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Community Care Facilities Licensing
FACILITY INSPECTION REPORT
HEALTH & SAFETY
JSAT-CAKU4L

FACILITY NAME
Ferguson Home
SERVICE TYPES
140 Community Living
FACILITY LICENSE #
TBIU-8F8MS5
FACILITY ADDRESS
32375 George Ferguson Way
FACILITY PHONE
(604) 850-1055
CITY
Abbotsford
POSTAL CODE
V2T 2L2
MANAGER
Karin Olsen

INSPECTION DATE
January 11, 2022
ADDITIONAL INSP. DATE (multi-day)
ADDITIONAL INSP. DATE (multi-day)
TIME SPENT (HRS.)
2.5
ARRIVAL
10:00 AM
DEPARTURE
12:30 PM
ARRIVAL
DEPARTURE
ARRIVAL
DEPARTURE
INSPECTION TYPE
Routine
# OBSERVED IN CARE
4

Introduction

An unscheduled routine inspection was completed to assess compliance with the Community Care and Assisted Living Act (CCALA) and the Residential Care Regulation (RCR) and the relevant Director of Licensing Standards of Practice (DOLSOP). 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.

Care systems reviewed during inspections include: Licensing, Physical Facility, Staffing, Policies and Procedures, Care and Supervision, Hygiene and Communicable Disease Control, Medication, Nutrition and Food Services, Program, Records & Reporting.

As part of the routine inspection a Facility Risk Assessment Tool is completed and a copy is provided. The Risk Assessment includes non-compliance identified during the routine inspection and a 3 year “historical” review of the facility’s compliance and operation.

Visit the CCFL website at 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: 31100 - RCR s.17 - A licensee must ensure that water accessible to a person in care, from any source, is not heated to more than 49° Celsius.
Observation: Water temperatures were taken in two area of the home accessible to persons in care, both areas checked had water temperatures exceeding 49 degrees.
Corrective Action(s): Ensure water temperatures accessible to persons in care, is not heated more than 49 degrees.
Date to be Corrected:

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: In one bathroom the following was observed:
-a drawer was missing a handle, making it difficult to open, and had a loose drawer front.
-There was rust on the side of some tile in the shower, above the rusted area there was a particle board shelf what appeared to have sustained some moisture damage from the nearby shower, and the shelving unit was swollen and damaged.
Corrective Action(s): Ensure all rooms and common areas are maintained in a good state of repair.
Date to be Corrected:

RECORDS AND REPORTING: 39320 - RCR s.83(4)(a) - Subject to subsection 83(5), a licensee, other than a licensee who provides a type of care described as Hospice, must (a) ensure that each person in care is weighed at least once each month.
Observation: Of two persons in care reviewed, both persons in care were missing monthly weights for 2/12 months, and 3/12 months, without a reason documented for the missing weight.
Corrective Action(s): Ensure that each person in care is weighted at least once each month.
Date to be Corrected:

RECORDS AND REPORTING: 39470 - RCR s.87(c) - A licensee must keep a record of the following matters respecting food services: (c) the results of monitoring, by the licensee, of food services and nutrition care.
Observation: Review of current menus and menu audits found that the current menu being used does not align with the last menu audit completed.
Corrective Action(s): Ensure any time the menu is updated or changed, there is a corresponding menu audit completed as well, counting how many items of each food group are being served on the menu.
Date to be Corrected:


Comments

It is requested that a written response be submitted on or before January 27th describing how the above noted contraventions have been appropriately addressed and/or the plan for compliance with legislated requirements. The plan shall include a time line for any items that have not already been addressed. Please note that a follow-up inspection may be conducted to confirm compliance after the written response has been received by Licensing.

Copies of the inspection report and the Facility Risk Assessment Tool were reviewed, discussed, and provided to the Licensee/Manager.

Action Required by Licensee/ManagerAction Required by Licensing Staff
Take corrective action to bring facility into compliance, Provide a written response to LicensingNo action required
Due Date
Jan 27, 2022

Click here for FAQ About Inspections.
Click here for a description of each "Category" of violation displayed.