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
April 1, 2026
Contraventions:
A summary of the new or corrected contraventions found during the inspections are listed below.Code
Category/Description
3010 - CCLR 19(1)(a)
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: a criminal record check for the person
Corrective Actions Required: Ensure a CRC is obtained for all employees.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: May 11, 2026
Observations: Licensing audited 10 staff files. Three files did not contain record of criminal record check.
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 a record of character references is obtained for all employees.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: May 11, 2026
Observations: Licensing audited 10 staff files. Five files were missing the record of character references.
3010 - CCLR 19(1)(c)
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: a record of the person’s work history
Corrective Actions Required: Ensure a record of work history is obtained for all employees.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: May 11, 2026
Observations: Licensing audited 10 staff files. One file did not contain a record of work history.
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 a record of immunization status is obtained for all employee.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: May 11, 2026
Observations: Licensing audited 10 staff files. Two files were missing an immunization status.
3010 - CCLR 19(4)(a)
Description: A licensee must not employ a person in a community care facility as an educator or an assistant unless the person holds a valid certificate issued under Division 2 [Employee Qualifications], which must be verified by the licensee using a system established and maintained by the director of the early childhood educator registry
Corrective Actions Required: Ensure the validation of the certification is obtained for all employee.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: May 11, 2026
Observations: Licensing audited 10 staff files. Three files were missing the validation of the certificate.
3030 - CCLR 39(1)
Description: A licensee must ensure that children are supervised at all times by a person who is an educator, an assistant or a responsible adult.
Corrective Actions Required: Ensure children are supervised at all times by an educator/ assistant/responsible adult.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: May 11, 2026
Observations: Licensing observed a child from Group Child Care (30 Months to School Age) Program at PS 2, was all alone at the hallway outside the office area. A staff at the Group Child Care (Under 30 Months) program observed the child was all alone in the hallway. Licensing Officer observed the child all along and told the staff in the Group Child Care (30 Months to School Age) program. The staff from the Group Child Care (30 Months to School Age) Program came out from the classroom and asked the child "Why are you here?". The staff stated she was handling the garbage bag and asked the child to line up and stay with her while they were forming a "special group" to take the garbage bag from the classroom to the bin in the hallway; however, the child ran away.
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 records of immunization status must be kept for each child's file.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: May 11, 2026
Observations: Licensing audited 11 children's file. One file did not contain immunization status.
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 a record of medical practitioner is kept for each child.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: May 11, 2026
Observations: Licensing audited 11 children's file. One file did not contain a record of medical practitioner.
3070 - CCLR 57(2)(j)
Description: A licensee must keep, for each child, a record showing the following information: (j) a record of any person who is not permitted access to the child
Corrective Actions Required: Ensure a record of any person not permitted access to child is obtained in all children's file.
Corrective Actions Taken By Licensee:
Actions Required By Licensing:
To Be Corrected By: May 11, 2026
Observations: Licensing audited 11 children's file. One file did not contain a record of any person not permitted access to child.
3080 - CCLR 11(4)
Description: A licensee must display in a prominent place in the community care facility the certificate of any educator or assistant employed to work in the community care facility.
Corrective Actions Required: Ensure the certification or copy of the certificate for all staff are displayed in a prominent place.
Corrective Actions Taken By Licensee:
Actions Required By Licensing: Follow Up Inspection to be conducted.
To Be Corrected By: May 11, 2026
Observations: Licensing observed the certification or copy of the certificate of one ECE and one ECEA were not displayed in a prominent place.