The most recent visit from government inspectors to the Golden Manor revealed a number of non-compliance violations.
The Ministry of Health and Long-Term Care performed a Resident Quality Inspection (RQI) which took place from November 2-6 and November 9-12, 2015.
The report was released on January 19, 2016.
Further inspections were carried out concurrently with the RQI, including:
- a complaint regarding abuse
- a complaint regarding falls
- two critical incidents regarding respiratory outbreaks
- three critical incidents regarding abuse
Twenty-three non-compliances were issued during the course of this inspection.
Longtime Golden Manor head administrator Heather Bozzer recently retired, so the Manor is currently without one.
City of Timmins Chief Administrative Officer Joe Torlone is handling certain duties during this period.
He offered the following statement when contacted by TimminsToday:
"The Golden Manor had 4 compliance orders which required action by January 29, 2016 and February 29, 2016. All compliance orders have now been rectified. With respect to the written notices and Voluntary Plans of Correction, they have all been addressed."
The January report marks an increase in non-compliance orders. A previous inspection which took place in December of 2014, and was released in February of 2015, revealed 14 violations.
Many of the issues stemmed from safety issues such as bed railings and wheelchairs.
The Golden Manor 'failed to comply' with a policy to promote zero tolerance of abuse and neglect of residents, the report says.
The report also says an incident occurred in December of 2014 in which a PSW (Personal Support Worker) is alleged to have verbally abused a resident using the restroom. The resident was told to 'hurry up' and that they 'did not own the bathroom'. The resident reported they felt like crying due to the mistreatment, the report states.
An Inspector reviewed the incident. The PSW admitted to rushing the resident and saying the things that the resident reported, says the report.
The resident filed a complaint to an RPN (Registered Practical Nurse) on the same day of the incident. However, the offending PSW was allowed to continue to work, says the report.
An inspector reviewed the Manor's policy entitled 'Zero Tolerance of Abuse and Neglect'. The policy stated that the staff member alleged to have caused abuse or neglect was to be suspended with pay, pending a further investigation, with the possibility of corrective action.
The PSW continued to perform their duties while the investigation was ongoing.
Furthermore, In November of 2015, a 'critical incident' was reviewed. The incident in question took place in July of 2015.
A resident was found lying on their back, on the bathroom floor. The resident's alarm was ringing faintly. The resident sustained two fractures and subsequently received surgery, says the report.
Staff did not hear the alarm, and thought it was coming from the floor below the unit. An RPN thought that perhaps the alarm battery was low. After this incident, staff asked management for a better alarm system for this particular resident, the report says.
An RPN explained that staff members are not expected to check for alarm reliability, the report says.
The Nursing Care Coordinator (NCC) confirmed the home has no process for checking alarm reliability, the report says.
An Inspector reviewed a resident's health care record which indicated that the resident fell three times in September and October of 2015. The resident's personal care plan included an hourly check to ensure safety. In November, the Inspector interviewed two PSWs who stated the resident had fallen more 'in the last while'. One of the PSWs explained the resident uses a walker and was prone to falling. The staff further indicated that they used to check on, and document on the resident every hour, and that they no longer did this.
The Manor also failed to comply with 'Security of Drug Supply', the report says.
By law, controlled substances are to be stored in a separate, double-locked stationary cupboard, or in a separate locked area, in a locked medication cart.
In an unlocked room, accessible from the Nurse Practitioner's office, the report says the Inspector observed a large single-locked medication cart which served as the home's Emergency Drug Box. The Inspector observed a vial of controlled medication in an unlocked refrigerator in the same room. The Inspector also found controlled medications, in unlocked, unsecured refrigerators in single locked rooms at four separate locations within the Manor.
The NCC explained to the Inspector that the Manor had been trying to find a way to lock the refrigerators containing narcotic and controlled drugs, but has not been successful to date.
The Golden Manor is funded by the City of Timmins, the provincial Ministry of Health, and resident co-payment.
The Manor currently has 177 residents, according to administrators.
