PHYSICAL FACILITY, EQUIPMENT AND FURNISHINGS: 31270 - RCR s.21(d) - A licensee must ensure that all furniture and equipment for use by persons in care (d) are maintained in a safe and clean condition.
Observation: The sanitizing product used for surfaces, did not demonstrate evidence of any bactericidal capability.
Corrective Action(s): Please provide a plan to ensure that products used to sanitize the facility are bactericidal and appropriate instructions for use are clearly labelled.
Date to be Corrected: March 7, 2019
POLICIES AND PROCEDURES: 33220 - RCR s.85(1)(a) - A licensee must do all of the following: (a) have written policies and procedures for the purposes of guiding staff in all matters relating to the care and supervision of persons in care.
Observation: The residents do not carry Westminster House identification when off-site.
Corrective Action(s): Please ensure that residents carry identification as described above.
Date to be Corrected: March 7, 2019
RECORDS AND REPORTING: 39090 - RCR s.77(2)(c) - Subject to subsection (3), if a person in care is involved in a reportable incident, the licensee must immediately notify (c) a medical health officer, in the form and in the manner required by the medical health officer.
Observation: The non-reportable incident records were reviewed. One record documented an injury to a resident that required medical intervention. This incident should have been reported to licensing. A review of the type of incidents requiring reporting, and the specific circumstances. Using the Licensing officer as a resource, if there is doubt about the reportability of an incident is also encouraged. Resources were provided to the manager.
Corrective Action(s): Please provide a plan that will assure that incidents that require reporting are reported in a timely manner.
Date to be Corrected: March 7, 2019
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