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: Inspection of the physical facility noted:
- Kitchen closet door handle broken and wood worn around it
- flickering lights in hallway- corrected at time of inspection
- rusted light fixtures in TV room -corrected at time of inspection
- room 123 bathroom counter laminate is off on the corner
- shower room has rusty shower curtain rod, counter laminate is coming off and chipped, mildew in the shower caulking
Corrective Action(s): Ensure all rooms and common areas are maintained in a good state of repair
Date to be Corrected: March 3, 2022
PHYSICAL FACILITY, EQUIPMENT AND FURNISHINGS: 31760 - RCR s.35(1)(c) - A licensee must provide the following appropriately furnished and equipped areas: (c) secure, safe and adequate storage areas for cleaning agents, chemical products and other hazardous materials.
Observation: Inspection of the physical facility noted that there were chemical cleaning supplies kept in cupboards in the kitchen, on counters in the laundry room and bathrooms
Corrective Action(s): ensure chemical cleaners are stored in a safe, secure place
Date to be Corrected: March 3, 2022
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: Review of PIC's MAR's noted that in one MAR the staff used the wrong medication name in documentation and were documenting the PRN information and results on the wrong page
Corrective Action(s): Ensure staff are documenting medication administration as stated in the MSAC policy and procedure manual
Date to be Corrected: March 3 2022
CARE AND/OR SUPERVISION: 34180 - RCR s.54(3)(a) - A licensee must (a) encourage persons in care to be examined by a dental health care professional at least once every year.
Observation: No documentation that PIC has seen a dental health care professional at least once per year
Corrective Action(s): Ensure there is documentation of dental care in the PIC's care plan
Date to be Corrected: March 4, 2022
HYGIENE AND COMMUNICABLE DISEASE: 35040 - RCR s.63(1) - A licensee must ensure that all food is safely prepared, stored, served and handled.
Observation: resident fridge in the dining area did not have temperature record available
Corrective Action(s): ensure fridges where food is stored area monitored
Date to be Corrected: corrected at the time of inspection
RECORDS AND REPORTING: 39330 - RCR s.83(4)(c) - Subject to subsection 83(5), a licensee, other than a licensee who provides a type of care described as Hospice, must (c) record the weight in the nutrition plan of the person in care.
Observation: review of PIC files noted that there was 1 month of weight not documented for the year, when speaking tot he manager it was noted that the PIC had refused the weighing but staff had not documented the refusal
Corrective Action(s): ensure weights or refusals are documented monthly
Date to be Corrected: March 3, 2022
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