PN11358
THE
ASSOCIATE: The Commission is now in session in matters AM2020/99,
AM2020/163 and AM2020/165, Aged Care work value case, for hearing.
PN11359
COMMISSIONER
O'NEILL: Good morning everybody. Unless there's anything anyone
wishes to raise, Mr Oski, I think Ms Roe is the first witness this
morning?
PN11360
MR
OSKI: Yes. Sorry, Commissioner, can I just indicate - - -
PN11361
COMMISSIONER
O'NEILL: I think she - - -
PN11362
MR
OSKI: Sorry, can I just indicate, Ms Rouse(?) is going to take
Ms Roe.
PN11363
COMMISSIONER
O'NEILL: Okay, terrific.
PN11364
Ms Roe,
I think you've just joined us, you can hear me all right?
PN11365
MS
ROE: Yes, I can, thank you.
PN11366
COMMISSIONER
O'NEILL: All right. I'm Commissioner O'Neill and my associate is
just going to take you through the affirmation.
PN11367
THE
ASSOCIATE: Ms Roe, can you please say your full name and work
address?
PN11368
MS
ROE: My full name is Karen Elizabeth Roe, my work address is - would that
be the main office, or - - -
PN11369
THE
ASSOCIATE: You can use a personal home address, if that's easier.
PN11370
MS
ROE: That's probably better. (Address supplied).
<KAREN
ELIZABETH ROE, AFFIRMED [9.31 AM]
EXAMINATION-IN-CHIEF
BY MR OSKI [9.31 AM]
*** KAREN ELIZABETH ROE XN
MR OSKI
PN11371
COMMISSIONER
O'NEILL: Mr Oski?
PN11372
MR
OSKI: Thank you, Commissioner.
PN11373
Good
morning, Ms Roe, my name is Sheldon Oski, I'm appearing for the UWU
today. Can you hear me okay?‑‑‑Yes, I can hear
me. Can you hear me?
PN11374
Yes,
I can hear you. Excellent. So can you just repeat your full name,
for the record?‑‑‑Karen Elizabeth Roe.
PN11375
I
understand that you've made a statement, for the purposes of these proceedings,
is that correct?‑‑‑I have, yes.
PN11376
I
understand that statement is dated 30 September 2021 and runs for 33 paragraphs
over six pages. Do you have a copy of that statement with you?‑‑‑I
do.
PN11377
Have
you had an opportunity to read through it again?‑‑‑Yes.
PN11378
Excellent.
Is it true and correct, to the best of your knowledge and recollection?‑‑‑At
that time, yes. It's become even more stressful, yes.
PN11379
No
problem, thank you.
PN11380
Commissioner,
that's at document 242 at page 12153 of the digital court book, and we seek to
rely upon that statement.
PN11381
COMMISSIONER
O'NEILL: All right.
PN11382
MR
OSKI: No, Ms Roe, you'll be able to see, in one of the windows
shortly, somebody will be asking you some further questions about your
statement?‑‑‑Okay.
PN11383
COMMISSIONER
O'NEILL: Mr Rafter?
PN11384
MR
OSKI: I'm sorry, Commissioner, I can't see Mr Ward or - - -
PN11385
COMMISSIONER
O'NEILL: No, that's what I was just about to raise.
*** KAREN ELIZABETH ROE XN
MR OSKI
PN11386
MR
OSKI: I'm not sure whether it's a problem that everyone else - yes,
apologies.
PN11387
COMMISSIONER
O'NEILL: No, that's common, so that's what I was going to ask if
Ms Rafter can turn the camera on.
PN11388
MS
RAFTER: Commissioner, my camera is on. I might try turning it on
and off to see if that assists.
PN11389
MR
McKENNA: Commissioner, can I just indicate, I'm in the same boat, I can't
get my camera to work this morning, I'll keep trying.
PN11390
COMMISSIONER
O'NEILL: All right. Well, it's worked for Ms Rafter so
hopefully you'll have the same luck, Mr McKenna.
PN11391
THE
WITNESS: I'd just like to say, I'm calling from Canada, I'm fine.
PN11392
COMMISSIONER
O'NEILL: All right. Mr McKenna, since we can't see you, if you
have any questions you wish to ask, if you can just let me know, just say so at
the time.
PN11393
MR
McKENNA: Thank you, Commissioner.
PN11394
COMMISSIONER
O'NEILL: So, Ms Roe, Ms Rafter is just going to ask you some questions
now.
CROSS-EXAMINATION
BY MS RAFTER [9.33 AM]
PN11395
MS
RAFTER: Hi, Ms Roe, my name is Alana Rafter, I am appearing for the
employer interests today and I take it you can see me now?‑‑‑Yes.
PN11396
Excellent.
So I'm just going to ask you a few questions about your statement?‑‑‑Yes.
PN11397
So,
I understand you're a home support team member for the Benevolent Society?‑‑‑I
am.
PN11398
And
you have a certificate III and certificate IV?‑‑‑Yes, I do.
*** KAREN ELIZABETH ROE XXN
MS RAFTER
PN11399
Were
you required to have that for your job as a home support team member or you'd
already had that?‑‑‑When I first was employed with them I was
not required to have any training whatsoever. I walked in off the street
basically. But since then I have taken the training.
PN11400
Excellent.
And just so I can get a picture of who you would be talking to in the office
from time to time, did you have a coordinator that you reported to at the
Benevolent Society?‑‑‑Yes, we always some specific, like,
supervisor. But then we also (indistinct) coordinators as well, so, we
have - and then of course there's rostering. Yes, we have quite a few
people.
PN11401
That's
no worries. And what's the title of your supervisor, or is it just
supervisor?‑‑‑I actually am not sure what he's called, the
present one.
PN11402
No
worries?‑‑‑Yes.
PN11403
And,
so are you aware of their qualifications at all, if they have to be a
registered ‑ ‑ ‑?‑‑‑No.
PN11404
No,
worries, I'll move on from that?‑‑‑No, we're ‑ ‑ ‑
PN11405
I
won't ask you to guess?‑‑‑ ‑ ‑ ‑the
bottom of everything, so we don't necessarily get that information.
PN11406
Okay.
And if you needed to, say, talk to a registered nurse during an appointment,
would you call your supervisor first or do you have a number for a registered
nurse?‑‑‑We don't have a registered nurse number, so I would
have to call, yes. Yes, I'd have to call my supervisor, I guess.
I've called the poison line on occasion straight through, but - yes.
PN11407
Thanks
for that. I now have a better picture of what you're working with
there. And if I could just ask - put a couple of scenarios to you to see
how it works, if you were showering a client, and during that shower you
noticed the client had a skin tear on their arm, is there a protocol you would
follow in that scenario?‑‑‑With a skin tear we would actually
alert people right away and make arrangements to have the client seen to by a
doctor as soon as possible, especially at that age a skin tear is monumental.
*** KAREN ELIZABETH ROE XXN
MS RAFTER
PN11408
If
I could walk that back, so, you've seen the skin tear and you would alert
people. So would you first call the office, your supervisor?‑‑‑I
would call the office first, and then I would probably - I mean, depending on
the client really too, whether it's an ambulance call or calling the doctor to
see if we can maybe take them to the doctor or if the doctor can come
out. It depends on the client.
PN11409
And
with the ‑ ‑ ‑?‑‑‑The family as
well too.
PN11410
‑ ‑ ‑doctor
that's their local doctor listed on the care plan that you're referring to?‑‑‑Yes.
PN11411
So,
I take it if the skin tear had blood or looked more serious you'd say that to
the supervisor and then call the ambulance?‑‑‑Yes.
Yes. Yes.
PN11412
To
make the decision whether to call the doctor or the ambulance would you be
talking that through with your supervisor, or how would you make the decision
to do one or the other?‑‑‑Once again, it really depends on if
you know the client well, if you know the doctor as well. You know,
because when we have regular clients we have knowledge of their doctors, and
things like this. But, anyway, I would call my supervisor, I would then
describe - sometimes - and this is where telephones come in handy, mobile
phones come in handy, you can take a photograph and send it off.
PN11413
Okay?‑‑‑You
know, and then in some cases you can send it off to the doctor's office too,
and they will, you know, tell you whether to be worried or not, but, yes, you
talk to your supervisor first and then quite often if we can't take them to the
doctor some of them do not leave their homes, and we can't get the doctor to
come out then we will call the ambulance and get them to come, yes.
PN11414
Thank
you for that. It's all very helpful. And, now, if you have another
client and they have a fall during an appointment, is there a protocol in place
by the Benevolent Society for when a client has a fall that you're to follow?‑‑‑Yes.
Yes. No, we would - I mean, if it's a fall I call the ambulance first,
and then I call the office.
PN11415
Sorry,
I didn't mean to interrupt. So, you call the ambulance?‑‑‑No,
that's fine.
PN11416
And
with a fall, are you required to prepare an incident report on that occasion?‑‑‑Yes.
*** KAREN ELIZABETH ROE XXN
MS RAFTER
PN11417
And
is that separate to progress notes or case notes?‑‑‑Yes.
Yes. No, it's a form you fill out, you know, time, what was happening,
who was doing what, how do you think it happened. And once again, having
a mobile phone comes in handy because you can take photographs of, like, in a
recent case I took a photograph - after the client had been taken to hospital I
took a photograph of the shower stall and, you know, basically how it happened
and things like that, so, yes.
PN11418
And
those get emailed - that incident report, once you've finished that, you email
that to your supervisor?‑‑‑Yes.
PN11419
Then
would you also write a case note or a progress note?‑‑‑We -
some clients have communication books, some clients don't. When it comes
to the incident and accident report we would send that to the client's case
manager and that's where it would go. I mean, that's as much as we would
really have to do unless the case manager comes back to us and asks for more
information.
PN11420
Now,
I will just go to - it's ordinary - just a - we'll take away the incident this
time, so if you're just going to an appointment to assist with a shower and
there's no skin tears, nothing of that (indistinct) on this one, would you
typically - I know that you've said there's a communication book in some
houses, so if they had that you might include some notes that, 'I showered the
client'?‑‑‑Yes. Yes. Yes.
PN11421
But
if there's no communication book, would you not be required to make a note of
anything?‑‑‑We're not required to do anything unless - we are
required - if we notice something different, if something's gone screwy, a
medication has been missed, the client themselves are exhibiting behaviour that
is not the normal then we would make a report to the office.
PN11422
Okay,
I see?‑‑‑Usually (indistinct) because if it is unusual enough
to make note of it is usually important.
PN11423
So,
at Benevolent Society they don't use, like, apps or whatnot to record ‑ ‑ ‑?‑‑‑We
don't have any apps. No, we don't have them.
PN11424
So,
if there's something out of the ordinary you'll contact the supervisor office
directly via phone or ‑ ‑ ‑?‑‑‑I
use my personal mobile phone for things like that, because we don't have access
to work mobile phones yet or any other thing. They're considering
bringing them in, but we don't have them yet.
PN11425
Now,
with clients that - is the client's care plan, do you have access to that
before you go see a client?‑‑‑Supposedly we do, yes.
*** KAREN ELIZABETH ROE XXN
MS RAFTER
PN11426
What
do you mean - could you just elaborate by 'supposedly' for me?‑‑‑We're
supposed to get it from rostering, but once again it depends on if they've sent
it to us.
PN11427
So
they should be sending it to you via email?‑‑‑Yes.
PN11428
But
I take it that doesn't always happen, does it?‑‑‑It doesn't
always happen, that's right. And sometimes we'll get a care plan that is
out of date, and this is where - because we work by ourselves but we actually
try to be a team, and this is what we try to do is if I know - if I'm going in
to someone that I don't know, and I know another care worker has been in there,
I will tap into that other care worker and say, 'What can I expect? What
kinds of things am I doing? What shouldn't I be doing, because this
person doesn't want me to do?' Like, you know, there's some people who
want to shower themselves, you just have to stand there. Other people
want more involvement if you'll excuse the expression. You know, so you
have to - it's getting a little bit of advanced knowledge before you walk in
the door. There's also some people who - I mean you have to know whether
you're going into a house - if you're waiting for someone to answer the door or
if the door will be open and you are invited in without - because they can't
answer the door themselves. I mean these are all things that we need to
know before we get in there.
PN11429
Are
they details that should be on the care plan?‑‑‑Possibly.
PN11430
Yes,
possibly might be on the care plan?‑‑‑Yes.
PN11431
But,
in your experience, you find you get that information from talking to other
carers?‑‑‑Very, very much so, very much so.
PN11432
Is
there a physical copy of the care plan in the client's house as well, or you
only have access to the one that's emailed?‑‑‑There is
supposed to be a physical copy in the house, but quite often it is somewhere
where we don't know where it is.
PN11433
Okay?‑‑‑Yes,
and if - you know, we can go in and ask the client where the care plan
is. Sometimes they don't know where it is either, you know, because
everybody comes in, families put things away, we put things away, whatever, but
also quite often they don't want you to look at the care plan, so you have to
play it the way it's presented to the client because - especially if you're
going into a client who you don't know, yes.
*** KAREN ELIZABETH ROE XXN
MS RAFTER
PN11434
Ms
Roe, sometimes you don't have access to the care plan, sometimes you do, so how
do you know what you're going to a client's house to do? Does the
rostering team send you a message saying that you're doing showering, domestic
assistance, or how do you know what you're doing at each appointment?‑‑‑That's
usually - it's usually on our roster whether it's domestic assistance, or
shower, or social, shopping, whatever.
PN11435
And
it will have a time attached to it as well?‑‑‑Yes, but also
when you're going into the client's place, they will tell you, most likely,
what they want you to do, and sometimes it's not exactly what's on the care
plan or what is on your roster.
PN11436
If
it's not on the care plan, I take it you would still be acting within the scope
of your competencies and everything you're trained to do?‑‑‑Yes,
yes.
PN11437
If
it was something that you knew not to be on the care plan, if it was outside
the scope, would you tell your supervisor or the office that this is being
asked for or requested?‑‑‑Well, if it's something I
definitely know not to do, I will definitely say, 'I'm sorry, I can't do this, just
let me call the office, I need to talk to them.'
PN11438
Okay?‑‑‑But
if it's just a case of, 'No, I don't want a shower today, can you vacuum',
that's - yes, that's a no-brainer, I can do that, but then, after that, I will
also let the office know that, you know, 'This person didn't want a shower
today; is this unusual?' so that the person who's coming in tomorrow, who is
supposed to be doing the vacuuming, maybe they can do the shower.
PN11439
I
might take you to a couple of parts of your statement now. Do you have
that in front of you?‑‑‑Yes.
PN11440
At
paragraph 10, you talk about a few different clients you're seeing and you
refer to the third client on that day, who I believe you say is deaf and blind,
and for that appointment, you tend to do 'whatever the client wants me to do;
they just like the company'?‑‑‑Yes.
PN11441
Do
you know prior to going - I'll take that back. On your roster, what will
it say that you are going to that client to do?‑‑‑Well, in
this case, it would say that she was domestic assistance.
PN11442
Domestic
assistance, and then, I take it, she will then tell you what she needs help
with in that way?‑‑‑Yes.
PN11443
Vacuuming,
maybe, doing all this?‑‑‑Yes.
*** KAREN ELIZABETH ROE XXN
MS RAFTER
PN11444
So,
doing whatever the client wants you to do, but it's within the scope of domestic
assistance?‑‑‑Yes.
PN11445
Thank
you for that; that's very helpful. Then if we go down to the next paragraph,
paragraph 11, here you're talking about a client you had that was a breast
cancer survivor?‑‑‑Mm-hm.
PN11446
And
during a shower, you noticed a hole in the breast was leaking and you put a
bandage on it. You say, 'We put a bandage on it.' Could you tell
me, did you put a bandage on it first or - - -?‑‑‑Where
are we?
PN11447
Paragraph
11?‑‑‑Yes, yes. When I say 'We', that was me with
her. I mean, yes, got it - - -
PN11448
(Indistinct)?‑‑‑
- - - (indistinct). I took photographs of it.
PN11449
(Indistinct.)
Sorry, I'm cutting over you. I'll let you - - -?‑‑‑No,
so it was - I mean this was a client who - it had been - obviously had been
leaking for a while and she was covering it up, and then she - we finally got
her to take the bandage off and saw that it was leaking, and so we - what I did
at that time, I took photographs of it, I sent photographs to my supervisor,
and we organised for - when I say 'we', the office organised for a call to her
doctor and then the community nurses came, because her doctor was one who came
to the home, and so we organised for him to come, I think within the next day
or two.
PN11450
Okay.
I'll say it back to make sure I get it. So she already had this hole
pre-existing and it was covered up with a bandage of sorts, and then you asked
her to just uncover it so you could see if there was something wrong?‑‑‑It
was coming through.
PN11451
It
was coming through, so you asked to take - you took a photo of that?‑‑‑Yes.
PN11452
Then
you sent it on to the office?‑‑‑Well, I sent it to the office
so the office could call the doctor.
PN11453
Then
the office would call the doctor and the doctor came and did - - -?‑‑‑Yes.
I mean when I say 'the office', I called her case manager - - -
PN11454
Her
case manager - - -?‑‑‑ - - - to call the
doctor, yes.
*** KAREN ELIZABETH ROE XXN
MS RAFTER
PN11455
Thank
you for that; I appreciate that. Now I will go to paragraph 22. At
22, you're talking about clients with dementia that pose particular
complications and you talk about how you have to observe them, things can
change quickly and you have to get a handle on it and be adept at judging
changing situations quickly?‑‑‑Yes.
PN11456
For
that, would you be drawing upon your training from your Cert III and Cert IV?‑‑‑Oh,
yes, and life experience.
PN11457
Thank
you for that. Now, just to talk about training, at paragraph 7, to take
you back a bit, you talk about in-house training that the Benevolent Society
used to provide. I note you said, since COVID, it's much less. Now,
as part of that in-house training, did you receive medication competency
training?‑‑‑We have done medication training, different
courses of medication training, yes.
PN11458
Would
one of them be regarding a medication prompt, so if clients have those Webster
packs - - -?‑‑‑Yes.
PN11459
And
the procedure to be followed with that?‑‑‑Yes.
PN11460
Would
that training - this might be going back a bit - would that training be
conducted by a registered nurse?‑‑‑The Webster pack training,
no, I think she was a registered nurse, yes.
PN11461
Was
there a theory component and a practical component for that training?‑‑‑A
theory? What do you mean?
PN11462
Were
you - - -?‑‑‑(Indistinct) medication or?
PN11463
For
this training with the Webster packs, were you in like a classroom-like setting
and they were walking you through what you need to check?‑‑‑It
was part of, I think, my Cert IV, so it was - - -
PN11464
Okay?‑‑‑
- - - in the classroom, yes.
PN11465
So
you received that training outside the Benevolent Society?‑‑‑No,
it was - - -
*** KAREN ELIZABETH ROE XXN
MS RAFTER
PN11466
Inside?‑‑‑No,
the Benevolent Society in those days provided Cert III and Cert IV training
within - - -
PN11467
I
get you now, and that was included as a unit within your Cert III or IV?‑‑‑Yes.
PN11468
Thank
you for that. I'm just looking - so if I could take you to - I just want
to ask you a question, staying with paragraph 7. You refer to your online
training, and I take it they're like modules where you click it and you may
watch a video, read some material and do a quiz?‑‑‑Mm-hm.
PN11469
You
give an example of case note fundamentals. Could you explain that?‑‑‑Sorry,
where do I give that?
PN11470
This
is paragraph 7 still?‑‑‑I don't say anything about case note
fundamentals.
PN11471
One
second. It very well could be my mistake, so bear with me?‑‑‑That
would be paragraph 9.
PN11472
Now
I'm confused. Yes. Apologies for that. At paragraph 9,
as you correctly corrected me there, in the second last line you refer to 'case
fundamentals?'---Yes.
PN11473
I
was just wondering if you could explain briefly what that involved?‑‑‑Well,
case note fundamentals was basically, you know, you're putting down what you've
done, what you've observed, and you know, what you do as required by the
client, what you're observing and what you think might need to be done as well.
PN11474
So
it's to assist with preparation of, like, progress notes and (indistinct) - -
-?‑‑‑Yes. Progress notes is probably another, yes.
PN11475
Now,
I want to take you to paragraph 12 where you identify a shower door hazard for
this client?‑‑‑Yes.
PN11476
So
that's a safety hazard you've identified, and I know ultimately six months
later it gets taken off, but I wanted to know if you could explain the
procedure to be followed when you identify – if you see a hazard, what's meant
to happen?‑‑‑Well, hopefully the hazard is mitigated, because
- - -
PN11477
I'll
just take it back. Are you meant to report it to the office?‑‑‑Yes,
very much so.
*** KAREN ELIZABETH ROE XXN
MS RAFTER
PN11478
And
you may take a photo of the hazard?‑‑‑Yes.
PN11479
And
then it's left with the office. They're meant to take the steps to - - -?‑‑‑And
then – well, in this particular case, yes, it was a case of having to negotiate
with the family of the client as well, because the family of the client did not
want anything to happen. So that was – it was a difficult situation, but
in the end we did have the shower door taken off, and she actually did have a
fall about two months later and I think the only reason she wasn't hurt more
was that the shower door was not there.
PN11480
With
the family, negotiating with the family, did you pass on – after identifying
the hazard first to the office and then finding out the family had some
resistance to this change, did you notify the office of that as well so they
were aware?‑‑‑The office was very aware of - - -
PN11481
They
were very aware of everything that was going on there?‑‑‑They
were very aware, yes. No, and I mean, once again, when you're in this
situation I quite often – one of her daughters was quite often there, either
coming or going as I was there, so this is – this is why I knew that there was
a problem with the family; they didn't want to make the changes, because the
daughter was telling me that this was going on.
PN11482
And
- - -?‑‑‑And that's a situation where you actually have to
tread very carefully, because you can't go – this has to be done, you have to
be gradual. It's – yes. I mean, I'm amazed at how diplomatic I can
be sometimes.
PN11483
Now,
if there's a situation where you feel – have you had a situation where you feel
unsafe in a client's home?‑‑‑(Witness laughing).
PN11484
I
take that as a yes?‑‑‑Yes.
PN11485
Is
there a protocol that The Benevolent Society tell you that you're to follow if
you ever feel unsafe in a house?‑‑‑Yes, get the hell out of
there. Yes, basically we – you know, this is the thing – if you feel
unsafe: 'Oh I am sorry, I've just got a phone call from the office, I'm
going to have to duck out; I'll be back soon; don't worry' – you know, just
things like this. It depends. Once again it depends on the
situation. When you're going into someone who you don't know but you feel
unsafe as soon as you walk in the door, you get the hell out of there. If
it's someone you may have some knowledge of and you feel maybe you can do
something, you know, you can calm the situation down – once again it comes to
experience, knowing the person, and how confident you are in your own abilities.
*** KAREN ELIZABETH ROE XXN
MS RAFTER
PN11486
So
you might use some de-escalation strategies if you feel comfortable that - - -?‑‑‑Yes.
PN11487
But
if you feel unsafe, get out is the protocol?‑‑‑Yes.
Yes, very much so, just get out.
PN11488
I
now want to take you to paragraph 15 and 16 and just ask you a couple more
questions about just medication?‑‑‑Yes.
PN11489
With
the Webster-pak medication at 15, that's the medication prompt that you were
doing, that you learnt in your Cert IV?‑‑‑Yes.
PN11490
So
you would get the Webster-pak, be checking the resident's (indistinct),
client's name?‑‑‑(Audio malfunction).
PN11491
Is
there a medicine chart or a picture chart for you to check the pills, or it's
just all with the Webster‑pak?‑‑‑Well, I mean once
again it depends on the client, because quite often – some clients actually
manage their own medication, and you just have to sort of watch them as they
open this box and take one out, and open this box and take one out.
PN11492
Yes?‑‑‑And
with the Webster-pak, we can if we feel we want to – we can check the back of
the Webster‑pak to make sure that all the pills are in there. Quite
often clients are fully aware of, you know, how many pills they should have and
things like that, so that's very good. But yes – no, we – what we try to
do is to get them to push a bubble of the Webster‑pak out and into like a
– well, for me, I try to put it on a little plate or a little bowl so that they
can see them, and then they can take them themselves, yes.
PN11493
And
then at paragraph 16 you talk about morphine patches?‑‑‑Mm.
*** KAREN ELIZABETH ROE XXN
MS RAFTER
PN11494
Is
it the situation where the client knows they need this patch so you might
assist with opening the packet so they can put it on, or they may have
difficulties putting it on so you might assist them, or how would that work?‑‑‑All
of the above. It depends. Yes, I mean it depends on the
client. I have – there is one client that I see occasionally who needs
assistance because it's on her back, and I have to actually ask her case
manager for permission to be able to do that, because I wasn't sure if I should
be able to do it. But the nurses who were supposed to be coming on a
regular basis were not, and she had no one else to put it on. So it
was a case of needs be, yes. So I mean it depends on the person.
Some people are very aware of how to put the patch on; they just want us to
watch and make sure that it's straight and not – you know, it's just
flat. Others need us to actually physically put it on.
PN11495
I
note that when it was on the back and you had to physically put it on, you had
to call the office. Is that the procedure with these morphine patches; if
they want you to physically put it on, you're meant to call the office to see
that you can do that?‑‑‑If I'm physically putting it on, yes,
I do want to get permission from the office first.
PN11496
A
couple more questions. Just in paragraph 16 again, you're talking about
clients with diabetes?‑‑‑Yes.
PN11497
And
you refer to checking their blood. I take it you have a blood glucose
level monitor?‑‑‑They do, yes.
PN11498
So
it's in their house?‑‑‑Yes.
PN11499
And
you might give it to them to do the prick test with their finger?‑‑‑Yes.
PN11500
And
then you would look at the reading?‑‑‑Yes.
PN11501
Are
you provided with a range that says if it's too high or too low you need to
call the office, or how do you know if the reading - - -?‑‑‑Well,
I mean it depends on the client once again. There have been some clients
when the doctor has said unless they're over 20 not to worry. There's
other clients that if they're in the 8s then we need to call. So really,
it's an individual thing once again.
PN11502
Where
is that notation down? Where do you access that information?‑‑‑That's
usually in the case notes.
PN11503
And
will these case notes be in the house? So is that with the communication
book?‑‑‑The communication book would probably have that, yes,
or – I mean, like I say, every client is different. It's either in the
communication book or it's somewhere close to where the BSL machines are, you
know, where we do the BSLs, or it comes from the case manager.
PN11504
If
it was missing or not there, I take it you'd - - -?‑‑‑Call
the office and see how we go.
*** KAREN ELIZABETH ROE XXN
MS RAFTER
PN11505
Thank
you for that. No further questions, Commissioner.
PN11506
COMMISSIONER
O'NEILL: All right. Thank you. Any re-examination,
Mr Oski?
PN11507
MR
OSKI: No re-examination, Commissioner.
PN11508
COMMISSIONER
O'NEILL: All right. Well, Ms Roe, thank you very much for
being available today, from Canada, and for your evidence and you're excused
and free to go?‑‑‑I'd like to mention that it's 4 degrees
here and it's snowing. Thank you.
<THE
WITNESS WITHDREW [10.04
AM]
PN11509
COMMISSIONER
O'NEILL: Now, is it Mr Heyan that's just joined us?
PN11510
MR
HEYAN: That's right, yes.
PN11511
COMMISSIONER
O'NEILL: Mr Heyan, I'm Commissioner O'Neill, you can see and hear me
all right?
PN11512
MR
HEYAN: I can.
PN11513
COMMISSIONER
O'NEILL: My associate is just going to take you through the affirmation.
PN11514
MR
HEYAN: No problem.
PN11515
THE
ASSOCIATE: Mr Heyan, can you please say your full name and work address?
PN11516
MR
HEYAN: My full name is Ross Evan Heyan, my work address is 27 Peel
Street, South Brisbane, Queensland.
<ROSS
EVAN HEYAN, AFFIRMED [10.04 AM]
EXAMINATION-IN-CHIEF
BY MR OSKI [10.04 AM]
*** ROSS EVAN HEYAN XN
MR OSKI
PN11517
COMMISSIONER
O'NEILL: Mr Oski?
PN11518
MR
OSKI: Thank you, Commissioner.
PN11519
Good
morning, Mr Heyan, my name is Sheldon Oski, I'm appearing for the UWU
today. Can you both see and hear me?‑‑‑I can, thank
you.
PN11520
Perfect.
Can you repeat your full name, for the record?‑‑‑My full name
is Ross Evan Heyan.
PN11521
Excellent.
I understand you've made a statement, for the purposes of these proceedings, is
that correct?‑‑‑That's correct, I have.
PN11522
I
understand that statement is dated 31 March 2021, it runs to 56 paragraphs
over seven pages. Do you have a copy of that statement with you?‑‑‑I
do.
PN11523
Excellent.
Have you had an opportunity to read through it again?‑‑‑I
have.
PN11524
Is
it true and correct to the best of your knowledge and recollection?‑‑‑It
is true and correct, yes.
PN11525
Thank
you. Commissioner, that's at document 238 at page 12120 of the digital
court book and we seek to rely upon that statement.
PN11526
Now,
Mr Heyan, one of my colleagues in one of these windows will now - it's
Mr Nigel Ward, he's in one of the windows there, he will now ask you some
questions about your statement?‑‑‑Okay.
CROSS-EXAMINATION
BY MR WARD [10.05 AM]
PN11527
MR
WARD: Mr Heyan, can you hear me okay?‑‑‑I can.
PN11528
Am
I pronouncing your name correctly?‑‑‑Yes, you are.
Close enough.
PN11529
That's
good. Mr Heyan, my name is Nigel Wood, I appear in these proceedings
for the employer interest. I'm just going to ask you - I won't keep you
very long this morning. Can I just start with your statement, do you have
it in front of you?‑‑‑I do.
*** ROSS EVAN HEYAN XXN
MR WARD
PN11530
Just
by way of background, am I right that in paragraph 7 you say you were a TESOL
teacher in mainland China, does that mean you were an English teacher in China?‑‑‑That's
right. TESOL is teaching English to speakers of other languages.
PN11531
I
take it you obviously would be qualified in that?‑‑‑That's
right, yes.
PN11532
Is
that what you traditionally did, before you started working at AusCare?‑‑‑I'd
done a variety of jobs in a variety of different industries, yes.
PN11533
Can
you just explain for me, did you come back to Australia in 2016, so you came
back and AusCare was your first job back in Australia?‑‑‑No,
it was my second job back in Australia. I worked, for a short time, in a
call centre and then later went to AusCare.
PN11534
Can
I ask why you took the job at AusCare?‑‑‑I was unemployed at
the time and I was willing to try anything. So it was close to home, I'd
never been in a job like that before but I thought, why not, and give it a
shot.
PN11535
Okay.
I understand you're the union delegate for the United Workers Union at the
facility?‑‑‑I was. So I'm no longer employed in aged
care. I now work for United Workers Union, as an organiser. But
during my time there I was the delegate at the facility, yes.
PN11536
I
don't think it's in your statement, when did you leave?‑‑‑I
left mid last year.
PN11537
And
you took up being an organiser for the union at that time?‑‑‑Correct.
PN11538
As
I read your statement, you have a Certificate III in cleaning operations, is
that right?‑‑‑That's correct.
PN11539
I'm
not familiar with that, Mr Heyan, what does that normally - what does that
involve? What does it teach you?‑‑‑Just basic sort of
cleaning, infection control. It was through TAFE. I'm not sure if
it was very COVID focused. I mean obviously I started doing it in 2020
but I think it was something organised by the Department of Education and
offered to all cleaners. So, yes, it was basic cleaning things, how to do
things safely and stuff like that.
PN11540
That
arose in your employment with the Department of Education?‑‑‑Correct.
*** ROSS EVAN HEYAN XXN
MR WARD
PN11541
Okay.
Now, I'm right that you don't have any clinical qualifications, you're not a
nurse or anything like that?‑‑‑I'm not.
PN11542
And
you don't hold a Cert III in aged care?‑‑‑I do not.
PN11543
And
I'd be right that you've never been involved in the management of an aged care
facility, would that be right?‑‑‑No, I have not.
PN11544
Now,
I've read your statement several times, Mr Heyan, is it reasonable to say
that when you worked there you didn't believe the facility was run very well?‑‑‑No,
I wouldn't say that. I think it was run, from at least the management at
the facility that I had contact with, I think while they're not perfect, they
did the best job they could.
PN11545
I'm
going to ask you some questions about your work, but before I do that - I'll
come back to that. As I understand your statement, you say you were
mostly cleaning?‑‑‑Well, as I say in my statement, my role
changed quite a lot. Certainly for the last two, two and a half years of
my employment I was mostly in a cleaning role.
PN11546
When
you say 'mostly', what percentage of your time was spent cleaning?‑‑‑I
would say 75 per cent, 80 per cent of my time was cleaning.
PN11547
The
other 25 or 20 per cent was in food service?‑‑‑Yes, usually
in food service. Occasionally in other roles that needed to be done
around the facility.
PN11548
Such
as what?‑‑‑Such as sometimes maintenance, if there was no
maintenance man then I would sometimes be asked to do that. That's moving
around furniture, helping do small repairs.
PN11549
You
mean like changing a - you mean changing a washer on a tap, by repairs?
What do you mean by repairs?‑‑‑No, I would say stuff like if
a lift bed, the bed that a resident lays in, that is able to be lifted up, if
that was not working for some reason, you know, someone would have to go there
and try and figure out what was wrong. If it was broken then obviously a
professional would be called in to service it, but often it was the remote
control that does the lifting wasn't quite plugged in right, so I'd have to
climb under the bed.
*** ROSS EVAN HEYAN XXN
MR WARD
PN11550
What,
in the old days, might have been described as the handyman?‑‑‑Yes.
Yes, that would be accurate.
PN11551
Can
you go to paragraph 12, I think in paragraph 12 you describe the cleaning
job. When you say, 'Disposing of accumulated rubbish', is that a
reference to the general rubbish bins that might be in residents' rooms, or is
that reference to something else?‑‑‑When I mentioned,
'Disposing of accumulated rubbish from essential storage space', there's
basically what's called a dirty room, what was called a dirty room, in our
facilities, and the personal carers, if they had soiled pads or any other sort
of rubbish, it would go to that dirty room and then the cleaner would be
required to come around twice a day and empty all the rubbish, take it out to
the main bin outside.
PN11552
Is
that rubbish bagged in any particular way?‑‑‑They were just
put into black plastic bags and tied on top.
PN11553
And
you would take the tied plastic bag and take it to what, a central rubbish bin
that then a contractor would take away?‑‑‑Yes, just a rubbish
truck would come and collect it, in a big blue bin.
PN11554
When
you talk about infection control of touch points, was that using like a spray
and wipe and wiping down handrails and things like that?‑‑‑Yes.
So this is something that was always a part of the job. It obviously
became more important because of COVID. It often changed what we were
using. Sometimes there were pre-dosed wipes, sometimes you'd have a spray
and a cloth, sometimes we used a gel-type solution, but it was wiping down hand
railings, light switches, door knobs, all that sort of stuff.
PN11555
I
take it when you cleaned the resident room, you would clean the bathroom as
well as the actual room where the bed was?‑‑‑That's correct,
yes.
PN11556
I
take it that when you cleaned the bathroom, were you using what I might
describe as domestic chemicals to clean that? You weren't using
industrial chemicals like formaldehyde, or something like that?‑‑‑No,
we only were able to use the chemicals provided by the facility. I don't
know if you could class them as domestic because they're from a specific
cleaning supplier. I don't think formaldehyde or anything like that would
be a part of it. I'm not a hundred per cent sure on that.
PN11557
Were
any of them - I take it some of them might have been bleaches for the shower
and things like that?‑‑‑Yes, yes, they were sort of quite
strong bleaches that were used, yes.
*** ROSS EVAN HEYAN XXN
MR WARD
PN11558
Then
you say you did general cleaning. Is that like vacuuming and
- - -?‑‑‑Yes, vacuuming, mopping floors, dusting,
you know, pictures and table tops, sort of general cleaning to keep the place
tidy.
PN11559
Did
you have a sort of roster of how you had to do it or did you make it up as you
went?‑‑‑No. Well, we do have a checklist of tasks that
should be done during the day. Certainly management were flexible in that
if something sort of happened during the day and, for some reason, it couldn't
all get done, as long as I explained that, then that was acceptable, but we did
have a checklist of duties that we were supposed to get completed.
PN11560
So,
if Mrs Smith was unwell in her bedroom today, you might make a decision with
the care staff not to go into Mrs Smith's room?‑‑‑Yes,
certainly.
PN11561
But
I take it - you sound quite diligent - I take it that most days you got the job
done?‑‑‑Yes, most days the job got done. It was always
a stretch to get it all done. It certainly wasn't an easy day, but mostly,
in the cleaning role, things got done in the section I worked in.
PN11562
In
the food service role, as I understand it, you worked in food service in
Eucalyptus?‑‑‑Yes.
PN11563
I
take it that was one of the wings, was it?‑‑‑It was one of
five wings.
PN11564
In
your facility, was there sort of a primary central kitchen where the cooking
was done?‑‑‑That's right, yes.
PN11565
I
take it that kitchen wasn't actually in the Eucalyptus wing, or was it in the
wing?‑‑‑No, it wasn't in the wing, it as in a sort of central
location.
PN11566
Tell
me if I'm wrong, but if it's hot food, I take it it would have been put in a
hot box and then moved into the Eucalyptus servery?‑‑‑That's
right.
PN11567
In
the servery itself, was that a servery that had sort of bain maries and things
like that there?‑‑‑That's right, yes, a bain marie, sink,
microwave, fridge.
PN11568
When
you were doing food service from the Eucalyptus servery, did you plate up or
was it pre-plated?‑‑‑No, I would plate up.
*** ROSS EVAN HEYAN XXN
MR WARD
PN11569
I
take it, having plated up, you would then take the food and effectively put the
plate in front of the resident?‑‑‑Generally, yes.
Sometimes a personal carer would assist with that, but that all depended on how
busy they were.
PN11570
Were
you ever required to cook?‑‑‑Yes, I have done that shift on
several occasions. It wasn't the majority of what I've done, but we were
required to be flexible, so, you know, if the cook had called in sick or gone
on holidays, then someone had to step up.
PN11571
So
were you competent to cook the roast pork and things like that, were you?‑‑‑No,
generally I didn't do - so there was an early morning shift where most of the
food was prepared. I would more often do the sort of late shift, which
was putting the pre-prepared things in the oven for however long the cook told
me it needed to go in for, temperature-checking the food as it came out and
putting it in the hot boxes to go off to the different wings.
PN11572
Did
you have any separate food safety qualifications yourself?‑‑‑No,
the only food safety qualifications I received was the mandatory training
provided by my employer.
PN11573
Thank
you, Mr Heyan, no further questions.
PN11574
COMMISSIONER
O'NEILL: Any re-examination, Mr Oski?
PN11575
MR
OSKI: No re-examination, Commissioner.
PN11576
COMMISSIONER
O'NEILL: All right. Mr Heyan, thank you very much for your evidence
this morning. You are excused and free to go?‑‑‑Thank
you.
<THE
WITNESS WITHDREW [10.19
AM]
PN11577
COMMISSIONER
O'NEILL: Now is it Ms Hafnagel next?
PN11578
MR
OSKI: Yes, she's available now. I will get her.
PN11579
COMMISSIONER
O'NEILL: All right. Good morning, is it Ms Hafnagel?
PN11580
MS
HAFNAGEL: Yes, it is.
*** ROSS EVAN HEYAN XXN
MR WARD
PN11581
COMMISSIONER
O'NEILL: All right, lovely. I'm Commissioner O'Neill and my
associate's just going to take you through the affirmation.
PN11582
MS
HAFNAGEL: Thank you.
PN11583
THE
ASSOCIATE: Ms Hafnagel, can you please say your full name and work
address.
PN11584
MS
HAFNAGEL: Sandra Kim Hafnagel. Did you ask my work address or my
home address?
PN11585
THE
ASSOCIATE: It can be either one. Okay, my home address is (address
supplied).
<SANDRA
KIM HAFNAGEL, AFFIRMED [10.20 AM]
EXAMINATION-IN-CHIEF
BY MR OSKI [10.20 AM]
PN11586
COMMISSIONER
O'NEILL: All right, Mr Oski.
PN11587
MR
OSKI: Thank you, Commissioner.
PN11588
Good
morning, Ms Hafnagel. I'm Sheldon Oski, I appear for the UWU today.
Can you repeat your full name for the record?‑‑‑Sandra Kim
Hafnagel.
PN11589
I
understand you have made a statement for the purposes of the proceeding; is
that right?‑‑‑Yes.
PN11590
I
believe that statement is dated 30 March 2021 and runs to 48 paragraphs over
nine pages. Do you have a copy of that statement with you?‑‑‑Yes,
I do.
PN11591
Have
you had an opportunity to read through it again?‑‑‑Yes.
PN11592
Is
it true and correct to the best of your knowledge and recollection?‑‑‑Yes.
PN11593
Commissioner,
that's at document 235 at page 12099 of the digital court book and we seek to
rely upon that statement.
*** SANDRA KIM HAFNAGEL XN
MR OSKI
PN11594
Ms
Hafnagel, you'll be able to see in one of the windows in the screen there is Ms
Rafter, under the caption 'Nigel Ward', and she is now going to ask you some
questions about your statement.
CROSS-EXAMINATION
BY MS RAFTER [10.22 AM]
PN11595
Hi,
Ms Hafnagel, my name's Alana Rafter and I'm appearing for the employer
interests in the proceedings today and I'm just going to ask you some questions
about your statement. I see you're a personal care worker - with PresCare
you worked as a personal care worker in community care?‑‑‑Yes.
PN11596
That
was between around 2010 to 2021?‑‑‑Yes.
PN11597
I
understand you have a Certificate III, which you had in around 2010. Is
it correct you were required by PresCare to have that qualification?‑‑‑Yes,
you are.
PN11598
I
note in paragraph 18, you refer to the requirement for first aid and CPR
training. Was that also a requirement by PresCare?‑‑‑Yes.
PN11599
Thank
you for that. Just so I can get a picture of the people you might be
contacting in the office in your work in community care, did you report to a
personal care worker coordinator?‑‑‑Yes, we did.
PN11600
They
act as your supervisor if you had a question whilst you were at an appointment?‑‑‑Correct.
PN11601
If
you needed to contact, say, had a question for a registered nurse, would you
contact your coordinator first or do you have a number for a registered nurse
as well?‑‑‑No, you could contact a registered nurse.
She had her own - - -
PN11602
Excellent.
So you had the numbers for both. You could go to the office or direct to
a registered nurse. And I note you also refer to a roster section.
I take it that's the team that sets the rosters and allocates appointments to
all the care workers?‑‑‑Correct, yes.
PN11603
Excellent.
Now, I'd just like to take you to paragraph 15 of your statement and just ask
you about some of your duties?‑‑‑Mm-hm.
*** SANDRA KIM HAFNAGEL XXN
MS RAFTER
PN11604
So,
at 15 you refer to administering medication, is that, from what I understand,
the medication prompt where clients with Webster packs you might give them a
prompt?‑‑‑Yes.
PN11605
And
if they were able, you might just watch them pop the packet themselves?‑‑‑Yes,
we were allowed to actually pop them, but not actually - just hand it to them.
PN11606
I
see. And so you might pop them into, like, a cup for something?‑‑‑Yes.
PN11607
You
wouldn't touch the pills?‑‑‑No.
PN11608
And
did you receive separate training from PresCare for that?‑‑‑Yes.
PN11609
Was
that medication training conducted by the registered nurse?‑‑‑Yes.
PN11610
Was
there a theory component and a practical component for that training? Or
if you can - I might take it back, if you can tell me a little bit about that
training, I'll make it like that?‑‑‑There were times where it
was practical, another time it was just theory, so depending on the staff
meeting we had, not necessarily both.
PN11611
I
take it prior to being able to administer medication the RN had to assess you ‑ ‑ ‑?‑‑‑Yes.
PN11612
‑ ‑ ‑and
be satisfied that you had that competency?‑‑‑Yes.
PN11613
Thank
you for that. At the third dot point you talk about meal
preparation. Could you give me an example of what meal preparation might
include?‑‑‑Meal preparation, in my case, was I would prepare
enough meals for a husband and wife for their seven days, because they were
incapable of preparing, cutting up vegetables, cooking meals, so that their
nutrition side of it would be value for themselves.
PN11614
And
would you get assistance from - to make sure the nutrition was there would you
have a care plan or assistance as to what food you would use, or how would that
be determined?‑‑‑No. No, that was determined by the
family.
*** SANDRA KIM HAFNAGEL XXN
MS RAFTER
PN11615
The
family would determine it?‑‑‑Due to some of them couldn't eat
certain foods or they couldn't chew food so it always had to be very soft to
accommodate their family, and what they liked.
PN11616
You
said you would prepare for the week, so I take it you would cook the food in
bulk and then freeze it?‑‑‑I would normally cook three
separate meals, and then, yes, freeze it, date it, and that's how it was put in
their freezer for them.
PN11617
Could
you give me an example of one of the dinner meals that might be cooked and
frozen?‑‑‑Yes, I used to cook a roast first, and they would
have that that day, and then always have the chicken for sandwiches during the
week if they needed it. I used to cook spaghetti bolognaise or what they
call porcupine meatballs, anything like that that was soft and better for them,
so, yes.
PN11618
If
you were doing meal preparation I take it you would have a longer appointment
for that client?‑‑‑Yes.
PN11619
Just
going down the list, the third-last dot point in that page, you refer to
teaching and assisting clients with their mobile phones and computers?‑‑‑Yes.
PN11620
Is
that just based off your knowledge or your usage of a phone?‑‑‑Yes,
especially over COVID, because they were so isolated.
PN11621
Just
checking to see if you've done, like, a separate phone course or computer ‑ ‑ ‑?‑‑‑No.
PN11622
No?‑‑‑I
made them get a Samsung so I knew how to use it.
PN11623
Good
show. And now over the page, on the first dot point, you talk about
buying household items, and you list some like mobile phones, clothing.
We might stay with the Samsung, because I take it this is one of them.
How did it work, did the client give you the list of what they wanted you to
buy, give you their card or money and you go and do it, or how did that work?‑‑‑No,
I actually took the client with me. Never ever had a card on me, it was
always with the clients.
*** SANDRA KIM HAFNAGEL XXN
MS RAFTER
PN11624
Thank
you for that. And then if we go down to the next dot point, mentoring,
could you just explain what you mean by mentoring?‑‑‑Well,
during COVID mentoring them, trying to teach them how to do use their Samsung,
and be able to teach them how to Skype, and so I'd mentor them how to do it, so
they could keep in contact with their families, because they were so isolated,
so I was just mentoring them in how to use different appliances and how to - I
don't know, really listen to music, showed them how to get music up, because
they were so vulnerable out there by themselves.
PN11625
I
think I understand you'd be helping them use - because you would be helping
them with their technology so they could still talk to their family, who might
not be in a position to see them especially due to COVID. And then you
talk about care - I think, I may have lost a spot, but I believe you refer to
hairdressing, and you would cut the client's hair. Was that all
(indistinct)?‑‑‑No, I never said cut the client's hair.
I ‑ ‑ ‑
PN11626
Okay,
I think that was a prompt for me to ask?‑‑‑No, I set ‑ ‑ ‑
PN11627
I'll
say what do you mean ‑ ‑ ‑?‑‑‑ ‑ ‑ ‑their
hair.
PN11628
I
spoke over you, I might have cut it, so what did you mean by hairdressing
again?‑‑‑No, we had a few clients that used to go to the
hairdressers every week, so I would put their rollers in their hair, just do
their rollers. I never cut hair, I never did anything, just so that they
make them feel good as if they'd been out and it just made them feel better in
themselves.
PN11629
Thank
you for clarifying. I didn't mean to put your words in your mouth
there. And, now, if we go - I wanted to talk about the annual training
modules you do. I believe you mention them at paragraph 21?‑‑‑Mm-hm.
PN11630
That
PresCare made it a requirement that you do these. Were these online
modules?‑‑‑Yes, they were.
PN11631
And
would some include maybe a video?‑‑‑Most of them had videos
and then questions and answers at the end.
PN11632
It
finishes with a quiz. Thank you for that. Do they take about - do
they range in length? Like, would some take 30 minutes, some might take
an hour?‑‑‑Yes.
PN11633
Thank
you. Now, I just want to ask some questions about protocols at
PresCare. So, if you're showering a client and you see, say, a skin tear
on their arm, is there a protocol you're to follow with that?‑‑‑Yes,
we would document it.
PN11634
Could
you (indistinct)?‑‑‑And then we would notify the RN, in case
it needed any medical assistance, but it was always documented and reported.
*** SANDRA KIM HAFNAGEL XXN
MS RAFTER
PN11635
Now,
when you say 'documented', is this in a - is this a progress note or how are
you documenting it?‑‑‑It would be in a progress note and I
would normally email the RN and take photos of it so she could actually see the
skin tear for herself.
PN11636
Do
you need to call someone as well, or do you just email and wait for a response
from the RN?‑‑‑It would all depend on the severity of the
tear, so that would be if it wasn't a hospital - to ring an ambulance, I would
just document it, send a photo to the RN. And then I would wait for
instructions from her.
PN11637
So,
if we put another scenario, so, a client's had a fall during your appointment,
so, would that be a scenario - would the protocol for that be to call the
ambulance first?‑‑‑Yes.
PN11638
And
then I take it you might then call your coordinator?‑‑‑Yes.
PN11639
Then
you would wait for the ambulance to come, and you've told the coordinator that
the ambulance is on their way?‑‑‑Yes, we'd make the client
comfortable and just reassure them that the ambulance was on their way.
PN11640
I
note at 38 you talk about when the paramedic arrives, and you give them a
handover. You refer to giving them the medical history. Is that
based off what's included on the client's care plan?‑‑‑The
medical history is normally in the care plan but also mainly for the medication
side, so that they're aware of what medication they're on, whether it be
Warfarin, or anything else like that.
PN11641
So
if there was a blister pack that you might hand the blister packet to the
paramedic ‑ ‑ ‑?‑‑‑Yes.
PN11642
‑ ‑ ‑so
they can see the pills that they typically have. And with an incident
like a fall would you prepare an incident report as well as prepare progress notes?‑‑‑Certainly.
We had to do an incident report from the time of the fall, what happened, how
we found them, what we did, whether it be ring an ambulance, and all our steps,
and send it - and do the incident report and send it to the coordinator.
PN11643
Thank
you for that. And with the progress notes, are they physical or hard copy
progress notes in the house, or are they done electronically via an app or
email?‑‑‑Well, that's changed, sometimes it's paper notes,
but sometimes the actual progress can go into a phone now.
*** SANDRA KIM HAFNAGEL XXN
MS RAFTER
PN11644
Okay?‑‑‑We
didn't have that app when I first started with them, but - I don't work for the
company anymore, but the company I work for now we do it on phone. So
I've heard that most of the providers these days, you can do your progress
notes on the phone.
PN11645
But
with Place Care it was still mainly paper notes?‑‑‑It was
paper.
PN11646
I
might just go back to the care plan, if I may. How did you have access to
the care plan for your clients?‑‑‑They had a folder in their
homes, and you would read the care plan before you started your service with
them.
PN11647
Did
you have access to it electronically at all, or the first time you would see it
is when you enter their home?‑‑‑At that stage the first time
was when I entered their home.
PN11648
With
the preparation of the care plan, to your understanding is that prepared by the
coordinator?‑‑‑Yes.
PN11649
If
any of this you don't know, feel free to let me know and don't answer, but I'm
just going to ask some questions about that initial stage where they're getting
admitted as a client. So the coordinator would go to the client's house?‑‑‑Yes.
PN11650
And
they'd prepare this care plan, find out what services and needs they have?‑‑‑(No
audible reply)
PN11651
Would
a risk assessment of the client's house occur at that time?‑‑‑Yes.
PN11652
And
I take it they'd be checking the shower and if they needed hand rails put in
that might be a part of that process?‑‑‑Yes.
PN11653
Were
you a part of that process in any way, or is that just - - -?‑‑‑No.
PN11654
-
- - coordinator? If you notice hazards in your role, so a safety hazard
at the client's house, is there a protocol you're to follow?‑‑‑Yes.
We would put in a hazard report, and report whether it's a mat that you could
trip on; it could be cords that have frayed. So under work health and
safety, that was an issue towards me and also the client.
*** SANDRA KIM HAFNAGEL XXN
MS RAFTER
PN11655
With
these reports, are the hazard reports more ad hoc, you do them as they go, or
are you expected to do them routinely?‑‑‑Only as you go
along.
PN11656
So
if you see one then you do it. And I take it this report would be much
like the incident reports – be emailed to the coordinator?‑‑‑Yes.
PN11657
And
then they would go from there. Bear with me. At 44 of your
statement you refer to the 'high risk.' Have there been occasions during
your work with Place Care where you felt unsafe?‑‑‑Definitely.
PN11658
Does
Place Care have a protocol that you're to follow when that happens?‑‑‑They
eventually put a protocol into place.
PN11659
So
I take it there wasn't always a protocol?‑‑‑No, not
necessarily.
PN11660
With
the protocol that is in place, what's that protocol?‑‑‑Our
protocol now is, if you feel unsafe in the environment, you can remove
yourself, whether it be you feel that – whether or not it's the client itself
or their partner or husband and that and you feel unsafe, you could remove
yourself and explain why, do an incident report why you have removed yourself.
PN11661
Going
back, if I may, to the progress notes, which are physical copies in the house
with Place Care I believe you said, would you typically write a progress
note for everything you do, or would you only be doing progress notes for
things that are out of the ordinary or exceptional?‑‑‑No,
progress notes would be noted on every service that you did for that client.
PN11662
And
I take it if something was out of the ordinary or of concern you would call the
coordinator or the RN?‑‑‑Yes, and email them with your
concerns.
PN11663
No
further questions, Commissioner.
PN11664
COMMISSIONER
O'NEILL: All right. Any re-examination, Mr Oski?
PN11665
MR
OSKI: No re-examination, Commissioner.
PN11666
COMMISSIONER
O'NEILL: Ms Hafnagel, thank you very much for your evidence this
morning. You're free to go and excused?‑‑‑Thank you.
*** SANDRA KIM HAFNAGEL XXN
MS RAFTER
<THE
WITNESS WITHDREW [10.37
AM]
PN11667
COMMISSIONER
O'NEILL: I think it's Ms Parke next.
PN11668
MR
OSKI: Yes, that's correct, Commissioner. I believe they're in the
process of joining the conference now. I understand they're just joining
now, Commissioner. They should be here shortly.
PN11669
COMMISSIONER
O'NEILL: No trouble.
PN11670
Ms
Parke, can you hear me?
PN11671
MS
PARKE: Yes, I can.
PN11672
COMMISSIONER
O'NEILL: I think you were just saying that your camera is turned off, are
you able to turn it on?
PN11673
MS
PARKE: I've got it on now, yes, I can see.
PN11674
COMMISSIONER
O'NEILL: I'm unable to see you. I'm not sure about the other -
there you are. There you are.
PN11675
Ms
Parke, I'm Commissioner O'Neill.
PN11676
MS
PARKE: Hi, how are you?
PN11677
COMMISSIONER
O'NEILL: Good. That's much better. That's lovely, thank you.
PN11678
My
associate is just going to take you through the affirmation.
PN11679
THE
ASSOCIATE: Ms Parke, can you please say your full name and work address?
PN11680
MS
PARKE: Lyndelle Anne Parke, our work address is 1 Wallaroo Street, Tiwi.
*** SANDRA KIM HAFNAGEL XXN
MS RAFTER
<LYNDELLE
ANNE PARKE, AFFIRMED [10.46 AM]
EXAMINATION-IN-CHIEF
BY MR OSKI [10.46 AM]
PN11681
COMMISSIONER
O'NEILL: Mr Oski?
PN11682
MR
OSKI: Thank you, Commissioner.
PN11683
Good
morning, Ms Parke, my name is Sheldon Oski, I'm appearing for the UWU
today. Can you both see and hear me?‑‑‑Yes, I can.
PN11684
Perfect.
Can you repeat your full name, for the record?‑‑‑Lyndelle
Anne Parke.
PN11685
Thank
you. I understand that you've made a statement for the purpose of the
proceedings today, is that right?‑‑‑That's correct.
PN11686
I
believe that statement is dated 31 March 2021, runs for 21 paragraphs over
five pages. Do you have a copy of that statement with you?‑‑‑I
do.
PN11687
Have
you had an opportunity to read through it again?‑‑‑I've had a
couple of looks through it, yes.
PN11688
Is
it true and correct, to the best of your knowledge and recollection?‑‑‑Yes,
it is.
PN11689
Commissioner,
that's at document 237, page 12115 of the digital court book, and we seek to
rely upon that statement.
PN11690
Now,
Mr Parke, you'll notice in one of your windows on your screen has
Ms Rafter in it, she'll how ask you some questions?‑‑‑Okay.
CROSS-EXAMINATION
BY MS RAFTER [10.47 AM]
PN11691
MS
RAFTER: Hi, Ms Parke, my name is Alana Rafter, and I'm appearing for
the employer interests today?‑‑‑Yes.
PN11692
*** LYNDELLE ANNE PARKE XN
MR OSKI
*** LYNDELLE ANNE PARKE XXN
MS RAFTER
I'm
just going to ask you some questions about your statement. I see you are
a community personal care worker with Australian Regional and Remote Community
Services?‑‑‑That's correct.
PN11693
And
you have a Certificate IV in Ageing Support and Disability?‑‑‑Yes.
PN11694
Now,
does Australian Regional, if I may shorthand to that?‑‑‑It's
ARRCs shorthand.
PN11695
ARRCs?‑‑‑Yes.
PN11696
No
worries, I'll use ARRCs then. Do ARRCs require you to have a Cert III or
Certificate IV?‑‑‑Usually at least a Cert III.
PN11697
Just
so I can get a picture of who you might be talking to in the office, or what
not, with ARRCS, is there a coordinator that you would talk to?‑‑‑Yes,
we have a level of people that we go to. So we'd start off with the team
leader then if there's no satisfaction there, you go - work your way up the list.
PN11698
So
I'll go - so just to get a picture, so we'll have you as a community personal
care worker, above you is the team leader?‑‑‑Or case manager,
sorry. Case managers.
PN11699
Case
managers?‑‑‑Yes.
PN11700
And
the case managers, so they're the case manager for each claim, I take it?‑‑‑Yes.
PN11701
There'd
be a long layer of those. Then you have the team leader above the case
managers, or separate department?‑‑‑Then you go on to the
management side. Yes.
PN11702
So
if you had a question, during an appointment, who would you first call?‑‑‑Case
manager.
PN11703
Case
manager, thank you for that. Are the case managers, are they typically
registered nurses or do they have qualifications like that?‑‑‑Case
managers are not registered nurses, but we do have registered nurses with
us. The registered nurses are the case managers for people that are on
packages.
*** LYNDELLE ANNE PARKE XXN
MS RAFTER
PN11704
Okay.
So if they're on a package their case manager will be an RN, but all other
clients, if you needed to speak to an RN you wouldn't go to the case manager,
you could call an RN?‑‑‑The RN. Yes, if you were
dealing with someone's medication and it was something wrong, you would call
the RN.
PN11705
I
would call the RN?‑‑‑Yes.
PN11706
Thank
you for that. I see, at paragraph 12 of your statement, you refer to a
typical day consisting of six to seven clients?‑‑‑Yes.
PN11707
Would
it be correct that you have a regular clientele that you would see each week?‑‑‑Yes,
but in the last few months, because we've been short-staffed, we're sort of all
over the place.
PN11708
There
might be filling in for other people and - - -?‑‑‑Yes.
PN11709
-
- - taking on extra shifts?‑‑‑Yes.
PN11710
I
see. And on this typical day, with the six to seven, do the appointment
times tend to vary?‑‑‑It does at the moment. Normally
they would be of a set time.
PN11711
Would
some be like for an hour, some might be for 15 minutes, some might be longer?‑‑‑Yes.
If you're just doing a med check it's usually 15 minutes. If you're doing
personal care, half an hour to 45 minutes. Sometimes an hour, if the
person - if you need to use a hoist, or something like that, it takes longer.
PN11712
So
it depends on the service that's being provided at the appointment?‑‑‑That's
right.
PN11713
Now,
you list some of these services at 12, so like domestic duties, helping with
showering, helping shopping and administering medication, for the administering
medication, is that the medication prompt I believe you just referred to?‑‑‑Yes.
We're only allowed to give medication if it's in a Webster pack, we are not
allowed to give any other medication, so you just follow the day, the date,
make sure you're giving the right medication at the right time.
*** LYNDELLE ANNE PARKE XXN
MS RAFTER
PN11714
And
you like maybe count the pills that are in that, once you pop them out, count
the pills?‑‑‑Yes, make sure - you have a look at the back of
the Webster pack, some people might only have two, some people might have six
and when you put them into the container you just have a look and make sure
there's however many that's supposed to be there.
PN11715
That
was going to be my next question, see if there was a chart that you're checking
against, but I take it it's on the blister pack itself?‑‑‑It
is. It's all written on the back of the blister pack.
PN11716
Did
ARRCs provide training for that, prior to you doing it?‑‑‑Yes,
I actually did a medication course through ARRCs.
PN11717
Would
that be through - that would be different to your Certificate IV, wouldn't it?‑‑‑That's
sort of an extra.
PN11718
An
extra?‑‑‑Yes.
PN11719
Was
that training conducted by a registered nurse?‑‑‑Yes.
It was through a company called Dolveston(?), who no longer exist at the
moment.
PN11720
Did
that training, was it over a day or how long was that training?‑‑‑It
was four half days, if I remember correctly.
PN11721
So
I take it, it included some theory and some practical?‑‑‑Yes.
PN11722
Did
you have to do a quiz, to start off, or did the RN just sign off that you were
competent and the end of it? How did you complete that training?‑‑‑Yes,
we actually had to - it was a quiz.
PN11723
Yes?‑‑‑So
we had to make sure it was the right person. So, you check the name, the
right dose, the right day, the right route, all of that, so, yes.
PN11724
Then
once you'd finished that quiz and shown that you have that understanding, then
you were allowed to be allocated the medication prompt appointments?‑‑‑Yes,
yes.
PN11725
Thank
you?‑‑‑And we also do - every year we do refresher courses
through work, so everything's done 12-monthly as we need to do it.
*** LYNDELLE ANNE PARKE XXN
MS RAFTER
PN11726
I
take it the refresher would be a more condensed version, it wouldn't be over
the four half days?‑‑‑No, it's usually our RN from the office
that takes us through it.
PN11727
So
the RN takes you through, just sees that you're keeping up with it and doing
the right thing, effectively?‑‑‑Yes.
PN11728
When
you are at a client's appointment doing a medication prompt, if there's
something looks wrong on the blister pack, so maybe a dose hasn't been used or
the pill number seems wrong, that's when you would call the RN?‑‑‑Yes,
and what we normally do is we take a photo of it.
PN11729
Yes?‑‑‑We
email it to the RN and then we call her. Just for instance, if I was to
go to someone to do a medication prompt and it was a Tuesday and Tuesday's
medication was already taken, then I would look at our books that we have that
we have to fill out, our medication charts, just to make sure that no one had
been there prior to me and done it.
PN11730
Yes?‑‑‑And
then I would ring the RN, yes.
PN11731
If
you checked the book - I take it there's a medication chart on the - I'll just
take it back actually. Is the book a communication book with the care
plan and progress notes?‑‑‑Yes.
PN11732
Is
that only in hard copy form in the client's house?‑‑‑Yes, it
is.
PN11733
You
don't have that; it's not emailed to you to see it, you need to go to the
client's house?‑‑‑Yes.
PN11734
Thank
you for that. And that's where you would write progress notes in if you
have been to an appointment?‑‑‑Yes, there's progress notes
with every client we go to.
PN11735
These
progress notes would set out everything you did for that client, so if you
helped them with showering, you do their medication prompt?‑‑‑Yes.
PN11736
If
you did their vacuuming?‑‑‑Give the eye drops,
whatever. Everything is written in.
PN11737
So
the next carer that comes along can see all of that's been covered?‑‑‑Yes.
*** LYNDELLE ANNE PARKE XXN
MS RAFTER
PN11738
If
something was wrong, if something was out of the ordinary, I take it you would
include it in those progress notes, but would you also then call the case
manager?‑‑‑Yes.
PN11739
If
a client was, say, less talkative than usual and you thought that might be -
that concerned you, you would note it in the case notes so that the next carer
would see, but you would also call the case manager and let them know that this
is what you've observed?‑‑‑Yes.
PN11740
Excellent.
You refer to a medication chart. That's included in that book as well?‑‑‑Yes,
it is. We have monthly charts, so every month, a new chart goes in.
PN11741
So
once you - - -?‑‑‑Once you've completed one chart,
one month, then you put a new form in for like a new one for April, one for
May.
PN11742
Is
it a checkbox type of chart where you just tick you've given the medication
that was in the Webster pack, or how do you fill out this chart?‑‑‑We've
got - there's little sections along it, so we put 'as per Webster pack', 'G'
for 'given', the time that it was given and then sign and signature, name and
signature, yes.
PN11743
Thank
you for that. And so that's when - - -?‑‑‑And
also with the medication, if someone refuses to take it, so we have - or if
they've taken it prior to, we put a 'P', and you still check that, you know,
their medication has been taken.
PN11744
Excellent.
So you have the blister pack, you can do (indistinct) there and you can - going
back to that example where a dose is missing or already taken for Tuesday, you
would then check the medication chart and the care book and it might actually
say 'P', so it was given, or it might say - - -?‑‑‑Prior.
PN11745
Prior?‑‑‑Yes.
PN11746
Then,
if there were still concern or the blanks were not all filled in, you then call
the case manager?‑‑‑Yes.
PN11747
Or
would you call the RN for the medication?‑‑‑Look, some of the
clients are not on packages.
PN11748
Yes?‑‑‑But
they're still on medication, so you would call their case manager, whoever that
be. The RN usually looks after package 3s and 4s.
*** LYNDELLE ANNE PARKE XXN
MS RAFTER
PN11749
Excellent?‑‑‑Yes.
PN11750
If
I could take you to paragraph 20 of your statement, here you are talking about
- you mention wounds and you say, 'Monitor, treat and record developments about
wounds.' Could you tell me what you mean by 'treat'?‑‑‑Look,
if there was a graze or something like that, dress it, maybe put some Betadine
on it, but always notify the RN.
PN11751
I
take it you're giving them first aid, basic first aid then?‑‑‑Yes.
PN11752
I
may not have asked this: do you have your first aid training as well?‑‑‑Yes.
PN11753
I
take it - - -?‑‑‑Yes, we have to do that.
PN11754
- - -
it's a requirement?‑‑‑Yes.
PN11755
But
if there was a significant wound, you might - - -?‑‑‑Call
the RN or call an ambulance.
PN11756
Yes?‑‑‑Yes.
PN11757
I
note you talk about taking photos of wounds and sending it to the RN?‑‑‑Yes.
PN11758
If
a client had a wound and it had previously been treated, would you typically
take photos each time you visit to keep the RN updated?‑‑‑Yes,
yes, if it was an open dressing, or, you know, if there was no dressing on
it. I, personally, like to get the feedback from the RN of what to do,
you know. Being a mum with kids, you know, you're always patching them
up, but this is different. You know, some wound could ulcerate. You
know, we're in the tropics, so things ulcerate up here quite easy.
PN11759
Yes?‑‑‑So,
therefore, it's more beneficial for the RN to be, you know, kept in the loop
about it.
PN11760
Is
there a formal - does ARRCs have a formal protocol that's to be followed with
wounds, that you're meant to keep the RN updated, or how does - - -?‑‑‑Yes.
*** LYNDELLE ANNE PARKE XXN
MS RAFTER
PN11761
Sorry,
I was just looking to see if you were nodding?‑‑‑Sorry.
PN11762
No,
you're right, the camera's gone in close and I can see now, so, yes, there's a
protocol, and is that protocol what we were just discussing, that you would
take photos?‑‑‑Yes.
PN11763
You
keep the RN updated, if you saw a change - - -?‑‑‑Then
definitely take a photo, email it to the RN and then it's in her hands.
PN11764
Yes?‑‑‑Yes.
PN11765
But
I take it if there was any - if you thought there was - if there was bleeding
or whatnot, you might go direct to the ambulance?‑‑‑Yes,
definitely.
PN11766
I
should not say 'whatnot'. If it's bleeding, you would call the ambulance?‑‑‑Yes,
if there was - you know, if it was just a trickle of blood, but if it was
really bleeding, it would be an ambulance, yes.
PN11767
I
note you do progress notes. Do you also do incident reports for that?‑‑‑Yes.
PN11768
Is
that when an ambulance gets involved you'd do an incident report?‑‑‑Yes.
PN11769
Or
would it be for any injury or something out of the ordinary you'd do an
incident report?‑‑‑Well, more for injuries or something out
of the ordinary, you know, if the person was - the instant you got there and
they were really angry, I would put it down to a UTI, you know, if it was out
of character for them, but you still involve the RN.
PN11770
You
would call for that because you see they're angry and in your experience that
could mean there's something wrong, so you call the RN?‑‑‑Yes.
PN11771
And
then the RN will take steps to see what - - -?‑‑‑Make
a doctor's appointment, get a blood test done, yes.
PN11772
Thank
you for that. To go back a bit in your statement, at paragraph 11, you
refer to giving companionship at all hours of the day and night. Is that
during your appointments or are you talking about - - -?‑‑‑During
the shifts, yes.
*** LYNDELLE ANNE PARKE XXN
MS RAFTER
PN11773
Just
checking for that one?‑‑‑That was a little bit of a - I don't
know why he's put that because our cut-off time is 9 o'clock at night
time.
PN11774
Sorry?‑‑‑So
that's the last - the last shift.
PN11775
When
you say 'I don't know why he's put that', what do you mean?‑‑‑'All
times of the day and night', you know, our cut off time is 9 o'clock at night,
so ‑ ‑ ‑
PN11776
So,
they're not your words for that one?‑‑‑No. No.
Yes.
PN11777
I
might get you to say it in your words for that dot point at paragraph 11.
How would you say it in your words?‑‑‑Between the hours of 7
o'clock and 9 o'clock, 7 am to 9 pm.
PN11778
And
just checking as you've made that, I just might ask you to briefly read the dot
points at paragraph 11 to make sure you agree with what's written there?‑‑‑Yes,
the rest of it is correct. Yes.
PN11779
That's
good just making sure. Now, I might ask you another question then.
For that final dot point with paperwork during shifts, is that what we've been
talking about with the progress notes, and the medication chart?‑‑‑Yes.
PN11780
Is
there additional paperwork?‑‑‑No, we have our progress notes,
our medication charts, and, you know, there's a medication chart for
everything. If someone's having drops there's a separate medication chart
for that, so, you fill that separately. If - yes, so, one's for
medication, one's for eye drops.
PN11781
Thank
you for that. Now, I'm going to ask you some questions, and if you don't
know the answer feel free to just tell me, say, 'No, that's not my role' or 'I
don't know that', so that's all fine?‑‑‑Yes.
PN11782
But
does the case manager prepare the initial care plan for the client?‑‑‑Yes,
they go out and do a visit, go through everything that needs to be done, and
then they make up the care plan.
PN11783
As
part of that process, are you aware if they do a risk assessment of the home?‑‑‑They're
supposed to.
*** LYNDELLE ANNE PARKE XXN
MS RAFTER
PN11784
They're
supposed to. I take it you're not involved in that process. So, are
you trusting that ‑ ‑ ‑?‑‑‑No,
not at all.
PN11785
So,
you're trusting that it's being done?‑‑‑No, we're not
involved in the - yes, we're not involved until we actually go in to provide
the service.
PN11786
And
then if you see safety hazards whilst you're at a client's house, is there a
procedure for notifying the office or the case manager about these hazards?‑‑‑Again,
an incident report.
PN11787
So
that would be an incident report?‑‑‑Yes. Not an incident - a
hazard report, sorry.
PN11788
A
hazard report for that one, okay?‑‑‑Sorry.
PN11789
So,
for example, if ‑ ‑ ‑?‑‑‑You
know, if it was - just if power points were a bit loose, or tiles off in the
bathroom, or mats in the way, you know, yes.
PN11790
Thank
you for that. Give me one second. Just one more question about, if
I can go back briefly to training - sorry, I'll withdraw that, I've already ask
you that.
PN11791
There's
no further questions, Commissioner. Sorry, Commissioner, you're on mute.
PN11792
COMMISSIONER
O'NEILL: Yes, apologies. Any re-examination, Mr Oski?
PN11793
MR
OSKI: No re-examination, Commissioner.
PN11794
COMMISSIONER
O'NEILL: Thank you very much for your evidence, Ms Parke. You're
excused and free to go?‑‑‑Okay, thank you very much.
<THE
WITNESS WITHDREW [11.07
AM]
PN11795
COMMISSIONER
O'NEILL: Well ‑ ‑ ‑
PN11796
MS
RAFTER: Could I be excused to get Mr Ward?
*** LYNDELLE ANNE PARKE XXN
MS RAFTER
PN11797
COMMISSIONER
O'NEILL: You may, but we will take a short break and adjourn until
11.25. The Commission is adjourned.
SHORT
ADJOURNMENT [11.07
AM]
RESUMED [11.24
AM]
PN11798
COMMISSIONER
O'NEILL: I think we have Ms Bowers next. Ms Bowers, can you
hear me all right?
PN11799
MS
BOWERS: Yes. Good morning everyone.
PN11800
COMMISSIONER
O'NEILL: Good morning. I'm O'Neill C and my associate is just going
to take you through the affirmation.
PN11801
THE
ASSOCIATE: Ms Bowers, can you please say your full name and work address?
PN11802
MS
BOWERS: I'm Geronima Bowers. I was born July 20
1963. Address, 42 Newport Drive in Dudley Park,
WA 6210.
<GERONIMA
BOWERS, AFFIRMED [11.25 AM]
EXAMINATION-IN-CHIEF
BY MR OSKI [11.26 AM]
PN11803
COMMISSIONER
O'NEILL: All right, Mr Oski.
PN11804
MR
OSKI: Thank you, Commissioner. Good morning, Ms Bowers.
My name is Sheldon Oski. I'm appearing for the UWU today. Can
you both see and hear me?‑‑‑Yes, I can hear you – yes, can
you speak a little bit louder?
PN11805
A
bit louder? No worries. Can you repeat your full name for the
record?‑‑‑Geronima Bowers.
PN11806
I
understand you've made a statement for the purposes of the proceedings, is that
correct?‑‑‑Yes.
PN11807
I
believe that statement is dated 1 April 2021 and runs to 37 paragraphs
over six pages. Do you have a copy of that statement with you?‑‑‑I've
got it in front of me.
*** GERONIMA BOWERS XN
MR OSKI
PN11808
Have
you had an opportunity to read through it again?‑‑‑I did read
some of them, but (audio malfunction) memorise it, but I can try my best to
answer what is the best – of what you're going to ask, best answer.
PN11809
Is
that statement true and correct to the best of your knowledge and recollection?‑‑‑Yes.
PN11810
Commissioner,
that's at document 239 at page 12127 of the digital court book, and we
seek to rely upon that statement. Ms Bowers, you'll be able to see
in one of the windows on your screen Mr Nigel Ward in it. He
will now ask you some questions about your statement?‑‑‑Good morning.
CROSS-EXAMINATION
BY MR WARD [11.27 AM]
PN11811
MR
WARD: Good morning. Ms Bowers, can you hear me okay?‑‑‑Yes.
PN11812
Thank
you, Ms Bowers. My name is Nigel Ward, Ms Bowers. I appear in
these proceedings for the employer interest. I'm just going to ask you
some questions. Can I just confirm again you have your statement in front
of you?‑‑‑Yes.
PN11813
Can
I just start with your qualifications? Could I ask you to go to
paragraph 15?‑‑‑(Indistinct). Yes, I have – my
qualification is I have Certificate III and IV in Aged Care.
PN11814
That's
okay. Can you tell me, you say that you got these certificates 'since
starting work in aged care in 2006.' Did you have both of them
before you started work in aged care?‑‑‑Yes.
Actually I'm studying on that time, because the company that I work with is the
one who's paying for my study.
PN11815
So
you started your Certificate III when you started working in aged care?‑‑‑Yes.
PN11816
What
year did you get your Certificate III?‑‑‑I think it was 2006.
PN11817
Then
you went on to do your Certificate IV afterwards?‑‑‑Well, I
did together at once.
PN11818
You
did it together?‑‑‑Yes.
*** GERONIMA BOWERS XXN
MR WARD
PN11819
I
wasn't aware you could do that. You did them literally at the same time?‑‑‑Just
extra modules that we have to do.
PN11820
Is
there any particular reason why you went on to do the Certificate IV?‑‑‑Yes.
I think the Certificate IV is giving me more understanding of how to deal with
caring for the most vulnerable members of our society.
PN11821
Are
there any particular competencies the Certificate IV gave you that the
Certificate III didn't?‑‑‑It's just an extra module
(indistinct) for me and all that stuff. Other than that, yes, it's just a
little bit of management I guess sort of thing, like a little bit more upgrade
than the Certificate III.
PN11822
Did
it teach you how to care for people with dementia better?‑‑‑Yes.
And also, apart from that, also I acquired understanding of dementia from the
University of Tasmania as well, so I have that certificate also.
PN11823
I
didn't see that in your statement. What certificate is that?‑‑‑Is
the 'Understanding of Dementia.' I got it – I think it was last year - -
-
PN11824
Okay,
so this happened after - - -?‑‑‑ - - - (indistinct).
PN11825
It
was after you made the statement?‑‑‑After I made the - - -
PN11826
That's
okay. You got that from the University of Tasmania, did you?‑‑‑Yes.
Dementia, yes.
PN11827
What
was that course called?‑‑‑Is 'Understanding of Dementia.'
PN11828
How
long did that course take to do?‑‑‑I think it was taking me –
I'm not sure, but I think about three months, or more or less, I'm not
quite sure, but I do it online.
PN11829
So
it wasn't three months of full-time study?‑‑‑No, it is not
full‑time study. I just spent, like, two hours every week.
PN11830
Okay?‑‑‑I
think, yes. But I did it more than that.
PN11831
Was
there an assessment at the end?‑‑‑Yes.
*** GERONIMA BOWERS XXN
MR WARD
PN11832
And
I'm assuming you passed?‑‑‑With flying colours obviously.
PN11833
Well
done, congratulations. Now, could I take you then back to the very
beginning, paragraph 5. You say in paragraph 5 that you've had
15 years experience in the aged care industry. What did you do
before you entered the aged care industry?‑‑‑Well,
before I entered the aged care industry, because also I have a Certificate in
Hospitality, III and IV also, so I was working as hotel services in that
facility I work with.
PN11834
So
when you say you 'entered the aged care industry 15 years ago', you were in it
before that, but you were working in the hospitality side of the industry?‑‑‑Yes,
in Brightwater, the same company.
PN11835
Is
all your experience in the industry at Brightwater?‑‑‑On that
time, yes, and then else I can relate myself I want to be carer, because I just
love to care the people.
PN11836
I'll
ask the question again. It wasn't very clear. Have you only ever
worked for Brightwater?‑‑‑Yes.
PN11837
Can
I take you to paragraph 8?‑‑‑Yes.
PN11838
At
paragraph 8 you talk about your hospitality services. You then say in the
second sentence, 'Since then I have worked as a personal care worker for
Brightwater Care Group.' Do you see that?‑‑‑Yes, I did.
PN11839
Have
you worked at one facility for Brightwater, or have you worked at different
Brightwater facilities?‑‑‑It's just one. It's just one
facilities, but they were looking for hotel services before and I did apply for
that, because I had my Cert III and IV in hospitality. Then a year
after that I moved to aged care.
PN11840
What's
the name of the Brightwater facility you worked in?‑‑‑The Cove.
PN11841
Sorry?‑‑‑The
Cove, Mandurah.
PN11842
Could
you spell it for me?‑‑‑Okay, the Cove?
PN11843
Yes?‑‑‑C-o-v-e.
*** GERONIMA BOWERS XXN
MR WARD
PN11844
C-e?‑‑‑C-o-v-e.
PN11845
O?‑‑‑Cove.
PN11846
Cove,
right. Okay?‑‑‑Sorry, my accent.
PN11847
No,
it's my hearing on my end, it's not your accent. I apologise. So,
as a care worker, you've only ever worked in that facility?‑‑‑Yes.
Yes, but last year - I think last year I was working also in disability, but I
don't do it in the (indistinct).
PN11848
So,
in a separate disability facility or ‑ ‑ ‑?‑‑‑It
was a separate one, because I need more money.
PN11849
That's
okay. But in terms of aged care it's that facility you've worked in?‑‑‑Yes.
PN11850
Can
I take you to paragraph 12?‑‑‑Yes.
PN11851
You
say this, 'At Brightwater Care Group', and I'm assuming when you've said
Brightwater Care Group, it's that facility we've just agreed on?‑‑‑Yes,
at Brightwater Care Group. Yes.
PN11852
Yes,
okay, 'I work in the acute dementia ward'. I take it that's a secure
ward?‑‑‑Yes, it is a secure ward, because most of the
residents that we have have unpredictable behaviours and it's sometimes they
don't know if they're going to run away or something like that, that's why we
are, like, (indistinct).
PN11853
So,
I haven't seen the word 'acute' before. If ‑ ‑ ‑?‑‑‑High
care dementia.
PN11854
So
high care, okay. That's fine?‑‑‑Sorry.
PN11855
No,
that's fine. That's fine. And can I just then take you - I'll just
do this slowly, if we could go through paragraph 13. You talk about your
duties in paragraph 13, and before I do that, do I take it that your facility
has a registered nurse on while you're working?‑‑‑Yes, we
always have a registered nurse. You know, I'm grateful for that.
PN11856
That's
all right?‑‑‑Because Brightwater is a good company to work
with.
*** GERONIMA BOWERS XXN
MR WARD
PN11857
Do
you have enrolled nurses as well?‑‑‑Yes, we have the enrolled
nurse.
PN11858
So,
if you look at the first dot point in paragraph 13 you say, this is explaining
what you do:
PN11859
Personal
care work which covers tasks such as showering, dressing, toileting, wound
care, and hygiene.
PN11860
Can
I just start with wound care, when you say 'wound care', and I'm going to give
you an example, and we might just walk through it, let's say I was the resident
and you were showering me today and you noticed a tear in my skin, is the
procedure that you have to inform the RN or the EN?‑‑‑Yes, we
have to - when we shower them and sometimes you have that, you know, because
the skin is so thin they, you know, being dementia, doesn't want to do
anything, so if they injure themselves, like for instance, a skin tear we do it
properly, like, we apply - so it's not going to be bleeding and then inform the
registered nurse to come and assess that wound.
PN11861
So
let's say the registered nurse comes down. I take it the registered nurse
will decide what should happen to the wound; is that right?‑‑‑Yes.
PN11862
And
let's say that the wound then is to be dressed, is it the registered nurse, the
enrolled nurse, or is it you who's going to dress that wound?‑‑‑Well,
actually the registered nurse would have to do it, we just assist them, because
there's not enough nurses and enrolled nurses to go around.
PN11863
So,
if you were assisting them in that sense you're keeping the resident calm while
the nurse dresses the wound?‑‑‑Exactly, yes, and helping
hands obviously.
PN11864
No,
I understand. And let's say that that wound had to be redressed in two
days' time, is it the registered nurse who comes and does that as well?‑‑‑We
have to - if it's loose then we have to do it ourselves, if the nurse isn't
available as well as the enrolled nurse, so we have to do it, and exchange that
to prevent from getting worse or getting more infected, and then the nurse will
come along and check if everything's okay, and, you know, obviously they are
more qualified than us, then they will assess the situation or ‑ ‑ ‑
*** GERONIMA BOWERS XXN
MR WARD
PN11865
That's
okay. so, let's say that the nurses dressed my arm with a cut on it, or
the tear on it, and the nurse says, 'We're going to put a new dressing on that
in two days' time', is it the registered nurse who comes down and does that?‑‑‑Usually
and to this time as a carer we have to be aware of that, and we remind them
that it's going to have to be, you know, checked and changed. If they are
not available we could ask the enrolled nurse, and if it's loose, obviously
because then they will undo, the staff will do it ourselves.
PN11866
I
see?‑‑‑And then obviously the nurse or the enrolled nurse
will come and do it the way they wanted to properly.
PN11867
I
see. So if my bandage is getting a little loose and you observe that
you'll make sure it's ‑ ‑ ‑?‑‑‑Yes,
we have to do that.
PN11868
‑ ‑ ‑tightened
back up so it doesn't fall off?‑‑‑Yes.
PN11869
And
then you'll get the enrolled nurse or RN to come and check it?‑‑‑To
just check it out if it's done properly just to make sure that everything is
okay.
PN11870
And
so when you talk about wound care you're talking about what we've just
discussed?‑‑‑Exactly.
PN11871
You
then talk about medicine administration?‑‑‑Yes.
PN11872
Am
I right, did you do the certificate III unit elective in administering medications?
Is that how you became medication competent?‑‑‑Yes.
Yes. Yes, I have that. But some of them haven't got the cert IV and
still giving the medication because obviously there's not enough staff.
PN11873
But
‑ ‑ ‑?‑‑‑But were trained by the
nurse.
PN11874
I
see. So ‑ ‑ ‑?‑‑‑At the
(indistinct).
PN11875
‑ ‑ ‑you
became medication competent because of your certificates?‑‑‑Yes.
PN11876
You're
saying some of your other care workers become medication competent separately
through a training program with the registered nurse?‑‑‑Exactly.
PN11877
That's
fine. And can I just make - I just want to run through what's involved in
the medications to see if my understanding is how you do it at
Brightwater. I take it we're talking here about Schedule 4 medications?‑‑‑Yes.
*** GERONIMA BOWERS XXN
MR WARD
PN11878
And
I assume that they're kept under lock and key somewhere? They might be in
a locked medication trolley or they might have even been in a locked medication
room; is that right?‑‑‑Yes, in Brightwater Group we have
always the medication in a locked room, and also it's not only that, they're
also the trolley they were in is in a locked room and there's a code to enter
it, so as we're medication competent we have to enter our own code, and then we
have an access to the medication trolley, then we can give the medication to
the residents.
PN11879
So,
you go in, you take the trolley with you, and, let's say that I'm your first
resident you're giving medications to, am I right that - I think you say in
your statement they would be in a Webster pack?‑‑‑Yes, in a
Webster pack, everything is a Webster pack, so we don't have those (indistinct)
which medication has to be given because in the Webster pack everything is in
there, and they just have to have the - you have to, as a medication competent,
you have to count down and read it properly that this is the right time and the
right doses and the right date obviously and then ‑ ‑ ‑
PN11880
You're
going to check that I'm the right person who's getting it?‑‑‑Exactly.
PN11881
You're
going to check that it's my 8 o'clock medication?‑‑‑Yes.
Yes.
PN11882
And
I understand that you have to verify that the pills are right pills. Some
people have said they look at picture charts of the pills to do that. Is
that what you do?‑‑‑We look at the picture chart also, and
also the blister pack, we have to count how many medication, and also we have
the - you know, these little iPads so we count all the medication and we have a
look at what's the time of medication and stuff like that. So, then we
have to have a look at the profile photos of that person, and then write the
name and all that there. But also ‑ ‑ ‑
PN11883
And
that ‑ ‑ ‑?‑‑‑Yes.
PN11884
All
of that information is on an iPad, is it?‑‑‑Yes.
PN11885
In
terms of the instructions for administering the medication, if I wasn't able to
swallow my tablets whole, they had to be crushed, would that be on the iPad
too?‑‑‑Yes. Yes.
PN11886
If
I had to take my medication with a custard or a jam that would be on there as
well?‑‑‑Yes. It'd have to be on the profile of what -
how you give that medication to the residents.
*** GERONIMA BOWERS XXN
MR WARD
PN11887
I
take it then that you would administer the medication to me; that would be
right?‑‑‑Yes, but some of dementia people it's very hard
because they don't want to take it, so ‑ ‑ ‑
PN11888
I
understand that?‑‑‑ ‑ ‑ ‑it takes
time for us, and you have to talk to them and all that stuff because the
medication has to be taken.
PN11889
So,
you might have to, as it were, persuade me that it's a good thing to ‑ ‑ ‑?‑‑‑Yes.
PN11890
‑ ‑ ‑take
my medication, and I take it that three things might happen in that situation,
I take it and afterwards you would record that I've taken it. That would
be one thing, isn't it?‑‑‑Yes, record it and tick it and
sign, obviously, that I have given that medication to the right person and the
right dose and the right time.
PN11891
I
take it if I was being difficult today and I didn't want to take it, you might
wait a while and then come back and try again?‑‑‑Yes,
exactly.
PN11892
If,
ultimately, I refuse to take it, I take it you would record that I had refused?‑‑‑Yes,
always.
PN11893
If
I refused, would you inform the RN or the EN or would you just write that down
on your iPad?‑‑‑We write it down on the iPad and also we
inform the RN that this patient's not taking their medication, especially if
they have the Parkinson's because it's important for them, otherwise they shake
too much more without the medication.
PN11894
If,
when you were looking through that Webster pack, let's say all the pills are
meant to be red and there's a blue one in the Webster pack, do you immediately
contact the EN or the RN to tell them something's wrong?‑‑‑Yes,
exactly. If the colour is not on the thing and there is another colour,
so obviously we are caution of what is the medication there for because we're
not informed on the profile of that resident that this medication have to be
given, so we have to ask the RN to come and check, and then obviously then can
make an investigation of what it is.
PN11895
They
will tell you how to proceed after that?‑‑‑Exactly, yes.
*** GERONIMA BOWERS XXN
MR WARD
PN11896
You
then, in the third dot point in paragraph 13, say you provide companionship,
which involves providing company to clients at all hours of the day and
night. I take it what you mean there is when you are actually rostered on
with the residents?‑‑‑Well, some residents are very
emotional, especially the new ones get emotional issues of coming into aged
care, so we have to make sure that we sit with them, we give them
companionship, like we treat them like an extension of our family, but somehow
it's very hard for us because there's not enough of us to do that. They
are - especially in high care dementia, they want you more, but because it's
lack of staff, it is - really it's very hard. So, some of them do get the
attention that we give and some is not because while you're giving the
attention to the other of the residents and another one's coming and another
one's on the floor, so you're constantly running, you don't really have - well,
I, myself, you know, don't really have enough time to - as you say
'companionship', you think that you're just sitting down and talk to them and
make them feel relaxed, but we don't have that because of understaffing and
there's so many - - -
PN11897
I
understand that that's your evidence?‑‑‑Yes.
PN11898
I
will try and ask the question in a different way. You say that you do that
all hours of the day and night. I take it you do that when you are
actually rostered on and actually at the facility?‑‑‑Yes.
PN11899
You
don't mean you do that on your days off?‑‑‑No.
PN11900
At
the next dot point, you say that you do various paperwork. If I could
just go through a little bit of that. I take it that at the end of your
shift, you will do progress notes on the people you are looking after?‑‑‑Yes,
most of us, we do our paperworks after. We have a small notebook we can
write it down what is happening and then, after the shift, because we cannot
simply do it while we're at work, I mean our opportunity, because the demand is
too high, the volume of it is so high, so we do that in our own spare time of
doing the documentation of it. Sometimes we stay extra one hour and we
don't get paid for that, but we are willing to do it because, obviously, it has
to be done.
PN11901
Let
me ask the question again, if I can. I take it that you write progress
notes at the end of every shift, whether or not you write them in paid time or
non-paid time?‑‑‑Yes.
PN11902
But
you do write progress notes, don't you?‑‑‑Yes, everything has
to be recorded.
PN11903
I
take it that when you say you have a notebook, you jot notes down during the
shift - - -?‑‑‑During the day.
PN11904
- - -
that might be referred to later on?‑‑‑Yes.
*** GERONIMA BOWERS XXN
MR WARD
PN11905
Okay?‑‑‑And
then, when we finish, we have a look our note and then we document everything
what happened on that day for the next shift.
PN11906
That's
fine. So, let's say that I was eating less than normal or if I was
quieter than normal, would you record something like that in the progress
notes?‑‑‑Everything has to be recorded, including the eating,
yes, the nutritions, the fluid intakes, everything has to be recorded so the
next shift can do what - you know, they can assess that person if he's not
eating well or not drinking well and then we can inform the RN as well and say
there's maybe something wrong with this person because they're not eating and
not drinking well.
PN11907
You
would record in your progress notes bowel movements?‑‑‑Exactly,
all the time, have to be (indistinct).
PN11908
Would
you record urine output?‑‑‑Everything, yes.
PN11909
Do
you record the volume of urine or do you simply record the fact that I went to
the toilet?‑‑‑Well, it depends. Sometimes, some people,
we have these residents that the output and input have to be recorded.
Some of them, we just say, okay, this not bowel movement so much and we have to
say what's the amount, the type and all that stuff, and including the - we
can't really say with the passing of urine because some of them, they're
wearing pads and we have no control over that or how much, obviously, but the
bowel movements and everything has to be recorded at all times.
PN11910
That's
fine. And do you check blood pressure?‑‑‑Yes.
PN11911
When
you check the blood pressure, do you simply record it?‑‑‑Yes.
PN11912
What
the blood pressure outcome is?‑‑‑Yes.
PN11913
Some
people have said that next to the client's blood pressure there's like a
traffic light system of green, yellow and red and if their blood pressure's in
the red zone, you'd tell the registered nurse straight away. Is that how
you operate?‑‑‑Exactly, yes.
PN11914
Okay?‑‑‑When
the blood pressure is low, we always inform the higher rank, obviously, so they
knows what's going on of the residents.
PN11915
By
'higher rank' you mean the EN or the RN?‑‑‑The RN
*** GERONIMA BOWERS XXN
MR WARD
PN11916
The
RN?‑‑‑Yes.
PN11917
The
RN, okay. Do you check for blood glucose, do you check for blood sugar?‑‑‑Yes.
PN11918
Is
that a finger prick test?‑‑‑Is a - yes, it's a finger test,
we have the small needles, and then we record it also, and if the sugar level
is high, then we have to inform the RN immediately because we do that all for
the people that are suffering from diabetes.
PN11919
Diabetes,
okay. I think you just said that if it's high, you have to inform the RN
immediately?‑‑‑Certainly, yes.
PN11920
And
the RN will decide what happens?‑‑‑High or low, we have to
inform the RN.
PN11921
High
or low. Okay. I take it that you would weigh the residents?‑‑‑Monthly
we weigh them.
PN11922
Do
you use a weigh chair for that?‑‑‑Either - it depends,
though. The people that's moveable, we can use the weigh chair, but the
one that is stay in bed and, you know, they cannot move, obviously we use the
hoist.
PN11923
Yes?‑‑‑But,
yet, we do that every month.
PN11924
In
my understanding, that's a hoist system that weighs them at the same time?‑‑‑Yes,
the hoist system that - the people from the bed, we can lift it up through the
hoist link and then we lift it up so we can weigh them with the hoist weighing
thing.
PN11925
Again,
I take it that you would write that down in your iPad as to what the person's
weight is?‑‑‑Yes, yes, everything is recorded what's going on
over the shift.
PN11926
You
keep using the word 'everything'. We have just gone through a list of
things that you might record. Have I missed anything out?‑‑‑I
think it's okay, it's right.
PN11927
It's
a good list?‑‑‑Yes.
*** GERONIMA BOWERS XXN
MR WARD
PN11928
Okay,
that's fine, that's fine. I take it if a resident has a fall, you have a
procedure you have to follow?‑‑‑Yes.
PN11929
What's
that procedure?‑‑‑When the resident has a fall, because we
don't know if they are broken something, we just make them feel comfortable and
then inform the RN straight away, so, within a very short period of time, the
RN will rush in and check the resident, if they're okay, not broken bones, but because
we're not allowed to move them until the nurses is able to say that, 'Now
everything is okay, then you can put them back to bed', or something like that.
PN11930
So
they will tell you how to proceed with them. If the nurse felt that the
person had to be put on observation after the fall, will they delegate that to
the enrolled nurse?‑‑‑Yes, and us, mainly us. We have
to - that's our duty to do that, to monitor every like - for instance every
hour, every two hours, to have to monitor if it's okay, if that person's okay,
and then inform them straight away if anything's unusual.
PN11931
They
would be indicating to you that you need to see whether or not their speech is
okay, or whether or not their - - -?‑‑‑Yes.
PN11932
I
take it they would say, if you see these signs come and get me straightaway?‑‑‑Exactly.
PN11933
Can
I take you to paragraph 14, and really I want to go over the page in 14.
You talk in 14 about, over the page – about 'a high level of interpersonal
skills and ability to communicate?'---Yes.
PN11934
Just
in terms of yourself, are these skills that your Certificate III and
Certificate IV helped with or were these just life skills that you have?‑‑‑I
think I have both.
PN11935
So
you think you have some good life skills in that area, but the
Certificate III and Certificate IV helped as well?‑‑‑It
helped, yes, enhanced – yes, enhance it.
PN11936
I'd
just like to go down to 17, 18 and 19, and I'll ask these questions – I don't
want to be rude when I ask these questions, I just want to clarify
something. In paragraph 17 you say, 'The nature of aged care
has changed.' I take it that when you express that opinion, you're
expressing it in the context of only having worked for the
Brightwater Care Group, is that right?‑‑‑Yes.
*** GERONIMA BOWERS XXN
MR WARD
PN11937
And
what you've observed at the facility for Brightwater Care?‑‑‑From
the beginning when I was working in aged care at Brightwater, you know, we
normally have four people for 20 residents and plus an EN. So it's
much easier. We have more time to care for the people. Over time we
only have three workers without any (indistinct), with 20 residents
high care dementia.
PN11938
I
understand that's your evidence. I was just trying to understand - you
make the statement, 'the nature of aged care' – I was just trying to
understand whether or not you were making that statement in the context of your
Brightwater experience; for instance, you haven't done any academic
research into the aged care industry, have you?‑‑‑No.
I read a bit, but, yes, I would like to learn more, you know, in that area.
PN11939
In
paragraph 18 when you say, 'In the past, aged care homes', do you see
that? Paragraph 18 starts, 'In the past, aged care homes' – do you
see that?‑‑‑Yes.
PN11940
I
take it again you're expressing that opinion in the context of what you've
observed at Brightwater facilities that you've worked at?‑‑‑Yes.
PN11941
Lastly,
in paragraph 19, in the middle of that paragraph you make a comment about,
'Many aged care providers' – again, I take it you're making that statement in
the context of working at Brightwater?‑‑‑Yes, and also I have
people from agency working with us as well, so I asked them (indistinct) - - -
PN11942
So
otherwise it's conversations you've had with people from an agency, is it?‑‑‑Yes,
sometimes I ask them – because they said, oh this is nice place and stuff, so I
would say (indistinct) think it's a nice place, because obviously we were
friendly and (indistinct) provided of what we need and stuff, and then:
how about your other side of aged care, and then they would tell me the
story, and I said, oh, it's (indistinct).
PN11943
In
paragraph 20 you say – you finish paragraph 20 with this sentence:
PN11944
There
used to be many more nurses in the residential home, but over time they have
been replaced by more personal care workers because it is cheaper.
PN11945
Do
you see that?‑‑‑Yes, I think so, yes - - -
*** GERONIMA BOWERS XXN
MR WARD
PN11946
Bear
with me. To be fair to you, has a person from management at Brightwater
told you they've done it because it's cheaper?‑‑‑I'm just
assuming. It never told me, but I just assume, because probably it's
cheaper for us, because now our workload is much more than that because - - -
PN11947
It's
just your opinion. You haven't been informed by Brightwater that's why
they've done that?‑‑‑No.
PN11948
Can
I take you to paragraph 23? Paragraph 23 says this:
PN11949
There
is usually no specialised training for personal care workers who work with
serious mental health conditions like dementia.
PN11950
I'm
just interested, you've done your Certificate III and you've done your
Certificate IV. Do you believe that the Certificate III and
Certificate IV is insufficient for a personal care worker to work with
people with dementia?‑‑‑Yes, I think they should have some
kind of certificate and also the extra training that you need for dementia
people, because even though you have the Certificate III and IV, you don't
really know what is going on with dementia people, you know, because you only
have a little bit of understanding of it, and I think - I will say that
everyone who work in aged care should have the training of how to deal
with dementia people.
PN11951
If
I understand your evidence, you believe that people need more qualifications -
- -?‑‑‑Yes.
PN11952
-
- - than Certificate III and IV to work with people with dementia?‑‑‑Exactly,
yes.
PN11953
Could
I just then take you to paragraph 32? You talk in paragraph 32 about
technology, and you say, 'Many personal care workers are not good with
technology.' Are you good with technology, or do you struggle with
technology?‑‑‑I'm an old thing. I'm struggling with it.
PN11954
You're
struggling with it, are you?‑‑‑I'm struggling with it, you
know, because, you know, the young people do it quickly, and it would take time
for me to grasp the – you know, the training. You need the training for
technology obviously.
PN11955
So
once you've been trained, are you okay with it?‑‑‑Yes, fine.
PN11956
And
then in paragraph 34 you say, 'We also must know how to use computers for
things like emails.' Do you see that?‑‑‑Yes.
*** GERONIMA BOWERS XXN
MR WARD
PN11957
Do
you use a computer at home, outside of work?‑‑‑I do – yes, I
do do that - - -
PN11958
You
send emails outside of work?‑‑‑I send emails outside of work
on my own personal thing, but not because of the – you know, the work‑related
thing usually - - -
PN11959
No,
that's okay, but - - -?‑‑‑ - - - at our work.
PN11960
You
do it at home though for personal things?‑‑‑Exactly.
PN11961
Ms
Bowers, thank you for your evidence. Commissioner, no further questions?‑‑‑Thank
you for your time. Have a lovely day, guys.
PN11962
COMMISSIONER
O'NEILL: Just stay there for a moment, Ms Bowers. Any re‑examination,
Mr Oski?
PN11963
MR
OSKI: No re-examination, Commissioner.
PN11964
COMMISSIONER
O'NEILL: Ms Bowers, thank you for your evidence this afternoon.
You're excused and free to go?‑‑‑Thank you very much.
Have a nice day.
<THE
WITNESS WITHDREW [12.01
PM]
PN11965
COMMISSIONER
O'NEILL: All right, I think it's Ms Clarke next. Hello,
Ms Clarke?
PN11966
MS
CLARKE: I've been eagerly waiting.
PN11967
COMMISSIONER
O'NEILL: All right. Well, you don't have to wait any longer.
I'm O'Neill C and my associate is just going to take you through the
affirmation.
PN11968
THE
ASSOCIATE: Ms Clarke, can you please say your full name and work address?
PN11969
MS
CLARKE: Judith Ann Clarke, and my work address is United Workers WA,
Cheriton Street.
*** GERONIMA BOWERS XXN
MR WARD
<JUDITH
CLARKE, AFFIRMED [12.01
PM]
EXAMINATION-IN-CHIEF
BY MR OSKI [12.02 PM]
PN11970
COMMISSIONER
O'NEILL: Mr Oski.
PN11971
MR
OSKI: Thank you, Commissioner. Good morning, Ms Clarke.
My name is Sheldon Oski. I'm appearing for the UWU today. Can
you hear me and see me?‑‑‑I can't hear you very well, but I
can definitely see you.
PN11972
How
about now, can you hear me better now?‑‑‑That's better.
PN11973
Could
you please repeat your full name for the record?‑‑‑Judith Ann Clarke.
PN11974
I
understand you've made a statement for the purpose of the proceeding, is that
correct?‑‑‑Yes.
PN11975
And
that statement is dated 29 March 2021 and runs to 27 paragraphs over
four pages?‑‑‑Yes.
PN11976
Do
you have a copy of that statement with you?‑‑‑I do.
PN11977
Have
you had an opportunity to read through it again?‑‑‑Yes, I
have.
PN11978
Was
that statement true and correct to the best of your knowledge and recollection
at the time you made the statement?‑‑‑Yes.
PN11979
I
understand that since then you've subsequently finished your employment and now
work for United Workers Union, is that right?‑‑‑Yes.
PN11980
Commissioner,
that's at document 243 at page 12095 of the digital court book, and we seek to
rely upon that statement.
PN11981
Now,
Ms Clarke, you'll be able to see in one of the windows on the screen Mr Nigel
Ward. He will now ask you some questions about your statement.
*** JUDITH CLARKE XN
MR OSKI
*** JUDITH CLARKE XXN
MR WARD
CROSS-EXAMINATION
BY MR WARD [12.03 PM]
PN11982
MR
WARD: Ms Clarke, can you hear me okay?‑‑‑I can.
PN11983
Thank
you very much, Ms Clarke. Ms Clarke, my name is Nigel Ward. I
appear in these proceedings for the employer interests. I'm just going to
ask you some questions about your statement. Do you have a copy in front?‑‑‑I
do.
PN11984
I
think you do, I think I can - there. You do, excellent. You
do. I'll try and be as prompt as I can with this. Can I just start
right at the beginning? You started in the industry at the age of 15?‑‑‑I
did.
PN11985
What
did you actually do back then at the age of 15?‑‑‑So, I
actually started at 14 but matron wouldn't pay me until I turned 15 and forced
me to go back to high school. So I used to go there, the facility was
across the road from where my grandparents lived, and so on the way home from
school I would drop my bike at Nana's house, and go across and play with the
oldies. So that's how I transitioned.
PN11986
That's
fine. I take it - was back then was it sort of a, like, warden attendance
job back then that you started with or ‑ ‑ ‑?‑‑‑We
were called assistants in nursing back then to my recollection.
PN11987
I
take it when you started you didn't get any formal qualification at that stage?‑‑‑No,
lots of help from matron who was strictly a matron, very hard.
PN11988
Now,
you then went on to get your qualifications, and you say in 1990 you got your
certificate III in aged care?‑‑‑Mm-hm.
PN11989
You
also then talked about something else. You talked about an advanced
practice certificate. Now, I haven't heard about one of those. Can
you just describe for me what one of those is?‑‑‑So, advanced
practices was you were trained and you would follow a doctor's direction, so
this was when I think I was in - we might have been in Victoria at that
point. I'm trying to think back.
PN11990
Is
this to do with medications?‑‑‑I did my med competency, yes,
but it was also we could treat simple wounds.
PN11991
Right?‑‑‑As
long as we followed doctor's protocol.
PN11992
Okay?‑‑‑Yes.
*** JUDITH CLARKE XXN
MR WARD
PN11993
As
best as you recall, was that something that happened in Victoria around 2000,
was it?‑‑‑Around - medcomp was 2000, the one in Victoria
would've been about 2008/2009, as much as I can recollect.
PN11994
No,
that's fine. That's fine. And the advanced practices certificate,
was that a TAFE certificate or ‑ ‑ ‑?‑‑‑No,
it was a certificate that you received - like from whichever hospital or doctor
that you were under they would, sort of, sign you off.
PN11995
Right?‑‑‑I
think it's all changed now, and you do have to do it through TAFE.
PN11996
That's
fine?‑‑‑Yes.
PN11997
That's
fine. And I see in paragraph 5 you talked about a variety of aged care
providers you've worked for. Were they all private sector or were some of
them in the public sector?‑‑‑No, I think most were in the
public sector.
PN11998
But
you work in the private sector now, Baptist Care?‑‑‑Yes,
Baptist Care is not for profit.
PN11999
You
talk about working in the locked dementia wing. Do you work exclusively
in that?‑‑‑Yes, pretty much. That was the place that I
liked to be in with the ladies and, you know, hair and nails, and stuff like
that.
PN12000
Then
in paragraph ‑ ‑ ‑?‑‑‑Lots of
cuddles.
PN12001
Sorry?‑‑‑Lots
of cuddles.
PN12002
For
you or for them?‑‑‑Both.
PN12003
Both.
In paragraph 11 you then talk about your duties. I just want to clarify a
few of these things if I could?‑‑‑Yes.
PN12004
You
say that the dementia ward has its own kitchen, but with no dedicated kitchen
staff. Does the Baptist Care facility have a central kitchen?‑‑‑Yes.
*** JUDITH CLARKE XXN
MR WARD
PN12005
Am
I right that things like cooked meals with come up from the central kitchen?‑‑‑Yes.
PN12006
Are
there any circumstances - is the kitchen in the dementia ward, is it a servery?‑‑‑It's
a servery but we used to sometimes to keep the ladies entertained we would do,
like, home cooked soups.
PN12007
Right?‑‑‑Like,
so, you know, crockpot and stuff like, or making bread, you know, in the
specific area, so we had access to be able to do that.
PN12008
Was
that on top of what was coming out of the main kitchen, was it?‑‑‑They
wouldn't eat what came out of the main kitchen if they were cooking.
PN12009
You
then talk about keeping residents occupied with activities and entertainment?‑‑‑Yes.
PN12010
Does
Baptist Care have recreational and leisure officers?‑‑‑They
do, but they tend to finish around about 4 o'clock in the afternoon, sometimes
before 4. And we have a practice of not keeping people in bed. If
they're able to be up, they're up, even if they're, you know, in a fall out
chair. It's just something that we like to do, we keep them up and we
keep their mind and their body and their soul, you know, in good condition as
we can.
PN12011
So,
some of these activities are day-to-day activities that you and the team do?‑‑‑Yes.
PN12012
I
take it that occasionally that your residents will do activities that the
leisure staff organise?‑‑‑As well during the day, yes.
PN12013
During
the day, okay. Now, you talk there about residents becoming violent or
distressed, do you see that?‑‑‑Yes.
PN12014
When
you use the word 'violent', I assume violent - there's a scale of what you mean
by 'violent'?‑‑‑Yes.
PN12015
Can
you just let me understand what you mean by violent in terms of what's at the
bottom of that scale and what's at the top?‑‑‑The bottom
would be hitting out at me or another resident for no apparent reason, nothing
that was promoted by anybody. The top of it would be me being physically
attacked and put to the floor and kicked a few times.
*** JUDITH CLARKE XXN
MR WARD
PN12016
You've
experienced that?‑‑‑Yes.
PN12017
Am
I right that you try and apply your de-escalation or diversional skills in
those situations?‑‑‑Absolutely.
PN12018
I
assume, from what you've just told me, they don't always work?‑‑‑No.
PN12019
No?‑‑‑No.
PN12020
If
you found yourself in a situation where you felt you were unsafe, is the
procedure that you're meant to leave that part of the facility, or is your
procedure at Baptist Care that you're to stay?‑‑‑Distract,
redirect, and call for help.
PN12021
Call
for help. And is there an alarm system for calling for help? How do
you call for help?‑‑‑You have to get to the phone.
PN12022
So,
you don't have an alarm system?‑‑‑No.
PN12023
No,
okay. You then talk about medications and I'm assuming that your medcomp
for Schedule 4 medications?‑‑‑Yes.
PN12024
I
take it that your pill medications come in Webster packs?‑‑‑Webster
packs or sachets.
PN12025
Yes,
okay. I hadn't heard about sachets till two weeks ago. And those
sachets are individually itemised for the residents; is that right?‑‑‑Absolutely.
PN12026
You
do medication rounds in the ward?‑‑‑Yes.
PN12027
I
take it that - do you have an iPad? What do you use to actually ‑ ‑ ‑?‑‑‑Paper.
PN12028
You're
paper based? Okay, you're paper based. So, I take it that if you
were giving me my medications, you'd have to verify that the pills in the
Webster pack or the sachet are correct?‑‑‑Yes.
*** JUDITH CLARKE XXN
MR WARD
PN12029
Some
people have said that they use colour charts with pictures of the pills.
Do you have that as well?‑‑‑Depends on who is providing the
medication, from which chemist. Most do, but some don't, and you then
have to recognise, you know, there'll be a description, round with a cut or
round with a zero no it, or, you know, something on it.
PN12030
I
take it that you'll have instructions as well coming out of the care plan about
how I'm meant to take my medication?‑‑‑It would be in the med
chart, so we have - I think it's six, six rights, so right time, right person,
right date, right amount. All those rights we go through every time.
PN12031
If
I have to have my pills crushed and put in custard, that will be in the med
chart as well, will it?‑‑‑Yes, it will.
PN12032
I
take it that there could be three situations: situation number one is I
take my tablet properly and you record that I've taken it?‑‑‑Yes.
PN12033
Situation
two is I'm being awkward today and you might decide to leave me alone for a
while and come back later?‑‑‑Yes.
PN12034
And
I imagine situation three is the tablets don't look like the right tablets?‑‑‑Yes.
That becomes a med incident.
PN12035
I
take it then that you would call the RN in to work out what to do?‑‑‑Yes.
PN12036
You
then talk in paragraph 11 about monitoring residents for skin wounds, bruises
and reporting these to the RN?‑‑‑Mm-hm.
PN12037
If
I can just follow that procedure that you have. Let's say I was the
resident and you were showering me and you saw a skin tear. Is that
something that has to be reported straight to the RN?‑‑‑Absolutely.
PN12038
If
I had bruising, would that be the same?‑‑‑Yes.
PN12039
If
I had, say, a bed sore, that would be the same as well?‑‑‑That
should have already been reported as a pressure sore before it got to being
that bad.
PN12040
That
bad, okay?‑‑‑Yes. So we have to monitor things that
we've already found, if they aren't covered.
*** JUDITH CLARKE XXN
MR WARD
PN12041
Yes?‑‑‑If
they're for - you know, just seeing how they're progressing, then I would get
the RN to come over and say, 'This is worse than yesterday, do you want to look
at it.'
PN12042
If
you saw the beginning of a bed sore on my leg, you might observe that for a
day, you see it's not getting any better and then you call the RN in and say,
'Look, it's getting worse than it was yesterday, what should we do'?‑‑‑No,
I would have reported it yesterday.
PN12043
Right?‑‑‑And
then said, 'This is worse than yesterday.'
PN12044
I've
got you. So, the RN already knows about it, but you're observing that it
actually is getting worse?‑‑‑Yes. Every single time you
walk in, you have to check those things - every day - because they escalate
really fast, or they can.
PN12045
In
terms of that skin tear, let's say that you observed a skin tear, you've
contacted the RN, the RN's come down to have a look at me. Is it the RN
who decides how it should be dressed and dealt with?‑‑‑Yes.
PN12046
Does
the RN or the EN dress it?‑‑‑Depending on the poor RN and how
fast she's running for the shift, she may give it to the EN or, if she's got
time, she would do it herself there and then.
PN12047
Let's
say the RN did that and then said, 'Look, I think it needs to be redressed
tomorrow', is that a job for her or will she delegate that to the EN?‑‑‑She'd
probably delegate it to the EN to write in the progress notes, or even the med
notes.
PN12048
You
say in paragraph 12 that, in order to be an aged care worker, you have to have
empathy and you have to care. In your case, I take it you have those
qualities?‑‑‑I would hope so, otherwise I wouldn't have
lasted five minutes.
PN12049
I
think you've lasted 48 years, so I'd say you've got those qualities. Were
those qualities you just have or were they qualities that you gained from your
Certificate III?‑‑‑I think I had them initially. I was
the sort of kid who collected old people in the street and made sure they were
okay. Even as an eight year old, I found my first dead body in a house at
eight years old from a blind lady who'd fallen through the night that I used to
check on on my way to school. So, I think I was born with it, but the
Certificate III gave me the tools and the knowledge and how to go about things
in an easier and better way.
*** JUDITH CLARKE XXN
MR WARD
PN12050
I
understand, I understand. So the Certificate III gave you a set of
competencies that allowed you to do your job better?‑‑‑Yes,
absolutely.
PN12051
In
paragraph 13, you talk about - I'll just call it the paperwork you do?‑‑‑Yes.
PN12052
But,
in terms of your progress notes, do you do those on the run or do you do them
at the back end of the shift?‑‑‑I still to this day carry a
notebook, a flippy notebook, and I write things down as I go, and then when
it's calm, usually before the first person goes off at 8 o'clock, so that I can
go out to do my notes, because the computers can't be in a dementia ward or
we'd never have computers.
PN12053
Yes?‑‑‑So
I would write up then before I went home, and if I didn't write up, I would
then hand the notes over to the next shift to do.
PN12054
Who
would write the notes up?‑‑‑Yes.
PN12055
Bear
with me, if we can. I take it in those progress notes you will be making
observations on the residents' behaviour?‑‑‑Absolutely.
PN12056
Particularly
if there's anything unusual in their behaviour?‑‑‑Yes.
PN12057
You
would take their weight occasionally and you'd record their weight?‑‑‑We
record their weight every month on the same day at the same time, if that's
possible.
PN12058
You
do a weight day, do you?‑‑‑Yes.
PN12059
Do
you take blood pressures?‑‑‑I can, but with my hearing not
very good, I could never - I never used to be able to do it very well, but now
with new technology, it's easy, you put it on their arm and it tells you.
I do, but I would always get the RN to come and check anyway, or the EN if they
were available. That's only in extreme circumstances would I do that.
PN12060
What
about blood glucose? Do you do a finger prick test or anything like that?‑‑‑I
don't, but I know of other people who are competent in doing that. The
last five years, I was really trying to get out of work rather than get into
work because we just ran out of time and sometimes something's got to go and
that's something the RN can do; that's their job, not mine.
*** JUDITH CLARKE XXN
MR WARD
PN12061
I
understand that, I understand that. I take it you would be recording
things like bowel movements and whether or not they've urinated during the day
and those things?‑‑‑Yes, how much fluid, how much output,
what they've eaten, the amount that they've eaten, and if they're on, you know
- like especially of the evening, if they've got a mat, a sensor mat, they know
how many times the sensor mat goes off, but not what it's gone off for.
PN12062
Yes?‑‑‑So
we'd be recording all that stuff, you know, like she stood on the mat, she was
lost, she couldn't find her mum, or whatever, that sort of thing.
PN12063
On
that note, if there is a fall, if a resident does have a fall, what's the
procedure you are required to follow?‑‑‑Make them safe.
If I'm on my own, make them safe, ring the RN, get back to them and keep them
safe.
PN12064
I
take it it's the RN then who makes the decisions about what happens with them
and they do an assessment?‑‑‑Yes.
PN12065
I
take it that while the RN is doing that assessment, you're there to try and
help keep the resident calm?‑‑‑Yes.
PN12066
Can
I take you to paragraph 21. You talk about making errors with medication?‑‑‑Yes.
PN12067
Have
you made errors with medications?‑‑‑I made a huge error with
a medication one night and I've never run so fast. I didn't even think
about the phone, I just ran out of the ward. We had a couple of ladies
who had the same name, two Marian Greens, we'll say.
PN12068
Right?‑‑‑Who
were in the same ward, next to each other, and I had a resident who was trying
to beat me over the back of the head with something and I had poured the Epilim
into the cups. One had - I can't even - 14 mil and the other one had 5
mil and I put them back into their little drawers - they've got their own
specific little drawers in the med trolley - and closed the drawers and calmed
Ellie down, got her sitting and watching TV for five minutes, and I went back
to the drawer and I picked them up and, as I picked them up, Ellie came back at
me again, so I put them back down, but I put them into the wrong pigeon hole.
*** JUDITH CLARKE XXN
MR WARD
PN12069
Yes?‑‑‑Because
she was really beating me with her shoe at that point, so when I've calmed
everything down and got back to the Epilim, I just automatically put it on a
table like in my right and left hand, and I stepped back, and as I stepped back
I thought, shit, that's the wrong one, so I've told them both to spit it out,
because then I got confused whether it was the wrong one or the right
one. And then one of the other nurses popped in and I said I've got to
find the RN, and I just took off, and I was crying and calling for the RN to
the facility, the main facility, and she came back over and she said, you know,
did you clean the mess up, and I said yes, and she said show me the tissues,
and I showed her the tissues and she said, well no one's got anything,
they're fine, calm down. But I took myself off meds at that point.
I said no more, I'm not doing this any more; if I can make that stupid mistake
I can't do this, I can't be responsible. So I went in to the boss and
said that's it, I'm done, and he said no, you're not, get back out there, back
on the horse, away you go; you're good at what you do, this is the first time
you've made an error in 12 years, I think you're fine. But I then
got so slow, because I was questioning myself, that I took two weeks'
holiday. When I came back I was fine again and I never made another med
error after that, but it was the 'what ifs', you know, I was imagining the
what ifs.
PN12070
I
understand. You've personally made one error in 48 years?‑‑‑One
that I know of. I'm not saying I never made any others. But
medications are very important, and I know that they say we can do no harm, but
you don't know when someone's going to have an adverse effect – it could be
Panadol and they could die from it, you know. So I still question whether
we need Medcomps, or whether we should go back to have nurses and ENs doing
it. They know if someone's having an adverse reaction to
medication. I can only guess, and sometimes I think, you know, is she
suddenly, you know, red in the face, you know, if you give them a new
medication or something – my God, is she suddenly red in the face, you know, or
is the heart rate a little bit too high, is it higher than normal – I don't
know that stuff, but I panicked, because I don't want to be responsible for
harming anybody.
PN12071
I
understand?‑‑‑And I know a lot of us feel the same way; you
know, when I talk now to other people, they're of the same mind.
PN12072
So
your Medcomp training teaches you how to deliver and administer the medication;
it doesn't teach you much more than that?‑‑‑No. We
don't – half the girls don't even look up – like, when I get a new medication
to one of my ladies I used to look it up to see what it did and how they could
have an adverse reaction so I knew what to look for, but a lot of them didn't
even know that, you know, the little oblong white one was cholesterol and you
could get this from this, you know – you know, take responsibility for what
you're doing.
PN12073
You
have a view that it might be better that ENs and RNs do that?‑‑‑Absolutely.
I still maintain that. I never went back to Medcomp after that.
*** JUDITH CLARKE XXN
MR WARD
PN12074
Ms
Clarke, can I thank you for your evidence, and I sincerely wish you well.
No further questions, Commissioner?‑‑‑I'm out, I'm retired
now. Five more months and I'm out - - -
PN12075
No,
just wait there a minute. The Commissioner wants to say something?‑‑‑Sorry.
PN12076
COMMISSIONER
O'NEILL: That's all right. Mr Oski, any re‑examination?
PN12077
MR
OSKI: No re-examination, Commissioner.
PN12078
COMMISSIONER
O'NEILL: All right. Well, Ms Clarke, thank you very much for your
evidence. You're excused, and enjoy your retirement or whatever comes next
for you?‑‑‑Thank you so very much. It's been a
pleasure.
<THE
WITNESS WITHDREW [12.27
PM]
PN12079
COMMISSIONER
O'NEILL: All right, Ms Capelluti.
PN12080
MR
OSKI: We're in the process of organising Ms Capelluti, Commissioner,
so should be ready in a minute or two.
PN12081
COMMISSIONER
O'NEILL: No troubles. Ms Capelluti, can you hear me?
PN12082
MS
CAPELLUTI: Yes, I can.
PN12083
COMMISSIONER
O'NEILL: I'm O'Neill C and my associate is just going to take you through
the affirmation.
PN12084
THE
ASSOCIATE: Ms Capelluti, can you please say your full name and work
address?
PN12085
MS
CAPELLUTI: Donna Lee(?) Capelluti, and it's
101 Henley Beach Road, Thebarton, Henley Beach.
<DONNA
CAPELLUTI, AFFIRMED [12.30 PM]
EXAMINATION-IN-CHIEF
BY MR OSKI [12.30 PM]
*** DONNA CAPELLUTI XN
MR OSKI
PN12086
COMMISSIONER
O'NEILL: Mr Oski.
PN12087
MR
OSKI: Thank you, Commissioner. Good morning,
Ms Capelluti. My name is Sheldon Oski. I'm appearing for
the UWU today. Can you see and hear me?‑‑‑Yes, I can.
PN12088
Can
you just repeat your full name for the record?‑‑‑Yes.
It's Ms Donna Lee Capelluti.
PN12089
I
understand you've made a statement for the purposes of the proceedings, is that
correct?‑‑‑Yes, that's correct.
PN12090
And
I believe that statement is dated 21 April 2022 and runs to 47 paragraphs
over six pages. Do you have a copy of that statement with you?‑‑‑Yes,
I do.
PN12091
Have
you had an opportunity to read through it again?‑‑‑Yes, I
have. Yes.
PN12092
Is
it true and correct to the best of your knowledge and recollection?‑‑‑Yes.
There's only one thing I need to change or to let you know, is that I – as of
January 16 this year, I no longer work with Southern Cross Care,
but while doing the statement I was in the employment of the provider.
PN12093
Thank
you for the update. Commissioner, for a reply statement filed by the UWU
on 21 April 2022, it does not yet appear in the digital
court book. We seek to have the statement added to the
court book and seek to rely upon that statement.
PN12094
COMMISSIONER
O'NEILL: Yes, I think this is the other one that was at the back of the
submissions. So you might check, but I think it might actually be at
page 2864 of the hearing book, but we will insert it as a separate
statement.
PN12095
MR
OSKI: Thank you, Commissioner. Ms Capelluti, you will now be able
to see one of the windows on the screen has Mr Ward in it. He will
now ask you some questions about your statement?‑‑‑Yes, no
worries. Hello.
CROSS-EXAMINATION
BY MR WARD [12.32 PM]
PN12096
MR
WARD: Hello – is it Ms Capelluti?‑‑‑Yes, that's
it.
PN12097
Can
you hear me okay?‑‑‑Yes, that's fine.
*** DONNA CAPELLUTI XXN
MR WARD
PN12098
Ms
Capelluti, my name is Nigel Ward. I appear in the proceedings for the
employer interest. I'm just going to ask you some questions. I see
from the screen you've got your statement in front of you, have you?‑‑‑Yes,
I do.
PN12099
Can
I just start you at paragraph 15?‑‑‑Yes.
PN12100
You
say in paragraph 15 that you've 'completed a specialised certificate for
first aid for residents with dementia.' Do you see that?‑‑‑Yes,
I do.
PN12101
I
just want to understand; this is – it's a first aid certificate, but
specifically for people who actually have dementia?‑‑‑Well,
it was a - it was for an elderly - to help with the signs of dementia, yes, so
it was - like there's a much broader training program to deal with dementia,
but this was the one that was offered at the time that some of us were able to
take, so it was more to do with as a person's getting older has dementia as
well, so what symptoms or signs to look out in case they were depressed or
having suicidal thoughts. That's where that one lay.
PN12102
Was
it a training course on people with dementia or was it a training course
dealing with first aid for people with dementia?‑‑‑Yes, yes.
PN12103
First
aid?‑‑‑It was more of a first aid, what to look for, than an
actual dementia as the main thing. It was actually - the first aid was
the basic of it, yes.
PN12104
Does
that certificate have a name, does the course have a name?‑‑‑Yes,
I'm pretty sure it was - I have got the certificate at home, but it's - it's
first aid dealing with the elderly, I think, something to that
description. It lasts for three years, so, yes, it's only a three-year
like certificate and then you have to reapply to do it again.
PN12105
That
was done in-house through your employer?‑‑‑Yes.
PN12106
How
long did the program last for?‑‑‑It was a two-day session and
I think it was like a 9 to 3 or 9 to 4 on both days.
PN12107
Okay,
and - - -?‑‑‑So then you had to - sorry.
PN12108
No,
that's all right, you keep going, I'm sorry?‑‑‑And then it
was just like a test thing and then you get your certificate.
*** DONNA CAPELLUTI XXN
MR WARD
PN12109
I
take it that made you competent to administer first aid, did it?‑‑‑It
wasn't really as in for us to do it, it was mainly to look at the signs of
behaviours of the residents, a bit more to if - how to deflect their
behaviour. That was the real - that's as me, as a food person, that was
the reason why I offered to do it, because it wasn't offered to everybody, but
I could see there was a lot of behavioural issues that I was worried about,
being an FSA, to approach or whether to trigger someone's behaviour or how to
deflect it, because if they're upset, so they wouldn't be throwing coffees or
cake or stuff around. So that was for my own benefit, but we were offered
in case we wanted to do it.
PN12110
Okay,
I understand?‑‑‑Yes.
PN12111
Can
I just take you back to that paragraph 16 then?‑‑‑Yes.
PN12112
When
you say you're the WH officer, does that mean you're the health and safety
representative for the workforce, or what does that actually mean?‑‑‑Yes,
so I was offered to do WHS training, so health and safety rep for my facility
because they didn't have any at that stage, so that meant that if I
volunteered, yes, to do it, they'd put me through the training and give me the
relevant training to be able to make reports, or whatever, or look around to
make sure that the workplace was safe for all workers.
PN12113
You
can do risk assessments on the workplace and raise hazards or issues that you
- - -?‑‑‑Yes, that's right.
PN12114
Can
I then take you backwards to paragraph 12?‑‑‑Mm-hm.
PN12115
Do
you operate with a set menu at Southern Cross?‑‑‑Yes, we do,
yes.
PN12116
You
might not know the answer and, if you don't, that's fine?‑‑‑Yes.
PN12117
Is
the set menu designed by a dietician or a nutritionist?‑‑‑Yes,
someone - from what I remember, our last menu that gets done - so we get a
seasonal menu.
PN12118
Yes?‑‑‑And
they are all in conjunction with a dietician, a nutritionist and, I think, the
chefs sometimes as well, or the chef managers of Southern Cross.
PN12119
It's
my understanding that if a resident was, say, gluten intolerant, that would be
in their care plan; is that your understanding?‑‑‑Yes, that's
right, yes.
*** DONNA CAPELLUTI XXN
MR WARD
PN12120
How
would you be informed of that?‑‑‑It would come through to the
kitchen, to the chef manager, and then that gets put out to the chefs who are
doing the food, and then, as an FSA, will be labelled what is gluten-free, what
this person can have, or it's coded, colour-coded, or whatever, and that's in
our care plan and what's on - in the area that person is, there's a duty
statement, which is a food preference, and we have to check that every day when
we're up there to make sure, if there's any changes that's been done, it's put
in the food preference record, so it's checked.
PN12121
Let
me put that back to you to see if I understand what you've just described?‑‑‑Sorry.
PN12122
No,
that's fine, please, don't worry about your answers. The care plan will
explain - let's use the gluten intolerance one as the example - the care plan
will explain that I'm gluten intolerant, that will be provided to the chef, the
chef's going to make some gluten-free versions of the meals. I take it
that will have a red sticker on it or a yellow sticker to say it's gluten-free?‑‑‑Mm.
PN12123
That
will come up for you, as the person who's going to do the serving, and you will
know in your servery that Nigel Ward has to have a gluten-free meal, so you'll
be making sure he gets the one with the red sticker?‑‑‑Yes.
I will then pass it to the carer and the carers also know who's gluten-free,
and then they'll take that meal to that person, so we know it's communicated
between the two of us who's going to get that plate and make sure it goes to
the right area.
PN12124
Do
you have a list in your servery?‑‑‑Yes.
PN12125
You've
got a list of people who are gluten-free?‑‑‑Yes, it's called
a food and fluid preference folder.
PN12126
Yes?‑‑‑That's
always in the serveries, and we go by it and the carers check that as
well. So, the nurse is the one that usually updates that, either daily or
weekly if there's any changes in a person's dietary needs.
PN12127
Yes?‑‑‑So
that has to get checked and we can't serve a meal unless that is in front of us
to make sure we're serving the right foods to the right people.
*** DONNA CAPELLUTI XXN
MR WARD
PN12128
If
I was one of your residents and the registered nurse had decided that I needed
my food minced and moist, they would make the change to that book and you would
know that I have to get a minced and moist meal?‑‑‑Yes, and
that will have to go through to the kitchen first before they will do that.
PN12129
Okay?‑‑‑So
that will go to the chef manager, then the chef manager will come out and let
us know that he has to have an extra minced moist meal provided and who it goes
to and then the changes are on the book.
PN12130
Can
I take you to the very back end of paragraph 18?‑‑‑Yes.
PN12131
You
say in the back end of paragraph 18:
PN12132
We
have knives there that they can injure themselves with or attack us with.
PN12133
?‑‑‑Mm-hm.
PN12134
Are
you suggesting that you've been attacked with a knife before?‑‑‑We've
had - I've had a spoon had a go at me, not actually a knife, but there has been
a knife produced to one of my co-workers.
PN12135
Right?‑‑‑But
it was - because everything is in sections in our area, so we have our utensils
next to us when we're about to serve, or especially in the high dementia wards,
we don't leave the cutlery out there, it gets passed out as the meal comes out.
PN12136
I
see?‑‑‑Okay? So, we have a door that's to our left and
one that's to our back right corner and I'll be serving, say, in front of me,
so if a resident decides to walk around, they can actually come in through the
back part of our servery and walk right up to us, and we wouldn't know they're
in there straight away because we're serving to the front, and that's when that
happens, maybe grab something off the sink, if we have a knife or something in
there, and that's when - they don't - depending on behaviours. There's
one lady who's very adamant she's going to kill everybody every day of the
week, but that's just her and she hasn't acted on that at all, thank God, but,
yes, you just have to know how to interact with her to calm her down and just
say, 'Oh, you know, just leave that there' type thing, but we're not allowed to
touch residents ourselves.
PN12137
You
haven't thought of locking the back door?‑‑‑We have, but it's
only got a latch from the inside, so it's not actually one that like - I think
they were looking at getting, you know, the number coded pads to walk through
the doors. I think eventually they would have had to do that, but, at
this stage, the latch is on our side of the kitchen, so they have to put their
hand over, but they can reach it because we can't block the whole entry off.
*** DONNA CAPELLUTI XXN
MR WARD
PN12138
As
the HSR for the workforce, have you raised the hazard with that with the safety
committee?‑‑‑Yes, we have. It was - it's not - I don't
know how they wanted to go along with it. We just said that it is a bit
of a hassle, and the padlock was too expensive at one stage. I think that
was what they looked at. But then other than that, it was never raised
again. It was done probably not long after the incidence of the residents
walking into to the facilities, but at the same time we also allow residents'
families – allowed to come and make tea and coffee in the servery. So
that's where the stoppage was. It was trying to let a resident come –
family come in to make tea, and if we couldn't let them in then they're not
able to do so, so that was where a bit of the hassle was.
PN12139
I
understand, but it went to your safety committee?‑‑‑Yes, it
did. It did.
PN12140
I
take it that - the servery you're working in, has that got bain maries and
things like that in the servery?‑‑‑Yes.
PN12141
Am
I right that the food will come from the central kitchen in hot boxes if it's
hot?‑‑‑Yes. So what will happen is our kitchen at
Buckland is the production kitchen. So it'll come straight out of the
ovens, straight onto the girls' trolleys and then straight up to the floor that
they're working in, and it gets tested temperature‑wise to make sure that
it's still at a proper temperature to serve.
PN12142
Do
you personally hold any food safety certificates?‑‑‑Yes.
I've done everything that Southern Cross has asked us to do, like the food
health, safety, hygiene, HACCP, all those – we've done all those. We do
those every six to 12 months.
PN12143
So
when the food's hot, you're making sure it stays within a certain temperature?‑‑‑Yes.
Yes, we have to check the temperature when it goes to the bain marie, and
also towards the end, just to make sure that it's still at that right
temperature between the 5 and 60 degrees.
PN12144
Am
I right that you have to write a record of what the temperature is at various
times?‑‑‑Yes.
PN12145
And
that goes back to the chef, or who does that go to?‑‑‑Yes,
that goes in there. We get a monthly printout of what our temperatures
are, and then that's get collected every month and you sign off on what you put
down as your temperatures, so it gets taken to the records and kept in the kitchen
with the folders.
PN12146
Can
I just take you to paragraph 21?‑‑‑Mm‑hm.
*** DONNA CAPELLUTI XXN
MR WARD
PN12147
I
take it in 21(e) where you say, 'Paperwork related to food, such as recording
food temperatures', that's what we've just talked about, is it?‑‑‑Yes.
PN12148
And
in 21(g) you talk about 'stocking areas?'---Yes.
PN12149
When
you say, 'areas' and 'stocking', are we talking about stocking the pantry, or
are we talking – what are you talking about there?‑‑‑Yes.
So we're making sure the pantry has got enough stock for breakfast cereals, and
make sure that you've got enough sugars, pepper, salt, or the condiments that
we need that can be kept in the pantry is all stocked up. Also fridges,
we have to make sure that there's enough milk, butter, whatever else, like, needs
to be kept in there, juices, so that you've got enough to start the following
day if it's not all stocked up, so you haven't got an FSA running to and from
the kitchen all the time. So make sure you've got enough stock to start
on your next one and then replenish it as it goes.
PN12150
So
there's a main area where stock's kept, and the FSA's role is to make sure –
for instance, let's say it's orange juice - they need to make sure they've
got enough orange juices from that main area taken up to the fridge in
their servery for the next breakfast?‑‑‑Yes, that's right.
PN12151
Then
in paragraph 23, right at the end, you say, 'The remaining FSAs work in the
kitchen preparing meals.' Do you see that?‑‑‑Yes.
PN12152
When
you say, 'The remaining FSAs', does that include you?‑‑‑Yes.
It's usually only one FSA who does the kitchen, besides the other three that
work and do the floors.
PN12153
When
you say, 'the kitchen', are you referring there, Ms Capelluti, to what you
call the production kitchen, the main kitchen?‑‑‑Yes, that's
right.
PN12154
When
you say, 'preparing meals', is that you're working with the chef or the cooks?‑‑‑Yes,
so the upper kitchen person, which is what I would do, would do fruit plates,
getting milkshakes made for residents, all the other bits and pieces – desserts
put out ready, the ones that need to go for vitamise, softs, and all that type
of thing, that was the other kitchen person's job, besides the normal dishes
and other little bits and pieces they need to do.
*** DONNA CAPELLUTI XXN
MR WARD
PN12155
So
when you're preparing meals, what are you preparing?‑‑‑Mine –
it's depending, because we've had – sometimes we've had short‑staff with
chefs and that rocking up. So I can go and just do prep work, like
chopping up bacon or tomatoes or whatever, pre stuff like that, and also
getting desserts sorted out, if they need to be heated, if they need to be cut,
pre‑cut before they go out to the serveries; making the
fruit plates, and making sure that everything's set up on the trolleys
that have to go to the right areas at lunchtime, and all the proper meals are
there and allocated to the right people.
PN12156
I
just want to clarify a couple of those, if I can?‑‑‑Yes.
PN12157
You
said, 'heated up', so let's say that there was a particular food that needed to
be re‑heated or heated up, is that heated up in the microwave or - - -?‑‑‑No,
it goes into the ovens. Like, just say it's apple crumble or something
that needs to be done for dessert, it just needs to have – it warms through, so
it gets put into the hot box or the oven, and then we'll put it into the right
area. Because we have two separate hot boxes that have got all your food
you need to take from that to the area that you're going to, so you don't get
mixed up, because some people have more minced, moist meals; others have
pureed. So we all have separate floors into the hot boxes, and they
all stay at 75 to 85 degrees, and then we test the food as well and then
take it straight to the floors.
PN12158
When
you said, 'cut up', just to see if I understand that, it might be that you've
done a big apple pie and you're cutting it up into portions to put in the bowl?‑‑‑Yes,
or if it's a cold dessert and it has to be – it's easy to have it cut, so they
can just serve it straightaway into the servery, like a cheesecake or a trifle
or something like, we do that just to help, so it helps them when they're
delivering it and serving it at lunchtime.
PN12159
If
I could just drop you to paragraph 28, at paragraph 28 you say, 'I check
my bain marie. I put the plate warmer on and check the stock in the
fridge.' That's the stock we talked about earlier about things like the
fruit juices and whatever in the servery?‑‑‑Yes.
Because sometimes after - the day shift will leave it full, but depending
on how much night shift might use some of the stock that's there, and we
don't like to have too much in there, so there's no – you know, because they're
always checking dates and that to make sure everything is fresh - so we don't
overstock them, but if they use too much juice during the night or whatever, we
may need just to grab something, so we check in the morning before we go to the
main kitchen, once we get there.
PN12160
In
paragraph 32 you talk about 'making breakfast?'---Mm‑hm.
PN12161
Can
you just explain to me what (indistinct) - - -?‑‑‑All right.
Okay. So the carers – FSAs have to make toast.
*** DONNA CAPELLUTI XXN
MR WARD
PN12162
Right?‑‑‑Right.
So we have to – so the carers will come to us and say that so and so wants a
porridge, so we have to put the porridge or eggs into the bowl and then get
toast ready, and then they tell us they want either jam or marmalade or
whatever, so then we also have to do that as well, and just – they'll come to
us and tell us what the resident likes, and we either plate it or get them the
toast or give them the cereal or fruit.
PN12163
And
the porridge, would that have come up from the main production kitchen?‑‑‑Yes.
Every day is porridge, scrambled eggs, either vitamised or pureed eggs and
porridge, and then on certain days they have a big breakfast, which is
tomatoes, mushrooms, sausages, bacon, eggs.
PN12164
I
take it that's – again, that's coming up from the main production kitchen?‑‑‑Yes.
PN12165
Right,
okay?‑‑‑Anything that's hot or cooked is all coming out of
the main production kitchen.
PN12166
In
paragraph 33, again you're talking about breakfast. Then you use these
words, or you talk about 'setting tables for lunch, then general cleaning in
each area as well?'---Yes.
PN12167
Do
you have to clean rather than a – you don't have a dedicated cleaner to clean
the dining rooms?‑‑‑No, it's us. We have to – it's all
under the FSAs now, because carers are too busy. Carers used to just
clear the tables for us, and then put the plates and everything onto a trolley
ready for us to do the dishes after the breakfast was done, but now the carers
are very busy in the morning, so that duty of theirs was taken away and put
onto the FSAs. So, FSAs then have to clear plates, tables, clean.
If a table cloth was dirty over a breakfast service we have to put new fresh
linen on. Yes, so - and then you have to check that in both areas because
in Bucklands one server does two areas there.
PN12168
In
terms of clean up?‑‑‑Yes. So, we've got to go - that's
why the timing and that is quite essential because you've got to start morning
tea between 10 and 10.15 in one area and that can take now, well, half an hour
to 45 minutes depending on if everyone's in their room, or they're out doing
stuff, and then you go from one to the other, and then, yes, it's - and, like,
some people have their breakfast in their rooms a lot, so those dishes ‑ ‑ ‑
PN12169
Do
you take ‑ ‑ ‑?‑‑‑ ‑ ‑ ‑don't
come out till late. No, carers do all that stuff, yes.
*** DONNA CAPELLUTI XXN
MR WARD
PN12170
Carers
do that?‑‑‑Yes, we have to stay in the servery and be in
charge of what happens there, and all the clean-up and then we have to be -
after every service we have to make sure drawers and fridges are wiped down and
benches are kept clean, so it's all very tidy and it's an ongoing thing after
every service.
PN12171
I
understand?‑‑‑Yes.
PN12172
And
so that's - you're doing that breakfast, lunch and dinner?‑‑‑Yes,
that's right. Yes.
PN12173
In
paragraph 36 you talk about you help wash the dishes?‑‑‑Mm-hm.
PN12174
I
take it that is it a commercial dishwasher or is it a, sort of, domestic ‑ ‑ ‑?‑‑‑Yes.
PN12175
It's
commercial?‑‑‑No, no, in the main production kitchen there's
a big dishwasher there. So the person who mainly works in the kitchen
after they've gone and served lunch will come back and get stuff, like, with
all the dishes leading up to the lunch from the chefs and that, and then the
girls bring back the big silver tray, serving trays and that from the bain
marie, and then we do those in the kitchen as well plus anything else that's
cropped up, so it's a large ‑ ‑ ‑
PN12176
Is
the doing the washing up - or, sorry, is loading the commercial dishwasher, is
that your job, or do you share that around?‑‑‑No, it's
usually the kitchen person who's there that day, so ‑ ‑ ‑
PN12177
It's
that one you talked about who's in the kitchen that day?‑‑‑Yes,
so that person who's responsible for the kitchen staff, her - well, you know,
her, me, would do - so from quarter past 12 till maybe 1.30 we do a massive
bulk of dishes there and then we'll have a break, and then we'll come, f the
dishes are there, or we have to finish up whatever is left that we couldn't get
done previous lunch. But that one person is always usually the one in
charge of getting all the dishes sorted out.
PN12178
Ms
Capelluti, thank you very much for your evidence. I wish you well.
Commissioner, no further questions?‑‑‑Thank you.
PN12179
COMMISSIONER
O'NEILL: Any re-examination, Mr Oski?
PN12180
MR
OSKI: No re-examination, Commissioner.
PN12181
COMMISSIONER
O'NEILL: Ms Capelluti, thank you very much for your evidence.
You're excused and free to go?‑‑‑Okay then. Thank you
very much.
*** DONNA CAPELLUTI XXN
MR WARD
<THE
WITNESS WITHDREW [12.56
PM]
PN12182
COMMISSIONER
O'NEILL: Well, who'd have thought we'd finish right on the knocker.
We're adjourned until 2 pm this afternoon.
PN12183
MR
GIBIAN: Commissioner, sorry, could I just raise one matter? I think
that we ‑ ‑ ‑
PN12184
COMMISSIONER
O'NEILL: Well, only if you are finished by 1 pm.
PN12185
MR
GIBIAN: I'll see what I can do. I think there were just two matters
I wanted to mention, one is I don't think we'd mentioned there was one witness,
Tracey Roberts, who was not required for cross-examination, whose witness
statements are at document 141 and 142 in the digital court book. We rely
upon those statements.
PN12186
COMMISSIONER
O'NEILL: Yes.
PN12187
MR
GIBIAN: In addition to that we did mention previously that there were -
and I think, Commissioner, you raised with me there are a number of other
individuals who we hadn't been able to produce for cross-examination for
various reasons. I think there are six in total. Ms Kelly, for
example, was diagnosed with COVID and is still too unwell, I think, for us to
insist that she attend.
PN12188
It
might be the most appropriate course if we just communicate with your chambers,
Commissioner, about those individuals and indicate in brief terms at least
their circumstances and that we do seek to rely upon their statements even
though they've not been able to come and be cross-examined.
PN12189
COMMISSIONER
O'NEILL: Look, that's fine, Mr Gibian. Does that include Mr Barnes,
or is he still - do we still need to find some opportunity for him too?
PN12190
MR
GIBIAN: Look, I think at this stage that incudes Mr Barnes. I think
we described that he was travelling and had said he would make himself
available but we've been unable to track him down. He's somewhere in
North Queensland as I understand the position that we're still in.
PN12191
COMMISSIONER
O'NEILL: All right.
*** DONNA CAPELLUTI XXN
MR WARD
PN12192
MR
WARD: Commissioner, can I just indicate that obviously we object to
that. It's not fair that they be admitted without us having the benefit
of cross-examination. It's very clear from all the cross-examinations
that we've solicited concessions from the witnesses, so, as a matter of
fairness, that shouldn't be permitted.
PN12193
MR
GIBIAN: Look, I can respond to that at an appropriate time. I'm not
sure now is necessarily the time, Commissioner.
PN12194
COMMISSIONER
O'NEILL: No. Look, we'll see how we go. I might deal with
that - I might come back to that either later today or at some stage tomorrow.
PN12195
MR
GIBIAN: Of course.
PN12196
COMMISSIONER
O'NEILL: The Commission is adjourned until 2 pm.
LUNCHEON
ADJOURNMENT [12.59 PM]
RESUMED [2.00
PM]
PN12197
JUSTICE
ROSS: Good afternoon. I think we have three witnesses scheduled for
this afternoon and the first is a Mr Paul Sadler; is that correct?
PN12198
MR
WARD: Yes, it is, your Honour.
PN12199
JUSTICE
ROSS: All right, we will call Mr Sadler and have him sworn in.
PN12200
THE
ASSOCIATE: Can you please state your full name and work address.
PN12201
MR
SADLER: I am Paul Michael Sadler. I'm the CEO of Aged and Community
Services Australia and my work address is Level 4/320 Pitt Street Sydney.
<PAUL
MICHAEL SADLER, AFFIRMED [2.01 PM]
EXAMINATION-IN-CHIEF
BY MR WARD [2.01 PM]
PN12202
Mr
Sadler, it's Mr Ward; can you see me?‑‑‑I can.
*** PAUL MICHAEL SADLER XN
MR WARD
PN12203
Thank
you, Mr Sadler. I wonder if you could restate your full name and
address for the record?‑‑‑Paul Michael Sadler, address, level
4/320 Pitt Street, Sydney.
PN12204
Am
I right that you have made a statement for these proceedings of some 98
paragraphs long dated 1 March 2022?‑‑‑That is correct.
PN12205
Do
you have a copy of that statement with you?‑‑‑I do.
PN12206
Have
you read that statement?‑‑‑I have.
PN12207
Is
it true and correct to the best of your knowledge and belief?‑‑‑It
is.
PN12208
If
the Commission pleases, Mr Sadler's statement is tab 251. It
appears in the court book at page 12219 to 12234 and the annexures, of which
there are nine, are contained in the court book at 12235 to 12618 and we rely
on that statement.
PN12209
JUSTICE
ROSS: Thank you, Mr Ward. Cross-examination?
PN12210
MR
GIBIAN: Thank you, your Honour.
CROSS-EXAMINATION
BY MR GIBIAN [2.03 PM]
PN12211
Mr Sadler,
my name's Mark Gibian; can you hear me?‑‑‑I can.
PN12212
I
think you may know I appear for the HSU in these proceedings. Just for
the Bench, I can't see Mr Ward, not that I think it matters immediately, but
I'm not sure whether that was something that affected others.
PN12213
JUSTICE
ROSS: I can't see him either, but, look, that's fine.
PN12214
MR
GIBIAN: Thank you.
PN12215
Mr Sadler,
first of all, as you just said, you are the CEO, as I understand it, of Aged
and Community Services Australia at present. I understand there has been
a recent resolution that a new organisation would be created, I think to be
known as Aged and Community Care Providers Association; is that right?‑‑‑That
is correct.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12216
Essentially
merging with Leading Aged Services Australia?‑‑‑So we're
creating a new legal entity and the asset staff will transfer from ACSA and
LASA into that new entity.
PN12217
As
I understand it, it's due to commence in July or commence operating in July; is
that right?‑‑‑That's right, 1 July we will be operating as
the single provider into the Aged and Community Care Providers Association.
PN12218
Has
it been decided whether you're going to have any - what role you will have in
that organisation?‑‑‑There will be an announcement on Monday
of the interim arrangements. There is a selection process underway for a
CEO of the new entity at the moment.
PN12219
I
understand. You also describe operating a consultancy business, which I
think you commenced before your, at least, current role at ACSA; is that right?‑‑‑That
is correct.
PN12220
Have
you continued to do that while you're the CEO of ACSA?‑‑‑I
have a couple of clients where I had a longstanding relationship with them
including the Australian Health Services Research Institute at the University
of Wollongong, Professor Kathy Eagar.
PN12221
So,
in a limited way, because of ongoing work in (indistinct) that's as I
understand it?‑‑‑Yes, it's a full-time job running ACSA.
PN12222
I
imagine so. The other thing I just wanted to ask you about was that there
is something known as the Australian Aged Care Collaboration?‑‑‑That's
correct. So, the Australian Aged Care Collaboration includes Aged &
Community Services Australia, Leading Aged Services Australia, and the four
faith based peak bodies for the Anglicans, Catholics, Uniting and Baptist
Churches.
PN12223
That's
Anglicare Australia, Baptist Care Australia, Catholic Health Australia, and,
sorry Uniting Care Australia; is that ‑ ‑ ‑?‑‑‑Correct.
PN12224
Correct
me if I'm wrong, that's not an organisation as it were, it's more a coalition
of organisations for the purpose of advancing a public position to government
and perhaps generally in relation to funding, pay and other issues affecting
aged care?‑‑‑It is a legal entity, so it's an incorporated
association in its own right, but you've accurately described its purpose.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12225
Does
it actually have staff, or ‑ ‑ ‑?‑‑‑It's
had some, you know, temporary/part-time staff, but essentially it operates with
the resources of the six bodies that you described working collaboratively.
PN12226
I
understand. And it's released various public statements, as I understand
it. Would we be right in assuming that any public statements that the -
sorry, what's it called - Australian Aged Care Collaboration releases are
approved by each of the bodies that are party to that organisation?‑‑‑That
is correct. So, yes, we've put out a number of statements around
workforce issues over the past number of months, and on occasion in
collaboration with the unions as well.
PN12227
Sorry,
just back to my questions, I think you were agreeing with me, that is, that any
of the public statements released by Australian Aged Care Collaboration are
approved by each of the constituent organisations?‑‑‑That's
right, they're approved by all six of us individually and collectively.
PN12228
And
no doubt each organisation has its own internal decision making processes in
that respect, but whatever process they adopt they're approving those
statements?‑‑‑That's correct.
PN12229
So
far as ACSA is concerned, what was that process, that is, was it through the
board or with consultation of members?‑‑‑So, look, it depends
on the particular statement and as is often the case with things that are
released to the media how quickly we need to respond to something, so there's a
delegated authority to me as the chief executive officer, to approve media
statements on behalf of ACSA, and in most cases it will have been me approving
it, but it may well have been on the basis of policy positions developed and
approved through either the ACSA board in consultation with our members.
PN12230
I
understand. All right, and I established - I imagine there'd be
discussions if there was any kind of disapproval, as it were, of public
statements that were made or the like, and correction and ‑ ‑ ‑?‑‑‑Absolutely.
And ‑ ‑ ‑
PN12231
I'm
not saying that came up, but in the event that it did?‑‑‑Yes.
And from time to time in any statement that's put out by a collaboration there
will be some need to compromise to get wording out in a fashion which, you
know, we can all adopt publicly.
PN12232
I
understand. All right, can I take you to - I'll come back to that in a
bit, but can I take you to your statement - a few things in your statement
first of all. You have that in front of you, do you?‑‑‑I
do.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12233
From
paragraph 15 you talk about or provide some, without being critical, general
overview of the background of regulation in aged care. I just wanted to
go to the present standards, which you start talking about at paragraph 23?‑‑‑Yes.
PN12234
Which
are the 2019 standards. There are a few aspects that are new to the
standards that you identify. Firstly, in the second sentence at paragraph
23 you indicate the new standards represented a shift from aged care consumers
being treated as passive recipients of care having an active role in choosing
and directing how their care is delivered. You see that?‑‑‑I
do.
PN12235
And
then in paragraph 24 you also refer to additional requirements around
governance and clinical care. Can I just ask you to turn to the
standards, this is the standards and requirements, you've annexed that at -
it's PS5. If it assists the Bench it's page 12557 in the digital court
book. I'm not sure how you're looking at it, Mr Sadler, but ‑ ‑ ‑?‑‑‑I
have it as a separate piece of paper in front of me, so I've got ‑ ‑ ‑
PN12236
Even
better. That's a lot easier than most of us have it. All right,
now, I think the emphasise on individual choice and the active role of the -
they do refer to it as the consumer in this context, don't they, but the
consumer in care is particularly evident in standards 1 and 2; is that ‑ ‑ ‑?‑‑‑Yes,
correct.
PN12237
‑ ‑ ‑what
you're referring to in that respect?‑‑‑Yes, it is.
PN12238
And
so far as there were changes in relation to clinical care requirement that was
primarily standards 3 and 4 you're referring to?‑‑‑Standard 3
and standard 8, because there was an expanded requirement in standard 8 on
clinical governance framework to be adopted by the governing board.
PN12239
I
understand. And, sorry, so far as standard 4 is concerned, you're
delineating there, are you, between personal care to daily living tasks and
clinical care; is that ‑ ‑ ‑?‑‑‑That's
correct. So, standard 3 addresses personal and clinical care, and then
all the other aspects of support for daily living are covered by standard 4.
PN12240
I
understand. And then the governance requirements are really - perhaps
they're all of 5, 6, 7 and 8, is that what you're referring to in that respect?‑‑‑Yes,
in a way the whole of the set of standards are governance requirements, but
there's a particular call out about organisational governance in standard 8.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12241
I
understand. All right, can you go back to your statement then, and I just
wanted to ask you about what you say, firstly, in paragraph 27 about the
assessment process. There you indicate that, 'Following the introduction
of 2019 standards and the rules in 2018 there was a change to the assessment
process', and you refer to there being announced and unannounced audits being
conducted. Firstly, in terms of your involvement with that, did that
occur during the time you were still with Presbyterian Aged Care?‑‑‑It
did, yes.
PN12242
And
were you a subject of that process?‑‑‑I was, yes.
PN12243
Did
you have direct involvement in that or was that dealt with at the facility
level?‑‑‑It would be a variety. So, usually if there
was an announced review I would be turning up for at least one of the days of
an audit. Where they're unannounced it may not have been physically
practical for me, or indeed others of the head office team to actually attend
depending, you know, if it was a regional service, for example, that had an unannounced
visit you might not be able to physically be there. But we'd often be
consulted during the conduct of the review by the service manager if necessary.
PN12244
I
understand. And in terms of the - if I can just ask you in a general
sense the purpose of the assessment process is that the assessors are
considering whether the particular facility is able to demonstrate that it is
meeting each of the standards and the requirements under the standards in the
aged care quality and safety standards?‑‑‑That is correct.
So, if they're conducting a full audit they will be looking at all eight of the
standards and the 42 requirements under the eight standards. If they're
coming in for an unannounced visit, it may be a narrower number of the
standards and requirements that they would look at.
PN12245
And
do the assessors just decide what they're looking at in the unannounced visits?‑‑‑That
would probably have been pre-determined by the quality and safety commission
before arrival, but there's always the scope for the assessment team if they
find evidence of a concern in a particular area to follow the lead of that, and
that might take them to look at requirements that they might not have intended
to look at at the start of the audit.
PN12246
I
understand. No doubt these things may vary from time to time, but I'd be
right in understanding in a general sense that the process would involve both a
review of policies and procedures, documentary records and the like?‑‑‑Yes.
PN12247
I
understand in addition that the assessors, generally speaking at least, are
also interested to talk to the staff who are actually providing the care or are
involved in the services at the particular facility?‑‑‑That's
right. So they would do both of those things that you described, look at
policies and procedures documentation, they would speak to staff and
management, and they would also speak to usually a minimum of 10 per cent of
the consumers at that service.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12248
I
think I asked you to be supplied with a few documents. One of those was a
document that's entitled 'The Guidance and Resources for Providers to Supply
Aged Care Quality Standards'?‑‑‑I have that document with me.
PN12249
Do
you have access to that document at least?‑‑‑I do.
PN12250
For
the members of the Bench, it is actually a document which is the court book
already, although I think a separate copy was provided. It is document
315, I think, in the digital court book within the ANMF's bundle for the
record.
PN12251
Are
you familiar with that document, Mr Sadler?‑‑‑I am.
PN12252
I
am correct in understanding it's intended to be a guide as to providers as to
how they are best to comply with the requirements in the standards and what
those requirements are intended to - the obligations those requirements are
intended to impose?‑‑‑That is correct.
PN12253
It's
obviously quite a long document, but I just wanted to see if I have understood
it correctly by way of example, at least, that is, the document goes through
each of the standards, so I think within the document itself, page 6 deals with
standard 1, or commences dealing with standard 1, and it sets out there
the consumer outcome, that is:
PN12254
I
am treated with dignity and respect and can maintain my identity. I can
make informed choices about my care and services and live the life I choose.
PN12255
Then
there's a statement of the organisation and then the more detailed requirements
are on the right-hand side. That's as we read the standard,
Mr Sadler?‑‑‑I would agree with you.
PN12256
I
think with each of the requirements, the guide then sets out the kind of things
that the assessors are likely to look for in terms of demonstrating
satisfaction of each of the requirements within each of the standards; that's
the way it's set out?‑‑‑That's correct.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12257
Can
I just provide one example in that respect. Because you've identified the
choice aspect particularly in your statement, if you go to page 17, I think,
first of all, it's requirement 3(c) within standard 1 and the document then
sets out on the following page, page 18, the intents of the requirement and
then, on page 19, there's some examples of actions and evidence?‑‑‑Yes.
PN12258
In
that particular requirement, that's the kind of actions and evidence that the
assessors would be looking to see within the facility on the audits?‑‑‑Correct.
PN12259
That's
both, as you say, what they would want to hear from the consumers and what they
would want to hear from the workforce and what they would want to hear from the
organisation as a whole and it's broken down into those three categories;
correct?‑‑‑Yes.
PN12260
In
this respect, so far as the workforce is concerned, they would speak to the
workforce for the purpose of assessing, for example, whether they are able to,
under the first dot point under the heading 'Workforce and Others', whether
they are able to describe how they have achieved the level of skills and
knowledge they need to support consumers to exercise choice; correct?‑‑‑Correct.
PN12261
That's
something that they would obtain from speaking to the workforce directly?‑‑‑Both
that and potentially their assessment of the clinical notes that have been
recorded.
PN12262
In
terms of clinical notes, are you referring to both - I think the terminology
changes somewhat, but I think most people refer to them as progress notes?‑‑‑Correct.
PN12263
Care
plans and other associated documentation?‑‑‑That's correct.
PN12264
The
second dot point refers to the workforce being able to give examples of how
they help consumers make day to day choices and help with access to any support
that the consumer needs to make or communicate decisions?‑‑‑Correct.
PN12265
That
is, again, something you expect them to ascertain by way of interview and
interaction with the workforce themselves?‑‑‑Yes.
PN12266
The
objective of all of this process, are we right in understanding, is to ensure
that, in this particular instance, the object of consumer choice and
independence is fulfilled in the way that the care staff and other staff within
facilities perform their work on a day to day basis?‑‑‑That
is correct.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12267
The
standards don't necessarily prescribe exactly how that's to be achieved, but
the assessors will want to see evidence that it is being achieved by methods of
this type?‑‑‑That's correct, and in clause 29 of my evidence,
I refer to the fact that the obligation is on the organisation. As you
read earlier, there's an organisation statement about how to comply, but then,
clearly, the workers are the people who are doing the care delivery and the
interactions with the consumers, so, at that point, what the Quality and Safety
Commission looks for is, well, how are you actually interacting, because that
would provide evidence as to whether the organisation's obligation to comply
with the standards has been met.
PN12268
In
that sense, when you say - I think it's paragraph 28 - but when you say in your
statement that the obligation falls on the provider to ensure compliance, it's
obviously the provider that is accredited and it can potentially be subject to
sanction if the audit results in findings that they are not meeting the
standards; correct?‑‑‑That is correct, yes.
PN12269
But
the point you were just making is that the methods in respect of most of the
requirements in the standards at least are concerned, the provider will ensure
compliance is through demonstrating that its staff in the work they do day to
day meet the objects of the standards and the detailed requirements of them?‑‑‑That's
correct.
PN12270
And
have been trained and skilled in order to do so?‑‑‑That's
correct.
PN12271
If
you can just go back to your statement for a moment, in paragraph 27, you also
refer to the rates of compliance, or non-compliance perhaps I should say.
That is, in the third sentence, you indicate that as a result of this, that is
the introduction of the unannounced visits, there had been an increase in the
prevalence of non-compliance, particularly in residential aged care
providers. Do you see that?‑‑‑I do.
PN12272
Were
you talking there about the period immediately after the new standards were
introduced?‑‑‑Yes, so referring particularly to the evidence
that's been over the last two and a-bit years since those standards came into
effect in July 2019.
PN12273
You
set out some documentation at PS6, which is referred to in that paragraph
commencing at page 12561 in the digital court book. Do you have a copy of
that, Mr Sadler?‑‑‑I do.
PN12274
This
is a publication of the Aged Care Quality and Safety Commission, is it?‑‑‑It
is. It's made available on a regular basis, a quarterly basis, on their
website.
PN12275
This
is just for the January-March 2020 period, but there is, up to today - at least
there may be some delay, but the quarterly reports up to the most recent ones?‑‑‑That's
correct.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12276
Just
on the first page, there's a reference to two different documents in the
text. You're familiar with them. The first is a non-compliance
notice and the second is a notice to agree; do you see that?‑‑‑I
do.
PN12277
The
first stage, if there's a non-compliance - well, firstly, the commission
doesn't always issue either of those notices if they've found a non-compliance;
it's a matter of discretion, is it?‑‑‑There is a level of
discretion. So, if they find what they would describe as a minor level,
you might, you know, have a problem in one requirement or something and they
wouldn't necessarily issue it as a non-compliance notice. They will tend to
issue a non-compliance notice where there are multiple requirements that they
find there's a shortfall.
PN12278
Even
short of a non-compliance notice, I take it, they would tell the facility what
the deficiency is?‑‑‑Yes. You would receive a report of
the assessment by the audit team and you have a period of time in which you can
reply to either provide additional evidence or contest the judgment that the
team or the decision maker made.
PN12279
Then
the non-compliance notice is a more serious measure and, I assume, requires compliance
then to be achieved within some particular period of time after the notice is
issued?‑‑‑That's right. The notice to agree is where
there's a significant level of concern - so it's the next step after the notice
of non-compliance you have alluded to - and that would be where the commission
will say, 'We need you to fix this in X date.'
PN12280
Above
that, there are various sanctions that can be imposed, I think, not permitting
new residents for a period of time, or, ultimately revocation of accreditation;
is that right?‑‑‑That is correct.
PN12281
I
just to make sure I'd understood where you got the figures from. If you
just go forward within that document two pages to - it's page 3 internally,
it's page 12563 in the digital court book. You will see there's some
tables there with residential care sector performance; do you see that?‑‑‑I
do.
PN12282
I
think table 3 is just the number of audits and table 4 refers to site audits;
do you see that?‑‑‑I do, and that's the one we got
- - -
PN12283
That's
the - - -?‑‑‑(Indistinct) per cent from, yes.
PN12284
Are
they the pre-announced audits?‑‑‑Well, there are
- - -
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12285
Or
is it both?‑‑‑There are no pre-announced audits, so they are
all unannounced. What happens with a full audit is you do have a sense of
a kind of three-month scope within which it's likely to happen because that's
pre-determined by when your accreditation expires, but we are not told any more
what day the assessment team is going to arrive. There are some
exceptions to that if the commission decides it's going to come for a
particular issue and, particularly through COVID, there's obviously been the
complication of, you know, is it safe to come, so the commission is using its
discretion to, on occasions, give us notice that they're coming, but mostly
they are now unannounced.
PN12286
I
understand. Underneath that, there are review audits. I take it
that's where there's a revisit, essentially, is it, following a site audit?‑‑‑A
review audit could be commissioned outright because a serious issue has been
identified or reported and that could have come through the complaints
mechanism or through another channel to the commission, and they will then do
what they call a review, which is really an intensive, immediate audit out of
the sequence of the usual three-yearly run of residential care audits.
PN12287
That
seemed to produce quite a high level of non-compliance?‑‑‑It's
because it's targeted to those situations where they have already been advised
that something could be seriously wrong.
PN12288
Lastly,
just over the page, page 4 of the document, page 12564 in the court book,
there's a reference to assessment contacts. That's the visits which are
not full audits; is that as I understand it?‑‑‑That's
correct, yes.
PN12289
Can
you go back to your statement then again. The next matter that you deal
with, from paragraph 30, is the Serious Incident Response Scheme. Is that
called SIRS?‑‑‑SIRS for short, yes.
PN12290
That
was introduced in 2021, as I understand it, and you describe it in paragraph 31
that there had been prior reporting obligations in relation to physical or
sexual assault or unreasonable use of force incidents, but that there's
expansion of the type of matters that are now required to be reported, and
that's to the Aged Care Quality and Safety Commission?‑‑‑That's
correct.
PN12291
I
can take you to the documents, but am I right in understanding that the SIRS
scheme, for short, did something else as well, that is, it did essentially two
things, it imposed on obligation upon providers to establish their own internal
incident management systems and, in addition, as you have described in your
statement, it imposed additional reporting requirements to the commission?‑‑‑That
is correct.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12292
The
requirement for an organisation to establish and implement its own incident
management systems were not limited to the types of incidents that are set out
in paragraph 32 of your statement?‑‑‑That is correct.
Both through the Aged Care Quality Standards there was mention of how you
handle - it's in standard 6 - so you needed to have an approach to an open
disclosure process under that standard, and then the Serious Incident Response
Scheme, as you descried, has gone further in clarifying for the residential
care services what other mechanisms they will need to have in place for
incident management.
PN12293
That
is, there was, at least from 2019, a standard which required some such process
to be in place, but the SIRS requirements are more specific and comprehensive?‑‑‑Correct.
PN12294
Just
briefly, we had another document sent through to you which is entitled 'Serious
Incident Response Scheme Guidelines for Residential Aged Care Providers' dated
1 October 2021. Do you have that available to you?‑‑‑I
have that in front of me.
PN12295
In
terms of the internal incident management systems, it's dealt with from page
12, I think, in that document, in chapter 2?‑‑‑That is
correct.
PN12296
If
you go over to page 13, there's a description of the obligation in relation to
incident management and prevention?‑‑‑That's correct.
PN12297
I
think, really in the third paragraph of that description, it makes clear that
the reporting requirements under SIRS relate to a range of serious incident
types outlined in chapter 3; however, the definition of 'incident' which a
provider is expected to prevent, manage and resolve through an effective
incident management system is broader than this. Do you see that?‑‑‑I
do.
PN12298
I
think in the definition in the shaded box, it's really anything that could have
caused harm to a resident; is that right?‑‑‑That's right.
PN12299
The
requirements in relation to the incident management system include process of
recording and documentation?‑‑‑They do, and also assessment
of the incident and what caused it and what remedial steps to avoid something
similar happening again.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12300
Can
you go back to your statement again. In dealing with SIRS, you're really
dealing with the - having described the types of matters that must be reported
on, you then discuss that matter in paragraphs 33, 34 and 35. You're
really dealing there with the reporting aspect of it, rather than the incident
management aspect of the SIRS process?‑‑‑Well, certainly in
35 that's true. I mean, in 33 and 34 when I mention internal reporting
systems that would be capturing some of what we just looked at in the SIRS
guidelines, yes.
PN12301
In
terms of 35, first of all, you refer to the legal responsibility of the
provider not the employee to report to SIRS. I take it you're referring
to reporting to the commission of one ‑ ‑ ‑?‑‑‑Correct.
PN12302
‑ ‑ ‑of
the serious incidents described in paragraph 32?‑‑‑That is
correct. So, unlike some mandatory reporting schemes for health
professionals, for example, or teachers where it's an individual professional
obligation, under the Serious Incident Response Scheme it's an organisational
responsibility to report.
PN12303
I
understand. But of course the way in which the organisation acquits that
obligation is by having in place systems that require their own employees to ‑ ‑ ‑?‑‑‑That's
‑ ‑ ‑
PN12304
‑ ‑ ‑notify
and report and document in an appropriate manner?‑‑‑That's
correct.
PN12305
And
then in paragraph - going back slightly, paragraph 34, you refer to care
workers being required to identify potential issues and provide concerns to the
registered nurse, and the registered nurse being required to document the
report in the provider's internal reporting system. Do you see that?‑‑‑I
do.
PN12306
Although
the SIRS, incident reporting requirements are more detailed, there is some
degree of discretion, is there not, as to the precise mechanics of the incident
management system within a particular provider?‑‑‑That is
true, and different providers will adopt different, both electronic and, you
know, other systems which they use to capture and document and address the
issues.
PN12307
Would
you agree with me that frequently those processes will involve - or some kind
of incident report or documentation by the staff member who witnessed or
happened upon the incident that is involved, and perhaps then collation by
either management or the registered nurse of that report?‑‑‑I
would say all the incident management systems would require reporting by the
individual staff.
PN12308
Now,
you then go on to deal with some funding issues. I just want to ask
really one question about that. From paragraph 37 you're dealing with the
ACFI process, the Aged Care Funding Instrument process?‑‑‑Correct.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12309
And
in paragraph 38 you refer to the documentation required by the provider to
claim funding. And we're right in understanding that that involves, initially
at least, an assessment being undertaken by an appropriate person within the
provider of the care needs of the resident and then updated to the extent
there's changes in those care needs that permit some change in funding
arrangements?‑‑‑That's correct.
PN12310
Then
that can be audited, as you say, which no doubt produces some additional
documentation requirements if that occurs?‑‑‑It does, yes.
PN12311
In
paragraph 41 you refer to RNs being diverted from direct care into the
completion of assessments for ACFI purposes. Do you see that?‑‑‑I
do.
PN12312
In
the second sentence of that paragraph you indicate that while this has affected
both registered nurses and care workers, it particularly impacted RN
workloads. Is the workload you're talking about there the completion of
documentation associated with the assessment processes?‑‑‑That's
right. It's undertaking the assessments themselves. In some
instances the assessments will require a monitoring for a defined period using
a particular tool in order to comply with the ACFI requirements. And then
overall there would be a set of assessments that are required to be completed
against each of the 10 domains for ACFI.
PN12313
So
far as the effect of that process on care workers, it may be perhaps no doubt
particularly for re-assessments that care workers might be consulted about
changes in a resident's behaviour or condition or the like?‑‑‑That's
correct.
PN12314
But
is principally what you're referring to in that respect that this is one aspect
at least of the matters affecting the registered nurse time which has resulted
in registered nurses providing less direct care themselves; correct?‑‑‑Correct.
PN12315
And
the consequent effect upon care workers of performing more direct care work and
doing so without at least as direct as supervision as may have been the case in
the past?‑‑‑Well, certainly the first part of your statement
I would agree with. The impact on availability for supervision, yes, I
think wherever possible we've tried as aged care providers to maintain direct
supervision lines to the staff, the care staff, but obviously if the registered
nurse time is being taken up by the assessment and the associated paperwork and
documentation then that will reduce the time that is available for the
supervision work.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12316
Can
I then just ask you a couple of questions about what you say about home care
from paragraph 42? At paragraph 43 you refer to change from funding in
advance to funding in arrears. Can you just describe what you're
referring to there, or what the effect of that is?‑‑‑Yes.
So, the government was previously providing basically subsidies in advance for
home care package arrangements, and they would then do a reconciliation.
Well, when I say 'they', the provider would do a reconciliation and the
government would then do - return any money that might be required as an offset
against its next payment to the provider. What they've done in the last
few months is swap that over now to a situation where they'd pay in arrears, so
we have to now lodge a claim that says, 'This is how much service we provided
in the past month', and we're paid for that service in arrears by the Federal
Government.
PN12317
Then
in paragraph 44 you refer to the concept of consumer directed care?‑‑‑I
do.
PN12318
And
there having been a change to the funding arrangements to adopt that concept,
at least from 2017 onwards. Now, am I right in understanding perhaps in a
crude way that's a change which was of a similar origin to the greater focus on
personal directed care in residential aged care?‑‑‑Yes, very
similar philosophical concept. In the case of home care being applied
through the funding mechanism rather than just the standards.
PN12319
That
is, consumers have a certain amount of choice in terms of the care and services
they desire, and the funding, at lease if it fits within their assessment, will
match those choices?‑‑‑That's correct. So, there's a
budget allocated against a particular level of home care that you're approved
for by the aged care assessment team, and then the consumer has the choice
within that funding allocation for which services they choose to receive.
PN12320
Am
I right in understanding that the move towards a philosophy at least of
consumer directed care also has, as part of it, a change within the goals or
the philosophy of the care that is directed towards identifying and achieving
the goals of the resident, re-enablement of the resident, to the extent that
the care can contribute towards that?‑‑‑Yes, I would agree
with both aspects of what you just said.
PN12321
In
addition to just the kinds of funding arrangements, or the funding choice that
the resident will have more say in and contribute to the way in which care is
provided on a day-to-day basis?‑‑‑Both on a day-to-day basis
and as part of the assessment and care planning process that their care manager
in the home care context would undertake with them.
PN12322
So,
both in the care planning that goes on initially and on a review basis, but
also in dealing with the carer on a day-to-day basis?‑‑‑That's
right.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12323
Can
I go back to – in paragraph 44 then, in the second sentence you say – or you
make an observation based on what you say is your experience and feedback from
ACSA in terms of your experience that you're talking about when you were with
Presbyterian Aged Care?‑‑‑Yes, because I was at
Presbyterian Aged Care obviously from that change in
November 2017 through till I'd finished with PAC in March 2021.
PN12324
You
then say that:
PN12325
This
has not impacted upon the work that is being performed, rather when it is being
performed and what services the client wants.
PN12326
Do
you see that?‑‑‑I do.
PN12327
So
certainly one way in which the client can exercise choice and independence is
by, as you say, choosing when things are done and what services they chose to
have access to within their package, correct?‑‑‑That's
correct.
PN12328
I
think you disagreed with me that, in addition to that, the philosophy of the
care and the interactions between the carer and the – I think we're still
saying 'consumer' in this context are different, in the sense that there is
more of a give and take, more of a recognition of the independence and choice
of the consumer?‑‑‑I think that's right. So what staff
need to do now when they're interacting with a consumer, it actually goes back
to the words in the standards when you read them out earlier. They need
to be able to respond to the express needs of the consumer on the day, and
negotiate and/or respond accordingly. If the care worker has any concerns
that the consumer's asking them to do something beyond that which they would
usually do, they can contact their supervisor, which in the home care
context would often be their care manager.
PN12329
But
if it's within the scope of what the services that are (indistinct) care which
is able to be provided by the carer, they are no doubt subject to communication
and negotiations about what the best way to do things is, to endeavour to adapt
to whatever choice and desires are expressed by the consumer?‑‑‑That's
correct.
PN12330
I
think there are just (audio malfunction) - - -?‑‑‑Just lost
the sound.
PN12331
JUSTICE
ROSS: Yes, you're on mute I think, Mr Gibian.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12332
MR
GIBIAN: I don't think I was. It may have been some kind of
interruption. Can you hear me now?‑‑‑I can.
PN12333
JUSTICE
ROSS: Yes.
PN12334
MR
GIBIAN: All right, well just identify if I broke up again. Sorry, I
was going on to where you refer to the work environment from paragraph 60
onwards?‑‑‑Yes.
PN12335
I
think you deal with both residential care and home care in this context – and
you refer to changes in the physical layout of at least some aged care
facilities?‑‑‑Yes.
PN12336
You
agree the extent to which that's been achieved, or the nature of the changes
are variable from institution to institution; you're referring to a general
trend at least?‑‑‑That's right. So for example, the
number of multiple bedrooms in residential care services – I think the latest
figure I saw is that it's around 80 per cent of aged care homes are
all single bedroom layouts now. So if you go back 15 years you
probably would have had that as a 50/50.
PN12337
At
paragraph 63 you refer to, or you indicate that (indistinct) allow the easy use
of the chemical aids, that is, where there has been changes to the physical
premises. Do you see that?‑‑‑I do.
PN12338
Are
you referring to lifters and slings and matters of that nature?‑‑‑That's
right. So when aged care homes are being upgraded or built new, they're
now being built with usually larger spaces around the beds for the use of
slings or lifting equipment.
PN12339
Devices
of that type are themselves not new, is that right?‑‑‑That's
correct.
PN12340
No
doubt there are innovations and newer models perhaps, but in a general sense
they're not new. You're really saying that in some respects the physical
changes to the facilities facilitate their use in a way which improves care?‑‑‑That's
correct.
PN12341
And
no doubt there is greater use of those aids because of the matter that you
earlier refer to in your statement, that is, the increasing levels of
immobility and frailty among residents?‑‑‑Correct.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12342
Further
on in your statement, and I don't need to take you to it necessarily, but you
refer at paragraph 96 to something you refer to as 'assistive
technologies.' Is that the same thing that you're referring to there, or
is that something different?‑‑‑It's both the same but more
that. So as well as things like lifters, there are other newer
technologies, for example, monitoring technologies and alarm systems, more
robotics and other assistive technologies that aged care providers are introducing,
in some cases gradually, in some cases quite quickly, as new technology is
developed.
PN12343
Sorry,
what robotics technology are you referring to there?‑‑‑So,
for example, in home care we've seen a significant pick up in the use of
automated cleaning systems. Whereas historically it would have needed to
be a cleaner who came in to clean the home, it frequently with the use of, you
know, funding out of the home care package, we're now buying automatic vacuum
cleaners that can steer around, you know, the home without the need for the
older person or a worker to actually use them, and then the worker might be
coming in to confirm that that's happened properly, to empty them out, whatever
else is necessary.
PN12344
If
I can go back to where you refer to the 'work environment', I think you then
refer to 'home care environment', and I think you're essentially saying, well,
home care workers have always had to deal with different home environments,
depending on the consumers who they're visiting?‑‑‑That's
correct.
PN12345
I
think you've otherwise said that both the age and frailty and acuity and health
needs of consumers of home care have also increased over the last 10 years
or so at least, together with the changes of a single nature in residential
care, correct?‑‑‑That is correct.
PN12346
And
we're right in understanding that that means that there's an increasing number
of home care consumers who would have difficulty or are unable to care for the
home themselves?‑‑‑That's right, and we're seeing, you know,
a significant increase in demand for home care services as a part of that,
including the long waiting lists that have been there for home care packages.
PN12347
In
addition, the change in the demographics and needs of home care consumers also
increased the need for the home care worker to be attuned to environmental and
physical risks in the home that might be occasioned to the consumer?‑‑‑Correct.
PN12348
Then
I think the last thing in your statement I wanted to ask you about was, from
paragraph 85 you deal with 'engagement with external parties.' Do
you see that?‑‑‑I do.
PN12349
And
I think one observation you make in the second sentence of paragraph 87 is
that, 'Families are increasingly more concerned about their family member in
care.' Do you see that?‑‑‑I do.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12350
Do
I detect from that, your understanding at least and your experience is that
families are more likely to make inquiries or to provide feedback in relation
to the care being received – I think you're referring really to residential
care here, but maybe also to home care providers?‑‑‑Yes, it's
both home care and residential care. So we do see families advocating
more strongly, and also linked in because of new capacities like, you know,
iPhones and iPads and things like that. So they're often monitoring
what's going on with their loved ones from a distance, and therefore making
more contact with our staff.
PN12351
I
think in addition to that, the quality standards also impose an obligation upon
providers to – in aged care at least – to provide avenues for and encourage
both residents and their families to provide feedback and, if the need arises,
make complaints in relation to the care that's being received?‑‑‑That
is correct. It's an obligation under Standard 6 of the Aged Care Quality
Standards.
PN12352
And
the reporting requirements as well, both in the standards and in the SIRS
process are also intended to provide greater transparency and accountability so
as to facilitate, to the extent necessary, families and other representatives
getting feedback and making complaints?‑‑‑That's correct.
PN12353
In
relation to the roles of different staff in that respect, at paragraph 88, In
the first sentence it expressed the opinion that:
PN12354
Good
quality aged care requires more than just formal communication. Personal
care -
PN12355
It
probably should say -
PN12356
care
workers on a daily basis engage in general conversation -
PN12357
Et
cetera -
PN12358
with
the consumer and their families.
PN12359
Do
you see that?‑‑‑I do.
PN12360
That
is, to the extent that the care worker is the worker who is likely to have most
regular contact with the resident and know most about their day-to-day
activities and wellbeing; correct?‑‑‑That's true.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12361
And
if families want to know about those matters, which presumably they would,
they're most likely both to encounter and to make inquiries of the care worker
directly?‑‑‑Correct.
PN12362
I
think the point you made further on in paragraph 88 is if there was some kind
of formal complaint of some nature you would expect that to involve someone
within the management of the facility, as one would expect?‑‑‑That's
correct.
PN12363
Or
that if there were specific clinical information which the personal care worker
was not able to provide then the registered nurse or appropriate care manager
would be involved in that kind of process?‑‑‑That's right,
yes.
PN12364
And
in either instance that may require the manager in dealing with a complaint to
discuss the matter or obtain a report of some nature from the care worker?‑‑‑Correct.
PN12365
And
the same with the clinical information from the registered nurse or a care
manager if that's the circumstance?‑‑‑Correct.
PN12366
Now,
lastly, there were a couple of other documents we sent around, which hopefully
you have access to, which are a couple of press releases from the Australian
Aged Care Collaboration?‑‑‑I have them.
PN12367
The
first of those is dated 1 March 2022, and I think you're listed on the second
page of that document as a person who can be interviewed or speak to its
substance?‑‑‑That's correct.
PN12368
And
it's the election statement for the Australian Aged Care Collaboration?‑‑‑That's
correct.
PN12369
I
take it, it was approved by all of the participants in that coalition in the
way that we discussed earlier?‑‑‑That's correct.
PN12370
And
is intended to represent their position in relation to matters of funding and
wages and the like?‑‑‑That is true.
PN12371
I
just want to ask you about one matter in it, I don't think it's page numbered,
but on the third page of the statement itself there's a heading, The Staffing
Crisis. Do you see that?‑‑‑So, that's in the attachment
document?
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12372
Sorry,
yes, it's the third page of the attachment, I think?‑‑‑Yes.
PN12373
As
I say, I don't think it has page numbers on it, does it?‑‑‑Yes,
I've got that.
PN12374
And,
again, I don't need to take you through all the detail, but that's a reference
to the difficulty in attracting and retaining sufficient and appropriate staff
in both resident and home care?‑‑‑That's correct.
PN12375
The
view expressed, particularly in the third paragraph under that heading, is that
the key to fixing that crisis or solving the crisis is questions of pay in
review?‑‑‑That's correct. The Australian Aged Care
Collaboration has been very clear for many, many months now that there is a
need for this Fair Work Commission work value case to proceed for it to make a
determination of how wages should be adjusted to reflect the work value of our
aged care workforce, that we believe that that will require an increase in
wages for aged care staff, and that it is very important then that the Federal
Government, whoever that is post 21 May, actually fully funds the outcome of
that decision that the Fair Work Commission will make, because at the moment we
have 60 per cent of residential aged care homes in the country in deficit, and
we would not be able to fully fund the outcome of the commission case without
the Federal Government giving in the money.
PN12376
And
is what you've just said really, if you go over to the last page of that
document, item 2, in what the coalition is calling for?‑‑‑That
is correct.
PN12377
Just
going back to the staffing crisis section, the final paragraph above the
heading, The Funding Crisis, you'll see there's a reference to staff turnover
rates in residential care, and in home care. Are you able to say where
that information came from?‑‑‑It came from information that
was available from surveys that our member organisations had participated
in. I don't have the reference in front of me today. If it would
help the Commission to obtain it I can take that one on notice.
PN12378
That
is, your understanding is it was surveys conducted by these six organisations?‑‑‑That's
right.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12379
In
the second sentence of that paragraph there's a reference to residents in home
care losing care. Again, are you able to say where that information's
derived from?‑‑‑Again, that was information available from
our members which was provided to us. And I should note on that one that
we - obviously we had the pandemic as a backdrop through that 2020/21, early 22
period, and, so, some of these figures where we have turnover rates and shifts
not being filled were being affected on top of the underlying issues for the
aged care workforce who were absolutely being compounded by the pandemic.
PN12380
Sorry,
in that answer were you indicating the extent of hours lost may have been
affected by absences due to COVID related reasons?‑‑‑To the
pandemic.
PN12381
I
understand?‑‑‑That's right, yes.
PN12382
And
in terms of turnover, do I understand what you're saying in that respect is
that, if I put it this way, that the impact of COVID - of the pandemic upon the
work of aged care workers was such as would lead to some people, in your
estimation at least, leaving the industry?‑‑‑That's
right. We've had reports of burn out from the additional work that staff,
who didn't catch COVID, had to do to cover for their colleagues who had COVID,
for example. So the stress through the last two and a-half years on our
workforce and on management has been due to the fact of COVID.
PN12383
Then
can I just ask you about the second of the press release documents that we provided.
It's dated 22 March 2022. Do you have that one with you?‑‑‑I
do.
PN12384
I
think it covers some of the same territory, but you're also listed as someone
who can speak to this, I think. And the attachment to the press release
is entitled, It's Time to Care About Aged Care, Priced Out Aged Care, Wages and
Living Costs. Do you see that?‑‑‑I do.
PN12385
Again,
I don't think they're numbered, but on the third page of that annexure there's
a heading, Introduction. Do you see that?‑‑‑I do.
PN12386
In
the - it might be the fourth paragraph under that heading, the second of the
black text paragraph it reads that priced out looks at how wages for aged care
workers are stacking up against living costs. Do you see that?‑‑‑I
do.
PN12387
I
take it the reference to 'priced out' refers to some particular analysis that
was conducted for this purpose?‑‑‑That's correct.
PN12388
Who
did that?‑‑‑So that was done in-house by members of the
Australian Aged Care Collaboration based on data available to us through the
ABS and other sources.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12389
I
understand. Yes, thank you. Can I just have a moment, your Honour?
PN12390
JUSTICE
ROSS: Certainly.
PN12391
MR
GIBIAN: Sorry, just one final thing, in relation to that information
about living costs and wages, and also the information about turnover and the
like in the earlier press release, you were and, I take it, all the
organisations were, confident enough in those figures to put them out publicly?‑‑‑We
were.
PN12392
Sorry,
there was one other thing in the second document. If you just go back to
the press release of 22 March 2022, on the second page of that press release,
there's a heading 'Background' and there's a heading 'Living Costs of Aged
Care' and then 'Aged Care Wage Comparison'. Do you see that?‑‑‑I
do.
PN12393
In
the middle part of that page. And in the dot points, there's a reference
to medium hourly wages for various types of workers?‑‑‑Correct.
PN12394
Are
you able to say where that was obtained from?‑‑‑Again, I
don't have the link because I was only told I'd be looking at these documents
just a few minutes before the hearing, so I can take that one on notice.
PN12395
All
right. I'm not being critical of you in this respect, but I think there
is a footnote there, but I'm not sure that the footnote relates to anything in
the document itself?‑‑‑I think I should take that on notice
if the Commission is happy to do it that way.
PN12396
JUSTICE
ROSS: No, that's fine.
PN12397
MR
GIBIAN: That's my cross-examination at least.
PN12398
JUSTICE
ROSS: All right, thank you. Is it Mr McKenna or Mr Hartley?
PN12399
MR
HARTLEY: It's Mr Hartley, your Honour. I wonder, your Honour, your
Honour expressed the preference that there not be doubling up of
cross-examination. It will assist me in that connection if I could just
have 60 or 90 seconds to just go through my notes.
PN12400
JUSTICE
ROSS: Of course.
*** PAUL MICHAEL SADLER XXN
MR GIBIAN
PN12401
MR
HARTLEY: And then that will save time in the long run. So, with the
Commission's indulgence, I'll put myself on mute.
PN12402
JUSTICE
ROSS: Certainly. Everyone can take a three-minute break and then we
will come.
PN12403
MR
HARTLEY: If it please the Commission.
PN12404
JUSTICE
ROSS: Just you remain where you are, Mr Sadler?‑‑‑Will
do.
<THE
WITNESS WITHDREW [3.06
PM]
SHORT
ADJOURNMENT [3.06
PM]
RESUMED [3.09
PM]
<PAUL
MICHAEL SADLER, RECALLED [3.10 PM]
CROSS-EXAMINATION
BY MR HARTLEY [3.10 PM]
PN12405
MR
HARTLEY: Good to go. Thank you, your Honour, for that time; it was
very useful.
PN12406
Mr Sadler,
my name's Jim Hartley, I appear for the ANMF. Can you see and hear me?‑‑‑I
can.
PN12407
You
have still got your statement there in front of you?‑‑‑I do.
PN12408
Could
you go to paragraph 34, please?‑‑‑Got it.
PN12409
In
the second sentence, you talk about the registered nurse then being required -
I'll maybe start at the beginning. You say:
PN12410
Care
workers identify potential issues and provide concerns to the registered nurse.
PN12411
It
might, of course, also be the case that an enrolled nurse spots an issue and
reports that?‑‑‑That's correct.
*** PAUL MICHAEL SADLER XXN
MR HARTLEY
PN12412
Or
a registered nurse identifies the issue herself or himself?‑‑‑Correct.
PN12413
But,
ultimately, there will be a report made to a registered nurse?‑‑‑That's
correct.
PN12414
Now
on the second sentence, we read that the RN is required to document the
report. Can you just confirm that my understanding is correct, which is
the process of documentation might involve investigation of the report that's
made by the other worker, the first responder, as it were, to the registered
nurse?‑‑‑That's correct.
PN12415
That
might involve speaking, of course, with that first responder?‑‑‑And
potentially an assessment, physical and cognitive assessment, of the resident.
PN12416
Yes?‑‑‑It
could involve checking that, you know, you're doing neuro obs on someone who
might have had a fall, for example. There would be a range of clinical
interventions that might be part of assessing the impact of that particular
incident on the resident.
PN12417
Is
it then the case that the registered nurse might form and document a view about
whether the incident that's described does in fact fall within one of the
serious categories?‑‑‑So what we'd usually be doing is asking
the registered nurse to indicate which category they think it actually falls
into, but then because, as I go on to mention in clause 35, it's the
responsibility of the provider to actually lodge the incident report to the
Quality and Safety Commission, we would usually have a process where a care
manager or the facility manager would then vet what has been written up by the
registered nurse, confirm they agree and then the information would be lodged
with the Quality and Safety Commission.
PN12418
The
care manager might him or herself also be a registered nurse from time to time?‑‑‑They
frequently would be, yes. There are some care managers who might have
another allied health professional background, but, in most cases, the care
manager, and often the facility manager, are also registered nurses.
PN12419
So
certainly that registered nurse and also, if I can say, the first registered
nurse whose report is then vetted by the care manager, those people are forming
views on contestable questions about, for example, whether a particular care
amounts to neglect?‑‑‑That's correct.
PN12420
Or
whether the use of a restricted practice was inappropriate?‑‑‑Correct.
*** PAUL MICHAEL SADLER XXN
MR HARTLEY
PN12421
These
are questions in which clinical judgment and training and skill and things of
this kind are brought to bear?‑‑‑That is correct, and
obviously the SIRS guidelines that we referred to earlier in the evidence would
also be consulted as part of confirming, you know, a decision about that.
PN12422
Yes.
Can I ask you to turn to paragraph 54?‑‑‑Yes.
PN12423
I
think it's uncontroversial, but when you set out these three categories
underneath paragraph 54, you're not suggesting that they are mutually
exclusive?‑‑‑No, absolutely not and, of course, particularly
category (c), many of the people in categories (a) and (b) will move into that
group, and there are absolutely people who have complex healthcare needs and
would have a diagnosis of dementia at the same time.
PN12424
So,
in the case of people that have, for example, complex healthcare needs and they
have dementia and they are palliative, that's going to increase the degree of
difficulty in caring for that person for nurses and care workers?‑‑‑Correct.
PN12425
Thank
you. Can I ask you to go to paragraph 70 now, please?‑‑‑Yes.
PN12426
In
paragraph 70, you identify the care plans are developed by registered nurses,
that's correct?‑‑‑Correct.
PN12427
And
you list a number of people in the second line that might have input into that
care plan. You haven't included, but I assume that they also might from
facility‑to‑facility provide input, enrolled nurses?‑‑‑That's
correct, yes. That list was not meant to be exhaustive in any way.
They're not – there's a range of other people who you would be consulting with,
including doctors, for example, GPs.
PN12428
So
enrolled nurses and also personal care workers?‑‑‑Correct.
PN12429
And
that might take the form of, for example, questions being asked by the
registered nurse of, say, the enrolled nurse?‑‑‑That's right.
PN12430
Or
it might be that the documentation that's prepared by, say, personal care
workers or enrolled nurses, or other registered nurses, is reviewed by the care
plan producing RN with a view to including information in the care plan?‑‑‑That's
correct.
*** PAUL MICHAEL SADLER XXN
MR HARTLEY
PN12431
Paragraphs
86 and following, you describe engage with families in an aged care
context. You don't mention it in these paragraphs, but I assume you
wouldn't disagree that sometimes it is the case that personal care workers and
nurses are faced with families who are rude?‑‑‑I'm sure that
happens from time‑to‑time.
PN12432
Or
demanding, or taking out frustrations?‑‑‑Yes, and you know, I
didn't expand on it when we were talking about the increasing concern that
family members have about care, but there is no question that from time‑to‑time,
whether it's family members or friends, will become distressed about what's
happening for a resident, or a home care client, and they may in that instance,
you know, be challenging to deal with their anger or their frustration.
PN12433
And
there may be fine lines for people confronted with this sort of conduct as to
whether it's something with which they can deal themselves, or whether it's
something that should be escalated to another person?‑‑‑Correct.
PN12434
And
these of course are decisions that are having to be made in real time?‑‑‑That's
right.
PN12435
I
think the last topic I wanted to ask you about, Mr Sadler, is
paragraph 98?‑‑‑Yes.
PN12436
You
say there that, 'Generally new technologies streamline work practices and make
work easier', and you include the word, 'generally', so you're not being
absolutist, but just to be clear, sometimes you'd accept apps, say on iPads,
are not very well designed and might create inefficiencies?‑‑‑All
new technologies have their downsides. Yes, I would absolutely concede
that not every single thing that's new that's introduced has a benefit, and you
rightly picked up my word, 'generally', there.
PN12437
And
it might also be the case, for example, that the technology's great but there's
too little of it, and so there might be an inefficiency in a care worker, say,
having to wait for a terminal to document a progress note?‑‑‑That's
right. What I guess I'm referring to though is the general impact of
these new technologies, in particular the ones that have streamlined some of
the care documentation that's been required, have tended to reduce the amount
of duplicative work that registered nurses, enrolled nurses and other staff
would have had to do, you know, 10/15 years ago when we didn't have
electronic‑based systems.
*** PAUL MICHAEL SADLER XXN
MR HARTLEY
PN12438
Just
on the subject of duplication, there's been some evidence in this case, and you
might have come across this, but you wouldn't disagree with the proposition
that sometimes it happens still that, for example, a nurse or a care
worker will document something on paper, and then at the end of the shift take
their paper to a computer and document it again?‑‑‑That is
absolutely still happening. Sometimes it's because the electronic apps
that you referred to don't capture everything, and sometimes it's because pen
and paper are actually the simplest way to get some information at the
bedside. So there's a range of reasons why that might happen, but I would
agree with your contention that that would still be happening in certain
circumstances.
PN12439
Just
give me one moment, Mr Sadler. That's the cross‑examination for the
ANMF, your Honour.
PN12440
JUSTICE
ROSS: Thank you, Mr Hartley. Mr Ward, any re‑examination?
PN12441
MR
WARD: Just a couple of questions, if I can, your Honour.
RE-EXAMINATION
BY MR WARD [3.19 PM]
PN12442
MR
WARD: Mr Sadler, right at the beginning of Mr Gibian's cross‑examination,
he was talking to you about aged care standard audits, be they regular audits
or spot audits, and you indicated to him that – and I think these were your
words – you said that it's your understanding that 'the auditor will normally
talk to 10 per cent of the staff.' Do you recall that?‑‑‑Ten per cent
of the consumers.
PN12443
The
consumers?‑‑‑Yes.
PN12444
But
I think you said in your evidence that they will normally speak to the staff as
well?‑‑‑They will, yes. They don't have a proportion of
staff that they need to speak to, but they do have a requirement to speak to a
minimum of 10 per cent of the consumers.
PN12445
Do
you have any understanding of how long an auditor might talk to a staff member
in an audit?‑‑‑It will vary. If it's a senior staff
member, like a care manager or the facility manager, it could be, you know, a
lengthy conversation, 20 minutes/half an hour at a time.
Most of the contact with the personal care workers or registered nurses would
be more limited. It might be five or 10 minutes.
PN12446
Then
Mr Gibian took you to the SIRS reporting process, and I think you gave some
evidence that 'SIRS required internal reporting systems and in addition to that
additional reporting of actual SIRS events.' Do you recall that?‑‑‑I
do.
*** PAUL MICHAEL SADLER RXN
MR WARD
PN12447
From
your experience in the industry, would there have been internal reporting
systems in place before SIRS?‑‑‑There would.
PN12448
And
what would they have reported on internally?‑‑‑So they would
have been reporting internally on things like near misses, in terms of, you
know, an incident that might have caused harm but didn't quite. They
would have been reporting on key issues like how many people have wounds, what
progression of those wounds is happening. They would have picked up other
clinical reporting information, and there would always have been a WHS‑based
incident reporting system that would have been in place.
PN12449
Just
one last question if I can, Mr Sadler. You then had some discussion with
Mr Gibian around home care, and Mr Gibian was talking about consumer‑direct
care, and I think he was talking to you about the consumer being able to make
choices while the care worker was there, and you used a phrase – you said, 'as
long as it's within scope, otherwise they would need to contact their case
manager.' I think you used words like that. What did you mean by
'within scope?'---So there's a range of things that a home care provider can
actually do for an older person. There are some out‑of‑scope
things that the government does not fund home care packages to provide.
So it could be at that end of the spectrum where the consumer has asked for
something that actually a home care service is not allowed to do. But
probably more likely would be a situation where, for example, a personal
care worker is asked to assist with a medication and the consumer does not
normally require that help, so there's not been an assessment of how to safely
provide and support the consumer to be administered a medication. It might
be that the personal care worker doesn't have the medication training that is
required, and so at that point, if the consumer asks for that help, it would be
the requirement that they go back to the supervisor, the care manager, and say
look, I've been asked to do this, you know, how can we help the consumer
another way to be helped with that issue.
PN12450
Does
the consumer's package have anything to do with that answer?‑‑‑Well,
it has to do with it in two ways. First is obviously, is there a resource
available. So there might be some financial capacity within the person's
budget to offer an additional service, and the second way is, as I describe
there, some things that home care packages are not allowed to do for
consumers. So that's where, you know, you might hit one of those things,
for example, a consumer cannot use their package to pay for food, but the
consumer might ask a care worker can you go and do the shopping and I want you
to take the money out of the home care package budget, and we're not allowed to
do that.
PN12451
And
then just lastly, you were being asked some questions from Mr Gibian about
the interaction of families and care workers, and I think Mr Gibian used the
phrase similar to that they're the first point of contact. Do you recall
that evidence?‑‑‑I do.
*** PAUL MICHAEL SADLER RXN
MR WARD
PN12452
Do
care workers, in your experience, have contact with families outside of their
working hours?‑‑‑No.
PN12453
No
further questions, thank you. May Mr Sadler be excused?
PN12454
JUSTICE
ROSS: Thank you for your evidence, Mr Sadler, you are excused?‑‑‑Thank
you.
<THE
WITNESS WITHDREW [3.25
PM]
PN12455
JUSTICE
ROSS: Just before we go to Ms Wade, can I get counsel's assistance on a
matter. My note has Ms Wade's cross-examination from 3.45 to 4.15 and
then Ms Bradshaw at 4.30. I just need - it's only an administrative
thing - I need to schedule a meeting after the evidence in this case closes
today and I'm wondering what time I could safely do that?
PN12456
MR
GIBIAN: I'm sorry, your Honour?
PN12457
JUSTICE
ROSS: How long do you think you are going - - -
PN12458
MR
GIBIAN: I think my camera was off inadvertently. I think that so
far as the parties were concerned, I think both ourselves and the ANMF had
suggested that we have another witness at least on standby today in case
there's time to reach her, and that was Ms Bradshaw, I think.
PN12459
JUSTICE
ROSS: All right.
PN12460
MR
GIBIAN: I think we'll see how Ms Wade goes. If we can finish her
quickly, then maybe - - -
PN12461
JUSTICE
ROSS: How long do you think we would be with Ms Bradshaw, if we get
to her?
PN12462
MR
GIBIAN: I think probably in the region of half an hour for myself.
PN12463
MR
McKENNA: Your Honour, I anticipate approximately 15 to 20 minutes with Ms
Bradshaw.
*** PAUL MICHAEL SADLER RXN
MR WARD
PN12464
JUSTICE
ROSS: All right. As you say, we will see how we go. All
right, thank you for the indication. We will call Ms Wade. We have
just got a technical issue with one of the associate's connection, so bear with
us for a moment and we will come back.
PN12465
MS
WADE: Thanks, your Honour.
PN12466
JUSTICE
ROSS: Are you taking the oath or the affirmation, Ms Wade?
PN12467
MS
WADE: The affirmation, please.
PN12468
JUSTICE
ROSS: Thank you.
PN12469
THE
ASSOCIATE: Ms Wade, can you please state your full name and work address.
PN12470
MS
WADE? Anna-Maria Wade, work address is Level 4, 320 Pitt Street, Sydney 2000.
<ANNA-MARIE
WADE, AFFIRMED [3.28 PM]
EXAMINATION-IN-CHIEF
BY MR WARD [3.28 PM]
PN12471
Ms
Wade, it's Nigel Ward; can you hear and see me?‑‑‑I can, Mr
Ward.
PN12472
Thank
you. Good afternoon. I wonder if I could ask you to restate your
full name and address for the record?‑‑‑Yes, Anna-Maria Wade,
Level 4, 320 Pitt Street, Sydney 2000.
PN12473
You
have prepared a statement for these proceedings dated 4 March 2022 of some
53 paragraphs?‑‑‑That's correct.
PN12474
I
understand you need to make an amendment to that statement; is that correct?‑‑‑That's
correct.
*** ANNA-MARIE WADE XN
MR WARD
PN12475
It
might be convenient, if the Bench pleases, I might just identify the correction
and, Ms Wade, you can confirm if this is correct. It's a correction to
paragraph 17. In the third line, the figure (audio malfunction) per cent
should be 17 per cent. Is that the correction, Ms Wade?‑‑‑That's
right.
PN12476
Your
Honour, we will file an amended version of that in Word in due course.
PN12477
JUSTICE
ROSS: Thank you.
PN12478
MR
WARD: That being changed, Ms Wade, is that (audio malfunction).
PN12479
JUSTICE
ROSS: You have just - Mr Ward's connection has just dropped out, from my
end in any event.
PN12480
MR
HARTLEY: Yes, from my end, too, your Honour.
PN12481
JUSTICE
ROSS: All right. He's coming back in.
PN12482
MR
WARD: I'm sorry, your Honour, I disappeared into the ether for a moment.
PN12483
JUSTICE
ROSS: No, no problem.
PN12484
MR
WARD: Ms Wade, with that change being made, is your statement true and
correct to the best of your knowledge and belief?‑‑‑Yes, it
is.
PN12485
If
the Commission pleases, Ms Wade's statement is contained at tab 258. In
the digital court book, it's page 13832 to 13842. It contains 10
annexures, AM01 to AM10, which are contained at 13943 to 14350, and we rely on
that statement. Ms Wade is available for cross-examination.
PN12486
JUSTICE
ROSS: Thank you. Who's up first?
PN12487
MR
HARTLEY: It's me, your Honour.
CROSS-EXAMINATION
BY MR HARTLEY [3.31 PM]
PN12488
Ms
Wade, my name is Jim Hartley, I appear for the ANMF. Can you see and hear
me?‑‑‑I can, Mr Hartley.
*** ANNA-MARIE WADE XXN
MR HARTLEY
PN12489
Thank
you. You've got a copy of your statement there?‑‑‑I do.
PN12490
There's
just one series of paragraphs I want to ask you about, which is at 22 to
25. Could you just open up your statement at 22?‑‑‑Yes.
PN12491
The
last line of 22, you describe - in context, you are here talking about the 2019
Aged Care Quality Standards; do you see that?‑‑‑Yes.
PN12492
In
the last line, you describe those new standards as being a different way of
looking at care?‑‑‑Yes.
PN12493
In
23 and 24, you describe the difference, and the main difference is, you say,
now that the new standards are about tailored and individualised consumer
needs; do you see that?‑‑‑Yes.
PN12494
Is
it fair to say that your understanding is that what's now required is
person-centred care? Have you heard that term?‑‑‑Yes.
PN12495
So
that's care that respects the autonomy of the individual resident?‑‑‑Yes.
PN12496
And
respects the choices made by the individual in the exercise of that autonomy?‑‑‑Yes.
PN12497
Taking
a pretty neutral example, it might involve a resident choosing to have a shower
at night rather than during a morning shower round, that type of thing?‑‑‑Yes.
PN12498
So
it involves not only a different way of look at care, as you say, but also a
different way of providing care?‑‑‑Yes.
PN12499
Can
I ask you - and I should say, you say at 24 that that involves tailored and
individualised consumer needs, and so what it would require is tailored and
individualised care provided by nurses and personal care workers?‑‑‑Yes.
PN12500
Can
you go to annexure AM02 of your statement, which should be the standards
themselves?‑‑‑Let me just scroll. I haven't printed it
out, so I have to scroll. Apologies.
*** ANNA-MARIE WADE XXN
MR HARTLEY
PN12501
Yes,
go ahead. If you've got red numbering in the lower right, it's 1721.
PN12502
JUSTICE
ROSS: I've got the printed copy, Mr Hartley. Would you mind going
to the page of the standard itself when you are asking questions, just so I can
follow.
PN12503
MR
HARTLEY: Yes, of course.
PN12504
JUSTICE
ROSS: Thank you.
PN12505
THE
WITNESS: Sorry, it's just taking a while.
PN12506
MR
HARTLEY: No problem?‑‑‑Do you have the electronic page
number? Sorry, it's just going to be easier.
PN12507
(Audio
malfunction) very large bundle?‑‑‑Yes, I'm the same, I've
only got the electronic copy, so just bear with me. Apologies again.
PN12508
Yes,
of course. I can tell you I think it's going to be about 107 pages in?‑‑‑All
right, okay, that makes it easier, thank you.
PN12509
That's
all right?‑‑‑No, not on mine, sorry.
PN12510
What
do you see on your screen?‑‑‑I've got it, I've got it.
Great, yes, I've got it, yes.
PN12511
Good,
thank you. So it's the Aged Care Quality Standards. These are the
2019 ones rather than the previous ones?‑‑‑Yes, yes.
PN12512
You
will see on page 2, for example, standard 3 is personal care and clinical care?‑‑‑Yes.
PN12513
See
that. And if you look at clause 3(3), the second 3(3) with the little (a)
next to it, commencing 'Each consumer gets', do you see that?‑‑‑Yes.
PN12514
So:
*** ANNA-MARIE WADE XXN
MR HARTLEY
PN12515
Each
consumer gets safe and effective personal care, clinical care, apart from other
things.
PN12516
That,
of course, is going to be safe and effective personal, clinical care provided
by nurses and personal care workers?‑‑‑Yes.
PN12517
And
that's to be care which is tailored to their needs, and that tailoring will be
done by nurses and personal care worker?‑‑‑Yes.
PN12518
There's
a requirement to take account of - this is in subparagraph (c)
PN12519
The
needs, goals and preferences of consumers nearing the end of life.
PN12520
And,
so, of course there's a need for nurses and personal care workers to understand
what those needs, goals and preferences are?‑‑‑Yes.
PN12521
And
to provide care in a way that has account of those needs, goals and
preferences?‑‑‑Yes.
PN12522
And
in the next subparagraph:
PN12523
Deterioration
or change of a consumer's mental health, cognitive or physical function.
PN12524
So,
again, there'll be a need for nurses and personal care workers to recognise deteriorations
or changes, and then to respond to those in a way which is individualised and
responsive to that consumer. Do you agree with that?‑‑‑Yes.
PN12525
And
then in (e):
PN12526
Information
about the consumer's condition, needs and preferences is documented and
communicated within the organisation.
PN12527
So,
again, there's a need for nurses and personal care workers to document
information about conditions, needs and preferences?‑‑‑Yes.
*** ANNA-MARIE WADE XXN
MR HARTLEY
PN12528
And
to provide care in a way that is consistent with what has been documented?‑‑‑Yes.
PN12529
It's
the same - I won't take you through each of the remaining subparagraphs, but
each of those subparagraphs you'd agree sets out a way in which care is to be
provided which is responsive to matters particular to the consumer?‑‑‑Yes.
PN12530
And
it's going to be the nurses and personal care workers who are responsible in
any aged care provider for providing that care?‑‑‑Yes.
PN12531
And
so in that context you identify, returning to your statement in paragraphs 22
to 25, you speak about, in the last sentence at 25, members reporting that
there may be an increase in documentation and processes to ensure that they
meet the standards. Are the processes that you're referring to processes
that are designed to ensure that the care that is provided is of the kind that
we've just been speaking about?‑‑‑Yes.
PN12532
The
point that you're making in paragraphs 23 and 24 is that those process and that
care is different from the processes and care that existed under the previous
less individualised standards. Is that a fair summary of what you're
saying there?‑‑‑Yes.
PN12533
So,
the change from the old care standards to the new care standards affect the
nature of the work being provided by nurses and personal care workers?‑‑‑Yes.
PN12534
And
it affects the skills involved in the provision of that work?‑‑‑No,
nurses and carers have always had to provide care and understand and know the
residents or the consumers that they're caring for, so, there's no difference
in that regard.
PN12535
So,
your answer is that the need to - I'll take it back a step, previously it was
the case you said that care was not required by the standards to be
individualised in the same way that now is?‑‑‑Yes, it's
assessed for individualised, whereas previously it was more the collective.
PN12536
And
in the care standard that was a reference, there was repeated references, to
the need, which you accepted, for nurses and personal care workers to
understand matters individual to the particular consumer; yes?‑‑‑Yes.
*** ANNA-MARIE WADE XXN
MR HARTLEY
PN12537
Now,
recognition of matters individual to a particular consumer is a matter
involving skill; is it not?‑‑‑It's understanding what the
consumer needs, and that's always had to be the case.
PN12538
I'll
put that again, recognition of matters that are individual to a particular
consumer is a matter involving skill; is it not?‑‑‑Yes.
PN12539
And
providing care in a way that differentiates between one consumer, who has one
set of preferences and another consumer how has another set of preferences is a
matter involving skill; is it not?‑‑‑Yes.
PN12540
And
so if it was the case previously, which you accepted, that the quality
standards did not require that sort of care, and now they do, then it is the
case, isn't it, that there is more skill involved in the work now?‑‑‑Yes.
PN12541
Thank
you. Just give me one moment. That's the cross-examination for the
ANMF, your Honour.
PN12542
JUSTICE
ROSS: Thank you, Mr Hartley. Mr Gibian.
CROSS-EXAMINATION
BY MR GIBIAN [3.39 PM]
PN12543
MR
GIBIAN: I think there was just one matter.
PN12544
Ms
Wade, can you hear me?‑‑‑I can.
PN12545
In
paragraph 18 of your statement you make an observation that industrial
instruments make the operation of aged care services difficult. Do you
see that?‑‑‑Yes.
PN12546
And
there are two aspects that you refer to. You refer to the classifications
in the aged care award and the SCHADS ward?‑‑‑Yes.
PN12547
You
see that?‑‑‑Yes.
PN12548
And
you say that they don't currently meet the needs of providers. You see
that?‑‑‑Yes. Yes.
PN12549
I
take that it that should be providers in aged care services?‑‑‑Yes.
Yes.
*** ANNA-MARIE WADE XXN
MR GIBIAN
PN12550
You
then refer to the enterprise agreements and you say that they attempt to make
classifications and progression through the classifications clearer. Do
you see that?‑‑‑Yes.
PN12551
Now,
just a couple of questions about that, one is the deficiency that you are
asserting there in the classifications in the Aged Care Award and the SCHADS
Award is that arising from the clarity with which those classifications are
(indistinct)?‑‑‑Yes.
PN12552
I'm
sorry, I'm not sure whether I broke up then. I might ask the question
again?‑‑‑Sure.
PN12553
Is
the deficiency you're asserting in the classifications in the Aged Care Award
and the SCHADS Award that the classification are not clear and progression
between the classifications is not clearly described?‑‑‑Yes.
PN12554
And
that, to some extent at least, is addressed or is sought to be addressed in the
enterprise agreements to which you refer?‑‑‑Yes.
PN12555
And
those are the enterprise agreements you set out at paragraph 14 that you
describe as either the ACSA agreement or the (indistinct) agreement; is that
right?‑‑‑That's right, yes.
PN12556
I
think that only one of those is attached, but can you go to AM1, which is the
first annexure to your statement, and it starts at page 13843 of the court
book. It's internally numbered pages 1 of 96 and following. Can you
go to the classifications which are in schedule A and commence at page, I
think, 56 of 96? The court book page is 13898?‑‑‑Yes,
I've got it.
PN12557
And
I just want to make sure I've understood the way in which the classifications
are more clearly described in your view in this enterprise agreement at
least. It seems to be done in three ways, the first is that at least so
far as the new entrant and - I'm sorry, I withdraw that. Taking one step,
the first set of employment classifications that I want to ask you about is the
care service employee classifications which commence on that page. Do you
see that?‑‑‑Yes. Yes.
PN12558
The
classifications seem to be delineated in maybe three ways that are
utilised. The first is that there are thresholds in terms of work
performed between the new entrant and a care service employee grade 1. Do
you see that?‑‑‑Yes. And the threshold is 500 hours,
which I think is about three months full time; is that right?‑‑‑That's
right, yes.
*** ANNA-MARIE WADE XXN
MR GIBIAN
PN12559
So
is that one way in which there's greater clarity in the classifications in the
agreement?‑‑‑yes.
PN12560
I
think there is also, if you go over the page to page 57 of 96, right at the
bottom of the page, a level 2 - sorry, care service employee grade 2, level 2
also has a - there's a two-year threshold at that ‑ ‑ ‑?‑‑‑That's
right.
PN12561
Of
the same nature. The second way in which there's delineations is that
there are qualification requirements. I think they really kick in at care
service employee grade 3 on page 58 of 96, I should say, at page 13900?‑‑‑They
actually kick in at a CSE 2, level 2.
PN12562
I'm
sorry, you're right. Sorry, if you go then, CSE grade 2 is on page 56 of
96, and level 2 is at the bottom of that page in clause 1.3(b). That's
what you're referring to?‑‑‑Yes.
PN12563
And
the classification requirement over the page is for a - the dot point at the
top of page 58 is for a certificate III Individual Support or Certificate III
in a similar field acceptable for the employer?‑‑‑Yes.
PN12564
Is
that the second way in which these classification descriptors are clearer?‑‑‑Yes.
PN12565
In
addition to that and noting that the Certificate III is utilised at grade 2,
level 2 and then at grade 3 and grade 4 is that there is a designation by the
employer that the employee perform work of a particular type. For
example, in grade 3, either that the person is designated as having
responsibility for leading or supervising work of others, or is required to
work individually with minimal supervision and designated as overall
responsibility for a particular function. Do you see that?‑‑‑Yes.
PN12566
Is
that another way in which the classification is clearer in your view than the
current award provisions?‑‑‑Yes.
PN12567
And
this is an agreement that's been no doubt in negotiation but formulated by ACSA
and accepted by you as the basis for enterprise agreements made in aged care?‑‑‑Yes.
PN12568
Thank
you. That was the additional cross-examination of Ms Wade.
*** ANNA-MARIE WADE XXN
MR GIBIAN
PN12569
JUSTICE
ROSS: Thank you. Mr Ward, re-examination.
RE-EXAMINATION
BY MR WARD [3.45 PM]
PN12570
MR
WARD: Thank you, your Honour. Ms Wade, just a couple of questions
if I can. Mr Hartley was asking you some questions about standard 3 and
consumer preferences. Do you recall that?‑‑‑Yes, Mr
Ward, yes.
PN12571
I
wonder if you could just explain what the role of the care plan is in relation
to consumer preferences?‑‑‑So, the care plan is a document
that basically sets out what a consumer requires of carers and nurses during
their stay in a residential aged care facility, so we're talking residential
aged care. It would document preferences. It would talk to things
like, you know, whether somebody does prefer a shower in the morning or the
afternoon. If they're a one or a two person assist. All of those
sorts of things that people need to know before they walk in the door of that
particular consumer's door - room.
PN12572
And
- sorry, I'll just go back a step. In that answer you talked about what
was required of carers. From your experience, would you expect the aged
care worker to work within their scope of competence and would you expect the
registered nurse to work within their scope of practice in doing that?‑‑‑Yes.
PN12573
No
further questions. Might the witness be excused, your Honour?
PN12574
JUSTICE
ROSS: Thank you. Certainly. Thank you for your evidence, Ms
Wade, you're excused?‑‑‑Thank you, your Honour.
<THE
WITNESS WITHDREW [3.47
PM]
PN12575
JUSTICE
ROSS: Given the time, shall we press on with Ms Bradshaw?
PN12576
MR
WARD: Your Honour, we can. We'll have to - we had her organised for
4 o'clock. We'll have to make a make a call if we can - - -
PN12577
JUSTICE
ROSS: No, no, that's fine. Is everyone else to do that?
PN12578
MR
GIBIAN: Yes, Your Honour.
PN12579
JUSTICE
ROSS: Right.
*** ANNA-MARIE WADE RXN
MR WARD
PN12580
MR
WARD: If we can just have a moment, we'll try and make a call.
PN12581
JUSTICE
ROSS: Certainly. Thank you.
PN12582
MR
WARD: Thank you, your Honour. Commission pleases, I think Ms
Bradshaw's attempting to connect now.
PN12583
JUSTICE
ROSS: Thank you.
PN12584
MR
WARD: Sorry, your Honour, we understand she's trying to connect as we
speak.
PN12585
JUSTICE
ROSS: That's okay. We'll persist for a little while.
PN12586
MR
WARD: Thank you, your Honour. We have asked her if she's having any
problems but we haven't heard back yet.
PN12587
JUSTICE
ROSS: Might answer that question.
PN12588
MR
WARD: Your Honour, it might be necessary for us to just go off line and
ring her and see if we can contact her.
PN12589
JUSTICE
ROSS: Certainly, thank you.
PN12590
MR
WARD: Thank you, your Honour. She's coming now, your Honour.
PN12591
JUSTICE
ROSS: Excellent, thank you.
PN12592
THE
ASSOCIATE: Ms Bradshaw, can you please say your full name and work
address?
PN12593
MS
BRADSHAW: So, it's Kim Leanne Bradshaw, at Warrigal Stirling, 41
Freemantle Drive, Stirling, ACT.
<KIM
LEANNE BRADSHAW, AFFIRMED [3.53 PM]
EXAMINATION-IN-CHIEF
BY MR WARD [3.53 PM]
PN12594
JUSTICE
ROSS: Mr Ward.
PN12595
MR
WARD: Thank you, your Honour. Ms Bradshaw, it's Nigel Ward.
Can you see and hear me?‑‑‑Yes, I can, Nigel.
PN12596
Thank
you very much. I wonder if you could re-state your full name and address
for the record?‑‑‑So it's Kim Leanne Bradshaw, my work address
is Warrigal Stirling, 41 Fremantle Drive, Stirling, ACT.
PN12597
Am
I correct that you've prepared a statement for these proceedings of
124 paragraphs long?‑‑‑Yes, I have.
PN12598
Do
you have a copy of that statement with you?‑‑‑Yes, I do.
PN12599
Have
you recently read that statement?‑‑‑Yes, I have.
PN12600
Is
that statement true and correct to the best of your knowledge and belief?‑‑‑Yes,
it is.
PN12601
If
the Commission pleases, Ms Bradshaw's statement can be found at
tab 256; the digital court book, it is 13576 to 13590, and the annexures
are – two annexures, KB1 and KB2 - they're found at 13591 to 13704. We
seek to rely on Ms Bradshaw's statement and she's available for cross‑examination.
PN12602
JUSTICE
ROSS: Thank you, Mr Ward. Mr Gibian?
PN12603
MR
GIBIAN: Thank you.
CROSS-EXAMINATION
BY MR GIBIAN [3.55 PM]
PN12604
MR
GIBIAN: Ms Bradshaw, can you hear me?‑‑‑Yes, I can.
PN12605
My
name is Mark Gibian. I appear for the HSU in the proceedings. Can
you hear me okay?‑‑‑(Indistinct).
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12606
Sorry,
I'm just hearing (indistinct) repeated back. I'm happy to try and
continue, but it's - - -
PN12607
JUSTICE
ROSS: Yes. No, we're hearing it as well. Perhaps if you
disconnect and reconnect, try that.
PN12608
MR
GIBIAN: It's been suggested to me it might have been because Mr Ward
was not muted.
PN12609
JUSTICE
ROSS: Yes. That's fine now. Thanks.
PN12610
MR
GIBIAN: Ms Bradshaw, you can hear me again?‑‑‑Yes, I
can.
PN12611
Firstly,
can I just make sure I've understood your history with Warrigal? You've
been at the Stirling facility employed by Warrigal since December 2020,
but before that were at the same facility when it was part of Bupa?‑‑‑Correct.
PN12612
Since
2019 sometime?‑‑‑Correct, yes.
PN12613
And
before that you were in the acute care sector I think?‑‑‑That's
correct.
PN12614
Am
I right in saying your only direct involvement with aged care was in the period
since you've been at the Stirling facility?‑‑‑In the aged
care sector, but I have managed and nursed aged care people for a long time.
PN12615
Sorry,
so your only work in the aged care sector is you've dealt with older people in
an acute care setting, is that what you're referring to?‑‑‑That's
correct.
PN12616
Sorry,
I'm getting the repeat again.
PN12617
JUSTICE
ROSS: Could everyone just make sure that they're on mute? Let's try
it again.
PN12618
MR
GIBIAN: And I think, as you indicate in your statement, you are a
registered nurse. Do you maintain your registration in your current job?‑‑‑Yes,
I do.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12619
How
long since you've worked sort of on the floor as a nurse, as it were?‑‑‑Two weeks
ago on a Wednesday night duty I worked on the floor as a registered nurse.
PN12620
Do
I take it that's because you fill in - - -?‑‑‑Yes, I was.
PN12621
-
- - if there's spare shifts, do you?‑‑‑I was short‑staffed
that night, yes.
PN12622
I
understand?‑‑‑(Indistinct).
PN12623
I'm
sorry?‑‑‑It's not my preferred – it's good to have the staff.
PN12624
Then
in relation to the facility, it's a 144‑bed facility spread over four
different - what you refer to as communities, is that right?‑‑‑That's
correct.
PN12625
Are
they all in the same building, or are they separate buildings?‑‑‑No,
all in the same building, two communities upstairs, two communities downstairs.
PN12626
Are
they about equal in size?‑‑‑They all have - - -
PN12627
The
number of residents I should say?‑‑‑They all have 36
individual bedrooms with individual ensuites.
PN12628
Am
I right in understanding this, is the staffing the same for each of the
communities?‑‑‑No.
PN12629
Can
you just go forward then to paragraph 22 in your statement where I think you
describe the staffing arrangements?‑‑‑Yes.
PN12630
As
I understand it, in 22(a) you say there's one registered nurse for each
community for day and afternoon shifts, and either one or two for the whole
facility at night, is that right?‑‑‑That's correct.
PN12631
And
then you say between four and six – what you refer to as AINs on the day and
afternoon shifts and four for the whole facility at night. Are there
particular communities that have the six rather than the four AINs; is that the
difference you're referring to?‑‑‑Correct. It's the
memory support unit that has the six carers in there.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12632
And
the other units have four on each shift?‑‑‑Yes. Four to
five, yes.
PN12633
Would
I be right in assuming that, no doubt to the extent possible, you try and
roster no doubt both the nurses and the care workers to endeavour to provide
continuity of care for the residents to the extent you can?‑‑‑Yes,
definitely correct, very much - - -
PN12634
That
is, the resident will have the same care worker, or no doubt the same care
workers, who they'll be dealing with as much as possible on an ongoing basis?‑‑‑That
is correct, yes.
PN12635
And
that's a preferable model of care. It allows them to know the residents
and their needs well and for them to have a familiarity in relationship?‑‑‑That's
correct, yes; important.
PN12636
I
just want to ask you, you've annexed job descriptions for those roles at the
end of paragraph 22, and it's Annexure KB2. Can I ask you to
turn to those? For the benefit of the Bench, it's page 13676 of the
court book. I'm not sure what the other red number refers to, I have
to say, but do you have that, Ms Bradshaw?‑‑‑I do have
it on my computer, yes.
PN12637
I
mean, it immediately follows the StewartBrown report?‑‑‑Yes.
PN12638
I
have also a number 101 in the bottom right-hand corner in red. I don't
know whether that matches any numbering that you have on the document?‑‑‑Not
really, no.
PN12639
No?‑‑‑No.
PN12640
I'm
not sure how else to describe it. It immediately follows after the
StewartBrown report, which is the first annexure to your statement. That
document is 83 pages and has page numbers internally in the bottom right‑hand
corner?‑‑‑Okay. Can you just go back and tell me what
you're looking at again?
PN12641
It's
the second annexure to your statement. It has got KB2 written at the top
of it?‑‑‑Yes.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12642
I
mean I'm not sure how to describe it in the bundle other than it follows
immediately after the StewartBrown report, which is the first annexure.
That document does have internal page numbers in the bottom right‑hand
corner, numbered up to page 83, and the first page at KB2 is headed,
'Position description - care service employee grade 1?'---Okay.
Jordan, can you send it?
PN12643
I'm
sure you were doing that with the best of intentions, but you shouldn't contact
Mr Ward or – if you have difficulty locating something, then just let me
know and we can endeavour to facilitate that through - - -?‑‑‑No,
I do apologise, but I do believe I said I didn't have it, so when you didn't
say I'll send it, I thought I needed to get the document.
PN12644
I'm
sorry, I thought you just meant you couldn't find it, not that you didn't have
it. So you don't have it at all?‑‑‑No.
PN12645
JUSTICE
ROSS: Deal with your other questions, and in the meantime have your
instructor forward it to Ms Bradshaw?‑‑‑Thank you,
and I apologise for not understanding.
PN12646
MR
GIBIAN: I don't have a difficulty if Mr Ward or those with him forward
that document or the annexures generally speaking to the witness.
PN12647
JUSTICE
ROSS: All right. Yes, they'll do that and in the meantime you move
on to your other questions and you can return to this.
PN12648
MR
GIBIAN: I'll do that. I'm still getting myself twice. I'll
continue - yes, I mean I'll continue if it's not too disruptive for
everyone. It is a little off putting.
PN12649
JUSTICE
ROSS: Can you use - - -
PN12650
MR
GIBIAN: I'm happy to continue if it's not too off putting for everyone
else.
PN12651
JUSTICE
ROSS: Why don't you lot out and then log back in. Can you just do
it on your computer rather than the larger screen. Maybe that will help.
PN12652
MS
RAFTER: I haven't got any feedback.
PN12653
JUSTICE
ROSS: You can also turn off your camera, see if that helps because we
just need to hear you.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12654
MR
GIBIAN: Yes. All right. We might log off and log on and then
we'll just be 30 seconds.
PN12655
JUSTICE
ROSS: Okay. All right, let's try.
PN12656
MR
GIBIAN: All right. Ms Bradshaw, can you hear me again?‑‑‑Yes,
I can.
PN12657
Now,
can I go back to your statement then. You start describing the work of
Warrigal's employees - I take it you're referring - from paragraph 28 and I
take it that you're referring to the Stirling facility in particular?‑‑‑That's
correct.
PN12658
And
you start describing the work in the dayshift for AINs. Do you see that?‑‑‑Yes,
I do.
PN12659
Just
one question in that respect. The position descriptions which are being
sent to you refer to Care Service employees. That's the title that
Warrigal uses. Is that right?‑‑‑Yes.
PN12660
Is
that the same thing you're referring to as an AIN in your statement?‑‑‑Yes,
it is. Yes, it is. I used AINs when I was with BUPA and that's a
terminology that just has remained through whilst we've been with
Warrigal. However, they are the same roles.
PN12661
I
understand. All right, now in terms of the description you then provide -
- -
PN12662
JUSTICE
ROSS: We're going to need to resolve this because we're not sitting
through this all day tomorrow. Can you - - -
PN12663
MR
GIBIAN: This is the first time we've had a difficulty of this
(indistinct).
PN12664
JUSTICE
ROSS: No, no, sure. Can you connect by phone? Is it - is
there any - do you have a number that we can ring you on?
PN12665
MR
GIBIAN: I can try and join through a different device.
PN12666
JUSTICE
ROSS: That's try that and see how we go.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12667
MR
HARTLEY: Your Honour, I'm sorry to interrupt. Can I just say one
thing. In a hearing recently I encountered this exact situation. It
turned out it was a person who had a computer with speakers that sort of
projected towards them. I don't know if Ms Bradshaw's got a speaker - a
computer where the speakers are separate from the computer but in the past I've
seen that cause feedback of that kind. Headphones solves it.
PN12668
JUSTICE
ROSS: Yes. No, it doesn't - thank you, Mr Hartley, but it
doesn't seem to be the case.
PN12669
MR
GIBIAN: We'll endeavour to connect on a different device, your Honour.
PN12670
JUSTICE
ROSS: Okay, thank you.
PN12671
THE
WITNESS: Your Honour, I have the documents that I've been asked to look
at. Thank you.
PN12672
JUSTICE
ROSS: Thank you.
PN12673
MR
GIBIAN: Hello (indistinct).
PN12674
JUSTICE
ROSS: Yes. Mr Gibian?
PN12675
MR
GIBIAN: Yes, can you hear me?
PN12676
JUSTICE
ROSS: Yes. And the witness has the document that you wanted to take
her to before, so if it's convenient - well, whatever suits you, just to let
you know.
PN12677
MR
GIBIAN: All right. Ms Bradshaw, can you go to that annexure then,
KB2?‑‑‑Yes.
PN12678
I
take it that - so the first page of KB2 which is page 13676 of the court book
is the position description of the Case Service Employee grade 1. I take
it these are position descriptions that apply across Warrigal. That is
they're not specific to Stirling?‑‑‑That's correct. No,
they're Warrigal wide.
PN12679
And
I take it I also assume from that that you didn't have involvement in the
preparation of these documents?‑‑‑No, I did not.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12680
Now,
I think what you've provided is position descriptions for and what you describe
as the relevant position descriptions are Care Service Employee grade 1, 2 and
then there's four level 2?‑‑‑Correct.
PN12681
Now,
are those - do you understand those to correspond to the position descriptions
in the Warrigal Enterprise Agreement?‑‑‑I believe so.
PN12682
Do
we assume from what you have provided that you don't have any workers, at least
at Stirling, in grade 3 or grade 4 level 1?‑‑‑I don't believe
so but I could not be 100 per cent guaranteed on that.
PN12683
Are
you able to tell us within Stirling whether the distribution, that is do you
know whether most are grade 1, 2 or 4?‑‑‑I would - I have the
significant amount of my CSEs have their Cert III and I couldn't - to be
honest, I couldn't give you an absolute. So, I would be - I would be
making an assumption on my workforce on that.
PN12684
That
is, I think you say, I'm sorry I've just lost it. I thought there was
somewhere where you said how many care service workers there are care service
employees there are at the facility?‑‑‑No, I haven't - in my
statement, I haven't broken it down into actual how many I may or may not have,
no.
PN12685
Are
you able to tell us how many care service employees there are that work at
Stirling?‑‑‑I can't give an accurate figure. I know
that I've got - currently at the moment, including casual staff, I know that I
have currently 163 staff. That fluctuates predominantly more than less
there, but, obviously, the large proponent of my workforce would be the CSEs.
PN12686
As
for the distribution between grade 1, grade 2 and grade 4, are you able to give
us any indication at all, that is, do you think there's a small number of grade
1 and most at grade 2, or are you unable to comment at all?‑‑‑I
would say predominantly I have a reasonably experienced workforce in the CSEs
and I would therefore have a large proportion in the high group.
PN12687
Do
you have the position descriptions in front of you?‑‑‑I do.
PN12688
Firstly,
the CSE employee grade 1, the first page contains a general description of the
function and then, over on the second page of that position description, at
page 13677 on the court book, there's a list of key responsibilities in the
second half of that page, from about a third of the way down?‑‑‑Yes.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12689
Do
you see that?‑‑‑Yes.
PN12690
I'll
try and summarise quickly. So far as care services are concerned, the
main roles seem to be providing assistance with respect to activities of daily
living and then associated documentation and reporting and consultation
obligations; is that a fair summary?‑‑‑That's correct.
That's a fair summary.
PN12691
Can
we go forward to the care service employee grade 2, which is the next document
commencing at page 13676 of the court book. You will see the first page
of that again provides a general description of the functions of the position;
see that?‑‑‑Yes, I can, yes.
PN12692
You
see in the last sentence of that description, there's a reference to the person
being required to undertake specific care service functions of a higher level
under general supervision; do you see that?‑‑‑Are you looking
down at where the last dot point is, 'Develop a rapport with medical
officers'? Is that where you're talking.
PN12693
I'm
sorry, on the preceding page, the first page of that position description?‑‑‑Yes,
I beg your pardon, yes. Yes, the person will be required to undertake
specific care service functions of a higher level, yes.
PN12694
If
you go over the page again to the second page of that position description,
commencing at page 13680 of the court book, there's a longer list of key
responsibilities; do you see that?‑‑‑Yes.
PN12695
Again,
I don't want to take too much time by going through each of them, but I'm right
in understanding that the differentiation is primarily centred upon - I don't
want to get caught too much up in terminology - but more clinical-style
tasks? So, you'll see that in addition to activities of daily living, the
second dot point refers to assisting with medication, utilising medication
compliance aids; do you see that?‑‑‑Yes, I can.
PN12696
Wound
dressings, implementation of continence programs, observations, urinalysis,
blood pressure, temperature, pulse checks, and then attending to blood sugar
levels and supporting diabetic residents with insulin management and the like;
do you see that?‑‑‑I do.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12697
Are
we right in understanding a broad overview to the extent there's a
differentiation of the higher level tasks, it's having a more clinical edge
that puts these people in grade 2?‑‑‑Yes, I can understand
where you're coming from, but these tasks that they would be doing would be
simple tasks that a resident, if they were able to live at home, would be able
to do themselves.
PN12698
We
will take that one at a time then. The second dot point under key
responsibilities refers to assisting and supporting residents with medication;
do you see that?‑‑‑Yes.
PN12699
Utilising
medication compliance aids. Do you know what the reference to a
medication compliance aid is?‑‑‑When our carers give out
medications, they would be using the Webster packs. Some people use a
Webster pack. We, in Stirling, use what they call sachets, and the
sachets would be compliance aids because they are already prepacked from the
pharmacies and therefore what the carers need to do is dispense their
medications from those sachets, which would be classed as a compliance aid.
PN12700
Firstly,
as we discussed, you didn't prepare this document, but you understand that the
reference to medication compliance aids would include the types of sachets that
you have just referred to?‑‑‑Yes.
PN12701
So
far as that function is concerned, do I understand from that that you do have
CSEs that do that form of - do medication rounds involving the use of sachets?‑‑‑Yes,
that's correct, yes, they do.
PN12702
I
think we have (audio malfunction) evidence about this, but, in broad overview,
the way in which - I'm sorry, your Honour could I just have a moment?
PN12703
JUSTICE
ROSS: Certainly.
PN12704
MR
GIBIAN: I'm still getting (audio malfunction).
PN12705
JUSTICE
ROSS: What's the solution?
PN12706
MR
OSKI: Sorry, your Honour, could I just (audio malfunction) quickly.
It's Sheldon here from the UWU. I've just been watching the proceedings
and I think the feedback is on Ms Bradshaw's screen, because every time the
feedback comes through, her screen is lighting up from my end, so I think maybe
her speakers may be (indistinct) noise.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12707
JUSTICE
ROSS: Yes, all right. Ms Bradshaw, you go on to mute when you're
being asked a question and then you click back on when you answer. Let's
try that. Okay, away you go, Mr Gibian. Thanks, Mr Oski.
PN12708
MR
GIBIAN: Ms Bradshaw, we have some evidence about this, but in the use of
that kind of sachet-type device as part of a medication round, a broad
overview, would you agree with me that this is what the care service employee
would do: they would firstly check the medications against the residents;
attend the room; check the medication is the correct medication, sometimes by
reference to a chart and name; assist the resident to take the medication,
whether that be simply providing them with the pill or applying the ointment or
eye drops, or whatever it might be, or crushing it up into an appropriate
solution or mixture, if the person requires that, and then documenting the
receipt of the medication?‑‑‑Yes, that would be what I would
be saying.
PN12709
And
that that would include having to address circumstances in which the resident
may either have difficulty taking the medication or be resistant to doing so on
a particular occasion?‑‑‑Yes, that would be correct.
PN12710
The
other matters that are referred to in the position description are simple wound
dressings. So, that's something that your CSEs do?‑‑‑Yes,
very simple wound dressings. The majority of wound dressings in Warrigal
Stirling is done by the registered nurses.
PN12711
Then
there's the implementation of continence programs, as identified in care
plans. I take it that's a reference to managing catheters and the like
that are in use by residents?‑‑‑The registered nurses do the
clinical side of managing a catheter. However, the - what that would be
referring to there would be the use of continence aids such as a continence
pad.
PN12712
Do
you have the CSEs involved in - - -
PN12713
JUSTICE
ROSS: Ms Bradshaw, can you put yourself on mute? Thanks.
PN12714
MR
GIBIAN: - - - involved in emptying catheter bags, measuring urine output
and the like?‑‑‑Yes, that would be the extent of what they
would do with a catheter.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12715
And
then involved in the routine - in observations. That is blood pressure
observations, temperature and pulse checks. That is something that the
CSEs would do?‑‑‑Yes, they would and they're aware of their
limits and if anything was outside the limits of those vitals, they would
escalate to a registered nurse. That's right.
PN12716
That
is the CSE is - would have knowledge of or access to information about what the
appropriate readings or range of readings might be and if there was detected to
be something outside those range, they'd discuss it with or take appropriate
action and discuss it with most likely the registered nurse?‑‑‑Yes,
they have access to what would be considered a safe range for a blood pressure,
and outside of that they would escalate to a registered nurse.
PN12717
And
finally, with blood sugar levels and diabetic patients, the CSEs are involved
in taking blood sugar level readings and assisting with insulin
administration. Is that right?‑‑‑No, the registered
nurses do the insulin administration but they would - the CSEs are involved in
blood sugar level taking.
PN12718
Are
those tasks that could - those matters that I've just asked you about from the
medications to the wound dressings, observations and the like, would they be
done by a CSE either at level 1 or level 2 or just at level 2?‑‑‑Predominantly
a level 2.
PN12719
That
is it could be done by either but you think primarily would be done at level 2?‑‑‑That
is correct.
PN12720
Can
you then go to the next position description which is the level - sorry grade
4, level 2, which is - it's at page 13682 in the digital court book. Do
you have that?‑‑‑(No audible reply)
PN12721
I'm
sorry, do you have that, Ms Bradshaw?‑‑‑Yes, I do.
PN12722
Can
you just go to the second page of that document and you'll see at the top
there's a heading of 'Essential criteria', and that involves - requires - that
grade requires a Certificate IV in Aged Care with a particular medication
module, or employee deemed equivalent. You see that?‑‑‑Yes,
I do.
PN12723
Are
we right in - am I right in understanding that what differentiates the level 4
CSE is that qualification and what it allows them to do?‑‑‑Yes,
that's what you're saying, yes.
PN12724
Again,
do you know how many of those you have or - - -?‑‑‑No, I
couldn't give you an exact number, no.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12725
I
just have one question in that respect. When you go down to 'Key
responsibilities', you'll see the first dot point under key responsibilities on
that same page refers to:
PN12726
Perform
work (indistinct) legal ethical framework and support the rights and interests
of consumers including.
PN12727
And
there's a number of sub dot points. The second refers to:
PN12728
Administer
pre-packed oral medication (indistinct) policies and procedures.
PN12729
You
see that?‑‑‑Yes, I can.
PN12730
Do
we understand that to be a reference to the same sachet type process that I've
asked you about already?‑‑‑That's correct.
PN12731
Finally
in that respect, there is a - I don't need to take you to it but there is a
position description for a companion. What is that?‑‑‑Sorry,
a companion is one of the CSEs and they are the staff that will take a resident
out to a - for example to a medical appointment, if the family's not available.
PN12732
Do
you have many of those?‑‑‑They are - we just use that
terminology to reference the fact that that CSE would not be working on the
floor. They would be working offsite with the resident at whatever they
were needed to be at.
PN12733
Okay.
I just have a small number of other questions, if you can go back to your
statement.
PN12734
JUSTICE
ROSS: Can you go on mute, Ms Bradshaw.
PN12735
MR
GIBIAN: You provide some general description of the type of work that
might be done during the day. I just want to ask you about a couple of
those matters. At paragraph 39 at the bottom of page 6, you refer to, and
this is still dealing with the CSE employees to engage them in
activities. Do you see that?‑‑‑Yes, I can.
PN12736
In
the first sentence you refer to getting the residents to do activities
prescribed by a physiotherapist. Do you see that?‑‑‑Yes,
I can.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12737
What's
an example of that type of activity?‑‑‑That may be an
exercise that the physiotherapist has stated is beneficial, which would be a
sitting/standing exercise on a chair, sitting and standing. Or some arm
exercises. Maybe lifting of leg up and down, sideways, those type of
fairly basic instructional exercises.
PN12738
So,
in that event there will have been a physiotherapist - presumably an external
person having visited the facility and having set a particular activity or
exercise that is prescribed for the particular resident. And will the
physio have explained it to the care worker or will that go through the
registered nurse?‑‑‑Warrigal Stirling and all Warrigal sites
have physiotherapists on site Monday to Friday. Predominantly the
physiotherapist would actually explain the exercise, however there is also
occasions where the registered nurse would give instruction around it if the
physio hasn't been able to.
PN12739
Right.
So, whichever one it is they would have explained the exercise to the care
worker and presumably demonstrated perhaps or have the resident demonstrate,
and then the care worker will both encourage and supervise that then being done
on a regular basis as recommended by the physio?‑‑‑Correct.
PN12740
Can
you go forward then to paragraph 83 you deal with servery employees or workers
in the servery?‑‑‑Yes.
PN12741
Bottom
of page 11 at paragraph 85 you refer to - well, initially the service of
breakfast being individual trays either in the resident's room or in the dining
room. You see that?‑‑‑Yes, I can.
PN12742
Over
the page you refer to the - paragraph 86, 87, you refer to the serving.
Are we right in understanding the servery staff serve the meals in the servery
area but the CSEs will take the meals into the residents' rooms where that is
necessary?‑‑‑That's correct.
PN12743
But
the servery employees would then go around to the room and collect the meals
afterwards or collect the plates, etcetera?‑‑‑No
predominantly the CSEs will bring the trays from the resident's rooms back to
the servery.
PN12744
Then
from paragraph 93 you deal with the kitchen staff and over the page at
paragraph 96 there's a reference to - or you refer to there being resident
changes or a particular request for the day and that those changes will be uploaded
into something called SoupedUp, an electronic meal management system. Did
you see that?‑‑‑Yes I can.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12745
You
say that's done by the chef after being notified by the RN, do you see that?‑‑‑Yes
I can.
PN12746
I
think we've had a bit of evidence about this but often, is it the case at
Stirling that the resident can make requests in relation to particular meals
and what they want on a particular day?‑‑‑So the chef has -
puts a menu together. There is two options to choose from in a main
course and then usually one for a dessert. Then there are little options
that are just always available, not necessarily written down, such as an
omelette or a toasted sandwich or some ice cream and fruit and possibly
jelly. But there is definitely a menu that is designed to give some
choice at each meal time.
PN12747
If
the residents wants something different in the manner you've discussed, is that
usually communicated directly to the chef or the staff in the kitchen?‑‑‑Usually
it goes to the servery person and then they will communicate that with the
chef.
PN12748
Then
lastly you deal with lifestyle employees or lifestyle from paragraph 101,
there's not a position description provided for that staff member in the bundle
at KB2. There is in the enterprise agreement a classification of leisure
and entertainment coordinator, is that what you are referring to here?‑‑‑Yes
I would assume that was what it would be.
PN12749
Within
the enterprise agreement that requires either a tertiary qualification or a
certificate IV level qualification. Those staff would have that level of
qualification, would they?‑‑‑No, no, I don't believe they do.
PN12750
How
many of those workers do you have?‑‑‑I have four regular
lifestyle officers and I have two casual ones that will fill in where required.
PN12751
Do
you know what (indistinct) under the enterprise agreement?‑‑‑No
I do not.
PN12752
Lastly
in that respect the lifestyle employees run activities and programs. I
think you also indicate they also assist with care function such as feeding, is
that right?‑‑‑Yes, that's correct.
*** KIM LEANNE BRADSHAW XXN
MR GIBIAN
PN12753
So
they are also qualified or trained to do care service employee work in addition
to the lifestyle program work that they undertake?‑‑‑Yes they
are. They would not - just to add to that - my lifestyle team would not
go in and do a shower, they may assist toileting, they do assist with feeding
though. They would not do a medication round, it's really more the - help
a resident ambulate, maybe do a bit of physical exercise as deemed appropriate
by the physiotherapy and certainly they do do feeding.
PN12754
In
terms of that limitation, is that really a time matter, that they don't really
have the time in addition to their lifestyle work to do the other care
functions?‑‑‑It is a time limitation but it's also they
predominantly don't do showering and those more intimate tasks. So they
don't have the experience which would give them a level of safety with the
resident in that. They would make a bed, all those kind of - and they
would help a resident but they wouldn't do the more intimate roles or the
assessment roles that a CSE would do.
PN12755
Yes,
thank you Ms Bradshaw. That's our cross-examination at least.
PN12756
JUSTICE
ROSS: Thank you Mr Gibian. Mr Hartley or Mr McKenna.
CROSS-EXAMINATION
BY MR MCKENNA [4.40 PM]
PN12757
Yes,
Your Honour, this is me.
PN12758
Ms
Bradshaw, my name is Jim McKenna, I am counsel for the ANMF or at least one of
them. You have already been asked some questions about paragraph
22. Could I direct you back to that paragraph. You there set out what
you say is an example of the staffing you generally have at Stirling. Do
you have that? You there identify registered nurses, AINs, cleaners and
other employees within the facility and you've also been taken to KB2.
Could I ask you to return to that. Within that exhibit, I think it is
about 14 pages or about five position descriptions in, there is a position
description for an endorsed enrolled nurse. Could I ask you to turn that
up please?‑‑‑Yes I have it.
PN12759
Firstly,
can I ask you what is meant by an endorsed enrolled nurse?‑‑‑Just
for clarity at Warrigal Stirling, I don't actually have endorsed enrolled
nurses. But in my previous experience it is a qualified enrolled nurse
who has qualifications in that and the endorsed part of it, my understanding is
that they are - have a certain level of medication competency.
PN12760
Just
returning to the first part of that answer. So it's your evidence that at
Stirling you do not have any endorsed enrolled nurses employed?‑‑‑That's
correct.
PN12761
Do
I take it from this annexure though that it is a position that otherwise exists
within Warrigal, it's something you are aware of?‑‑‑Yes it
does and I am aware of it.
*** KIM LEANNE BRADSHAW XXN
MR MCKENNA
PN12762
Thank
you. Returning to your statement, paragraph 32, and this paragraph arises
under a part of your statement where you are dealing with the work of Warrigal
employees and in particular AINs on day shift. You there say that
although not an explicit task the AIN undertakes emotional and pastoral care of
the resident as part of their role. You have that? Then if I can
ask you to again return to the position descriptions annexures KB02 and just to
the first of those if you can, the care service employee grade 1. You
have that?‑‑‑(Audio malfunction)
PN12763
You'll
see on the first - sorry, thank you. You'll see on the first page of that
position description under the heading, Function, it provides, 'To holistic
care services that meets the industry standards and ensures the physical,
emotional and social wellbeing of the customers.' Do you see that?
You are nodding your head and I'm sure we can that as an affirmation?‑‑‑Yes,
sorry. I'm scrolling between two screens - yes, sorry, I'm muting and
unmuting, yes, I do have it, yes.
PN12764
I
appreciate the muting and unmuting, it must be inconvenient. What is
provided there about the function to provide emotional and social wellbeing of
customers? Is that essentially what you mean by the AIN undertaking the
emotional and pastoral care of the resident?‑‑‑Yes, correct.
PN12765
Then
if we turn over the page within the position description under the key
responsibilities. There is nothing there about providing emotional and
pastoral care, you would agree with that?‑‑‑Yes I would.
PN12766
Likewise
for the care services employees level 2, which is the next position
description, you'll see the same description under Function about emotional and
social wellbeing of residents and then nothing under care responsibilities
about that task, you'd agree with that?‑‑‑I would agree with
that.
PN12767
And
I take it you would agree that it's undoubtedly a function of the role of an
AIN to ensure that social and emotional wellbeing of residents?‑‑‑Yes.
They are part of the whole team that do that. We all do that, yes.
PN12768
Well,
in fact I suggest that the AIN is the person who would have the most frequent
interactions with residents?‑‑‑Yes, they would, and the care
that they would give in pastoral and emotional between an AIN, a CSE and a
registered nurse has different levels of - I would have to say from my time in
aged care all staff members provide that for residents and do that a little bit
at different levels, but it is also very person‑dependent. But I
would agree that the AINs have a large role in that.
PN12769
Part
of that role I presume would be identifying when a resident might be of low
mood?‑‑‑Correct.
*** KIM LEANNE BRADSHAW XXN
MR MCKENNA
PN12770
And
part of that would also be knowing how best to engage that resident to address
that low mood?‑‑‑Yes.
PN12771
And
once that is done, the AIN would exercise communication skills to provide
social and emotional care to the resident?‑‑‑That's correct.
PN12772
In
doing so they would exercise and display empathy?‑‑‑Let's
hope so, yes.
PN12773
Yes,
let's hope so. And you'd of course agree that they are all skills that
AINs are exercising in their day‑to‑day work?‑‑‑Yes,
they do.
PN12774
Also
in that paragraph you describe the AIN – you say,
PN12775
That
work of undertaking emotional and pastoral care includes sitting with a
resident, reminiscing through their photo albums, taking them for a walk, or
doing an activity that makes the resident happy.
PN12776
Do
you see that?‑‑‑Yes, I can.
PN12777
I
take it that that sort of work, sitting and reminiscing, a stroll that isn't
otherwise necessary, the performance of that work could only occur once an AIN
has completed the other necessary tasks for the day?‑‑‑Yes,
it would be best to have completed all the tasks in a day; however, some of the
residents are in an emotional space where the AINs would be required to address
the situation that they're in with the resident and deal with those emotional
needs before they move on to the next person. You wouldn't just leave a
distressed resident because they had a task to do somewhere else.
PN12778
No,
and in fact I suggest to you that what AINs were frequently doing is addressing
the emotional needs of a resident whilst carrying out all of the tasks that you
identify from paragraph 29 and following?‑‑‑That's correct,
yes.
PN12779
At
paragraph 44 you identify that AINs can be the first point of contact for
families, you see that?‑‑‑That's correct, yes.
PN12780
At
the end of that paragraph, you refer to the fact that from your experience
they, being family members, will often express their expectations for the
resident to the carer?‑‑‑Yes, they do.
*** KIM LEANNE BRADSHAW XXN
MR MCKENNA
PN12781
Can
I take it from that that those expectations can somehow sometimes be expressed
as anger or frustration?‑‑‑Yes, they are.
PN12782
At
paragraph 17, you identify the hours of the shifts at Stirling. Do I take
it that there are three eight‑hour shifts – the general shift is eight‑hour
shifts, 7 am to 3 pm, 3 pm till 10 pm, and 10 pm till
7 am?‑‑‑On the whole, yes.
PN12783
Is
that the hours that registered nurses work as well?‑‑‑Yes,
they are.
PN12784
In
your evidence, you describe, as I understand it, the most time‑consuming
tasks that are performed by an RN are the S8 medication round; that's correct?‑‑‑That
can be very time‑consuming, yes.
PN12785
Yes,
I think you say two hours, that's your estimate?‑‑‑The S8 – I
think I said the two hours was more to do with documentation.
PN12786
Could
I direct you to paragraph 63?‑‑‑No, you are correct. I
have said that, yes.
PN12787
And
I presume (indistinct) not only in this evidence, but that is correct?‑‑‑Sorry,
could you repeat that?
PN12788
Yes,
of course, sorry. I presume that not only had you said that, but that
statement is true and correct?‑‑‑Yes, I do believe that, yes.
PN12789
In
addition to that, as you've already indicated, you estimate that the
performance of documentation takes around two hours as well?‑‑‑Yes,
easily. Yes.
PN12790
So
of an eight-hour shift we have, what, at least half taken up by medication
rounds and documentation?‑‑‑Yes.
PN12791
As
I understand it, in addition to that work, you identify at paragraph 60
and following some of the other tasks that are undertaken by a registered nurse
on a day shift or an afternoon shift, that's correct?‑‑‑That's
correct.
PN12792
The
first issue you identify there is receiving a handover from the outgoing
registered nurse?‑‑‑That's correct.
*** KIM LEANNE BRADSHAW XXN
MR MCKENNA
PN12793
And
I understand that there's no overlap between the shift times of a registered
nurse?‑‑‑Very minimal.
PN12794
Well,
I suggest to you that if one shift is finishing at 3 pm and the next is
starting at 3 pm, there's in fact no overlap?‑‑‑Yes,
correct, however the RNs at night will start 15 minutes earlier. The
day shifts start at 7 o'clock and there technically is no overlap
there, no, correct.
PN12795
So
to the extent that there is a handover on a day shift, one or other of the RNs
will be doing it in their own time?‑‑‑That's correct.
PN12796
Then
at 61 you refer to the registered nurse meeting with the AINs to allocate the work
for the day?‑‑‑Yes, that's right.
PN12797
And
throughout, the registered nurse will remain responsible for the coordination
and delegation of the care within the community that they're rostered on?‑‑‑Yes,
they do.
PN12798
Then
at 62 you refer to the RN undertaking the blood glucose level and administering
the insulin round?‑‑‑Correct.
PN12799
I
understand that if it's done before breakfast, lunch and dinner, it will be
done twice on the day shift and once on the afternoon shift?‑‑‑That's
right.
PN12800
The
registered nurse will also undertake a wound management round?‑‑‑Yes.
PN12801
They
will do doctor rounds if the doctor attends the facility?‑‑‑Yes,
they do.
PN12802
They
will deal with new admissions?‑‑‑Yes, they do.
PN12803
And
that can involve a substantial amount of work in preparing new care plans?‑‑‑Substantial
amount of work, yes.
PN12804
I
presume that when a resident returns from hospital, there will be some form of
admission process, even though it's a readmission rather than a first time
admission?‑‑‑Yes, it is, and it often entails a lot of follow up,
as the hospital handovers are not always complete - - -
*** KIM LEANNE BRADSHAW XXN
MR MCKENNA
PN12805
As
they should be, no. You also refer to the registered nurse attending to
residents that are palliative to check if they're in pain or agitated?‑‑‑Yes,
they do.
PN12806
Now,
Ms Bradshaw, I understand that you've only been directly employed in the aged
care industry since 2009. Are you able to identify any changes to the
prevalence of residents in palliative care in aged care facilities?‑‑‑Yes.
By the time they come into aged care they are in significant decline, so there
is a lot of work to ensure that the resident is cared for in a manner that
keeps them comfortable and in a manner in which they have chosen to pass away
with us, and it also includes a lot of time for the RN with the family
members. It's just as much quality of care for the family members as it
is for the resident.
PN12807
I
suggest to you that many residents are now selecting through advance care plans
to go through that process within a facility like yours?‑‑‑Yes,
that's correct; it's quite a privilege.
PN12808
Registered
nurses will also dispense PRN medication, so that might involve being contacted
by an AIN to say that a particular resident is in pain?‑‑‑That's
right, yes, or agitated.
PN12809
They
will have ongoing contact with families about issues that are raised by
families?‑‑‑Yes.
PN12810
They
will attend to other issues, buzzers directly from residents and requests from
AINs for assistance?‑‑‑That's correct.
PN12811
At
72, you also identify attend to phone calls, answer emails, supervise student
RNs, mentor staff, and so on?‑‑‑Yes.
PN12812
Ms
Bradshaw, there has been evidence in this proceeding that there really is no
such thing as a standard shift in an aged care facility. Would you agree
with that?‑‑‑Do you mean a standard shift in time frame or
duties/tasks that they perform?
PN12813
Every
shift is different, as a starting proposition?‑‑‑As a
starting proposition, yes, definitely.
PN12814
And
incidents can, and do, occur on shifts that might throw any schedule out the
window?‑‑‑Yes, every day.
*** KIM LEANNE BRADSHAW XXN
MR MCKENNA
PN12815
You're
saying that every day the schedule is thrown out the window?‑‑‑Every
day there's an incident that changes the workload, or the plan that the
registered nurse starts with usually is quite different by the time she gets to
the end of her day.
PN12816
I
presume that that necessitates the registered nurse balancing competing
priorities?‑‑‑Yes, very much so. They have to be
thinking all the time, problem-solve and de-escalate often.
PN12817
With
reference to de-escalation, you refer in your statement to, I think, 70 per
cent of the residents having cognitive issues?‑‑‑Correct.
PN12818
Particularly
within the memory support unit, residents can exhibit difficult behaviours,
maybe once a day, you say, I think?‑‑‑Yes, definitely within
the memory support, but it's also within all the communities.
PN12819
When
you say 'exhibit difficult behaviours', can that sometimes manifest as violence
and aggression?‑‑‑Yes, at times, yes.
PN12820
When
you say 'sometimes', how frequently would difficult behaviours be manifesting
as violence?‑‑‑At Warrigal Stirling, my team is particularly
good at managing the memory support unit and managing difficult behaviours, so
significant violence and behaviours is limited in Stirling, but I am aware of
other facilities that do struggle, and it's also dependent on the admissions
that you take and the deterioration that you might get. So, to say do I
have it once a day or twice a day is a little challenging to give you something
accurate, but it is something that we are aware of every day and we work to
make sure we don't get to a significant outburst. But, when you have a
resident that is challenging and has those behaviours, once a day would not be
unusual - - -
PN12821
(Indistinct)?‑‑‑
- - - or even more than that.
PN12822
Sorry
to interrupt you. Had you finished?‑‑‑Sorry, for those
ones, I'd say once a day would not be unusual and for a really challenging
resident that's got quite advanced dementia, once a shift would not be unusual.
*** KIM LEANNE BRADSHAW XXN
MR MCKENNA
PN12823
In
a previous answer, you mentioned - I think you said that your team were
particularly good at managing behaviours. Can you explain what your team
does to manage those behaviours and how it is that they are particularly good?‑‑‑Well,
we do try and ensure that our staff that work in our memory support unit with
our dementia sufferers, they have adequate training. That's really
important to understand dementia before you can work with it and be effective
with it. The registered nurses are very pivotal in keeping the communities
as calm and as settled as possible. They do that with ensuring medication
is delivered on time; they do that by speaking with the GP, or possibly even
the geriatrician; we involve Dementia Support Australia to work with them as
well.
PN12824
The
registered nurses will mentor (audio malfunction) on the floor, especially if
we have noted that we have an unsettled resident, that the whole team is aware
of it and they will talk about what their strategies for that resident might be
for that day, what has worked, what hasn't worked. Sometimes a strategy
works on one shift, it doesn't work on a second shift, but it is all about
communication, it is all about diversion, it is all about trying to engage them
in activities.
PN12825
It's
about not - if they are resistive on a behaviour, it's not about being forceful
with them, it's about giving them choice, it's about being calm with them, it's
about letting the resident feel when they're agitated that they still do have
choice in their life, even if they may not understand it. It's about not
forcing them to go anywhere. It is about just being calm with them, being
understanding with them and being gentle with them and just trying to encourage
them into the activity you need them to do. If they don't want to get up
and have a shower, well then, we don't try and shower them at that time and we
may need to come back to that two hours later. It just depends what the
agitation and the aggression actually is.
PN12826
MR
McKENNA: Ms Bradshaw, in that answer, you referred a couple of times to
your 'team'. You referred specifically to registered nurses, but can I
take it that the team includes AINs or care service employees as well?‑‑‑Yes,
it definitely does. When I talk 'team' on the floor, and it is very much
a team and it has to be, the CSEs are the ones that will be really quite
heavily hands on with trying to keep a resident distracted or calm or to
encourage them into what is needed to be done at the time, whereas, in those
situations, the registered nurse will focus on supervising the AINs to make
sure the techniques and the strategies they are using are correct and are in
actual fact working, that they are fulfilling those distraction techniques in
the correct manner. So, the registered nurses are very much oversighting
and supervising in that and are responsible for medication decisions. But
it is definitely a team.
PN12827
Thank
you, Ms Bradshaw. If the Full Bench pleases, I have no further
cross-examination.
PN12828
JUSTICE
ROSS: Thank you, Mr McKenna. Any re-examination, Mr Ward?
PN12829
MR
WARD: Just two questions, if I can, your Honour.
RE-EXAMINATION
BY MR WARD [5.03 PM]
*** KIM LEANNE BRADSHAW RXN
MR WARD
PN12830
Ms
Bradshaw, very early on in Mr Gibian's cross-examination, he was asking you
about the job description for a CSE 2 and he took you to the statement that
they perform simple wound dressing. In Stirling, do all wounds have to be
reviewed by a registered nurse?‑‑‑Yes, all wounds are
definitely reviewed by a registered nurse, and a CSE would not make a selection
on a wound dressing or caring for a wound until they have spoken to a
registered nurse.
PN12831
Lastly,
you were being asked some questions in relation to CSEs about emotional and
pastoral care. Do you recall that?‑‑‑Yes, I do.
PN12832
And
you were being about the distinction between – I think you were talking about
the distinction between registered nurses and AINs, and you said you 'would
expect them to be at a different level.' Do you remember saying those
words?‑‑‑I do remember.
PN12833
Can
you tell me what you meant by 'a different level?'---When a CSE will be working
and caring for one of our residents, they are in a very privileged intimate
space with that resident, and there are often things that may be said or
displayed with the CSE at that time, and the CSE may be able to give them some
emotional care around, for example: it's all right, Mrs X,
we know that the doctor's coming today, I'm going to make sure I tell the
registered nurse that you're really feeling quite depressed, or you've got pain
in your left hip and that's making you sad; it's okay, we'll work together
and I'll make sure the registered nurse gets that. And that's the level –
that's the difference. And then when the registered nurse would come in,
they would say to Mrs X: Mrs X, the CSE has spoken with me
today that you've got pain in your left hip or you're feeling really flat
and sad; look, the doctor is coming today; I'm going to talk to him about it,
because I have been watching you this week and I have noticed that you do seem
to be getting a little bit more depressed because of these symptoms, so
therefore we'll talk with the doctor together and you'll be able to explain to
him what you're feeling and I'll be able to give him some examples; does that
make you feel better; is that you're wanting; do you think that would be a good
way forward. It's just a different level of emotional support there.
PN12834
Thank
you, Ms Bradshaw. Your Honour, if Ms Bradshaw could be excused.
PN12835
JUSTICE
ROSS: Thank you for your evidence, Ms Bradshaw. You're excused.
<THE
WITNESS WITHDREW [5.06
PM]
*** KIM LEANNE BRADSHAW RXN
MR WARD
PN12836
JUSTICE
ROSS: I think we have our first witness at 9 am, is that everyone's
understanding? Yes? All right. Thank you for your
patience with the feedback issue, and to you, Mr Hartley, and you,
Mr Oski, for managing to troubleshoot. We'll take you on as our IT
consultants as we go into tomorrow. We'll adjourn until 9 am in the
morning.
ADJOURNED
UNTIL THURSDAY, 12 MAY 2022 [5.07 PM]
LIST OF WITNESSES, EXHIBITS AND
MFIs
KAREN
ELIZABETH ROE, AFFIRMED..................................................... PN11370
EXAMINATION-IN-CHIEF
BY MR OSKI................................................... PN11370
CROSS-EXAMINATION
BY MS RAFTER.................................................. PN11394
THE
WITNESS WITHDREW......................................................................... PN11508
ROSS
EVAN HEYAN, AFFIRMED................................................................ PN11516
EXAMINATION-IN-CHIEF
BY MR OSKI................................................... PN11516
CROSS-EXAMINATION
BY MR WARD..................................................... PN11526
THE
WITNESS WITHDREW......................................................................... PN11576
SANDRA
KIM HAFNAGEL, AFFIRMED.................................................... PN11585
EXAMINATION-IN-CHIEF
BY MR OSKI................................................... PN11585
CROSS-EXAMINATION
BY MS RAFTER.................................................. PN11594
THE
WITNESS WITHDREW......................................................................... PN11666
LYNDELLE
ANNE PARKE, AFFIRMED..................................................... PN11680
EXAMINATION-IN-CHIEF
BY MR OSKI................................................... PN11680
CROSS-EXAMINATION
BY MS RAFTER.................................................. PN11690
THE
WITNESS WITHDREW......................................................................... PN11794
GERONIMA
BOWERS, AFFIRMED............................................................ PN11802
EXAMINATION-IN-CHIEF
BY MR OSKI................................................... PN11802
CROSS-EXAMINATION
BY MR WARD..................................................... PN11810
THE
WITNESS WITHDREW......................................................................... PN11964
JUDITH
CLARKE, AFFIRMED..................................................................... PN11969
EXAMINATION-IN-CHIEF
BY MR OSKI................................................... PN11969
CROSS-EXAMINATION
BY MR WARD..................................................... PN11981
THE
WITNESS WITHDREW......................................................................... PN12078
DONNA
CAPELLUTI, AFFIRMED............................................................... PN12085
EXAMINATION-IN-CHIEF
BY MR OSKI................................................... PN12085
CROSS-EXAMINATION
BY MR WARD..................................................... PN12095
THE
WITNESS WITHDREW......................................................................... PN12181
PAUL
MICHAEL SADLER, AFFIRMED..................................................... PN12201
EXAMINATION-IN-CHIEF
BY MR WARD................................................ PN12201
CROSS-EXAMINATION
BY MR GIBIAN................................................... PN12210
THE
WITNESS WITHDREW......................................................................... PN12404
PAUL
MICHAEL SADLER, RECALLED..................................................... PN12404
CROSS-EXAMINATION
BY MR HARTLEY.............................................. PN12404
RE-EXAMINATION
BY MR WARD............................................................. PN12441
THE
WITNESS WITHDREW......................................................................... PN12454
ANNA-MARIE
WADE, AFFIRMED.............................................................. PN12470
EXAMINATION-IN-CHIEF
BY MR WARD................................................ PN12470
CROSS-EXAMINATION
BY MR HARTLEY.............................................. PN12487
CROSS-EXAMINATION
BY MR GIBIAN................................................... PN12542
RE-EXAMINATION
BY MR WARD............................................................. PN12569
THE
WITNESS WITHDREW......................................................................... PN12574
KIM
LEANNE BRADSHAW, AFFIRMED................................................... PN12593
EXAMINATION-IN-CHIEF
BY MR WARD................................................ PN12593
CROSS-EXAMINATION
BY MR GIBIAN................................................... PN12603
CROSS-EXAMINATION
BY MR MCKENNA............................................. PN12756
RE-EXAMINATION
BY MR WARD............................................................. PN12829
THE
WITNESS WITHDREW......................................................................... PN12835
