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Community Care Facilities Licensing
FACILITY INSPECTION REPORT
HEALTH & SAFETY
NBIH-BK29XM

FACILITY NAME
The Madison
SERVICE TYPES
401 Long Term Care (Hospital Act)
FACILITY LICENSE #
LBAA-95YUG4
FACILITY ADDRESS
1399 Foster Av
FACILITY PHONE
(604) 936-9231
CITY
Coquitlam
POSTAL CODE
V3J 2N1
MANAGER
Annie Kinamore

INSPECTION DATE
December 18, 2019
ADDITIONAL INSP. DATE (multi-day)
December 19, 2019
ADDITIONAL INSP. DATE (multi-day)
December 20, 2019
TIME SPENT (HRS.)
7
ARRIVAL
10:30 AM
DEPARTURE
12:30 PM
ARRIVAL
10:30 AM
DEPARTURE
04:30 PM
ARRIVAL
09:00 AM
DEPARTURE
10:30 AM
INSPECTION TYPE
Routine
# OBSERVED IN CARE
137

Introduction

An unscheduled 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). Evidence for this report was based on the Licensing Officer’s observations, review of the facility records and information provided by the facility staff at the time of inspection.
The following areas were reviewed:
· Licensing
· Physical Facility
· Staffing
· Polices & Procedures
· Care & Supervision
· Hygiene and Communicable Disease Control
· Medication
· Nutrition and Food Services
· Program
· Records and Reporting
As part of the routine inspection a Facility Risk Assessment Tool is completed and a copy is provided. The Risk Assessment includes non-compliance identified during the routine inspection and a 3 year “historical” review of the facility’s compliance and operation.
Visit the Community Care Facilities Licensing website at https://www.fraserhealth.ca/health-topics-a-to-z/residential-care-licensing#.W2NubJioupo

Contraventions
Previous Inspection -
Current Inspection - Items reviewed comply with the Act, regulations & standards of practice.

Observed Violations
No violations were found during the inspection.

Comments

LO discussed some updating of forms with the contracting managers. Forms used for tuberculosis screening were missing checkboxes and referred to older versions of the regulations.

Action Required by Licensee/ManagerAction Required by Licensing Staff
No action requiredNo action required

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Click here for a description of each "Category" of violation displayed.