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Providers registered in any registration category must use this form to notify the Commission of this type of change in circumstances.

The guidance for this smart form does not cover questions, such as those relating to identification or contact details, which are self-explanatory.

If the new responsible person is a member of the governing body, you need to also complete the ‘Significant change in the organisation or governance arrangements of the provider’ form.

Section 2: Job role

These questions relate to sections 12, 13 and 167(3)(c) of the Aged Care Act 2024

Questions 2.1.1 to 2.1.4

Explanatory Note
  • The Occupation Standard Classification for Australia (OSCA) establishes definitions for job classifications based on skill level and specialisations required for specific occupations. Classifications are broken down into major, sub-major, minor and unit groups, and occupations. For each occupation, OSCA provides a statement describing the nature, main activities and skill level. For question 2.1.2, provide an explanatory response in section 8.1 with reference to the OSCA guidance 

  • For Question 2.1.2, job role should be consistent with OSCA occupation definitions

Evidence
  • For questions 2.1.3 & 2.1.4, include attachments to support your response, such as employment contracts and role/position description
  • Any other documents to support your response
These questions relate to sections 13(1)(g)(viii) and 167(3)(c) of the Aged Care Act 2024

Questions 2.2.1, 2.2.2, 2.2.5 and 2.2.6 

Explanatory Note
  • Questions 2.2.1 to 2.2.6 only need to be answered if you selected ‘a registered nurse responsible for the management of the nursing services’ for question 2.1.4

  • Provide Ahpra registration details for each responsible person

  • If ‘no’ to all options in Question 2.2.5, no additional information is required 

  • Otherwise, if ‘yes’ to any option in Question 2.2.5, provide an explanatory response explaining what the registration is subject to

  • In the context of Question 2.2.6, ‘state’ refers to any conditions the registration has been subject to (e.g. conditions, undertakings or reprimands)

Section 3: Qualifications and experience

These questions relate to sections 13(1)(a) and 167(3)(c) of the Aged Care Act 2024

Questions 3.2 and 3.3

Explanatory Note
  • Include the following details where relevant, which you should have been made aware of in determining suitability of the person to become a responsible person:

    • Qualification or certificate details, including:
      • Qualification or certificate title and educational facility

      • Date obtained (or date started if still studying) 

    • Registration details
    • Membership details
    • Licence details
  • Detail the person’s experience in, or relevant to, providing aged care or similar services against the relevant service types you are currently registered to provide or are looking to be registered for. This may include the delivery of care under the CHSP, NDIS, sub-contractor or private fee for service care. 

    • In explaining the e person’s prior experience, include where relevant, their employer’s name and address, period of employment and role description (including relevance to providing aged care)

    • Multiple relevant prior experience may be included in the response

    • Experience and performance should be of the person, not of a parent company or franchise organisation to which they belong. 

       

If you are unable to respond to these questions, reconsider your nomination of this person as a responsible person.

Evidence
  • If available, documentation of the above 

  • Any other documents to support your response 

Section 4: Adverse findings and enforcement actions

These questions relate to sections 13(1)(c) and 167(3)(c) of the Aged Care Act 2024

Questions 4.1 and 4.2

Explanatory Note

You must disclose if a banning order issued by us, or an NDIS banning order issued by the NDIS Quality and Safeguards Commission has ever been made against you. 

 

You must make this disclosure even if the order is no longer in force. 

 

This information is relevant to your suitability to be a responsible person of a registered provider. 

 

If you need to explain a banning order or NDIS banning order, your explanation should include: 

  • when the order was made
  • the period of effect of the order (including if it is indefinite)
  • what the order applies to (e.g. specified NDIS activities)
  • the reasons for the order (e.g. explanation of the incident(s))
  • relevant legislative references (e.g. to the National Disability Insurance Scheme Act 2013)
  • any other relevant information 

 

If the banning order or NDIS banning order is no longer in force, also provide detail on: 

  • when this occurred
  • the reasons why it is no longer in force
  • any relevant actions taken by you (e.g. to address previous non-compliance)
  • any processes you have in place to monitor and ensure ongoing compliance with your legal obligations (e.g. to the National Disability Insurance Scheme Act 2013)
Evidence
  • Notice of banning order

  • Any other documents to support your response

These questions relate to sections 13(1)(e) and 167(3)(c) of the Aged Care Act 2024

Questions 4.3 and 4.4

Explanatory Note
  • If ‘yes’ to Question 4.3:

  • Identify when the civil penalty order was made, and the civil penalty imposed

  • Identify on what grounds the civil penalty order was issued

  • Detail actions taken to remedy misconduct

  • Detail the processes in place to review ongoing compliance with legislation

Evidence
  • Notice of civil penalty order

  • Any other documents to support your response

These questions relate to sections 13(1)(g) and 167(3)(c) of the Aged Care Act 2024

Questions 4.5 and 4.6

Explanatory Note
  • For Question 4, listed bodies refers to those listed in section 13(1)(g) of the Aged Care Act 2024:

    • a Department of the Commonwealth or of a State or Territory;

    • the Australian Securities and Investments Commission;

    • the Australian Charities and Not‑for‑profits Commission;

    • the Australian Competition and Consumer Commission;

    • the Australian Prudential Regulation Authority;

    • the Australian Crime Commission;

    • AUSTRAC (within the meaning of the Anti‑Money Laundering and Counter‑Terrorism Financing Act 2006);

    • the Australian Health Practitioner Regulation Agency;

    • another body established for a public purpose by or under a law of the Commonwealth;

    • a State or Territory authority (including, but not limited to, a body that is equivalent to a body mentioned in subparagraphs (ii) to (viii));

    • a local government authority;

    • a body responsible for maintaining standards of conduct in a profession that is involved in the delivery of funded aged care services;

  • If ‘yes’ to Question 4.5:

    • Identify what the negative finding or enforcement action was

    • Identify on what grounds the negative finding was made, or enforcement action issued

    • Detail actions taken to remedy previous misconduct

    • Detail the processes in place to review ongoing compliance with legislation

Evidence
  • Notice of negative finding/enforcement action

  • Any other documents to support your response

These questions relate to sections 13(1)(h)(i) and 167(3)(c) of the Aged Care Act 2024

Questions 4.7 and 4.8

Explanatory Note
  • If ‘yes’ to Question 4.7:

  • Identify what the finding or judgement was about

  • Identify on what grounds the finding or judgement was made

  • Detail actions taken to remedy misconduct

  • Detail the processes in place to review ongoing compliance with legislation

Evidence
  • Notice of finding/judgment

  • Any other documents to support your response

These questions relate to sections 13(1)(h)(ii) and 167(3)(c) of the Aged Care Act 2024

Questions 4.9 and 4.10

Explanatory Note
  • If ‘yes’ to Question 4.9:

  • Identify on what grounds the administrative, civil, or criminal proceedings have been initiated

  • Identify the expected decision date for the final finding or judgment

  • Detail the processes in place to review ongoing compliance with legislation

Evidence
  • Notice of court proceedings

  • Any other documents to support your response

These questions relate to sections 13(1)(i) and 167(3)(c) of the Aged Care Act 2024

Questions 4.11 and 4.12

Explanatory Note
  • If ‘yes’ to Question 4.11:

    • Identify the date and period of disqualification, noting it may be a current or previous disqualification

    • Identify on what grounds the person is or was disqualified from management

  • If the disqualification is no longer in place:

    • Detail why the disqualification is no longer in place (e.g. lapsed, revoked)

    • Detail actions taken to remedy previous misconduct leading to disqualification

    • Detail the processes in place to review ongoing compliance with legislation

Evidence
  • Notice of disqualification 

  • Notice revoking disqualification 

  • Any other documents to support your response

This question relates to sections 13(1) and 167(3)(c) of the Aged Care Act 2024

Question 4.13

Explanatory Note
  • If ‘no’ to any question from 4.1 to 4.12, you do not need to complete this question. Continue to Section 5. 

  • If ‘yes’ to any question from 4.1 to 4.12, provide an explanation for each adverse finding or enforcement action. That is, if you answered ‘yes’ to more than one question, suitability needs to be explained for each question. Your explanation should detail the person’s suitability to provide safe, reliable, and high-quality care and services. 

  • If ‘yes’ to Question 5.1, provide details of the bankruptcy, administration or insolvency.

Section 5: Insolvency

These questions relate to sections 13(1)(f) and 167(3)(c) of the Aged Care Act 2024

Questions 5.1 to 5.3

Explanatory Note

If ‘yes’ to Question 5.1, provide details of the bankruptcy, administration or insolvency.

Evidence
  • For administration:

    • Evidence of appointment of an administrator

    • Administrator’s investigation and report

    • Administrator’s statement 

  • For insolvency: 

    • Evidence of debt agreement

    • Evidence of bankruptcy notice 

    • Evidence of insolvency or insolvency risks

    • Response to and management of insolvency or insolvency risks

  • Any other documents to support your response

Section 6: Worker screening details

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These questions only need to be completed if you selected National Disability Insurance Scheme (NDIS) screening application is pending for Question 6.1.1.

These questions relate to sections 13(1)(j) and 167(3)(c) of the Aged Care Act 2024

Questions 6.3.1 to 6.3.3

Explanatory Note
  • Provide details on how you plan on managing the risk associated with the person, as a result of their NDIS clearance decision
  • Outline and describe the risk management plan that will be in place for this person, including a description on the strategies that will be used for how the person will be supervised
  • For question 6.3.3, if the person has been banned from being in a risk assessed role, outline and describe the reasons for why this has occurred 
     
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This question only needs to be completed if you selected Police certificate for Question 6.1.1.

This question relates to sections 13(1)(d) and 167(3)(c) of the Aged Care Act 2024

Question 6.4.6

Explanatory Note
  • Provide a response to questions 6.4.1 to 6.4.5 to support verification of their Nationally Coordinated Criminal History Check.
  • Detail the actions the responsible person has undertaken since any previous disclosable court outcomes, that shows they may now be suitable for a responsible person role 
     
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This question only needs to be completed if you selected Registered health professional for Question 6.1.1.

This question relates to sections 13(1)(g) and 167(3)(c) of the Aged Care Act 2024

Question 6.5.5

Explanatory Note
  • Provide a response detailing any suspensions, exclusions or conditions 
Evidence
  • Ahpra registration details, including profession, registration number, and registration expiry date
  • Details and attachments about the suspensions, exclusions or conditions to the registration. This should include information on what the registered health professional may be excluded from doing, or required to do, under their suspension, exclusion or condition.
  • Any other documents to support your response
     

Section 7: Membership of governing body

This question relates to sections 12, 13 and 167(3)(c) of the Aged Care Act 2024

Question 7.4

Explanatory Note
  • Describe any roles or responsibilities currently held at other organisations, including any directorships with other organisations.

Section 8: Additional details

This question relates to sections 12, 13 and 167(3)(c) of the Aged Care Act 2024

Question 8.1

Explanatory Note
  • Provide any additional details about the person that were not addressed by the above questions, such as if the person has been disqualified under the Corporations (Aboriginal and Torres Strait Islander) Act 2006
  • Skip this question if there is no additional information you would like to provide