PHYSICAL FACILITY, EQUIPMENT AND FURNISHINGS: 31260 - RCR s.21(c) - A licensee must ensure that all furniture and equipment for use by persons in care (c) are maintained in a good state of repair.
Observation: Inspection of the physical facility found
Building #1- 1st floor
Broken planter pot outside
Resident fridge has no handle, has scratched and is dented
Door to outside smoking area has significant scratches and paint removed
Servery counter edge lamination is broken and chipped
Hand sink in dining area light cover is missing
wood edge of nursing station counter is worn to the raw wood
Broken cupboard door in the medication room
Building #2 - BSTN
Hand hygiene sink laminate counter edge coming off
Floor damage to personal laundry room
Servery has a broken cupboard door next to the fridge
Corrective Action(s): ensure all furniture and equipment is maintained in a state of good repair
Date to be Corrected:
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 sapphire unit found cleaners stored in the spa room accessible to the PIC's
Corrective Action(s): Ensure all cleaners are stored in a safe and secure manner
Date to be Corrected: April 9, 2021
STAFFING: 32010 - RCR s.37(1)(a) - 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: (a) a criminal record check for the person.
Observation: Review of 8 staff files found that 2 did not have up to date criminal record checks
Corrective Action(s): Ensure all staff have clear criminal record checks prior to employment
Date to be Corrected: April 09, 2021
STAFFING: 32050 - RCR s.37(1)(e) - 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: (e) evidence that the person has complied with the Province's immunization and tuberculosis control programs.
Observation: Review of 8 staff files noted that 1 did not have immunization records and 2 did not have TB test results
Corrective Action(s): please ensure all staff have records of TB and immunization prior to employment
Date to be Corrected: June 15 2021
CARE AND/OR SUPERVISION: 34900 - RCR s.83(5)(a) - If a person in care refuses or is unable to be weighed, the licensee must (a) record in the nutrition plan of the person in care the reason why the person in care was not weighed.
Observation: Review of care plans noted that 1 resident had 3 months of missing weights out of 12 months. discussion with staff noted that this PIC often refuses. No documentation was available to confirm refusal
Corrective Action(s): Ensure that refusal to weigh is documented
Date to be Corrected: April 09, 2020
HYGIENE AND COMMUNICABLE DISEASE: 35030 - RCR s.54(1) - A licensee must establish a program to instruct, if necessary, and assist persons in care in maintaining health and hygiene.
Observation: Inspection of the facility noted that there was a shaver that was labeled as extra and is being used for multiple residents as well as multiple body washes
Corrective Action(s): Ensure that personal hygiene products are not shared between residents
Date to be Corrected: April 12, 2021
HYGIENE AND COMMUNICABLE DISEASE: 35040 - RCR s.63(1) - A licensee must ensure that all food is safely prepared, stored, served and handled.
Observation: Inspection of the facility noted that there were
nutritional supplements stored in cardboard in the medication fridge and in the clean utility room
Food fridge in the medication room required cleaning due to spilled liquids
Food in the freezer of a resident fridge had open, non labeled foods
Corrective Action(s): Ensure food is stored safely
Date to be Corrected: April 09, 2021
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