The Ministry of Health and Long-term Care found numerous problems of compliance with regulations at Bruce County-run Brucelea Haven long-term care home in Walkerton.
Procedures to ensure safety, staffing shortages, nursing certifications, the mishandling of complaints and testing of emergency plans were among the problems cited in the Dec. 24 ministry inspection report, which has been available online since Jan. 9.
The ministry issued six written notifications of non-compliance, two voluntary plan of corrections and three compliance orders, based on inspections done between Aug. 28 and Sept. 25.
Compliance orders were also issued to the home concerning plan of care, skin and wound assessments and sufficient staffing pursuant to a 2017 report, the latest report noted.
Brucelea Haven administrator Willy Van Klooser declined comment when reached Friday, deferring to the county spokesperson on this issue, Marianne Nero, director of human resources.
She said in an interview the administrator just sent the county’s “plan to make corrections” to the ministry which details which concerns have been addressed and a timeline for the rest to be dealt with.
“Some of them have been addressed. The majority still remain to be addressed,” Nero said. There will be biweekly calls with the ministry to update the progress, she said.
One staff training plan concerning procedures to follow when different codes are called will take 10 months to complete, she noted.
Education about resident rights, issuance of an event notification guide for charge nurses, implementing a new nursing master schedule, additional auditing protocols and a review of staff attraction and retention plans are part of the plan, she said.
Brockton Mayor Chris Peabody said he was upset when he read the Brucelea Haven inspection reports. He began asking questions about them at county council in December, he said. He’s the chair of the county homes committee and the Walkerton facility is in his municipality.
The facility was short 19 personal support workers at the start of 2018 but the county made hiring a priority and reduced the shortage to three PSWs, he said.
“That’s what all those problems are linked to, is the staffing issues,” Peabody said.
The county also invested $30,000 in a scheduling system for Brucelea Haven and its other long-term care home in Wiarton, Gateway Haven. And it is training frontline staff to give them more power to deal with problems, he said.
Peabody said the home administrator issued a published apology in a local paper in which he noted a health and long-term care ministry representative met with home and county staff in December.
The ministry person found “substantial progress” was made “and she was pleased with it, but more would need to be done,” Peabody said, citing that letter.
The inspection found Brucelea Haven failed to “ensure that the home was safe and secure” for its residents by failing to keep a door locked in a facility when all of the doors leading outside were supposed to be locked.
The report said police arrested an intruder in the building and a door leading to a patio was unlocked, the only exterior door which was.
The ministry issued an order requiring the home to come up with and document the process for checking all external doors, change door codes and develop a process for changing them to ensure resident safety. Nero said that was done before the Jan. 3 deadline.
Another notice said the home failed to ensure all nursing staff had current certificates of registration with the College of Nurses of Ontario, which came to light due to an anonymous complaint to the ministry.
A temporary nurse shouldn’t have been allowed to be “solely ‘in-charge’ or act in a formal leadership role,” the report said. The employer is responsible for “having sufficient resources” to monitor the temporary member.
In one case a registered nurse without permanent certification worked 15 night shifts without a second RN in the building as required. A registered practical nurse worked and administered medications during orientation without a licence, the report said.
A personal support worker working a first shift the night of the intruder incident said they didn’t know what to do if a “code” concerning the intruder were called.
A second order required the home to develop a process to ensure all staff who should be certified are before they perform any duties as a registered nurse, registered practical nurse or registered nurse in the extended class. It must be documented who checked to ensure the rules are being followed. This must be done by Jan. 21.
The report said the home failed to meet regulatory requirements to annually test plans that deal with a missing resident, medical emergencies and violent outburst; test others plans every three years; do an emergency evacuation at least every three years, and record these actions and plan improvements.
A third order issued to Brucelea Haven requires it to develop and implement testing and training for emergency plans related to loss of essential services, missing residents, medical emergencies and violent outbursts and to ensure staff complete the training. That must be done by next Oct. 31.
The home also failed to handle a complaint properly after a substitute decision-maker raised concerns that family members’ requests and concerns had not be heard concerning specific resident care issues.
The administrator apologized two months afterwards for not responding to the concerns faster. The administrator told the report’s inspector that after receiving an email about the complaint “they had not followed up with the complainant.”
The inspector found under the home’s policy, the administrator or designate should have contacted the complainant to gather information, then conduct and document an internal investigation and respond in writing within 10 business days.
Brucelea Haven was requested to prepare a written plan of correction for achieving compliance with the complaints policy.
The home was also found to have failed to comply with regulations in the intruder incident by not reporting it to the director as a “critical incident” within one business day. Critical incidents are those which affect the provision of care or the safety, security or well-being of one or more residents for a period greater than six hours.
The administrator, told of the intruder incident and the unlocked door, which remained so for three nights, didn’t view it as something that needed a Critical Incident System report. The administrator said because “there was no disruption of residents, staff were okay, and they had reviewed the criteria and could not discern what to report as nothing pointed to resident safety or care.”
The ministry required the home to prepare a plan to comply with the regulations to ensure such incidents are reported.
The home also failed to immediately forward written complains concerning care of a resident or the operation of the long-term care home to the director of health services as required, the report said.
In one case, the home didn’t submit the written complaint to the ministry for six weeks, after they were reminded of the concern by another staff member. The complaints concerned general care, medication administration and wound care, nutrition and falls prevention.