Body: Council Type: Document Meeting: Regular Date: January 17, 2013 Collection: Documents Municipality: Frontenac County
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Draft
Fairmount Home Meeting Agenda Management Team Date: January 17, 2013 Time: 9:30 a.m. Place: Fairmount Boardroom Members:
Julie Shillington Deb Crawford Tom Mercer
Mary Lake Gail Williams Rosemarie Christian Jones
Page 1.
Welcome and Introductions
Adoption of Minutes of the Previous Meeting
Additions to Agenda under Other Business
Delegations
Communications
Business Arising out of Minutes a)
Email Account for Restorative Care Nurse
b)
Dietary Workflow Report
c)
“We Love Your Opinion” Book
d)
Evacuation Chairs (Picture Frames for Instructions)
e)
Scent Awareness Policy - Final Approval
f)
1North Care Carts (Locking Doors/Curtains)
g)
Fire Drill Scenarios
h)
Snoozelen Policy
i)
Fire Plan Updates
j)
Emergency Callback Exercise Summary
k)
Door/Door Frame Protection
l)
Emergency Evacuation Sites
m)
1North Humidity
n)
Garbage Receptacle Lids on the Pathways
o)
Bomb Threat Exercise
p)
Missing Resident Information Package for RN
Page 1 of 22
Draft Page 6.
5-9
10-14
15
Business Arising out of Minutes q)
Spare Doors for Resident Wall Unit
r)
Clinical Chart and Electrical Policy Updates
s)
Location of Evacuation Lists
t)
Scabies Policy/Checklist
u)
2North Chart Room Set-Up
v)
Removal of Black Marks on Floor
w)
Storage Unit
x)
Phone/Power Outage Communication
y)
Lift/Repositioning Policy Drafts
z)
New Performance Appraisal Format (trial)
aa)
Cleaning of 1st and 2nd Floor Servery Sinks
ab)
Annual Cleaning and Sanitizing of Ice Machines
ac)
Resident/Family Dinner/Chair Count
ad)
Staff Body Mechanics-OHN Report to Dietary Meeting
ae)
2North Tub Room - Removal of Hard Water Scale
af)
Fire Pull Cover (2North)
ag)
Staff Survey - Departmental Box
ah)
Swipe Verification Form
ai)
11-7 Duties for PSW (weights)
aj)
Bed Alarm Order
ak)
Diet Orders (policies)
al)
Lift/Room Ceiling Tracking Quotations
am)
Gentle Persuasive Approach (GPA) Training
an)
HAACP/QI Training
ao)
1North Flooring Replacement
ap)
Rechargeable and Double A Batteries (staff education)
aq)
Food Brought in from Outside (policy update)
ar)
WeCare Footcare
as)
1North Resident’s Laundry
at)
Recycle Bins at Staff Smoking Area
au)
“Medically Required” Definition/Guideline
av)
OANHSS Website Passwords
aw)
Dietary Keys
ax)
Bones in Chicken (1North)
Page 2 of 22
Draft Page 7.
New Business a)
16-20
Resident Care – Compliance, Accreditation, Classification i)
Compliance
ii)
Accreditation
iii)
Residents’ Council Update
iv)
SE-LHIN Telemedicine Nursing Initiative
v)
Paid Sitters/Companion Agreement
b)
Support Services
c)
Treasury
d)
Administration
21-22 e)
i)
Concerns
ii)
Risk ID’s
iii)
Work Plan
iv)
Website Content
v)
Administrative Team Discussion
vi)
Ontario LTC Homes Policy and Procedure Management
Human Resources i)
f)
Staffing
Health & Safety i)
Monthly Fire Drill
ii)
Management Inspections Schedule: Julie – June 13, 2013, November 7, 2013 Tom – February 8, 2013, July 11, 2013, December 12, 2013 Rosemarie – March 7, 2013, August 8, 2013, January 11, 2014 Gail – January 11, 2013, April 11, 2013, September 12, 2013 Mary – May 9, 2013, October 10, 2013
g)
Information Technology
h)
Communications
i)
Education Information Sharing (Staff Attendance at Conventions/Workshops)
j)
Quality Improvements/Audits
Page 3 of 22
Draft Page j)
Quality Improvements/Audits i)
Hazard Analysis Report (Quarterly-Feb)
ii)
Complaint Documentation Report (Quarterly-March)
iii)
Symptoms Report (Monthly-January report due in February)
iv)
Near Misses/Incident Reports (Quarterly-Feb)
v)
Restraint Audits (Monthly – done the 3rd week, report the 4th week)
Other Business
Confirmation of time, date and location of next meeting
- Adjournment
Page 4 of 22
AgendaItem#6t)
Fairmount Home - Infection Prevention & Control Manual
Index #24
Subject: Scabies
Policy:
Page 1 of 2
Fairmount Home will have a standardized protocol for diagnosing and treating scabies Scabies is a parasitic infection that can occur in long-term care facilities. It is highly contagious and can result in outbreaks in long-term care homes if not contained (an outbreak is an increase incidence over the baseline rate). The diagnosis of scabies is often based on clinical history and skin lesions in the absence of microbiological diagnosis. Scabies should be considered as the cause of any undiagnosed pruritic skin rash.
Objective:
Prompt diagnosis of scabies based on history and examination of skin lesions. Prompt treatment of scabies to prevent outbreaks. Implementation of infection prevention and control measures to contain the spread of scabies in LTC.
Procedure:
Scabies is caused by infestation of the skin by a mite, Sarcoptes scabiei var. hominis which belongs to the arthropod class. It is an obligate parasite that completes its entire life cycle on humans. Sarcoptes scabiei undergoes four stages in its life cycle with only female mites burrowing into the skin. The maturation process lasts about 15 days with larvae appearing approximately 3-4 days after the eggs are hatched. Scabies is passed primarily by direct skin-to-skin contact with an infested person. However, crusted (Norwegian) scabies can spread with only brief skin-to-skin contact due to its high volume of mites. Individuals should avoid direct skin-toskin contact with any infested resident. Contact with items such as bedding, clothing and furniture of infested residents is also a source of transmission.
Those at risk of contracting scabies include the elderly, institutionalize individuals and immunocompromised individuals. As well, scabies can spread if there is failure to recognize an infestation or failure to treat close contacts of the infected person, including health care workers. Symptoms The most common symptoms of non-crusted or typical scabies are pruritus with a skin rash and possibly visualization of burrows. The pruritus is usually worse at night.
Approved:
Effective Date: December 2, 2010 Replaces: June 23. 2010
Scabies Policy/Checklist
Page 5 of 22
AgendaItem#6t)
Fairmount Home - Infection Prevention & Control Manual
Index #24
Subject: Scabies
Page 2 of 2
Tiny burrows sometimes are seen on the skin caused by the female scabies mite tunneling just underneath the skin surface. Burrows appear as tiny, raised and crooked grayish-white or skincoloured lines on the skin surface. They are often found in the webbing between the fingers, in skin folds on the flexor surfaces of the wrist, elbow or knees and on the breasts and penis. For a primary infestation with scabies mites, symptoms may not appear for 2-6 weeks after being infested. For a secondary re-infestation with scabies, symptoms appear as soon as 1-4 days after exposure. An infected person can transmit scabies while being asymptomatic. The pruritus caused by scabies is due to a hypersensitivity reaction to both the mites and their feces. Itching may continue for several weeks after treatment even if all the mites and eggs are killed. It is important to continue to monitor the rash areas for continuation of spread as this will indicate that the treatment has been unsuccessful and needs to be repeated. Crusted (Norwegian) Scabies This was initially described in Norwegian leprosy patients. It is a more severe presentation of infestation that often affects the elderly, the immunocompromised or those with neurological conditions such as neuropathies or being cognitively challenged that prevent them from noticing pruritus and/or scratching. It is characterized by marked thickening and crusting of the skin (hyperkeratosis dermatosis5), particularly on the hands, although the entire body including the face and scalp can be affected. The mites in crusted scabies are much more numerous (up to 2 million mites per patient4) resulting in those who are infected being much more contagious. It is a common cause of institutional outbreaks of scabies. Definite diagnosis Occurs with skin scrapings identifying mites, mite eggs or mite fecal matter (scybala) under low light microscopy.1,2,4 In order to obtain a sample, scrape the skin with razor blade and place skin specimens in a sterile container with 70% rubbing alcohol (just enough alcohol to cover bottom of jar). Place the labelled container with a public health requisition in a specimen bag and have it transported to a public health laboratory. A negative skin scraping from a person with typical scabies does not rule out scabies infestation. Treatment If scabies are suspected, the Physician or NP will be notified immediately. The Physician or NP shall prescribe a cream or lotion. One treatment usually kills the mites. If treatment is effective, no new burrows or rashes should appear within 24 to 48 hours after treatment. Note: itching can persist for weeks after mites are eradicated.
Approved:
Effective Date: December 2, 2010 Replaces: June 23. 2010
Scabies Policy/Checklist
Page 6 of 22
AgendaItem#6t)
Fairmount Home - Infection Prevention & Control Manual
Index #24
Subject: Scabies
Page 3 of 2
If you see a new rash or a continuation of previous rashes, contact the physician or NP, who may order a second treatment First Line The first line drug is topical permethrin cream 5% which is the most effective topical agent with minimal treatment failures and low toxicity5. The cream must be applied to the whole body from the neck down to the feet and toes including skin folds, finger and toenails, behind the ears and the groin. Do not apply the cream to the head or face. If the patient washes any area where the cream has been applied during the treatment period, it must be reapplied. Apply 1 application topically to the skin and wash off thoroughly after at least 8 hours, but no more than 14 hours. A second application may be repeated 1 week later. Do not use permethrin 1% solution which is used to treat head lice since this has been shown to be ineffective in treating scabies. Second Line Oral ivermectin6 appears to be more effective than both placebo and lindane but less effective than topical permethrin.5 It is given as a single dose of usually 3-12 μg (150-200 μg/kg) on an empty stomach. Ivermectin is contraindicated in children under the age of five, those that weigh less than 15 kg7, those who are breastfeeding, and those who have a hepatic or renal disease. In Canada, ivermectin is a special access drug (http://www.hc-sc.gc.ca/dhp-mps/acces/drugsdrogues/index-eng.php). Oral anti-histamines may be used to control the itching as needed. Topical and oral antibiotics may be used to treat skin infections such as impetigo and cellulitis as indicated. Management The infested resident, his or her family and any close contacts including health care workers mustbe treated at the same time, regardless of whether they are symptomatic. If there are 2 or more cases of scabies identified on a particular unit, strong consideration should be given to prophylactically treating all residents and staff on the unit. Initiate contact precautions (gowns, gloves) for residents diagnosed with scabies. Precautions must remain in place until effective treatment has been completed. Identify all family members, friends, volunteers, staff and contract staff who have had direct contact and exposure with the infested resident(s) and/or to clothing, bedding and furniture for the six weeks prior to the diagnosis of scabies. Inform them about the diagnosis and the need to watch for symptoms. If they have had several contacts with the resident, they should receive prophylactic treatment. Visitors should use the same contact precautions and protective clothing as staff, when providing direct care.
Approved:
Effective Date: December 2, 2010 Replaces: June 23. 2010
Scabies Policy/Checklist
Page 7 of 22
AgendaItem#6t)
Fairmount Home - Infection Prevention & Control Manual
Index #24
Subject: Scabies
Page 4 of 2
Staff will clean hands thoroughly after providing care to any infested resident. Asymptomatic staff can return to work the day after receiving prophylactic treatment. Symptomatic staff can return to work the day after receiving treatment. Bedding and clothing used by an infested resident within the last 3 days must be collected and transported in a plastic bag. These need to be machine washed using hot water and dried using high heat cycles (T > 50oC for at least 30 minutes).4 If hot water is unavailable, place all linen and clothing into plastic bags for one week. Cleaning of clothing and linens needs to be done at the same time as treatment to effectively manage the spread of scabies.
Non-washable items can be put in the dryer for 30 minutes, dry cleaned or stored in a sealed plastic bag for 10 days Footwear such as slippers, etc. – if washable, wash or put in dryer as explained above -if leather, vinyl, etc., no special treatment required
The room of the infested residents must be thoroughly cleaned and vacuumed. Furniture and surfaces in the resident rooms must be disinfected. Steam cleaning of upholstered furniture may be necessary.
Chairs, couches, etc. can be vacuumed. The vacuum bag will be disposed of immediately after using it
A scabies checklist (Appendix I) is in place to provide guidance to management and staff related to the flow of activities to ensure residents are treated and rooms disinfected and cleaned. Staff will continue to monitor all residents for rashes for the next 6 weeks (incubation period of scabies). The Director of Resident Care or designate shall consult Infection Control at Public Health for further guidance on management of scabies. REFERENCES
- Chosidow O. Scabies. NEJM 2006;354(16):1718-1727.
- Johnston G and Sladden M. Scabies: diagnosis and treatment. BMJ 2005;331:619-622.
- Baker F. Canadian Paediatric Society Statement. Scabies management. Pediatr Child Health 2001;6(10):775-777.
- CDC. Scabies. 2010. http:///www.cdc.gov/parasites/scabies/epi.html.
- Strong M and Johnstone P. Interventions for treating scabies. The Cochrane library. 2010.
- Fawcett RS. Ivermectin Use in Scabies. Am Fam Physician 2003;68(6):1089-1092.
- Dourmishev AL, Dourmishev LA, Schwartz RA. Ivermectin: pharmacology and application in dermatology. International Journal of Dermatology 2005;44 (12): 981–988.
- Stone, ND et. al. Surveillance Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria. Infect Control Hosp Epidemiol. 2012;33(10): 965-977.
Approved:
Effective Date: December 2, 2010 Replaces: June 23. 2010
Scabies Policy/Checklist
Page 8 of 22
AgendaItem#6t)
Fairmount Home - Infection Prevention & Control Manual
Index #24
Subject: Scabies
Approved:
Page 5 of 2
Effective Date: December 2, 2010 Replaces: June 23. 2010
Scabies Policy/Checklist
Page 9 of 22
AgendaItem#6ak)
Policy & Procedure Manual Program:
Dietary & Hydration Services
Policy:
Diets – Resident Diet Information
Revision Date: Index Number: D&HS-10 Page 1 of 1 Effective: July 1, 2011
Approved:
Policy:
Systems will be in place to ensure that resident diet information is accurate and readily available.
Objective:
To ensure that resident information is accurate and readily available to all that need it. To ensure that all diet orders are ordered following the approved procedure. To ensure that residents are provided with the proper nutritional care.
Procedure:
It is the responsibility of the Clinical Dietitian or designate to co-ordinate the gathering and updating of resident diet information. It is the responsibility of the Nurse Practitioner, Physician or Clinical Dietitian to approve all diet orders. Resident diet information is kept in the following places:
Diet list at the each servery counter Diet list in main kitchen Nourishment menu cycle on nourishment cart Programming list on programming cart Resident’s Health Record in the Dietary section Resident’s Care Plan
When a referral is received for a diet change the Clinical Dietitian will follow-up on the request. If a diet order is changed, it will be entered on the Nutrition Profile Form for that resident as well as updated in the resident’s care plan, on the diet list at the servery and nourishment cart. The individual changing the diet list must be sure to date and initial the change. For other changes, such as table changes, they must be noted on the seating plan on the resident home area and the Manager of Food Services or designate will update as needed. They must be sent to the Manager of Food Services immediately. Changes must be made on all information sources immediately. If there is a discrepancy between what texture or diet the resident is on, the following process will be followed: a) The RN will assess the situation and make a recommendation based on all available information, assessing risk, resident choice, etc., and b) The RN will complete a referral form to the Clinical Dietitian requesting a change in diet order. c) The Dietary Aide will provide requested diet as per change. The Clinical Dietitian must review these diet changes.
Diet Orders (policies)
Page 10 of 22
AgendaItem#6ak)
Policy & Procedure Manual Program:
Dietary & Hydration Services
Policy:
Meal Service – Resident Meal Service
Approved:
Revision Date: Index Number: D&HS-11 Page 1 of 3 Effective: July 1, 2011
Policy:
Residents will be provided with a variety of food experiences that meet nutrition requirements, social needs and individual cultural and religious preferences, in a manner that respects their dignity and promotes a positive eating experience in accordance with the requirements of the Long-Term Care Homes Act.
Objective:
Individual nutrition and health needs of residents will be met. Dining experiences will enhance intake and promote quality of life. Socialization among residents and with staff will be promoted.
Procedure:
All members of the care team work together to address resident needs and ensure all residents receive a pleasant dining experience. All residents will be treated with respect. Staff will face the resident when speaking to them, make eye contact and address them by their preferred name. Meal hours with service from dietary staff are: Breakfast – 0730-0845 for hot breakfast items; continental breakfast is available until 1100 Lunch – 1145 – 1230 Supper – 1700 – 1800 Diet order, food likes and dislikes, special needs and residents’ requests are discussed with resident and family, as soon as possible, on admission and at least quarterly. Appropriate documentation is maintained by the Dietary department for reference by Nursing and Dietary staff, and is included in the care plan. It is the responsibility of each server to know what the daily menu is and be aware of what is not available. Staff should familiarize themself with the resident’s individual diet and consider food likes and dislikes whenever possible. Any diet changes, room changes, special requests, need for tray service, or other changes to the resident’s nutrition care are communicated to Nursing and Dietary staff as soon as possible to prevent any distress to the resident. Dining areas are kept clean and free from offensive odours. Furnishings are attractive and comfortable. Lighting is appropriate. Surroundings are quiet and relaxed, providing a home-like environment. Adequate space is provided to maneuver wheelchairs and walkers. Residents are properly dressed, groomed and toileted prior to coming to the dining room.
Diet Orders (policies)
Page 11 of 22
AgendaItem#6ak)
Policy & Procedure Manual Program:
Dietary & Hydration Services
Policy:
Meal Service – Resident Meal Service
Approved:
Revision Date: Index Number: D&HS-11 Page 2 of 3 Effective: July 1, 2011
Clothing protectors (bibs) are offered to those residents who wish them. Residents are properly positioned at a comfortable height. Nursing supervision is provided throughout the meal. Seating plans are available for resident and staff reference and are adhered to at all meals. Order of meal service is rotated so that all residents have opportunity to be served first. Nursing staff will refer to the calendar to determine which table to start service with. Residents will be allowed to make personal choices whenever possible and staff will encourage and assist residents in adhering to their therapeutic diets. Never say “NO” to a resident, but encourage the resident to choose from the main or alternate menu first. If they want something else, find out from the kitchen if the request is possible. If it is not, explain why. Always serve plates and bowls to the right of the resident and clear from the left unless it is impossible. Carry all food plates with the thumb and fingers off the plate surface, or use a service napkin. Serve beverages from the right of each resident and place gently on the table on top of the right of the dinner plate. When pouring coffee from a glass coffee pot, be sure to remove the cup away from the table first to prevent any possible injury. Staff will proceed with service in the following manner: a) b) c) d)
Nursing will greet the residents at their table within two minutes of their arrival Offer each resident a choice of appetizers (soup) and beverages (may be hot or cold) Gather the appetizer and beverage order from the dietary aide by the resident’s name Once the resident is finished with the appetizer, clear the plates or bowls and offer the two choices of entrée according to the daily menu choices e) Place the resident’s order with the dietary aide according to the resident’s name f) The dietary aide will refer to the diet list before assembling the resident’s order. The diet list will provide instructions to staff regarding the resident’s diet, allergies, likes and dislikes g) Nursing staff will deliver the resident’s meal h) Nursing and dietary staff will clear the entrée plates and prepare the table for the dessert and hot beverage choice
Diet Orders (policies)
Page 12 of 22
AgendaItem#6ak)
Policy & Procedure Manual Program:
Dietary & Hydration Services
Policy:
Meal Service – Resident Meal Service
Approved:
Revision Date: Index Number: D&HS-11 Page 3 of 3 Effective: July 1, 2011
i)
Nursing and dietary staff will offer the resident two choices for dessert and place the appropriate choice, according to the diet list, in front of the resident j) Nursing and dietary staff will offer a hot beverage to the resident k) Staff will clear the dessert dishes to the scraping cart once the resident is finished eating Every resident, regardless of diet, is offered two choices at the time of meal service. Appropriate safe food and beverage temperatures are maintained throughout the meal service. It is the responsibility of Dietary staff to ensure hot foods are served at a maximum of 70 degrees C. Staff will encourage residents to be as independent as possible. Ask if they need help before help is given. Assist only those who require help. Assistance may include opening pre-portioned food (i.e. jam, butter, creamers, etc.) or describing type and location of food on the plate for those with impaired vision. Any assistance required should be given in a way that is not embarrassing to the resident. Residents are given a comfortable and adequate amount of time to complete their meal, with appropriate consideration given to residents with special needs. Residents are offered second servings as appropriate. Interaction and conversation among residents is encouraged during meal service. Residents are included in staff conversation. Staff should never raise their voice in front of a resident or shout across the dining room. Delivery of meals to residents requiring assistance in eating will occur no more than five minutes in advance of assistance being provided. Once service is complete the dietary aides will clean up the service area and return all food items to the kitchen. Dietary aides will report any changes in resident diet orders to the Manager of Food Services or the Clinical Dietitian. The use of adaptive utensils may be used to encourage the resident to eat after proper assessment from the Occupational Therapist. If a resident is blind, his/her food should be identified.
Diet Orders (policies)
Page 13 of 22
AgendaItem#6ak)
Policy & Procedure Manual Program:
Dietary & Hydration Services
Policy:
Diets – Diet Orders
Approved:
Policy:
Revision Date: Index Number: D&HS-16 Page 1 of 1 Effective: July 1, 2011
A system will be in place to ensure that diet orders are in place for all residents. It is the responsibility of the Clinical Dietitian to monitor the new admission process, write orders and to enter all diet information on the diet list and forms.
Objective:
To ensure that all diet orders are approved by the Clinical Dietitian, Nurse Practitioner or the Physician. To ensure that diet orders are written in the approved manner using approved terminology.
Procedure:
If nursing staff feels that a resident requires a change in diet due to a change in medical condition, they will send a referral to the Clinical Dietitian. The Clinical Dietitian will investigate the resident and recommend the diet change as appropriate, using the House Diets for terminology. If a change is necessary the Clinical Dietitian will write the order on the order sheet to be carried out. The Clinical Dietitian will notify the RN of the order so the RN can follow the transcription procedure including notifying the POA for consent, etc. The Dietitian will also notify the main kitchen. If it is a doctor’s or Nurse Practitioner’s order the RN will also change the diet list, dating and signing it and will notify the main kitchen. No diets can be changed without Clinical Dietitian, Nurse Practitioner or Physician approval. The exception is the RN can recommend a temporary diet due to acute illness, missing dentures, etc. The RN can only move a diet down e.g. regular to ground. The Clinical Dietitian must review these diet changes.
Diet Orders (policies)
Page 14 of 22
AgendaItem#6at)
� � � �
I put something in a recycling bin: Several times a day Once a day Occasionally Never
� � �
I think recycling is worthwhile: Agree Disagree Not sure
� � � � �
I’m most likely to use the recycling bins: In the [room] In the [room] In the [room] In the [room] I don’t recycle
- Which of the following items are recyclable? Wax paper food wrap Bubble wrap Zipper storage bags (Ziploc) Glossy magazine paper Gift wrapping paper
Recyclable Recyclable Recyclable Recyclable Recyclable
� � � � � �
The type of thing I recycle the most while at work is: Plastic (including bottles) Paper Aluminum cans Glass Cardboard I don’t recycle
� � �
I have easy access to a recycling bin: Agree Disagree Not sure
Not recyclable Not recyclable Not recyclable Not recyclable Not recyclable
- The best places to put new recycling bins would be:
� � �
Recycling is an organizational priority at Fairmount Home: Agree Disagree Not sure
Recycle Bins at Staff Smoking Area
Page 15 of 22
AgendaItem#7av)
Policy & Procedure Manual Program:
Administration
Policy:
Paid Sitters/Companions
Approved:
Policy:
Revision Date: Index Number: ADM-23 Page 1 of 3 Effective: July 1, 2011
All residents/substitute decision makers wishing to engage the services of a paid sitter/companion (who does not provide personal care) or a trained health care worker (“THCW”, who would give direct personal care) must sign a waiver of indemnification and take responsibility for the hiring and payment of same. A THCW is an individual who is an employee of a recognized health care organization (other than Fairmount Home for the Aged, hereinafter “Fairmount Home” or “the Home”) and is employed by the resident/substitute decision maker through that organization. A paid sitter/companion is not an employee of Fairmount Home and may or may not have health care training.
Objective:
To define the relationship between the paid sitter/companion/THCW, the resident/substitute decision maker and Fairmount Home.
Procedure:
The resident/substitute decision maker will be made aware of this policy upon admission to the Home. Should the resident/substitute decision maker wish to engage the services of a paid sitter/companion/THCW, he/she shall sign the applicable Release and Indemnification form (Form 10) and introduce the paid sitter/companion/THCW to the Director of Resident Care/Assistant Director of Care. The paid sitter/companion/THCW shall then provide all necessary contact information to facilitate ongoing dialogue about this arrangement for the provision of company/care for their resident. The paid sitter/companion/THCW will be orientated to the Home and the Home area by designated staff. The Director of Resident Care or the Assistant Director of Resident Care will arrange the orientation. The paid sitter/companion/THCW will not solicit business from other families or clients in the Home. The paid sitter/companion/THCW will be made aware of any relevant medical/nursing/care issues by the relevant member of the care team. The paid sitter/companion/THCW will liaise with the Nurse in Charge (RN/RPN) at the Home to establish the visiting schedule as per the resident’s needs. The paid sitter/companion will provide companionship to his/her resident exclusively throughout their hours of employment. Services of any type (e.g. bringing in food, drinks, etc.) will not be directed toward any other resident. The THCW will provide personal care to his/her resident
Paid Sitters/Companion Agreement
Page 16 of 22
AgendaItem#7av)
Policy & Procedure Manual Program:
Administration
Policy:
Paid Sitters/Companions
Approved:
Revision Date: Index Number: ADM-23 Page 2 of 3 Effective: July 1, 2011
exclusively throughout their hours of employment. Services of any type (e.g. bringing in food, drinks, providing care, etc.) will not be directed toward any other resident. The paid sitter/companion/THCW will not have access to resident medical records. The paid sitter/companion/THCW will provide verbal feedback to the Home’s nursing staff routinely. He/She will notify the Home’s Charge Nurse or delegate of arrival and departure from the home area and any resident changes. The THCW agency will provide their resident progress notes on request from Fairmount Home. Outings from the Home area must be discussed in advance with the Home’s Charge Nurse or designate. Outings must not interfere with scheduled appointments, assessments, etc. The paid sitter/companion/THCW will report any incident to the Home’s Charge Nurse or designate and will assist in completion of an incident report in accordance with Home policy. The paid sitter/companion/THCW must comply with all relevant Fairmount Home policies and procedures (confidentiality, immunization, health and safety, etc.). The paid sitter/companion/THCW is not an employee of Fairmount Home and is accordingly not entitled to any benefits, privileges, rights or information to which a Fairmount Home employee may be entitled, except as specifically set out in this policy. Nothing in this policy shall modify, replace or waive the employment relationship that exists between the paid sitter/companion/THCW and their regular employer, if any. Nothing in this policy shall be construed to create any duty, liability or responsibility whatsoever for Fairmount Home with respect to the paid sitter/companion/THCW and the Workplace Safety and Insurance Act, 1997 or its successor legislation. The paid sitter/companion/THCW is required to possess the necessary training, certification and competencies as identified by the Director of Care at Fairmount Home to carry out special activities such as feeding, restorative care, etc. The paid sitter/companion will not be permitted to bathe a resident or administer medications to a resident. The THCW may do personal care for his/her resident within the scope of the THCW’s practice. The Home shall have the ability to deny any paid sitter/companion/THCW access to the Home on either a temporary or permanent basis. Such denial may arise as a result of, but is not limited to, situations where (1) the paid sitter/companion/THCW becomes a risk to the resident, the Home or the Home staff; or (2) the Home has had an unsatisfactory experience with the paid sitter/companion/THCW or their employer in the past and determines that there is a risk of further unsatisfactory experiences in the future. The Home shall not be liable for any damages incurred
Paid Sitters/Companion Agreement
Page 17 of 22
AgendaItem#7av)
Policy & Procedure Manual Program:
Administration
Policy:
Paid Sitters/Companions
Approved:
Revision Date: Index Number: ADM-23 Page 3 of 3 Effective: July 1, 2011
by the resident or the paid sitter/companion/THCW, should the Home choose to deny access to the Home. The THCW will maintain insurance coverage (either personally or through their employer, as the case may be) in a form and amount satisfactory to the Home. The THCW shall provide evidence of such insurance coverage to the Home upon request. Prior to commencement of services, the paid sitter/companion/THCW must sign a Release and Indemnification form (Form 11) that also acknowledges and accepts the provisions of this Policy. All references to “Home”, “Fairmount Home” and “Fairmount Home for the Aged” in this Policy and related documents shall be interpreted to include the Corporation of the County of Frontenac, which owns and operates the Home.
Paid Sitters/Companion Agreement
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AgendaItem#7av)
Form #10
Resident/Substitute Decision Maker’s Release and Indemnification I, ____________________ (Name of Resident/Substitute Decision Maker), have retained the services of ________________________________(Name of Paid Sitter/Companion/ Trained Health Care Worker, or “THCW”) to provide the following services (“the Services”):
to ___________________________ (Name of Resident), who resides at Fairmount Home for the Aged (“the Home”). I acknowledge that ___________________________________ (Name of Paid Sitter/Companion/THCW) is not an employee of the Home or the Corporation of the County of Frontenac (“the County”). I accept full responsibility for the payment of _____________________________________ (Name of Paid Sitter/ Companion/THCW). I hereby release the County, the Home and their directors, officers, employees and agents from all actions, causes of action, suits, claims, liability, damages and demands of any kind, whether direct, indirect, special, exemplary or consequential, including interest thereon (“the Claims”) which may occur as a result of ____________________________ (Name of Paid Sitter/Companion/THCW) providing the Services to the Resident in the Home. I hereby agree to indemnify and hold harmless the County, the Home and their directors, officers, employees and agents from and against all Claims whatsoever incurred by the County, the Home or such other persons as a result of ____________________________ (Name of Paid Sitter/Companion/THCW) providing the Services to the Resident in the Home.
Signature of Resident/Substitute Decision Maker
Witness
Date
Relationship of Witness to Resident
Policy ADM-23 July 1, 2011
Paid Sitters/Companion Agreement
Page 19 of 22
AgendaItem#7av)
Form #11
Paid Sitter/Companion/Trained Health Care Worker Release and Indemnification In the matter of _______________________ (Name of Paid Sitter/Companion/Trained Health Care Worker), ___________________________(Name of Resident, hereinafter “the Resident”) and the Corporation of the County of Frontenac (hereinafter ”the County”), operator of Fairmount Home for the Aged (hereinafter “the Home”): I hereby release the County, the Home and their directors, officers, employees and agents from all actions, causes of action, suits, claims, liability, damages and demands of any kind, whether direct, indirect, special, exemplary or consequential, including interest thereon (hereinafter “the Claims”) which occur as a result of me providing (or contracting to provide) services to the Resident in the Home. I hereby agree to indemnify and hold harmless the County, the Home, their directors, officers, employees and agents from and against all Claims whatsoever which may occur as a result of me providing (or contracting to provide) services to the Resident in the Home. I acknowledge that in keeping with its responsibility for resident care, the County and/or the Home have the right to intervene in those instances where I may be functioning in a manner considered by the County and/or the Home to be of potential danger to the well-being of the Resident or contrary to the Home’s regulations, rules, policies or procedures. I have received a copy of and understand and accept the Home’s Paid Sitter/Companion/Trained Health Care Worker Policy and Procedures.
Signature of Paid Sitter/Companion/THCW/
Date
Or Representative Agency
Witness
Relationship of Witness to Resident
Policy ADM-23 July 1, 2011
Paid Sitters/Companion Agreement
Page 20 of 22
AgendaItem#7dvi)
Ontario LTC Homes Policy and Procedure Management
Page 21 of 22
AgendaItem#7dvi)
Ontario LTC Homes Policy and Procedure Management
Page 22 of 22
