COUNTY OF SIMCOE ITEM FOR: Human Services Committee SECTION: Homes for the Aged ITEM NO: HS 03-036 MEETING DATE: March 11, 2003 SUBJECT: Homes Annual Report RECOMMENDATION: THAT Item HS 03-036, being the Homes’ Annual Report be received for information. BACKGROUND: As part of our Continuous Quality Improvement program, statistics are collated to provide a basis for program evaluation and development. FINANCIAL ANALYSIS: A summary of the financial performance for the period January 1 – December 31, 2002 is presented in Schedule 1, page 4. SCHEDULES: Schedule 1 Statistical Highlights/Analysis Schedule 2 Georgian Manor – Detailed Annual Report Schedule 3 Simcoe Manor and Simcoe Village – Detailed Annual Report Schedule 4 Sunset Manor – Detailed Annual Report Schedule 5 Trillium Manor – Detailed Annual Report PREPARED BY: Jane Sinclair, Senior Homes Administrator APPROVALS: Date Peter Finlay, General Manager of Finance March 4, 2003 Helen MacRae, Chief Administrative Officer March 4, 2003 Schedule 1 Homes’ Resident Statistical Highlights NOTE: Please refer to detailed analysis in later section for statistics that are highlighted. INDICATOR GEORGIAN SIMCOE SUNSET TRILLIUM Long Stay Beds 105 124 148 120 Admissions 19 36 65 46 Admissions from 14 33 50 43 Waiting List Deaths - In Hospital 4 9 7 4 - In Home 15 28 52 41 Discharges 2 2 18 4 Resident Turnover % 20% 31.45% 52.0% 40.8 % Occupancy 99.6% 99.08% 98.7% 98.8 Average Age of Admissions 81 81.58 83 83.7 Barrie Residents at 3 6 9 1 period end Orillia Residents at 1 2 0 63 period end % Preferred at period end 44.8% 54.8% 62.1% 61.5 YTD Preferred Occupancy 46.9% 57.33% 62.1% 61.9 % Basic – Full 5.7% 9.67% 6.1% 7.7 % Basic – Part 47.6% 33.06% 30.5% 30.8 Waiting List 161 187 59 190 Short Stay Beds 2 2 2 2 Days of Service 386 369 325 332 Clients Served 33 25 28 32 % Occupancy 52.9% 50.54% 44.5% 45.5 Adult Day Clients Served 75 18 63 n/a Client Days 2817 33 2172 n/a Volunteer Hours 3110 -- -- -- Schedule 1 Homes’ Staff Statistical Highlights INDICATOR GEORGIAN SIMCOE SUNSET TRILLIUM Discharges 2 2 4 3 Resignations/Retirements 6 23 17 12 % Turnover 7.6 17.5 13.6 11.0 New Staff 12 34 26 22 # Active Full Time 63 59 75 62 # Active Part Time 32 72 71 61 Scheduled FTE 76.43 93.4 109.95 88.388 Staff on Leave 9 12 9 13 Total Staff 105 143 155 136 Casual Pool 31 16 21 28 Total Worked Hours 161,483.92 177,000.45 209,932.59 174,875.81 Worked FTE 82.81 90.77 107.65 89.68 NPC Hours/Resident Day - Scheduled 2.42 2.49 2.43 2.52 - Worked 2.46 2.46 2.40 2.50 C.M.I. 88.84 94.74 99.03 93.66 Volunteer Hours 8380.65 7503 6685 9360 Ontario Works Hours 1887.5 191 155 0.0 Other Unpaid Hours 3050.5 1699 2593 2382.5 Sick and Absent Days/FTE 12.17 19.78 15.26 14.36 Incidents of 5.93 8.59 5.51 6.21 Absenteeism/FTE W.S.I.B. Lost Days/FTE 0.072 .045 .81 3.8 Modified Work Days/FTE 0.1457 .257 1.72 .42 (W.S.I.B.) New W.S.I.B. Claims/FTE 0.08 .053 .05 .07 Schedule 1 Homes’ Per Diem Costs COST CENTRE GEORGIAN SIMCOE SUNSET TRILLIUM 5.45 5.17 8.92 5.33 Programs 21.92 20.12 23.30 20.70 Dietary 75.19 73.30 72.08 74.65 Nursing 8.54 8.80 9.18 7.46 Housekeeping 4.85 4.21 3.42 4.46 Laundry 11.60 13.47 11.65 12.79 Buildings 4.65 3.97 5.44 7.36 Administration .28 0.046 .28 .19 Medical/Funeral .012 -- 0 .42 Donation/Other 2.65 1.18 .73 .18 Capital 135.14 130.26 135.05 132.70 TOTAL 134.92 136.50 135.09 133.30 BUDGETED Fire Drills Conducted HOME DAYS EVENINGS NIGHTS COMMENTS 10 8 8 Staff participation is GEORGIAN good SIMCOE 16 13 19 Powerteam and D&L Fire Protection inspections done in December. 11 13 9 -- SUNSET 11 10 8 16 Audible TRILLIUM 13 Silent Schedule 1 Homes’ Medications GEORGIAN SIMCOE SUNSET TRILLIUM # Medications per resident per 10.76 13.13 7.86 8.8 month (includes prns and treatments) Medication Errors – Pharmacy 7 2 14 20 - No impact on resident 1 1 6 0 - Resident affected Medication Errors – Staff 2 17 0 1 - No impact on resident 30 40 53 9 - Resident affected 40 60 73 30 Total Medication Errors 0.37 0.47 0.49 0.25 Errors/Resident Homes’ Resident Falls FALL CATEGORY GEORGIAN SIMCOE SUNSET TRILLIUM 158 340 293 282 Level 1 - No Injury 25 42 80 72 Level 2 - First Aid 3 5 14 5 Level 3 - Medical Aid 5 5 10 7 Level 4 – Hospital 191 392 397 376 Total Falls 4 3 8 5 Fractures 15.9 20 20 18 Average # Residents Falling Per Month 1.8 3.1 2.6 3.08 Resident Falls Bed Schedule 1 Homes’ Aggressive Behaviour Summary PERIOD COVERING GEORGIAN SIMCOE SUNSET TRILLIUM 122 147 372 237 # of incidents 1.14 1.16 2.48 1.9 # of incidents/resident in facility 41 18.9 11.25 12.75 # of residents exhibiting aggressive behaviour/month 53 155 155 92 # of incidents/shift Days 57 56 132 Evenings 210 12 85 7 13 Nights 67 6 158 84 # of incidents Staff 38 55 214 151 directed toward Residents 15 92 0 2 Other 111 0 159 229 # of incidents of Physical each type monitored Verbal 4 130 213 7 7 17 0 1 Sexual 110 141 372 219 # of incidents where the resident had a known cognitive illness Schedule 1 STATISTICAL ANALYSIS 1. Resident Turnover: The Resident turnover rate increased significantly in 2002. The range for the Homes in 2001 was between 10 to 35 percent. In 2002 the range was between 20 to 52 percent. An increase in the acuity level of Residents admitted to the Long Term Care facilities was the largest contributing factor in this increase. For example, at Sunset Manor in 2001, the mortality rate of Residents with a length of stay less then one year was 32 percent. In 2002, the mortality rate of Resident with a length of stay less then one year increased to 43 percent. 2. Occupancy Rates: The overall Resident occupancy rate for the four Homes decreased slightly in 2002, dropping from a average rate of 99.45 in 2001to 99.04 in 2002. Contributing factors impacting this trend included unoccupied bed days related to a higher turnover rates, delays in admissions as a result of facility outbreaks, increased waiting times in receiving applications as a result of changes in the CCAC process, and additional Long Term Care beds within the County of Simcoe. 3. Preferred Accommodation Fees: The preferred accommodation rate changed across all four sites in 2002. Trillium and Sunset Manor experienced a decrease, maintaining a preferred rate slightly above 60 percent. Georgian and Simcoe Manor experienced a more significant drop, decreasing more then five percent from the year prior at rates below the 60 percent. An increase in the basic accommodation fee of $3.02 per day played a significant factor in this change. Shortly after the increases were announced by the Ministry of Health, waiting lists developed in response to a large volume of requests from Residents and families to change to a lower accommodation rates. 4. Basic Accommodation Fees: Of those Residents paying the basic amount of accommodation, an increased proportion was subsidized by the MOHLTC division in 2002. The percentage increased from 31 percent in 2001 to 35 percent in 2002. Similar to the trend noted above regarding preferred accommodation fees, following the increase in basic accommodation fees, an increase in requests for subsidy was observed. 5. Respite Utilization: The short stay utilization rate decreased significantly from 56 percent in 2001 to 48 percent in 2002. Trends impacting this reduction in utilization include delays in admissions as a result of facility outbreaks and an infusion of new “respite” beds in the area with the opening of several new Long Term Care facilities. 6. Staff Turnover: A marked reduction in staff turnover has been observed in 2002. The turnover rate ranged from 15.3 percent to 27.1 percent for the Homes in 2001. In 2002, the turnover rate ranged from 7.6 percent to 17.5 percent. With the implementation of the pay equity plan and ratification of several collective agreements, wages and salaries increased in 2002. Other factors commonly effecting retention and recruitment will be investigated in 2003 with the implementation of staff satisfaction survey. 7. Volunteer Hours: The reported number of volunteer hours across all four Homes decreased by 5,776 hours in 2002. A total of 37,705 hours reported in 2001 was reduced to 31,928 in 2002. The disbandment of the Ladies Auxiliary and the new requirement for flu immunization of volunteers played a significant impact on the reduction in hours in 2002. 8. Per Diem Costs: The per Diem rate for Program and Support Services was significantly higher at Sunset Manor during 2002 related to a variance in the level of Chaplaincy services. With the new model of Chaplaincy services in 2003, equitable service delivery and a more consistent per Diem will apply across all Homes. The per Diem for Administration was higher at Trillium Manor in 2002 as a result of a Human Resource issue. A more consistent administration per Diem is projected for 2003. The actualized costs per Diem across the four Homes in 2002 were more consistent and reduced overall. The costs ranged from 126.89 to 156.03 in 2001 and 130.26 to 135.14 in 2002. The heightened per Diem costs in 2001 included a pay equity agreement that resulted in retro active payment extending back to 1990. 9. Medication Incidents: There has been a significant reduction in the number of medication incidents, falling from 268 in 2001 to 203 in 2002. The initial inflation of incidents occurred in 2001 at Sunset Manor following the implementation of a new medication delivery system. With continued monitoring and education, the rate of incidents decreased considerably. 10. Resident Falls: A reduction in the number of falls occurring in the Homes decreased by 171 incidents in the year 2002. In addition to some initial strategies implemented in 2002 around fall prevention and increased therapy programs, this area has been targeted as one of the Homes’ Best Practice pilots. Ongoing development in this area by the Best Practice Team for the County of Simcoe Homes will continue throughout 2003 to work toward further reductions in Resident falls. 11. Resident Aggressive Incidents: An increase of 174 incidents occurred in 2002. Of particular note, was the implementation of “verbal aggression” reporting at Sunset Manor. With the onset of their new tracking system, increased sensitivity in reporting was observed. However, due to the large variance in reported verbal incidents across the four Homes, further investigation into the definition and reporting systems for this particular indicator will take place in 2003. Schedule 2 GEORGIAN MANOR – 2002 ACCOMPLISHMENTS Resident Care Conversion of 10 DLX Carroll Beds to electrically operated models All Liko lifts were serviced and a new Arjo lift was ordered, to be delivered in the early 2003 A new 5 week cycle menu was introduced to enhance meal selection Family BBQ held with good attendance. Change of location to parking area outside 2nd floor made inside food set up possible in the air conditioned ADC Area, and easy movement in & out of building for food pick up. It also provided easy access to wheelchair accessible washroom & allowed event to continue without interruption due to rain (tent covered seating area) The Medical Protocol was revised Laundry and nursing routines were reviewed and revised for improved service delivery On site kinesiology provided services 5 days per week until the October. Will be recruiting new kinesiologist in 2003 related resignation of previous provider Resident Audit noted that 98 percent of residents are involved in some activities and/or Therapy Programs Respite Care/Admission/Annual Surveys responses indicate a high level of satisfaction, with some helpful comments that have resulted in minor changes which hopefully increase customer satisfaction Incontinence Product utilization audit was developed to ensure proper sizing & use of product Wound Care Team continues to be proactive in prevention & management of wounds Adult Day Care (ADC) staff have arranged outings - several combining both sites which have been enjoyed by both clients and care givers ADC Penetang Program has a waiting list of ten. Program goal of maintaining participants in the community is well met at both sites ADC Penetang Program booked for 12-13 clients/day on frail elderly days. This is done to hopefully meet attendance expectations (10/day) With the referral process from CCAC, an increase in referrals noted resulting in an increase in admissions to both programs this year ADC Client Visits-Penetang Jan-Dec 2161 - increase of 62 units from 2001 ADC Client Visits-Elmvale Jan-Dec 656 - increase of 295 units from 2001 Family Caregivers are appreciative of the support the staff gives, especially through the admission process to LTC if it becomes necessary. ADC Client/Caregiver surveys responses indicated a high level of satisfaction with the program. An Information Day with speakers from the local Fire Dept. and Police, held at the Elmvale Site achieved positive results Resident pictures are now being taken with digital camera upon admission process A family information session on Alzheimer’s was provided Family Christmas Dinners held Dec 10th & 11th were well attended Implementation of bed alarm system to improve resident safety. Received Reader’s Choice Award as favorite Retirement Home in our Area. Schedule 2 Information Management Adult Day Care was added to Manor server and E-mail. Four new computers installed Revision of Resident /Family Handbook Most registered staff are now inputting resident care plans and updates (information) on computers. An on-site staff Resource person trained for Compu Care Program Therapy Program developed for Computerized Care Plan Audit of the ”Quarterly” Documentation in Resident Charts & Care Plans to identify any inconsistencies & make recommendations to ensure documentation standards are being met for Classification Utilization of New Computerized Infection Control & Resident Incident Record System making Statistical Data Collection & Reports more efficient A computer for the Elmvale ADC Program was purchased in Sept. from funds donated by Elmvale Lion’s Club, Legion and Maple Syrup Festival ADC Staff continue to provide progress summaries every six months and on discharge These are forwarded to CCACSC and LTC facilities (to assist with admission process) One ADC staff member continues to upgrade computer skills and is sharing this information with other staff Initiating relocation of frequently used forms to Dept/Program specific Forms folders. Resident Wandering lists revised to include residents’ pictures for easier identification Health & Safety & Professional Advisory Minutes have been moved to the U: drive to a Minutes Folder to allow access to additional designated staff required to enter data. For effective tracking, the Narcotic Control Summary Sheet was revised and a new Emergency Narcotic Control Sheet developed Revised Quarterly Assessment Sheet introduced to make information easier to read and can be completed in sections as time permits Dietary Policy & Procedure Manuals updated prior to retirement of Dietary Supervisor. All Department & Program Manuals converted to Word Resident/Family Annual Survey revised to include better mechanism for follow-up regarding comments New Catering Form implemented (to be used when planning a function or needing supplies from Dietary Department) Education manuals for Georgian Manor Wound Program are complete and will be circulated to the Units, as well as to new staff during their Orientation Digital photograph tracking is being used to track wounds by offering a pictorial view of the status and progress of the wound Human Resources A new Cook and Food Service Supervisor were hired in the Dietary department An Orientation Package was put together for Dept. Heads who have Co-op/Ontario Works or Volunteers working in their Dept. Orientation Evaluation Form was revised Maintenance hired a casual temporary Electrician to complete some major electrical projects - then hired full time in Dec. 2002 Multiple casual positions were recruited in the nursing department Two Summer Students hired through HRC program, which maintained and enhanced Schedule 2 the Activation programs for the summer Staff Dress Code revised for compliance across the four Homes Post Placement Evaluation Form developed Staff Satisfaction Survey completed, Facility Wide results posted & Dept specific results given to Dept Heads for Follow-up as indicated Implementation of re-imbursement for required in-services with record of attendance to Dept. Heads Volunteer efforts supported programming e.g. meal assistance, outings, Palliative Care, Residents Council, Spiritual services , visiting, special events, and fundraising. Volunteer Recognition luncheon held Utilization of Ontario Works & Community Service Workers provided additional support in several departments to enhance care and service delivery. Resident Care Manager assisted one day a week as extra resident Care Manager Coverage at Sunset for two months until the SA/DRC in place New County Psychogeriatric Resource Consultant has held one in-service and had two meetings with Psychogeriatric Resource Staff Continue to have a good relationship with Georgian College providing training for PSW students. The students develop excellent work habits when they peer with staff and the residents benefit from the additional attention and care ADC Volunteers 2580 hours in Penetang & 530 hours in Elmvale. They support programming and special events. Two students from local high school have done community placements with positive results. Change in role for Activation Director to PSSM for two County Homes (Georgian & Sunset) initiated Dec 2002 Supervisor for Maintenance & Services took on responsibility for housekeeping/ Laundry Services. Environment Health & Safety – Six months in the year incident free with close monitoring of near miss incidents & lost time, with emphasis on utilization of Modified work program where indicated Installation of carpet for 1st Floor Lounge & draperies installed on 1st floor North side Purchase of steam cleaner which can be used for a variety of items by housekeeping and nursing Water Coolers installed on 4 East, 1North and Special Care connected to the Home’s water supply. Easy access to cold water is enjoyed by the residents and staff. Environmental services initiated use of Resident Room Audit and Schedule to audit all rooms yearly. Installation of Fencing around 4 East & 3rd floor patios to increase building security by limiting the doorways that can be used to enter & exit the building. Keys for the gates have been given to Nursing staff for emergency exit use Fan Out Calling System retested in January with good results – format being adapted across all Homes to ensure most effective and consistent process is in place Water testing of 4 Whirlpool tubs & Main dining room water cooler – all were good & Schedule 2 met Bacteriological & Provincial Standards Arranged for an extra pick up for garbage to alleviate build up of refuse Window air conditioners installed in staff lounge, Main Dining Room and front office Emergency Plan reviewed by Penetang Emergency Planning Coordinator , no revisions required Emergency Planning contract and Hot Weather procedure updated Roof project completed Emergency Planning Audit completed for – door name plates, emergency boxes, bomb threat folders and emergency supplies Penetang Fire Dept toured the facility to familiarize themselves, and ask questions Introduced procedure for Personal Clothing Precautions which doesn’t use bleach in the sanitizing process Central air conditioning purchase from Springwater Hydro Funds agreed to by Elmvale Advisory Group for Elmvale ADP Site. To be installed Spring 2003 In-house phone installed in main dining room and 5th floor staff lounge to provide emergency support if needed Renovation of storage room to Resident Care Manager’s office. Storage room created in back half of residents’ laundry room Successful Influenza Immunization Program - 91.5% Resident and 89% staff participation Trees removed from area between two parking lots Provisions for replacement of Domestic hot water boiler, with installation date early in January Leadership SCREAM Team and Maintenance involved in the review of purchasing process for all Homes Site Administrator/Director of Resident Care along with other SA/DRC’s is working with Senior Homes Administrator to provide consistent service to the residents in all four Homes Maintenance & Services now report to County of Simcoe Property, Fleet & Purchasing Manager in Administration Centre Accreditation Teams have created opportunities for improvement – Document updated ADC Program Manager is doing at least one presentation a month to promote programs. These have been successful, resulting in donations to augment renovations, supplies, and equipment for the Elmvale Site Winterama Community Pancake Breakfast hosted by Manor Volunteers. ADC Fundraising efforts have been successful with garage sales, 50/50 draws, MacDonald’s Restaurant, quilt raffle, and craft sales to augment supplies and equipment and subsidize outing. These enhance quality of programming at both sites Money has been set aside for renovations (materials & equipment) at Elmvale Site Adult Day Program daily attendance fee increased to $12.00 from $10.00/day to increase recovery line on budget Hosted Health Unit Flu Clinic for the general public Schedule 2 Quality Display Week in November with seven Quality Projects and new AIM Accreditation information displayed Staff Appreciation Breakfast held Dec 18th from 0630 – 1000. Compliance Standards met, action taken to address the Recommendations and observations made during the Nov.-Dec. Compliance Review. GEORGIAN MANOR – UNMET OBJECTIVES Adult Day Care To support and inform those clients with CVA issues Information Day at Penetang Site not done due to lack of interest. 2 meetings arranged but had to be cancelled. Volunteer Manual Policies and Procedures not revised. Advisory Council not developed for Penetang site. Objectives will be brought forward to 2003. Administration Accreditation Teams were not reactivated to work on new Accreditation Standards & Document due to proposed structure changes in Accreditation Teams for the Homes awaiting further direction. Maintenance & Services Purchase of 2 new washers for Laundry has been brought forward to 2003 budget Nursing Palliative Care brochure not revised, carried forward to 2003 objectives Relocation of RCM Offices on or near units will be completed in 2003. GEORGIAN MANOR – EXTERNAL REVIEWS A. Simcoe County Health Unit Inspection Food premises and Hazard Analysis Critical Control Point Audit - March 26,2002, good report. Food premises and Hazard Analysis Critical Control Point Audit –October 29, 2002. No Recommendations were made and Dietary department was found “Very clean and well maintained throughout”. B Penetanguishene Fire Department January 25, 2002 - Minor issue re replacement of batteries & one heat detector needing replacement. Items corrected. Aug 2002 - As a result of fencing the 3rd floor patio, the Fire Dept can’t access the standpipe hose connections. After discussing the standpipe connection problem it was agreed that we would supply an additional gate in direct line with the connections and Schedule 2 put the lock on the exterior for their access. This has been completed. C. Otis Elevator Inspection Monthly Inspections Completed. A minor problem was identified, which Otis has corrected. D. Dietary Fire Hood Inspection January 2002. E. Roof Inspection Aug. 2002 Audit by Tremco Canada Roofing Division. F. Economy Chemical Laundry Service Monthly Reports -Test on chemicals and equipment G. ECO Lab Monthly Dishwasher Inspection Efficiency of Operation & Cleaning & Sanitizing. H. City Chemical Audit of Water Treatment for heating/cooling systems. I. PCO Monthly Inspections. GEORGIAN MANOR – INSERVICE LIST TOPIC Attendance Care Related Alzheimer’s & Its Progression 5 Bed Alarms 8 Chronic Non Malignant Pain Management 5 Compression Bandages/Support Stockings 14 CPR 21 Glucometer Pen 4 Hearing Aide Workshop 6 KCI Therakair Pressure Relief Mattress 9 New Medi SENSE 8 Novolin Pen – Insulin Injection 10 Psychogeriatric Consultation Role/ LTC 32 Sabina Sit to Stand Lift Video 11 Sling Removal Made Easy 15 Uno Lift Video 4 Vital Air Information on Oxygen 7 Concentrators & Services Provided Care Standards CMI Training 12 Information Management Compu Care Training 11 Payroll Training Vadim 12 Photocopier 12 Personal Development True Colours 40 Whats New About Menopause, What Are 11 The Options Required Back Care / Emergency Transfers 76 Fire Equipment Demonstration 56 Health & Safety Review 41 Prevention of Abuse / Harassment 45 Safety Program Prevention & Management of Aggressive 22 Behaviour General Orientation 9 GEORGIAN MANOR - CONTINUING EDUCATION ACTIVITIES CONFERENCE/WORKSHOP/MEETING Attendance Care Related Advanced Directives 2 Caregiver Conference 3 Caregiving in a Healthy Way 6 Classification Training 2 Connections that Heal 1 CPR 1 Developing a Dementia Network 1 Pain Management in the Cognitive Imp. 5 Elderly Doing Our Best For Your Mother 12 Management of Psychosis & Aggression 3 Associated with Dementia Preventing Alzheimer’s Aggression 7 Roho seating & Support Services 1 The Kaleidoscope World of Dementia 4 Wound Care & Seating 1 Ontario LTC Conference Trade Show 1 Care Standards College of Nurses - Documentation 2 National Sanitation Training Program 4 Conference OANHSS Region 4 Meeting/Workshop 7 Information Management Compucare Training Program 2 Electronic Records Management 1 Lotus Training 2 Microsoft Word Training 1& 2 1 Excel Training 1 Palliative Care Aboriginal Palliative Care (six sessions) 3 Annual Palliative Care Workshop 6 CA of the Brain 3 8th Annual Palliative Care Workshop 6 Hospice Presentation 1 Nausea & Vomiting 3 Terminal Delirium 5 Spiritual Care in Palliative Care 4 Personal Development Performance Review & Development 11 Program CONFERENCE/WORKSHOP/MEETING Attendance Safety Program Every Second Counts 1 Train the Trainer Fire Safety For Care 1 Facilities Meetings OANHSS Convention 1 DOC Meeting 1 Administrators Forum Monthly Meetings 1 PMHC 1 SCREAM Team Monthly Meetings 2 Environmental Managers Conference 1 County Manor Environmental Managers 1 CCAC 1 County Administrators 1 Region 4 Maintenance & Housekeepers 1 OANHSS Region 4 Meeting 1 PIECES Meeting 2 Maintenance & Services Dept. 1 LTC Purchase Group Presentation 2 Best Practice Guidelines 1 RNAO Orientation Program 1 Schedule 2 GEORGIAN MANOR – CURRENT ISSUES General Continue to support each other through restructuring process. Some challenges experienced with budget decisions during transition with new system. Regular budget printouts not always available. Dietary New Dietary Food Supervisor started in December. Nursing Redefining roles for Resident Care Managers. Adult Day Care Senior Homes Administrator and Program Manager continue to review budget to address salary increase Laundry/Housekeeping Lead Hand position pending in 2002. Maintenance & Services New Maintenance & Services Supervisor started in December. Lead Hand position pending in 2002. Program and Support Services (P.S.S.) PSS decrease in Kinesiologist hours in October 2002 from five days per week, seven hours per day, to one day per week. Noted decrease in Kinesiology treatments from 757 in the 3rd quarter to56 treatments in the 4th quarter GEORGIAN MANOR - 2003 ACTION PLAN RESIDENT CARE Goal Objectives Indicator To continue to enhance the Complete an updated New brochure completed by Palliative Care Program. Palliative Care brochure to June 2003. inform residents/families of the services. Increase resident participation Work with the Therapy Increase therapy services by in Rehabilitation Programs. provider to reinstitute the Mar. 2003. Kinesiology programf to five days per week, (lost this service the last quarter in 2002, stats reflect). Develop Pain Management Select pain management Implement program by June Best Practice Model. committee to develop terms of 30, 2003 that ongoing reference. evaluation of pain Utilize Best Practice management supports the Guidelines to enhance pain resident’s pain management management. plan. Ensure policy & guidelines in Present Best Practice model to place by June 30, 2003 to Professional Advisory support model. Committee by July 31, 2003. Development of Diabetic Select one Registered staff Consistent approach to Resource Staff Person. interested in leadership role to diabetic management by Sept. liaison with PGH Diabetic 30, 2003 Clinic Staff & Dietician consultant by April 30, 2003. Establish Diabetic protocol & guidelines by June 30, 2003. Provide education to Diabetic Resource Person by June 30, 2003. Address Dietary issues & be Provide alternate choice for all MOH Dietary Consultant prepared for MOH Dietary meals including pureed diets Review with no unmet Consultant Review related to by January 2003. standards. hire of Dietary Food By March 17, 2003 to serve Supervisor. all evening meals no earlier than 5pm. Utilize nourishment carts when purchased by April 2003. Institute multi-dose drug Provision of education to all Multi dose drug system in administration system to all 4 Registered Staff to ensure place and all staff proficient Units. competence in the new with the process by April 30, system. 2003. Introduce multi-dose drug Staff evaluated for time system, one Unit at a time, in utilization, competence, & consultation with Pharmacist. reduction in medication errors by June 30, 2003. Environment Goal Objectives Indicator To maintain the assistive Repair and replace Infra Red Canadian Hearing society to hearing system at optimum System by May 2003. inspect and recommend level. changes and repairs. Contact local service club that provided equipment to cover cost. System upgraded. To improve Resident patios Volunteer committee to Project of patio repairs and and maintain a safe pleasing explore cost of renovation on enhancements of patio environment. 4E patio and enhancement of completed by July 2003. 1st and 3rd patios. To improve Resident access to Work with Fleet manager to Replacement of 1984 Bus by transportation. investigate possibility of September 2003. purchase or lease of new bus with greater WC capacity. To eliminate the staff smoke The Employee/Management The staff smoking room will room. Committee will implement a be eliminated by May 1, 2003. no smoking policy for staff A designated outside smoking inside the facility May 2003. area will be chosen taking into With input from consideration safety issues and employee/management staff input. committee to designate a winter & summer outside staff smoking area by May 1, 2003. Human Resources Goal Objectives Indicator Provision in place for Staff A budget is established Budget Line Established and 1 Health & Safety Certification specifically for Health & staff trained by June 2003. Training. Safety Certification Training by February 2003 To implement the Lead Hand To keep the lines of Service levels are maintained system throughout various communication open between or improved. levels of service delivery. all disciplines involved. Target date February 2003 Provide volunteers for Adult Investigate in-services, & At orientation provide each Day Program with education, videos available. volunteer with education especially in Alzheimer’s Contact Education videos and articles. Provide Dementia. coordinator at Alzheimer this initiative on an ongoing Society re giving an in- basis by April 2003. service for volunteers. Survey volunteers to find out what it is that they need to learn. Increased days at Elmvale Senior Homes Administrator Funding received & staffing Site to dialogue with Ministry of increased by May 2003. Health to provide increased funds for staffing for one additional day by March 2003. Information Management Goal Objectives Indicator Computerized Care Plans will Compu Care program installed Computerized Care plans for reflect resident Activation and on Activation Computer for Activation and Restorative by Restorative Care. easy access. Mar. 2003. Staff training for computerized care plans. To enhance customer Development of on-line Implementation of system satisfaction by improving on request for Maintenance through the satisfaction delivery of service. system to be utilized through- surveys: out all areas of responsibility - # of follow-up calls by March 2003. - Budgets controlled To enable Management and Target date June 20, 2003. customer tracking of requests. To assist with tracking of costs associated with the requests. Leadership Goal Objectives Indicator To evaluate building status of Evaluate status of Georgian Recommendations submitted Georgian Manor Manor and provide to Human Services Committee recommendations around in 2003. future utilization or development. Increase in fundraising for Call churches, service clubs Increase in donations realized both Adult Day Program sites. and businesses, set dates for to enhance activities provided presentations. by Adult Day Program. Program Manager to write letters and do presentations to service clubs and businesses educating community re function of program by April 2003. Review and monitor menu Dietary department spending Obtain and comply with a set costs to comply with set costs will be within the set Dietary Budget for raw food budget. budget for 2003 and meet costs, dietary supplies and Know what limitations there Ministry of Health Standards. small wares. are for dietary supplies i.e. paper products and small wares. To have all recommendations Documentation has been Responses to Accreditation & suggestions addressed from completed from 2000 recommendation have been 2000 Accreditation. Accreditation by target date: addressed and recorded in June 2003. readiness for Accreditation. Teams have addressed the AOpportunities for Improvement which they identified and responses recorded in readiness for Accreditation. Final report forward to Senior Administrator by target date. Prepare for Accreditation Georgian Manor will Accreditation document review in 2003. participate in the New Simcoe completed. County Accreditation Teams Successful Accreditation. to facilitate the completion of the self assessment document and identify opportunities for improvement which will lead to the development of common policies and procedures where possible. To participate in the development of the schedule for teams to review standards to ensure all documents for Accreditation completed by target date. Schedule 3 SIMCOE MANOR - 2002 ACCOMPLISHMENTS Resident Care Water jug implementation to increase residents’ water intake. Purchase of insulated dishes for tray meals. Developed and implemented monitoring and documentation system for nutritional supplements Re-developed and re-introduced a system to monitor utilization of general purpose resident equipment Audited all facility owned resident mobility equipment to ensure safety and appropriateness Requested ergonomic review of inside wheelchair ramp. Report received along with recommendations regarding purchasing of future wheelchairs Successful management of significant enteric illness outbreak. Developed new “Outbreak Manager Kits” Continue to develop wound care skills of Clinical Resource Nurse Supported introduction of the role of County Psychogeriatric Resource Consultant at this site Trained an RN in the MOHLTC PIECES Psychogeriatric assessment program Successful increase to Nursing and Personal Care Funding via increase in Case Mix Index. Strategies learned from consultant appear to have been key success factors Activation Department successfully implemented CompuCARE care planning for all residents. Information Management Increased numbers of staff using email and other programs for communication Clerical support added to weekly Senior Management Meetings Revised payroll input responsibilities on site to match Finance Department goals. Human Resources Identified and developed skills of one Administration Secretary to become Site Purchasing Coordinator Successfully filled all vacant RPN and RN positions after lengthy shortages Provided placement opportunity for ten (10) first year Nursing Students from Georgian College Supported change in PFP department at this site Environment Adjala ice machine replaced Pronto steamer (1) replaced in main kitchen. Monitored successful renovation of community outreach space to host VON Adult Day Program Continued to implement Electronic Card Access System Renovation to staff dining room doors to allow visibility related to OHSC recommendation Successfully moved all residents (6) that smoke to unit where designated smoking area located Schedule 3 Roof restoration of the area set out by Tremco was completed by LaFleche; decking was removed on the two large decks on the Innisfil unit, membrane was replaced by LaFleche, then new decking was installed by maintenance(old decking lumber went to the museum) one domestic water tank was replaced in Inn/Nott mechanical room uneven uni-lock areas were leveled added a cut into the curb where residents walk in order to reduce risks of falls bed inventory of the complete facility completed and kept up at all times A/C was installed for the Inn/Nott units, north and south by Lobby Mechanical, with very good results Simcoe Village suite doors, we added five more suite closures to aide in ease of door opening (automatically close upon activation of the fire alarm) Simcoe Village decks on the 2nd and 3rd floors had automatic door openers installed 26 resident rooms were painted, meeting our goal of five year paint program Leadership Assisted PFP Department with physical asset inventory Developed further understanding of MOHLTC funding formulas Developed understanding of Supportive Housing Funding formulas Developed and implemented action plan to address unmet compliance standard. No concerns have been noted on routine tours Reorganized roles of Nursing Resident Care Managers to enrich leadership role Lead staff through reorganization of Maintenance Department SIMCOE MANOR – UNMET OBJECTIVES A. Compliance review resulted in one unmet standard related to control of hazardous substances. Action plan developed and successfully implemented to correct issues. SIMCOE MANOR – EXTERNAL REVIEWS A. Simcoe County Health Unit Inspection – Planned inspections in January, May & September - no outstanding issues. Outbreak inspections in January & December. B New Tecumseth Fire Department – no visit in 2002. Review January 2003, and full tour scheduled for February 2003. C. Otis Elevator Inspection - monthly inspections, no outstanding issues. Door timing adjusted at Simcoe Village D. Dietary Fire Hood Inspection – two inspections, no outstanding issues. J. Roof Inspection LaFleche Roofing - infra red scan done Spring 2002. K. Eco-Lab Chemical – monthly reviews, no outstanding issues Schedule 3 L. PCO – monthly inspections, no outstanding issues M Boiler Room Inspection - monthly, no outstanding issues. SIMCOE MANOR – INSERVICE LIST TOPIC Attendance Cooling Temperature Rates/ Clostridium Perfringens 7 Importance of Increasing Resident Fluid Intakes (Unit Team Meetings) 30 Dysphagia Inservice (Dec. 6/02) 20 Tube Feeding (Dec. 13/02) 14 Proton Sanitation Course (July/Aug./02) 6 Swish Dispenser Use (Dietary) 9 Automatic Floor Scrubber Review 15 Bed Alarms 11 Pharmacology – Zyprexia 8 Cauterization Training 1 Chest Assessment review 1 Oxygen Therapy 6 Pharmacology – Resperdal and Reminyl 8 Chest Auscultation 19 Floor Scrubber 15 H/S WHMIS review 94 Swish Dispenser 9 Swish Products 24 WHMIS full training 14 Performance Evaluations 6 SIMCOE MANOR – CONTINUING EDUCATION ACTIVITIES CONFERENCE/WORKSHOP/MEETING Attendance Palliative Care Workshop 2 Spring Serca Food Show 3 Fall Serca Healthcare Show 4 Complete Purchasing Show 1 OANHSS Dietary Managers (Feb/May/Sept) 1 Advanced Care Planning 7 Aggressive Behaviour Management 1 Basic Rescuer 7 Care Giving in a Healthy Way 1 Dementia Care Conference 3 Functional Fitness – Restorative Care Workshop 1 Nurses Make a Difference 1 OANHSS Annual Convention 4 OANHSS Region 4 Annual Conference 6 Pain Management 1 PIECES Training 1 Corporate Health and Safety Training 3 Food Safety Training 8 Health and Safety Basic Certification 1 Health and Safety Workplace Specific Training 1 OANHSS Administrator Certification – Recertification 1 CompuCARE Software Training 3 Memorabilia Scapbooking 3 Palliative Care Training 2 Palliative Care Workshop 2 Foot Reflexology 1 OANHSS Region 4 Environmental Services Managers Meetings 1 OANHSS Region 4 Administrators/Directors of Care Meetings 1 SIMCOE MANOR – CURRENT ISSUES General New corporate philosophy requires moving of resident designated smoking area and elimination of inside staff smoking area. Dietary Currently do not meet MOHLTC standard for leadership (dietitian plus food service supervisor hours). To be addressed during reorganization. Nursing Current Resident Care Managers are not in role full time. Hours allocated are 15 hours/week. A review of the nursing and personal care services is currently in progress to review potential enhancements to leadership roles to ensure effective service delivery and equity across all Homes. Adult Day Care No outstanding issues. Laundry/Housekeeping Recent retirement of Housekeeping/Laundry Supervisor resulted in responsibility for Schedule 3 department moving to PFP Department. Site representatives will be working closely together to review and improve overall housekeeping procedures. Maintenance Implementation of new supervisor role completed. Lead hand positions in maintenance and housekeeping/laundry pending. Program and Support Services (P.S.S.) Program continues to operate under traditional style. Full implementation of new Program and Support Services Manager role expected Spring 2003. Activation Director temporarily provided management support to Trillium Manor January – February 2003. 2003 Facility Wide Action Plan Resident Care Goal Objectives Indicator To move resident smoking a) Meet with residents to explain Guardian Satisfaction Survey lounges away from a need for move resident care area(s). b) Develop plan of action to minimize impact To ensure safe, secure c) Develop polices and Monitoring of incident reports resident smoking area. procedures for safe resident smoking in this site Renovate with budget d) Renovate lounge for general approval purpose use To enhance independence a) Develop guidelines for # of residents using individual and health status by assessing resident seating seating (%) developing guidelines for needs. seating and surface b) Outline staff responsibilities guardian satisfaction survey assessment. and accountabilities for assessment, access for funding and evaluation of seating and surface needs. c) Audit internal equipment and review of data base for develop a data base to accuracy maintain accurate records of facility resources. To Evaluate work a) assess impact of 2002 report # of staff complaints re: work conditions via Ergonomist b) develop plan of action to place conditions Assessment promote healthy work # of workplace injuries practices. Increase Resident Access to a) develop spaces that will # of residents using Refreshments Current promote this independence refreshment areas systems do not allow those opportunity guardian satisfaction survey residents who are capable b) coordinate with all access to refreshments departments to ensure safety without supervision ENVIRONMENT Goal Objectives Indicator Renovation of Smoking a) renovation of resident As above Areas smoking lounge b) move residents to current staff smoking lounge c) eliminate staff smoking inside the building d) designate outside smoking areas Dining Room Space a) review spaces to maximize All residents will be seated utilization without within designated dining renovation. room. Guardian satisfaction survey To enhance facility security a) Complete installation. Continuation of 2002 project. by completing installation b) Provide all staff with access of electronic access. cards. c) Determine hours of operation for outside doors. d) Develop policies for utilization. e) Revise existing security policies. HUMAN RESOURCES Goal Objectives Indicator To ensure that all a) Develop standards of safety Ergonomist will audit equipment purchases meet for facility owned and equipment in fall 2002. the health and safety needs resident owned equipment. of staff. b) Review standards with all staff via education series. c) Review standards with residents and families via Family Information Meeting. To enhance staff education a) Develop staff education skills Staff needs assessment by developing a staff in lead staff members. Participation and interest in education team. b) Ensure core group of staff education team with knowledge base and education skills at all times. # of on site education sessions c) Provide onsite, timely held educational activities for # of staff participating in staff. sessions To enhance the facility’s a) Survey other facilities and Defer to HR attendance management types of organization program to ensure attendance rates. scheduled staffing levels at b) Recruit an attendance all times. management team. c) Determine a program suited to facility. d) Implement and evaluate program. Smoking Cessation a) Offer cessation programs in # of staff participating in conjunction with health unit. programs # of staff reporting smoking cessation after 6 months Corporate Relationship Develop front line staff member’s awareness of, and feelings of connectedness with corporation as a whole. INFORMATION MANAGEMENT Goal Objectives Indicator Review compliance with a) Audit and determine level of corporate records compliance. management policy. b) Remove and destroy records as needed. c) Educate departments on corporate and facility policies for records management. Develop facility wide a) Review current practices for Continuation from 2002 comfort levels with communication under four electronic communication. broad categories: resident information; facility wide communication; interdepartmental communication; staff communication. LEADERSHIP Goal Objectives Indicator Review funding and a) Educate and review funding Ongoing as part of revenue plans to develop and revenue mechanisms. Performance Management performance indicators. b) Determine areas where Activities. Review 2002 planned expenditures exceed funding. expenditures to determine c) Determine indicators of compliance with above. performance related to above. Enhance staff knowledge of a) Share quarterly management Continued from 2002 facility operation. activities and reports quarterly. Share action plan(s) and progress within departments. SIMCOE VILLAGE REPORT Period: Jan. 1 – Dec. 31, 2002 INDICATOR 1996 1997 1998 1999 2000 2001 2002 COMMENTS CLIENT DATA Admissions 6 12 11 5 11 9 5 Discharges 4 10 7 3 9 8 4 4 Deaths 2 2 4 2 2 1 Avg. Length of Stay (Yrs) 3.45 5.0 3.6 2.7 4 % Occupancy 99.2 99.4 99.3 98.9 99.25 # Clients at Period End 36 37 36 36 36 36 34 # Clients Served in Period 40 46 47 41 47 45 38 # Females at Period End 28 30 30 30 28 # Males at Period End 8 6 6 6 6 # Couples at Period End 4 4 4 4 2 Average Age of Clients 82.0 82.9 82.8 82.9 83 Waiting List 169 202 241 183 195 192 New Applications/Period 47 51 48 40 24 % Full Pay Clients 53.0 49.0 49.0 49.25 54.5 50.7 49.25 #Client Complaints 0 0 0 0 0 HOMEMAKING Dietary Homemaking Hrs 910 912 913 910 912 Hskpg Homemaking Hrs 588 588 588 592 592 592 592 Red Cross Home. Hours 2978 4489 5917 5568 4675 4639 4638 Total Homemaking Hours 7415 7072 6698 6141 6142 SIMCOE VILLAGE REPORT INDICATOR 1996 1997 1998 1999 2000 2001 2002 COMMENTS MEAL PROGRAM Service Package Meals 5718 5568 5673 5562 5595 Extra Client Meals 1541 1522 1450 1400 1835 Visitor Meals 73 65 61 80 87 Total Meals 6962 6880 7332 7155 7184 7042 7517 OTHER SUPPORT #One Way Trips 1358 1538 1432 1448 1627 #Manor Nursing Visits 72 108 94 94 206 85 N/A Housekeeping Hours 941.5 941.5 941.5 972 972 972 968 FINANCIAL Budgeted Per Diem 38.79 40.59 36.01 43.52 43.40 Per Diem at Period End 32.86 34.32 36.85 42.43 40.26 N/A # Overdue Accounts 0 0 0 0 0 0 0 Schedule 4 SUNSET MANOR - 2002 ACCOMPLISHMENTS Resident Care Progress in maintaining consistency of staffing achieved following increased challenges in recruitment during the summer months of 2002 Palliative Care Lounge Chair donated by local Canadian Legion for Resident comfort and utilization Flu vaccine policy revised, and Resident, Staff and Public Influenza Clinics held at Sunset Manor. Sunset Manor staff assisted in corporate flu clinic held at the Administration Centre Policy and procedure developed for CPR protocol upon ambulance transfer Resident Falls Assessment protocol developed and implemented. Ongoing development continues on program to establish a Best Practice for all County Homes Head Injury Routine (HIR) protocol developed and implemented A multi-disciplinary task force lead by the Manager of Food Services, successfully developed enhancements of the meal and nourishment services to Residents. The effectiveness of food service delivery was noted in the 2002 Annual MOH Compliance Review Continued monitoring of Multi-dose medication system occurred. Analysis indicated a reduction in medication incidents during the year and staff time efficiencies Sunset Manor was voted the “Readers Choice Award” for the best LTC facility in the Georgian Triangle area Wound Care Program continued to develop throughout the year within additional assessment and preventative measures established PIECES Psychogeriatric program enhanced with the addition of a new resource Team operating in the County of Simcoe. Regular meetings and consultations held with staff and resource person to assist in care planning and service delivery Policy & procedure development completed regarding assessment and application of compression stockings. Information Management Staff training of CompuCare computerized care plan model implemented and care plans revised facility wide Completion of computer upgrades to Microsoft Word and Lotus Notes Decrease in use of paging system for incoming calls by direct forwarding Companion Phone system upgraded to eliminate “dead zones” within facility Enhanced utilization of 24 hour Resident Care report implemented Payroll input commenced with Vadim Program Introduced Performance Management to Supervisors Introduced voice mail for Administrative Staff to enhance communication Human Resources Site Administrator/Director Resident Care hired in October 2002 Program & Support Services Director hired in November 2002 Team Leader position for Program & Support Services hired December 2002 Part-time Program & Support Services staff hired December 2002 Opportunity for job shadowing increased through “Bring Your Child To Work” Program Schedule 4 Development of Best Practice Model for delivery of care in process and new Team members being recruited. Non Violent Crisis Intervention Training (NVCIT) recertification program for currently trained staff completed. Restructuring of the Environmental Department accomplished through the twining of Sunset Manor and Simcoe Manor Back Care program & return to work orientation implemented across the organization Environment Utilization of County of Simcoe purchasing support systems to ensure quality and cost- effective purchases of equipment/repairs to building Expansion to Resident Dining area in South Simcoe Unit completed Internal building décor improved and maintained as appropriate A Smoking By-law implemented in the Town of Collingwood. Resident smoking lounges reduced from two to one and staff prohibited from smoking in the facility. Specialty protective equipment provided for staff who are required to clean or enter the Resident smoking lounge. Purchase of ergonomically designed wheels for utility carts within the department Participation in the S.C.R.E.A.M. Team for the procurement of goods and services Old, broken or unusable wheel chairs and other assistive devices removed from service Second phase of lawn sprinkler system installed Uneven areas of Unilock stone have been leveled in front entrance Three pull stations replaced in West Simcoe Unit due to Resident’s ability to pull the fire alarm. Maintenance Shop and Day Away fire zones have been split into two separate zones. Hot water boiler for the laundry was replaced. Emergency planning – Fan Out procedure established for Sunset Manor. Fan out system run through planned for 2003 Leadership Georgian Triangle Hospice suites development for respite care to clients in the Community supported with completion in February 2003 Investigation/Research into establishing a Foundation for the Residents of Sunset Manor initiated Leadership roles for the Senior Homes Administrator and Site Administrator/Director Resident Care were successfully implemented Implementation of monthly meetings of the four Site Administrator/Director Resident Care and the Senior Homes Administrator to promote continuity and consistency in communication and program development Initiation of a Program & Support Services Director and Team Leader positions successfully implemented Successful Ministry of Health Compliance Review Sunset Village Emergency response system established at front entrance to ensure prompt access of emergency services such as ambulance and police. Intercom system has been integrated Schedule 4 into the nurse call system at Sunset Manor for emergency purposes. Enhancements to landscaping implemented to increase privacy for ground floor occupants. Large maple trees replaced at the Village related to previous damage as a result of car accident. Sunset Manor Catered meal service increased to twice per month at the request of occupants. Ongoing review of meal service in progress. SUNSET MANOR – UNMET OBJECTIVES Initial training of staff in NVCIT presently at seventy-five percent not 100 percent as projected Exterior garden maintenance and enhancements not completed Development of a mortality audit not completed in 2002 SUNSET MANOR – EXTERNAL REVIEWS A. Simcoe County Health Unit Inspection Public Health Inspection for Dietary was conducted on December 12, 2002 and no concerns were identified at that time. B Collingwood Fire Department Annual Fire Audit and Annual Inspection and testing of alarm system completed. C. Hytrack Elevator Inspection Elevators inspected on a monthly basis by Hytrack. Elevator down time approximately one week as problem intermittent in nature. New circuit board in place as of February 3, 2003. D. Dietary Fire Hood Inspection Kitchen hood inspected on May 4, 2002. The six month inspection pending and will be completed early in the New Year. E. Roof Inspection LaFleche Roofing Infrared roof scan completed. Required repairs scheduled for 2003. F. EcoLab Inspections conducted on a regular basis re: utilization of chemicals. No concerns identified. H. PCO Regularly monthly inspections and treatments completed. A few bedbugs identified but no source identified. Continued to monitor through the year. Schedule 4 SUNSET MANOR – INSERVICE LIST TOPIC Attendance General Staff Orientation 11 Wheelchair Seating 13 Nonviolent Crisis Intervention Recertification 28 Nonviolent Crisis Intervention Training 12 Introduction to Tai Chi 6 Computerized Care Planning 9 Life Goes On Grief Discussion 9 Nutrition 9 Wheelchair Steamcleaner 13 Ergonomics 8 Compression Stockings 7 Hydration 7 Caring for People with Dementia 23 Antipsychotics 9 PIECES 12 Wound Care 11 Psychogeriatric Case Study 7 Fan-Out Procedure 31 Compliance 28 Documentation: Registered Staff 22 ADL Documentation for HCAs 28 BDL Documentation for HCAs 26 Purchasing 6 Hepatitis 8 Urinary Tract Infections 8 Fire Extinguishers 67 The Health of the Health Professional 11 Influenza 10 Stress Management & Back Care 14 General Staff Orientation 8 Stress Management 15 CONFERENCE/WORKSHOP/MEETING Attendance Advance Care Planning 2 Palliative Care 8 OAHNSS 6 Managing Pain in the Cognitively Impaired Elderly 3 Professional & Practical Ethics and Nutrition and Wound Care 5 Housekeeping Workshop 3 PIECES Training 2 SUNSET MANOR – CURRENT ISSUES General Bedbugs remain to be a problem within the Facility. Identification of entry point (s) has not yet been determined. Dietary Electronic menu boards have recently been installed and activated on all five units. Staff continue to learn how to input data for meal service. Nursing CMI results decreased 1.1 during 2002 MOH Classification The Union contract remains outstanding for the Registered Nurses. Recruitment of Registered staff inhibited by changes in Ontario College of Nurses protocol and increased requirements for entry to practice Laundry/Housekeeping Usage of ergonomically designed casters for large carts has been positive for staff in easing their workload and may assist in decreasing physical stress and strain on staff. Maintenance Snow removal has been more challenging this year as area traditionally used for dumping of snow is no longer available. Sourcing of new area for removal of snow is in process. Program and Support Services (P.S.S.) Adjustment to the changes within the structure of the Department continues to evolve. Schedule 4 SUNSET MANOR – 2003 ACTION PLAN RESIDENT CARE Goal Objectives Indicator Enhance the Resident 1. Revise the Resident 1. Resident Handbook Admission Process Handbook revised. 2. Create a warm inviting 2. Separate quiet room with environment for Resident quiet comfortable admission atmosphere to be utilized for Resident/Family admission process. Enhance level of care funding 1. Documentation team to 1. Training by external receive further training consultants. from external consultants. 2. Schedule the documentation team 2. Each member scheduled 15 adequate hours for hours for 6 weeks preparation. commencing July 2003. Implement Best Practice 1. Support the Best Practice 1. The Best Practice Guidelines Team participants and Guidelines and protocols be assist as appropriate. initiated. Environment Goal Objectives Indicator Preventative Maintenance 1. Development of 1. Compliance with the Program to be implemented Preventative maintenance established schedule. schedule. 2. Development of a 2. Audit developed. Once preventative maintenance developed compliance of audit 90 percent or better. Enhancement of external 1. Review maintenance 1. Establish availability of gardens/grounds routines with Manager to staff for grounds keeping. estimate availability of staff to do grounds work. 2. Initiate tendering process 2. Contact PFP at the for grounds management if County of Simcoe for appropriate contracting out grounds keeping. 3. Grounds will be appropriately maintained and appealing to the eye. Schedule for internal 1. Establish regular schedule 1. An appropriate number of maintenance of Resident for repairing /painting rooms per month, rooms to be initiated Resident rooms determined in conjunction with manager to be 2. Establish inventory control completed. list related to required 2. Adequate amount of supplies for refurbishing of supplies present in house at Resident rooms. all times. Human Resources Goal Objectives Indicator Introduce Orientation Program 1. Encourage new Registered 1. College of Nurses to LTC as outlined in the staff to be involved in the Orientation Package College of Nurses Orientation Orientation program incorporated into existing Package. Orientation. Increase retention and 1. Implementation of Exit 1. Increase in recruitment & recruitment of all levels of Interviews once finalized retention as appropriate staff. through human resources. based on availability of new staff. Implementation of New 1. Enhance the quality of 1. Resident, family and staff Chaplain contract Spiritual care for satisfied with Chaplaincy Residents, families and services. staff. Decrease staff absenteeism 1. Once need identified, 1. Monthly reporting of staff Resident Care absenteeism at Nursing Coordinators to Management meetings. speak/counsel staff to Staff counseling conducted identify potential areas by Resident Care that we can assist with. Coordinators. 2. Encourage involvement of 2. Chaplain involved as Chaplain as appropriate. appropriate. Increase Volunteer base to 1. Work with Ontario Works 1. Human Resources to enhance programming Program to encourage assist in recruitment of volunteers these students. 2. General meetings for volunteers quarterly. 2. Volunteer base will increase by 50 percent over the next year. Information Management Goal Objectives Indicator Integrate Computerized Care 1. PSSM to work with PSSM 1. Implementation of Care Plans for Program & Support of Simcoe Manor to Planning Services implement Computerized Care Planning for Activation staff. 2. Staff training on 2. All staff appropriately computerized care trained planning. 3. CompuCare program 3. Program installed on installed on Activation Activation computer computer for ease of documentation. Improve communication with 1. Create a Family Council 1. Family Council established Family members within the Home. with meetings scheduled. Improve communication 1. Establish a safe 1. Staff feeling safe & secure between staff on shift communication system for while working on any unit. staff working on all units but particularly in the Secure Units. Leadership Goal Objectives Indicator MOH Compliance 1. Meet or exceed all MOH 1. No unmet standards at standards review. Accreditation 1. Create teams to participate 1. Successful Accreditation in all areas of accreditation Review November 2003. utilizing expertise within the County of Simcoe. 2. Educate all Teams in the new AIMS standards related to accreditation Continue to foster positive 1. Establish positive rapport 1. Positive team and team working relationship between with Managers attitude developed Managers & new S.A./D.R.C. 2. Continue to encourage 2. Maintaining their their involvement in issues enthusiasm and related to the Home. involvement in Home 3. Participate in Team activities. building exercises/events 3. Team building event in including the other County conjuction with other Homes. Homes. Schedule 5 TRILLIUM MANOR - 2002 ACCOMPLISHMENTS Resident Care Heart and Stroke Strategy Program implemented. Infection Control Program has been reassessed to produce pertinent data. Palliative Care program upgraded to include a user friendly terminology for residents, families and staff. Initiated an Enteric Protocol for outbreaks. PIECES Program has two staff members to share the assessments. Increased the utilization of the facility’s flexible care and behaviour programs. College of Nurses standards emphasized to increase awareness regarding medication documentation. Revitalized the lifts, transfer and carry team. Reestablished the nursing routines committees on each unit. Completed a trial of fruit spread in the Severn Unit which resulted in a decrease in the number of residents requiring peristaltic stimulants. The Programs and Support staff initiated new programs including dances and a fashion show. Initiated Best Practice Teams in conjunction with the other three County Homes. Information Management Nursing stations and offices computers upgraded and Lotus Notes installed for increased communication. Purchased a portable telephone for the Trillium Manor bus. Initiated monthly meetings for all departments. Introduced performance management to supervisors. Streamlined purchasing protocols Payroll input commenced with the Vadim Program Human Resources Increase in Staff development attained due to increase in inservice education which exceeded the Ministry of Health expectations. Focus was placed on team building, resident abuse, resident aggression and health and safety. Retention and recruitment – Colleges and student placement utilized to hire staff. Successfully recruited a new Medical Director. Successfully recruited for the vacant Resident Care Manger position. One staff member was certified in Health and Safety. Restructuring of the environmental department has been accomplished with the twinning of Trillium Manor and Georgian Manor. Purchasing contact established in the Manor. Environment Restoration of part of the roof was completed by LaFleche Roofing. Participation in the S.C.R.E.A.M. Team for the procurement of goods and services. Deceased resident files past time lines shredded. Unusable, broken, outdated furniture and equipment removed from the Manor. New storage for deceased resident files created with the discarding of broken furniture Schedule 5 and equipment. Hot holding unit purchased to ensure compliance with food temperatures. Food blender purchased to ensure the pureed menu is consistent with the regular menu. Specialized utensils purchased to assist residents rehabilitation. Consumption of milk by residents increased according to Ministry of Health guidelines. Increased the meals on wheels program by one route due to the fact that Trillium Manor is able to provide specialized diets of varying consistencies. Purchased the Manual of Clinical Dietetics to assist with regular and specialized diets and nutrition. Visual plate audit commenced as per Ministry expectations. Monthly Theme Days held for the residents with the lunch menu reflecting the theme. Increase in the number of food committee meetings from four to five at the residents request. Simcoe County Public Health Unit held a successful Influenza Clinic at Trillium Manor in November 2002. Leadership Successful Ministry of Health Compliance Review. Successful efficient transition of leadership by the Senior Administrator and the Site Administrator. Staff survey completed and analyzed to determine appropriate food items for the vending machines to increase staff usage; therefore increasing dietary revenue. Best practice guidelines commenced as recommended by the accreditation process. Ministry of Health’s classification funding system increased by 4.17 points. TRIILIUM MANOR – UNMET OBJECTIVES Resource Sharing. – Compiling common manuals between the four Homes will be commenced in 2003. Wall protectors on the doorways to resident units and rooms were not installed. TRILLIUM MANOR – EXTERNAL REVIEWS A. Simcoe County Health Unit Inspection Public Health Inspections were conducted on January 2, 2003, June 4, 2003 and December 4, 2003. Hazardous Analysis Critical Point follow through were conducted on June 28, 2003 and October 21, 2003. Minor recommendations from these inspections received and instituted. B Orillia Fire Department Orillia Fire Department used Trillium Manor as a training walk through for the fire department on October 22, 2003. The fire inspection planned for December 17, 2003 was cancelled due the Norwalk like symptoms in the building and rescheduled for 2003. C. Hytrack Elevator Inspection The elevator was inspected monthly by Hytrack. Preventative maintenance was Schedule 5 preformed during the inspections. D. Dietary Fire Hood Inspection The kitchen hood was inspected by Huronia Fire Safety on October 9, 2002. The hood passed inspection and will require recertification before April 9, 2003 E. Roof Inspection Tremco LaFleche Roofing completed restoration of the roof on the west side of the building. Water damage occurred to one bathroom due to rain during the maintenance. This was repaired by LaFleche roofing in a timely fashion.. F. Diversy Chemical Quarterly chemical analyses and preventative maintenance were conducted by Diversy. Recommendations on chemical usage and loading the machines were received and instituted. G. Critter Ritter Monthly inspections were performed by Critter Ritter. TRILLIUM MANOR – INSERVICE LIST TOPIC Attendance Nestle – Med Pass (staff) 13 “Turkey” (residents, families) 17 The Anatomy of a Stroke (staff) 16 PSW Student Orientation (students) 4 A Fire Fighter’s Experience Residents) 29 Chemspec – New Rug Cleaning Products (Housekeeping) 8 The Psychosocial Effects of a Stroke (staff) 13 “Turkey” (residents) 29 Critiquing New Menu Items (Dietary, Nursing) 19 DN Student Orientation (students) 2 “Stepping into Spring” Footwear (staff) 14 “Stepping into Spring” Support Hose (staff) 12 “Stepping into Spring” Staff foot Care (staff) 12 Communications and Stroke (staff) 12 CPR Recertification (staff) 19 Leisure Activities for Stroke Victims (staff) 11 Cooking Demo (residents, families) 27 Ongoing Changes of Orillia (Residents) 25 HCA Behaviour Documentation (HCA’s) 8 Policies, Procedures and Forms (Reg’d staff) 11 Mobility and Skin Care R/T Strokes (staff) 4 Antipsychotic Drugs (Reg’d staff) 8 History of CFOR (Residents) 21 Stephen Leacock (Residents) 9 Dehydration (staff) 25 New HCA Assignment and Behaviour Protocol (HCA’s) 6 Tena Products and Incontinence (Nrsg. Staff) 4 Mock Compliance Review (Management) 6 Classification Documentation Training (Documentation staff) 5 Strawberry Island (Residents) 11 Phila Shave Cleaning Demo (Ramara staff) 5 Strokes – Routine Activities of Daily Living (staff) 4 Strokes – Cognitive and Perceptual Problems (staff) 4 No Bake Pie Making (Residents) 10 Purpose of the Tena Team/Increasing Membership (Tena Team) 5 The Origin of the Word “Trillium” and “Grace Avenue” (Residents) 15 Travel Log from Utah and Arizona (Residents, families) 21 Low Air Loss Mattresses (Nrsg. Staff) 9 Origin of Orillia (Residents, families) 13 Occupational Health & Safety Responsibilities of Supervisors 4 Strokes – Meal Assistance and Hydration (staff) 6 Family History (Residents, families) 19 Rug Hooking (Residents, families) 32 Fire Extinguisher Hands on Demo (staff) 105 Fire Safety (staff) 101 Bed Alarms (staff) 101 Evacu Sled (staff) 105 WHMIS Review (staff) 104 Back Safety (staff) 101 Worker Responsibilities (staff) 102 Hand Washing (Glitter Glo) (staff) 101 Russia (Residents, families) 27 Cholesterol (staff) 8 Specific Behaviours with Stroke Patients (staff) 8 Use of Respirator for Resident Smoking Lounge (staff) 6 on going Managing Incontinence after a Stroke (staff) 2 Carpet Cleaning and Floor Care (new Hskg staff) 1 Abuse (staff) 78 Food cooking Demo (Residents, families) 36 Fax Training (management, office staff) 7 Test Taste – Egg Substitutions (staff) 9 Cholesterol Meds and Physiology (staff) 11 Student Orientation (student RPN’s) 7 Risk Factors for Stroke (staff) 2 TRILLIUM MANOR – CONTINUING EDUCATION ACTIVITIES CONFERENCE/WORKSHOP/MEETING Attendance B.Sc.N completed at York University 1 RN B.Sc.N part time on going at St. FX University N.S. 1 RN B.Sc.N. part time on going at Laurentian 1 RN B.A. part time on going at York University 1 RN Gerontology Certificate at Georgian College 1 HCA Intramuscular Injection Course at Georgian College 1 RPN Advanced Care Planning at Woods Park Care Center 1 RCM Annual Palliative Care Conference at Georgian College 8 PC Team Pain Management in the Frail Elderly Workshop at Trillium 5 nursing Managing Challenging Behaviours of the Alzheimer Victim in Mississauga 5 Activation American Sign Language 1 C with Huronia Hearing Impaired 1 Activation Professionalism, Legalities and Medical Ethics at Georgian College 1 RN American Sign Language 1 A with Huronia Hearing Impaired 1 Activation American Sign Language ABC/123 with Huronia Hearing Impaired 1 Activation Chartered Herbalist course completed through Dominion Herbalist College, Burnaby B.C. 1 RN Treating the Behavioural and Psychological Symptoms of Dementia, Barrie 10 nursing LTC – Priority Project at CCAC Barrie 2 RCM’s Adult Physical Assessment Course at Georgian College Barrie 3 RPN’s Visiting Volunteer Training Program through Hospice 1 HCA Meeting the Challenge of Dementia at the Army, Navy and Air Force Club, 1 RPN Barrie SCPHU Educational Workshop at Public Health Unit Barrie Med. Dir., 1 RCM OANHSS Region 4 Annual Meeting at York Region NewMarket H.C. Center 5 Management Putting the Pieces Together: Multidisciplinary Approach in NewMarket 2 RCM’s OPP Abuse Workshop in Orillia 2 RPN’s Advanced Care Planning at Simcoe Manor 1 Admin., 2 RCM’s, 1 RPN Managing Performance Outcomes at Nottawasaga Inn SA/DOC The Art & Science of Chronic Wound Care at OSMH 4 Reg’d staff Schedule 5 Infection Control Outbreaks Enteric Outbreak Norwalk Virus Final Report Dec. 27, 2002 Outbreak Number: 2260 – 63 - 02 Index Case: Nov. 26, 2002 Case Definition: Any resident or staff who after and including Dec. 3, 2002 exhibited 2 or more episodes of vomiting/diarrhea, abdominal cramps or fever, or any lab confirmed case. Length of Closure: December 3 to December 25 at 1200. Deaths as a result of Outbreak: none Residents Hospitalized: none Total Residents Ill: 25 Total Staff Ill: 31 Enteric Outbreak: 2260 – 63 – 02 TOTALS 9 8 7 6 5 Residents 4 Staff 3 2 Total 1 0 Nov. Dec. 4 Dec. 8 Dec. Dec. Dec. Dec. 26 12 16 20 24 Concerns during the outbreak: Staffing was the biggest issue with respect to cost, staff illness and authenticity and not wanting to work on the affected units. Supplies and costs such as incontinent products, gloves, sanitizers and linens became an issue. Visitors who were visiting non affected units and not following hand sanitizing protocol upon entering the facility was another issue. Successes: 1. Quick response to signs and symptoms by RPN on both Severn and Ramara. 2. The virus was kept to one unit at a time and only two units were affected. 3. No laundry staff came down ill. Isolation procedures were in place and worked well. 4 No deaths resulted from the virus. 5. No resident hospitalizations resulted from the virus. Outcomes: 1. Hand sanitizer dispensers will be installed at main entrance to facility and all entrances Schedule 5 to each unit. Hand sanitizing will be encouraged on a regular basis upon entering the facility and the units. 2. Disinfectant spray changed from 256 to Virox, a more concentrated solution. 3. Dietary staffs are to wear gloves when handling and preparing foods at all times. Copolymer gloves will be provided on an on going basis to the kitchen and each servery. 4. Enteric Outbreak Protocol package devised. 5. Electrolyte Replacement recipe given by Dr. Crawford was beneficial. TRILLIUM MANOR – CURRENT ISSUES General There is a decrease in the number of applicants for private accommodation for the secure unit. Dietary There has been an increase in the Meals on Wheels program by one route. New containers are being discussed to maintain heat and for ease of the recipients. Nursing CMI increased to reflect the present care requirements of the residents. Staff have been redeployed to meet the needs of the residents. Casual staff often resign due to lack of hours requiring more casual staff to be hired to fill the vacancies. Laundry/Housekeeping Approximately 25% of the linen in the building needs replacing. A colour coded system for linens will be put in place to ensure adequate linen for each unit. Maintenance Ice build up on the roof allows water seepage onto the walk-in cooler creating ice conditions on the floor of the cooler. The lead hand position for maintenance remains vacant at this time. Program and Support Services (P.S.S.) The Activation Director was off for several weeks. During this absence, the Program and Support Services Manager from Simcoe Manor visited site weekly to assist activation staff. All programming and activities for the residents have continued. Schedule 5 TRILLIUM MANOR - 2003 ACTION PLAN RESIDENT CARE Goal Objectives Indicator Improve continuity of care 1. Review unit routines on a 1. Routines committee audit monthly basis to ensure an for number of meetings and even work load. outcomes. 2. Implement a basic check 2. Resident care audit. sheet for care for each resident. 3. Revise staffing levels on all 3. MOH Levels of Care units to ensure all residents Classification CMI for per unit receive quality care. 4. Completed, current care 4. Care plan audit 100% plans reflecting the residents’ needs, strengths and goals.. 5. Medication documentation 5. PRN Medication audit reflects pain management. 100% Incontinence product use will reflect the actual need of the resident. 6. A process for 6. Nourishment documentation of resident documentation audit 100% nourishments will be initiated. 7. Restraint use will be 7. Restraint audit 100% documented as per policy and MOH standards. Enhance the resident 1. Initiate a post admission 1. Survey implemented. admission process survey. 2. Revise the Resident 2. Resident handbook revised. handbook. 3. Revise the admission 3. Admission process revised. process. Enhance level of care funding 1. Documentation team to 1. Training by external receive further training from consultants. external consultants. 2. Schedule the documentation 2, Each member scheduled 15 team adequate hours for hours for 6 weeks preparation. commencing in July 2003. 3. Review documentation 3. MOH Levels of Care prior to MOH Levels of Care Classification audit 100 Classification. percent Best Practice Guidelines Participate in the Best Practice The best practice protocols. team initiated. Enhance resident quality of 1. Present ten theme days a 1. Resident satisfaction life year. survey. Theme day audit 100 percent. 2. Introduce new programs 2, Resident satisfaction covering all four domains. survey. New program audit increase percent. Environment Goal Objectives Indicator Environmental Manual review Include procedures for all Manual is complete and up to maintenance equipment. date. Fire prevention On going Instruction for all Annual fire extinguisher staff on fire extinguishers and inservice completed. fire procedures. Fire drill audit 100 percent compliance. Preventative maintenance roof Prevent water from seeping No further ice back up on the onto the walk-in cooler in the roof. kitchen Preventative maintenance That the preventative Preventative maintenance program maintenance program is audit 100 percent compliance. completed. Enlarge resident dining rooms Contact architect through PFP Plans developed and in 2004 department for structural approved. design and plans. Public Health Inspections Meet all Public Health Public Health Inspection audit guidelines and standards. 100 percent Food wastage Decrease food wastage. Recipes devised for use of leftover food. Storage space Redefine storage areas. Designated storage areas. Infection Control Common manual for all the Manual completed. Homes Human Resources Goal Objectives Indicator Improve staff participation Change monthly meetings to Audit for staff attendance alternate months. shows increase. Survey staff for educational Develop a survey to be and work needs. distributed to staff. Implement fun days quarterly Staff survey shows positive for staff and residents feed back. Provide an enhanced Offer new registered staff the RNAO orientation program orientation package for RNAO orientation program. implemented. Registered Staff Staff absenteeism Decrease Staff absenteeism Initiate staff absenteeism audit. Staff education Increase staff attendance by Audit for staff attendance surveying staff for topics. increased 25 percent Recruitment and retention Conduct exit interviews. Increase in staff recruitment Survey staff for work related and retention. needs. Information Management Goal Objectives Indicator Improve communications Upgrade the telephone system IMS approval of new phone system. All staff to be instructed in the Staff use of e-mail for use of e-mail communication. Revitalize Family Council. Increase in the number of meetings and attendance. Family meetings quarterly Number of meetings held. Family newsletter semi Number of newsletters annually. Improve computer usage Train staff basic computer Initiate a computerized report skills. audit. Leadership Goal Objectives Indicator Financial accountability Each department to remain Departments within budgetary within budgetary allotment. limits. Bed utilization Maintain the 60/40 ratio. Bed utilization audit 100 percent MOH Compliance Meet all MOH Standards No unmet standards. Compliance audits 100 percent. Maintain dietary revenue Increase meal costs for Meals Revenue covers cost of on Wheels and the VON Day programs Away Program to reflect increasing costs. Fund raising Staff and family participation Committee established on a fund raising committee.. Accreditation Create teams to participate in Successful accreditation. all areas of accreditation. Educate teams in the new AIMS standards for accreditation.