Description: A licensee must do all of the following: (b) operate the community care facility in a manner that will promote (i) the health, safety and dignity of persons in care,

Corrective Actions Required: Ensure that the licensee operates the community care facility in a manner that promotes 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 August 14, 2025, Licensee submitted a corrective action plan to Licensing. The corrective action plan included: staff were provided education regarding the expectation around documenting care provided, for all persons in care, during shift huddle from August 15 to 22, 2025, followed by Registered Nurses (RNs) completing weekly audits on documentation from August 25 to 29, 2025 and an email was sent to all care staff reminding them of the expectation to complete documentation regarding care provided, on August 22, 2025. The corrective action plan was reviewed and accepted by Licensing.

Corrective Actions Taken By Licensee:

Actions Required By Licensing: Follow Up Inspection to be conducted.

To Be Corrected By: September 25, 2025

Observations: Regarding intake dated June 30, 2025. Through the investigation process, Licensing determined that the licensee had not operated the community care facility in a manner that promoted the health, safety and dignity of persons in care. Specifically, related to documentation.