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Community Care Facilities Licensing FACILITY INSPECTION REPORT HEALTH & SAFETY

JKAS-CMST8B

FACILITY NAME 123rd Home		SERVICE TYPES 140 Community Living	FACILITY LICENSE # 1081391
FACILITY ADDRESS 20878 123rd Ave			FACILITY PHONE (604) 463-5484
CITY Maple Ridge	POSTAL CODE V2X 4B2		MANAGER Peter Scheltgen

INSPECTION DATE January 05, 2023	ADDITIONAL INSP. DATE (multi-day)		ADDITIONAL INSP. DATE (multi-day)		TIME SPENT (HRS.) 4
ARRIVAL 10:30 AM	DEPARTURE 02:30 PM	ARRIVAL	DEPARTURE	ARRIVAL	DEPARTURE
INSPECTION TYPE Routine					# OBSERVED IN CARE 4

Introduction

An unscheduled routine inspection was conducted to assess compliance with the Community Care and Assisted Living Act (C.C.A.L.A.), the Residential Care Regulation (R.C.R.), and the relevant Director of Licensing Standards of Practice (D.L.S.P.). Evidence for this report was based on the licensing officer's observations, review of the facility records, and information provided by the facility staff at the time of inspection. The following areas were reviewed: - Licensing - Physical Facility - Policies and Procedures - Care and Supervision - Hygiene and Communicable Disease Control - Medication - Nutrition and Food Services - Program - Records and Reporting As part of this routine inspection a facility risk assessment tool is completed. The risk assessment includes contraventions identified during the routine inspection, and a 3 year historical review of the facility's compliance and operation. Visit the CCFL website at https://www.fraserhealth.ca/residentialcare for: -Additional resources and -Links to the Legislation(CCALA & RCR)

Contraventions

Previous Inspection -

Current Inspection - Items reviewed comply with the Act, regulations & standards of practice except for those noted on supplementary pages.

Observed Violations

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: Noted during inspection that a number of exit doors/door trim(2 exit doors in the front hallway and 1 french door off of the dining room) each have a number of dents, scrapes and missing paint. Corrective Action(s): Ensure that all rooms and common areas are maintained in a good state of repair. Date to be Corrected: January 19, 2023

Comments

This Licensing Officer would like to thank the Manager and Staff for their assistance in completing this routine inspection. The Licensing Officer did not have access to staff files during inspection and the manager has requested a staff checklist to be sent from Head Office, it will be emailed before January 6, 2023. Discussion with the manager, if checklist is not provided this will be added as a contravention. There is evidence of substitution tracking through 2021 and 2022. Discussion with the manager while on site to remind the team to note the date and year on the substitution list. Please provide a written response by January 19, 2023 indicating the corrective actions taken and/or time line and plan for compliance with legislative requirements. Please contact your Licensing Officer if you have any questions or concerns regarding this inspection report. (Please note: this inspection report was written on site, reviewed with manager and signed , a copy was provided to the manager.)

Action Required by Licensee/Manager	Action Required by Licensing Staff
Take corrective action to bring facility into compliance, Provide a written response to Licensing	No action required
Due Date Jan 19, 2023

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