This was a dual Format Meeting conducted in person and via Zoom
1. Welcome and opening remarks by the Chair
We had a good attendance at this meeting and welcomed some new faces. Welcome to Paul, Michele and Gisele who joined for the first time in person. We hope to see you again in future. Family participation is always encouraged.
The previous minutes from Oct 16, 2024 were circulated previously and considered approved at this time. Unfortunately, they cannot be posted due to technical issues with the Manor website which will not be resolved pending development of a new site. Prior minutes from June, March and Jan 2023, can be found here: https://maxvillemanor.ca/family-council/.
The Family Council had a very productive 2023 including Alzheimer’s and Parkinson’s information sessions and staff training on MS. Alexandra Laderoute from Lahie and Sullivan Funeral Homes presented on end of live planning. The chair mentioned that he took advantage of their 10% discount offered to attendees.
The chair will be completing a 2023 year end summary and report of activities for distribution and (hopefully) posting on the new website at some point.
With thanks to the Family Council Liaison for setup of a laptop and connectivity to the large screen and the Manor’s Owl’ technology. Owl provides for a better hybrid meeting between those present and via Zoom. It will focus on the person speaking anywhere around the room rather than just those who have a laptop in front of them. https://owllabs.ca/ . Unfortunately we lost connectivity to remote Zoom participants once screen sharing for the emergency preparedness planning. The Manor was informed in case this was a general issue going forward.
Thanks to Gail Seguin once again for her help, excellent notes and for getting them out so quickly.
2. Emergency Preparedness Overview
Presented by Michelle Wilson - Staff Development and Liz Bray (Director of Environmental Services. Michelle has professional training modules covering different emergency codes/scenarios with possible causes for the disruption of normal service. They are typically used for staff training. Together they would take over an hour and a half, especially if allowing time for Q&A. The modules are as follows:
Red: Fire
Yellow: Missing Resident
Green: Evacuation
Blue: Medical Emergency
Grey: System Power Failure/Loss of Essential Service
Brown: Hazardous/Chemical Spill
Orange: External and Natural Disaster
White: Security /Violent Situation
Black: Bomb Threat
To keep this meeting within the allocated time we focused on Fire. It wasn’t asked so is assumed by this writer, that Michele would accommodate FC members who would like to see any of the modules or the whole package. Contact info: Michelle Wilson mwilson@maxvillemanor.ca
Some Key points:
- Disaster Box is kept in the library and the contents were reviewed regularly. It contains plans but also emergency supplies such as first aid kits.
- If alternative shelter is required, the Maxville Sports Complex is available and up to 13 critical residents can be transferred via arrangement to the Palace in Alexandria.
- The fire alarm pull boxes in the secure unit have a special key to initiate a fire alarm.
- Emergency transportation would be provided by Roxborough Bus Lines and can accommodate a lift for wheelchairs.
- As part of testing the TELUS Monitoring System is dispatched right away. They call back to confirm.
- Fire Drill Test once per month
- Doors to hallways are fire rated, sprinkler system throughout the building. There is fire suppression in the kitchen.
- A portable Kitchen is part of the business continuity plan, if necessary.
- Even if access to the building is lost Point Click Care allows staff to access residents’ client charts and medical information from the cloud – basically anywhere there is Internet access.
Comments and questions identified that there is only one disaster box housed in the library. It’s unclear what Plan B is if it cannot be accessed. Another suggestion was to simulate an actual disaster transfer to the alternative locations using a significant number of staff and volunteers in wheelchairs and various states of mobility just to see how it goes as this has not been done. There are also stairs at certain emergency exits that impede egress for disabled persons. Thank you Michelle and Lise.
3. Summary update from Anya and Courtney on the Nov 15th Inspection report and Q4 Critical Incidents
Anya Gwyn was welcomed as our new Director of Care as was Courtney Jeske as the Assistant Director of Care. Both started in late 2023. A short bio on Anya, welcoming her from Nova Scotia, had been copied from a Manor newsletter and distributed previously.
A copy of the Q4 Critical Incidents missing from the Quality Steering Committee, was distributed prior this meeting. Thank you, Courtney. They are summarized as follows:
a) Critical Incidents in Q3- October 1, 2023- December 31, 2023
· Nov 3, 2023 Unlawful Behavior of a Resident; Resident-Resident; managing accordingly , no recent behaviour noted.
· Nov 9th 2023 Disease Outbreak; COVID-19.
i. 11 residents had COVID with mild symptoms.
· Dec 11, 2023 Verbal Abuse of a Resident; Staff-Resident; action taken and resolved
· Dec 28. 2023 Incident that Caused Injury to a Resident; Fall and broken clavicle; action taken and managed accordingly.
b) The chair requested information on what defines a critical incident. It was not received in time for this writing.
c) The chair requested a monthly summary of critical incidents going forward so that FC could be advised as it may be several months before they are received from a Quality Steering Committee, and it could be months again before that aligns with a FC meeting.
4. Inspection Report Review and Update from DoC Anya Gwyn
Inspection report # 2023-1497-0005 had been distributed previously covering an inspection that took place on October 18, 19, 20, 23, 25, 2023. Inspection reports can be found online at http://publicreporting.ltchomes.net/en-ca/homeprofile.aspx?Home=c540&tab=1
Anya’s dissertation focused on how an inspection comes about, more so than the details of the intake and incidents covered in this report. Her emphasis is on how these incidents are prevented going forward. Here are some of the words used / comments made - as jotted down by our scribe:
- Management on call structure was implemented for after hours and weekends
- Staff-Nurse in Charge
- Compliant- Director of Care notified immediately (24 hours)
- Report in a specific time frame with transparency
- Portal for Critical Incident – staff log on and details are entered therein
- Compelled to investigate
- corrective action
- keep education a priority and correct behaviour
- can be fired if not following policy and procedures
- Policies are presently being updated
- Staffing the building correctly
- Safe competent care
- This will take time and effort, day by day sorting through staff and taking corrective action
- Risk Management
- Proper Model of Care
- Priority this year “Model of Care Delivery”
- Resident Centered
- The service model for PSWs is changing to groups for 6-8 residents each.
- Primary caregiver for those residents but will help and cover each other.
- The two person teams that were the norm currently will change.
- This ensures accountability and if there is an issue the RN or the DOC know who to talk to
- PSW is accountable for residents daily care
- Fall Prevention
- -Comprehensive Plan to prevent falls and injuries
- -Every fall has to be reviewed
- -RN responsible needs to address and take action
- Care Team-rotation depends on how many PSWs are available
- adapt to the number of PSWs available
- Feb starting to change staff around
- -co- ordinate residents with their team
- 6 registered staff /day
- 5-6 evening shift
- 3 night shift
- Will now have a registered staff per unit instead of one for the whole building
- RN to reestablish supervisory role
- designating chores to each group.
- Ex -dining room supervisor to help reduce choking risk. Specific oriented tasks
- Anya stated that changes need to be made.
- Require reports from the nurses
- RN’s to monitor their staff closely
- Continuous feedback
- If suspect an injury to a resident then to be sent to the hospital
- Not within an RN’s scope of practice to diagnosis fractures etc.
- Need to provide Resident Centered Care- they receive the care they deserve.
- Bring up level of Pro Active calling to the family contact.
- Meet with nurses every week instead of every month.
- Should be lots of interaction ex- if medication change.
- Staffing in place to make more calls.
- Anya has requested an increase in staffing budget from the CEO.
- Families are encouraged to come forward if they have concerns.
- From 8 am to 8 pm either Anya or Courtney will be available in their office which has been relocated from the back offices to near the hairdresser’s . Anya will start in the afternoon. Anya gave her ext as 235.
- Someone with a concern can report to the supervising RN, RPN, email the Director of Care
- Manager can be called at any time to provide uninterrupted reporting structure.
- Complaint Process
- Written Compliant
- Accountability
- Verbal Concern get back within 24 hours
- RN has support of DOC and ADOC
- The Residents Bill of Rights need to be upheld
- FC should get involved in the facilities redesign
Comment from the Chair. These are all good words. As in anything, the proof is in the delivery. The chair has already been participating in the facility redesign meetings with the architects.
Concerns were raised that staffing challenges exist already. It is hoped that clear directions and measurements will triumph over firing.
5. Courtney presented Nursing Department Priorities for 2024
1. Implement a new Maxville Model of Care
2. Quality Improvement
3. Workforce planning, Policies, Recruitment and Retention
4. Caregiver and Family Engagement-promoting FC
5. Facilities Redevelopment
6. Recreational Substances Policy
A new Recreational Substances policy was implemented at the Manor and first announced via a newsletter on Dec 22 without any consultation with Resident or Family councils.
Due to an incident, Anya said she was required by her license to act immediately to implement a Recreation Substance Policy without consultation as it was a ‘safety’ issue.
There was a concern about a single intoxicated resident and their behaviour and wants to encourage alcohol safety.
The new practice is to store alcohol in the unit’s medication room, labeled properly and dispensed only by a nurse. At present, according to Anya, that aspect of care wasn’t per best practice. Alcohol is to be stored safely and properly dispensed.
Similarly, authorized use of Cannabis is now required to be stored, locked, and dispensed accordingly as it was deemed not meeting a standard for safety.
The DoC also expressed a concern about people visiting the Manor; overusing alcohol and that then leaving the Manor would be a liability. There is no way to control that.
After Anya finished, all staff members were asked to leave so that the FC could conduct a closed session. This was done so that all members, including new attendees, would feel comfortable and to encourage open and free discussion.
· This policy is slated to be added to the new resident handbook. Currently it has a brief paragraph about alcohol with allowance for up to 2 drinks per day unless approved by a physician. It implies that residents manage their own consumption. There is nothing about central storage and controls/dispensing by nurses.
· The outcome of closed session discussion was that while everyone understands the need to ensure resident safety it’s not clear why an issue with a single resident required immediate action to change a long-standing practice for all without consultation with Resident or Family Councils. Questions remain on why I could not have been phased in, nor is it clear that this action did not infringe on residents’ rights as executed and implemented?
· Questions arose about what a service expectation might be for this new extra duty, especially at night or when nurses are busy elsewhere as only nurses are allowed to dispense under the new policy. Were they, or should they, receive extra training? How will a resident’s personal property be tracked, measured, and accounted for if there is disagreement on quantities dispensed or remaining? Has the Manor actually increased their liability as the single source of recreational substances?
· What is the Manor’s stance if Visitors bring in a recreational substance for consumption with a resident especially during a festive season, considering that this policy was rushed through just days before Christmas? Fears were raised that the visitor might be barred.
· There remains a question whether recreational cannabis belonging to an individual can be legally stored and distributed by an organization under the Cannabis Act. The Health Canada guidance in the paper Anya waved is dated 2018 but clearly states that LTC’s are not allowed to centrally store unless authorized. Anya stated that they were ‘authorized’ but did not explain how nor did she offer up any more current guidance.
· These are just a few questions that were not made available to residents, friends or families with the recreational substances policy implementation.
As such, roundtable consensus from the FC members was to direct the Chair to delve a little deeper into the policy implementation to consider whether legislation and residents rights were respected in a manner that achieves a proper balance between strict compliance and basic human rights of persons residing in Long Term Care.
7. Roundtable – final comments, feedback, schedule next meeting
Next Meeting: Monday, March 25th at 6:30pm
Rainer reaffirmed that his initial 2-year term as chair of FC will be coming up in time for the next meeting. Ideally someone will put their name forward to replace him as chair by a vote at the next meeting. He would be happy to continue in a supporting role.
Family Council Legislation and the Residents Bill of Rights are proposed topics for our next meeting. Please send an email to FamilyCouncil@maxvillemanor.ca if you have any other suggestions.
The meeting adjourned at 8:30 pm after 2.0 hours. Thanks to all who participated, to our new attendees, to Lise, Michele, Courtney for their informative presentations and especially Anya for leading much of the discussion on various maters.
With apologies to Zoom attendees for our technical glitches. We will attempt to have a second laptop monitoring remote attendees should screen sharing be used in future