The environment | Aged Care Quality and Safety Commission

I feel safe when receiving funded aged care services. Where I receive funded aged care services through a service environment, the environment is clean, safe and comfortable and enables me to move around freely. Equipment is safe, appropriate and well-maintained and precautions are taken to prevent the spread of infections.

- Expectation statement for older people

Intent of Standard 4

The intent of Standard 4 is to ensure that older people receive funded aged care services in a physical environment that is safe, supportive and meets their needs. Effective infection prevention and control measures are a core component of service delivery to protect older people, their supporters and aged care workers.

Service context considerations

Standard 4 outcomes apply to providers delivering funded aged care services in a residential care home or in a home or community setting who are registered to deliver aged care services in registration categories 4-6. However, the way in which providers delivering aged care services in a residential care home, home or community setting approach the key tasks may be different.

For example, Outcome 4.1 is split into two parts. Outcome 4.1a applies to services delivered in the older person’s home, while Outcome 4.1b applies to services delivered other than in the older person’s home, such as residential care homes. This is because processes for a safe, supportive and tailored physical environment and methods of oversight involved in managing environmental risks differ between aged care services delivered in a residential care home, home or community setting. For aged care services delivered in a residential care home, the provider is responsible for providing older people with a residential care home environment as part of accommodation funding to deliver their aged care services, which does not apply in aged care services delivered in a home or community setting. These differences are outlined in the guidance for each outcome in this Standard.

Key tasks

Governing body

Information for governing bodies

This guidance should be read in conjunction with Quality Standard 2 which relates directly to the governing body.

The governing body plays an important role in funded aged care services. They’re responsible for an organisation delivering quality care and services (Outcomes 2.2a, 2.2b and 2.3).

The governing body needs to:

supervise provider activities
lead a culture of safety, inclusion and quality
help identify and address issues.

It is important the governing body puts in place processes to check the organisation’s strategies for delivering tailored aged care services meet each older person’s needs, goals and preferences. This includes monitoring the organisation’s performance, such as by reviewing reports on:

how they’re delivering aged care services
how they’re managing complaints, feedback and incidents (Outcomes 2.5 and 2.6)
the quality of aged care services workers are delivering. For example, through quality assurance or system reviews (Outcome 2.8).

Make sure the organisation has a culture of safety, inclusion and quality by monitoring and investigating areas you find in the organisation’s reports you can improve. Identify opportunities and make recommendations to your organisation to improve its culture of safety, including quality care. Provide feedback and support to the provider.

You also need to monitor the performance of any associated providers.

If you find any issues or ways you can improve, you need to address them. If things go wrong, you need to:

practise open disclosure. This means being open about what has gone wrong. Share this information with older people, their supporters and others they may want to involve, such as family and carers
have strategies to reduce the risk of things going wrong again.

The provider guidance for Outcome 2.3 has more information on open disclosure.

Standard 2 provides detailed information for governing bodies.

Key tasks:

Track the organisation’s performance. Make sure the aged care services older people receive in a residential care home, home or community setting are safe.

The governing body is responsible for the organisation delivering safe and quality care and services (Outcomes 2.2a, 2.2b and 2.3). You need to oversee the provider’s operations. This includes reviewing:

reports on how they manage complaints, feedback, and incidents (Outcomes 2.5, 2.6a and 2.6b)
the quality of services workers deliver through quality assurance activities.

You must address any issues or areas for continuous improvement you identify. If needed, you must help the organisation make the necessary changes.

Track the organisation’s performance. Make sure their strategies for managing equipment are effective.

You must make sure the organisation uses effective equipment management strategies. They should focus on the safety and wellbeing of older people, including older people living at home in the community.

You must review reports on how effective these strategies are. You should check incident reports and feedback on equipment safety, availability and functionality (Outcomes 2.5, 2.6a and 2.6b). This needs to include feedback from older people, their supporters and workers. Make sure equipment management practices support safe and quality care and services and that equipment is used for its intended purpose.

If you find any issues or areas for continuous improvement, you need to address them. 

Track the organisation’s performance in preventing and controlling infections.

Make sure the organisation has systems to prevent and control infections. You need to review reports on the organisation’s infection prevention and control practices, including:

how well the organisation follows hygiene protocols
the availability and use of personal protective equipment
how they manage suspected or confirmed outbreaks (Outcomes 2.5, 2.6a, 2.6b and 4.2).

You should also review feedback about infection prevention and control practices. This includes feedback from older people, their supporters, and workers.

If you find any issues or areas to improve, you must address them.

Support the organisation to improve their infection prevention and control processes. This will protect the health and safety of older people receiving aged care services at home, in the community and in the residential community.

You can find more resources about the role of the governing body and governance in the Quality Standards Resource Centre.

The Commission developed the Governing for Reform in Aged Care Program to support the key recommendations of the Royal Commission into Aged Care Quality and Safety. The Program supports governing body members, leaders and emerging leaders to strengthen corporate and clinical governance capabilities and enact critical reform.

Workers

What does this Standard mean for workers?

Standard 4 describes requirements relating to the physical environment where care is delivered. This includes infection prevention and control and using equipment safely.

Regardless of your role, you should:

Support older people to move freely and feel comfortable in the residential care home. When delivering care in a residential care home, you may identify hazards or issues that affect the safety and comfort of older people and other workers. It’s important you escalate any concerns within your organisation so timely action can be taken to address these. This may involve using your organisation’s risk management system. You may also have ideas for how the service environment could be improved to be more welcoming, enjoyable and accessible for older people. You are encouraged to share your ideas with your organisation.
Identify risks in an older person’s home. When delivering care in an older person’s home, you may find risks that put the older person, or you (and other workers), at risk of harm. It’s important these risks are escalated within your organisation. This may involve using your organisation’s risk management system to discuss risks with the older person’s environment and identify strategies to mitigate risks (in line with the older person’s preferences).
Use equipment safely. Whether delivering care in the home or in a residential care home, the home or a community setting, it’s important you are appropriately trained and competent in using the equipment needed for an older person’s care. If you don’t feel confident using certain types of equipment, let your organisation know so you can get the necessary training and support. You may also be responsible for identifying issues with equipment. For example, equipment that:
- isn’t working
- needs maintenance or cleaning
- does not meet the older person’s needs
- is not being used in the way it was designed or for its intended purpose.
Practise infection prevention and control (IPC). Your organisation should have detailed IPC procedures that cover matters like:
- hand hygiene
- cleaning and maintenance of equipment and the physical environment
- disinfection methods
- respiratory hygiene and cough etiquette
- waste management
- handling of linen
- use of Personal Protective Equipment (PPE)
- outbreak management.

It’s important you know and follow these procedures in all aspects of your care delivery.

Key concepts

Infection prevention and control (IPC)

In aged care settings, IPC protects older people and workers by reducing the risk of spreading infections and developing antimicrobial resistance.

Infections can spread in any environment. Older people may be more vulnerable to infection for several reasons, including medical conditions or age-related changes in function. As highlighted in Standard 1, IPC practices should respect the dignity, privacy and choices of older people while focusing on person-centred care. Actively involving older people in planning and carrying out IPC measures helps make sure their needs, preferences and safety are always the priority. Infection prevention and control is an essential part of care and the responsibility of all staff.