The environment | Aged Care Quality and Safety Commission

Intent of Standard 4

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

Updates to guidance

The Commission is currently updating our guidance content to reflect these changes. Please ensure you check back regularly.

Governing body

Information for governing bodies*

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

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

The governing body* needs to:

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

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

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

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

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

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

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

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

Standard 2 provides detailed information for governing bodies*.

Key tasks:

Track the organisation’s performance. Make sure the care and services older people receive at home and in a service setting are safe.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Workers

What does this Standard mean for workers*?

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

Regardless of your role, you should:

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

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

Key concepts

Infection prevention and control* (IPC)

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

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