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 92 Health Services statewide themes and recommendations 4 Message from the Public Advocate and Chairperson 94 Health Services regional reports

8 Introducing the Community 99 Barwon-South Western Region Visitors Boards 101 Eastern Metropolitan Region 104 Gippsland Region 10 Introducing Community Visitors 106 Grampians Region 106 Hume Region 11 Reporting Regions 108 Lodden-Mallee Region 111 North and West 12 Mental Health Statewide themes Metropolitan Region (North) and recommendations 112 North and West Metropolitan Region (West) 14 Mental Health Regional Reports 114 Southern Metropolitan Region 20 Barwon-South Western Region Appendices 21 Eastern Metropolitan Region 23 Gippsland Region 117 Facilities visited by Community 23 Grampians Region Visitors 2011-12 24 Hume Region 26 Lodden-Mallee Region 119 Community Visitors 2011-2012 29 North and West Metropolitan Region (North) 121 Acronyms 35 North and West Metropolitan Region (West) 37 Southern Metropolitan Region

42 Disability 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 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 In mental health, most services have developed of people with a disability or a mental illness is gender-specific areas but Community Visitors still a pressing human rights issue, and a key priority report serious difficulties. At one adult acute unit, area for both my office and Community Visitors. the gender-specific area is generally locked at night as it is out-of-sight of the nurses’ station. In other While many people are given caring support by settings, the mix of residents and the pressure on dedicated staff, Community Visitors are encountering beds makes it hard to justify keeping a separate an increasing number of people who are victims of area available. Not surprisingly, women continue to abuse, violence including sexual assault, and neglect. fear for their safety in many mental health services The figure on page 5 shows Community Visitor and SRS where staff struggle to support large reports of these matters have more than doubled in numbers of people with a variety of complex needs. three years. Government and service providers must In disability services, there have been several well- act immediately to stop the suffering of vulnerable publicised cases of sexual assault of residents by people with a disability and their families who are staff and other acts of violence against residents. being irreparably damaged by abuse. Resident incompatibility and the heightened risk They must also do everything possible to prevent of abuse between residents, continues to be of abuse from occurring in the first place and respond concern for Community Visitors. In some facilities, with care, concern and immediate action when people with very different needs are forced to allegations of abuse are made. share confined spaces and staff constantly manage This year, Community Visitors reported numerous potentially volatile situations, resulting in safety very troubling cases of assault by staff, serious and concerns or in unnecessary restrictions on an unexplained injuries, and people living in fear of individual’s freedom. Again, this year, Community violence. In 30 instances, Community Visitors were Visitors cite services where people with violent so concerned for the immediate safety and wellbeing and challenging behaviours have assaulted other of individuals, I received formal written notifications residents and staff. Community Visitors reported of these cases. multiple incidents of residents being threatened with knives, and of other physical and verbal abuse. In A review of Community Visitors reports and the one case, a resident of an SRS murdered another increasing number of formal notifications reinforces resident. In a mental health facility, a consumer who to me, the urgent need for service providers to foster had been in care for an extended period of time a culture that is alert to signs of abuse, neglect and – ‘long-stay’ – was repeatedly assaulted by other exploitation, where abuse is not tolerated, where consumers, up to three times in a month. victims and their families are supported without hesitation and incidents are reported immediately Individuals, staff, families and friends, concerned and appropriately. about safety and desperate for help in dealing with challenging situations have accessed OPA’s Advice Community Visitors have reported allegations of Service 316 times for advice, support or to request sexual assault in mental health services, Supported a visit from a Community Visitor. Residential Services (SRS) and in group homes for people with a disability. The Health Services Board, Of particular concern is an increase in reports of so disturbed by allegations of sexual assault in SRS, significant, unexplained injuries consistent with being reported their concerns directly to the Community caused by assault or trauma. In one case, a forensic Services Minister, Mary Wooldridge. physician’s independent review stated that

4 200 183 180

160 69 140

120 110 100 91 27

80 26 87 60 number of issues identified 66 40 55

20 27 10 17 0 2009-2010 2010-2011 2011-2012 stream Health Disability Mental Health

Figure 1. Abuse, Neglect and Assaults across all Community Visitor streams, 2009-2012

Graph 1. Abuse, Neglect and Assaults across all Community Visitor streams, 2009-2012

a resident’s injury “does not necessarily require Community Visitors identified cases where multiple a fall. It does, however, require inappropriate and health assessments had been undertaken before rough handling as a minimum”. In a different case, fractures were identified. Health professionals the same physician stated, “it is hard to see how often struggle to assess people with a disability such severe injuries could have gone unwitnessed who have difficulty communicating, yet Community and unrecorded.” If a service provider cannot identify Visitors report instances where residents are sent the cause of an injury, how can it guarantee that the alone by ambulance, with no written summary of person concerned has not been a victim of assault? their communication or health issues and no staff Moreover, if it is an assault, how will that person be to advocate on their behalf. Consequently, they protected from further injury? receive inadequate healthcare that compounds their suffering. Incidences such as these highlight that significant communication and sensory issues Neglect may prevent a person raising concerns, and it is Disturbingly, Community Visitors reported cases imperative that these individuals have access where fractures and other serious injuries were to communication aids. identified and reported only after bruising, swelling and pain was noted by a third party. While staff report Responding to abuse, violence and neglect to Community Visitors their struggle in identifying pain in those who are unable to speak, evidence- The lack of staff training on recognising indicators based, reliable and easy-to-use tools are available to of abuse and neglect can have dire consequences, measure and assess pain in such circumstances. It with abuse continuing unabated, undetected and seems these tools are rarely used by staff to assess unreported. This year’s report highlights an incident people with a disability, the consequence being that where staff witnessed a resident being physically pain management is minimal, or non-existant causing abused by a family member. Staff did not intervene, unnecessary suffering. notify their manager or write an incident report. Abuse can take many forms and it is imperative Poor manual handling practices by staff led to that staff are trained to recognise physical and a resident in the Grampians Region nearly having behavioural indicators that correlate with abusive her leg amputated. Comprehensive staff training situations and are empowered by management on manual handling can help prevent injuries to act immediately. Any report of abuse or neglect to residents with compromised bone density.

Community Visitors Annual Report 2012 5 must be taken seriously. Service providers have a The people Community Visitors meet have a right responsibility to report all such incidents as soon as to be free from abuse or the fear of abuse. They possible and ensure people are safe from harm. have the right to be treated with respect and dignity and to receive the best quality of care available. To create safer environments and to transform Empowering people by educating them about a culture that tolerates violence and abuse, a their rights is an important protective mechanism comprehensive abuse prevention program needs to against any human rights violations. Equally be introduced. Service providers need to develop important is promoting self-determination through a staff code of practice that specifically prohibits increased choices and opportunities, encouraging abusive and neglectful practices. They must also independence and self-advocacy and supporting have polices and procedures that clearly explain the people to make decisions about their lives. process for identifying, reporting and responding to abuse. These policies need to be supported by Community Visitors are volunteers and are systematic reviews that demonstrate that they are independent of government and service providers. being followed and are effective. Service providers Their regular, independent and fearless monitoring that do not demonstrate a commitment to such of mental health and social-care settings continues a program risk the loss of community confidence to point to ways in which organisations can improve in their organisations. services to ensure the protection and promotion of the human rights of people in their care. Following a referral from my office and the Ombudsman Victoria’s subsequent report in March It is doubtless that these attributes have led our 2011, I asked the Department of Human Services Community Visitors Program to be proposed as (DHS) to adopt a Seven Point Safety Plan regarding one of the monitoring features for the coming allegations of abuse which requires: National Disability Insurance Scheme (NDIS). The Productivity Commission, in its advocacy for the • protection for the individual by ensuring their NDIS, proposed that Community Visitors should help immediate and ongoing safety to monitor the NDIS, and called for community visitor • criminal acts are reported to the police schemes to be introduced in jurisdictions that do not have them. It further argued that, in this process, • allegations against staff are taken seriously “It is desirable to replicate features of the Victorian and they are stood down pending the police model”. My office is very excited by this prospect, and/or independent investigation and is seeking to ensure that its Community Visitors play an active role in monitoring the NDIS trial in • incident reports are prepared by the person Barwon Region, beginning next year. who observed the abuse, not rewritten by senior management and are available to I am pleased to be able to highlight the work of these Community Visitors tireless champions, because, without Community Visitors, many people with a disability or a mental • an independent investigation of the incident illness would be in danger of being isolated, is reported to senior management marginalised and vulnerable to human rights abuses. • the victim of crime is supported to tell their I commend their report to you. 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 Colleen Pearce of abuse, neglect and exploitation that has led to improved health, safety and wellbeing of individuals Public Advocate and Chairperson of the Boards 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 Case study – Broken There were serious concerns for the the pressure on her lower limbs or any welfare of Cynthia, a resident with other appropriate equipment. She also a disability in a DHS house. Formerly had head lice and diarrhoea. Staff also a resident of Kew Residential Services said they had been told Cynthia had (Kew Cottages), Cynthia could not osteoporosis. speak and needed staff to help her Some staff told Community Visitors that with all her activities of daily living. they were not confident in assessing One evening, staff noticed bruising and the pain of someone who could not swelling to one of her feet. A doctor and speak. Management reported that they the ambulance were called but as the recognised that staff needed more nearest hospital emergency was full, intensive training in manual-handling it was decided Cynthia would remain but could not say when this would occur. at home overnight. The doctor ordered As soon as DHS was notified by the paracetamol to ease her pain. Public Advocate of the Community The next day, Cynthia went to the hospital Visitors’ serious concerns, rapid action and was diagnosed with a broken ankle. was taken to ensure the house had the She was returned home. Two days later, equipment and staff needed to provide Cynthia went back to the hospital as Cynthia with appropriate care. In the staff who knew her thought she was in response to the Public Advocate’s considerable pain. The hospital further notification, DHS advised that the diagnosed that both legs were broken. “group home concerned was found Old fractures to both hips were also not to have followed the DHS incident identified. She was discharged from reporting instructions accurately and hospital two weeks later with minimal compounding to this issue was the staff training provided. house office fax was out of order”. Shortly after Cynthia’s return from A forensic physician was asked to hospital Community Visitors attended report on the unexplained injuries, the facility. They were so concerned but there is still no explanation of how about her wellbeing, they notified the these injuries occurred. Public Advocate. They found Cynthia The Public Advocate also assigned still did not have a mattress to relieve 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 Her previous roles include: and Disability Services Boards • director, UnitingCare Victoria and Tasmania, Ms Pearce is the Public Advocate of Victoria and, an organisation providing services to more under the relevant legislation, is the chairperson than 350,000 disadvantaged people of the Community Visitor Boards. • executive director at Moreland Hall, a drug and Ms Pearce has almost 30 years experience in the alcohol treatment service providing counselling, community and health sectors. From 2004, she was withdrawal, prison and court services and state- Director of the Victims Support Agency (VSA), wide drug education in the Department of Justice. • executive officer North Richmond Community Ms Pearce has devoted her working life to Health Centre. helping society’s most disadvantaged people, and advocating for a better deal on their behalf. Ms Pearce commenced as Public Advocate She serves on the Frontier Services Board on 8 September 2007. of Governance.

8 Sophy Athan (Mental Health Board) Dave Parker (Health Services Board) Ms Athan has held senior positions in local and Mr Parker is a retired former Royal Australian Navy state government for over 20 years. She has been service man. While in the Royal Australian Navy, on numerous committees and boards at all levels Mr Parker spent over six years as an instructor in of government. submarine daily operations and electrical systems. She is on a number of health service committees He has completed an Advanced Welfare Officers as a consumer representative. course. He also volunteers his time as both a Welfare Officer and a Pension Officer for the Currently, she is the Managing Director of Euroforce Warrandyte Branch of the Submarine Association Music Pty Ltd. Ms Athan’s qualifications are BA of Victoria. (Melbourne), Grad. Dip. Lib. (RMIT), Grad. Dip. Soc. Pol. (Swinburne), MA (Adelaide), NATI Level 4. Mr Parker joined the Community Visitors Program in 2004 visiting in the Health Services stream and is Ms Athan was a Community Visitor from 2003 currently an appointed Health Services Community to 2012 in both the mental health and disability Visitor until February 2015. streams. She has made an enormous contribution to the program as an active Community Visitor, Regional Convenor in both streams and as Dawn Richardson (Health Services Board) a Board member. Ms Richardson has a background in telecommunications, training and disability. Dr. Carol Morse (Mental Health Board) She has served on the committee of management for the Communications, Electrical and Plumbing Dr Morse is an academic Health Psychologist with Union and has spent six years in a voluntary over 30 years of university experience researching position managing Food Relief. and teaching lifespan development, public health and wellbeing among Australian-born, Indigenous She joined the Community Visitors Program in Australians and migrant peoples. the disability stream in 2006 and transferred to the Health Services stream in 2009. This is her She is also an experienced clinician in mental disorders and relationship counselling. third term on the Health Services Board. Her many publications include a recent two-volume book comparing challenges to positive ageing Trish Guglielmino and Shiela Winter in Australia with Israel and the USA. She was (Disability Services Board) resigned prior to appointed a Community Visitor in the Mental Health the preparation of this year’s annual report. stream in 2008.

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 Where an issue cannot be resolved at facility level, it is usually taken to a more senior manager in the independent volunteers who agency and/or the DHS/DH regional office. Serious safeguard the interests of people matters may be referred for action within OPA and dealt with as part of the Public Advocate’s with a disability. 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 The program is organised into three streams to response to specific complaints. This includes reflect the type of services visited: referrals to the program via OPA’s Advice Service. On occasions, repeated visits are necessary to • Mental Health – visits are made to consumers certain facilities over a short period, in response and residents in mental health facilities providing to serious issues identified and at the discretion 24-hour nursing care of the Community Visitors. • Disability Services – visits are conducted to The ongoing support, training and recruitment institutions and community-based facilities for of the Community Visitors and the boards is the people with a disability responsibility of staff in the Volunteer Programs Unit. • Health Services – visits are made to people who reside in Supported Residential Services (SRS) and require additional support. Stream Visits 11/12 The legislative framework is derived from the following Acts of Parliament: Mental Health 1359

• Mental Health Act 1986 Disability Services 2821 • Disability Act 2006 Health Services 924 • Health Services Act 1988. Total 5104 The legislation establishes three respective boards: Mental Health, Disability Services and Health Figure 2: Number of Community Visitor visits made 11/12 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. Stream Numbers 11/12 Community Visitors are appointed for three years Mental Health 66 by the Governor in Council. They are empowered Disability Services 215 by legislation to visit specified facilities, to make enquiries of residents and staff and examine Health Services 79 selected documentation in relation to the care of people residing at the facilities. Community Visitors Total 360 usually make unannounced visits and visit in teams of two or more. Figure 3: Total number of Community Visitors by stream 11/12 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 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 The Hume Region extends over 40,000 square from Geelong and Queenscliff in the east to the kilometres of provincial northeast Victoria. The South Australian border. The region contains region contains 12 Local Government Areas. nine Local Government Areas. It includes Victoria’s alpine areas, some relatively remote farming communities and the major regional centres of Wodonga, Eastern Metropolitan Wangaratta and Shepparton. The Eastern Metropolitan Region includes inner suburbs such as Kew and Hawthorn, large outer metropolitan suburbs such as Ringwood Loddon Mallee and Boronia, and semi-rural townships such as The Loddon Mallee Region is located in the Healesville and Yarra Junction in the Shire of north-west corner of Victoria. It is the largest Yarra Ranges. The region contains seven Local DHS region in geographic area. The region Government Areas. covers ten Local Government Areas.

Gippsland North and West Metropolitan The Gippsland Region stretches along the The North and West Metropolitan Region east coast of the state and covers 41,538 covers 14 Local Government Areas. The square kilometres, representing over 18 per region is now the most populous region cent of the land mass of Victoria. The region in Victoria, encompassing suburbs from covers six Local Government Areas. Werribee to Eltham.

Grampians Southern Metropolitan The Grampians Region covers an area of The Southern Metropolitan Region is made 47,980 square kilometres and includes up of 10 Local Government Areas, ranging 11 Local Government Areas, stretching from from Stonnington to Frankston and the Ballarat through to the South Australian border. 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 5. revise the existing Mental Health Act as soon as networks to: possible with adequate resourcing to enable its effective implementation to: • establish more acute beds in areas with unmet need to reduce waiting times in • provide service consistent with the emergency departments, out of areas government’s human rights obligations transfers and inappropriate discharges • enable Community Visitors to visit Prevention • provide adequate information and support to and Recovery Centres and respond to visit all consumers on admission, including people requests from other mental health facilities from culturally and linguistically diverse that provide 24-hour treatment and support backgrounds (CALD) • ensure all services document incidents and • effectively renovate and maintain mental Community Visitors are able to access all health facilities incident report records 2. create more affordable accommodation and • ensure all consumers have access to support options to ensure choice and security for independent advocacy support to attend people who have a chronic mental illness, and in Mental Health Review Board hearings and particular for people with a dual disability and/or clinical appointments complex needs 6. ensure the National Disability Insurance Scheme 3. promote the practice of recovery models and includes people who have an ongoing disability holistic healthcare throughout the mental health as a result of a chronic mental illness, dual system and enable psychosocial therapeutic disabilities and/or complex care needs interventions such as counselling services to be widely available within the public mental 7. ensure the Community Visitors Program has health system the resources to effectively meet its legislative requirements. 4. address shortfalls in mental health nursing and allied health staff and establish and maintain a highly skilled, responsive and sustainable mental health workforce

Community Visitors Annual Report 2012 13 Mental Health legal rights/dignity 96 medical care 92

discharge planning 86

maintenance 75

information provision 68 Statewide report legal rights/dignity 96 treatment plan 63 medical care 92

appropriateness discharge planning 86 This year 66 mental health for clients 52

maintenance 75 Community Visitors conductedpersonal needs/food 52

information provision 68 1359 visits to facilities and safety issues/hazards 51 identified 948 issues on these visits. treatment plan 63 adequacy of programs appropriateness 49 The graphs in this section provide for clients 52 program staff further information about the nature personal needs/food 42 52 least restrictivesafety issues/hazards 51 of these visits and the issues environment 37 appropriatenessadequacy of programs 49 reported. There was an increase in 37 of rooms/areas program staff 42 the number of issues reportedsmoking in provisions 28 least restrictive environment 37 Issue types identified relation to health issues, discharge assaults appropriateness27 planning, appropriateness of of rooms/areas 37 adequacy of beds smoking provisions21 28

facilities and services for clients, Issue types identified assaults 27 assaults, safety issues, staffingrestraint & seclusion 20 adequacy of beds 21 safety procedures 16 issues and restrictive interventions. restraint & seclusion 20 security of 11 On a more positive front, there possessions safety procedures 16 suitable facilities was a decrease in the number of 8 security of for programs possessions 11 reports related to the adequacy of suitable facilities 8 admission process 5 for programs programs and maintenance issues. admission process 5 rights re E.C.T. 5 rights re E.C.T. 5 Many of the key issues reported by Mental Health privacy 4 Community Visitors in previous years remain privacy 4 illicit drug use 3 unresolved and in need of urgent government illicit drug use 3 action and community investment. The regional 0 20 0 40 20 6040 6080 80 100 100 reports highlight many good things happening in number number Victorian mental health services. The statewide Figure 5. Mental HealthFigure Streams 5. Mental Healthnumber Streams and typesnumber of and issues types ofidentified issues identified 11/12 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 the key government initiatives and mental health Accommodation and bed shortages board activities undertaken in 2011-12. Despite the early promise of some new government initiatives in relation to affordable housing and some successful pilot programs over the last decade, the 400 400 options remain very limited throughout the state. 350 350 356 The lack of accessible accommodation and support 356 300 300 options for people with a severe mental illness, dual 250 267 250 267 disability and/or complex needs often causes people 200 200 to remain in hospitals or Community Care Units 150 169 (CCU) for longer than they should. In other instances 150 169 100 they are prematurely discharged. Blockages in the 100 99 99 50 57 system mean that the demands for beds cannot be 50 57 number of issues identified 0 readily met for people experiencing acute phases

number of issues identified 0 visit/ treatment/ amenities/ activities/ least restrictive rightsvisit/ resourcestreatment/ programsamenities/ programsactivities/ leastservices restrictive of illness. Community Visitors repeatedly report rights resources programs programs services issue groups that patients are shunted around between units or issue groups Figure 4. Mental Health Stream issue groups 11/12 between inpatient care and short-term leave at home 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 Mental Health stream 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

Region No. of units visited No Requested visits Scheduled visits Total constantly monitored. The shortage of affordable Barwon-South accommodation options and demand for mental 7 6 4 68 72 Western health beds often means that unpaid carers are relied on to support their family members when Eastern 18 12 33 199 232 patients are discharged at short notice. Metropolitan People with a mental illness are also often Gippsland 6 3 4 66 70 discharged to privately operated Supported Residential Services (SRSs), which are visited by Grampians 8 4 4 86 90 Community Visitors from the Health Services stream of the program. SRSs employ staff with limited formal training who care for up to 80 residents Hume 9 7 2 109 111 with disabilities, mental illness or substance abuse problems. With shared bedrooms and communal Loddon Mallee 6 7 7 51 58 areas, this scenario provides a recipe for disaster. Reports of serious assaults, self-harm and even Northern 20 7 20 213 233 deaths are not uncommon. Although public mental Metropolitan health services may be reluctant to discharge their Southern patients to SRSs and unregistered boarding houses, 27 11 25 185 210 Metropolitan there are often no other options available. Western 23 9 18 265 283 Metropolitan Discharge planning Discharge plans with adequate supports are 124 66 117 1242 1359 essential components of the treatment regimen and should be in place before a person is discharged Figure 6. Total visits Mental Health Stream 11/12 back into the community. Without comprehensive arrangements being provided, the likelihood of the patient’s mental health and social wellbeing being optimal care can not be provided, but are simply negatively impacted is increased. In some instances, a place to eat, sleep and receive medication, until patients have been left hungry and homeless due to they are discharged to the community so that other the inappropriate timing of their departure from the consumers can enter the system. hospital. The constant pressure on beds and staff means discharge planning for short stay patients is A shortage of inpatient beds in many hospitals has often done in a rush leaving both patients and carers serious implications for admissions and waiting to feel marginalised in the process. periods in Emergency Departments (ED). Many services still have large numbers of people who There have also been reported cases of suicide by remain in ED much longer than the national target desperate patients within 48 hours post-discharge of four hours. Lengthy stays in ED appear to be a when a breakdown occurred without continuing problem at a number of hospitals such as Werribee support being available (Report into Inpatient Deaths Mercy and Sunshine Hospital which service areas 2008-2010, Office of the Chief Psychiatrist, 2012). experiencing high population growth. In March of this year, Monash Medical Centre reportedly had Some patients Community Visitors talk to report ten mental health patients in ED on one night. feeling anxious and not ready for discharge back into At the Alexander Bayne Centre in Bendigo in June their community. This is especially the case when no 2012, Community Visitors reported there were eight reliable support awaits them, or where a guardian patients concurrently in ED. Two of these patients is still to be appointed, or no interpreter has been were reported to remain in ED for more than provided to explain the procedures to a person of 24 hours and a third patient was sent home after a CALD background. 23 hours but represented an hour or two later. In other cases, people are keen to leave acute units People from rural areas who require specialist where beds are urgently needed but the shortage services such as eating disorder beds are required of suitable options prevent them from moving on. to transfer to services in the city away from friends Community Visitors in all metropolitan regions have reported people being unable to be discharged

Community Visitors Annual Report 2012 15 Mental Health

because of a lack of suitable accommodation. In issue can be clarified in the new Mental Health Act September 2011, Community Visitors reported that if it is not resolved before then. eight clients had been in the adult acute unit at St Vincent’s Hospital for more than two months and There have been a number of complaints from in May 2012, four people had been in the aged patients about their treatment by police, security persons’ acute unit at St Georges Hospital for more staff, nursing staff or other patients while in hospital. than 50 days. These include a resident put into seclusion to “cool off” after throwing hot coffee at a staff member, a In one concerning case, an individual with autism female patient in a wheelchair being held down by remained in Upton House acute unit in Box Hill for eight police from the tactical response squad and 92 days as no appropriate accommodation could shackled in order to be taken into hospital, and a be found. In another instance, a patient remained in male patient who claimed he was shackled to a bed the Maroondah Hospital acute unit awaiting suitable for 30 hours after being treated violently by police accommodation for more than 100 days. Further and taken to hospital in the back of a police van. data about long-stay patients in mental health One male patient in the statewide forensic facility facilities in Victoria is presented later in this report. 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 Care and Treatment and North and West Metropolitan Regions (West) and reports of consensual sexual activity between Serious incidents and assaults patients in acute inpatient units in the North and In many regions across the state, Community West Metropolitan Region (North) and Southern Visitors report serious assaults between patients Metropolitan regions. Patients may be vulnerable or between patients and staff. Often these incidents while in a psychotic state to other patients whose are managed appropriately, but in some cases the own cognitive functions are simultaneously police have not been notified despite this being compromised so nursing staff need to remain required by hospital policy and guidelines set by the vigilant to ensure people are safe. In most instances, Chief Psychiatrist. Community Visitors are unable Community Visitors report that allegations of assault to access incident reports at most services, so they and sexual assault have been taken seriously and typically find out about these events from patients’ investigated appropriately in line with guidelines from family members or other patients calling OPA’s the Chief Psychiatrist and local protocols. 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. 3030 Throughout Victoria, Community Visitors report 2525 2727 being unable to obtain documented reports of critical 2020 1717 incidents from mental health facilities. Some regional 1515 health networks provide de-identified summaries of 1010 incidents to Community Visitors on a quarterly basis. 1010 While these are helpful, they are no substitute for 55 number of issues identified number of issues identified 00 timely access to the detailed records of incidents. 2009-102009-10 2010-112010-11 2011-122011-12 Access to incident reports at the time of visits is essential for monitoring purposes and to ensure reportingreporting year year that the human rights of patients and residents are FigureFigure 7 7. .Mental Mental Health Health Stream Stream assaults assaults and and violence violence 2009-2012 2009-2012 upheld. Community Visitors are frustrated that this issue continues to be a problem across the state Service charge despite extensive discussions over many years with the Office of the Chief Psychiatrist, the department A new issue identified by Community Visitors this and local service managers. year is the issue of fees and charges. Thomas Embling Hospital, the statewide forensic care facility, Hospitals say they cannot provide hard copies of recently started requiring their long-stay involuntary reports or allow Community Visitors online access and forensic patients to pay patient fees. The fee to reports because of data security or privacy issues. is 33 per cent of the Disability Support Pension The principle that Community Visitors should have (approximately $17.81 per day). CCU residents are access to incident reports in services they are also sometimes charged rent or a service fee but legislated to visit is not debated in the other streams this appears to be inconsistently applied. Thomas of the program. Community Visitors hope that this Embling is believed to be the first clinical mental

16 health service in Victoria to charge a fee. Community A focus on a mental illness can sometimes result in Visitors have been advised that forensic services in other medical conditions being minimised or ignored. New South Wales have been charging fees for some Community Visitors have reported patient and time. Community Visitors will watch with interest to resident concerns regarding simultaneous medical see how the user pays principle is applied elsewhere conditions like toothaches, hearing problems, in the mental health system. The general prison cancer, or heart and respiratory conditions. One population does not pay ‘rent’ during their period patient, complaining of a raging toothache, waited of incarceration so the question remains whether more than a week to access a community dental involuntary patients with a mental illness should be service. The provision of low-grade pain medication subject to these fees. 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 Again this year, many mental health consumers that create feelings of frustration and dissatisfaction questioned the medications they were prescribed and this cements the belief that they are regarded and the application of electroconvulsive therapy as second-class citizens. These delays include (ECT). It is essential that the staff discuss and access to the person’s doctor for a personal explain the treatment rationale as many times as discussion, communication with a social worker required, given that the patient’s mental state is about accommodation or employment needs, and likely to be fluid and shifting. In addition ECT and limited or no provision of counselling services or anti-psychotic drugs can interfere with rational psychotherapy sessions with a psychologist. Other thinking and memory. complaints include unexpected postponements to mental health review board hearings, the lack A common complaint concerns side effects of of advocacy support, and complaints that night time different drugs particularly when patients and nursing staff do not respond to calls promptly. All residents have been taking these medications for of these experiences are disempowering and they a long time. Most are very aware of the side effects compromise the recovery and rehabilitation of different drugs. Occasionally, patients report of consumers at a time when they are often the treating doctor dismisses their concerns or is most vulnerable. unavailable for discussions. A common response is the person refuses to take a particular drug or a The mental health system can be bewildering to certain method of dispensing and is then judged to many consumers and carers and this experience be non-compliant and difficult to manage. This issue is intensified for people from a CALD background. is a common cause of advice calls to OPA. Often Effort needs to be made throughout the system to all a Community Visitor can do is advise the person keep people informed and to promote the autonomy they are entitled to a second opinion. Sometimes, and participation of consumers and their families. Community Visitors work with service providers to In services where people live for extended periods convey a patient’s concerns. This can in turn result of time, opportunities for active participation are in adherence by a patient once they feel their views particularly important. have been heard and taken seriously. Patient anxiety can be exacerbated when a patient does not have Rehabilitation, education and recreation English as their first language and staff do not seek out an interpreter to assist. opportunities In residential facilities such as CCUs, Secure Community Visitors frequently have cause to Extended Care Units (SECUs), aged mental health question the adequacy of supports to patients in facilities and in Thomas Embling Hospital, patients adult acute inpatient units and CCUs, especially and residents are on extended stays while they when diagnoses involve a dual disability of mental undergo recovery, rehabilitation and retraining or illness and intellectual disability. Often these patients remain in a locked facility because of a supervision find themselves at greater disadvantage as a result order. A frequent complaint is that few or no of their intellectual disability. They are sometimes opportunities for employment or access to education isolated from the general population as they are programs and skills training are available. Where unable to communicate effectively or cope alone staff and managers are enthusiastic and far- without skilled support. Community Visitors urge sighted they seek out and support opportunities for a more collaborative approach between mental residents. Otherwise, residents complain frequently health and disability service providers in order about the boredom and onerous nature of their to gain a greater understanding of an individual’s lives, which can be unstructured and meaningless. support and care needs. 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, Legal rights and access to information when some local employers have accepted mental All regions report instances of patients and residents health residents as employees. With support and feeling that they had not been given adequate encouragement from staff and employers, residents information about their rights as well as the risks have been able to engage in part-time work that has and benefits of various treatment options. Concerns produced wide-ranging benefits to their self-esteem include lack of explanation about changed status and rehabilitation. This joint enterprise model from voluntary to involuntary patient and the deserves to be widely replicated. restrictions to freedom which accompany that; lack of provision of treatment plans or discharge plans; Staffing lack of explanation about the process to appear A frequent request made to Community Visitors at mental health review board hearings; and a is for patients and residents to be able to access perceived negative attitude towards consumers allied health services (activity officers, dieticians, from some service staff. Obtaining information and occupational therapists, psychologists and social appropriate support is a major challenge for people workers). These services experience cutbacks in from CALD backgrounds with limited understanding times of funding constraints yet they are the services of English. While interpreters are generally arranged that can most assist patients and residents to for important meetings, these patients can be obtain an enhanced quality of life. Some services isolated for days at time. have advertised allied health positions but have Patients and residents have also raised concerns had difficulty recruiting and retaining staff with regarding meals, meal sizes, food choices and appropriate skills and experience. security of their possessions. Requests for soymilk The turnover of mental health nurses and frequent and vegan food have been reportedly dismissed use of casual or agency staff was noted in several by staff and some patients have been expected parts of the state. This year industrial action was to consume foods like pork that contravene their taken by nurses who were members of the Health religious practices. Cultural and dietary requirements and Community Services Union (HACSU). The of patients and residents must be considered within impact of this varied across the state. In some all services and efforts made to respect these areas, there were bans in relation to the keeping of requirements. data and documentation. The introduction of some Residents in one aged persons’ mental health unit programs was also reportedly delayed in some complained that personal items went missing from services because of industrial action. However, their bedrooms as their bedroom doors were not overall a minimal impact on patients and residents locked. Issues related to the storage of possessions was reported by Community Visitors. for long-stay patients has also been raised. Unfortunately, services do not have the capacity to Smoking store possessions so patients sometimes have to forfeit their possessions or pay for private storage. 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. Appropriateness of facilities Many staff are concerned that prohibition of smoking may trigger aggressive behaviours in patients and Building design and gender-sensitivity residents. They believe that it is their role to police issues the situation and possibly put themselves or other Several mental health facilities utilise dated buildings patients at risk in the process. and stock that do not conform to the standards While a common belief is that the provision of expected in the 21st century. While adjustments nicotine patches or inhalers and information on the may be made, the design can make observation of Quit program will be all that is required, this is a patients difficult or compromise patient conditions. short-sighted view of what it takes for a long-term Most services have attempted to implement gender smoker to stop. Importantly, the first step in the sensitive guidelines, and to create areas specifically process to change an addictive behaviour is for the designated for use by women. However, the existing individual to take a determined decision to alter their design of buildings, the pressure on beds, gender practices. This is rarely the position of patients and mix of patients, and staff/client ratios all impact on residents who are faced with a blanket demand the ability of services to manage facilities in a gender to cease a lifelong habit. sensitive way.

18 Maintenance and cleanliness Government initiatives Maintenance delays and cleanliness issues continue This year, the State Government funded a number to be reported by Community Visitors. of projects to improve mental health services and reduce homelessness and ED presentations. These Some of these issues have serious health and safety projects include home-based outreach services implications such as call bells or lights in courtyards and a pilot program to enable people to enter the not working and consumers having to rely on others rental market. Funds have also been provided for to call staff for help. the integration of mental health services in North Other concerns include poor cleaning practices East Victoria, and an expert taskforce to deliberate such as body fluids and rubbish in courtyards and on reforms to eating disorder services. Community inoperable public phones. Outdoor areas were Visitors have reported concerns about the clinical often unable to be used by those in a wheelchair care received by patients with eating disorders so or present a risk to older residents. this taskforce is welcomed. The government also announced $18.5 million for a step-down facility Community Visitors believe that patients and as a result of the Community Visitors work on the residents have a right to experience pleasant long-stay project. and well-kept facilities while residing in care and for maintenance issues to be dealt with The Report into Inpatient Deaths 2008-2010 in a timely manner. prepared by the Office of the Chief Psychiatrist, which examined how services responded in the event of unnatural/unexpected or violent death Mental Health Board Activities of mental health inpatients, was also timely This year the Combined Board had three meetings and informative. It was encouraging that 12 with parliamentary secretaries. One of these of the 15 recommendations were accepted by meetings focussed on mental health issues and government. Community Visitors are heartened members of the Board discussed their concerns that recommendations were included relating to regarding the pressures in the Victorian mental additional staff training and enhanced security health system. In addition, the urgent need for more procedures. safe and affordable accommodation for people with complex needs was raised including examples from The Mental Health Act 1986 (the Act) has been the coalface. Quarterly meetings with the Chief in place for more than 20 years and a major Psychiatrist and the department representatives consultation regarding the new Act commenced in have also been useful to foster collaborative 2008. When consultations regarding changes to the relationships, discuss patient and resident Act commenced that year, it was envisaged that a complaints and provide opportunities for enhanced new Act would be introduced to Parliament in 2010. understanding of the government policy. Work on However, the change of government led to a rethink the protocol that guides the relationship with of the previous exposure draft, due to the sector’s services was progressed. critical response to it. Community Visitors welcomed the opportunity afforded by the current government A forum was established with a range of mental to contribute further to this process. health advocacy organisations to enable valuable information exchange and identify common ground Community Visitors are keen to see a new Mental for concerted action. Health Act based on human rights principles enacted as soon as possible. However, Community Visitors The Mental Health Board notes the Community believe it is essential that adequate resourcing is Visitors Program has been inadequately resourced provided to ensure its effective implementation. 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 Long-stay project and to follow-up on serious issues that require This year marks the fifth year that Community investigation or advocacy. Funding concerns and Visitors have been collecting information on long-stay the need for government to adequately resource consumers in mental health facilities. Long stays are and support the program is a recurring theme identified as more than three months in an adult acute from previous years that provokes frustration and unit and more than two years in a CCU SECU. dissatisfaction among Community Visitors who give their own time and lifelong expertise willingly and Commencing in 2006-07, the project has seen many unstintingly. Increased funding by government is successes. In the 2009-10 budget, the Victorian urgently required to enable the program to meet its State Government funded 50 intensive psychosocial legislative requirements. rehabilitation support packages, some which

Community Visitors Annual Report 2012 19 Mental Health

enabled the discharge of long-stay SECU patients in a CCU setting rather than move. It may be the into the community. In 2010-11, Disability Services case that in the absence of adequately supported commenced building a purpose built facility to house community-based alternatives, that additional CCU long-stay patients from the Austin SECU with dual beds are required. disabilities. The Mental Health Review Board (MHRB) recently Community Visitors are happy to report this year that held a forum for its members and included the issue the original six patients with dual disabilities at the of long-stay patients in mental health facilities. The Austin identified by Community Visitors in 2007-08, Public Advocate, Colleen Pearce, spoke at this have been discharged into suitable and supported forum and is keen to be supporting the MHRB work. accommodation in the community. These people had Community Visitors are pleased that their work is a primary diagnosis of intellectual disability and had being taken up by other bodies concerned for the lived in a SECU-type setting for between eight and rights of people in mental health facilities. 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 Regional Reports 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 Barwon-South Western Region has now been discharged into a suitable home-like environment where she can participate in the life of South West Healthcare and Barwon Health manage the community. the mental health services in the Barwon-South Western Region. These services consist of two This year, Community Visitors have identified 72 adult acute inpatient units, one aged persons mental long-stay patients. The number is slightly lower this health residential unit, two CCUs, one Prevention year as Community Visitors did not collect data on and Recovery Care (PARC) and two EDs. patients in aged adult acute units. These patients accounted for 22 long-stay cases last year. Some A total of 72 visits were made by seven Community other patients who Community Visitors know have Visitors. Four of these visits were requested by spent extended periods in facilities this year, are also consumers and others. not included in our 2011-12 figures because they had either transferred to another service or been Legal rights and information provision discharged to the community just prior to the data Four cases occurred where patients requested collection period in April to May 2012. attendance of a Community Visitor regarding a Community Visitors identified 22 long-stay patients desire to seek a second opinion, how to obtain legal in SECU this year and two patients in the statewide services or in one case a complaint about lack of Brain Disorders Unit, 16 of whom have been in these respect and dignity. 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 Care and treatment injuries, intellectual disability and substance abuse problems. Community Visitors encourage further Admission process collaboration between the department and DHS, the ED visits by Community Visitors ceased because in provision of more supervised 24-hour care models the Warrnambool Hospital the majority of cases are and additional individualised funding packages to admitted directly to the acute ward and do not go secure the transition of more long-stay patients into through the ED. In the case of the Geelong Hospital, the community. Community Visitors obtained data from the ED regarding mental health patients rather than visiting Community Visitors identified 36 long-stay patients the ED personally. 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 Appropriateness of rooms and areas Adequacy of programs The adult acute inpatient unit has created a Staff at the Community Rehabilitation Facility female-only corridor as well as a lounge for women. have assisted two of their long-stay residents It has been observed that the Aged Care Mental to commence gradual re-integration into the Health Residential Facility is very clinical with community. Similarly the staff in Ward 9 and the little differentiation between wings. This has been Extended Inpatient Care Unit at Warrnambool discussed repeatedly with management and it is Hospital should feel very satisfied that success accepted by Community Visitors that given the level is imminent with a long-stay patient being of cognition of the residents, sufficient has been gradually re-integrated into the community. done for the residents’ benefit. The need for shade cover at the Geelong Hospital in outdoor areas has Program staff been mentioned a number of times and it is still being considered. 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 Appropriateness for clients position is now being opened up to recent university Both the Community Rehabilitation Facility, which is graduates in the form of an internship in the hope combined with the PARC, and Geelong Hospital have that a person will fill this role on an ongoing basis. 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. Eastern Metropolitan Region

Eastern Health and St Vincent’s Hospital manage Case study mental health services visited by the Eastern Metropolitan Region Community Visitors. A 21-year-old man has frequently been admitted to several mental health units The services comprise four adult acute units, two throughout the region. The man has aged persons’ acute inpatient units, four aged autism and mild intellectual disability and persons’ mental health residential units, one child his local GP suspected a psychotic illness. unit and one adolescent inpatient unit, three CCUs, three EDs and one specialised personality disorder His subsequent admission to an adult unit. Twelve Community Visitors conducted a total of acute unit did not support this diagnosis 232 visits, 33 of which were requested by consumers and his symptoms were considered to be and others. behavioural in origin. In 2009, the man was living with his mother and by 2011 he Legal rights and information provision obtained accommodation within Disability The Community Visitors found that patients in acute Accommodation Services where he adult units often feel that their opinions are being remained for one year. ignored and even that they are not being treated as Following a number of violent episodes in adults. Community Visitors regularly give advice on avenues for seeking a second opinion or asking for which police and ambulance attended, he a MHRB hearing. Recently a consumer consultant was again transferred to a mental health was appointed to Normanby House who will provide unit due to his previous label of psychosis. advocacy support to the patients there. He refused to return to his disability service accommodation so was placed in an SRS. Police again attended numerous Care and treatment times so he was sent back to the mental health acute unit until accommodation Assaults could be found. For a short while, the Community Visitors have heard of alleged assaults man resided with another resident with this year in all units both by consumers on staff, a disability in a Department of Housing staff on consumers and consumers on others. All incidents were handled well by staff and one aged residence. care acute unit is seeking to modify the environment Questions are raised in this case study to better contain difficult behaviour. Community about the system’s inability to find suitable Visitors had several call outs regarding alleged accommodation for a vulnerable individual sexual assaults, again these were handled well by staff. with complex needs. Community Visitors Annual Report 2012 21 Mental Health

Good Practice Appropriateness of rooms/areas A woman admitted to Maroondah Hospital had a New security provisions are being implemented heightened fear of sexual assault as a result of her at St Vincent’s Hospital and Normanby House mental illness. Staff worked with her and her family particularly regarding safety after hours. to ascertain the best approach for her and what level of supervision and observation she was most Upton House has renovated the adult acute unit comfortable with. She was accommodated in the to incorporate gender specific areas such as a women’s only corridor and her stay at the hospital separate courtyard and are planning a gender passed without incident. 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 There was an incident at the Peter James Centre in swipe cards are lost. the acute ward where one patient is alleged to have assaulted another. The family of the man assaulted Patients and residents with a dual disability needing were very upset at the perceived lack of supervision treatment can have great difficulty settling into an and shortage of staff. Both men involved in the acute unit as it cannot meet their particular needs. incident are sufferers of dementia with behaviours This was a traumatic experience for one person that are difficult to manage. It was difficult therefore admitted to Upton House. One acute aged care unit to ascertain all the facts. is investigating ways to modify the environment to cope with disruptive or aggressive behaviours. The Peter James Centre was one of the first hospitals to be built after the closure of the Following an incident in the garden area of the institution, Willsmere, and the needs of the clientele adolescent unit, young people must now be have changed over time. There is an increase in supervised while outside. Staff find it difficult to consumers suffering from dementia and the corridors free people for this duty and modifications to allow on the ward are hard to supervise adequately. There for better observation have not yet happened. are plans now to adapt a bathroom at the head of Community Visitors have many discussions with one of these corridors to a nurses’ office that should management over this unacceptable situation. make management easier. On the positive side, a mural created in cooperation with a community group has brightened the area considerably. Adequacy of beds All adult acute units have experienced difficulty One aged care residential unit with old infrastructure in accessing SECU beds for patients needing has renovated the area to provide a more home-like specialised care. There have been delays of many environment. There is new lounge furniture months before a bed is available. EDs in Eastern and televisions positioned to allow for better viewing Health have on occasion not been able to find and there are also more activities available. beds for patients needing admission to acute inpatient wards. Personal needs Community Visitors have noted that patients in the Discharge planning aged care acute unit at the Peter James Centre There continues to be long delays while patients often wear pyjamas throughout the day. Carers have wait for suitable accommodation before discharge. not brought in sufficient clothing and laundry facilities Difficulty finding employment is also a factor in are limited. Washing machines at St Vincent’s have delayed discharge from CCUs. Patients in the often been out of action and there have been long specialist unit are concerned that community support delays before new machines were installed. One services in regional areas have difficulty in meeting adult acute unit has a supply of donated clothing their needs in some circumstances. St Vincent’s ED available for those in need. has started a program of mental health enhanced triage where patients discharged home after Least restrictive environment presenting to ED are followed up to ensure referrals The level of aggressive behaviours and the risk to other services have been acted on. 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 Rehabilitation, educational and recreational There are often long and frustrating delays in opportunities getting repairs attended to but all matters reported A lack of educational and recreational opportunities for attention are now completed. was of concern for most of the year with the responsible staff member, a recreational worker, Refurbishment that requires painting or furniture absent on sick leave for an extended period. renewal is an ongoing issue. Several units have Community Visitors were advised that during June been able to achieve much this year to meet 2012 this staff member returned to duties and there this need. was the appointment of an occupational therapist. Hopefully, some enjoyable recreation activities will be added to existing programs. Gippsland Region Community Visitors were greeted pleasantly on each visit and co-operation by staff and management The Latrobe Regional Hospital manages the mental in dealing with enquiries and resolving issues of health services in the Gippsland Region. 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 Ballarat Health Services manage the Grampians Visitors. Four of these visits were requested by Region mental health services. The services located consumers and others. 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 Legal rights and information provision and one ED. There are also six funded mental Generally, legal rights and information provision health beds for aged care in two nursing homes were not an issue, with no concerns expressed located in Stawell and Nhill, managed by Stawell by patients or residents. Regional Health and Wimmera Health respectively. Ninety visits were undertaken to these facilities by Care and treatment five Community Visitors, of which four visits were requested by patients and residents. Patient/resident No complaints were received from patients on visit requests have been actioned within a 24-hour their care and treatment but a continuing shortage response time. of available beds made management difficult, as patients were often discharged earlier than Regular meetings are held every three months with desirable. Re-admission numbers within 28 days hospital management who are very supportive of the were high during some periods of the year as a Community Visitor role and actively respond to local direct result of the rapid turnover. issues raised in a timely manner. The meetings are informative and outcomes are positive. 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 Accommodation, treatment and to access medical practitioners after discharge appropriateness of facilities faced a three to four week wait for appointments The lack of housing options is an ongoing issue in some areas. at the CCU when residents are ready to move On a positive note, consumers and carers are invited back into the community. There are difficulties to participate in a range of committees including experienced in locating suitable housing and long clinical governance and clinical risk. 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 Appropriateness of rooms and areas their wellbeing and treatment plans. The standards of the facilities are appropriate although maintenance issues arose several times, A smoking policy has been a persistent issue, and continual requests to have graffiti removed from particularly at Eastern View CCU where staff attempt courtyard walls have not been attended to. 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 Gender sensitivity butts often discarded into the shrubbery creating The SECU unit consists of 12 beds with a a fire risk. Patients and residents know the smoking predominately male population, and at times, policy is in place and signs are displayed. A call with disturbed residents, it becomes volatile. to OPA’s Advice Service was received regarding On occasions, hospital security is called on for the smoking issue at the adult acute unit. The assistance. For the past few months there have patient only wanted the Community Visitor to obtain only been two females, and in recent weeks only permission for her to go outside for a cigarette, one female in this unit. At times, there have which was denied. No other issue was discussed. been two sittings in the dining room to alleviate Upgrading the facilities in the time out or seclusion safety concerns. area is long overdue and plans are underway to Community Visitors express continuing concern improve this area. about the vulnerability and safety of female The aged care residential unit provides a very residents. This has been a reoccurring problem caring environment with a wide variety of innovative reported over recent years, which is constantly outings, activities and interests for the residents raised with staff, as there is no separate women’s with volunteers both young and old supporting the area or lounge available. Community Visitors have programs. This gives residents one-on-one time with been told there is no funding available to redevelop a visitor showing a personal interest in them, while it the unit, which is long overdue for an upgrade. frees up staff time. It is pleasing to report that the adult acute unit The kitchen, and lounge area of the unit have been now has a user-friendly women’s lounge, tastefully recently upgraded with fresh paint, new curtains and furnished, and also used for visiting purposes. a television provided by the Womens’ Auxilliary. Life Adequate activities are also provided to occupy stories of residents are displayed in attractive frames younger children who visit the facility. External doors and provide a great source for a chat. Community are locked at all times in this unit. Visitors often receive positive comments from There were initial issues of concern to Community residents’ families regarding the care provided to Visitors with the access door being locked and their loved ones and there is opportunity for them residents having to request use of the lounge. One to have input at the regular unit meetings. resident indicated she was too frightened to use the Iona House in Nhill seldom has vacancies and the lounge and others stated they were unaware the six funded beds are fully utilised. There is a high lounge existed. There is now a notice on the door, standard of care provided. Community Visitors but the location is isolated from the nurses’ station, have continuing concerns regarding the delay in and needs to be physically monitored for safety and the provision of a set of special scales necessary to security purposes, as there is no CCTV to this area. 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 Hume Region been unable to fill most of the six funded beds with Goulburn Valley Health, Beechworth Health Service, mental health residents and an average of only two North East Health and Albury Wodonga Health or three residents are visited by Community Visitors. Services manage Hume Region mental health These people appear well cared for and settled in services. this environment. The visited services comprise two adult acute units, Access to incident reports one-aged persons’ acute inpatient unit, two aged persons’ mental health residential units, two CCUs Community Visitors express concern at the lack of and two EDs. current incident reports being provided on request at the time of visits to all units. This is part of the Seven Community Visitors conducted a total of Community Visitors’ role but little information is given 111 visits. Two of these were requested by a patient on enquiry. Reports made available in this region or resident. 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. 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.

24 Documented evidence of incidents was not made After reporting vacancies at some facilities, available to Community Visitors at the time of their Community Visitors now report improved occupancy visit for a large part of the year. This has improved rates at Blackwood and the Willows. recently with some mental health service providers, Blackwood aged persons unit, Kerferd adult acute The generous donation of significant funds to the inpatient unit, and the Willows CCU, so Community Gruztner aged mental health residential unit from Visitors are encouraged by this. a local community club enabled a new family room area to be provided for visitors. Patients and residents often voice their concern to Community Visitors about their legal rights, Smoking provisions treatment, medication and discharge planning from the facility because of either misunderstanding or The implementation of a consistent approach to being unclear of the information initially provided considering the non-smoking policy and impact to them by staff. on patients and residents deprived of liberty and freedom of movement continues to be an ongoing concern with few positive solutions in sight. Some Care and treatment residents are subjected to negative community After initial concerns regarding the potential loss bias as a result of having to smoke in front of the of aged persons’ acute beds at the Rosewood Unit Wanyarra adult acute inpatient unit. The area and the impact of renovations on the Grutzner Unit, remains littered with drink containers and cigarette it is very pleasing to report that renovations were butts adding to the overall shabby presentation on completed with no impact to the support and care of entering the facility. There are no protected areas patients and no patients having to move. No beds for residents to smoke at this unit so people are were lost in the renovation. exposed to the elements. Community Visitors note an increase in the number of people with high needs dementia and young Maintenance adolescents being specialled in the Wanyarra adult New furniture was eventually provided at the acute unit and the Kerferd adult acute unit resulting Grutzner Unit to replace old and tattered chairs in additional pressures on existing staff and budgets. and meet OH&S requirements of staff supporting residents sitting down and getting out of their chairs. Community Visitors report positively an increase in New televisions have replaced the old analogue sets mental health services from two to four hours per in all services. Damage caused by residents appears fortnight at the Grutzner aged persons’ mental health to be quickly addressed and rectified. However, unit. A further increase in available hours may be Community Visitors regularly report lengthy delays in of benefit to residents. repairs and fault rectification at Wanyarra, the adult acute unit in Shepparton. Matters such as painting Standard and appropriateness of facilities of marked and scuffed walls; graffiti removal; Community Visitors note an increase in admissions cleaning of floors and whitegoods; rubbish removal to the Wanyarra and Kerferd adult inpatient unit including cigarette butts, coffee cups, soft drinks of not only drug and alcohol affected people but bottles and repair/replacement of a clothes dryer also young adolescents. As there appears to be a are often reported. Delays in repairing or replacing lack of appropriate short-term support options for air conditioners at the Gruztner and Blackwood Units these people, there should be greater consideration have now been addressed. Repairs to a toilet at the of professional services and support options in Blackwood Unit, which was damaged after this area. Community Visitors are concerned that a resident’s fall, have now occurred. there appears to be few community based allied As a result of a federal accreditation review, the mental health services to minimise readmissions. laundry at Gruztner, the aged persons’ mental health Readmissions place additional pressures on the unit, was earmarked for upgrade. However, this has availability of inpatient beds. not occurred as yet because of financial constraints. SECU funding for long-term residents has been Recent rain damage to carpets and ceilings from well received and resulted in more appropriate a water overflow was rectified very quickly and accommodation and support services. This has been positively at the Willows CCU. to the benefit of two residents from the Willows and one resident from Kerferd being more appropriately Safety issues/hazards accommodated and supported. Community Visitors Community Visitors noted staff at the Kerferd look forward to other eligible residents being Unit found a knife in the high dependency unit. considered and supported in a similar manner. 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 Loddon Mallee Region emergency response system at the Wanyarra Unit. Although little information was provided as to why Bendigo Health and Ramsay Health Services this was now required of Community Visitors this manage the Loddon Mallee Region mental health appeared to be in their best interests and is regularly services located in Bendigo and Mildura. provided and worn when visiting this unit. The services visited comprise two adult acute units, One-off funding from the Commonwealth one aged persons’ acute inpatient unit, one aged Government to provide support and advice training persons’ mental health residential unit, one CCU, in sexual health was welcomed for all residents at one SECU and one ED. the Gruztner aged mental health unit. Seven Community Visitors conducted a total of 58 visits and seven visits were directly requested Rehabilitation, educational and recreational by residents and others via OPA’s Advice Service. opportunities Community Visitors noted an incentive was provided Legal rights and information provision to residents at the Willows Unit to attend activities Community Visitors believe that non-provision with an allowance each month for participation. of incident reports adversely affects patient and While initially the activities officer was unaware resident protections. The reason most often given of this, this issue was clarified and remedied very for restricting Community Visitor access to reports positively. is that the Riskman information technology system Activities and opportunities are wide and varied used does not provide sufficient privacy protections when staff are available to coordinate and support for staff. This situation hinders adequate enquiry residents undertaking activities. For example, trips following consumer reports of incidents, or when to Queenscliff and other outings such as meals Community Visitors wish to review incidents, which and coffee at local venues, attending football have previously, or are currently, affecting patient matches, ANZAC parades and in-house activities and resident care. Consideration of the use of staff like vegetable gardens, indoor bowls, billiards, daily ID numbers on Riskman may mitigate concerns walks and a one-off ‘clowning around’ activity have regarding staff confidentiality. been organised. Community Visitors have reported several times that With the unfortunate passing of a resident who the Community Visitor notice is not displayed for was supported independently long-term in a three- patients at the Alexander Bayne Centre acute unit. bed unit, the Willows now plans to use this unit for varied day activities for the benefit of the remaining Care and treatment residents. This is a positive resolution to ongoing On occasions, patients have been required to stay discussions regarding a ‘Green Shed’ option for much longer than the targeted time of four hours on-site resident activities. Community Visitors while waiting for bed availability at the adult acute also support this facility being used for on-site unit. In June of this year, Community Visitors noted consultations as an alternative to residents having that two of eight patients in the ED one weekend had to travel off site for appointments or assessments. spent over 24 hours there and a third patient was Community Visitors have regularly reported on the sent home after 23 hours but represented an hour or fluctuating workforce among occupational therapists, two later. Treatment plans are not routinely provided activity officers, nurse unit managers and other to patients in a timely manner at the adult acute unit. staff positions. Clearer communication about some When there is no alternative, patients less than aspects of staffing would minimise Community 16 years of age may be required to stay in the Visitor confusion in this area. Currently management adult acute unit. Should this be necessary, they are and the union are negotiating their Enterprise admitted to a single room and monitored individually. Bargaining Agreement and staff have taken some industrial action. Community Visitors hope there Another patient was also concerned about the length will be little to no impact on the direct care and of time he spent in the high needs area of the same supports to patients and residents while this unit. At that time, he had been in high needs area is being negotiated. 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 management and an investigation took place with are staying in CCUs much longer than is required the involvement of an advocate. However, as the making badly needed beds unavailable. incident was alleged to have occurred some months previously, and the patient who has an ABI was Health Services Community Visitors spoke to confused about the dates and details of the alleged someone who had been a mental health patient who assault, the matter was not pursued any further. 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 Standard and appropriateness to find somewhere else to live. The proprietor of the of facilities SRS told Community Visitors that he would most likely have to live in a caravan park. This patient Appropriateness of rooms/areas requires stable housing with a caring environment, The adult acute inpatient and SECU both provide anything less would have a severe impact on his gender sensitive care with separate wards and mental and physical health. A permanent caseworker both mixed and separate lounge areas. Sometimes needs to be provided to this person to protect them women were allocated a room in the men’s section from becoming lost in the system. 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 Case study office for added security. One consumer was in the high needs The aged persons’ mental health residential unit area of an acute unit for a period of provides separate wards for men and women, 117 days. Management said she had separate and shared lounges, and shared outdoor areas. The non-gender specific outdoor area assaulted several staff during this period. provides the perfect setting for combined activities The consumer said she attacked a nurse such as themed activities and meals provided on due to frustration following “too many Australia Day and other occasions. In the SECU, questions”. Incident reports were not separate wards and both mixed and separate lounge available to Community Visitors. The areas are provided. A new separate outdoor area consumer was eventually accommodated was also added in 2011-12 for residents to spend at the SECU. time individually with family and friends. The aged persons’ acute inpatient unit provides separate bedrooms opening onto shared lounge and outdoor areas. For the most part, designated gender Assaults 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 Despite research outlining the benefits to mental a medical check, occupational therapist advice and health patients who quit smoking while in hospital, X-rays for one of them. Police were called by staff, patients who initially enter the high dependency but did not attend. The unit manager advised the unit may gain more from being allowed to smoke injured patient that she could phone police herself in that area. Since a non-smoking policy was if she wished. implemented staff reported increased agitation and stress to patients. When admitted, patients who are A patient reported a sexual assault to Community smokers not only need to adjust to treatment for Visitors and this was reported to management. their medical condition, but simultaneously to the The incident report was unavailable to Community effects of withdrawal from nicotine. While patches Visitors. The patient had a long history of making may be prescribed, benefits are not immediate and accusations against others, decided she did not want not a replacement for smoking in the short-term. the matter pursued and has now been discharged. Some patients are also aware that, when on the open ward, smoking is permitted in the attached A patient told Community Visitors he had observed courtyard. Many patients, residents and staff believe another patient dragged into the high dependency denying access to cigarettes is an infringement unit by staff, following an incident in the courtyard. of consumers’ human rights; however, four staff After the patient concerned confirmed the allegation, members have expressed a wish that the smoking Community Visitors reported the matter to 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 The adult acute unit at Mildura had been given a high dependency unit. grant of $60,000 to assist clinical staff to improve service delivery to patients in remote areas through While consideration of the rights and needs of the use of ipads and modern technology. 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 Staffing the high dependency courtyard by using targeted In June, a patient in the adult acute inpatient unit rostering of staff in this area. Meanwhile, as plans in Mildura reported to Community Visitors that they are being drawn up for the new hospital acute ward, were are unable to access a psychiatrist from Friday careful consideration should be given to planning to Monday. for safe smoking areas in the new high dependency unit. There would be a need to consider ‘air curtain’ There was some staff disruption during work doorways or specially designed smoking booths and bans for better staff/patient ratios and remuneration. other measures to ensure the safety and wellbeing Effects on patients have included that nursing of both patients/residents and staff. staff will not make toast for breakfast or enter patient data. Appropriateness of rooms/areas Staff at the aged persons’ acute inpatient unit, feel In the acute inpatient unit, new lounge furniture that staff numbers are limited. Two staff members and dining tables and chairs and new floor coverings said that they felt “stressed and battered” and were have made a tangible difference to the comfort worried that the situation could not lead to good and wellbeing of patients. New furniture and floor outcomes for patients, and paperwork was not coverings have been provided in the ECT waiting being done. The staff had worked at the unit for area. A total of $36,000 to $38,000 has been many years. made available for a safety audit of the adult acute At the SECU, nursing staff are required to attend to inpatient and the secure extended care units. patient meals as there is no kitchen staff. Meals are Ashtrays are still required for the courtyard area of delivered in foil packs, with some fresh food added, the adult acute unit. It is currently littered with butts, and then re-heated in a household-size oven taking and requires more regular cleaning until these are considerable time. Nurses have been told they may provided. High cleaning of cobwebs from under not use the on-site commercial oven, due to lack of the eaves and also cleaning of outside windows training. The task of meal preparation consequently to the men’s lounge area would also provide more takes more time and when emergency situations agreeable surroundings for patients. arise, as is quite common in the SECU setting, other patients meals are delayed and safety of meals is Patients in the high dependency unit have benefited not ensured. Patients and staff are concerned with from the provision of new couches, however, when the quality of the food and say it is degrading to be the unit is at capacity there is still seating room only served all their meals from these foil packs. One for four instead of five. The dining table-bench unit patient also missed her usual, planned activity time was also replaced during 2011-12, but patients and due to staff being needed in the kitchen. staff are dissatisfied with it. It is made of stainless steel and is an immovable combination design. The new pathology team for Bendigo Hospital now However, it does not provide back support or allow sends staff to take blood tests from patients at the patients to place their feet on the floor or reach the Alexander Bayne Centre (the acute unit in Bendigo) table when eating or reading the paper. Patients are and this will free up nurse time. More courses are uncomfortable when eating or reading and, in some also being offered to nurses on trauma-based care, cases, their circulation is cut causing pain in their which aim to enhance the already high standard of legs. The table-bench combination lacks ergonomic care offered to patients. design, and has been described by patients and staff as looking aesthetically unpleasing. It urgently needs Rehabilitation, educational and recreational replacement with a more appropriate table/bench opportunities combination or breakfast bar/stool arrangement. Art therapy provided for patients at the acute unit Toilet seats would enhance comfort and safety of is proving to be a very valuable aid to recovery for patients in the high dependency unit. Currently, the a number of patients. The therapist making the toilet is being shared by both men and women; it is difference here should be congratulated for her in the same room as the shower and is often wet, dedication to this program. A new exercise bike has either from the shower or urine. also recently been installed at the adult acute unit

28 Good practice Legal rights and information provision Staff at the aged persons’ mental health residential unit should be congratulated on the initiative shown Information provision in producing ‘story boards’ which are displayed Community Visitors report consistent good practice on the walls of patient rooms and are compiled across all units in the provision on noticeboards of in co-operation with families. The storyboards timely, up-to-date and relevant information on patient comprise a written and photographic ‘life story’ which rights, complaints procedures, contact numbers for provides all staff with a quick reference tool, and Victoria Legal Aid, the Community Visitors Program, greatly enhances staff ability to communicate with other advocacy and support organisations, recovery consumers. One family said they were extremely and treatment information, and weekly and daily pleased with the level of care at this particular unit, program activities. Information displays make especially in relation to the respect and dignity increasing use of colour and graphical presentations shown to consumers at all times. for effective communication.

Cultural and Linguistic Diversity (CALD) Melbourne’s multicultural community and the cultural and linguistic diversity that follows is reflected in the patient population in mental health units. Diversity North and West Metropolitan Region of language is a challenge to the immediacy of (North) effective treatment. While the Victorian Government interpreter service is available and is used, hospital Austin Health, Northern Area Mental Health Service staff increasingly reflect the wider cultural and (NAMHS) and Forensicare manage the mental language mix of our community. In particular, some health services in the region. Northern Hospital staff who are Arabic speakers have provided timely assistance to patients of that Austin Health manages a mother and baby unit, an culture. The general community in the Northern adult acute inpatient unit, a SECU, a child unit and Hospital area contains a strong Arabic cultural an adolescent unit, a specialist brain disorder unit, presence. a specialist veterans post traumatic stress disorder unit, and an ED. Legal rights/dignity NAMHS manages two adult acute inpatient units A number of complaints and questions were located in the Northern Hospital, a CCU, an aged made by patients in acute units challenging their persons’ mental health residential unit and an aged involuntary status. Most of these complaints were persons’ acute inpatient unit. An ED is also located made in the very early stages of the patients’ at the Northern Hospital. admission to hospital when they were often seriously Forensicare manages the Thomas Embling Hospital, ill and confused. On occasion this confusion was a seven-unit forensic mental health hospital. This exacerbated by the transfer of the patient from hospital is reported separately in this section one hospital to another as part of the day-to-day because of the unique nature of forensic mental operational bed management that occurs as unit health care. staff balance cross-regional bed demand with availability. A total of 233 visits were made by seven Community Visitors. Twenty of these visits were requested by In all instances, Community Visitors referred the consumers and others. 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) 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 Case study caused by bed availability. At the Austin, the delay is exacerbated by the geographic distance between Community Visitors were contacted by the the ED and the acute unit and the regulatory parents of a patient in the Brain Disorder requirement for such moves to be made in a fully Unit expressing their concern about a equipped and serviced ambulance. MHRB direction to arrange the discharge of their son who had been a long-term Medical care patient. The patient’s brain disorder had Community Visitors have responded to a number of been as a result of an accident some patients with concerns about their medication, their 20 years earlier. The disorder had resulted involuntary status, their desire for a second opinion in a long history of inappropriate and or about their general health. offensive behaviour towards women. All of these concerns were referred to the primary The parents were concerned about the nurses or shift leaders and Community Visitors high likelihood of continuing offences often observed the nurses going immediately to the on discharge. patient to commence follow-up on the issue. The Public Advocate became involved through the guardianship role, and the clinicians at the hospital were also Hospital transfers and complaints concerned so an appeal to the MHRB was organised. The outcome was an adjustment to the MHRB direction so that Case study the unit increased the number and degree A patient was transferred from another of community familiarisation exposures, hospital and admitted to Austin Acute escorted and then unescorted, with a Adult Inpatient Unit as an involuntary further review in three months time. patient. The patient submitted a series The purpose of this case study is to of complaints about his treatment in the note that balancing patients’ rights previous hospital, about his status as an and community safety is a difficult task involuntary patient and about a number where there is mental impairment and a of patient management practices. The propensity to offend. While there is no patient was articulate, well-versed in the easy answer to such cases, Community mental health system, and very aware of Visitors note that there was an appeal his rights. Community Visitors discussed process, relevant clinical, community the patient’s issues in a long interview safety and human rights concerns were with him, were assured he was aware of addressed, and an outcome negotiated the complaints procedures and advocacy that responded to these factors. organisations available, and referred his issues to the unit manager. The manager responded in detail and in writing. The patient recovered enough Care and treatment to be discharged within a couple of weeks. He was separately pursuing his Admission process complaints against the previous hospital. Initial admissions to acute units generally come Community Visitors mention this incident via the EDs of the hospitals or by direct transfer as an example of the difficulties that can between different mental health units as part of arise when patients are moved between balancing the demand and supply of available hospitals. 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 Long stays – Discharge Smoking provisions Community Visitors are concerned about the number Smoking continues to be variously managed in of hospitalised patients who are ready for discharge acute units. There are blanket bans on smoking on but for whom no appropriate accommodation can be hospital property. These are strictly enforced in some found in the general community. In a practical sense, units to the extent that escorting duties off-site for this ties up beds that would otherwise be available an arbitrarily limited number of cigarettes a day are but in a more profound sense, it limits the person’s loaded onto staff duties. In other units where garden enjoyment of life. Two patients with acquired brain areas or external courtyards are available, smoking injury (ABI) who are long-stay patients, one over by patients continues unabated and there is tacit 20 years and one over three years, have recently acceptance at operational levels. Community Visitors completed rehabilitation programs. They are observe that smoking is consistently claimed by assessed as suitable for discharge to ‘suitable patients to have a calming effect and that attempts supported accommodation’, however, the search to forcibly restrict smoking adds to their level for such accommodation is continuing. of agitation. In one specific case, a CCU patient who is ready and willing for discharge, is unable to find Assaults appropriate accommodation in regional Victoria. While incidents were appropriately entered on OPA has become involved in a guardianship role. patient records, aggregated statistics on assaults The case is ongoing. were not available due to the industrial action by mental health nurses.

Standard and appropriateness of facilities Rehabilitation, educational and recreational opportunities Appropriateness of rooms/areas The basic structure of facilities provided are sound. Adequacy of programs The acute adult inpatient unit, mothers and babies Community Visitors have observed a wide range unit, SECU, ABI and veterans units are all purpose of music, art, gym, gardening, speech, pet, peer designed, make good use of natural light, and support, community visits, community engagement include specific activities and counselling rooms. and other more technical therapy programs in Most units have courtyard or garden facilities operation. Nursing staff have been considerate of, included in the design and these are generally well and responsive to, requests for information and maintained. The child and adolescent unit has a situation reports. primary school on-site and an excellent playground. No separate female units are available. However, Patient advocacy – consumer consultants bedroom allocation is managed to co-locate the Community Visitors noted the presence in Austin female patients in specific room areas. Community Health of consumer and carer consultants (who have Visitors note that NAMHS is investigating the personal consumer or carer experience themselves) practicality of a ‘women only’ room with TV and other with a mandate to visit patients, identify and raise facilities in their acute units. patient issues and report to senior management meetings attended by all unit managers. Community Visitors are concerned at the standard of decor in the common rooms in the SECU. The This initiative has been established for several main common room, while bright with natural light years. Apart from the identification of patient issues and with high ceilings, presents an austere and to a person who shares the patient experience and stark appearance. There is little colour and no soft which might not be revealed to a ‘staff’ person, furnishing to moderate noise, so it lacks warmth it serves as a model in demonstrating hope of a and any sense of homeliness. successful recovery to patients during the more severe stages of their illness. This approach also SECU patients remain in the unit for prolonged operates through the Veterans Liaison Group at the periods and Community Visitors believe a more Veterans Post Traumatic Stress Disorder Unit and home-like appearance is essential from a human at the adolescent unit, which operates a ‘graduate’ rights, if not a recovery, perspective. Austin system whereby former patients now successfully management have acknowledged the situation and established in life return to speak to current indicated they will address this over the coming year. day patients.

Community Visitors Annual Report 2012 31 Mental Health

Least restrictive practice NAMHS / Police Ambulance Crisis Emergency Response (PACER) Proposal Least restrictive environment The Mental Health Service is working with Victoria Community Visitors observed that the practices Police to provide a Police Ambulance Crisis across all units involving early intervention, talking Emergency Response team in the North of the calmly, the use of low intensity rooms and alert region to respond to emergency calls. The team observation are all consistent with a least restrictive provides immediate ‘on site/at site’ diagnosis and environment approach. treatment of mentally ill patients in emergency Community Visitors observed two separate incidents situations. that exemplify the approach. In one acute unit, a patient became loud, argumentative and abusive Seclusion Reduction/Trauma Informed Care with nursing staff over a perceived grievance The Area Mental Health Service has created a new regarding food and cigarettes. Community Visitors senior nursing position with a focus on seclusion observed nursing staff respond to the episode with reduction and trauma-informed care for its acute two nurses attending to the patient and managing units. This position will work with the consumers the incident successfully, without recourse to and the treating team to reduce distress, agitation, more restrictive options. In another unit, a patient and adverse events including aggression, violence, experienced an episode of irrational fear when restraint and seclusion. approached by another patient; nurses successfully managed the patient by calm talking.

Restraint and seclusion Thomas Embling Hospital Episodes of seclusion continue to decline across (statewide service) all acute units. Community Visitors note that staff at Austin and NAMHS (and Forensicare) are confident The Victorian Institute of Forensic Mental Health, this trend will continue and therapeutic approaches Forensicare, is a statutory authority responsible for and developments are directed to this end. 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. New initiatives Forensic patients have been found unfit to plead Veterans’ post-traumatic stress disorder or not guilty by reasons of mental impairment and are then committed by a judge to Thomas improvements Embling Hospital. The unit manager briefed Community Visitors on the establishment of the Australian Defence The duration of supervision orders and the nature Force Mental Health Team to coordinate mental and severity of the illnesses treated results in health treatment to serving Australian Defence forensic patients being treated for much longer Force personnel. periods than non-forensic patients. The average length of stay for a forensic patient is six to eight The ward staff have initiated contact with the team years and some patients remain in care over to develop a liaison and information protocol and 20 years. This prolonged length of stay presents improve the process for referring serving personnel. particular challenges to the treatment plans developed for patients at the hospital. Austin Health – New CCU and PARC Thomas Embling Hospital has seven distinct units Austin Health has a new 22-bed CCU under within its bounds. They provide specialist male, construction on its Heidelberg campus. Seven of the female and mixed gender units ranging from beds are earmarked for Forensicare and will ease acutely ill to rehabilitation and independent living the demand for acute beds. The CCU is planned to treatment regimes. open in March 2013. During the year, Community Visitors made 95 visits Austin Health is developing a new ten-bed PARC to the Thomas Embling Hospital units. Eleven of in Heidelberg West, due to open in March 2014. these visits were requested by patients and others.

32 Legal rights and information provision Assaults Community Visitors have been involved in the Information provision follow-up of a number of patient-on-patient assaults. Full statistics on these matters are not available Community Visitors consistently report the provision because of industrial action by most mental health on noticeboards of up-to-date information about nursing staff. Community Visitors became aware that patient rights, complaints procedures, recovery and one patient was assaulted by other patients three other treatment-related information. times in a month. This matter was referred to the program for follow-up. Legal rights – Patient service charge Community Visitors were informed that hospital Patients advised Community Visitors in January protocols were followed in all the assaults of which 2012 that the hospital intended to introduce a Community Visitors became aware. Immediate service charge to help defray costs of treatment. seclusion of the offending patient is generally Subsequently, Community Visitors were advised of followed with intense observation and treatment and detailed briefings to patients by Thomas Embling a review of the patient’s treatment and medication. management and an on-site discussion forum on In some instances, the offending patient has the topic involving patients and carers, conducted been moved to a different unit. Community Visitor by the Victoria Mental Illness Awareness Council discussions with shift leaders indicate growing staff (VMIAC). Community Visitors also examined confidence in observing early symptoms of rising minutes of discussions on the topic by patient agitation and taking measures to pre-empt potential and consumer committees. violent outbursts. The issue of a service charge was discussed in broad terms by the Community Visitors Mental Adequacy of beds Health Board at a meeting with the Chief Executive The Barossa Unit includes female patients in both Officer (CEO) of Thomas Embling Hospital on the acute and sub-acute stages of mental illness. 16 May 2012. The CEO explained the background, This is a necessity forced by the current capacity fee setting, exemptions approach and governance of female specific wards. While this arrangement of the proposed charge and the much higher meets gender sensitivity requirements, it causes charges in comparable schemes operating complications in managing patients in a single unit interstate. He advised that initial planning proposed at different stages of acuity of their mental illnesses. the charge be introduced from 1 July 2012. Community Visitors will closely monitor the impact of its introduction. Standard and appropriateness of facilities Care and treatment The most common observation by Community Appropriateness of rooms/areas Visitors about patients’ general appearance and health is the very high incidence of obesity in both The general design of the grounds and facilities are male and female patients. They are advised this well suited to a long-stay facility with garden areas is partly a side effect of the medication treating with shade sails and barbecue facilities. Common their illness. There are, however, patients under rooms include information boards, phone access, medication who do not progress to abnormal TV viewing lounges and adjoining activities and weight gains. The very long-term nature of forensic quiet rooms. The broader campus area includes treatment, its associated medication regimes and extensive grassed areas, pathways for exercise, correlated patient obesity represent a significant risk trees and shrubs and long unobstructed sightlines. to patient health and wellbeing. The campus area includes educational facilities, a gymnasium, a pool, and other program facilities. Patient obesity has been a long-term concern of the clinical staff and a number of initiatives have been Personal needs/food introduced over the years. Community Visitors noted the recent introduction of the ‘healthy living program’ Treatment units make provision for catered meals with its focus on healthy diet, exercise and taking or self-catering, and household purchasing and control and support the hospital seeking solutions management depending on the stage of recovery. to treatment-related patient obesity. 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 Availability of courses including personal patient recovery and an increased exercise improvement options of their human rights. Community Visitors support the on-site TAFE courses and exercise and fitness programs as enormously beneficial to patients. Rehabilitation, educational and recreational opportunities Community Visitors understand implementation of Least restrictive practice the new model of care has stalled, partly as a result of funding and hiring constraints, and partly because Least restrictive environment of industrial action. Whatever the cause, the delay is While each unit is ‘secure’ from the other units, there a real risk to the planned benefits and improvements is generally free access between patient rooms and to the recovery process. the main common room. Campus leave (access to the main grounds), both escorted and unescorted, Consumer Advisory Group (CAG) is available depending on the stage of recovery. The CAG comprises elected patient representatives The Forensic Leave Panel can approve short- from each unit, the senior social worker, hospital term leave (generally four hours) first escorted management executives and therapists. The CAG then progressing to unescorted as patient health meets monthly to discuss and negotiate on patient improves, for shopping and other program purposes. identified issues covering housekeeping, therapy These leaves are highly valued by patients and are and operational matters. Executives, therapists, an essential step in their recovery to full community social workers and the contract caterer respond reintegration. to questions and issues raised by patients. Seclusion Program availability Seclusion continues to be an essential but closely Some staff have expressed concern that funding managed and monitored practice at the hospital. constraints are limiting the availability of appropriate Seclusion is applied as a last resort measure in rehabilitative programs. Prisoners who are the case of immediate risk to safety. The general temporarily located in the hospital for treatment approach is to minimise the time spent in seclusion. comment on the wider range of programs available in prison. Boredom with the programs available is Episodes of seclusion are documented, patient an issue and a risk to patients’ recovery. observations are frequent and intense counselling and consultation with the psychiatrist are part of the Work opportunities approach to safely manage the patient back to the general unit community. Engagement in meaningful work is a powerful counter to boredom and an essential element of self-esteem. There are countless examples in the Specialling general community where a supportive working ‘Specialling’ is a less restrictive approach than environment is a positive influence on improved seclusion. The practice refers to arms-length mental health. close observation of a patient in an ‘at risk’ state and includes specific assignment of a nurse (or Work opportunities are highly valued by patients nurses) to the patient, close observations, and and an essential element of rehabilitation. However, quiet talking and walking, generally in the garden they arise very late in a patient’s recovery timeline area. The practice is noted in the patient record and and occur off-site in normal commercial premises. reported to the nurse unit manager and consultant In contrast with prisoners in the corrections system, psychiatrist. paid meaningful work is not available as part of the structured day of patients. Community Visitors would support research into the practicality and Quiet room – Low intensity room opportunities for providing on-site paid meaningful In recent years, the hospital has created a number of work much earlier in the recovery process. ‘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.

34 Mental Health Act was appropriately dealt with North and West Metropolitan Region by senior management, who addressed the issue (West) by email to staff in general and verbally with the psychiatrist. Western Health, Mercy Health Services and Melbourne Health manage the mental health services in the western part of the North and West Care and treatment Metropolitan Region (West). These services consist of four adult acute inpatient Admissions and adequacy of beds units, two aged acute inpatient units, four aged All the acute services in the region are subject to persons’ mental health residential units, one adult high demand, particularly those that service the rehabilitation unit, four CCUs, one eating disorders outer metropolitan growth areas. Constant demand and neuropsychiatric unit, one mother and baby unit, and a shortage of available beds in the region has two youth and adolescent units, and three EDs. meant that new patients at the Werribee Mercy and A total of 283 visits were made by nine Community Sunshine hospitals can often wait for more than Visitors. Eighteen of these visits were requested by eight hours in ED. At the Sunshine ED in February patients and others. 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 Legal rights and information provision the Royal Melbourne Hospital ED in February, one At the Royal Melbourne Hospital, patients did not person who required one-on-one supervision waited have copies of their treatment plans at the time of for 17 hours and another person waited for 13 hours. the Community Visitor visit. Staff agreed with the The Werribee Mercy adult acute unit constantly Community Visitors that patients should have a copy operates at full capacity. This is not surprising as of their plan and agreed to find out why this was the Wyndham Local Government Area (LGA) has not happening. Staff also told Community Visitors experienced a growth in population of 7.8 per cent, that patients were entitled to a treatment plan on the highest of all LGAs in Australia. Detainees from admission, and a weekly care plan on Monday ward the Marybyrnong detention centre add to the patient rounds. The registrar stated that it was not practical load at the service and it is challenging to provide to issue up-dated treatment plans, but the care plans the security required for these patients while trying were updated on a daily basis. to provide a least restrictive environment to other At Werribee CCU, efforts have been made hospital patients. to improve the process of passing on clinical A new initiative to streamline and improve discharge information about residents to the incoming staff planning has been introduced and this will hopefully at handover. Previously this information had to assist in the management of admissions. Community be extracted from a number of different locations, Visitors have been told that greater efficiency in but, by using a new standardised framework, all patient discharge has not led to any noticeable the clinical information about a resident will be increase in the readmission of patients. Ongoing presented on one A4 sheet, which should lead to discussions are taking place in an effort to increase improved service delivery. the number and availability of step-down beds. At the Werribee Mercy acute unit, a patient who did At Werribee, the ED staff are also discussing the not understand why she had to remain in the facility establishment of a pool of mental health nurses, for one month in order to receive two injections, which should improve efficiency and reduce and did not have a copy of her treatment plan. She response times, but the national target of not signed an ‘Authorisation to Inspect’ document to exceeding four hours is unlikely to be achieved enable the visiting Community Visitor to access due to demand pressures. 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 Treatment Visitors could have a look at the patient’s plan A resident at a CCU stated that she had been instead. The Community Visitors thought it was prescribed lithium and was gaining weight. Due to inappropriate to pursue the matter at the time due an ongoing friendship with a male resident, she was to fairly intense activity taking place between the also told she must have a birth control injection. The psychiatrist and other staff members, but reported nurse unit manager stated that although the lithium the matter on the visit report. The refusal of the injections were part of the resident’s treatment plan, psychiatrist to comply with a requirement of the 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 Case study weight level that is well within the normally accepted The mother of a woman admitted to an parameters. The nurse unit manager further stated adult acute unit rang OPA to say that, that staff were keeping an eye on the friendship when she had visited her daughter, there between the female and a male resident at the CCU due to their concerns about the potential for sexual were no staff available on the floor and exploitation, but there was no question of trying her daughter was walking like a “zombie” to force her to have a birth control injection. The and wearing an older man’s clothing. The CCUs attempt to educate her on potential risks was mother claimed she had spoken with a considered to be justified. male patient who alleged that both he and A man was admitted to the high dependency area another male patient had had sex with of the Werribee Mercy adult acute unit in January her daughter. The mother also said her 2010 as an involuntary patient. He was very unwell daughter believed that a staff member and, despite the best efforts of staff and clinicians, who her daughter alleged had raped her did not exhibit the expected improvement. During the at another service was working in the course of his stay in the HDU his case was brought inpatient unit. She also made a number of to the attention of the Chief Psychiatrist who, in turn, other allegations relating to the cleanliness enlisted the aid of the service provider’s Director of Psychiatry. His symptoms and the refusal of some and maintenance of the unit and the facilities to accept him meant it was not possible support and care provided. to move him to more suitable accommodation. He, These issues were reported to the therefore, remained in the HDU for more than two service manager who arranged for the years. As the result of constant efforts at the adult acute unit there was a recent improvement in the leadership team to meet with the mother, patient’s illness making it possible to transfer him to undertake an investigation, and put in a SECU. He is reported to be making good progress place a number of actions to improve the towards recovery. quality of care at the unit. The service said none of the current staff at the Assaults service had worked at the service where A number of serious concerns came to the attention the young woman had previously been of Community Visitors this year. a patient. While OPA is pleased with action reportedly undertaken by the unit, A 40-year-old man at an adult acute unit made it is of concern that a comprehensive serious allegations of sexual assault. In line with hospital policy, the police were contacted and investigation report is still outstanding the patient was taken to another hospital to be three months after the mother contacted independently examined. However, the medical OPA and the service about these matters. assessment was inconclusive and no perpetrator was identified.

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 Appropriateness of rooms/areas drinking detergent. Gender sensitivity funding was applied for by At a mother and baby unit, there were three reported Werribee but the request was unsuccessful. Despite events of varying severity: a baby’s head was this, the service managed to create gender sensitive accidentally knocked against a door by its mother; areas such as gender specific corridors and lounges. another mother scalded her finger while putting hot A nurse is undertaking training to broaden the water into a feeding bottle; and, most serious of all, concept and scope of gender sensitivity initiatives a mother attempted suicide. beyond the demarcation of geographic areas. A sensory room is being established in one of the At an adult acute inpatient unit, there were eleven bedrooms and staff are being trained in its use. incidents including two medication errors and a Expressions of interest are also being sought for patient was not being seen by a consultant at an the formation of a fathers group. appropriate time. Several incidents involved the need for strong behavioural management by staff: one patient threatened staff and damaged property, Good practice a second allegedly attempted rape, a third exhibited At the Werribee CCU, a support worker has threatening behaviour toward others; a fourth in encouraged all residents to become involved in open seclusion needed mechanical restraint; and creating a vegetable garden and planting several a fifth was aggressive and violent during seclusion fruit trees. They have also built their own hothouse from the general ward. One patient absconded while to propagate seedlings, and, during one visit, the on escorted day leave and another patient was Community Visitors watched as the support worker found with an unexplained two-centimetre cut demonstrated how to take the seeds out of tomatoes on his forehead. and dry them ready for next season’s planting. There Although Community Visitors asked managers is now such an abundance of fruit and vegetables and staff if there had been any serious incidents that a ‘MasterChef’ kitchen has been set up where during the previous month, none of the above cooking lessons are held on a regular basis. incidents were reported to them at the time of their This initiative offers a great opportunity for the visit. The systemic inability of Community Visitors residents to learn the various stages that are to access electronic incident log reports means that involved in getting the produce from the ground a high percentage of incidents remain unreported to the table. In addition, due to the well-rounded and unknown. nature of the program, the residents have a unique The above examples are out of 25 incidents that opportunity to learn skills that will be of real value occurred in three facilities over five months. If this when their time comes to move on from the CCU data is extrapolated to cover the 22 facilities in and continue life in the outside world. 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 Southern Metropolitan Region level of verbal abuse directed towards the staff has The Southern Metropolitan Region mental health reportedly reduced. The nurse unit manager and services are managed by Alfred Health, Peninsula other staff attribute this to enhanced training of staff Health and Southern Health networks. The services and appropriate use of de-escalation techniques. visited comprise seven adult acute inpatient units, four aged persons’ acute inpatient units, six aged Rights re ECT persons’ mental health residential units, four CCUs, A patient in a CCU enjoys engaging with the one SECU, one child and adolescent mental health community and is ready to be discharged. However, unit, one mother and baby unit, one eating disorders he must remain on the ward for a period of up to unit and five EDs. four hours after treatment for assessment purposes, Nine Community Visitors conducted a total of 210 as he is not permitted to be unaccompanied during visits, 25 of which were requested by consumers that period. He must also be accompanied during and others. 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.

Community Visitors Annual Report 2012 37 Mental Health

Legal rights and information provision Patients and residents often complain of the limited Case study provision of relevant information by staff about their admission and little support. A patient denied that he was in a psychotic state and expressed distrust Concerns reported to Community Visitors include of his psychiatrist. He also did not believe negation of their rights by staff; uncertainty about their diagnosis; confusion about the admission the nurses listened to his concerns and process; little or no involvement in their treatment was worried that the medication would or discharge plans; unexplained shifts between make it difficult for him to defend his involuntary and voluntary status; uncertainty about case for discharge. The Community navigating the mental health system and MHRB Visitors discussed this with the nurse unit process; how to obtain second opinions; timely manager who assisted the patient with access to allied health services; access to the an application to the MHRB, obtained a clinical treating team and their treating doctors; and opportunities to contact their family or employer. second opinion regarding medication and organised independent advocacy. Patients want clear information about how a unit Community Visitors reported that his operates and what is scheduled, the location of medication concerns had been resolved, facilities in the unit, the role of the Community he was calmer and his progress to Visitors and some require information in languages other than English. A usual staff response is that discharge planning was being assisted new patients and residents are provided on arrival by a social worker. 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 Treatment plans clearly, in simple language. Patients continue to question the prescribed In an adult acute inpatient unit, one female patient medications and the application of ECT. Given the desperately wanted to consult a social worker to patient’s mental state is likely to be fluid and shifting, discuss the care of her children while she was and that ECT and anti-psychotic drugs do interfere admitted, fearing they were alone and unsupported. with rational thinking and memory, the staff must When she learned her mother was taking care of explain the treatment rationale as many times her children she expressed relief, but also anger as required. regarding her mother being unfit to look after the When diagnoses involve a dual disability of mental children. The patient’s greatest annoyance was that illness and intellectual disability in acute inpatient she had not been consulted about the plans and her units and CCUs, the adequacy of supports to wishes were overlooked. The patient lost trust in patients may not be sufficient. Often, patients find the staff and harboured strong negative feelings themselves at greater disadvantage as a result of towards them. 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 goal- orientated aspirations. Agreed activity schedules are individually structured, developed conjointly

38 between staff and residents and regularly updated. him to receive dental service. The provision of This approach is welcomed and lauded as best low-grade pain medication was inadequate to practice that other CCUs could replicate. Community afford relief and his daily request for service met Visitors noted in one CCU some discrepancies with little response. and omissions in the recovery plans which were discussed with the nurse unit manager who A resident of an aged persons’ mental health proposed to update them. SECU, diagnosed with breast cancer, was refusing treatment. Despite the patient’s cognitive capacity to understand and remember explanations about Assaults her condition and treatment options, the service Critical incidents are commonly reported to have provider initially regarded her decision not to receive occurred within mental health inpatient units and treatment as ill-informed. After family and clinical occasionally in residential care facilities. There have consultations, her right to refuse treatment was been assaults between patients and patients and respected. Community Visitors regard this as a occasionally between staff and patients. In an adult positive outcome. acute inpatient unit, a patient complained about When the mother and baby unit’s regular doctor the use of excessive force when he was taken to was on leave, patients complained of the irregular the seclusion room and remained in the HDU for and untimely attendance of the locum clinical team. a number of days. The service provider advised he In addition, there was dissatisfaction with the very was very difficult to manage and uncooperative but limited time available for counselling services, of was reviewed frequently to see if he was ready only 15 minutes a week to address concerns. The to move back to the general ward. small time allocation of psychological services was Through the OPA Advice Service, Community reported as inadequate by Community Visitors. A Visitors attended an adult acute inpatient unit to part-time psychologist was eventually appointed visit a young patient with mild-moderate intellectual and the availability of therapy increased. disability and psychotic hallucinations. He was placed in the HDU due to his clinical instability and Discharge planning vulnerability yet he was allegedly sexually assaulted there by another patient. Although the appropriate Patients advise that they are concerned about being remedial actions were implemented, Community discharged too early when they do not feel clinically Visitors remained concerned about the lapse in ready, have limited understanding of their discharge monitoring by staff and the appropriateness of plans, accommodation options, or of the date of their the treatment plan which was based on a reward/ expected return home. punishment approach. Given the patient’s disordered thought processes and hallucinations, it is debatable Adequacy of beds whether the behaviour modification strategies would During the year, increased demand for patient be effective at that time. admissions from EDs to the adult acute inpatient Unjustified methods of intervention were reportedly units resulted in some patients being relocated used at an adult acute unit when a patient allegedly into spare beds in the aged persons’ acute units was forced to the ground, injected with medication or elsewhere within the hospitals. The transferred and put into isolation. Community Visitors were patients experienced difficulties with gender/age/ advised the patient had absconded and was diagnosis mixes and Community Visitors observed returned by police in an aggressive and violent that the patients’ psychosocial activities were not mood that necessitated restraint and medication. adequately met. While the unsatisfactory relocation He remained in isolation until the medication was acknowledged by service providers and stabilised his mental state. Subsequently, the claimed to be a short-term solution only, the practice patient did not recall his request for Community has continued. Several mental health units hold Visitor support, stated there was nothing wrong weekly telephone conferences within their networks with him and he did not require hospitalisation. about bed availability. This is a useful exercise to He was referred to the Mental Health Legal Centre. determine appropriate accommodation for new and existing patients. A review of the Clinical Practice Guidelines in relation to the transfer of patients was Medical care completed and Community Visitors will monitor A focus on a particular aspect of ill-health frequently its implementation. results in other medical conditions including toothaches, hearing problems, heart and respiratory Community Visitors reported concerns regarding conditions and cancer illnesses being minimised two eating disorder beds at Monash Medical Centre or ignored. One patient complained of a raging relocated to a general medical ward. The patients’ toothache, however, it took more than a week for clinical care focussed more on their general medical

Community Visitors Annual Report 2012 39 Mental Health

condition while the complex eating disorders issues Residents have raised concerns regarding an may be relegated to a secondary consideration. enforced non-smoking policy and Community These clinical issues require a daily decisional Visitors have noticed the policy appears to contribute balancing act that can be more challenging when the to the escalation of aggressive behaviours and patients are placed on a general ward where normal encourages patients to adopt secretive behaviours. meals and medical care are being provided to other patients. Also nursing staff may not be experienced Appropriateness for clients in caring for these mental disorders. Clearly, eating disordered patients require intensive psychosocial A male resident of an aged persons’ mental health therapies in addition to structured weight gain residential unit, complained of being bothered by management. another resident of Greek origin who had also been aggressive when interacting with other male residents. It became apparent the Greek resident Gender sensitivity was feeling isolated and frustrated with no-one to Community Visitors perceive that the gender specific talk to in his own language and no Greek-specific areas require more active monitoring by staff as reading materials or activities. Community Visitors male patients regularly use female designated requested the nurse unit manager facilitate contact lounges. Female patients have also complained that with an ethno-specific community group to visit and they felt unsafe due to behaviours of some males. converse with the resident with positive outcomes. Community Visitors have learned of attempts to separate sleeping areas by gender, however, have Community Visitors are concerned the mother observed males sleeping in the female section. In and baby unit at Monash Medical Centre appears one instance, a female patient was startled to find inappropriate for its function. Windows are frosted a male in her bedroom just after she had finished over for privacy reasons from the passing general showering. public, rendering the interior dim and lacking natural light. Bathrooms are also in need of renovation Community Visitors are informed that a gender- and upgrade. The nurse unit manager advised sensitivity policy is in place, but implementation that renovation plans are awaiting allocation of of the policy remains inconsistent, often driven government funding. Community Visitors support by inpatient gender mix at a given time. this initiative and trust that funding will be provided to allow the work to be undertaken. Personal needs Patients and residents continue to raise concerns Maintenance and safety issues regarding meals, meal sizes, food choices and General maintenance and delays to rectification security of their possessions. A patient in an adult continue to be reported by Community Visitors. acute inpatient unit requested soy milk and vegan Concerns include urine smells around facilities; food. The nurse unit manager advised Community body fluids and rubbish in courtyard areas not Visitors that she had been eating meat and other cleaned or disposed of regularly; rooms and foods, which the patient advised she was eating bathrooms requiring renovations and not being because they were not providing her with vegan cleaned frequently enough; cleaners leaving at food. Community Visitors also noted an issue the end of shift whether the cleaning has been with a patient who refused to eat pork for dinner. completed or not; bins left unemptied; inoperable Consideration must be given to the cultural and public phones; worn furniture requiring replacement dietary requirements of patients and residents. and old furniture not removed; call bells not working and patients/residents advising they must Some residents in an aged persons’ mental health rely on others to call staff for help; uncomfortable unit complained personal items have gone missing temperature control within units and rooms; from their bedrooms. At the time, none of the flashing lights in dining rooms; clocks displaying residents’ bedroom doors were locked resulting the wrong time and date; mould under eaves; in little security for their personal effects. and general weeding and gardening required in residential complexes. Non-smoking policy Some outdoor areas lack disability friendly access The non-smoking policy continues to be an issue. for residents who utilise a wheelchair or are frail Some service providers operate an exemption and elderly; outside pathways, plants and internal policy or have adopted a common-sense approach linoleum causing potential trip hazards; and the by ensuring patients are able to smoke in exterior absence of a hazard strip to identify a change courtyards with some overhead cover from the in the incline. weather. This practical approach has been very encouraging although another service provider has adopted a blanket non-smoking approach.

40 Rehabilitation, educational and At an aged persons’ acute inpatient unit, recreational opportunities Community Visitors observed a female consumer restrained in a chair and noted she was unable to Patients and residents have advised that they are communicate. Staff advised that her mental status bored saying the only activities available are “TV was deteriorating rapidly and a transfer to and sleeping” and on occasion making their own high-level care was approaching. Community activities. There is a lack of choice in music and Visitors later discovered the patient had been options of different activities on offer, particularly relocated to a high care unit elsewhere where she on the weekends. They have little exercise options continued to deteriorate and subsequently died. available and younger consumers requested more physical activities like gym access and games and A resident of an aged persons’ mental health yoga. The provision of reading material is often unit was admitted to the ED with bruising to face inadequate and patients requested access to and body as a result of a recent fall. The resident more reading material. Positively reported was an continued to have falls out of bed and was restrained occupational therapist who changed the program during the day for her own safety. The bed has been for consumer activities, which seems to be working lowered but injuries are still occurring. Community much better for them. However, on one visit, it was Visitors have been assured that every measure is noted that the planned activities schedule could being undertaken to prevent falls and injuries. 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 Staffing compromise the living conditions for all. The limited availability of allied health staff continues to be a problem. Patients and residents often Unfortunately, funding cuts have meant that experience delays in seeing their activities officer/ two residents at an aged persons’ residential occupational therapist, social worker or psychologist. unit can no longer attend their activity group for Shortages are reportedly because of illness, annual social interaction, which they very much enjoyed. or maternity leave. Importantly, the network’s budget Community Visitors understand that additional rarely provides for temporary replacements so the programs are being scheduled. patients’ needs remain unfulfilled. An associated Community Visitors have expressed great concern is the high usage of agency staff. Nurses appreciation of the implementation of the recovery also often cover double shifts due to the difficulty in model of care at an aged persons’ mental health filling short-term vacancies. 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.

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 Disability Services statewide themes and recommendations

42 Recommendations Disability Services

The Community Visitor Board recommends that the State Government:

1. require disability service providers to have 8. immediately increase funding for respite policies and procedures for identifying, accommodation so families can access reporting and responding to abuse and neglect services when and where they need them to ensure safe environments 9. develop a strategy and timetable for the closure 2. protect human rights by ensuring that no of Colanda and Sandhurst and the remaining resident is subjected to unauthorised restrictive congregate care facilities such as the Oakleigh interventions Centre 3. as a priority, ensure residents participate 10. implement the Productivity Commission in planning processes and are given the proposal that Community Visitors monitor opportunity to express real choice in the the NDIS way they live. Those who cannot speak for themselves must be provided with alternative 9. adequately fund the Community Visitor Program communication support to enable this to occur 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 upkeep of building 555 and fittings

health care needs 500 staff support/care/ assistance from 328 support staff

Disability Services individual plans/ 288 individualised or person-centred plans personal safety 198

incident reports 152

aids and equipment 126 upkeep of building 555 and fittings Statewide report fire safety 120 health care needs 500 staff support/care/ external presentation/ 117 assistance from 328 In 2011-12, 215 Community outdoor areassupport staff

ambience andindividual plans/110 288 Visitors undertook 2821 visits to comfortindividualised or person-centred plans 198 residential services provided by otherpersonal safety105 the Department of Human Services enabled accessincident reports 152 to the community 94 (DHS), Disability Accommodation aids and equipment 126 leisure activities 93 Services (DAS) and Community and recreation fire safety 120

environmentalexternal safety presentation/90 117 Service Organisations (CSO) outdoor areas

ambience and 110 and visited in a range of different dignity/rights comfort89 accommodation settings, including participation/ other 105 engagement/inclusion 79 in the communityenabled access group homes, respite houses for 94 choice/decisionto the community making 75 leisure activities 93 both adults and children, and and recreation compatibility 74 institutions. environmental safety 90

financial managementdignity/rights74 89 Fifty-nine trainees were recruited to the program building structureparticipation/ and 51 appointed by the Governor in Council. It is engagement/inclusion69 79 issue types identified and design expected that this increase in Community Visitors in the community choice/decision 75 facilitating/encouraging making48 will see visit numbers improve in the 2012-13 independence reporting year. compatibility 74 heating and cooling 42 The Board is very pleased to report the positive financial management 74 staff training/ engagement of the government with the Community building structure35 attitudes presented 69 Visitors Program. Parliamentary Secretary for issue types identified and design ageing andfacilitating/encouraging planning 34 48 Families and Community Services, Andrea Coote, independence attended three meetings of the Combined Board in staff awareness of Community Visitorsheating and30 cooling 42 order to hear first hand the views and concerns of protocol staff training/ Community Visitors. Following each meeting, she 35 resident complaintattitudes presented27 took up a range of important issues on behalf of the ageing and planning 34 program. The program looks forward to continuing restraint & seclusionstaff awareness24 of this positive relationship. Community Visitors 30 protocol security 19 resident complaint 27

unmet need 17 in accommodationrestraint & seclusion 24 313 Barwon-South Western restrictive practice/ security16 19 660 Eastern locks unmet need 17 124 Gippsland abuse/neglectin accommodation15 301 Grampians restrictive practice/ 16 locks 225 Hume access 14 abuse/neglect 15 195 Loddon Mallee 13 respite issues 14 228 Northern access insititutions and 537 Southern congregaterespite9 issues 13 care settings 238 Western insititutions and congregate8 9 reportable deathscare settings Figure 8. Disability Services Stream number of visits by Community Visitors 11/12 reportable deaths 8 landlord issues 7

landlord issues 7 preventative 5 health carepreventative 5 health0 care100 200 300 400 500 600 0 100 200 300 400 500 600 numbernumber

Figure 9. DisabilityFigure 9 Services. Disability StreamServices numberStream number and types and types of issues of issues identified identified 11/1211/12

44 Disability Services Stream Dignity, respect and rights 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 Region No. of units visited ofNo. CVs Requested visits Scheduled visits Total choices about such things as who they live with, Barwon-South activities they engage in or even when they retire. 79 25 3 310 313 Western Sadly, many people still have unmet communication Eastern needs, so are unable to actively participate in the 249 54 15 645 660 Metropolitan decisions that affect their lives or to understand the information that might help them to do so. Gippsland 47 15 4 120 124 The principles of the Disability Act state that people with a disability have the same rights as other Grampians 82 13 6 295 301 members of the community to: • respect for their human worth and dignity Hume 64 15 5 220 225 • live free from abuse, neglect and exploitation • realise their individual capacity for physical, Loddon Mallee 60 9 3 192 195 social, emotional and intellectual development Northern • exercise control over their own lives 132 17 6 222 228 Metropolitan • participate actively in the decisions that affect Southern their lives and have information and be supported 206 49 29 508 537 Metropolitan where necessary to enable this to occur Western • access information and communicate in 95 18 8 230 238 Metropolitan a manner appropriate to their communication and cultural needs 1014 215 79 2742 2821 • services to support their quality of life.

Figure 10. Total visits Disability Services Stream 11/12 In practice, it is often difficult for people living in residential services to fully exercise these rights.

Abuse, neglect and personal safety This year, there was an increase in the number 100 of reports of serious incidents involving abuse, 90 80 87 neglect and personal safety. Since the tabling of the 70 Ombudsman Investigation, Assault of a Disability 60 66 Services Client by Department of Human Services 50 55 40 Staff 2011, there is greater awareness of the role of 30 Community Visitors. This has resulted in an increase 20 10 in calls to the Office of the Public Advocate’s Advice number of issues identified 0 Service requesting visits by Community Visitors. 2009-10 2010-11 2011-12 reporting year Calls are often from staff in residential services who Figure 11. Disability Services Stream abuse, neglect and do not feel confident about raising concerns within assaults 2009-2012 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, Incident reporting residents were assaulted and threatened by a The Ombudsman’s report recommended that housemate, and a woman was discovered by staff DHS review its critical incident reporting forms to have suffered unexplained bruising and a and consider the implementation of a web-based fractured arm. In a CSO house in the Eastern reporting system “to provide a more efficient Metropolitan Region, a staff member was charged and immediate reporting process”. DHS did not by police with the sexual assault of a number of implement a web-based system, however, it did residents. North and West Region Community review its incident reporting requirements. In Visitors reported that staff who witnessed a December 2011, it introduced a new policy, the family member assaulting a resident did nothing Critical Client Incident Management Instruction 2011 to intervene and, in another case, two residents which applies to all departmental services and those suffered multiple, unexplained fractures. provided by funded agencies. Community Visitors reported a large number of Notification of serious and significant issues with the implementation of the new policy, matters to the Public Advocate including a lack of clarity about the management In 2011, the Public Advocate negotiated a protocol of records and variations in the application of with the DHS Disability Services Division to ensure the instruction. In both DHS and funded agency protection for residents subject to abuse, neglect services, there was inconsistent practice across or assault. Following notification by staff of a regions and, in some cases in different houses serious and significant incident, the Public Advocate of the same provider. assesses the matter and, in most instances, refers it directly to the Executive Director, Disability Services The understanding of the instruction’s specific Division, for immediate attention. requirements varied greatly. For example, the requirement that an incident report is written by the The first element of the response from DHS must be most senior staff member present at the time of the an assurance of the immediate safety of the resident actual event. Many Community Visitors reported that identified as being at risk. This year, there were 21 they were told by senior managers that they routinely notifications to the Public Advocate covering a range rewrote the original report because the handwriting of matters including: assault, unexplained injuries, was illegible or to provide clarity, correct poor inadequate behaviour support, and poor standards grammar or remove inappropriate comments. of care. In some organisations incident reports were not The department’s responses to matters have been accessible to Community Visitors. This was most prompt and generally thorough. In some instances, common in CSOs where documents are often only Community Visitors were not satisfied. For example, kept in an electronic format, but it also occurred in a matter in the Eastern Metropolitan Region, a in DHS houses where casual and agency staff, in young resident with violent behaviours continues particular, told Visitors that they themselves were to live with older housemates, whose physical unable to access incident reports. circumstances leave them vulnerable to his threats and assaults. In other matters, DHS investigations Community Visitors reported concerns about the have failed to identify the likely cause of serious incorrect categorisation of incident reports. For injuries sustained by residents. example, in the Barwon-South Western Region, a resident was assaulted by a housemate; police and This year, the Board began negotiating the protocol ambulance were involved but the incident report was covering the interaction between the program, the recorded as a category two and not a category one department and CSOs. During this process, there which would be usual in the circumstances. When have been discussions about the formal inclusion of questioned about this, the CEO of the organisation the notification process in the protocol to guide future told Community Visitors that it was not a serious arrangements to protect residents at risk of abuse incident and that the resident had been “putting or neglect. on a bit of an act”. DHS and CSOs must go further and prevent The new reporting instruction did away with the abuse from happening in the first place. They must requirement to report category three incidents, have a zero tolerance of abuse and encourage instead, service providers are required to maintain staff to report any actual or suspected abuse or a record of non-critical events for each client. neglect. Responses to incidents must be swift and Community Visitors in the Southern Metropolitan decisive with police involved where appropriate or Region have noted that, in some services, incidents independent investigations undertaken. Residents that have been recorded as non-critical would, under and families must be kept informed and their support the previous reporting instruction, been reported needs properly addressed. as a category two.

46 In response to Community Visitors’ feedback on the treatment provided. While they waited for implementation of the instruction, the department appropriate treatment they would have suffered conducted extensive training with its own staff. constant pain and distress. The Public Advocate was It also convened a meeting with the Board and so concerned about the standard of care provided National Disability Services to discuss incident to this person that a complaint was lodged on their reporting issues and clarify requirements. These behalf with the Health Services Commissioner. discussions led the department to plan a project, to be undertaken in 2012-13, to train staff in CSOs. Concerns about the capacity of staff and the system to manage the changing needs of an Community Visitors watch with interest the effect ageing population were also consistently reported. the changed reporting requirements will have on Community Visitors have pushed for people with the management of critical incidents. They continue a disability to have the same choices as other to report concerns that the new system does not Victorians to ‘age in place’ and in their own home require a central register of serious incidents to be if they choose to do so. However, current staffing maintained in each house, that it is still a possibility models often impede this. Monitoring of this issue that no incident report will be prepared at all, and will be a focus of Community Visitors’ work over the that serious incidents will escape unnoticed due coming year. to incorrect categorisation. In the Hume Region, a number of residents were admitted to mental health facilities and Community Individual Support Packages Visitors reported there was not always enough open Last year, the Board expressed concerns that communication between the mental health services Community Visitors were unable to visit people and house staff to enable appropriate supports for who were on an Individual Support Package and a person with dual disability. In the North and West who purchased their supports through different Metropolitan Region, a resident fell in the shower service providers. and sustained a head injury but staff delayed seeking medical attention for three days. This year, the Disability Amendments Act 2012 redefined residential services and clarified that the In the Gippsland and Southern Metropolitan accommodation and support services in a residential Regions, Community Visitors reported matters service may be provided by different providers and, involving poor quality care and the apparent lack as a consequence, Community Visitors can now visit of staff capacity to adequately support residents. more houses. While it will place greater demands on In the Gippsland Region, Community Visitors the program, the Board believes that everyone who responded to a call from staff at the local hospital is entitled to the protections afforded by Community who were concerned that a woman had been taken Visitors should have access to them. to hospital multiple times suffering from hypothermia. In the Southern Metropolitan Region, they reported There have been a number of occasions during concerns about the high use of agency or casual the year when Community Visitors have sought staff in a group home where a number of the clarification from the department about whether residents have complex medical support needs. Community Visitors could visit. They are concerned, however, that services only came to their attention Community Visitors reported on a number of incidentally and that there is currently no system in relatively young residents who have a diagnosis place to ensure that they are informed of all services of reduced bone density and who have suffered eligible for visits. This is a matter that the Board will serious fractures. The development of preventative pursue in the coming year. programs aimed at minimising the potential for painful, disabling and costly fractures must be a priority. Community Visitors understand that early Healthcare intervention to minimise osteoporosis can improve The treatment of people with a disability in the health quality of life and reduce the cost to the community. system varies greatly. Health care issues reported in all regions include: delays in seeking medical attention; lack of up-to-date health care plans; Staff capability and support incorrect administration of medications; lack of While many Community Visitors reports noted the access to general practitioners in rural areas as excellent work staff were doing, it remains a concern well as poor treatment and understanding of that care standards can vary widely. Some residents patients with a disability in the medical system. are fortunate to be supported by appropriately trained staff with whom they are familiar. Others live In one case, a non-verbal person was sent with a constant stream of ‘strangers’ in their home, unaccompanied by ambulance to a rural hospital. some of whom do not have the skills to adequately It took three presentations at a hospital before care for them. several fractures were identified and appropriate

Community Visitors Annual Report 2012 47 Disability Services

In the Grampians Region a house with three In the Eastern Metropolitan Region, Community residents who require one-on-one staffing Visitors commented that one of the keys to effective consistently operates with one or two staff planning was ensuring that people were able to supporting five residents. In other houses, two communicate their goals and that, in many cases, residents suffered serious injuries from falls when residents have not had adequate communications staff failed to follow proper procedures. assessments, so are unable to provide active input into their personal plans. In the Southern A shortage of staff in the disability sector generally Metropolitan Region, Community Visitors reported has put pressure on rosters and affected the that they found it difficult to track the implementation ability of services to recruit and retain skilled staff. of plans due to inconsistent recording of progress Community Visitors reported persistent shortages notes; they noted that consistent staffing leads to of permanent staff and the high use of agency staff. better recording of information. Agency staff often lack the specific skills required to work with the group of residents to which they were The unauthorised use of restrictive interventions is a assigned and Community Visitors reported that they serious breach of human rights. Community Visitors often missed out on the induction and orientation have reported a lack of Behaviour Support Plans necessary to provide adequate care and support to (BSPs) for people who require them and BSPs that residents. have not been lodged with the Office of the Senior Practitioner (OSP). In the Barwon-South Western Chronic staff shortages lead to poor quality care; Region, staff in a CSO house told Community high use of casual and agency staff often means Visitors that a resident was subject to chemical that only the most basic support tasks get done, and restraint but did not have a BSP. In the Eastern more long-term activities such as person-centred Metropolitan Region, Community Visitors reported active support fall by the wayside. that a young man who had violent outbursts may An emerging issue is the lack of communication have been subject to chemical restraint but, as he between staff in day programs and house staff. did not have a current BSP, they could not be sure. There is an expectation that there will be close Community Visitors report that, in some regions, collaboration between house and day program staff, there was a lack of holiday planning for residents but Community Visitors have noted issues that have but, in others, residents have taken a variety of arisen in day programs that have affected a person’s different holidays. A large number of residents from wellbeing at home. In some cases, medication has Colanda, in the Barwon-South Western Region, not been missed, in others residents have been involved only went on holidays for the first time, but went in incidents that have not been communicated to on holidays interstate and without the support of house staff. Colanda staff. However, in the Grampians Region, it was again reported that a number of residents Family relationships with high support needs have been unable to take Many people living in residential services have good annual holidays. family relationships that add a positive and satisfying Community Visitors continue to report concerns dimension to their lives. However, in a few instances, about lack of long-term planning for the Community Visitors documented abuse in these accommodation needs of an ageing population relationships or interactions with family that have led in residential services. The approach to ageing to adverse outcomes for the resident. Community appears to vary widely across regions and within Visitors urge vigilance on the part of service DAS and CSOs. providers to protect residents from abuse, neglect or exploitation in all their relationships. The support of ageing residents continues to prove challenging with concerns around transport, retirement options and increased health needs. In Planning the Barwon-South Western, Eastern Metropolitan A range of issues have been reported relating to and Hume Regions, Community Visitors reported individual planning. Some people still do not have that a number of people have moved into nursing person-centred plans (PCPs), but most commonly, homes as residential services could no longer Community Visitors have reported that, while plans provide them with the support they needed to stay are in place, they are out-of-date, not updated when in their homes. a person’s circumstances change or that they lack meaningful goals, strategies and evaluation. In some Community Visitors have also reported on the lack of cases, staff are unfamiliar with a person’s plan or environmental planning. They expressed concerns goals are not realistic, given the person’s financial about the poor maintenance of many DAS and CSO circumstances. houses and about the future replacement of old and inadequate houses.

48 In the Barwon-South Western Region, it was Community Visitors have always believed that reported that a number of DAS houses had unsafe institutions and congregate care facilities deny floor coverings; in one, this had caused many falls. residents their basic human rights. They call on A house managed by a CSO was so unsuited to the State Government to plan for the closure of the needs of the residents who lived there that one the remaining institutions and congregate facilities man, who uses a wheelchair, needs assistance to so that Victoria’s policy of quality community-based navigate the way to his bedroom or he risks hitting support for people with a disability is finally his head against the architraves. 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 Draft Victorian State Disability Plan inadequate housing. 2013 – 2016

Respite DHS released a draft State Disability Plan for comment in June 2012. Community Visitors support A range of respite service issues were reported. its direction: addressing the “disadvantages that Most concerning was the shortage of respite beds people with a disability, their families and carers and their use to accommodate people for reasons experience as part of their everyday lives”. other than genuine respite. Community Visitors found that the draft plan was In the Barwon-South Western Region, Community more in the nature of a policy framework, rather than Visitors reported that parents at one service were an actual plan. The state plan should properly outline getting only half the respite they required and that, the leadership, service delivery and coordination role in a six-bed facility, three residents were taking of government in advancing the social inclusion and up four places on a long-term basis. In the Hume citizenship of people with a disability. Community Region, the demand for respite continued to be Visitors commented on the draft plan and will greater then the beds available and, in the Eastern monitor its further development. 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 Healthy Living Survey in a CSO respite service into another seemingly permanent placement in a DAS respite service. Inspired by the release of the Victorian Population Health Survey of People with an Intellectual The respite situation is simply unacceptable. Disability 2009 in late 2011, OPA and the Board Families who desperately need services are being decided to undertake a survey of residents in denied them, while people who deserve a secure residential services and, between 1 March and 31 home languish in temporary circumstances where May 2012, Community Visitors collected information they are denied the same rights as residents living in relation to 697 residents. in permanent accommodation. The residents Closing institutions and congregate Fifty-six per cent of people surveyed were male and care facilities 44 per cent were female. The majority were under Today more than 100 people continue to be 60 years old, with just one in seven aged 60 years institutionalised at Colanda and Sandhurst and old or more. One-third of the people surveyed many more live in medium and large group facilities needed assistance to walk, while two-thirds were that have more in common with an institution than able to walk unassisted. a home in the community. 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.

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Physical activity 40% Responses showed that four out of five residents had undertaken some form of physical activity in 30% the last week and 40 per cent had met the minimum recommended physical activity guideline of half an 20% hour of physical activity on five or more days per week. This is lower than the equivalent rate for the general Victorian population. 10% The survey asked if the person was physically able to undertake more vigorous activity than they 0% had in the last week. Overall, more than one in 18-39 years 40-59 years 60+ years three residents (36 per cent) were thought able to Sports group undertake more vigorous activity. This varied by Church group resident age (see Figure 10.) Community action group Member of at least one group

Figure 13. Proportion of residents who are members 80% of various sorts of community groups, by age group 11/12 70%

60% 50% Person-centred plans 40% The vast majority of residents had up-to-date 30% person-centred plans that were being implemented. 20% Where this was not the case, the most common 10% reason given was inadequate staffing ratios. 0% 18-39 years 40-59 years 60+ years

Could do more vigorous activity Couldn't do more vigorous activity Don't know Regional reports Figure 12. Proportion of residents thought able to undertake more vigorous activities, by age group 11/12

Barwon-South Western Region Community engagement Eighty per cent of residents had attended Geelong and Colac a community event in the last two months. Eighty-seven per cent had done so in the last six Planning months, compared to 53 per cent of the general Victorian population. With good transition planning, some residents have relocated to more appropriate settings or to be Residents were more likely to belong to a community closer to their family. Staff have made tactile and action group than a sports or church group memorial areas in some houses and the availability (22 per cent compared to 19 per cent and 12 per of a room allows ageing residents to participate cent respectively). The general Victorian population in day programs in their home. is less likely to belong to a community action group (19 per cent) but more likely to belong to a sports Choice and decision-making or church group (26 per cent and 16 per cent respectively). Increasingly, residents are making their own choices about the things that matter to them, such as day Overall, more than one in three residents programs that match their interests, pets, paint (36 per cent) were members of some sort of colours, furniture, holidays and activities. Many community group. This varies by age group, residents regularly spend time with their families. with residents aged 40-59 years the most likely One resident has a ride-on mower and a dune to belong to a community group. 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 Three banks of lights in the 30-metre long passage homes. In one house, they continued to support of one new house are all controlled by a light switch two residents to spend time together. inside the front door. The living area is at the end of the passage and there is no two-way switch to Some staff are very creative in their support, for provide the residents with the opportunity to turn example, producing a calendar with photos of the their passage lights on and off. 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 Participation and engagement resident who died. Residents access the community for family contact and outings. Some residents, enjoyed helicopter ‘The Farm’ staff team were finalists in the Team rides for birthdays and others enjoyed ‘high tea’ at Support Worker Award for working with residents to the Windsor Hotel. Many residents participate in keep them safe and involved with living. This team organised sporting activities, such as competitions, is small with regular staff and regular casuals. The swimming, gym, surfing and Tai Chi. Some take part personal gains by the residents in their care are in community events such as Relay for Life, while a testament to this staff team’s great work. others choose more solitary activity like going for Nursing support in the My Future My Choice houses long walks to the local library. Other residents prefer is vital as many residents have complex healthcare arts-based activities with dance, drama and music needs. One resident was significantly affected by proving very popular. A number of residents entered the lack of nursing support; outcomes for him were their artwork in local exhibitions. positive when he moved from a house without Inadequate transport options continue to affect the support to one with it. ability of some residents to access the community. There will be a significant need for palliative care For example, in one house, the designated vehicle support in these houses if the wishes of some was not wheelchair accessible; at a respite facility residents to remain in their own home is to be there was no designated vehicle and at another respected. One resident returned from hospital to house wheelchair issues and the number of staff the house for palliative care. While the resident was needed to support the residents prohibited a group in hospital, house staff supported him for one hour outing. An outing to the Melbourne Aquarium was at each staff changeover and, when at home, two terminated when the designated vehicle was unable active night staff assisted with palliative care. to access the carpark because of its height. Residents regularly go out for meals and two Facilitating and encouraging independence residents had their first opportunity to have a family Person Centred Active Support (PCAS) is enabling Christmas when staff invited them home to join their residents to become increasingly independent. Apart celebrations. There has been considerable effort by from household chores, residents are learning many staff to keep residents in contact with their friends new skills including: making cappuccinos; managing who still live at Colanda. their medication; using public transport; participating in meetings; becoming more independent in Enabled access to the community personal hygiene; using keys; and managing Moving younger people out of nursing homes finances. Some are studying at TAFE, and one and into the community should improve their receives payment for sitting on interview selection quality of life and give them a real chance to make panels for staff. A few residents have moved into choices about how they live. Residents who live independent units and one resident has regained in My Futures My Choice houses have complex independence by using a lighter wheelchair, which needs, including healthcare, but this should not she can propel herself. Very occasionally, parents be a barrier to their involvement in the community. object to efforts by staff to encourage independence. Some problems with the establishment of these One group of residents, which has moved from services have been addressed, but, in some cases, Colanda, are enjoying their spacious new home. They timeframes for resolution have been unacceptable. have a spa bath but, unfortunately, the wrong model Improved access to the community can only be was installed and there are no handrails, making it achieved if the appropriate equipment and aids are only accessible by hoist. One resident regularly uses available and repaired in a timely manner. Staff must a hoist, but for four mobile residents, hoisting them be alert to every opportunity to engage residents into the bath would be undignified. Residents are with the community and organisations have a encouraged to take an interest in cooking, but electric responsibility to ensure the staffing is sufficient to hot plates, which give no indication they are hot, facilitate these opportunities. are an accident waiting to happen and will only be replaced at the residents’ expense.

Community Visitors Annual Report 2012 51 Disability Services

Community access has been restricted for residents even further. There are programs promoting who use wheelchairs because of inadequate access healthy eating and keeping fit and a few of the and amenities at local sports venues. The local pool houses have treadmills. has a broken hoist and a shortage of chairs for pool access. While construction is underway at Simonds Aids and equipment Stadium, there is reduced access for people who use wheelchairs. New beds, walkers, wheelchairs, and electronic shower chairs have improved the quality of life for One resident, who lives in a My Future My Choice many people. A young resident has a new trampoline house, had no community access for two to three and a three-wheeled bike and another bought a weeks because his manual wheelchair presented a massage chair. A hoist was installed for a new personal risk and another resident was housebound resident in one house, however, in other houses, for seven months. One resident has hydrotherapy there is still a need for hoists and an adjustable once a week instead of the three scheduled shower chair. Communication aids are being trialled sessions because he needs the support of two staff. to relieve a resident’s anxiety over being unable Community access and socialisation for a resident to communicate to staff. who has chosen to be nocturnal has been very limited. On one occasion, staff overlooked a diary Specialised electronic equipment needs regular entry for a dance outing, consequently residents servicing if it is to operate as expected and a missed an opportunity to socialise. lifting hoist was unable to be fixed over the holiday season. One resident’s bedrails were considered to The lack of wheelchair funding for ageing residents be restrictive and were not to be used. The resident, impacts on family finances. Repairs to a standing who experiences drop seizures, got out of bed and frame have been delayed and the repairs short-lived. knocked his head causing injury. The bedrails were Plans by the two service providers to share aids and subsequently reinstated. equipment in the future should help to avoid some lengthy waiting times. Personal safety Unlocked medication, un-regulated hot water, Leisure activities and recreation a broken auto-ignition on a gas oven, white-tailed Residents travelled widely for holidays, supported spiders, a lack of shower grab rails and no cooling by house staff or staff from other organisations in a unit were all issues for residents. In some such as day programs, mental health agencies and instances, episodes of escalated behaviours by one holiday companies. Some residents had holidays resident have had an impact on all residents. For with their families. example, a resident was breaking energy efficient globes and the other residents and staff had to Some residents have lost weight after becoming evacuate the house because of the mercury content. involved in a walking program which won the DAS In another house, escalated behaviours resulted in Award for Perpetual WorkSafe Week. In contrast, considerable property damage, police attendance a resident in a house built on a busy through road and disruption to planned social activities. is missing being able to walk freely around the Colanda grounds. Ageing and planning Healthcare needs Staff undertook dementia training to address the need at some houses. A variety of approaches Some residents required medical and dental to meet the needs of ageing residents were checks to be performed under general anaesthetic. undertaken: one resident moved closer to family, A resident was hospitalised with pressure sores. another moved into a house with 24-hour staffing Common issues included swallowing difficulties and and three ageing residents moved into nursing medication reviews. homes. In one house, a man moved into a larger There are many strategies to assist residents to room closer to toilet facilities and was able to stay lead healthier lifestyles. One house has a swing, a in his home and with his sister. 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 Respite Residents of one house chose outdoor furniture, A young, long-term respite user moved into a group worked on an outdoor makeover and made a DVD home but three homeless residents were living in a of their project for the Geelong PCAS presentation. respite facility taking up four of the six respite beds. Residents at another group home had as much input On one occasion, two respite users were sent home as possible into their outdoor make-over and the to allow two emergency respite placements. house supervisor made the outdoor furniture. On occasions there were concerns about the Veggie gardens across the region are flourishing. deployment of staff in respite services, for example, A seat and handrails were incorporated into new five residents with high-care needs were supported planter boxes in a Colac backyard to provide by only two staff. In contrast, two staff were residents with independent access and a place to required to monitor one permanent resident in sit and watch the birds in the aviary. A wonderful a respite service. sensory wall depicting a rural scene is also being completed at this house. There is a lack of recreational activities at a Geelong respite facility where many users are physically There were considerable improvements made to active. At one respite facility, it was reported that outdoor areas with café and shade blinds but there parents are getting half of the respite they used is a need for an appropriate outdoor surface at one to receive. house for a resident who crawls.

Ambience and comfort Building structure and design Houses have been improved in a range of ways: A new house with an independent unit opened rearranging living areas; moving a TV so residents in Geelong. Modifications to existing structures can also see what is going on in the kitchen; included the installation of a shower in a unit, moving wheelchairs behind a craft area; brightening bathroom renovations and converting one unit with photo displays and artwork; new furniture for into two. The conversion of a former sensory room lounges and bedrooms; new furnishings and interior into a second bathroom in a Camperdown house decorating. has stalled. Some bathrooms in Geelong CSO houses are out- Five residents who use wheelchairs live in a Colac dated and an independent unit continues to be stale house which is unsuited to their needs. It has narrow and stuffy. passageways and doorways, small bedrooms and unsheltered access to the house. For many years, In one house, families have purchased a massage Community Visitors have been reporting on the chair and swing. In another, house staff are providing unacceptable conditions in which these residents sensory opportunities by making a number of live and, while they are pleased that the department plaques in picture frames which are hanging on the has undertaken to work with the CSO to address wall. Sensory toys hang from the handrail and small the issues, they are disappointed that the promised sensory balls are enjoyed by residents. renovations were still not completed at the end of the reporting period. Heating and cooling In some houses, the heating level does not always match the needs of residents who spend a lot of time Case study sitting. After many months, the lack of heating in a A male resident who uses a wheelchair new house was found to be due to vents not being has difficulty accessing his room as reopened after the heating was tested. Eastern facing bedrooms get very hot in summer and need he slumps sideways in his wheelchair. outside awnings. The most accessible outside area Staff assist him to navigate the narrow needs retractable shade if the residents are to safely passageway and guide him through his use this space all year. doorway to his room, so he doesn’t hit his head on the architraves. The inappropriate External areas design of this house is preventing him The water issues at a Gateways house have been from maintaining his independence. 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.

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Independence is encouraged in many other ways: Colanda one resident is learning to self-administer their medication; another mows the grass with his hand Colanda is home to 99 residents. There is a positive mower and one man now communicates by typing atmosphere, with staff planning for the future. into a tablet computer that speaks for him. In Finch Unit closed in November 2011 and eleven preparation for the inaugural Colanda Ball, residents clients transitioned to Wren Unit. Increased staffing have had dance lessons and have brought suits and provided residents with greater opportunities for dresses with the assistance of staff. individuality and community access. A hand rail in a day room and a small easily manoeuvred wheelchair encourage independence Planning but in Hostel Unit, clients are no longer able to wash Some clients moved into group homes or between their clothes as their new washing machine is an units to better address their needs. For one client, ‘industrial’ model. it was their third move and, for another, their fourth. There was no opportunity for transition for a client Participation and engagement who transferred to a Geelong nursing home at short notice. Residents are encouraged to keep in touch with their families, some of whom live in Melbourne Eagle Unit is being transformed and is moving and Geelong. Skype is being trialled for less away from the use of restraint. Staff had specialised mobile clients. training and the unit was unlocked in May. The seclusion room has become the ‘reflection room’ Some residents participated in community events, and is the final stage in behaviour management. It others enjoyed regular facials and massages has been painted and will have a mural, soft chairs and Hostel Unit residents went on an outing to and piped music. Birregurra. Residents attending the OPUS After Hours Program have the opportunity to mix with Day programs were reviewed and changed. Ageing people from group and private homes and clients will have shorter sessions with more intensive 19 residents went to the OPUS ball. support and residents who use wheelchairs will have increased uptake of part-time day programs, While residents had regular community outings, at where available. times the community came to Colanda: Delta Dogs visited Robin Unit fortnightly and two staff members regularly brought their dogs in for pet therapy. Choice and decision-making The aged clients in Martin Unit have more Considerable efforts were made to maintain opportunity to be involved in decision-making. For friendships with former Colanda clients who had example, breakfast is made in the unit, instead of the moved. However, since the closure of Finch Unit, central kitchen, and there are a number of lounge former residents visiting Colanda are having difficulty areas, including a new ‘quiet lounge’. associating with their friends. Wren Unit clients have a greater choice of activities Leisure activities and recreation at weekends. A pampering room has been set up in the aged unit where clients can have massages All Robin Unit residents had holidays this year, and nail care. A shelter has been built, overlooking some for the first time. Queensland was a popular Forest Road, for a resident who has spent much destination. One woman, who was unable to go time there over the past 30 years. interstate, enjoyed a long weekend in Warrnambool. Short holidays are being planned for other residents. Facilitating and encouraging independence It is difficult to find accommodation for some Staff supported clients in hospital, in rehabilitation residents who have high support needs such and through medical procedures and assisted some as PEG feeding. clients to walk around the Colanda grounds. Residents enjoy a variety of interests and have Innovative approaches encourage residents to get bought a range of equipment to enhance their out walking; a blue line was painted on the footpath leisure options. Other residents enjoy massages so residents can independently find their way to for relaxation and playing music. 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 Abuse and neglect Late in 2011, the manager at Colanda notified South West Community Visitors that a resident had been assaulted by a staff member. The assault was Planning witnessed by two other staff members who were prompt in reporting the incident. The staff member, Planning is generally well-managed, however, it who no longer works at Colanda, was stood down was reported that some PCPs and BSPs were not immediately and the incident was reported to the updated as required. In one instance, a resident was police for investigation. chemically restrained but his BSP was out-of-date.

Healthcare needs Choice and decision-making Residents have regular access to allied health Two residents living in accommodation provided by professionals including a dietician, a speech the same CSO told Community Visitors they would therapist and a physiotherapist. A resident for whom like to live elsewhere and would like help to explore PEG feeding is unsuitable had chest infections and alternative accommodation options. had been hospitalised on a number of occasions; he has benefitted greatly from the dietician’s Staff support recommendations and has not had a recurrence. A young man who lives in a CSO-managed house To maintain flexibility, the residents of Martin Unit is aware that he has difficulty managing his temper have physiotherapy sessions three times a week. and asked Community Visitors if they could get him As they are ageing, they are also kept home from help. He said he wanted a case manager to arrange day program at the first sign of being unwell or if counselling support and that he did not want to be the weather is extreme. using medication. Community Visitors understand that the resident is subject to chemical restraint and A video link was used for a specialist check-up and that his BSP is out-of-date. They raised the matter saved an ageing client a round trip to Geelong. In with the organisation but have had no response. Robin Unit the filing of health records has improved and a health information folder now accompanies residents to medical appointments and hospital.

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.

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Abuse and neglect Compatibility Resident incompatibility was consistently reported. In one house, a resident was assaulted by Case study housemates and, in others, the behaviours of A man living in a group home managed residents with complex support needs affected the quiet enjoyment of other residents. A young man by a CSO was assaulted on two separate who is quite capable lives with older residents who occasions by two different housemates. have poor communication skills. Community Visitors His parents informed Community Visitors have questioned whether this young man would of the assaults and said that they were benefit from living in a house where he has more in having difficulties making a complaint to common with his housemates. the CEO of the organisation. The man said that, during the first assault, Healthcare needs he was dragged out of a car and punched Concerns were reported about the experiences of around the head and during the second residents within the medical system. In one case, a resident had to wait four hours in a hospital waiting he was pulled out of his wheelchair; room and Community Visitors questioned whether police and ambulance attended on both concessions could be made in these circumstances occasions. The man also said he wanted for people with a disability, especially when they to make a complaint to the CEO but was are elderly. Sometimes medical staff discharged prohibited from doing so. residents from hospital with little understanding of the capacity of the group home to provide adequate Community Visitors reported difficulties supports during recovery. Community Visitors accessing incident reports and expressed suggested that the department develop a resource concerns about their accuracy and for hospital administrators and doctors to help categorisation. address this issue. They met with the CEO and senior managers who confirmed that the Aids and equipment incidents occurred. When questioned In two DAS houses, there were issues with hoists: about the categorisation of the incidents, in one the remote for the hoist has not worked for over 12 months and, in the other, a woman has been the CEO told them that the second one told that she must purchase her own hoist sling. The was not really a serious assault and that fairness of this was questioned as the sling, once the resident, who he said was smiling and installed, becomes the property of the house. laughing afterwards, had been “putting on a bit of an act”. He said that the first Incident reports incident had been recorded as a category Concerns were raised about an organisation’s one, but that it had been “downgraded” handling of incident reports. After being informed of by DHS to a category two. three separate incidents in the house, Community Concerns about the matter were Visitors and staff could initially not locate the reports and then had concerns about their accuracy and raised with DHS and a Quality Service categorisation. They raised their concerns with Review has been commenced with the the house’s management and the department with organisation. the result that a Quality Practice Review is now underway.

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 from the organisation’s management. The majority of service providers respond to this request in Case study accordance with the protocol with Community A resident said he lost his temper with Visitors, however, it should be noted that some a staff member who he believed had providers, including DHS, have not provided spoken to him in an inappropriate way responses to Community Visitor reports this year. and that, during the argument, the staff In a house run by a CSO, the staff member on duty member pushed him onto the bed. was not aware of Community Visitors and their role; she seemed unnerved by their presence so The incident report agreed with the Community Visitors left and took the matter up with resident’s account of the incident but the organisation’s management. The organisation did not make any mention that the staff has ceased operations and its services have been member had pushed him. A staff member taken over by another CSO. on duty corroborated the resident’s account, including that he had been spoken to inappropriately. Eastern Metropolitan Region Community Visitors met with the organisation’s CEO and senior managers who told them that the staff member’s DHS Disability Accommodation Services behaviour during the incident had only In 2012, relationships improved between the come to light a few days after the report Community Visitors and the DHS in the region. was written, so had not been included Meeting protocols were revised so that official and that the staff member had been liaisons between the two organisations were more efficient and relevant to service improvement. The counselled and disciplined. Community Visitors issues response protocol was reinforced by training and workshops delivered by Community Visitors to departmental staff. These initiatives have improved working relationships Upkeep of buildings between the two organisations. A wide range of issues were reported in DAS Despite this hard work, it is disappointing to note houses. Floors were of particular concern including that there are still many overdue responses to trip hazards caused by uneven surfaces and worn issues raised by Community Visitors. There have carpets. One report noted a floor was often slippery been instances where house supervisors have been due to a resident’s incontinence and had caused unaware of the protocol between the Community many falls. Other issues were a rotting beam in a Visitors Program, DHS and National Disability pergola, unkempt gardens and poor drainage at the Services. The protocol requires Community Visitors’ bottom of a ramp. Community Visitors reported a reports to be sent to the regional office for response. bathroom with pooling water, a shower tap handle In other cases, no reasons were provided for a lack that kept coming off and lack of a handrail to assist of response or responses were deemed inadequate. people in and out of the shower. Community Visitors hope that this problem will Two houses managed by STAY and owned by become less of an issue in the coming year, but the Director of Housing require urgent bathroom are concerned that some organisational ‘inertia’ modifications. In January and June 2012, STAY overcomes the best efforts of most in the department informed Community Visitors that it had provided the to deliver the best outcomes for residents. Constant Office of Housing with referrals from an occupational management reshuffling creates an atmosphere therapist and builders’ quotes for both houses of uncertainty and lack of accountability, which but the office had not responded. Acknowledging affects results. Some issues may remain unresolved Community Visitor’s frustrations with the situation, because there is no-one at the appropriate STAY undertook to follow-up reasons for the delay. management level to make decisions.

Awareness of Community Visitors protocol Incident reporting Community Visitors in the far west of the region visit Incident reporting procedures were scrutinised at group homes managed by DHS and five different the instigation of Community Visitors. A survey of CSOs. They are generally able to address any incident reporting in the inner-east found many issues that arise at the time of the visit, however, departmental processes were not being adhered sometimes they need to request a written response

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to. Incident reports were generally unavailable for Abuse and neglect review by Community Visitors, reasons given were Despite the improvement overall, some very serious variously: inaccessible on the computer, archived issues involving allegations of abuse, assault and or missing altogether. There did not seem to be neglect arose. In many cases, the processes that the a system in place to write, register or file incident department undertook to investigate these issues reports. Staff were also unclear about proper have been transparent and open, and involved reporting processes. extensive consultation with Community Visitors, Examination of incident report forms is a critical as well as other authorities. However, in some part of a Community Visitor’s role and, accordingly, cases, there has not been an adequate response these should be readily accessible, especially given from DHS. that there is no alternative independent third-party People with a disability have the same rights as scrutiny of incident reports. other members of the community. One of these is In response to a report by Ombudsman Victoria the fundamental right to live in safety both at home in 2011, new incident reporting procedures were and in the community. When considering instances implemented for all service providers. These involve of abuse, neglect or assault, it is important to new guidelines regarding the preparation and consider all the circumstances in which a person storage of reports and address some of the concerns might find themselves in a position of threat- that Community Visitors have raised. however it occurs. Community Visitors remain concerned that these DHS procedures and practices are rightly aimed provisions do not address some fundamental at ensuring staff are appropriately placed and problems with the incident reporting process. Central trained to care for and support the residents in their registers of critical incidents are not available at care. Sometimes, these processes fail, or staff are each house. Current procedures allow for reports ignorant of proper procedure, or are deficient in to ‘disappear’ from the house and there may be training. 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, Case study Community Visitors often cannot locate them. There is still a real possibility that no incident report will be A taxi driver called the OPA Advice prepared in the instance of staff-to-resident abuse. 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 Case study face to his nose and, while there did not Community Visitors received a referral appear to be any bruising, the welt was from the OPA Advice Service. A person raised. When asked what had happened, had contacted OPA alleging that residents the resident replied that a man hit him, in a group home were being abused. and then clearly identified a staff member When they visited the house Community from his house. Visitors were told that a staff member had The Public Advocate referred the matter been stood down and that an investigation to DHS Disability Services Division, and was underway but they were not provided the staff member was immediately stood with any details. down, pending an investigation. 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 Sometimes it is other residents who abuse, and client. Community Visitors could not find assault the people that they live with. It is the department’s responsibility to ensure that all the completed incident report, nor has residents are safe at home, and when this doesn’t there been any follow-up or response to happen, the impacts on residents can be significant. issues raised about the alleged assault.

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Case study A young man has mild intellectual Other residents were suffering and impairment but Community Visitors could distressed because of his behaviour. find no evidence of any behavioural Community Visitors reported that some assessment or diagnosis. He was placed were not eating and others were soiling in a house on a temporary basis, but themselves when the man was screaming is still there 18 months later. He may and shouting in the house. There are be subject to some form of chemical many casual or agency staff working at restraint, however, Community Visitors this house, who operate without guidance have found that his BSP is not current. from an experienced person who knows the men well. Community Visitors have been reporting their concerns for this man for a number Community Visitors progressed this of years, having visited him in three matter as far as they could within the different group homes. He has violent region. Concerned for the safety of outbursts and threatens other residents other residents in the house, the Public and staff. The other residents are all older Advocate referred it to DHS Disability men who have high personal care needs Services Division. and little in common with the young DHS outlined the measures put in place resident. to address the issues, including the There have been multiple calls to OPA’s appointment of a new house supervisor Advice Service: in one, a house staff and the establishment of a care team to member said they felt “stressed to “implement a coordinated approach to breaking point”. review ... current supports and determine if further supports are required”. When Community Visitors spoke to the man he seemed to be upset about living While Community Visitors appreciate in the house. He seems to communicate the efforts being made to provide this unhappiness by being aggressive, adequate support for this young man, and on occasion has used weapons to they have little confidence that staff can threaten himself and other residents. He do this while still ensuring the safety of had also assaulted staff, and the police other residents. have been called to the house on a number of occasions.

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.

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Case study Case study A staff member called the OPA Advice A distressed agency staff member Service to share her concerns about the called the OPA Advice Service about a welfare of a resident. She had raised her resident who was “in agony” as a result of concerns with management, but said what appeared to be serious injury. The there had been no action. Community Visitors Program contacted the DHS regional manager and made The resident has limited verbal skills a notification to the Public Advocate, and mobility. Due to the seriousness who contacted DHS. Community Visitors of her medical condition, and her high visited the home that day. personal care needs, she is particularly vulnerable. Staff told Community Visitors While an incident report had been that they believed the woman’s safety and completed when the injury was identified, wellbeing were at risk when she stayed there was no report of how the injury away from the group home, saying her actually occurred. The injury occurred on health deteriorated - sometimes resulting a Friday, the DAS manager did not receive in hospitalisation. the incident report until the Monday and was only preparing to act on the Tuesday, Community Visitors reported their when notified by the program about concerns for the woman’s wellbeing the injury. to regional management and referred the matter to the Public Advocate. The DHS requested that a forensic medical Office of the Public Advocate, DHS and specialist review the injury; he found Community Visitors are working together that the injury was so significant and to address the woman’s needs and substantial that it was unlikely that it had improve her quality of life. 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 Unfortunately, in another instance, procedures and and hip. processes failed to protect and support a person who had suffered an injury. 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. Case study The importance of appropriate healthcare and its A woman called the OPA Advice Service impact on the quality of life of those with complex care needs cannot be underestimated. Healthcare complaining about the abusive behaviour is one of the most frequently reported issues by of a fellow resident, saying she was Community Visitors. verbally bullied and physically attacked. Incident reports supported her complaint, Issues of concern ranged from a lack of up-to-date Health Care Plans, the improper administration of indicating that confrontations were medication, medication given to the wrong person, frequent, with the complainant confined the management of healthcare records, inadequate to her room for safety reasons. discharge planning following hospitalisation, and the Little had been done to restrain the other lack of timely annual health checks. More frequently, residents require dementia assessments as they resident’s abusive behaviour. Community age, and require other age-related health checks Visitors questioned management as to such as pap smears, mammograms and prostate what the complainant had described and checks. There were several reports of Epilepsy were told that management had not visited Management Plans being out-of-date and CHAPS the house, nor spoken to the resident not being completed. about the situation. Management confirmed that the resident Planning with behaviours of concern had a BSP A fundamental part of achieving real outcomes for and that there were strategies in place people with a disability is getting the life plan right. Plans should include input from all stakeholders, but to help her calm down and manage priority must be given to the individual’s personal her grievances. Regular meetings goals. The ability to communicate those goals is were planned regarding this resident’s a crucial part of the planning process. Those who behaviour support strategies, health plans cannot communicate have no active input into their and family relationships. own plans, defeating the whole purpose of the planning process. The manager eventually visited the house and spoke to the complainant, and short- Visitors report that some plans are out-of-date, term strategies were put into place to help or in disarray, and require updating for current circumstances. In other cases, there are no holidays her feel safer in her home. planned for people. Staff should be better trained to understand that sometimes plans need to change to better reflect A lack of appropriate support has a huge impact on a person’s expectations as they age. Some people a person’s quality of life and negatively impacts on would like to spend more time at home because they the quality of life of those who share a home with are ageing and find day programs tiring. that person. This results in an unhappy home where all residents feel unsafe and at risk. 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.

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Dignity, respect, and rights Case study An essential element of being human is the ability to communicate. Where a person has complex and A woman has a long history of multiple disabilities, the ability to speak may be impulsive and violent behaviours. She is compromised. For many years, Community Visitors aggressive towards other residents and have reported the distressing situation of observing has destroyed furniture and fittings in people trying to communicate without the support communal areas. She shouts and swears of augmentative communication. and exhibits very challenging behaviour, The region is home to many people who were which the others have to tolerate. housed in institutions like Kew Cottages, where communication support was negligible. It was hoped Various specialists have recommended that moving into the community would present medications to help the resident control more opportunities for people to become more her unpredictable and aggressive independent in this area, but it has taken many behaviour, but it seems none of these years for this to eventuate, and then only in recommendations have been put into a few houses. place. Staff report the resident’s family Other people have also waited many years are resistant to the use of medication. for communication support. In one house, it is The resident is ostracised at home and at distressing to note that, despite reports from day care, she cannot form nurturing and Community Visitors for many years, a person who meaningful relationships and is lonely. Her urgently required communication support has, as access to the community is restricted. yet, had nothing done to achieve this. This person regularly tries to communicate with Community One-on-one support has been put in Visitors, using gestures, and attempts at speech, place for this resident and active night but is unintelligible, which is undignified and upsets staff mitigate some of the effects of her everyone concerned. behaviour on other residents. However, It is important that all people’s right to advocate for Community Visitors are concerned that themselves is recognised and facilitated so they the residents’ needs continue to be unmet. 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, Another important consideration is what happens self-determination, and, on occasion, affects their once the plan is made. Community Visitors are personal safety. concerned that where plans appear to be well- It was very pleasing, therefore, to note that a formulated, it is difficult to ascertain how effectively Complex Communication Project is being trialled in they have been applied. Often, progress notes are five group homes which house people with multiple incomplete, and it is difficult to find out by asking the disabilities, where a need for communication support residents if they are satisfied because, many cannot has been identified by both Community Visitors and speak or communicate in other ways. Sometimes, the department. It is hoped that this pilot results Community Visitors resort to analysing financial in new policy and that speech assessments and records, or the vehicle logs to see what funds augmentation become routine in all houses were spent, and where the residents went in in the region. the house bus. Staff training is also an important issue. In some It is pleasing to note that DHS is benchmarking the instances, people with a disability have learned sign success of the person-centred planning process. language, such as Auslan, but none of the support The region is participating in a La Trobe University staff in the house are trained to use it, rendering this PCAS research project to evaluate active support in person ‘speechless’. achieving personal goals and measure if residents’ aspirations are facilitated by the planning process. The dignity of work is something that many take for Eight group homes have been selected to participate granted. It is important that people with a disability in this important five-year project. have the opportunity to contribute by being involved in meaningful and paid employment, if this is what they choose.

62 Community Visitors reported that people employed by a local disability enterprise had been stood down and were concerned the rights of these residents to Case study continue working were not being respected, because In one house, two men suffered from due to funding arrangements, no other placement compulsive eating. One man ate opportunities were available. In some cases, family everything in the pantry and put on too members were concerned that this would affect their ability to continue to pay for their accommodation, much weight. The other did the same which might require them to seek alternative housing and this caused ulcers on his legs which arrangements that might not suit their needs. meant that he couldn’t work. In both cases, their unrestricted access to food Community Visitors raised this issue with DHS which affected their health and quality of life. reported that, due to the recent economic downturn, the enterprise had lost some long-term contracts, For a number of years, cupboards were and could not offer consistent employment. DHS locked, as were the fridge and pantry. This undertook to look into alternative employment and was supported appropriately by BSPs. If activity options for this group of residents. other residents required additional food, they asked for it. The two affected men There are some very positive outcomes for people who work for this enterprise. Their art studio lost weight, and the ulcers resolved so supports 12 artists with a disability who augment that the resident could return to work. their funds by selling their work through the gallery Then policy changed, and management in the restored Kew Courthouse precinct. Earlier this year, the latest exhibition was opened by the decided that this was an unnecessary local Member of Parliament and the community restrictive practice. Cupboards were came together to celebrate their work. The artists unlocked and a dietician recommended appeared to gain great satisfaction from selling their a broader diet including sweet and some art and talking about their work. fatty foods. Both men gained weight, and the ulcers returned. Dialogue with Restrictive practices the department revealed that it was There are some people who need support to be able considered that there should be no to live in the community. In some cases, this is in restrictions applied despite the known the form of behaviour support to assist them control risks. The resident with the ulcers antisocial or challenging behaviours in the residential commented that if the food was there, environment. Practices which restrict a person’s he couldn’t help himself and he would rights or freedom of movement, that are restrictive eat it. The department is now treating practices, even if applied in order to help a person control such behaviours, must always be supported the issue of the ulcers as a vascular by a properly authorised BSP which has been condition, which is not resolving while lodged with the OSP. these men continue to have unrestricted access to food. 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.

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Staff training Case study For many years, Community Visitors have reported that some staff do not appear to have A female resident has a long history been sufficiently trained to properly support the of overeating and obesity. On occasion, residents in their care. This negatively impacts on this becomes so extreme that it is the standard of care that residents receive. Many life threatening. In order to stop her reported issues are due to the lack of staff training compulsive overeating, staff removed on procedures, specialised care, behaviour support, medical processes, communication support, and snacks and other food from the kitchen planning processes. Sometimes there are no entries and locked it in the laundry to restrict in the resident’s progress notes or the Shift Report access to it. Other residents, who were Book, so that there is no record of activities or not overweight and did not suffer any other incidents. At other houses, there are no staff food-related health issues also had specially trained in autism, diabetes and epilepsy access to these foods denied by this management, or in sign language, and residents restrictive practice. suffer because staff cannot offer appropriate support. Community Visitors questioned this practice and changes were made to allow In other houses, staff are not trained to recognise when residents require additional support. In one the other residents unrestricted access to house, there was no speech and communication this food, by storing some of their favourite support for residents, because staff did not think it snacks in their own bedrooms, which was required. In this house, one resident displays were locked by residents who had their inappropriate sexual behaviour, but there has been own keys. very little support provided by staff who do not recognise the problem.

Lack of consistency of house supervisors In one house, Community Visitors were told that and permanent staff the restrictive practice of putting bed rails up on all Lack of consistency of house supervisors and the residents’ beds to prevent them getting out of permanent staff was again raised as an issue of bed and injuring themselves did not require a BSP concern in the region. Generally, lack of consistent because it was part of a therapeutic plan. This house supervision, and use of non-familiar staff is at odds with the guidelines which require results in poor outcomes for residents. a BSP for all restrictive interventions involving mechanical restraint. Residents depend on staff for their care. They may form long and lasting relationships with those they Other inappropriate behaviours may be the result see regularly. They need consistency of care and of ignorance about a person’s needs. There are a time to form meaningful relationships where trust is number of people who display inappropriate sexual established, and the person is comfortable with the behaviours and whose requirement for sexual relief level of intimacy that they must endure from those is consistently ignored by staff and family. Antisocial that they are not related to. This continuity of trust sexual behaviour can occur when they are not given and care is lacking in situations where staff are non- the appropriate support to control their urges, or to familiar, or key workers and house supervisors are relieve them. While the reluctance to face this issue continuously replaced with new staff. among carers and parents is understandable, the rights of the person should be paramount, and they Staff who do not know residents well, have should be supported to manage their sexual needs insufficient information about them to make with dignity. 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.

64 Good practice Strategic Replacement and Refurbishment Community Visitors were happy to find that the Plan update men in a house had settled and their challenging Community Visitors remain concerned about behaviours declined because staff who knew them the condition of some houses in the region. The were working there again. impact of badly maintained or designed buildings on the quality of lives of residents cannot be Once the residents had settled down with familiar underestimated. This also affects the capacity of staff, other quality-of-life issues have been staff to give adequate care, and sometimes costs progressing positively. One resident, who did not like the residents money, because they have to pay high the texture of food and had a PEG feed, has now utility bills, which means that their outings and other been encouraged to eat food normally. One man, personal expenditures are limited. who was socially isolated, is now speaking to staff and had a conversation with Community Visitors with The maintenance budget is only $1 million for the support from staff. entire region, which is insufficient, given the issues around poor condition of buildings, and lack of maintenance that are continuously reported.

In houses where there are complex medical or Community Visitors have received no advice that behavioural issues, the use of non-familiar staff there will be a new strategic replacement plan. This can make the situation worse. 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. Case study A resident with autism lives with two Kew, Main Drive others. She is verbally and physically Community Visitors met with the Parliamentary abusive and aggressive towards the Secretary for Families and Community Services, Andrea Coote, to discuss: the lack of appropriate other residents and is causing physical footpaths for the passage of wheelchairs around the damage to their property and home. BIST Main Drive site; lack of community facilities; lack of intervention is ongoing, but the behaviours adequate allied health supports for residents; the have progressed. ‘institutional feel’ of some houses; and the lack of community interaction between residents and other The situation is exacerbated by the poor people who live at Main Drive. relationship between the woman’s family and staff. Staff turnover is high and the Since the meeting, Community Visitors have been new house supervisor has only been informed by the department that the entire matter is now being reviewed by the Minister. Community there for a short time. The staff have not Visitors await the positive resolution of these issues been given training in autism, and this in favour of residents. means that they are unable to respond adequately to support residents who display behavioural extremes. 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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throughout the year. They get to know the residents be moved: the victim or the aggressor? And then and support workers and are often well able to what happens to the person with behaviours of sort out issues as they arise. Residents often see concern? Community Visitors as ‘our CVs’ and welcome them as friends. 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. Planning PCPs come in a variety of shapes and sizes, from Staff support butcher’s paper and cartoons to complex computer- generated documents, perhaps with photographs While the staff support is generally good in added for explanation. The majority of PCPs are CSO-managed houses in the region, Community thoughtfully written with input from many people Visitors have consistently reported concerns about important to the residents. There are still occasions an organisation that has seemed to struggle to when Community Visitors question the language provide adequate supports in some of its houses. of people’s PCP – formal, therapeutic vocabulary, The organisation has been undergoing a significant albeit in first person, does not fit well in the context, organisational restructure; staff turnover has been especially when written in the first person. high and management inconsistent. The main issue with PCPs is the lack of access to them and the accuracy with which they are Case study updated, annotated and filed. On several occasions there were discrepancies serious enough to raise There are concerns for residents in a as matters of concern. These concerns do make house that has a room with padded and Community Visitors wonder if staff have similar carpet-covered walls. Community Visitors difficulty at change-over and after leave. had previously been told that this room Community Visitors often find file notes, progress was not used for ‘seclusion’ of residents. notes or day books are more often available and comprehensive. In several houses, support workers It appears that this room was used for add a comment to a resident’s file on a daily basis seclusion of a resident who had assaulted as a matter of course; this is especially useful for another resident and a staff member, incoming staff and where there are residents with as well as causing property damage. It behaviours of concern, illness or specific needs. was not clear from the records how long the resident was secluded. The on-call Choice and decision-making manager refused permission to give ‘as- Residents often make their preferences known to required’ medication and later suggested Community Visitors ranging from making a will, to that the staff member call police to assist who they would prefer to live with, or not to live with. the staff member to administer medication Day placement preferences are accommodated by to calm the resident. The staff member the CSO and the happiest people seem to be those had sustained a head injury but was told who go to work; this is where independence, choice by a manager that she could not leave the and competence show up best. house to seek medical assessment until a replacement staff member arrived at Dignity and rights the house. It was some two hours later While most households are harmonious, that the staff member was relieved by incompatibility must be acknowledged, especially an on-call manager. where a resident has behaviours of concern and where people’s residence is determined by others. Community Visitors are concerned It also brings into sharp focus conflicting rights. about the effectiveness of behaviour In two instances, residents were causing such management strategies in this house concern that others locked themselves in their and, consequently, the safety of the rooms. In one instance residents told Community other residents. It is also of concern Visitors and house staff they did not want a particular that this incident was not rated as the man in their home, they were afraid of him yet he highest category. 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 Staffing Community Visitors repeatedly expressed concerns Community Visitors report that residents feel that new, inexperienced staff are left in charge of this well-supported by committed and competent staff, CSO’s facilities, especially where there are people especially those who are open to new ideas, with complex needs. Despite meetings with the CEO suggestions and ways of thinking. There are many and senior management, these practices still remain. examples of outstanding staff ‘going the extra mile’, Community Visitors are pleased to report, however, sourcing special equipment, organising camping a great reduction in the use of agency staff, who holidays and birthday outings. Staff mediate with might not be familiar with residents. families, who may have different perspectives on a resident’s care, take residents to doctors and make Facilitating and encouraging independence sure their clothes are clean and ready for the day. Looking into the fridges of some houses it is clear Casual staff are obviously going to be necessary; that the quality and standard of food is very high some CSOs have their own pool of casual staff, and thoughtfully purchased; fresh meat and cheeses however, these may cover the whole metropolitan – some for lunches and some for cooking – and area and so unfamiliar people go into peoples’ a mass of fresh vegetables and fruit. One CSO homes. One house has seven regular staff and invariably has three bowls of fruit on the kitchen 22 listed as casuals. There are five men living bench or the table: apples and pears, oranges and, in the house. even when they were at top price, bananas. In these homes the food is there to be eaten as desired. While Community Visitors acknowledge there are some CSOs who allow four days or so for induction In one house, a man’s care plan told his into the organisation, this does not necessarily responsibility in pictures: picture one is of a full sugar induct them into the house in which they will work. jar; picture two is an empty sugar jar and picture Some allow for ‘shadow shifts’ where the new three is a shopping list and bag of sugar. Compare support worker follows an experienced worker and this approach to the home where a support worker so learns about the people and culture of the house decides and shops for the food to those houses and its members. where there is a group discussion and whoever proposes the meal gets to help cook it. Similarly, in Of concern is communication between residents and some houses people return home from their day at new support workers who are not familiar with local work, clear out their lunch box and prepare it for the vernacular, humour or expectations. Community following day; they then help with the evening meal. Visitors are concerned that support workers should be able to support residents where needed, including In most homes everyone has a job – it may be to personal hygiene, bathing and menstruation. They make one’s own lunch for the following day, make were told by a family member of a support worker sure dirty clothes are in the laundry, make your who, for religious or cultural reasons, cannot look at own bed. In others the person who chose the day’s a naked person. menu at the planning meeting does the cooking – or helps. People are on a roster to shop with the Community Visitors believe there is a necessity for support worker for the weekly food and other needs. staff to be provided with support and processes There may be a roster for laundry, clearing the table, where they are able to safely self-assess, update cleaning the house, clearing the garden. their skills and self-appraise with peers. In other houses, people come home and sit and wait It appears rare that CSOs hold full staff meetings for tea. There are still some houses where support where informal and formal networking takes place. workers, ‘kindly’ and in a ‘motherly way’, do it all. Community Visitors are told there is not the budget One approach produces independence, the other and that staff will not attend if they are not paid. does not. Community Visitors strongly recommend that time and processes are provided for such exchanges to take place. Participation and engagement The majority of residents attend day placement One CSO has had a major staff restructure over or work away from their homes and are at home the past year which Community Visitors report has at weekends. Many people use public transport, caused a great deal of anxiety in residents as well as although the majority go out in the house bus. staff. Individual house managers have been replaced Community Visitors report that most residents by a service manager effectively removing one staff regularly help with household shopping or shop member from the pool available. Many residents for themselves and enjoy a coffee with a support claimed they had not been advised of the changes, worker. Residents participate in a range of were unaware and confused; some families banded entertainment and leisure activities including dances, together to seek to modify the changes. The cinema trips and attend exercise classes. changes have created disquiet and instability.

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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 Case study do something different at the weekend. Where there Early in 2012, Community Visitors are four people with two staff on duty they are able were notified that a resident had been to take it in turns over the course of a month to each interviewed regarding a sexual assault by have a one-on-one outing. This is more problematic where those left at home have higher support needs a staff member. When seeking information or simply do not all want to do the same thing. In about the incident they were told by senior some instances, funding only allows for one worker management of the CSO that when the to be on duty for a weekend; the funding model resident had complained of the assault being five days in care and two days with family. the police were notified and the interview Transport too can be problematic, although staff in took place. Another resident then also some CSOs work together to pool their time and came forward as a victim of assault and vehicles to take groups out. was also interviewed. One of the strongest links with the wider community is through footy, rarely soccer or rugby. Residents Community Visitors were told that a similar do go to the footy, they wear the colours and allegation had been made some time barrack loud and strong. The easiest way to earlier about the same staff member while start a conversation is to ask someone how their he was working at another house. Police team went. investigated, no charges were laid and Each year, two organisations build into their culture the staff member was moved to another ‘The Show’. Monkami and Nadrasca put on a house. musical in which the majority of performers live While the CSO notified the next of kin of with each other and have often grown up together. the people who were able to say they The Show is the highlight and culmination of the year’s activity, when residents, family, friends and were assaulted, it took some time for all community members join together to celebrate the relatives at houses where the staff their achievement. member worked to be notified regarding the incidents. A number of the residents Abuse and neglect said that they were fearful the alleged Community Visitors reported a number of instances offender would return. Counselling had of abuse. Of particular concern was an allegation been offered. The CSO reports it is of the sexual assault by a staff member of a number reviewing how it recruits, supervises and of residents from the same house. 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.

68 Community Visitors are concerned that there is no Respite process at present for incidents which take place at The need for respite places for children and older day placement to be acknowledged in an incident family members continues to be an issue for families report and filed at the house. who have one or more children with high care needs. The stability of the family often depends on respite. Institutions and congregate care Villa Maria’s four houses have 22 beds. They The improvements at the Oakleigh Centre were currently have five children living permanently welcomed. However, passageways are narrow in respite and an additional child was recently and maintenance, poor safety and hygiene issues placed in foster care. Villa Maria is supporting are still not addressed. Considerable work could the arrangement with regular respite so it can be done to make the houses feel safer, more successfully continue. Villa Maria supports about respectful of peoples’ needs and more welcoming. 100 families and has significant waiting lists. Community Visitors reported that the ageing of its Community Visitors see significant unmet demand, residents will become a challenge. Documentation exacerbated by respite places being used for is still inadequate and there are many cases where full-time care. it needed updating. Incident reports were another issue; staff language skills are sometimes so poor, CSOs also run recreation community-based it is claimed by a manager, that reports need to weekends, school holiday programs and camps. be rewritten. The original facility is now quite old and will need Ambiance and comfort to be replaced soon. There is only so much that can CSO houses are first and foremost a home and be done to make it liveable. furnished and decorated as such, for comfort and safety. They are well-maintained in the main, A congregate care facility run by Wesley Mission especially where the CSO employs maintenance Melbourne caters conscientiously to the needs of people on staff and, in these houses, repairs are residents. They have a volunteer co-ordinator who attended to quickly. In other instances, where ensures: residents have friends, with whom they there is a ‘landlord’, delays may well occur; in maintain their hobbies and interests; residents run other houses there is a distinct lack of furnishings an in-house newspaper; their dietician and cook and decoration, which may have been due to the work closely together to cater to the tastes and behaviours or anticipated behaviours of individuals. needs of residents. In addition to exercise and movement therapies, Wesley run music therapies Community Visitors would contend that while a and the outside space is well-used. With support building may no longer be appropriate or ‘best from family and staff, residents decorate their rooms practice’ so far as width of corridors and doors are as they wish. Community Visitors reports indicate concerned, there is no reason for doors to be jammed that this is a good place to live. 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 Ageing and planning spooky. These are maintenance issues which the An ongoing concern is how to better care for people CSO management has a responsibility to fix. as they age. Some people want to retire from work and day placement, to stay home for the day. In two instances, management decisions made the Community Visitors acknowledge that some people difference to residents while their home was being are less inclined to go out as they get older, even repainted. In one instance, people moved out of when encouraged. Many people like to stay in bed the house for a few days while the whole place was longer but this is rarely possible where shifts end repainted. In the second instance, in a house where at 9.30am and restart at 3pm. For many people, most of the residents use wheelchairs, the residents ageing and its attendant needs mean they are forced remained in their home while it was painted. The to move from the home they have known for many men had to avoid the wet paint as well as put up with years to a nursing home. the smell. The issue for CSOs is how to budget for this in the best interests of those whose homes they service Building structure and design and support. 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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one resident could help the support worker prepare food. Issues with other residents required the removal of cupboard doors so they were not yanked Case study off, and the fridge had to be locked, as did the The OPA Advice Service was contacted cupboard containing the fire blanket. by hospital staff who were very concerned about the care of a resident External presentation and outdoor areas who had been taken to hospital twice in Much is reported about the tidiness and neatness eight weeks suffering from hypothermia. of the environment surrounding residents’ homes. In both instances, it was day placement Of greater importance to residents is access to the staff who noticed the illness and garden or yard. One man in particular was seen as transferred the resident to hospital. an irritant by those with whom he lived; constantly running up and down the corridor, banging doors A care coordination meeting was held and generally making a nuisance of himself. Moved involving all parties relevant to the to another house with a large and accessible back resident’s wellbeing, including her family, yard, he runs around, waves his arms and looks at medical guardian, physiotherapist, doctor, the trees and the sky. There is no longer mention of him being an irritant to others. 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 Gippsland Region hypothermia again.

Responses to visits have been positive and, overall, residents are treated well. The introduction of active supports for residents has been a welcome and Upkeep of buildings and fittings positive outcome. Visit numbers are down slightly Maintenance issues, particularly for the older but Community Visitors are pleased to report the houses, continue to be problematic in West recruitment of new Community Visitors to East Gippsland. A lack of resources seems to be the Gippsland and facilities in this area are once main problem. One house in Drouin had been again being visited. waiting for renovations for over 12 months before having some of it done just before the end of the Planning financial year. Houses in East Gippsland appear Some houses have been slow to review support to be very well-maintained with new furnishings plans such as BSP. Management has been made and maintenance being completed. aware of the importance of these plans and the situation is reportedly being addressed. Leisure activities and recreation Some residents attend a painting club and classes Healthcare needs at their local community house in Bairnsdale and Gaining weight can be a health problem for some their paintings decorate the walls of their home. One residents. One person gained weight very quickly. resident, who is particularly talented, has regularly This situation is being monitored by the person’s exhibited his paintings in the local community, and doctor, staff and family. This is a common enough has been assisted to exhibit at a show in Adelaide. problem where exercise is difficult and temptations are many. 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 Good practice Grampians Staff at a Tipping home with two residents with dual disorders have established, with the support of Community Visitors divide the region into two areas: mental health services, a detailed mood chart for Inner and Outer Grampians. Inner Grampians one of the residents. There are six colour-coded includes Ballarat and its surrounding towns, categories and this is filled in every hour. This will and Outer Grampians includes Horsham, Ararat increase to eight categories and be recorded every and Stawell 15 minutes. This extremely high level of support In both parts of the region, the introduction of the will hopefully bring about a better outcome for new incident report system and the challenging this resident. paper trail was consistently an issue. Often the original was not available, with a poor chronological order of later reports. Casual staff, when requested A transition house has a display of photos and notes by Community Visitors, often could not find about previous residents and what they are doing paperwork such as incident reports. Service now as an incentive for others to improve their skills providers should ensure all staff can locate important so that they too can live independently. At one CSO information readily in case of an emergency. house, weekend breakfast in bed is enjoyed by Across the Grampians, individualised choices residents, evidence of how far some staff will go for residents improved. Many residents reported to make a house a home. being able to go on assisted holidays and overall participation in community activities appeared to Enabled access to the community increase, such as attending community events One resident, who had been offered a move to and personal shopping. PCAS plans were also another house, was concerned that she would not be well-implemented in most DHS houses. 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 Inner Grampians her friend and travel on the public bus.

Choice and decision-making Good practice In many houses, residents rooms are decorated Sadly, a resident passed away but staff and to reflect individuality and interests, for example, neighbours ensured that his life was celebrated and murals, colours and themes - some are even that his funeral was very special. The man endeared allowed to be a bit messy. himself to all who knew him. A staff member wrote One resident, who had no available information a poem that captured his personality and read it about his past, was able, with the help of staff, to at his funeral. get his birth certificate and find a niece and nephew. A young neighbour, who enjoyed visiting the Unfortunately, the sister he remembered had died. residents and helped them to bring in the shopping, Some residents have moved to a different home was invited to the funeral and asked to act as a pall that better suits their needs and provides a better bearer. His school principal invited him to share his resident mix. For example, before a resident with experiences with his fellow students. 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 Personal safety other residents. 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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At another home, one resident was in conflict with Grampians Outer another, resulting in other less assertive residents fearing for their safety, while in another house, a female resident remains targeted by a male resident Planning and staff have to be constantly aware of where each As reported in 2011, a young man has only home- resident is in the home at all times. based daytime activities and Community Visitors continue to ask why he cannot be supported to To increase the safety of a resident with severe participate in meaningful activities in the community. epilepsy, her bedroom door has been removed and replaced by a lovely curtain. This improves Community Visitors raised concerns with DHS access to the room if the resident happened to regional management about the lack of consistent fall in the doorway. support for the complex needs of residents in two day placement organisations and the affect that this Reported in last year’s annual report was the is having on their wellbeing. The conclusion reached reluctance of a resident to relocate. She expressed seems to be that there is a need for staff training a wish to live with her fiancé but DHS felt that and more formal communications between staff from she would be at risk if she lived without supports. both the group home and ATSS. 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 Staff support accommodation in which she doesn’t live, and Community Visitors have recorded concerns about community supports for her have not yet been put counselling for residents and staff resulting from in place. Community Visitors hope that regional traumatic events. While DHS responds that, where management will be able to gain alternative funding a death has occurred, “courses have been run and support for her and that her unit can be for palliative care which incorporates grief and reallocated if she does not need to live there. 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 Case study opening, staff received extensive training in the A resident fell from a shower chair while different conditions such as ABI, multiple sclerosis and cerebral palsy. The house has a separate area being assisted by one staff member and where residents can entertain their family or share it was reported that the safety belt was a meal away from other residents. In a unit attached not in use at the time. The resident was to the house, a resident lives almost independently. treated by the local medical service for She has training on public transport so she can a mild head injury and returned home. eventually travel by bus to day placement or work. Staff felt that something else was wrong Another service provider is extending its services so requested further investigation, which to provide intensive support for two residents with revealed a broken leg. The resident dual disabilities and is to be commended on their was again sent home to be treated commitment to stabilising the lives of these young “conservatively”. The resident was taken people. Two new facilities have been built in Ballarat to a regional hospital for a second opinion. over the past financial year for young people who It was reported to Community Visitors that have a disability. the hospital refused to assess the resident A new, spacious respite facility for school-age as only the X-ray report accompanied children was opened in September 2011. Paintings the resident. Again the resident was sent done by the children, prior to moving to the new home. The staff at the home are already location, line the walls. Separate areas for recreation caring for very high needs clients. They are available indoors and a large outdoor space with paths for bikes encourages play for active children had no specific training in assessing pain once they return from school. or in managing the care of a person with a fractured femur.

72 This year, several people have moved, some to Abuse and neglect 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 Case study relocations. In one case, the reason for the move was not clear and the impact for the resident was For over five years, residents of a house likely to be negative. Another man was expected have been verbally and physically to move to another town which did not offer any assaulted and property damaged by a different support than he currently receives. The housemate. At times the house has had Community Visitors Program was alerted, a guardian to be locked down to protect the residents appointed and the proposed move was averted. from assault. Recently, this resident scalded a housemate by throwing boiling water over him.

Case study Efforts were made to manage the situation by isolating the resident but this was One CSO house in the region has a unsuccessful. history of accommodating residents with very complex care needs, including dual Early in 2012, the DHS Regional Director disabilities. Three residents in this house asked the Office of the Senior Practitioner required one-on-one support. Despite to conduct a review of the house. In April this need, at times there are one or two 2012, the review was completed and an staff looking after all five residents. While advisory group formed to consider its 30 staff attempt to care for the residents to recommendations. the best of their ability, they acknowledge In June, Community Visitors were informed the risk is very high that care could that the house was again in lockdown. be compromised. Community Visitors They continue to report their concerns for reported that incident reports could not the safety of these residents and question be found for the serious incidents that the lack of trauma counselling for them. had occurred. 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.

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Healthcare needs Aids and equipment Aids and equipment purchases continue to be a problem due to delays in occupational therapy Case study assessments, modifications to equipment, staff A non-verbal, paraplegic resident who training requirements and funding. was being transferred to bed was left Several new ergonomic tilting shower chairs have with only one other staff member while been purchased following significant falls when lifting equipment was stored. The bed transferring residents; this has alleviated the use rails were not in place and the resident of extra moves from hoists. rolled off the bed and appeared to be in considerable distress. Respite The resident was unaccompanied on her It is pleasing to note that after reporting for many years about the depleted state of respite services in trip to hospital in an ambulance. No X-ray rural country towns, upgrades are planned. The last was taken during this trip to the hospital resident who has been living for years in a respite or the next, despite house staff concerns. facility will soon move to live in a local group home. Ten days later when an X-ray was finally The facility had been under administration but is now taken, a broken leg was diagnosed. After managed by a Ballarat CSO. surgery and a return home, staff were A congregate care facility in another town has been still very concerned about the resident gradually transitioning ageing residents to more who appeared to be in significant pain appropriate accommodation and there is a more some weeks after surgery. Another trip vibrant atmosphere and freedom of movement for to hospital was required. the younger residents. It is also pleasing to note more person-centred activities in evidence. When the hospital advised of imminent discharge back to the house, the house Building structure and design supervisor requested a delay as house Community Visitors continue to raise the problem staff had visited the resident who still of a group home where four females and two males appeared in significant pain. Further share one toilet, which is located in the bathroom. X-rays were ordered and re-fractures of DHS has responded saying no current funding is the leg were diagnosed. A meeting was available to build an extra toilet and the house is held to discuss options including possible not considered as appropriate for renovation. This amputation of the leg. At this time it was is despite the fact that a similar house in the same also suggested that the resident, in her town was renovated successfully to provide an late thirties, had severe loss of bone extra bathroom, a fourth bedroom and an office. Community Visitors will continue to press this case. density. While three new group homes have been built to Community Visitors notified the Public replace decommissioned houses, several others, Advocate who appointed an advocate which were purpose-built following the closure of and later applied to VCAT for the two country institutions in the late 1990s, are now appointment of a guardian to ensure in need of refurbishment and new soft furnishings. appropriate care was provided to this This is unlikely to occur in the near future. 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

Hume Region Case study Community Visitors continue to report Planning on the plight of a resident who, while While the electronic lodgement of residents’ BSP having much clinical support, remains with the OSP has remedied the problem of overdue plans, it is disappointing for Community Visitors to dangerously overweight. He is very continue to report individual plans being out-of-date unhealthy as a result of poor diet choices or in need of a review. and inadequate personal hygiene. Clothes he owns no longer fit him and expose Community Visitors question how effectively body parts inappropriately. He does residents are supported if staff do not have the time for administration. This is of great concern when not have the funds to buy specially agency or casual staff are unaware of where to find made garments. residents’ plans. If documentation cannot be found While he has support with both short and Community Visitors wonder how adequately staff can support the residents’ particular needs. long-term goal-setting the achievement of these goals is routinely undermined Community Visitors have also regularly reported by a failure to follow through with an inability to view incident reports at the house, strategies. Unfortunately, he resides in an as they are either on a computer, which staff advise independent unit with less immediate staff they cannot access, or are too complicated to view, consider and reflect on through the computer support available to him than when he filing system. resided in the group-home setting. Hygiene and cleanliness are major health Dignity and rights concerns, with urine and excrement Community Visitors report limited opportunity for throughout the unit and rubbish strewn residents to choose who will fill vacancies in their both inside and out. He is unable to sleep home or have their interests met in respite or new in his bed due to his size and is finally accommodation. being supported in gaining a supportive Community Visitors also report difficulties in chair more suitable than the one he tries viewing transitional plans for residents, particularly to sleep in. those looking to live more independently. In one example, it was noted that, despite there being While attempts have been made to no transition plan evident, a resident was moved improve his health, Community Visitors into an independent living unit. Further complicating feel more focussed support for this this is the Disability Support Register, which appears resident should be made. Meanwhile his largely crisis-placement driven, offering little choice dignity and wellbeing continue to suffer. for residents to determine where they live and with whom. One resident, who enjoyed watching the passing Staff support traffic and pedestrians, is now unable to do this in Community Visitors report difficulties recruiting her new home because of a fence blocking her view. and retaining staff. In an extreme case, a house While recognised that residents benefit from the new could not be staffed so it was closed and residents purpose-built houses, Community Visitors believe relocated at short notice. This house remains closed, that more consideration should be given to residents’ its future uncertain. likes and interests in the planning stages. 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.

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Enabled access to the community Personal safety Community Visitors would like to see each house Community Visitors report a female resident who considering the most appropriate transport options accepted a lift in a car with a stranger, a resident to enable full access to the community for residents not returning home for days on end failing to advise and the means to pursue their individual needs and staff, and a resident being dropped off at their house interests. Vehicle-sharing imposes limitations on all with no staff present. Such behaviours can place residents as it relies on much forward planning by a resident at great risk and greater consideration staff, leads to greater use of taxis at much expense and supports should be provided where these risk to residents and limits community inclusion. More factors exist. consideration should be given to individual activities and outings. Restrictive practices Residents carry a greater financial burden than that Community Visitors reported a new purpose-built of other members of the community for outings and house was locked to ensure the safety of one of the socialising. On occasions, residents have had to pay residents. Unfortunately, no consideration was given for staff support so they can attend social activities. to reporting to the OSP and development of a BSP As community inclusion is a key element of the State to implement supports to ensure the least restrictive Disability Plan, 2002-12 Community Visitors believe environment. However, when the matter was raised, service providers should give greater consideration the service provider and DHS acted very quickly to to reducing the financial burden for residents to liaise with the OSP and develop strategies to support ensure better outcomes. 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 Building structure and design period of time is very damaging. In one house, while Community Visitors report positively on the new support services are in place, there is continual purpose-built homes. Aside from some normal minor conflict, destruction of windows, fixtures and fittings warranty maintenance matters, the design very and ongoing disharmony. This residence is neither much supports and considers the needs of residents. homely nor welcoming. While renovations were being undertaken, Community Visitors have reported instances where Community Visitors reported a safety and evacuation skilled staff support has resulted in a new resident risk because of blocked emergency exits and with disruptive behaviours settling positively with inactive smoke alarms. However, the service their fellow residents. However, this is not always provider addressed these concerns promptly. the case and residents sometimes find themselves trapped with few alternative accommodation options, Residents deserve to live in homes that do not and facing lengthy waits for other vacancies to have a neglected and uncared for appearance and become available. where safety standards are routinely maintained. Community Visitors report ongoing concerns with unacceptable delays to repair or replace essential Healthcare needs household items and address damage to fabric and A number of residents have been noted as having essential fittings like dryers, washing machines and admissions to the local adult mental health service dishwashers. Other inadequate maintenance matters for various periods. Community Visitors express have included squeaking and sagging floor boards, concern that there is not always enough open broken windows, poor drainage, rusty guttering, communication between mental health staff and holes and cracks in plaster walls, damaged blinds house staff to enable a complete understanding of and curtains, uneven pathways causing potential trip a resident with an intellectual disability. This lack hazards, slippery kitchen and bathroom tiles, worn of knowledge and understanding by mental health floor coverings and damaged eaves. providers adversely affects support given. Ageing and planning Aids and equipment A number of residents have aged in place well Delays in residents receiving aids and equipment or moved to aged care as their support needs go like wheelchairs and communication devices are beyond the training and experience of the staff. often reported. Being without essential items like More consideration should be given to discussing these limits a resident’s ability to communicate retirement-like activities and options with residents and be heard, as well as to access the community so that they can give up some of their daily activities independently. at a pace which suits them.

76 Unmet need in accommodation Staff support The number of people needing respite continues Most staff are to be commended for their dedicated to exceed the places available. While the policy of support of residents but there were two matters segregating adults and children is commendable, involving staff that were of serious concern. it makes for added constraints to placements in respite care. Community Visitors visited a DHS house following a complaint that a house supervisor restricted Community Visitors believe it is entirely inappropriate client activities in response to behavioural issues. to have residents living long-term in a house that is There were also allegations of possible financial designated as a respite, contingency or transitional. mismanagement at this house. When Community After lengthy discussions with a service provider, the Visitors reported these issues to DHS management, request by a resident to have a lock on his door, in they were promptly investigated and the situations a house used by others for day activities, is finally addressed. being considered. Community Visitors also visited a unit managed by A positive initiative has been the new home in a CSO to find two residents with complex needs left Wodonga built from My Future My Choice and unattended in a locked unit. After approximately 20 Older Carer funding. The house is purpose-built and minutes, a staff member returned in a work vehicle. management has sought to ensure that residents An investigation was conducted after Community are fully engaged in their immediate local community Visitors reported this incident to the service manager and beyond. and the staff member involved is no longer employed with this agency. The Hume Reconfiguration Project has modelled good practice in supporting long-term residents in respite to find permanent accommodation. Enabled access to the community The initiative also provided an opportunity for Transport is a major issue for clients who use family input to the most appropriate accommodation wheelchairs, where the house does not have a for residents. dedicated vehicle. For example, three DHS houses in Mildura share one wheelchair-accessible bus and The region is also trialling a new respite booking this makes it difficult for residents to participate in service, initially for DAS houses and eventually community activities without planning in advance. rolling out to all houses. This is a very positive initiative in supporting families and clients in Residents at one DHS house in Bendigo travel in a determining availability of respite services across maxi taxi to and from their day placement. The bus competing priorities. had broken and unsafe steps for many months and clients were often picked up late. The bus was finally Awareness of Community Visitor protocol replaced after an accident. Community Visitors feel more education from service Limited staffing also affects the participation of providers would provide a better understanding of residents in activities they enjoy. At one CSO house, the Community Visitor role as many staff still seem there is only one staff member on duty, so if a unaware. This has delayed access to information resident has an appointment all residents have to go and has taken away direct-care time. along, even if they have just arrived home from day placement, as they cannot be left unsupervised.

Healthcare needs Loddon Mallee Region Healthcare needs of residents seem to be responded to effectively in most houses. A psychiatrist who has been working with Sandhurst Planning clients has also reviewed the medications of several In general, Community Visitors have been impressed DAS residents and this has reportedly been very with the efforts of staff to address the individual positive for the people concerned. needs of clients in both DHS and CSO-managed houses. Most residents have current individual In one CSO house in Swan Hill, extra staffing plans, however, the steps taken to implement these hours were provided to enable a resident to receive are not always clear. 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

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then moved to aged care. Community Visitors have Choice and decision-making also reported that a couple of residents have had While staff try to promote individual choice and falls and that issues related to obesity are common. decision-making, the institutional environment limits Compatibility of residents remains an issue in some some aspects of this, for example most residents still homes with one resident attacking other residents have their main meals prepared centrally. Small but and affecting their quality of life by playing loud significant gains have been promoted within these music late at night and damaging their property. constraints. Residents have been observed making In one DHS house, one resident was secluded their own morning tea or hot drinks on their return 15 times in a three-week period because of her from day placement and some residents who are behaviour and incidents, many involving other preparing to move on from Sandhurst have been residents. One-on-one support throughout the actively encouraged and assisted to prepare meals, day was introduced for this resident and she and do their own housekeeping and laundry. During is now starting to self-manage her behaviour. renovations, residents were consulted about the colours they would like in their bedrooms and Community Visitors have also noted increased living areas. efforts to carefully fill vacancies in houses and create positive home environments. VALID has continued to support a resident group called the Sandhurst Self-Advocacy Team which meets monthly. This group has come up with Upkeep of buildings and fittings suggestions like the introduction of water coolers Not surprisingly, given the large number of houses and developed a poster about resident rights. in the region, there are frequently issues related to the upkeep and maintenance of buildings, fittings, Staff support and outdoor areas. Fortunately, most of these have been minor. A number relate to broken doors and Staff tell Community Visitors about the positive gates which are not locking properly and these work occurring and the growth and development issues have security implications. A stove at a of Sandhurst residents. Staff training has been CSO house was out of order for months because ongoing and included training on ageing and it required a new seal. individualised planning. Maintenance issues at some CSO houses seem One female resident moved to a transition unit a to take a long time to resolve. This is complicated short distance from Sandhurst and was very excited by the fact that the houses are not owned by the to get her own key. She has been employed in agencies that manage the houses. New houses the laundry at Sandhurst on supported wages, have been built and some DHS houses have increasing her income and gaining valuable had major renovations in order to better meet work experience. She continues to have contact resident needs. with staff who can monitor her progress in living independently. Her work is seen as a stepping-stone to further independence.

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 Good practice A resident, who Community Visitors have known North and West Metropolitan Region for some time, has blossomed this year. He (North) appeared non-verbal and to have limited understanding of what was going on around him and his communication was often aggressive. Planning Community Visitors have seen significant effort Since the resident moved into his own area, he has made to improve PCPs so they are ‘working begun to speak more often and has begun to read documents’ and there are many examples of the paper and undertake more tasks on his own. residents being assisted to exercise their choices. There has been a significant reduction in challenging These include residents planning and participating behaviours. in holidays, household activities or external activities Photos of a holiday by the sea showed his obvious with the assistance of staff. There are still areas of delight in experiencing the ocean. Staff assist him to concern in relation to individual plans in some plan other outings and holidays for the future. The CSO-managed houses, while others are of an resident now recognises and responds warmly to exceptional standard. Community Visitors and staff. 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 Healthcare needs what is actually occurring in the lives of each person. Approximately half of Sandhurst residents have Family members have been seen to overturn the increased health needs related to ageing. Some decisions of some residents. Agencies need to find have required hospital stays and two residents a way to ensure the choices of residents are moved to an aged-care facility. respected where people have the capacity to make their wishes known.

Restrictive practices The use of seclusion at Sandhurst has reduced Good practice significantly; from 148 incidents in 2010-11 to 64 Each resident is to have his own activity roster in 2011-12 with only 11 instances recorded in the board in his bedroom. The board provides details last six months. This is a credit to the efforts of of ‘requests, community activities, home based Sandhurst management and staff in redesigning activities, and things I would like to talk about’. some units and relocating residents to promote The pictorial illustrations are actual photos which compatibility and quality of life. are laminated and which have a magnet on the back. This means that residents who are non-verbal Upkeep of buildings and fittings can move the photos and indicate what they are interested in doing. Residents are enthusiastic The use of funds and creative efforts of staff to about this. Similar boards are planned for menus improve the residential environment has been and food selection. 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.

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Staffing There were also a number of serious incidents In a number of houses a stable staff team results involving unexplained or undiagnosed fractures in good outcomes and support for the residents. and inadequate medical support. 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 Case study needs of the residents. On visits to houses which employ a large number of casual staff, issues are A caller to OPA’s Advice Service reported often reported of goals not being achieved for some very serious concerns, which the residents. prompted extensive follow-up. The In two DAS houses, Community Visitors have medical examination of a non-verbal commented on the need to continue with staffing woman with osteopenia and other which is active overnight; DHS has said it will complex health needs had discovered consider this as part of its general roster reviews. the young woman had three leg fractures which had occurred at different times over Leisure activities and recreation the previous six months. Many residents are supported to lead very busy lives The resident also had bruising and and to participate in an amazing array of activities. swelling to her face on one occasion, However, staffing levels and limited access to accessible forms of transport can restrict the access allegedly from a hoist incident in the of clients to community activities. Residents from house. The resident’s private guardian one house were unable to stay in a holiday house had not been able to establish how the as planned because the house bus was unsuitable fractures occurred nor had been able to for access. At one house, a DVD player was not access relevant incident reports. replaced for some time as it was unclear who was to pay for the replacement when it was broken by Community Visitors viewed all the a resident. In another house, a resident received available documentation. The matter a TV and DVD player for Christmas but it took some was reported to DAS area management months for DHS to organise for this to be mounted who conducted their own investigation on the wall for him. Funding for day placements and organised for a review by a forensic is also an issue for some residents medical specialist. Meetings with the resident’s guardian and the family were Healthcare needs held. However, the investigation did not Residents are generally well-supported in relation establish how the fractures occurred. to their healthcare needs, however, Community A number of strategies have been put in Visitors have reported a number of very serious place to reduce the likelihood of further issues this year. injuries occurring.

Case study In one complex case, a woman who is unable to speak sustained unexplained fractures to both Community Visitors reported concerns her legs and received very poor medical support. about a resident who sustained a head In addition to this, there were delays in notifying injury when she fell to the bathroom floor her family of her injuries and in fulfilling incident while staff were changing her continence reporting requirements. 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 Compatibility There are many maintenance issues such as Compatibility of residents continues to be a serious damaged floors, carpets and curtains, walls in need problem in some houses. One active resident was of painting, taps that fall off or cannot be turned placed in a DAS house with residents who have on, broken exhaust fans, missing tiles, damaged complex needs and who are virtually non-verbal. fencing, a chipped kitchen bench, and dirty heating She told Community Visitors she felt isolated ducts. One house with five adult residents has been and unhappy. She was promised a full-time day without a dishwasher for more than a year. When placement but still has only minimal part-time hours. Community Visitors enquire about these issues Despite some months of advocacy, an application to they are usually told a maintenance request has the Disability Support Register to enable a move had been submitted. In liaison meetings, management not been completed when Community Visitors last staff explained that the budget for maintenance met with DHS management. is inadequate to address all maintenance issues and that there is a need to prioritise. And, if urgent, One resident from a CSO house over-indulges serious, structural bathroom or kitchen issues arise, in alcoholic drinks daily and places himself at risk then the majority of the budget may be spent on just in the community, assaults staff, and frightens his two or three houses in the region. 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 Plenty Residential Services remains complex and ongoing and his housemates Unlike Sandhurst and Colanda, which have no remain disadvantaged. admissions policies, this site continues to be In a number of other houses, there are residents used as ‘accommodation of last resort’ for some who are either violent towards staff or other people with complex needs and personalities who residents or unsuited to shared living. Community have challenged the system elsewhere. These Visitors acknowledge these situations are not easy people require a situation where, if they should to resolve but still find it unacceptable to expect experience an instance of traumatic behaviour, an more passive, gentle people to live in fear for alarm system is available to alert nearby staff to years on end. respond effectively. The outcome of this has been the dislocation of long-term residents from Plenty Residential Services (PRS). External presentation 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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Community Visitors have advocated for months that PRS arrange an Italian-speaking service Case Study or volunteer to visit an Italian-speaking resident A resident was accommodated in a house who is isolated because of her visual impairment, at PRS late in 2009.The two existing communication needs and intellectual disability. So residents at that time were required to be far, there appears to have been few efforts made to address her situation. moved urgently to accommodate him. This followed a decision by a court to have this In instances where goals are for increased man removed from prison, as he had been community access, lack of access to vehicles or found unfit to plea in court. Very high staff insufficient staff support are often reasons given for levels were required to support this man why goals are not being implemented. These are strong indications of inequality for the people who as a result of his very restricted situation are housed at PRS. in prison and severe disengagement from staff. The back-up duress alarm system The situation is so dire that some residents are now was also a requirement. using their own savings to pay agency staff to take them out, for example, to have a meal, visit family, or It has taken two years to regain this man’s go to a disco. At one visit, an agency staff member trust and present him with a slightly arrived and all five men surrounded him, hoping improved quality of life. In January 2012, that it was their turn to be going out. Such a sad Community Visitors noticed a new house situation to experience, and one that emphasised how deprived they are of normal opportunities. being built on the edge of the PRS site. It is the opinion of Community Visitors that both Information was that this was for this additional staff support hours and additional vehicles resident. He now lives alone in this house are required to ensure opportunities for equality in with a reduced level of staff support from human rights for these people. PRS as a transition situation towards, hopefully in the future, being able to move Staffing back into the community. 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 Many of the residents at PRS could live in to be informed that a project officer has been the community. If DHS provided them with this appointed to address the findings of the Review opportunity then this site could be used for the of Supervision Arrangements – Plenty Residential specific purpose of accommodating people Services, August 2011. However, the slow progress with special needs as a duress alarm system is on this front continues to disadvantage the residents available for staff to call for assistance when severe of PRS. 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 Leisure activities and recreation and develop a clear vision for the service consistent In a number of houses, residents sit around with with both the Victorian Charter of Human Rights and no opportunity to engage in any leisure activity. Responsibilities Act 2006 and the principles of the Various reasons are given for this, for example, Disability Act. 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, Planning and community access Community Visitors have noted from client files, Most residents have a PCP. Community Visitors interest in such activities as riding three-wheeler continue to question the implementation of the bikes and using trampolines. This has been brought planned actions from these lifestyle plans. Despite to the attention of management to make such the introduction of monthly key worker reports to equipment available. 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.

82 Abuse and neglect Planning In last year’s annual report, Community Visitors In many houses there is a lack of continuity in the expressed concern about the impact of one woman’s documentation with no clear connection between aggressive and assaultive behaviours on the other PCPs and key worker reports. Residents’ goals are residents in the house where she lives. This resident often written as statements such as, “I want to have has not been moved and Community Visitors remain a healthy life”. Where residents have goals to which concerned that other residents live in fear and they aspire included in PCPs, they are sometimes have been observed cowering in their own home not documented in action plans. because of the abuse and aggression of this resident towards them. DHS recently had training for all house supervisors and domain managers in person-centred thinking skills. It is hoped this training will improve the External presentation implementation of PCPs and that they will be During summer, the grounds around the three an accurate reflection of each resident’s goals. courts of what is PRS became very overgrown. Hopefully, there will be more actions linked to these A gardening service employing people with a goals and that Community Visitors will see more disability has now been contracted to address diversity in the goals within each house. this. Most houses have large backyards of which There have been many reports of paperwork many are very under-developed or uncared for. not filed or filed incorrectly. This is frustrating for These areas could provide increased activity for Community Visitors because they cannot find the residents. When PRS was developed there were required documents. five maintenance staff employed. As PRS houses are regarded as community houses, these positions have not been replaced as they became vacant. Dignity and rights External contractors are supposed to be utilised. A number of houses are having regular house It seems this is often not done with staff being meetings with the residents. Many are using unused to this practice. inventive ways to help residents express their The houses at PRS are now approximately choices in everything from outings to the weekly 20 years old and require upgrades in such areas menu. Some houses call for agenda items prior to as the bathrooms and toilets and particularly in the meeting. In another, one of the residents takes external and internal re-painting. The present level the minutes and in another, days for the meetings of budget for minor maintenance does not allow this are rotated so that all staff have an opportunity to be done. Community Visitors request that the to attend sometimes. Where all residents are government address this by increasing the budget non-verbal some houses use chat sheets at to this area. 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. North and West Metropolitan Region (West) Staffing In comparing this year’s annual report with last It appears to Community Visitors that more casual year’s, it would seem that nothing much has and agency staff are being used in the houses. This changed. The problems with person-centred obviously affects residents in many ways. Houses planning, maintenance, retaining permanent staff, where there are residents with high needs and the use of casual staff, transport, and financial serious behaviour problems seem to have many constraints are perennial issues. However, the temporary staff and staff changes. Understandably, Community Visitors come across many very this affects residents. dedicated and hard-working staff in these houses Community Visitors know that it must be very and applaud them. Community Visitors continue to stressful working in some houses. It is felt that more strive to uphold the rights of the people they visit. support for staff and residents could be given. The residents are noticeably more settled when there are permanent staff, with whom they are familiar.

Community Visitors Annual Report 2012 83 Disability Services

Good practice Family involvement is strongly encouraged. One A young woman in a house managed by a CSO was resident’s family provides the house with lots of fruit quite disruptive when all residents were preparing and vegetables and has arranged for a local butcher to attend their day programs. The house supervisor to supply most of the meat to the house. Once a devised a range of strategies to help her manage week, all the residents have free fish and chips from better in the mornings. These included a pictorial another local shop. program of steps to follow each morning to get ready Many residents have close family and it is pleasing for her day program and a ‘feelings’ book, to help to find that these ties are respected and encouraged staff identify problems she might have had that day. by staff who often drive long distances so residents She also had one-on-one time with a staff member can visit family. In some houses, these drives are at the end of each day where, over afternoon tea, combined with an outing for the other residents. One she is asked to pick a face which best describes house arranges for a resident’s mother to sleep on her feeling that day; if there are three unhappy a folding bed when she visits from interstate. faces in a row, staff note this and follow up. These strategies have been very successful and the resident is much happier. 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 Well-planned arrangements were made for residents does mean that the opportunity for spontaneous who have moved out of their homes. One new community access is limited. This is particularly felt house has opened and the residents were pleased during holiday periods. to show the Community Visitors their new home. Three other new houses are being built in this Each house has access to a vehicle from DHS in region. Residents from another house where there Footscray each weekend. As houses are as far away were serious structural problems are now settled as Melton, Sunbury and Werribee, collecting the into other houses where bedrooms were painted and vehicle on Friday evening in peak hour traffic and wardrobes installed. returning it on Sunday evening is onerous. It also means that sometimes houses are not fully staffed There are many maintenance problems in the while this pickup is occurring. Also, some residents houses, however, a number of houses have been who use taxis to take them to day placements or painted and other improvements made. appointments find they either come late or not at all.

Communication Communication both verbally and by other means Good practice is such a vital way for us all to relate. It is wrong Staff arranged for a resident to go to a new that so many residents are being denied access physiotherapist who suggested a different style to speech therapists and other experts in this area of walker. It has given the resident mobility and because they cannot afford to pay for such services freedom to move and to make decisions about and because the waiting lists are so long. While where he wants to go in the house. This was not most permanent staff say they understand non- possible before, as he was reliant on staff to assist verbal residents’ needs and wishes, this certainly him to move around. 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. Abuse and neglect Community Visitors reported the assault of a man It is vital that all residents are given expert help to in his home by a family member. It was a serious assist them in communication. concern to them that staff who witnessed the assault did not intervene; there was a delay in seeking Participation and engagement medical treatment and a category one incident report In many houses, residents go on regular annual was not completed as required. 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.

84 Unfortunately, these strategies are not always followed. This could sometimes be explained by Case study the lack of permanent staff in some houses. A telephone call from a concerned staff Another house continues to grapple with ongoing member alerted Community Visitors to friction between two residents and with another a case of abuse in a DAS house. Staff resident who sometimes becomes violent. When this advised that a family member had a happens most know to stay in their rooms but one dispute with a resident who was forcefully resident refuses to do this and often gets assaulted. sat down, resulting in bruising that was The problems of ageing and dementia have to be still very visible four days later. While two faced in a number of houses. Staff are given training staff members witnessed the incident at to help such residents. However, it is a concern that the time, they did not intervene to protect other residents are missing out on activities and the resident, did not immediately report outings because of staffing levels. to management and an incident report was not made on the day. Other residents Ambiance and comfort were also present and were very upset Residents and staff have made many houses into following this incident. The resident was homes. Photos of family, holidays and outings not taken to the doctor until two days later. are displayed. Ornaments, DVDs, magazines and flowers are around. Written directives displayed on A category one incident report was only walls are kept to a minimum. Residents have been completed when the domain manager involved in choice of colour and decoration in their became aware of the incident. On bedrooms. learning of the incident, the domain The continuing work of ‘theming’ each resident’s manager took the doctor’s report to police bedroom in one house has resulted in the bright who declined to take any action, but and personalised rooms that the residents obviously noted the incident. The domain manager love. The house supervisor is leading this work. advised that the house would engage Residents’ likes and interests are considered in the VALID to assist the resident to deal with choice of theme and colours. his family. 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 Incident reports used to patch up floor coverings in living areas Incident reports are not always available in hard and bathrooms. This is a tripping hazard and looks copy when Community Visitors ask to see them. unattractive and water gets under the tape, causing When sighted, they do not always have follow- more problems. It is unfortunate that these tripping up, outcomes or recommendations to prevent a hazards are often left a long time. reoccurrence. DHS houses have implemented the One house in Sunbury has not been able to use the non-critical incident register as required by the back steps for years. These steps should be the department’s incident reporting guidelines in late exit from the laundry to the outside clothesline but 2011. Community Visitors will be observing, with because one resident fell and hurt her ankle badly interest, what results will come of this change. three years ago, residents and staff were told not to use that door. Compatibility Too often curtains are left hanging by just a few rings Residents should be able to feel safe in their or strips of Velcro when all that is needed is to have own home. Unfortunately, there are a number of them re-attached. Old furniture and junk is left piled instances where one resident’s disruptive behaviour up both inside and outside houses waiting for hard is having an impact on the lives of the others in the rubbish collection or until families remove it. house. Two residents from one house were moved to other houses (at their request) because of another In some houses, there are reports of water not resident’s behaviour. While they have settled into draining away from the shower, mould on the ceiling, their new homes, this did mean they had to leave loose and leaking toilets, and holes in the walls. In a place which had been their home for years. DHS one house, the metal coil around the flexible shower has brought in an expert from BIST to help formulate hose had been broken leaving a sharp edge at both strategies to help staff with such behaviours. 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. Southern Metropolitan Region

In situations where a resident has damaged or Community Visitors in the Southern Metropolitan destroyed furniture or white goods they are expected Region were pleased to report that there were nine to pay for the replacement. This sometimes means new houses built under the Older Carer and the that all the residents are disadvantaged. Would My Future My Choice funding initiatives. These it not be possible for these items to be replaced homes were purpose-built with resident support immediately and paid for later? needs a primary focus. DHS also built and operates a well-considered and designed house for residents Respite issues with complex behaviours that support their individual needs. 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 Planning respite house, where she had been living for a long The quality of plans overall reflects residents’ time, to a DHS respite house where she is to live on individuality, however, clear documentation of a seemingly permanent basis. Surely a better option implementation is not always evident. A majority could be found so that she has a real home rather of activities take place at formal day programs than this temporary one. and, unless day program agendas are available, Community Visitors find tracking goals and aspirations difficult. Consistent staffing in houses Case study leads to better outcomes in recording of this information. DHS has implemented a section in A very assertive young woman gets the Day Report Book for notations regarding angry and frustrated when her personal resident’s activities. desires are not being met. She informed There should be consistency in describing the Community Visitors that she had been hit progress of each resident’s goals and aspirations. with a remote control by a staff member; When the focus of a resident’s person-centred they did not see an incident report about support is on their abilities, not their disabilities, this or other issues. It was reported that Community Visitors have observed great progress a staff member left half way through the in the resident’s quality of life. shift; the reply from the facility indicated Often documented evidence of activities is not the staff member was replaced for the available for Community Visitors to monitor and remainder of the shift. reflect on how the plans are being implemented, The house manager has explained the achieved or updated. reasons the young woman’s requests have Delays in preparing, updating or finalising residents’ not been fulfilled, as staff have to try to support documents continue to be reported. House balance her needs against the needs of staff are often required to write information in a the other residents in the house. number of different documents, not only taking away direct-care time of residents but also when This house is a respite house and the the documents are archived they are not available Community Visitors feel that this woman to reflect on. Community Visitors note that where has been there too long, resulting in her a house consists of permanent staff, the resident provoking other residents and causing support documentation is generally well-maintained. unwanted problems. Living in a respite situation appears to be a trigger in Dignity and rights escalating her behaviours. 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

86 from this project, with the aim to source ongoing model culture is based on dependence with little funding for its implementation in all SCOPE houses. opportunity for independence even when people become adults. Community Visitors remain concerned with the lack of clear guidelines regarding the use of an Independence in all aspects of lifestyle in houses independent person, as required under the Disability where the person-centred approach is evident Act. There is also a lack of clarity regarding who has been reported. Appropriate individualised can be used as an independent person; this is communication methods are also noted in other an important role for ensuring that a resident’s sections of this regional report as essential for fundamental rights are upheld. independence. Community Visitors reported concerns regarding the Behaviour Support Team’s capacity to meet Case study increasing needs of both staff and residents. Five Community Visitors report a female team members cover a wide area of need, from the resident’s home, family home, day programs resident with autism who needs more and other support providers. Intensive, brief and consideration of her privacy and dignity secondary consultations are afforded on individual given she is living with four males. In cases and prioritised by urgency. Depending addition to a sliding door, she has a on caseload it may take up to six months for a screen door to her bedroom as she is consultation. This team requires additional resources fearful of not being able to see out. The and support to ensure early intervention and sliding door is often damaged and cannot a proactive, not reactive, approach. be closed leaving an open view to her Community Visitors report that the health and safety bedroom while she dresses. Even though of residents with high medical or support needs are house staff open her wardrobe door to at risk where casual or agency staff are utilised in block some of the view there is no clear the absence of specifically qualified staff members. plan being considered to address her The lack of appropriate training and instruction rights to privacy and dignity. for these replacement staff to meet the complex healthcare needs of residents is a great concern.

Community Visitors report that, in one house, Case study the toilet door has been removed and replaced Community Visitors have been concerned by a curtain due to the decreasing mobility of the that a house that accommodates a residents. This impacts on the privacy and dignity of the residents. Recognising the ageing and number of residents with high needs associated mobility issues of the residents, the is often staffed with agency or casual urgent need for a new bathroom is still not actioned, staff who may not have had orientation despite several years of Community Visitors to the house and who may not have the reporting about this issue. qualifications related to caring for people with a disability. It was of concern that Staffing while a number of residents require tube Permanent staffing ratios remain a concern, feeding the agency or casual staff filling particularly in houses where residents have high in the shifts may not have had training support needs. Community Visitors note dramatic in managing this type of feeding. This changes to the quality of life for residents caused by places resident health at risk as these heavy usage of casual staff who are not familiar with staff may not recognise some of signs of the residents’ individual programs or needs. Houses the complications related to tube feeding. 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 Security of Community Visitor reports and responses eight-hour model of care. Where this has occurred, has been an issue. In many cases, requests for Community Visitors have reported positive copies of reports due to the loss of the original has changes and a person-centred approach leading occurred, after a follow-up request for a response to greater independence and enhanced quality of was made to the service manager. life for residents. It is noted that the cottage parent

Community Visitors Annual Report 2012 87 Disability Services

Facilitating and encouraging independence Good practice Community Visitors are impressed by a program A resident who moved from Kew to a group home six initiated by DHS staff to enable one of their residents years ago, had been limited in house activities due to work towards moving into more independent to her aversion to wearing seatbelt restraints. The living. The plan is called a STEPS program and resident, who has mobility and balance difficulties, focuses on undertaking small steps with an has been severely stressed when seatbelt restraints ultimate goal. 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 Staff sought professional advice and, for many reported many instances of caring and dedicated months concerted efforts were made to make her staff who find innovative ways to enrich the lives of feel comfortable, but without success. However, the people they support. An example, which proved Community Visitors are delighted to report that very successful for the residents of one house, was a major breakthrough occurred recently with the when a staff member arranged to take two of the resident now picking up the house keys and waving residents ice-skating while they were sitting in their them at staff, indicating her desire to go on the bus. wheelchairs. Regular outings now occur and her quality of life has been enhanced considerably. Many other residents have enjoyed attending live theatre performances in the city, also concerts and Community Visitors commend the ‘never say never’ meals in local cafes and coffee shops. Community approach of staff in supporting this woman to Visitors note individual birthdays are often a overcome her fears. reason for celebration in many houses with photos displayed to enable everyone to continue to enjoy the occasion. Community Visitors continue to report that a major In a respite house for adults, the staff placed barrier to residents’ participation in their community, pictures on the doors of the kitchen cupboards or in pursuing individual interests, is the lack of displaying the items stored inside. Another house readily available or dedicated vehicles or suitable conducted a client satisfaction survey and an low-cost transport options. Residents can spend innovative staff member and resident of another large amounts on taxis going to work, leaving little house have designed and built a chook shed with money for leisure activities. When one vehicle a run, which can be moved to different locations is shared between houses, a range of problems around the garden. become apparent. These are just a few examples of many, and Holiday options are generally provided. However, Community Visitors believe it is important that for residents with complex health or high support dedicated and caring staff are recognised for taking needs, holidays and outings are limited due to the time and making the extra effort to improve the high costs. This is further complicated where staff quality of residents’ lives. and management are in dispute about appropriate payment of staff wages when supporting residents on their holidays. Staff training and attitudes Community Visitors report concern with the training and information provided to agency and casual staff. Abuse and neglect Without appropriate orientation, support needs will Community Visitors reported a number of allegations barely be met with the little time staff have available of abuse and neglect. In one instance, two residents to familiarise themselves with the 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 Community inclusion attend and speak with all the residents. A number Community Visitors are pleased to report increased of additional supports were implemented with sourcing of options by staff for community inclusion counselling sessions and information provided about of residents. Overall, inclusion and residents’ appropriate behaviour, respect and sexual relations. choices are met, although there is still room for improvement within some areas of this region.

88 Aids and equipment Case study Community Visitors have ascertained that the delays of new custom-made wheelchairs can be Community Visitors note a marked caused by the lack of qualified personnel. The long improvement for residents in a DHS house process of evaluation sometimes takes 18 months. previously the subject of abuse and This can lead to a need for further equipment neglect concerns. Following renovations changes as a result of changing needs. Financial to the rear of the house, one resident concerns can also cause delays when State-wide Equipment Program (SWEP) funding leaves a now has independent living. He feels substantial amount to be found by the resident for safer and in control of his environment the equipment. and has interaction, by choice, with the other residents. The introduction of In fire-prone areas, Community Visitors regularly two residents into the main house has report inadequately stocked evacuation packs that are missing items like radios, torches or items led to little disruption. There has been that were past their use-by date. These items are a stabilisation of permanent staff, a replaced quickly. reduction in incidents and staff are still active in improving the quality of life for It was also reported, with concern, a drop out in all residents. internet connection to certain houses in the region, causing delays in updating or receiving electronic information from the main office.

Compatibility Personal safety Incompatibility continues to be raised as an issue Concerns are expressed for a resident who is by Community Visitors in the region. Residents of capable of unlocking the front door of the house, widely varying ages and abilities can be placed which is on a busy highway. The snib on the wire together and, in one house, a woman lives with four door is now employed as extra security, however, men. The Disability Support Register and vacancy Community Visitors feel this is not an adequate management process continues to be crisis-driven safety measure. with little opportunity for resident choice. Community Visitors are concerned that the staff Community Visitors would like to see greater sleepover room in one house is upstairs and the autonomy afforded to existing residents in choosing residents’ rooms are downstairs. The residents are new residents when vacancies occur in their own vision and hearing impaired and, in an emergency, home. This would lead to fewer incompatibility there is no way to communicate with staff. issues, while also acknowledging the need for DHS to provide accommodation for homeless people or Incident reporting emergency placements. In these circumstances, Community Visitors continue to report difficulty in normal transition processes do not occur which accessing documents; often staff do not know how results in placement of incompatible residents, to locate or access them. The lack of incident reports which often has safety implications. in hard copy remains an impediment to Community Visitors fulfilling their responsibilities under the Act. Healthcare needs Viewing reports by computer has proved very time- For many years, Community Visitors have reported consuming as it takes approximately eight minutes concerns about a resident whose family will not to scroll through one report. permit him to undergo certain medical procedures, The recently introduced incident reporting such as blood tests and dental care, as they think guidelines, thought by Community Visitors to they would be too distressing for him. Community rectify access concerns, has been implemented Visitors are of the opinion that the resident has inconsistently across DHS and CSO houses. At a the right to health monitoring and have observed number of CSOs, staff email or advise their manager varied methods utilised by health professionals to who grammatically edits the report, categorises overcome any anxieties this creates. 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 Unmet needs in accommodation requirement to report category one and two Community Visitors acknowledge new models of incidents. Service providers are required to care to accommodate residents who, due to their keep a non-critical incident register for each complex support needs, have difficulty coping with resident, however, it appears that some services shared support arrangements. However further are using this to record incidents that would have allowances in future planning for this increasing been reported as a category two under the need is necessary. One respite house, operated by previous system. SASI, caters specifically for children with autism in this area and another operates only on weekends Upkeep of building and fittings and school holidays. A funding allocation has enabled many longstanding A respite house which is run down and lacking painting and minor maintenance projects to be comfort is still being used despite land being completed, however, most older houses are purchased some time ago. Families who desperately not purpose-built and disadvantage residents. need respite are reluctant to use this house in its Bathrooms with one toilet are shared by up to five current state, although Community Visitors are people and are not compatible with a resident’s right impressed with the care provided by the staff. to maintain dignity. DHS has acknowledged houses are in need of a rebuild, however, funding is subject to financial constraints. Restrictive practices Community Visitors have continued to report houses Community Visitors again report many maintenance where fridges, cupboards or kitchens are locked issues. Matters reported include: rotting window for ‘safety reasons’. However overall, restrictive sills and door jambs, dirty ceiling vents, nails practices regarding locks has improved, with positive protruding from ageing fences, guttering choked with support provided by the OSP to educate services. 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 CSO- managed, 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 Community Visitors General Meeting 2012

Community Visitors Annual Report 2012 91 Health Services 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

Appointment of Community Visitors Statewide report This year, there were 79 Health Services Community Visitors appointed, and another 23 trainees in In 2011-12, 79 Community Visitors the stream. Recruitment of volunteers is always challenging and, with a shortage of Community in the Health Services stream Visitors in many areas, any delay in transitioning conducted 924 visits to 171 SRS trainees to appointed Community Visitors has an impact on the ability to recruit and retain volunteers. across nine regions of Victoria. Unfortunately, processing delays occurred this Thirty-two of these visits were year due to system hold-ups and changes in the paperwork required. However, Eastern Region referred by OPA’s Advice Service. Health Service visits are up substantially from last year’s record low as the new team of Community The Board is very pleased to report the positive Visitors have taken up their roles. 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 Health Services Stream 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.

Region No. of units visited ofNo. CVs Requested visits Scheduled visits Total The Board commends the Department of Health Barwon-South 10 8 1 73 74 SRS executive team for the other positive response Western to issues they raised and highlights the following Eastern outcomes achieved this year: 49 10 13 151 164 Metropolitan • guidelines for SRS closures Gippsland 6 5 0 31 31 • collaboration around addressing the palliative care needs of some long-term SRS residents Grampians 13 6 1 75 76 • the fostering of a more collaborative working relationship between the Community Visitors and Hume 2 5 0 23 23 Authorised Officers under the newly proclaimed Supported Residential Services (Private Proprietors) Act 2010 and Regulations. Loddon Mallee 7 8 2 53 55 Northern 19 10 0 113 113 Metropolitan Southern 51 21 14 272 286 Metropolitan Western 14 6 1 101 102 Metropolitan

171 79 32 892 924

Figure 14. Total visits Health Service Stream 11/12

94 healthcare 155

incident records 82

abuse/neglect/ 69 violence

other hazards 54

staffing/support 54 care plans & referral 50 information

Statewide findings cleaning healthcare 46 155 The following table and series of graphs financialincident records 82 provide an overview of the visits made by matters 41

Community Visitors and the issues of concern abuse/neglect/ 69 meals & violence 41 raised by them. beverages other hazards 54 During the year, Community Visitors identifiedmaintenance 39 880 issues that affected the lives and wellbeing staffing/support 54 care plans of people living in SRS. A number of common 32 resident mix & referral 50 themes were identified and, while many cases information reflect the patterns of previous years, the fire safety cleaning30 46 highest number of matters reported related financial 41 to health issues, which is a change from lastindividuality matters28 & choice year’s report. meals & 41 beverages medication 25 maintenance 39 Health and personal care rec/education 22 SRS, by their nature, provide for those whoseopportunities resident mix 32 age, mental or physical health, social or financialsupport to move/ fire safety20 30 circumstance make them vulnerable. SRS dorelocations individuality 28 not provide nursing or high-care support, noraccess are to & choice19 they mental health facilities, yet many peopleinformation in medication 25 these SRS have complex physical and mentalheating/ 19 cooling rec/education health needs, more than can be addressed with 22 opportunities current funding. complaint support14 to processes move/ 20 Healthcare issues dominated reporting inissues types identified the relocations privacy access13 to 19 Health Services stream this year. Residents information continue to be accepted by pension-level SRS, heating/ community cooling 19 often without appropriate referral informationinteraction 12 complaint 14 and at inconvenient times. Residents also processes 8 continue to transfer from one SRS to anothercall system issues types identified privacy 13 without documentation that would support theirgrooming/ continuity of care. Another pressing issue in clothes 5community interaction 12 some SRS is that residents are given little orresidential no choice in their medical practitioner and in somestatements 4call system 8 cases, all appointments are booked for the grooming/ chemical 4 5 same day. storage clothes residential statements 4 routines 4

chemical 4 storage 300 food safety 3 routines 4 284 3 250 lighting food safety 3 250

lighting 3 200 confidentially 2

189 confidentially 2 citizenship 0 150 citizenship 0 religious/ 0 100 cultural choice religious/ cultural choice 0 relationships 0 number of issues identified relationships 50 of choice of choice 0 53 43 45 0 20 0 4020 6040 6080 80 100 100 120120 140140 160160 12 22 0 numbernumber 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 Health/ Safety Activities Finances Home-like & Choice Information & Environment Dignity, Privacy Personal Care Social Independence Complaint Processes 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 Case study often no evidence of resident involvement in their Since 1999, John has been a client development. Community Visitors continue to report of public mental health services with instances where care plans remain locked in offices at least seven admissions between and are inaccessible to both staff and Community Visitors. Residents’ healthcare, interests, and life 2003 and 2008. His diagnoses include goals are vital to the ongoing welfare and wellbeing bi-polar disorder, schizophrenia and of residents and regular reference to care plans can post-traumatic stress. lead to better support and outcomes for residents. In a three-year period, John was evicted The high incidence of resident falls and lack of or forced to move from at least ten SRS appropriate monitoring of residents’ subsequent across three regions due to behavioural support and healthcare needs in both pension-level issues associated with his mental illness and pension-plus SRS means that fall prevention that prevented him from successfully guidelines are urgently needed. Community Visitors noted that some pension-level SRS had integrating into the community. The implemented falls prevention programs. longest stay was a year where staff worked tirelessly to support John despite One of the most pressing health issues identified by his repeated threatening and violent Community Visitors this year was the lack of support behaviour. Community Visitors have for SRS residents with mental health problems. In the worst cases, this led to repeated evictions assisted John through regular visits, with proprietors and staff unable to deal with the including responding to Advice Service problems the individual created. The program would calls to help support him. like to see the ‘Information Sharing and Referral At various times John is alleged to have: Practices Between Supported Residential Services and Mental Health Services’ Protocol audited for • pushed a resident to the floor its effectiveness and to ensure the appropriate placement of potential SRS residents. • been unpredictable and out of control • bullied other residents The Combined Board at its May meeting met with the Parliamentary Secretaries for Families and • been verbally and physically aggressive Community Services and for Health and discussed • self-administered medication or was not the case of a resident who has now lived in three taking his medication metropolitan regions and who had been evicted from at least ten SRS. Each time he moved SRS John has had very patchy mental health or region his connection to the service system support and one of the reasons cited for diminished until he fell through the cracks, leaving this is ‘confidentiality’ which translates the proprietor to manage the erratic behaviour to no records being kept of where he caused by his ill health. The SRS and mental health goes to live, where he did live, what day branches within the departments have agreed to review this case and see what can be done to placements he attended, what behaviours support this individual. The Board looks forward to a and issues of concern, as well as what positive outcome to this particular case and hopes therapies and strategies have been that the service system can respond more effectively used to assist him. John continues to fall to this and other cases that Community Visitors have through the service system gaps which highlighted over the year. has had adverse consequences for him and those he has lived with.

96 Dignity, privacy and choice Community Visitors would like to see a more In some SRS, concerns have been expressed about proactive response to potentially serious issues to the general cleanliness and hygiene of residents. avert situations deteriorating. Unfortunately, some Dignity must surely be a concern with some staff have neither the knowledge nor skills to diffuse residents going into the community in a dishevelled conflict situations that arise between residents and and unwashed state with clothes stained by the which sometimes escalate far beyond what they previous meal. Privacy continues to be an issue in should. Staff may then be at a loss as to how they situations where there are shared bedrooms. support residents in the aftermath of these events. All SRS must ensure the residents’ safety and Abuse and neglect wellbeing so that they can feel safe in their own There has been an increase in violence, abuse homes. It is important that documentation and and assaults in a number of SRS this year. In the records are maintained, staff training deficits most serious case, a resident was alleged to have identified and serious issues are not allowed to murdered his roommate. Residents and staff remain deteriorate. In many cases, action is only taken traumatised by this event. Other incidents where following the involvement of Community Visitors residents faced serious risk included alleged sexual and/or the Public Advocate. Community Visitors assaults and rapes, a suicide on a property adjoining would like to see additional supports for proprietors an SRS, physical assaults and other violence. to enable them to deal effectively with these difficult situations. 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 80 serious of these as case studies. Subsequently, 70 there have been fruitful negotiations at a statewide 60 69 50 level about improving the responsiveness of SRS 40 to allegations of sexual assault. Specific work in 30 relation to enhancing responses to allegations of 20 26 27 10 sexual assaults in SRS included: number of issues identified 0 2009-10 2010-11 2011-12 • the development of a checklist for SRS staff reporting year • the development of a protocol with Centres Figure 17. Health Services Stream abuse, neglect and violence 2009-2012 Against Sexual Assault • information on responding to allegations of sexual assault included in SRS resources/ Home-like environment training The majority of SRS provide good quality care and • a review by Authorised Officers of immediate a home-like environment for residents. However, and post allegation response to ensure resident mix and compatibility issues continue to appropriate steps were taken compromise the environment residents are entitled • the development of a protocol between OPA to enjoy. Instances of aggressive behaviour, often and the SRS Program for responding to a drug and/or alcohol-fuelled impact on resident safety notification of a serious allegation of abuse, which is not a pleasant way to live. neglect or exploitation. The cleanliness of some SRS and the lengthy delays The Board looks forward to a positive conclusion for minor repairs in others continues to be an issue. of these negotiations with the department SRS The right of residents to have pride in their home executive team early in the next reporting year, should be respected. and consider this work by Community Visitors has contributed to significant long-term benefits for residents from the work of Community Visitors.

Community Visitors Annual Report 2012 97 Health Services

Activities The Supporting Accommodation for Vulnerable At most SRS, the activities which are offered Victorians Initiative (SAVVI) funding continued to be positively support residents’ community inclusion reported positively. This year, the focus appeared to and are reflective of their interests. Often this is be primarily on supporting proprietors to meet the a result of thoughtful staff and positive community new legislative requirements. connections through local groups or council. The Board is concerned about the inequity between Meaningful community engagement is an entitlement SAVVI-funded SRS and SRS that would now meet that neither age nor disability should impede. the SAVVI criteria. It is unfortunate that SAVVI is Therefore it was concerning for Community Visitors now closed. The financial and business pressures when visiting some pension-level SRS to observe on pension-level SRS continue to grow and SAVVI residents sleeping in bed and only leaving their funding has enhanced the viability of participating bedroom for meals or sitting in chairs sleeping SRS while simultaneously improving the lives of throughout the day. In other SRS, Community residents. The Board would like to see additional Visitors observed that with a little imagination and funding to support SRS that would now meet the creativity everyone can be meaningfully engaged SAVVI criteria. This needs new funds as the Board and residents can have a more fulfilling life. would not like to see a diminution of the funds available to SAVVI-funded SRS. Finances Recognition of Community Visitors’ role Residents have raised concerns regarding their financial administrators and the difficulty they have The legislated role of Community Visitors is to in communicating with them. Community Visitors support the independence and dignity of SRS have supported these residents to raise their residents as well as identify system failures It is concerns with the person or agency involved. unfortunate that, this year, the Board needs to However, more consideration should be given to report that there has been an increase in ensuring that residents are linked with financial inappropriate and threatening behaviour towards counselling services that can assist them to Community Visitors. In some instances, Community understand their finances. Concern has been Visitors have been refused entry or requested to expressed about the potential for the carbon tax leave. It is unacceptable and extremely disappointing to be used to justify rent increases although the that Community Visitors are treated in this way and program has no evidence to substantiate this. challenged to such a degree. The department was Community Visitors will monitor this issue. notified in all instances where proprietors have not acted in accordance with their obligations under the Act. Information and complaint processes Residents, out of fear of eviction or other These challenges led the program to work creatively ramifications, are reluctant to complain and often with the department to address these problems. only advise Community Visitors of their concerns Consequently, ‘roundtable’ meetings were organised ‘in confidence’. The new legislation provides a in a number of regions. These ‘roundtable’ meetings, mechanism of support for residents who feel facilitated by an experienced mediator, allowed they have been treated unfairly or face eviction. each party to better understand the other’s roles, Community Visitors will monitor and report on the the pressures faced by them and how departmental impact of these legislative changes and believe staff and Community Visitors can collaborate to it will provide better protection for residents. protect vulnerable SRS residents. These sessions have led to significant improvements in the working relationships between the Community Visitors and Viability of the sector the SRS Program. Eight SRS closed in the state this year. This equates In addition, two training sessions between to a loss of 309 beds for people needing low-level Authorised Officers and Community Visitors, to support and placing significant pressure on many develop skills in dealing with difficult conversations other areas of community services and housing. and creative problem-solving were held this year, Community Visitors support the government’s with another planned for early next reporting year. commitment to explore and develop new and These sessions provided a solid foundation for innovative accommodation options for people ensuring any future problems are dealt with swiftly requiring low-level support and housing and see and effectively. 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 Funding for the Community Abuse and neglect Visitors Program Community Visitors are concerned about the impact The Board was disappointed that no additional of repeated moves between SRS on the mental funding was provided to support the Community health of one very vulnerable resident. The female Visitors Program. The importance of the program as resident with mental health issues and exhibiting an independent protector of vulnerable Victorians is behaviours of concern moved from Melbourne to highlighted by the fact that some of the criticisms by Geelong three months ago. On a recent visit, the proprietors of volunteers followed the identification resident told Community Visitors that she had been of system failures in these SRS. Community Visitors asked by the proprietor to move back to Melbourne are often the only ones speaking for these residents, to another SRS he runs, as staff can no longer as many have no family or friends to act on their manage her behaviour. This will be her sixth SRS behalf. It is essential that the program is funded in two years and this pattern will continue while her and staffed appropriately. underlying support needs remain unaddressed. Community Visitors regard the failure to assist her as ongoing neglect. Resident evictions are an issue in one pension- Regional reports level 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 Barwon-South Western Region frightened when these behaviours escalated. These incidents eventually led to some residents Eight Community Visitors conducted 74 visits to ten being evicted. 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 Home-like environment SRS and the remaining five pension-plus SRS. One SAVVI funded improvements to pension-level SRS pension-plus SRS has remained unoccupied. 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 Health and personal care footwear for residents. In this region there are some very positive developments in healthcare management with Resident activities were in some cases funded by a podiatrist funded by a service provider visiting SAAVI. These included bus trips to Warrnambool, three pension-level SRS every eight weeks to where residents enjoyed sports and a BBQ, while in meet resident needs. A diabetic nurse from the GP Ballarat they went ten pin bowling. A pension-level association attends one pension-level SRS monthly SRS took residents to Werribee Zoo, Sovereign Hill to follow-up GP referrals. A SAVVI-funded ‘Men’s and fishing. Other benefits have included Tai Chi Business’ group visited one pension-level SRS to sessions, a Christmas lunch and the purchase of discuss men’s health issues, while a nurse health pets such as a lorikeet and a fish. educator presented at pension-level SRS to support The source of a much-reported smell of rot and urine residents to quit smoking and offered to personally at a pension-level SRS was identified when the vinyl assist anyone who wanted to quit. was recently replaced. It was noted that the previous One pension-level SRS is making positive steps proprietor had used SAVVI funding to lay vinyl over in addressing medication errors, while another the existing, rotting floor. This highlights the need for pension-level SRS had to contact a hospital to find SAVVI-funded improvements to be audited. out a resident’s medication needs when she returned A number of residents at a pension-plus SRS joined without her medication. Staff at a pension-level SRS a ‘Food Focus Group’ and raised concerns with continued to support two young residents to manage staff. This resulted in a four-week menu plan with their diabetes and, pleasingly, one was recently able good variety and choice and it included vegetarian to move into independent accommodation. options. One SRS changes the menu every three to Residents with terminal illnesses were well- four weeks, yet another pension-level SRS had no supported by caring staff in the initial stages of menu on display. During a subsequent visit when it their illness, often augmented by palliative care and did display a menu on a whiteboard, it did not match community nurses, generally moving to higher care the meal being served. On two occasions, lunch at as their illness progressed. In one case, to support a pension-level SRS was finished by midday. At one such a move, staff made a photo book for the pension-level SRS, mealtimes were disrupted by resident and her family of her time in the SRS. escalated behaviours.

Community Visitors Annual Report 2012 99 Health Services

A flourishing vegetable garden at a pension-level Art plays a big role in the lives of some residents SRS continued to provide fresh produce for meals. with their work displayed on SRS walls. One A SAVVI-funded dietician is assisting the proprietor pension-level SRS has an ‘artists in residence’ and cooking staff of one SRS with ‘Healthy Ideas’, program where residents paint with watercolours. while a resident’s case manager helped make a herb Their paintings will be framed for an art display later garden in another. in the year. There is unmet need in the region for art/craft programs for residents with complex needs Community Visitors reported on the inadequacy of arising from mental health issues. the air conditioner in one pension-level SRS on a very hot day and the fact that staff needed prompting Computer access is now available at a pension-level to provide water for residents. SRS and a local community centre member comes to assist the residents. Community engagement with SRS saw a community group knit matching scarves and beanies for all A newly opened pension-level SRS lacks activities residents and a Rotary project will provide quilted for residents. The closure of activities for four blankets to all residents at another. to six weeks during the holiday season impacts adversely on SRS residents with boredom resulting In one SRS, a resident feels the need to have his in problematic behaviours. Consideration should be wallet kept in the office to avoid theft while another given to a holiday program to supplement ‘in-house’ resident’s door handle has been broken for some activities. time, so was concerned about the security of their possessions while on holidays. The region’s encouragement of best practice in pension-level SRS led to a DVD featuring behaviours and activities being produced as well Safety as an activity calendar being adopted in all SAVVI Residents’ falls are of concern. Some falls are pension-level SRS. caused by drinking; some are the result of self- harming behaviours; and others are age-related. Some residents have been hospitalised for Good practice medication reviews and for medical conditions, and one after an accident. One pension-plus SRS has provided a range of activities to engage residents. A pension-plus SRS has improved resident safety with the installation of clearly visible yellow strips Residents and their families were supported to to the stairs leading to the second level. Security participate in a quilt exhibition with two quilts made cameras were installed at two SRS to address safety by them on display, including a ‘Cats’-themed quilt. and theft issues. The smoking area at the rear of This quilt was used as the background for photos the newly opened pension-level SRS presented a taken of residents when a Geelong Football Club number of safety issues and is no longer used. representative brought the premiership cup to the SRS. A resident knitting group makes rugs for At a pension-level SRS, blood was observed the charity,‘Cottage by the Sea’, and scarves for being taken at a dining room table while afternoon Australian soldiers. tea was in progress. There are many opportunities for those residents who enjoy music with activities such as visits from Activities church choirs, a harpist and a musical entertainer. At one pension-level SRS some residents are This SRS is fortunate to have a former professional supported to undertake training while others have pianist in residence who regularly plays for on-site the option to access libraries, go to pampering church services or just to entertain the residents. 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 Finances profits donated to the Geelong Hospital. Increasingly, residents at pension-level SRS find Residents of one pension-level SRS went to a themselves with financial issues. Community Visitors community centre to learn ballroom dancing and noted difficulties communicating with administrators, have ballroom dancing in their SRS on Saturday the inappropriate use of a resident’s money to nights. Residents who are talented singers, actors support their partner’s smoking habit, and the and artists continue to perform in choirs and inability to access money due to the lack of a bank concerts while one resident recently performed account. Community Visitors noted that a financial in London with ‘Back to Back’ theatre. administrator provided insufficient evidence to VCAT resulting in the postponement of a scheduled review.

100 The move from a NSW administrator to one in Victoria was a good outcome for one resident. Eastern Metropolitan Region

Payments by administrators can be slow and drawn For much of this reporting year, there was a full out, which impacts on resident behaviour. In one complement of committed Community Visitors who case, a resident had sufficient funds to purchase a made 164 visits to 49 SRS. Of these, 13 visits were new digital television. She chose a television and at the request of a resident or another person. placed her order. Unfortunately, the administrator sent the cheque to the wrong store and this could The region has nine pension-level SRS and 40 not be rectified until they returned from leave. It took pension-plus SRS. One pension-plus SRS closed four weeks before the resident received her TV. permanently and one temporarily during the reporting year. 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 Health and personal care with his superannuation for a long time, to no avail. 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 Viability of the sector comfortable atmosphere. Resident numbers at Sea View House have declined over the year due to the uncertainty of its future. Case managers working with people who have Currently, there are only five residents although Individual Support Packages (ISP) or mental higher numbers are needed for the SRS to be viable. health concerns vary in their attitude. Community A public meeting was held in May 2012, resulting Visitors are concerned that some case managers in the establishment of a local steering committee will not communicate with proprietors regarding to consider retention options. An extension of the health and care needs of a client. Too often, time was sought from Portland District Health in mental health facilities send clients home with little order to develop a business plan. The steering or no paperwork, promising it later. In one case, the committee aims to take over the SRS in early 2013 hospital sent a bag of medications but there was no to provide accommodation and support for the follow through. existing residents, people with a disability or those The proprietor or personal care co-ordinators affected by road trauma or an acquired brain injury. assist residents who do not have a case manager. Community Visitors are hopeful that this initiative Community Visitors were notified by the OPA Advice will be successful, as it would provide continuity Service about a proprietor who saw administering for the existing residents and additional regional activities paid from a client’s ISP as too much ‘red accommodation options. tape’. As a result, the resident concerned was A Geelong pension-plus SRS was converted to an unable to attend a day program. aged care facility and all but one of the existing The health and personal care of clients is sensitively residents was accommodated by the new service. and warmly managed in most SRS, but, too often, This remaining resident moved to another SRS and people with complex mental health needs have no the timing of the family information session allowed option but a pension-level SRS. Community Visitors for maximum involvement of families in the process. have contact with a man residing in his fourth SRS One pension-plus SRS closed to undertake and, in between, has been in hospital. He appears renovations and all residents were happy to move to to have no on-going support, is adamant that he another SRS operated by the same proprietor. is able to manage his finances, however, has left owing money. Community Visitors respect his right The opening in January 2012 of a pension-level to manage his own life but are concerned that there SRS put enormous strain on Barwon Health’s Surf may come a point where this right will be removed. Coast Mental Health Team when eight residents with mental health issues moved from Melbourne Community Visitors are delighted to report a doctor to Geelong and sought local caseworker support. visits several pension-level SRS with a mental health This lack of planning and consultation with the nurse. This partnership ensures a full understanding local mental health services meant supports were of the circumstances and concerns of clients, care delayed. There was some community angst because is delivered where people live, and proprietors are this SRS had changed from one that accommodated given advice on follow-up care and medications. aged residents to younger people with mental health issues.

Community Visitors Annual Report 2012 101 Health Services

Good practice Abuse and neglect On a visit to a pension-plus SRS, Community Eviction of residents with mental health issues is a Visitors found Hannah in a wheelchair pushed into problem in this region and, in one case, has resulted a table in front of a television. She appeared very in three evictions in a matter of months. unsettled, was slumped down in the wheelchair, dribbling and unable to feed herself. The proprietor The placement of young people in SRS with much advised that Hannah was from Eastern Europe older people is of concern. These young people originally and had reverted to the language of her may have come from children’s residential care, childhood. rehabilitation units or hospital and often they are not able to fit with other residents, simply because of On the next visit, she was sitting upright and alert age, lack of experience and insight into themselves. in her wheelchair. The proprietor had found DVDs They tend to ignore rules and courtesies designed in Hannah’s native language and a doll that she for communal living such as letting someone know absolutely loves. Hannah cuddles and talks to the when they intend to miss a meal, are staying out doll as well as planting several kisses on its face and all night, drinking alcohol or taking drugs, playing head. Hannah looked totally different to the previous basketball in the corridor or playing music loud visit. She was still in her wheelchair in front of the and late. Most pension-level SRS have had young television but was now singing. 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 Dignity, privacy and choice accommodation options. Maintaining independence is important to dignity and residents are encouraged to do as much as possible Home-like environment for themselves and their decisions are respected. A SRS in the region range in style from a four-star resident recently told Community Visitors that what hotel to older ‘comfortable’ facilities. The care of she loved about her SRS was being “independent clients varies with some treated as honoured guests, but still dependent”. others as family and still others as ‘patients’ with ‘behaviours of concern’. Costs to residents range While acknowledging the need to enter people’s from the purchase of room plus payment of $700 a rooms to clean or to check they are well, many SRS week for board and care, to an average payment of respect resident privacy and most rooms have locks. 84 per cent of pension and rent allowance for board Community Visitors responded to a call from the and lodgings. OPA Advice Service from a resident in a shared Community Visitors have seen changes and room, who was unable to sleep because her improvements, especially in those SRS supported by roommate played music all night. Community SAVVI. These improvements range from an increase Visitors were dismayed to find her room very in staff, to lights in corridors being left on during the cramped with approximately two metres between day increasing the feeling of safety, to better quality the beds. Community Visitors suggest that minimum food and residents’ understanding of nutrition. space requirements could be reviewed for shared rooms in SRS. What constitutes a home-like environment can be a subjective judgment. There is general agreement, Recently, Community Visitors were invited into however, that the floor should be free and clear to a room where a man told them that he had not avoid accidents and should be vacuumed regularly. received a residential agreement and had no recollection of signing one. During the discussion, In many SRS, the cook discusses with residents a staff member entered his room without knocking. their taste preferences. Many SRS with older The next visit, another resident stressed his residents rarely serve pasta or rice; however, these difficulties with the SRS, his concerns about his tend to be staple items of the diet in pension-level health and his fear of the people who made noise SRS. Community Visitors were told it is a matter of at night. Community Visitors observed two staff cost. In SAVVI-funded SRS using dietary advice, members outside his window clearing up the the standard and quality of food is rated highly by courtyard, and listening to the conversation. These residents perhaps because they have had input into breaches of privacy were reported, however, the menu. Some residents have access to herbs and “the investigation found this matter could not vegetables from an SRS garden. be substantiated.” Community Visitors remain concerned about this lack of privacy. 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

102 the OPA Advice Service about complaints about lack As falls are a major concern in many SRS, of meat and no BBQ found, when they attended the Community Visitors have queried whether falls SRS, roast pork and vegetables had been served prevention strategies could be instituted to help that day. overcome this problem. One personal care worker tries to make sure she is Corridors are usually well-lit increasing perceptions in the resident’s room when they go into the shower of safety, while kitchens are closed. Where possible, so she can put out clean clothes for them. “I like Community Visitors check night bells and can report them to look nice,” she says. Recognising the close that one SRS has introduced touch or noise pads tie between confidence and self-care, a Maroondah which set off an alarm if a client gets up at night so church group has set up a community scheme so personal care staff can check that all is well. that every resident in the three pension-level SRS has a year’s supply of toiletries. Fire audits are the responsibility of local government and, therefore, require a separate notification to A local health group prepared posters showing ensure another authority acts which can cause dental care (cleaning dentures, brushing teeth, care confusion for Community Visitors. The region covers of gums and mouth) using the residents as models, several fire prone areas and this split seems illogical, giving them a reminder and a confidence boost. especially given the stress on safety of clients. On a recent visit, Community Visitors observed the personal care coordinator’s weekly haircut and Activities beard trim session. Care and respect for residents is often reflected in their activities schedules: hairdresser once a week, Good practice craft session and word games in the garden, golf putting in the wide hallway, organised shopping The proprietors decided to ‘do up’ the communal and day trips, or outings for lunch. Community areas of the pension-plus SRS so it was more client- groups are active in taking residents, usually from centred and less food centred. At the next visit, the pension-level SRS out for lunches, swimming and on Community Visitors found the area transformed. weekends to church services. 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 Good practice behind chairs, was accessible and the fire was lit. A resident had taken to playing Mahler and Mozart A few older gentlemen with a love of golf find it a bit on the uncovered piano. A second TV devoted to hard to get around a golf course these days. The the sport channel has an exercise bike in front of it proprietor of the SRS organised a putting competition and a Hawthorn supporter exercises as she watches with a well-marked out fairway in the corridor and her team play. The smokers’ area, given over to an great fun – and exercise – was had by all. 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 Activities range from putting a rug over a client’s happy to visit because they have ‘something to do’. knees as they watch television to being assisted One man paints and others, who had not previously walking around the garden or to a neighbour’s room done so, now take walks. 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 Safety those for whom this is not possible, it becomes even Incident reports continue to be an area of confusion. more important that the garden surrounding the SRS Community Visitors found an example where one is inviting, even if it is only to smell the roses. SRS that caters for older people had detailed incident reports, acknowledging minor falls or trips. Maroondah Council has a dedicated social inclusion In other SRS, where the clients tend to be less and wellbeing officer whose role is to work with socially able or referred from mental health services, pension-level SRS to ensure people are assisted the incident reports only record major incidents or to access the community. Finding people were altercations. A personal care coordinator recently reluctant to go to the gym, a trainer from the gym commented that the new incident report book will be went to the SRS. Other services include a council much easier to use. Community Visitors hope that bus, using the local pool and a librarian organising as SRS transition to this new reporting requirements a book group. Unfortunately, other councils told they will see more detailed and consistent reports. 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 This year, the region lost 74 beds from the local together and especially when there are changes in community after a pension-plus SRS closed, putting the residential profile, such as when people arrive additional pressure to other SRS in the region straight from hospital with insufficient information as urgent accommodation for displaced persons and follow-up. While the department advises reduces regular resident admission. proprietors to investigate new referrals before deciding whether to take people, often the hospital Recognition of Community Visitor role placement nurse pleads on behalf of the client. Proprietors then accept residents out of sympathy, The majority of proprietors embrace the role of out of fear of losing a future contact or sometimes Community Visitors enabling them to discuss, and because they cannot afford a spare room. Paper support, proprietors in concerns they may have with work, including medication scripts, usually follows their clients. though it can take some time. However, the arrangements between proprietors and the department preclude Community Visitors being provided with any action plan issued by an Case study Authorised Officer to address problems in an SRS. Consequently, Community Visitors may continually Anna’s mum phoned the police twice in raise the same issues, unaware of the timeframes or the week before she took out a family specific expectations set for resolving the issues by violence intervention order against her these action plans. 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 Gippsland Region found not to be suffering from psychosis. As she was unable to return to her own Five Community Visitors conducted 31 visits to the home, Anna’s disability case manager six SRS in the Gippsland Region. These SRS have all now been operating in the region for a number persuaded an SRS to take Anna at of years. There are five pension-plus SRS and one 5.37pm on Friday afternoon. pension-level SRS. Two SRS are solely for frail On the Saturday night, SRS staff called elderly residents and the other four SRS have police when Anna smashed the glass a mix of frail elderly residents and residents with mental health, intellectual disability or drug and doors. She then spent the night at the alcohol issues. police station where a number of police were involved in dealing with and caring for her. Health and personal care SRS staff generally provide a good level of care There was nowhere for Anna to go; the for their residents and the SRS are usually clean, SRS refused to allow her to return and comfortable and adequately furnished. Care plans all emergency accommodation was have improved and are now usually up–to-date, closed and support services do not work reflective of residents’ needs and are accessible. weekends. Community Visitors noted that although there has been an increase in residents with mental health So Anna returned home, where she issues in the region, there was a decrease in mental remained alone until Monday morning. 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 Community Visitors were pleased to report on a pension-level SRS that has been undergoing Mary, an elderly resident at one SRS, continuous renovation works throughout the regularly complained of pain and, as a year. Improvements include structural, plumbing, result, was heavily medicated. Although carpeting, painting, furnishing and landscaping Mary was being treated by the visiting renovations. The work has resulted in vast doctor who regularly attended the SRS, improvement to the SRS and its environment in order to promote harmony among the residents. she consistently told Community Visitors over a five-month period that she wanted Meals in all the Gippsland SRS usually appear a ‘second opinion’. While Community appetising, nutritious, and fresh fruit is available. Visitors regularly passed this message onto management, they claimed that, Safety in their conversations with her, she Community Visitors observed an innovative repeatedly changed her mind. Community approach to addressing emergency situations and Visitors met with Mary and the proprietor at one pension-plus SRS for frail elderly people, and confirmed her request for a second each resident had an ‘emergency bag’ clearly opinion but it took a further two months for labelled and prominently placed in their bedrooms. It contains a water bottle, undies, nightwear, blanket this to occur. Eventually Mary’s medication and documentation with relevant personal details was changed and she appears much of residents. happier. Community Visitors persistence led to a very positive outcome for There are two pension-plus SRS where residents this resident. 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 Dignity, privacy and choice residents have requested locks be placed on their Residents at some SRS can be limited in choice bedroom doors. of daily living simply by the mix of young and older residents. At one pension-plus SRS, complaints Activities were made by some older residents that younger residents made noise late into the night or early Community Visitors report a lack of activities and morning. Similarly, there were complaints from in several SRS residents sit in the lounge or lie younger residents saying that portions of food on their beds during the daytime. One SRS finds served were insufficient, though none of the older it difficult to access activities due to its isolation residents had complained about this issue. and the requirement of one service provider that residents travel to them rather than programs being provided on-site. The combination of residents Abuse and neglect lacking the confidence to leave the SRS and the lack Community Visitors noted an incident at a pension- of transport meant this was an inappropriate option. level SRS where a female resident alleged she was Consequently, the proprietor employed an activities raped by another resident. The matter was referred co-ordinator to run in-house programs to boost to police, with support provided by the SRS for the resident confidence and offer a range of options. The victim and alleged perpetrator. Community Visitors situation for these residents has improved markedly were satisfied that it was well-handled. with the generous purchase of a bus by one of the residents, thereby solving the transport issue. Medication issues have been a concerning pattern this year in one pension-plus, where this had not previously been the case. This SRS documented Good practice 106 cases over a six-month period with many incidents involving residents refusing medication Gippsland SRS have higher-than-required staff or missing it due to them being absent at the time ratios, are located in pleasant surroundings, are of administration. The department implemented generally well-run and staff are considerate when a medication review at this SRS, which resulted supporting residents in their care. One pension-plus in revised procedures, staff training and resident SRS has long-term residents of 17 years and 20 education being put in place. years who speak well of care provided at this SRS.

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Activities Grampians Region Community Visitors in the Grampians Region are pleased to note that most SRS have weekly Six Community Visitors undertook 76 visits to 13 activities plans, which means the residents are able SRS in the Grampians Region. Of these, one visit to further their engagement and involvement with was at the request of a resident or another person. their community. Of the 13 SRS in this region, nine are pension-level SRS and four are pension-plus. Most SRS in this Viability of the sector region are well-managed, providing their residents It is concerning that one SRS in the region will with excellent care. change to an aged care facility in the near future, reducing the number of SRS beds available in the Health and personal care region and placing vulnerable people at risk of Community Visitors remain concerned with the homelessness. ‘motel style’ entrances at two SRS, with no cover and residents being exposed to the elements. Community Visitors were advised that there remains Good practice no funding available to remedy this and the ageing After a long delay, a resident at one SRS has had fabric at other SRS. medical treatment which has greatly reduced his discomfort. SRS management and Ballarat Care Care plans could be improved across the region Connect have been working collaboratively to and Community Visitors urge better quality and advocate for this to occur for the last 12 months consistency in care planning. At one pension-level because of concern for his wellbeing. 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 Hume Region in SRS and Community Visitors noted funding has been used to purchase fridges, carpets and new Five Community Visitors conducted 23 visits to SRS furniture, in the Hume Region. The region has two SRS, both pension-level and managed by the same proprietor. 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 Health and personal care was not on until Community Visitors queried this. The engagement of community and health service Community Visitors continue to monitor one SRS agencies to support residents continues to be after an article in the local paper alerted them to monitored by Community Visitors. The shortage concerns about the quality of its meals. Community of suitably trained medical practitioners and allied Visitors and department staff visited the SRS health professionals impacts on resident care and to ensure residents were receiving appropriate support needs. Over the year, a number of residents nutrition. have been admitted to hospitals. Several residents have also been assessed by the Aged Care It is pleasing to report that a young woman who Assessment Service and have moved into had an inappropriate long-term placement at a aged care. pension-plus SRS has now found more suitable accommodation. This matter was raised in the Community Visitors were pleased to note that Community Visitor Annual Report 2010-2011. further care-plan training was provided to staff, in preparation for the new Supported Residential Services (Private Proprietor) Act 2010.

106 Dignity, privacy and choice Case study For almost two years, Community Visitors Good practice were concerned about the deteriorating Joan, a resident in her 80s, was assessed by the health needs of a regional SRS resident ACAS team as needing a low-care accommodation placement. Joan did not want to move and, when the with incontinence. The needs of this SRS demonstrated that they could provide the support resident were complex and challenging for needed, she was able to remain living at the SRS. SRS staff and it was difficult to get timely This is a positive example of ‘ageing in place’. treatment from the local health service. The resident’s condition was reported on monthly due to concerns about his The ‘no alcohol’ rule now in place at both SRS, has deterioration. been accepted by residents. Some residents who While intensive medical support was smoke continue to pose problems for other residents with incidents reported of residents aggressively being explored, the resident was admitted demanding cigarettes or begging for cigarettes in to hospital with severe stomach pain. The the community. resident died following an operation to rectify a blocked bowel. Abuse and neglect There was a concerted effort prior to his There were a number of incidents where residents death to coordinate the community health demonstrated aggressive behaviour after returning and support agencies, however, the fact home intoxicated. Accessing support for residents he did not recover from surgery after an with drug and alcohol issues is difficult and the emergency admission was not considered situation is often compounded by staff not having the training necessary to de-escalate these situations. a Sentinel Event by the hospital. Therefore, it was not reported to the Coroner. Unfortunately, no SRS residents were Case study able to attend his funeral. A young SRS resident was having a psychotic episode in the community. Police and ambulance services were Both SRS struggle to manage residents with called. The SRS staff were advised by the complex health and care needs as well as mental health facility (90 kilometres away) challenging behaviours though improved support that there were no beds available. The from the area mental health team has seen better ambulance service was not in a position outcomes for residents. to transport the resident and, when police There were several incidents where medication became aware of the severity of the errors were reported. situation, the resident was transported to the police station in the same town One SRS was required to accept a new resident as the mental health facility. Police were who, following discharge from a Melbourne hospital, arrived without paperwork to support their transition eventually able to get a bed for the or detailing their care requirements. The SRS had resident at the mental health facility. no information to assess whether they were able to After several weeks of treatment and support this person, although the information was provided a short time later. medication changes, the resident returned to the SRS and is receiving the ongoing One resident who was refusing most meals received support of the mental health service and support from the department with the development the SRS staff. of a new eating plan. SRS staff supported the implementation of the plan and the resident agreed This demonstrates how community to follow it. This was a pleasing result. 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.

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Home-like environment Finances SAVVI funding continues to be a positive initiative A resident who wanted to manage his own finances for both SRS. was assisted to do so by staff at one SRS. He obtained a photo ID card and was then able to get This year, while the fresh fruit initiative continued his own bank keycard. for a further six months, the main focus was on supporting the SAVVI-eligible SRS to ‘get ready’ There was one incident where a resident was for the implementation of new Act. evicted for failing to pay accommodation fees. Ongoing maintenance issues at both SRS are regularly reported, though it was pleasing to note Recognition of Community Visitor role that a major kitchen refurbishment was completed It is important that SRS staff understand that at one SRS. Community Visitors are volunteers with specific responsibilities under the Act aimed at supporting Community Visitors would welcome greater support SRS residents to lead more engaged and rewarding for residents’ independence and a broader range of lives. There were a series of difficult interactions activities such as the purchase of computers for use between staff at one SRS and Community Visitors, by residents. which at least in one instance, became open hostility. This led the program to work creatively with Safety the department to address these issues. The department finally funded the replacement of A ‘round table’ facilitated by an experienced mediator the fire safety alarm system in one SRS. However, took place and allowed SRS Program staff and Community Visitors still report a faulty alarm at Community Visitors to discuss perceptions of the the other SRS. Despite this, regular audits of the others’ role and work through difficult issues. This system by an independent auditor have found the very productive session improved the relationships system to be compliant. Community Visitors remain and engagement between the Community Visitor concerned that the intermittent non-emergency and SRS Program. 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. Loddon Mallee Region

Eight Community Visitors in the Loddon Mallee Activities Region undertook 55 visits to seven SRS. Two of It is pleasing to note the variety of activities available the visits were requested by a resident or others. to residents at the two SRS. The region has four pension-level and three pension-plus SRS. A number of residents at one SRS have enjoyed participating in a local Mental Illness Fellowship Community Visitors have significantly increased program of weekly activities. Some residents have their number of visits within the region and should also enjoyed short holiday breaks organised by the be congratulated for their persistent hard work same organisation. and dedication. Both SRS have cultivated vegetable gardens and also have chickens. One SRS has a community Health and personal care worker who attends weekly to engage with and Care plans in most pension-level SRS are basic encourage this resident activity. and fail to capture the full care-needs of residents. One SRS has a weekly swimming and gym program Incident reporting continues to be of concern. One for the residents. A local community organisation pension-level SRS had an incident report book that has donated fishing rods and stools and fishing was 14 years old and a pension-plus SRS had one excursions will occur when the weather is fine and that was nine years old. One proprietor said that she staff are available. kept her own private incident report book. Generally, incident reports contained very little information, The other SRS has started a regular residents’ with little or no follow-up. Community Visitors look meeting to engage with residents and gauge their forward to the incident reporting requirements under interest in activities. Community Visitors regard this the new Act, which come into effect at the beginning as a positive initiative. of the next reporting year. They anticipate that this will provide a wealth of information, which should lead to better protection for vulnerable residents.

108 Community Visitors report an improvement in in the same small bedroom. Another resident, so palliative care for affected residents who received disturbed by the behaviour of other residents, was regular visits from their doctor and palliative care evicted when they resorted to violence. At another nurses. The extra support and monitoring of pain pension-level SRS, a resident with mental health management by staff is vital. Because pension-level issues who had recently been discharged from a SRS staff may not have palliative care qualifications mental health facility was facing eviction because to support residents in these situations, it is essential of their behavioural issues. Sadly, due to the lack of they receive training alternate accommodation, these residents can end up living without any support in a caravan park. One concern reported is residents receiving palliative care in shared rooms. This situation The high incidence of resident falls and lack of impacts adversely on both the person receiving appropriate monitoring of subsequent support and palliative care and their roommate. healthcare needs in both pension-level and pension- plus SRS, means that fall prevention guidelines are urgently needed. Case study A resident at one pension-level SRS had fallen Bronwyn is a relatively new SRS multiple times causing pain and bruising. After another fall, he was on life support in hospital resident who previously received life- for a lengthy period before moving to high-care threatening injuries, resulting in a lengthy accommodation. One pension-plus SRS reported recuperation. She was displaced from her eight resident falls in two months resulting in home, has cognitive impairment and still one resident breaking their hip and needing suffers from intermittent headaches. rehabilitation. Another resident at a pension- plus SRS fell down a ramp, was hospitalised Bronwyn had not found a friend in this and subsequently relocated to a nursing home. SRS, even though there are a number Community Visitors are now pleased to report that of residents of a similar age. this proprietor is upgrading facilities to minimise the risk of resident falls. Bronwyn’s long-term goal is to apply for her own unit, so she can be more A pension-level SRS resident was recently attacked independent. She indicates that she does by a dog that was under the supervision of the not want to be in an SRS for the rest of proprietor. The resident suffered bruising and severe facial lacerations that required multiple stitches. her life and has difficulty coping with the A resident with a mental illness who resides at needs of some of the older residents in a pension-level SRS, was found wandering near the SRS. a main highway. These instances raise concern With intensive assistance and about the level of monitoring SRS residents receive. appropriate support, Bronwyn should eventually be able to fulfil her goal of Home-like environment independent living. 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 high- fat food continues to dominate the menu. Some Dignity, privacy and choice residents complained that they no longer receive Room-sharing often leads to difficult situations a biscuit with their morning and afternoon tea. The because of the disruptive behaviour of roommates. lack of fruit supplied to residents is another issue Residents can feel uncomfortable, offended and carried over from the Community Visitors Annual even depressed but have little choice because there Report 2010-2011. At one pension-level SRS, some are limited alternatives. 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 Abuse and neglect daily servings of fruit, nor should they be restricted in An inappropriate mix of residents resulting in the amount of fruit they wish to consume. arguments, anger and abuse has led to a number of evictions. All residents have the right to live in peace It was pleasing that the fabric of one pension-level and harmony and not be subjected to violent and SRS had improved using SAVVI funding to provide anti-social behaviour. A new resident at a pension- amenities such as new lounge suites, dining settings level SRS complained that he could not sleep due to or even clothes dryers. A fresh coat of paint to older the constant disruption and noise of his roommate buildings, and new carpet and tiling has brightened

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up many areas. The creation of outdoor areas has Finances proved very popular with the residents. On the other At one pension-level SRS, only one resident is hand, it was disappointing that an outdoor billiard receiving regular statements from State Trustees table (purchased with SAVVI funding and mentioned Limited, with others having to ask for them. At in the Community Visitors Annual Report 2010-2011) another pension-level SRS, staff went out of their remains idle. It was disappointing that such a large way to help a resident to complete forms received amount of money was used for this purchase and from the State Trustees Limited. this has not been of benefit to residents. The SRS should consider selling the billiard table and using A pension-level SRS resident complained he was the money more productively. paying more in rent than other residents. While the SRS explained that this related to the extra care he received, Community Visitors observations were Safety to the contrary and they will continue to monitor Community Visitors are disappointed with the lack this issue. of response of a proprietor after repeatedly reporting serious safety concerns at one pension-plus SRS If rents are increased due to increased pension where items, such as bed frames, are partially payments, then this should be fully explained to blocking the small passage that leads to the exit residents to ensure they understand it. Concern has door. In an emergency, many residents would find been expressed about the potential for the carbon evacuation difficult, particularly if they have limited tax to be used to justify rent increases, although the mobility or use aids. This will continue to be raised program has no found no evidence to substantiate with the department until it is satisfactorily resolved. this. Community Visitors intend to monitor this issue in the coming year. Activities While residents at pension-plus SRS appear to Information and complaint processes have numerous and varied activities, residents at Residents have raised many issues and complaints pension-level SRS continue to have less opportunity with Community Visitors such as finances, fairness, to engage in community and social activities. This is equity, dignity and support. All of these issues due to varying levels of commitments by proprietors. were discussed with SRS staff or raised with the department as appropriate. Many of these issues remain unresolved despite the best efforts of the Good practice Community Visitors through the agreed protocol process. Community Visitors will continue to Management and staff at one pension-level SRS advocate for the rights and dignity of SRS residents. 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 Recognition of Community Visitor role local agencies. The manager and staff also display It is important that SRS staff understand that a commitment to residents by accompanying them Community Visitors are volunteers with specific on outdoor and artistic activities. responsibilities under the Act aimed at supporting Community Visitors regularly find when visiting that SRS residents to lead more engaged and rewarding many of the residents are out enjoying life in the lives. A number of challenges by SRS staff to community. Residents actively participated in fishing Community Visitors training and authority, as well trips, football and other sports-related trips. Some as open hostility in some instances, led the program residents formed their own competitive basketball to work creatively with the department to address team. Other activities included a holiday to Port these issues. Arlington and sightseeing trips on the Sorrento A ‘round table’ facilitated by an experienced mediator Ferry and the Drysdale train. took place and allowed SRS Program staff and Residents were also encouraged to enter a regional Community Visitors to discuss perceptions of the art competition and one resident won first prize with others’ role and work through difficult issues. This his ‘Portrait of Mum’. very productive session improved the relationship and engagement between the Community Visitor The residents maintain a floral garden which rambles and SRS Programs. over approximately half an acre and a productive kitchen garden which supplies fresh vegetables for their meals.

110

Good practice Extensive changes have taken place under the Case study new management of a very popular pension-plus Carol, a pension-level SRS resident, was SRS. A new upstairs wing caters for transitional reported missing. A couple of hours later, care residents and can accommodate up to 22 she was brought back to the SRS by a taxi residents. This area, completely separate from the driver. Blood was found on her underwear SRS, offers services including speech therapy, case management, aged-care specific medical services and she was taken to the doctor. and access to a geriatrician and physiotherapy. Carol disclosed to her doctor and an Recently built, features include a new office for SRS manager that she had been sexually the transitional care staff, a separate medication room (with a two-way mirror) and another room assaulted twice by two different people solely for storing care plans. A lift will be installed in the time that she was missing. She to replace the long ramps and there are future also alleged that the male SRS proprietor plans for a coffee shop and doctors’ surgery. had previously sexually assaulted her. SRS residents have access to the numerous and It was agreed these allegations should wide-ranging activities offered by a very diligent be reported to the police but it took two activities coordinator. 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 North and West Metropolitan Region assault allegations about the male (North) proprietor a number of months earlier but nothing was done about it. Ten Community Visitors conducted 113 visits to Carol’s case manager, who had been 19 SRS in the North and West Metropolitan Region contacted when she went missing, was (North). The region has nine pension-level SRS and ten pension-plus SRS. very concerned about her state. This, and the fact that the SRS manager felt unsupported and unaware of how to Health and personal care handle the situation, led the case It was noted that care plans and other resident manager to contact OPA’s Advice Service. support documentation was generally well- maintained and up-to-date in the pension-plus SRS. The Public Advocate visited the SRS However, some pension-level SRS continue to with Community Visitors to assess the have out-of-date and unsigned care plans that are situation. She also met with the case not accessible to Community Visitors or even staff. manager and the department. The Community Visitors question how staff can support residents when they can neither access care plans departmental response was slow and not or care plans are not reflective of the residents’ as comprehensive as it could have been. current situation. It is concerning that Community Despite the best efforts, Carol remained Visitors, empowered under the legislation, are denied access to care plans and other relevant living at this SRS for a further three weeks. documents simply because staff cannot locate them. However, it took considerably longer before she was housed closer to her Community Visitors also reported a lack of soap and family in another region. towels in a bathroom of a pension-level SRS. This raised health and hygiene concerns for residents, Police advised charges would be laid however, it was quickly remedied. against the male proprietor, however, proceedings ceased when he died. Abuse and neglect Community Visitors were troubled by the This year there were serious allegations of sexual fact that it took so long for staff to notice assault in one pension-level SRS in the region. This Carol’s absence and pondered whether matter was included in a report to the Minister as it raised a number of very concerning issues.

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these assaults could have been avoided North and West Metropolitan Region if her absence had been reported to (West) police earlier. Six Community Visitors conducted 102 visits to It was concerning that Carol did not have 14 SRS in the North and West Metropolitan Region the support of an Independent Third (West), of which one was requested by residents Person (ITP) in her dealings with police. or another person. ITPs are specially trained OPA volunteers The region has eight pension-level SRS and six who support anyone with a mental illness pension-plus SRS. One pension-plus SRS closed or a cognitive impairment during a police during the reporting year. Community Visitors are interview. 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. Home-like environment Community Visitors continue to support SAVVI funding and note the positive influence it has within Health and personal care the pension-level SRS. In particular, residents Generally, all SRS have positive and inclusive appreciate the fresh fruit initiative. resident care plans, with one exception at a pension- level SRS. At this SRS, Community Visitors noted Maintenance and housekeeping issues persist at little change from residents’ initial care plans, as well some pension-level SRS with Community Visitors as the filing of resident care plans against the wrong raising concerns about rubbish and clutter, mouldy room number in some cases. showers and the serious safety issue of residents’ call buzzers not working. Also reported were lengthy While residents at one SRS are well-groomed and delays to repair a severed phone line. dressed appropriately for the weather, at another pension-level SRS residents are regularly observed A resident at a pension-plus SRS complained that to be dirty and dishevelled. he could not read due to poor lighting while, at a pension-level SRS, residents complained that they Community Visitors noted that, at some SRS, there were cold as the heater was inoperable. While it was is little variation in the menu and residents have pleasing that they were promptly responded to, it few vegetable choices with one pension-level SRS was concerning that these issues were not dealt with reported as serving boiled cabbage every day. prior to Community Visitors raising them. Community Visitors noted that a staff member at Concerns relating to meals and food storage a pension-level SRS, who was not rostered on continue to be reported, including unlabelled food duty, was listed as having signed off on dispensing stored in a freezer and boxes of rotten fruit being left medication, when some medication had allegedly on tables in a recreation area. At one pension-level not been dispensed at all. SRS, there were not enough chairs at the dining tables for all residents, so some residents had their Community Visitors reported with concern that meals in their bedrooms, resting plates on their staff at one pension-level appeared unavailable to knees. While this has now been rectified, it should support residents at night. A sign was placed on the not have happened in the first place. staff sleep-over door stating ‘Do not knock between 7pm and 7am’. Despite staff advising that they Community Visitors encourage proprietors and staff were available should an emergency arise, this sign to support their residents in a positive home-like deterred residents from contacting them. environment. Community Visitors regularly report residents in bed throughout the day with little motivation or alternative Safety activities for them to be more engaged and involved Some pension-level SRS continue to have difficulty in their community. supporting residents with challenging behaviours and this significantly impacts on other residents and staff. Dignity, privacy and choice At one pension-level SRS, a door thought to be too A pension-level SRS resident approached close to the stairs and creating a potential risk to the Community Visitors gravely concerned and fearful residents walking past, has been reported. While of being evicted. Despite Community Visitors raising a sign has been affixed to the door, Community this with the department, nothing could be done, as Visitors remain concerned about the risk to residents the eviction threat was not perceived to be imminent. and wait on the results of further inquiries.

112 Abuse and neglect When Community Visitors noted in a pension-level Resident complexity and mix at pension-level SRS SRS that the shower in a resident’s room was not remains an ongoing concern. Community Visitors working, staff advised that residents could use have reported concerns regarding violence, abuse another shower in the SRS. and neglect of residents in some pension-level SRS. An increase in aggression and violence potentially stems from residents with drug and alcohol-related Good practice - A pension-plus SRS where problems. Staff organise additional supports for the ‘plus’ is a little bit extra residents where possible but, in many instances, the When a proprietor noticed a resident taking an chaos continues and is only resolved when evictions interest in the garden, asking questions about occur or police are called to intervene. various plants and how to bring the old garden back Some residents reported living in fear of other to life, he brought a range of gardening equipment residents who have assaulted and caused injury to and seeds. Soon plants were propagated, both residents and staff. One female SRS resident beds raised, lawns came to life, trees fruited, a was fearful that her ex-partner would find her and passionfruit vine covered an old gazebo, and herbs kill her. Community Visitors were concerned that and vegetables were in abundance. A pleasing situations such as this could pose a security risk to aspect was the return of many native birds (lorikeets other residents. and rosellas) to the garden. Other residents now take an interest in and take pleasure from what The neighbour of an SRS tragically committed happens outdoors. 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. At three pension-level SRS, poor cleaning and Further counselling was offered but was not taken hygiene standards are regularly reported. Examples up by anyone. However, Community Visitors remain include dirty floors, unwiped tables, black mould concerned about the long-term effect of this incident around condiment containers, dried food on the on residents. dining room walls, bathrooms with mould on Residents also regularly complain about one staff showers, bed linen that appears to be infrequently member yelling at them and generally treating them changed, and cigarette butts left discarded around discourteously. This behaviour is not acceptable as the SRS. this SRS is their home. While there has generally been an improvement Community Visitors continue to express concerns in SRS menu planning and meals, some pension- with the inadequate and inconsistent reporting and level SRS residents complained they are frequently recording of incidents at SRS. At one pension-level served dessert before the main meal, they are SRS, staff were unaware of an alleged assault the served stale rolls and broiled chops and boiled previous night and nothing had been documented cabbage or savoury mince padded with rice and nor mentioned at handover. In another case, the gravy. Community Visitors observed a resident, proprietor could not show Community Visitors any who had kitchen duties as part of their care plan incident reports and was unaware of the procedure activities, licking their fingers while making residents’ to record them. Violence and aggression could be sandwiches for lunch. minimised if staff reflected on potential triggers by Community Visitors note that, every winter, one reviewing incident reports. pension-level SRS is extremely cold. On one Community Visitors are eagerly awaiting occasion, residents were observed wearing beanies the implementation of the incident reporting and dressing gowns over their clothes to keep warm. requirements in the new Act in the next Staff advised the heater was broken but had done reporting year. nothing to organise its repair. This was reported to the department who undertook to ensure the repair occurred promptly and that interim measures were Home-like environment put in place to keep residents warm. 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.

Community Visitors Annual Report 2012 113 Health Services

Safety Recognition of Community Visitor role Community Visitors at one pension-level SRS It is important SRS staff understand that Community reported hazards such as passageway lights being Visitors are volunteers with specific responsibilities inoperable and lifting and bubbling flooring. One under the Act aimed at making the lives of people in resident cut his foot on exposed nails from a carpet SRS more supported, engaging and rewarding. In tack strip that had been removed. Residents are a few instances this year, Community Visitors have entitled to walk safely about SRS. found themselves in situations where they were challenged or their authority questioned. This led the Residents have complained to Community Visitors program to work creatively with the department to that boarders from houses on either side of the address these issues with very positive outcomes. SRS have entered their rooms, uninvited and stolen money. Residents have requested locks for their At one SRS, Community Visitors were constantly bedrooms to protect their belongings but this has unable to observe and report issues. The proprietor not occurred. verbally abused Community Visitors, aggressively demanding they leave the premises. Residents While there are a number of SRS who have provided reported they were told not to talk to Community very positive and informative evacuation information Visitors for fear of reprisals if they did. At another for their guests and residents, one pension-level pension-level SRS, Community Visitors found a sign SRS failed to provide clear emergency evacuation affixed to a cupboard stating that the department procedures and information. had advised the SRS that Community Visitors were A Community Visitor injured her hand after the door authorised to view incident reports and care plans rail on the stove fell off. Her injured hand took a long only and any further documentary requests should time to heal. However, this was also not recorded as be referred to the region’s Authorised Officer. an incident by the SRS. A ‘roundtable’ facilitated by an experienced mediator allowed SRS Program staff and Community Activities Visitors to discuss their perceptions of each other’s It is positive to report that the simple provision of role and work through difficult issues. This very an oval table at one pension-plus SRS encouraged productive session had a transformative effect on residents who would normally have been sitting the relationships and engagement between the around the SRS in chairs to sit around the table Community Visitor and SRS Programs. 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 Southern Metropolitan Region create jigsaw puzzles. Twenty-one Community Visitors conducted 286 visits A resident of a pension-level SRS returned to her to 51 SRS; of these, 14 visits were at the request homeland for a holiday accompanied and supported of residents or other people.The region has 25 by a SRS staff member. Her family were supportive pension-level and 26 pension-plus SRS. of this occurring. Health and personal care Viability of the sector Most pension-plus SRS continue to provide well- The closure of a pension-plus SRS reduced the planned and documented care plans to meet their available beds in this region by 44. The closure of residents’ support and care needs. However, some this SRS not only impacts on the residents forced to residents remain poorly catered for in this area. In find alternate accommodation but on members of the one instance, Community Visitors were advised community who would prefer to reside in a low-care that a local doctor had concerns regarding the facility, rather than in aged care. inadequate care provided to residents at a pension- level SRS so the female doctors in the practice did Community Visitors are also concerned about the not visit the SRS due to safety concerns. lack of pension-level beds available in this region. Resident mix and compatibility issues may mean Care plans continue to lack strategies to support that the only choice in living arrangements is to residents with changing physical and medical needs. move from one SRS to another and back again There is still concern regarding the inadequacy of or be homeless. 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

114 when the SRS has a low roster of staff and not a and they did not return to the SRS. At another normal acceptance time. The resident left the SRS pension-level SRS, 16 incidents were recorded since almost immediately but was not missed by SRS staff the beginning of March 2012, with many relating until the morning shift. By then, police had found the to one resident with issues such as aggression, person dead in that area. inappropriate behaviour, threats of suicide, self-harm and repeatedly calling ambulance services. The There are concerns that some SRS are either not resident’s mental health caseworker is seeking a willing or are unable to provide the level of support more appropriate placement for them, however, this that some residents require. A resident, who is is taking some time. diabetic, complained that her support needs were not being met in one SRS and in another, where Community Visitors in this region are concerned more then a third of the residents are diabetic, some about the neglect implications of repeated eviction complained that the SRS did not accommodate their on some residents with complex and challenging dietary needs. Community Visitors reviewed the behaviours. One of the most serious of these cases menu plans and undertook to raise the resident’s is reported in the statewide section of this report. concerns with the proprietor. Two residents were evicted twice in six months Community Visitors reported, at times, SRS were because of their abusive behaviours to other being used inappropriately as respite facilities residents. Some SRS proprietors accept residents for people discharged from hospitals after major without prior knowledge or planning for their complex surgery. Often they arrive with no proper discharge needs and then their only recourse is to complain notes or medication. Most SRS staff are ill-equipped about the lack of information and support from case to support and care for these people. managers or eviction. The timely and appropriate consideration of a Dignity, privacy and choice prospective resident, their support and care needs Many residents appear happy sharing bedrooms and the ability of the SRS to provide safe, supportive however, privacy and dignity of residents is and harmonious accommodation for them. sometimes compromised. This can become a major Prospective residents and existing residents must be issue if incompatible residents have been placed a priority. The ad hoc acceptance of residents has together. demonstrated an unacceptable risk to members of our community seeking accommodation and support in SRS. Abuse and neglect Community Visitors have reported multiple incidents occurring at many pension-level SRS involving drug Home-like environment and alcohol abuse, inappropriate sexual behaviour, The meals and variety in menu is reported as very alleged rape and indecent exposure, violence, positive and, overall, residents appear to be very aggression and attempted suicide. This can lead to happy to have a roof over their head and three police and ambulance being regularly called to these meals a day. Without this, many would potentially be SRS. homeless. Residents with mental health issues and complex Community Visitors report that, in some pension- behaviours, continue to create enormous problems level SRS, residents’ drug alcohol use severely for proprietors and other residents. Staff often do not impacts on the quality and home-like environment have the skills or training to manage these issues. for other residents. All SRS have seen a marked increase in a younger demographic replacing the At one pension-level SRS, there is a volatile mix frail-aged population, and the mix can create a of residents with complex needs. While residents difficult living arrangement for all. have expressed their concerns that the proprietor moves problematic residents between SRS they This year, SAVVI was more focussed on SRS and own, there are no other housing options for these staff ‘getting ready’ for the new Act. Funding was residents and he is reluctant to evict them for fear of provided to the SAVVI-eligible SRS to replace homelessness. staff so that they could undertake information and training sessions as well as provide managers and A number of residents who have threatened and proprietors with opportunities to gain business and attempted suicide are served eviction notices or legal advice to support meeting the requirements not allowed back to the SRS after hospitalisation. of the new Act. The residents welcomed the One incident report detailed an attempted suicide continuation of the Fruit Initiative for a further by a resident who lay in the middle of the road. The six months. resident was transferred by ambulance to hospital

Community Visitors Annual Report 2012 115 Health Services

Community Visitors also noted the activities of ERMHA which was well-attended by the community two SRS were included in the publication Stories and service providers. This provided positive from SAVVI which demonstrated the positive recognition and support of individual skills and improvements in the viability of the SRS and achievements and was a welcome opportunity for provided residents with better support, new community inclusion for these residents. opportunities and a more home-like environment. While Community Visitors reported an overall Good practice decrease in maintenance concerns, there were many reports relating to unclean bathrooms, mouldy Community Visitors were impressed when a local showers and curtains, unhygienic toilets and council installed gym equipment in a pension-level cigarette butts strewn around the SRS. SRS and engaged a physiotherapist to ensure correct usage of the equipment by residents. This complements the weekly walking program the Safety council has provided to residents for several years. 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. Finances Community Visitors noted with concern a number Concerns have been raised about the potential of fires reported to be caused by residents at some for the carbon tax to be used to justify rent pension-level SRS. One resident of a pension-level increases although the program has no evidence to SRS is alleged to have set some cloth material alight substantiate this. Community Visitors will monitor in a bucket in the laundry causing damage to a wall, this issue. cupboard and washing machine and a fire erupted when another left cigarette butts in an outside Viability of the sector ashtray. Four pension-plus SRS and two pension-level SRS A resident of one pension-level SRS deliberately set closed during the reporting year and one pension- fire to bedding in his room, badly damaging it, and plus SRS remains temporarily closed. the room required total refurbishment. Police were involved when the attending fire officer deemed it a Residents had been well cared for in two SRS and crime scene. The resident was evicted from the SRS were distressed when they were slated for closure. and the proprietor expressed concern regarding lack These two SRS were placed in the hands of of available assistance from various agencies to administrators and, although their approach was support the remaining residents. uncoordinated, all residents were placed by the Of serious concern to residents is the risk to required time. However, in one case, a resident residents caused by inactive or inoperable fire was not given any choice of accommodation and alarms or fire panels and blocked fire exits. One was placed in a retirement village close to shops, SRS advises that there have been delays in the contrary to her documented needs. This person had alarm company attending to rectify. One persistent no family to assist with her placement. alarm fault was rectified after a resident left the Later in the year, one pension-level SRS, where SRS. The department has advised that the local there were grave concerns for the safety of the council and/or the fire brigade have authority in residents, closed. The department managed the these matters and has attempted to liaise with these process for relocation and involved all service organisations. In the meantime, residents remain providers and Community Visitors. It was well- at risk of not being aware of an emergency situation coordinated and all residents were provided with because of a faulty/inoperable emergency more than one choice. Some residents had trial alarm system. stays before they made their decision. Community Visitors monitored resident moves and visited Activities them to ensure they were settling in and had Activities continue to be positive and engaging appropriate support. for residents with many external service providers Ten years ago there were over 83 SRS in the region, providing options for those wishing to participate. now there are only 51. This equates to an average At one pension-level SRS, staff place resident loss of about 1150 beds for people in the region. It special-event photos and trophies in strategic is very disappointing that so many SRS have closed locations around the SRS for all to see. At another within this reporting year. SRS, staff held a resident art show supported by

116 Facilities eligible to be visited by Community Visitors 2011-2012

Mental Health Disability Services providers 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 Merriwa Industries Forensicare Organisation Inc. MIND Goulburn Valley Health Australian Home Care Services Mirridong Services Inc. La Trobe Valley Health Autism Plus Transitional MOIRA Inc. Accommodation Mercy Health and Aged Monkami Centre Inc. Care Inc. Bayley House Multiple Sclerosis Limited Northern Health Brighton & District Branch Helping Murdoch Community Services Inc. Hand Association for Intellectually North Eastern Psychiatric Services Disabled Inc. Murray Human Services Inc. NorthWestern Mental Health Carinya Society Nadrasca Peninsula Health Colac – Otway Disability Nepean Centre for Physically Ramsay Health Services Accommodation Inc. Handicapped Inc. Royal Childrens’ Hospital Community Connections (Victoria) Northern Support Services for People Southern Health Limited with Disabilities South West Health care Community Living and Respite Noweyung Limited St Vincent’s Health Services Inc. Oakleigh Centre For Intellectually Disabled Citizens Inc. Stawell Regional Health Services ConnectGV ONCALL Personnel & Training West Wimmera Health Services Cooinda-Terang Inc. Plenty Valley Community Services Inc. Western Health Department of Human Services EW Tipping Foundation Inc. Providing All Living Supports (PALS) Family Plus Inc. SCOPE Victoria Ltd Focus Southern Way Direct Care Gateways Support Services Services Inc. Gellibrand Residential Services Inc. St John of God Services Victoria Golden City Support Services Inc. Statewide Autistic Services Inc. Healthscope Limited STAY – Residential Services Independence Australia Association Inc. Ivanhoe Diamond Valley Community Sunraysia Residential Centre Inc. Services Inc. Jesuit Social Services Limited Uniting Care Harrison Community Services Jewish Care (Victoria) Inc. Victoria Deaf Society Karingal Inc. Villa Maria Society Kirinari Community Services Inc. Wallara Australia Ltd Knoxbrooke Inc. Wesley Mission Victoria Kyeema Support Services Inc Wimmera Uniting Care Life Without Barriers Woodbine Inc. Lifestyle Solutions WRESACARE Inc. Maccro, Mansfield Adult Autistic Services Limited 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 Crutchfield, Graeme Sydenham Grace Beard, Jane Cull, Robert Templestowe Manor Bechaz, Vicki Cunningham, Robyn (RC) Templestowe Orchards Retirement Becket, Anne-Marie Cunningham, Cheryl Living Bink, Judith D’ Cruze, Noosha Blythman, Marion (RC) The Connault Dalrymple, Doreen Bodenham, Margaret The Heights Daly, William Boland, Dominic The Manor (Glen Waverley) Dann, Aideen Bolton, Sally Themar Heights Dare, Linda Borg, Myra Trentleigh Lodge Davies, Aaron Borg, Sam Vermont Gardens Davis, Valmai Bowen, John Veronica Gardens Davison, Pat Bowman, Lisa (RC) Viewbank House Di Iorio, Sonia Bragge, Kathleen (RC) Viewmont Terrace Dickinson, Graham Brown, Geoff Dimer, Christine Warranvale Brown, Jeanise, (RC) Dimopoulos, Taz Warrina Retirement Village Brown, Cassandra Dinner, Stephen Wattle-Brae Supported Brown, Susan Residential Service Brubacher, Marc Dixon, Sue Waverley Hill SRS Bryan, Peter, Doherty, Diane Westley Garden Buckles, Ian (RC) Donohue, Diana Whitehaven Burbidge, Andrew Downing, Audrey (RC) Windermere Retirement Lodge Butler, Ronald Drayton, Robert Woodford Gables Byard, Tennille Duell, Liz Wynalla House Cahill, Pamela Dunbar, Jan

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 King, Chris Nichol, Philippa Santowiak, Jeanette Gleeson, Kathleen Lagerwey, Tineke Nicholson, Judi Scott, Bill Gleeson, John Lawrence, David Nirens, Sherry Scrace, Raymond Glenn, James (RC) Libbis, Beverley Nutt, Edwina Seavers, Brenda Glover, Fiona Lippold, Margaret Nyikos, Paul Sedgewick, Amanda Gold, Una Lloyd, Vashti O’Brien, Michael Shafar, Robert Grace, Audrey Locke, Ken O’Connor, John Shallow, Lois Graham, Eddie Loxton, Kathleen (RC) O’Neil, Anne Shaw, Rosemary Graham, Bernie Luke, Graeme Owen, Barbara Shoebridge, Colin Green, Avril MacIntosh, Brian (RC) Pargetter, Faye Shoebridge, Margaret Green, Ernie MacKenzie, Keith Park, Sonia Sholl, Eileen Green, Hannah Mai, Karin Parker, Dave (RC) Sivakumar, Puvana Greenland, Linda Manners, Kaye Parrott, Barbara Slattery, Mike Greenwood, John Marriott, Neville Patchett, Wendy Smith, Jenny Gribble, Alison Martin, Ross Paterson, James (RC) Stafford, Meredith (RC) Grigson, Alan Martin, Raymond Pearson, JP, Loes Stannard, Mary Groves, Judi Masovic, Bob Peldys, Roman Steadman, Ray (RC) Guglielmino, Trish Maugey, Julian Penning, Jillian Sterlus, Erlinda Gulizia, Donna May, Kathy (RC) Penry-Williams, Peter Stewart, Evan Hadley, Michael (RC) McBeath, Ian Penson, Barbara (RC) Stickland, Graham Hammer, Garry McCann, Debra Perry, Jennifer (RC) Stone, Loraine Harraway, Susan (RC) McCarthy, James Pfeifer, Wendy Stoneman, Jenny

120 Acronymns

Straney, Suzanne BIST Behaviour Intervention Sullivan, Bernadette Support Team Sullivan, Victor BSP Behaviour Support Plan Taft, Leon CALD Culturally and Linguistically Diverse Talati, Jayesh CCU Community Care Unit Tarrant, Paul CRF Community Rehabilitation Facility Taylor, Will (RC) CSO Community Service Organisation Taylor-Barnett, Pamela DAS Disability Accommodation Service Terranova, Alessia DH Department of Health Thimm, Margot DHS Department of Human Services Thomas, Kathryn ECT Electroconvulsive Therapy Thompson, Mark ED Emergency Department Thornley, Jim (RC) HACSU Health and Community Services Union Thurrowgood, Rosslyn (RC) HCA Housing Choices Australia Titman, Cherie HDU High Dependency Unit Tribe, Helen ISP Individual Support Package Trompf, Julie KRS Kew Residential Services Tune, Marion LGA Local Government Area Tunstall, Merrill OPA Office of the Public Advocate Turner, Gary OSP Office of the Senior Practitioner Tyben, Lana MHRB Mental Health Review Board Udorly, Michael NDS National Disability Services Vallance, Helen PARC Prevention and Recovery Care Volk, Christine PCAS Person Centred Active Support Wallace-Clancy, Lynne PCP person-centred plan Warren, Elizabeth PRS Plenty Residential Services Waters, Betty SAVVI Supporting Accommodation for Vulnerable Webster, Joy Victorians Initiative Wellwood, Marion (RC) SECU Secure Extended Care Unit Wescott, Christine SRS Supported Residential Services White, Judith VDDS Victorian Dual Disabilities Services Wilde, Dianne 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

OPA uses Greenhouse Friendly™ ENVI RECYCLED 50/50 ENVI RECYCLED 50/50 is an Australian Government certified Greenhouse Friendly™ Product.

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