Island Health
1952 Bay Street Victoria, B.C. V8R 1J8 | Visit Official Website (opens in a new tab)
1952 Bay Street Victoria, B.C. V8R 1J8 | Visit Official Website (opens in a new tab)
Routine
June 7, 2024
Contraventions:
A summary of the new or corrected contraventions found during the inspections are listed below.Code
Category/Description
3000 - CCLR 16(4)(a)
Description: A licensee must ensure that all indoor and outdoor play materials and equipment accessible to children are suitable for the age and development of the children,
Corrective Actions Required: Ensure indoor material and equipment accessible to children are suitable for the age and development of the children.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Licensing observed that there was not an adequate amount of toys and supplies for the children in the Group Child Care (30 Months to School Age) program. Licensee Contact stated that toys were getting broken and staff were not replacing them.
3000 - SPS DOLSOP (Depth)
Description: Depth guidelines for loose fill material (if protective surfacing used) :
minimum 15 cm (6”) for 1.5 metre (5’) equipment height
minimum 30 cm (12”) for 2.3 metre (7’) equipment height
(Consider surfacing table, Triax, etc.)
Corrective Actions Required: Ensure six inches of protective surfacing is installed for equipment between five feet and seven feet in height.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Licensing observed that the surfacing under the spinning wheel on the composite climber measured between one to two inches and the underlay was exposed. The spinning wheel measured approximately six feet in height.
3010 - CCLR 19(1)(b)
Description: A licensee must not employ a person in a community care facility unless the licensee or, in the case of a person who is not the manager, the manager has first met with the person and obtained all of the following: (b) character references in respect of the person
Corrective Actions Required: Ensure staff files contain character references.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Licensing observed nine staff files this date. One file was missing a character references.
3010 - CCLR 19(1)(f)
Description: A licensee must not employ a person in a community care facility unless the licensee or, in the case of a person who is not the manager, the manager has first met with the person and obtained all of the following: evidence that the person has complied with the Province’s immunization and tuberculosis control programs
Corrective Actions Required: Ensure staff files contain an immunization status.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Licensing observed nine staff files this date. Six files were missing an immunization status.
3010 - CCLR 19(5)(c)
Description: Despite this section, a licensee may employ a person as a volunteer who does not provide care to children or supervise children if the licensee or the manager has first met with the person and obtained all of the following: evidence that the person has complied with the Province’s immunization and tuberculosis control programs.
Corrective Actions Required: Ensure volunteer files contain an immunization status.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Licensing observed one volunteer file which was missing an immunization status.
3010 - CCLR 22(2)(b)
Description: A licensee must ensure that each employee practices implementing the fire drill system at least once each month,
Corrective Actions Required: Ensure staff practice monthly fire drills.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Manager stated that the staff in the Group Child Care (School Age) program are not practicing montly fire drills. Licensing observed that the staff in the Group Child Care (30 Months to School Age) program have not consistantly practiced monthly fire drills.
3010 - CCLR 22(2)(c)
Description: A licensee must ensure that each employee practices implementing the emergency plan at least once each year.
Corrective Actions Required: Ensure staff practice implementing the emergency plan at least once annually.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Licensing observed that an emergency plan had not bee practiced in the past year.
3010 - CCLR 29(c)
Description: To qualify for employment in a community care facility as a responsible adult, a person must have completed a course, or a combination of courses, of at least 20 hours duration in child development, guidance, health and safety, or nutrition,
Corrective Actions Required: Ensure Responsible Adults have completed a course/combination of course of at least 20 hours in child development, guidance, health and safety or nutrition.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Licensing observed that one staff who worked in the Group Child Care (School Age) program as a Responsible Adult had not completed a course/combination of course of at least 20 hours in child development, guidance, health and safety or nutrition.
3070 - CCLR 57(2)(a)
Description: A licensee must keep, for each child, a record showing the following information: (a)name, sex, date of birth, medical insurance plan number (MSP number does not apply to REC only) and immunization status.
Corrective Actions Required: Ensure children's files contain a medical insurance plan number.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Licensing performed an audit of 11 children's files this date. Two files were missing a medical insurance plan number.
3070 - CCLR 57(2)(d)
Description: A licensee must keep, for each child, a record showing the following information: (d) name and telephone number of a parent, medical practitioner (doctor's name and number does not apply to REC only) and emergency contact
Corrective Actions Required: Ensure children's files contain medical practitioner information and an emergency contact.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Licensing performed an audit of 11 children's files this date. One file was missing medical practitioner information and two files were missing an emergency contact.
3070 - CCLR 57(2)(i)
Description: A licensee must keep, for each child, a record showing the following information:(i) a photograph or digital image of the child, and other information that can be used to readily identify the child in an emergency
Corrective Actions Required: Ensure children's files contain photo/digital image of the child.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Licensing performed an audit of 11 children's files this date. Four files were missing a photo.
3070 - CCLR 57(3)(b)
Description: A licensee must have in writing from a parent, and maintain at the community care facility, consent (b) to release a child to someone other than the parent.
Corrective Actions Required: Ensure children's files contain consent to release to someone other than the parent.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Licensing performed an audit of 11 children's files this date. Two files were missing consent to release the child to someone other than the parent.
3070 - CCLR 58(2)(a)
Description: The licensee must develop the care plan in consultation,with a parent of the child requiring extra support and any person requested by the parent.
Corrective Actions Required: Ensure care plans are developed in consultation with the parent and any person requested by the parent.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Licensing observed seven care plans this date. Two plans did not demonstrate that they were made in consultation with the children's parents.
3070 - SPS DOLSOP (Log Kept)
Description: Log kept of all inspections, maintenance & repairs
Corrective Actions Required: Ensure a log is kept of all inspections maintenance and repairs.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: July 7, 2024
Observations: Staff in the Group Child Care (30 Months to School Age) program stated that daily outdoor play space checks were completed, but not recorded.