11 Queensland nursing homes to fail federal standards
These are the 11 Queensland aged care homes being monitored for failing health and safety standards. Use our interactive table to see how your nursing home is ranked.
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Eleven Queensland nursing homes have been put on notice and are under close monitoring by the national aged care watchdog after dire failures of health and safety standards.
The Aged Care Quality and Safety Commission stepped in at the 11 facilities and made recommendations for improvements after site reports found dozens of protocol breaches.
Failures for some of the homes included giving a resident another’s medication, running out of pain killers, incorrectly restraining and locking people in rooms, allowing a resident to fall asleep smoking in bed, not changing wound dressings for days and leaving a resident with a broken bone for days.
“The commission will not hesitate to take action should it find a service is moving too slowly, or ineffectively, or otherwise fails to make improvements, or if the commission finds the service is placing residents at risk,” the federal agency said in a statement.
The failures were highlighted in performance reports compiled and published by the commission which were published after site audits and consideration of responses from each facility.
Along with naming non-compliant homes, the federal Department of Health and Aged Care also updated rankings for the country’s 2500 aged care homes in May.
The country’s best and worst facilities were named and given a rating out of five, based on four categories — residents’ experiences, compliance, staffing, and quality measures.
The data showed only six facilities nationally received the lowest performing one-star rating.
Of Queensland’s 454 aged care homes, one received one star; 11 received two stars; 242 received three stars; 190 received four stars and 10 got the top score of five stars.
The worst was Warrina at Innisfail, which received the state’s only rating of one, even though residents gave it three out of five.
Its poor overall rating also included one star for compliance; two for staffing; and a top score of five out of five for quality measures.
A site assessment, contained in publicly available documents released by the watchdog, in November found there had been inadequate care and planning for three residents with diabetes who needed insulin injections, and a year delay in drawing up a mobility plan for a resident who often had falls and found it difficult to walk.
In its response, Warrina agreed with the findings and moved to set up a “resident of the day” program and start three-monthly care plan reviews.
At the top end of the scale, the Darling Downs led the way with four facilities getting 5-star ratings and taking out positions in the top 10 rated aged care facilities in Queensland.
They included Leslie Place Aged Persons Hostel at Killarney; Milton House at Miles and Dalby’s Karingal Nursing Home and Ningana all of which received 19 out of a possible 20.
Others with five-star ratings included the Sunshine Coast’s Bowder Care Centre; Woombye Care; and Brighton Health Campus’s Gannet House in Brisbane’s north which all received 19 out of 20.
Wide Bay’s Churches of Christ Petrie Gardens Aged Care; Harristown’s Westhaven Nursing Home and St Vincent Care Services at Boondall all received five starts with scores of 18 out of 20.
In Queensland, seven nursing homes were exempt from receiving an overall star rating in the May quarterly update as they were new services.
Six were left off the list as they had recently been transferred to new providers.
HERE are the 11 homes which are being closely monitored by the federal government after reports of safety and health breaches.
NY-KU BYUN ELDERS VILLAGE
★★★★
The Uniting Church in Australia Property Trust
1 Fisher Street, CHERBOURG
A site audit in December found a resident had been drugged and restrained with no evidence of consent or authorisation and there had been no monitoring when restrictive practices were in use.
The commission’s performance report in February said three drugs used for restraint were administered at higher doses than prescribed even when the resident had shown no signs of agitation.
Additional doses of the restraining drugs were not recorded on the resident’s medication chart and records of wound management were inaccurate resulting in poor monitoring, inadequate treatment and bandages showing signs of “breakthrough”.
Staff also confirmed that during a two-week period, pain relief was unavailable for five residents because stocks had been exhausted and not replenished while the medical officer was on leave and the pharmacy did not have the required repeat prescriptions.
“In relation to high impact or high prevalence risks, consumers who required catheter care, did not have a catheter care plan in place and staff were unable to demonstrate knowledge of when the catheter had last been changed,” the performance report in February said.
“For two consumers, who required their food and fluid intake to be monitored to either prevent fluid overload, or ongoing unplanned weight loss, care documentation evidenced this had been completed sporadically or omitted in its entirety.”
Following the performance report, the commission re-accredited the service until April 2026.
NIRVANA HOSTEL
★★★★
Clifton Co-Op Hospital Ltd
20 Norman Street CLIFTON
A performance report for the Aged Care Quality and Safety Commission in February found the hostel in Toowoomba was non-compliant in ongoing assessment and planning and organisational governance.
The report found staff at the facility had insufficient reporting guidance in wound care for a resident who had two skin tears. The commission report said there was confusion over updates to documentation.
“Wound charts were completed to demonstrate wound care was occurring; however, there was a lack of documentation to demonstrate the appropriateness of the wound care delivery,” the report said.
“Clifton acknowledged there were gaps in wound management during the site audit and improvement actions were commenced during the site audit.
“Information management systems were ineffective, including policies that did not align with legislation, procedures did not reflect policies and care and wound documentation was not complete or accessible.
“End-of-life preferences and lifestyle care plans for consumers were not consistently recorded in consumer care plans.”
In its defence, Nirvana presented a care plan schedule and case conference due dates which were annual and recorded on the anniversary date of the resident’s entry to the home.
Training has also been instigated to help staff with care plans and reviews using the electronic care management system.
Accreditation at the facility was extended until May 13, 2026.
A refundable deposit for a single room in May 2022 cost $360,000 or daily payments of $40.14.
CLIFTON NURSING HOME
★★★
Clifton Co-Op Hospital Ltd
20 Norman Street CLIFTON
The commission has decided to allow Clifton to operate under “exceptional circumstances” until September but the facility will remain subject to strict Aged Care Quality and Safety Commission monitoring due to Covid disruptions.
The decision followed a Department of Health decision made under Section 42.5 of the Aged Care Act 1997.
The commission has extended the facility’s accreditation until February 2026, following a site audit in January.
A commission performance report in February, which considered the site audit report along with Clifton’s response, found the facility breached two federal standards.
The report found wound care directives were not consistently recorded or monitored and clinical oversight of wounds was ineffective, with wound evaluations not consistently assessed or documented.
The nursing home acknowledged there were gaps in wound management at the site audit and improvement actions were commenced immediately.
The report detailed the case of a resident with a wound under their toe where the staff had failed to record adequate descriptions of the wound or the frequency of required wound care.
BLUE CARE CAPRICORN AGED CARE FACILITY
★★★★
The Uniting Church in Australia Property Trust
26 Magpie Ave YEPPOON
A site audit in January found the facility had breached one of eight federal standards.
A performance report filed in March, which included Blue Care’s response to the claims, found there were seven cases of “serious incidents” which had not been reported on time, with some reports more than 10 months late.
The performance report also found that there was no consent documentation for one resident to use restraining drugs and seven residents did not have risk assessments completed for activities including smoking and drinking alcohol.
Blue Care accepted the site audit findings and submitted plans to improve including training staff to handle serious incidents.
In March, the commission reaccredited the nursing home until March 6, 2026.
THE TERRACES ASSISTED AGED CARE
★★★★
McKenzie Aged Care Group Pty Ltd
74 University Dr, VARSITY LAKES
A site audit conducted in January found The Terraces had breached one of the eight federal standards because it had failed to show it regularly monitored a resident who was receiving restraining drugs for mental health issues.
The assessment found the facility had obtained informed consent and there was a behaviour support plan in place but no proof of regular monitoring.
There was also no documentation to show consent to put two patients on mental health drugs.
McKenzie Group management instigated a review and included the findings in updated documents.
In March, the commission extended accreditation at The Terraces until April 2026.
NEWDIRECTION CARE AT BELLMERE
★★★
NewDirection Care Bellmere Pty Ltd
41 Lotus Ave BELLMERE
A site audit of this facility in Bellmere near Caboolture found NewDirection Care breached five of the eight federal standards.
A performance report published in December found care was not always delivered or timely and risks associated with pressure wounds were not effectively managed.
Residents reported 47 occasions when they were frightened by the aggressive behaviour of another resident in a one-month period in November.
The resident has since been referred to an external dementia specialist.
The performance report also found 16 instances where another resident had been verbally and physically violent, including one occasion in which three staff were needed to restrain the person, later referred to an external dementia specialist.
The audit also found a third resident had hit another resident.
“The service is unable to demonstrate management of restrictive practices, specifically recognition and understanding of consumers who are subject to environmental restraint,” the commission report found.
A site audit report also found some residents were unable to get outside as the doors were locked between 7pm and 7am.
NewDirection management said residents could move freely inside the facility and said under quality of care principles, it would strengthen the consent process and get residents to sign a restraint form.
The report also showed an increase in smoking incidents with several residents found smoking in their rooms because the smoking room was “too far away”.
The audit found that staff had not monitored or supervised residents when they were smoking.
The report also found a resident had a number of smoking incidents, including being found asleep in bed with a lit cigarette.
Management showed evidence of smoking agreements and risk assessments for smokers and said the facility took a range of precautions to prevent smoking-related incidents.
The service intended considering a flame-free lighter device for the smoking area which will allow the removal of individual lighters.
The site assessment also documented complaints about cleaning after staff advised they did not have enough time to complete many cleaning tasks.
The service’s cleaning records for November showed daily and weekly cleaning tasks had not been consistently completed.
Management has since engaged an external cleaning contractor to complete professional cleaning jobs including carpet steam cleaning.
The service was also developing new cleaning schedules and staff training.
Two residents also raised concerns about the availability of food over weekends.
Residents in a Queen-sized one-bedroom unit with ensuite pay $550,000 to live at NewDirection.
OZCARE MACKAY
★★★
Ozcare
15 Charlotte Street West Mackay
A site audit in February found breaches of three of eight federal standards including failing to identify and manage residents’ medication management risks and pain management.
One resident complained there had been consistent delays in getting pain medication, which had resulted in increased pain.
A report to the commission found blood pressure medication had not been administered due to a lack of supply and the person’s blood pressure was not monitored, causing distress.
The audit also found repackaged medication was given to the wrong resident while another resident complained they did not receive medication at the correct time before breakfast.
Ozcare said action was taken to remedy delays in administering medication “due to technical issues”, and resolved the issue in November.
For a third resident, medication was often left under or beside the bed.
The commission report said documentation also showed evidence that mental health drugs to restrain residents were used before other strategies.
The report also highlighted the case of a resident who was unable to stand due to pain but no immediate action was taken for pain assessment.
The document showed the resident continued to decline in health, including increased overall weakness and difficulty swallowing and was transferred to hospital in February.
However, the report said there was no evidence of risks to the resident associated with the withholding of medication.
A sixth resident, who fell over in February, was assessed as not having an injury or pain despite later being diagnosed with a broken bone and after a medical officer prescribed increased doses of pain medication.
The commission report said progress notes reflected increasing pain and swelling, and the resident was later transferred to hospital where they were diagnosed with a fractured femur.
The commission report also said Ozcare management acknowledged residents’ behaviour support plans were not individualised and did not consistently reflect current needs.
Management refuted the findings about delays in administering some medications.
Ozcare said since January 1, pain medication was administered outside of the prescribed window (an hour on either side of the prescribed time) on only seven per cent of occasions with the rationale for the delay being the lack of familiarity of newly recruited registered staff with the medication management system.
Management said it had taken action and was allowing the resident to self-administer pain relief.
The facility has also moved to rectify procedures for administering blood pressure medication.
Ozcare said for five days in December, the pharmacy was unable to supply the prescribed drugs and stated that an increase in the frequency of assessing the consumers’ blood pressure could have been introduced while some medications were unavailable.
An apology was also made to the resident at an open meeting in March. The commission also found that Ozcare had minimised the risk for the consumer during the shortage.
Following the commission report, the facility was granted an extension of accreditation until May 2024.
PALM LAKE AGED CARE DECEPTION BAY
★★★
Palm Lake Care Operations Pty Ltd
42-46 Bay Street Deception Bay
Palm Lake Aged Care Deception Bay was found to have breached five of eight federal government standards in an Aged Care Quality Standards Commission report in April.
Following a site audit in March, the commission found some residents were living in fear of an aggressive resident which had led to bedroom doors being locked.
Palm Lake put on additional staff and held a meeting to address residents’ concerns.
The site audit report also reported widespread concern among residents that they were forced to delay or postpone showering and toileting due to staff shortages.
The report said one carer also requested that the kitchen not provide hot breakfasts to some as they would not eat all the food and there was wastage.
“As a result, some residents were not receiving hot breakfasts despite requesting them,” the April commission report said.
Palm Lake said it had conducted a full review of showering preferences after concerns were raised.
Management also “acknowledged there had been issues with the hot breakfast option” and said that had been reinstated and would be maintained.
Another concern raised during the site audit was about the management of one resident’s catheter.
The resident had been hospitalised twice due to blockages in the catheter with the person’s family complaining but no response from management and no documentation to show a complaint had been lodged.
Palm Lake management acknowledged residents’ feelings but said it was hard to address concerns that had not been raised with staff or management.
The facility’s response confirmed that staff did not always complete complaint or feedback forms as they attempted to address issues immediately.
The site audit also indicated that 25 residents said they did not feel there was enough staff to consistently provide adequate care.
A majority of care and clinical staff interviewed during the Site Audit said that there were not enough staff to complete consumer care needs
Palm Lakes acknowledged staff concerns about the staffing and said it was committed to fix the problem.
Management said a review of resident care was conducted along with a complete review of the roster and skills mix with an extra 33.5 hours of staffing per day added to the roster.
A recruitment process had been taken to fill positions and found that a permanent clinical nurse was also required and was being recruited.
Palm Lake also said workforce planning had been discussed with residents at a meeting and a full survey was due to be conducted.
In April, the commission decided to re-accredit the facility until February 2026.
BLUE CARE STAR OF THE SEA ELDERS VILLAGE 5372
★★★/★★★★
The Uniting Church in Australia Property Trust
121 Waiben Esplanade THURSDAY ISLAND
A site audit in March found Blue Care Star of the Sea was unable to show that all staff were adequately trained to deliver safe and quality care and services.
A review of records provided by the service showed significant noncompliance and low compliance rates for mandatory training modules.
Blue Care clarified staffing arrangements and said local staff were supported by a newly implemented fly-in fly-out model for additional staff.
In response to the site audit report, management said staff were contracted to a minimum 12 month fly-in fly-out contract.
Management also acknowledged that some staff may not have been consistently following the organisation’s policies and processes, and refresher education was arranged.
In May, the commission reaccredited the service until May 2026.
BLUE CARE STAR OF THE SEA ELDERS VILLAGE (Merged)
McAULEY PLACE
★★★★
Mercy Health and Aged Care Central Queensland Limited
263 Agnes Street ROCKHAMPTON
Mercy Health and Aged Care acknowledged a site audit finding that time specific medications for one resident had been missed many times.
Since then, the facility had changed procedures to ensure medication delivery would not be overlooked.
The facility also acknowledged there had been an issue with monitoring blood glucose levels because of “contradictory parameters being kept on paper based observations sheets and the services electronic management system, but the situation had now been rectified”.
A report from the commission found incident reports, training records and clinical indicator data, all had effective monitoring.
The commission report, published in May, also found the site audit report was correct to claim there had been under-reporting of serious incidents, specifically in relation to medication.
Mercy Health acknowledged the site audit findings and put on extra staff education along with additional clinical support staff engagement and onsite management.
Management said processes were underway to move to a new electronic care management system.
McAuley Place has implemented additional staff education, more clinical support staff engagement and onsite management.
In May, the commission re-accredited the service until September 2026.
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