Complaint Investigation
Inspection Information
Facility Type
Residential Care - 400
Received Date
23-Apr-2024
Subject
["Nutrition and Food Service (Includes issues such as consistency, quantity, quality, feeding assistance, timing, etc.)"]
Contraventions: A summary of the new contraventions found during the inspections are listed below.
Code
Category/Description
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 there was a lack of food substitution documentation.
Corrective action: Ensure to operate the community care facility in a manner that will promote the health, safety and dignity of persons in care. Action/s Required by Licensee: Licensee to submit a corrective action plan to Licensing specific to the contravention. Action/s Required by Licensing: On July 9 2024, Licensee submitted a corrective action plan to Licensing. The corrective action plan included that a nutritional binder with the menu was created by the Dietician and Executive Chef, which included nutritional guidelines for menu planning, food preparation, information on meal substitutions and planning and meal substitution tracking forms and audits, and that all requests made by persons in care were documented, submitted to the kitchen and recorded on the alternate meal form. The corrective action plan was reviewed and accepted by Licensing. On July 9, 2024, Licensing received a meal substitution tracking form and audit which included alternate meals provided to persons in care and a memo which indicated education was provided to the kitchen, nursing and recreation staff regarding the corrective action plan.
The licensee must take all reasonable steps to ensure that the food served to persons in care follows the menu and, if unable to do so because of unforeseen circumstances, that the food provided to persons in care meets the nutritional requirements set out in subsection (2).
Observation: Through the investigation process, Licensing determined that food served to persons in care was not consistent with the menu.
Corrective action: Ensure that food served to persons in care follows the menu and, if unable to do so because of unforeseen circumstances, that the food provided to persons in care meets the nutritional requirements set out in subsection (2). Action/s Required by Licensee: Licensee to submit a corrective action plan to Licensing specific to the contravention. Action/s Required by Licensing: On July 9 2024, Licensee submitted a corrective action plan to Licensing. The corrective action plan included that a nutritional binder with the menu was created by the Dietician and Executive Chef, which included nutritional guidelines for menu planning, food preparation, information on meal substitutions and planning and meal substitution tracking forms and audits, and that all requests made by persons in care were documented, submitted to the kitchen and recorded on the alternate meal form. The corrective action plan was reviewed and accepted by Licensing. On July 9, 2024, Licensing received a meal substitution tracking form and audit which included alternate meals provided to persons in care and a memo which indicated education was provided to the kitchen, nursing and recreation staff regarding the corrective action plan.