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Community Care Facilities Licensing FACILITY INSPECTION REPORT HEALTH & SAFETY

LBUL-BLQR84

FACILITY NAME Rainbow Ridge Special Care Home		SERVICE TYPES 140 Community Living	FACILITY LICENSE # 1081489
FACILITY ADDRESS 10666 277th St			FACILITY PHONE (604) 462-9824
CITY Maple Ridge	POSTAL CODE V2W 1M7		MANAGER Leanne Porter

INSPECTION DATE February 12, 2020	ADDITIONAL INSP. DATE (multi-day)		ADDITIONAL INSP. DATE (multi-day)		TIME SPENT (HRS.) 3
ARRIVAL 09:30 AM	DEPARTURE 12:30 PM	ARRIVAL	DEPARTURE	ARRIVAL	DEPARTURE
INSPECTION TYPE Routine					# OBSERVED IN CARE

Introduction

A scheduled routine inspection was conducted to assess compliance with the Community Care & Assisted Living Act (CCALA), the Residential Care Regulation (RCR) and the relevant Director of Licensing Standards of Practice (DOLSP). The Practice Consultant was onsite to conduct this inspection, as part of a pilot project. This facility met the criteria necessary to participate in the project in which the Practice Consultant completed an abbreviated routine inspection. Areas inspected included: licensing, physical facility, staffing, policies and procedures, care and supervision, hygiene and communicable disease, nutrition and food services, medications, programming, records and reporting.

Contraventions

Previous Inspection -

Current Inspection - Items reviewed comply with the Act, regulations & standards of practice except for those noted on supplementary pages.

Observed Violations

STAFFING: 32100 - RCR s.40(1)(a) - 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 (a) continues to meet the requirements of this regulation. Observation: Fifty percent of staff did not have a regular performance evaluation completed. Corrective Action(s): Please submit a written response on how you will ensure that a regular performance evaluation is completed for each staff. Date to be Corrected: February 28, 2020 NUTRITION AND FOOD SERVICES: 37040 - RCR s.62(2)(b) - A licensee must ensure that each menu provides (b) for each day, at least 2 nutritious snacks, with each snack containing at least 2 food groups as described in Canada's Food Guide. Observation: The menu did not provide a second snack for one person and, for a second person, it only included food from one food group. [Information was provided as to why the menu did not meet this requirement and the exemption process was discussed during this inspection.] Corrective Action(s): An exemption request will need to be submitted to Licensing. Date to be Corrected: February 28, 2020

Comments

As part of this inspection, a Facility Risk Assessment Tool was completed and a copy provided to staff. The Risk Assessment includes non-compliance identified during the routine inspection and a three year “historical” review of the facility’s compliance and operation.

Action Required by Licensee/Manager	Action Required by Licensing Staff
Take corrective action to bring facility into compliance, Provide a written response to Licensing	No action required
Due Date Feb 28, 2020

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