Erie St. Clair LHIN and South West LHIN: Notable infractions at long-term care homes
Erie St. Clair Local Health Integration Network and South West Local Health Integration Network: Notable infractions in alphabetical order based on data obtained through Ministry of Health and Long-Term Care inspection reports. (July 2010 to Dec. 2013)*
Afton Park Place Long Term Care Community, Sarnia (S & R Nursing Homes Ltd.)
September 26, 2010 - Resident was slapped by staff, police were not called.
Brouillette Manor, Tecumseh (1230839 Ontario Limited)
January 5, 2011- Policy says resident must be watched every hour - he/she wasn’t. He/she went missing for several hours in the middle of the night (2 a.m. - 5:30 a.m.), although a “checklist” indicated he/she had been seen every hour up to 5 a.m.
Caressant Care Courtland, Courtland (Caressant Care Nursing and Retirement Homes Ltd.)
May 12, 2012 - Staff are directed to only wash residents with cognitive disabilities when they request it, although staff admit, that three of the residents in question did not have the cognitive abilities to do so.
Caressant Care on Bonnie Place, St. Thomas (Caressant Care Nursing and Retirement Homes Ltd.)
August 12, 2011 - Kitchen staff knowingly used a broken blender to prepare pureed meals. A screw was found in a resident’s meal
Chateau Gardens Parkhill, Parkhill (Chartwell Master Care LP)
October 19, 2010 - Resident was placed on a bedpan at 9:30 p.m. on September 25, 2010. According to the resident’s “restraint monitoring record,” their position was checked and changed at 11 p.m. that night, and at 3 a.m. and 5 a.m. on September 26th, 2010, yet the bed pan wasn’t discovered until 5:30 a.m.
Country Terrace, Komoka (Omni Health Care)
October 2, 2012 - Didn’t protect resident when their money was being stolen from them. Staff member told management they had a criminal record, and management didn’t do a criminal reference or vulnerable sector check on specific staff member. Another staff member didn’t sign the self-declaration of a criminal record and management didn’t check to see if they had one. The resident became a victim of financial abuse.
Dearness Home for Senior Citizens, London (City of London)
March 5, 2012 - Staff didn’t ensure that assessments and communication of safety and risks were in place for a resident, resident was transferred internally to a less secure wing, without involving family in the decision. He left the grounds unaccompanied and died after being hit by a car. During the investigation, the administrator stopped staff interviews in progress and refused to hand over surveillance videos and provide requested information.
Elgin Abbey Nursing Home, Chesley (Capricorn Investments)
October 3, 2012 - RN on duty only about 25 per cent of the time between September 13 and October 2, despite several warnings about proper staffing levels.
Extendicare Southwood Lakes, Windsor (Extendicare Canada Inc.)
March 14, 2013 - Hazardous chemicals accessible to residents and resident ingested an unknown amount of chemicals resulting in health concerns.
March 16, 2011 - The “restraints monitoring record” for a resident had been completed for the entire day when it was reviewed at 10:30 a.m.
Iler Lodge, Essex (Revera Long Term Care Inc.)
April 11 2011 - Ministry didn’t receive report after one employee verbally abused resident, resulting in emotional and psychological harm. Multiple people confirm that employee was abusive to resident for months and the Resident Non Abuse policy wasn’t followed.
Meadow Park, London (Meadow Park London Inc.)
December 2, 2013 - Used a sheet as a restraining device.
October 17, 2012 - Resident has lower natural teeth and their plan of care says he/she needs help in brushing them. All PSWs interviewed said the resident wears only dentures- hence, no assistance has been provided in brushing his/her teeth.
May 12, 2012 - Lower sheets were bunched up and crumbs were found on a bed just after a PSW had made it.
Ritz Lutheran Villa, Mitchell (Ritz Lutheran Villa)
April 23, 2013 - Home doesn’t have a medical director. The senior administrator confirmed that the home has a plan in place to recruit medical director.
March 19, 2012 - Police involved - agency RN pulled over after completed a shift. She was fraudulently acting as an RN, and dispensed prescription medication at the home. She hadn’t been trained and home was unable to provide evidence of agency staff receiving screening measures for their credentials including criminal reference checks.
Terrace Lodge, Aylmer (Elgin County)
May 16, 2011 – As an April Fool’s Day prank, RN and PSW applied Vaseline to the crossbars, lift handles, closet door and room handle. Resident was dressed in briefs filled with jam, and jam was smeared on a commode.
*Click on the incident date to view the Ontario Ministry of Health and Long-Term Care Inspection Report.