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TRANSCRIPT OF PROCEEDINGS
Fair Work Act 2009                                                    

 

JUSTICE ROSS, PRESIDENT

DEPUTY PRESIDENT ASBURY

COMMISSIONER O'NEILL

 

s.158 - Application to vary or revoke a modern award

 

AM2020/99 – Aged Care Award 2010 – Application by Ellis & Castieau and Others

 

AM2021/63 – Nurses Award 2020 – Application by  Australian Nursing and Midwifery Federation-Victorian Branch

 

AM2021/65 – Social, Community, Home Care and Disability Services Industry Award 2010 – Application by Health Services Union

 

Melbourne

 

9.30 AM, WEDNESDAY, 11 MAY 2021

 

Continued from 10/05/2022

 


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 a