1 “C NOVA SCOTIA Health and Weliness Facility: File #: Administrator: Investigator: Date allegation reported: PC Box 488 Halifax, Nova Scotia Canada 83i 2R8 T: 902-424-1 2846 F: 902-428-5829 navascotia.ca’dhw Alderwood Rest Home ALDE0003 Arlene Morrison Adele Griffith October 26, 2015 OVERVIEW: • On October 26, 2015 a report was made under the Protection for Persons in Care Act (PPCA) alleging the use of physical force resulting in pain, discomfort or injury and mistreatment causing emotional harm as defined in sections 3(1 )(a) and (b) of the Regulations. 20(1) 20(1) • It was alleged that emotional harm to residents. • Following an inquiry into the allegation, it was determined that there were reasonable grounds to conduct an investigation pursuant to Section 8(2) of the PPCA. • The investigation included interviews with relevant individuals. Progress notes, statements and other related information was reviewed as part of the investigation. used physical force with residents and caused SUMMARY OF FACTS: The following summary of the facts is limited to high-level details to ensure resident specific information is protected. #I 20(1) 20(1) ALDE0003 Page lofS Page 2 Withheld Section 20(1) Page 3 of 5 4 20(1) 20(1) ADDITIONAL INFORMATION: 20(1) 20(1) FINDINGS: The allegation of the use of physical force as defined in Section 3(1) (a) of the Protection for Persons in Care Regulations is unfounded for the following reason: • Although there is no doubt that several incidents occurred (as there were a number of witnesses to separate allegations) there was no report made by staff at the time after any allegation of or an assessment completed physical force. The allegation of mistreatment causing emotional harm as defined in sections 3(1)(b) of the Protection for Persons in Care Regulations is founded for the following reasons: • There are multiple accounts and witnesses that consistently demonstrate that 20(1) 20(1) DIRECTIVES: 1. During the investigation, staff who witnessed the incident did not appear to recognize the incident as possibly being a situation of abuse. As such, the administrator shall provide specific education to staff regarding recognizing escalating situations and techniques for responding, signs of abuse and definitions of abuse. If this education has already occurred, please provide details regarding the education sessions, such as dates, content, attendance, etc. ALDE0003 Page4ofs 5 2) Multiple staff who witnessed various incidents did not report the situations promptly to Protection for Persons in Care or management following the incidents. As such, when a service provide suspects and/or witnesses an incident of abuse, this information shall be promptly reported to PPCA. The administrator shall ensure staff are aware of their duty to report and understand the process of prompt reporting. 3) 20(1) 20(1) there was no documentation regarding the incident. As such, the administrator shall ensure staff are aware of facility policies and procedures regarding documentation of such incidences (i.e. progress notes, incident report, etc). (AhIL4 A Adele Griffith, BW, RSW Investigation & Compliance Officer Department of Health and Wellness ALDE0003 4 aYj2/6 ate Page5of5 NOVA SC TIA T: 902-424-6816 Health and Wellness PO Box 488 F: 902423-5829 Halifax. Nova Scotia navascoliacaidhw Canada 2R8 File Facility: Arborstone Enhanced Care Administrator: Melissa Jenkins Investigator: Sarah Goldstein Date allegation reported: October 29, 2015 OVERVIEW: . On October 29, 2015, an allegation was received under the Protection for Persons in Care Act alleging mistreatment causing emotional harm as defined in section of the Regulations. . . was eermlne at there were reasonable grounds to conduct an investigation under the Protection for Persons in Care Act. . The investigation included a review of the internal investigation notes provided by the facility management, facility policy and interviews with relevant individuals. SUMMARY OF FACTS: ADDITIONAL INFORMATION: A response to the Preliminary Investigation Report was received from - a 1 runs acts or evidence related to the investigation was provided. AR800034 Page 1 of2 FINDINGS: As such, the InveSIQann mo a ega Ion mistreatment causing emotional harm, including intimidating and humiliating as de?ned in section 3 (1) of the Protection for Persons in Care Regulations is founded. DIRECTIVES: Based on the findings from the investigation, the following directives are issued: 1. As a delay in responding and reporting the allegation of abuse was identified during the course of the investigation, the administrator will ensure that managers and staff are aware of the procedures for responding to allegations of abuse and are aware of the facility policies/procedures for reporting in order to ensure prompt reporting of incidents. Jd?ajw Wk Sarah Goldstein, MSW, RSW ate Investigation Compliance Officer Department of Health and Wellness Page 2 of2 . 8 NOVA SCOTIA Health and Wellness T: 902-424-0498 F: 902-428-5829 novascotiacaldhw File #: GABL0007 Facility: Gables Lodge Administrator: Kathy Maltby Investigator: Jennifer Tough Date allegation reported: May 5, 2015 OVERVIEW: On July May 5, 2015, a complaint alleging mistreatment causing emoUonal harm, as defined in section 3(1) (b) of the Protection for Persons in Care Regulations was reported to the Protection for Persons in Care office. • • 20(1) 20(1) An inquiry was completed and it was determined that there were reasonable grounds to conduct an investigation under the Protection for Persons in Care Act. The investigation included interviews with the involved parties and a review of facility investigation documentation and the facility policy regarding resident abuse. SUMMARY OF FACTS: • On a situation which allegedly occurred on reported to facility management. • The facility followed up on the report and spoke with working when the alleged incident occurred. was and staff 20(1) 20(1) GABL0007 Page 1 of 3 9 20(1) 20(1) ADDITIONAL INFORMATION: No additional information was provided in response to the preliminary report. FINDINGS: The following is a summary of the facts from the investigation that led to the findings and the directives: On a situation which allegedly occurred on facility management, was reported to 20(1) 20(1) GABL0007 Page2of3 10 20(1) 20(1) As such, the investigation into the allegation of mistreatment causing emotional harm as defined in section 3 (1) (b) of the Protection for Person’s in Care Regulations, reported under the Protection for Person’s in Care Act on May 5, 2015 is founded. DIRECTIVES: As a result of the investigation, the following directive is being issued to the facility: 20(1) 20(1) 1. The Administrator shall ensure that staff receive training upon hire and on an ongoing basis regarding the signs/symptoms of potential abuse, and are aware of their requirement to report allegations of suspected abuse to the Protection for Persons in Care toll free line. JculaiHSd4tim I Jennifer Tough, BSW, RSW 1 \ Qte C) Investigation & Compliance Officer Department of Health and Weliness GABL0007 Page3of3 11 NOVA SC TM. Health and Wellness Uox 488 Halifax, Nova Scotia Canada 83J 2R8 T: 902-424-6816 F: 902-428-5829 tovascotiacaldhw File #: GLASOO1O Facility: Parkland at the Lakes Glasgow Hall Administrator: Cathy Johnson Investigator: Sarah Goldstein Date allegation reported: April 16, 2015 — OVERVIEW: On April 16, 2015, an allegation of mistreatment causing emotional harm at Glasgow Hall was reported to the Protection of Persons in Care office as defined in section 3(1) (b) of the Protection for Persons in Care Regulations. • 20(1) 20(1) • • A determination was made that there were reasonable grounds to conduct an investigation pursuant to section 8(2) of the Protection for Persons in Care Act. The investigation included a review of information provided by the facility management, progress notes, and interviews with relevant individuals. SUMMARY OF FACTS: 20(1) 20(1) GLASOO1O Page lof3 12 ADDITIONAL INFORMATION: 20(1) 20(1) No additional facts or evidence related to the investigation was provided. FINDINGS: The following is a summary of the facts from the investigation that led to the findings and the directives: 20(1) 20(1) As such, there are reasonable grounds to conclude that mistreatment causing emotional harm as defined in section 3(1 )(b) of the Protection for Persons in Care Regulations was likely to have occurred and the allegation is founded. DIRECTIVES: As a result of the investigation, the following directives are being issued to the facility: 20(1) 20(1) 1. The Administrator shall ensure that managers and staff receive training upon hire and on an ongoing basis regarding the signs/symptoms of potential abuse, and are aware of their requirement to report allegations of suspected abuse in a timely manner to the Protection for Persons in Care toll free line. 2. During the course of the investigation, it became apparent that there were other instances that could fall within the definition of abuse that had not been reported. The Administrator will ensure that all staff and managers receive training on abuse, including the definition of abuse, and the requirements of the Protection for Persons in Care Act including the duty to report allegations to the Minister. GLASOO1O Page2of3 13 3. It was noted that immediate action was not taken when the allegation of abuse was made. The administrator will ensure that managers and staff review internal processes of reporting allegations and responses to allegations, which may include reviewing the facility’s related policies of responding to allegations of abuse. The Administrator shall ensure managers are aware of the internal investigations process and procedure, including who staff should report concerns to and the process for management staff to follow-up on those concerns. Sarah Goldstein, RSW Investigation & Compliance Officer Department of Health and Wellness GLASOO1O fl1. L, Date Page3of3 14 NOVA>S’S3TIA Health and WeIlness PC Box 4 T; 902-424-5226 F; 902-428-5829 Halifax, Nova Scotia novascoiiacaidhw Canada B3J iRS File #: GLENOO16 Facility: Glen Haven Manor Administrator: Lisa Smith Investigator: Heather Avery Date allegation reported: August 12, 2015 OVERVIEW: On August 12, 2015, a report was received under the Protection for Persons in Care Act alleging the administration, withholding or prescribing of medication for inappropriate purposes as defined in section 3(1) (c) of the Regulations. • 20(1) 20(1) • Based on the information received, it was determined that there were reasonable grounds to proceed with an investigation pursuant to section 8(2) of the Protection for Persons in Care Act. • An investigation was conducted which included interviews with relevant individuals, a review of information from residents’ charts and care plans, review of medication administration records and facility policies. SUMMARY OF FACTS: a. The incidents of the administration of medications for inappropriate purposes were reported to the management of the home in February 20 15. 20(1) 20(1) h. Several staff reported that the PRN medications were administered to certain residents because they were too disruptive to other residents on the unit. GLENOO1 6 Page 1 of 5 15 20(1) 20(1) n. On review of selected resident’s MAR sheets, there were several PRN medications that did not have a documented intended use from the physician. o. Several staff reported following the practice of administering PRN medications as soon as a resident started to escalate as the medication may not be effective once a resident’s agitation increases. 20(1) 20(1) q. Staff interviewed reported that they were unaware of the Challenging Behavior Resource Consultant Program or other outside resources for challenging behaviors. r. Staff were unaware or had never used internal programs or resources to address challenging behaviors (such as PIECES). s. The facility “Protective Measures & Restraints Policy” was reviewed. Staff were unfamiliar with the definition of chemical restraints or which medications may be considered a chemical restraint. t. The “Protective Measures & Restraints Policy” policy states that “a healthcare team assessment and analysis of the resident behavior being completed, the resident or substitute decision maker consenting or the consideration of restraints as temporary measures requiring continual assessment and evaluation, remaining in use only until the underlying problem can be resolved”. In the resident charts reviewed, where a resident was receiving PRN medications for agitation, there was no documentation of this assessment, analysis or consultation with the substitute decision maker. GLENOO16 Page2of5 16 u. Pharmacy reviews were completed every 6 months. v. Staff interviewed reported that they had not received any education at the facility related to Protection for Persons in Care. ADDITIONAL INFORMATION: 20(1) 20(1) The administrator responded to the preliminary investigation report and reported the following: The facility has mandatory professional development on Protection for Persons in Care each May and during orientation. The facility has safe work practice policies established for working with residents with responsive or aggressive behaviors. Resident care plans were reviewed in March 2014 with plans for monthly care plan reviews. The challenging behavior consultant and seniors mental health are utilized A review of practices related to PRN medications and safe work practices with staff is planned. A corrective action plan for physician documentation is being implemented. Staff will be receiving education on restraint use. - - - - - - - FINDINGS: 20(1) 20(1) GLENOO16 Page 3 of 5 17 20(1) 20(1) As such, the allegation of the administration, withholding or prescribing of medication for inappropriate purposes is founded. DIRECTIVES: 20(1) 20(1) the following directives will address concerns that were identified during the course of the investigation. 1. The facility was aware of this allegation of abuse in February 2015 and it was not reported to the PPCA office. As such, the administrator shall ensure that all allegations of abuse and suspected abuse will be reported the Protection for Persons in Care Office in a timely manner. 2. Staff interviewed during the course of the investigation were unaware of resources available to them for addressing challenging behaviors. As such, it is required that the facility provide education to registered staff to increase awareness of internal and external resources such as PIECES, Challenging Behavior Resource Consultant and Seniors Mental Health. 3. Several residents had evidence of ongoing, frequent responsive behaviors, however care plans did not include interventions for the responsive behaviors and/or there was no documentation to reflect that the interventions were attempted by staff prior to the use of PRN medications. As such, it is required that care plans include interventions for responsive behaviors when present and staff receive education for awareness of the interventions. 4. Numerous concerns with the use, documentation and monitoring of PRN medications were identified during the course of the investigation. These included: • • • • Administration of 2 PRN medications for agitation at once Documentation of the effect of a PRN medication immediately after its administration Minimal documentation of challenging behaviors that led to frequent PRN medication administration for agitation and lack of non-medication interventions for challenging behaviors. Lacking documentation of the intended use of PRN medications by the physician ordering the medication As such, it is required that the administrator provide training around the appropriate use and monitoring of PRN medications to staff who administer medications to residents of the home. GLENOO16 Page4of5 18 5. Staff interviewed had minimal knowledge of the facilitVs Protective Measures & Restraints Policy and its application. As such, it is required that the administrator review the policy to ensure that it is in keeping with current best practice with regard to least restraint use in long term care and provide education and training to staff around the policy and its application. 6. Residents are serviced by a group of physicians. Documentation on the physician’s visit, assessment and medication changes (other than the physician’s order) were not consistently present in the resident charts reviewed. As such, it is required that the administrator ensure that physician’s documentation is completed. i-leather Avery, B.Sc.AHNP.Dt. Investigation & Compliance Officer Department of Health and Wellness GLENOQ16 -vij zi/j& Date Page 5 of 5 File 19 NOVA SC TIA T: 902424-5032 Health and Wellness PO Box 433 F1 9024285829 Halifax, Nova Scotia novascoliaoaldhw Canada 831 2R8 Facility: Harbourview Haven Administrator: Tim McAuley Investigator: Barbara McCarthy Date allegation reported: April 17, 2015 OVERVIEW: - On April 17, 2015 a complaint alleging failure to provide adequate nutrition, care, medical attention, or necessities of life without valid consent was re orted to the Protection of Person's in Care Office. ere were reasona groun to proceed with an investigation under Section 3(1) (9) of the Protection of Persons in Care Act. - The investigation included a review of documentation provided by facility management, ervrews wut relevant witnesses were also con ucted. SUMMARY OF FACTS: Page 1 of 5 Page 20 Withheld Section 20(1) 20 -- . Staff consistently reported when a dressing is changed it should be documented on the wound assessment form. a Staff consistently reported the facility follows the NS wound care protocol. . There is evidence of an incomplete draft wound care policy in the home that does not identify interventions at all stages of the wound. The wound care committee has not met since February 2014. The care ans were repo up a as concerns an 0 anges were identified. . Care plan goals were reported by staff to be initiated or reviewed and updated at care conferences only, both the initial and annual. ADDITIONAL INFORMATION: A reSponse was received from No additional information related to the Inves iga Ion was provn . A response was received from the facility. The administrator re-iterated some of the information in the preliminary report in more detail. The administrator detailed changes to the facilities procedures and planned education to address issues identified during the course of the investigation. The administrator reported the facility has a least restraint policy. Alternatives to restraints are used rather than physically securing a resident to a chair or bed. - Page 3 of 5 22 FINDINGS: a As such the allegation of failure to provide adequate nutrition is unfounded. suc a egation ai ure to provide adequate care? is unfounded. ?the allegation of failure to provide adequate medical attention is founded. DIRECTIVES: Through the course of the investigation, several gaps facility, documentation, communication, policies and procedures were identified. As such, the following directives will be issued: 1. The facility care plans do not include interdisciplinary goals to meet the resident?s identified needs. As such, it is required that resident care plans are mo I Ie to inc ude pertinent risk, goals, interventions and timeframes for evaluation. 2. The facility?s wound care policies and procedures were incomplete and in draft form at the time of the investigation. As such, it is required that wound care policies are Page 4 of 5 23 up-to-date and staff are aware of and follow the policies and procedures Relevant staff are to receive education on the wound care policies and procedures once implemented. such, it is required that the facility provide education to staff around recognizing the need for further intervention and the process in place at the facility for seeking the interventions. 2k (2&1 90+ Barbara McCarthy, Heather Avery, 5Dt. Investigation Compliance Of?cer Investigation and Compliance Officer Department of Health and Wellness Department of Health and Wellness Seam/9110a 9 90/5? Date Date Page 5 of 5 . 24 NOVA SC TIA T: 902?424-1284 Health and Wellness PO BOX 488 F: 9024235829 Halifax, Nova Scotia novascotiapaidhw Canada 2R8 File HILL0011 Facility: Hillside Pines Administrator: Marisa Eisner Investigator: Adele Grif?th Date allegation reported: September 24, 2015 OVERVIEW: . On September 24, 2015 a report was made under the Protection for Persons in Care Act (PPCA) alleging failure to provide adequate care as de?ned in section of the Regulations. I . Following an inquiry into the allegation. it was determined that there were reasonable grounds to conduct an investigation pursuant to Section 8(2) of the PPCA. . The investigation included interviews with relevant individuals. Progress notes, statements and other related information was reviewed as part of the investigation. STATEMENT OF FACTS: . The call bell system was tested following the alleged incident and found to be in working order on the night of the allegation. . The call bell system works in conjunction with a pager and a light system over the resident's door. There was a full complement of staff working on the unit at the time of the alleged incident. . It is reported that extra staff came over to the unit to offer assistance to the staff on the unit. There are con?icting reports about what time the extra staff arrived. Page 1 of 3 25 - Staff from the other unit do not carry pagers when assisting another unit, they carry pagers for their own unit. . Staff report that they found the evening in which the alleged incident occurred to be more hectic and busier than usual. - Staff members report taking breaks individually and report they would never leave the unit unattended. . Staff interviewed report that their pagers were not turned off at any point. . Staff members report that the pager system works inconsistently. - Rounds were not completed through the evening. Page 2 of 3 . Staff members interviewed reported attending education sessions regarding PPCA and demonstrated awareness of the facility policy of abuse. ADDITIONAL INFORMATION: . No additional information was received in reSponse to the Preliminary Investigation Report. FINDINGS: The report made under the Protection for Persons in Care Act (PPCA) alleging failure to provide adequate care as de?ned in section of the Regulations is founded for the following reasons: . The call bell system was tested and found to be in working order on the night of the allegation. . Staff did not complete round DIRECTIVES: On October 13, 2015 in response to the allegation, it was reported that a number of actions and recommendations have been initiated since the alleged incident occurred, such as communication protocols and audits, which may fulfill some of the directives being issued below. 1. The administrator shall ensure that staff receive training and education around staff responses to residents call bells in safe and appropriate timeframe. 2. The administrator shall ensure there is a process in place to ensure staff communicate and know who is responsible for resident care needs. 3. The administrator shall ensure there is a process to regularly monitor residents to ensure they are safe routine checks). ?ea/a aims/9% WA Adele Grif?th, te Investigation Compliance Of?cer Department of Health and Wellness HILL0011 Page 3 of 3 26 16 NOVAn'bTIA Health and Weliness PD Box 488 Halifax, Nova Scotia Canada B3i 2R8 T: 902-424-0529 F: 902-428-5829 novascotra.caftmw File #: MAH000I2 Facility: Mahone Bay Nursing Home Administrator: Tracey Cousins Investigator: Joanne Blight Date allegation reported: July 25, 2016 OVERVIEW: On July 25, 2016, a report was made under the Protection for Persons in Care Act alleging mistreatment causing emotional harm between as defined in sections 3(1) (b) of the Regulations. The alleged incident involved 20(1) 20(1) o o It was determined that there were reasonable grounds to proceed with an investigation pursuant to section 8(2) of the Protection for Persons in Care Act An investigation was conducted which included interviews with relevant individuals and a review of information from SUMMARY OF FACTS: 20(1) 20(1) o o The alleged incident was documented by staff. The home quickly responded to the allegation, and put a prevention plan in place. ADDITIONAL INFORMATION: o No additional information was received. MAH00012 Page 1 of 2 17 FINDINGS: There is evidence of mistreatment causing emotional harm, including threatening, intimidating, humiliating, harassing, coercing or restricting from appropriate social contact for the following reasons: o Witnesses consistently reported the incident with the implicated person and o As the home reacted quickly to protect at the time of the incident and acted to prevent any future incidents no directives will be issued. 20(1) 20(1) o Joanne Blig BSc, PDt Investigation & Compliance Officer Department of Health and Wellness , MAH0001 2 Septmber29, 2016 Page 2 of 2 27 ‘C NOVA SCOTIA Health and Weilness T: 902-424-0484 F: 902-428-5829 novascotiaca’dhw PD Box 488 Halifax, Nova Scotia Canada 83i 2R8 File#: MELGOO19 Facility: Melville Gardens Administrator: Cecile Adair Investigator: Laura MacMaster Date allegation reported: November 10, 2015 OVERVIEW: On November 10, 2015 an allegation of mistreatment causing emotional harm was received under the Protection for Persons in Care Act as defined in section 3(1) (b) of the Regulations. 20(1) 20(1) Following an inquiry into the allegation it was determined that there were reasonable grounds to proceed with an investigation pursuant to section 8(2) of the Protection for Persons in Care Act. The investigation included interviews with the relevant parties. Information from and facility documents were also reviewed as part of the investigation. SUMMARY OF FACTS: 20(1) 20(1) 20(1) 20(1) ADDITIONAL INFORMATION: • A response to the preliminary report was received from the Administrator outlining actions taken following the alleged incident. • An emailed response to the preliminary report was received requesting an appointment to discuss concerns. A follow up response was sent requesting that any additional information or clarification to be forwarded in writing. PPCA File # MELGOO1 9 Page 1 of 2 28 FINDINGS: The investigation into the allegation of mistreatment causing emotional harm as defined in section 3(1) (b) under the Protection of Persons in Care Regulations is founded. The following outlines the rational for the finding: 20(1) 20(1) DIRECTIVES: No directives are issued. cm3Jt Laura MacMaster Investigation & Compliance Officer Department of Health and Wellness PPCA File # MELGOO19 Date Page 2 of 2 29 NOVA SCZTIA Health and Weliness po ox 485 Halifax, Nova Scotia Canada B31 Th8 T: 902-424-1284 F; 902-428-5829 wwwgov.ns.ca File #: MGNH0007 Facility: Melville Gardens Administrator: Cecile Adair Investigator: Louise Beaton/Adele Griffith Date allegation reported: June 18, 2015 20(1) 20(1) OVERVIEW: • On June 18, 2015 an allegation was received under the Protection of Persons in Care Act alleging mistreatment causing emotional harm, including humiliating and intimidating as defined under section 3(1) (b) of the Regulations. • • • There were reasonable grounds to proceed with an investigation under the Protection for Persons in Care Act. The investigation included a review of information provided by the facility, including the Interviews were completed with relevant individuals. SUMMARY OF FACTS: 20(1) 20(1) MGNH0007 Page 1 of 2 30 20(1) 20(1) ADDITIONAL INFORMATION: Concerns, details and clarification around several points were provided. 20(1) 20(1) FINDINGS: 20(1) 20(1) As such, the allegation of mistreatment causing emotional harm, including humiliating and intimidating as defined under section 3(1) (b) of the Protection for Persons in Care Regulations is founded. 20(1) 20(1) DIRECTIVES: but it was not reported to the PPCA office until 1. The incident occurred on June 18, 2015. As per the per section 4(2) of the Protection for Persons in Care Act, the administrator of a health facility shall report to the Minister all allegations of abuse against a patient or resident that come to the knowledge of the administrator. As such, the administrator will ensure that all allegations of abuse or likely abuse are reported to the PPCA office in a timely manner. 2. 20(1) 20(1) 4rlih &ZYi ‘Adle Griffith, SW, RSW di bte Investigation & Compliance Officer Department of Health and Wellness MGNH0007 Page 2 of 2 31 NOVA SC TIA 7; 9024245529 Health and Wellness PO Box 433 F1902423-5329 Halifax. Nova Scotia novascotiacaidhw Canada Bill 2R8 File MOUN0010 Facility: Mountain Lea Lodge Administrator: Joyce D'Entremont Investigator: Joanne Blight Date allegation reported: April 15, 2015 OVERVIEW: . On April 15, 2015, an allegation was received under the Protection for Persons in Care Act concerning the failure to provide adequate nutrition, care, medical attention or necessities of life without valid consent as defined in section 3(1) (9) of the Protection for Persons in Care Regulations. - Based on the information received, it was determined that there were reasonable grounds to proceed with an investigation pursuant to section 8(2) of the Protection for Persons in Care Act. - An investigation was conducted which included interviews with relevant individuals and a review of information from SUMMARY OF FACTS: Staff reported that they sometimes verbally report resident care issues to the Physician, which is not documented. F. a repo not aving? ?knowledge of the Nova Scotia provincial protocol for wound management. . The nursing home's wound care protocol does not reference the recommended treatment or the Nova Scotia provincial protocol for wound management. Page 1 of3 32 . Staff indicated they usually follow the physician's orders for wound treatment and their wound treatment does not include regular measurement, assessment or evaluation of the wound. . Staffs understanding of treatment procedures for wound care and documentation of wounds varied. . Staff indicated there is not currently a wound care committee at the facility. ADDITIONAL INFORMATION: . No additional information was provided in response to the Preliminary Investigation Report. FINDINGS: The investigation into the allegation of the failure to provide adequate nutrition, care, medical attention or necessities of life without valid consent as defined in section 3(1) (9) under the Protection of Persons in Care Regulations is founded. The following outlines the rational for the finding: MOUN0010 Page 2 of3 . Staff interviewed lacked knowledge and understanding of up to date wound care treatment and reported the current system at the nursing home does not allow for timely wound treatment. DIRECTIVES: Through the course of the investigation, several gaps of care provision were identified. As such, the following directives will be issued: 1. As such, the Administrator will ensure there are processes in place to have appropriate assessments completed on residents in a timely manor. 2. The staffs understanding of treatment procedures for wound care and documentation of wounds varied. The Administrator will ensure wound care treatment and related documentation reflects leading practice. 3. ministrator will ensure that there is a process in place to ensure wound referrals are completed in a timely manner. The Administrator will ensure ere is staff training on documentation and communication, and that all staff know, understand, and practice the principles and legal requirements of prompt and accurate documentation. 5. minis ra or a ensure ere IS a system in place so care ans are comp eted in a timely manner, updated regularly and include pertinent and multidisciplinary goals, interventions and plans for monitoring. 6. Staff interviewed had varying understanding of abuse. The Administrator will ensure that staff and managers receive training on abuse, including the definition of abuse, signs of abuse, and to reinforce the requirements of the Protection of Persons in Care Act, including the duty to report allegations to the Minister. Jaw/Mar Joanne Blight Date Investigation Compliance Officer Department of Health and Wellness Page 3 of3 33 34 NOVA SC TIA T: 9024241234 Health and Wellness PO Box 483 F: 902428-5329 Halifax, Nova Scotia novascntia.caidhw Canada 2R8 File Facility: Musquodobit Valley Home for Special Care Administrator: Dianna Graham Investigator: Adele Griffith Date allegation reported: May 1, 2015 OVERVIEW: . On May 1, 2015 a report was made under the Protection for Persons in Care Act (PPCA) alleging physical and emotional abuse as defined in section and of the Regulations. . Following an inquiry into the allegation, it was determined that there were reasonable grounds to conduct an investigation pursuant to Section 8(2) of the PPCA. . The investigation included interviews with relevant individuals. Progress notes, statements and other related information was reviewed as part of the investigation. SUMMARY OF FACTS: Page 1 of 4 Page 35 Withheld Section 20(1) . Staff were not able to recall the last time they had training on abuse prevention. ADDITIONAL INFORMATION: 1. No additional information was received. FINDINGS: The investigation into the use of physical force resulting in pain, discomfort or injury, including slapping, beating, burning, rough handling, tying up or binding as defined in section of the Protection for Persons in Care Regulations is founded. The following is a summary of facts from the investigation that lead tothe?ndingsr? . The allegation was corroborated by witnesses. The investigation into mistreatment causing emotional harm, including threatening, intimidating, humiliating, harassing, coercing or restricting from appropriate social contact as defined in section of the Protection for Persons in Care Regulations is founded. The following is a summary of facts from the investigation that lead to the findings: The allegation was corroborated by witnesses. DIRECTIVES: 1. inconsistencies were reported with staff knowledge on what to do following the incident. The administrator will ensure that all staff receive training on abuse, including the definition of abuse, signs of abuse, the requirements of the Protection for Persons in Care Act, including the duty to report abuse allegations to the Protection for Persons in Care, as well as the facilities internal process for reporting witnessed or suspected incidents of abuse. Page 3 Of 4 35 37 2. Although the incident was witnessed, there was no documentation regarding the incident. ?As such. the a ministrator shall ensure staff are aware of facility policies and procedures regarding documentation and that pertinent information regarding residents is maintained. Wm aim mam Adeie Griffith," Date/ Investigation Compliance Officer Department of Health and Wellness Page 4 of 4 38 NOVA SC TIA T: 90242443434 Health and Wellness PO Box 4843 F1902423-5329 Halifax. Nova Scotla novascoliacaldhw Canada 831 2R8 File NOBIOO17 Facility: Northwood Bedford Inc. (Ivany Place) Administrator: Josie Ryan Investigator: Laura MacMaster Date allegation reported: August 10, 2015 OVERVIEW: On August 20, 2015 a report was received under the Protection of Persons in Care Act alleging mistreatment causing emotional harm, including threatening, humiliating and intimidating as defined under section 3(1) of the Regulations. Based on the information provided, it was determined that there were reasonable grounds to proceed with an investigation pursuant to section 8(2) of the Protection for Persons in Care Act. An investigation was conducted which included interviews with the relevant parities. Information from the? and facility policies were reviewed as part of the investigation. SUMMARY OF FACTS: . Staff report that Gentle Persuasion training has been offered. Page 1 of 2 39 ADDITIONAL INFORMATION: No additional information was provided in response to the preliminary investigation report. FINDINGS: The following is a summary of facts from the investigation that lead to the ?ndings: Thus the allegation of mistreatment causing emotional harm, as de?ned under section 3(1) of the Protection for Persons in Care Regulations is founded. DIRECTIVES: The following directives will be issued to the facility: 1) -2) 3) Du, Laura MacMaster, Date Investigation Compliance Officer Department of Health and Wellness NOBI0017 Page 2 of 2 4o NOVA SC TIA T: 902-424-6816 Health and Wellness PO Box 488 FI 902428-5529 Halifax. Nova Scotia novascoiiacaidhw Canada 83} 2R8 File OCEA0022 Facility: Ocean View Continuing Care Centre Administrator: Dion Mouland Investigator: Sarah Goldstein Date allegation reported: July 13, 2015 OVERVIEW: - On July 13, 2015, an allegation was received under the Protection for Persons in Care Act alleging mistreatment causing emotional harm as defined in section 3(1) of the Regulations. . Based on the information received, it was determined that there were reasonable grounds to proceed with an investigation pursuant to section 8(2) of the Protection for Persons in Care Act. - An investigation was conducted which included interviews with relevant individuals and 5' rewew 0? ?mam" from? SUMMARY OF FACTS: Summary of facts relevant to the investigation: . The alleged incident was reported to have occurred on a ege li'lCl ent and any impacts?were not documented. ADDITIONAL INFORMATION: No additional information was provided in response to the preliminary investigation report. OCEAOOZZ Page 1 of2 41 FINDINGS: As such, the investigation into the allegation of mistreatment causing emotional harm as de?ned in section 3 (1) of the Protection for Persons in Care Regulations, reported under the Protection for Persons in Care Act on July 13, 2015 is founded. DIRECTIVES: As a result of the investigation, the following directives are being issued to the facility: 1- ?The Administrator shall ensure that staff receive training upon hire and on an ongoing basis regarding the of potential abuse, and are aware of their requirement to report allegations of su5pected abuse to the Protection for Persons in Care toll free line. Atmilu?o?otmm MM Sarah Goldstein, MSW, RSW ate I Investigation Compliance Of?cer Department of Health and Wellness OCEAOOZZ Page 2 of2 42 NOVA SCOTIA Health and Wellness PD Box 488 Halifax, Nova Scotia Canada 83) iRS 1902-424-0529 F: 902-428-5829 novascotia cadhw File #: PARKOO22 Facility: Parkstone Enhanced Care Administrator: Pam Currie Investigator: Joanne Blight Date allegation reported: 2/11/2015 OVERVIEW: • On November 2, 2015, an allegation was received under the Protection for Persons in Care Act alleging failure to provide adequate care or medical attention without valid consent as defined in section 3(1 )(g) of the Regulations. • 20(1) 20(1) • • In conducting an inquiry under the Protection for Persons in Care Act, questions were raised with respect to and the care and medical attention that was provided by the staff of the facility. It was determined that there were reasonable grounds to conduct an investigation pursuant to section 8(2) of the Protection for Persons in Care Act. The investigation included a review of information provided by the facility management, a review of hospital documentation, progress notes and interviews with relevant individuals. SUMMARY OF FACTS: 20(1) 20(1) PARKOO22 Page 1 of 3 43 20(1) 20(1) • The Shannex policy for a registered Dietitian assessment indicates a Registered Dietitian assessment is to be completed within 7 days of resident admission. 20(1) 20(1) ADDITIONAL INFORMATION: FINDINGS: The investigation into the allegation of the failure to provide adequate nutrition, care, medical attention or necessities of life without valid consent as defined in section 3(1) (g) under the Protection of Persons in Care Regulations is founded. The following outlines the rational for the finding: • • 20(1) 20(1) • PARKOO22 Page 2 of 3 44 DIRECTIVES: 1. As such, the Administrator will ensure there are processes in place to have appropriate assessments completed on residents in a timely manner. 2. As such, the Administrator shall ensure nutrition referrals are completed in a timely manner. 3. 20(1) 20(1) As such, the Administrator will ensure there is a process in place to review resident assessment information to ensure current care plans are developed which includes a review of wound care. 4. Education shall be provided to staff on wound care treatment and identification. 5. The Administrator shall ensure there is a system in place so care plans are completed in a timely manner, updated regularly and include pertinent and multidisciplinary goals, interventions and plans for monitoring. 6. As such, the Administrator shall review process for ensuring pertinent information is shared when resident transfers occur. As this may delay treatment, the Administrator shall ensure pertinent information is shared when a resident transfer occurs. Joanne Blight, c, PDt. Investigation & Compliance Officer Department of Health and Weliness PARKOO22 Date Page 3 of 3 45 air-<0 NOVA. SC TIA i?C: first 902-424-6251? Win-i ii ?mi 902-428-5289 5 Health and WEHFIESS File ROWA0004IIORM004 Facility: Roseway Manor Administrator: Sharon Callan Investigator: Jackie Herder Date allegation reported: January 6, 2015 OVERVIEW: An allegation was received under the Protection of Persons in Care Act on January 6, 2015 alleging abuse under section 3(1) and of the Regulations: a) the use of physical force resulting in pain, discomfort or injury, including slapping, beating, burning, rough handling, tying up or binding; and b) mistreatment causing emotional harm, including threatening, intimidating, humiliating, harassing, coercing or restricting from appropriate social contact. it was determined that there were reasonable grounds to conduct an investigation under the Protection for Persons in Care Act. The investigation included interviews with the involved parties and documents reviewed such as, witness statements, progress notes, and other related information. SUMMARY OF FACTS: Page 1 of 4 On December 27, 2014, the incident was reported to the staff in?charge. On December 29, 2014 documented the incident and it was given to senior management. Page 2 of 4 47 . Senior management were away from the facility on the date of the alleged incident. The incident was reported to management on January 5, 2015. ADDITIONAL INFORMATION: No additional evidence/information was provided in response to the preliminary investigation report. FINDINGS: The investigation into the allegations of the use of physical force resulting in pain, discomfort or injury and mistreatment causing emotional harm, as defined in sections 3(1) of the Protection for Persons in Care Regulations is founded. Witnesses provided corroborating evidence to support that on= On the accounts provided for? there are reasonable grounds to support that physical force happened and or circumstances occurred which likely would lead to abuse. DIRECTIVES: 1. During the investigation, it appeared there was a lack of awareness by staff of the procedures for reporting allegations of abuse in order to address situations and mitigate further abuse. The Administrator shall ensure there is a process in place for the flow of timely reporting and acting on suspected cases of abuse, so as to address situations to mitigate further abuse. 2. During the investigation, it appeared as though there was lack of knowledge of the definition and signs of abuse. All staff and managers are to receive training on abuse, including the definition of abuse and signs of abuse. Page 3 of 4 48 3. During the investigation, staff reported not being aware of their responsibilities in terms of what individual actions they are to take when abuse is suspected or witnessed. The Administrator shall ensure staff understand their responsibilities under the Protection of Person in Care Act, including the duty for staff to report when they have a reasonable basis to believe that a resident is, or is likely to be, abused. 4. The Administrator shall provide education around resident respect, sensitivity and communication to staff members identified as requiring such education. 5. During the investigation, staff did not appear to have knowledge regarding interventions available to support residents with responsive behaviors. Training on care of residents with dementia/responsive behaviors is to be provided to those staff members that the Administrator identifies as requiring such training. MW KW Jacqueline Herder, BSW, MA, RSW Date investigation Compliance Officer Department of Health and Wellness Page 4 of 4 49 )s NOVA SC TIA ?1 Po 902424-123: Health and Wellness Facility: Sagewood Continuing Care Centre File SAGE0006 Administrator: Tracy Bonner Investigator: Adele Griffith Date allegation reported: February 24, 2015 OVERVIEW: - On February 24, 2015 a report was made under the Protection for Persons in Care Act (PPCA) alleging physical abuse as de?ned in section of the Regulations. 0 . Following an inquiry into the allegation, it was determined that there were reasonable grounds to conduct an investigation pursuant to Section 8(2) of the PPCA. The investigation included interviews with relevant individuals. Progress notes, statements and other related information was reviewed as part of the investigation. SUMMARY OF FACTS: SAGE0006 Page 1 of 3 50 . Staff report inconsistencies on abuse training. ADDITIONAL INFORMATION: FINDINGS: The evidence gathered during the course of the investigation supports that the alleged incident occurred. There were witnesses to the incident and As such, the allegation of abuse investigated under the Protection for ersons in are ct, specifically section 3(1) ?the use of physical force resulting in pain, discomfort, or injury including slapping hitting, beating, burning, rough handling, tying up or binding" is founded. DIRECTIVES: In response to the Preliminary Investigation Report, the administrator reported a number of actions have been initiated since the alleged incident occurred, such as further education for staff, which may ful?ll some of the directives issued below. 1) During the investigation, staff who witnessed the incident did not appear to recognize the incident as possibly being a situation of abuse. As such, the administrator shall provide specific education to staff regarding recognizing SAG E0006 Page 2 of 3 2) 3) 51 escalating situations, signs of abuse and definitions of abuse. If this has already occurred, please provide details of when this was completed and how many staff attended education sessions. Various staff who witnessed the incident did not report the situation to Protection for Persons in Care or management until two days following the incident. As such, when a service provide suspects and/or witnesses an incident of abuse, this information shall be reported to PPCA. The administrator shall ensure staff are aware of their duty to report and understand the process of prompt reporting. Although the incident was witnessed and the administrator reports that there was no documentation regarding the incident. As such, the administrator shall ensure staff are aware of facility policies and procedures regarding documentation of such incidences (Le. progress notes, incident report, etc). 4) As such, the administrator shall provide training for staff identified as needing such training related to the reasons for various responsive behaviors exhibited by residents. If this has already occurred, please provide details of when this was completed, details of the training, and how many staff attended education sessions. Adele Griffith, stv, st Investigation Compliance Officer Department of Health and Wellness 52 NOVA SC TIA T: 902-424-5226 Health and Wellness PO Box 433 F: 902-423-5329 Halifax. Nova Scotia novascotiacaidhw Canada 2R8 File SVNH0024 Facility: Saint Vincent's Nursing Home Administrator: Angela Berrette Investigator: Heather Avery Date allegation reported: October 20, 2015 OVERVIEW: . On October 20, 2015, an allegation was received under the Protection for Persons in Care Act alleging the use of physical force resulting in pain, discomfort or injury as defined in section 3(1) of the Regulations. . Based on the information received, it was determined that there were reasonable grounds to proceed with an investigation pursuant to section 8(2) of the Protection for Persons in Care Act. . An investigation was conducted which included interviews with relevant parties, and a review of information from the SUMMARY OF FACTS: SVNH0024 Page 1 of 3 - ADDITIONAL INFORMATION: FINDINGS: mm SVNH0024 Page 2 of3 54 As such, the allegation of the use of physical force resulting in pain, discomfort or injury is founded. DIRECTIVES: Through the course of the investigation, several areas of concern were identified. As such, the following directives will be issued: 1. 3. The administrator shall ensure that pertinent information related to resident care is included in resident care plans, including resident-specific strategies to reduce the risk of responsive behaviors. Ave/?" pram Heather Avery, [Date Investigation Compliance Officer Department of Health and Wellness SVNH0024 Page 3 of3 55 NOVA SC TIA T: 902424-6032 Health and Wellness PO Box 488 F: 9024285529 Halifax, Nova Scotia novasculiasatdhw Canada 83] 2R8 File TIVM0011 Facility: The Meadows Administrator: Anna Babin Investigator: Louise Beaton Date allegation reported: June 5, 2015 OVERVIEW: . On June 5, 2015 an allegation was received under the Protection of Persons in Care Act alleging mistreatment causing emotional harm, including humiliating and intimidating as defined under section 3(1) of the Regulations. - - Based on the information provided during the initial inquiry, it was determine ere were reasonable grounds to proceed with an investigation pursuant to section 8(2) of the Protection for Persons in Care Act. The investigation included a review of information provided by the facility, including the and relevant policies. Interviews were completed with relevant witnesses and SUMMARY OF FACTS: Allegation #1 Allegation #2 TIVM0011 Page 1 of3 56 Allegation #3 Allegation #4 ADDITIONAL INFORMATION: No additional information was provided in response to the Prelimnary Investigation Report. FINDINGS: The following is a summary of facts from the investigation that lead to the findings . During the course of the investigation, it was determined there was insufficient evidence to conclude the allegations 1 and #2 of mistreatment causing emotional harm as defined in Section 3(1) of the Protection for Persons in Care Regulations occurred. ?therefore. a ega Ion mistreatment causmg emotional arm is unfounded. . During the course of the investigation, it was determined there was sufficient evidence to conclude the allegations 3 and 4 of mistreatment causing emotional harm as defined in Section 3(1) of the Protection for Persons in Care Regulations occurred. there is reasonable grounds to believe thelikelihood a a ege ences were umiliating and embarrassing to the residents. Page 2 of3 DIRECTIVES: . During the course of the investigation it was determined that not all staff were aware of the definition of abuse and reporting requirements under the Protection for Persons in Care Act. As such, the administrator shall ensure all staff, including contracted individuals, students, and volunteers, receive training on abuse, including the definition of abuse, recognizing the signs of abuse and the requirements of reporting abuse under the Protection of Persons In Care Act. 66.71451?. slit 1/8 Barbara McCarthy, Date Investigation Compliance Officer Department of Health and Wellness Page 3 of3 57 58 NOVA SC TIA T: 902424-0434 Health and Wellness Po Box 488 F1902-423-5529 Halifax. Nova Scotia nnvascolianafdhw Canada 83] 2R8 File VAVVOO17 Facility: Valley View Villa Administrator: Emily MacEachern Investigator: Laura MacMaster Date allegation reported: July 30, 2015 OVERVIEW: On July 30. 2015 an allegation of the use of physical force resulting in pain, discomfort or injury was received under the Protection for Persons in Care Act as defined in section 3(1) of the Regulations. Following an inquiry into the allegation it was determined that there were reasonable grounds to proceed with an investigation pursuant to section 8(2) of the Protection for Persons in Care Act. The investigation included interviews with the relevant parties. Information from the *facility reports and facility policies were also reviewed as part of the Inves Iga Ion. SUMMARY OF FACTS: File VAW0017 Page 1 of2 59 ADDITIONAL INFORMATION: No additional information was provided in response to the preliminary investigation report. FINDINGS: The following is a summary of the facts from the investigation that led to the ?ndings and directives: Based on the above information, the allegation of the use of physical force resulting in pain, discomfort or injury is founded. DIRECTIVES: The following directives will be issued to the facility: 1. 2. a minus ra or a ensure are is a process to ensure current care plans are developed in a manner that re?ect resident preferences and decisions. XML WW Z340 .23, 205 Laura Ncs, Date Investigation 8: Compliance Officer Department of Health and Wellness 60 NOVKSCOTIA Health and Wellness PD Box 488 Halifax, Nova Scotia Canada B3J 2R8 T: 902.424-484 F: 902-428-5829 novascoia ca!dhw File #: VILLA0005 Facility: Villa Acadienne Administrator: Lucifle Maiflet Investigator: Laura MacMaster Date allegation reported: November 6, 2015 20(1) 20(1) OVERVIEW: • On November 6, 2015, a report was received under the Protection of Persons in Care Act alleging the use of physical force resulting in pain, discomfort or injury as defined in section 3(1) (a) of the regulations. • • Following an inquiry into the allegation, it was determined that there were reasonable grounds to conduct an investigation pursuant to Section 6(2) of the PPCA. • The investigation included interviews with relevant individuals. The and other related information were reviewed as part of the investigation. SUM MARY OF FACTS: 20(1) 20(1) • Details regarding the incident were documented. ADDITIONAL INFORMATION: A response to the preliminary investigation report was received from the Administrator outlining actions taken following the alleged incident. A response to the preliminary investigation report was received As this 20(1) 20(1) information is protected under the Freedom of In formation and Protection of Privacy Act it can not be provided. VILL0005 Page lof2 61 FINDINGS: 20(1) 20(1) The allegation as defined in section 3(1) (a) of the regulations is founded. DIRECTIVES: 1. As such, staff shall receive education on abuse including the definitions of abuse, recognizing the signs of abuse and the requirements for reporting abuse. 2. 20(1) 20(1) 3. There were no care plans or guidelines regarding intervenitons to be used when a resident may be experiencing responsive behaviors. As such, a plan shall be developed to guide staff in providing care to residents exhibing responsive behaviors and ensure resident care plans reflect such interventions. 4. C ‘7flOt74nfl Lau a MacMaster Investigation & Compliance Officer Department of Health and Wellness VJLL0005 I o Date Page2of2 62 NOVA SC TIA T: 902424-5225 Health and Wellness PO Box 488 F1902423-5529 Halifax. Nova Statia novascotiacafdhw Canada 2R8 File WHHIOOBO Facility: White Hills Long Term Care Centre Administrator: Tara Deveau Investigator: Louise Beaten/Heather Avery Date allegation reported: June 4, 2015 OVERVIEW: . On June 4, 2015 an allegation was received under the Protection of Persons in Care Act alleging mistreatment causing emotional harm, including humiliating, as de?ned under section 3(1) of the Regulations. I . IanIry was comp ete an it was determined there were reasonable grounds to proceed with an investigation pursuant to section 8(2) of the Protection for Persons in Care Act. - The investigation included a review of information provided by the facility, including the? and relevant policies. Interviews were completed with relevant witnesses and SUMMARY OF FACTS: Page 1 of 3 ADDITIONAL INFORMATION: A response to the Preliminary Investigation Report was received from the administrator of the facility. WHHI0080 Page 2 of 3 64 FINDINGS: As such, following investigation, the allegation of mistreatment causing emotional harm, including humiliating, as defined in section 3 (1) of the Protection for Persons in Care Regulations, reported under the Protection for Persons in Care Act on June 4, 2015 is founded. DIRECTIVES: As a result of the investigation, the following directive will be issued: 1) Staff reported having ongoing concerns with The incident occurred in and was not repo 0 management untl June 2015. ??1,931,me q/{b Heather Avery, Date Investigation Compliance Of?cer Department of Health and Wellness WHHIOOBO Page 3 of 3 65 NOVA SCOTIA Health and Wellness T: 902-424-6316 F: 902-424-5629 novascotia c&dhw File #: W1LL0002 Facility: Willow Lodge Administrator: Douglas Cunningham Investigator: Sarah Goldstein Date allegation reported: May 13, 2015 OVERVIEW: • On May 13, 2015, an allegation was received under the Protection for Persons in Care Act alleging the use of physical force resulting in pain, discomfort or injury as defined in section 3(1)(a) of the Regulations. • 20(1) 20(1) • • It was determined that there were reasonable grounds to conduct an investigation under the Protection for Persons in Care Act. The investigation included a review of information provided by the facility management, progress notes and interviews with relevant individuals. SUMMARY OF FACTS: 20(1) 20(1) WTLL0002 Page lof2 66 ADDITIONAL INFORMATION: A response to the Preliminary Investigation Report was received from the facility which 20(1) 20(1) No additional facts or evidence related to the investigation was provided. FINDINGS: There is sufficient information to demonstrate reasonable grounds that the allegation of the use of physical force resulting in pain, discomfort or injury reported under the Protection for Persons in Care Act on occurred. 20(1) 20(1) The allegation of the use of physical force resulting in pain, discomfort or injury as per section 3(1) (a) of the Protection of Persons in Care Regulations is founded. DIRECTIVES: Based on the findings from the investigation, the following directives are issued: 1. The Administrator will ensure that documentation on resident files and care plans provide details on effective staff approaches, interventions and strategies to support resident needs and address responsive behaviours. 20(1) 20(1) 2. The Administrator will ensure that all staff receive training on abuse, including the definition of abuse, signs of abuse, and the requirements of the Protection for Persons in Care Act, including the duty to report allegations to the Minister. Th &QIQLi1VQJA J 2 AA Sarah Goldstein, MSW, RSW Investigation & Compliance Officer Department of Health and Wellness WILL0002 te )fl O) Page2of2