PHYSICAL FACILITY, EQUIPMENT AND FURNISHINGS: 31290 - RCR s.22(1)(b) - A licensee must ensure that all rooms and common areas are (b) maintained in a good state of repair.
Observation: A small sized patio near the office was noted on February 12, 2020 and February 26, 2020 to be showing wear and tear. As part of the Manager's written response to the February 12, 2020 routine inspection report a maintenance request was put in to address this. The Manager stated on February 26, 2020 that the Licensee Contact was contacted and the fence maybe removed all together. Please note: If required for health and safety, please ensure a fence or other means is in-place.
Corrective Action(s): Please ensure all rooms and common areas are maintained in a good state of repair.
Date to be Corrected: Please provide a written response to this item by the timeline noted in this report.
STAFFING: 32040 - RCR s.37(1)(d) - A licensee must not employ a person in a community care facility unless the licensee or, in the case of a person who is not the manager, the manager has obtained all of the following: (d) copies of any diplomas, certificates or other evidence of the person's training and skills.
Observation: A random review of the computerized system for staff documentation indicated for one staff member (details provided at the time of the inspection to the Manager) that there were nothing noted for "certificate". The Manager stated this is an item that needs to be in-place prior to a staff working. The Manager will review this with Human Resources.
Corrective Action(s): Please ensure where required that copies of any diplomas, certificates or other evidence of the staff's training and skills is obtained.
Date to be Corrected: Please provide a written response to this item by the timeline noted in this report.
STAFFING: 32320 - RCR s.68(4) - A licensee must ensure that all employees comply with the policies and procedures of the medication safety and advisory committee.
Observation: A random review of the medication administration records (MARs) indicated for example two PRN (as needed) medications were charted/initialed for February 20, 2020 on the front of the MAR, however on the back of the MAR there is charting for February 21, 2020 instead and no charting for the second medication administered.
In addition there is a entry for February 25, 2020 that a PRN was administered for "pain", however the medication is not for pain. The Manager did address as part of the routine inspection report response PRN charting with the staff and will address the additional items the writer reviewed with the Manager.
Corrective Action(s): Please ensure all staff comply with the policies and procedures of the medication safety and advisory committee.
Date to be Corrected: Please provide a written response to this item by the timeline noted in this inspection report.
RECORDS AND REPORTING: 39410 - RCR s.86(a) - A licensee must keep the following records in respect of each employee: (a) criminal record check results,.
Observation: A random review of the computerized system that has staff information it was noted for a staff member (details provided to the Manager) there was nothing noted for criminal record check. The Manager stated prior to employment all staff would require a criminal record check to be in-place. The Manager will check with Human Resources regarding this.
Corrective Action(s): Please ensure records for each employee regarding criminal record check results are documented.
Date to be Corrected: Please provide a written response to this item by the timeline noted in this report.
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