PHYSICAL FACILITY, EQUIPMENT AND FURNISHINGS: 11220 - CCLR s.23(2) - A licensee must have first aid kits that are readily accessible to all employees, including while care is provided off the community care facility premises.
Observation: CCFL asked the 2 employees if they bring their 1st aid kit on outings (including transporting to/from school), in which they both denied.
Corrective Action(s): The 1st aid kit must be taken on all outings.
Date to be Corrected: 25/Apr/2023
STAFFING: 12040 - CCLR s.19(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 first met with the person and obtained all of the following: (a) a criminal record check for the person.
Observation: CCFL reviewed 4 employees' files. 1 employee held an RCMP CRC & the other employee had no CRC.
Corrective Action(s): Valid BC Ministry of Justice CRCs must be obtained by employees' 1st day of employment. W/o this, employees cannot work alone w/ children.
Date to be Corrected: 23/May/2023
STAFFING: 12050 - CCLR s.19(1)(b) - 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 first met with the person and obtained all of the following: (b) character references in respect of the person.
Observation: CCFL reviewed 4 employees' files. 2 employees lacked references.
Corrective Action(s): ≥ 2 references per employee must be obtained & verified by their 1st day of employment.
Date to be Corrected: 23/May/2023
STAFFING: 12070 - CCLR s.19(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 first met with the person and obtained all of the following: (d) copies of any diplomas, certificates or other evidence of the person's training and skills.
Observation: CCFL reviewed 4 employees' files. 2 employees lacked evidence of completing ≥ 20 hours of Responsible Adult courses.
Corrective Action(s): Evidence that employees have taken ≥ 20 hours of Responsible Adult courses must be obtained by their 1st day of employment.
Date to be Corrected: 23/May/2023
STAFFING: 12090 - CCLR s.19(1)(f) - 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 first met with the person and obtained all of the following: (f) evidence that the person has complied with the Province's immunization and tuberculosis control programs.
Observation: CCFL reviewed 4 employees' files. 2 employees lacked their immunization status.
Corrective Action(s): Employees' immunization status must be obtained by their 1st day of employment.
Date to be Corrected: 23/May/2023
STAFFING: 12150 - CCLR s.19(4)(b) - A licensee must not employ a person in a community care facility as (b) a responsible adult unless the person has the qualifications required under Division 2 [Employee Qualifications].
Observation: CCFL reviewed 4 employees' files. 2 employees lacked evidence of completing ≥ 20 hours of Responsible Adult courses.
Corrective Action(s): Evidence that employees have taken ≥ 20 hours of Responsible Adult courses must be obtained by their 1st day of employment.
Date to be Corrected: 23/May/2023
STAFFING: 12210 - CCLR s.23(1)(a) - A licensee must ensure that children have at all times immediate access to an employee who (a) holds a valid first aid and CPR certificate, provided on completion of a course that meets the requirements of Schedule C.
Observation: CCFL asked the 2 employees if they have a 1st aid/CPR certificate, in which 1 employee said yes but was unable to show evidence of it. The other employee was unsure.
Corrective Action(s): Children must always have access to ≥ 1 1st aid/CPR-certified employee.
Date to be Corrected: 23/May/2023
STAFFING: 12260 - CCLR s.29(c) - To qualify for employment in a community care facility as a responsible adult, a person must (c) have completed a course, or a combination of courses, of at least 20 hours duration in child development, guidance, health and safety, or nutrition.
Observation: CCFL reviewed 4 employees' files. 2 employees lacked evidence of completing ≥ 20 hours of Responsible Adult courses.
Corrective Action(s): Evidence that employees have taken ≥ 20 hours of Responsible Adult courses must be obtained by their 1st day of employment.
Date to be Corrected: 23/May/2023
STAFFING: 12430 - CCLR s.56(1)(b) - A licensee must keep current records of each of the following: (b) for each employee, the records required under section 19 (1) [character and skill requirements].
Observation: CCFL reviewed 4 employees' files. A substitute employee's CRC has expired.
Corrective Action(s): CRCs must be renewed before the 5-year expiry date.
Date to be Corrected: 23/May/2023
POLICIES AND PROCEDURES: 13050 - CCLR s.56(1)(c) - A licensee must keep current records of each of the following: (c) a record respecting compliance with section 22 (2) (b) and (c) [emergency training and equipment].
Observation: The last documented monthly fire drill was in 2022/Apr & the last documented annual emergency drill was in 2021/Nov. An employee stated that these drills are practiced regularly despite being undocumented. Fire drills & emergency drills are typed onto a single page.
Corrective Action(s): Monthly fire drills & annual emergency drills must be documented upon completion. CCFL suggests writing them immediately upon completion rather than typing them onto a single document.
Date to be Corrected: 23/May/2023
CARE AND/OR SUPERVISION: 14020 - CCLR s.34(2)(a) - Without limiting subsection (1), a licensee must ensure that (a) children attending a community care facility are divided into groups, with each group having no more children than that permitted in Schedule E.
Observation: CCFL reviewed last week's attendance & found that there were 25 children on the afternoon of 19/Apr/2023 & 24 children on the afternoon of 20/Apr/2023 & 21/Apr/2023.
Corrective Action(s): The licensed maximum capacity of ≤ 23 must never be exceeded.
Date to be Corrected: 25/Apr/2023
RECORDS AND REPORTING: 19070 - CCLR s.57(2)(a) - A licensee must keep, for each child, a record showing the following information: (a) name, sex, date of birth, medical insurance plan number and immunization status.
Observation: CCFL reviewed 9 children's files & found that 1 child lacked his PHN.
Corrective Action(s): All requirements of CCLR s.57 must be obtained by children's 1st day of care.
Date to be Corrected: 01/May/2023
RECORDS AND REPORTING: 19080 - CCLR s.57(2)(b) - A licensee must keep, for each child, a record showing the following information: (b) date of enrolment in the community care facility.
Observation: CCFL reviewed 9 children's files & found that 3 children lacked start dates.
Corrective Action(s): All requirements of CCLR s.57 must be obtained by children's 1st day of care.
Date to be Corrected: 01/May/2023
RECORDS AND REPORTING: 19090 - CCLR s.57(2)(c) - A licensee must keep, for each child, a record showing the following information: (c) daily attendance record, indicating for each day whether the child is absent or, if the child is present, the time of arrival and departure.
Observation (CORRECTED DURING INSPECTION): 1 child's arrival time was undocumented.
Corrective Action(s):
Date to be Corrected:
RECORDS AND REPORTING: 19100 - CCLR s.57(2)(d) - A licensee must keep, for each child, a record showing the following information: (d) name and telephone number of a parent, medical practitioner and emergency contact.
Observation: CCFL reviewed 9 children's files & found that 3 children lacked a medical practitioner's contact information.
Corrective Action(s): This field can never be left. If a child lacks a family doctor, the clinic or hospital they visit can be documented. If a child lacks all of these due to being new to BC, the licensee can make a note in the child's file to follow-up w/ their parent in the future.
Date to be Corrected: 01/May/2023
RECORDS AND REPORTING: 19160 - CCLR s.57(2)(i) - A licensee must keep, for each child, a record showing the following information: (i) a photograph or digital image of the child, and other information that can be used to readily identify the child in an emergency.
Observation: Several children lacked a photograph.
Corrective Action(s): All requirements of CCLR s.57 must be obtained by children's 1st day of care.
Date to be Corrected: 01/May/2023
RECORDS AND REPORTING: 19190 - CCLR s.57(3)(a) - A licensee must have in writing from a parent, and maintain at the community care facility, consent (a) to call a medical practitioner or ambulance in case of accident or illness if the parent cannot immediately be reached.
Observation: Only 14 children had emergency consent cards, which the 2 employees said are not taken during outings (including transporting to/from school).
Corrective Action(s): Emergency consent cards are required for all children, which must be taken on outings.
Date to be Corrected: 01/May/2023
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