Complaint Investigation

Inspection Information

Facility Type

Residential Care - 400

Received Date

20-Jan-2022

Subject

["Emotional Abuse","Staffing (Includes issues such as suitability, insufficient levels, etc.)","Reporting (Includes issues such as not reporting, insufficient reporting, etc.)"]

Contraventions: A summary of the new contraventions found during the inspections are listed below.

Code

Category/Description

A licensee must ensure that the performance of each employee is reviewed both regularly and as directed by the medical health officer under subsection (2) to ensure that the employee demonstrates the competence required for the duties to which the employee is assigned.

Observation: Through the investigation process, Licensing determined that a staff member had not had a performance review conducted regularly.

Corrective action: Ensure that the performance of each employee is reviewed both regularly and as directed by the medical health officer under subsection (2) to ensure that the employee demonstrates the competence required for the duties to which the employee is assigned. Action/s Required by Licensee: Licensee to submit a corrective action plan to Licensing specific to the contravention. Action/s Required by Licensing: On February 25, 2022, Licensee submitted a corrective action plan to Licensing. This corrective action plan included that a staff was to have a performance review conducted on March 2, 2022 and the staff was given a written warning for their personnel file. This corrective action plan was reviewed and accepted by Licensing. Follow Up Inspection required. On August 22, 2022, Licensing received an email from the Operations Manager which indicated the staff members employment was terminated on this date.

A licensee must ensure that a person in care is not, while under the care or supervision of the licensee subjected to any of the following types of abuse or neglect, as described in section 1 of Schedule D: emotional abuse

Observation: Through the investigation process, Licensing determined that staff had subjected a person in care to emotional abuse.

Corrective action: Ensure that a person in care is not, while under the care and supervision of the Licensee, subjected to emotional abuse. Action/s Required by Licensee: Licensee to submit a corrective action plan to Licensing specific to the contravention. Action/s Required by Licensing: On February 25, 2022, Licensee submitted a corrective action plan to Licensing. This corrective action plan included that a staff reviewed policies and procedures related to conduct and behaviour, confidentiality and respectful workplace, the staff was to have a performance review conducted on March 2, 2022 and a written warning added to their file. This corrective action plan was reviewed and accepted by Licensing. On February 25, 2022, Licensing received copies of policies and procedures that the staff member reviewed. Follow Up Inspection required. On August 22, 2022, Licensing received an email from the Operations Manager which indicated the staff members employment was terminated on this date.

Subject to subsection (3), if a person in care is involved in a reportable incident, the licensee must immediately notify a medical health officer, in the form and in the manner required by the medical health officer

Observation: Through the investigation process, Licensing determined that the facility had not immediately notified the medical health officer of a reportable incident.

Corrective action: Ensure that if a person in care is involved in a reportable incident, the licensee must immediately notify a medical health officer, in the form and in the manner required by the medical health officer. Action/s Required by Licensee: Licensee to submit a corrective action plan to Licensing specific to the contravention. Action/s Required by Licensing: On February 25, 2022, Licensee submitted a corrective action plan to Licensing. This corrective action plan included an email, dated February 25, 2022, that was sent to all staff and signed by the Support Services department which reviewed reporting of concerns. This corrective action plan was reviewed and accepted by Licensing.

A licensee must operate the community care facility in a manner that will promote the health, safety and dignity of persons in care

Observation: Through the investigation process, Licensing determined that staff had not demonstrated they had the character and skills necessary to carry out the duties assigned.

Corrective action: Ensure the community care facility is operated in a manner that promotes the health, safety and dignity of persons in care. Specifically, that all staff have the character and skills necessary to carry out the duties assigned. Action/s Required by Licensee: Licensee to submit a corrective action plan to Licensing specific to the contravention. Action/s Required by Licensing: On February 25, 2022, Licensee submitted a corrective action plan to Licensing. This corrective action plan included that a staff reviewed policies and procedures related to conduct and behaviour, confidentiality and respectful workplace which was received by Licensing on February 25, 2022, the staff was scheduled to have a performance review conducted on March 2, 2022 and the staff was given a written warning for their personnel file. This corrective action plan was reviewed and accepted by Licensing. Follow Up Inspection required. On August 22, 2022, Licensing received an email from the Operations Manager which indicated the staff members employment was terminated on this date.

Subject to subsection (3), if a person in care is involved in a reportable incident, the licensee must immediately notify a medical health officer, in the form and in the manner required by the medical health officer

Observation: Through the investigation process, Licensing determined that the facility had not immediately notified the medical health officer of a reportable incident.

Corrective action: Ensure that if a person in care is involved in a reportable incident, the licensee must immediately notify a medical health officer, in the form and in the manner required by the medical health officer. Action/s Required by Licensee: Licensee to submit a corrective action plan to Licensing specific to the contravention. Action/s Required by Licensing: On February 25, 2022, Licensee submitted a corrective action plan to Licensing. This corrective action plan included an email, dated February 25, 2022, that was sent to all staff and signed by the Support Services department which reviewed reporting of concerns. This corrective action plan was reviewed and accepted by Licensing.

A licensee must ensure that a person in care is not, while under the care or supervision of the licensee subjected to any of the following types of abuse or neglect, as described in section 1 of Schedule D: emotional abuse

Observation: Through the investigation process, Licensing determined that staff had subjected a person in care to emotional abuse.

Corrective action: Ensure that a person in care is not, while under the care and supervision of the Licensee, subjected to emotional abuse. Action/s Required by Licensee: Licensee to submit a corrective action plan to Licensing specific to the contravention. Action/s Required by Licensing: On February 25, 2022, Licensee submitted a corrective action plan to Licensing. This corrective action plan included that a staff reviewed policies and procedures related to conduct and behaviour, confidentiality and respectful workplace, the staff was to have a performance review conducted on March 2, 2022 and a written warning added to their file. This corrective action plan was reviewed and accepted by Licensing. On February 25, 2022, Licensing received copies of policies and procedures that the staff member reviewed. Follow Up Inspection required. On August 22, 2022, Licensing received an email from the Operations Manager which indicated the staff members employment was terminated on this date.

A licensee must ensure that the performance of each employee is reviewed both regularly and as directed by the medical health officer under subsection (2) to ensure that the employee continues to meet the requirements of this regulation,

Observation: Through the investigation process, Licensing determined that a staff had not had a performance review conducted regularly to ensure the staff continued to meet the requirements of the legislation.

Corrective action: Ensure that the performance of each employee is reviewed both regularly and as directed by the medical health officer under subsection (2) to ensure that the employee continues to meet the requirements of this regulation. Action/s Required by Licensee: Licensee to submit a corrective action plan to Licensing specific to the contravention. Action/s Required by Licensing: On February 25, 2022, Licensee submitted a corrective action plan to Licensing. This corrective action plan included that a staff was to have a performance review conducted on March 2, 2022 and the staff was given a written warning for their personnel file. This corrective action plan was reviewed and accepted by Licensing. Follow Up Inspection required. On August 22, 2022, Licensing received an email from the Operations Manager which indicated the staff members employment was terminated on this date.

A licensee must ensure that the performance of each employee is reviewed both regularly and as directed by the medical health officer under subsection (2) to ensure that the employee continues to meet the requirements of this regulation,

Observation: Through the investigation process, Licensing determined that a staff had not had a performance review conducted regularly to ensure the staff continued to meet the requirements of the legislation.

Corrective action: Ensure that the performance of each employee is reviewed both regularly and as directed by the medical health officer under subsection (2) to ensure that the employee continues to meet the requirements of this regulation. Action/s Required by Licensee: Licensee to submit a corrective action plan to Licensing specific to the contravention. Action/s Required by Licensing: On February 25, 2022, Licensee submitted a corrective action plan to Licensing. This corrective action plan included that a staff was to have a performance review conducted on March 2, 2022 and the staff was given a written warning for their personnel file. This corrective action plan was reviewed and accepted by Licensing. Follow Up Inspection required. On August 22, 2022, Licensing received an email from the Operations Manager which indicated the staff members employment was terminated on this date.

A licensee must ensure that the performance of each employee is reviewed both regularly and as directed by the medical health officer under subsection (2) to ensure that the employee demonstrates the competence required for the duties to which the employee is assigned.

Observation: Through the investigation process, Licensing determined that a staff member had not had a performance review conducted regularly.

Corrective action: Ensure that the performance of each employee is reviewed both regularly and as directed by the medical health officer under subsection (2) to ensure that the employee demonstrates the competence required for the duties to which the employee is assigned. Action/s Required by Licensee: Licensee to submit a corrective action plan to Licensing specific to the contravention. Action/s Required by Licensing: On February 25, 2022, Licensee submitted a corrective action plan to Licensing. This corrective action plan included that a staff was to have a performance review conducted on March 2, 2022 and the staff was given a written warning for their personnel file. This corrective action plan was reviewed and accepted by Licensing. Follow Up Inspection required. On August 22, 2022, Licensing received an email from the Operations Manager which indicated the staff members employment was terminated on this date.

A licensee must operate the community care facility in a manner that will promote the health, safety and dignity of persons in care

Observation: Through the investigation process, Licensing determined that staff had not demonstrated they had the character and skills necessary to carry out the duties assigned.

Corrective action: Ensure the community care facility is operated in a manner that promotes the health, safety and dignity of persons in care. Specifically, that all staff have the character and skills necessary to carry out the duties assigned. Action/s Required by Licensee: Licensee to submit a corrective action plan to Licensing specific to the contravention. Action/s Required by Licensing: On February 25, 2022, Licensee submitted a corrective action plan to Licensing. This corrective action plan included that a staff reviewed policies and procedures related to conduct and behaviour, confidentiality and respectful workplace which was received by Licensing on February 25, 2022, the staff was scheduled to have a performance review conducted on March 2, 2022 and the staff was given a written warning for their personnel file. This corrective action plan was reviewed and accepted by Licensing. Follow Up Inspection required. On August 22, 2022, Licensing received an email from the Operations Manager which indicated the staff members employment was terminated on this date.