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Culverden Group Limited certification cancelled

10 April 2006
Please attribute to Dr Colin Feek, Deputy Director General

The Director General of Health has cancelled the certification of Culverden Group Limited, trading in Mangere as Pasifika Centre and Hospital, because of its failure to satisfy the Director General that it meets the relevant service standards required for such facilities.

Culverden's certification is to provide Hospital Care (medical services and geriatric services) and Rest Home Care.

The 101 residents and their families are being informed of the decision and what it will mean for them.

The Ministry of Health and the Counties Manakau District Health Board are considering issues around moving the residents of the Pasifika Centre and Hospital into alternative accommodation.

A temporary manager, appointed by the Ministry of Health and the Counties Manukau District Health Board, has been managing the Pasifika Centre and Hospital since early last month. This was in order to provide the Ministry and the DHB with a level of assurance about the care residents receive and the facility's compliance with the relevant standards under the Health and Disability Services (Safety) Act 2001.

Culverden Group Ltd has been the subject of three Ministry inspections in the past 15 months, which have raised serious and ongoing concerns about its compliance with those standards. While an independent audit report by a Designated Auditing Agency indicated that the intent of the standards was being met, their audit report also identified a number of risk areas.

The Ministry's preference would have been to see Culverden Group Ltd meet the standards, enabling the 101 residents to remain at the centre and hospital, but in the current circumstances the Ministry believes that is not possible.

The Ministry sees compliance with the standards as a vital part of ensuring the safety and quality of care for residents, which is a paramount consideration for the Ministry.

Culverden has the right to appeal the Director General's decision and can apply for a suspension of the revocation of its certificate.



* What is the relevant law and the process followed?

Health care providers are certified under the Health and Disability Services (Safety) Act 2001 to provide rest home care, hospital services and residential disability support services.

The purpose of the Health and Disability Services (Safety) Act 2001 is to promote the safe provision of health and disability services to the public and to encourage providers to improve continuously the quality of these services.

Under the Act, the Director General of Health issues certificates for providers to operate. To apply for certification, providers must be audited against standards that the Minister of Health approves. The auditors are independent, designated auditing agencies. The maximum period a provider can be certified for is five years.

The Director General is the only person who can cancel certification.

In December 2005 Culverden Group Ltd was certified for six months on the basis of an audit report by designated auditing agency, Bureau Veritas Quality International.

For more general information on the certification process go to

Under the Health and Disability Services (Safety) Act 2001 providers of hospitals, old peoples' homes and disabled peoples' community welfare homes, who wished to continue to operate, were required to meet the requirements of the Act by September 2004 to become certified. The requirements have lifted the bar for these health care providers.

The Ministry of Health believes that the implementation of the Health and Disability Services (Safety) Act 2001, since October 2004, is leading to overall improvements in standards in the residential care sector in New Zealand.

*What inspections has Culverden been subject to and why?

Under the Act, the Director General may authorise Ministry of Health staff to enter and inspect a premises if there are concerns about residents' safety.

December 2004
The first unannounced inspection of Culverden took place in December 2004 following the receipt of two complaints alleging inadequate care of residents.

The December inspection listed 101 required corrective actions in relation to the relevant standards for certification. Among these were issues related to a lack of registered nurse input, issues related to Health and Disability Sector standards, aspects of the Infection Control Standard and the Restraint Minimisation and Safe Practice Standard.

For example, pain management was poor and several clients identified as "in pain'' had inadequate or no pain management strategies in place.

As a result of the inspection, there was agreement between the Ministry and the provider representatives for both parties to work together to remedy the situation. Culverden Group Ltd made a number of changes - for example, one of its buildings was closed down because the Ministry believed it was substandard and unsuitable in its present state for residential care. Following concerns raised about its management structure a new chief executive and executive officer were appointed.

Between December 2004 and July 2005, Culverden Group Ltd provided written documentation to the Ministry of Health about changes to its policies and procedures.

June 2005
In June 2005 a second unannounced inspection took place to check the progress made to meet the requirements outlined in the December report. The July report found 41 corrective actions from the December inspection had been addressed while 58 remained active (two were unable to be assessed).

The inspection team acknowledged progress towards making improvements, including major restructuring at management and senior registered nurse levels and improved reporting systems but found a number of significantly high-risk areas still needed to be addressed. The most urgent of these was inadequate input by health professionals, in particular a registered nursing shortage.

The Ministry required Culverden Group Ltd to address the registered nursing shortage within four weeks and to provide a detailed management plan within a month about how it would address the outstanding corrective actions. Culverden Group Ltd was required to provide a progress report every two months.

February 2006
In February 2006 a third unannounced inspection was carried out. The purpose of this inspection was to confirm corrective actions had been addressed and because of reported changes to management.This inspection was unable to substantiate the implementation of any significant improvements in meeting the requirements of the Act. There continued to be concerns of:
- inadequate input by health professionals
- inadequate preparation, orientation, ongoing education and support of caregivers
- inability to show adequate assessment, planning and delivery of care and support
- inability to evidence adequate and timely medical intervention, especially in emergencies
- inability to show a formalised quality and risk management system
- inability to evidence an operational infection control programme

It was recommended a second building, which the Ministry believed was substandard and unsuitable in its present state for residential care, be closed down.

In addition to the ministry inspections, in December 2005, an audit of Culverden Group Ltd was carried out by designated auditing agency, Bureau Veritas Quality International. Culverden Group Ltd had made application for new certification because the trading name of the company had changed to Culverden Group Ltd, trading as Pasifika Centre and Hospital. The audit stated that the intent of the applicable standards was being met but that several issues remained outstanding. A renewal certificate was granted for only six months.

March 2006
On March 7 a temporary manager was appointed by the Ministry and Counties Manukau District Health Board to provide a level of assurance about the quality of care residents were receiving.

Director General of Health, Dr Karen Poutasi, wrote to Culverden Group Ltd trading as Pasifika Centre and Hospital on March 6 notifying the company of the Ministry's concerns.

Dr Poutasi notified the company she was considering cancelling the certification of Culverden Group Ltd, trading as Pasifika Centre and Hospital, under the Health and Disability Services (Safety) Act 2001. Culverden Group Ltd was given the opportunity to respond.

Culverden Group Ltd sought an extension to the timeframe in which to respond and this was granted by the Director General.

Culverden Group Ltd sent a 48-page response. As a result, Dr Poutasi requested further information from Culverden and the temporary manager.

Since then another onsite inspection has been completed. It was noted the temporary manager had remedied some issues but the Ministry was not confident in the absence of a temporary manager that these changes would continue.

Culverden Group Ltd provided an action plan outlining how it planned to meet best practice standards.

* Why has the process taken 15 months?

The process the Ministry follows under the Health and Disability Services (Safety) Act 2001 is to encourage providers to continuously improve the quality of the services they provide. As part of the principles of natural justice, institutions are given time to work through improvements.

Following the December 2004 inspection, Culverden Group Ltd was required to provide the Ministry of Health with a plan about how they would address the issues raised. Given there were a significant number of issues to work through Culverden Group Ltd were given time to act on these.

After the June 2005 inspection the Ministry wanted to give the new management time to bring about the changes required however it learned in January 2006 that the management had again changed and the previous management was in place.

A third inspection was carried out in February this year.

* Who are the residents of Culverden?

At the time of the inspection in February there were 106 residents at the centre and hospital. The majority of residents were aged 65 and over. The bulk of these residents are funded by the Counties Manukau District Health Board. Some people with disabilities are funded by the Ministry of Health's Disability Services Directorate.


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