Description: A licensee must ensure that all rooms and common areas are maintained in a safe and clean condition.

Corrective Actions Required: Ensure that all rooms and common areas are maintained in a safe and clean condition.

Corrective Actions Taken By Licensee:

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

To Be Corrected By: July 6, 2025

Observations: Licensing toured the facility and observed significant staining on the carpets located on the stairs. The Mental Health Worker stated this was an ongoing challenge for the facility.

Description: A licensee must ensure that all employees comply with the policies and procedures of the medication safety and advisory committee.

Corrective Actions Required: Ensure that all employees comply with the policies and procedures of the medication safety and advisory committee. Specifically, ensuring all medications remain in their labelled packaging.

Corrective Actions Taken By Licensee:

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

To Be Corrected By: July 6, 2025

Observations: Licensing audited the facility medication cart and observed one person in care's medication was not labelled by the pharmacy. The Mental Health Worker stated staff had removed the medication, from the previous packaging, which was labelled.

Description: A licensee must display a copy of the emergency plan in a prominent place in the community care facility.

Corrective Actions Required: Ensure that a copy of the emergency plan is displayed in a prominent place, in the community care facility.

Corrective Actions Taken By Licensee:

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

To Be Corrected By: July 6, 2025

Observations: Licensing toured the facility and did not observe an emergency plan, displayed in a prominent place, in the community care facility.

Description: A licensee must have, and keep with each person in care’s record, consent in writing from the person in care or a parent or representative of the person in care to call a medical practitioner, nurse practitioner or ambulance in case of accident or illness,

Corrective Actions Required: Ensure there is consent in writing but the person in care, or their representative to call a medical practitioner, nurse practitioner or ambulance in case of accident or illness.

Corrective Actions Taken By Licensee:

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

To Be Corrected By: July 6, 2025

Observations: Licensing audited two person in care's records and observed both records did not include consent, in writing, from the person in care or their representative, to call a medical practitioner, nurse practitioner or ambulance in case of accident or illness.

Description: A licensee, other than a licensee who provides a type of care described as Hospice, must provide persons in care, without charge, with an ongoing planned program of physical, social and recreational activities suitable to the needs of the persons in care

Corrective Actions Required: Ensure that there is an ongoing planned program of physical, social and recreation activities suitable to the needs of the persons in care.

Corrective Actions Taken By Licensee:

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

To Be Corrected By: July 6, 2025

Observations: Licensing reviewed the facility's recreation calendars for June 2025 and there were no ongoing planned recreation activities written.