01 - February 11, 2025 Homes Committee of Management Agenda PackageOZ5
ElgmCounty
Homes Committee of Management
Orders of the Day
Tuesday, February 11, 2025, 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/ElginCounty
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 October 1, 2024 — December 31, 2024
6.2 Homes — Committee of Management — Long -Term Care Operational
Report October 1, 2024 — December 31, 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
21
Homes Committee of Management
Minutes
November 12, 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 Mike Hentz
Councillor Richard Leatham
Members Absent: Councillor Andrew Sloan (with notice)
Councillor Todd Noble (with notice)
Staff Present: Blaine Parkin, Chief Administrative Officer/Clerk
Michele Harris, Director of Homes and Seniors Services
Katherine Thompson, Manager of Administrative
Services/Deputy Clerk
Jenna Fentie, Legislative Services Coordinator
Stefanie Heide, Legislative Services Coordinator
1. Call to Order
The meeting was called to order at 11.46 a.m. with Warden Ketchabaw in the
Chair.
2. Approval of Agenda
Moved by: Councillor Couckuyt
Seconded by: Councillor Leatham
RESOLVED THAT the November 12, 2024 Homes Committee of Management
agenda be approved as presented.
Motion Carried.
1
Page 2 of 35
3. Adoption of Minutes
Moved by: Deputy Warden Jones
Seconded by: Councillor Widner
RESOLVED THAT the minutes of the meeting held on August 13, 2024 be
adopted.
Motion Carried.
4. Disclosure of Pecuniary Interest and the General Nature Thereof
None.
5. Delegations
None.
6. Reports/Briefings
6.1 Homes — Committee of Management — Long -Term Care Director's
Update July 1, 2024 — September 30, 2024
The Director of Homes and Seniors Services presented 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.
6.2 Homes — Committee of Management — Long -Term Care Operational
Report July 1, 2024 — September 30, 2024
The Director of Homes and Seniors Services provided 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.
Moved by: Councillor Hentz
Seconded by: Councillor Couckuyt
RESOLVED 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; and
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.
Motion Carried.
7. Other Business
2
Page 3of35
91
9
11.
12
None.
Correspondence
None.
Closed Meeting Items
None.
Motion to Rise and Report
None.
Date of Next Meeting
The Homes Committee of Management will meet again at the call of the Chair.
Adjournment
Moved by: Councillor Widner
Seconded by: Councillor Leatham
RESOLVED THAT we do now adjourn at 12.11 p.m. to meet again at the call of
the Chair.
Motion Carried.
Blaine Parkin,
Chief Administrative Officer/Clerk.
Warden Ed Ketchabaw,
Chair.
3
Page 4 of 35
ElginCounty
Report to Homes Committee of Management
From: Michele Harris, Director of Homes and Seniors Services
Date: February 11, 2025
Subject: Homes — Committee of Management — Long -Term Care Director's Update
October 1, 2024 — December 31, 2024
Recommendation(s):
THAT the report titled "Homes — Committee of Management — Long -Term Care
Director's update October 1, 2024 — December 31, 2024" from the Director of Homes
and Seniors Services dated February 11, 2025 be received and filed.
Introduction:
This report provides an overview of 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
October 1, 2024 — December 31, 2024.
Background and Discussion:
Ministry Updates
On October 1, 2024 the Ministry of Long -Term Care released a memo regarding
seasonal respiratory illness preparedness for long-term care homes. In anticipation of
another challenging respiratory illness season, with respiratory syncital virus (RSV),
influenza (flu) and COVID-19 circulating over the fall and winter, the ministry provided
reminders regarding infection prevention and control (IPAC) prevention and
management, vaccination timing guidance for residents and staff, and access to
resources such as the IPAC Hub, the personal protective equipment (PPE) portal and
preparedness checklist. An additional memo was received from the Ministry on
November 14, 2024 reminding licensees of access to the COVID-19 vaccine from their
local public health.
On November 6, 2024 the Ministry of Long -Term Care released a memo regarding
public consultations on proposed amendments to Ontario Regulation 246/22 under the
Fixing Long -Term Care Act, 2021 (FLTCA). The ministry is proposing to implement a
time -limited Long -Term Care Homes Cultural Pilot Project (the Pilot) to evaluate how
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changes to long-term care (LTC) waitlist prioritization requirements can improve
Ontarian's access to cultural, ethnic, religious and linguistically appropriate care. These
initial regulations will enable the Pilot to prioritize applicants on the crisis waiting list who
seek admission to a LTC home that primarily serves their specific religious, ethnic, or
linguistic needs. A follow-up memo was received on December 18, 2024, notifying
licensees that the amendments to Ontario Regulations 246/22 under the FLTCA will
come into effect to enable the long-term care cultural pilot which also included a
frequently asked questions document.
On November 18, 2024 the Ministry of Long -Term Care released a memo advising
licensees of a guidance document to support the sector in ensuring screening measures
are conducted in accordance with the requirements of the FLTCA. The guidance
document includes information about:
• Applicable provisions of the FLTCA and Regulation regarding police record
check (PRC) and tuberculosis (TB) screening requirements;
• Strategies to ensure timely completion of screening requirements; and
• Strategies to verify the authenticity of completed PRC and TB screening
documents
The PRC and declaration requirements apply to all staff, volunteers and members of a
licensee's board of directors/committee of management; and, the TB requirements
apply to all staff and volunteers. The memo was distributed to human resources to
support onboarding of persons. Tuberculosis policy and procedures were updated
accordingly.
On December 6, 2024 the Ministry of Long -Term Care released a memo and guidance
document on the amendments to the Regulation to support updates on staffing
qualification requirements for staff roles in long-term care.
Amending section 52 (qualifications requirements) to fully align with the
registration pathways under the Ministry of Health "Health and Supportive Care
Providers Oversight (HSCPOA) for a person to be hired as a personal support
worker (PSW) by a long-term care licensee; and,
Extending the transitional flexibility to January 1, 2026
On December 12, 2024, the Ministry of Long -Term Care released a Celebrating the
Holiday Season Safely memo and frequently asked questions document outlining
important reminders to support long-term care homes readiness during the holiday
season with the following general practices:
• Find ways to celebrate the holidays safely while not unreasonably restricting
activities and celebrations
• Review foundational infection prevention and control practices
• Ensure adequate PPE and other necessary supplies are on hand
• Review visitor policies
• Review and update staffing and other contingency plans
• Admit applicants safely and efficiently to help maintain bed capacity in hospitals
• Vaccines and therapeutics
• Outbreak management
Page 6 of 35
• Emergency plans
The ministry reminded all long-term car homes of the requirement to evaluate and
update their emergency plans, including outbreak preparedness plans, at least annually
and to submit the Emergency Planning Attestation form by December 31, 2024.
On December 20, 2024, the the Ministry of Long -Term Care released a memo advising
of the requiment to submit the Integrated Technology Solutions Program Year One
Supplementary Report no later than January 30, 2025 to support the ministry to better
understand the broader future technology needs of homes and to measure the success
of the program.
On December 31, 2024, the Ministry of Long -Term Care released a memo with
information related to Candida auris (C. auris) advising that as of January 1, 2025, C.
auris will be a disease of public health significance and reportable under the Health
Protection and Promotion Act 1990. C. Auris is a fungal pathogen that is often resistant
to antifungal medications, is highly transmissible and can infect any body part, including
a wound or the blood. Persistent outbreaks in hospitals and other health care settings
have been documented in other countries including the United States, is challenging to
treat and it is considered to be an emerging global health threat.
Ministry of Long -Term Care and Ontario Health 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.
Reporting and documents submitted for the three County of Elgin Homes during the
timeframe of October 1, 2024 — December 31, 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 consulation with finance and human resource
department staff, quarterly staffing reports to the Ministry.
• All three homes completed and submitted the Semi -Annual Infection Prevention
and Control Personnel, Training and Education and Lead report with the support
of the finance department.
• All three homes completed a survey of preferences for timelines/phase for the
implementation of the interRAI-LTCF project.
• November 2024, each home completed the Respite Bed survey to maintain one
(1) respite bed/home for the 2025 calendar year.
• December 19, 2024, the Homes worked with facilities and finance/IT to complete
and submit the Ministry of Long -Term Care survey related to building condition
assessments (BCAs), wifi access for residents, and, the presence of any
Reinforced Autoclaved Aerated Concrete (RAAC) in the buildings.
• All three (3) long-term care homes submitted the "Emergency Planning
Attestation Form" by December 31, 2024 indicating compliance with emergency
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plan requirements under section 90 of the Fixing Long -Term Care Act, 2021 and
sections 268 and 269 of Ontario Regulation 246/22.
Agreements Executed
The following agreements have been developed and executed in consultation with legal
services, the procurement team, and, as required, the Chief Administrative Officer
(CAO), and align with the authority of the delegation bylaw.
• October 9, 2024, agreement signed by the CAO Adult Day Program (Bobier Villa
and Terrace Lodge) for Community Support Services (CSS) Base Funding
increase and one time funding (3.4%) increase for workforce compensation and
one-time increase of $2900 to support a 0.6% increase for general costs which
will then be converted to base funding in 2025/26.
• October 28, 2024, agreement signed by the CAO for Terrace Lodge Behavioural
Support Ontario (BSO) base funding increase of $40,000 related to the increase
in size of the memory care resident home area. This funding will be utilized to
increase weekly hours for nursing staff trained in BSO (personal support worker
and registered practical nurse).
• Attending Physician Agreement with Dr. Elsie Osagie for Terrace Lodge resident
medical services (two year).
• Extending attending physician agreement with Dr. Brendan Boyd for Elgin Manor
resident medical services.
• Extending attending physician agreement with Dr. Derek Vaughan for Bobier
Villa and Elgin Manor resident medical services.
• Extending Medical Director agreement with Dr. Derek Vaughan for Bobier Villa
and Elgin Manor medical director services.
• Extending attending physician agreement with Dr. Eric Wong for Terrace Lodge
resident medical services.
• Extending medical director agreement with Dr. Eric Wong for Terrace Lodge
medical director services.
Project Updates
• RNAO Clinical Pathways implementation continues with go live set for April 1,
2025.
o Year 1 focus includes Admission Assessment, Delirium Assessment, and
Resident and Family Centred Care.
o Training continues for front line staff and is funded through ministry one-
time funding.
o Policy and procedures will be reviewed and updated as needed to
streamline processes, reduce duplication, standardize assessments and
align with legislative requirements.
RNAO Best Practice Guideline launch "Developing and Sustaining Leadership"
o Registered staff training planned for 2025 and will be funded through
ministry one-time funding.
InterRAI-LTCF — management of the Home are reviewing resource information,
participating in webinars and educational opportunities to prepare for
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implementation pending notification by the ministry as to which Phase our Homes
will be required to transition.
Policy and Procedure 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. The majority of policy updates were minor in nature and do not
require formal education. The quality improvement/education coordinator and
departmental managers have provided education to front line staff for those policies in
ured f n I .
Policy
Policy #/Name
Revision
Revisions
Manual
Date
Administrati
1.12 Employee
Dec. 2024
Updated verbiage related to footwear
on — Section
Dress Code
1
1.18 Employee
Dec. 2024
Updated to include signed declarations
Records
as per ON Reg. 246/22
1.31 Social
Dec. 2024
Very minor wording update
Worker Role
1.36
Dec. 2024
Updated to current legislation and IPAC
Operational
guidelines
Scheduling
Cohorting Plan
Section 2
2.11 Resident
Dec. 2024
Updated reporting requirements and
Abuse
utilization of decision -making appendix
B
Section 3
3.6 Staff
Dec. 2024
Addition of reference to Code White if
Duress System
deemed necessary
3.15.01 Code
Dec. 2024
Minor update to reference the use of
White
staff duress system to support staff
assistance
3.15.02
Dec. 2024
Minor update to include assigning a
Missing
staff member to front door to greet
Resident/Perso
police/in case resident returns to the
ns
Home; updated reporting chart
3.15.05 Code
Dec. 2024
Removal of fan out list; update to mass
Orange —
messaging; update to team members
External
and communications
Disaster
15 06 Code
Dec. 2024
Updates to process throughout policy
Giree n
as part of Emergency planning exercise
vac a llo n
with community partners across all 3
Homes.
3.15.07 Code
Dec. 2024
Addition to include workplace violence
Black — Bomb
assessment as part of debrief and
Threat
follow up.
3.15.09 Code
Dec. 2024
Update to team members, additional
Purple —
safety measures included.
Severe
Weather
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3.15.10 Code
Dec. 2024
Updated contact information.
Grey — Gas
Leak
3.15.11 Code
Dec. 2024
Updated with contact/support for
Grey — Air
shutting off the ventilation system.
quality
.15 .1 Code
Dec. 2024
Updated with action related to fire alarm
Iillveir : "eirso n
during code silver; updated paging
1ith a Weapon
content; reminder to use any phone or
o uIT a L.IIh re a 1
device to call 911.
Dietary
3.1 Supply
November
Updated as per emergency plan
Purchasing
2024
requirements.
4.1.3RAI MDS
December
Updated to reflect the use of mealsuite
Quarterly
2024
system Kardex.
Nutrition
Assessment
4.3 Nutrition
December
Updated Reference
Care and
2024
Hydration
Program
4.5 Weight
December
Updated to best practice
Change
2024
Management
4.6 Diet Order
December
Minor texture and process updates
Policy and
2024
Temporary and
Trial Diets
4.7 Diet
December
Minor process update and reference
Requisition
2024
Nutrition
Referral
4.9
December
Updated references
Management
2024
of Residents
with Refusal to
Eat
4.10 Recording
December
Updated references
of Foods and
2024
Fluids
4.11 Oral
December
Updated references
Nutrition
2024
Supplement
4.13 Small
December
Addition of verbiage regarding desserts
Portions
2024
4.14 Diabetes
December
Reference Updates
Food
2024
Replacements
4.15.1 Dietary
December
Reference updates
Management
2024
During
Outbreak —
Transition
Diets
4.16 Bowel
December
Minor update to best practice; reference
Management
2024
updates
Page 10 of 35
4.17
December
Reference Update
Dysphagia
2024
Management
4.19 Enteral
December
Typo, reference update
Feeding
2024
4.20 Palliative
December
Reference Update
Care
2024
4.21 Detailed
December
Reference Update
Fluid Intake
2024
Record
4.22 Food
December
Reference Update
Allergies &
2024
Intolerances
4.23 Assistive
December
Reference Update
Devices for
2024
Eating and
Drinking
4.25
December
Updated to best practices, reference
Encouraging
2024
updates
Fluid Intake
4.26 Hydration
December
Updated to best practices; reference
Assessment
2024
updates
and
Management
4.27 Nutrition
December
Updated reference
Supplement
2024
Medication
Pass
4.29 Nutrition
December
Updated to current legislative changes
and Skin
2024
to ON Reg 246/22
Integrity
4.33 Nutritional
Dec. 2024
Updated to best practice and liberalized
Management
diet approach
of Diabetes
Mellitus
Section 5
5.8.14
Dec. 2024
Addition of verbiage regarding deliming
Cleaning
Dishwasher
Section 6
6.14
December
Updated process for contacting
Malfunctions &
2024
maintenance
Repairs —
Equipment
Housekeepin
3.5 Use of the
November
Delete- duplicate info — contained in 3.7
g
Swiffer Mop
2024
Microfibre Cleaning
4.10 Delivery
November
Increase supply of laundry on hand
of Laundry
2024
from 48 hour supply to 72 hour supply
4.12 Mending
November
Updated to include valet services as
of Residents
2024
available for minor repairs of clothing
Clothing
Infection
1.11nfection
December
Updated auditing requirements and
Prevention
Control
2024
reference
and Control
Philosophy &
Goals
Page 11 of 35
2.3 Hand
Dec. 2024
Updated timeframes for audits
Hygiene
Program
2.8
Dec. 2024
Updated reference and charts to
Surveillance
current standards and best practice
Resident
2.8 a
Dec. 2024
Updated reference and updated best
Screening and
practice/guidance related to employee
Surveillance
return to work protocols
Staff
2.8 c
Dec. 2024
Updated reference
Screening and
Surveillance
Visitors
2.4
Oct. 2024
Updated to best practice and
Immunization —
references
Resident
Influenza,
Pneumovax,
Shingles, RSV,
antiviral and
COVID 19
2.4a Medical
Oct. 2024
Updated to align with Public Health
Directive for
Ontario guidelines
Administration
of Influenza
Vaccine for
Residents
2.4b
Oct. 2024
Updated reference
Immunization
consent
influenza,
pneumovax
and antiviral
medication
2.4d Medical
Oct. 2024
Updates as per fall COVID vaccine
Directive —
guidance
COVID 19
Vaccine
Administration
2.4e RSV
Oct. 2024
Updated to align with current PHO
Medical
guidelines
Directive
2.4f RSV
Oct. 2024
Minor updates to best practice
consent form
2.4g COVID 19
Oct. 2024
Updated to ministry of health consent
vaccine
form as per Public health
consent form
recommendations
2.5
Jan 2025
Updates to antiviral medication
Immunization —
requirements and minor wording update
Staff Influenza
2.5a Medical
Oct. 2024
Minor updates to align with current
directive for
guidelines
administration
of Influenza
Page 12 of 35
and COVID
vaccine for
staff
2.6a medical
Oct. 2024
Updated to best practices
directive for
Administratio of
Epinephrine for
Management
of Anaphylaxis
related to
vaccination
2.13
Dec. 2024
Minor updates to best practice
Equipment
Cleaning
Disinfection,
Sterilization
Protocol
2.21 PPE —
Dec. 2024
Minor update to N95 masks
Face
Shields/Protect
ive Eyewear,
Masks,
Respirators
2.23 Pandemic
Dec. 2024
Minor updates to reflect current practice
Prevention and
Control — Staff
Testing —
COVID 19
.2 L.III p
Dec. 2024
Updated to best practice and
Scireenlng
documentation requirements
staff, students,
v II u irn tcc it ,
cxteir n 11 c uITc
pirovlideuIT
4.10 Isolation -
Dec. 2024
Updated screening requirements
Resident
Visitor
Education
4 12
Dec. 2024
Name Change to include additional
"ireveirnllo n and
AROs — CPE and Candida Auris and
Co nluIT 11 of
relevant best practice for all 4 AROs
�11:111:
4 11
Dec. 2024
Updated to best practice
Guldelllnes four
Manageinent
1..I..ubeiITcUosl
4.18
Dec. 2024
Updated references
Guidelines for
Management
of Blood Borne
Illnesses
4.19 Hepatitis
Dec. 2024
Updated references
B
4.24 HIV/AIDS
Dec. 2024
Updated references
Page 13 of 35
4.28
Dec. 2024
Updated references
Monkeypox
4.30
Dec. 2024
Updated references
Management
of Creutzfeldt-
Jakob Disease
CJ D
4.34 Head Lice
Dec. 2024
Updated references
4.35 Shingles
Dec. 2024
Updated reference and removal of
name of vaccine
4.36 Viral
Dec. 2024
Updated references
Haemorrhagic
Fevers (VHF)
e.g. Ebola
5.1 Outbreak
Dec. 2024
Updated to best practice/outbreak
Contingency
guidance
Plan
5.2 Resident
Dec. 2024
Updated to best practice
and Staff
Surveillance
Line Listing
5.3 Outbreak
Dec. 2024
Minor update r/t outbreak declaration
Management —
guidance
General
5.4 Outbreak
Dec. 2024
Minor reordering of policy content for
Management —
ease of flow; minor updates to best
Roles and
practice
Responsibilitie
s
5.5 Respiratory
Dec. 2024
Updated to best practice
Outbreak
Protocol —
Residents &
Staff
5.5a Algorithm
Dec. 2024
DELETE — no longer valid
Respiratory
Symptoms
5.6 Enteric —
Dec. 2024
Updated to best practice
Outbreak
Protocol
(Contingency
Plan) —
Residents &
Staff
5.6 a Algorithm
Dec. 2024
DELETE — no longer valid
Enteric
Symptoms
Residents
5.9 Outbreak
Dec. 2024
Updated reference
De-escalation
Nursing
Section A
A in c II':3 iclhula
December
New policy to support use of funded
����"iressuire Ilindex
2024
diagnostic equipment related to
essi nernt
peripheral artery disease.
Page 14 of 35
Admission of a
November
Minor revision to reflect current practice
Resident
2024
AM & HS Care
November
Minor revision to reflect resident
2024
specific care planning
Ambulance
November
Minor revision to documentation
Services
2024
requirements
Ambulation
November
Updated to reflect best practices for
2024
body mechanics and safety
Arm Sling
November
Updated to reflect best practices
2024
Section B
Bladder
December
Delete policy; amalgamate with Bladder
Irrigation
2024
Irrigation — intermittent policy
pll ddeir
December
Amalgamate with Bladder irrigation
iriJgaflon
2024
policy; addition of recommendation for
rnteiri Ntte nt
continuous irrigation if obstruction
anticipated and physician's order
Section C
Catheter
December
Updated with a provision for irrigation
rndwec llng
2024
with a physician's order
Catheter
December
Addition of physician's order required
u I�i) ra I�)ull lic
2024
Compress —
November
Updated reference and duration
Cold Ice Pack
2024
Continuous
November
Updated guidance for personal
Positive Airway
2024
protective equipment and reference to
Pressure —
IPAC policy 2.15 AGMPs
CPAP
Section D
Death —of a
December
Removed reference to registry form
Resident
2024
App. A
Death — Care
December
Updated reference, minor process
of a Resident
2024
updates
After Death
Death of a
December
Deleted — no longer applicable
Resident
2024
Registry Form -
Appendix A
I: ); iabetc
Dec. 2024
Updated to best practice
irn cu,.ncirnt:
I..ureati e nt of
Seveire and
U irn ire Ipo irn live
I w Ipogu l ccu,.nl
Documentation
November
Updated to include written format
2024
documentation in case of internet/PCC
access issues
Dressing —
November
Updated documentation requirements
Sterile
2024
Section E
Ear irrigation
December
Updated procedure based on new
2024
equipment
Falls
December
Addition of process for assessment and
Prevention and
2024
evaluation of residents with near miss
Mana ement
Appendix B —
December
Minor update to add monitoring for
Managing a
2024
bruising x 48 hours
Fall Post Fall
Assessment/M
Page 15 of 35
anagement
Algorithm
Section H
Health Record
November
Updated to current practice and name
— Chart Order
2024
change — Ontario Health At Home
Height and
December
Updated to best practice and to align
Weight
2024
with Dietitian recommendations/dietary
Mana ement
policy
Section I
Inhalation
November
Updated guidance for personal
Therapy
2024
protective equipment and reference to
IPAC policy 2.15 AGMPs
Intake and
November
Include medication pass fluid intake in
Output
2024
POC.
Intravenous
December
Updated to support registered with
Therapy —
2024
competency in IV insertion; and
Care and
updated IV therapy pump usage
Maintenance
Section M
Mechanlca11
December
Policy name change to Transfers and
l ift lNai ne
2024
Transfer Assessment; updated to best
Chas n c
practice, online assessment,
un vc to
discontinuation of transfer disk
ecdo rn ..
Section 0
Oxygen
November
Updated reference
Therapy
2024
Section P
:"IICc Il....liirnc
December
Updated to current/best practice
2024
Section R
Responsive
December
Updated to include investigation and
Behaviours
2024
reporting responsibilities should a
Critical Incident submission be required
Section S
Skin Care and
December
Updated to legislative changes related
Wound
2024
to referral to registered dietitian
Management
i nairt II: "uu nlp
December
New policy to support use of diagnostic
rntulion
2024
equipment purchased with funding for
IV infusion therapy at the Home level .
Section T
Transfer or
December
Update to change from Home
Discharge of
2024
Community Care Support Services to
Resident from
Ontario Health at Home
Home
Transferring
December
Delete — incorporated into transfer
2024
policy
Two Person
December
Delete — incorporated into transfer
Lifts and
2024
policy
Transfers
I ubeircUo§s
December
Updated regarding TST requirements
kli n L esflng
2024
no longer recommended for residents
unless directed by Public
Health/physician; updated reference
I ubeircUo§s
December
Updated name change — Tuberculosis
Scireenlng
2024
Screening -Residents, best practice
guidance and references
Appendix A update and rename to
Active TB Screening in LTC and
Retirement Homes — checklist for
Clinicians
Page 16 of 35
Program and
1.8 Safe
Dec. 2024
Minor grammatical update; update to
Therapy
Handling and
Southwestern Public Health reference
Serving of
Food
5.3 A Daily
Dec. 2024
Formatting Updates
Record of
Sales
Appendix A
5.3 B Gift Shop
Dec. 2024
Formatting and Addition of Terrace
Cash Out
Lodge Gift Shop
Appendix B
Financial Implications:
The Ministry of Long -Term Care is adopting a new mandatory standard for 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) must be replaced by the interRAl Long -Term Care Facilities
(LTCF)Assessment Instrument and the interRAl Reporting System (IRRIS) by April 1,
2026.
In October 2024, the Ministry of Long -Term Care released a fact sheet and frequently
asked questions document regarding transitions to the updated Resident Assessment
interRAl-LTCF and the interRAl Reporting System for long-term care homes in Ontario.
The preparation for the transition and post -implementation process is expected to take
3-6 months and homes submitted timeframe/phase preferences to the ministry for the
transition go live. The Ministry has set minimum training requirements which is
recommended to be supported by the RAI coordinators; the County of Elgin Homes will
utilize ministry one time funding to support training of front line staff conducting and
submitting interRAl- LTCF assessments.
The Ministry acknowledges that the new interRAl LTCF may impact future funding
levels for some homes should the data continue to be used to inform Nursing and
Personal Care (NPC) funding amounts. However, the Ministry is committed to
temporarily freezing the case mix data used in the NPC envelope (for the amount
allocated for resident acuity from assessment data) for transitioning homes as
discussions continue with the sector on future options.
Elgin Couty Homes continue to follow communications and updates regarding the
interRAl LTCF closely and will work with vendors to ensure appropriate updates to
assessments, policy, procedures and auditing to support/maintain current CMI during
and following the transition.
On November 22, 2024 the Ministry of Long -Term Care released a memo announcing
the increase in funding for the Hiring More Nurse Practitioners (HMNP) program.
Effective November 1, 2024, eligible long-term care homes can request a maximum of
$149,668 in salary and annual benefits for a full 1.0 nurse practitioner (NP) Full-time
equivalent (FTE); this is a 21 % increase from the previous maximum funding of
$123,340 per year. The memo also included a frequently asked questions document.
Pending budget approval, the County of Elgin Homes will pursue the recruitment of one
FTE Nurse Practitioner throught the HMNP program funding.
Page 17 of 35
On December 2, 2024 the province announced proposed legislation aimed at enhancing
the support for seniors and their caregivers. This legislation aims to better support
seniors living in long-term care, congregate settings, and in the community, while also
providing crucial support to their caregivers. On December 5, 2024, the Ministry
released a memo related to public consultations on proposed amendments to the
FLTCA, 2021 introducing the Support for Seniors and Caregivers Act, 2024 in the
Ontario Legislature. The key features of the proposed amendments to the FLTCA are
fully outlined in the memo and the news release.
Once passed, the legislation will facilitate better connections to complex care services
and broaden access to community and social programs and is designed to enhance the
quality of life and care for seniors and their caregivers. Key aspects of the legislation
include:
Dementia Care: Investing $79 million over three years to improve and expand
dementia care programs in long-term care homes and provide primary care
providers with the necessary tools and resources.
o $9 million over three years to launch a new program to train staff in
emotion -based models of care.
o $15 million over two years to launch Community Access to Long-term care
that will give seniors still living in their own homes access to certain
services in LTC Homes such as personal care and clinical services.
o $9 million over three years to continue support of the Alzheimer Society of
Ontario's First Link program and the Dementia Society of Ottawa and
Renfrew County's Dementia Care Coaches.
o $6 milllion over three years to continue support for GeriMedRisk.
o $20 million over three years to expand adult day programs.
o $20 million over three years to expand access to respite services, to
support the caregivers of people living with dementia.
Adult Day Programs and Respite Services: Expanding these programs to offer
recreational and social activities for people wih dementia, giving their caregivers
a much -needed break.
Protections Against Abuse and Neglect: Strengthening measures to protect
long-term care residents from abuse and neglect and enhancing the province's
ability to investigate and prosecute such offenses.
Cultural and Linguistic Needs: Requiring long-term care homes to recognize and
respect the cultural, linguistic, religious, and spiritual needs of residents,
including increasing information available in French.
On December 6, 2024 the Ministry of Long -Term Care released a memo providing an
overview of the Expanded Eligibility and new Incentive Funding through the Personal
Support Worker Stipends and Incentives Program. The additional incentives include:
Expanding eligibility to include PSW's hired after November 18, 2024, who in the
past 12 months, have not worked in a role providing direct patient, client or
resident care as part of an organization providing healthcare of long-term care
services in Ontario.
Page 18 of 35
• A new, Rural, Remote and Northern (RRN) Community Incentive of $10,000
available to PSWs hired after November 18, 20214 who make a 12 month
employment commitment to a publicly funded LTC home or HCC organization in
Northern Ontario or a rural community with a rurality index for Ontario scroe of 40
or above.
This new $10,000 RRN Community Incentive is a stackable incentive that can be
combined with the PSW Incentive Program's existing recruitment incentive of $10,000
for either new graduates or those returning to healthcare/long-term care), and its
existing RRN Relocation Support grant of $10,000.
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:
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 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.
Page 19 of 35
All of which is Respectfully Submitted
Michele Harris
Director of Homes and Seniors Services
Approved for Submission
Blaine Parkin
Chief Administrative Officer/Clerk
Page 20 of 35
ElginCounty
Report to Homes Committee of Management
From: Michele Harris, Director of homes and Seniors Services
Date: February 11, 2025
Subject: Homes — Committee of Management — Long -Term Care Operational Report
October 1, 2024 — December 31, 2024
Recommendation(s):
THAT the report titled "Homes — Committee of Management — Long -Term Care
Operational Report October 1, 2024 — December 31, 2024" from the Director of Homes
and Seniors Services dated February 11, 2025 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 October 1, 2024 — December 31, 2024.
Backaround and Discussion:
Ministry of Long -Term Care (MLTC) Compliance Inspection Visit Reports Summary
MLTC 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
submisssions 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 which 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 and post -occupancy inspection
visits to a home undergoing the development/redevelopment of beds.
Page 21 of 35
There were no ministry inspections at Bobier Villa between October — December 2024.
Elgin Manor
Ministry inspectors visited the Home on September 23, 24, and 25, 2024 to conduct a
critical incident inspection regarding an outbreak at the Home. Inspection protocols
utilized during the inspection included Infection Prevention and Control, and Staffing,
Training and Care Standards.
During the course of the inspection the inspector made relevant observations, reviewed
records and conducted interviews. There was one finding of non-compliance and an
order was issued related to hand hygiene. The order was complied with in advance of
the compliance date of November 1, 2024.
Ministry inspectors visited the home on November 12, 13, and 14, 2024 to conduct a
follow up to the hand hygiene compliance order. Inspection protocols utilized during
the inspection included Infection Prevention and Control and Resident Care and
Support Services.
During the course of the inspection the inspector made relevant observations, reviewed
records and conducted interviews. There were no findings of non-compliance; and, the
previously issued compliance order was found to be in compliance.
:: �i'ii. a \�le��ir:u��u Il�u°,�II ��� nu;�i�u II�'��p, ��u�5` � (,,,) 4:.
Terrace Lodge
Ministry inspectors visited the home on December 18 and 19, 2024 to conduct a critical
incident inspection. Inspection protocols utilized during the inspection included
Infection Prevention and Falls Prevention and Management.
During the course of the inspection the inspector made relevant observations, reviewed
records and conducted interviews. A non-compliance remedied was found related to a
resident's plan of care which was updated during the inspection. A written notification
was issued related to falls prevention and management assessment completion.
Ie1`p�a! (� II o�N¢i�"....Ili�u� V IM„� nuD[i II�������p ��u„�5` II���� �:�ui��ll����r: ��()24
Critical Incident Systems Report Summary for all Three Homes
Types of Critical Incidents — October 1, 2024 — December 30, 2024 Total
Number
— Three
Homes
Page 22 of 35
Abuse & Neglect — Any alleged, suspected or witnessed abuse of a
20
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
0
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
0
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 18 of the
20 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.
No written complaints were received in this quarter at any of the 3 Homes.
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
Page 23 of 35
Bobier Villa
0
N/A
N/A
Elgin Manor
2 outbreaks
#1 — October 9 -26,
#1 — 15
#1 — Rhinovirus
2024
#2 — 4
#2 — Rhinovirus
#2 —November 16,
2024
Terrace Lodge
1 outbreak
December 31, 2024
January 21, 2025
COVID, Influenza A
and unknown
respiratory
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 influenza and COVID vaccine campaign.
Hand hygiene audit training has been provided for all managers and front line staff
"ambassadors" and "champions" regarding the 4 moments of hand hygiene to support
infection prevention and control best practice.
Mandatory Masking
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. Masking is mandatory
for all persons, including visitors when the home is in outbreak. 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.
Vaccination Updates
Information and promotion of the RSV, influenza and COVID-19 vaccine was circulated
to all residents and families and a high percentage of residents across our 3 Homes
received each of the 3 vaccinations.
Staff vaccination promotion continues across the Homes.
Page 24 of 35
Seasonal Preparedness
Each of the 3 County of Elgin Homes has been "gearing up" for "Seasonal
Preparedness". IPAC assessments have been completed alongside staff from
Southwestern Public Health in order to support the Homes 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 biweekly 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.
Audits are completed weekly when a home is in outbreak.
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.
,TelOT VIIIR
Occupancy Data excluding
respite bed
October 1 — December 31,
2024
Occupancy
97 %
Admissions (Move -Ins)
7
Discharges
10
Elgin Manor
Occupancy Data excluding
respite bed
October 1 — December 31,
2024
Occupancy
99 %
Admissions (Move -Ins)
13
Discharges
13
Terrace Lodge
Occupancy Data excluding
respite bed
October 1 — December 31,
2024
Occupancy
99%
Admissions (Move -Ins)
4
Discharges
4
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.
Page 25 of 35
• The Homes completed their annual fire evacuation and inspection and are final
reports were received with no findings. This year each home (management,
JHSC, CQI) conducted table talk evacuation exercises with community partners
including representatives from Emergency planning, fire department, police,
library, and human resources. A review of Code policy and procedures was
conducted and updates were implemented across the 3 Homes to support
emergency preparedness and legislative requirements.
• Each of the 3 Homes fire plan was reviewed, updated as needed and approved
by the local fire department.
• Bobier Villa received a visit from Southwestern Public Health on October 24,
2024 and there were no findings or concerns.
• Elgin Manor had a visit from Southwestern Public Health to inspect the kitchen
on November 7, 2024 and there were no findings or concerns.
• Terrace Lodge received a visit from Southwestern Public Health on December 5,
2024 and there were no findings or concerns.
• Bobier Villa received a Ministry of Labour, Immigration, Training and Skills
Development visit on December 13, 2024 as a follow up to the September 18,
2024 visit. The inspector noted that corrective action had been implemented and
training completed. No contraventions were noted and no orders were issued.
Dietary and Housekeeping/Laundry Departmental Updates
Department
Bobier Villa
Elgin Manor
Terrace Lodge
Dietary
Theme days
Theme days have
Terrace Lodge
continue and a
kept the kitchen
main kitchen
traditional holiday
busy with
remains "under
meal with all the
traditional meals
renovation" with
fixings was enjoyed
for kitchens of the
completion
by residents and
1950s, Polish
anticipated soon.
visitors for
cuisine and
Staff were
Christmas.
traditional holiday
provided access to
treats in the month
the "new cooking
of December (egg
area" in October of
nog, mincemeat,
2024 which
peppermint ice
includes a new
cream, lobster
prep area and
ravioli, Yorkshire
soup kettle.
pudding).
Food Committee
Theme meal
Food committee
Food committee
planning continued
members have
members have
this quarter with
been supporting
been supporting
food committee
and involved in
and involved in the
involvement and
the review of the
review of the new
support.
new 2025 menus.
2025 menus.
Housekeeping/laundry
Acknowledgement
The
The housekeeping
to the
Housekeeping
team continues to
housekeeping
team worked
work diligently to
Page 26 of 35
team —their
exceptional,
diligent cleaning
and IPAC practices
has supported 0
outbreaks this
quarter.
diligently to deep
clean resident
rooms to prepare
for painting.
provide a clean
environment for
residents during
the redevelopment
project.
Joint Health & Safety
Code Drills -
Code Drills —Code
Monthly Code
Code Green and
Green policy
Drills with team
Purple policy
reviewed, revised
members creating
reviewed and
and approved.
poster boards to
approved
increase staff
Regular
awareness -Code
Regular
inspections and
Brown.
inspections and fire
fire drills.
drills
MSDS binders
2 new front line
updated
staff members
joined the
Regular
committee.
inspections and
fire drills
Completion of the
workplace
violence
assessment.
Resident & Family Council Updates
Resident Council
Bobier Villa
Elgin Manor
Terrace Lodge
Continue to meet
Continue to meet
Continue to meet
monthly with an
monthly with an
monthly with an
average of 8
average of 10
average of 12
residents attending.
residents attending.
residents attending.
October meeting
cancelled due to
outbreak.
Discussion topics:
Discussion topics:
Discussion Topics:
Introduction of new
Resident Bill of
Resident Bill of
manager of
Rights review; fire
Rights; religious
program and
exit maps, resident
and spiritual care;
therapy; treasurer
remembrance,
courtyard tree
report, Residents
outings and special
trimming, harvest
Bill of Rights
events, welcome to
tea, giftshop grand
review; Food
new residents,
opening; food
Committee,
introduction of new
committee; IPAC
manager of
update including
Page 27 of 35
Additional
programming.
program and
therapy.
vaccination; front
entrance; students;
CQI update;
washroom
assistance; Holly
Berry Bazaar;
satisfaction survey
question review.
Family Council
Bobier Villa
Elgin Manor
Terrace Lodge
Continue to host
Continue to host
Continue to host
meetings monthly —
meetings monthly —
meetings monthly —
in person and
in person and
in person and
virtual options
virtual options
virtual options
available. 2 family
available. 10 family
available. 1 new
members at
members at
family member at
present.
present.
present; 4
members at
present.
Discussion topics:
Discussion topics:
Discussion topics:
Quality
Quality
Quality
Improvement;
Improvement;
Improvement;
home updates;
home updates;
home updates;
resident/family
resident/family
resident/family
memos and
memos and
memos and
newsletters
newsletters; IPAC
newsletters; IPAC
distributed
updates; Resource
updates; menu and
electronically if no
Guide for Family
meal choices; Tour
attendees.
Council; Care
of the kitchen with
Conferences;
dietary manager.
Resident and
Family Satisfaction
Terrace Lodge
Surveys.
Redevelopment
Update and Core
Area Renovations
sent to members
electronically and
posted in the Home
Program and Therapy Department Updates
Item
Bobier Villa
Elgin Manor
Terrace Lodge
Special Programs &
Ice Cream Cart
Lunch outing to
Gift Shop Grand
Event Highlights
room to room
Wimpy's diner and
Opening — Kickoff
Swiss Chalet
events throughout
History Talk with
December with
Guest Speaker
snacks and treats
(Pete Sheridan —
Page 28 of 35
St. Thomas
Courthouse,
Christmas
Traditions)
Bus Trip to Great
Lakes Farm
Wear your
Spooktacular
Costume Day
Crock A Doodle
Art Class
Christmas Bazaar
Christmas Songs
with Dutton Public
School
Entertainment by
"Stone Soup
Dunwich Highland
Ringers",
"Christmas
Caroling with Suzie
Q" and "New Years
Eve Countdown
with Jeremy Smith"
Sunday Tea with
the Auxiliary
50's Day with Live
music "Frankie and
the Fairlanes"
Childrens Trick or
Treating
Pizza and Movie
Night "Hubie
Halloween"
Costume Day
Remembrance Day
Service with Port
Stanley Legion
Lighting tour outing
— Magic of Lights
Aylmer Community
Choir
Harry's lunch
outing and matinee
movie
"Feelin' Fesitive
Day" Morning visits
with Santa
New Years Eve
Party
Weekly tuck shop
with the Auxiiliary
Monthly Library
Outreach Program
Auxiliary Harvest
Celebration and
Holly Berry Bazaar
Seasonal Tasting —
apple crisp and
salted caramel
apple ice cream
Order -in — pizza
lunch, Swiss Chalet
Blanket Making
Annual Memorial
Tree Lighting
Halloween Haunted
Room
Pumpkin Smash
History Talk with
Guest Speaker
Pete Sheridan — D-
day and Military
History Tour;
Christmas
Traditions
Remembrance Day
Ceremony, war
time songs, bag
piper (The Last
Post)
Christmas
Ornament Making,
Jewelery Creation,
Cookie Decorating
Spirit of Christmas
Room
Page 29 of 35
Candlelight Service
with Evan
Thompson
Christmas Party
with the Ukes of
Hazard
Santa Visits
Christmas Pary
New Years Even
Party and Music
with Brian May
Education
Behavioural
Behavioural
Healing Sounds
Supports Ontario
Supports Ontario
(BSO) training
(BSO) training
DEI
DEI
Student Placements
None this quarter
None this quarter
None this quarter
Volunteer Services
14 registered active
13 registered active
50 active
volunteers; 1 new
volunteers; 1 new
volunteers; 3 new
since last quarter.
since last quarter.
since last quarter.
Continue to seek
One highly
Training and
and recruit
dedicated volunteer
orientation for gift
volunteers and
every week whom
shop volunteer
students.
supports 1.1 visits
position ongoing.
with residents.
Nursing Department and Quality Improvement Updates
Department
Bobier Villa
Elgin Manor
Terrace Lodge
Mandatory
Initiation of training
Initiation of training
Initiation of training
Programs &
for clinical
for clinical
for clinical
Committees
pathways to
pathways to
pathways to
support mandatory
support mandatory
support mandatory
programs and
programs and
programs and
streamline
streamline
streamline
processes.
processes.
processes.
Skin and wound
Introduction of
education for team
model change with
leader.
implementation of
charge nurse on
day shift.
Page 30 of 35
Home specific
nursing/quality
updates
Total revamp of the
incontinence
program tracking
system; additional
team members.
Ongoing
implementation of
initial coaching
concepts to support
onboarding of new
employees.
Continued focus on
falls prevention and
management and
change in status.
Implementation of
hydration policy
updates with the
support of dietitian
Student
RPN student
PSW students and
7 RN and 7 RPN
placements
placements
RPN student
students this
2 out of 5 summer
placements
quarter with
students continued
continue with
excellent feedback
employment at the
extremely positive
from students and
Home after
feedback.
front line staff.
program
completion.
One Bobier Villa
PSW conducting
clinical RN
placement at Elgin
Manor.
Education
Diagnostic
Diagnostic
Diagnostic
equipment training
equipment training
equipment training
ongoing
ongoing
ongoing
Best Practice
Best Practice
Best Practice
Guideline
Guideline
Guideline
Champion Training
Champion Training
Champion Training
ongoing.
ongoing.
ongoing.
Management team
Management team
Management team
members across all
members across all
members across all
departments
departments
departments
engaged in
engaged in
engaged in
Indigenous Cultural
Indigenous Cultural
Indigenous Cultural
Awareness Safety
Awareness Safety
Awareness Safety
Training and
Training and
Training and
Equity, Diverstity,
Equity, Diverstity,
Equity, Diverstity,
Inclusion and Anti-
Inclusion and Anti-
Inclusion and Anti -
Racism training
Racism training
Racism training
Quality Indicators
Key Performance
Bobier Villa
Elgin Manor
Terrace Lodge
Indicator
Page 31 of 35
Falls
Jan — March
15%
18%
April — June
7%
9.6%
24.4%
July — September
11 %
15.3%
20%
October —
0%
11.8%
20%
December
Daily Physical
Restraints
Jan — March
2.1 %
1.1 %
April — June
0%
0%
1.1 %
July — September
0%
2%
2.2%
October -December
0%
0%
1.3%
Worsening
Pressure Ulcer
(Stage 2-4)
Jan — March
3.4%
8.7%
April — June
1 %
3.0%
8.6%
July — September
1 %
2%
6.1 %
October —
2.3%
6.4%
6.7%
December
Antipsychotics
without a
supporting
Diagnosis
Jan — March
20%
15%
April — June
3%
23.8%
3.8%
July — September
6%
21 %
2%
October —
3%
34%
18.7%
December
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 —
onboarded —
refresher education
refresher education
refresher education
provided to support
provided to support
provided to support
scheduling and
scheduling and
scheduling and
robocall; education
robocall; education
robocall; education
recordings
recordings
recordings
available for future
available for future
available for future
use.
use.
use.
Clinical
Training and
Training and
Training and
Connect/econnect
onboarding delayed
onboarding delayed
onboarding delayed
related to PCC
related to PCC
related to PCC
issue — awaiting
issue — awaiting
issue — awaiting
resolve.
resolve.
resolve.
Reimbursement of
Page 32 of 35
fees during the
delay.
Staffing Updates
No changes
No changes
Vacancy for
Manager of
Resident Care
position —
successful
recruitment for full-
time role with
onboarding planned
for February 2025.
Education
Several Managers
Several Managers
Several Managers
enrolled in the
enrolled in the
enrolled in the
"Manager as a
"Manager as a
"Manager as a
Coach Learning
Coach Learning
Coach Learning
Sessions across
Sessions across
Sessions across
the Homes and
the Homes and
the Homes and
prior attendees are
prior attendees are
prior attendees are
implementing small
implementing small
implementing small
work groups to
work groups to
work groups to
support ongoing
support ongoing
support ongoing
implementation of
implementation of
implementation of
concepts at the
concepts at the
concepts at the
Home level
Home level
Home level
Director,
Director,
Director,
Administrators,
Administrators,
Administrators,
Managers of
Managers of
Managers of
Resident Care and
Resident Care and
Resident Care and
Quality
Quality
Quality
Improvement lead
Improvement lead
Improvement lead
continue RNAO
continue RNAO
continue RNAO
Clinical Pathways
Clinical Pathways
Clinical Pathways
training.
training.
training.
Director and
Director and
Director and
Administrators
Administrators
Administrators
presentation for
presentation for
presentation for
AdvantAge Ontario
AdvantAge Ontario
AdvantAge Ontario
workshop
workshop
workshop
Compliance
Compliance
Compliance
Inspections —
Inspections —
Inspections —
"Catch Issues
"Catch Issues
"Catch Issues
Before They Catch
Before They Catch
Before They Catch
You" November 26,
You" November 26,
You" November 26,
2024.
2024.
2024.
Page 33 of 35
Director of Finance
and Director of
Homes and Seniors
Services
presentation for
AdvantAge Ontario
— "Cybersecurity-
Real Life
Experiences"
October 24, 2024.
Director of Finance
and Director of
Homes and Seniors
Services
presentation for
AdvantAge Ontario
— "Cybersecurity-
Real Life
Experiences"
October 24, 2024.
Director of Finance
and Director of
Homes and Seniors
Services
presentation for
AdvantAge Ontario
— "Cybersecurity-
Real Life
Experiences"
October 24, 2024.
Diagnostic
All 3 Homes
All 3 Homes
All 3 Homes
Equipment Funding
submitted
submitted
submitted
Application
application for
application for
application for
software and
software and
software and
equipment to
equipment to
equipment to
support resident
support resident
support resident
care and services;
care and services;
care and services;
awaiting response
awaiting response
awaiting response
from Ontario Health
from Ontario Health
from Ontario Health
to submission.
to submission.
to submission.
Individual Home
On November 20,
On October 25,
Phase 3 of the
Highlights
2024, Bobier Villa
2024, Elgin Manor
Terrace Lodge
staff attended and
management
Redevelopment
presented at the
attended the 94.1
Project well
RNAO Symposium
myFM Spirit
underway.
on the great work
Awards where they
Occupancy plan
completed by
received the award
approved; pre -
dietary and
for "Favourite
occupancy
recreation teams
Retirement/Long-
inspection
for the "Countries of
Term Care Home"
anticipated to be
Discovery" initiative
— congratulations to
early 2025 with
which included
all staff for their
move day
Chemed meals and
commitment and
anticipated to be
events to recognize
dedication to
spring of 2025.
and support
residents and
diversity, equity
families that made
and inclusion.
this possible.
Staff Appreciation
Staff Appreciation
Staff Appreciation
Days — "Pancakes
Days — "Pancakes
Days — "Holiday
and PJs Day"
and PJs Day"
Luncheon"
Page 34 of 35
Financial Implications:
�m
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:
None.
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 35 of 35