Snap inspections reveal issues at long-term care facilities

Long-term care homes where provincial inspectors have found abuse and understaffing are expected to come into compliance says Dipika Damerla, Associate Minister of Health and Long-Term Care.

Damerla was responding to SooToday questions regarding inspection reports for long term care homes in Sault Ste. Marie.

The province ramped up inspections in 2013, doubling the inspection staff and promising every long term care home in Ontario will receive a comprehensive inspection annually.

Cedarwood Lodge — which opened last spring in the former Davey Home location — was subject to three inspections between December and January, including an extensive 10-day Resident Quality Inspection (RQI).

With 49 residents in care, a Complaint Inspection conducted in December found the facility was chronically understaffed, says a report posted by the ministry.

The inspection found at times only three Personal Support Workers (PSWs) were on staff over the evening shift, one of which was on modified duties and unable to lift — leaving two PSWs to transfer, toilet and put all residents to bed.

During the RQI conducted in January, inspectors reviewed complaints from residents not receiving their scheduled showers or baths — to be completed twice per week — due to staffing shortages.

In the case of one resident, investigators determined there were no documented baths over the course of a two-week period, while another resident had no documented baths over an 11-day period.

Two PSWs who were interviewed by MOHLTC inspectors said residents are often given a bed-bath instead of a bath or shower when the home is under-staffed.

The report says the director of care for Cedarwood confirmed to inspectors that baths are to be provided, even if the facility is understaffed, and a failure to document the bathing on Activity of Daily Living Flow Sheets indicates the baths were not provided.

As a result of the ministry’s RQI at Cedarwood Lodge, 12 written notifications, 4 voluntary plans of correction and 3 compliance orders were issued by MOHLTC.

Rudy Putton, director of care for Cedarwood, declined an opportunity to comment for this article.

At another long term care home in Sault Ste. Marie, investigators found there were delays in reporting staff-on-resident abuse allegations, which rules say should be reported immediately.

Over a six-month period, four Critical Incident (CI) reports were submitted by the F.J. Davey Home which related to physical abuse toward residents. 

In all four cases, the reports were made to the director between one and four days after the incident occurred.

Of those four cases, three involved allegations of abuse by staff toward residents.

As a result of the ministry’s RQI at the F.J. Davey Home, nine written notifications, four voluntary plans of correction and two compliance orders were issued by MOHLTC.

Barbara Harten, executive director for the F.J. Davey home, did not return a call for comment.

Damerla said transparency is of upmost importance when it comes to the inspection reports, but she also hopes to ‘move the needle even more’ in an effort to make them easier for the layperson to read.

“Some of these reports are not always easy to understand,” she said.

A long term care home could, for example, show seven relatively minor infractions on an inspection report.

“Another home could have just one infraction, but be very serious,” said Damerla.

She said the ministry’s expectation is that homes come into compliance.

“If an inspector finds there is an issue and highlights it, we have a process where we expect the homes to come into compliance. There is a timeline in which they are to come into compliance. An inspector will go back there and if they are still not in compliance there are obviously progressive steps we can take,” said Damerla.

Back at Cedarwood Lodge, inspections also highlighted a lack of equipment — including for transfer of residents from a wheelchair to a toilet.

Interviewed by MOHLTC investigators, a Registered Nurse who works at Cedarwood stated the home does not have enough equipment to meet the needs of certain residents, who are offered use of bedpans instead of toilets against their plan of care, said the report.

Inspectors also found a bathroom with no pull cord for the call bell to alert staff and in three other rooms the call bells were found to be on the floor under the bed, out of reach of residents, the report said.

A report says during an MOHLTC interview, the executive director confirmed the expectation of staff was to ensure the call bell should be within reach of residents at all times while they are in their rooms.

Inspectors observed multiple residents who did not have control of either their bowels or bladder, says the report.

One resident was reported as being incontinent of bladder three times over five of the days MOHLTC investigators were conducting their investigation, the report states.

A PSW interviewed by MOHLTC investigators stated the residents of the home were not on any specific toiletting plans.

In response, an order from MOHLTC states the facility must develop and implement an interdisciplinary continence care and bowel management program.

December’s Complaints Inspection also found a lack of training of staff to deal with responsive behaviours — such as grabbing, screaming and agitation — often associated with people suffering from dementia or Alzheimer’s disease.

Interviewed by an MOHLTC inspector, three PSWs stated they had not received training in how to care for residents with dementia, nor have they been taught techniques and approaches to deal with responsive behaviours.

Management was unable to provide training records and later confirmed education had not been provided to staff who provide direct care, says the report.

Damerla said the province has committed to spending an additional $10-million in the 2016 provincial budget toward Behaviour Services Ontario (BSO), which specializes in training health care providers to deal with responsive behaviours.

BSO training focuses on identifying the root causes of responsive behaviours instead of treating them with drugs.

Damerla cited one case in which a long term care resident consistently became agitated during meal times.

“What we found out was he really wanted a Coca-Cola. He had no way of expressing that for some reason,” she said.

Upon dealing with the trigger, Damerla said the resident’s responsive behaviours became much easier to manage.

“That’s because someone took the time to notice what time his agitation happened,” said Damerla.

The province’s Long-Term Care Home Quality Inspection Program continuously investigates complaints, concerns and critical incidents, performing unannounced inspections and ensures all long-term homes are inspected at least once per year.

Along with the BSO funding, the province has committed to increasing by two percent the amount of money long term care homes receive from the province, as well as spending an additional $250-million on in-home care.

"The more home care we can provide will slow down the tap of people going into long-term care,” said Damerla.

Cedarwood Lodge was developed in consultation with Ministry of Health and Long-Term Care, North East LHIN, Sault Area Hospital and other community partners as part of the Alternate Level of Care (ALC) Plan for Sault Ste Marie.

The province funded the project to the tune of $2.4-million.

ALC patients are those who remain in hospital after the acute portion of their care is completed, but their next destination is unavailable for a variety of reasons.

Operated by Sudbury-based Autumnwood Community Care Inc., Cedarwood Lodge is home to 50 beds for seniors, many of whom have been waiting in hospital as alternate level of care patients.

A spokesperson for Autumnwood Community Care Inc. also declined an opportunity to comment for this story.

The F.J. Davey home is a 374-bed long-term care nursing home which provides three levels of care — assisted care, supportive care and special care.

Damerla said the annual comprehensive inspections have had an added benefit, prior to the 2013 ramp-up some low-risk homes were only inspected when complaints were received.

“By inspecting every home we have learned a lot about what the good homes are doing,” said Damerla.