Description: A licensee must ensure that the performance of each employee is reviewed both regularly and as directed by the medical health officer under subsection (2) to ensure that the employee continues to meet the requirements of this regulation,

Corrective Actions Required: Ensure each staff has a regular performance review to ensure they continue to meet the requirements of the legislation.

Corrective Actions Taken By Licensee:

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

To Be Corrected By: July 17, 2026

Observations: Licensing reviewed five staff files and two staff files had performance reviews from October and November 2024.

Description: A licensee must keep the following records in respect of each employee: criminal record check results,

Corrective Actions Required: Ensure that criminal record check results are kept.

Corrective Actions Taken By Licensee:

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

To Be Corrected By: July 17, 2026

Observations: Licensing reviewed five staff files and four staff files had expired criminal record checks.

Description: A licensee must do all of the following: review and, if necessary, revise the policies and procedures at least once each year

Corrective Actions Required: Ensure the policies and procedures are reviewed and if necessary revised at least once each year.

Corrective Actions Taken By Licensee:

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

To Be Corrected By: July 17, 2026

Observations: Licensing observed the policies and procedures were last reviewed in March 2024.