| Peace Arch Hospital ECU - Complaint Information |
| General Details | |
|---|---|
| Facility Type | Residential Care (Hospital Act) - 400 |
| Investigation Completed | August 18, 2020 |
| Reason for Investigation | - Staffing - Care and supervision - Nutrition and food services - Program - Records and reporting |
| Report of Findings |
|---|
| Community Care Facilities Licensing [CCFL] received a complaint on June 25, 2020, alleging concerns regarding: · Care and supervision – neglect · Nutrition and food services · Program · Staffing · Records and Reporting – Dispute Resolution All areas of the complaint were fully investigated. This investigation was conducted in collaboration with Long Term Care Services, Quality Assurance Coordinators. Evidence was obtained and reviewed through interviews, on-site inspections, review of documentation, and the Long Term Services Investigation Report. The following contravention has been determined: · Residential Care Regulation (RCR) Section 52 (1)(a) Harmful actions not permitted – neglect · RCR Section 81 (4) (a) Care plan needed if more than 30 day stay · RCR Section 82 Implementation of care plans. · RCR Section 85 (1) (d) Policies and procedures |
| Substantiated Contraventions: Evidence for this summary report is based on a combination of the Licensing Officer’s observations, a review of facility records and information provided by the facility staff at the time of the investigation. |
| Observed Violations/Contraventions: A summary of the violations found during the complaint investigation are listed below. |
| Code | Category/Description |
|---|---|
| 33280 - RCR s.85(1)(d) | A licensee must do all of the following: (d) ensure that policies are implemented by employees. Observation: The licensee did not ensure that policies are implemented by employees. Corrective action: The licensee will provide a correction action plan. |
| 34120 - RCR s.52(1)(a) | A licensee must ensure that a person in care is not, while under the care or supervision of the licensee, subjected to (a) financial abuse, emotional abuse, physical abuse, sexual abuse or neglect as those terms are defined in section 1 of Schedule D. Observation: The licensee did not ensure that a person in care was not subjected to neglect. Corrective action: The licensee will provide a corrective action plan. |
| 34740 - RCR s.81(4)(a) | A licensee must ensure that (a) the implementation of each care plan is monitored on a regular basis to ensure proper implementation. Observation: The licensee did not ensure that the implementation of each care plan was monitored on a regular basis to ensure proper implementation. Corrective action: The licensee will provide a corrective action plan. |
| 34780 - RCR s.82 | A licensee must ensure that the care and supervision of a person in care is consistent with the terms and conditions of the person in care's care plan. Observation: The licensee did not ensure that the care and supervision of a person in care was consistent with the terms and conditions of the person in care's care plan. Corrective action: The licensee will provide a corrective action plan. |
| Actions Required by Licensee/Operator | |
|---|---|
| - Corrective action plan to be developed and submitted. |
| Action Required by Licensing Officer or Medical Health Officer | |
|---|---|
| - Review and monitor corrective action plan > Follow up inspection required. |
| Status Update |
|---|
| No further action required. All contraventions have been addressed. |
| Updated on September 11, 2020. |
