff did not intervene,
notify their manager or write an incident report.
Abuse can take many forms and it is imperative
that staff are trained to recognise physical and
behavioural indicators that correlate with abusive
situations and are empowered by management
to act immediately. Any report of abuse or neglect
Community Visitors Annual Report 2012
5
must be taken seriously. Service providers have a
responsibility to report all such incidents as soon as
possible and ensure people are safe from harm.
To create safer environments and to transform
a culture that tolerates violence and abuse, a
comprehensive abuse prevention program needs to
be introduced. Service providers need to develop
a staff code of practice that specifically prohibits
abusive and neglectful practices. They must also
have polices and procedures that clearly explain the
process for identifying, reporting and responding
to abuse. These policies need to be supported by
systematic reviews that demonstrate that they are
being followed and are effective. Service providers
that do not demonstrate a commitment to such
a program risk the loss of community confidence
in their organisations.
Following a referral from my office and the
Ombudsman Victoria’s subsequent report in March
2011, I asked the Department of Human Services
(DHS) to adopt a Seven Point Safety Plan regarding
allegations of abuse which requires:
•
protection for the individual by ensuring their
immediate and ongoing safety
•
criminal acts are reported to the police
•
allegations against staff are taken seriously
and they are stood down pending the police
and/or independent investigation
•
incident reports are prepared by the person
who observed the abuse, not rewritten by
senior management and are available to
Community Visitors
•
an independent investigation of the incident
is reported to senior management
•
the victim of crime is supported to tell their
story and provide evidence
•
notification occurs to the family of the victim.
I am pleased to report that, following the adoption
of these procedures, there has been a significant
improvement in the DHS’ responses to allegations
of abuse, neglect and exploitation that has led to
improved health, safety and wellbeing of individuals
affected. Subsequently, OPA has successfully
initiated discussions with the Department of Health
as to how the notification process can be adapted
for SRS facilities.
6
The people Community Visitors meet have a right
to be free from abuse or the fear of abuse. They
have the right to be treated with respect and dignity
and to receive the best quality of care available.
Empowering people by educating them about
their rights is an important protective mechanism
against any human rights violations. Equally
important is promoting self-determination through
increased choices and opportunities, encouraging
independence and self-advocacy and supporting
people to make decisions about their lives.
Community Visitors are volunteers and are
independent of government and service providers.
Their regular, independent and fearless monitoring
of mental health and social-care settings continues
to point to ways in which organisations can improve
services to ensure the protection and promotion of
the human rights of people in their care.
It is doubtless that these attributes have led our
Community Visitors Program to be proposed as
one of the monitoring features for the coming
National Disability Insurance Scheme (NDIS). The
Productivity Commission, in its advocacy for the
NDIS, proposed that Community Visitors should help
to monitor the NDIS, and called for community visitor
schemes to be introduced in jurisdictions that do not
have them. It further argued that, in this process,
“It is desirable to replicate features of the Victorian
model”. My office is very excited by this prospect,
and is seeking to ensure that its Community Visitors
play an active role in monitoring the NDIS trial in
Barwon Region, beginning next year.
I am pleased to be able to highlight the work of these
tireless champions, because, without Community
Visitors, many people with a disability or a mental
illness would be in danger of being isolated,
marginalised and vulnerable to human rights abuses.
I commend their report to you.
Colleen Pearce
Public Advocate and Chairperson of the Boards
Case study – Broken
There were serious concerns for the
welfare of Cynthia, a resident with
a disability in a DHS house. Formerly
a resident of Kew Residential Services
(Kew Cottages), Cynthia could not
speak and needed staff to help her
with all her activities of daily living.
One evening, staff noticed bruising and
swelling to one of her feet. A doctor and
the ambulance were called but as the
nearest hospital emergency was full,
it was decided Cynthia would remain
at home overnight. The doctor ordered
paracetamol to ease her pain.
The next day, Cynthia went to the hospital
and was diagnosed with a broken ankle.
She was returned home. Two days later,
Cynthia went back to the hospital as
staff who knew her thought she was in
considerable pain. The hospital further
diagnosed that both legs were broken.
Old fractures to both hips were also
identified. She was discharged from
hospital two weeks later with minimal
staff training provided.
Shortly after Cynthia’s return from
hospital Community Visitors attended
the facility. They were so concerned
about her wellbeing, they notified the
Public Advocate. They found Cynthia
still did not have a mattress to relieve
the pressure on her lower limbs or any
other appropriate equipment. She also
had head lice and diarrhoea. Staff also
said they had been told Cynthia had
osteoporosis.
Some staff told Community Visitors that
they were not confident in assessing
the pain of someone who could not
speak. Management reported that they
recognised that staff needed more
intensive training in manual-handling
but could not say when this would occur.
As soon as DHS was notified by the
Public Advocate of the Community
Visitors’ serious concerns, rapid action
was taken to ensure the house had the
equipment and staff needed to provide
Cynthia with appropriate care. In the
response to the Public Advocate’s
notification, DHS advised that the
“group home concerned was found
not to have followed the DHS incident
reporting instructions accurately and
compounding to this issue was the
house office fax was out of order”.
A forensic physician was asked to
report on the unexplained injuries,
but there is still no explanation of how
these injuries occurred.
The Public Advocate also assigned
an advocate to monitor Cynthia’s care.
Community Visitors Annual Report 2012
7
Introducing the
Community Visitors Boards
Dave Parker (Health Services Board); Public Advocate Colleen Pearce; Sophy Athan (Mental Health Board);
Dawn Richardson (Health Services Board), Dr Carol Morse (Mental Health Board).
Colleen Pearce
Chairperson, Health Services, Mental Health
and Disability Services Boards
Ms Pearce is the Public Advocate of Victoria and,
under the relevant legislation, is the chairperson
of the Community Visitor Boards.
Ms Pearce has almost 30 years experience in the
community and health sectors. From 2004, she was
Director of the Victims Support Agency (VSA),
in the Department of Justice.
Ms Pearce has devoted her working life to
helping society’s most disadvantaged people,
and advocating for a better deal on their behalf.
She serves on the Frontier Services Board
of Governance.
8
Her previous roles include:
• d
irector, UnitingCare Victoria and Tasmania,
an organisation providing services to more
than 350,000 disadvantaged people
• e
xecutive director at Moreland Hall, a drug and
alcohol treatment service providing counselling,
withdrawal, prison and court services and statewide drug education
• e
xecutive officer North Richmond Community
Health Centre.
Ms Pearce commenced as Public Advocate
on 8 September 2007.
Sophy Athan (Mental Health Board)
Dave Parker (Health Services Board)
Ms Athan has held senior positions in local and
state government for over 20 years. She has been
on numerous committees and boards at all levels
of government.
Mr Parker is a retired former Royal Australian Navy
service man. While in the Royal Australian Navy,
Mr Parker spent over six years as an instructor in
submarine daily operations and electrical systems.
She is on a number of health service committees
as a consumer representative.
He has completed an Advanced Welfare Officers
course. He also volunteers his time as both a
Welfare Officer and a Pension Officer for the
Warrandyte Branch of the Submarine Association
of Victoria.
Currently, she is the Managing Director of Euroforce
Music Pty Ltd. Ms Athan’s qualifications are BA
(Melbourne), Grad. Dip. Lib. (RMIT), Grad. Dip. Soc.
Pol. (Swinburne), MA (Adelaide), NATI Level 4.
Ms Athan was a Community Visitor from 2003
to 2012 in both the mental health and disability
streams. She has made an enormous contribution
to the program as an active Community Visitor,
Regional Convenor in both streams and as
a Board member.
Dr. Carol Morse (Mental Health Board)
Dr Morse is an academic Health Psychologist with
over 30 years of university experience researching
and teaching lifespan development, public health
and wellbeing among Australian-born, Indigenous
Australians and migrant peoples.
She is also an experienced clinician in mental
disorders and relationship counselling.
Her many publications include a recent two-volume
book comparing challenges to positive ageing
in Australia with Israel and the USA. She was
appointed a Community Visitor in the Mental Health
stream in 2008.
Mr Parker joined the Community Visitors Program
in 2004 visiting in the Health Services stream and is
currently an appointed Health Services Community
Visitor until February 2015.
Dawn Richardson (Health Services Board)
Ms Richardson has a background in
telecommunications, training and disability.
She has served on the committee of management
for the Communications, Electrical and Plumbing
Union and has spent six years in a voluntary
position managing Food Relief.
She joined the Community Visitors Program in
the disability stream in 2006 and transferred to
the Health Services stream in 2009. This is her
third term on the Health Services Board.
Trish Guglielmino and Shiela Winter
(Disability Services Board) resigned prior to
the preparation of this year’s annual report.
Health Services Board member, Dave Parker, receives an
award at the Community Visitors annual meeting 2012
Community Visitors Annual Report 2012
9
Introducing
Community Visitors
Community Visitors are
independent volunteers who
safeguard the interests of people
with a disability.
Where an issue cannot be resolved at facility level,
it is usually taken to a more senior manager in the
agency and/or the DHS/DH regional office. Serious
matters may be referred for action within OPA
and dealt with as part of the Public Advocate’s
broader powers.
The Community Visitors Program is part of OPA.
While the vast majority of visits are scheduled
and unannounced, a significant number are in
response to specific complaints. This includes
referrals to the program via OPA’s Advice Service.
On occasions, repeated visits are necessary to
certain facilities over a short period, in response
to serious issues identified and at the discretion
of the Community Visitors.
The program is organised into three streams to
reflect the type of services visited:
• M
ental Health – visits are made to consumers
and residents in mental health facilities providing
24-hour nursing care
• D
isability Services – visits are conducted to
institutions and community-based facilities for
people with a disability
• H
ealth Services – visits are made to people who
reside in Supported Residential Services (SRS)
and require additional support.
The ongoing support, training and recruitment
of the Community Visitors and the boards is the
responsibility of staff in the Volunteer Programs Unit.
The legislative framework is derived from the
following Acts of Parliament:
Stream
Visits 11/12
Mental Health
1359
• Mental Health Act 1986
Disability Services
2821
Health Services
924
• Disability Act 2006
• Health Services Act 1988.
The legislation establishes three respective boards:
Mental Health, Disability Services and Health
Services. These boards are responsible for reporting
the activities, issues and findings of the Community
Visitors to the Victorian Parliament each year,
through the relevant minister.
Community Visitors are appointed for three years
by the Governor in Council. They are empowered
by legislation to visit specified facilities, to make
enquiries of residents and staff and examine
selected documentation in relation to the care of
people residing at the facilities. Community Visitors
usually make unannounced visits and visit in teams
of two or more.
At the conclusion of each visit, the Community
Visitors prepare a report summarising the findings
and indicating items where action is required. A copy
of the report is provided to the most senior staff
member at the facility or the proprietor in the case
of an SRS.
10
Total5104
Figure 2: Number of Community Visitor visits made 11/12
Stream
Numbers 11/12
Mental Health
66
Disability Services
215
Health Services
79
Total360
Figure 3: Total number of Community Visitors by stream 11/12
Reporting Regions
Barwon-South Western
Eastern Metropolitan
Gippsland
Grampians
Hume
Loddon Mallee
North and West Metropolitan
Southern Metropolitan
Barwon-South Western
Hume
The Barwon-South Western Region extends
from Geelong and Queenscliff in the east to the
South Australian border. The region contains
nine Local Government Areas.
The Hume Region extends over 40,000 square
kilometres of provincial northeast Victoria. The
region contains 12 Local Government Areas.
It includes Victoria’s alpine areas, some
relatively remote farming communities and
the major regional centres of Wodonga,
Wangaratta and Shepparton.
Eastern Metropolitan
The Eastern Metropolitan Region includes inner
suburbs such as Kew and Hawthorn, large
outer metropolitan suburbs such as Ringwood
and Boronia, and semi-rural townships such as
Healesville and Yarra Junction in the Shire of
Yarra Ranges. The region contains seven Local
Government Areas.
Loddon Mallee
The Loddon Mallee Region is located in the
north-west corner of Victoria. It is the largest
DHS region in geographic area. The region
covers ten Local Government Areas.
Gippsland
North and West Metropolitan
The Gippsland Region stretches along the
east coast of the state and covers 41,538
square kilometres, representing over 18 per
cent of the land mass of Victoria. The region
covers six Local Government Areas.
The North and West Metropolitan Region
covers 14 Local Government Areas. The
region is now the most populous region
in Victoria, encompassing suburbs from
Werribee to Eltham.
Grampians
Southern Metropolitan
The Grampians Region covers an area of
47,980 square kilometres and includes
11 Local Government Areas, stretching from
Ballarat through to the South Australian border.
The Southern Metropolitan Region is made
up of 10 Local Government Areas, ranging
from Stonnington to Frankston and the
Mornington Peninsula.
Community Visitors Annual Report 2012
11
Mental Health
statewide themes and
recommendations
12
Recommendations
Mental Health
The Community Visitors Mental
Health Board recommends that
the State Government:
1.provide adequate levels of funding to health
networks to:
• e
stablish more acute beds in areas with
unmet need to reduce waiting times in
emergency departments, out of areas
transfers and inappropriate discharges
• p
rovide adequate information and support to
all consumers on admission, including people
from culturally and linguistically diverse
backgrounds (CALD)
• e
ffectively renovate and maintain mental
health facilities
2.create more affordable accommodation and
support options to ensure choice and security for
people who have a chronic mental illness, and in
particular for people with a dual disability and/or
complex needs
3.promote the practice of recovery models and
holistic healthcare throughout the mental health
system and enable psychosocial therapeutic
interventions such as counselling services to
be widely available within the public mental
health system
4.address shortfalls in mental health nursing and
allied health staff and establish and maintain a
highly skilled, responsive and sustainable mental
health workforce
5.revise the existing Mental Health Act as soon as
possible with adequate resourcing to enable its
effective implementation to:
• p
rovide service consistent with the
government’s human rights obligations
• e
nable Community Visitors to visit Prevention
and Recovery Centres and respond to visit
requests from other mental health facilities
that provide 24-hour treatment and support
• e
nsure all services document incidents and
Community Visitors are able to access all
incident report records
• e
nsure all consumers have access to
independent advocacy support to attend
Mental Health Review Board hearings and
clinical appointments
6.ensure the National Disability Insurance Scheme
includes people who have an ongoing disability
as a result of a chronic mental illness, dual
disabilities and/or complex care needs
7.ensure the Community Visitors Program has
the resources to effectively meet its legislative
requirements.
Community Visitors Annual Report 2012
13
Mental Health
legal rights/dignity
96
medical care
92
discharge planning
86
maintenance
information provision
Statewide report
treatment plan
75
92
52
86
75
52
68
51
63
49
52
42
52
51
37
49
37
42
Issue types identified
rights re E.C.T.
96
63
medical care
appropriateness discharge planning
This year 66 mental health
for clients
maintenance
personal needs/food
Community Visitors conducted
1359 visits to facilities and safety issues/hazardsinformation provision
treatment plan
identified 948 issues on these
visits.
adequacy of programs appropriateness
for clients
The graphs in this section provide
program staff
personal needs/food
further information about the nature
safety issues/hazards
least restrictive
environment
of these visits and the issues
adequacy of programs
appropriateness
reported. There was an increase
in
of rooms/areas
program staff
smoking
the number of issues reported
in provisions least restrictive28
environment
relation to health issues, discharge assaults appropriateness
27
of rooms/areas
planning, appropriateness of adequacy of beds smoking
provisions
21
facilities and services for clients,
assaults
restraint & seclusion
20
assaults, safety issues, staffing
adequacy of beds
safety procedures
16
issues and restrictive interventions.
restraint & seclusion
security of
On a more positive front, there possessions safety11procedures
facilities
security of
8
was a decrease in the number suitable
offor programs
possessions
facilities
reports related to the adequacy
of process 5suitable
admission
for programs
admission process
programs and maintenance issues.
rights re E.C.T. 5
Issue types identified
68
legal rights/dignity
37
37
28
27
21
20
16
11
8
5
5
numberofofissues
issuesidentified
identified
number
Many of the key issues reported by Mental Health
privacy 4
privacy 4
Community Visitors in previous years remain
unresolved and in need of urgent government illicit drug use 3 illicit drug use 3
action and community investment. The regional
0
20 0
40 20
60
40
6080
80 100
100
reports highlight many good things happening in
number
number
Victorian mental health services. The statewide
Figure 5. Mental Health Streams number and types of issues identified 11/12
Figure 5. Mental Health
Streams number and types of issues identified 11/12
summary has a concentration on the serious issues
of concern noted and areas where there is room for
improvement. This section also highlights some of
Accommodation and bed shortages
the key government initiatives and mental health
Despite the early promise of some new government
board activities undertaken in 2011-12.
initiatives in relation to affordable housing and some
successful pilot programs over the last decade, the
400
options remain very limited throughout the state.
400
350
The lack of accessible accommodation and support
356
350
356
300
options for people with a severe mental illness, dual
300
250
267
disability and/or complex needs often causes people
250
267
200
to remain in hospitals or Community Care Units
200
169
150
(CCU) for longer than they should. In other instances
169
150
100
they are prematurely discharged. Blockages in the
99
100
99
50
system mean that the demands for beds cannot be
57
50
57
0
readily met for people experiencing acute phases
0
visit/
treatment/
amenities/
activities/
least restrictive
of illness. Community Visitors repeatedly report
rights
resources
programs
programs
services
visit/
treatment/
amenities/
activities/
least
restrictive
rights
resources
programs
programs
services
that patients are shunted around between units or
issue groups
issue groups
between inpatient care and short-term leave at home
Figure 4. Mental Health Stream issue groups 11/12
Figure 4. Mental Health Stream issue groups 11/12
or even discharged prematurely. Beds are constantly
juggled on a seeming merry-go-round. These
responses to manage demand frequently mean
mentally ill people may be placed in situations where
14
No. of units
visited
No
Requested
visits
Scheduled
visits
Total
Mental Health stream
Barwon-South
Western
7
6
4
68
72
Eastern
Metropolitan
18
12
33
199
232
Gippsland
6
3
4
66
70
Grampians
8
4
4
86
90
Hume
9
7
2
109
111
Loddon Mallee
6
7
7
51
58
Northern
Metropolitan
20
7
20
213
233
Southern
Metropolitan
27
11
25
185
210
Western
Metropolitan
23
9
18
265
283
124
66
117
1242 1359
Region
Figure 6. Total visits Mental Health Stream 11/12
optimal care can not be provided, but are simply
a place to eat, sleep and receive medication, until
they are discharged to the community so that other
consumers can enter the system.
A shortage of inpatient beds in many hospitals has
serious implications for admissions and waiting
periods in Emergency Departments (ED). Many
services still have large numbers of people who
remain in ED much longer than the national target
of four hours. Lengthy stays in ED appear to be a
problem at a number of hospitals such as Werribee
Mercy and Sunshine Hospital which service areas
experiencing high population growth. In March of
this year, Monash Medical Centre reportedly had
ten mental health patients in ED on one night.
At the Alexander Bayne Centre in Bendigo in June
2012, Community Visitors reported there were eight
patients concurrently in ED. Two of these patients
were reported to remain in ED for more than
24 hours and a third patient was sent home after
23 hours but represented an hour or two later.
People from rural areas who require specialist
services such as eating disorder beds are required
to transfer to services in the city away from friends
and family or be housed inappropriately in their
local area. In the Kerford Unit in the Hume Region,
a 12-year-old child was admitted overnight into
the adult high dependency unit because there was
no other more suitable option available locally.
However, the child was placed in a single room and
constantly monitored. The shortage of affordable
accommodation options and demand for mental
health beds often means that unpaid carers are
relied on to support their family members when
patients are discharged at short notice.
People with a mental illness are also often
discharged to privately operated Supported
Residential Services (SRSs), which are visited by
Community Visitors from the Health Services stream
of the program. SRSs employ staff with limited
formal training who care for up to 80 residents
with disabilities, mental illness or substance abuse
problems. With shared bedrooms and communal
areas, this scenario provides a recipe for disaster.
Reports of serious assaults, self-harm and even
deaths are not uncommon. Although public mental
health services may be reluctant to discharge their
patients to SRSs and unregistered boarding houses,
there are often no other options available.
Discharge planning
Discharge plans with adequate supports are
essential components of the treatment regimen and
should be in place before a person is discharged
back into the community. Without comprehensive
arrangements being provided, the likelihood of the
patient’s mental health and social wellbeing being
negatively impacted is increased. In some instances,
patients have been left hungry and homeless due to
the inappropriate timing of their departure from the
hospital. The constant pressure on beds and staff
means discharge planning for short stay patients is
often done in a rush leaving both patients and carers
to feel marginalised in the process.
There have also been reported cases of suicide by
desperate patients within 48 hours post-discharge
when a breakdown occurred without continuing
support being available (Report into Inpatient Deaths
2008-2010, Office of the Chief Psychiatrist, 2012).
Some patients Community Visitors talk to report
feeling anxious and not ready for discharge back into
their community. This is especially the case when no
reliable support awaits them, or where a guardian
is still to be appointed, or no interpreter has been
provided to explain the procedures to a person of
a CALD background.
In other cases, people are keen to leave acute units
where beds are urgently needed but the shortage
of suitable options prevent them from moving on.
Community Visitors in all metropolitan regions have
reported people being unable to be discharged
Community Visitors Annual Report 2012
15
Mental Health
In one concerning case, an individual with autism
remained in Upton House acute unit in Box Hill for
92 days as no appropriate accommodation could
be found. In another instance, a patient remained in
the Maroondah Hospital acute unit awaiting suitable
accommodation for more than 100 days. Further
data about long-stay patients in mental health
facilities in Victoria is presented later in this report.
Care and Treatment
Serious incidents and assaults
In many regions across the state, Community
Visitors report serious assaults between patients
or between patients and staff. Often these incidents
are managed appropriately, but in some cases the
police have not been notified despite this being
required by hospital policy and guidelines set by the
Chief Psychiatrist. Community Visitors are unable
to access incident reports at most services, so they
typically find out about these events from patients’
family members or other patients calling OPA’s
Advice Service requesting either a visit or advocacy.
OPA sometimes learns of these incidents through
Independent Third Person reports to OPA, when
OPA volunteers are called to police interviews.
Throughout Victoria, Community Visitors report
being unable to obtain documented reports of critical
incidents from mental health facilities. Some regional
health networks provide de-identified summaries of
incidents to Community Visitors on a quarterly basis.
While these are helpful, they are no substitute for
timely access to the detailed records of incidents.
Access to incident reports at the time of visits is
essential for monitoring purposes and to ensure
that the human rights of patients and residents are
upheld. Community Visitors are frustrated that this
issue continues to be a problem across the state
despite extensive discussions over many years with
the Office of the Chief Psychiatrist, the department
and local service managers.
Hospitals say they cannot provide hard copies of
reports or allow Community Visitors online access
to reports because of data security or privacy issues.
The principle that Community Visitors should have
access to incident reports in services they are
legislated to visit is not debated in the other streams
of the program. Community Visitors hope that this
16
issue can be clarified in the new Mental Health Act
if it is not resolved before then.
There have been a number of complaints from
patients about their treatment by police, security
staff, nursing staff or other patients while in hospital.
These include a resident put into seclusion to “cool
off” after throwing hot coffee at a staff member, a
female patient in a wheelchair being held down by
eight police from the tactical response squad and
shackled in order to be taken into hospital, and a
male patient who claimed he was shackled to a bed
for 30 hours after being treated violently by police
and taken to hospital in the back of a police van.
One male patient in the statewide forensic facility
was assaulted by other patients on three occasions
in a month.
There were also allegations of sexual assaults in the
Grampians, Loddon Mallee, Eastern Metropolitan
and North and West Metropolitan Regions (West)
and reports of consensual sexual activity between
patients in acute inpatient units in the North and
West Metropolitan Region (North) and Southern
Metropolitan regions. Patients may be vulnerable
while in a psychotic state to other patients whose
own cognitive functions are simultaneously
compromised so nursing staff need to remain
vigilant to ensure people are safe. In most instances,
Community Visitors report that allegations of assault
and sexual assault have been taken seriously and
investigated appropriately in line with guidelines from
the Chief Psychiatrist and local protocols.
number of
of issues
issues identified
identified
number
because of a lack of suitable accommodation. In
September 2011, Community Visitors reported that
eight clients had been in the adult acute unit at St
Vincent’s Hospital for more than two months and
in May 2012, four people had been in the aged
persons’ acute unit at St Georges Hospital for more
than 50 days.
30
30
25
25
2727
20
20
17
17
15
15
10
10
10
10
55
00
2009-10
2009-10
2010-11
2010-11
2011-12
2011-12
reporting
reportingyear
year
Figure
Figure7.7.Mental
MentalHealth
HealthStream
Streamassaults
assaultsand
andviolence
violence2009-2012
2009-2012
Service charge
A new issue identified by Community Visitors this
year is the issue of fees and charges. Thomas
Embling Hospital, the statewide forensic care facility,
recently started requiring their long-stay involuntary
and forensic patients to pay patient fees. The fee
is 33 per cent of the Disability Support Pension
(approximately $17.81 per day). CCU residents are
also sometimes charged rent or a service fee but
this appears to be inconsistently applied. Thomas
Embling is believed to be the first clinical mental
health service in Victoria to charge a fee. Community
Visitors have been advised that forensic services in
New South Wales have been charging fees for some
time. Community Visitors will watch with interest to
see how the user pays principle is applied elsewhere
in the mental health system. The general prison
population does not pay ‘rent’ during their period
of incarceration so the question remains whether
involuntary patients with a mental illness should be
subject to these fees.
A focus on a mental illness can sometimes result in
other medical conditions being minimised or ignored.
Community Visitors have reported patient and
resident concerns regarding simultaneous medical
conditions like toothaches, hearing problems,
cancer, or heart and respiratory conditions. One
patient, complaining of a raging toothache, waited
more than a week to access a community dental
service. The provision of low-grade pain medication
was inadequate to afford him relief and his daily
request for service took a long while to be met.
Treatment and medical care
Patients and residents commonly experience delays
that create feelings of frustration and dissatisfaction
and this cements the belief that they are regarded
as second-class citizens. These delays include
access to the person’s doctor for a personal
discussion, communication with a social worker
about accommodation or employment needs, and
limited or no provision of counselling services or
psychotherapy sessions with a psychologist. Other
complaints include unexpected postponements
to mental health review board hearings, the lack
of advocacy support, and complaints that night time
nursing staff do not respond to calls promptly. All
of these experiences are disempowering and they
compromise the recovery and rehabilitation
of consumers at a time when they are often
most vulnerable.
Again this year, many mental health consumers
questioned the medications they were prescribed
and the application of electroconvulsive therapy
(ECT). It is essential that the staff discuss and
explain the treatment rationale as many times as
required, given that the patient’s mental state is
likely to be fluid and shifting. In addition ECT and
anti-psychotic drugs can interfere with rational
thinking and memory.
A common complaint concerns side effects of
different drugs particularly when patients and
residents have been taking these medications for
a long time. Most are very aware of the side effects
of different drugs. Occasionally, patients report
the treating doctor dismisses their concerns or is
unavailable for discussions. A common response
is the person refuses to take a particular drug or a
certain method of dispensing and is then judged to
be non-compliant and difficult to manage. This issue
is a common cause of advice calls to OPA. Often
all a Community Visitor can do is advise the person
they are entitled to a second opinion. Sometimes,
Community Visitors work with service providers to
convey a patient’s concerns. This can in turn result
in adherence by a patient once they feel their views
have been heard and taken seriously. Patient anxiety
can be exacerbated when a patient does not have
English as their first language and staff do not seek
out an interpreter to assist.
Community Visitors frequently have cause to
question the adequacy of supports to patients in
adult acute inpatient units and CCUs, especially
when diagnoses involve a dual disability of mental
illness and intellectual disability. Often these patients
find themselves at greater disadvantage as a result
of their intellectual disability. They are sometimes
isolated from the general population as they are
unable to communicate effectively or cope alone
without skilled support. Community Visitors urge
a more collaborative approach between mental
health and disability service providers in order
to gain a greater understanding of an individual’s
support and care needs.
The mental health system can be bewildering to
many consumers and carers and this experience
is intensified for people from a CALD background.
Effort needs to be made throughout the system to
keep people informed and to promote the autonomy
and participation of consumers and their families.
In services where people live for extended periods
of time, opportunities for active participation are
particularly important.
Rehabilitation, education and recreation
opportunities
In residential facilities such as CCUs, Secure
Extended Care Units (SECUs), aged mental health
facilities and in Thomas Embling Hospital, patients
and residents are on extended stays while they
undergo recovery, rehabilitation and retraining or
remain in a locked facility because of a supervision
order. A frequent complaint is that few or no
opportunities for employment or access to education
programs and skills training are available. Where
staff and managers are enthusiastic and farsighted they seek out and support opportunities for
residents. Otherwise, residents complain frequently
about the boredom and onerous nature of their
lives, which can be unstructured and meaningless.
This situation can contribute to excessive smoking,
secondary depression and may trigger aggressive
behaviours resulting in damage or arguments and
fights among residents. Positive collaborations
Community Visitors Annual Report 2012
17
Mental Health
have been reported to occur at a CCU in Frankston,
when some local employers have accepted mental
health residents as employees. With support and
encouragement from staff and employers, residents
have been able to engage in part-time work that has
produced wide-ranging benefits to their self-esteem
and rehabilitation. This joint enterprise model
deserves to be widely replicated.
Staffing
A frequent request made to Community Visitors
is for patients and residents to be able to access
allied health services (activity officers, dieticians,
occupational therapists, psychologists and social
workers). These services experience cutbacks in
times of funding constraints yet they are the services
that can most assist patients and residents to
obtain an enhanced quality of life. Some services
have advertised allied health positions but have
had difficulty recruiting and retaining staff with
appropriate skills and experience.
The turnover of mental health nurses and frequent
use of casual or agency staff was noted in several
parts of the state. This year industrial action was
taken by nurses who were members of the Health
and Community Services Union (HACSU). The
impact of this varied across the state. In some
areas, there were bans in relation to the keeping of
data and documentation. The introduction of some
programs was also reportedly delayed in some
services because of industrial action. However,
overall a minimal impact on patients and residents
was reported by Community Visitors.
Smoking
The implementation of non-smoking policies
in facilities across all regions is a vexed issue.
It remains inconsistently applied. Where a ban
is required by health network policy, this may be
either rigidly enforced or not actively pursued.
Many staff are concerned that prohibition of smoking
may trigger aggressive behaviours in patients and
residents. They believe that it is their role to police
the situation and possibly put themselves or other
patients at risk in the process.
While a common belief is that the provision of
nicotine patches or inhalers and information on the
Quit program will be all that is required, this is a
short-sighted view of what it takes for a long-term
smoker to stop. Importantly, the first step in the
process to change an addictive behaviour is for the
individual to take a determined decision to alter their
practices. This is rarely the position of patients and
residents who are faced with a blanket demand
to cease a lifelong habit.
18
Legal rights and access to information
All regions report instances of patients and residents
feeling that they had not been given adequate
information about their rights as well as the risks
and benefits of various treatment options. Concerns
include lack of explanation about changed status
from voluntary to involuntary patient and the
restrictions to freedom which accompany that; lack
of provision of treatment plans or discharge plans;
lack of explanation about the process to appear
at mental health review board hearings; and a
perceived negative attitude towards consumers
from some service staff. Obtaining information and
appropriate support is a major challenge for people
from CALD backgrounds with limited understanding
of English. While interpreters are generally arranged
for important meetings, these patients can be
isolated for days at time.
Patients and residents have also raised concerns
regarding meals, meal sizes, food choices and
security of their possessions. Requests for soymilk
and vegan food have been reportedly dismissed
by staff and some patients have been expected
to consume foods like pork that contravene their
religious practices. Cultural and dietary requirements
of patients and residents must be considered within
all services and efforts made to respect these
requirements.
Residents in one aged persons’ mental health unit
complained that personal items went missing from
their bedrooms as their bedroom doors were not
locked. Issues related to the storage of possessions
for long-stay patients has also been raised.
Unfortunately, services do not have the capacity to
store possessions so patients sometimes have to
forfeit their possessions or pay for private storage.
Appropriateness of facilities
Building design and gender-sensitivity
issues
Several mental health facilities utilise dated buildings
and stock that do not conform to the standards
expected in the 21st century. While adjustments
may be made, the design can make observation of
patients difficult or compromise patient conditions.
Most services have attempted to implement gender
sensitive guidelines, and to create areas specifically
designated for use by women. However, the existing
design of buildings, the pressure on beds, gender
mix of patients, and staff/client ratios all impact on
the ability of services to manage facilities in a gender
sensitive way.
Maintenance and cleanliness
Government initiatives
Maintenance delays and cleanliness issues continue
to be reported by Community Visitors.
This year, the State Government funded a number
of projects to improve mental health services and
reduce homelessness and ED presentations. These
projects include home-based outreach services
and a pilot program to enable people to enter the
rental market. Funds have also been provided for
the integration of mental health services in North
East Victoria, and an expert taskforce to deliberate
on reforms to eating disorder services. Community
Visitors have reported concerns about the clinical
care received by patients with eating disorders so
this taskforce is welcomed. The government also
announced $18.5 million for a step-down facility
as a result of the Community Visitors work on the
long-stay project.
Some of these issues have serious health and safety
implications such as call bells or lights in courtyards
not working and consumers having to rely on others
to call staff for help.
Other concerns include poor cleaning practices
such as body fluids and rubbish in courtyards and
inoperable public phones. Outdoor areas were
often unable to be used by those in a wheelchair
or present a risk to older residents.
Community Visitors believe that patients and
residents have a right to experience pleasant
and well-kept facilities while residing in care
and for maintenance issues to be dealt with
in a timely manner.
Mental Health Board Activities
This year the Combined Board had three meetings
with parliamentary secretaries. One of these
meetings focussed on mental health issues and
members of the Board discussed their concerns
regarding the pressures in the Victorian mental
health system. In addition, the urgent need for more
safe and affordable accommodation for people with
complex needs was raised including examples from
the coalface. Quarterly meetings with the Chief
Psychiatrist and the department representatives
have also been useful to foster collaborative
relationships, discuss patient and resident
complaints and provide opportunities for enhanced
understanding of the government policy. Work on
the protocol that guides the relationship with
services was progressed.
A forum was established with a range of mental
health advocacy organisations to enable valuable
information exchange and identify common ground
for concerted action.
The Mental Health Board notes the Community
Visitors Program has been inadequately resourced
for many years. A reduction in extra funding to OPA
exacerbated pressures on the volunteer programs.
Volunteers need the support of paid staff to assist in
the recruitment, selection and training of volunteers;
to process and analyse data arising from visits
and to follow-up on serious issues that require
investigation or advocacy. Funding concerns and
the need for government to adequately resource
and support the program is a recurring theme
from previous years that provokes frustration and
dissatisfaction among Community Visitors who give
their own time and lifelong expertise willingly and
unstintingly. Increased funding by government is
urgently required to enable the program to meet its
legislative requirements.
The Report into Inpatient Deaths 2008-2010
prepared by the Office of the Chief Psychiatrist,
which examined how services responded in the
event of unnatural/unexpected or violent death
of mental health inpatients, was also timely
and informative. It was encouraging that 12
of the 15 recommendations were accepted by
government. Community Visitors are heartened
that recommendations were included relating to
additional staff training and enhanced security
procedures.
The Mental Health Act 1986 (the Act) has been
in place for more than 20 years and a major
consultation regarding the new Act commenced in
2008. When consultations regarding changes to the
Act commenced that year, it was envisaged that a
new Act would be introduced to Parliament in 2010.
However, the change of government led to a rethink
of the previous exposure draft, due to the sector’s
critical response to it. Community Visitors welcomed
the opportunity afforded by the current government
to contribute further to this process.
Community Visitors are keen to see a new Mental
Health Act based on human rights principles enacted
as soon as possible. However, Community Visitors
believe it is essential that adequate resourcing is
provided to ensure its effective implementation.
Long-stay project
This year marks the fifth year that Community
Visitors have been collecting information on long-stay
consumers in mental health facilities. Long stays are
identified as more than three months in an adult acute
unit and more than two years in a CCU SECU.
Commencing in 2006-07, the project has seen many
successes. In the 2009-10 budget, the Victorian
State Government funded 50 intensive psychosocial
rehabilitation support packages, some which
Community Visitors Annual Report 2012
19
Mental Health
enabled the discharge of long-stay SECU patients
into the community. In 2010-11, Disability Services
commenced building a purpose built facility to house
long-stay patients from the Austin SECU with dual
disabilities.
Community Visitors are happy to report this year that
the original six patients with dual disabilities at the
Austin identified by Community Visitors in 2007-08,
have been discharged into suitable and supported
accommodation in the community. These people had
a primary diagnosis of intellectual disability and had
lived in a SECU-type setting for between eight and
21 years. The success of the project is a testament
to the willingness of government departments to work
together to secure the human rights of these patients.
Community Visitors are also happy to report success
in another region with a long-term patient with
a dual disability who had lived in an institutional
setting for around 15 years. Disability Services has
provided intensive funding to this individual who
has now been discharged into a suitable home-like
environment where she can participate in the life of
the community.
This year, Community Visitors have identified 72
long-stay patients. The number is slightly lower this
year as Community Visitors did not collect data on
patients in aged adult acute units. These patients
accounted for 22 long-stay cases last year. Some
other patients who Community Visitors know have
spent extended periods in facilities this year, are also
not included in our 2011-12 figures because they
had either transferred to another service or been
discharged to the community just prior to the data
collection period in April to May 2012.
Community Visitors identified 22 long-stay patients
in SECU this year and two patients in the statewide
Brain Disorders Unit, 16 of whom have been in these
environments for four years or more. Most have
been previously identified by Community Visitors.
These patients have multiple and complex needs
– a mental illness combined with acquired brain
injuries, intellectual disability and substance abuse
problems. Community Visitors encourage further
collaboration between the department and DHS, the
provision of more supervised 24-hour care models
and additional individualised funding packages to
secure the transition of more long-stay patients into
the community.
Community Visitors identified 36 long-stay patients
in CCUs and 12 patients in adult acute units. While
some consumers may require this level of support
over the long term to develop or relearn skills for
community living, their long stay has the effect of
blocking entry into much needed beds for other
patients. Community Visitors note that many families
express a desire for their significant other to remain
20
in a CCU setting rather than move. It may be the
case that in the absence of adequately supported
community-based alternatives, that additional CCU
beds are required.
The Mental Health Review Board (MHRB) recently
held a forum for its members and included the issue
of long-stay patients in mental health facilities. The
Public Advocate, Colleen Pearce, spoke at this
forum and is keen to be supporting the MHRB work.
Community Visitors are pleased that their work is
being taken up by other bodies concerned for the
rights of people in mental health facilities.
Regional Reports
Barwon-South Western Region
South West Healthcare and Barwon Health manage
the mental health services in the Barwon-South
Western Region. These services consist of two
adult acute inpatient units, one aged persons mental
health residential unit, two CCUs, one Prevention
and Recovery Care (PARC) and two EDs.
A total of 72 visits were made by seven Community
Visitors. Four of these visits were requested by
consumers and others.
Legal rights and information provision
Four cases occurred where patients requested
attendance of a Community Visitor regarding a
desire to seek a second opinion, how to obtain legal
services or in one case a complaint about lack of
respect and dignity.
Care and treatment
Admission process
ED visits by Community Visitors ceased because in
the Warrnambool Hospital the majority of cases are
admitted directly to the acute ward and do not go
through the ED. In the case of the Geelong Hospital,
Community Visitors obtained data from the ED
regarding mental health patients rather than visiting
the ED personally.
Appropriateness of rooms and areas
Adequacy of programs
The adult acute inpatient unit has created a
female-only corridor as well as a lounge for women.
It has been observed that the Aged Care Mental
Health Residential Facility is very clinical with
little differentiation between wings. This has been
discussed repeatedly with management and it is
accepted by Community Visitors that given the level
of cognition of the residents, sufficient has been
done for the residents’ benefit. The need for shade
cover at the Geelong Hospital in outdoor areas has
been mentioned a number of times and it is still
being considered.
Staff at the Community Rehabilitation Facility
have assisted two of their long-stay residents
to commence gradual re-integration into the
community. Similarly the staff in Ward 9 and the
Extended Inpatient Care Unit at Warrnambool
Hospital should feel very satisfied that success
is imminent with a long-stay patient being
gradually re-integrated into the community.
Appropriateness for clients
Both the Community Rehabilitation Facility, which is
combined with the PARC, and Geelong Hospital have
instituted a sensory modulation room. Work has only
recently commenced at Geelong Hospital, to modify an
existing, unused bathroom into a sensory modulation
room. The final outcome is eagerly awaited.
Case study
A 21-year-old man has frequently been
admitted to several mental health units
throughout the region. The man has
autism and mild intellectual disability and
his local GP suspected a psychotic illness.
His subsequent admission to an adult
acute unit did not support this diagnosis
and his symptoms were considered to be
behavioural in origin. In 2009, the man
was living with his mother and by 2011 he
obtained accommodation within Disability
Accommodation Services where he
remained for one year.
Following a number of violent episodes in
which police and ambulance attended, he
was again transferred to a mental health
unit due to his previous label of psychosis.
He refused to return to his disability
service accommodation so was placed in
an SRS. Police again attended numerous
times so he was sent back to the mental
health acute unit until accommodation
could be found. For a short while, the
man resided with another resident with
a disability in a Department of Housing
residence.
Questions are raised in this case study
about the system’s inability to find suitable
accommodation for a vulnerable individual
with complex needs.
Program staff
A continuing concern is the need for a social worker
appointment at Geelong Hospital. As it has not been
possible to appoint an experienced person, the
position is now being opened up to recent university
graduates in the form of an internship in the hope
that a person will fill this role on an ongoing basis.
Eastern Metropolitan Region
Eastern Health and St Vincent’s Hospital manage
mental health services visited by the Eastern
Metropolitan Region Community Visitors.
The services comprise four adult acute units, two
aged persons’ acute inpatient units, four aged
persons’ mental health residential units, one child
unit and one adolescent inpatient unit, three CCUs,
three EDs and one specialised personality disorder
unit. Twelve Community Visitors conducted a total of
232 visits, 33 of which were requested by consumers
and others.
Legal rights and information provision
The Community Visitors found that patients in acute
adult units often feel that their opinions are being
ignored and even that they are not being treated as
adults. Community Visitors regularly give advice on
avenues for seeking a second opinion or asking for
a MHRB hearing. Recently a consumer consultant
was appointed to Normanby House who will provide
advocacy support to the patients there.
Care and treatment
Assaults
Community Visitors have heard of alleged assaults
this year in all units both by consumers on staff,
staff on consumers and consumers on others. All
incidents were handled well by staff and one aged
care acute unit is seeking to modify the environment
to better contain difficult behaviour. Community
Visitors had several call outs regarding alleged
sexual assaults, again these were handled well
by staff.
Community Visitors Annual Report 2012
21
Mental Health
Good Practice
Appropriateness of rooms/areas
A woman admitted to Maroondah Hospital had a
heightened fear of sexual assault as a result of her
mental illness. Staff worked with her and her family
to ascertain the best approach for her and what
level of supervision and observation she was most
comfortable with. She was accommodated in the
women’s only corridor and her stay at the hospital
passed without incident.
New security provisions are being implemented
at St Vincent’s Hospital and Normanby House
particularly regarding safety after hours.
There was an incident at the Peter James Centre in
the acute ward where one patient is alleged to have
assaulted another. The family of the man assaulted
were very upset at the perceived lack of supervision
and shortage of staff. Both men involved in the
incident are sufferers of dementia with behaviours
that are difficult to manage. It was difficult therefore
to ascertain all the facts.
The Peter James Centre was one of the first
hospitals to be built after the closure of the
institution, Willsmere, and the needs of the clientele
have changed over time. There is an increase in
consumers suffering from dementia and the corridors
on the ward are hard to supervise adequately. There
are plans now to adapt a bathroom at the head of
one of these corridors to a nurses’ office that should
make management easier.
Adequacy of beds
All adult acute units have experienced difficulty
in accessing SECU beds for patients needing
specialised care. There have been delays of many
months before a bed is available. EDs in Eastern
Health have on occasion not been able to find
beds for patients needing admission to acute
inpatient wards.
Discharge planning
There continues to be long delays while patients
wait for suitable accommodation before discharge.
Difficulty finding employment is also a factor in
delayed discharge from CCUs. Patients in the
specialist unit are concerned that community support
services in regional areas have difficulty in meeting
their needs in some circumstances. St Vincent’s ED
has started a program of mental health enhanced
triage where patients discharged home after
presenting to ED are followed up to ensure referrals
to other services have been acted on.
Upton House has renovated the adult acute unit
to incorporate gender specific areas such as a
separate courtyard and are planning a gender
specific bathroom in the High Dependency Unit.
St Vincent’s are converting a corridor into a female
only area. Unfortunately, the women’s areas at
Maroondah Hospital are often unlocked as the
swipe cards are lost.
Patients and residents with a dual disability needing
treatment can have great difficulty settling into an
acute unit as it cannot meet their particular needs.
This was a traumatic experience for one person
admitted to Upton House. One acute aged care unit
is investigating ways to modify the environment to
cope with disruptive or aggressive behaviours.
Following an incident in the garden area of the
adolescent unit, young people must now be
supervised while outside. Staff find it difficult to
free people for this duty and modifications to allow
for better observation have not yet happened.
Community Visitors have many discussions with
management over this unacceptable situation.
On the positive side, a mural created in cooperation
with a community group has brightened the
area considerably.
One aged care residential unit with old infrastructure
has renovated the area to provide a more home-like
environment. There is new lounge furniture
and televisions positioned to allow for better viewing
and there are also more activities available.
Personal needs
Community Visitors have noted that patients in the
aged care acute unit at the Peter James Centre
often wear pyjamas throughout the day. Carers have
not brought in sufficient clothing and laundry facilities
are limited. Washing machines at St Vincent’s have
often been out of action and there have been long
delays before new machines were installed. One
adult acute unit has a supply of donated clothing
available for those in need.
Least restrictive environment
The level of aggressive behaviours and the risk
of absconding are reasons given for units being
so often locked despite an open ward policy.
The CCUs report an increase in the acuity level
of consumers being admitted and who, therefore,
need a higher level of care.
22
Maintenance
There are often long and frustrating delays in
getting repairs attended to but all matters reported
for attention are now completed.
Refurbishment that requires painting or furniture
renewal is an ongoing issue. Several units have
been able to achieve much this year to meet
this need.
Gippsland Region
Rehabilitation, educational and recreational
opportunities
A lack of educational and recreational opportunities
was of concern for most of the year with the
responsible staff member, a recreational worker,
absent on sick leave for an extended period.
Community Visitors were advised that during June
2012 this staff member returned to duties and there
was the appointment of an occupational therapist.
Hopefully, some enjoyable recreation activities will
be added to existing programs.
The Latrobe Regional Hospital manages the mental
health services in the Gippsland Region.
Community Visitors were greeted pleasantly on each
visit and co-operation by staff and management
in dealing with enquiries and resolving issues of
a minor nature was appreciated.
These services consist of one adult acute inpatient
unit, one SECU, one aged persons inpatient mental
health unit, one adolescent inpatient unit, one CCU
and one ED.
Grampians Region
A total of 70 visits were made by three Community
Visitors. Four of these visits were requested by
consumers and others.
Legal rights and information provision
Generally, legal rights and information provision
were not an issue, with no concerns expressed
by patients or residents.
Care and treatment
No complaints were received from patients on
their care and treatment but a continuing shortage
of available beds made management difficult,
as patients were often discharged earlier than
desirable. Re-admission numbers within 28 days
were high during some periods of the year as a
direct result of the rapid turnover.
There are ongoing issues with a shortage of housing
in the region and this was exacerbated with the
closure of a caravan park this year. People trying
to access medical practitioners after discharge
faced a three to four week wait for appointments
in some areas.
On a positive note, consumers and carers are invited
to participate in a range of committees including
clinical governance and clinical risk.
Appropriateness of rooms and areas
The standards of the facilities are appropriate
although maintenance issues arose several times,
and continual requests to have graffiti removed from
courtyard walls have not been attended to.
Ballarat Health Services manage the Grampians
Region mental health services. The services located
in Ballarat consist of one adult acute unit, one aged
persons acute inpatient unit, one-aged persons
mental health residential unit, one CCU, one SECU
and one ED. There are also six funded mental
health beds for aged care in two nursing homes
located in Stawell and Nhill, managed by Stawell
Regional Health and Wimmera Health respectively.
Ninety visits were undertaken to these facilities by
five Community Visitors, of which four visits were
requested by patients and residents. Patient/resident
visit requests have been actioned within a 24-hour
response time.
Regular meetings are held every three months with
hospital management who are very supportive of the
Community Visitor role and actively respond to local
issues raised in a timely manner. The meetings are
informative and outcomes are positive.
Accommodation, treatment and
appropriateness of facilities
The lack of housing options is an ongoing issue
at the CCU when residents are ready to move
back into the community. There are difficulties
experienced in locating suitable housing and long
waiting periods before being offered accommodation
through the Office of Housing. At times, this delays
a person’s return to the community and may affect
their wellbeing and treatment plans.
A smoking policy has been a persistent issue,
particularly at Eastern View CCU where staff attempt
to enforce the policy but with limited success. An
accumulation of butts has been exposed at the
perimeter of the facility. At the time of Community
Visitors’ visits residents have been sighted openly
Community Visitors Annual Report 2012
23
Mental Health
smoking on their verandas or in the grounds, with
butts often discarded into the shrubbery creating
a fire risk. Patients and residents know the smoking
policy is in place and signs are displayed. A call
to OPA’s Advice Service was received regarding
the smoking issue at the adult acute unit. The
patient only wanted the Community Visitor to obtain
permission for her to go outside for a cigarette,
which was denied. No other issue was discussed.
Upgrading the facilities in the time out or seclusion
area is long overdue and plans are underway to
improve this area.
The aged care residential unit provides a very
caring environment with a wide variety of innovative
outings, activities and interests for the residents
with volunteers both young and old supporting the
programs. This gives residents one-on-one time with
a visitor showing a personal interest in them, while it
frees up staff time.
The kitchen, and lounge area of the unit have been
recently upgraded with fresh paint, new curtains and
a television provided by the Womens’ Auxilliary. Life
stories of residents are displayed in attractive frames
and provide a great source for a chat. Community
Visitors often receive positive comments from
residents’ families regarding the care provided to
their loved ones and there is opportunity for them
to have input at the regular unit meetings.
Iona House in Nhill seldom has vacancies and the
six funded beds are fully utilised. There is a high
standard of care provided. Community Visitors
have continuing concerns regarding the delay in
the provision of a set of special scales necessary to
weigh a resident needing regular dialysis. A request
was submitted last year but the scales have not yet
been purchased.
The Macpherson Smith Nursing Home in Stawell has
been unable to fill most of the six funded beds with
mental health residents and an average of only two
or three residents are visited by Community Visitors.
These people appear well cared for and settled in
this environment.
Access to incident reports
Community Visitors express concern at the lack of
current incident reports being provided on request
at the time of visits to all units. This is part of the
Community Visitors’ role but little information is given
on enquiry. Reports made available in this region
are limited in content and are received two or three
months after the event when the resident has often
been discharged and the file is unavailable.
24
Gender sensitivity
The SECU unit consists of 12 beds with a
predominately male population, and at times,
with disturbed residents, it becomes volatile.
On occasions, hospital security is called on for
assistance. For the past few months there have
only been two females, and in recent weeks only
one female in this unit. At times, there have
been two sittings in the dining room to alleviate
safety concerns.
Community Visitors express continuing concern
about the vulnerability and safety of female
residents. This has been a reoccurring problem
reported over recent years, which is constantly
raised with staff, as there is no separate women’s
area or lounge available. Community Visitors have
been told there is no funding available to redevelop
the unit, which is long overdue for an upgrade.
It is pleasing to report that the adult acute unit
now has a user-friendly women’s lounge, tastefully
furnished, and also used for visiting purposes.
Adequate activities are also provided to occupy
younger children who visit the facility. External doors
are locked at all times in this unit.
There were initial issues of concern to Community
Visitors with the access door being locked and
residents having to request use of the lounge. One
resident indicated she was too frightened to use the
lounge and others stated they were unaware the
lounge existed. There is now a notice on the door,
but the location is isolated from the nurses’ station,
and needs to be physically monitored for safety and
security purposes, as there is no CCTV to this area.
Hume Region
Goulburn Valley Health, Beechworth Health Service,
North East Health and Albury Wodonga Health
Services manage Hume Region mental health
services.
The visited services comprise two adult acute units,
one-aged persons’ acute inpatient unit, two aged
persons’ mental health residential units, two CCUs
and two EDs.
Seven Community Visitors conducted a total of
111 visits. Two of these were requested by a patient
or resident.
Legal rights and information provision
Community Visitors reported positively on the
provision of information and supports to staff and
residents on the passing of a staff member at the
Benambra CCU. This was handled in a considered
and respectful manner.
Documented evidence of incidents was not made
available to Community Visitors at the time of their
visit for a large part of the year. This has improved
recently with some mental health service providers,
Blackwood aged persons unit, Kerferd adult acute
inpatient unit, and the Willows CCU, so Community
Visitors are encouraged by this.
Patients and residents often voice their concern
to Community Visitors about their legal rights,
treatment, medication and discharge planning from
the facility because of either misunderstanding or
being unclear of the information initially provided
to them by staff.
Care and treatment
After initial concerns regarding the potential loss
of aged persons’ acute beds at the Rosewood Unit
and the impact of renovations on the Grutzner Unit,
it is very pleasing to report that renovations were
completed with no impact to the support and care of
patients and no patients having to move. No beds
were lost in the renovation.
Community Visitors note an increase in the number
of people with high needs dementia and young
adolescents being specialled in the Wanyarra adult
acute unit and the Kerferd adult acute unit resulting
in additional pressures on existing staff and budgets.
Community Visitors report positively an increase in
mental health services from two to four hours per
fortnight at the Grutzner aged persons’ mental health
unit. A further increase in available hours may be
of benefit to residents.
Standard and appropriateness of facilities
Community Visitors note an increase in admissions
to the Wanyarra and Kerferd adult inpatient unit
of not only drug and alcohol affected people but
also young adolescents. As there appears to be a
lack of appropriate short-term support options for
these people, there should be greater consideration
of professional services and support options in
this area. Community Visitors are concerned that
there appears to be few community based allied
mental health services to minimise readmissions.
Readmissions place additional pressures on the
availability of inpatient beds.
SECU funding for long-term residents has been
well received and resulted in more appropriate
accommodation and support services. This has been
to the benefit of two residents from the Willows and
one resident from Kerferd being more appropriately
accommodated and supported. Community Visitors
look forward to other eligible residents being
considered and supported in a similar manner.
After reporting vacancies at some facilities,
Community Visitors now report improved occupancy
rates at Blackwood and the Willows.
The generous donation of significant funds to the
Gruztner aged mental health residential unit from
a local community club enabled a new family room
area to be provided for visitors.
Smoking provisions
The implementation of a consistent approach to
considering the non-smoking policy and impact
on patients and residents deprived of liberty and
freedom of movement continues to be an ongoing
concern with few positive solutions in sight. Some
residents are subjected to negative community
bias as a result of having to smoke in front of the
Wanyarra adult acute inpatient unit. The area
remains littered with drink containers and cigarette
butts adding to the overall shabby presentation on
entering the facility. There are no protected areas
for residents to smoke at this unit so people are
exposed to the elements.
Maintenance
New furniture was eventually provided at the
Grutzner Unit to replace old and tattered chairs
and meet OH&S requirements of staff supporting
residents sitting down and getting out of their chairs.
New televisions have replaced the old analogue sets
in all services. Damage caused by residents appears
to be quickly addressed and rectified. However,
Community Visitors regularly report lengthy delays in
repairs and fault rectification at Wanyarra, the adult
acute unit in Shepparton. Matters such as painting
of marked and scuffed walls; graffiti removal;
cleaning of floors and whitegoods; rubbish removal
including cigarette butts, coffee cups, soft drinks
bottles and repair/replacement of a clothes dryer
are often reported. Delays in repairing or replacing
air conditioners at the Gruztner and Blackwood Units
have now been addressed. Repairs to a toilet at the
Blackwood Unit, which was damaged after
a resident’s fall, have now occurred.
As a result of a federal accreditation review, the
laundry at Gruztner, the aged persons’ mental health
unit, was earmarked for upgrade. However, this has
not occurred as yet because of financial constraints.
Recent rain damage to carpets and ceilings from
a water overflow was rectified very quickly and
positively at the Willows CCU.
Safety issues/hazards
Community Visitors noted staff at the Kerferd
Unit found a knife in the high dependency unit.
Fortunately, nobody was injured prior to its removal.
Community Visitors Annual Report 2012
25
Mental Health
Community Visitors were issued personal alarm
devices for the first time after an upgrade to the
emergency response system at the Wanyarra Unit.
Although little information was provided as to why
this was now required of Community Visitors this
appeared to be in their best interests and is regularly
provided and worn when visiting this unit.
One-off funding from the Commonwealth
Government to provide support and advice training
in sexual health was welcomed for all residents at
the Gruztner aged mental health unit.
Rehabilitation, educational and recreational
opportunities
Community Visitors noted an incentive was provided
to residents at the Willows Unit to attend activities
with an allowance each month for participation.
While initially the activities officer was unaware
of this, this issue was clarified and remedied very
positively.
Activities and opportunities are wide and varied
when staff are available to coordinate and support
residents undertaking activities. For example, trips
to Queenscliff and other outings such as meals
and coffee at local venues, attending football
matches, ANZAC parades and in-house activities
like vegetable gardens, indoor bowls, billiards, daily
walks and a one-off ‘clowning around’ activity have
been organised.
With the unfortunate passing of a resident who
was supported independently long-term in a threebed unit, the Willows now plans to use this unit for
varied day activities for the benefit of the remaining
residents. This is a positive resolution to ongoing
discussions regarding a ‘Green Shed’ option for
on-site resident activities. Community Visitors
also support this facility being used for on-site
consultations as an alternative to residents having
to travel off site for appointments or assessments.
Community Visitors have regularly reported on the
fluctuating workforce among occupational therapists,
activity officers, nurse unit managers and other
staff positions. Clearer communication about some
aspects of staffing would minimise Community
Visitor confusion in this area. Currently management
and the union are negotiating their Enterprise
Bargaining Agreement and staff have taken some
industrial action. Community Visitors hope there
will be little to no impact on the direct care and
supports to patients and residents while this
is being negotiated.
Loddon Mallee Region
Bendigo Health and Ramsay Health Services
manage the Loddon Mallee Region mental health
services located in Bendigo and Mildura.
The services visited comprise two adult acute units,
one aged persons’ acute inpatient unit, one aged
persons’ mental health residential unit, one CCU,
one SECU and one ED.
Seven Community Visitors conducted a total of
58 visits and seven visits were directly requested
by residents and others via OPA’s Advice Service.
Legal rights and information provision
Community Visitors believe that non-provision
of incident reports adversely affects patient and
resident protections. The reason most often given
for restricting Community Visitor access to reports
is that the Riskman information technology system
used does not provide sufficient privacy protections
for staff. This situation hinders adequate enquiry
following consumer reports of incidents, or when
Community Visitors wish to review incidents, which
have previously, or are currently, affecting patient
and resident care. Consideration of the use of staff
ID numbers on Riskman may mitigate concerns
regarding staff confidentiality.
Community Visitors have reported several times that
the Community Visitor notice is not displayed for
patients at the Alexander Bayne Centre acute unit.
Care and treatment
On occasions, patients have been required to stay
much longer than the targeted time of four hours
while waiting for bed availability at the adult acute
unit. In June of this year, Community Visitors noted
that two of eight patients in the ED one weekend had
spent over 24 hours there and a third patient was
sent home after 23 hours but represented an hour or
two later. Treatment plans are not routinely provided
to patients in a timely manner at the adult acute unit.
When there is no alternative, patients less than
16 years of age may be required to stay in the
adult acute unit. Should this be necessary, they are
admitted to a single room and monitored individually.
Another patient was also concerned about the length
of time he spent in the high needs area of the same
unit. At that time, he had been in high needs area
for nine days.
The lack of suitable and affordable rental properties
and government housing available to people with
a mental health illness remains a huge concern
26
and needs addressing urgently. Many patients
are staying in CCUs much longer than is required
making badly needed beds unavailable.
Health Services Community Visitors spoke to
someone who had been a mental health patient who
was now living in an SRS after spending some time
in a SECU. The resident said he was too young to
be in the SRS, did not fit in and would like to find
a rental property. Some months later, this resident
was told he was to be evicted and given two weeks
to find somewhere else to live. The proprietor of the
SRS told Community Visitors that he would most
likely have to live in a caravan park. This patient
requires stable housing with a caring environment,
anything less would have a severe impact on his
mental and physical health. A permanent caseworker
needs to be provided to this person to protect them
from becoming lost in the system.
management and an investigation took place with
the involvement of an advocate. However, as the
incident was alleged to have occurred some months
previously, and the patient who has an ABI was
confused about the dates and details of the alleged
assault, the matter was not pursued any further.
Standard and appropriateness
of facilities
Appropriateness of rooms/areas
Case study
The adult acute inpatient and SECU both provide
gender sensitive care with separate wards and
both mixed and separate lounge areas. Sometimes
women were allocated a room in the men’s section
of the acute inpatient unit due to ‘logistics’. While this
was undesirable, when it was necessary, the room
allocated was in ‘line of sight’ and closest to the
office for added security.
One consumer was in the high needs
area of an acute unit for a period of
117 days. Management said she had
assaulted several staff during this period.
The consumer said she attacked a nurse
due to frustration following “too many
questions”. Incident reports were not
available to Community Visitors. The
consumer was eventually accommodated
at the SECU.
The aged persons’ mental health residential unit
provides separate wards for men and women,
separate and shared lounges, and shared outdoor
areas. The non-gender specific outdoor area
provides the perfect setting for combined activities
such as themed activities and meals provided on
Australia Day and other occasions. In the SECU,
separate wards and both mixed and separate lounge
areas are provided. A new separate outdoor area
was also added in 2011-12 for residents to spend
time individually with family and friends.
Assaults
The aged persons’ acute inpatient unit provides
separate bedrooms opening onto shared lounge and
outdoor areas. For the most part, designated gender
specific areas were being used appropriately.
Four assaults have been reported, including one
in the last case study.
Smoking provisions
One incident was between two patients and required
a medical check, occupational therapist advice and
X-rays for one of them. Police were called by staff,
but did not attend. The unit manager advised the
injured patient that she could phone police herself
if she wished.
A patient reported a sexual assault to Community
Visitors and this was reported to management.
The incident report was unavailable to Community
Visitors. The patient had a long history of making
accusations against others, decided she did not want
the matter pursued and has now been discharged.
A patient told Community Visitors he had observed
another patient dragged into the high dependency
unit by staff, following an incident in the courtyard.
After the patient concerned confirmed the allegation,
Community Visitors reported the matter to
Despite research outlining the benefits to mental
health patients who quit smoking while in hospital,
patients who initially enter the high dependency
unit may gain more from being allowed to smoke
in that area. Since a non-smoking policy was
implemented staff reported increased agitation and
stress to patients. When admitted, patients who are
smokers not only need to adjust to treatment for
their medical condition, but simultaneously to the
effects of withdrawal from nicotine. While patches
may be prescribed, benefits are not immediate and
not a replacement for smoking in the short-term.
Some patients are also aware that, when on the
open ward, smoking is permitted in the attached
courtyard. Many patients, residents and staff believe
denying access to cigarettes is an infringement
of consumers’ human rights; however, four staff
members have expressed a wish that the smoking
ban is maintained. A fire in the unit was also reported
Community Visitors Annual Report 2012
27
Mental Health
recently when a patient brought a lighter into the
high dependency unit.
While consideration of the rights and needs of
non-smoking patients/residents and staff is of equal
importance, it may in the short-term be possible to
monitor smokers who are well enough to smoke in
the high dependency courtyard by using targeted
rostering of staff in this area. Meanwhile, as plans
are being drawn up for the new hospital acute ward,
careful consideration should be given to planning
for safe smoking areas in the new high dependency
unit. There would be a need to consider ‘air curtain’
doorways or specially designed smoking booths and
other measures to ensure the safety and wellbeing
of both patients/residents and staff.
Appropriateness of rooms/areas
In the acute inpatient unit, new lounge furniture
and dining tables and chairs and new floor coverings
have made a tangible difference to the comfort
and wellbeing of patients. New furniture and floor
coverings have been provided in the ECT waiting
area. A total of $36,000 to $38,000 has been
made available for a safety audit of the adult acute
inpatient and the secure extended care units.
Ashtrays are still required for the courtyard area of
the adult acute unit. It is currently littered with butts,
and requires more regular cleaning until these are
provided. High cleaning of cobwebs from under
the eaves and also cleaning of outside windows
to the men’s lounge area would also provide more
agreeable surroundings for patients.
Patients in the high dependency unit have benefited
from the provision of new couches, however, when
the unit is at capacity there is still seating room only
for four instead of five. The dining table-bench unit
was also replaced during 2011-12, but patients and
staff are dissatisfied with it. It is made of stainless
steel and is an immovable combination design.
However, it does not provide back support or allow
patients to place their feet on the floor or reach the
table when eating or reading the paper. Patients are
uncomfortable when eating or reading and, in some
cases, their circulation is cut causing pain in their
legs. The table-bench combination lacks ergonomic
design, and has been described by patients and staff
as looking aesthetically unpleasing. It urgently needs
replacement with a more appropriate table/bench
combination or breakfast bar/stool arrangement.
Toilet seats would enhance comfort and safety of
patients in the high dependency unit. Currently, the
toilet is being shared by both men and women; it is
in the same room as the shower and is often wet,
either from the shower or urine.
28
The adult acute unit at Mildura had been given a
grant of $60,000 to assist clinical staff to improve
service delivery to patients in remote areas through
the use of ipads and modern technology.
Staffing
In June, a patient in the adult acute inpatient unit
in Mildura reported to Community Visitors that they
were are unable to access a psychiatrist from Friday
to Monday.
There was some staff disruption during work
bans for better staff/patient ratios and remuneration.
Effects on patients have included that nursing
staff will not make toast for breakfast or enter
patient data.
Staff at the aged persons’ acute inpatient unit, feel
that staff numbers are limited. Two staff members
said that they felt “stressed and battered” and were
worried that the situation could not lead to good
outcomes for patients, and paperwork was not
being done. The staff had worked at the unit for
many years.
At the SECU, nursing staff are required to attend to
patient meals as there is no kitchen staff. Meals are
delivered in foil packs, with some fresh food added,
and then re-heated in a household-size oven taking
considerable time. Nurses have been told they may
not use the on-site commercial oven, due to lack of
training. The task of meal preparation consequently
takes more time and when emergency situations
arise, as is quite common in the SECU setting, other
patients meals are delayed and safety of meals is
not ensured. Patients and staff are concerned with
the quality of the food and say it is degrading to be
served all their meals from these foil packs. One
patient also missed her usual, planned activity time
due to staff being needed in the kitchen.
The new pathology team for Bendigo Hospital now
sends staff to take blood tests from patients at the
Alexander Bayne Centre (the acute unit in Bendigo)
and this will free up nurse time. More courses are
also being offered to nurses on trauma-based care,
which aim to enhance the already high standard of
care offered to patients.
Rehabilitation, educational and recreational
opportunities
Art therapy provided for patients at the acute unit
is proving to be a very valuable aid to recovery for
a number of patients. The therapist making the
difference here should be congratulated for her
dedication to this program. A new exercise bike has
also recently been installed at the adult acute unit
Good practice
Staff at the aged persons’ mental health residential
unit should be congratulated on the initiative shown
in producing ‘story boards’ which are displayed
on the walls of patient rooms and are compiled
in co-operation with families. The storyboards
comprise a written and photographic ‘life story’ which
provides all staff with a quick reference tool, and
greatly enhances staff ability to communicate with
consumers. One family said they were extremely
pleased with the level of care at this particular unit,
especially in relation to the respect and dignity
shown to consumers at all times.
Legal rights and information provision
Information provision
Community Visitors report consistent good practice
across all units in the provision on noticeboards of
timely, up-to-date and relevant information on patient
rights, complaints procedures, contact numbers for
Victoria Legal Aid, the Community Visitors Program,
other advocacy and support organisations, recovery
and treatment information, and weekly and daily
program activities. Information displays make
increasing use of colour and graphical presentations
for effective communication.
Cultural and Linguistic Diversity (CALD)
North and West Metropolitan Region
(North)
Austin Health, Northern Area Mental Health Service
(NAMHS) and Forensicare manage the mental
health services in the region.
Austin Health manages a mother and baby unit, an
adult acute inpatient unit, a SECU, a child unit and
an adolescent unit, a specialist brain disorder unit,
a specialist veterans post traumatic stress disorder
unit, and an ED.
NAMHS manages two adult acute inpatient units
located in the Northern Hospital, a CCU, an aged
persons’ mental health residential unit and an aged
persons’ acute inpatient unit. An ED is also located
at the Northern Hospital.
Forensicare manages the Thomas Embling Hospital,
a seven-unit forensic mental health hospital. This
hospital is reported separately in this section
because of the unique nature of forensic mental
health care.
A total of 233 visits were made by seven Community
Visitors. Twenty of these visits were requested by
consumers and others.
Melbourne’s multicultural community and the cultural
and linguistic diversity that follows is reflected in the
patient population in mental health units. Diversity
of language is a challenge to the immediacy of
effective treatment. While the Victorian Government
interpreter service is available and is used, hospital
staff increasingly reflect the wider cultural and
language mix of our community. In particular, some
Northern Hospital staff who are Arabic speakers
have provided timely assistance to patients of that
culture. The general community in the Northern
Hospital area contains a strong Arabic cultural
presence.
Legal rights/dignity
A number of complaints and questions were
made by patients in acute units challenging their
involuntary status. Most of these complaints were
made in the very early stages of the patients’
admission to hospital when they were often seriously
ill and confused. On occasion this confusion was
exacerbated by the transfer of the patient from
one hospital to another as part of the day-to-day
operational bed management that occurs as unit
staff balance cross-regional bed demand with
availability.
In all instances, Community Visitors referred the
complaints or questions to hospital staff and were
able to ensure that patient requests for second
opinions were properly addressed and that patients
were updated on their legal and medical situation.
Community Visitors Annual Report 2012
29
Mental Health
Mental Health Review Board (MHRB)
Case study
Community Visitors were contacted by the
parents of a patient in the Brain Disorder
Unit expressing their concern about a
MHRB direction to arrange the discharge
of their son who had been a long-term
patient. The patient’s brain disorder had
been as a result of an accident some
20 years earlier. The disorder had resulted
in a long history of inappropriate and
offensive behaviour towards women.
The parents were concerned about the
high likelihood of continuing offences
on discharge.
The Public Advocate became involved
through the guardianship role, and
the clinicians at the hospital were also
concerned so an appeal to the MHRB
was organised. The outcome was an
adjustment to the MHRB direction so that
the unit increased the number and degree
of community familiarisation exposures,
escorted and then unescorted, with a
further review in three months time.
The purpose of this case study is to
note that balancing patients’ rights
and community safety is a difficult task
where there is mental impairment and a
propensity to offend. While there is no
easy answer to such cases, Community
Visitors note that there was an appeal
process, relevant clinical, community
safety and human rights concerns were
addressed, and an outcome negotiated
that responded to these factors.
Care and treatment
Admission process
Initial admissions to acute units generally come
via the EDs of the hospitals or by direct transfer
between different mental health units as part of
balancing the demand and supply of available
beds. Government standards set an 80 per cent
compliance rate with a target of four hours from
admission at EDs to transfer to a mental health
bed. This is a significant increase over the former
30
standard of eight hours. Overall, the region is
generally performing at a 40-50 per cent compliance
rate with the four-hour standard. In part, this is
caused by bed availability. At the Austin, the delay
is exacerbated by the geographic distance between
the ED and the acute unit and the regulatory
requirement for such moves to be made in a fully
equipped and serviced ambulance.
Medical care
Community Visitors have responded to a number of
patients with concerns about their medication, their
involuntary status, their desire for a second opinion
or about their general health.
All of these concerns were referred to the primary
nurses or shift leaders and Community Visitors
often observed the nurses going immediately to the
patient to commence follow-up on the issue.
Hospital transfers and complaints
Case study
A patient was transferred from another
hospital and admitted to Austin Acute
Adult Inpatient Unit as an involuntary
patient. The patient submitted a series
of complaints about his treatment in the
previous hospital, about his status as an
involuntary patient and about a number
of patient management practices. The
patient was articulate, well-versed in the
mental health system, and very aware of
his rights. Community Visitors discussed
the patient’s issues in a long interview
with him, were assured he was aware of
the complaints procedures and advocacy
organisations available, and referred his
issues to the unit manager.
The manager responded in detail and in
writing. The patient recovered enough
to be discharged within a couple of
weeks. He was separately pursuing his
complaints against the previous hospital.
Community Visitors mention this incident
as an example of the difficulties that can
arise when patients are moved between
hospitals.
Long stays – Discharge
Smoking provisions
Community Visitors are concerned about the number
of hospitalised patients who are ready for discharge
but for whom no appropriate accommodation can be
found in the general community. In a practical sense,
this ties up beds that would otherwise be available
but in a more profound sense, it limits the person’s
enjoyment of life. Two patients with acquired brain
injury (ABI) who are long-stay patients, one over
20 years and one over three years, have recently
completed rehabilitation programs. They are
assessed as suitable for discharge to ‘suitable
supported accommodation’, however, the search
for such accommodation is continuing.
Smoking continues to be variously managed in
acute units. There are blanket bans on smoking on
hospital property. These are strictly enforced in some
units to the extent that escorting duties off-site for
an arbitrarily limited number of cigarettes a day are
loaded onto staff duties. In other units where garden
areas or external courtyards are available, smoking
by patients continues unabated and there is tacit
acceptance at operational levels. Community Visitors
observe that smoking is consistently claimed by
patients to have a calming effect and that attempts
to forcibly restrict smoking adds to their level
of agitation.
In one specific case, a CCU patient who is ready
and willing for discharge, is unable to find
appropriate accommodation in regional Victoria.
OPA has become involved in a guardianship role.
The case is ongoing.
Standard and appropriateness
of facilities
Appropriateness of rooms/areas
Assaults
While incidents were appropriately entered on
patient records, aggregated statistics on assaults
were not available due to the industrial action by
mental health nurses.
Rehabilitation, educational and
recreational opportunities
The basic structure of facilities provided are sound.
The acute adult inpatient unit, mothers and babies
unit, SECU, ABI and veterans units are all purpose
designed, make good use of natural light, and
include specific activities and counselling rooms.
Most units have courtyard or garden facilities
included in the design and these are generally well
maintained. The child and adolescent unit has a
primary school on-site and an excellent playground.
Adequacy of programs
No separate female units are available. However,
bedroom allocation is managed to co-locate the
female patients in specific room areas. Community
Visitors note that NAMHS is investigating the
practicality of a ‘women only’ room with TV and other
facilities in their acute units.
Patient advocacy – consumer consultants
Community Visitors are concerned at the standard
of decor in the common rooms in the SECU. The
main common room, while bright with natural light
and with high ceilings, presents an austere and
stark appearance. There is little colour and no soft
furnishing to moderate noise, so it lacks warmth
and any sense of homeliness.
SECU patients remain in the unit for prolonged
periods and Community Visitors believe a more
home-like appearance is essential from a human
rights, if not a recovery, perspective. Austin
management have acknowledged the situation and
indicated they will address this over the coming year.
Community Visitors have observed a wide range
of music, art, gym, gardening, speech, pet, peer
support, community visits, community engagement
and other more technical therapy programs in
operation. Nursing staff have been considerate of,
and responsive to, requests for information and
situation reports.
Community Visitors noted the presence in Austin
Health of consumer and carer consultants (who have
personal consumer or carer experience themselves)
with a mandate to visit patients, identify and raise
patient issues and report to senior management
meetings attended by all unit managers.
This initiative has been established for several
years. Apart from the identification of patient issues
to a person who shares the patient experience and
which might not be revealed to a ‘staff’ person,
it serves as a model in demonstrating hope of a
successful recovery to patients during the more
severe stages of their illness. This approach also
operates through the Veterans Liaison Group at the
Veterans Post Traumatic Stress Disorder Unit and
at the adolescent unit, which operates a ‘graduate’
system whereby former patients now successfully
established in life return to speak to current
day patients.
Community Visitors Annual Report 2012
31
Mental Health
Least restrictive practice
Least restrictive environment
Community Visitors observed that the practices
across all units involving early intervention, talking
calmly, the use of low intensity rooms and alert
observation are all consistent with a least restrictive
environment approach.
Community Visitors observed two separate incidents
that exemplify the approach. In one acute unit, a
patient became loud, argumentative and abusive
with nursing staff over a perceived grievance
regarding food and cigarettes. Community Visitors
observed nursing staff respond to the episode with
two nurses attending to the patient and managing
the incident successfully, without recourse to
more restrictive options. In another unit, a patient
experienced an episode of irrational fear when
approached by another patient; nurses successfully
managed the patient by calm talking.
Restraint and seclusion
Episodes of seclusion continue to decline across
all acute units. Community Visitors note that staff at
Austin and NAMHS (and Forensicare) are confident
this trend will continue and therapeutic approaches
and developments are directed to this end.
New initiatives
Veterans’ post-traumatic stress disorder
improvements
The unit manager briefed Community Visitors
on the establishment of the Australian Defence
Force Mental Health Team to coordinate mental
health treatment to serving Australian Defence
Force personnel.
The ward staff have initiated contact with the team
to develop a liaison and information protocol and
improve the process for referring serving personnel.
Austin Health – New CCU and PARC
Austin Health has a new 22-bed CCU under
construction on its Heidelberg campus. Seven of the
beds are earmarked for Forensicare and will ease
the demand for acute beds. The CCU is planned to
open in March 2013.
Austin Health is developing a new ten-bed PARC
in Heidelberg West, due to open in March 2014.
32
NAMHS / Police Ambulance Crisis
Emergency Response (PACER) Proposal
The Mental Health Service is working with Victoria
Police to provide a Police Ambulance Crisis
Emergency Response team in the North of the
region to respond to emergency calls. The team
provides immediate ‘on site/at site’ diagnosis and
treatment of mentally ill patients in emergency
situations.
Seclusion Reduction/Trauma Informed Care
The Area Mental Health Service has created a new
senior nursing position with a focus on seclusion
reduction and trauma-informed care for its acute
units. This position will work with the consumers
and the treating team to reduce distress, agitation,
and adverse events including aggression, violence,
restraint and seclusion.
Thomas Embling Hospital
(statewide service)
The Victorian Institute of Forensic Mental Health,
Forensicare, is a statutory authority responsible for
the provision of adult forensic mental health services
in Victoria. Forensicare manages the Thomas
Embling Hospital, a forensic mental health hospital
providing 116 acute and continuing care beds.
Forensic patients have been found unfit to plead
or not guilty by reasons of mental impairment
and are then committed by a judge to Thomas
Embling Hospital.
The duration of supervision orders and the nature
and severity of the illnesses treated results in
forensic patients being treated for much longer
periods than non-forensic patients. The average
length of stay for a forensic patient is six to eight
years and some patients remain in care over
20 years. This prolonged length of stay presents
particular challenges to the treatment plans
developed for patients at the hospital.
Thomas Embling Hospital has seven distinct units
within its bounds. They provide specialist male,
female and mixed gender units ranging from
acutely ill to rehabilitation and independent living
treatment regimes.
During the year, Community Visitors made 95 visits
to the Thomas Embling Hospital units. Eleven of
these visits were requested by patients and others.
Legal rights and information provision
Information provision
Community Visitors consistently report the provision
on noticeboards of up-to-date information about
patient rights, complaints procedures, recovery and
other treatment-related information.
Legal rights – Patient service charge
Patients advised Community Visitors in January
2012 that the hospital intended to introduce a
service charge to help defray costs of treatment.
Subsequently, Community Visitors were advised of
detailed briefings to patients by Thomas Embling
management and an on-site discussion forum on
the topic involving patients and carers, conducted
by the Victoria Mental Illness Awareness Council
(VMIAC). Community Visitors also examined
minutes of discussions on the topic by patient
and consumer committees.
The issue of a service charge was discussed in
broad terms by the Community Visitors Mental
Health Board at a meeting with the Chief Executive
Officer (CEO) of Thomas Embling Hospital on
16 May 2012. The CEO explained the background,
fee setting, exemptions approach and governance
of the proposed charge and the much higher
charges in comparable schemes operating
interstate. He advised that initial planning proposed
the charge be introduced from 1 July 2012.
Community Visitors will closely monitor the impact
of its introduction.
Care and treatment
The most common observation by Community
Visitors about patients’ general appearance and
health is the very high incidence of obesity in both
male and female patients. They are advised this
is partly a side effect of the medication treating
their illness. There are, however, patients under
medication who do not progress to abnormal
weight gains. The very long-term nature of forensic
treatment, its associated medication regimes and
correlated patient obesity represent a significant risk
to patient health and wellbeing.
Patient obesity has been a long-term concern of the
clinical staff and a number of initiatives have been
introduced over the years. Community Visitors noted
the recent introduction of the ‘healthy living program’
with its focus on healthy diet, exercise and taking
control and support the hospital seeking solutions
to treatment-related patient obesity.
Assaults
Community Visitors have been involved in the
follow-up of a number of patient-on-patient assaults.
Full statistics on these matters are not available
because of industrial action by most mental health
nursing staff. Community Visitors became aware that
one patient was assaulted by other patients three
times in a month. This matter was referred to the
program for follow-up.
Community Visitors were informed that hospital
protocols were followed in all the assaults of which
Community Visitors became aware. Immediate
seclusion of the offending patient is generally
followed with intense observation and treatment and
a review of the patient’s treatment and medication.
In some instances, the offending patient has
been moved to a different unit. Community Visitor
discussions with shift leaders indicate growing staff
confidence in observing early symptoms of rising
agitation and taking measures to pre-empt potential
violent outbursts.
Adequacy of beds
The Barossa Unit includes female patients in both
the acute and sub-acute stages of mental illness.
This is a necessity forced by the current capacity
of female specific wards. While this arrangement
meets gender sensitivity requirements, it causes
complications in managing patients in a single unit
at different stages of acuity of their mental illnesses.
Standard and appropriateness
of facilities
Appropriateness of rooms/areas
The general design of the grounds and facilities are
well suited to a long-stay facility with garden areas
with shade sails and barbecue facilities. Common
rooms include information boards, phone access,
TV viewing lounges and adjoining activities and
quiet rooms. The broader campus area includes
extensive grassed areas, pathways for exercise,
trees and shrubs and long unobstructed sightlines.
The campus area includes educational facilities,
a gymnasium, a pool, and other program facilities.
Personal needs/food
Treatment units make provision for catered meals
or self-catering, and household purchasing and
management depending on the stage of recovery.
Self-catering includes escorted and unescorted
leave to shopping centres to purchase groceries and
supplies. This is an important part of recovery and
community reintegration. It is highly valued by the
Community Visitors Annual Report 2012
33
Mental Health
patients and a significant component of
patient recovery and an increased exercise
of their human rights.
Rehabilitation, educational and
recreational opportunities
Community Visitors understand implementation of
the new model of care has stalled, partly as a result
of funding and hiring constraints, and partly because
of industrial action. Whatever the cause, the delay is
a real risk to the planned benefits and improvements
to the recovery process.
Consumer Advisory Group (CAG)
The CAG comprises elected patient representatives
from each unit, the senior social worker, hospital
management executives and therapists. The CAG
meets monthly to discuss and negotiate on patient
identified issues covering housekeeping, therapy
and operational matters. Executives, therapists,
social workers and the contract caterer respond
to questions and issues raised by patients.
Program availability
Some staff have expressed concern that funding
constraints are limiting the availability of appropriate
rehabilitative programs. Prisoners who are
temporarily located in the hospital for treatment
comment on the wider range of programs available
in prison. Boredom with the programs available is
an issue and a risk to patients’ recovery.
Work opportunities
Engagement in meaningful work is a powerful
counter to boredom and an essential element of
self-esteem. There are countless examples in the
general community where a supportive working
environment is a positive influence on improved
mental health.
Work opportunities are highly valued by patients
and an essential element of rehabilitation. However,
they arise very late in a patient’s recovery timeline
and occur off-site in normal commercial premises.
In contrast with prisoners in the corrections system,
paid meaningful work is not available as part of
the structured day of patients. Community Visitors
would support research into the practicality and
opportunities for providing on-site paid meaningful
work much earlier in the recovery process.
34
Availability of courses including personal
improvement options
Community Visitors support the on-site TAFE
courses and exercise and fitness programs as
enormously beneficial to patients.
Least restrictive practice
Least restrictive environment
While each unit is ‘secure’ from the other units, there
is generally free access between patient rooms and
the main common room. Campus leave (access to
the main grounds), both escorted and unescorted,
is available depending on the stage of recovery.
The Forensic Leave Panel can approve shortterm leave (generally four hours) first escorted
then progressing to unescorted as patient health
improves, for shopping and other program purposes.
These leaves are highly valued by patients and are
an essential step in their recovery to full community
reintegration.
Seclusion
Seclusion continues to be an essential but closely
managed and monitored practice at the hospital.
Seclusion is applied as a last resort measure in
the case of immediate risk to safety. The general
approach is to minimise the time spent in seclusion.
Episodes of seclusion are documented, patient
observations are frequent and intense counselling
and consultation with the psychiatrist are part of the
approach to safely manage the patient back to the
general unit community.
Specialling
‘Specialling’ is a less restrictive approach than
seclusion. The practice refers to arms-length
close observation of a patient in an ‘at risk’ state
and includes specific assignment of a nurse (or
nurses) to the patient, close observations, and
quiet talking and walking, generally in the garden
area. The practice is noted in the patient record and
reported to the nurse unit manager and consultant
psychiatrist.
Quiet room – Low intensity room
In recent years, the hospital has created a number of
‘quiet rooms’ which have soft furnishings, low lighting
and a peaceful atmosphere. This year the Barossa
(female) Unit has secured funding to convert one
seclusion unit to a ‘quiet room’. This will provide
a less restrictive alternative in managing patients
approaching an ‘agitated’ state. Work is scheduled
to be completed by the end of 2012.
North and West Metropolitan Region
(West)
Western Health, Mercy Health Services and
Melbourne Health manage the mental health
services in the western part of the North and West
Metropolitan Region (West).
These services consist of four adult acute inpatient
units, two aged acute inpatient units, four aged
persons’ mental health residential units, one adult
rehabilitation unit, four CCUs, one eating disorders
and neuropsychiatric unit, one mother and baby unit,
two youth and adolescent units, and three EDs.
A total of 283 visits were made by nine Community
Visitors. Eighteen of these visits were requested by
patients and others.
Legal rights and information provision
At the Royal Melbourne Hospital, patients did not
have copies of their treatment plans at the time of
the Community Visitor visit. Staff agreed with the
Community Visitors that patients should have a copy
of their plan and agreed to find out why this was
not happening. Staff also told Community Visitors
that patients were entitled to a treatment plan on
admission, and a weekly care plan on Monday ward
rounds. The registrar stated that it was not practical
to issue up-dated treatment plans, but the care plans
were updated on a daily basis.
At Werribee CCU, efforts have been made
to improve the process of passing on clinical
information about residents to the incoming staff
at handover. Previously this information had to
be extracted from a number of different locations,
but, by using a new standardised framework, all
the clinical information about a resident will be
presented on one A4 sheet, which should lead to
improved service delivery.
At the Werribee Mercy acute unit, a patient who did
not understand why she had to remain in the facility
for one month in order to receive two injections,
and did not have a copy of her treatment plan. She
signed an ‘Authorisation to Inspect’ document to
enable the visiting Community Visitor to access
the file copy. The psychiatrist was asked, via a
staff member, for the treatment plan but refused to
comply with the request stating that the Community
Visitors could have a look at the patient’s plan
instead. The Community Visitors thought it was
inappropriate to pursue the matter at the time due
to fairly intense activity taking place between the
psychiatrist and other staff members, but reported
the matter on the visit report. The refusal of the
psychiatrist to comply with a requirement of the
Mental Health Act was appropriately dealt with
by senior management, who addressed the issue
by email to staff in general and verbally with the
psychiatrist.
Care and treatment
Admissions and adequacy of beds
All the acute services in the region are subject to
high demand, particularly those that service the
outer metropolitan growth areas. Constant demand
and a shortage of available beds in the region has
meant that new patients at the Werribee Mercy and
Sunshine hospitals can often wait for more than
eight hours in ED. At the Sunshine ED in February
this year, Community Visitors recorded that one
person with a mental illness had waited in ED for
16 hours; in March, one person waited in ED for 19
hours; and, in April, one person waited 18 hours. At
the Royal Melbourne Hospital ED in February, one
person who required one-on-one supervision waited
for 17 hours and another person waited for 13 hours.
The Werribee Mercy adult acute unit constantly
operates at full capacity. This is not surprising as
the Wyndham Local Government Area (LGA) has
experienced a growth in population of 7.8 per cent,
the highest of all LGAs in Australia. Detainees from
the Marybyrnong detention centre add to the patient
load at the service and it is challenging to provide
the security required for these patients while trying
to provide a least restrictive environment to other
hospital patients.
A new initiative to streamline and improve discharge
planning has been introduced and this will hopefully
assist in the management of admissions. Community
Visitors have been told that greater efficiency in
patient discharge has not led to any noticeable
increase in the readmission of patients. Ongoing
discussions are taking place in an effort to increase
the number and availability of step-down beds.
At Werribee, the ED staff are also discussing the
establishment of a pool of mental health nurses,
which should improve efficiency and reduce
response times, but the national target of not
exceeding four hours is unlikely to be achieved
due to demand pressures.
Treatment
A resident at a CCU stated that she had been
prescribed lithium and was gaining weight. Due to
an ongoing friendship with a male resident, she was
also told she must have a birth control injection. The
nurse unit manager stated that although the lithium
injections were part of the resident’s treatment plan,
she is not forced to have them, but she had seen
Community Visitors Annual Report 2012
35
Mental Health
and acknowledged the benefit of these in the recent
past. Regarding the alleged weight gain, records
show that the resident has a slightly fluctuating
weight level that is well within the normally accepted
parameters. The nurse unit manager further stated
that staff were keeping an eye on the friendship
between the female and a male resident at the CCU
due to their concerns about the potential for sexual
exploitation, but there was no question of trying
to force her to have a birth control injection. The
CCUs attempt to educate her on potential risks was
considered to be justified.
A man was admitted to the high dependency area
of the Werribee Mercy adult acute unit in January
2010 as an involuntary patient. He was very unwell
and, despite the best efforts of staff and clinicians,
did not exhibit the expected improvement. During the
course of his stay in the HDU his case was brought
to the attention of the Chief Psychiatrist who, in turn,
enlisted the aid of the service provider’s Director of
Psychiatry. His symptoms and the refusal of some
facilities to accept him meant it was not possible
to move him to more suitable accommodation. He,
therefore, remained in the HDU for more than two
years. As the result of constant efforts at the adult
acute unit there was a recent improvement in the
patient’s illness making it possible to transfer him to
a SECU. He is reported to be making good progress
towards recovery.
Assaults
A number of serious concerns came to the attention
of Community Visitors this year.
A 40-year-old man at an adult acute unit made
serious allegations of sexual assault. In line with
hospital policy, the police were contacted and
the patient was taken to another hospital to be
independently examined. However, the medical
assessment was inconclusive and no perpetrator
was identified.
Case study
The mother of a woman admitted to an
adult acute unit rang OPA to say that,
when she had visited her daughter, there
were no staff available on the floor and
her daughter was walking like a “zombie”
and wearing an older man’s clothing. The
mother claimed she had spoken with a
male patient who alleged that both he and
another male patient had had sex with
her daughter. The mother also said her
daughter believed that a staff member
who her daughter alleged had raped her
at another service was working in the
inpatient unit. She also made a number of
other allegations relating to the cleanliness
and maintenance of the unit and the
support and care provided.
These issues were reported to the
service manager who arranged for the
leadership team to meet with the mother,
undertake an investigation, and put in
place a number of actions to improve the
quality of care at the unit. The service
said none of the current staff at the
service had worked at the service where
the young woman had previously been
a patient. While OPA is pleased with
action reportedly undertaken by the unit,
it is of concern that a comprehensive
investigation report is still outstanding
three months after the mother contacted
OPA and the service about these matters.
Safety issues and hazards
Werribee CCU reported that it is coming under
increasing pressure to accept patients who display
a higher level of unwellness than previously. This
pressure manifests itself in the form of inappropriate
referrals to the CCU including some from Thomas
Embling.
Serious incidents
Community Visitors have had difficulty accessing
incident reports but recently received a de-identified
summary from one service covering the previous five
months. During the five months, January 2012 to
May 2012 inclusive, the following incidents occurred:
At a CCU there were two medication errors, two
assaults and five residents attempted self-harm
36
including one jumping off a bridge and two people
drinking detergent.
At a mother and baby unit, there were three reported
events of varying severity: a baby’s head was
accidentally knocked against a door by its mother;
another mother scalded her finger while putting hot
water into a feeding bottle; and, most serious of all,
a mother attempted suicide.
At an adult acute inpatient unit, there were eleven
incidents including two medication errors and a
patient was not being seen by a consultant at an
appropriate time. Several incidents involved the
need for strong behavioural management by staff:
one patient threatened staff and damaged property,
a second allegedly attempted rape, a third exhibited
threatening behaviour toward others; a fourth in
open seclusion needed mechanical restraint; and
a fifth was aggressive and violent during seclusion
from the general ward. One patient absconded while
on escorted day leave and another patient was
found with an unexplained two-centimetre cut
on his forehead.
Although Community Visitors asked managers
and staff if there had been any serious incidents
during the previous month, none of the above
incidents were reported to them at the time of their
visit. The systemic inability of Community Visitors
to access electronic incident log reports means that
a high percentage of incidents remain unreported
and unknown.
The above examples are out of 25 incidents that
occurred in three facilities over five months. If this
data is extrapolated to cover the 22 facilities in
the region, it suggests there may be 35 reportable
incidents per month that are unreported and
unknown to Community Visitors.
Program staff
At Orygen youth and adolescent inpatient unit, the
level of verbal abuse directed towards the staff has
reportedly reduced. The nurse unit manager and
other staff attribute this to enhanced training of staff
and appropriate use of de-escalation techniques.
Rights re ECT
A patient in a CCU enjoys engaging with the
community and is ready to be discharged. However,
he must remain on the ward for a period of up to
four hours after treatment for assessment purposes,
as he is not permitted to be unaccompanied during
that period. He must also be accompanied during
his journey home, and, as there is no organisation
available that can accommodate these requirements,
he must remain in the CCU longer than is clinically
necessary. His clinical records must also be carried
both ways during this process.
Appropriateness of rooms/areas
Gender sensitivity funding was applied for by
Werribee but the request was unsuccessful. Despite
this, the service managed to create gender sensitive
areas such as gender specific corridors and lounges.
A nurse is undertaking training to broaden the
concept and scope of gender sensitivity initiatives
beyond the demarcation of geographic areas.
A sensory room is being established in one of the
bedrooms and staff are being trained in its use.
Expressions of interest are also being sought for
the formation of a fathers group.
Good practice
At the Werribee CCU, a support worker has
encouraged all residents to become involved in
creating a vegetable garden and planting several
fruit trees. They have also built their own hothouse
to propagate seedlings, and, during one visit, the
Community Visitors watched as the support worker
demonstrated how to take the seeds out of tomatoes
and dry them ready for next season’s planting. There
is now such an abundance of fruit and vegetables
that a ‘MasterChef’ kitchen has been set up where
cooking lessons are held on a regular basis.
This initiative offers a great opportunity for the
residents to learn the various stages that are
involved in getting the produce from the ground
to the table. In addition, due to the well-rounded
nature of the program, the residents have a unique
opportunity to learn skills that will be of real value
when their time comes to move on from the CCU
and continue life in the outside world.
Southern Metropolitan Region
The Southern Metropolitan Region mental health
services are managed by Alfred Health, Peninsula
Health and Southern Health networks. The services
visited comprise seven adult acute inpatient units,
four aged persons’ acute inpatient units, six aged
persons’ mental health residential units, four CCUs,
one SECU, one child and adolescent mental health
unit, one mother and baby unit, one eating disorders
unit and five EDs.
Nine Community Visitors conducted a total of 210
visits, 25 of which were requested by consumers
and others.
Community Visitors Annual Report 2012
37
Mental Health
Legal rights and information provision
Patients and residents often complain of the limited
provision of relevant information by staff about their
admission and little support.
Concerns reported to Community Visitors include
negation of their rights by staff; uncertainty about
their diagnosis; confusion about the admission
process; little or no involvement in their treatment
or discharge plans; unexplained shifts between
involuntary and voluntary status; uncertainty about
navigating the mental health system and MHRB
process; how to obtain second opinions; timely
access to allied health services; access to the
clinical treating team and their treating doctors;
and opportunities to contact their family or employer.
Patients want clear information about how a unit
operates and what is scheduled, the location of
facilities in the unit, the role of the Community
Visitors and some require information in languages
other than English. A usual staff response is that
new patients and residents are provided on arrival
with information booklets about these issues. Yet
when an individual is experiencing a florid episode,
explanations should be given calmly several times,
with written information and timetables displayed
clearly, in simple language.
In an adult acute inpatient unit, one female patient
desperately wanted to consult a social worker to
discuss the care of her children while she was
admitted, fearing they were alone and unsupported.
When she learned her mother was taking care of
her children she expressed relief, but also anger
regarding her mother being unfit to look after the
children. The patient’s greatest annoyance was that
she had not been consulted about the plans and her
wishes were overlooked. The patient lost trust in
the staff and harboured strong negative feelings
towards them.
Case study
A patient denied that he was in a
psychotic state and expressed distrust
of his psychiatrist. He also did not believe
the nurses listened to his concerns and
was worried that the medication would
make it difficult for him to defend his
case for discharge. The Community
Visitors discussed this with the nurse unit
manager who assisted the patient with
an application to the MHRB, obtained a
second opinion regarding medication
and organised independent advocacy.
Community Visitors reported that his
medication concerns had been resolved,
he was calmer and his progress to
discharge planning was being assisted
by a social worker.
Treatment plans
Patients continue to question the prescribed
medications and the application of ECT. Given the
patient’s mental state is likely to be fluid and shifting,
and that ECT and anti-psychotic drugs do interfere
with rational thinking and memory, the staff must
explain the treatment rationale as many times
as required.
When diagnoses involve a dual disability of mental
illness and intellectual disability in acute inpatient
units and CCUs, the adequacy of supports to
patients may not be sufficient. Often, patients find
themselves at greater disadvantage as a result of
their intellectual disability and are isolated from
the general population as they are unable to cope
alone. Community Visitors urge a more collaborative
approach between mental health service providers
and disability staff to provide greater understanding
and rapid response to individuals’ support and
care needs.
Community Visitors were concerned when four
residents with intellectual disability were admitted to
a CCU at Frankston. As their needs were complex,
the stay was considered long-term not transitional
with few suitable options within the disability services
system. The residents were eventually supported to
move on to appropriate supportive accommodation.
Community Visitors have been positively impressed
with treatment plans at Michael Court, Seaford,
that focus on recovery with relevant goalorientated aspirations. Agreed activity schedules
are individually structured, developed conjointly
38
between staff and residents and regularly updated.
This approach is welcomed and lauded as best
practice that other CCUs could replicate. Community
Visitors noted in one CCU some discrepancies
and omissions in the recovery plans which were
discussed with the nurse unit manager who
proposed to update them.
Assaults
Critical incidents are commonly reported to have
occurred within mental health inpatient units and
occasionally in residential care facilities. There have
been assaults between patients and patients and
occasionally between staff and patients. In an adult
acute inpatient unit, a patient complained about
the use of excessive force when he was taken to
the seclusion room and remained in the HDU for
a number of days. The service provider advised he
was very difficult to manage and uncooperative but
was reviewed frequently to see if he was ready
to move back to the general ward.
Through the OPA Advice Service, Community
Visitors attended an adult acute inpatient unit to
visit a young patient with mild-moderate intellectual
disability and psychotic hallucinations. He was
placed in the HDU due to his clinical instability and
vulnerability yet he was allegedly sexually assaulted
there by another patient. Although the appropriate
remedial actions were implemented, Community
Visitors remained concerned about the lapse in
monitoring by staff and the appropriateness of
the treatment plan which was based on a reward/
punishment approach. Given the patient’s disordered
thought processes and hallucinations, it is debatable
whether the behaviour modification strategies would
be effective at that time.
Unjustified methods of intervention were reportedly
used at an adult acute unit when a patient allegedly
was forced to the ground, injected with medication
and put into isolation. Community Visitors were
advised the patient had absconded and was
returned by police in an aggressive and violent
mood that necessitated restraint and medication.
He remained in isolation until the medication
stabilised his mental state. Subsequently, the
patient did not recall his request for Community
Visitor support, stated there was nothing wrong
with him and he did not require hospitalisation.
He was referred to the Mental Health Legal Centre.
Medical care
A focus on a particular aspect of ill-health frequently
results in other medical conditions including
toothaches, hearing problems, heart and respiratory
conditions and cancer illnesses being minimised
or ignored. One patient complained of a raging
toothache, however, it took more than a week for
him to receive dental service. The provision of
low-grade pain medication was inadequate to
afford relief and his daily request for service met
with little response.
A resident of an aged persons’ mental health
SECU, diagnosed with breast cancer, was refusing
treatment. Despite the patient’s cognitive capacity
to understand and remember explanations about
her condition and treatment options, the service
provider initially regarded her decision not to receive
treatment as ill-informed. After family and clinical
consultations, her right to refuse treatment was
respected. Community Visitors regard this as a
positive outcome.
When the mother and baby unit’s regular doctor
was on leave, patients complained of the irregular
and untimely attendance of the locum clinical team.
In addition, there was dissatisfaction with the very
limited time available for counselling services, of
only 15 minutes a week to address concerns. The
small time allocation of psychological services was
reported as inadequate by Community Visitors. A
part-time psychologist was eventually appointed
and the availability of therapy increased.
Discharge planning
Patients advise that they are concerned about being
discharged too early when they do not feel clinically
ready, have limited understanding of their discharge
plans, accommodation options, or of the date of their
expected return home.
Adequacy of beds
During the year, increased demand for patient
admissions from EDs to the adult acute inpatient
units resulted in some patients being relocated
into spare beds in the aged persons’ acute units
or elsewhere within the hospitals. The transferred
patients experienced difficulties with gender/age/
diagnosis mixes and Community Visitors observed
that the patients’ psychosocial activities were not
adequately met. While the unsatisfactory relocation
was acknowledged by service providers and
claimed to be a short-term solution only, the practice
has continued. Several mental health units hold
weekly telephone conferences within their networks
about bed availability. This is a useful exercise to
determine appropriate accommodation for new and
existing patients. A review of the Clinical Practice
Guidelines in relation to the transfer of patients was
completed and Community Visitors will monitor
its implementation.
Community Visitors reported concerns regarding
two eating disorder beds at Monash Medical Centre
relocated to a general medical ward. The patients’
clinical care focussed more on their general medical
Community Visitors Annual Report 2012
39
Mental Health
condition while the complex eating disorders issues
may be relegated to a secondary consideration.
These clinical issues require a daily decisional
balancing act that can be more challenging when the
patients are placed on a general ward where normal
meals and medical care are being provided to other
patients. Also nursing staff may not be experienced
in caring for these mental disorders. Clearly, eating
disordered patients require intensive psychosocial
therapies in addition to structured weight gain
management.
Gender sensitivity
Community Visitors perceive that the gender specific
areas require more active monitoring by staff as
male patients regularly use female designated
lounges. Female patients have also complained that
they felt unsafe due to behaviours of some males.
Community Visitors have learned of attempts to
separate sleeping areas by gender, however, have
observed males sleeping in the female section. In
one instance, a female patient was startled to find
a male in her bedroom just after she had finished
showering.
Community Visitors are informed that a gendersensitivity policy is in place, but implementation
of the policy remains inconsistent, often driven
by inpatient gender mix at a given time.
Personal needs
Patients and residents continue to raise concerns
regarding meals, meal sizes, food choices and
security of their possessions. A patient in an adult
acute inpatient unit requested soy milk and vegan
food. The nurse unit manager advised Community
Visitors that she had been eating meat and other
foods, which the patient advised she was eating
because they were not providing her with vegan
food. Community Visitors also noted an issue
with a patient who refused to eat pork for dinner.
Consideration must be given to the cultural and
dietary requirements of patients and residents.
Some residents in an aged persons’ mental health
unit complained personal items have gone missing
from their bedrooms. At the time, none of the
residents’ bedroom doors were locked resulting
in little security for their personal effects.
Non-smoking policy
The non-smoking policy continues to be an issue.
Some service providers operate an exemption
policy or have adopted a common-sense approach
by ensuring patients are able to smoke in exterior
courtyards with some overhead cover from the
weather. This practical approach has been very
encouraging although another service provider has
adopted a blanket non-smoking approach.
40
Residents have raised concerns regarding an
enforced non-smoking policy and Community
Visitors have noticed the policy appears to contribute
to the escalation of aggressive behaviours and
encourages patients to adopt secretive behaviours.
Appropriateness for clients
A male resident of an aged persons’ mental health
residential unit, complained of being bothered by
another resident of Greek origin who had also
been aggressive when interacting with other male
residents. It became apparent the Greek resident
was feeling isolated and frustrated with no-one to
talk to in his own language and no Greek-specific
reading materials or activities. Community Visitors
requested the nurse unit manager facilitate contact
with an ethno-specific community group to visit and
converse with the resident with positive outcomes.
Community Visitors are concerned the mother
and baby unit at Monash Medical Centre appears
inappropriate for its function. Windows are frosted
over for privacy reasons from the passing general
public, rendering the interior dim and lacking natural
light. Bathrooms are also in need of renovation
and upgrade. The nurse unit manager advised
that renovation plans are awaiting allocation of
government funding. Community Visitors support
this initiative and trust that funding will be provided
to allow the work to be undertaken.
Maintenance and safety issues
General maintenance and delays to rectification
continue to be reported by Community Visitors.
Concerns include urine smells around facilities;
body fluids and rubbish in courtyard areas not
cleaned or disposed of regularly; rooms and
bathrooms requiring renovations and not being
cleaned frequently enough; cleaners leaving at
the end of shift whether the cleaning has been
completed or not; bins left unemptied; inoperable
public phones; worn furniture requiring replacement
and old furniture not removed; call bells not
working and patients/residents advising they must
rely on others to call staff for help; uncomfortable
temperature control within units and rooms;
flashing lights in dining rooms; clocks displaying
the wrong time and date; mould under eaves;
and general weeding and gardening required
in residential complexes.
Some outdoor areas lack disability friendly access
for residents who utilise a wheelchair or are frail
and elderly; outside pathways, plants and internal
linoleum causing potential trip hazards; and the
absence of a hazard strip to identify a change
in the incline.
Rehabilitation, educational and
recreational opportunities
Patients and residents have advised that they are
bored saying the only activities available are “TV
and sleeping” and on occasion making their own
activities. There is a lack of choice in music and
options of different activities on offer, particularly
on the weekends. They have little exercise options
available and younger consumers requested more
physical activities like gym access and games and
yoga. The provision of reading material is often
inadequate and patients requested access to
more reading material. Positively reported was an
occupational therapist who changed the program
for consumer activities, which seems to be working
much better for them. However, on one visit, it was
noted that the planned activities schedule could
not be displayed as a consumer had ripped the
whiteboard off the wall. It is sometimes the case
that disordered behaviours by a few residents
compromise the living conditions for all.
Unfortunately, funding cuts have meant that
two residents at an aged persons’ residential
unit can no longer attend their activity group for
social interaction, which they very much enjoyed.
Community Visitors understand that additional
programs are being scheduled.
Community Visitors have expressed great
appreciation of the implementation of the recovery
model of care at an aged persons’ mental health
residential unit in Seaford, implementing new ideas
and energy in support to residents. This is modelled
on a similar program instituted at a local CCU for
younger residents.
At an aged persons’ acute inpatient unit,
Community Visitors observed a female consumer
restrained in a chair and noted she was unable to
communicate. Staff advised that her mental status
was deteriorating rapidly and a transfer to
high-level care was approaching. Community
Visitors later discovered the patient had been
relocated to a high care unit elsewhere where she
continued to deteriorate and subsequently died.
A resident of an aged persons’ mental health
unit was admitted to the ED with bruising to face
and body as a result of a recent fall. The resident
continued to have falls out of bed and was restrained
during the day for her own safety. The bed has been
lowered but injuries are still occurring. Community
Visitors have been assured that every measure is
being undertaken to prevent falls and injuries.
Staffing
The limited availability of allied health staff continues
to be a problem. Patients and residents often
experience delays in seeing their activities officer/
occupational therapist, social worker or psychologist.
Shortages are reportedly because of illness, annual
or maternity leave. Importantly, the network’s budget
rarely provides for temporary replacements so the
patients’ needs remain unfulfilled. An associated
concern is the high usage of agency staff. Nurses
also often cover double shifts due to the difficulty in
filling short-term vacancies.
Least restrictive practice
Community Visitors continue to report that units
are locked requiring a key code to gain entry. The
explanation is that the patients are at risk of leaving
the facility or that patients must be protected from
unlawful entry by the public. The Mental Health
Act requires services to provide a least restrictive
environment, however, this often does not occur.
The voluntary versus involuntary status of patients
and residents is a vexed area that appears to be
applied indiscriminately and without explanation. A
voluntary patient in an aged persons’ acute inpatient
unit was unhappy he was not allowed to go out when
he wished. The nurse unit manager indicated that,
although he has voluntary status, the treating team
would like him to have escorted leave at this stage
but often staff are not available. He has voluntary
status so long as he complies with treatment,
instruction and orders.
Community Visitors Annual Report 2012
41
isability Services
D
statewide themes and
recommendations
42
Recommendations
Disability Services
The Community Visitor Board
recommends that the State
Government:
1.require disability service providers to have
policies and procedures for identifying,
reporting and responding to abuse and neglect
to ensure safe environments
2.protect human rights by ensuring that no
resident is subjected to unauthorised restrictive
interventions
3.as a priority, ensure residents participate
in planning processes and are given the
opportunity to express real choice in the
way they live. Those who cannot speak for
themselves must be provided with alternative
communication support to enable this to occur
8.immediately increase funding for respite
accommodation so families can access
services when and where they need them
9.develop a strategy and timetable for the closure
of Colanda and Sandhurst and the remaining
congregate care facilities such as the Oakleigh
Centre
10.implement the Productivity Commission
proposal that Community Visitors monitor
the NDIS
9.adequately fund the Community Visitor Program
to ensure it meets its legislative requirements.
4.as a matter of urgency, provide better
accommodation options for people with
complex needs
5.fund healthcare professionals to support staff
and manage health care planning for residents
with complex health needs
6.uphold the principles of the Disability Act 2006
by ensuring that residents are supported by
adequate numbers of appropriately trained staff
7.ensure staff have the skills needed to provide
optimal and individualised support to residents
through the development, delivery and
evaluation of an ongoing sector-wide
training plan
Community Visitors Annual Report 2012
43
health care needs
staff support/care/
assistance from
support staff
individual plans/
individualised or
person-centred plans
personal safety
500
Disability Services
328
288
198
incident reports
152
aids and equipment
upkeep of building
and fittings
Statewide report
fire safety
health care needs
126
555
120
500
staff support/care/
external presentation/
assistance from 117
outdoor areas
support staff
In 2011-12, 215 Community
ambience and
individual plans/
Visitors undertook 2821 visits to
individualised or
comfort
person-centred plans
residential services provided by
personal safety
other
incident reports
the Department of Human Services enabled access
aids and equipment
(DHS), Disability Accommodation to the community
leisure activities
and recreation fire safety
Services (DAS) and Community
environmental
safetypresentation/
external
Service Organisations (CSO)
outdoor areas
ambience
and
and visited in a range of different
dignity/rights
comfort
participation/
other
accommodation settings, including
engagement/inclusion
in the community
enabled
access
group homes, respite houses for
to the community
choice/decision
making
leisure activities
both adults and children, and
and recreation
compatibility
institutions.
environmental safety
90
financial managementdignity/rights
74
89
328
110
288
198
105
152
94
126
93
120
90
117
89
110
105
issue types identified
79
94
75
93
74
issue types identified
Fifty-nine trainees were recruited to the program
structureparticipation/
and 51 appointed by the Governor in Council. It is building
69
andengagement/inclusion
design
in the community
expected that this increase in Community Visitors
choice/decision
making
48
will see visit numbers improve in the 2012-13 facilitating/encouraging
independence
reporting year.
compatibility
heating and cooling
79
75
74
42
financial management
The Board is very pleased to report the positive
staff training/ 35
engagement of the government with the Communityattitudes
building structure
presented
and design
Visitors Program. Parliamentary Secretary for
ageing
and
planning
34
facilitating/encouraging
Families and Community Services, Andrea Coote,
independence
of
attended three meetings of the Combined Board in staff awareness
heating and
30cooling
Visitors
order to hear first hand the views and concerns of Communityprotocol
staff
training/
Community Visitors. Following each meeting, she
attitudes presented
27
resident complaint
took up a range of important issues on behalf of the
ageing and planning
program. The program looks forward to continuingrestraint & seclusion
24
staff awareness
of
this positive relationship.
Community Visitors
security
660 Eastern
124 Gippsland
301 Grampians
225 Hume
195 Loddon Mallee
228 Northern
537 Southern
238 Western
Figure 8. Disability Services Stream number of visits by
Community Visitors 11/12
69
48
42
35
34
30
protocol
19
resident complaint
313 Barwon-South Western
74
27
unmet
need
17
restraint & seclusion
in accommodation
24
security
16
19
unmet need
in accommodation
15
abuse/neglect
17
restrictive practice/
locks
restrictive practice/
14 locks
16
access
abuse/neglect
respite issues
15
13
access
14
insititutions and
9 issues
congregate
respite
care settings
13
insititutions and
congregate
8
reportable deathscare
settings
9
reportable deaths
8
landlord issues
7
landlord issues
7
preventative 5
health carepreventative
5
health
0 care100
0
200
100
300
400
200
300
400
number
number
500
500
600
600
Figure 9.Services
Disability Stream
Services number
Stream number
and types
of issues
identified 11/12
11/12
Figure 9. Disability
and types
of issues
identified
44
Dignity, respect and rights
No. of units
visited
No. of CVs
Requested
visits
Scheduled
visits
Total
Disability Services Stream
Barwon-South
Western
79
25
3
310
313
Eastern
Metropolitan
249
54
15
645
660
Gippsland
47
15
4
120
124
Grampians
82
13
6
295
301
Hume
64
15
5
220
225
Loddon Mallee
60
9
3
192
195
Northern
Metropolitan
132
17
6
222
228
Southern
Metropolitan
206
49
29
508
537
Western
Metropolitan
95
18
8
230
238
1014
215
79
2742
2821
Region
Community Visitors regularly report that residents
have limited opportunities to realise their individual
capacities. This might due to poor access to affordable
transport or staff shortages or inadequate support. In
many cases, residents are not able to make genuine
choices about such things as who they live with,
activities they engage in or even when they retire.
Sadly, many people still have unmet communication
needs, so are unable to actively participate in the
decisions that affect their lives or to understand the
information that might help them to do so.
The principles of the Disability Act state that people
with a disability have the same rights as other
members of the community to:
•
•
•
•
•
•
•
respect for their human worth and dignity
live free from abuse, neglect and exploitation
realise their individual capacity for physical,
social, emotional and intellectual development
exercise control over their own lives
participate actively in the decisions that affect
their lives and have information and be supported
where necessary to enable this to occur
access information and communicate in
a manner appropriate to their communication
and cultural needs
services to support their quality of life.
In practice, it is often difficult for people living in
residential services to fully exercise these rights.
Figure 10. Total visits Disability Services Stream 11/12
number of issues identified
Abuse, neglect and personal safety
100
90
80
70
60
50
40
30
20
10
0
87
66
55
2009-10
2010-11
2011-12
reporting year
Figure 11. Disability Services Stream abuse, neglect and
assaults 2009-2012
This year, there was an increase in the number
of reports of serious incidents involving abuse,
neglect and personal safety. Since the tabling of the
Ombudsman Investigation, Assault of a Disability
Services Client by Department of Human Services
Staff 2011, there is greater awareness of the role of
Community Visitors. This has resulted in an increase
in calls to the Office of the Public Advocate’s Advice
Service requesting visits by Community Visitors.
Calls are often from staff in residential services who
do not feel confident about raising concerns within
their organisations or, in the case of some agency
and casual staff, do not know who to go to with their
concerns. Some calls were from family members,
friends and, in a matter in the Eastern Metropolitan
Region, a concerned taxi driver who reported that
a resident he picked up from a group home had
a large red welt across his face.
Community Visitors across the state reported on
assaults and personal safety of residents. In the
Barwon-South Western Region, a Colanda staff
member assaulted a resident and a man living in
a group home was assaulted twice by people who
Community Visitors Annual Report 2012
45
Disability Services
he lives with. In the Eastern Metropolitan Region,
residents were assaulted and threatened by a
housemate, and a woman was discovered by staff
to have suffered unexplained bruising and a
fractured arm. In a CSO house in the Eastern
Metropolitan Region, a staff member was charged
by police with the sexual assault of a number of
residents. North and West Region Community
Visitors reported that staff who witnessed a
family member assaulting a resident did nothing
to intervene and, in another case, two residents
suffered multiple, unexplained fractures.
Incident reporting
Notification of serious and significant
matters to the Public Advocate
Community Visitors reported a large number of
issues with the implementation of the new policy,
including a lack of clarity about the management
of records and variations in the application of
the instruction. In both DHS and funded agency
services, there was inconsistent practice across
regions and, in some cases in different houses
of the same provider.
In 2011, the Public Advocate negotiated a protocol
with the DHS Disability Services Division to ensure
protection for residents subject to abuse, neglect
or assault. Following notification by staff of a
serious and significant incident, the Public Advocate
assesses the matter and, in most instances, refers it
directly to the Executive Director, Disability Services
Division, for immediate attention.
The first element of the response from DHS must be
an assurance of the immediate safety of the resident
identified as being at risk. This year, there were 21
notifications to the Public Advocate covering a range
of matters including: assault, unexplained injuries,
inadequate behaviour support, and poor standards
of care.
The department’s responses to matters have been
prompt and generally thorough. In some instances,
Community Visitors were not satisfied. For example,
in a matter in the Eastern Metropolitan Region, a
young resident with violent behaviours continues
to live with older housemates, whose physical
circumstances leave them vulnerable to his threats
and assaults. In other matters, DHS investigations
have failed to identify the likely cause of serious
injuries sustained by residents.
The Ombudsman’s report recommended that
DHS review its critical incident reporting forms
and consider the implementation of a web-based
reporting system “to provide a more efficient
and immediate reporting process”. DHS did not
implement a web-based system, however, it did
review its incident reporting requirements. In
December 2011, it introduced a new policy, the
Critical Client Incident Management Instruction 2011
which applies to all departmental services and those
provided by funded agencies.
The understanding of the instruction’s specific
requirements varied greatly. For example, the
requirement that an incident report is written by the
most senior staff member present at the time of the
actual event. Many Community Visitors reported that
they were told by senior managers that they routinely
rewrote the original report because the handwriting
was illegible or to provide clarity, correct poor
grammar or remove inappropriate comments.
In some organisations incident reports were not
accessible to Community Visitors. This was most
common in CSOs where documents are often only
kept in an electronic format, but it also occurred
in DHS houses where casual and agency staff, in
particular, told Visitors that they themselves were
unable to access incident reports.
This year, the Board began negotiating the protocol
covering the interaction between the program, the
department and CSOs. During this process, there
have been discussions about the formal inclusion of
the notification process in the protocol to guide future
arrangements to protect residents at risk of abuse
or neglect.
Community Visitors reported concerns about the
incorrect categorisation of incident reports. For
example, in the Barwon-South Western Region, a
resident was assaulted by a housemate; police and
ambulance were involved but the incident report was
recorded as a category two and not a category one
which would be usual in the circumstances. When
questioned about this, the CEO of the organisation
told Community Visitors that it was not a serious
incident and that the resident had been “putting
on a bit of an act”.
DHS and CSOs must go further and prevent
abuse from happening in the first place. They must
have a zero tolerance of abuse and encourage
staff to report any actual or suspected abuse or
neglect. Responses to incidents must be swift and
decisive with police involved where appropriate or
independent investigations undertaken. Residents
and families must be kept informed and their support
needs properly addressed.
The new reporting instruction did away with the
requirement to report category three incidents,
instead, service providers are required to maintain
a record of non-critical events for each client.
Community Visitors in the Southern Metropolitan
Region have noted that, in some services, incidents
that have been recorded as non-critical would, under
the previous reporting instruction, been reported
as a category two.
46
In response to Community Visitors’ feedback on the
implementation of the instruction, the department
conducted extensive training with its own staff.
It also convened a meeting with the Board and
National Disability Services to discuss incident
reporting issues and clarify requirements. These
discussions led the department to plan a project,
to be undertaken in 2012-13, to train staff in CSOs.
Community Visitors watch with interest the effect
the changed reporting requirements will have on
the management of critical incidents. They continue
to report concerns that the new system does not
require a central register of serious incidents to be
maintained in each house, that it is still a possibility
that no incident report will be prepared at all, and
that serious incidents will escape unnoticed due
to incorrect categorisation.
Individual Support Packages
Last year, the Board expressed concerns that
Community Visitors were unable to visit people
who were on an Individual Support Package and
who purchased their supports through different
service providers.
This year, the Disability Amendments Act 2012
redefined residential services and clarified that the
accommodation and support services in a residential
service may be provided by different providers and,
as a consequence, Community Visitors can now visit
more houses. While it will place greater demands on
the program, the Board believes that everyone who
is entitled to the protections afforded by Community
Visitors should have access to them.
There have been a number of occasions during
the year when Community Visitors have sought
clarification from the department about whether
Community Visitors could visit. They are concerned,
however, that services only came to their attention
incidentally and that there is currently no system in
place to ensure that they are informed of all services
eligible for visits. This is a matter that the Board will
pursue in the coming year.
Healthcare
The treatment of people with a disability in the health
system varies greatly. Health care issues reported
in all regions include: delays in seeking medical
attention; lack of up-to-date health care plans;
incorrect administration of medications; lack of
access to general practitioners in rural areas as
well as poor treatment and understanding of
patients with a disability in the medical system.
In one case, a non-verbal person was sent
unaccompanied by ambulance to a rural hospital.
It took three presentations at a hospital before
several fractures were identified and appropriate
treatment provided. While they waited for
appropriate treatment they would have suffered
constant pain and distress. The Public Advocate was
so concerned about the standard of care provided
to this person that a complaint was lodged on their
behalf with the Health Services Commissioner.
Concerns about the capacity of staff and the
system to manage the changing needs of an
ageing population were also consistently reported.
Community Visitors have pushed for people with
a disability to have the same choices as other
Victorians to ‘age in place’ and in their own home
if they choose to do so. However, current staffing
models often impede this. Monitoring of this issue
will be a focus of Community Visitors’ work over the
coming year.
In the Hume Region, a number of residents were
admitted to mental health facilities and Community
Visitors reported there was not always enough open
communication between the mental health services
and house staff to enable appropriate supports for
a person with dual disability. In the North and West
Metropolitan Region, a resident fell in the shower
and sustained a head injury but staff delayed
seeking medical attention for three days.
In the Gippsland and Southern Metropolitan
Regions, Community Visitors reported matters
involving poor quality care and the apparent lack
of staff capacity to adequately support residents.
In the Gippsland Region, Community Visitors
responded to a call from staff at the local hospital
who were concerned that a woman had been taken
to hospital multiple times suffering from hypothermia.
In the Southern Metropolitan Region, they reported
concerns about the high use of agency or casual
staff in a group home where a number of the
residents have complex medical support needs.
Community Visitors reported on a number of
relatively young residents who have a diagnosis
of reduced bone density and who have suffered
serious fractures. The development of preventative
programs aimed at minimising the potential for
painful, disabling and costly fractures must be a
priority. Community Visitors understand that early
intervention to minimise osteoporosis can improve
quality of life and reduce the cost to the community.
Staff capability and support
While many Community Visitors reports noted the
excellent work staff were doing, it remains a concern
that care standards can vary widely. Some residents
are fortunate to be supported by appropriately
trained staff with whom they are familiar. Others live
with a constant stream of ‘strangers’ in their home,
some of whom do not have the skills to adequately
care for them.
Community Visitors Annual Report 2012
47
Disability Services
In the Grampians Region a house with three
residents who require one-on-one staffing
consistently operates with one or two staff
supporting five residents. In other houses, two
residents suffered serious injuries from falls when
staff failed to follow proper procedures.
A shortage of staff in the disability sector generally
has put pressure on rosters and affected the
ability of services to recruit and retain skilled staff.
Community Visitors reported persistent shortages
of permanent staff and the high use of agency staff.
Agency staff often lack the specific skills required to
work with the group of residents to which they were
assigned and Community Visitors reported that they
often missed out on the induction and orientation
necessary to provide adequate care and support to
residents.
Chronic staff shortages lead to poor quality care;
high use of casual and agency staff often means
that only the most basic support tasks get done, and
more long-term activities such as person-centred
active support fall by the wayside.
An emerging issue is the lack of communication
between staff in day programs and house staff.
There is an expectation that there will be close
collaboration between house and day program staff,
but Community Visitors have noted issues that have
arisen in day programs that have affected a person’s
wellbeing at home. In some cases, medication has
been missed, in others residents have been involved
in incidents that have not been communicated to
house staff.
Family relationships
Many people living in residential services have good
family relationships that add a positive and satisfying
dimension to their lives. However, in a few instances,
Community Visitors documented abuse in these
relationships or interactions with family that have led
to adverse outcomes for the resident. Community
Visitors urge vigilance on the part of service
providers to protect residents from abuse, neglect
or exploitation in all their relationships.
Planning
A range of issues have been reported relating to
individual planning. Some people still do not have
person-centred plans (PCPs), but most commonly,
Community Visitors have reported that, while plans
are in place, they are out-of-date, not updated when
a person’s circumstances change or that they lack
meaningful goals, strategies and evaluation. In some
cases, staff are unfamiliar with a person’s plan or
goals are not realistic, given the person’s financial
circumstances.
48
In the Eastern Metropolitan Region, Community
Visitors commented that one of the keys to effective
planning was ensuring that people were able to
communicate their goals and that, in many cases,
residents have not had adequate communications
assessments, so are unable to provide active
input into their personal plans. In the Southern
Metropolitan Region, Community Visitors reported
that they found it difficult to track the implementation
of plans due to inconsistent recording of progress
notes; they noted that consistent staffing leads to
better recording of information.
The unauthorised use of restrictive interventions is a
serious breach of human rights. Community Visitors
have reported a lack of Behaviour Support Plans
(BSPs) for people who require them and BSPs that
have not been lodged with the Office of the Senior
Practitioner (OSP). In the Barwon-South Western
Region, staff in a CSO house told Community
Visitors that a resident was subject to chemical
restraint but did not have a BSP. In the Eastern
Metropolitan Region, Community Visitors reported
that a young man who had violent outbursts may
have been subject to chemical restraint but, as he
did not have a current BSP, they could not be sure.
Community Visitors report that, in some regions,
there was a lack of holiday planning for residents
but, in others, residents have taken a variety of
different holidays. A large number of residents from
Colanda, in the Barwon-South Western Region, not
only went on holidays for the first time, but went
on holidays interstate and without the support of
Colanda staff. However, in the Grampians Region,
it was again reported that a number of residents
with high support needs have been unable to take
annual holidays.
Community Visitors continue to report concerns
about lack of long-term planning for the
accommodation needs of an ageing population
in residential services. The approach to ageing
appears to vary widely across regions and within
DAS and CSOs.
The support of ageing residents continues to
prove challenging with concerns around transport,
retirement options and increased health needs. In
the Barwon-South Western, Eastern Metropolitan
and Hume Regions, Community Visitors reported
that a number of people have moved into nursing
homes as residential services could no longer
provide them with the support they needed to stay
in their homes.
Community Visitors have also reported on the lack of
environmental planning. They expressed concerns
about the poor maintenance of many DAS and CSO
houses and about the future replacement of old and
inadequate houses.
In the Barwon-South Western Region, it was
reported that a number of DAS houses had unsafe
floor coverings; in one, this had caused many falls.
A house managed by a CSO was so unsuited to
the needs of the residents who lived there that one
man, who uses a wheelchair, needs assistance to
navigate the way to his bedroom or he risks hitting
his head against the architraves.
Community Visitors have always believed that
institutions and congregate care facilities deny
residents their basic human rights. They call on
the State Government to plan for the closure of
the remaining institutions and congregate facilities
so that Victoria’s policy of quality community-based
support for people with a disability is finally
fully implemented.
With the end of the Strategic Replacement
and Refurbishment Plan, Community Visitors
are concerned that more and more residents will
be forced to live in poorly maintained and
inadequate housing.
Draft Victorian State Disability Plan
2013 – 2016
Respite
A range of respite service issues were reported.
Most concerning was the shortage of respite beds
and their use to accommodate people for reasons
other than genuine respite.
In the Barwon-South Western Region, Community
Visitors reported that parents at one service were
getting only half the respite they required and that,
in a six-bed facility, three residents were taking
up four places on a long-term basis. In the Hume
Region, the demand for respite continued to be
greater then the beds available and, in the Eastern
Metropolitan Region, waiting lists for services
are exacerbated by places taken up by people in
full-time care. In the North and West Metropolitan
Region, Community Visitors reported on a young
girl who was moved from one long-term placement
in a CSO respite service into another seemingly
permanent placement in a DAS respite service.
The respite situation is simply unacceptable.
Families who desperately need services are being
denied them, while people who deserve a secure
home languish in temporary circumstances where
they are denied the same rights as residents living
in permanent accommodation.
Closing institutions and congregate
care facilities
Today more than 100 people continue to be
institutionalised at Colanda and Sandhurst and
many more live in medium and large group facilities
that have more in common with an institution than
a home in the community.
DHS released a draft State Disability Plan for
comment in June 2012. Community Visitors support
its direction: addressing the “disadvantages that
people with a disability, their families and carers
experience as part of their everyday lives”.
Community Visitors found that the draft plan was
more in the nature of a policy framework, rather than
an actual plan. The state plan should properly outline
the leadership, service delivery and coordination role
of government in advancing the social inclusion and
citizenship of people with a disability. Community
Visitors commented on the draft plan and will
monitor its further development.
Healthy Living Survey
Inspired by the release of the Victorian Population
Health Survey of People with an Intellectual
Disability 2009 in late 2011, OPA and the Board
decided to undertake a survey of residents in
residential services and, between 1 March and 31
May 2012, Community Visitors collected information
in relation to 697 residents.
The residents
Fifty-six per cent of people surveyed were male and
44 per cent were female. The majority were under
60 years old, with just one in seven aged 60 years
old or more. One-third of the people surveyed
needed assistance to walk, while two-thirds were
able to walk unassisted.
This year marks the 20th anniversary of the closure
of the Caloola Centre, following Community Visitors
reports into the terrible conditions for residents.
The closure of Kew Cottages’ was announced ten
years ago, after a long series of Community Visitors’
reports detailing its unsuitability.
Community Visitors Annual Report 2012
49
Disability Services
Physical activity
40%
Responses showed that four out of five residents
had undertaken some form of physical activity in
the last week and 40 per cent had met the minimum
recommended physical activity guideline of half an
hour of physical activity on five or more days per
week. This is lower than the equivalent rate for the
general Victorian population.
The survey asked if the person was physically
able to undertake more vigorous activity than they
had in the last week. Overall, more than one in
three residents (36 per cent) were thought able to
undertake more vigorous activity. This varied by
resident age (see Figure 10.)
30%
20%
10%
0%
18-39 years
40-59 years
60+ years
Sports group
Church group
Community action group
Member of at least one group
Figure 13. Proportion of residents who are members
of various sorts of community groups, by age group 11/12
80%
70%
60%
Person-centred plans
50%
The vast majority of residents had up-to-date
person-centred plans that were being implemented.
Where this was not the case, the most common
reason given was inadequate staffing ratios.
40%
30%
20%
10%
0%
18-39 years
40-59 years
60+ years
Could do more vigorous activity
Couldn't do more vigorous activity
Don't know
Figure 12. Proportion of residents thought able to undertake
more vigorous activities, by age group 11/12
Community engagement
Eighty per cent of residents had attended
a community event in the last two months.
Eighty-seven per cent had done so in the last six
months, compared to 53 per cent of the general
Victorian population.
Residents were more likely to belong to a community
action group than a sports or church group
(22 per cent compared to 19 per cent and 12 per
cent respectively). The general Victorian population
is less likely to belong to a community action group
(19 per cent) but more likely to belong to a sports
or church group (26 per cent and 16 per cent
respectively).
Overall, more than one in three residents
(36 per cent) were members of some sort of
community group. This varies by age group,
with residents aged 40-59 years the most likely
to belong to a community group.
Regional reports
Barwon-South Western Region
Geelong and Colac
Planning
With good transition planning, some residents have
relocated to more appropriate settings or to be
closer to their family. Staff have made tactile and
memorial areas in some houses and the availability
of a room allows ageing residents to participate
in day programs in their home.
Choice and decision-making
Increasingly, residents are making their own choices
about the things that matter to them, such as day
programs that match their interests, pets, paint
colours, furniture, holidays and activities. Many
residents regularly spend time with their families.
One resident has a ride-on mower and a dune
buggy and is paid to mow the grass.
Staff support
Residents are well-supported by staff who have
assisted them to visit housemates in hospital, attend
a housemate’s funeral and maintain contact with
50
ageing residents who have moved into nursing
homes. In one house, they continued to support
two residents to spend time together.
Some staff are very creative in their support, for
example, producing a calendar with photos of the
year for residents and their families for Christmas, a
photo album of a resident’s life for his 21st birthday,
and a tribute photo board to commemorate a
resident who died.
‘The Farm’ staff team were finalists in the Team
Support Worker Award for working with residents to
keep them safe and involved with living. This team
is small with regular staff and regular casuals. The
personal gains by the residents in their care are
a testament to this staff team’s great work.
Nursing support in the My Future My Choice houses
is vital as many residents have complex healthcare
needs. One resident was significantly affected by
the lack of nursing support; outcomes for him were
positive when he moved from a house without
support to one with it.
There will be a significant need for palliative care
support in these houses if the wishes of some
residents to remain in their own home is to be
respected. One resident returned from hospital to
the house for palliative care. While the resident was
in hospital, house staff supported him for one hour
at each staff changeover and, when at home, two
active night staff assisted with palliative care.
Facilitating and encouraging independence
Person Centred Active Support (PCAS) is enabling
residents to become increasingly independent. Apart
from household chores, residents are learning many
new skills including: making cappuccinos; managing
their medication; using public transport; participating
in meetings; becoming more independent in
personal hygiene; using keys; and managing
finances. Some are studying at TAFE, and one
receives payment for sitting on interview selection
panels for staff. A few residents have moved into
independent units and one resident has regained
independence by using a lighter wheelchair, which
she can propel herself. Very occasionally, parents
object to efforts by staff to encourage independence.
One group of residents, which has moved from
Colanda, are enjoying their spacious new home. They
have a spa bath but, unfortunately, the wrong model
was installed and there are no handrails, making it
only accessible by hoist. One resident regularly uses
a hoist, but for four mobile residents, hoisting them
into the bath would be undignified. Residents are
encouraged to take an interest in cooking, but electric
hot plates, which give no indication they are hot,
are an accident waiting to happen and will only be
replaced at the residents’ expense.
Three banks of lights in the 30-metre long passage
of one new house are all controlled by a light switch
inside the front door. The living area is at the end
of the passage and there is no two-way switch to
provide the residents with the opportunity to turn
their passage lights on and off.
Participation and engagement
Residents access the community for family contact
and outings. Some residents, enjoyed helicopter
rides for birthdays and others enjoyed ‘high tea’ at
the Windsor Hotel. Many residents participate in
organised sporting activities, such as competitions,
swimming, gym, surfing and Tai Chi. Some take part
in community events such as Relay for Life, while
others choose more solitary activity like going for
long walks to the local library. Other residents prefer
arts-based activities with dance, drama and music
proving very popular. A number of residents entered
their artwork in local exhibitions.
Inadequate transport options continue to affect the
ability of some residents to access the community.
For example, in one house, the designated vehicle
was not wheelchair accessible; at a respite facility
there was no designated vehicle and at another
house wheelchair issues and the number of staff
needed to support the residents prohibited a group
outing. An outing to the Melbourne Aquarium was
terminated when the designated vehicle was unable
to access the carpark because of its height.
Residents regularly go out for meals and two
residents had their first opportunity to have a family
Christmas when staff invited them home to join their
celebrations. There has been considerable effort by
staff to keep residents in contact with their friends
who still live at Colanda.
Enabled access to the community
Moving younger people out of nursing homes
and into the community should improve their
quality of life and give them a real chance to make
choices about how they live. Residents who live
in My Futures My Choice houses have complex
needs, including healthcare, but this should not
be a barrier to their involvement in the community.
Some problems with the establishment of these
services have been addressed, but, in some cases,
timeframes for resolution have been unacceptable.
Improved access to the community can only be
achieved if the appropriate equipment and aids are
available and repaired in a timely manner. Staff must
be alert to every opportunity to engage residents
with the community and organisations have a
responsibility to ensure the staffing is sufficient to
facilitate these opportunities.
Community Visitors Annual Report 2012
51
Disability Services
Community access has been restricted for residents
who use wheelchairs because of inadequate access
and amenities at local sports venues. The local pool
has a broken hoist and a shortage of chairs for pool
access. While construction is underway at Simonds
Stadium, there is reduced access for people who
use wheelchairs.
One resident, who lives in a My Future My Choice
house, had no community access for two to three
weeks because his manual wheelchair presented a
personal risk and another resident was housebound
for seven months. One resident has hydrotherapy
once a week instead of the three scheduled
sessions because he needs the support of two staff.
Community access and socialisation for a resident
who has chosen to be nocturnal has been very
limited. On one occasion, staff overlooked a diary
entry for a dance outing, consequently residents
missed an opportunity to socialise.
The lack of wheelchair funding for ageing residents
impacts on family finances. Repairs to a standing
frame have been delayed and the repairs short-lived.
Plans by the two service providers to share aids and
equipment in the future should help to avoid some
lengthy waiting times.
Leisure activities and recreation
Residents travelled widely for holidays, supported
by house staff or staff from other organisations
such as day programs, mental health agencies and
holiday companies. Some residents had holidays
with their families.
Some residents have lost weight after becoming
involved in a walking program which won the DAS
Award for Perpetual WorkSafe Week. In contrast,
a resident in a house built on a busy through road
is missing being able to walk freely around the
Colanda grounds.
Healthcare needs
Some residents required medical and dental
checks to be performed under general anaesthetic.
A resident was hospitalised with pressure sores.
Common issues included swallowing difficulties and
medication reviews.
There are many strategies to assist residents to
lead healthier lifestyles. One house has a swing, a
treadmill, a bike, a trampoline, a basketball ring and
soccer balls to promote exercise, and another has
a shed with bike and exercise equipment. Residents
are encouraged to walk to suit their circumstances
and abilities. Residents who use walkers do laps of
a ‘circuit’, some residents walk laps around outside
tables, while others venture around the block or
52
even further. There are programs promoting
healthy eating and keeping fit and a few of the
houses have treadmills.
Aids and equipment
New beds, walkers, wheelchairs, and electronic
shower chairs have improved the quality of life for
many people. A young resident has a new trampoline
and a three-wheeled bike and another bought a
massage chair. A hoist was installed for a new
resident in one house, however, in other houses,
there is still a need for hoists and an adjustable
shower chair. Communication aids are being trialled
to relieve a resident’s anxiety over being unable
to communicate to staff.
Specialised electronic equipment needs regular
servicing if it is to operate as expected and a
lifting hoist was unable to be fixed over the holiday
season. One resident’s bedrails were considered to
be restrictive and were not to be used. The resident,
who experiences drop seizures, got out of bed and
knocked his head causing injury. The bedrails were
subsequently reinstated.
Personal safety
Unlocked medication, un-regulated hot water,
a broken auto-ignition on a gas oven, white-tailed
spiders, a lack of shower grab rails and no cooling
in a unit were all issues for residents. In some
instances, episodes of escalated behaviours by one
resident have had an impact on all residents. For
example, a resident was breaking energy efficient
globes and the other residents and staff had to
evacuate the house because of the mercury content.
In another house, escalated behaviours resulted in
considerable property damage, police attendance
and disruption to planned social activities.
Ageing and planning
Staff undertook dementia training to address the
need at some houses. A variety of approaches
to meet the needs of ageing residents were
undertaken: one resident moved closer to family,
another moved into a house with 24-hour staffing
and three ageing residents moved into nursing
homes. In one house, a man moved into a larger
room closer to toilet facilities and was able to stay
in his home and with his sister.
Respite
A young, long-term respite user moved into a group
home but three homeless residents were living in a
respite facility taking up four of the six respite beds.
On one occasion, two respite users were sent home
to allow two emergency respite placements.
On occasions there were concerns about the
deployment of staff in respite services, for example,
five residents with high-care needs were supported
by only two staff. In contrast, two staff were
required to monitor one permanent resident in
a respite service.
There is a lack of recreational activities at a Geelong
respite facility where many users are physically
active. At one respite facility, it was reported that
parents are getting half of the respite they used
to receive.
Ambience and comfort
Residents of one house chose outdoor furniture,
worked on an outdoor makeover and made a DVD
of their project for the Geelong PCAS presentation.
Residents at another group home had as much input
as possible into their outdoor make-over and the
house supervisor made the outdoor furniture.
Veggie gardens across the region are flourishing.
A seat and handrails were incorporated into new
planter boxes in a Colac backyard to provide
residents with independent access and a place to
sit and watch the birds in the aviary. A wonderful
sensory wall depicting a rural scene is also being
completed at this house.
There were considerable improvements made to
outdoor areas with café and shade blinds but there
is a need for an appropriate outdoor surface at one
house for a resident who crawls.
Building structure and design
Houses have been improved in a range of ways:
rearranging living areas; moving a TV so residents
can also see what is going on in the kitchen;
moving wheelchairs behind a craft area; brightening
with photo displays and artwork; new furniture for
lounges and bedrooms; new furnishings and interior
decorating.
A new house with an independent unit opened
in Geelong. Modifications to existing structures
included the installation of a shower in a unit,
bathroom renovations and converting one unit
into two. The conversion of a former sensory room
into a second bathroom in a Camperdown house
has stalled.
Some bathrooms in Geelong CSO houses are outdated and an independent unit continues to be stale
and stuffy.
Five residents who use wheelchairs live in a Colac
house which is unsuited to their needs. It has narrow
passageways and doorways, small bedrooms and
unsheltered access to the house. For many years,
Community Visitors have been reporting on the
unacceptable conditions in which these residents
live and, while they are pleased that the department
has undertaken to work with the CSO to address
the issues, they are disappointed that the promised
renovations were still not completed at the end of
the reporting period.
In one house, families have purchased a massage
chair and swing. In another, house staff are providing
sensory opportunities by making a number of
plaques in picture frames which are hanging on the
wall. Sensory toys hang from the handrail and small
sensory balls are enjoyed by residents.
Heating and cooling
In some houses, the heating level does not always
match the needs of residents who spend a lot of time
sitting. After many months, the lack of heating in a
new house was found to be due to vents not being
reopened after the heating was tested. Eastern
facing bedrooms get very hot in summer and need
outside awnings. The most accessible outside area
needs retractable shade if the residents are to safely
use this space all year.
External areas
The water issues at a Gateways house have been
overcome and there is a new car shell on a concrete
pad and a new basketball ring and court. Along
with a bike, swing, table tennis table, trampoline,
chook house, raised veggie garden and space for a
game of cricket, this provides an ideal setting for the
residents of the houses to gather for social activities.
Case study
A male resident who uses a wheelchair
has difficulty accessing his room as
he slumps sideways in his wheelchair.
Staff assist him to navigate the narrow
passageway and guide him through his
doorway to his room, so he doesn’t hit his
head on the architraves. The inappropriate
design of this house is preventing him
from maintaining his independence.
Community Visitors Annual Report 2012
53
Disability Services
Colanda
Colanda is home to 99 residents. There is a positive
atmosphere, with staff planning for the future.
Finch Unit closed in November 2011 and eleven
clients transitioned to Wren Unit. Increased staffing
provided residents with greater opportunities for
individuality and community access.
Planning
Some clients moved into group homes or between
units to better address their needs. For one client,
it was their third move and, for another, their fourth.
There was no opportunity for transition for a client
who transferred to a Geelong nursing home at
short notice.
Eagle Unit is being transformed and is moving
away from the use of restraint. Staff had specialised
training and the unit was unlocked in May. The
seclusion room has become the ‘reflection room’
and is the final stage in behaviour management. It
has been painted and will have a mural, soft chairs
and piped music.
Day programs were reviewed and changed. Ageing
clients will have shorter sessions with more intensive
support and residents who use wheelchairs will
have increased uptake of part-time day programs,
where available.
Choice and decision-making
Independence is encouraged in many other ways:
one resident is learning to self-administer their
medication; another mows the grass with his hand
mower and one man now communicates by typing
into a tablet computer that speaks for him. In
preparation for the inaugural Colanda Ball, residents
have had dance lessons and have brought suits and
dresses with the assistance of staff.
A hand rail in a day room and a small easily
manoeuvred wheelchair encourage independence
but in Hostel Unit, clients are no longer able to wash
their clothes as their new washing machine is an
‘industrial’ model.
Participation and engagement
Residents are encouraged to keep in touch with
their families, some of whom live in Melbourne
and Geelong. Skype is being trialled for less
mobile clients.
Some residents participated in community events,
others enjoyed regular facials and massages
and Hostel Unit residents went on an outing to
Birregurra. Residents attending the OPUS After
Hours Program have the opportunity to mix with
people from group and private homes and
19 residents went to the OPUS ball.
While residents had regular community outings, at
times the community came to Colanda: Delta Dogs
visited Robin Unit fortnightly and two staff members
regularly brought their dogs in for pet therapy.
The aged clients in Martin Unit have more
opportunity to be involved in decision-making. For
example, breakfast is made in the unit, instead of the
central kitchen, and there are a number of lounge
areas, including a new ‘quiet lounge’.
Considerable efforts were made to maintain
friendships with former Colanda clients who had
moved. However, since the closure of Finch Unit,
former residents visiting Colanda are having difficulty
associating with their friends.
Wren Unit clients have a greater choice of activities
at weekends. A pampering room has been set up
in the aged unit where clients can have massages
and nail care. A shelter has been built, overlooking
Forest Road, for a resident who has spent much
time there over the past 30 years.
Leisure activities and recreation
Facilitating and encouraging independence
Staff supported clients in hospital, in rehabilitation
and through medical procedures and assisted some
clients to walk around the Colanda grounds.
Innovative approaches encourage residents to get
out walking; a blue line was painted on the footpath
so residents can independently find their way to
the day program and administration buildings, and
one client has a two-way radio which he uses to
communicate with staff when he is out.
54
All Robin Unit residents had holidays this year,
some for the first time. Queensland was a popular
destination. One woman, who was unable to go
interstate, enjoyed a long weekend in Warrnambool.
Short holidays are being planned for other residents.
It is difficult to find accommodation for some
residents who have high support needs such
as PEG feeding.
Residents enjoy a variety of interests and have
bought a range of equipment to enhance their
leisure options. Other residents enjoy massages
for relaxation and playing music.
Abuse and neglect
Late in 2011, the manager at Colanda notified
Community Visitors that a resident had been
assaulted by a staff member. The assault was
witnessed by two other staff members who were
prompt in reporting the incident. The staff member,
who no longer works at Colanda, was stood down
immediately and the incident was reported to the
police for investigation.
Healthcare needs
Residents have regular access to allied health
professionals including a dietician, a speech
therapist and a physiotherapist. A resident for whom
PEG feeding is unsuitable had chest infections and
had been hospitalised on a number of occasions;
he has benefitted greatly from the dietician’s
recommendations and has not had a recurrence.
To maintain flexibility, the residents of Martin Unit
have physiotherapy sessions three times a week.
As they are ageing, they are also kept home from
day program at the first sign of being unwell or if
the weather is extreme.
A video link was used for a specialist check-up and
saved an ageing client a round trip to Geelong. In
Robin Unit the filing of health records has improved
and a health information folder now accompanies
residents to medical appointments and hospital.
South West
Planning
Planning is generally well-managed, however, it
was reported that some PCPs and BSPs were not
updated as required. In one instance, a resident was
chemically restrained but his BSP was out-of-date.
Choice and decision-making
Two residents living in accommodation provided by
the same CSO told Community Visitors they would
like to live elsewhere and would like help to explore
alternative accommodation options.
Staff support
A young man who lives in a CSO-managed house
is aware that he has difficulty managing his temper
and asked Community Visitors if they could get him
help. He said he wanted a case manager to arrange
counselling support and that he did not want to be
using medication. Community Visitors understand
that the resident is subject to chemical restraint and
that his BSP is out-of-date. They raised the matter
with the organisation but have had no response.
Aids and equipment
Individuals have benefited from new pressure
relieving cushions, low-profile PEGS and easily tilted
matrix chairs. Allied healthcare workers, based at
Colanda, continually review clients needs for beds,
wheelchairs, helmets and other types of equipment
and aids.
External areas
The large outdoor area of Robin Unit is being
transformed into an adventure playground. Clients
are purchasing playground equipment and students
from Colac College are involved in the veggie
garden makeover. A resident has purchased
a large bird aviary, which is home to some brightly
coloured birds.
To address fire and safety concerns the eaves of
Swan Unit were replaced and large trees in the
grounds were felled and undergrowth was removed.
Community Visitors Annual Report 2012
55
Disability Services
Abuse and neglect
Case study
A man living in a group home managed
by a CSO was assaulted on two separate
occasions by two different housemates.
His parents informed Community Visitors
of the assaults and said that they were
having difficulties making a complaint to
the CEO of the organisation.
The man said that, during the first assault,
he was dragged out of a car and punched
around the head and during the second
he was pulled out of his wheelchair;
police and ambulance attended on both
occasions. The man also said he wanted
to make a complaint to the CEO but was
prohibited from doing so.
Community Visitors reported difficulties
accessing incident reports and expressed
concerns about their accuracy and
categorisation.
They met with the CEO and senior
managers who confirmed that the
incidents occurred. When questioned
about the categorisation of the incidents,
the CEO told them that the second one
was not really a serious assault and that
the resident, who he said was smiling and
laughing afterwards, had been “putting
on a bit of an act”. He said that the first
incident had been recorded as a category
one, but that it had been “downgraded”
by DHS to a category two.
Concerns about the matter were
raised with DHS and a Quality Service
Review has been commenced with the
organisation.
Financial management
In reviewing assets registers in DAS houses,
Community Visitors noted that some residents own
goods of considerable value; in more then one report
they asked if arrangements are made to insure
residents’ possessions but, as yet, have received no
response. One CSO did not have assets registers,
however, Community Visitors were told they were
being prepared.
56
Compatibility
Resident incompatibility was consistently reported.
In one house, a resident was assaulted by
housemates and, in others, the behaviours of
residents with complex support needs affected the
quiet enjoyment of other residents. A young man
who is quite capable lives with older residents who
have poor communication skills. Community Visitors
have questioned whether this young man would
benefit from living in a house where he has more in
common with his housemates.
Healthcare needs
Concerns were reported about the experiences of
residents within the medical system. In one case, a
resident had to wait four hours in a hospital waiting
room and Community Visitors questioned whether
concessions could be made in these circumstances
for people with a disability, especially when they
are elderly. Sometimes medical staff discharged
residents from hospital with little understanding of
the capacity of the group home to provide adequate
supports during recovery. Community Visitors
suggested that the department develop a resource
for hospital administrators and doctors to help
address this issue.
Aids and equipment
In two DAS houses, there were issues with hoists:
in one the remote for the hoist has not worked for
over 12 months and, in the other, a woman has been
told that she must purchase her own hoist sling. The
fairness of this was questioned as the sling, once
installed, becomes the property of the house.
Incident reports
Concerns were raised about an organisation’s
handling of incident reports. After being informed of
three separate incidents in the house, Community
Visitors and staff could initially not locate the reports
and then had concerns about their accuracy and
categorisation. They raised their concerns with
the house’s management and the department with
the result that a Quality Practice Review is now
underway.
Case study
A resident said he lost his temper with
a staff member who he believed had
spoken to him in an inappropriate way
and that, during the argument, the staff
member pushed him onto the bed.
The incident report agreed with the
resident’s account of the incident but
did not make any mention that the staff
member had pushed him. A staff member
on duty corroborated the resident’s
account, including that he had been
spoken to inappropriately.
Community Visitors met with the
organisation’s CEO and senior managers
who told them that the staff member’s
behaviour during the incident had only
come to light a few days after the report
was written, so had not been included
and that the staff member had been
counselled and disciplined.
Upkeep of buildings
A wide range of issues were reported in DAS
houses. Floors were of particular concern including
trip hazards caused by uneven surfaces and worn
carpets. One report noted a floor was often slippery
due to a resident’s incontinence and had caused
many falls. Other issues were a rotting beam in a
pergola, unkempt gardens and poor drainage at the
bottom of a ramp. Community Visitors reported a
bathroom with pooling water, a shower tap handle
that kept coming off and lack of a handrail to assist
people in and out of the shower.
from the organisation’s management. The majority
of service providers respond to this request in
accordance with the protocol with Community
Visitors, however, it should be noted that some
providers, including DHS, have not provided
responses to Community Visitor reports this year.
In a house run by a CSO, the staff member on duty
was not aware of Community Visitors and their
role; she seemed unnerved by their presence so
Community Visitors left and took the matter up with
the organisation’s management. The organisation
has ceased operations and its services have been
taken over by another CSO.
Eastern Metropolitan Region
DHS Disability Accommodation Services
In 2012, relationships improved between the
Community Visitors and the DHS in the region.
Meeting protocols were revised so that official
liaisons between the two organisations were more
efficient and relevant to service improvement. The
Community Visitors issues response protocol was
reinforced by training and workshops delivered by
Community Visitors to departmental staff. These
initiatives have improved working relationships
between the two organisations.
Despite this hard work, it is disappointing to note
that there are still many overdue responses to
issues raised by Community Visitors. There have
been instances where house supervisors have been
unaware of the protocol between the Community
Visitors Program, DHS and National Disability
Services. The protocol requires Community Visitors’
reports to be sent to the regional office for response.
In other cases, no reasons were provided for a lack
of response or responses were deemed inadequate.
Two houses managed by STAY and owned by
the Director of Housing require urgent bathroom
modifications. In January and June 2012, STAY
informed Community Visitors that it had provided the
Office of Housing with referrals from an occupational
therapist and builders’ quotes for both houses
but the office had not responded. Acknowledging
Community Visitor’s frustrations with the situation,
STAY undertook to follow-up reasons for the delay.
Community Visitors hope that this problem will
become less of an issue in the coming year, but
are concerned that some organisational ‘inertia’
overcomes the best efforts of most in the department
to deliver the best outcomes for residents. Constant
management reshuffling creates an atmosphere
of uncertainty and lack of accountability, which
affects results. Some issues may remain unresolved
because there is no-one at the appropriate
management level to make decisions.
Awareness of Community Visitors protocol
Incident reporting
Community Visitors in the far west of the region visit
group homes managed by DHS and five different
CSOs. They are generally able to address any
issues that arise at the time of the visit, however,
sometimes they need to request a written response
Incident reporting procedures were scrutinised at
the instigation of Community Visitors. A survey of
incident reporting in the inner-east found many
departmental processes were not being adhered
Community Visitors Annual Report 2012
57
Disability Services
to. Incident reports were generally unavailable for
review by Community Visitors, reasons given were
variously: inaccessible on the computer, archived
or missing altogether. There did not seem to be
a system in place to write, register or file incident
reports. Staff were also unclear about proper
reporting processes.
Examination of incident report forms is a critical
part of a Community Visitor’s role and, accordingly,
these should be readily accessible, especially given
that there is no alternative independent third-party
scrutiny of incident reports.
In response to a report by Ombudsman Victoria
in 2011, new incident reporting procedures were
implemented for all service providers. These involve
new guidelines regarding the preparation and
storage of reports and address some of the concerns
that Community Visitors have raised.
Community Visitors remain concerned that these
provisions do not address some fundamental
problems with the incident reporting process. Central
registers of critical incidents are not available at
each house. Current procedures allow for reports
to ‘disappear’ from the house and there may be
no record remaining in the house files. The new
reporting process can take many weeks and, while
there is supposed to be a hard copy in the house,
Community Visitors often cannot locate them. There
is still a real possibility that no incident report will be
prepared in the instance of staff-to-resident abuse.
Case study
Community Visitors received a referral
from the OPA Advice Service. A person
had contacted OPA alleging that residents
in a group home were being abused.
When they visited the house Community
Visitors were told that a staff member had
been stood down and that an investigation
was underway but they were not provided
with any details.
When Community Visitors returned a few
days later they found the front page of
a report which mentioned an incident
relating to the alleged sexual assault of a
client. Community Visitors could not find
the completed incident report, nor has
there been any follow-up or response to
issues raised about the alleged assault.
58
Abuse and neglect
Despite the improvement overall, some very serious
issues involving allegations of abuse, assault and
neglect arose. In many cases, the processes that the
department undertook to investigate these issues
have been transparent and open, and involved
extensive consultation with Community Visitors,
as well as other authorities. However, in some
cases, there has not been an adequate response
from DHS.
People with a disability have the same rights as
other members of the community. One of these is
the fundamental right to live in safety both at home
and in the community. When considering instances
of abuse, neglect or assault, it is important to
consider all the circumstances in which a person
might find themselves in a position of threathowever it occurs.
DHS procedures and practices are rightly aimed
at ensuring staff are appropriately placed and
trained to care for and support the residents in their
care. Sometimes, these processes fail, or staff are
ignorant of proper procedure, or are deficient in
training.
Case study
A taxi driver called the OPA Advice
Service to report an alleged assault on
a resident in a group home. The caller
reported a red welt about an inch or two
wide, starting from behind the left cheek,
moving horizontally across the man’s
face to his nose and, while there did not
appear to be any bruising, the welt was
raised. When asked what had happened,
the resident replied that a man hit him,
and then clearly identified a staff member
from his house.
The Public Advocate referred the matter
to DHS Disability Services Division, and
the staff member was immediately stood
down, pending an investigation.
Sometimes it is other residents who abuse, and
assault the people that they live with. It is the
department’s responsibility to ensure that all
residents are safe at home, and when this doesn’t
happen, the impacts on residents can be significant.
Case study
A young man has mild intellectual
impairment but Community Visitors could
find no evidence of any behavioural
assessment or diagnosis. He was placed
in a house on a temporary basis, but
is still there 18 months later. He may
be subject to some form of chemical
restraint, however, Community Visitors
have found that his BSP is not current.
Community Visitors have been reporting
their concerns for this man for a number
of years, having visited him in three
different group homes. He has violent
outbursts and threatens other residents
and staff. The other residents are all older
men who have high personal care needs
and little in common with the young
resident.
There have been multiple calls to OPA’s
Advice Service: in one, a house staff
member said they felt “stressed to
breaking point”.
When Community Visitors spoke to the
man he seemed to be upset about living
in the house. He seems to communicate
this unhappiness by being aggressive,
and on occasion has used weapons to
threaten himself and other residents. He
had also assaulted staff, and the police
have been called to the house on a
number of occasions.
Other residents were suffering and
distressed because of his behaviour.
Community Visitors reported that some
were not eating and others were soiling
themselves when the man was screaming
and shouting in the house. There are
many casual or agency staff working at
this house, who operate without guidance
from an experienced person who knows
the men well.
Community Visitors progressed this
matter as far as they could within the
region. Concerned for the safety of
other residents in the house, the Public
Advocate referred it to DHS Disability
Services Division.
DHS outlined the measures put in place
to address the issues, including the
appointment of a new house supervisor
and the establishment of a care team to
“implement a coordinated approach to
review ... current supports and determine
if further supports are required”.
While Community Visitors appreciate
the efforts being made to provide
adequate support for this young man,
they have little confidence that staff can
do this while still ensuring the safety of
other residents.
It is debatable whether a failure by DHS to take all
reasonable steps to protect residents in their own
home amounts to neglect. Sometimes, other factors
influence the capacity of staff to provide an adequate
standard of care.
Community Visitors Annual Report 2012
59
Disability Services
Case study
Case study
A staff member called the OPA Advice
Service to share her concerns about the
welfare of a resident. She had raised her
concerns with management, but said
there had been no action.
A distressed agency staff member
called the OPA Advice Service about a
resident who was “in agony” as a result of
what appeared to be serious injury. The
Community Visitors Program contacted
the DHS regional manager and made
a notification to the Public Advocate,
who contacted DHS. Community Visitors
visited the home that day.
The resident has limited verbal skills
and mobility. Due to the seriousness
of her medical condition, and her high
personal care needs, she is particularly
vulnerable. Staff told Community Visitors
that they believed the woman’s safety and
wellbeing were at risk when she stayed
away from the group home, saying her
health deteriorated - sometimes resulting
in hospitalisation.
Community Visitors reported their
concerns for the woman’s wellbeing
to regional management and referred
the matter to the Public Advocate. The
Office of the Public Advocate, DHS and
Community Visitors are working together
to address the woman’s needs and
improve her quality of life.
Unfortunately, in another instance, procedures and
processes failed to protect and support a person
who had suffered an injury.
While an incident report had been
completed when the injury was identified,
there was no report of how the injury
actually occurred. The injury occurred on
a Friday, the DAS manager did not receive
the incident report until the Monday and
was only preparing to act on the Tuesday,
when notified by the program about
the injury.
DHS requested that a forensic medical
specialist review the injury; he found
that the injury was so significant and
substantial that it was unlikely that it had
not been witnessed. The resident had
a fractured arm and extensive bruising
relating to the fracture, but there was also
bruising to the back of her shoulder, chest
and hip.
This woman’s discomfort was exacerbated
because health professionals have limited
experience in assessing people with
a disability who are unable to speak.
The house staff did not send a health
summary or history with the resident to the
hospital. The specialist recommended that
DHS empowers staff to clearly advocate
for residents. The specialist also noted
reduced bone density of this resident
and suggested that DHS should put in
place practices that manage and prevent
osteoporosis for those in care.
Healthcare
On the whole, the healthcare of residents has
been better managed during this reporting period.
It is clear that following many years of reporting
by Community Visitors on this issue, that the
department is addressing training needs to ensure
60
house supervisors and key staff have the skills
required to support residents’ appropriately.
The importance of appropriate healthcare and its
impact on the quality of life of those with complex
care needs cannot be underestimated. Healthcare
is one of the most frequently reported issues by
Community Visitors.
Issues of concern ranged from a lack of up-to-date
Health Care Plans, the improper administration of
medication, medication given to the wrong person,
the management of healthcare records, inadequate
discharge planning following hospitalisation, and the
lack of timely annual health checks. More frequently,
residents require dementia assessments as they
age, and require other age-related health checks
such as pap smears, mammograms and prostate
checks. There were several reports of Epilepsy
Management Plans being out-of-date and CHAPS
not being completed.
Planning
A fundamental part of achieving real outcomes for
people with a disability is getting the life plan right.
Plans should include input from all stakeholders, but
priority must be given to the individual’s personal
goals. The ability to communicate those goals is
a crucial part of the planning process. Those who
cannot communicate have no active input into their
own plans, defeating the whole purpose of the
planning process.
Visitors report that some plans are out-of-date,
or in disarray, and require updating for current
circumstances. In other cases, there are no holidays
planned for people.
Staff should be better trained to understand that
sometimes plans need to change to better reflect
a person’s expectations as they age. Some people
would like to spend more time at home because they
are ageing and find day programs tiring.
In other instances, BSPs are out of date, meaning
staff do not know how to adequately support a
person who has behaviours of concern. These
should be active documents which change as a
person’s behaviour stabilises, or should reflect any
changes in behaviour which might relate to other
issues. Lack of proper planning leaves residents
vulnerable, as more resources might be required to
manage a situation when behaviour deteriorates. In
other cases, residents are left feeling vulnerable at
home because of another resident’s behaviour.
Case study
A woman called the OPA Advice Service
complaining about the abusive behaviour
of a fellow resident, saying she was
verbally bullied and physically attacked.
Incident reports supported her complaint,
indicating that confrontations were
frequent, with the complainant confined
to her room for safety reasons.
Little had been done to restrain the other
resident’s abusive behaviour. Community
Visitors questioned management as to
what the complainant had described and
were told that management had not visited
the house, nor spoken to the resident
about the situation.
Management confirmed that the resident
with behaviours of concern had a BSP
and that there were strategies in place
to help her calm down and manage
her grievances. Regular meetings
were planned regarding this resident’s
behaviour support strategies, health plans
and family relationships.
The manager eventually visited the house
and spoke to the complainant, and shortterm strategies were put into place to help
her feel safer in her home.
A lack of appropriate support has a huge impact on
a person’s quality of life and negatively impacts on
the quality of life of those who share a home with
that person. This results in an unhappy home where
all residents feel unsafe and at risk.
Community Visitors Annual Report 2012
61
Disability Services
Dignity, respect, and rights
Case study
A woman has a long history of
impulsive and violent behaviours. She is
aggressive towards other residents and
has destroyed furniture and fittings in
communal areas. She shouts and swears
and exhibits very challenging behaviour,
which the others have to tolerate.
Various specialists have recommended
medications to help the resident control
her unpredictable and aggressive
behaviour, but it seems none of these
recommendations have been put into
place. Staff report the resident’s family
are resistant to the use of medication.
The resident is ostracised at home and at
day care, she cannot form nurturing and
meaningful relationships and is lonely. Her
access to the community is restricted.
One-on-one support has been put in
place for this resident and active night
staff mitigate some of the effects of her
behaviour on other residents. However,
Community Visitors are concerned that
the residents’ needs continue to be unmet.
Another important consideration is what happens
once the plan is made. Community Visitors are
concerned that where plans appear to be wellformulated, it is difficult to ascertain how effectively
they have been applied. Often, progress notes are
incomplete, and it is difficult to find out by asking the
residents if they are satisfied because, many cannot
speak or communicate in other ways. Sometimes,
Community Visitors resort to analysing financial
records, or the vehicle logs to see what funds
were spent, and where the residents went in
the house bus.
It is pleasing to note that DHS is benchmarking the
success of the person-centred planning process.
The region is participating in a La Trobe University
PCAS research project to evaluate active support in
achieving personal goals and measure if residents’
aspirations are facilitated by the planning process.
Eight group homes have been selected to participate
in this important five-year project.
62
An essential element of being human is the ability
to communicate. Where a person has complex and
multiple disabilities, the ability to speak may be
compromised. For many years, Community Visitors
have reported the distressing situation of observing
people trying to communicate without the support
of augmentative communication.
The region is home to many people who were
housed in institutions like Kew Cottages, where
communication support was negligible. It was hoped
that moving into the community would present
more opportunities for people to become more
independent in this area, but it has taken many
years for this to eventuate, and then only in
a few houses.
Other people have also waited many years
for communication support. In one house, it is
distressing to note that, despite reports from
Community Visitors for many years, a person who
urgently required communication support has, as
yet, had nothing done to achieve this. This person
regularly tries to communicate with Community
Visitors, using gestures, and attempts at speech,
but is unintelligible, which is undignified and upsets
everyone concerned.
It is important that all people’s right to advocate for
themselves is recognised and facilitated so they
are able to speak on their own account. Often staff
report that they know what a person is saying, but
being dependent entirely on another to speak on
their behalf reduces a person’s independence,
self-determination, and, on occasion, affects their
personal safety.
It was very pleasing, therefore, to note that a
Complex Communication Project is being trialled in
five group homes which house people with multiple
disabilities, where a need for communication support
has been identified by both Community Visitors and
the department. It is hoped that this pilot results
in new policy and that speech assessments and
augmentation become routine in all houses
in the region.
Staff training is also an important issue. In some
instances, people with a disability have learned sign
language, such as Auslan, but none of the support
staff in the house are trained to use it, rendering this
person ‘speechless’.
The dignity of work is something that many take for
granted. It is important that people with a disability
have the opportunity to contribute by being involved
in meaningful and paid employment, if this is what
they choose.
Community Visitors reported that people employed
by a local disability enterprise had been stood down
and were concerned the rights of these residents to
continue working were not being respected, because
due to funding arrangements, no other placement
opportunities were available. In some cases, family
members were concerned that this would affect their
ability to continue to pay for their accommodation,
which might require them to seek alternative housing
arrangements that might not suit their needs.
Community Visitors raised this issue with DHS which
reported that, due to the recent economic downturn,
the enterprise had lost some long-term contracts,
and could not offer consistent employment. DHS
undertook to look into alternative employment and
activity options for this group of residents.
There are some very positive outcomes for people
who work for this enterprise. Their art studio
supports 12 artists with a disability who augment
their funds by selling their work through the gallery
in the restored Kew Courthouse precinct. Earlier
this year, the latest exhibition was opened by the
local Member of Parliament and the community
came together to celebrate their work. The artists
appeared to gain great satisfaction from selling their
art and talking about their work.
Restrictive practices
There are some people who need support to be able
to live in the community. In some cases, this is in
the form of behaviour support to assist them control
antisocial or challenging behaviours in the residential
environment. Practices which restrict a person’s
rights or freedom of movement, that are restrictive
practices, even if applied in order to help a person
control such behaviours, must always be supported
by a properly authorised BSP which has been
lodged with the OSP.
During this reporting period, it became clear that
there is some confusion among staff regarding the
reporting of restrictive practices. The application
of restrictive practices varies, from the removal
of all restrictive practices to the implementation
of a restrictive practice which affects all the other
residents, when only one resident’s rights are
involved.
Case study
In one house, two men suffered from
compulsive eating. One man ate
everything in the pantry and put on too
much weight. The other did the same
and this caused ulcers on his legs which
meant that he couldn’t work. In both
cases, their unrestricted access to food
affected their health and quality of life.
For a number of years, cupboards were
locked, as were the fridge and pantry. This
was supported appropriately by BSPs. If
other residents required additional food,
they asked for it. The two affected men
lost weight, and the ulcers resolved so
that the resident could return to work.
Then policy changed, and management
decided that this was an unnecessary
restrictive practice. Cupboards were
unlocked and a dietician recommended
a broader diet including sweet and some
fatty foods. Both men gained weight,
and the ulcers returned. Dialogue with
the department revealed that it was
considered that there should be no
restrictions applied despite the known
risks. The resident with the ulcers
commented that if the food was there,
he couldn’t help himself and he would
eat it. The department is now treating
the issue of the ulcers as a vascular
condition, which is not resolving while
these men continue to have unrestricted
access to food.
Community Visitors Annual Report 2012
63
Disability Services
Staff training
Case study
A female resident has a long history
of overeating and obesity. On occasion,
this becomes so extreme that it is
life threatening. In order to stop her
compulsive overeating, staff removed
snacks and other food from the kitchen
and locked it in the laundry to restrict
access to it. Other residents, who were
not overweight and did not suffer any
food-related health issues also had
access to these foods denied by this
restrictive practice.
Community Visitors questioned this
practice and changes were made to allow
the other residents unrestricted access to
this food, by storing some of their favourite
snacks in their own bedrooms, which
were locked by residents who had their
own keys.
In one house, Community Visitors were told that
the restrictive practice of putting bed rails up on all
the residents’ beds to prevent them getting out of
bed and injuring themselves did not require a BSP
because it was part of a therapeutic plan. This
is at odds with the guidelines which require
a BSP for all restrictive interventions involving
mechanical restraint.
Other inappropriate behaviours may be the result
of ignorance about a person’s needs. There are a
number of people who display inappropriate sexual
behaviours and whose requirement for sexual relief
is consistently ignored by staff and family. Antisocial
sexual behaviour can occur when they are not given
the appropriate support to control their urges, or to
relieve them. While the reluctance to face this issue
among carers and parents is understandable, the
rights of the person should be paramount, and they
should be supported to manage their sexual needs
with dignity.
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For many years, Community Visitors have
reported that some staff do not appear to have
been sufficiently trained to properly support the
residents in their care. This negatively impacts on
the standard of care that residents receive. Many
reported issues are due to the lack of staff training
on procedures, specialised care, behaviour support,
medical processes, communication support, and
planning processes. Sometimes there are no entries
in the resident’s progress notes or the Shift Report
Book, so that there is no record of activities or
other incidents. At other houses, there are no staff
specially trained in autism, diabetes and epilepsy
management, or in sign language, and residents
suffer because staff cannot offer appropriate
support.
In other houses, staff are not trained to recognise
when residents require additional support. In one
house, there was no speech and communication
support for residents, because staff did not think it
was required. In this house, one resident displays
inappropriate sexual behaviour, but there has been
very little support provided by staff who do not
recognise the problem.
Lack of consistency of house supervisors
and permanent staff
Lack of consistency of house supervisors and
permanent staff was again raised as an issue of
concern in the region. Generally, lack of consistent
house supervision, and use of non-familiar staff
results in poor outcomes for residents.
Residents depend on staff for their care. They may
form long and lasting relationships with those they
see regularly. They need consistency of care and
time to form meaningful relationships where trust is
established, and the person is comfortable with the
level of intimacy that they must endure from those
that they are not related to. This continuity of trust
and care is lacking in situations where staff are nonfamiliar, or key workers and house supervisors are
continuously replaced with new staff.
Staff who do not know residents well, have
insufficient information about them to make
decisions regarding their care, as often there is little
time for handover at the end of shift, and it takes
time to read a person’s file. When non familiar staff
are routinely used, there is usually a training deficit
and these staff, however well-meaning, are unable
to offer the unique care that is often required.
Good practice
Community Visitors were happy to find that the
men in a house had settled and their challenging
behaviours declined because staff who knew them
were working there again.
Once the residents had settled down with familiar
staff, other quality-of-life issues have been
progressing positively. One resident, who did not like
the texture of food and had a PEG feed, has now
been encouraged to eat food normally. One man,
who was socially isolated, is now speaking to staff
and had a conversation with Community Visitors with
support from staff.
In houses where there are complex medical or
behavioural issues, the use of non-familiar staff
can make the situation worse.
Case study
A resident with autism lives with two
others. She is verbally and physically
abusive and aggressive towards the
other residents and is causing physical
damage to their property and home. BIST
intervention is ongoing, but the behaviours
have progressed.
The situation is exacerbated by the poor
relationship between the woman’s family
and staff. Staff turnover is high and the
new house supervisor has only been
there for a short time. The staff have not
been given training in autism, and this
means that they are unable to respond
adequately to support residents who
display behavioural extremes.
Strategic Replacement and Refurbishment
Plan update
Community Visitors remain concerned about
the condition of some houses in the region. The
impact of badly maintained or designed buildings
on the quality of lives of residents cannot be
underestimated. This also affects the capacity of
staff to give adequate care, and sometimes costs
the residents money, because they have to pay high
utility bills, which means that their outings and other
personal expenditures are limited.
The maintenance budget is only $1 million for the
entire region, which is insufficient, given the issues
around poor condition of buildings, and lack of
maintenance that are continuously reported.
Community Visitors have received no advice that
there will be a new strategic replacement plan. This
means that there will be no identification process
for new builds and no replacement of unsuitable
housing. Maintenance of existing properties is,
therefore, a priority.
Kew, Main Drive
Community Visitors met with the Parliamentary
Secretary for Families and Community Services,
Andrea Coote, to discuss: the lack of appropriate
footpaths for the passage of wheelchairs around the
Main Drive site; lack of community facilities; lack of
adequate allied health supports for residents; the
‘institutional feel’ of some houses; and the lack of
community interaction between residents and other
people who live at Main Drive.
Since the meeting, Community Visitors have been
informed by the department that the entire matter
is now being reviewed by the Minister. Community
Visitors await the positive resolution of these issues
in favour of residents.
Community Service Organisations
This year, in roughly 210 reports, an issue of
concern was raised. These ranged from minor
comment worth noting for reference, to major
concerns regarding the safety, wellbeing and rights
of those who live in the house. The major concerns
are the substance of this report.
Several new houses have been built and others
replaced in this reporting year; one CSO handed
over its houses and care of residents to a larger
organisation. Community Visitors tend to work with
one or two organisations and visit the same houses
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65
Disability Services
throughout the year. They get to know the residents
and support workers and are often well able to
sort out issues as they arise. Residents often see
Community Visitors as ‘our CVs’ and welcome them
as friends.
Planning
PCPs come in a variety of shapes and sizes, from
butcher’s paper and cartoons to complex computergenerated documents, perhaps with photographs
added for explanation. The majority of PCPs are
thoughtfully written with input from many people
important to the residents. There are still occasions
when Community Visitors question the language
of people’s PCP – formal, therapeutic vocabulary,
albeit in first person, does not fit well in the context,
especially when written in the first person.
The main issue with PCPs is the lack of access
to them and the accuracy with which they are
updated, annotated and filed. On several occasions
there were discrepancies serious enough to raise
as matters of concern. These concerns do make
Community Visitors wonder if staff have similar
difficulty at change-over and after leave.
Community Visitors often find file notes, progress
notes or day books are more often available and
comprehensive. In several houses, support workers
add a comment to a resident’s file on a daily basis
as a matter of course; this is especially useful for
incoming staff and where there are residents with
behaviours of concern, illness or specific needs.
Choice and decision-making
Residents often make their preferences known to
Community Visitors ranging from making a will, to
who they would prefer to live with, or not to live with.
Day placement preferences are accommodated by
the CSO and the happiest people seem to be those
who go to work; this is where independence, choice
and competence show up best.
Dignity and rights
While most households are harmonious,
incompatibility must be acknowledged, especially
where a resident has behaviours of concern and
where people’s residence is determined by others.
It also brings into sharp focus conflicting rights.
In two instances, residents were causing such
concern that others locked themselves in their
rooms. In one instance residents told Community
Visitors and house staff they did not want a particular
man in their home, they were afraid of him yet he
has a right to be housed. Eventually the man moved
to a new home. In another instance the target of
aggression was moved and is very happy, but others
remain in the house. The issue becomes who should
66
be moved: the victim or the aggressor? And then
what happens to the person with behaviours of
concern?
These issues are never simple, nor are they easily
resolved; all too often it is a balancing act for the
support workers and CSO management.
Staff support
While the staff support is generally good in
CSO-managed houses in the region, Community
Visitors have consistently reported concerns about
an organisation that has seemed to struggle to
provide adequate supports in some of its houses.
The organisation has been undergoing a significant
organisational restructure; staff turnover has been
high and management inconsistent.
Case study
There are concerns for residents in a
house that has a room with padded and
carpet-covered walls. Community Visitors
had previously been told that this room
was not used for ‘seclusion’ of residents.
It appears that this room was used for
seclusion of a resident who had assaulted
another resident and a staff member,
as well as causing property damage. It
was not clear from the records how long
the resident was secluded. The on-call
manager refused permission to give ‘asrequired’ medication and later suggested
that the staff member call police to assist
the staff member to administer medication
to calm the resident. The staff member
had sustained a head injury but was told
by a manager that she could not leave the
house to seek medical assessment until
a replacement staff member arrived at
the house. It was some two hours later
that the staff member was relieved by
an on-call manager.
Community Visitors are concerned
about the effectiveness of behaviour
management strategies in this house
and, consequently, the safety of the
other residents. It is also of concern
that this incident was not rated as the
highest category.
Staffing
Community Visitors report that residents feel
well-supported by committed and competent staff,
especially those who are open to new ideas,
suggestions and ways of thinking. There are many
examples of outstanding staff ‘going the extra mile’,
sourcing special equipment, organising camping
holidays and birthday outings. Staff mediate with
families, who may have different perspectives on a
resident’s care, take residents to doctors and make
sure their clothes are clean and ready for the day.
Casual staff are obviously going to be necessary;
some CSOs have their own pool of casual staff,
however, these may cover the whole metropolitan
area and so unfamiliar people go into peoples’
homes. One house has seven regular staff and
22 listed as casuals. There are five men living
in the house.
While Community Visitors acknowledge there are
some CSOs who allow four days or so for induction
into the organisation, this does not necessarily
induct them into the house in which they will work.
Some allow for ‘shadow shifts’ where the new
support worker follows an experienced worker and
so learns about the people and culture of the house
and its members.
Of concern is communication between residents and
new support workers who are not familiar with local
vernacular, humour or expectations. Community
Visitors are concerned that support workers should
be able to support residents where needed, including
personal hygiene, bathing and menstruation. They
were told by a family member of a support worker
who, for religious or cultural reasons, cannot look at
a naked person.
Community Visitors believe there is a necessity for
staff to be provided with support and processes
where they are able to safely self-assess, update
their skills and self-appraise with peers.
It appears rare that CSOs hold full staff meetings
where informal and formal networking takes place.
Community Visitors are told there is not the budget
and that staff will not attend if they are not paid.
Community Visitors strongly recommend that time
and processes are provided for such exchanges
to take place.
One CSO has had a major staff restructure over
the past year which Community Visitors report has
caused a great deal of anxiety in residents as well as
staff. Individual house managers have been replaced
by a service manager effectively removing one staff
member from the pool available. Many residents
claimed they had not been advised of the changes,
were unaware and confused; some families banded
together to seek to modify the changes. The
changes have created disquiet and instability.
Community Visitors repeatedly expressed concerns
that new, inexperienced staff are left in charge of this
CSO’s facilities, especially where there are people
with complex needs. Despite meetings with the CEO
and senior management, these practices still remain.
Community Visitors are pleased to report, however,
a great reduction in the use of agency staff, who
might not be familiar with residents.
Facilitating and encouraging independence
Looking into the fridges of some houses it is clear
that the quality and standard of food is very high
and thoughtfully purchased; fresh meat and cheeses
– some for lunches and some for cooking – and
a mass of fresh vegetables and fruit. One CSO
invariably has three bowls of fruit on the kitchen
bench or the table: apples and pears, oranges and,
even when they were at top price, bananas. In these
homes the food is there to be eaten as desired.
In one house, a man’s care plan told his
responsibility in pictures: picture one is of a full sugar
jar; picture two is an empty sugar jar and picture
three is a shopping list and bag of sugar. Compare
this approach to the home where a support worker
decides and shops for the food to those houses
where there is a group discussion and whoever
proposes the meal gets to help cook it. Similarly, in
some houses people return home from their day at
work, clear out their lunch box and prepare it for the
following day; they then help with the evening meal.
In most homes everyone has a job – it may be to
make one’s own lunch for the following day, make
sure dirty clothes are in the laundry, make your
own bed. In others the person who chose the day’s
menu at the planning meeting does the cooking –
or helps. People are on a roster to shop with the
support worker for the weekly food and other needs.
There may be a roster for laundry, clearing the table,
cleaning the house, clearing the garden.
In other houses, people come home and sit and wait
for tea. There are still some houses where support
workers, ‘kindly’ and in a ‘motherly way’, do it all.
One approach produces independence, the other
does not.
Participation and engagement
The majority of residents attend day placement
or work away from their homes and are at home
at weekends. Many people use public transport,
although the majority go out in the house bus.
Community Visitors report that most residents
regularly help with household shopping or shop
for themselves and enjoy a coffee with a support
worker. Residents participate in a range of
entertainment and leisure activities including dances,
cinema trips and attend exercise classes.
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67
Disability Services
People who use a wheelchair do have difficulty going
out or doing something on their own. Funding for
support workers makes it impossible for everyone to
do something different at the weekend. Where there
are four people with two staff on duty they are able
to take it in turns over the course of a month to each
have a one-on-one outing. This is more problematic
where those left at home have higher support needs
or simply do not all want to do the same thing. In
some instances, funding only allows for one worker
to be on duty for a weekend; the funding model
being five days in care and two days with family.
Transport too can be problematic, although staff in
some CSOs work together to pool their time and
vehicles to take groups out.
One of the strongest links with the wider community
is through footy, rarely soccer or rugby. Residents
do go to the footy, they wear the colours and
barrack loud and strong. The easiest way to
start a conversation is to ask someone how their
team went.
Each year, two organisations build into their culture
‘The Show’. Monkami and Nadrasca put on a
musical in which the majority of performers live
with each other and have often grown up together.
The Show is the highlight and culmination of the
year’s activity, when residents, family, friends and
community members join together to celebrate
their achievement.
Abuse and neglect
Community Visitors reported a number of instances
of abuse. Of particular concern was an allegation
of the sexual assault by a staff member of a number
of residents from the same house.
Case study
Early in 2012, Community Visitors
were notified that a resident had been
interviewed regarding a sexual assault by
a staff member. When seeking information
about the incident they were told by senior
management of the CSO that when the
resident had complained of the assault
the police were notified and the interview
took place. Another resident then also
came forward as a victim of assault and
was also interviewed.
Community Visitors were told that a similar
allegation had been made some time
earlier about the same staff member while
he was working at another house. Police
investigated, no charges were laid and
the staff member was moved to another
house.
While the CSO notified the next of kin of
the people who were able to say they
were assaulted, it took some time for all
the relatives at houses where the staff
member worked to be notified regarding
the incidents. A number of the residents
said that they were fearful the alleged
offender would return. Counselling had
been offered. The CSO reports it is
reviewing how it recruits, supervises and
trains staff. The staff member has been
charged by police.
Incident reports
The changes introduced this year in reporting
incidents have created some confusion, but is
gradually being sorted out. Access for Community
Visitors is an ongoing concern, because more
documentation is being kept on computer and
because the importance of the incident report
register is not clear to many support workers.
While the new processes were intended to promote
accountability it doesn’t seem to have worked in
some organisations. A senior manager of a large
CSO rewrites original reports, claiming it is to correct
language and spelling. Many CSOs do keep incident
reports well, and still keep records of minor incidents
as a way of improving procedures.
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Community Visitors are concerned that there is no
process at present for incidents which take place at
day placement to be acknowledged in an incident
report and filed at the house.
Institutions and congregate care
The improvements at the Oakleigh Centre were
welcomed. However, passageways are narrow
and maintenance, poor safety and hygiene issues
are still not addressed. Considerable work could
be done to make the houses feel safer, more
respectful of peoples’ needs and more welcoming.
Community Visitors reported that the ageing of its
residents will become a challenge. Documentation
is still inadequate and there are many cases where
it needed updating. Incident reports were another
issue; staff language skills are sometimes so poor,
it is claimed by a manager, that reports need to
be rewritten.
The original facility is now quite old and will need
to be replaced soon. There is only so much that can
be done to make it liveable.
A congregate care facility run by Wesley Mission
Melbourne caters conscientiously to the needs of
residents. They have a volunteer co-ordinator who
ensures: residents have friends, with whom they
maintain their hobbies and interests; residents run
an in-house newspaper; their dietician and cook
work closely together to cater to the tastes and
needs of residents. In addition to exercise and
movement therapies, Wesley run music therapies
and the outside space is well-used. With support
from family and staff, residents decorate their rooms
as they wish. Community Visitors reports indicate
that this is a good place to live.
Ageing and planning
An ongoing concern is how to better care for people
as they age. Some people want to retire from
work and day placement, to stay home for the day.
Community Visitors acknowledge that some people
are less inclined to go out as they get older, even
when encouraged. Many people like to stay in bed
longer but this is rarely possible where shifts end
at 9.30am and restart at 3pm. For many people,
ageing and its attendant needs mean they are forced
to move from the home they have known for many
years to a nursing home.
The issue for CSOs is how to budget for this in the
best interests of those whose homes they service
and support.
Respite
The need for respite places for children and older
family members continues to be an issue for families
who have one or more children with high care needs.
The stability of the family often depends on respite.
Villa Maria’s four houses have 22 beds. They
currently have five children living permanently
in respite and an additional child was recently
placed in foster care. Villa Maria is supporting
the arrangement with regular respite so it can
successfully continue. Villa Maria supports about
100 families and has significant waiting lists.
Community Visitors see significant unmet demand,
exacerbated by respite places being used for
full-time care.
CSOs also run recreation community-based
weekends, school holiday programs and camps.
Ambiance and comfort
CSO houses are first and foremost a home and
furnished and decorated as such, for comfort
and safety. They are well-maintained in the main,
especially where the CSO employs maintenance
people on staff and, in these houses, repairs are
attended to quickly. In other instances, where
there is a ‘landlord’, delays may well occur; in
other houses there is a distinct lack of furnishings
and decoration, which may have been due to the
behaviours or anticipated behaviours of individuals.
Community Visitors would contend that while a
building may no longer be appropriate or ‘best
practice’ so far as width of corridors and doors are
concerned, there is no reason for doors to be jammed
or locks on people’s doors broken, creating lack of
privacy for residents. Similarly, lack of light bulbs or
bulbs of sufficient wattage make corridors dim and
spooky. These are maintenance issues which the
CSO management has a responsibility to fix.
In two instances, management decisions made the
difference to residents while their home was being
repainted. In one instance, people moved out of
the house for a few days while the whole place was
repainted. In the second instance, in a house where
most of the residents use wheelchairs, the residents
remained in their home while it was painted. The
men had to avoid the wet paint as well as put up with
the smell.
Building structure and design
New houses do not always take into account the
particular needs of the clients the house was built
for. For example, a group of residents with significant
behaviours of concern was moved into a new,
purpose-built home but it was not possible to close
the cooking area off from the rest of the kitchen so
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Disability Services
one resident could help the support worker prepare
food. Issues with other residents required the
removal of cupboard doors so they were not yanked
off, and the fridge had to be locked, as did the
cupboard containing the fire blanket.
External presentation and outdoor areas
Much is reported about the tidiness and neatness
of the environment surrounding residents’ homes.
Of greater importance to residents is access to the
garden or yard. One man in particular was seen as
an irritant by those with whom he lived; constantly
running up and down the corridor, banging doors
and generally making a nuisance of himself. Moved
to another house with a large and accessible back
yard, he runs around, waves his arms and looks at
the trees and the sky. There is no longer mention
of him being an irritant to others.
Gippsland Region
Responses to visits have been positive and, overall,
residents are treated well. The introduction of active
supports for residents has been a welcome and
positive outcome. Visit numbers are down slightly
but Community Visitors are pleased to report the
recruitment of new Community Visitors to East
Gippsland and facilities in this area are once
again being visited.
Planning
Some houses have been slow to review support
plans such as BSP. Management has been made
aware of the importance of these plans and the
situation is reportedly being addressed.
Healthcare needs
Gaining weight can be a health problem for some
residents. One person gained weight very quickly.
This situation is being monitored by the person’s
doctor, staff and family. This is a common enough
problem where exercise is difficult and temptations
are many.
Case study
The OPA Advice Service was contacted
by hospital staff who were very
concerned about the care of a resident
who had been taken to hospital twice in
eight weeks suffering from hypothermia.
In both instances, it was day placement
staff who noticed the illness and
transferred the resident to hospital.
A care coordination meeting was held
involving all parties relevant to the
resident’s wellbeing, including her family,
medical guardian, physiotherapist, doctor,
house supervisor and key worker at day
placement. A plan was developed that
included the need to dress the resident in
thermal-wear to protect her from suffering
hypothermia again.
Upkeep of buildings and fittings
Maintenance issues, particularly for the older
houses, continue to be problematic in West
Gippsland. A lack of resources seems to be the
main problem. One house in Drouin had been
waiting for renovations for over 12 months before
having some of it done just before the end of the
financial year. Houses in East Gippsland appear
to be very well-maintained with new furnishings
and maintenance being completed.
Leisure activities and recreation
Some residents attend a painting club and classes
at their local community house in Bairnsdale and
their paintings decorate the walls of their home. One
resident, who is particularly talented, has regularly
exhibited his paintings in the local community, and
has been assisted to exhibit at a show in Adelaide.
Ageing and planning
Ageing residents in some houses have health
issues such as dementia. In one house, a person
with dementia tended to wander off causing concern
for staff and the other residents.
In another house, a mature-aged person wanted
to stay at home on occasions during the day instead
of going to day placement. Community Visitors
were pleased that DAS was able to accommodate
his wishes.
70
Grampians
Community Visitors divide the region into two areas:
Inner and Outer Grampians. Inner Grampians
includes Ballarat and its surrounding towns,
and Outer Grampians includes Horsham, Ararat
and Stawell
In both parts of the region, the introduction of the
new incident report system and the challenging
paper trail was consistently an issue. Often the
original was not available, with a poor chronological
order of later reports. Casual staff, when requested
by Community Visitors, often could not find
paperwork such as incident reports. Service
providers should ensure all staff can locate important
information readily in case of an emergency.
Across the Grampians, individualised choices
for residents improved. Many residents reported
being able to go on assisted holidays and overall
participation in community activities appeared to
increase, such as attending community events
and personal shopping. PCAS plans were also
well-implemented in most DHS houses.
Inner Grampians
Choice and decision-making
In many houses, residents rooms are decorated
to reflect individuality and interests, for example,
murals, colours and themes - some are even
allowed to be a bit messy.
One resident, who had no available information
about his past, was able, with the help of staff, to
get his birth certificate and find a niece and nephew.
Unfortunately, the sister he remembered had died.
Some residents have moved to a different home
that better suits their needs and provides a better
resident mix. For example, before a resident with
autism moved to a new home, the staff prepared for
his needs by working with the staff in his old home.
The kitchen area was modified to make a safe area
and decisions were made so as not to compromise
other residents.
Good practice
Staff at a Tipping home with two residents with dual
disorders have established, with the support of
mental health services, a detailed mood chart for
one of the residents. There are six colour-coded
categories and this is filled in every hour. This will
increase to eight categories and be recorded every
15 minutes. This extremely high level of support
will hopefully bring about a better outcome for
this resident.
A transition house has a display of photos and notes
about previous residents and what they are doing
now as an incentive for others to improve their skills
so that they too can live independently. At one CSO
house, weekend breakfast in bed is enjoyed by
residents, evidence of how far some staff will go
to make a house a home.
Enabled access to the community
One resident, who had been offered a move to
another house, was concerned that she would not be
able to access the community as she had previously.
The staff at the new house have supported her in
her requests to continue to go to church, meet with
her friend and travel on the public bus.
Good practice
Sadly, a resident passed away but staff and
neighbours ensured that his life was celebrated and
that his funeral was very special. The man endeared
himself to all who knew him. A staff member wrote
a poem that captured his personality and read it
at his funeral.
A young neighbour, who enjoyed visiting the
residents and helped them to bring in the shopping,
was invited to the funeral and asked to act as a pall
bearer. His school principal invited him to share his
experiences with his fellow students.
Personal safety
Concerns have been expressed regarding the safety
of residents when accessing the front door of some
houses. In one instance, where a lady is in a unit
alone, there is no security door.
A resident has gone missing from one facility on two
occasions and run across nearby busy roads. On the
second occasion, the resident was not noticed as
missing for quite some time, so the SES and police
were required.
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Disability Services
At another home, one resident was in conflict with
another, resulting in other less assertive residents
fearing for their safety, while in another house, a
female resident remains targeted by a male resident
and staff have to be constantly aware of where each
resident is in the home at all times.
To increase the safety of a resident with severe
epilepsy, her bedroom door has been removed
and replaced by a lovely curtain. This improves
access to the room if the resident happened to
fall in the doorway.
Reported in last year’s annual report was the
reluctance of a resident to relocate. She expressed
a wish to live with her fiancé but DHS felt that
she would be at risk if she lived without supports.
The woman chose to live with her fiancé and has
now been doing so successfully for the past eight
months. However, she still pays rent for DHS
accommodation in which she doesn’t live, and
community supports for her have not yet been put
in place. Community Visitors hope that regional
management will be able to gain alternative funding
and support for her and that her unit can be
reallocated if she does not need to live there.
Grampians Outer
Planning
As reported in 2011, a young man has only homebased daytime activities and Community Visitors
continue to ask why he cannot be supported to
participate in meaningful activities in the community.
Community Visitors raised concerns with DHS
regional management about the lack of consistent
support for the complex needs of residents in two
day placement organisations and the affect that this
is having on their wellbeing. The conclusion reached
seems to be that there is a need for staff training
and more formal communications between staff from
both the group home and ATSS.
Staff support
Community Visitors have recorded concerns about
counselling for residents and staff resulting from
traumatic events. While DHS responds that, where
a death has occurred, “courses have been run
for palliative care which incorporates grief and
bereavement”, there does not appear to be a formal
practice to support residents through the process.
Unmet need in accommodation
In July 2011, a new house opened for young people
who may have had to move to a nursing home
because of their high needs. Prior to the house
opening, staff received extensive training in the
different conditions such as ABI, multiple sclerosis
and cerebral palsy. The house has a separate area
where residents can entertain their family or share
a meal away from other residents. In a unit attached
to the house, a resident lives almost independently.
She has training on public transport so she can
eventually travel by bus to day placement or work.
Another service provider is extending its services
to provide intensive support for two residents with
dual disabilities and is to be commended on their
commitment to stabilising the lives of these young
people. Two new facilities have been built in Ballarat
over the past financial year for young people who
have a disability.
A new, spacious respite facility for school-age
children was opened in September 2011. Paintings
done by the children, prior to moving to the new
location, line the walls. Separate areas for recreation
are available indoors and a large outdoor space with
paths for bikes encourages play for active children
once they return from school.
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Case study
A resident fell from a shower chair while
being assisted by one staff member and
it was reported that the safety belt was
not in use at the time. The resident was
treated by the local medical service for
a mild head injury and returned home.
Staff felt that something else was wrong
so requested further investigation, which
revealed a broken leg. The resident
was again sent home to be treated
“conservatively”. The resident was taken
to a regional hospital for a second opinion.
It was reported to Community Visitors that
the hospital refused to assess the resident
as only the X-ray report accompanied
the resident. Again the resident was sent
home. The staff at the home are already
caring for very high needs clients. They
had no specific training in assessing pain
or in managing the care of a person with
a fractured femur.
This year, several people have moved, some to
group homes in other towns. The lack of local
transition training and the de-commissioning of
homes were cited as the reasons for some of these
relocations. In one case, the reason for the move
was not clear and the impact for the resident was
likely to be negative. Another man was expected
to move to another town which did not offer any
different support than he currently receives. The
Community Visitors Program was alerted, a guardian
appointed and the proposed move was averted.
Case study
One CSO house in the region has a
history of accommodating residents with
very complex care needs, including dual
disabilities. Three residents in this house
required one-on-one support. Despite
this need, at times there are one or two
staff looking after all five residents. While
staff attempt to care for the residents to
the best of their ability, they acknowledge
the risk is very high that care could
be compromised. Community Visitors
reported that incident reports could not
be found for the serious incidents that
had occurred.
Abuse and neglect
Case study
For over five years, residents of a house
have been verbally and physically
assaulted and property damaged by a
housemate. At times the house has had
to be locked down to protect the residents
from assault. Recently, this resident
scalded a housemate by throwing boiling
water over him.
Efforts were made to manage the situation
by isolating the resident but this was
unsuccessful.
Early in 2012, the DHS Regional Director
asked the Office of the Senior Practitioner
to conduct a review of the house. In April
2012, the review was completed and an
advisory group formed to consider its 30
recommendations.
In June, Community Visitors were informed
that the house was again in lockdown.
They continue to report their concerns for
the safety of these residents and question
the lack of trauma counselling for them.
Community Visitors were so concerned
about the risk to residents that a
notification was made to the Public
Advocate.
Leisure activities and recreation
A small number of residents with challenging
behaviours have been unable to successfully
undertake annual assisted holidays. Community
Visitors have had reassurance from DAS that
individual applications may be made to management
for staff-assisted short holidays.
Several men were supported to meet together
once a month in a men’s workshop environment.
When it was closed due to confusion about who
was ‘in charge’, these men made their concerns
quite clear to Community Visitors. Their ‘castle’ has
been re-opened due to some creative thinking by
local staff and other citizens.
Community Visitors Annual Report 2012
73
Disability Services
Healthcare needs
Case study
A non-verbal, paraplegic resident who
was being transferred to bed was left
with only one other staff member while
lifting equipment was stored. The bed
rails were not in place and the resident
rolled off the bed and appeared to be in
considerable distress.
The resident was unaccompanied on her
trip to hospital in an ambulance. No X-ray
was taken during this trip to the hospital
or the next, despite house staff concerns.
Ten days later when an X-ray was finally
taken, a broken leg was diagnosed. After
surgery and a return home, staff were
still very concerned about the resident
who appeared to be in significant pain
some weeks after surgery. Another trip
to hospital was required.
When the hospital advised of imminent
discharge back to the house, the house
supervisor requested a delay as house
staff had visited the resident who still
appeared in significant pain. Further
X-rays were ordered and re-fractures of
the leg were diagnosed. A meeting was
held to discuss options including possible
amputation of the leg. At this time it was
also suggested that the resident, in her
late thirties, had severe loss of bone
density.
Community Visitors notified the Public
Advocate who appointed an advocate
and later applied to VCAT for the
appointment of a guardian to ensure
appropriate care was provided to this
resident. House staff have since received
further training and equipment to assist
them to safely provide for the very high
care needs of this resident who, after
many months in a nursing home, has
returned to the house with her leg intact.
74
Aids and equipment
Aids and equipment purchases continue to be
a problem due to delays in occupational therapy
assessments, modifications to equipment, staff
training requirements and funding.
Several new ergonomic tilting shower chairs have
been purchased following significant falls when
transferring residents; this has alleviated the use
of extra moves from hoists.
Respite
It is pleasing to note that after reporting for many
years about the depleted state of respite services in
rural country towns, upgrades are planned. The last
resident who has been living for years in a respite
facility will soon move to live in a local group home.
The facility had been under administration but is now
managed by a Ballarat CSO.
A congregate care facility in another town has been
gradually transitioning ageing residents to more
appropriate accommodation and there is a more
vibrant atmosphere and freedom of movement for
the younger residents. It is also pleasing to note
more person-centred activities in evidence.
Building structure and design
Community Visitors continue to raise the problem
of a group home where four females and two males
share one toilet, which is located in the bathroom.
DHS has responded saying no current funding is
available to build an extra toilet and the house is
not considered as appropriate for renovation. This
is despite the fact that a similar house in the same
town was renovated successfully to provide an
extra bathroom, a fourth bedroom and an office.
Community Visitors will continue to press this case.
While three new group homes have been built to
replace decommissioned houses, several others,
which were purpose-built following the closure of
two country institutions in the late 1990s, are now
in need of refurbishment and new soft furnishings.
This is unlikely to occur in the near future.
Hume Region
Planning
While the electronic lodgement of residents’ BSP
with the OSP has remedied the problem of overdue
plans, it is disappointing for Community Visitors to
continue to report individual plans being out-of-date
or in need of a review.
Community Visitors question how effectively
residents are supported if staff do not have the time
for administration. This is of great concern when
agency or casual staff are unaware of where to find
residents’ plans. If documentation cannot be found
Community Visitors wonder how adequately staff
can support the residents’ particular needs.
Community Visitors have also regularly reported
an inability to view incident reports at the house,
as they are either on a computer, which staff advise
they cannot access, or are too complicated to
view, consider and reflect on through the computer
filing system.
Dignity and rights
Community Visitors report limited opportunity for
residents to choose who will fill vacancies in their
home or have their interests met in respite or new
accommodation.
Community Visitors also report difficulties in
viewing transitional plans for residents, particularly
those looking to live more independently. In one
example, it was noted that, despite there being
no transition plan evident, a resident was moved
into an independent living unit. Further complicating
this is the Disability Support Register, which appears
largely crisis-placement driven, offering little choice
for residents to determine where they live and
with whom.
One resident, who enjoyed watching the passing
traffic and pedestrians, is now unable to do this in
her new home because of a fence blocking her view.
While recognised that residents benefit from the new
purpose-built houses, Community Visitors believe
that more consideration should be given to residents’
likes and interests in the planning stages.
Case study
Community Visitors continue to report
on the plight of a resident who, while
having much clinical support, remains
dangerously overweight. He is very
unhealthy as a result of poor diet choices
and inadequate personal hygiene. Clothes
he owns no longer fit him and expose
body parts inappropriately. He does
not have the funds to buy specially
made garments.
While he has support with both short and
long-term goal-setting the achievement
of these goals is routinely undermined
by a failure to follow through with
strategies. Unfortunately, he resides in an
independent unit with less immediate staff
support available to him than when he
resided in the group-home setting.
Hygiene and cleanliness are major health
concerns, with urine and excrement
throughout the unit and rubbish strewn
both inside and out. He is unable to sleep
in his bed due to his size and is finally
being supported in gaining a supportive
chair more suitable than the one he tries
to sleep in.
While attempts have been made to
improve his health, Community Visitors
feel more focussed support for this
resident should be made. Meanwhile his
dignity and wellbeing continue to suffer.
Staff support
Community Visitors report difficulties recruiting
and retaining staff. In an extreme case, a house
could not be staffed so it was closed and residents
relocated at short notice. This house remains closed,
its future uncertain.
A high number of medication errors were noted at
one house staffed with a high ratio of casual staff.
While Community Visitors appreciate transparent
documentation, it is doubtful whether this number
of errors would have occurred with permanent staff.
In the laundry of one house, residents’ clothing was
left smelling strongly of urine. Active support plays
a vital role in supporting residents, and dealing with
clothing in a soiled and unhygienic state should be
considered as a priority.
Community Visitors Annual Report 2012
75
Disability Services
Enabled access to the community
Personal safety
Community Visitors would like to see each house
considering the most appropriate transport options
to enable full access to the community for residents
and the means to pursue their individual needs and
interests. Vehicle-sharing imposes limitations on all
residents as it relies on much forward planning by
staff, leads to greater use of taxis at much expense
to residents and limits community inclusion. More
consideration should be given to individual activities
and outings.
Community Visitors report a female resident who
accepted a lift in a car with a stranger, a resident
not returning home for days on end failing to advise
staff, and a resident being dropped off at their house
with no staff present. Such behaviours can place
a resident at great risk and greater consideration
and supports should be provided where these risk
factors exist.
Residents carry a greater financial burden than that
of other members of the community for outings and
socialising. On occasions, residents have had to pay
for staff support so they can attend social activities.
As community inclusion is a key element of the State
Disability Plan, 2002-12 Community Visitors believe
service providers should give greater consideration
to reducing the financial burden for residents to
ensure better outcomes.
Community Visitors reported a new purpose-built
house was locked to ensure the safety of one of the
residents. Unfortunately, no consideration was given
to reporting to the OSP and development of a BSP
to implement supports to ensure the least restrictive
environment. However, when the matter was raised,
the service provider and DHS acted very quickly to
liaise with the OSP and develop strategies to support
the resident. The resident is now attending some day
activities on his way to a less-restrictive life.
Compatibility
The impact of residents’ incompatibility over a long
period of time is very damaging. In one house, while
support services are in place, there is continual
conflict, destruction of windows, fixtures and fittings
and ongoing disharmony. This residence is neither
homely nor welcoming.
Community Visitors have reported instances where
skilled staff support has resulted in a new resident
with disruptive behaviours settling positively with
their fellow residents. However, this is not always
the case and residents sometimes find themselves
trapped with few alternative accommodation options,
and facing lengthy waits for other vacancies to
become available.
Healthcare needs
A number of residents have been noted as having
admissions to the local adult mental health service
for various periods. Community Visitors express
concern that there is not always enough open
communication between mental health staff and
house staff to enable a complete understanding of
a resident with an intellectual disability. This lack
of knowledge and understanding by mental health
providers adversely affects support given.
Aids and equipment
Delays in residents receiving aids and equipment
like wheelchairs and communication devices are
often reported. Being without essential items like
these limits a resident’s ability to communicate
and be heard, as well as to access the community
independently.
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Restrictive practices
Building structure and design
Community Visitors report positively on the new
purpose-built homes. Aside from some normal minor
warranty maintenance matters, the design very
much supports and considers the needs of residents.
While renovations were being undertaken,
Community Visitors reported a safety and evacuation
risk because of blocked emergency exits and
inactive smoke alarms. However, the service
provider addressed these concerns promptly.
Residents deserve to live in homes that do not
have a neglected and uncared for appearance and
where safety standards are routinely maintained.
Community Visitors report ongoing concerns with
unacceptable delays to repair or replace essential
household items and address damage to fabric and
essential fittings like dryers, washing machines and
dishwashers. Other inadequate maintenance matters
have included squeaking and sagging floor boards,
broken windows, poor drainage, rusty guttering,
holes and cracks in plaster walls, damaged blinds
and curtains, uneven pathways causing potential trip
hazards, slippery kitchen and bathroom tiles, worn
floor coverings and damaged eaves.
Ageing and planning
A number of residents have aged in place well
or moved to aged care as their support needs go
beyond the training and experience of the staff.
More consideration should be given to discussing
retirement-like activities and options with residents
so that they can give up some of their daily activities
at a pace which suits them.
Unmet need in accommodation
Staff support
The number of people needing respite continues
to exceed the places available. While the policy of
segregating adults and children is commendable,
it makes for added constraints to placements in
respite care.
Most staff are to be commended for their dedicated
support of residents but there were two matters
involving staff that were of serious concern.
Community Visitors believe it is entirely inappropriate
to have residents living long-term in a house that is
designated as a respite, contingency or transitional.
After lengthy discussions with a service provider, the
request by a resident to have a lock on his door, in
a house used by others for day activities, is finally
being considered.
A positive initiative has been the new home in
Wodonga built from My Future My Choice and
Older Carer funding. The house is purpose-built and
management has sought to ensure that residents
are fully engaged in their immediate local community
and beyond.
The Hume Reconfiguration Project has modelled
good practice in supporting long-term residents
in respite to find permanent accommodation.
The initiative also provided an opportunity for
family input to the most appropriate accommodation
for residents.
The region is also trialling a new respite booking
service, initially for DAS houses and eventually
rolling out to all houses. This is a very positive
initiative in supporting families and clients in
determining availability of respite services across
competing priorities.
Awareness of Community Visitor protocol
Community Visitors feel more education from service
providers would provide a better understanding of
the Community Visitor role as many staff still seem
unaware. This has delayed access to information
and has taken away direct-care time.
Loddon Mallee Region
Planning
In general, Community Visitors have been impressed
with the efforts of staff to address the individual
needs of clients in both DHS and CSO-managed
houses. Most residents have current individual
plans, however, the steps taken to implement these
are not always clear.
Community Visitors visited a DHS house following
a complaint that a house supervisor restricted
client activities in response to behavioural issues.
There were also allegations of possible financial
mismanagement at this house. When Community
Visitors reported these issues to DHS management,
they were promptly investigated and the situations
addressed.
Community Visitors also visited a unit managed by
a CSO to find two residents with complex needs left
unattended in a locked unit. After approximately 20
minutes, a staff member returned in a work vehicle.
An investigation was conducted after Community
Visitors reported this incident to the service manager
and the staff member involved is no longer employed
with this agency.
Enabled access to the community
Transport is a major issue for clients who use
wheelchairs, where the house does not have a
dedicated vehicle. For example, three DHS houses
in Mildura share one wheelchair-accessible bus and
this makes it difficult for residents to participate in
community activities without planning in advance.
Residents at one DHS house in Bendigo travel in a
maxi taxi to and from their day placement. The bus
had broken and unsafe steps for many months and
clients were often picked up late. The bus was finally
replaced after an accident.
Limited staffing also affects the participation of
residents in activities they enjoy. At one CSO house,
there is only one staff member on duty, so if a
resident has an appointment all residents have to go
along, even if they have just arrived home from day
placement, as they cannot be left unsupervised.
Healthcare needs
Healthcare needs of residents seem to be
responded to effectively in most houses. A
psychiatrist who has been working with Sandhurst
clients has also reviewed the medications of several
DAS residents and this has reportedly been very
positive for the people concerned.
In one CSO house in Swan Hill, extra staffing
hours were provided to enable a resident to receive
palliative care. However, one very frail client in a
DHS house in Bendigo required two staff to turn
her to prevent bed sores. This could not be done at
night with only one staff on sleepover and as a result
the resident suffered significant pain and her health
deteriorated. She was eventually hospitalised and
Community Visitors Annual Report 2012
77
Disability Services
then moved to aged care. Community Visitors have
also reported that a couple of residents have had
falls and that issues related to obesity are common.
Compatibility of residents remains an issue in some
homes with one resident attacking other residents
and affecting their quality of life by playing loud
music late at night and damaging their property.
In one DHS house, one resident was secluded
15 times in a three-week period because of her
behaviour and incidents, many involving other
residents. One-on-one support throughout the
day was introduced for this resident and she
is now starting to self-manage her behaviour.
Community Visitors have also noted increased
efforts to carefully fill vacancies in houses and
create positive home environments.
Upkeep of buildings and fittings
Not surprisingly, given the large number of houses
in the region, there are frequently issues related to
the upkeep and maintenance of buildings, fittings,
and outdoor areas. Fortunately, most of these have
been minor. A number relate to broken doors and
gates which are not locking properly and these
issues have security implications. A stove at a
CSO house was out of order for months because
it required a new seal.
Maintenance issues at some CSO houses seem
to take a long time to resolve. This is complicated
by the fact that the houses are not owned by the
agencies that manage the houses. New houses
have been built and some DHS houses have
had major renovations in order to better meet
resident needs.
Sandhurst
Community Visitors note a marked improvement in
the way Sandhurst residents are supported. There
is real effort to improve the lives of the residents
who remain at Sandhurst and to assist them to move
to more independent living situations.
The number of Sandhurst residents has reduced
to 29, enabling staff to provide more individualised
support to those who remain. The reduction of six
residents to three in Unit 6 has enabled renovations
to give residents with challenging behaviours more
individual space. This has resulted in a reduction in
incidents and a much more relaxed lifestyle for the
residents remaining. This unit was once locked all
the time but is now unlocked most of the time.
78
Choice and decision-making
While staff try to promote individual choice and
decision-making, the institutional environment limits
some aspects of this, for example most residents still
have their main meals prepared centrally. Small but
significant gains have been promoted within these
constraints. Residents have been observed making
their own morning tea or hot drinks on their return
from day placement and some residents who are
preparing to move on from Sandhurst have been
actively encouraged and assisted to prepare meals,
and do their own housekeeping and laundry. During
renovations, residents were consulted about the
colours they would like in their bedrooms and
living areas.
VALID has continued to support a resident group
called the Sandhurst Self-Advocacy Team which
meets monthly. This group has come up with
suggestions like the introduction of water coolers
and developed a poster about resident rights.
Staff support
Staff tell Community Visitors about the positive
work occurring and the growth and development
of Sandhurst residents. Staff training has been
ongoing and included training on ageing and
individualised planning.
One female resident moved to a transition unit a
short distance from Sandhurst and was very excited
to get her own key. She has been employed in
the laundry at Sandhurst on supported wages,
increasing her income and gaining valuable
work experience. She continues to have contact
with staff who can monitor her progress in living
independently. Her work is seen as a stepping-stone
to further independence.
Good practice
A resident, who Community Visitors have known
for some time, has blossomed this year. He
appeared non-verbal and to have limited
understanding of what was going on around him
and his communication was often aggressive.
Since the resident moved into his own area, he has
begun to speak more often and has begun to read
the paper and undertake more tasks on his own.
There has been a significant reduction in challenging
behaviours.
Photos of a holiday by the sea showed his obvious
delight in experiencing the ocean. Staff assist him to
plan other outings and holidays for the future. The
resident now recognises and responds warmly to
Community Visitors and staff.
Healthcare needs
Approximately half of Sandhurst residents have
increased health needs related to ageing. Some
have required hospital stays and two residents
moved to an aged-care facility.
Restrictive practices
The use of seclusion at Sandhurst has reduced
significantly; from 148 incidents in 2010-11 to 64
in 2011-12 with only 11 instances recorded in the
last six months. This is a credit to the efforts of
Sandhurst management and staff in redesigning
some units and relocating residents to promote
compatibility and quality of life.
Upkeep of buildings and fittings
The use of funds and creative efforts of staff to
improve the residential environment has been
terrific. There have been a handful of maintenance
and cleanliness issues such as a roof leak, missing
tiles and the need to replace a clothes drier but
these are insignificant given the improvements
throughout the facility with new carpets, colourful
painting and the use of photos to brighten and
individualise living areas. New fire equipment has
been installed and there are regular drills.
North and West Metropolitan Region
(North)
Planning
Community Visitors have seen significant effort
made to improve PCPs so they are ‘working
documents’ and there are many examples of
residents being assisted to exercise their choices.
These include residents planning and participating
in holidays, household activities or external activities
with the assistance of staff. There are still areas of
concern in relation to individual plans in some
CSO-managed houses, while others are of an
exceptional standard.
Key worker reports have been implemented in all
DAS homes and are gradually being introduced into
many of the CSO houses. There is a need for these
reports to be used more effectively so they reflect
what is actually occurring in the lives of each person.
Family members have been seen to overturn the
decisions of some residents. Agencies need to find
a way to ensure the choices of residents are
respected where people have the capacity to make
their wishes known.
Good practice
Each resident is to have his own activity roster
board in his bedroom. The board provides details
of ‘requests, community activities, home based
activities, and things I would like to talk about’.
The pictorial illustrations are actual photos which
are laminated and which have a magnet on the
back. This means that residents who are non-verbal
can move the photos and indicate what they are
interested in doing. Residents are enthusiastic
about this. Similar boards are planned for menus
and food selection.
Community Visitors Annual Report 2012
79
Disability Services
Staffing
In a number of houses a stable staff team results
in good outcomes and support for the residents.
However, there are a number of houses where
many staff positions are vacant. These continue
to be filled by various casual and agency staff and
not all of them are adequately trained to meet the
needs of the residents. On visits to houses which
employ a large number of casual staff, issues are
often reported of goals not being achieved for
the residents.
In two DAS houses, Community Visitors have
commented on the need to continue with staffing
which is active overnight; DHS has said it will
consider this as part of its general roster reviews.
Leisure activities and recreation
Many residents are supported to lead very busy lives
and to participate in an amazing array of activities.
However, staffing levels and limited access to
accessible forms of transport can restrict the access
of clients to community activities. Residents from
one house were unable to stay in a holiday house
as planned because the house bus was unsuitable
for access. At one house, a DVD player was not
replaced for some time as it was unclear who was
to pay for the replacement when it was broken by
a resident. In another house, a resident received
a TV and DVD player for Christmas but it took some
months for DHS to organise for this to be mounted
on the wall for him. Funding for day placements
is also an issue for some residents
Healthcare needs
Residents are generally well-supported in relation
to their healthcare needs, however, Community
Visitors have reported a number of very serious
issues this year.
Case study
Community Visitors reported concerns
about a resident who sustained a head
injury when she fell to the bathroom floor
while staff were changing her continence
aid. Despite bruising, the resident was
not seen by a doctor until three days later.
Staff were told after this event that any
resident who hits their head should be
seen by a doctor as soon as possible.
80
There were also a number of serious incidents
involving unexplained or undiagnosed fractures
and inadequate medical support.
Case study
A caller to OPA’s Advice Service reported
some very serious concerns, which
prompted extensive follow-up. The
medical examination of a non-verbal
woman with osteopenia and other
complex health needs had discovered
the young woman had three leg fractures
which had occurred at different times over
the previous six months.
The resident also had bruising and
swelling to her face on one occasion,
allegedly from a hoist incident in the
house. The resident’s private guardian
had not been able to establish how the
fractures occurred nor had been able to
access relevant incident reports.
Community Visitors viewed all the
available documentation. The matter
was reported to DAS area management
who conducted their own investigation
and organised for a review by a forensic
medical specialist. Meetings with the
resident’s guardian and the family were
held. However, the investigation did not
establish how the fractures occurred.
A number of strategies have been put in
place to reduce the likelihood of further
injuries occurring.
In one complex case, a woman who is unable to
speak sustained unexplained fractures to both
her legs and received very poor medical support.
In addition to this, there were delays in notifying
her family of her injuries and in fulfilling incident
reporting requirements.
Compatibility
Compatibility of residents continues to be a serious
problem in some houses. One active resident was
placed in a DAS house with residents who have
complex needs and who are virtually non-verbal.
She told Community Visitors she felt isolated
and unhappy. She was promised a full-time day
placement but still has only minimal part-time hours.
Despite some months of advocacy, an application to
the Disability Support Register to enable a move had
not been completed when Community Visitors last
met with DHS management.
One resident from a CSO house over-indulges
in alcoholic drinks daily and places himself at risk
in the community, assaults staff, and frightens his
housemates. He is frequently brought home by
police and is at risk of serious harm. Community
Visitors contributed to the appointment of an
independent advocate. A number of ‘expert’ disability
providers are trying to improve his lifestyle. This
remains complex and ongoing and his housemates
remain disadvantaged.
In a number of other houses, there are residents
who are either violent towards staff or other
residents or unsuited to shared living. Community
Visitors acknowledge these situations are not easy
to resolve but still find it unacceptable to expect
more passive, gentle people to live in fear for
years on end.
External presentation
There are many maintenance issues such as
damaged floors, carpets and curtains, walls in need
of painting, taps that fall off or cannot be turned
on, broken exhaust fans, missing tiles, damaged
fencing, a chipped kitchen bench, and dirty heating
ducts. One house with five adult residents has been
without a dishwasher for more than a year. When
Community Visitors enquire about these issues
they are usually told a maintenance request has
been submitted. In liaison meetings, management
staff explained that the budget for maintenance
is inadequate to address all maintenance issues
and that there is a need to prioritise. And, if urgent,
serious, structural bathroom or kitchen issues arise,
then the majority of the budget may be spent on just
two or three houses in the region.
Plenty Residential Services
Unlike Sandhurst and Colanda, which have no
admissions policies, this site continues to be
used as ‘accommodation of last resort’ for some
people with complex needs and personalities who
have challenged the system elsewhere. These
people require a situation where, if they should
experience an instance of traumatic behaviour, an
alarm system is available to alert nearby staff to
respond effectively. The outcome of this has been
the dislocation of long-term residents from Plenty
Residential Services (PRS).
Community Visitors reported a lack of fire evacuation
drills at two houses. They have also noted some
unsuitable backyard and outdoor areas and weeds,
lawns and yards in need of attention. This was
exacerbated during the mild, wet summer months
when there was unusual growth and DAS must
maintain safe and usable garden areas for residents.
Building structure and design
Several houses which were closed in the past year
were outdated or inappropriate to client needs. A
number of other design issues have been noted. In
one Housing Choices Australia house, two men are
forced to share a bedroom. This house is located
on a busy and potentially dangerous road. There is
also no ramp at the front door so the house is not
accessible to one of the resident’s family members
and one resident who had broken her foot has found
access difficult. One CSO-managed house has a
sloping property and is inappropriately designed.
In another house, the doorway of a bathroom is
not wide enough for walkers and ageing residents.
Some houses have only one shower or one toilet
for five residents.
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Disability Services
Case Study
A resident was accommodated in a house
at PRS late in 2009.The two existing
residents at that time were required to be
moved urgently to accommodate him. This
followed a decision by a court to have this
man removed from prison, as he had been
found unfit to plea in court. Very high staff
levels were required to support this man
as a result of his very restricted situation
in prison and severe disengagement from
staff. The back-up duress alarm system
was also a requirement.
It has taken two years to regain this man’s
trust and present him with a slightly
improved quality of life. In January 2012,
Community Visitors noticed a new house
being built on the edge of the PRS site.
Information was that this was for this
resident. He now lives alone in this house
with a reduced level of staff support from
PRS as a transition situation towards,
hopefully in the future, being able to move
back into the community.
Many of the residents at PRS could live in
the community. If DHS provided them with this
opportunity then this site could be used for the
specific purpose of accommodating people
with special needs as a duress alarm system is
available for staff to call for assistance when severe
behaviours of concern are manifested. It is the
opinion of Community Visitors that it would be in
everyone’s best interest to review the future of PRS
and develop a clear vision for the service consistent
with both the Victorian Charter of Human Rights and
Responsibilities Act 2006 and the principles of the
Disability Act.
Planning and community access
Most residents have a PCP. Community Visitors
continue to question the implementation of the
planned actions from these lifestyle plans. Despite
the introduction of monthly key worker reports to
assist in monitoring the plans, the reporting is not in
sufficient detail to provide a clear ‘picture’ of what is
or is not happening in an individual’s life.
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Community Visitors have advocated for months
that PRS arrange an Italian-speaking service
or volunteer to visit an Italian-speaking resident
who is isolated because of her visual impairment,
communication needs and intellectual disability. So
far, there appears to have been few efforts made to
address her situation.
In instances where goals are for increased
community access, lack of access to vehicles or
insufficient staff support are often reasons given for
why goals are not being implemented. These are
strong indications of inequality for the people who
are housed at PRS.
The situation is so dire that some residents are now
using their own savings to pay agency staff to take
them out, for example, to have a meal, visit family, or
go to a disco. At one visit, an agency staff member
arrived and all five men surrounded him, hoping
that it was their turn to be going out. Such a sad
situation to experience, and one that emphasised
how deprived they are of normal opportunities.
It is the opinion of Community Visitors that both
additional staff support hours and additional vehicles
are required to ensure opportunities for equality in
human rights for these people.
Staffing
Rosters are historical and the legacy of this is that
staffing hours are often suited more to needs of the
staff than the needs of the residents. At the end of
the reporting year, Community Visitors were pleased
to be informed that a project officer has been
appointed to address the findings of the Review
of Supervision Arrangements – Plenty Residential
Services, August 2011. However, the slow progress
on this front continues to disadvantage the residents
of PRS.
Leisure activities and recreation
In a number of houses, residents sit around with
no opportunity to engage in any leisure activity.
Various reasons are given for this, for example,
residents who are blind may trip and fall over items,
people with autism may put the items in the rubbish,
over the fence, or down the toilet. During the year,
Community Visitors have noted from client files,
interest in such activities as riding three-wheeler
bikes and using trampolines. This has been brought
to the attention of management to make such
equipment available.
Abuse and neglect
Planning
In last year’s annual report, Community Visitors
expressed concern about the impact of one woman’s
aggressive and assaultive behaviours on the other
residents in the house where she lives. This resident
has not been moved and Community Visitors remain
concerned that other residents live in fear and
have been observed cowering in their own home
because of the abuse and aggression of this
resident towards them.
In many houses there is a lack of continuity in the
documentation with no clear connection between
PCPs and key worker reports. Residents’ goals are
often written as statements such as, “I want to have
a healthy life”. Where residents have goals to which
they aspire included in PCPs, they are sometimes
not documented in action plans.
External presentation
During summer, the grounds around the three
courts of what is PRS became very overgrown.
A gardening service employing people with a
disability has now been contracted to address
this. Most houses have large backyards of which
many are very under-developed or uncared for.
These areas could provide increased activity for
residents. When PRS was developed there were
five maintenance staff employed. As PRS houses
are regarded as community houses, these positions
have not been replaced as they became vacant.
External contractors are supposed to be utilised.
It seems this is often not done with staff being
unused to this practice.
The houses at PRS are now approximately
20 years old and require upgrades in such areas
as the bathrooms and toilets and particularly in
external and internal re-painting. The present level
of budget for minor maintenance does not allow this
to be done. Community Visitors request that the
government address this by increasing the budget
to this area.
North and West Metropolitan Region
(West)
In comparing this year’s annual report with last
year’s, it would seem that nothing much has
changed. The problems with person-centred
planning, maintenance, retaining permanent staff,
the use of casual staff, transport, and financial
constraints are perennial issues. However, the
Community Visitors come across many very
dedicated and hard-working staff in these houses
and applaud them. Community Visitors continue to
strive to uphold the rights of the people they visit.
DHS recently had training for all house supervisors
and domain managers in person-centred thinking
skills. It is hoped this training will improve the
implementation of PCPs and that they will be
an accurate reflection of each resident’s goals.
Hopefully, there will be more actions linked to these
goals and that Community Visitors will see more
diversity in the goals within each house.
There have been many reports of paperwork
not filed or filed incorrectly. This is frustrating for
Community Visitors because they cannot find the
required documents.
Dignity and rights
A number of houses are having regular house
meetings with the residents. Many are using
inventive ways to help residents express their
choices in everything from outings to the weekly
menu. Some houses call for agenda items prior to
the meeting. In another, one of the residents takes
the minutes and in another, days for the meetings
are rotated so that all staff have an opportunity
to attend sometimes. Where all residents are
non-verbal some houses use chat sheets at
meetings, others find one-on-one talks work better.
Unfortunately, there are still too many houses where
such meetings are not held and Community Visitors
are told that the staff know what residents like to eat
or where they like to go.
Staffing
It appears to Community Visitors that more casual
and agency staff are being used in the houses. This
obviously affects residents in many ways. Houses
where there are residents with high needs and
serious behaviour problems seem to have many
temporary staff and staff changes. Understandably,
this affects residents.
Community Visitors know that it must be very
stressful working in some houses. It is felt that more
support for staff and residents could be given. The
residents are noticeably more settled when there are
permanent staff, with whom they are familiar.
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Disability Services
Good practice
A young woman in a house managed by a CSO was
quite disruptive when all residents were preparing
to attend their day programs. The house supervisor
devised a range of strategies to help her manage
better in the mornings. These included a pictorial
program of steps to follow each morning to get ready
for her day program and a ‘feelings’ book, to help
staff identify problems she might have had that day.
She also had one-on-one time with a staff member
at the end of each day where, over afternoon tea,
she is asked to pick a face which best describes
her feeling that day; if there are three unhappy
faces in a row, staff note this and follow up. These
strategies have been very successful and the
resident is much happier.
Well-planned arrangements were made for residents
who have moved out of their homes. One new
house has opened and the residents were pleased
to show the Community Visitors their new home.
Three other new houses are being built in this
region. Residents from another house where there
were serious structural problems are now settled
into other houses where bedrooms were painted and
wardrobes installed.
There are many maintenance problems in the
houses, however, a number of houses have been
painted and other improvements made.
Communication
Communication both verbally and by other means
is such a vital way for us all to relate. It is wrong
that so many residents are being denied access
to speech therapists and other experts in this area
because they cannot afford to pay for such services
and because the waiting lists are so long. While
most permanent staff say they understand nonverbal residents’ needs and wishes, this certainly
cannot apply to the many casual and agency staff
that are frequently in the houses. Some staff are to
be congratulated on the ways they have devised to
communicate with residents.
It is vital that all residents are given expert help to
assist them in communication.
Participation and engagement
In many houses, residents go on regular annual
individual holidays and some also have short breaks
away. It does seem that the high cost of support for
residents who need one-on-one assistance for such
holidays is beyond their ability to pay in some cases.
Other residents did not go on holidays because their
families do not want them to go away or they choose
not to.
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Family involvement is strongly encouraged. One
resident’s family provides the house with lots of fruit
and vegetables and has arranged for a local butcher
to supply most of the meat to the house. Once a
week, all the residents have free fish and chips from
another local shop.
Many residents have close family and it is pleasing
to find that these ties are respected and encouraged
by staff who often drive long distances so residents
can visit family. In some houses, these drives are
combined with an outing for the other residents. One
house arranges for a resident’s mother to sleep on
a folding bed when she visits from interstate.
Enabled access to the community
Most DHS houses share transport. A variety of
timetables for sharing have been agreed, to best
suit the houses involved. However, sharing vehicles
does mean that the opportunity for spontaneous
community access is limited. This is particularly felt
during holiday periods.
Each house has access to a vehicle from DHS in
Footscray each weekend. As houses are as far away
as Melton, Sunbury and Werribee, collecting the
vehicle on Friday evening in peak hour traffic and
returning it on Sunday evening is onerous. It also
means that sometimes houses are not fully staffed
while this pickup is occurring. Also, some residents
who use taxis to take them to day placements or
appointments find they either come late or not at all.
Good practice
Staff arranged for a resident to go to a new
physiotherapist who suggested a different style
of walker. It has given the resident mobility and
freedom to move and to make decisions about
where he wants to go in the house. This was not
possible before, as he was reliant on staff to assist
him to move around.
Abuse and neglect
Community Visitors reported the assault of a man
in his home by a family member. It was a serious
concern to them that staff who witnessed the assault
did not intervene; there was a delay in seeking
medical treatment and a category one incident report
was not completed as required.
Case study
A telephone call from a concerned staff
member alerted Community Visitors to
a case of abuse in a DAS house. Staff
advised that a family member had a
dispute with a resident who was forcefully
sat down, resulting in bruising that was
still very visible four days later. While two
staff members witnessed the incident at
the time, they did not intervene to protect
the resident, did not immediately report
to management and an incident report
was not made on the day. Other residents
were also present and were very upset
following this incident. The resident was
not taken to the doctor until two days later.
A category one incident report was only
completed when the domain manager
became aware of the incident. On
learning of the incident, the domain
manager took the doctor’s report to police
who declined to take any action, but
noted the incident. The domain manager
advised that the house would engage
VALID to assist the resident to deal with
his family.
Incident reports
Incident reports are not always available in hard
copy when Community Visitors ask to see them.
When sighted, they do not always have followup, outcomes or recommendations to prevent a
reoccurrence. DHS houses have implemented the
non-critical incident register as required by the
department’s incident reporting guidelines in late
2011. Community Visitors will be observing, with
interest, what results will come of this change.
Compatibility
Residents should be able to feel safe in their
own home. Unfortunately, there are a number of
instances where one resident’s disruptive behaviour
is having an impact on the lives of the others in the
house. Two residents from one house were moved
to other houses (at their request) because of another
resident’s behaviour. While they have settled into
their new homes, this did mean they had to leave
a place which had been their home for years. DHS
has brought in an expert from BIST to help formulate
strategies to help staff with such behaviours.
Unfortunately, these strategies are not always
followed. This could sometimes be explained by
the lack of permanent staff in some houses.
Another house continues to grapple with ongoing
friction between two residents and with another
resident who sometimes becomes violent. When this
happens most know to stay in their rooms but one
resident refuses to do this and often gets assaulted.
The problems of ageing and dementia have to be
faced in a number of houses. Staff are given training
to help such residents. However, it is a concern that
other residents are missing out on activities and
outings because of staffing levels.
Ambiance and comfort
Residents and staff have made many houses into
homes. Photos of family, holidays and outings
are displayed. Ornaments, DVDs, magazines and
flowers are around. Written directives displayed on
walls are kept to a minimum. Residents have been
involved in choice of colour and decoration in their
bedrooms.
The continuing work of ‘theming’ each resident’s
bedroom in one house has resulted in the bright
and personalised rooms that the residents obviously
love. The house supervisor is leading this work.
Residents’ likes and interests are considered in the
choice of theme and colours.
Unsuitable floor covering is mentioned in a number
of reports. Surely it is important that the floor
covering in the bedroom of a resident who vomits
frequently should be washable. Duct tape has been
used to patch up floor coverings in living areas
and bathrooms. This is a tripping hazard and looks
unattractive and water gets under the tape, causing
more problems. It is unfortunate that these tripping
hazards are often left a long time.
One house in Sunbury has not been able to use the
back steps for years. These steps should be the
exit from the laundry to the outside clothesline but
because one resident fell and hurt her ankle badly
three years ago, residents and staff were told not to
use that door.
Too often curtains are left hanging by just a few rings
or strips of Velcro when all that is needed is to have
them re-attached. Old furniture and junk is left piled
up both inside and outside houses waiting for hard
rubbish collection or until families remove it.
In some houses, there are reports of water not
draining away from the shower, mould on the ceiling,
loose and leaking toilets, and holes in the walls. In
one house, the metal coil around the flexible shower
hose had been broken leaving a sharp edge at both
ends. For months, residents had to eat at an old
Community Visitors Annual Report 2012
85
Disability Services
plastic table that had a sharp edge where it had
been broken.
In situations where a resident has damaged or
destroyed furniture or white goods they are expected
to pay for the replacement. This sometimes means
that all the residents are disadvantaged. Would
it not be possible for these items to be replaced
immediately and paid for later?
Respite issues
As reported in last year’s annual report, respite
houses are still being used for ‘temporary residents’.
One young girl was moved from a CSO children’s
respite house, where she had been living for a long
time, to a DHS respite house where she is to live on
a seemingly permanent basis. Surely a better option
could be found so that she has a real home rather
than this temporary one.
Case study
A very assertive young woman gets
angry and frustrated when her personal
desires are not being met. She informed
Community Visitors that she had been hit
with a remote control by a staff member;
they did not see an incident report about
this or other issues. It was reported that
a staff member left half way through the
shift; the reply from the facility indicated
the staff member was replaced for the
remainder of the shift.
The house manager has explained the
reasons the young woman’s requests have
not been fulfilled, as staff have to try to
balance her needs against the needs of
the other residents in the house.
This house is a respite house and the
Community Visitors feel that this woman
has been there too long, resulting in her
provoking other residents and causing
unwanted problems. Living in a respite
situation appears to be a trigger in
escalating her behaviours.
Southern Metropolitan Region
Community Visitors in the Southern Metropolitan
Region were pleased to report that there were nine
new houses built under the Older Carer and the
My Future My Choice funding initiatives. These
homes were purpose-built with resident support
needs a primary focus. DHS also built and operates
a well-considered and designed house for residents
with complex behaviours that support their
individual needs.
Planning
The quality of plans overall reflects residents’
individuality, however, clear documentation of
implementation is not always evident. A majority
of activities take place at formal day programs
and, unless day program agendas are available,
Community Visitors find tracking goals and
aspirations difficult. Consistent staffing in houses
leads to better outcomes in recording of this
information. DHS has implemented a section in
the Day Report Book for notations regarding
resident’s activities.
There should be consistency in describing the
progress of each resident’s goals and aspirations.
When the focus of a resident’s person-centred
support is on their abilities, not their disabilities,
Community Visitors have observed great progress
in the resident’s quality of life.
Often documented evidence of activities is not
available for Community Visitors to monitor and
reflect on how the plans are being implemented,
achieved or updated.
Delays in preparing, updating or finalising residents’
support documents continue to be reported. House
staff are often required to write information in a
number of different documents, not only taking
away direct-care time of residents but also when
the documents are archived they are not available
to reflect on. Community Visitors note that where
a house consists of permanent staff, the resident
support documentation is generally well-maintained.
Dignity and rights
There are excellent examples within houses of
communication dictionaries with individualised
focus, photo cards for meal choices and My Day
communication boards. However, communication
support for many non-verbal residents is still lacking.
SCOPE has trained a staff member in individualised
communication needs within some houses in this
area. Community Visitors report the Let’s Talk project
has proved rewarding for both staff and residents.
SCOPE is currently evaluating the data collected
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from this project, with the aim to source ongoing
funding for its implementation in all SCOPE houses.
Community Visitors remain concerned with the
lack of clear guidelines regarding the use of an
independent person, as required under the Disability
Act. There is also a lack of clarity regarding who
can be used as an independent person; this is
an important role for ensuring that a resident’s
fundamental rights are upheld.
Case study
Community Visitors report a female
resident with autism who needs more
consideration of her privacy and dignity
given she is living with four males. In
addition to a sliding door, she has a
screen door to her bedroom as she is
fearful of not being able to see out. The
sliding door is often damaged and cannot
be closed leaving an open view to her
bedroom while she dresses. Even though
house staff open her wardrobe door to
block some of the view there is no clear
plan being considered to address her
rights to privacy and dignity.
Community Visitors report that, in one house,
the toilet door has been removed and replaced
by a curtain due to the decreasing mobility of the
residents. This impacts on the privacy and dignity
of the residents. Recognising the ageing and
associated mobility issues of the residents, the
urgent need for a new bathroom is still not actioned,
despite several years of Community Visitors
reporting about this issue.
Staffing
Permanent staffing ratios remain a concern,
particularly in houses where residents have high
support needs. Community Visitors note dramatic
changes to the quality of life for residents caused by
heavy usage of casual staff who are not familiar with
the residents’ individual programs or needs. Houses
subjected to this occurrence often change from a ‘no
issue’ house to one with multiple issues.
Community Visitors welcome the gradual change
from the cottage parent/24-hour model to the
eight-hour model of care. Where this has occurred,
Community Visitors have reported positive
changes and a person-centred approach leading
to greater independence and enhanced quality of
life for residents. It is noted that the cottage parent
model culture is based on dependence with little
opportunity for independence even when people
become adults.
Independence in all aspects of lifestyle in houses
where the person-centred approach is evident
has been reported. Appropriate individualised
communication methods are also noted in other
sections of this regional report as essential for
independence.
Community Visitors reported concerns regarding
the Behaviour Support Team’s capacity to meet
increasing needs of both staff and residents. Five
team members cover a wide area of need, from
the resident’s home, family home, day programs
and other support providers. Intensive, brief and
secondary consultations are afforded on individual
cases and prioritised by urgency. Depending
on caseload it may take up to six months for a
consultation. This team requires additional resources
and support to ensure early intervention and
a proactive, not reactive, approach.
Community Visitors report that the health and safety
of residents with high medical or support needs are
at risk where casual or agency staff are utilised in
the absence of specifically qualified staff members.
The lack of appropriate training and instruction
for these replacement staff to meet the complex
healthcare needs of residents is a great concern.
Case study
Community Visitors have been concerned
that a house that accommodates a
number of residents with high needs
is often staffed with agency or casual
staff who may not have had orientation
to the house and who may not have the
qualifications related to caring for people
with a disability. It was of concern that
while a number of residents require tube
feeding the agency or casual staff filling
in the shifts may not have had training
in managing this type of feeding. This
places resident health at risk as these
staff may not recognise some of signs of
the complications related to tube feeding.
Security of Community Visitor reports and responses
has been an issue. In many cases, requests for
copies of reports due to the loss of the original has
occurred, after a follow-up request for a response
was made to the service manager.
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Disability Services
Facilitating and encouraging independence
Good practice
Community Visitors are impressed by a program
initiated by DHS staff to enable one of their residents
to work towards moving into more independent
living. The plan is called a STEPS program and
focuses on undertaking small steps with an
ultimate goal.
A resident who moved from Kew to a group home six
years ago, had been limited in house activities due
to her aversion to wearing seatbelt restraints. The
resident, who has mobility and balance difficulties,
has been severely stressed when seatbelt restraints
have been applied and when, for safety reasons, a
belt has been used to take her out in her wheelchair.
While Community Visitors have identified many
issues over the past 12 months, they have also
reported many instances of caring and dedicated
staff who find innovative ways to enrich the lives of
the people they support. An example, which proved
very successful for the residents of one house, was
when a staff member arranged to take two of the
residents ice-skating while they were sitting in their
wheelchairs.
Many other residents have enjoyed attending live
theatre performances in the city, also concerts and
meals in local cafes and coffee shops. Community
Visitors note individual birthdays are often a
reason for celebration in many houses with photos
displayed to enable everyone to continue to enjoy
the occasion.
In a respite house for adults, the staff placed
pictures on the doors of the kitchen cupboards
displaying the items stored inside. Another house
conducted a client satisfaction survey and an
innovative staff member and resident of another
house have designed and built a chook shed with
a run, which can be moved to different locations
around the garden.
These are just a few examples of many, and
Community Visitors believe it is important that
dedicated and caring staff are recognised for taking
the time and making the extra effort to improve the
quality of residents’ lives.
Staff training and attitudes
Community Visitors report concern with the training
and information provided to agency and casual staff.
Without appropriate orientation, support needs will
barely be met with the little time staff have available
to familiarise themselves with the residents.
Community inclusion
Community Visitors are pleased to report increased
sourcing of options by staff for community inclusion
of residents. Overall, inclusion and residents’
choices are met, although there is still room for
improvement within some areas of this region.
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Staff sought professional advice and, for many
months concerted efforts were made to make her
feel comfortable, but without success. However,
Community Visitors are delighted to report that
a major breakthrough occurred recently with the
resident now picking up the house keys and waving
them at staff, indicating her desire to go on the bus.
Regular outings now occur and her quality of life has
been enhanced considerably.
Community Visitors commend the ‘never say never’
approach of staff in supporting this woman to
overcome her fears.
Community Visitors continue to report that a major
barrier to residents’ participation in their community,
or in pursuing individual interests, is the lack of
readily available or dedicated vehicles or suitable
low-cost transport options. Residents can spend
large amounts on taxis going to work, leaving little
money for leisure activities. When one vehicle
is shared between houses, a range of problems
become apparent.
Holiday options are generally provided. However,
for residents with complex health or high support
needs, holidays and outings are limited due to
high costs. This is further complicated where staff
and management are in dispute about appropriate
payment of staff wages when supporting residents
on their holidays.
Abuse and neglect
Community Visitors reported a number of allegations
of abuse and neglect. In one instance, two residents
were involved and staff advised of their difficulty
in having the matter investigated by the police.
While no charges were laid, the police agreed to
attend and speak with all the residents. A number
of additional supports were implemented with
counselling sessions and information provided about
appropriate behaviour, respect and sexual relations.
Aids and equipment
Case study
Community Visitors note a marked
improvement for residents in a DHS house
previously the subject of abuse and
neglect concerns. Following renovations
to the rear of the house, one resident
now has independent living. He feels
safer and in control of his environment
and has interaction, by choice, with
the other residents. The introduction of
two residents into the main house has
led to little disruption. There has been
a stabilisation of permanent staff, a
reduction in incidents and staff are still
active in improving the quality of life for
all residents.
Compatibility
Incompatibility continues to be raised as an issue
by Community Visitors in the region. Residents of
widely varying ages and abilities can be placed
together and, in one house, a woman lives with four
men. The Disability Support Register and vacancy
management process continues to be crisis-driven
with little opportunity for resident choice.
Community Visitors would like to see greater
autonomy afforded to existing residents in choosing
new residents when vacancies occur in their own
home. This would lead to fewer incompatibility
issues, while also acknowledging the need for DHS
to provide accommodation for homeless people or
emergency placements. In these circumstances,
normal transition processes do not occur which
results in placement of incompatible residents,
which often has safety implications.
Healthcare needs
For many years, Community Visitors have reported
concerns about a resident whose family will not
permit him to undergo certain medical procedures,
such as blood tests and dental care, as they think
they would be too distressing for him. Community
Visitors are of the opinion that the resident has
the right to health monitoring and have observed
varied methods utilised by health professionals to
overcome any anxieties this creates.
Community Visitors have ascertained that the
delays of new custom-made wheelchairs can be
caused by the lack of qualified personnel. The long
process of evaluation sometimes takes 18 months.
This can lead to a need for further equipment
changes as a result of changing needs. Financial
concerns can also cause delays when State-wide
Equipment Program (SWEP) funding leaves a
substantial amount to be found by the resident for
the equipment.
In fire-prone areas, Community Visitors regularly
report inadequately stocked evacuation packs
that are missing items like radios, torches or items
that were past their use-by date. These items are
replaced quickly.
It was also reported, with concern, a drop out in
internet connection to certain houses in the region,
causing delays in updating or receiving electronic
information from the main office.
Personal safety
Concerns are expressed for a resident who is
capable of unlocking the front door of the house,
which is on a busy highway. The snib on the wire
door is now employed as extra security, however,
Community Visitors feel this is not an adequate
safety measure.
Community Visitors are concerned that the staff
sleepover room in one house is upstairs and the
residents’ rooms are downstairs. The residents are
vision and hearing impaired and, in an emergency,
there is no way to communicate with staff.
Incident reporting
Community Visitors continue to report difficulty in
accessing documents; often staff do not know how
to locate or access them. The lack of incident reports
in hard copy remains an impediment to Community
Visitors fulfilling their responsibilities under the Act.
Viewing reports by computer has proved very timeconsuming as it takes approximately eight minutes
to scroll through one report.
The recently introduced incident reporting
guidelines, thought by Community Visitors to
rectify access concerns, has been implemented
inconsistently across DHS and CSO houses. At a
number of CSOs, staff email or advise their manager
who grammatically edits the report, categorises
the incident and advises DHS. Community Visitors
believe that this process lacks transparency and
the new guidelines should be implemented across
all houses.
Community Visitors Annual Report 2012
89
Disability Services
The new reporting system only includes the
requirement to report category one and two
incidents. Service providers are required to
keep a non-critical incident register for each
resident, however, it appears that some services
are using this to record incidents that would have
been reported as a category two under the
previous system.
Upkeep of building and fittings
A funding allocation has enabled many longstanding
painting and minor maintenance projects to be
completed, however, most older houses are
not purpose-built and disadvantage residents.
Bathrooms with one toilet are shared by up to five
people and are not compatible with a resident’s right
to maintain dignity. DHS has acknowledged houses
are in need of a rebuild, however, funding is subject
to financial constraints.
Community Visitors again report many maintenance
issues. Matters reported include: rotting window
sills and door jambs, dirty ceiling vents, nails
protruding from ageing fences, guttering choked with
vegetation, shade cloth requiring replacement, trip
hazards in slippery steps and flooring, holes in living
room walls and leaking showers.
Some houses seem to be in a state of ‘limbo’
awaiting a decision on whether their ownership
will transfer from the Director of Housing to DHS.
Community Visitors have been advised that the
Disability Leasing Model only applies to 23 CSOmanaged, Secretary-owned facilities in the region.
Ageing and planning
Accommodating the needs of ageing residents
continues to be a challenge, with concerns regularly
reported about inadequate transport, increased
health needs, poor retirement choices, and houses
unsuitable to the changing mobility needs of
residents.
90
Unmet needs in accommodation
Community Visitors acknowledge new models of
care to accommodate residents who, due to their
complex support needs, have difficulty coping with
shared support arrangements. However further
allowances in future planning for this increasing
need is necessary. One respite house, operated by
SASI, caters specifically for children with autism in
this area and another operates only on weekends
and school holidays.
A respite house which is run down and lacking
comfort is still being used despite land being
purchased some time ago. Families who desperately
need respite are reluctant to use this house in its
current state, although Community Visitors are
impressed with the care provided by the staff.
Restrictive practices
Community Visitors have continued to report houses
where fridges, cupboards or kitchens are locked
for ‘safety reasons’. However overall, restrictive
practices regarding locks has improved, with positive
support provided by the OSP to educate services.
Community Visitors
General Meeting 2012
Community Visitors Annual Report 2012
91
ealth Services
H
statewide themes and
recommendations
92
Recommendations
Health Services
The Community Visitors Health
Services Board recommends
that the State Government:
1.establish a team of behaviour management
specialists that support proprietors to maintain
a safe, home-like environment to minimise
abuse, neglect and violence
2.audit the implementation of the ‘Information
Sharing and Referral Practices Between
Supported Residential Services and Mental
Health Services’ protocol to ensure the
appropriate placement of people in the
SRS sector
3.ensure that the record of incidents and injuries
is accessible to Community Visitors at all times
4.improve the viability of the sector by increasing
the pool SAVVI funding to enable those SRS that
would now meet the eligibility criteria to be able
to participate
5.develop an information campaign that ensures
proprietors and staff fully understand the roles
and powers of Community Visitors so they are
treated with dignity and respect
6.provide adequate funding to ensure the
Community Visitors Program meets its
legislative requirements.
Community Visitors Annual Report 2012
93
Health Services
guidelines for SRS closures
•
c ollaboration around addressing the palliative
care needs of some long-term SRS residents
•
the fostering of a more collaborative working
relationship between the Community Visitors and
Authorised Officers under the newly proclaimed
Supported Residential Services (Private
Proprietors) Act 2010 and Regulations.
Total
•
Scheduled
visits
The Board commends the Department of Health
SRS executive team for the other positive response
to issues they raised and highlights the following
outcomes achieved this year:
Health Services Stream
Requested
visits
The Board is very pleased to report the positive
engagement of the government with the Community
Visitors Program. Parliamentary Secretary for
Families and Community Services, Andrea Coote,
attended three meetings of the Combined Board in
order to hear firsthand the views and concerns of
Community Visitors. Following each meeting, she
took up a range of important issues on behalf of the
program. The program looks forward to continuing
this positive relationship.
This year, there were 79 Health Services Community
Visitors appointed, and another 23 trainees in
the stream. Recruitment of volunteers is always
challenging and, with a shortage of Community
Visitors in many areas, any delay in transitioning
trainees to appointed Community Visitors has an
impact on the ability to recruit and retain volunteers.
Unfortunately, processing delays occurred this
year due to system hold-ups and changes in the
paperwork required. However, Eastern Region
Health Service visits are up substantially from last
year’s record low as the new team of Community
Visitors have taken up their roles.
No. of CVs
In 2011-12, 79 Community Visitors
in the Health Services stream
conducted 924 visits to 171 SRS
across nine regions of Victoria.
Thirty-two of these visits were
referred by OPA’s Advice Service.
Appointment of Community Visitors
No. of units
visited
Statewide report
Barwon-South
Western
10
8
1
73
74
Eastern
Metropolitan
49
10
13
151
164
Gippsland
6
5
0
31
31
Grampians
13
6
1
75
76
Hume
2
5
0
23
23
Loddon Mallee
7
8
2
53
55
Northern
Metropolitan
19
10
0
113
113
Southern
Metropolitan
51
21
14
272
286
Western
Metropolitan
14
6
1
101
102
171
79
32
892
924
Region
Figure 14. Total visits Health Service Stream 11/12
94
incident records
82
abuse/neglect/
violence
69
other hazards
54
staffing/support
54
care plans
& referral
information
Statewide findings
50
cleaning
46
healthcare
The following table and series of graphs
financialincident records
provide an overview of the visits made by
matters
Community Visitors and the issues of concern
abuse/neglect/
meals &
violence
raised by them.
beverages
155
82
41
69
41
other hazards
54
During the year, Community Visitors identified
maintenance
staffing/support
880 issues that affected the lives and wellbeing
care plans 32
of people living in SRS. A number of common
resident mix
& referral
information
themes were identified and, while many cases
cleaning30
reflect the patterns of previous years, the fire safety
highest number of matters reported related
financial
individuality
matters
to health issues, which is a change from last
28
& choice
meals &
year’s report.
issues types identified
number of issues identified
issues types identified
complaint
processes
14
privacy
13
community
interaction
12
4call system
8
grooming/
clothes
5
residential
statements
4
chemical
storage
4
routines
4
4
4
3
3
food safety
3
lighting
3
2
confidentially
50
relationships
of choice
Pe
rs
on H
al ea
C lth
En Ho are /
vir m
on e-l
m ike
en
t
S
af
Di
et
gn
y
ity
& , Pr
Ch iva
oi cy
ce
So
Ac
cia
tiv
lI
itie
nd
ep
s
en
de
nc
e
Fi
Co
na
m
nc
pl In
ai fo
es
nt rm
Pr a
oc tio
es n
se &
s
19
5
100
0
19
8
0
12
20
heating/
religious/
cultural choice
22
22
12 cooling
0
45
25
rec/education
opportunities
support
to
14
move/
relocations
access
to
13
information
citizenship
43
28
19
confidentially
53
30
medication
lighting
189
32
individuality
& choice
19
250
150
39
fire safety
20
food safety
200
41
22
routines
250
41
resident mix
these SRS have complex physical and mentalheating/
cooling
health needs, more than can be addressed with
current funding.
complaint
284
46
maintenance
rec/education
opportunities
SRS, by their nature, provide for those whose
support to
age, mental or physical health, social or financial
move/
circumstance make them vulnerable. SRS do
relocations
not provide nursing or high-care support, noraccess
are to
information
they mental health facilities, yet many people
in
300
50
25
Health and personal care
processes
54
beverages
medication
Healthcare issues dominated reporting in the
Health Services stream this year. Residents privacy
continue to be accepted by pension-level SRS,
community
often without appropriate referral informationinteraction
and at inconvenient times. Residents also
call system
continue to transfer from one SRS to another
without documentation that would support their
grooming/
continuity of care. Another pressing issue in clothes
some SRS is that residents are given little orresidential
no
choice in their medical practitioner and in some
statements
cases, all appointments are booked for the chemical
same day.
storage
39
2
citizenship
0
religious/
cultural choice
0
0relationships
0
of choice
0
20 0
4020
60
40
6080
80 100 100
120120
140
140
160
160
number
number
Figure 16. Health Services Stream number and types of issues identified 11/12
Figure 16. Health Services Stream number and types of issues identified 11/12
Figure 15. Health Services Stream issue groups 11/12
Community Visitors Annual Report 2012
95
Health Services
Care plans continue to be inadequately maintained.
In many cases, these documents are simply
updated with a new review date and there is
often no evidence of resident involvement in their
development. Community Visitors continue to report
instances where care plans remain locked in offices
and are inaccessible to both staff and Community
Visitors. Residents’ healthcare, interests, and life
goals are vital to the ongoing welfare and wellbeing
of residents and regular reference to care plans can
lead to better support and outcomes for residents.
The high incidence of resident falls and lack of
appropriate monitoring of residents’ subsequent
support and healthcare needs in both pension-level
and pension-plus SRS means that fall prevention
guidelines are urgently needed. Community
Visitors noted that some pension-level SRS had
implemented falls prevention programs.
One of the most pressing health issues identified by
Community Visitors this year was the lack of support
for SRS residents with mental health problems.
In the worst cases, this led to repeated evictions
with proprietors and staff unable to deal with the
problems the individual created. The program would
like to see the ‘Information Sharing and Referral
Practices Between Supported Residential Services
and Mental Health Services’ Protocol audited for
its effectiveness and to ensure the appropriate
placement of potential SRS residents.
The Combined Board at its May meeting met with
the Parliamentary Secretaries for Families and
Community Services and for Health and discussed
the case of a resident who has now lived in three
metropolitan regions and who had been evicted
from at least ten SRS. Each time he moved SRS
or region his connection to the service system
diminished until he fell through the cracks, leaving
the proprietor to manage the erratic behaviour
caused by his ill health. The SRS and mental health
branches within the departments have agreed
to review this case and see what can be done to
support this individual. The Board looks forward to a
positive outcome to this particular case and hopes
that the service system can respond more effectively
to this and other cases that Community Visitors have
highlighted over the year.
96
Case study
Since 1999, John has been a client
of public mental health services with
at least seven admissions between
2003 and 2008. His diagnoses include
bi-polar disorder, schizophrenia and
post-traumatic stress.
In a three-year period, John was evicted
or forced to move from at least ten SRS
across three regions due to behavioural
issues associated with his mental illness
that prevented him from successfully
integrating into the community. The
longest stay was a year where staff
worked tirelessly to support John despite
his repeated threatening and violent
behaviour. Community Visitors have
assisted John through regular visits,
including responding to Advice Service
calls to help support him.
At various times John is alleged to have:
• pushed a resident to the floor
• been unpredictable and out of control
• bullied other residents
• been verbally and physically aggressive
• self-administered medication or was not
taking his medication
John has had very patchy mental health
support and one of the reasons cited for
this is ‘confidentiality’ which translates
to no records being kept of where he
goes to live, where he did live, what day
placements he attended, what behaviours
and issues of concern, as well as what
therapies and strategies have been
used to assist him. John continues to fall
through the service system gaps which
has had adverse consequences for him
and those he has lived with.
In some SRS, concerns have been expressed about
the general cleanliness and hygiene of residents.
Dignity must surely be a concern with some
residents going into the community in a dishevelled
and unwashed state with clothes stained by the
previous meal. Privacy continues to be an issue in
situations where there are shared bedrooms.
Abuse and neglect
There has been an increase in violence, abuse
and assaults in a number of SRS this year. In the
most serious case, a resident was alleged to have
murdered his roommate. Residents and staff remain
traumatised by this event. Other incidents where
residents faced serious risk included alleged sexual
assaults and rapes, a suicide on a property adjoining
an SRS, physical assaults and other violence.
Concern about the prevalence and seriousness of
sexual assaults reported by Community Visitors this
year prompted the Board to work with OPA’s Policy
and Research team on a report detailing the most
serious of these as case studies. Subsequently,
there have been fruitful negotiations at a statewide
level about improving the responsiveness of SRS
to allegations of sexual assault. Specific work in
relation to enhancing responses to allegations of
sexual assaults in SRS included:
•
•
•
•
•
the development of a checklist for SRS staff
the development of a protocol with Centres
Against Sexual Assault
information on responding to allegations of
sexual assault included in SRS resources/
training
a review by Authorised Officers of immediate
and post allegation response to ensure
appropriate steps were taken
the development of a protocol between OPA
and the SRS Program for responding to a
notification of a serious allegation of abuse,
neglect or exploitation.
The Board looks forward to a positive conclusion
of these negotiations with the department SRS
executive team early in the next reporting year,
and consider this work by Community Visitors has
contributed to significant long-term benefits for
residents from the work of Community Visitors.
Community Visitors would like to see a more
proactive response to potentially serious issues to
avert situations deteriorating. Unfortunately, some
staff have neither the knowledge nor skills to diffuse
conflict situations that arise between residents and
which sometimes escalate far beyond what they
should. Staff may then be at a loss as to how they
support residents in the aftermath of these events.
All SRS must ensure the residents’ safety and
wellbeing so that they can feel safe in their own
homes. It is important that documentation and
records are maintained, staff training deficits
identified and serious issues are not allowed to
deteriorate. In many cases, action is only taken
following the involvement of Community Visitors
and/or the Public Advocate. Community Visitors
would like to see additional supports for proprietors
to enable them to deal effectively with these
difficult situations.
number of issues identified
Dignity, privacy and choice
80
70
60
50
40
30
20
10
0
69
27
26
2009-10
2010-11
2011-12
reporting year
Figure 17. Health Services Stream abuse, neglect and violence 2009-2012
Home-like environment
The majority of SRS provide good quality care and
a home-like environment for residents. However,
resident mix and compatibility issues continue to
compromise the environment residents are entitled
to enjoy. Instances of aggressive behaviour, often
drug and/or alcohol-fuelled impact on resident safety
which is not a pleasant way to live.
The cleanliness of some SRS and the lengthy delays
for minor repairs in others continues to be an issue.
The right of residents to have pride in their home
should be respected.
Community Visitors Annual Report 2012
97
Health Services
Activities
At most SRS, the activities which are offered
positively support residents’ community inclusion
and are reflective of their interests. Often this is
a result of thoughtful staff and positive community
connections through local groups or council.
Meaningful community engagement is an entitlement
that neither age nor disability should impede.
Therefore it was concerning for Community Visitors
when visiting some pension-level SRS to observe
residents sleeping in bed and only leaving their
bedroom for meals or sitting in chairs sleeping
throughout the day. In other SRS, Community
Visitors observed that with a little imagination and
creativity everyone can be meaningfully engaged
and residents can have a more fulfilling life.
Finances
Residents have raised concerns regarding their
financial administrators and the difficulty they have
in communicating with them. Community Visitors
have supported these residents to raise their
concerns with the person or agency involved.
However, more consideration should be given to
ensuring that residents are linked with financial
counselling services that can assist them to
understand their finances. Concern has been
expressed about the potential for the carbon tax
to be used to justify rent increases although the
program has no evidence to substantiate this.
Community Visitors will monitor this issue.
Information and complaint processes
Residents, out of fear of eviction or other
ramifications, are reluctant to complain and often
only advise Community Visitors of their concerns
‘in confidence’. The new legislation provides a
mechanism of support for residents who feel
they have been treated unfairly or face eviction.
Community Visitors will monitor and report on the
impact of these legislative changes and believe
it will provide better protection for residents.
Viability of the sector
Eight SRS closed in the state this year. This equates
to a loss of 309 beds for people needing low-level
support and placing significant pressure on many
other areas of community services and housing.
Community Visitors support the government’s
commitment to explore and develop new and
innovative accommodation options for people
requiring low-level support and housing and see
the implementation of this as a matter of urgency.
Further, Community Visitors are concerned about the
lack of appropriate accommodation options for those
residents whose care and support needs exceed
those that the SRS sector can provide.
98
The Supporting Accommodation for Vulnerable
Victorians Initiative (SAVVI) funding continued to be
reported positively. This year, the focus appeared to
be primarily on supporting proprietors to meet the
new legislative requirements.
The Board is concerned about the inequity between
SAVVI-funded SRS and SRS that would now meet
the SAVVI criteria. It is unfortunate that SAVVI is
now closed. The financial and business pressures
on pension-level SRS continue to grow and SAVVI
funding has enhanced the viability of participating
SRS while simultaneously improving the lives of
residents. The Board would like to see additional
funding to support SRS that would now meet the
SAVVI criteria. This needs new funds as the Board
would not like to see a diminution of the funds
available to SAVVI-funded SRS.
Recognition of Community Visitors’ role
The legislated role of Community Visitors is to
support the independence and dignity of SRS
residents as well as identify system failures It is
unfortunate that, this year, the Board needs to
report that there has been an increase in
inappropriate and threatening behaviour towards
Community Visitors. In some instances, Community
Visitors have been refused entry or requested to
leave. It is unacceptable and extremely disappointing
that Community Visitors are treated in this way and
challenged to such a degree. The department was
notified in all instances where proprietors have
not acted in accordance with their obligations
under the Act.
These challenges led the program to work creatively
with the department to address these problems.
Consequently, ‘roundtable’ meetings were organised
in a number of regions. These ‘roundtable’ meetings,
facilitated by an experienced mediator, allowed
each party to better understand the other’s roles,
the pressures faced by them and how departmental
staff and Community Visitors can collaborate to
protect vulnerable SRS residents. These sessions
have led to significant improvements in the working
relationships between the Community Visitors and
the SRS Program.
In addition, two training sessions between
Authorised Officers and Community Visitors, to
develop skills in dealing with difficult conversations
and creative problem-solving were held this year,
with another planned for early next reporting year.
These sessions provided a solid foundation for
ensuring any future problems are dealt with swiftly
and effectively.
Funding for the Community
Visitors Program
The Board was disappointed that no additional
funding was provided to support the Community
Visitors Program. The importance of the program as
an independent protector of vulnerable Victorians is
highlighted by the fact that some of the criticisms by
proprietors of volunteers followed the identification
of system failures in these SRS. Community Visitors
are often the only ones speaking for these residents,
as many have no family or friends to act on their
behalf. It is essential that the program is funded
and staffed appropriately.
Regional reports
Barwon-South Western Region
Eight Community Visitors conducted 74 visits to ten
SRS throughout the Barwon-South Western Region.
Of these, one visit was at the request of a resident
or another person. Five of these are pension-level
SRS and the remaining five pension-plus SRS. One
pension-plus SRS has remained unoccupied.
Health and personal care
In this region there are some very positive
developments in healthcare management with
a podiatrist funded by a service provider visiting
three pension-level SRS every eight weeks to
meet resident needs. A diabetic nurse from the GP
association attends one pension-level SRS monthly
to follow-up GP referrals. A SAVVI-funded ‘Men’s
Business’ group visited one pension-level SRS to
discuss men’s health issues, while a nurse health
educator presented at pension-level SRS to support
residents to quit smoking and offered to personally
assist anyone who wanted to quit.
One pension-level SRS is making positive steps
in addressing medication errors, while another
pension-level SRS had to contact a hospital to find
out a resident’s medication needs when she returned
without her medication. Staff at a pension-level SRS
continued to support two young residents to manage
their diabetes and, pleasingly, one was recently able
to move into independent accommodation.
Residents with terminal illnesses were wellsupported by caring staff in the initial stages of
their illness, often augmented by palliative care and
community nurses, generally moving to higher care
as their illness progressed. In one case, to support
such a move, staff made a photo book for the
resident and her family of her time in the SRS.
Abuse and neglect
Community Visitors are concerned about the impact
of repeated moves between SRS on the mental
health of one very vulnerable resident. The female
resident with mental health issues and exhibiting
behaviours of concern moved from Melbourne to
Geelong three months ago. On a recent visit, the
resident told Community Visitors that she had been
asked by the proprietor to move back to Melbourne
to another SRS he runs, as staff can no longer
manage her behaviour. This will be her sixth SRS
in two years and this pattern will continue while her
underlying support needs remain unaddressed.
Community Visitors regard the failure to assist her
as ongoing neglect.
Resident evictions are an issue in one pensionlevel SRS because staff were unable to effectively
manage residents with complex behaviour and
support needs. Police and ambulance services
have frequently attended and other residents are
frightened when these behaviours escalated.
These incidents eventually led to some residents
being evicted.
Home-like environment
SAVVI funded improvements to pension-level SRS
included painting, maintenance, heating repairs, new
floor coverings and furniture as well as plants in one
courtyard. It was also used to buy new clothes and
footwear for residents.
Resident activities were in some cases funded by
SAAVI. These included bus trips to Warrnambool,
where residents enjoyed sports and a BBQ, while in
Ballarat they went ten pin bowling. A pension-level
SRS took residents to Werribee Zoo, Sovereign Hill
and fishing. Other benefits have included Tai Chi
sessions, a Christmas lunch and the purchase of
pets such as a lorikeet and a fish.
The source of a much-reported smell of rot and urine
at a pension-level SRS was identified when the vinyl
was recently replaced. It was noted that the previous
proprietor had used SAVVI funding to lay vinyl over
the existing, rotting floor. This highlights the need for
SAVVI-funded improvements to be audited.
A number of residents at a pension-plus SRS joined
a ‘Food Focus Group’ and raised concerns with
staff. This resulted in a four-week menu plan with
good variety and choice and it included vegetarian
options. One SRS changes the menu every three to
four weeks, yet another pension-level SRS had no
menu on display. During a subsequent visit when it
did display a menu on a whiteboard, it did not match
the meal being served. On two occasions, lunch at
a pension-level SRS was finished by midday. At one
pension-level SRS, mealtimes were disrupted by
escalated behaviours.
Community Visitors Annual Report 2012
99
Health Services
A flourishing vegetable garden at a pension-level
SRS continued to provide fresh produce for meals.
A SAVVI-funded dietician is assisting the proprietor
and cooking staff of one SRS with ‘Healthy Ideas’,
while a resident’s case manager helped make a herb
garden in another.
Community Visitors reported on the inadequacy of
the air conditioner in one pension-level SRS on a
very hot day and the fact that staff needed prompting
to provide water for residents.
Community engagement with SRS saw a community
group knit matching scarves and beanies for all
residents and a Rotary project will provide quilted
blankets to all residents at another.
In one SRS, a resident feels the need to have his
wallet kept in the office to avoid theft while another
resident’s door handle has been broken for some
time, so was concerned about the security of their
possessions while on holidays.
Safety
Residents’ falls are of concern. Some falls are
caused by drinking; some are the result of selfharming behaviours; and others are age-related.
Some residents have been hospitalised for
medication reviews and for medical conditions,
and one after an accident.
A pension-plus SRS has improved resident safety
with the installation of clearly visible yellow strips
to the stairs leading to the second level. Security
cameras were installed at two SRS to address safety
and theft issues. The smoking area at the rear of
the newly opened pension-level SRS presented a
number of safety issues and is no longer used.
At a pension-level SRS, blood was observed
being taken at a dining room table while afternoon
tea was in progress.
Activities
At one pension-level SRS some residents are
supported to undertake training while others have
the option to access libraries, go to pampering
sessions, see movies as well as participate in
walking groups. One SRS has bikes available for
resident use and residents are supported to make
billy carts on-site and sell them at a local market with
profits donated to the Geelong Hospital.
Residents of one pension-level SRS went to a
community centre to learn ballroom dancing and
have ballroom dancing in their SRS on Saturday
nights. Residents who are talented singers, actors
and artists continue to perform in choirs and
concerts while one resident recently performed
in London with ‘Back to Back’ theatre.
100
Art plays a big role in the lives of some residents
with their work displayed on SRS walls. One
pension-level SRS has an ‘artists in residence’
program where residents paint with watercolours.
Their paintings will be framed for an art display later
in the year. There is unmet need in the region for
art/craft programs for residents with complex needs
arising from mental health issues.
Computer access is now available at a pension-level
SRS and a local community centre member comes
to assist the residents.
A newly opened pension-level SRS lacks activities
for residents. The closure of activities for four
to six weeks during the holiday season impacts
adversely on SRS residents with boredom resulting
in problematic behaviours. Consideration should be
given to a holiday program to supplement ‘in-house’
activities.
The region’s encouragement of best practice
in pension-level SRS led to a DVD featuring
behaviours and activities being produced as well
as an activity calendar being adopted in all SAVVI
pension-level SRS.
Good practice
One pension-plus SRS has provided a range of
activities to engage residents.
Residents and their families were supported to
participate in a quilt exhibition with two quilts made
by them on display, including a ‘Cats’-themed quilt.
This quilt was used as the background for photos
taken of residents when a Geelong Football Club
representative brought the premiership cup to
the SRS. A resident knitting group makes rugs for
the charity,‘Cottage by the Sea’, and scarves for
Australian soldiers.
There are many opportunities for those residents
who enjoy music with activities such as visits from
church choirs, a harpist and a musical entertainer.
This SRS is fortunate to have a former professional
pianist in residence who regularly plays for on-site
church services or just to entertain the residents.
Finances
Increasingly, residents at pension-level SRS find
themselves with financial issues. Community Visitors
noted difficulties communicating with administrators,
the inappropriate use of a resident’s money to
support their partner’s smoking habit, and the
inability to access money due to the lack of a bank
account. Community Visitors noted that a financial
administrator provided insufficient evidence to VCAT
resulting in the postponement of a scheduled review.
The move from a NSW administrator to one in
Victoria was a good outcome for one resident.
Payments by administrators can be slow and drawn
out, which impacts on resident behaviour. In one
case, a resident had sufficient funds to purchase a
new digital television. She chose a television and
placed her order. Unfortunately, the administrator
sent the cheque to the wrong store and this could
not be rectified until they returned from leave. It took
four weeks before the resident received her TV.
Staff at a pension-level SRS supported a resident to
prepare a budget to manage her finances, though
a resident at another SRS has been asking for help
with his superannuation for a long time, to no avail.
Viability of the sector
Resident numbers at Sea View House have declined
over the year due to the uncertainty of its future.
Currently, there are only five residents although
higher numbers are needed for the SRS to be viable.
A public meeting was held in May 2012, resulting
in the establishment of a local steering committee
to consider retention options. An extension of
time was sought from Portland District Health in
order to develop a business plan. The steering
committee aims to take over the SRS in early 2013
to provide accommodation and support for the
existing residents, people with a disability or those
affected by road trauma or an acquired brain injury.
Community Visitors are hopeful that this initiative
will be successful, as it would provide continuity
for the existing residents and additional regional
accommodation options.
A Geelong pension-plus SRS was converted to an
aged care facility and all but one of the existing
residents was accommodated by the new service.
This remaining resident moved to another SRS and
the timing of the family information session allowed
for maximum involvement of families in the process.
One pension-plus SRS closed to undertake
renovations and all residents were happy to move to
another SRS operated by the same proprietor.
The opening in January 2012 of a pension-level
SRS put enormous strain on Barwon Health’s Surf
Coast Mental Health Team when eight residents
with mental health issues moved from Melbourne
to Geelong and sought local caseworker support.
This lack of planning and consultation with the
local mental health services meant supports were
delayed. There was some community angst because
this SRS had changed from one that accommodated
aged residents to younger people with mental
health issues.
Eastern Metropolitan Region
For much of this reporting year, there was a full
complement of committed Community Visitors who
made 164 visits to 49 SRS. Of these, 13 visits were
at the request of a resident or another person.
The region has nine pension-level SRS and 40
pension-plus SRS. One pension-plus SRS closed
permanently and one temporarily during the
reporting year.
Health and personal care
Older residents living in an SRS as an alternative to
a nursing home often have family to assist, support
and advise and, in most SRS, there is a warm and
comfortable atmosphere.
Case managers working with people who have
Individual Support Packages (ISP) or mental
health concerns vary in their attitude. Community
Visitors are concerned that some case managers
will not communicate with proprietors regarding
the health and care needs of a client. Too often,
mental health facilities send clients home with little
or no paperwork, promising it later. In one case, the
hospital sent a bag of medications but there was no
follow through.
The proprietor or personal care co-ordinators
assist residents who do not have a case manager.
Community Visitors were notified by the OPA Advice
Service about a proprietor who saw administering
activities paid from a client’s ISP as too much ‘red
tape’. As a result, the resident concerned was
unable to attend a day program.
The health and personal care of clients is sensitively
and warmly managed in most SRS, but, too often,
people with complex mental health needs have no
option but a pension-level SRS. Community Visitors
have contact with a man residing in his fourth SRS
and, in between, has been in hospital. He appears
to have no on-going support, is adamant that he
is able to manage his finances, however, has left
owing money. Community Visitors respect his right
to manage his own life but are concerned that there
may come a point where this right will be removed.
Community Visitors are delighted to report a doctor
visits several pension-level SRS with a mental health
nurse. This partnership ensures a full understanding
of the circumstances and concerns of clients, care
is delivered where people live, and proprietors are
given advice on follow-up care and medications.
Community Visitors Annual Report 2012
101
Health Services
Good practice
Abuse and neglect
On a visit to a pension-plus SRS, Community
Visitors found Hannah in a wheelchair pushed into
a table in front of a television. She appeared very
unsettled, was slumped down in the wheelchair,
dribbling and unable to feed herself. The proprietor
advised that Hannah was from Eastern Europe
originally and had reverted to the language of her
childhood.
Eviction of residents with mental health issues is a
problem in this region and, in one case, has resulted
in three evictions in a matter of months.
On the next visit, she was sitting upright and alert
in her wheelchair. The proprietor had found DVDs
in Hannah’s native language and a doll that she
absolutely loves. Hannah cuddles and talks to the
doll as well as planting several kisses on its face and
head. Hannah looked totally different to the previous
visit. She was still in her wheelchair in front of the
television but was now singing.
Dignity, privacy and choice
Maintaining independence is important to dignity and
residents are encouraged to do as much as possible
for themselves and their decisions are respected. A
resident recently told Community Visitors that what
she loved about her SRS was being “independent
but still dependent”.
While acknowledging the need to enter people’s
rooms to clean or to check they are well, many SRS
respect resident privacy and most rooms have locks.
Community Visitors responded to a call from the
OPA Advice Service from a resident in a shared
room, who was unable to sleep because her
roommate played music all night. Community
Visitors were dismayed to find her room very
cramped with approximately two metres between
the beds. Community Visitors suggest that minimum
space requirements could be reviewed for shared
rooms in SRS.
Recently, Community Visitors were invited into
a room where a man told them that he had not
received a residential agreement and had no
recollection of signing one. During the discussion,
a staff member entered his room without knocking.
The next visit, another resident stressed his
difficulties with the SRS, his concerns about his
health and his fear of the people who made noise
at night. Community Visitors observed two staff
members outside his window clearing up the
courtyard, and listening to the conversation. These
breaches of privacy were reported, however,
“the investigation found this matter could not
be substantiated.” Community Visitors remain
concerned about this lack of privacy.
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The placement of young people in SRS with much
older people is of concern. These young people
may have come from children’s residential care,
rehabilitation units or hospital and often they are not
able to fit with other residents, simply because of
age, lack of experience and insight into themselves.
They tend to ignore rules and courtesies designed
for communal living such as letting someone know
when they intend to miss a meal, are staying out
all night, drinking alcohol or taking drugs, playing
basketball in the corridor or playing music loud
and late. Most pension-level SRS have had young
people through the course of this year, often with
poor outcomes. There is an urgent and increasing
need for provision for them in this sector in order
to ensure they are not neglected or for alternative
accommodation options.
Home-like environment
SRS in the region range in style from a four-star
hotel to older ‘comfortable’ facilities. The care of
clients varies with some treated as honoured guests,
others as family and still others as ‘patients’ with
‘behaviours of concern’. Costs to residents range
from the purchase of room plus payment of $700 a
week for board and care, to an average payment of
84 per cent of pension and rent allowance for board
and lodgings.
Community Visitors have seen changes and
improvements, especially in those SRS supported by
SAVVI. These improvements range from an increase
in staff, to lights in corridors being left on during the
day increasing the feeling of safety, to better quality
food and residents’ understanding of nutrition.
What constitutes a home-like environment can be a
subjective judgment. There is general agreement,
however, that the floor should be free and clear to
avoid accidents and should be vacuumed regularly.
In many SRS, the cook discusses with residents
their taste preferences. Many SRS with older
residents rarely serve pasta or rice; however, these
tend to be staple items of the diet in pension-level
SRS. Community Visitors were told it is a matter of
cost. In SAVVI-funded SRS using dietary advice,
the standard and quality of food is rated highly by
residents perhaps because they have had input into
the menu. Some residents have access to herbs and
vegetables from an SRS garden.
At one SRS, the women saw quiche and fresh fruit
as a delight while the men referred to it as ‘rabbit
food’. Asked what they would prefer, the men said
“meat”. Community Visitors responding to a call to
the OPA Advice Service about complaints about lack
of meat and no BBQ found, when they attended the
SRS, roast pork and vegetables had been served
that day.
As falls are a major concern in many SRS,
Community Visitors have queried whether falls
prevention strategies could be instituted to help
overcome this problem.
One personal care worker tries to make sure she is
in the resident’s room when they go into the shower
so she can put out clean clothes for them. “I like
them to look nice,” she says. Recognising the close
tie between confidence and self-care, a Maroondah
church group has set up a community scheme so
that every resident in the three pension-level SRS
has a year’s supply of toiletries.
Corridors are usually well-lit increasing perceptions
of safety, while kitchens are closed. Where possible,
Community Visitors check night bells and can report
that one SRS has introduced touch or noise pads
which set off an alarm if a client gets up at night so
personal care staff can check that all is well.
A local health group prepared posters showing
dental care (cleaning dentures, brushing teeth, care
of gums and mouth) using the residents as models,
giving them a reminder and a confidence boost.
On a recent visit, Community Visitors observed
the personal care coordinator’s weekly haircut and
beard trim session.
Good practice
The proprietors decided to ‘do up’ the communal
areas of the pension-plus SRS so it was more clientcentred and less food centred. At the next visit, the
Community Visitors found the area transformed.
Chairs were no longer arranged ‘cinema’ style
around a TV, a table had games on it, a billiard
table installed and the fireplace, previously hidden
behind chairs, was accessible and the fire was lit.
A resident had taken to playing Mahler and Mozart
on the uncovered piano. A second TV devoted to
the sport channel has an exercise bike in front of it
and a Hawthorn supporter exercises as she watches
her team play. The smokers’ area, given over to an
above-ground garden, is sunny and well-used.
A table football, infrequently used by residents, is
now used by their grandchildren who loved it and are
happy to visit because they have ‘something to do’.
One man paints and others, who had not previously
done so, now take walks.
Safety
Incident reports continue to be an area of confusion.
Community Visitors found an example where one
SRS that caters for older people had detailed
incident reports, acknowledging minor falls or trips.
In other SRS, where the clients tend to be less
socially able or referred from mental health services,
the incident reports only record major incidents or
altercations. A personal care coordinator recently
commented that the new incident report book will be
much easier to use. Community Visitors hope that
as SRS transition to this new reporting requirements
they will see more detailed and consistent reports.
Fire audits are the responsibility of local government
and, therefore, require a separate notification to
ensure another authority acts which can cause
confusion for Community Visitors. The region covers
several fire prone areas and this split seems illogical,
especially given the stress on safety of clients.
Activities
Care and respect for residents is often reflected in
their activities schedules: hairdresser once a week,
craft session and word games in the garden, golf
putting in the wide hallway, organised shopping
and day trips, or outings for lunch. Community
groups are active in taking residents, usually from
pension-level SRS out for lunches, swimming and on
weekends to church services.
Good practice
A few older gentlemen with a love of golf find it a bit
hard to get around a golf course these days. The
proprietor of the SRS organised a putting competition
with a well-marked out fairway in the corridor and
great fun – and exercise – was had by all.
Activities range from putting a rug over a client’s
knees as they watch television to being assisted
walking around the garden or to a neighbour’s room
for a talk about the football. Several staff encouraged
group walks around the neighbourhood or to the
park, while others have pianos for sing-a-longs,
visiting speakers and exercise classes. Many older
residents go out with family on a regular basis. For
those for whom this is not possible, it becomes even
more important that the garden surrounding the SRS
is inviting, even if it is only to smell the roses.
Maroondah Council has a dedicated social inclusion
and wellbeing officer whose role is to work with
pension-level SRS to ensure people are assisted
to access the community. Finding people were
reluctant to go to the gym, a trainer from the gym
went to the SRS. Other services include a council
bus, using the local pool and a librarian organising
a book group. Unfortunately, other councils told
Community Visitors that they do not visit people in
privately run accommodation.
Community Visitors Annual Report 2012
103
Health Services
Resident mix
Viability of the sector
Concerns and conflicts do arise when people live
together and especially when there are changes in
the residential profile, such as when people arrive
straight from hospital with insufficient information
and follow-up. While the department advises
proprietors to investigate new referrals before
deciding whether to take people, often the hospital
placement nurse pleads on behalf of the client.
Proprietors then accept residents out of sympathy,
out of fear of losing a future contact or sometimes
because they cannot afford a spare room. Paper
work, including medication scripts, usually follows
though it can take some time.
This year, the region lost 74 beds from the local
community after a pension-plus SRS closed, putting
additional pressure to other SRS in the region
as urgent accommodation for displaced persons
reduces regular resident admission.
Case study
Anna’s mum phoned the police twice in
the week before she took out a family
violence intervention order against her
daughter. Anna’s mother and pregnant
sister became increasingly afraid of her
and, although Anna was seen by the
local mental health service, she was
found not to be suffering from psychosis.
As she was unable to return to her own
home, Anna’s disability case manager
persuaded an SRS to take Anna at
5.37pm on Friday afternoon.
On the Saturday night, SRS staff called
police when Anna smashed the glass
doors. She then spent the night at the
police station where a number of police
were involved in dealing with and caring
for her.
There was nowhere for Anna to go; the
SRS refused to allow her to return and
all emergency accommodation was
closed and support services do not work
weekends.
So Anna returned home, where she
remained alone until Monday morning.
Recognition of Community Visitor role
The majority of proprietors embrace the role of
Community Visitors enabling them to discuss, and
support, proprietors in concerns they may have with
their clients.
However, the arrangements between proprietors
and the department preclude Community Visitors
being provided with any action plan issued by an
Authorised Officer to address problems in an SRS.
Consequently, Community Visitors may continually
raise the same issues, unaware of the timeframes or
specific expectations set for resolving the issues by
these action plans.
Gippsland Region
Five Community Visitors conducted 31 visits to the
six SRS in the Gippsland Region. These SRS have
all now been operating in the region for a number
of years. There are five pension-plus SRS and one
pension-level SRS. Two SRS are solely for frail
elderly residents and the other four SRS have
a mix of frail elderly residents and residents with
mental health, intellectual disability or drug and
alcohol issues.
Health and personal care
SRS staff generally provide a good level of care
for their residents and the SRS are usually clean,
comfortable and adequately furnished. Care plans
have improved and are now usually up–to-date,
reflective of residents’ needs and are accessible.
Community Visitors noted that although there has
been an increase in residents with mental health
issues in the region, there was a decrease in mental
health support for them.
While a common practice at SRS is to have
a doctor visit regularly, residents, like other members
of the community, have the right to choose their
own doctor.
104
Home-like environment
Case study
Mary, an elderly resident at one SRS,
regularly complained of pain and, as a
result, was heavily medicated. Although
Mary was being treated by the visiting
doctor who regularly attended the SRS,
she consistently told Community Visitors
over a five-month period that she wanted
a ‘second opinion’. While Community
Visitors regularly passed this message
onto management, they claimed that,
in their conversations with her, she
repeatedly changed her mind. Community
Visitors met with Mary and the proprietor
and confirmed her request for a second
opinion but it took a further two months for
this to occur. Eventually Mary’s medication
was changed and she appears much
happier. Community Visitors persistence
led to a very positive outcome for
this resident.
Dignity, privacy and choice
Residents at some SRS can be limited in choice
of daily living simply by the mix of young and older
residents. At one pension-plus SRS, complaints
were made by some older residents that younger
residents made noise late into the night or early
morning. Similarly, there were complaints from
younger residents saying that portions of food
served were insufficient, though none of the older
residents had complained about this issue.
Abuse and neglect
Community Visitors noted an incident at a pensionlevel SRS where a female resident alleged she was
raped by another resident. The matter was referred
to police, with support provided by the SRS for the
victim and alleged perpetrator. Community Visitors
were satisfied that it was well-handled.
Medication issues have been a concerning pattern
this year in one pension-plus, where this had not
previously been the case. This SRS documented
106 cases over a six-month period with many
incidents involving residents refusing medication
or missing it due to them being absent at the time
of administration. The department implemented
a medication review at this SRS, which resulted
in revised procedures, staff training and resident
education being put in place.
Community Visitors were pleased to report on
a pension-level SRS that has been undergoing
continuous renovation works throughout the
year. Improvements include structural, plumbing,
carpeting, painting, furnishing and landscaping
renovations. The work has resulted in vast
improvement to the SRS and its environment in
order to promote harmony among the residents.
Meals in all the Gippsland SRS usually appear
appetising, nutritious, and fresh fruit is available.
Safety
Community Visitors observed an innovative
approach to addressing emergency situations and
at one pension-plus SRS for frail elderly people,
each resident had an ‘emergency bag’ clearly
labelled and prominently placed in their bedrooms.
It contains a water bottle, undies, nightwear, blanket
and documentation with relevant personal details
of residents.
There are two pension-plus SRS where residents
have reported minor theft from their rooms. Staff are
monitoring the situation. At one of these, Community
Visitors reported there had been a break-in, so
cameras were installed in the hallway to help
remedy these problems. At the other SRS, some
residents have requested locks be placed on their
bedroom doors.
Activities
Community Visitors report a lack of activities and
in several SRS residents sit in the lounge or lie
on their beds during the daytime. One SRS finds
it difficult to access activities due to its isolation
and the requirement of one service provider that
residents travel to them rather than programs being
provided on-site. The combination of residents
lacking the confidence to leave the SRS and the lack
of transport meant this was an inappropriate option.
Consequently, the proprietor employed an activities
co-ordinator to run in-house programs to boost
resident confidence and offer a range of options. The
situation for these residents has improved markedly
with the generous purchase of a bus by one of the
residents, thereby solving the transport issue.
Good practice
Gippsland SRS have higher-than-required staff
ratios, are located in pleasant surroundings, are
generally well-run and staff are considerate when
supporting residents in their care. One pension-plus
SRS has long-term residents of 17 years and 20
years who speak well of care provided at this SRS.
Community Visitors Annual Report 2012
105
Health Services
Grampians Region
Six Community Visitors undertook 76 visits to 13
SRS in the Grampians Region. Of these, one visit
was at the request of a resident or another person.
Of the 13 SRS in this region, nine are pension-level
SRS and four are pension-plus. Most SRS in this
region are well-managed, providing their residents
with excellent care.
Health and personal care
Community Visitors remain concerned with the
‘motel style’ entrances at two SRS, with no cover
and residents being exposed to the elements.
Community Visitors were advised that there remains
no funding available to remedy this and the ageing
fabric at other SRS.
Care plans could be improved across the region
and Community Visitors urge better quality and
consistency in care planning. At one pension-level
SRS, residents can only access the office by walking
through the smoking area, which may lead to issues
for residents with already compromised health.
Home-like environment
SAVVI funding continues to provide improvements
in SRS and Community Visitors noted funding has
been used to purchase fridges, carpets and new
furniture,
Community Visitors were concerned when visiting
one SRS on a very cold day in July to find that no
heating was turned on. It is concerning the heating
was not on until Community Visitors queried this.
Community Visitors continue to monitor one SRS
after an article in the local paper alerted them to
concerns about the quality of its meals. Community
Visitors and department staff visited the SRS
to ensure residents were receiving appropriate
nutrition.
It is pleasing to report that a young woman who
had an inappropriate long-term placement at a
pension-plus SRS has now found more suitable
accommodation. This matter was raised in the
Community Visitor Annual Report 2010-2011.
106
Activities
Community Visitors in the Grampians Region
are pleased to note that most SRS have weekly
activities plans, which means the residents are able
to further their engagement and involvement with
their community.
Viability of the sector
It is concerning that one SRS in the region will
change to an aged care facility in the near future,
reducing the number of SRS beds available in the
region and placing vulnerable people at risk of
homelessness.
Good practice
After a long delay, a resident at one SRS has had
medical treatment which has greatly reduced his
discomfort. SRS management and Ballarat Care
Connect have been working collaboratively to
advocate for this to occur for the last 12 months
because of concern for his wellbeing.
Hume Region
Five Community Visitors conducted 23 visits to SRS
in the Hume Region. The region has two SRS, both
pension-level and managed by the same proprietor.
Health and personal care
The engagement of community and health service
agencies to support residents continues to be
monitored by Community Visitors. The shortage
of suitably trained medical practitioners and allied
health professionals impacts on resident care and
support needs. Over the year, a number of residents
have been admitted to hospitals. Several residents
have also been assessed by the Aged Care
Assessment Service and have moved into
aged care.
Community Visitors were pleased to note that
further care-plan training was provided to staff,
in preparation for the new Supported Residential
Services (Private Proprietor) Act 2010.
Dignity, privacy and choice
Case study
For almost two years, Community Visitors
were concerned about the deteriorating
health needs of a regional SRS resident
with incontinence. The needs of this
resident were complex and challenging for
SRS staff and it was difficult to get timely
treatment from the local health service.
The resident’s condition was reported
on monthly due to concerns about his
deterioration.
While intensive medical support was
being explored, the resident was admitted
to hospital with severe stomach pain. The
resident died following an operation to
rectify a blocked bowel.
There was a concerted effort prior to his
death to coordinate the community health
and support agencies, however, the fact
he did not recover from surgery after an
emergency admission was not considered
a Sentinel Event by the hospital. Therefore,
it was not reported to the Coroner.
Unfortunately, no SRS residents were
able to attend his funeral.
Both SRS struggle to manage residents with
complex health and care needs as well as
challenging behaviours though improved support
from the area mental health team has seen better
outcomes for residents.
There were several incidents where medication
errors were reported.
One SRS was required to accept a new resident
who, following discharge from a Melbourne hospital,
arrived without paperwork to support their transition
or detailing their care requirements. The SRS had
no information to assess whether they were able to
support this person, although the information was
provided a short time later.
One resident who was refusing most meals received
support from the department with the development
of a new eating plan. SRS staff supported the
implementation of the plan and the resident agreed
to follow it. This was a pleasing result.
Good practice
Joan, a resident in her 80s, was assessed by the
ACAS team as needing a low-care accommodation
placement. Joan did not want to move and, when the
SRS demonstrated that they could provide the support
needed, she was able to remain living at the SRS.
This is a positive example of ‘ageing in place’.
The ‘no alcohol’ rule now in place at both SRS, has
been accepted by residents. Some residents who
smoke continue to pose problems for other residents
with incidents reported of residents aggressively
demanding cigarettes or begging for cigarettes in
the community.
Abuse and neglect
There were a number of incidents where residents
demonstrated aggressive behaviour after returning
home intoxicated. Accessing support for residents
with drug and alcohol issues is difficult and the
situation is often compounded by staff not having the
training necessary to de-escalate these situations.
Case study
A young SRS resident was having a
psychotic episode in the community.
Police and ambulance services were
called. The SRS staff were advised by the
mental health facility (90 kilometres away)
that there were no beds available. The
ambulance service was not in a position
to transport the resident and, when police
became aware of the severity of the
situation, the resident was transported
to the police station in the same town
as the mental health facility. Police were
eventually able to get a bed for the
resident at the mental health facility.
After several weeks of treatment and
medication changes, the resident returned
to the SRS and is receiving the ongoing
support of the mental health service and
the SRS staff.
This demonstrates how community
services in rural regions are often
stretched and the difficulty SRS staff have
in managing residents who do not always
receive the services they need.
Community Visitors Annual Report 2012
107
Health Services
Home-like environment
Finances
SAVVI funding continues to be a positive initiative
for both SRS.
A resident who wanted to manage his own finances
was assisted to do so by staff at one SRS. He
obtained a photo ID card and was then able to get
his own bank keycard.
This year, while the fresh fruit initiative continued
for a further six months, the main focus was on
supporting the SAVVI-eligible SRS to ‘get ready’
for the implementation of new Act.
Ongoing maintenance issues at both SRS are
regularly reported, though it was pleasing to note
that a major kitchen refurbishment was completed
at one SRS.
Community Visitors would welcome greater support
for residents’ independence and a broader range of
activities such as the purchase of computers for use
by residents.
Safety
The department finally funded the replacement of
the fire safety alarm system in one SRS. However,
Community Visitors still report a faulty alarm at
the other SRS. Despite this, regular audits of the
system by an independent auditor have found the
system to be compliant. Community Visitors remain
concerned that the intermittent non-emergency
tripping of the fire system could lead to resident and
staff complacency in a real emergency. Community
Visitors regularly check the Emergency Evacuation
Packs and have noted that, in some cases, resident
lists are incorrect.
Activities
It is pleasing to note the variety of activities available
to residents at the two SRS.
A number of residents at one SRS have enjoyed
participating in a local Mental Illness Fellowship
program of weekly activities. Some residents have
also enjoyed short holiday breaks organised by the
same organisation.
Both SRS have cultivated vegetable gardens and
also have chickens. One SRS has a community
worker who attends weekly to engage with and
encourage this resident activity.
One SRS has a weekly swimming and gym program
for the residents. A local community organisation
has donated fishing rods and stools and fishing
excursions will occur when the weather is fine and
staff are available.
The other SRS has started a regular residents’
meeting to engage with residents and gauge their
interest in activities. Community Visitors regard this
as a positive initiative.
108
There was one incident where a resident was
evicted for failing to pay accommodation fees.
Recognition of Community Visitor role
It is important that SRS staff understand that
Community Visitors are volunteers with specific
responsibilities under the Act aimed at supporting
SRS residents to lead more engaged and rewarding
lives. There were a series of difficult interactions
between staff at one SRS and Community Visitors,
which at least in one instance, became open
hostility. This led the program to work creatively with
the department to address these issues.
A ‘round table’ facilitated by an experienced mediator
took place and allowed SRS Program staff and
Community Visitors to discuss perceptions of the
others’ role and work through difficult issues. This
very productive session improved the relationships
and engagement between the Community Visitor
and SRS Program.
Loddon Mallee Region
Eight Community Visitors in the Loddon Mallee
Region undertook 55 visits to seven SRS. Two of
the visits were requested by a resident or others.
The region has four pension-level and three
pension-plus SRS.
Community Visitors have significantly increased
their number of visits within the region and should
be congratulated for their persistent hard work
and dedication.
Health and personal care
Care plans in most pension-level SRS are basic
and fail to capture the full care-needs of residents.
Incident reporting continues to be of concern. One
pension-level SRS had an incident report book that
was 14 years old and a pension-plus SRS had one
that was nine years old. One proprietor said that she
kept her own private incident report book. Generally,
incident reports contained very little information,
with little or no follow-up. Community Visitors look
forward to the incident reporting requirements under
the new Act, which come into effect at the beginning
of the next reporting year. They anticipate that this
will provide a wealth of information, which should
lead to better protection for vulnerable residents.
Community Visitors report an improvement in
palliative care for affected residents who received
regular visits from their doctor and palliative care
nurses. The extra support and monitoring of pain
management by staff is vital. Because pension-level
SRS staff may not have palliative care qualifications
to support residents in these situations, it is essential
they receive training
One concern reported is residents receiving
palliative care in shared rooms. This situation
impacts adversely on both the person receiving
palliative care and their roommate.
Case study
Bronwyn is a relatively new SRS
resident who previously received lifethreatening injuries, resulting in a lengthy
recuperation. She was displaced from her
home, has cognitive impairment and still
suffers from intermittent headaches.
Bronwyn had not found a friend in this
SRS, even though there are a number
of residents of a similar age.
Bronwyn’s long-term goal is to apply
for her own unit, so she can be more
independent. She indicates that she does
not want to be in an SRS for the rest of
her life and has difficulty coping with the
needs of some of the older residents in
the SRS.
With intensive assistance and
appropriate support, Bronwyn should
eventually be able to fulfil her goal of
independent living.
Dignity, privacy and choice
Room-sharing often leads to difficult situations
because of the disruptive behaviour of roommates.
Residents can feel uncomfortable, offended and
even depressed but have little choice because there
are limited alternatives.
Abuse and neglect
An inappropriate mix of residents resulting in
arguments, anger and abuse has led to a number of
evictions. All residents have the right to live in peace
and harmony and not be subjected to violent and
anti-social behaviour. A new resident at a pensionlevel SRS complained that he could not sleep due to
the constant disruption and noise of his roommate
in the same small bedroom. Another resident, so
disturbed by the behaviour of other residents, was
evicted when they resorted to violence. At another
pension-level SRS, a resident with mental health
issues who had recently been discharged from a
mental health facility was facing eviction because
of their behavioural issues. Sadly, due to the lack of
alternate accommodation, these residents can end
up living without any support in a caravan park.
The high incidence of resident falls and lack of
appropriate monitoring of subsequent support and
healthcare needs in both pension-level and pensionplus SRS, means that fall prevention guidelines are
urgently needed.
A resident at one pension-level SRS had fallen
multiple times causing pain and bruising. After
another fall, he was on life support in hospital
for a lengthy period before moving to high-care
accommodation. One pension-plus SRS reported
eight resident falls in two months resulting in
one resident breaking their hip and needing
rehabilitation. Another resident at a pensionplus SRS fell down a ramp, was hospitalised
and subsequently relocated to a nursing home.
Community Visitors are now pleased to report that
this proprietor is upgrading facilities to minimise the
risk of resident falls.
A pension-level SRS resident was recently attacked
by a dog that was under the supervision of the
proprietor. The resident suffered bruising and severe
facial lacerations that required multiple stitches.
A resident with a mental illness who resides at
a pension-level SRS, was found wandering near
a main highway. These instances raise concern
about the level of monitoring SRS residents receive.
Home-like environment
Nutrition and the need for meat dishes to be offered
to residents was again raised as a concern.
In some pension-level SRS, processed and highfat food continues to dominate the menu. Some
residents complained that they no longer receive
a biscuit with their morning and afternoon tea. The
lack of fruit supplied to residents is another issue
carried over from the Community Visitors Annual
Report 2010-2011. At one pension-level SRS, some
residents complained they had not received fruit for
two weeks. Residents should not have to wait for the
SAVVI-funded fruit initiative to arrive before receiving
daily servings of fruit, nor should they be restricted in
the amount of fruit they wish to consume.
It was pleasing that the fabric of one pension-level
SRS had improved using SAVVI funding to provide
amenities such as new lounge suites, dining settings
or even clothes dryers. A fresh coat of paint to older
buildings, and new carpet and tiling has brightened
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Health Services
up many areas. The creation of outdoor areas has
proved very popular with the residents. On the other
hand, it was disappointing that an outdoor billiard
table (purchased with SAVVI funding and mentioned
in the Community Visitors Annual Report 2010-2011)
remains idle. It was disappointing that such a large
amount of money was used for this purchase and
this has not been of benefit to residents. The SRS
should consider selling the billiard table and using
the money more productively.
Safety
Community Visitors are disappointed with the lack
of response of a proprietor after repeatedly reporting
serious safety concerns at one pension-plus SRS
where items, such as bed frames, are partially
blocking the small passage that leads to the exit
door. In an emergency, many residents would find
evacuation difficult, particularly if they have limited
mobility or use aids. This will continue to be raised
with the department until it is satisfactorily resolved.
Activities
While residents at pension-plus SRS appear to
have numerous and varied activities, residents at
pension-level SRS continue to have less opportunity
to engage in community and social activities. This is
due to varying levels of commitments by proprietors.
Good practice
Management and staff at one pension-level SRS
should be commended for their ongoing commitment
to providing in-house activities like cooking and craft
days as well as regular outings in conjunction with
local agencies. The manager and staff also display
a commitment to residents by accompanying them
on outdoor and artistic activities.
Community Visitors regularly find when visiting that
many of the residents are out enjoying life in the
community. Residents actively participated in fishing
trips, football and other sports-related trips. Some
residents formed their own competitive basketball
team. Other activities included a holiday to Port
Arlington and sightseeing trips on the Sorrento
Ferry and the Drysdale train.
Residents were also encouraged to enter a regional
art competition and one resident won first prize with
his ‘Portrait of Mum’.
The residents maintain a floral garden which rambles
over approximately half an acre and a productive
kitchen garden which supplies fresh vegetables
for their meals.
110
Finances
At one pension-level SRS, only one resident is
receiving regular statements from State Trustees
Limited, with others having to ask for them. At
another pension-level SRS, staff went out of their
way to help a resident to complete forms received
from the State Trustees Limited.
A pension-level SRS resident complained he was
paying more in rent than other residents. While the
SRS explained that this related to the extra care
he received, Community Visitors observations were
to the contrary and they will continue to monitor
this issue.
If rents are increased due to increased pension
payments, then this should be fully explained to
residents to ensure they understand it. Concern has
been expressed about the potential for the carbon
tax to be used to justify rent increases, although the
program has no found no evidence to substantiate
this. Community Visitors intend to monitor this issue
in the coming year.
Information and complaint processes
Residents have raised many issues and complaints
with Community Visitors such as finances, fairness,
equity, dignity and support. All of these issues
were discussed with SRS staff or raised with the
department as appropriate. Many of these issues
remain unresolved despite the best efforts of the
Community Visitors through the agreed protocol
process. Community Visitors will continue to
advocate for the rights and dignity of SRS residents.
Recognition of Community Visitor role
It is important that SRS staff understand that
Community Visitors are volunteers with specific
responsibilities under the Act aimed at supporting
SRS residents to lead more engaged and rewarding
lives. A number of challenges by SRS staff to
Community Visitors training and authority, as well
as open hostility in some instances, led the program
to work creatively with the department to address
these issues.
A ‘round table’ facilitated by an experienced mediator
took place and allowed SRS Program staff and
Community Visitors to discuss perceptions of the
others’ role and work through difficult issues. This
very productive session improved the relationship
and engagement between the Community Visitor
and SRS Programs.
Good practice
Extensive changes have taken place under the
new management of a very popular pension-plus
SRS. A new upstairs wing caters for transitional
care residents and can accommodate up to 22
residents. This area, completely separate from the
SRS, offers services including speech therapy, case
management, aged-care specific medical services
and access to a geriatrician and physiotherapy.
Recently built, features include a new office for
the transitional care staff, a separate medication
room (with a two-way mirror) and another room
solely for storing care plans. A lift will be installed
to replace the long ramps and there are future
plans for a coffee shop and doctors’ surgery.
SRS residents have access to the numerous and
wide-ranging activities offered by a very diligent
activities coordinator.
North and West Metropolitan Region
(North)
Ten Community Visitors conducted 113 visits to
19 SRS in the North and West Metropolitan Region
(North). The region has nine pension-level SRS
and ten pension-plus SRS.
Health and personal care
It was noted that care plans and other resident
support documentation was generally wellmaintained and up-to-date in the pension-plus SRS.
However, some pension-level SRS continue to
have out-of-date and unsigned care plans that are
not accessible to Community Visitors or even staff.
Community Visitors question how staff can support
residents when they can neither access care plans
or care plans are not reflective of the residents’
current situation. It is concerning that Community
Visitors, empowered under the legislation, are
denied access to care plans and other relevant
documents simply because staff cannot locate them.
Community Visitors also reported a lack of soap and
towels in a bathroom of a pension-level SRS. This
raised health and hygiene concerns for residents,
however, it was quickly remedied.
Abuse and neglect
This year there were serious allegations of sexual
assault in one pension-level SRS in the region. This
matter was included in a report to the Minister as it
raised a number of very concerning issues.
Case study
Carol, a pension-level SRS resident, was
reported missing. A couple of hours later,
she was brought back to the SRS by a taxi
driver. Blood was found on her underwear
and she was taken to the doctor.
Carol disclosed to her doctor and an
SRS manager that she had been sexually
assaulted twice by two different people
in the time that she was missing. She
also alleged that the male SRS proprietor
had previously sexually assaulted her.
It was agreed these allegations should
be reported to the police but it took two
days for this to happen. Carol’s access
to justice was compromised when the
manager spoke to the female proprietor
and then confronted the male proprietor.
Carol had disclosed to SRS staff sexual
assault allegations about the male
proprietor a number of months earlier
but nothing was done about it.
Carol’s case manager, who had been
contacted when she went missing, was
very concerned about her state. This,
and the fact that the SRS manager felt
unsupported and unaware of how to
handle the situation, led the case
manager to contact OPA’s Advice Service.
The Public Advocate visited the SRS
with Community Visitors to assess the
situation. She also met with the case
manager and the department. The
departmental response was slow and not
as comprehensive as it could have been.
Despite the best efforts, Carol remained
living at this SRS for a further three weeks.
However, it took considerably longer
before she was housed closer to her
family in another region.
Police advised charges would be laid
against the male proprietor, however,
proceedings ceased when he died.
Community Visitors were troubled by the
fact that it took so long for staff to notice
Carol’s absence and pondered whether
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Health Services
these assaults could have been avoided
if her absence had been reported to
police earlier.
It was concerning that Carol did not have
the support of an Independent Third
Person (ITP) in her dealings with police.
ITPs are specially trained OPA volunteers
who support anyone with a mental illness
or a cognitive impairment during a police
interview.
Home-like environment
Community Visitors continue to support SAVVI
funding and note the positive influence it has within
the pension-level SRS. In particular, residents
appreciate the fresh fruit initiative.
Maintenance and housekeeping issues persist at
some pension-level SRS with Community Visitors
raising concerns about rubbish and clutter, mouldy
showers and the serious safety issue of residents’
call buzzers not working. Also reported were lengthy
delays to repair a severed phone line.
A resident at a pension-plus SRS complained that
he could not read due to poor lighting while, at a
pension-level SRS, residents complained that they
were cold as the heater was inoperable. While it was
pleasing that they were promptly responded to, it
was concerning that these issues were not dealt with
prior to Community Visitors raising them.
Concerns relating to meals and food storage
continue to be reported, including unlabelled food
stored in a freezer and boxes of rotten fruit being left
on tables in a recreation area. At one pension-level
SRS, there were not enough chairs at the dining
tables for all residents, so some residents had their
meals in their bedrooms, resting plates on their
knees. While this has now been rectified, it should
not have happened in the first place.
Community Visitors encourage proprietors and staff
to support their residents in a positive home-like
environment.
Safety
Some pension-level SRS continue to have difficulty
supporting residents with challenging behaviours and
this significantly impacts on other residents and staff.
At one pension-level SRS, a door thought to be too
close to the stairs and creating a potential risk to the
residents walking past, has been reported. While
a sign has been affixed to the door, Community
Visitors remain concerned about the risk to residents
and wait on the results of further inquiries.
112
North and West Metropolitan Region
(West)
Six Community Visitors conducted 102 visits to
14 SRS in the North and West Metropolitan Region
(West), of which one was requested by residents
or another person.
The region has eight pension-level SRS and six
pension-plus SRS. One pension-plus SRS closed
during the reporting year. Community Visitors are
concerned about the lack of pension-level beds
available in this region and often residents only
choice in living arrangements is to relocate
between SRS.
Health and personal care
Generally, all SRS have positive and inclusive
resident care plans, with one exception at a pensionlevel SRS. At this SRS, Community Visitors noted
little change from residents’ initial care plans, as well
as the filing of resident care plans against the wrong
room number in some cases.
While residents at one SRS are well-groomed and
dressed appropriately for the weather, at another
pension-level SRS residents are regularly observed
to be dirty and dishevelled.
Community Visitors noted that, at some SRS, there
is little variation in the menu and residents have
few vegetable choices with one pension-level SRS
reported as serving boiled cabbage every day.
Community Visitors noted that a staff member at
a pension-level SRS, who was not rostered on
duty, was listed as having signed off on dispensing
medication, when some medication had allegedly
not been dispensed at all.
Community Visitors reported with concern that
staff at one pension-level appeared unavailable to
support residents at night. A sign was placed on the
staff sleep-over door stating ‘Do not knock between
7pm and 7am’. Despite staff advising that they
were available should an emergency arise, this sign
deterred residents from contacting them.
Community Visitors regularly report residents in bed
throughout the day with little motivation or alternative
activities for them to be more engaged and involved
in their community.
Dignity, privacy and choice
A pension-level SRS resident approached
Community Visitors gravely concerned and fearful
of being evicted. Despite Community Visitors raising
this with the department, nothing could be done, as
the eviction threat was not perceived to be imminent.
Abuse and neglect
Resident complexity and mix at pension-level SRS
remains an ongoing concern. Community Visitors
have reported concerns regarding violence, abuse
and neglect of residents in some pension-level SRS.
An increase in aggression and violence potentially
stems from residents with drug and alcohol-related
problems. Staff organise additional supports for
residents where possible but, in many instances, the
chaos continues and is only resolved when evictions
occur or police are called to intervene.
Some residents reported living in fear of other
residents who have assaulted and caused injury to
both residents and staff. One female SRS resident
was fearful that her ex-partner would find her and
kill her. Community Visitors were concerned that
situations such as this could pose a security risk to
other residents.
The neighbour of an SRS tragically committed
suicide on the adjoining property. Most of the SRS
residents were aware of the situation and the
department reported that Doutta Galla Community
Health Services spoke to all staff and residents.
Further counselling was offered but was not taken
up by anyone. However, Community Visitors remain
concerned about the long-term effect of this incident
on residents.
Residents also regularly complain about one staff
member yelling at them and generally treating them
discourteously. This behaviour is not acceptable as
this SRS is their home.
Community Visitors continue to express concerns
with the inadequate and inconsistent reporting and
recording of incidents at SRS. At one pension-level
SRS, staff were unaware of an alleged assault the
previous night and nothing had been documented
nor mentioned at handover. In another case, the
proprietor could not show Community Visitors any
incident reports and was unaware of the procedure
to record them. Violence and aggression could be
minimised if staff reflected on potential triggers by
reviewing incident reports.
Community Visitors are eagerly awaiting
the implementation of the incident reporting
requirements in the new Act in the next
reporting year.
Home-like environment
Community Visitors were impressed by the speed
in which minor maintenance issues were rectified in
all but one pension-level SRS where the flooring is
lifting, large cracks are unrepaired and the
toilet broken.
When Community Visitors noted in a pension-level
SRS that the shower in a resident’s room was not
working, staff advised that residents could use
another shower in the SRS.
Good practice - A pension-plus SRS where
the ‘plus’ is a little bit extra
When a proprietor noticed a resident taking an
interest in the garden, asking questions about
various plants and how to bring the old garden back
to life, he brought a range of gardening equipment
and seeds. Soon plants were propagated,
beds raised, lawns came to life, trees fruited, a
passionfruit vine covered an old gazebo, and herbs
and vegetables were in abundance. A pleasing
aspect was the return of many native birds (lorikeets
and rosellas) to the garden. Other residents now
take an interest in and take pleasure from what
happens outdoors.
At three pension-level SRS, poor cleaning and
hygiene standards are regularly reported. Examples
include dirty floors, unwiped tables, black mould
around condiment containers, dried food on the
dining room walls, bathrooms with mould on
showers, bed linen that appears to be infrequently
changed, and cigarette butts left discarded around
the SRS.
While there has generally been an improvement
in SRS menu planning and meals, some pensionlevel SRS residents complained they are frequently
served dessert before the main meal, they are
served stale rolls and broiled chops and boiled
cabbage or savoury mince padded with rice and
gravy. Community Visitors observed a resident,
who had kitchen duties as part of their care plan
activities, licking their fingers while making residents’
sandwiches for lunch.
Community Visitors note that, every winter, one
pension-level SRS is extremely cold. On one
occasion, residents were observed wearing beanies
and dressing gowns over their clothes to keep warm.
Staff advised the heater was broken but had done
nothing to organise its repair. This was reported to
the department who undertook to ensure the repair
occurred promptly and that interim measures were
put in place to keep residents warm.
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Health Services
Safety
Recognition of Community Visitor role
Community Visitors at one pension-level SRS
reported hazards such as passageway lights being
inoperable and lifting and bubbling flooring. One
resident cut his foot on exposed nails from a carpet
tack strip that had been removed. Residents are
entitled to walk safely about SRS.
It is important SRS staff understand that Community
Visitors are volunteers with specific responsibilities
under the Act aimed at making the lives of people in
SRS more supported, engaging and rewarding. In
a few instances this year, Community Visitors have
found themselves in situations where they were
challenged or their authority questioned. This led the
program to work creatively with the department to
address these issues with very positive outcomes.
Residents have complained to Community Visitors
that boarders from houses on either side of the
SRS have entered their rooms, uninvited and stolen
money. Residents have requested locks for their
bedrooms to protect their belongings but this has
not occurred.
While there are a number of SRS who have provided
very positive and informative evacuation information
for their guests and residents, one pension-level
SRS failed to provide clear emergency evacuation
procedures and information.
A Community Visitor injured her hand after the door
rail on the stove fell off. Her injured hand took a long
time to heal. However, this was also not recorded as
an incident by the SRS.
Activities
It is positive to report that the simple provision of
an oval table at one pension-plus SRS encouraged
residents who would normally have been sitting
around the SRS in chairs to sit around the table
reading and talking to each other.
At a pension-level SRS, a room was converted into
a library/games room and now residents socialise
and play games like chess and bingo as well as
create jigsaw puzzles.
A resident of a pension-level SRS returned to her
homeland for a holiday accompanied and supported
by a SRS staff member. Her family were supportive
of this occurring.
Viability of the sector
The closure of a pension-plus SRS reduced the
available beds in this region by 44. The closure of
this SRS not only impacts on the residents forced to
find alternate accommodation but on members of the
community who would prefer to reside in a low-care
facility, rather than in aged care.
Community Visitors are also concerned about the
lack of pension-level beds available in this region.
Resident mix and compatibility issues may mean
that the only choice in living arrangements is to
move from one SRS to another and back again
or be homeless.
114
At one SRS, Community Visitors were constantly
unable to observe and report issues. The proprietor
verbally abused Community Visitors, aggressively
demanding they leave the premises. Residents
reported they were told not to talk to Community
Visitors for fear of reprisals if they did. At another
pension-level SRS, Community Visitors found a sign
affixed to a cupboard stating that the department
had advised the SRS that Community Visitors were
authorised to view incident reports and care plans
only and any further documentary requests should
be referred to the region’s Authorised Officer.
A ‘roundtable’ facilitated by an experienced mediator
allowed SRS Program staff and Community
Visitors to discuss their perceptions of each other’s
role and work through difficult issues. This very
productive session had a transformative effect on
the relationships and engagement between the
Community Visitor and SRS Programs.
Southern Metropolitan Region
Twenty-one Community Visitors conducted 286 visits
to 51 SRS; of these, 14 visits were at the request
of residents or other people.The region has 25
pension-level and 26 pension-plus SRS.
Health and personal care
Most pension-plus SRS continue to provide wellplanned and documented care plans to meet their
residents’ support and care needs. However, some
residents remain poorly catered for in this area. In
one instance, Community Visitors were advised
that a local doctor had concerns regarding the
inadequate care provided to residents at a pensionlevel SRS so the female doctors in the practice did
not visit the SRS due to safety concerns.
Care plans continue to lack strategies to support
residents with changing physical and medical needs.
There is still concern regarding the inadequacy of
referral information provided to SRS by various
service providers. In the most serious instance, a
resident was referred from an acute adult inpatient
unit to an SRS late on a Friday afternoon, a time
when the SRS has a low roster of staff and not a
normal acceptance time. The resident left the SRS
almost immediately but was not missed by SRS staff
until the morning shift. By then, police had found the
person dead in that area.
There are concerns that some SRS are either not
willing or are unable to provide the level of support
that some residents require. A resident, who is
diabetic, complained that her support needs were
not being met in one SRS and in another, where
more then a third of the residents are diabetic, some
complained that the SRS did not accommodate their
dietary needs. Community Visitors reviewed the
menu plans and undertook to raise the resident’s
concerns with the proprietor.
Community Visitors reported, at times, SRS were
being used inappropriately as respite facilities
for people discharged from hospitals after major
surgery. Often they arrive with no proper discharge
notes or medication. Most SRS staff are ill-equipped
to support and care for these people.
Dignity, privacy and choice
Many residents appear happy sharing bedrooms
however, privacy and dignity of residents is
sometimes compromised. This can become a major
issue if incompatible residents have been placed
together.
Abuse and neglect
Community Visitors have reported multiple incidents
occurring at many pension-level SRS involving drug
and alcohol abuse, inappropriate sexual behaviour,
alleged rape and indecent exposure, violence,
aggression and attempted suicide. This can lead to
police and ambulance being regularly called to these
SRS.
Residents with mental health issues and complex
behaviours, continue to create enormous problems
for proprietors and other residents. Staff often do not
have the skills or training to manage these issues.
At one pension-level SRS, there is a volatile mix
of residents with complex needs. While residents
have expressed their concerns that the proprietor
moves problematic residents between SRS they
own, there are no other housing options for these
residents and he is reluctant to evict them for fear of
homelessness.
A number of residents who have threatened and
attempted suicide are served eviction notices or
not allowed back to the SRS after hospitalisation.
One incident report detailed an attempted suicide
by a resident who lay in the middle of the road. The
resident was transferred by ambulance to hospital
and they did not return to the SRS. At another
pension-level SRS, 16 incidents were recorded since
the beginning of March 2012, with many relating
to one resident with issues such as aggression,
inappropriate behaviour, threats of suicide, self-harm
and repeatedly calling ambulance services. The
resident’s mental health caseworker is seeking a
more appropriate placement for them, however, this
is taking some time.
Community Visitors in this region are concerned
about the neglect implications of repeated eviction
on some residents with complex and challenging
behaviours. One of the most serious of these cases
is reported in the statewide section of this report.
Two residents were evicted twice in six months
because of their abusive behaviours to other
residents. Some SRS proprietors accept residents
without prior knowledge or planning for their complex
needs and then their only recourse is to complain
about the lack of information and support from case
managers or eviction.
The timely and appropriate consideration of a
prospective resident, their support and care needs
and the ability of the SRS to provide safe, supportive
and harmonious accommodation for them.
Prospective residents and existing residents must be
a priority. The ad hoc acceptance of residents has
demonstrated an unacceptable risk to members of
our community seeking accommodation and support
in SRS.
Home-like environment
The meals and variety in menu is reported as very
positive and, overall, residents appear to be very
happy to have a roof over their head and three
meals a day. Without this, many would potentially be
homeless.
Community Visitors report that, in some pensionlevel SRS, residents’ drug alcohol use severely
impacts on the quality and home-like environment
for other residents. All SRS have seen a marked
increase in a younger demographic replacing the
frail-aged population, and the mix can create a
difficult living arrangement for all.
This year, SAVVI was more focussed on SRS and
staff ‘getting ready’ for the new Act. Funding was
provided to the SAVVI-eligible SRS to replace
staff so that they could undertake information and
training sessions as well as provide managers and
proprietors with opportunities to gain business and
legal advice to support meeting the requirements
of the new Act. The residents welcomed the
continuation of the Fruit Initiative for a further
six months.
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Community Visitors also noted the activities of
two SRS were included in the publication Stories
from SAVVI which demonstrated the positive
improvements in the viability of the SRS and
provided residents with better support, new
opportunities and a more home-like environment.
ERMHA which was well-attended by the community
and service providers. This provided positive
recognition and support of individual skills and
achievements and was a welcome opportunity for
community inclusion for these residents.
While Community Visitors reported an overall
decrease in maintenance concerns, there were
many reports relating to unclean bathrooms, mouldy
showers and curtains, unhygienic toilets and
cigarette butts strewn around the SRS.
Good practice
Safety
Smoking in bedrooms continues to be a major
concern and ‘no smoking’ policies are not enforced,
evidenced by cigarette butts and ashtrays in
residents’ bedrooms.
Community Visitors noted with concern a number
of fires reported to be caused by residents at some
pension-level SRS. One resident of a pension-level
SRS is alleged to have set some cloth material alight
in a bucket in the laundry causing damage to a wall,
cupboard and washing machine and a fire erupted
when another left cigarette butts in an outside
ashtray.
A resident of one pension-level SRS deliberately set
fire to bedding in his room, badly damaging it, and
the room required total refurbishment. Police were
involved when the attending fire officer deemed it a
crime scene. The resident was evicted from the SRS
and the proprietor expressed concern regarding lack
of available assistance from various agencies to
support the remaining residents.
Of serious concern to residents is the risk to
residents caused by inactive or inoperable fire
alarms or fire panels and blocked fire exits. One
SRS advises that there have been delays in the
alarm company attending to rectify. One persistent
alarm fault was rectified after a resident left the
SRS. The department has advised that the local
council and/or the fire brigade have authority in
these matters and has attempted to liaise with these
organisations. In the meantime, residents remain
at risk of not being aware of an emergency situation
because of a faulty/inoperable emergency
alarm system.
Activities
Activities continue to be positive and engaging
for residents with many external service providers
providing options for those wishing to participate.
At one pension-level SRS, staff place resident
special-event photos and trophies in strategic
locations around the SRS for all to see. At another
SRS, staff held a resident art show supported by
116
Community Visitors were impressed when a local
council installed gym equipment in a pension-level
SRS and engaged a physiotherapist to ensure
correct usage of the equipment by residents. This
complements the weekly walking program the
council has provided to residents for several years.
Finances
Concerns have been raised about the potential
for the carbon tax to be used to justify rent
increases although the program has no evidence to
substantiate this. Community Visitors will monitor
this issue.
Viability of the sector
Four pension-plus SRS and two pension-level SRS
closed during the reporting year and one pensionplus SRS remains temporarily closed.
Residents had been well cared for in two SRS and
were distressed when they were slated for closure.
These two SRS were placed in the hands of
administrators and, although their approach was
uncoordinated, all residents were placed by the
required time. However, in one case, a resident
was not given any choice of accommodation and
was placed in a retirement village close to shops,
contrary to her documented needs. This person had
no family to assist with her placement.
Later in the year, one pension-level SRS, where
there were grave concerns for the safety of the
residents, closed. The department managed the
process for relocation and involved all service
providers and Community Visitors. It was wellcoordinated and all residents were provided with
more than one choice. Some residents had trial
stays before they made their decision. Community
Visitors monitored resident moves and visited
them to ensure they were settling in and had
appropriate support.
Ten years ago there were over 83 SRS in the region,
now there are only 51. This equates to an average
loss of about 1150 beds for people in the region. It
is very disappointing that so many SRS have closed
within this reporting year.
Facilities eligible to be visited by
Community Visitors 2011-2012
Mental Health
providers
Disability Services
providers
Albury Wodonga Health
ABLE Australia
MacKillop Family Services
Alfred Health
AGAPI Care
Mallee Family Care Inc.
Austin Health
Alkira Centre - Box Hill Inc.
Marillac House
Ballarat Health
Annecto Inc.
McCallum Disability Services Inc.
Barwon Health
Araluen Centre
Melba Support Services Inc.
Beechworth Health Services
Ashcare Incorporated
Melbourne City Mission Inc.
Bendigo Health
Asteria Inc
Melton Shire Council – Melbacc
Eastern Health
Australian Community Support
Organisation Inc.
Merriwa Industries
Australian Home Care Services
Mirridong Services Inc.
Autism Plus Transitional
Accommodation
MOIRA Inc.
Bayley House
Multiple Sclerosis Limited
Forensicare
Goulburn Valley Health
La Trobe Valley Health
Mercy Health and Aged
Care Inc.
Northern Health
North Eastern Psychiatric Services
NorthWestern Mental Health
Peninsula Health
Ramsay Health Services
Royal Childrens’ Hospital
Southern Health
South West Health care
St Vincent’s Health
Stawell Regional Health Services
West Wimmera Health Services
Western Health
Brighton & District Branch Helping
Hand Association for Intellectually
Disabled Inc.
Carinya Society
Colac – Otway Disability
Accommodation Inc.
Community Connections (Victoria)
Limited
Community Living and Respite
Services Inc.
ConnectGV
Cooinda-Terang Inc.
Department of Human Services
EW Tipping Foundation Inc.
Family Plus Inc.
Focus
Gateways Support Services
Gellibrand Residential Services Inc.
Golden City Support Services Inc.
Healthscope Limited
Independence Australia
Ivanhoe Diamond Valley Community
Centre Inc.
Jesuit Social Services Limited
Jewish Care (Victoria) Inc.
Karingal Inc.
Kirinari Community Services Inc.
Knoxbrooke Inc.
Kyeema Support Services Inc
Life Without Barriers
Lifestyle Solutions
Maccro, Mansfield Adult Autistic
Services Limited
MIND
Monkami Centre Inc.
Murdoch Community Services Inc.
Murray Human Services Inc.
Nadrasca
Nepean Centre for Physically
Handicapped Inc.
Northern Support Services for People
with Disabilities
Noweyung Limited
Oakleigh Centre For Intellectually
Disabled Citizens Inc.
ONCALL Personnel & Training
Plenty Valley Community Services Inc.
Providing All Living Supports (PALS)
SCOPE Victoria Ltd
Southern Way Direct Care
Services Inc.
St John of God Services Victoria
Statewide Autistic Services Inc.
STAY – Residential Services
Association Inc.
Sunraysia Residential
Services Inc.
Uniting Care Harrison Community
Services
Victoria Deaf Society
Villa Maria Society
Wallara Australia Ltd
Wesley Mission Victoria
Wimmera Uniting Care
Woodbine Inc.
WRESACARE Inc.
Yooralla
Community Visitors Annual Report 2012
117
Health Services
– Supported Residential Services
Aaron Lodge
Chatsworth Terrace
Hambleton House
Absalom
Chesterfield
Hampton House
Acacia Gardens
Chippendale Lodge
Harrier Manor
Acacia Place
CooRondo Home SRS
Hawthorn Grange
Achmore Lodge
Corandirk House
Hawthorns Victoria Gardens
Acland Grange
Cottisfield
Hazelwood Boronia
Adare Supported Residential Care
Covenant House
Heathmont Lodge
Airlie Supported Residential Service
Cranhaven Lodge
Hepburn House
Alexandra Gardens
Crofton House
Highgrove
Allbright Manor
Crosbie House
Hillview Lodge
Alma House
Crosbie Lodge
Hollydale Lodge
Alphington Lodge
Crystal Manor
Home Residential Care SRS
Ascot House
Darebin Lodge
Homebush Hall
Aveo Bentleigh
Delany Manor
Iris Grange
Aveo The George
Domain Gardens
Iris Manor
Bacchus Marsh – Browen Lee
Doncaster Manor
Janoak Villa
Balmoral
Dorset Lodge
Jasmine Lodge
Balwyn Manor
Dunelm
Kallara Residential Care
Bamfield House
Eagle Manor
Karinya
Bayview Waters
Edwards Lodge
Kiah
Belair Gardens
Elgar Home
Kilara Retirement Home
Bella Chara
Eliza Lodge
Kooralbyn Lodge
Bellarine Court
Eliza Park
Kyneton Lodge
Bellden Lodge
Eltham Villa
L’Abri
Belmont Lodge
Fermont Lodge
Landora Care
Bentleys Aged Care
Ferntree Gardens
Lilydale Lodge
Berwick House
Ferntree Manor
Lisson Grove Manor
Bignold Park
Finchley Court
Malon House
Blue Dolphin on Bayside
Footscray House
Manalin House
Blue Willows Residential Aged Care
Galilee
Mayfair Lodge
Brighton Lodge
Glenhaven Special Care Facility
Meadowbrook
Brooklea
Glenhuntly Terrace
Melton Willows
Brooklyn House
Glenville Lodge
Mentone Gardens
Browen Lee Home
Glenwood
Merriwa Grove
Brunswick Lodge
Golden Gate Lodge SRS
Milford Hall
Buninyong Lodge
Gracedale Lodge
Mont Albert Manor
Burke Lodge
Gracevale Grange
Mornington House
Burwood Lodge
Gracevale Lodge
Mt. Alexander
Camberwell Manor
Grandel
Mt. Eliza Terraces
Carrington Court
Green Ridge
Mulvra
Casa Serena
Greenhaven
Mulvra Place
Caulfield House
Greenslopes
Nepean Gardens
Caulfield Manor
Hamble Court SRS
Oakern Lodge
118
Community
Visitors 2011-2012
OPA acknowledges and thanks Community Visitors
in all streams who stood up for the rights of people
with a disability or a mental illness during the year.
Parkland Close
Aarons, Susan
Campbell,Jacqui
Pineview Residential Care
Abraham, Chrys
Caplan, Eve
Princes Park Lodge
Adair, Ian
Carman, Rodney
Queens Lodge
Adams, Beverly
Casbolt, Robert
Queenscliff Lodge
Ades, Deanne
Castanelli, Ken
Raynes Park Court
Adler, Simon
Cesal, Julie
Reservoir Gardens
Alcock, Jo
Chapman, Chris
Reservoir Lodge
Alexander, Ian
Cheary, Patricia
Rosewood Downs
Alexander,Priya
Chesterman, John
Rosewood Gardens
Amato, Lynne
Chew, Siok
Royal Avenue
Armitage, Shirley
Chiang, Peter
Sandy Lodge
Armstrong,Mary
Clarke, Warren
Seaview House – Portland SRS
Arnold, Lyn
Coate, Bruce
Sheridan Hall – Brighton
Athan, Sophy (RC)
Cohen, Jo
Sheridan Hall – Caulfield
Au, Karina
Collins, Max (RC)
Sheridan Hall – Malvern
Ball, Joyce
Cooper, Sandra (RC)
Southcare Lodge
Bamkin, John
Cooze, Christine
St James Terrace
Bamkin, Sandra
Costa, Cathy
Stewart Lodge
Barber, Alan
Cox, Douglas
Strabane Gardens
Bardella, Ennio
Cross, Patricia (RC)
Sunnyhurst Gardens
Barraclough, Georgina
Beard, Jane
Crutchfield, Graeme
Cull, Robert
Bechaz, Vicki
Cunningham, Robyn (RC)
Becket, Anne-Marie
Bink, Judith
Blythman, Marion (RC)
Cunningham, Cheryl
Sydenham Grace
Templestowe Manor
Templestowe Orchards Retirement
Living
The Connault
The Heights
The Manor (Glen Waverley)
Themar Heights
Trentleigh Lodge
Vermont Gardens
Veronica Gardens
Viewbank House
Viewmont Terrace
Warranvale
Warrina Retirement Village
Wattle-Brae Supported
Residential Service
Waverley Hill SRS
Bodenham, Margaret
Boland, Dominic
Bolton, Sally
Borg, Myra
Borg, Sam
Bowen, John
Bowman, Lisa (RC)
Bragge, Kathleen (RC)
Brown, Geoff
Brown, Jeanise, (RC)
Brown, Cassandra
Brown, Susan
Brubacher, Marc
Bryan, Peter,
D’ Cruze, Noosha
Dalrymple, Doreen
Daly, William
Dann, Aideen
Dare, Linda
Davies, Aaron
Davis, Valmai
Davison, Pat
Di Iorio, Sonia
Dickinson, Graham
Dimer, Christine
Dimopoulos, Taz
Dinner, Stephen
Dixon, Sue
Doherty, Diane
Buckles, Ian (RC)
Donohue, Diana
Downing, Audrey (RC)
Windermere Retirement Lodge
Burbidge, Andrew
Butler, Ronald
Drayton, Robert
Woodford Gables
Byard, Tennille
Duell, Liz
Wynalla House
Cahill, Pamela
Dunbar, Jan
Westley Garden
Whitehaven
Community Visitors Annual Report 2012
119
Dunn, Ian
Harrison, Lee
McCredden, Stan
Phelan, Lyn
Dunn, Rita
Hart, John
McElvaney, Carole
Pindard, Charles
Eames, Aileen
Hawkins, Cliff
McKenzie, Celia
Pitre, Aldo (RC)
Edge, Rosalie
Haynes, Carol (RC)
McLachlan, Deborah
Poynter, Denise
Evans,Don
Henry, Jennifer
McLeish, Heather
Price, Nancy
Faiman, Marilyn
Hickerton, Anne
McMillan, Pamela
Raftis, Ric
Fallshaw, Eveline
Hickey, Bill
McMinn, Brenda
Rankin, Don
Faulkner, Pamela
Hickey, Robyn
McPhee, Louise
Rao, Sowmya
Ferguson, David (RC)
Hoffman, Ruth (RC)
McVey, Hilary
Rattray, Judy
Ferreiro, Oscar
Hutchens, Carolyn
Michael, Neil
Rea, June (RC)
Firth, Trudy
Iles, Paul
Middleditch, Jan (RC)
Reese, Harvey
Firth, Helen
Ingram, Chris (RC)
Miles, Sandra
Reeve, Keren
Fletcher, Max
Isaacs, Dallas
Milgate, Shirley
Reeves, Brian
Flett, Lyn
Jackson, Terri
Miller, Toni
Reid, Helen
Fontana, Maureen (RC)
Jacob, Beverley
Miller, Catherine
Rewell, Sue (RC)
Fowkes, Bruce
Jamieson, Rick
Miragliotta, Frank
Reyment, Joy
Franc, Pauline
Johnson, Lyn
Morgan, Irene
Richards, Fay (RC)
Fraser, Paulette
Jones, Catherine
Morris, David
Richardson, Dawn
Fregon, Janis
Jones, M. R. (Taffy)
Morse, Carol
Richardson, Norman
Fung, Joseph
Judkins, Lynda
Munro, Marj (RC)
Ring, Valerie
Furey, Dale
Juniper, Donald
Munshey, Aneeka
Roberts, Arthur
Furtado, Gemma
Kagan, Mariann
Murray, Bruce
Robinson, Ernest
Fyffe, Allan
Kelly, Glennyce
Musgrave, Pauline (RC)
Robinson, Margaret
Galgut, Des
Kiley, Brian
Nankervis, Wal (RC)
Roche, David
Garland, Shona
Kincade, Joan
Newman, Paul
Rosier, Mick
Gauld, Peter
Kincade-Sharkey, Katrina
Newnham, Geoff
Rubinstein, Linda
Gilbertson, Edward
Gleeson, Kathleen
Gleeson, John
King, Chris
Nichol, Philippa
Santowiak, Jeanette
Lagerwey, Tineke
Nicholson, Judi
Scott, Bill
Lawrence, David
Nirens, Sherry
Scrace, Raymond
Libbis, Beverley
Nutt, Edwina
Seavers, Brenda
Lippold, Margaret
Nyikos, Paul
Sedgewick, Amanda
Lloyd, Vashti
O’Brien, Michael
Shafar, Robert
Locke, Ken
O’Connor, John
Shallow, Lois
Loxton, Kathleen (RC)
O’Neil, Anne
Shaw, Rosemary
Luke, Graeme
Owen, Barbara
Shoebridge, Colin
MacIntosh, Brian (RC)
Pargetter, Faye
Shoebridge, Margaret
MacKenzie, Keith
Park, Sonia
Sholl, Eileen
Parker, Dave (RC)
Sivakumar, Puvana
Greenwood, John
Mai, Karin
Manners, Kaye
Marriott, Neville
Parrott, Barbara
Slattery, Mike
Gribble, Alison
Martin, Ross
Patchett, Wendy
Smith, Jenny
Grigson, Alan
Martin, Raymond
Paterson, James (RC)
Stafford, Meredith (RC)
Groves, Judi
Masovic, Bob
Pearson, JP, Loes
Stannard, Mary
Guglielmino, Trish
Maugey, Julian
Peldys, Roman
Steadman, Ray (RC)
Gulizia, Donna
May, Kathy (RC)
Penning, Jillian
Sterlus, Erlinda
Hadley, Michael (RC)
McBeath, Ian
Penry-Williams, Peter
Stewart, Evan
Hammer, Garry
McCann, Debra
Penson, Barbara (RC)
Stickland, Graham
Harraway, Susan (RC)
McCarthy, James
Perry, Jennifer (RC)
Stone, Loraine
Pfeifer, Wendy
Stoneman, Jenny
Glenn, James (RC)
Glover, Fiona
Gold, Una
Grace, Audrey
Graham, Eddie
Graham, Bernie
Green, Avril
Green, Ernie
Green, Hannah
Greenland, Linda
120
Acronymns
Straney, Suzanne
Sullivan, Bernadette
Sullivan, Victor
Taft, Leon
Talati, Jayesh
Tarrant, Paul
Taylor, Will (RC)
Taylor-Barnett, Pamela
Terranova, Alessia
Thimm, Margot
Thomas, Kathryn
Thompson, Mark
Thornley, Jim (RC)
Thurrowgood, Rosslyn (RC)
Titman, Cherie
Tribe, Helen
Trompf, Julie
Tune, Marion
Tunstall, Merrill
Turner, Gary
Tyben, Lana
Udorly, Michael
Vallance, Helen
Volk, Christine
Wallace-Clancy, Lynne
Warren, Elizabeth
Waters, Betty
Webster, Joy
Wellwood, Marion (RC)
Wescott, Christine
White, Judith
Wilde, Dianne
BISTBehaviour Intervention
Support Team
BSP
Behaviour Support Plan
CALD
Culturally and Linguistically Diverse
CCU
Community Care Unit
CRF
Community Rehabilitation Facility
CSO
Community Service Organisation
DAS
Disability Accommodation Service
DH
Department of Health
DHS
Department of Human Services
ECT
Electroconvulsive Therapy
ED
Emergency Department
HACSUHealth and Community
Services Union
HCA
Housing Choices Australia
HDU
High Dependency Unit
ISP
Individual Support Package
KRS
Kew Residential Services
LGA
Local Government Area
OPA
Office of the Public Advocate
OSP
Office of the Senior Practitioner
MHRB Mental Health Review Board
NDS
National Disability Services
PARC
Prevention and Recovery Care
PCAS
Person Centred Active Support
PCP
person-centred plan
PRS
Plenty Residential Services
SAVVISupporting Accommodation for Vulnerable
Victorians Initiative
SECU
Secure Extended Care Unit
SRS
Supported Residential Services
VDDS
Victorian Dual Disabilities Services
Williams, Carole
Wilson, Carolynne
Winter, Sheila (RC)
Woodrow, Rhonda
Woollan, Ted
Wraith, Junia
Wright, Julie
Wright, Dawn
Wyse, Trudy
Zammit, Lewis
Zammit, Susan
(RC) - Regional Convenor
Community Visitors Annual Report 2012
121
Office of the Public Advocate
Level 1, 204 Lygon Street,
Carlton, 3053.
DX 210293
Local Call: 1300 309 337 TTY: 1300 305 612 Fax: 1300 787 510
www.publicadvocate.vic.gov.au
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