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03 - November 8, 2024 Homes Committes of Management Agenda PackageOZ5 ElgmCounty Homes Committee of Management Orders of the Day Tuesday, November 12, 2024, 11:00 a.m. Council Chambers 450 Sunset Drive St. Thomas ON Note for Members of the Public: Please click the link below to watch the Committee Meeting: https://www.facebook.com/ElginCountyAdmin/ Accessible formats available upon request. 1. Call to Order 2. Approval of Agenda 3. Adoption of Minutes 4. Disclosure of Pecuniary Interest and the General Nature Thereof 5. Delegations 6. Reports/Briefings 6.1 Homes — Committee of Management — Long -Term Care Director's Update July 1, 2024 — September 30, 2024 6.2 Homes — Committtee of Management — Long -Term Care Operational Report July 1, 2024 — September 30, 2024 7. Other Business 8. Correspondence 9. Closed Meeting Items 10. Motion to Rise and Report 11. Date of Next Meeting 12. Adjournment Pages 2 5 12 Homes Committee of Management Minutes August 13, 2024, 11:00 a.m. Council Chambers 450 Sunset Drive St. Thomas ON Members Present: Warden Ed Ketchabaw Deputy Warden Grant Jones Councillor Dominique Giguere Councillor Mark Widner Councillor Jack Couckuyt Councillor Andrew Sloan Councillor Todd Noble Councillor Mike Hentz Councillor Richard Leatham Staff Present: Blaine Parkin, Chief Administrative Officer/Clerk (virtual) Michele Harris, Director of Homes and Seniors Services Andrew Case, Solicitor Katherine Thompson, Manager of Administrative Services/Deputy Clerk Jenna Fentie, Legislative Services Coordinator Stefanie Heide, Legislative Services Coordinator (virtual) 1. Call to Order The meeting was called to order at 11.24 a.m. with Warden Ketchabaw in the chair. 2. Approval of Agenda Moved by: Councillor Widner Seconded by: Councillor Leatham RESOLVED THAT the August 13, 2024 Homes Committee of Management agenda be approved as presented. Motion Carried. 1 Page 2 of 29 3. Adoption of Minutes Moved by: Councillor Hentz Seconded by: Councillor Couckuyt RESOLVED THAT the minutes of the meeting held on June 25, 2024 be adopted. Motion Carried. 4. Disclosure of Pecuniary Interest and the General Nature Thereof None. 5. Delegations None. 6. Reports/Briefings 6.1 Director of Homes and Seniors Services - Homes — Committee of Management — Long -Term Care Director's Update April 1, 2024 — June 30, 2024 The Director of Homes and Seniors Services presented the report that provides an overview of recent updates and Ontario Health and Ministry of Long -Term Care announcements that impact the County of Elgin's three (3) Long -Term Care Homes. The report also provides an overview of projects and services occurring at the Homes to support quality services and care for residents and staff. Moved by: Councillor Couckuyt Seconded by: Deputy Warden Jones RESOLVED THAT the report titled "Homes — Committee of Management — Long -Term Care Director's Update April 1, 2024 — June 30, 2024" from the Director of Homes and Seniors Services dated August 13, 2024 be received and filed. Motion Carried. 6.2 Director of Homes and Seniors Services - Homes — Committee of Management — Long -Term Care Operational Report The Director of Homes and Seniors Services presented the report that provides an overview of day-to-day operations of the County's three (3) Long -Term Care Homes as well as pertinent departmental and committee updates and inspections for the period of April 1, 2024 to June 30, 2024. Moved by: Councillor Widner Seconded by: Councillor Leatham 2 Page 3 of 29 RESOLVED THAT the report titled "Homes — Committee of Management — Long -Term Care Operational Report" from the Director of Homes and Seniors Services dated August 13, 2024 be received and filed. Motion Carried. 7. Other Business None. 8. Correspondence None. 9. Closed Meeting Items None. 10. Motion to Rise and Report I101rem 11. Date of Next Meeting The Homes Committee of Management will meet again at the call of the Chair. 12. Adjournment Moved by: Councillor Widner Seconded by: Councillor Giguere RESOLVED THAT we do now adjourn at 12.09 p.m. to meet again at the call of the Chair. Motion Carried. Blaine Parkin, Warden Ed Ketchabaw, Chief Administrative Officer/Clerk. Chair. 3 Page 4 of 29 ElginCounty Report to Homes Committee of Management From: Michele Harris, Director of Homes and Seniors Services Date: November 12, 2024 Subject: Homes — Committee of Management — Long -Term Care Director's Update July 1, 2024 — September 30, 2024 Recommendation(s): THAT the report titled "Homes — Committee of Management — Long -Term Care Director's Update July 1, 2024 — September 30, 2024" dated November 12, 2024 be received and filed. Introduction: This report provides an overview of recent updates, and, Ontario Health, Ministry of Health, and Ministry of Long -Term Care announcements which impact the three (3) County of Elgin Long -Term Care Homes services and operations for the period of July 1, 2024 — September 30, 2024. Background and Discussion: Ministry Updates On July 15, 2024, the Ministry of Long -Term Care released an update to the Entrance Conference Checklist for Proactive Compliance Inspections. Information was circulated to the Homes Management and Continuous Quality Improvement teams to support inspection readiness. On July 15, 2024, the Ministry of Health released a memo related to the survey request for the 2024-2025 influenza and COVID-19 vaccine administration in long-term care who plan to partner with external providers for the administration of influenza and/or COVID-19 vaccine(s). The three County of Elgin Homes have the capacity and will be providing vaccinations without external support. On July 31, 2024, the Ministry of Long -Term Care released follow up communications related to the Alignment with the Health and Supportive Care Providers Oversight Authority (HSCPOA) for the Class of Personal Support Workers (PSW). The Act will allow PSWs to voluntarily register with the new HSCPOA effective December 1, 2024. Page 5 of 29 The ministry intends to continue to consult on proposed amendments to Ontario Regulation 246/22 this fall and winter to align its staffing qualifications with the registration pathways within the HSCPOA. In the interim, the current PSW qualification requirements within section 52 of the Ontario Regulation 246/22 continue to apply. On August 14, 2024, the Ministry of Long -Term Care released a memo reiterating the Fixing Long -Term Care Act requirements related to long-term care homes establishing Family Councils and the role that they play in representing the interests of families and residents along with a review of sections 65 -67 of the Act. This information was shared with the management team, including the Managers of Program and Therapy whom provide support to the Family Councils of the three Homes. On August 14, 2024, the Ministry of Health released a memo regarding Ontario's High - Risk Older Adult RSV Vaccine Program 2024-2025 and the importance of vaccinating high -risk groups, including LTCH residents. The Infection Prevention and Control Managers across the three Homes worked collaboratively with the Homes Medical Directors and Director to develop and implement a medical directive to support vaccine administration for residents. Information regarding the Ontario Seniors Dental Care Program and Application was received from Southwestern Public Health and communicated to residents and substitute decision makers of our Home. The Homes current contracted dental care provider supports is registered with the program which supports affordable access to dental care for residents of our Homes. On September 11, 2024, the Ministry of Long -Term Care released a memo providing further information regarding prpoposed amendments to Ontario Regulation 246/22. The Ministry has been working with key partners and stakeholders to support enhancements, greater flexibility in staffing and stability within the sector. Proposed amendments include: • Amending section 52 of the Regulation to fully align with the registration pathways for PSWs under the HSCPOA • Adding a permanent exemption to section 52 to provide LTCH licensees flexibility in leveraging resident support personnel • Amendments to registered dietitian requirements to enable health human resource flexibility while upholding resident care If approved, the ministry would propose that the amendments come into force on December 1, 2024 to align with the HSCPOA, and all other amendments would come into force on January 1, 2025. Ministry of Long -Term Care and Ontario Health West Reporting Long -Term Care Homes continue to have weekly, quarterly, annual and other one-time sensitive reporting and document extension/submission obligations and requirements which are completed within the authority of the delegation bylaw. Page 6 of 29 Reporting and documents submitted for the three County of Elgin Homes during the timeframe of July 1 — September 30, 2024, within the delegation bylaw include the following: Each home continues to complete the LTCH data submission (L9 Form) weekly to provide details regarding bed vacancies, bed rate changes, etc. Each home continues to submit, in consultation with finance and human resource department staff, quarterly staffing reports to the Ministry. Staffing reports were submitted prior to the deadline of August 16, 2024 for all 3 Homes. Agreements Executed The following agreements have been developed and executed in consultation with legal services, the procurement team, and, as required, the CAO, and align with the authority of the delegation bylaw. Laboratory services — Sole Source, only one provider available to provide scheduled phlebotomy services, specimen collection, ECG, and pick/updelivery for long-term care homes. o Agreement signed July 8, 2024 with LifeLabs and each of the three Homes — Bobier Villa, Elgin Manor and Terrace Lodge. o Costs are submitted to Ministry of Long -Term Care and fully funded through the Ministry phlebotomy funding. o Total costs are less than $15,000 annually. Registered Nurses Association of Ontario (RNAO) Clinical Pathways and Point Click Care (PCC) o Agreements signed July 31, 2024 to support the launch of RNAO clinical pathways. The three County of Elgin LTCH's are part of Cohort 7 to implement six clinical pathways/clinical support tools to support quality resident care and services over a three-year period. o An agreement was signed with both RNAO for the usage of clinical pathway support tools and project support; and, an agreement with Point Click Care for access to the assessments and project related PCC updates. o Software and access costs are funded through the Integrated Technology System funding (former clinical support tools/medication safety technology funding). Southwestern Public Health and Corporation of the County of Elgin — Provincial COVID-19 Vaccine Solution Letter of Agreement signed on August 12, 2024 supporting the provision of COVID-19 vaccine to the three County of Elgin Homes. Vaccine administration documentation requirements are met via documenting within the "Covax" provincial system. Point Click Care (PCC) Single Sign On Agreement signed on September 10, 2024 to provide additional cyber security measures for all staff utilizing PCC. Project Updates Page 7 of 29 E-connect project implementation has been paused due to a PCC system issue. It is anticiptated that implementation efforts will resume by year end. RNAO Clinical Pathways implementation will support quality resident care and service delivery; and, is anticipated to support future positive Ministry inspection outcomes. o Clinical support tool implementation o Three (3)-year project with year 1 focus including Admission Assessment, Delirium Assessment, and Resident and Family Centred Care Assessment o Training began in September 2024 and "go live" date will be March 2025 o Staff training costs will be funded through ministry one-time funding o PCC updates will be implemented by Home staff with the support of Point Click Care o Policy and procedure and assessment updates will be developed and implemented to streamline processes, reduce duplication, standardize assessments and align with legislative requirements RNAO Best Practice Guideline Launch "Developing and Sustaining Leadership" o Completion of Gap Analysis o Registered staff training planned for early 2025 Policy and Procedue Updates The following policies and procedures were reviewed and revised by the Director of Homes and Seniors Services in collaboration with the respective departmental managers to align with the Fixing Long -Term Care Act (FLTCA), 2021 and Ontario Regulation 246/22. Policy Policy #/Name Revision Revisions Manual Date Administrati 1.35 August Updated to align with July 2024 MLTC on — Section Visitors and 2024 updates — essential caregiver access 1 Resident and age of essential caregivers updates Absences During a Disease Outbreak, Epidemic or Pandemic 3.8 Terrace July 2024 New Policy — policy and procedure to Lodge Pool, support the resumption of aquatic Emergency programming Action Plan Nursing Section C Catheter August Updated to best practice and IPAC best policies — 2024 practice; deletion of irrigation policy as 1. Catheter best practice and evidence no longer Care — Daily recommends intermittent irrigation 2. Catheter irrigation — deleted Page 8 of 29 3. Catheter — intermittent 4. Catheter — indwelling 5. Catheter- suprapubic Section H Heat Related August To align with legislation - air Illness 2024 conditioning verbiage updates related Prevention and to situations in which air conditioning is Management not required and related monitoring and Plan interventions Maintenance 2.14 Pool August Classification of pool updated for rental Maintenance 2024 agreement/public use Class A; and Class B for Life After Stroke (LAS) Adult Day Program (ADP) clients 2.14 A Pool August Updated to current version of Public Log book 2024 pool inspections and records logbook 2.15 HVAC August Updated to include July 1, 2024 2024 legislative updates — inspections, additional interventions to reduce heat and humidity Program 1.13 Terrace September WhisperGLIDE wheelchair swing. and Lodge only 2024 New policy to support implementation Therapy New — of wheelchair swings at Terrace Lodge WhisperGLIDE as part of the "Comforts of Home" Wheelchair fundraising project. Swing Financial Implications: On July 12, 2024 the Ministry of Long -Term Care announced that the funding for the "Hiring More Nurse Practitioners (HMNP) in Long -Term Care" initiative would be provided as base funding going forward for all homes approved for funding under the HMNP program. The HMNP initiative was announced on October 5, 2022 as a three- year investment to hire and retain NP's in the LTC sector. The County of Elgin Homes investigated the potential of the HMNP opportunity in 2022 but found that the allotted funding amount was insufficient to attract and retain NP's without additional investment. On July 31, 2024, the Ministry of Long -Term Care announced that they will be adopting a new mandatory standard for quarterly resident assessments, advised by the Canadian Institute for Health Information (CIHI). The current RAI-MDS 2.0 Assessment Instrument and Continuing Care Reporting System (CCRS) will be replaced by the new interRAI Long -Term Care Facilities (LTCF) Assessment Instrument and Integrated interRAI Reporting System (IIRS) in Ontario Long -Term Care Homes by April 1, 2026. A call for early adopters was received on August 23, 2024, and on September 24, 2024, the Ministry of Long -Term Care announced that a total of 50 early adopter Homes will be implementing the LTCF beginning fall 2024. The transition for most Homes will occur in the 2025-26 fiscal year (April 1, 2025 — March 31, 2026) with additional opportunities to volunteer for subsequent phases of the transition. Page 9 of 29 Elgin County Homes will be following communications and updates regarding the LTCF closely and will work with Point Click Care to ensure appropriate updates to assessments are implemented. The Director, Administrators, Managers of Resident Care and MDS-RAI coordinators will be working closely with our partners to make any necessary adjustments in policy, procedure, assessments, and auditing to support/maintain current Case Mix Index (CMI) during, and following, the transition, which ultimately may impact Level of Care Funding. On August 22, 2024, the Ministry of Long -Term Care released a memo regarding funding for the 2024-2025 (April 1, 2024 — March 31, 2025) Comprehensive Minor Capital Fund. Eligible long-term care homes will receive funding towards Infection Prevention and Control (IPAC) Minor Capital funds for minor capital improvements directly linked to improved IPAC practices, Long -Term Care Minor Capital funding to maintain and extend the life of LTCHs, and Falls Prevention Equipment Fund as base funding targeted to help reduce the number of falls and fall related injuries in LTCHs and promote increased mobility and enhanced safety and quality of life for LTC residents. As part of 2024 budget planning, in consultation with finance department, the Homes budgeted based on prior years funding. With the August 22, 2024 announcment, a analysis of budgeted versus actual funding was conducted and is outlined in the table provided below. The Homes approach to minor capital spending was conservative while awaiting the funding announcement and spending will not exceed actual funding. 024-25 Comprehensive Min cir Capitau IHolime Budgeted ActuaL Perfoirmane BobierVitla 192,498 86,465 (16,033) A lla"JOUir bl,e- IEI,gjin Mainoir 129,997 99,17.E �39,822) UnfaVOUirabl.e Tenrace (Lodge 176,830 148,49 (28,334) A lla"JOUir bl.e On September 17, 2024, the Ministry of Long -Term Care released a memo reminding LTCHs to complete and submit the 2024 in -year occupancy report to specify resident days and co -payment revenue for the period of January 1, 2024 to September 30, 2024. This information will be used to inform of potential adjustments to the monthly cash flow (payment notices) due to change in occupancy rates. Finance departmental staff completed and submitted the report within the required timelines. On September 27, 2024, the Ministry of Long -Term Care released a memo advising long-term care homes to complete the "2023-2024 One -Time Funding Increase Reporting Template" by November 1, 2024. This report was submitted with the support of the finance department, incorporated discussion with facilities, and includes details for actual and planned/projected usage of the funding. Alianment with Strateaic Priorities: Page 10 of 29 Serving Elgin Growing Elgin Investing in Elgin ® Ensuring alignment of ❑ Planning for and ® Ensuring we have the current programs and facilitating commercial, necessary tools, services with community industrial, residential, and resources, and need. agricultural growth. infrastructure to deliver programs and services ® Exploring different ways ® Fostering a healthy now and in the future. of addressing community environment. need. ® Delivering mandated ® Enhancing quality of programs and services ® Engaging with our place. efficiently and effectively. community and other stakeholders. Local Municipal Partner Impact: The announcements from the Ministry of Long -Term Care and Ontario Health West support the quality of care and support positive outcomes for the three County of Elgin Long -Term Care Homes as staff and managers work collaboratively to provide care and services to the residents of our Homes and community clients. Communication Requirements: Information has been communicated to the appropriate departments, resident council, family council, residents, staff and visitors as required. Conclusion: The long-term care homes management team continues to be thankful for the support from Council, the Chief Administrative Officer, the Senior Management Team, and the staff in all departments as we work collaboratively to maintain and improve the quality of services and care for our residents, families, staff and communities. All of which is Respectfully Submitted Michele Harris Director of Homes and Seniors Services Approved for Submission Blaine Parkin Chief Administrative Officer/Clerk Page 11 of 29 ElginCounty Report to Homes Committee of Management From: Michele Harris, Director of Homes and Seniors Services Date: November 12, 2024 Subject: Homes — Committtee of Management — Long -Term Care Operational Report July 1, 2024 — September 30, 2024 Recommendation(s): THAT the report titled "Homes — Committee of Management — Long -Term Care Operational Report July 1, 2024 — September 30, 2024" dated November 12, 2024 be received and filed. Introduction: This report provides an overview of the day-to-day operations of the three (3) County of Elgin Homes along with pertinent departmental and committee updates and inspections for the period of July 1, 2024 to September 30, 2024. Backaround and Discussion: Ministry of Long -Term Care (MLTC) Compliance Inspection Visit Reports Summary Ministry of Long -Term Care inspections are unannounced and last from 1 day to 2 weeks depending on the purpose of the inspection. There are several types of inspections of long-term care homes as follows: Reactive Inspections which are done in response to complaints or critical incident submissions and generally focus on the substance of the complaint or incident; and follow up -inspections conducted to ensure that any compliance orders have been addressed. Proactive Inspections are broad -based inspections carried out on a regular basis to ensure that a home is in ongoing compliance with the Act and Regulation. Other types of inspections include pre -occupancy inspections and post - occupancy inspections visits to a home undergoing the development/redevelopment of beds. There were no MLTC inspections at any of the County of Elgin three LTCH's during the timeframe of July 1 — September 30, 2024. Page 12 of 29 Critical Incident Systems Report Summary for all Three Homes Types of Critical Incidents — July 1, 2024 — September 30, 2024 Total Number — Three Homes Abuse & Neglect — Any alleged, suspected or witnessed abuse of a 28 resident by anyone or neglect of a resident by the licensee or staff that resulted in harm or risk of harm to the resident, misue or misappropriation of residents' money, misuse or misappropriation of funds provided to licensee. Unlawful or Improper or Incompetent Treatment or Care — Includes care of 2 a resident that resulted in harm or risk of harm to resident. Unexpected Death — Including a death resulting from an accident or 0 suicide. Medication Incident — Includes a medication incident or adverse drug 0 reaction in respect of which a resident is taken to hospital. Environmental Hazard — Includes breakdown or failure of the security 1 system or major equipment or a system in the Home that affects the provision of care or the safety, security, or well-being of residents for a period greater than six hours Disease Outbreak 3 Contamination of Drinking Water Supply 0 Incident that Causes Injury and Transfer to Hospital — Includes injury in 3 respect of which a person is taken to hospital resulting in a significant change in status Controlled Substance Missing/Unaccounted — Includes missing or 1 unaccounted for controlled substance Written complaint 8 The above noted critical incidents have been reviewed and internally investigated. It is important to note that the abuse and neglect critical incident reporting includes "harm or risk of harm". Each of the three Homes have a memory care resident home area supporting mild to severe cognitively impaired residents that may, at times, and despite interventions, exhibit responsive behaviours resulting in "risk of harm". The Homes are diligent in reporting responsive behaviours in the "risk of harm" category with 25 of the 28 reports falling into this category. Follow up to each incident is conducted by the management team in collaboration with both the internal and external Behavioural Support Ontario (BSO) teams and is ongoing to develop interventions and update plans of care to support all residents on the memory care resident home areas and throughout the Homes. Eight written complaints were received in this quarter in relation to entry to the home, potential breach of information, concerns related to care, and communications related to dietary intake; and, appropriate follow up was completed. Page 13 of 29 The management team and continuous quality improvement team have developed and implemented a plan of action to address all of the critical incident related areas and written complaints, including, but not limited to, providing additional training and education as required. Outbreaks Home Number of Timeframe of # of Residents Outbreaks and Outbreak Impacted Agent Bobier Villa 0 N/A N/A Bobier Villa recently celebrated 1 year outbreak free! Elgin Manor 2 outbreaks #1 — July 1 — July #1 — 22 #1 — COVID-19 18, 2024 #2 — 3 #2 — COVID-19 #2 —July 23 — July 30, 2024 Terrace Lodge 1 outbreak July 11 — July 15, 2 Rhinovirus 2024 Infection Prevention and Control (IPAC) managers continue to participate in the IPAC Hub and community of practice meetings. Ongoing collaboration with Southwestern Public Health continues to support accuracy in decision -making and planning regarding updated circulating pathogens, guidance documents and policy and procedures. The IPAC teams across the Homes have been providing education to residents and families and promoting the Fall COVID vaccine campaign. Some residents may be ineligible for the fall COVID vaccine based on recent COVID infections. Mandatory Masking The July 2024 outbreaks at Elgin Manor and Terrace Lodge occurred during a timeframe when Public Health was reporting increased respiratory activity, and when masking was not mandatory. Based on an analysis of local and regional IPAC data including respiratory activity and outbreaks in Elgin and Oxford health care facilities, a decision was made by the Homes management team to resume "mandatory masking" for all staff, students and volunteers at the three County of Elgin LTCHs in early October. Masking is strongly recommended, but not mandatory, for all visitors to the Homes. Mandatory masking will be evaluated throughout the cold and flu season and will be adjusted, where supported by local and regional data. This information was communicated to resident and family council and was highly supported by both residents and families. Page 14 of 29 Vaccination Updates Information and promotion of the RSV vaccine was circulated to all residents and families and a high percentage of residents across our 3 Homes received the RSV vaccination. The COVID-19 vaccine was not available to residents during the month of September while awaiting the updated COVID-19 vaccine. COVID-19 and Influenza vaccinations will be prioritized in October and November across the 3 Homes. Fall Preparedness — Soutwestern Public Health Assessments Each of the 3 County of Elgin Homes has been "gearing up" for "Fall Preparedness". IPAC assessments have been completed alongside staff from Southwestern Public Health to support the Homes preparedness for cold and flu season. Recommendations were provided to the Homes IPAC managers by SWPH to support readiness and work is being done to implement the recommendations. Each Home IPAC team conducts IPAC audits and provides staff, residents and visitors with education to support IPAC measures — hand hygiene, personal protective equipment, passive and active screening for symptoms, etc. Elgin Manor has developed new signage as part of the visitor education campaign. Each Home is conducting hand hygiene audits weekly to support best practices and to minimize the risk of infection transmission. Occupancy Data A 97 % occupancy rate is required to support full ministry funding. All 3 Homes continue to work diligently to support >97% occupancy rates. Bobier Villa Occupancy Data excluding respite bed July 1 — September 30, 2024 Occupancy 99 % Admissions (Move -Ins) 6 Discharges 6 Elgin Manor Occupancy Data excluding respite bed July 1 — September 30, 2024 Occupancy 99 % Admissions (Move -Ins) 13 Discharges 13 Terrace Lodge Page 15 of 29 Occupancy Data excluding respite bed July 1 — September 30, 2024 Occupancy 99% Admissions (Move -Ins) 7 Discharges 8 Health System Partners (i.e. Fire, Public Health, Ministry of Labour) • Monthly fire drills and health and safety inspections are conducted each month on all shifts at all three Homes • Terrace Lodge had a Food Safety Inspecton in July 2024 with Southwestern Public Health; there were no findings of non-compliance. • Elgin Manor received a field/site visit from the Ministry of Labour, Immigration, Training and Skills Development on August 23, 2024 to review infection prevention and control of COVID 19 measures. No orders were issued during the inspection. • Bobier Villa received a field/site visit from the Ministry of Labour, Immigration, Training and Skills Development on September 18, 2024. The inspector was onsite regarding workers caring for residents with responsive behavours. Two orders were issued regarding completion of the 2024 workplace violence risk assessment; and, protection of the worker while providing care for residents with responsive behaviours. The timeline for corrective action related to the orders was October 4, 2024. The required actions were taken within these timelines, however, an extension was requested and provided due to the joint health and safety committee (JHSC) member's schedule and requirement of the JHSC member to sign to indicate compliance. • The Homes are each preparing for their annual fire evacuation and inspection. This year each home is also preparing for mandatory evacuation exercises. Dietary and Housekeeping/Laundry Departmental Updates Department Bobier Villa Elgin Manor Terrace Lodge Dietary Recreation and The residents Terrace Lodge dietary staff enjoyed local main kitchen collaboration harvest produce remains "under continues to including corn on renovation". support Chemed the cob, Staff should be meals. watermelon and commended for August — the teams yellow beans. having adjusted to worked together to reduced work make Eggs Theme days have spaces and Benedict; and, in kept the kitchen revised job September they busy with routines in the hosted a "Fall Fair" traditional meals main kitchen to whereby residents for Camp Day, accommodate enjoyed live Country Hoedown renovations. entertainment and Lunch and Page 16 of 29 pulled pork and Flavours of the For the month of homemade Carribbean. August residents coleslaw. enjoyed fresh There were no vegetables and There were no public health fruit including public health kitchen raspberries, kitchen inspections inspections during strawberries, during this this timeframe. blueberries, timeframe. peaches, honeydew, wax/green beans, and corn on the cob. Food Committee Relocation of the Food committee Residents barbeque location members helped thoroughly so that residents inspire the enjoyed the "BBQ could enjoy the flavours of each Thursday" that smells of BBQ theme day. took place from days and watch July through to their food being September. cooked on the grill. Housekeeping/laundry Acknowledgement The The to the Housekeeping Housekeeping housekeeping team are working team are working team —their through the Public through the Public exceptional, Health Ontario Health Ontario diligent cleaning modules for "IPAC modules for "IPAC and IPAC practices for Environmental for Environmental has supported zero Cleaning in Health Cleaning in Health outbreaks this Care". Care". quarter. This training will This training will support ongoing support ongoing continuous continuous education education reflective of IPAC reflective of IPAC best practices. best practices. Joint Health & Safety One additional staff Code Drills —Code Monthly Code certified as a JHSC White and code Drills with team member! Brown policy members creating reviewed and poster boards to education increase staff Regular provided. awareness. inspections and fire drills Regular Violence in the inspections and Workplace fire drills Assessment completed Page 17 of 29 Regular inspections and fire drills Resident & Family Council Updates Resident Council Bobier Villa Elgin Manor Terrace Lodge July July 18t", 2024 Resident Council July 8, 2024 - Treasurer's Meeting scheduled Sharing and Report and took place on July discussing updates - Bill of Rights 23rd, 2024 and memo review — review - Bill of Rights redevelopment - Family Suite - Home's Mission project updates, air Update Statement exchange vents, - Age -wise - Eulogy menu boards, Solutions — Memories dessert options, introduction of - Admissions & receiving dock, Social Worker Discharges visitor washroom - Program update, entrance Calendar access, review of Review residents rights, - Suggested question related to programs for the meaning of future "compliance"; - Treasurer's memo review — Report accommodation - Front door rate changes, IPAC situation updates and - Front door vaccination, and bump masking. - Emergency planning - Outbreak update - Listeria concern in media August Residents Council Resident Council August 12 Meeting scheduled Meeting scheduled Discussion topics: and took place on and took place on Air exchange vents, August 14t" 2024 August 22, 2024 menu boards, - Postponement - Resident's Bill washroom of August of Rights review response times, Residents' - Eulogy OARC renewal and Council- Memories payment, IV Residents - Admissions & therapy, washroom Council in Discharge update lobby, agreeance. recreation Page 18 of 29 - Program calendars (new Calendar larger size), Review Olympic Games - Suggested enjoyment, programs for enjoyment of local future fresh produce and - Treasurer BBQs, upcoming Report CQI meeting - Request for invitation "dollar like items" in the August 29 Gift Shop - Mel's place light Discussion topics: repair Air exchange vents, - Outdoor pole entrance door time repair update, washroom - RSV, Covid, & response update, Flu Vaccines review of resident update rights (#17, 18, 19), redevelopment bowling tournament and process for lottery license, new administration clerk, update redevelopment, new genealogy program, draft September recreation calendars, legislation and meal service update, CQI meeting update, Emergency Codes, draft resident and family satisfaction survey review; memo redevelopment update Aug. 30 September Residents Council Resident Council September 13 Meeting scheduled Meeting scheduled Discussion topics: and took place on and took place on Air Exchange Vents September 19t", September 19t", 2024 Update, resident 2024 - Bill of Rights council week, - Treasurer's review refrigeration of Report personal items, Page 19 of 29 Bill of Rights review Resident & Family Satisfaction Survey Purchase of Large Hallway Clock by Residents' Council Silent Auction in November Eulogy memories - Admissions & Discharge - Program Calendar Review - Treasurer Report - Suggested program(s) for future - Hairdressing services - Annual Satisfaction Surveys - Staff hiring Fire Map, Fire Drills, Planned annual evacuation in October religious and spiritual care update, birds nest update, redevelopment memo, recreation program update, whisper glide swing program and policy, IPAC update re- vaccination, community outings update, CQI meeting date and time, Emergency codes cards and poster, resident and family satisfaction survey September 26 Discussion topics: Air exchange vents update, lift batteries, resident rights review (#20, 21, 22), OARC membership update, IV therapy, religious and spiritual care, birds nest update, large tree in courtyard, camera monitoring front entrance, shower room, family council invitation cards, IPAC update — flu season and vaccinations, IPAC masking conversation, shingles vaccination, resident and family satisfaction survey, visitor policy, memo — enhanced Page 20 of 29 masking and IPAC measures Family Bobier Villa Elgin Manor Terrace Lodge Council July Family Council Family Council Monthly Meeting scheduled Meeting scheduled on on July 17t" 2024,- July 12t" 2024 Meeting information no members in - Cancelled as communciated but attendance, Family per Family members unable to Council meeting Council due to attend minutes posted and outbreak virtually/inperson sent to members. Recruitment efforts ongoing (posted in the Home, sent via email/newsletter); options to communicate via meetings available in person/phone/zoom to support attendance. August Family Council Family Council Monthly Meeting scheduled Meeting scheduled Meeting information on August 21st, and took place on communciated but 2024, no members in August 9t"7 2024 members unable to attendance, Family - Home Updates attend Council meeting - Introduction of minutes posted and Social worker in sent to members. the Home Information sent - Introduction of electronically to Quality members Improvement Co-ordinator - Capital projects - IPAC updates - Glove Dispenser's in Residents' Rooms September Family Council Family Council Monthly Meeting scheduled Meeting scheduled Meeting information on September 18t" and took place on communciated but 2024, no members in September 13t"7 2024 members unable to attendance, Family - Home updates, attend. Council meeting specifically Page 21 of 29 minutes posted and related to front sent to members. door access - IPAC Updates including communications of outbreaks - Introductions to new Resident Care Coordinator and Education & Quality Improvement Coordinator - Director Memo of Family Council - Annual Family & Residents Satisfaction Survey - Upcoming Quarterly Continuous Quality Improvement Meeting Crafter's Market on November 23rd, 2024 Program and Therapy Department Updates Item Bobier Villa Elgin Manor Terrace Lodge Special Programs & Country of Celebration of the Mistyglen Event Highlights Discover: Canada, commencement of Creamery and Greece, Paris the Summer Farm Outing Olympics Celebration of the Ruby's Cookhouse commencement of Bus Outing — Order -in the Summer Shaw's Ice Olympics Cream,Mackies, Aylmer Burger Boston Pizza Stand Order -in Watermelon Social Lemonade Social Celebration of Life Walkers Dairy Bar Cooking Outing Demonstration with Fitness with Larry Recreation: Make Aylmer Bandshell your own Pizza Concert in the Park Page 22 of 29 Bus Trip — GTs in Port Stanley, Palassads Bowling in London and Magnolia Outing to Port Glasgow; London Majors Game, Sparta Tea room Fitness with Larry Art Class with Krista Historian Pete Sheridan —Johnny Cash Pet Therapy visits Sunday Tea with Bobier Villa Auxiliary Group Croc-A-Doodle: Painting Ceramics Daycare visits from Dutton Daycare Country of Discover: Paris including Parisian breakfast Country Fall Fair — open to residents & families. Fall Fair included popcorn & games, music entertainment and dinner Resident & Family Collaboration event in memory of resident passing — family paid for Art Therapy with Krista Country of Discover: Caribbean Day which included a Mocktail Tiki Bar and Life Music from Golden Harps Steel Drum Band History Talk with Guest Speaker (Pete Sheridan) Weekly tuck shop with the Auxiiliary Reduced programming during month of July related to outbreak activity with Spicer's Bakery Refreshments Aylmer Fair Entries — prize ribbons ranging from participation up to 1st place! Aylmer Art in the Park Participant Local Car Show at Terrace Lodge featuring Pop Shop Pop and Snacks Page 23 of 29 entertainment and ice cream sundae bar New Celebration of the Hire of the Golden Terrace Lodge Initiatives/Enhanced Summer Olympics Harps Steel Drum Olympic Games Programming in Paris Band and Medal Tracking French inspired Animal Farm Gorgeous Cooking Therapy by Little Grandma Photo Demonstration with Hobby Hill Farm Shoot MSS Chris and Recreation Team — Reduced due to Gorgeous Grandpa making crepes outbreak activity Photo Shoot featuring a Model T Heart for Music Ford Application submitted to New Genealogy enhance our music Program with based Volunteer Supprot programming at Bobier Villa Gift Shop Preparedness and County Fall Fair Purchases New Large Print Calendars Education Recreation staff Recreation staff Whisper Glide completed their completed their Swing training and Food Handlers Food Handlers policy Training/Food Training/Food implementation Safety Program Safety Program Mental health First during this time during this time Aid Training for period. period. Seniors Volunteer Services 14 registered active 16 registered active 52 active volunteers; 2 new volunteers; 2 new volunteers since last quarter since last quarter Gift Shop Volunteer Campaign Nursing Department and Quality Improvement Updates Department Bobier Villa Elgin Manor Terrace Lodge Mandatory All mandatory Work to increase RNAO clinical Programs & teams and committee pathway awareness Committees programs in place; membership. communication continue to build membership. Page 24 of 29 Behavioural RNAO clinical Supports Ontario pathway awareness (BSO) team communication onboarding 2 new members. Comfort rounds initiated on all new admissions x 7 days to flag high risk residents. Home specific Catheter and Catheter and Ongoing increased nursing/quality hydration focus hydration focus. frequency of team updates huddles for day and Focus on afternoon shifts to falls, change in enhance status, pain, communication, documentation decision making related to prior and teamwork; inspection BSO team huddle outcomes. frequency increased to support knowledge sharing and embedded processes. Catheter and hydration focus. Student 2 groups of Year 3 PSW students and PSW students and placements RN students — RPN students RPN students planning for placements in October 2024. Additional CMHA 15 minute CMHA 15 minute CMHA 15 minute educational education sessions education sessions education sessions opportunities for all staff onsite for all staff onsite for all staff onsite Letters of RNAO Best RNAO Best understanding in Practice Guideline Practice Guideline place to support Champion Training Champion Training education ongoing ongoing opportunity RNAO Best Management team Management team Practice Guideline members across all members across all Champion Training departments departments ongoing engaged in engaged in Page 25 of 29 Management team Indigenous Cultural Indigenous Cultural members across all Awareness Safety Awareness Safety departments Training and Training and engaged in Equity, Diverstity, Equity, Diverstity, Indigenous Cultural Inclusion and Anti- Inclusion and Anti - Awareness Safety Racism training Racism training Training and Hydration forms Equity, Diverstity, Hydration forms Inclusion and Anti- New catheter Racism training New catheter policies policies Continence refresher education and inservices with provider Quality Indicators Key Performance Bobier Villa Elgin Manor Terrace Lodge Indicator Falls April — June 7% 9.6% 24.4% July — September 11 % 15.3% 20% Daily Physical Restraints April — June 0% 0% 1.1 % July — September 0% 2% 2.2% Worsening Pressure Ulcer (Stage 2-4) April — June 1 % 3.0% 8.6% July — September 1 % 2% 6.1 % Antipsychotics without a supporting Diagnosis April — June 3% 23.8% 3.8% July — September 6% 21 % 2% Administrative Department Updates Item Bobier Villa Elgin Manor Terrace Lodge Staff Schedule New clerical staff New clerical staff New clerical staff Care (SSC) onboarded — onboarded — refresher onboarded — refresher education provided to refresher education support scheduling and education provided to robocall; education provided to support support Page 26 of 29 scheduling and recordings available for scheduling and robocall; future use. robocall; education education recordings recordings available for available for future use. future use. Clinical Training and Training and Training and Connect/econnect onboarding onboarding delayed onboarding delayed related to related to PCC issue — delayed related to PCC issue — awaiting resolve. PCC issue — awaiting resolve. awaiting resolve. Reimbursement of fees during the delay. Staffing Updates Retirement of Homes Quality Vacancy for long-term full time Improvement/education administrative administrative role filled by former clerk filled — clerk employee in Resident Care successful September. Coordinator. onboarding for Former part time full-time role. clerk accepted full Elgin Manor RPN, time role. accepted the full time Successful Resident Care onboarding for Coordinator role. part time role. Education Several Managers Several Managers Several Managers enrolled in the enrolled in the enrolled in the "Manager as a "Manager as a Coach "Manager as a Coach Learning Learning Sessions Coach Learning Sessions across across the Homes and Sessions across the Homes and prior attendees are the Homes and prior attendees implementing small prior attendees are implementing work groups to support are implementing small work groups ongoing small work groups to support implementation of to support ongoing concepts at the Home ongoing implementation of level implementation of concepts at the concepts at the Home level Home level Director, Director, Director, Administrators, Administrators, Administrators, Managers of Managers of Resident Managers of Resident Care Care and Quality Resident Care and Quality Improvement lead and Quality Improvement lead attended 2 day RNAO Improvement lead attended 2 day Clinical Pathways attended 2 day RNAO Clinical RNAO Clinical Page 27 of 29 Pathways launch launch for Cohort 7 in Pathways launch for Cohort 7 in September for Cohort 7 in September September Wellness Wellness Moments Wellness Moments with with CMHA for all staff Moments with CMHA for all staff in July/August — 15 CMHA for all staff in July/August — minute sessions to in July/August — 15 minute introduce health care 15 minute sessions to wellness strategies; sessions to introduce health additional training introduce health care wellness planned. care wellness strategies; strategies; additional training additional training planned. planned. Diagnostic All 3 Homes All 3 Homes submitted All 3 Homes Equipment submitted application for software submitted Funding application for and equipment to application for Application software and support resident care software and equipment to and services; awaiting equipment to support resident response from Ontario support resident care and services; Health to submission. care and services; awaiting response awaiting response from Ontario from Ontario Health to Health to submission. submission. Terrace Lodge Phase 3 of the Redevelopment Terrace Lodge Redevelopment Project well underway. Director finalizing occupancy plan for submission to Ministry; pre- occupancy inspection and move day anticipated to be spring 2025. Financial Implications: None Page 28 of 29 Alignment with Strategic Priorities: Serving Elgin Growing Elgin Investing in Elgin ® Ensuring alignment of ❑ Planning for and ® Ensuring we have the current programs and facilitating commercial, necessary tools, services with community industrial, residential, and resources, and need. agricultural growth. infrastructure to deliver programs and services ® Exploring different ways ® Fostering a healthy now and in the future. of addressing community environment. need. ® Delivering mandated ® Enhancing quality of programs and services ® Engaging with our place. efficiently and effectively. community and other stakeholders. Local Municipal Partner Impact: Communication Requirements: Information has been communicated to the appropriate departments, resident council, family council, residents, staff and visitors as required. Conclusion: The long-term care homes management team continues to be thankful for the support from Council, the Chief Administrative Officer, the Senior Management Team, and the staff in all departments as we work collaboratively to maintain and improve services and care for our residents, families, staff and communities. All of which is Respectfully Submitted Michele Harris Director of Homes and Seniors Services Approved for Submission Blaine Parkin Chief Administrative Officer/Clerk Page 29 of 29