Published May 5, 2014

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Body: RULAC Type: Agenda Meeting: Committee Date: May 5, 2014 Collection: Council Agendas Municipality: Frontenac County

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Rural Urban Liaison Advisory Committee (RULAC) Monday, May 5, 2014 at 9:00 a.m. County Administration Office AGENDA

Page 1.

Welcome and Confirmation of the Agenda

Adoption of Notes -

4-9

10-83

13-11-25 RULAC Meeting Notes

Communications

Fairmount Home a)

Fairmount Home - Highlights of Reports Fairmount Home 2013 City Reconciliation 2014-005 2013 Fairmount Home Accounts Receivable Write-Offs 2014-062 Fairmount Home -1st Quarter Activity Report 2013-228 Fairmount Home - Additions and Alterations to FMT Home Construct.Report # 2-attachments. 2014-020-Fairmount Home - Auditorium Renovation Progress Report #3 2014-058 Additions and Alterations to Fairmount Home Auditorium Construction Progress Report #4 2014-060 Fairmount Home - Auditorium Renovation Project Progress_Report_ #5 2013-221 Fairmount Home - 3rd Quarter Consolidated Statistical Update 2014-061 Fairmount Home - MOHLTC RQI

Page 1 of 182

Page 5. 84-101

LSR Services a)

Community and Family Services, Housing and Provincial Offences City of Kingston - Highlights of City Reports (October 2013-April 2014) The City of Kingston Report includes: OW, ODSP, Childcare & Housing: Local Service Realignment (LSR) YTD Quarterly Financial Reports Q4 2013, Q1 2014 Childcare Funding Update Amendments to 10 Year Housing and Homelessness Plan Approval of 10 Year Housing & Homelessness Plan Implementation of 10 Year Housing and Homelessness Plan Implementation #2 of the 10 Year Housing & Homelessness Plan Information Report - Directives issued under the HSA Proposed significant amendments to Directives Issued under the Housing Services Act 2011 Preliminary Homelessness Count Results Point-in-Time Homelessness Count Final Report Homelessness Study 2013 Frontenac and Rural Kingston Housing Department Performance Indicators Housing Programs Reporting Provincial Offences Q4 2013

102-182

Emergency and Transportation Services Emergency and Transportation Services - Highlights of Reports Land Ambulance 2013 City Reconciliation 2014-019 Emergency and Transportation Services - 2013 4th Quarter Activity Update 2014-063 Emergency and Transportation Services - 2014 1st Quarter Activity Update 2013-226 Emergency and Transportation Services - Land Ambulance Services Grant LASG Transfer Payment Framework Agreement 2014-040 Emergency and Transportation Services -2013 Legislated Response Time

Page 2 of 182

Page 5.

LSR Services Standard Performance Plan Reporting to MOHLTC 2014-059 Emergency and Transportation Services - Community Paramedicine in Ontario Application 2014-039 Emergency and Transportation Services - Election to Paramedic Chiefs of Canada PCC Board of Directors Executive of the Chief of Paramedic Services

Other Matters of Common Interest

Confirmation of Next Meeting

Adjournment

Page 3 of 182

AgendaItem#2a)

Present:

County of Frontenac - Members Denis Doyle, Councillor Gary Davison, Councillor Other Staff Marian VanBruinessen, Treasurer/Acting CAO Paul Charbonneau, Director of Emergency Services Jannette Amini, Acting Clerk (Recording Secretary)

Present:

City of Kingston - Members Deputy Mayor Sandy Berg Brian Reitzel, Councillor Jeff Scott, Councillor Other Staff Gerard Hunt, CAO Kevin Arjoon, Deputy Clerk Adele Lafrance, Director, Community and Family Services Sheldon Laidman, Director, Housing Hal Linscott, Director of Legal Services and City Solicitor

Welcome

Deputy Mayor Berg called the meeting to order at 3:07 p.m. The agenda was accepted by consensus. 2.

Adoption of Notes

The notes of the RULAC meeting held on September 9, 2013 were accepted by consensus 3.

Communications – Nil

Fairmount Home



2013-152 Fairmount Home - Quality Improvement Activities Update Ms. VanBruinessen expressed regrets for Ms. Shillington who was unable to attend the meeting and provided an overview of the report. She did point out that

Rural-Urban Liaison Advisory Committee Minutes November 25, 2013

13-11-25 RULAC Meeting Notes

Page 1 of 6

Page 4 of 182

AgendaItem#2a)

Fairmount Home is tracking a new performance appraisal for staff which will now be used for corporate services. 

2013-179 Fairmount Home - 2013 3rd Quarter Activity Update Ms. VanBruinessen provided an overview of the report, specifically noting that the contract for the Fairmount Home Auditorium has been awarded and is within budget. Staff are now in the process of finalizing the contract. She also noted that the contract for the Nursing Software has also been awarded and will be rolled out in 3 phases.



2013-182 Fairmount Home - 2nd Quarter Consolidated Statistical Update Ms. VanBruinessen provided an overview of the report and pointed out to the Committee the excellent resident satisfaction rate. Ms. VanBruinessen also updated the Committee on the 2013 3rd Quarter Financials, noting that wages for Fairmount Home are slightly under budget; however there is a separate reserve for severance that might be required. She also noted that the High Intensity Needs is also under budget and that the $35,000 contingency has not yet been utilized.

LSR Services Community & Family Services  Q3 2013 LSR Ms. Lafrance provided an overview of the report and noted that all programs are looking at a surplus with respect to administration costs mainly due to staffing issues. With respect to programs, this is also experiencing a surplus specifically with respect to Ontario Works allowances. To a question by Councillor Doyle regarding year end surpluses, Ms. Lafrance advised that staff do track administrative surpluses at year end and any surplus is placed into reserves.

Housing  Report No. 13-313 - Consolidated Homelessness Prevention Initiative (CHPI) Extension of Contracts for Homeless programs and Revisions to the Ontario Works Discretionary Benefit Schedules Mr. Laidman provided an overview of the report which precipitated the resolution that came from Kingston City Council (noted on the agenda). He advised that City staff met with County staff on October 31st as a result of that resolution with the outcome being a report by County staff to their Council at its November 18th meeting in which County Council also approved that any surplus funds be redirected to the Kingston-Frontenac Renovates Program.  Report No. HHC-13-014 - Housing Programs Reporting Mr. Laidman provided an overview of the report.

Rural-Urban Liaison Advisory Committee Minutes November 25, 2013

13-11-25 RULAC Meeting Notes

Page 2 of 6

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AgendaItem#2a)

 Report No. HHC-13-015 - 10 Year Housing & Homelessness Plan - City of Kingston and County of Frontenac Mr. Laidman provided an overview of the report which has already been presented to and endorsed by the Housing and Homelessness Advisory Committee and will be presented the ARCP this week for approval at which point it will then be forwarded to City Council for final approval. For the benefit of County members of the Committee, Mr. Laidman advised that County Councillor John McDougall has been well involved in this.  Report No. HHC-13-017 - Homelessness Point-In-Time-Count and Homelessness Survey Mr. Laidman advised that a report will be presented to City Council on December 3, 2013 outlining the preliminary results of the October 16th survey. With respect to the County, a 2 week survey was conducted by service providers which were done to address the geographic differences between the City and the County. To Councillor Doyle’s question of whether or not the Point-In-Time-Count addressed the issue of couch surfing, Mr. Laidman advised that this group was not targeted in the approach taken with respect to the City; however with respect to the County, this was done through the service agencies who look at who accesses their services and this could have been captured as a result.  Report No. HHC-13-018 - Proposed Significant Amendments to Directives Issued Under the Housing Services Act, 2011 Mr. Laidman advised that it has taken a year to implement the changes that came into effect last year with respect to these Directives. With respect to the required changes, 10 of those changes are considered housekeeping and staff are working with the various housing providers to make the other necessary changes, with the more significant changes brought to the Housing and Homelessness Committee seeking an implementation date of December 1, 2013.  Council Motion from the Council meeting held on October 15, 2013: WHEREAS the City of Kingston is reinvesting municipal surplus funds from the Residency Benefit Fund into Homelessness Programs, Kingston-Frontenac Renovates, and Poverty Reduction Initiatives, as approved at the October 1 Council Meeting; and, WHEREAS these programs benefit both the City of Kingston and County of Frontenac; and, WHEREAS the County of Frontenac may also have similar surplus funds; THEREFORE BE IT RESOLVED THAT the City of Kingston, as the Service Manager, explore the possibility with the County of Frontenac for surplus funds to

Rural-Urban Liaison Advisory Committee Minutes November 25, 2013

13-11-25 RULAC Meeting Notes

Page 3 of 6

Page 6 of 182

AgendaItem#2a)

be similarly reinvested into Homelessness Programs, Kingston-Frontenac Renovates, and Poverty Reduction Initiatives. This matter was previously discussed under Report No. 13-313 - Consolidated Homelessness Prevention Initiative (CHPI) Extension of Contracts for Homeless programs and Revisions to the Ontario Works Discretionary Benefit Schedules. 6. 

Emergency and Transportation Services Report No. 2013-150 – Emergency and Transportation Services - Medical Tiered Response Program - Wolfe Island District Volunteer Fire Department Chief Charbonneau provided an overview of the report which simply advises that Wolfe Island has joined the program, with Kingston departments already being involved for the past 7 years.



Report No. 2013-161 – Emergency and Transportation Services - 2014 Legislated Response Time Performance Plan Chief Charbonneau provided an overview of the report, noting that with the new rules in the legislation, this needs to be done yearly regardless of any changes or lack thereof. He did note the one minor change with respect to the verbiage around the definition of “responder”.



Report No. 2013-162 – Emergency and Transportation Services -2013 Legislated Response Time Standard Update Chief Charbonneau provided an overview of the report which provides an update on the 2013 response times. He did point out for the Committee, as noted on the graph identifying the 52 delivery agents across Ontario, that Frontenac Paramedic Services has the second highest response time standard in Eastern Ontario. He walked the Committee through the various indicator graphs identified in the report and what each graph means. To a question by Councillor Scott regarding rural and urban response times, Mr. Charbonneau advised that response time analysis for rural and urban areas is tracked; however the data does not break that down between the City of Kingston and the County of Frontenac. He did point out that, with respect to the removal of one ambulance at the Palace Road station, that response times has increased by less than 1%, with the average response time to the most critical being just over 6 minutes.



Report No. 2013-178 – Emergency and Transportation Services - 2013 3rd Quarter Activity Update Chief Charbonneau provided an overview of the report, most notably pointing the Committee to the photograph of 4 paramedics receiving the Governor General Exemplary Services Medal award.

Rural-Urban Liaison Advisory Committee Minutes November 25, 2013

13-11-25 RULAC Meeting Notes

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AgendaItem#2a)



3rd Quarter Financials It was noted that the 3rd Quarter Financials for the Frontenac Paramedic Services is on target pending a WSIB assessment which could possibly increase costs; however there are some dollars set aside in reserves for this. Rebates for WSIB have been received over the last 3 years; however he suspects a bill will be received for 2013. Ms. VanBruinessen added that she suspects the County will receive more funding than anticipated and that there are construction costs associated with the Robertsville Station which is now underway. Provincial Offences Q3 2013 Mr. Linscott provided an overview of the report, noting that revenues are on target; however cautioned that enforcement agencies become lax during the Christmas season and charges may fall and decrease revenue as has been the case in past years. With respect to questions raised at previous meetings regarding Wolfe Island OPP enforcement being the Leeds and Grenville detachment, he did advise that although they have been provided with ticket books from Frontenac and Kingston, most tickets issued on the Islands are done on Leeds and Grenville tickets in which we do not receive revenue for. This issue has been addressed with the Commander in Landsdowne in order to bring this to their attention and to use the Kingston Frontenac ticket books. He also suggested that the Frontenac Islands Township may wish to address this issue as it pays for this enforcement. Mr. Linscott also advised to the Committee that the City is looking to relocate the Provincial Offences Act (POA) office to 362 Montreal Street. The capital budget of $1.6M has been approved for this project; however the move will not take place until late 2014 early 2015 and at this time, poses not budget implications. To a question by Councillor Reitzel regarding how the City collects unpaid fines, Mr. Linscott advised that the City does utilize the services of a collection agency; however the returns are very low. He did confirm that these numbers are comparable to other municipalities and the City uses all tools available by the Province when there are large fines outstanding; however the majority of fines are small. The larger fines, such as those through the Ministry of the Environment and the Ministry of Labour are collected through other methods such as judgments, garnishments and property tax. If an outstanding fine shows up on a vehicle it must be paid prior to a new sticker being issued. Some of the changes made by the Province address some of the ways people in the past were able to get around this such as re-plating a vehicle or getting new vehicle and re-plating it.

Rural-Urban Liaison Advisory Committee Minutes November 25, 2013

13-11-25 RULAC Meeting Notes

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AgendaItem#2a)

Other Business

Draft Budget Estimates Report for Joint Services Mr. Hunt apologized that Ms. Kennedy was not able to attend the meeting and spoke on her behalf to the Committee, noting that submissions on the City of Kingston budget have an impact on the County. He provided an overview of the report located in the package, noting the impact on the County of Frontenac is about $30,000, with the overall net to the County up by 2.5% which is in line with the budget presented to Council. There is a calculation regarding the allocation to determine the actual impact which the Treasurer will determine. With respect to the City of Kingston’s share of Land Ambulance and Fairmount Home, he advised City of Kingston members that there is an envelope built into the City’s budget which should accommodated any requests. 7.

Confirmation of Next Meeting

Mr. Hunt noted that in the past, the practice of setting meeting dates has proven difficult as it typically requires adjusting and asked the Committee if this could be re-visited in the New Year. 8.

Adjournment

The meeting adjourned at 3:47 p.m.

Rural-Urban Liaison Advisory Committee Minutes November 25, 2013

13-11-25 RULAC Meeting Notes

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AgendaItem#4a)

INFORMATION REPORT TO RULAC To:

Chair and Members of RULAC

From:

Marian VanBruinessen Acting CAO/Treasurer

Prepared by:

Julie Shillington Administrator – Fairmount Home

Date Prepared:

April 16, 2014

Date of Meeting:

May 5, 2014

Re:

Fairmount Home – Highlights of Reports

Highlights Auditorium Project: The Auditorium Renovation Project is moving along. It is behind schedule at this time however the general contractor is trying to make up time. Residents of the Home are enjoying the activity and the regular updates provided through the Project Manager’s reports to County Council. Nursing Software: The Home implemented new nursing software throughout January and February. We will be implementing the final piece of the software, electronic medication administration records, in September which includes a new contract with our Pharmacy. Resident Quality Inspection: The Home underwent its first annual Resident Quality Inspection by the Ministry of Health & Long-Term Care. It was a positive experience and we feel the results were excellent given the complexity of the legislation. Issues/Challenges None at this time. Upcoming Activity In recognition of the importance of quality and resident safety in long-term care and the governing board’s responsibilities in this area, Deputy Warden Doyle will be attending the Home’s Quality Assessment and Assurance Committee meetings starting in June. Information Report st Fairmount Home – 1 Quarter Highlights May 5, 2014

Fairmount Home - Highlights of Reports

Page 1 of 2

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AgendaItem#4a)

We are also undertaking a full pay equity review of the jobs at Fairmount. This will commence with job rating training in May and we hope to have the review completed by the end of June.

Information Report st Fairmount Home – 1 Quarter Highlights May 5, 2014

Fairmount Home - Highlights of Reports

Page 2 of 2

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AgendaItem#4a)

2014-005

ADMINISTRATIVE REPORT To:

Warden and Council Members of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/ Treasurer

Date prepared:

January 9, 2014

Date of meeting:

January 15, 2014

Re:

Financial Services – 2013 Fairmount Home Accounts Receivable Write-Offs

Recommendation RESOLVED THAT the Council of the County of Frontenac receive this Financial Services – 2013 Fairmount Home Accounts Receivable Write-Offs report; AND FURTHER that Council authorize the Treasurer to write off accounts totalling $9,495.44. Background The Ministry of Health and Long Term Care provides funding to Long Term Care Facilities and sets standard rates for resident payments. Residents are billed monthly for their share of the rent and any other miscellaneous expenditures that have occurred in that month. Overdue accounts are assessed regularly and payment notices forwarded to residents and responsible family members. When the overdue amount exceeds $5,000 legal action is taken to recoup funds. Comment Having pursued legal action in all 3 overdue accounts that exceed $5,000, at this time one account is deemed to be uncollectible. Financial Implications At this time, the Treasurer is requesting Council approval to write off those revenues deemed to be uncollectible in the total amount of $9,495.44.

Organizations, Departments and Individuals Consulted and/or Affected Julie Shillington, Administrator Fairmount Home

Administrative Report 2014 Financial Services – 2013 Fairmount Home Accounts Receivable Write-Offs January 15, 2014

Fairmount Home - Highlights of Reports

Page 1 of 1

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AgendaItem#4a)

County of Frontenac 2013 YEAR END Fairmount Summary Description

2013 Budget

2013 Actuals

OPERATING REVENUE Provincial/Federal Funding User Fees Other Revenue Recoveries TOTAL REVENUE Transfer from Reserves TOTAL REVENUE AND RESERVE TRNSF. EXPENSE Salaries Benefits Office Supplies and Repair Medical Supplies and Repair Equipment Supplies and Repair Raw Food Advertising Public Relations Travel Membership Fees Training Fees, Accommodation, Travel Conference Fees, Accommodation, Travel Health and Safety Training Audit Legal and Labour Relations Contracted services Insurance Building Maintenance Communications Supplies, Service and Equip. Vehicle Service and Supplies Rentals, Leases, Penalties and Interest Utility Costs Other Internal Transfers - Reserve Depreciation TOTAL OPERATING EXPENSE TOTAL OPERATING less depreciation

5,216,928 2,851,947 1,000 85,395 8,155,270

5,330,419 2,805,630 6,125 59,349 8,201,523

61,000 18,990 ================== ================== 8,216,270 8,220,513

6,467,410 6,726,794 2,035,702 1,977,252 31,344 28,443 110,040 66,391 337,730 318,770 424,608 404,215 3,500 4,813 3,500 2,733 0 132 17,000 16,713 21,220 10,253 3,003 2,680 3,500 76 6,847 7,282 25,000 24,234 317,798 365,675 60,505 68,794 236,024 291,465 72,480 72,558 6,400 3,258 16,500 14,975 208,100 224,368 39,119 4,406 39,000 39,000 540,852 540,778 11,027,182 11,216,058 ================== ================== 10,486,330 10,675,280

NET OPERATING EXPENSE

2,270,060

City share of Operating

1,543,641

2,454,767 1,669,241.56

CAPITAL Capital General equipment Capital - Fire Suppression Tank Capital - Prior year project - well

Fairmount Home - Highlights of Reports

182,932 30,000 140,000

129,779 28,564 65,374

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AgendaItem#4a)

Capital - Fairmount Auditorium

2,175,000

191,273

Total Capital

2,527,932

414,990

City share of Capital

282,193

less City prior year contribution

95,200

Net City contribution to capital

1,623,794

44,454 237,738.86

TOTAL CITY CONTRIBUTION

1,906,980.42

Amount received 2013

1,688,433.00

Account receivable

218,547.42

Fairmount Home - Highlights of Reports

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AgendaItem#4a)

Fairmount Home - Highlights of Reports

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AgendaItem#4a)

Report 2014-062 INFORMATION REPORT TO COUNCIL To:

Warden and Council of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/Treasurer

Prepared by:

Julie Shillington Administrator of Fairmount

Date Prepared:

March 24, 2014

Date of Meeting:

April 16, 2014

Re:

Fairmount Home – 2014 1st Quarter Activity Report

Recommendation This report is for information only. Background The following are some of the highlights from January 1 to March 31, 2014 of which County Council should be aware. Comment Ministry of Health & Long-Term Care Resident Quality Inspection (RQI) The Home underwent its first RQI since the implementation of the Long-Term Care Homes Act. A separate report has been provided to Council on the outcome of the inspection. Case Mix Index The Home has been advised of its CMI effective April 1, 2014. Our CMI went from 0.9479 to 0.9224 which results in a loss of funding in the Nursing & Personal Care envelope of $78,259. As was the case last year, our base CMI dropped slightly and we were capped at 5% for the Special Rehabilitation category. We are very hopeful that with the implementation of the new nursing software staff will be better able to capture the information required to increase our CMI. Nursing Software Implementation and Training Information Report Fairmount Home – 2014 1st Quarter Activity Report April 16, 2014

Fairmount Home - Highlights of Reports

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AgendaItem#4a)

Implementation of the new nursing software is complete with the exception of the Point of Care hardware and e-MARs (electronic medication administration records). The Point of Care hardware will be in place before the end of spring and we are in the planning stages of e-MARs with our pharmacy provider looking at software and hardware needs, equipment replacement, education and support. It is important for Council to note that it is the pharmacy provider that takes on these costs - not the Home. If all goes well we hope to implement the e-MARs in September. Enteric Outbreak There was an enteric outbreak on our secure unit with five residents and no staff affected. Outside the Box The Outside the Box program is now complete. This was the theatre program funded by New Horizons for Seniors. The program culminated in three performances by the residents – one at Fairmount Home and two more at two other long-term care homes in the area. Zero Tolerance for Abuse and Neglect Policy We received one-time funding from the Ministry of Health & Long-Term Care that was to be used for training and development of direct care staff which would advance the quality of care provided to the residents. We used some of this funding to conduct a review of our Zero Tolerance for Abuse and Neglect Policy and to focus specifically on staff knowledge of the policy and capacity to apply it in the workplace. The review included a review of policies, some individual interviews as well as a general survey. We anticipate the final results to be available by March 31st. Donation from Legion Fairmount received a $2,000 donation from the Royal Canadian Legion Branch 496 to be used to enhance the quality of life of our Veterans. General Staff Meeting I held several general staff meetings in the first quarter of 2014. Agenda topics included budget, attendance management, the SDOR, Dietary Workflow project and MOHLTC inspection results. PSW Coding Training Upon implementation of the Point of Care software it became evident that PSWs needed further training on documentation, particularly around activities of daily living. Training sessions were provided by our Documentation Assistants. Effective Governance for Quality and Patient Safety With Deputy Warden Doyle, I attended a session presented by Health Quality Ontario and the Canadian Patient Safety Institute which focused on the role of a health care organization’s governing body as it relates to quality and patient safety.

Organizations, Departments and Individuals Consulted and/or Affected Fairmount Management Team Information Report Fairmount Home – 2014 1st Quarter Activity Report April 16, 2014

Fairmount Home - Highlights of Reports

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AgendaItem#4a)

Staff Residents Volunteers

Information Report Fairmount Home – 2014 1st Quarter Activity Report April 16, 2014

Fairmount Home - Highlights of Reports

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AgendaItem#4a)

Report 2014-020 INFORMATION REPORT To:

Warden and Council Members of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/Director of Corporate Services/Treasurer

Prepared by:

Julie Shillington Administrator – Fairmount Home

Date prepared:

January 29, 2014

Date of meeting:

February 19, 2014

Re:

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 3

Recommendation That the Council of the County of Frontenac accept this Additions and Alterations to Fairmount Home Auditorium Construction Progress Report #3 report for information only.

Construction Update The report prepared by our Project Manager, Patrick Thompson of TCMS, for the period is attached. Change Orders – See Change Notice Summary Sheet attached. Other Matters – See attached.

Organizations, Departments and Individuals Consulted and/or Affected Patrick Thompson, Project Manager, TCMS Marian VanBruinessen, County Treasurer

Information Report for Council

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 3 February 19, 2014

Fairmount Home - Highlights of Reports

Page 1 of 6

Page 19 of 182

AgendaItem#4a)

Additions and Alterations Fairmount Home Auditorium

PROGRESS REPORT # 3

Prepared by TCMS 2014

January 29,

Information Report for Council

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 3 February 19, 2014

Fairmount Home - Highlights of Reports

Page 2 of 6

Page 20 of 182

AgendaItem#4a)

Additions and Alterations to Fairmount Home Auditorium PROGRESS REPORT # 3

INDEX

PROGRESS SUMMARY…………………………………………………………………4, 5, 6 CONTRACT CHANGE SUMMARY…………………………………………………..attached PROPOSED AND ACTUAL CASHFLOW – CONSTRUCTION …………………….attached

Information Report for Council

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 3 February 19, 2014

Fairmount Home - Highlights of Reports

Page 3 of 6

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AgendaItem#4a)

Additions and Alterations to Fairmount Home Auditorium PROGRESS REPORT # 3 PROGRESS SUMMARY

The following activities have been completed during the current report period. • • • • • • • •

Interior demolition work is approximately 80% complete. Exterior demolition of the existing entrance stair, landing and ramp has been completed. Temporary partition wall separating the work site from Fairmount Home has been constructed. New electrical feeds from the existing electrical room in Fairmount Home have been installed. Excavation work and construction of new foundation walls at the front entrance is scheduled to start on February 3, 2014. Interior trenching for plumbing infrastructure is scheduled to begin the week of February 3, 2014. Interior structural steel fabrication has started and installation will commence by midFebruary, 2014. Shop drawing submission and review process is approximately 50% complete.

Additional Notes • • •

Cold weather in December, 2013 has affected the project start schedule for exterior work. Impact on final completion date is not known at this time. An updated project schedule will be prepared during the next reporting period. Construction planning and coordination work is well underway and no major issues have been identified at this point in time.

Information Report for Council

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 3 February 19, 2014

Fairmount Home - Highlights of Reports

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AgendaItem#4a)

Interior demolition work.

Temporary partition and door separating Fairmount Home from the renovation zone.

Interior demolition is approximately 80% complete at the time of this report.

Information Report for Council

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 3 February 19, 2014

Fairmount Home - Highlights of Reports

Page 5 of 6

Page 23 of 182

AgendaItem#4a)

Exterior demolition of the existing entrance stair, landing and ramp has been completed.

Trenching for plumbing infrastructure is about to start.

Electrical infrastructure underway.

work

Auditorium.

Information Report for Council

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 3 February 19, 2014

Fairmount Home - Highlights of Reports

Page 6 of 6

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Fairmount Home - Highlights of Reports

ADDITIONS AND ALTERATIONS TO FAIRMOUNT HOME AUDITORIUM CHANGE NOTICE SUMMARY SHEET General Contractor To be determined Original Contract Value = Change Orders to Date = Current Contract Value = Other Anticipated Changes = Expected Final Value =

Revised $1,796,000.00 $0.00 $1,796,000.00 $17,750.00 $1,813,750.00

Current Funding (Original Contract Value + Contingency - 5%) = Remaining Contingency = CHANGE ID #

DESCRIPTION OF CHANGE

29-Jan-14

$1,885,800.00

DATE OF ISSUE

ESTIMATE/FINAL VALUE

CHANGE ORDER #

DATE OF ISSUE

CURRENT STATUS

CCN No. 1 - Add foundation dowels

07.01.14

$2,500.00

Waiting for Contractor’s quotation

CCN No. 2 - Increase door widths/Corridor A-105

14.01.14

$3,500.00

Waiting for Contractor’s quotation

CCN No. 3 - Modify steel at Entrance roof

20.01.14

$1,000.00

Waiting for Contractor’s quotation

CCN No. 4 - Increase conductor size - 1N6201

23.01.14

$750.00

Waiting for Contractor’s quotation

Handrail clarifications

$3,500.00

CCN to be issued

Temporary measures - electrical

$2,500.00

CCN to be issued

Add drywall furring - Auditorium walls

$1,000.00

CCN to be issued

Relocate standpipe to clear ductwork

$1,500.00

CCN to be issued

Add wall and floor finishes - Church Storage Room

$1,500.00

CCN to be issued

10 11 12 13 14 15 16

18 19 20

AgendaItem#4a)

Page 25 of 182

Fairmount Home - Highlights of Reports

ADDITIONS AND ALTERATIONS TO FAIRMOUNT HOME AUDITORIUM Proposed and Actual Cash Flow - Construction Only

Month 31-Oct-13 30-Nov-13 31-Dec-13 31-Jan-14 28-Feb-14 31-Mar-14 30-Apr-14 31-May-14 30-Jun-14 31-Jul-14

Proposed Proposed Actual Actual Monthly Bill (P) Cumulative Bill (P) Monthly Bill (A) Cumulative Bill (A) $25,000 $25,000 $0 $0 $50,000 $75,000 $0 $0 $75,000 $150,000 $60,271 $60,271 $150,000 $300,000 $200,000 $500,000 $250,000 $750,000 $400,000 $1,150,000 $350,000 $1,500,000 $250,000 $1,750,000 $50,000 $1,800,000

29-01-2014

AgendaItem#4a)

Page 26 of 182

$2,000,000 $1,800,000

$450,000

Cumulative Bill (P) $400,000

Cumulative Bill (A) Monthly Bill (P) $1,400,000

Monthly Bill (A)

$350,000 $300,000

$1,200,000 $250,000 $1,000,000 $200,000 $800,000 $150,000 $600,000 $400,000 $200,000 $0

Monthly Bill

$1,600,000

Cumulative Bill

Fairmount Home - Highlights of Reports

Proposed and Actual Cash Flow Auditorium - Construction Only

$100,000 $50,000 $0

29-01-2014

AgendaItem#4a)

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AgendaItem#4a)

Report 2013-228 ADMINISTRATIVE REPORT To:

Warden and Council Members of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/Treasurer

Prepared by:

Julie Shillington Administrator – Fairmount Home

Date prepared:

December 4, 2013

Date of meeting:

December 18, 2013

Re:

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 2

Recommendation That the Council of the County of Frontenac accept this Additions and Alterations to Fairmount Home Auditorium Construction Progress Report #2 report for information only.

Construction Update The report prepared by our Project Manager, Patrick Thompson of TCMS, for the period is attached. Change Orders – No change orders are being brought forward. Other Matters – See attached.

Organizations, Departments and Individuals Consulted and/or Affected Patrick Thompson, Project Manager, TCMS Marian VanBruinessen, County Treasurer Administrative Report

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 2 December 18, 2013

Fairmount Home - Highlights of Reports

Page 1 of 4

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AgendaItem#4a)

Additions and Alterations Fairmount Home Auditorium

PROGRESS REPORT # 2

Administrative Report

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 2 December 18, 2013

Fairmount Home - Highlights of Reports

Page 2 of 4

Page 29 of 182

AgendaItem#4a)

Prepared by TCMS 2013

Decemebr 4,

Additions and Alterations to Fairmount Home Auditorium PROGRESS REPORT #2

INDEX

PROGRESS SUMMARY………………………………………………………………………4 CONTRACT CHANGE SUMMARY…………………………………………………..attached PROPOSED AND ACTUAL CASHFLOW – CONSTRUCTION …………………….attached

Administrative Report

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 2 December 18, 2013

Fairmount Home - Highlights of Reports

Page 3 of 4

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AgendaItem#4a)

Additions and Alterations to Fairmount Home Auditorium PROGRESS REPORT #2 PROGRESS SUMMARY

The following activities have been completed during the current report period. • •

• •

The construction contract has been awarded to Emmons & Mitchell Construction Ltd. of Kingston, for the amount of $1,796,000. This award value included an option cost to construct a greenhouse addition. A pre-construction start meeting was held at the site on November 27, 2013. Representatives from both the Owner’s project team and the Contractor’s project team were present. Among the various project issues discussed was the key element of how to implement the project without adversely affecting the ongoing long term care facility. A number of measures have been put in place to minimize the impact on Fairmount Home. On December 4, 2013, the Contractor’s management team, including the project supervisor and electrical project manager, were on site to meet with Fairmount Home residents to officially “launch” the project. Work on site will commence December 9, 2013. Exterior excavation works will commence on January 6, 2014.

Administrative Report

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 2 December 18, 2013

Fairmount Home - Highlights of Reports

Page 4 of 4

Page 31 of 182

$2,000,000 $1,800,000

$450,000

Cumulative Bill (P) $400,000

Cumulative Bill (A) Monthly Bill (P) $1,400,000

Monthly Bill (A)

$350,000 $300,000

$1,200,000 $250,000 $1,000,000 $200,000 $800,000 $150,000 $600,000 $400,000 $200,000 $0

Monthly Bill

$1,600,000

Cumulative Bill

Fairmount Home - Highlights of Reports

Proposed and Actual Cash Flow Auditorium - Construction Only

$100,000 $50,000 $0

04-12-2013

AgendaItem#4a)

Page 32 of 182

Fairmount Home - Highlights of Reports

ADDITIONS AND ALTERATIONS TO FAIRMOUNT HOME AUDITORIUM Proposed and Actual Cash Flow - Construction Only

Month 31-Oct-13 30-Nov-13 31-Dec-13 31-Jan-14 28-Feb-14 31-Mar-14 30-Apr-14 31-May-14 30-Jun-14 31-Jul-14

Proposed Proposed Actual Actual Monthly Bill (P) Cumulative Bill (P) Monthly Bill (A) Cumulative Bill (A) $25,000 $25,000 $50,000 $75,000 $75,000 $150,000 $150,000 $300,000 $200,000 $500,000 $250,000 $750,000 $400,000 $1,150,000 $350,000 $1,500,000 $250,000 $1,750,000 $50,000 $1,800,000

04-12-2013

AgendaItem#4a)

Page 33 of 182

AgendaItem#4a)

Report 2014-058 INFORMATION REPORT TO COUNCIL To:

Warden and Council Members of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/Treasurer

Prepared by:

Julie Shillington Administrator, Fairmount Home

Date prepared:

March 7, 2014

Date of meeting:

April 16, 2014

Re:

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 4

Recommendation That the Council of the County of Frontenac accept this Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 4 report for information only.

Organizations, Departments and Individuals Consulted and/or Affected Patrick Thompson, Project Manager, TCMS Marian VanBruinessen, Acting CAO/Treasurer

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 4 April 16, 2014

Fairmount Home - Highlights of Reports

Page 1 of 8

Page 34 of 182

AgendaItem#4a)

Additions and Alterations Fairmount Home Auditorium

PROGRESS REPORT # 4

Prepared by TCMS

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 4 April 16, 2014

Fairmount Home - Highlights of Reports

March 7, 2014

Page 2 of 8

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AgendaItem#4a)

Additions and Alterations to Fairmount Home Auditorium PROGRESS REPORT # 4

INDEX

PROGRESS SUMMARY…………………………………………………………………4, 5, 6 CONTRACT CHANGE SUMMARY……………………………………………………………7 PROPOSED AND ACTUAL CASHFLOW – CONSTRUCTION ……………………………….8

Additions and Alterations to Fairmount Home Auditorium Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 4 April 16, 2014

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AgendaItem#4a)

PROGRESS REPORT # 4 PROGRESS SUMMARY

The following activities have been completed during the current report period. • • • • • • • • • •

Interior demolition work is approximately 90% complete. Excavation work for the greenhouse addition, new front entrance vestibule and north side addition has been completed. Foundation wall footings for the greenhouse addition and new front entrance vestibule have been placed. Formwork and re-inforcing steel for foundation walls - greenhouse addition and new front entrance vestibule have been installed. Walls are scheduled to be poured during the week of March 10, 2014. Structural steel framing to support the new folding partition doors is now complete. Structural steel lintels above new window opening have been set in place. New electrical panels and all new main power feeds have been installed and connected. Interior trenching for plumbing infrastructure is scheduled to begin the week of March 17, 2014. Ductwork is scheduled to start the week of March 17, 2014. Shop drawing submission and review process is approximately 85% complete.

Additional Notes •

A revised project schedule has been received from the General Contractor and completion of the project has been delayed by approximately 8 weeks. The contractor is reviewing opportunities to advance the schedule and minimize the delay.

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 4 April 16, 2014

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AgendaItem#4a)

Excavation work for the new front entrance vestibule has been completed.

Excavation work for the north side addition has been completed.

Foundation wall footings for the greenhouse addition have been placed.

Foundation wall footings for the new front entrance vestibule have been placed.

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 4 April 16, 2014

Fairmount Home - Highlights of Reports

Page 5 of 8

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AgendaItem#4a)

Formwork and re-inforcing steel for foundation walls - new front entrance vestibule - have been installed. Walls are scheduled to be poured during the week of March 10, 2014.

Formwork and re-inforcing steel for foundation walls greenhouse addition - have been installed. Walls are scheduled to be poured during the week of March 10, 2014.

Structural steel lintel above new opening into the Auditorium Hall has been set in place.

Structural steel framing to support the new folding partition doors is now complete.

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 4 April 16, 2014

Fairmount Home - Highlights of Reports

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AgendaItem#4a)

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 4 April 16, 2014

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AgendaItem#4a)

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 4 April 16, 2014

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Page 8 of 8

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AgendaItem#4a)

Report 2014-060 INFORMATION REPORT TO COUNCIL To:

Warden and Council Members of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/Treasurer

Prepared by:

Julie Shillington Administrator – Fairmount Home

Date prepared:

March 31, 2014

Date of meeting:

April 16, 2014

Re:

Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 5

Recommendation That the Council of the County of Frontenac accept this Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 5 report for information only.

Organizations, Departments and Individuals Consulted and/or Affected Patrick Thompson, Project Manager, TCMS Marian VanBruinessen, Acting CAO/Treasurer

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 5 April 16, 2014

Fairmount Home - Highlights of Reports

Page 1 of 9

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AgendaItem#4a)

Additions and Alterations Fairmount Home Auditorium

PROGRESS REPORT # 5

Prepared by TCMS Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 5 April 16, 2014

Fairmount Home - Highlights of Reports

March 31, 2014

Page 2 of 9

Page 43 of 182

AgendaItem#4a)

Additions and Alterations to Fairmount Home Auditorium PROGRESS REPORT # 5

INDEX

PROGRESS SUMMARY………………………………………………………………4, 5, 6, 7 CONTRACT CHANGE SUMMARY……………………………………………………………8 PROPOSED AND ACTUAL CASHFLOW – CONSTRUCTION ……………………………….9

Additions and Alterations to Fairmount Home Auditorium Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 5 April 16, 2014

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Page 3 of 9

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AgendaItem#4a)

PROGRESS REPORT # 5 PROGRESS SUMMARY

The following activities have been completed during the current report period. • • • • • • • • • • •

Interior demolition work is approximately 90% complete. Excavation work for the greenhouse addition, new front entrance vestibule and north side addition has been completed. Foundation wall footings for the greenhouse addition, new front entrance vestibule and north side addition have been placed. Formwork and re-inforcing steel for foundation walls - greenhouse addition, new front entrance vestibule and north side addition have been installed. Foundation walls have been placed during the week of March 10 and March 21, 2014. Structural steel framing to support the new folding partition doors is now complete. Structural steel lintels above new window opening have been set in place. New electrical panels and all new main power feeds have been installed and connected. Interior trenching for plumbing and electrical infrastructure and related underground piping have been installed. Ductwork is scheduled to start the week of March 31, 2014. Shop drawing submission and review process is approximately 90% complete.

Additional Notes •

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 5 April 16, 2014

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Page 4 of 9

Page 45 of 182

AgendaItem#4a)

Excavation work for the new front entrance vestibule has been completed.

Excavation work for the north side addition has been completed.

Foundation wall footings for the greenhouse addition have been placed.

Foundation wall footings for the new front entrance vestibule have been placed.

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 5 April 16, 2014

Fairmount Home - Highlights of Reports

Page 5 of 9

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AgendaItem#4a)

Formwork and re-inforcing steel for foundation walls - new front entrance vestibule - have been installed. Walls are scheduled to be poured during the week of March 10, 2014.

Formwork and re-inforcing steel for foundation walls greenhouse addition - have been installed. Walls are scheduled to be poured during the week of March 10, 2014.

Structural steel lintel above new opening into the Auditorium Hall has been set in place.

Structural steel framing to support the new folding partition doors is now complete.

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 5 April 16, 2014

Fairmount Home - Highlights of Reports

Page 6 of 9

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AgendaItem#4a)

Foundation wall footings for the north side addition have been placed.

Foundation walls for new front entrance vestibule have been placed.

Formwork and re-inforcing steel for foundation walls at north side addition have been set in place.

Interior trenching for plumbing infrastructure at new washroom core and related underground piping have been installed.

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 5 April 16, 2014

Fairmount Home - Highlights of Reports

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AgendaItem#4a)

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 5 April 16, 2014

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AgendaItem#4a)

Information Report to Council Additions and Alterations to Fairmount Home Auditorium Construction Progress Report # 5 April 16, 2014

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AgendaItem#4a)

Report 2013-221 ADMINISTRATIVE REPORT To:

WARDEN AND COUNCIL OF THE COUNTY OF FRONTENAC

From:

Marian VanBruinessen Action CAO

Prepared by:

Julie Shillington Administrator of Fairmount

Date Prepared:

November 27, 2013

Date of Meeting:

December 18, 2013

Re:

Fairmount Home – 2013 3rd Quarter Consolidated Statistical Update

Recommendation THAT Council of the County of Frontenac receive the Fairmount Home – 2013 3rd Quarter Consolidated Statistical Update report for information only.

Background As the “licensee” of the home under the Long-Term Care Homes Act and as a requirement for Accreditation, Council needs to be aware of the performance measures that are being collected at Fairmount, the results of those measures and any action plans that may be developed as a result. The home also has a responsibility under the Quality Improvement section of the Act to report our quality improvement activities to our residents, staff, volunteers and family members. With this in mind, Fairmount’s Quality Assurance and Assessment Committee (QAAC) has developed a Quality Improvement Consolidated Statistical Report (Appendix A). This report contains information on all of the performance measures that were being collected in the home in the first, second and third quarters of 2013 and includes information such as goals (if established) and comments about the information collected.

Administrative Report Fairmount Home – 2013 3rd Quarter Consolidated Statistical Update December 18, 2013

Fairmount Home - Highlights of Reports

Page 1 of 2

Page 51 of 182

AgendaItem#4a)

Comment There is an increase in the number of programs offered to residents as a result of the exercise program funding provided by the Ministry of Health & Long-Term Care. Housekeeping staff conducted a trial on a new type of portascrubber. Staff completed new equipment feedback sheets and through that process the decision was made not to purchase that type of scrubber. Please note that the Fire Inspector conducted her annual inspection and we are compliant. There has been an increase in resident aggression, particularly on our secure unit. We continue to meet our goal of ensuring the employee and management workplace health and safety inspections are completed 100% on time. We will be sharing these results with Residents’ Council, family members and staff in the coming months.

Sustainability Implications Measuring performance is essential to providing a high quality service. It allows an organization to identify areas where improvement is needed and triggers discussion as to how this can be done.

Financial Implications Measuring performance is a part of the home’s risk management and compliance processes. Failure to manage risk and assess compliance can lead to financial implications.

Organizations, Departments and Individuals Consulted and/or Affected Fairmount Management Team Staff Residents Volunteers

Administrative Report Fairmount Home – 2013 3rd Quarter Consolidated Statistical Update December 18, 2013

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Page 2 of 2

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Fairmount Home - Highlights of Reports

FAIRMOUNT HOME QUALITY ASSURANCE & ASSESSMENT COMMITTEE (QAAC)

Quality Improvement (QI) Consolidated Statistical Report 2013

AgendaItem#4a)

Page 53 of 182

Fairmount Home - Highlights of Reports

PROGRAMMING Statistic / Audit

Measurement

Program Attendance: First floor

residents

attending at least one program

Goal

4th Quarter Results

1st Quarter Results

2nd Quarter Results

3rd Quarter Results

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

62/64

61/64

62/63

60/64

61/63

62/64

63/64

61/64

59/63

60/64

63/64

47/64

58/64

46/64

62/64

59/63

59/64

2nd quarter stats 2nd fl. incomplete

18/18

23/15

18/20

18/19

19/18

19/13

24/24

28/24

27/23

Feb – 8 on Mondays 1st fl – 0 on 2nd – otherwise relatively equal Overall increase in # of programs includes exercise classes 3rd quarter on.

Oct

Nov

Dec

Comments Enteric Outbreak 1st fl in March – all large group activities cancelled for both floors

(monthly) / # total residents Program Attendance: Second floor

residents

attending at least one program

(monthly) / # total residents Activity Calendar (monthly)

1st floor

programs & # 2nd floor programs (to ensure equitable)

Activity Calendar

/ # total weekends

QAAC – QI Consolidated Statistical Report 2013 Page | 1

46/13

38/13

44/13

AgendaItem#4a)

Page 54 of 182

weekend

programs in the quarter

Fairmount Home - Highlights of Reports

8/12.5

9/13.7

8/13.1

3rd quarter = 5 in Sept; Aug=1; July=2

100%

N/A

100%

New indicator - not collected until 3rd quarter

100%

N/A

Process for recording minutes revised and meets MDS requirements without need for a progress note each time.

evening

programs in the quarter / # weeks in the quarter NEW – Program Descriptions

completed

program descriptions /total # programs

Documentation for 1:1’s

Documented progress notes /total # 1:1’s facilitated by Recreationists

New indicator - not collected for 1st quarter – still not collected for 2nd quarter – will meet with Recreationists to determine process (decided to record on attendance sheets). Attendance forms were revised to include 1:1 section on the back. All 1:1’s are being recorded here and minutes reflected so available for MDS 7-day look back. Form allows for progress notes but minutes recorded so not always need for PN.

AgendaItem#4a)

Page 55 of 182 QAAC – QI Consolidated Statistical Report 2013 Page | 2

N/A

Fairmount Home - Highlights of Reports

NEW - Large group activity evaluations

large group

activity evaluations completed

100%

N/A

Process and forms evaluated and revised Oct/Nov. To be used for coffee break in Oct. Octoberfest evaluated with departmental form only.

/total # large group activities

VOLUNTEERS Measurement

Goal

1st Quarter Results

2nd Quarter Results

3rd Quarter Results

Volunteer Hours

volunteer hours

6500

1151 (Some lrg programs cancelled-outbreak)

1729.5

1422.5 (VC off – some hrs not captured)

Volunteer Survey (annual)

of surveys

returned

Statistic/Audit

4th Quarter Results

Comments

35% return rate

QAAC – QI Consolidated Statistical Report 2013 Page | 3

AgendaItem#4a)

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/ # surveys issued

Fairmount Home - Highlights of Reports

of satisfied

volunteers

95% satisfaction rate

/ #of volunteers surveyed Volunteer Program Review

of programs

reviewed

4 programs / 12+ programs

April –Meeting with General Store Volunteers

/ # of volunteer assisted programs June –Pet Therapy Program reviewed

100% of volunteer suggestions to improve programs considered Quarterly enewsletter

volunteer enewsletters

distributed

4 e-newsletters per year

1 in February

1 in May

/4 quarters

methods used to

ensure communication of volunteer contributions each quarter

NEW – Volunteer Education

of in-services

held for volunteers/

1 per quarter / 8 attendees

QAAC – QI Consolidated Statistical Report 2013 Page | 4

Road sign of total volunteer hours
Newsletter produced highlighting appreciation night
3 in-services
4 attendees Jan
14 attendees Feb
1 in-service
4 attendees

AgendaItem#4a)

Page 57 of 182

Recognition of volunteer contributions

Article in the County newsletter – hours + contributions in 2012
Nominations for Ontario Vol Awards
Year in Review brochure produced

Fairmount Home - Highlights of Reports

of volunteers

attended

AgendaItem#4a)

Page 58 of 182 QAAC – QI Consolidated Statistical Report 2013 Page | 5

10 attendees March

Fairmount Home - Highlights of Reports

DIETARY Goal

1st Quarter Results

2nd Quarter Results

3rd Quarter Results

Daily Food Temperature Audit

Weekly audit of individual meals where food temperature was taken and documented

100%

84.5%

78%

82%

Daily Café Fridge and Freezer Temperature Audit

Monthly audit of days temperatures were taken and documented

100%

TBA

89%

94%

Weekly BBQ Food Temperature Audit

Weekly audit of individual BBQs where food temperature was taken and documented

100%

N/A

Refrigerator & Freezer Temperature Log

Monthly audit of days temperatures were taken and documented

100%

91.50%

75%

80%

Daily Warewashing Sanitation Logs

Monthly audit of days sanitation logs information was documented

100%

74.50%

77%

81%

NEW – Dietary referrals

dietary referrals

completed as legislated.

100%

QAAC – QI Consolidated Statistical Report 2013 Page | 6

4th Quarter Results

Comments

AgendaItem#4a)

Page 59 of 182

Measurement

Statistic/Audit

Fairmount Home - Highlights of Reports

NEW – Quality initiatives

new quality

initiatives undertaken

75%

n/a

*Results of Dietary Workflow project.

(annual) NEW - % of dietary staff rating their shifts as a good or great day

65%

Overarching aim for dietary workflow project – data collection starts 2nd quarter

AgendaItem#4a)

Page 60 of 182 QAAC – QI Consolidated Statistical Report 2013 Page | 7

38%

Fairmount Home - Highlights of Reports

HOUSEKEEPING Statistic/Audit Goldcheck

New - Routine Cleaning Audit

NEW – New products & processes testing

Measurement

Goal

1st Quarter Results

2nd Quarter Results

3rd Quarter Results

Weekly audits, monthly and quarterly reports indicating % of perceived cleanliness

90%

1N – 84% 1S – 85% 2N – 91% 2S – 89%

1N – 83% 1S- 85% 2N – 92% 2S- 90%

Not available

87.25% Avg.

87.5% Avg.

Routine cleaning of resident rooms as recorded by staff. % calculated on number of opportunities vs. completed

92%

1N – 94% 2N – 89% 1S – 88% 2S – 87%

1S – 88.4% 2S – 95.8% 1N – 75.3% 2N – 92.9%

1N – 78% 1S – 71% 2N – 89% 2S – 77.6%

Avg. = 89.5%

Avg. 88.1%

Avg. 78.9%

new product &

processes tested

100%

100% - new lighting in 1N staff washroom tested -locking door carts trialed Sheets offered no feedback received

No support services trials in this quarter

100% - housekeeping trialed a new porta scrub. Although all believed it was a good unit input was that it was too large for here.

/total number of new products & processes implemented

Comments

4th Quarter Results

Comments

LAUNDRY Statistic/Audit

Measurement

Goal

QAAC – QI Consolidated Statistical Report 2013 Page | 8

1st Quarter Results

2nd Quarter Results

3rd Quarter Results

AgendaItem#4a)

Page 61 of 182

4th Quarter Results

Fairmount Home - Highlights of Reports

Laundry Poundage

Measured daily compiled monthly

NEW - Lost Clothing

lost clothing

found

90%

64000 lbs

64000lbs

1 item lost to date not recovered

No reports of missing items

No reports this period

/total # lost clothing forms submitted

MAINTENANCE Statistic/Audit Work Orders

Measurement

completed

Goal

1 Quarter Results

2nd Quarter Results

3rd Quarter Results

100%

1223 issued 1183 completed

1343 issued 1222 completed

1298 issued 1209 completed

96.7% completed

90.9% completed

93.1% completed

100%

100% 10 of 10 complete 7 - 6 week follow up inspections done 3 pending

100% 9 of 9 complete, all follow up inspections done.

N/A

100%

100% - fire marshals inspection, fire panel annual testing

/total # work orders Electrical Inspection Admission

of inspections

completed / # of new inspections

NEW – Regulatory Testing

regulatory

testing completed

QAAC – QI Consolidated Statistical Report 2013 Page | 9

4th Quarter Results

Comments

AgendaItem#4a)

Page 62 of 182

/total # regulatory testing scheduled

Fairmount Home - Highlights of Reports

NURSING Statistic/Audit Restraint Use (monthly)

1st Quarter Results

2nd Quarter Results

3rd Quarter Results

4th Quarter Results

Average # of restraints used (excluding bedrails)

Average # of restraints used (including bedrails)

of residents

using a restraint

100%

1/3

33%

0/2 = 0%

0/1= 0%

2/3 = 66%

0/2 = 0%

2/2 = 100%

N/A

1/1= 100%

2/3 = 66%

N/A

100%

19/ 57= 66%

93/ 124= 75%

65/97 = 68%

152/ 182

84%

77%

39/74

53%

16/ 43= 62%

77/12 3= 62%

113/ 138= 81%

176/ 198= 86%

100%

Labeling 72% done VRE/MRSA 36% done on time and indicated done in computer PRN 45% 1st Mantoux done

Measurement

residents with

complete restraint documentation

Goal

Comments

N/A = none new

/ # resident charts audited

residents entries

with complete flow sheet documentation / # resident entries audited

QAAC – QI Consolidated Statistical Report 2013 Page | 10

VRE/MRSA 71% done on time 1st Mantoux and 2nd Mantoux 100% on time

VRE/MRSA 86% done on time 1st Mantoux 86% done on time and 2nd Mantoux 100% on time

AgendaItem#4a)

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PostAdmission Audit

Fairmount Home - Highlights of Reports

on time but 2nd Mantoux 81% on time

Medication Reconciliation Verified

of time

admission meds are reconciled/# of admissions

100%

Medication Sign-off (MDSRAI audits)

% assessments with all meds signed in 7days

100%

65%

60%

68%

Do Not Use List (MDS-RAI audits)

% assessments with acceptable abbreviations

100%

99%

100%

N/A

Completed in Aug but stats not compiled yet

MSSA (completed annually)

100%

Out of the 5 personal items to label, 72-86% were labeled

100%

CIHI measures

Medication Incidents

medication

incidents

3rd quarter – 1 RPN had 5 of the errors 1 pharmacy error

medication

incidents resulting

Resident OK after 24 hours

QAAC – QI Consolidated Statistical Report 2013 Page | 11

AgendaItem#4a)

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CIHI Statistics

Fairmount Home - Highlights of Reports

in harm to resident

discrepancies in

count of narcotic & controlled drugs

completed

102

charts lacking

f/u progress notes

N/A

22%

25%

N/A

38%

15%

159

195

236

/ # time counted

adverse drug

reactions Chart Audits

/# chart audits completed

charts lacking

progress notes in general /# chart audits completed Quarterly reports for trending

Palliative Care

Number of

QAAC – QI Consolidated Statistical Report 2013 Page | 12

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

An increase in resident aggression incidents in first and second quarter and third quarter (56 incidents in 3rd quarter); near miss elopements in first quarter related to several residents Sep

Oct

Nov

Dec

No meetings in

AgendaItem#4a)

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Resident Incident Reports

Fairmount Home - Highlights of Reports

residents with PPS 30% or less monthly

No data

of compliments,

donations and deaths from Memory Book quarterly

Jan

Feb

Mar

Apr

May

Jun

Oct 1/1/4

2/1/2

1/1/1

1/2/2

2/1/2

Aug No data

Sept *4/4/8

0/3/7

Jul No data

90%

N/A

7 admissions - 98%

7 admissions - 72%

NEW – Incidence of Decline in all ADLs

Below 32%

37%

No data

NEW – Improved Locomotion on Unit

Above 10%

5.8%

No data

NEW - Resident Personal Items Labeling

% admission assessments & labeling completed on time

Nov

Dec

No meetings in summer *data since June meeting

AgendaItem#4a)

Page 66 of 182 QAAC – QI Consolidated Statistical Report 2013 Page | 13

summer

Fairmount Home - Highlights of Reports

INFECTION PREVENTION & CONTROL Statistic/Audit Symptoms

Measurement

Goal

residents

displaying symptoms resulting in an infection

1st Quarter Results

2nd Quarter Results

3rd Quarter Results

39 (32 r/t enteric & respiratory outbreaks; 1 MRSA; 1 VRE; 1 Cdiff)

7 (3 respiratory/1 enteric/ 2 C-diff/2 VRE (post admission swabs)

8 (8 respiratory 1N – no outbreak)

1 (C-diff)

1 (MRSA urine)

4th Quarter Results

Comments

/ 128

nosocomial

infections

Wheelchair Cleaning

wheelchairs

cleaned

100%

(monthly)

/ # scheduled

Hand Hygiene (JCYH audits x2/yr)

compliant/total

opportunities observed

Hand Hygiene (Bi-weekly Nursing Audit) Handling Dirty Linen

65%

378/ 477= 80%

277/ 467= 59%

341/ 515= 66%

341/ 486= 70%

346/ 507= 60%

316/ 502= 62%

364/ 519= 70%

336/ 495= 68%

330/ 480= 69%

N/A

60%

N/A

compliant/total

opportunities observed

21/26 = 81%

11/19 = 58%

Snack time identified as problem time

37/43 = 86%

carts on unit/#

staff assignments

11/15 = 73% (r/t 1N)

13/18 = 72% (r/t 1N except x1 on 1S)

23/31 = 74% (1 week r/t 1N before increasing to 4 carts)

QAAC – QI Consolidated Statistical Report 2013 Page | 14

C-diff admitted to previous infected resident’s room – was terminally cleaned but will look at process when this resident discharged. Feb dates wrong on sign off sheet

1N = 11/23 1S = 22/26 2S = 20/21 2N = 17/20

AgendaItem#4a)

Page 67 of 182

MRSA/CDif

Fairmount Home - Highlights of Reports

AgendaItem#4a)

Page 68 of 182

QAAC – QI Consolidated Statistical Report 2013 Page | 15

Fairmount Home - Highlights of Reports

FALLS Statistic/Audit Falls

Measurement

of falls

1st Quarter Results

Goal 30

(monthly)

residents who

have fallen

2nd Quarter Results

3rd Quarter Results

4th Quarter Results

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

2/2

6/7

N/A

6/6

5/5

4/4

1/1

N/A

2/2

Nov

Comments

Dec

/ 128 Severity of falls

of near miss

falls

of residents who

have fallen 2 or more times in a week on whom falls round were conducted

100%

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6/6

Fairmount Home - Highlights of Reports

1 resident did not have formal falls rounds, but we were constantly assessing how to care for her to meet her needs

/ # of residents who have fallen 2 or mores times in a week where falls rounds were not conducted

falls prevention

education opportunities offered to staff, residents & family members

At least once per year to each group

1– Gazette – all

1– RNs on Beers list meds

1– Reg staff

1 – all in Gazette

AgendaItem#4a)

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10 – staff

Fairmount Home - Highlights of Reports

INCONTINENT & BOWEL MANAGEMENT Statistic/Audit

Measurement

Goal

1st Quarter Results

2nd Quarter Results

3rd Quarter Results

Voiding record

residents with

completed 3d voiding record on admission

100%

9/11=82%

7/7 = 100%

4th Quarter Results

Comments

/ #admissions

SKIN & WOUND MANAGEMENT 1st Quarter Results

2nd Quarter Results

3rd Quarter Results

4th Quarter Results

N/A

Statistic/Audit

Measurement

Goal

Pressure Ulcer Prevalence

of residents with

pressure ulcers

5.5%

of residents with

new pressure ulcers

.7%

5.5%

3.1%

3.5%

3.9

1.5%

5.4%

3.1%

6.2%

1.5%

Wound Care Sheets

treatments

completed

100%

No data

45/47= 96%

On hold

D/C

n/a

(monthly)

/ # treatments scheduled

(annually) Pressure Ulcer Incidence (monthly) n/a

No need to measure at present

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QAAC – QI Consolidated Statistical Report 2013 Page | 18

n/a

Fairmount Home - Highlights of Reports

HEALTH & SAFETY / RISK MANAGEMENT Statistic/Audit Fire Drill Attendance (annually)

Measurement

Goal

1st Quarter Results

2nd Quarter Results

3rd Quarter Results

staff attending at

least one fire drill per year

100%

N/A

100%

69%

100%

N/A

13/13=100%

4th Quarter Results

Comments

/ total # of staff Employee Workplace Inspections

inspections

completed on time / # of inspections scheduled

Management Workplace Inspections

inspections

completed on time / # of inspections scheduled

lost time injuries

High Risk Activity Verification Process

staff knowing 1

identifier

Hazards

Quarterly hazard reports for trending

/ # of total injuries

/ # staff knowing 2 identifiers

QAAC – QI Consolidated Statistical Report 2013 Page | 19

Several related to ergonomics and lifting; resident personal products not

29 claims related to outbreak first quarter

13/15 = 86%

10/13 = 76%

11/15 = 73%

Several related to slippery floors on 1N

One related to slippery floors on 1N; two related to equipment maintenance in the

Air balancing to identify air flow problems on 1N scheduled for

AgendaItem#4a)

Page 72 of 182

Employee Incident Reports (from OHN quarterly updates)

Fairmount Home - Highlights of Reports

labeled Floor to Ceiling Poles

compliant/#

rooms checked

100%

main kitchen

17/20 = 85%

24/25 = 96%

QAAC – QI Consolidated Statistical Report 2013 Page | 20

32/37 = 86%

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EDUCATION &TRAINING

September

Fairmount Home - Highlights of Reports

Statistic/Audit Inservice Attendance

Measurement

1st Quarter Results

2nd Quarter Results

218

228

70%

This measure has been discontinued as we have the mandatory training program now

75%

18/22 = 82%

7/7 = 100%

Goal

staff in

attendance at all inservices

of staff that

attend at least one inservice per year / 185 (total # of staff)

3rd Quarter Results

4th Quarter Results

Comments

(annual) Inservice Evaluations

inservices

evaluated

8/13 = 61%

/ # inservices offered Topics (annual)

of educational

needs addressed / # of educational needs identified (annual)

100%

of staff attended

sessions on mandatory topics

100%

137

N/A

106

AgendaItem#4a)

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N/A

Fairmount Home - Highlights of Reports

GENERAL Statistic/Audit Family/Resident Satisfaction Survey (annual) Staff Satisfaction Survey (annual) NEW - Staff Absenteeism Rate

Measurement

respondents

satisfied

Goal

1st Quarter Results

2nd Quarter Results

3rd Quarter Results

4th Quarter Results

90%

Issued in May

95%

n/a

80%

83.7%

n/a

5.3%

3.2%

8.5%

Average 522 shifts/3918 hrs per week

2 terminations; 11 resignations; 1 retirement

Comments

/ total # respondents

respondents

satisfied / total #respondents

sick days taken

/average # shifts scheduled

(not including full 15 week leaves) NEW - Staff Turnover

staff leaving

employment /total # staff

Complaints

Bed Occupancy

written

complaints

98%

99.3%

99.5%

99.7%

days bed

actually occupied / total number of

QAAC – QI Consolidated Statistical Report 2013 Page | 22

AgendaItem#4a)

Page 75 of 182

(trended quarterly)

verbal

complaints

Fairmount Home - Highlights of Reports

days

PAIN & SYMPTOM MANAGEMENT

3rd Quarter Results

4th Quarter Results

Statistic/Audit

Measurement

Goal

1st Quarter Results

2nd Quarter Results

Prevalence of Daily ModerateSevere Pain scores

of residents with

moderate-severe daily pain scores

10%

This measure has been discontinued

N/A

Incidence of new Daily ModerateSevere Pain scores

of new resident

with moderatesevere daily pain scores

10%

This measure has been discontinued

N/A

New measures being discussed at pain & symptom management team

100%

N/A

To date – 5/6

Dec 2nd

Comments

/ 128 residents

/ 128 residents Admission pain screen done

of admission

residents with pain screen completed/# of admissions

AgendaItem#4a)

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Fairmount Home - Highlights of Reports

RELIGIOUS & SPIRITUAL CARE Statistic/Audit NEW - Pastoral Visiting

(monthly) NEW - Multifaith Services provided

Measurement

resident

receiving a pastoral visit

Goal

1st Quarter Results

2nd Quarter Results

3rd Quarter Results

4th Quarter Results

90%

Jan

Feb

Mar

Apr

July

Aug

Sep

Oct

100%

100% 100% 100%

100%

99%

May

June

Nov

Comments

Dec

/ total # respondents

weeks with at

least one multifaith service provided

80%

77%

100%

1st quarter – 3 services cancelled due to outbreak

/ total # weeks

AgendaItem#4a)

Page 77 of 182 QAAC – QI Consolidated Statistical Report 2013 Page | 24

AgendaItem#4a)

Report 2014-061 INFORMATION REPORT TO COUNCIL To:

Warden and Council of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/Treasurer

Prepared by:

Julie Shillington Administrator – Fairmount Home

Date Prepared:

March 24, 2014

Date of Meeting:

April 16, 2014

Re:

Fairmount Home – 2014 Ministry of Health & Long-Term Care Resident Quality Inspection (RQI)

Recommendation This report is for information only. Background The Resident Quality Inspection (RQI) is a comprehensive inspection conducted by the Ministry of Health & Long-Term Care (MOHLTC) that is designed and aligned with the Long-Term Care Homes Act, 2007. On June 10, 2013 a commitment was made by the Hon. Deb Matthews, Minister of Health and Long-Term Care to ensure completion of an RQI in every long-term care home by the end of 2014 and annually thereafter. On March 10, 2014 the MOHLTC inspectors arrived at Fairmount to conduct our first RQI since the implementation of the Act in 2010. Three inspectors were present over a period of nine days. Comment During the course of the inspection that inspectors conducted a walkthrough of all resident areas, observed resident dining, observed resident activities, reviewed Residents’ Council minutes, observed medication administration, observed infection prevention and control practices, reviewed staffing schedules, reviewed resident health care records and reviewed relevant home policies. Information Report Fairmount Home – 2014 Ministry of Health & Long-Term Care Resident Quality Inspection (RQI) April 16, 2014

Fairmount Home - Highlights of Reports

Page 1 of 3

Page 78 of 182

AgendaItem#4a)

The inspectors utilized a series of protocols to conduct their inspections which included protocols on: a) Accommodation Services – Housekeeping b) Accommodation Services – Laundry c) Continence Care and Bowel Management d) Dignity, Choice and Privacy e) Dining Observation f) Falls Prevention g) Family Council h) Food Quality i) Hospitalization and Change in Condition j) Infection Prevention and Control k) Medication l) Minimizing of Restraining m) Pain n) Personal Support Services o) Prevention of Abuse, Neglect and Retaliation p) Reporting and Complaints q) Residents’ Council r) Responsive Behaviours s) Skin and Wound Care t) Sufficient Staffing When the inspectors find an area of non-compliance they have the option of: a) issuing a written notification to the licensee b) issuing a written request to the licensee to prepare a written plan of correction for achieving compliance, to be implemented voluntarily c) making an order under section 153 or 154 d) issuing a written notification to the licensee and refer the matter to the Director for further action by the Director at the Ministry. Fairmount received seven written orders, two of which require voluntary plans of compliance. Staff at the Home have put together voluntary plans of compliance for all written orders. A summary of the written orders and plans for compliance are attached as Appendix A. Sustainability Implications The MOHLTC RQI will help the Home identify areas for improvement in order to ensure resident safety and quality care. Financial Implications There are no financial implications as a result of this inspection. Organizations, Departments and Individuals Consulted and/or Affected MOHLTC Inspectors Information Report Fairmount Home – 2014 Ministry of Health & Long-Term Care Resident Quality Inspection (RQI) April 16, 2014

Fairmount Home - Highlights of Reports

Page 2 of 3

Page 79 of 182

AgendaItem#4a)

Staff Residents Resident Family Members Volunteers

Information Report Fairmount Home – 2014 Ministry of Health & Long-Term Care Resident Quality Inspection (RQI) April 16, 2014

Fairmount Home - Highlights of Reports

Page 3 of 3

Page 80 of 182

AgendaItem#4a)

MOHLTC RQI Voluntary Plans of Correction March 24, 2014 **Note that all findings and plans for correction will be discussed at the next general staff meeting, Residents’ Council meeting and Family Information Session. WN #1: The Licensee has failed to comply with O. Reg. 79/10, s.8 Policies, etc. to be followed and records. VPC required for achieving compliance to ensure drugs are disposed of according to the drug destruction policy, medications are administered and effectiveness is monitored in accordance with the policy on medication administration and reported lost laundry is recovered in accordance with the policy on lost and found clothing. Finding #1 – Drug Destruction – RPN’s disposing of medications in sharps container on medicine cart An email was sent from the Director of Resident Care to all Registered Staff on March 21, 2014 advising of the finding and of the proper destruction procedure. A copy of the Home’s policy on the destruction of drugs was attached. In addition to the meetings noted above, this will be an agenda item at the Registered Staff meeting scheduled for March 27, 2014. The Director of Resident Care and Assistant Director of Care will monitor compliance. Finding #2 – Medication Administration – failure to observe residents to ensure medications taken The Director of Resident Care spoke directly to the RPN who was witnessed not observing the residents to ensure medications were taken. In addition to the meetings noted above, this will be an agenda item at the Registered Staff meeting scheduled for March 27, 2014. Finding #3 – Medication Administration – failure to document effectiveness of PRNs In addition to the meetings noted above, this will be an agenda item at the Registered Staff meeting scheduled for March 27, 2014. The implementation of electronic medication administration records is scheduled for September, 2014. This system has an electronic prompt to remind staff to document the effectiveness of PRNs. The Director of Resident Care and Assistant Director of Care will monitor compliance through ad hoc audits of the medication administration records and RAI MDS Audits.

Fairmount Home - Highlights of Reports

Page 81 of 182

AgendaItem#4a)

Finding #4 – Lost Clothing – failure to complete lost clothing forms upon receipt of lost clothing notification In addition to the meetings noted above, this item will also be discussed at departmental meetings and nursing unit meetings. Staff will be reminded of the process and the policy will be amended to ensure it is clear that all staff are responsible for completing the form should they receive a report of lost clothing. This amendment will be completed by April 4th. The lost clothing forms are available on-line, in the forms binder and will be made available on the laundry delivery carts. The Manager of Environmental Services will continue to monitor the submission of the lost clothing forms. WN #2: The Licensee has failed to comply with O. Reg. 9/10, s.129 Safe storage of drugs. VPC required for achieving compliance to work with the home’s pharmacy provider to ensure all controlled drugs are stored in a separate, double-locked area within the medication cart. Finding #1 – Storage of Controlled Substances – failure to store benzodiazepines in a separate, locked area within the medication cart Discussion was held with the pharmacist on March 24, 2014 and benzodiazepines will be stored in a separate locked are within the medication cart effective March 31, 2014. WN #3: The Licensee has failed to comply with LTCHA, 2007 S.O. 2007, c.8, c.6 Plan of care. Finding #1 – Plan of care - failed to provide clear direction to staff The care plan was updated immediately to provide clear direction. WN #4: The Licensee has failed to comply with LTCHA, 2007 S.O. 2007, c.8, s.79 Posting of information Finding #1 – Failure to post copies of Inspection Reports The copy of the October, 2012 and August, 2012 MOHLTC inspection reports were reposted on March 24, 2014 and instruction provided to the Executive Assistant that inspection reports must remain posted for two years. The “Admission Process” checklist will be reviewed quarterly by the EA to ensure compliance with posting requirements and this review will be documented and filed.

Fairmount Home - Highlights of Reports

Page 82 of 182

AgendaItem#4a)

WN #5: The Licensee has failed to comply with LTCHA, 2007 S.O. 2007, c.8, s.85 Satisfaction survey Finding #1 – Failure to seek the advice of Residents’ Council in the development of the resident satisfaction survey The request for input on the development of the survey will be part of the Administrator’s report to Residents’ Council on April 1st. It will be part of the Administrator’s report annually now. WN #6: The Licensee has filed to comply with O. Reg. 79/10, s.87. Housekeeping. Finding #1 – Failure to develop procedures to address incidents of lingering offensive odors The Manager of Environmental Services will develop a policy and procedures to address incidents of lingering offensive odors by April 4, 2014. Once the policy is established it will be shared with staff via the intranet, email, General staff meetings, departmental meetings and nursing unit meetings. WN #7: The Licensee has failed to comply with O. Reg. 79/10, s.229 Infection prevention and control program.

Finding #1 – All pets visiting as part of a pet visitation program do not have up to date immunizations. The Volunteer Coordinator immediately commenced updating of pet immunizations. She will develop a carry-forward procedure so that pet owners are contacted prior to current immunization expiry dates. It will also note that if up to date immunizations are not on file the pet cannot visit. This procedure will be in place by April 4, 2014 and reflected in the Home’s Pet policy.

Fairmount Home - Highlights of Reports

Page 83 of 182

AgendaItem#5a)

City of Kingston Report to Rural-Urban Liaison Advisory Committee (RULAC) To:

Chair and Members of RULAC

From:

Gerard Hunt, Chief Administrative Officer

Resource Staff:

Adele Lafrance, Director, Community & Family Services Lee Campbell, Acting Director, Housing Hal Linscott, Director of Legal Services & City Solicitor

Date of Meeting:

May 5, 2014

Subject:

HIGHLIGHTS OF CITY REPORTS (October 2013-April 2014)

This new reporting format is intended to provide RULAC members with a more practical approach to highlighting work that has been completed over the timeframe highlighted in the subject line. For some time, staff have struggled with a mechanism to reduce the volume of detail and reports at the RULAC table, given that much of the work is a reflection of service manager responsibilities, and is often shared for information purposes. Beginning this meeting, staff have approached this matter by preparing an overarching report to assist RULAC members. Included are links to the detail reports, should they be required. We will appreciate feedback on the new approach. The summary below reflects specific summary information by report topic and is numbered for convenience of reference. Staff will be available at the meeting to discuss content of the reports as is the usual practice. 1.

OW, ODSP, CHILDCARE & HOUSING: Local Service Realignment (LSR) YTD Quarterly Financial Reports

Q4 2013 (Exhibit A) Highlights: Consolidated net 2013 year end LSR Social Services costs (OW, Childcare and Housing) represented 91.0% of approved operating budget, with city costs at 90.6% and county costs at 94.2% of respective budgets.

Community and Family Services, Housing and Provincial Offences

Page 84 of 182

AgendaItem#5a) City of Kingston Report to RULAC

May 5, 2014 Page 2 of 13

OW Allowances trended under budget with caseload stable and benefit costs below budget (more notably in the City). Childcare fee subsidy demands exceeded available funds which required implementation of a wait list in April, lasting through to August. At year end approximately $30K of one time provincial mitigation funding was required to offset Childcare Program expenditures. Receipt of additional unanticipated provincial funding resulted in surpluses where municipal funds had initially been budgeted. In particular, one time provincial transitional funds related to Homelessness funding reform eliminated the need for $234K in municipal (consolidated) funding for the new discretionary residency benefit. Surpluses in OW Administration resulted from both additional provincial funding and vacancies associated to staff turnover over the course of the year. County over expenditure in Childcare administration and Housing administration related to change in weighted assessment rate with the county share budgeted at 20.408% and reconciled at 20.889%. This change in apportionment rate was also responsible for higher County contributions to Childcare Wage Subsidy cost sharing. Issues/Challenges: The most significant administrative challenges experienced in 2013 related to staffing vacancies related to turnover along with workload and logistics of site renovations and internal relocations. The most significant service management challenges experienced, included required program adjustments related to the reformed provincial funding model for Homelessness and late advisement of provincial mitigation funding provided The requirement for a childcare fee subsidy wait list resulted in both program delivery and administrative challenges with some families waited as long as 5 months for fee subsidy applications, some childcare centres experienced reduced revenues and a wait list of over 400 registrants required administration (and eventual dissolution). Upcoming Activity: Modernization of the provincial Social Assistance technology (including for Ontario Works) is underway. The project, initially due for implementation in the fall of 2013 has experienced several delays but is now tentatively scheduled for implemented in Q4 2014. This initiative will consume significant local resources related to training, redevelopment of local office processes, data cleansing and go-live trouble shooting. Q1 2014 (Exhibit B) Highlights: Q1 2014 financials are on track with overall expenditures at 25.2% of consolidated budget. Year to date County expenditures are tracking at 20.8% while city expenditures are tracking at 25.8%.

Community and Family Services, Housing and Provincial Offences

Page 85 of 182

AgendaItem#5a) City of Kingston Report to RULAC

May 5, 2014 Page 3 of 13

With the exception of OW Allowances, no budget categories are over expended once adjusted for advanced cash flows to service providers. While OW Allowances are tracking slightly over budget, this is normal for Q1. A seasonal caseload reduction is historically experienced in Q3 and is expected to address this very slight overage (Q1 consolidated actual = 25.4%). An additional $685K in provincial childcare operating funds provided for 2014 has eliminated the need for a fee subsidy wait list at this time. Housing Administration is trending a surplus at present due to staffing vacancies and contracted services not yet retained for planned work. Issues/Challenges: Rescheduling and delay of the provincial social assistance technology modernization initiative continues to create uncertainty and operational burden. Upcoming Activity: The Request for Information (RFI) and Request for Proposals (RFP) for provision of Housing and Homelessness Services as detailed in the 10 Year Housing and Homelessness Plan will be issued in the coming weeks. 2.

CHILDCARE FUNDING

Report No. & Title

Date to Committee/ Council

14-095 Childcare Funding Council – April 1, 2014 Update

Link on City website

Group/ Department

14-095

Community Services

Highlights: This report provides a summary of the 2013 Childcare financial standing and related service management activities as well as recommendations for allocation of the additional $685K in provincial childcare operating funds provided for 2014 along with a minor entitlement adjustment related to fee subsidy. Most notable in 2013 was the need for a Fee Subsidy wait list invoked in April 2014 and in effect until August 2013 at which time a cautious dissolution was initiated and the list fully closed out by the end of February 2014. $30K in one time provincial mitigation funding was drawn upon at year end to balance program expenditures to the approved municipal budget for 2014. Council approved the recommendation that the current service management funding policies remain in effect for 2015, effectively adding a second year for local transitioning to the new provincial funding framework. Likewise, recommendations were approved for allocation of the additional provincial childcare operating funds provided for 2014 as follows:

Community and Family Services, Housing and Provincial Offences

Page 86 of 182

AgendaItem#5a) City of Kingston Report to RULAC

May 5, 2014 Page 4 of 13

$585,770 of additional provincial funding dedicated to fee subsidies,
Adjustment to Priority 2 “referral care” fee subsidy entitlement so that children can attend childcare for 12 months (Sept to Aug) rather than being limited to 10 months (September to June),
Allocation of an additional $37,697 in program funding to Community Living Kingston for Special Needs Resourcing, for the expressed purpose of restoring the Enhanced Support funding allocation to its 2012 levels and to enhance French Language service delivery,
Approval of $61,413 for service management administration to address the previous funding shortfall related to longstanding provincial capping of funding for this purpose. Issues/Challenges: The receipt of the additional provincial operating funds for 2014 has significantly reduced the Childcare funding pressures that exist in Kingston and Frontenac at this time. While the expansion of the referral care fee subsidy entitlement to 12 months (item 2 above) is principally intended to ensure that the developmental benefits that children realize through childcare are not lost during the summer vacation hiatus, it is recognized that for childcare centres that serve higher ratios of referral care children (such as the Child Centre in Sharbot Lake), there will be a financial benefit as summer enrollment reductions will be lessened. While the reduction of funding pressures is welcome, it is recognized that childcare providers continue to experience uncertainty from several directions. A significant local change factor is the required remodelling of the current wage subsidy distribution model and policies required under the new Provincial Childcare Funding Framework (2013). Childcare providers continue to anticipate enrollment shifts related to the final phase (Year 5) of Full Day Kindergarten implementation that will occur in Sept 2014. The local childcare service system will also be impacted by other provincial reforms including but not limited to: Ministry of Education - Schools’ First Childcare policy and most recently introduction of the provincial Childcare Modernization Act 2013 and proposed regulatory changed under the Day Nurseries Act (DNA) and Early Childhood Educators Act (ECEA). Upcoming Activity: Locally, staff will continue to work on development and testing of the new distribution model for the new provincial “general operating expense” childcare funding category. Development of this model is being informed by input from service providers and with the extension of the transition period through 2015, has a target effective date of January 2016.

Community and Family Services, Housing and Provincial Offences

Page 87 of 182

AgendaItem#5a) City of Kingston Report to RULAC

May 5, 2014 Page 5 of 13

HOUSING

Report No. & Title

Date to Committee/ Council

Link on City website

Group/ Department

13-025 Amendments to 10 Year Housing & Homelessness Plan

Arts, Recreation & Community Policies Committee – Nov 28, 2013

13-025

Community Services

HHC-13-019 Approval of 10 Year Housing & Homelessness Plan

Housing & Homelessness Committee – Nov 14, 2013

HHC-13-019

Community Services

HHC-14-002

Community Services

HHC-14-002 Implementation of 10 Year Housing & Homelessness Plan

Housing & Homelessness Committee – Jan 23, 2014

Community Services HHC-14-006 Implementation #2 of the 10 Year Housing & Homelessness Plan

HHC-14-007 Implementation of 10 Year Housing & Homelessness Plan

Information Report to Housing & Homelessness Committee – Mar 20, 2014

HHC-14-006

Information Report to Housing & Homelessness Committee – April 10, 2014

HHC-14-007

Community Services

Highlights: Consultations on the development of the provincially mandated 10 Year Municipal Housing & Homelessness Plan began in September 2012 and beginning in April 2013 City staff began reporting to the Housing & Homelessness Advisory Committee (HHAC) on the draft 10 Year Plan giving the opportunity for the Committee to review the draft plan and recommendations over the course of 2013. The Committee’s edits to the recommendations in the Plan were approved by Council in Report 13-025. By way of HHC-13-019 City Council approved the 10 Year Municipal Housing & Homelessness Plan on December 13, 2013 and met the provincial deadline to have an approved plan in place by January 1, 2014.

Community and Family Services, Housing and Provincial Offences

Page 88 of 182

AgendaItem#5a) City of Kingston Report to RULAC

May 5, 2014 Page 6 of 13

In January 2014, City staff took the first of 3 implementation reports to HHAC providing details on each of the four program areas identified in the 10 year plan: Prevention and Diversion; Basic Supports; Emergency Shelters and Housing Assistance Centres; and Housing First/Rapid Re-Housing Programs. The implementation of the plan represents a shift in homeless service delivery, a transformation of the system from one of managing homelessness to one of ending chronic homelessness and a re-allocation of $2.6M of provincial and municipal homelessness funding to support a housing first model. HHC Reports 14-002, 14-006 and 14007 provide details on these changes and information about the issuance of a Request for Information (RFI) scheduled for issuance on April 24th to solicit interest from community agencies in delivering homeless services under the new service delivery model. Under the RFI, agencies can submit their interest in delivering services under three separate streams: Urban services for Individuals and Families; Rural services and Youth services. Under the rural stream, interested parties must commit to providing all services being sought which includes the Prevention Diversion Program including the provision of basic support funding to eligible households and a rapid re-housing program to provide supports to households eligible for support under the program and residing in the rural community. Issues/Challenges: It is the goal to have new homeless service delivery model and associated service providers in place on January 1, 2015 with the exception of the new shelter system which will be in place on July 1, 2015. To meet this goal, the timelines for the issuance and response to the RFI and a subsequent Request for Proposal (RFP) and the evaluation and award of the contracts must be met to allow both successful and unsuccessful service providers the opportunity to make the necessary changes in their organizations. Upcoming Activity: The last date for submissions under the RFI will be May 21, 2014 and will be followed by the release of a Request for Proposal where proponents will be asked to provide more details on their proposals which is scheduled for release on May 29, 2014.

Community and Family Services, Housing and Provincial Offences

Page 89 of 182

AgendaItem#5a) City of Kingston Report to RULAC

May 5, 2014 Page 7 of 13

Report No. & Title

Date to Committee/ Council

Link on City website

Group/ Department

13-344 Information Report – Directives issued under the HSA

Information Report to Council – Nov 5, 2013

13-344

Community Services

HHC 13-018

Community Services

HHC 13-018 Proposed significant amendments to Directives Issued under the Housing Services Act 2011

October 10, 2013

Highlights: The Housing Services Act, 2011 (HSA) replaced the Social Housing Reform Act effective January 1, 2012 and as a result the Service Manager developed local policies to implement the new legislation. The HSA is less prescriptive and provides Service Managers with more flexibility to create policies that are better suited to the needs of their community. The Service Manager collaborated with Housing Providers to develop local policies (Directives) that will direct and assist Housing Providers to meet their legislated requirements and provide safe, well maintained and affordable housing for households in receipt of rent-geared-to-income (RGI) assistance. Most of the new Directives have minor and more housekeeping type of changes and a description of each is included in Council Report 13-344. There are four Directives that may have a greater impact on households applying for social housing and residing in social housing. Although Directives do not require Council approval, Report HHC-018 was for endorsement of four Directives only. H-13-01 Occupancy Standards This local policy sets out the criteria for determining the size of unit a household is eligible for based on the number of household members and the grounds for an additional bedroom. Change: The SHRA was very prescriptive and required Housing Providers to provide an additional bedroom if spouses could not share a bedroom due to a disability or medical condition, for a caregiver or to store equipment required for a disability or medical condition. Under the SHRA, occupancy standards required Housing Providers to provide an additional bedroom for a caregiver. This was removed from the HSA and this Directive. The HSA requires an additional bedroom for children living away from home to attend school and to accommodate a disability or medical condition. The local policy includes the requirements of the HSA and

Community and Family Services, Housing and Provincial Offences

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AgendaItem#5a) City of Kingston Report to RULAC

May 5, 2014 Page 8 of 13

continues to provide bedrooms for foster children and children who are in the unit as part of a visitation order or joint custody. H-13-02 Over-housed Households Over-housed households are households that are residing in an RGI unit that has more bedrooms than the household qualifies for based on the occupancy standards. Change: The SHRA required households to be on the internal transfer list or Centralized Wait List (CWL) immediately following notification of being over-housed. After 12 months, the overhoused household must be added to the CWL with the date of their original application for RGI assistance. The HSA does not require over-housed households to be on any list for the first 12 months and after that time they must follow the local policy which requires over-housed households to be added to the CWL with the date they are added to the CWL. The HSA does not allow using the original application date. H-13-03 RGI Internal Transfer Policy An internal transfer is the move of an RGI household from one RGI unit to another RGI unit managed by the same Housing Provider. Change: The SHRA required Housing Providers to have an internal transfer policy and prescribed the rules allowed in the policy. The HSA does not require Housing Providers to have an internal transfer policy, but if they do, the HSA requires that Special Priority households must be placed at the top of the internal transfer list. A major change in the local policy is allowing current RGI households to apply to the CWL for units managed by their current Housing Provider. Previously, RGI households could apply for an internal transfer only and, unless the household was Special Priority, Over-housed or needed to move for urgent medical reasons, the household was unlikely to be transferred. This change will give households more opportunity to move from one RGI unit to another RGI unit managed by the same Housing Provider. H-13-04 Housing Provider’s Refusal to Offer an RGI Unit This policy sets out the reasons under which a Housing Provider can refuse to offer an RGI unit. Change: The SHRA prescribed the reasons to refuse to offer an RGI unit to a particular household and did not allow the Service Manager to create additional reasons within a local policy. The HSA states that the Service Manager’s reasons to refuse to offer must include the four reasons set out in the HSA. In consultation with Housing Providers and the City’s Senior Legal Counsel, this Directive sets out an additional four reasons. The Service Manager and Housing Providers want to provide safe, well-maintained and affordable housing for low income households. The intent of this policy is to provide Housing Providers with the ability to refuse to offer an RGI unit to households who, based on past behaviour and/or tenancy have demonstrated that they are not likely to adhere to the principles of safe and well maintained housing. Specifically, households that have been evicted from a social housing unit for reasons such as drug trafficking, physical violence, possession of weapons, uttering threats, setting fires or other willful acts which result in significant property damage or that impact the health, safety, quiet enjoyment or security of the Housing Provider’s staff, other tenants or their guests and households that have been convicted of criminal activity while on social housing property and/or

Community and Family Services, Housing and Provincial Offences

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AgendaItem#5a) City of Kingston Report to RULAC

May 5, 2014 Page 9 of 13

while a tenant residing in a local social housing unit that could reasonably impact the health, safety or security of the Housing Provider’s staff, other tenants, their guests or the property. Issues/Challenges: The Service Manager had 45 Directives for Housing Providers which had been issued since 2002. On December 1, 2013, 18 of the current Directives were archived and replaced with the new Directives. Upcoming Activity: The four Directives under Report HHC-10-018 are being introduced as a pilot project which shall be subject to review prior to December 31, 2015, or another date as set by the Service Manager, to determine if it should be amended, revoked, or continues in its current form.

Report No. & Title

Date to Committee/ Council

Link on City website

Group/ Department

14-026 Preliminary Homelessness Count Results

Information Report to Council – Dec 3, 2013

14-026

Community Services

HHC-14-003

Community Services

HHC-14-003 Point-inTime Homelessness Count Final Report

Information Report to Housing & Homelessness Committee – Feb 13, 2014

HHC-14-008 Homelessness Study 2013 Frontenac and Rural Kingston

Information Report to Housing & Homelessness Committee – April 10, 2014

HHC-14-008 Community Services

Highlights: The Housing Department in co-operation with OrgCode and the United Way of Kingston Frontenac Lennox and Addington (United Way of KFLA) conducted the first Point-In-Time Count of homeless persons in the urban area of Kingston on the evening of October 16, 2013. A Point-In-Time Homeless Count was determined not to be an appropriate methodology for the rural areas of the City and the County of Frontenac and instead a survey was conducted by homeless service providers over a ten day period. The survey for both of these purposes was developed in consultation with over 30 homeless service providers.

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AgendaItem#5a) City of Kingston Report to RULAC

May 5, 2014 Page 10 of 13

The Urban Point-In-Time Count is essentially a census of people who are homeless at the time of the Count. Volunteers, recruited with the assistance of the United Way KFLA, were assigned to count homeless persons on the street while shelter staff counted persons staying in one of the six emergency shelters and Interval House and persons who were identified as homeless on the night of the count were asked to answer the anonymous survey. A final report entitled: “State of Homelessness in Kingston, 2013 – Results of the Urban Point-In-Time Homeless Count” was released in February 2014 “ It was determined that the methodology required of a PIT Homeless Count was not feasible in the rural areas of Kingston and in the County of Frontenac. Therefore a different strategy was used which involved outreach to known individuals and families who were homeless or precariously housed. From October 21, 2013 to November 1, 2013, a survey was conducted across Frontenac County to learn more about the experience of rural homelessness in rural Kingston and the County of Frontenac. The survey was conducted through staff at participating social services agencies including South Frontenac Community Services, North Frontenac Community Services, Children’s Aid Society, Frontenac Community Mental Health and Addictions Services, and Ontario Works. The final report, “The State of Homelessness in Frontenac – Results of the Frontenac and Rural Kingston Homelessness Study – 2013” was released in April 2014. Issues/Challenges: The first Point in Time Homeless Count and rural surveys provide the baseline for measuring the success of the implementation of the 10 Year Municipal Housing & Homelessness Plan going forward. There were lessons learned in the first count and survey and the methodology going forward will be improved based on these learnings. Upcoming Activity: One of the strategies identified in the 10 Year Municipal Housing and Homelessness Plan (the Plan) is to conduct a “Point-In-Time” (PIT) Homeless Count at the outset of the implementation of the Plan and every two years thereafter. Report No. & Title

Date to Committee/ Council

Link on City website

Group/ Department

HHC-14-001 Housing Department Performance Indicators

Housing & Homelessness Committee – February 13, 2014

HHC-14-001

Community Services

Highlights: The Housing Department’s Operational Plan for 2013 includes the development of a comprehensive list of benchmarks and performance indicators to be used to assess the progress of the Housing Department.

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AgendaItem#5a) City of Kingston Report to RULAC

May 5, 2014 Page 11 of 13

The Housing Department identified seven key strategic objectives and organized each objective into the following four perspectives: Community, Internal Operations, Employee Engagement and Financial Management. The Department’s objectives were then used to guide the selection of indicators. Over 100 possible indicators were identified through consultation with members of the Housing Department as well as other departments. This list was refined to 28 indicators by focusing on those indicators which most closely reflected one of the seven strategic objectives and could be benchmarked. Issues/Challenges: To narrow the number of indicators from 100 to 28, staff selected the indicators that best represented the core responsibilities of the Housing Department, that were statistically relevant, could be easily tracked and calculated, and would be most useful in assessing the performance of the Housing Department. A clear definition of each indicator was established along with the formula calculation, data source and target. Although the majority of the performance indicators are within the Housing Department’s control, there are others that are influenced by external factors and beyond the Department’s direct control. Both controllable and non-controllable performance indicators have been included as they represent the City’s overall state of housing and homelessness. Upcoming Activity: The performance indicators relating to the Municipal Housing Strategy and 10-Year Housing & Homelessness Plan have been assigned targets based on the recommendations in these documents. For the remaining indicators that do not currently have a target, the intention is to establish a baseline and respective target for each indicator using 2013 results with annual reporting commencing in 2015 for the 2014 calendar year.

Report No. & Title

Date to Committee/ Council

Link on City website

Group/ Department

HHC-14-005 Housing Programs Reporting

Housing & Homelessness Committee - March 20, 2014

HHC-14-005

Community Services

Highlights: The Housing and Homelessness Advisory Committee have a standing request to receive an information update report from the Housing Department on a bi-annual basis in March and September of each year. This report mostly covers information and statistics related to the last half of 2013 on the following 10 programs and statistics:

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AgendaItem#5a) City of Kingston Report to RULAC

May 5, 2014 Page 12 of 13

         

Social Housing Registry waiting list numbers by household size and type Social Housing Registry statistics on households housed and applications received Update on capital project developments under the IAH and AHP programs Rent supplement program updates Emergency shelter usage Kingston Frontenac Renovates Program statistics Homeownership program statistics Update on the Affordable Housing Land Acquisition and Disposition program Update on the Affordable Housing Capital Investment Program Miscellaneous – any other updates relevant to housing programs

Year-end statistics for the Housing Registry indicate that at year end there were 1110 households on the centralized wait list (CWL) for rent-geared-to-income (RGI) assistance. 267 households were housed from the CWL in 2013 and there was a total of 967 new RGI applications received by the Registry in 2013. Year-end Emergency shelter statistics indicate that shelter bed usage in 2013 was eighty-three (83%) percent overall. In March 2014, SHS Consulting was awarded the contract in response to an RFP issued for the End of Operating Agreements and Step-Down Funding strategy. Under the Kingston-Frontenac Renovates Program, grants for accessibility projects (to a maximum of $3,500) and/or interest free forgivable loans (to a maximum of $10,000) are made available to assist low income homeowners complete emergency repairs to their homes. From April to December 2013, 28 households were assisted in this program with a total of $184,000 being allocated. A small amount of funding is deferred to 2014 to address emergency requests such as ’no heat’ calls that materialize during the winter months. Over seventy-five percent of the allocations under this program assist households in the County. Issues/Challenges: Some of the reporting relates to municipally funded programs including the Affordable Housing Land Acquisition and Disposition program, the Affordable Housing Capital Investment Program, the Secondary Suites program, Rideau Heights Renewable Strategy and the Municipal Home ownership program. Upcoming Activity: The 2014 Homeownership program includes repaid funding from the Affordable Housing Program Revolving Fund and is therefore available to both City and County residents. The 2014 program rolled out in March 2014. The 2014 Kingston-Frontenac Renovates Program commences in May 2014 with an additional $200,000 allocation from the provincial Investment in Affordable Housing (IAH) program.

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AgendaItem#5a) City of Kingston Report to RULAC

May 5, 2014 Page 13 of 13

PROVINCIAL OFFENSES

Q4 2013: Please refer to the 2013 Fourth Quarter POA report included as Exhibit C. A verbal summary will be provided at the RULAC meeting.

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Community and Family Services, Housing and Provincial Offences

City of Kingston Analysis - OW, ODSP, CHILDCARE & HOUSING: LSR YTD QUARTERLY REPORT YEAR: 2013

QUARTER:

PROGRAM DESCRIPTION

2013 Consolidated Net Budget

2013 Consolidated Actual Costs to Date

4th

% Consolidated Budget Expended

PERIOD ENDING DATE: 31-Dec-13

2013 City Net Approved Budget

City Actual Costs to Date

City % Budget Expended

Comments

Cost share based on wt assessm’t @ 79.111 City / 20.889 County

ONTARIO WORKS

OW Administration

3,764,036

3,314,730

88.1%

3,063,436

2,668,756

87.1%

$ $ $

3,297,756 63,616 234,301

$ $ $

3,007,392 58,145 210,871

86.5%

3,276,408

$ $ $ $ $

2,824,236 21,488 (14,463) 2,831,260

93.9% 37.0% 0.0%

3,595,673

3,103,486 23,211 (15,891) 3,110,806

94.1% 36.5% 0.0%

$ $ $ $ $

7,359,709

6,425,536

87.3%

6,339,844

5,500,015

86.8%

7,359,709

288,200

100.0%

230,520

227,998

98.9%

$ $ $ $

823,221 2,000 523,938 128,004

$ $ $ $ $

767,653 1,920 419,077 117,354

99.9%

1,306,004

$ $ $ $ $ $ $

732,230 509 442,988 118,445 5,574 (820) 1,298,926

95.4% 26.5% 105.7% 100.9%

1,477,163

784,110 509 559,957 126,197 6,390 (1,030) 1,476,133

95.2% 25.5% 106.9% 98.6%

$ $ $ $ $ $ $

$ $

1,765,363 1,765,363

1,764,333

99.9%

1,536,524

1,526,923

99.4%

Housing Administration Housing Program Costs

$ $

1,092,967 9,596,825

$ $

1,060,529 8,792,269

97.0% 91.6%

$ $

877,283 9,069,680

$ $

843,234 8,295,574

96.1% 91.5%

Emergency Hostels Total Housing Admin & Prog Costs

$ $ $ $

16,378 10,706,170 10,706,170 19,831,242

$ $

294 9,853,092

1.8% 92.0%

$ $

14,740 9,961,703

$ $

268 9,139,076

1.8% 91.7%

18,042,962

91.0%

17,838,071

16,166,014

90.6%

OW Program Delivery OW Allowances Employment Assistance Delivery Residency Benefit other: 1% rate increase subsidy Subtotal OW Program Costs Total OW Admin & Program Costs Actual OW Allowance & Benefit Ratio YTD OW Caseload Average

Includes additional one-time transitional funding from MCSS. As well, higher provincial cost share was available for administration due to client employment expenses being below budget.

Provincial cost share 85.8%. Client employment expenses under budget. Utilized provincial funding only.

86.4%

91.014% 2688

2,943

CHILDCARE SERVICES Childcare Admin. (Reg & ELCC) Childcare Programs Fee Subsidy (DNA, ELCC, OW Formal) Fee Subsidy (Informal OW) Wage Subsidy (DNA, ELCC) Special Needs (DNA & ELCC) Other (Repairs & Maintenance) Other (Prior Year Recovery) Net CC Program Delivery Total Childcare Costs

based on wt apportionment of 79.111%

based on wt apportionment of 79.592%

99.5%

HOUSING SERVICES

date: 2014/04/03

AgendaItem#5a)

Page 97 of 182

Total City-County LSR Soc Serv Costs

Includes $16K additional CHPI funding and one-time MCSS transitional funding.

Community and Family Services, Housing and Provincial Offences

County Analysis - OW, ODSP, CHILDCARE & HOUSING: LSR YTD QUARTERLY REPORT YEAR: 2013

QUARTER:

PROGRAM DESCRIPTION

2013 Consolidated Net Budget

2013 Consolidated Actual Costs to Date

4th

% Consolidated Budget Expended

PERIOD ENDING DATE: 31-Dec-13 County % County Actual Budget Costs to Date Expended

2013 County Net Draft Budget

Comments

ONTARIO WORKS

OW Administration OW Program Delivery OW Allowances Employment Assistance Delivery Residency Benefit other: 1% rate increase subsidy Subtotal OW Program Costs Total OW Admin & Program Costs

3,764,036

3,314,730

88.1%

700,600

645,975

92.2%

$ $ $

3,297,756 63,616 234,301

$ $ $

290,364 5,471 23,430

86.5%

319,265

$ $ $ $ $

279,251 1,724 (1,428) 279,546

96.2% 31.5%

3,595,673

3,103,486 23,211 (15,891) 3,110,806

94.1% 36.5% 0.0%

$ $ $ $ $

7,359,709

6,425,536

87.3%

1,019,865

925,521

90.7%

Actual OW Allowance & Benefit Ratio YTD OW Caseload Average

Includes additional one-time transitional funding from MCSS. As well, higher provincial cost share was available for administration due to client employment expenses being below budget.

Provincial cost share 85.8%. Client employment expenses under budget. Utilized provincial funding only.

87.6%

8.986% 255

2,943

CHILDCARE SERVICES Childcare Admin (Reg & ELCC)

288,200

100.0%

57,680

60,202

104.4%

$ $ $ $ $

823,221 2,000 523,938 128,004

$ $ $ $ $

55,568 80 104,861 10,650

99.9%

171,159

$ $ $ $ $ $ $

51,880 116,969 7,752 816 (210) 177,208

93.4% 0.0% 111.5% 72.8%

1,477,163

784,110 509 559,957 126,197 6,390 (1,030) 1,476,133

95.2% 25.5% 106.9% 98.6%

$ $ $ $ $ $ $

1,765,363

1,764,333

99.9%

228,839

237,410

103.7%

Housing Administration

1,092,967

1,060,529

97.0%

215,684

217,295

100.7%

County share at 20.889% weighted assessment excludes Extreme Clean costs of $20,291 which are 100% City. Salaries/benefits were budgeted lower than actual.

Housing Program Costs

9,596,825

8,792,269

91.6%

527,145

496,695

94.2%

Housing Program Costs include $12,500 Verona loan repayment.

Emergency Hostels Total Housing Admin & Prog Costs

$ $

16,378 10,706,170

$ $

294 9,853,092

1.8% 92.0%

$ $

1,638 744,467

$ $

26 714,016

1.6% 95.9%

Total City-County LSR Soc Serv Costs

19,831,242

18,042,962

91.0%

1,993,171

1,876,947

94.2%

Childcare Programs Fee Subsidy (DNA, ELCC, OW Formal) Fee Subsidy (Informal OW) Wage Subsidy ( DNA, ELCC) Special Needs (DNA & ELCC) Other (Repairs & Maintenance) Other (Prior Year Recovery) Subtotal CC Program Delivery Total Childcare Costs

based on wt apportionmemt pf 20.889%

based on wt apportionmemt 0f 20.889%

based on wt apportionment of 20.408%

103.5%

HOUSING SERVICES

date: 2014/04/03

AgendaItem#5a)

Page 98 of 182

Includes $16K additional CHPI funding and one-time MCSS transitional funding .

Community and Family Services, Housing and Provincial Offences

City of Kingston Analysis - OW, ODSP, CHILDCARE & HOUSING: LSR YTD QUARTERLY REPORT YEAR: 2014

QUARTER: 2014 Consolidated Net Budget

PROGRAM DESCRIPTION

2014 Consolidated Actual Costs to Date

1st

% Consolidated Budget Expended

PERIOD ENDING DATE: 31-Mar-14

2014 City Net Approved Budget

City Actual Costs to Date

City % Budget Expended

Comments

2014 actual includes additional 100% provincial funding and staffing vacancies.

ONTARIO WORKS OW Administration

3,709,409

757,057

20.4%

2,995,311

607,674

20.3%

OW Program Delivery OW Allowances Employment Assistance Delivery Subtotal OW Program Costs

$ $ $

2,630,398 51,072 2,681,470

$ $ $

668,975 3,108 672,084

25.4% 6.1% 25.1%

$ $ $

2,393,019 46,476 2,439,495

$ $ $

606,731 3,039 609,770

25.4% 6.5% 25.0%

Total OW Admin & Program Costs

6,390,879

1,429,140

22.4%

5,434,806

1,217,445

22.4%

surplus due to 1 FTE vacancy & availability of 100% Prov funding

Actual OW Allowance & Benefit Ratio YTD OW Caseload Average

1,429,140

90.728% 2690

2,963

CHILDCARE SERVICES Childcare Admin. (Reg & ELCC)

288,200

55,901

19.4%

229,384

44,224

19.3%

$ $ $ $

810,164 1,604 523,939 125,932

$ $ $ $

166,896 134 159,453 40,547

20.6% 8.4% 30.4% 32.2%

1,461,639

367,030

25.1%

755,350 1,524 417,304 114,976 1,289,154

$ $ $ $ $ $

154,065 134 126,145 37,019 317,363

20.4% 8.8% 30.2% 32.2%

$ $ $ $ $ $

1,749,839

422,931

24.2%

1,518,538

361,587

23.8%

Housing Administration Housing Program Costs Emergency Hostels Total Housing Admin & Prog Costs

$ $ $ $

1,089,909 9,705,848 10,795,757

$ $ $ $

112,824 2,811,897 2,924,721

10.4% 29.0% 0.0% 27.1%

$ $ $ $

868,301 9,115,044 9,983,345

$ $ $ $

89,607 2,692,639 2,782,246

10.3% 29.5% 0.0% 27.9%

Total City-County LSR Soc Serv Costs

18,936,475

4,776,792

25.2%

16,936,689

4,361,278

25.8%

4,776,792

$ $

4,776,792

Childcare Programs Fee Subsidy (DNA, ELCC, OW Formal) Fee Subsidy (Informal OW) Wage Subsidy (DNA, ELCC) Special Needs (DNA & ELCC) Other Net CC Program Delivery Total Childcare Costs

reflects 4 mos of cashflow reflects 4 mos of cashflow

24.6% $

422,931

HOUSING SERVICES Over budget due to property tax cash flow.

2,924,721

4,776,792

AgendaItem#5a)

Page 99 of 182

Under budget as new HPA not yet hired and consulting fees not fully incurred.

Community and Family Services, Housing and Provincial Offences

County Analysis - OW, ODSP, CHILDCARE & HOUSING: LSR YTD QUARTERLY REPORT YEAR: 2014

QUARTER: 2014 Consolidated Net Budget

PROGRAM DESCRIPTION

2014 Consolidated Actual Costs to Date

1st

% Consolidated Budget Expended

PERIOD ENDING DATE: 31-Mar-14 County % County Actual Budget Costs to Date Expended

2014 County Net Draft Budget

Comments

ONTARIO WORKS OW Administration

3,709,409

757,057

20.4%

714,098

149,382

20.9%

OW Program Delivery OW Allowances Employment Assistance Delivery Subtotal OW Program Costs

$ $ $

2,630,398 51,072 2,681,470

$ $ $

668,975 3,108 672,084

25.4% 6.1% 25.1%

$ $ $

237,379 4,596 241,975

$ $ $

62,244 69 62,313

26.2% 1.5% 25.8%

Total OW Admin & Program Costs

6,390,879

1,429,140

22.4%

956,073

211,696

22.1%

Actual OW Allowance & Benefit Ratio YTD OW Caseload Average

2014 actual includes additional 100% provincial funding and staffing vacanies.

9.272% 273

2,963

CHILDCARE SERVICES surplus due to 1 FTE vacancy & availability of 100% Prov funding

Childcare Admin (Reg & ELCC)

288,200

55,901

19.4%

58,816

11,677

19.9%

Childcare Programs Fee Subsidy (DNA, ELCC, OW Formal) Fee Subsidy (Informal OW) Wage Subsidy ( DNA, ELCC) Special Needs (DNA & ELCC) Other Subtotal CC Program Delivery

$ $ $ $ $ $

810,164 1,604 523,939 125,932 1,461,639

$ $ $ $ $ $

166,896 134 159,453 40,547 367,030

20.6% 8.4% 30.4% 32.2%

54,814 80 106,635 10,956 172,485

$ $ $ $ $ $

12,831 33,308 3,528 49,667

23.4% 0.0% 31.2% 32.2%

25.1%

$ $ $ $ $ $

Total Childcare Costs

1,749,839

422,931

24.2%

231,301

61,344

26.5%

Housing Administration

1,089,909

112,824

10.4%

221,608

23,217

10.5%

Under budget as new HPA not yet hired and consulting fees not fully incurred.

Housing Program Costs

9,705,848

2,811,897

29.0%

590,804

119,258

20.2%

Under budget due to prior subsidy adjs for Loughborough and North Frontenac.

Emergency Hostels Total Housing Admin & Prog Costs

$ $

10,795,757

$ $

2,924,721

0.0% 27.1%

$ $

812,412

$ $

142,475

0.0% 17.5%

Total City-County LSR Soc Serv Costs

18,936,475

4,776,792

25.2%

1,999,786

415,515

20.8%

relfects 4 mos of cashflow reflects 4 mos of cashflow

28.8%

HOUSING SERVICES

AgendaItem#5a)

Page 100 of 182

AgendaItem#5a)

CITY OF KINGSTON MEMORANDUM TO:

RULAC

FROM:

HAL LINSCOTT, CITY SOLICITOR AND DIRECTOR OF LEGAL SERVICES

SUBJECT:

POA 2013 FOURTH QUARTER

DATE:

4/22/2014

QUARTERLY REPORT – REVENUE AND EXPENDIT URES 201 3 Q1 2013

Q2 2013

Q3 2013

Q4 2013

YTD 2013

Budget

Fine Revenue

$399,202

$520,233

$480,182

$440,862

$1,840,479

$1,839,000

$162,784

$239,253

$201,941

$250,647

$854,625

$826,901

$12,790,944

$12,874,615

$13,076,635

$13,135,814

Expenditures Outstanding 2 Receivables

Expenditures are shown net of the county’s share of revenues in order to reflect the actual costs of operating the POA
Uncollected fines

COMPARATIVE CHARGES AND REVENUE BY QUARTER Quarter 1 Revenues Charges

Quarter 2 Revenues Charges

Quarter 3 Revenues Charges

Quarter 4 Revenues Charges

Year To Date Revenues Charges

2009

$375,373

3,314

$400,371

3,773

$553,483

5,032

$575,450

3,721

$1,094,677

15,840

2010

$448,840

4,362

$553,252

5,867

$422,766

4,640

$633,876

4,292

$2,058,734

19,161

2011

$448,818

4,211

$547,838

4,708

S552,984

4,452

$424,459

3,161

$1,974.099

16,532

2012

$393,899

3,756

$468,246

3,898

$500,516

4,242

$433,008

2,891

$1,795,669

14,787

2013

$399,202

3,627

$520,233

4,530

$480,182

3,318

$440,862

2,829

$1,840,479

14,304

ACCOUNTS RECEIVABLE POA UNCOLLECTED FINES1 Uncollected Fines Outstanding

60 days or less

2009

2010

$9,772,267

$10,710,985

2011 $12,179,509

2012 $12,720,675

2013 $13,135,814

$260,050

$559,641

$343,595

$204,924

$168,949

$186,625

$239,501

$12,329,125

$12,727,364

60 -120 days

$263,125

$291,707

$523,864

Over 120 days

$9,249,092

$9,859,638

$11,312,050

Collected During $1,246,749 $1,278,689 $1,387,158 $1,268,527 $1,299,505 Period

fines, fees, costs, victim surcharge and collection fees/ 2. Past due date / 3. As of conviction

LARGEST ENFORCEMENT AGENCIES COMPARATIVE CHARGES Agency

2009

2010

2011

Kingston Police South Frontenac OPP Sharbot Lake OPP Ministry of Transportation All other Total

10,986 1,717 1,598 470 1,068 15,840

13,698 2,508 1,731 228 996 19,161

11,437 2,499 847 498 1,251 16,532

Community and Family Services, Housing and Provincial Offences

2012 9,438 2,372 948 381 1,648 14,787

2013 8,453 2,647 1,111 745 1,348 14,304

Page 101 of 182

AgendaItem#5b)

INFORMATION REPORT TO RULAC To:

Chair and Members of RULAC

From:

Marian VanBruinessen Acting CAO/Treasurer

Prepared by:

Paul J. Charbonneau Director of Emergency & Transportation Services/Chief of Paramedic Services

Date Prepared:

April 16, 2014

Date of Meeting:

May 5, 2014

Re:

Emergency and Transportation Services – Highlights of Reports

Highlights Land Ambulance Services Grant (LASG) Transfer Payment Framework Agreement: This agreement is required to be compliant with the Transfer Payment Accountability Directive (TPAD). The Directive requires a signed agreement with each of the Upper Tier Municipalities (UTMs)/Designated Delivery Agents (DDAs) that deliver land ambulance services. The agreement, for the most part, documents existing accountability mechanisms which includes current LASG calculation methodology and financial reporting requirements. Many of the UTMs/DDAs have existing transfer payment agreements in place with the Emergency Health Services Branch (EHSB) for programs such as funding for Dedicated Nurses for Offload Delays. There are also agreements with other areas of the ministry and other ministries for a number of other programs and services (e.g., Public Health Boards of Health). 2013 Legislated Response Time Standard Performance Plan Reporting to MOHLTC: The County of Frontenac met and in fact exceeded all of the response time targets set under our 2013 Response Time Standard Performance Plan.

Information Report Emergency and Transportation – Highlights of Reports May 5, 2014

Emergency and Transportation Services

Page 1 of 2

Page 102 of 182

AgendaItem#5b)

Community Paramedicine (CP) in Ontario Application: County Council approved the submission of an application under the CP initiative to our proposal will look at establishing a rock solid foundation for future programs that meet the objective of “improved delivery and coordination of services in the community for seniors and other patients with unmet needs”, in the geographical area of the County of Frontenac and the City of Kingston. Issues/Challenges None at this time. Upcoming Activity

Essential Ambulance Service Agreement: Pursuant to the Ambulance Services Collective Bargaining Act, 2001 the parties must establish an “Essential Ambulance Services Agreement (EASA)” prior to commencing bargaining for a new or renewal Collective Agreement. The EASA dictates the minimum level of service to be maintained by the bargaining unit in the event of a legal strike or lockout. The County and OPSEU Local 462 have been unable to reach an agreement therefore the parties are commencing a mediation process at the Ontario Labour Relations Board on May 12, 2014.
FPS is commencing the review and update of the 2005 IBI Study - Strategic Review of Ambulance Station Options in the City of Kingston. This will involve an analysis of 2013 call volumes and response trends, current and possible station locations and reviewing opportunities to co-locate with Kingston Fire & Rescue stations. County staff will communicate with City planning and GIS staff as well as other stakeholders.

Information Report Emergency and Transportation – Highlights of Reports May 5, 2014

Emergency and Transportation Services

Page 2 of 2

Page 103 of 182

AgendaItem#5b)

County of Frontenac 2013 YEAR END Frontenac Paramedic Service Summary Description

2013 Budget

2013 Actuals

OPERATING REVENUE Provincial/Federal Funding User Fees Recoveries Internal Transfers TOTAL REVENUE Transfer from Reserves TOTAL REVENUE AND RESERVE TRNSF. EXPENSE Salaries Benefits Office Supplies and Repair Medical Supplies and Repair Equipment Supplies and Repair Advertising Public Relations Travel Membership Fees Training Fees, Accommodation, Travel Conference Fees, Accommodation, Travel Health and Safety Training Training Materials Audit Legal and Labour Relations Contracted services Insurance Building Maintenance Communications Supplies, Service and Equip. Vehicle Service and Supplies Rentals, Leases, Penalties and Interest Utility Costs External Transfers Other Internal Transfers - Reserve Depreciation TOTAL OPERATING EXPENSE TOTAL OPERATING - NON CASH DEPRECIATION

7,541,214 0 0 0 7,541,214

7,646,352 11,970 803 6,542 7,665,667

0 151,860 ================== ================== 7,541,214 7,817,527

9,115,868 9,424,332 2,883,643 3,068,034 101,000 89,906 317,000 310,059 89,900 77,056 5,600 4,394 7,500 5,671 29,000 14,442 3,500 3,723 21,000 23,425 8,000 7,250 5,000 0 3,000 0 6,340 6,366 15,000 25,067 41,000 68,725 117,681 122,925 153,875 210,176 230,336 227,093 658,740 563,031 232,074 209,915 79,960 83,281 233,768 233,832 5,500 4,608 737,275 737,275 903,396 824,107 16,004,956 16,344,693 ================== ================== 15,101,560 15,520,586

NET OPERATING EXPENSE

7,560,346

City of Kingston Contribution (79.11% budgeted at 79.509%)

6,011,164

7,703,059 6,093,966.25

CAPITAL CAPITAL REVENUE

Emergency and Transportation Services

Page 104 of 182

AgendaItem#5b)

Reserve transfer TOTAL CAPITAL REV. AND RESERVE TRNSF.

861,662 861,662

528,381 528,381

CAPITAL EXPENSE

888,924

553,357

Net capital expense

27,262

24,976

City’s share of capital

24,135

19,759

Total City contribution City contribution to capital - prior year

6,035,299 11,998

TOTAL City contribution Amount received in 2013 Account receivable from City

Emergency and Transportation Services

19,759 6,113,725 10,873 6,102,852

6,023,301

6,023,301 79,551

Page 105 of 182

AgendaItem#5b)

Report 2014-019 INFORMATION REPORT TO COUNCIL To:

Warden and Council Members of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/Director of Corporate Services/Treasurer

Prepared by:

Paul J. Charbonneau Director of Emergency & Transportation Services/Chief of Paramedic Services

Date prepared:

January 24, 2014

Date of meeting:

February 19, 2014

Re:

Emergency and Transportation Services - 2013 4th Quarter Activity Update

Recommendation RESOLVED THAT the Council of the County of Frontenac accept the Emergency and Transportation Services – 2013 4th Quarter Activity Update report for information.

Background This report is presented to Council to provide an update on the various ongoing activities and special projects during the 4th quarter of 2013.

Comment Meetings Attended County Council – Regular Meeting County Council – Special Meeting County Council – Committee of the Whole County Council – Joint Council Joint Management and RULAC County Emergency Management Program Committee City of Kingston Emergency Management Program Information Report to Council th Emergency and Transportation Services – 2013 4 Quarter Activity Update February 19, 2014

Emergency and Transportation Services

Dates Oct 16, Nov 20, Dec 18 Nov 6 Nov 14/Nov 25

Page 1 of 5

Page 106 of 182

AgendaItem#5b)

CACC Adviisory C R Regional P Paramedic Program of Easte ern Ontario o ( (RPPEO) O OPSEU Loc cal 462 Lab bour Manag gement Com mmittee C CUPE Loca al 109 Labo our Manage ement Committee C County Hea alth & Safetty Committe ee E EMO Loyalist Sector Meeting M

C Committee Activities

Ontarrio Associattion of Para amedic Chie efs (OAPC)) Executive e (Teleconfe erence): Every y Monday morning m
Ontarrio Associattion of Para amedic Chiefs (OAPC C) Board: Oct 25 and Dec D 10/11 (face ( to fac ce in Torontto)
EHSB B/OAPC Qu uarterly Mee eting: Dece ember 12
OAPC C - Eastern Ontario Ch hiefs:
Param medic Chieffs of Canad da (PCC) (v via teleconfference): a. Executive e: Novembe er 4 D ace-to-face in Toronto)) b. Board of Directors: November 26 & 27 (fa

Q Performance Standards - Ke Q4 ey Performance Indic cators (KPII)

C County of Frontenac c Legislated Respons se Time Sttandard (RT TS)

Infformation Repo ort to Council Em mergency and Transportation n Services – 20 013 4th Quarter Activity Update Fe ebruary 19, 201 14

Emergency and Transportation Services

Page 2 of 5

Page 107 of 182

AgendaItem#5b)

For the calen ndar year of o 2013, from m January 1 to Decem mber 31, Co ouncil set th he following g sttandards: i. Des signated De elivery Agen nt (DDA) - SUDDEN S C CARDIAC A ARREST 48% percent p of the t time, wiithin 6 minu utes from th he time amb bulance dis spatch conv veys the ca all informatiion to the paramedic, p t County the y of Fronten nac will endeavour to have h a resp ponder equ uipped and ready to us se an AED at the locattion of a patient determ mined to be e in sudden n cardiac arrrest. MS Designatted Delivery y Agent - CTAS C 1 ii. EM 68% percent p of the t time, wiithin 8 minu utes from th he time amb bulance dis spatch conv veys the ca all informatiion to the paramedic, p t County the y of Fronten nac will endeavour to have h a PAR RAMEDIC as a defined by the Amb bulance Actt and duly equipped e att the locatio on of a patient determined to be CTAS 1. iii. EM MS Designa ated Deliverry Agent - CTAS C 2, 3, 4, 5 The County C of Frontenac will w endeavo our to have a PARAME EDIC as de efined by the e Ambu ulance Act and a duly eq quipped at the t location n of a patien nt determin ned to be CT TAS 2, 3, 4, 4 5 within a period of time determ mined apprropriate by the t DDA an nd noted be elow in Tab ble 1, or as resources permit (lev vel of effort)):

CTAS 2, 3, 3 4, 5 EMS S Delivery Agent A Com mmitment CTA AS 2 3 4 5

Targe et Time from m Paramedic Received d Until on Scene S 10 minutes 10 minutes 10 minutes 10 minutes

Target 65% 65% 65% 65%

The im mage below w speaks to o the fact th hat 98.49% of our resp ponses during the 4th quarte er of 2013 were w deem med emerge ency ambula ance respo onses comp pared to 66% % in 2000.. Non-urge ent transfers s have beco ome a very y small perc centage (1.5 5%) of our worklo oad compa ared to 33% % in 2000. This T was ou ur goal whe en we estab blished Minim mum Emerg gency Cove erage (MEC C) in the earrly 2000s.

Infformation Repo ort to Council Em mergency and Transportation n Services – 20 013 4th Quarter Activity Update Fe ebruary 19, 201 14

Emergency and Transportation Services

Page 3 of 5

Page 108 of 182

AgendaItem#5b)

The im mage (belo ow) illustrate es the type of emergen ncy calls we responde ed to during g the 4th qu uarter.

Q Ischemic Q4 c Chest Pain (131 calls s—50% clin nical improv vement)

Q Operatio Q4 ons - Key Pe erformance e Indicators (KPI) During 2012, our entire D e ambulance e fleet was outfitted with the new w ACETECH H software. The so oftware has s two eleme ents to it:

Au utomatic Ve ehicle Locator (AVL) which w is ourr GPS syste em
EC CO-RUN which is the program th hat monitors s battery vo oltage and inside temperatures s The report below, b extra acted from the t software e shows on ne ambulan nce’s perforrmance (Un nit

within the ECOR RUN softwarre. aded boxes s show the total t saving gs for the fle eet of fifteen ambulanc ces for the 4th The four sha qu uarter of 20

Infformation Repo ort to Council Em mergency and Transportation n Services – 20 013 4th Quarter Activity Update Fe ebruary 19, 201 14

Emergency and Transportation Services

Page 4 of 5

Page 109 of 182

AgendaItem#5b)

The system has saved the County of Frontenac EMS $1078.25 in fuel costs from October to December, 2013 based on $1.25/litre.

Information Report to Council th Emergency and Transportation Services – 2013 4 Quarter Activity Update February 19, 2014

Emergency and Transportation Services

Page 5 of 5

Page 110 of 182

AgendaItem#5b)

Report 2014-063 INFORMATION REPORT TO COUNCIL To:

Warden and Council Members of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/Director of Corporate Services/Treasurer

Prepared by:

Paul J. Charbonneau Director of Emergency & Transportation Services/Chief of Paramedic Services

Date prepared:

March 26, 2014

Date of meeting:

April 16, 2014

Re:

Emergency and Transportation Services - 2014 1st Quarter Activity Update

Recommendation RESOLVED THAT the Council of the County of Frontenac accept the Emergency and Transportation Services – 2014 1st Quarter Activity Update report for information.

Background This report is presented to Council to provide an update on the various ongoing activities and special projects during the 1st quarter of 2014.

Comment Meetings Attended County Council – Regular Meeting County Council – Special Meeting County Council – Committee of the Whole County Council – Joint Council Joint Management and RULAC County Emergency Management Program Committee City of Kingston Emergency Management Program Information Report to Council st Emergency and Transportation Services – 2014 1 Quarter Activity Update April 16, 2014

Emergency and Transportation Services

Dates Jan 15, Feb 19, Mar 19 Jan 29, Jan 30 Jan 8, Feb 5, Feb 7, Mar 5

Feb 25

Page 1 of 5

Page 111 of 182

AgendaItem#5b)

CACC Adviisory C R Regional P Paramedic Program of Easte ern Ontario o ( (RPPEO) O OPSEU Loc cal 462 Lab bour Manag gement Com mmittee Jan 7, Feb F 27 C CUPE Loca al 109 Labo our Manage ement Committee Feb 25 C County Hea alth & Safetty Committe ee Mar 14 E EMO Loyalist Sector Meeting M

C Committee Activities

Ontarrio Associattion of Para amedic Chie efs (OAPC)) Executive e (Teleconfe erence): Every y Monday morning m
Ontarrio Associattion of Para amedic Chie efs (OAPC) Board: Oc ct 25 and Dec D 10/11 (ffaceto-fac ce in Torontto)
EHSB B/OAPC Qu uarterly Mee eting: s
OAPC C - Eastern Ontario Ch hiefs: Jan 30 3 th and 31st
Param medic Chieffs of Canad da (PCC) (v via teleconfference): a. Executive e: Jan 27th and a 28th (face-to-face in Toronto) D J 13, Feb Jan b 10, Mar 10 1 b. Board of Directors:

Q Performance Standards - Ke Q4 ey Performance Indic cators (KPII) C County of Frontenac c Legislated Respons se Time Sttandard (RT TS)

Infformation Repo ort to Council Em mergency and Transportation n Services – 20 014 1st Quarter Activity Update Ap pril 16, 2014

Emergency and Transportation Services

Page 2 of 5

Page 112 of 182

AgendaItem#5b)

For the calen ndar year of o 2014 from m January 1 to Decem mber 31, Co ouncil set th he following sttandards: i. Des signated De elivery Agen nt (DDA) - SUDDEN S C CARDIAC A ARREST 48% percent p of the t time, wiithin 6 minu utes from th he time amb bulance dis spatch conv veys the ca all informatiion to the paramedic, p t County the y of Fronten nac will endeavour to have h a resp ponder equ uipped and ready to us se an AED at the locattion of a patient determ mined to be e in sudden n cardiac arrrest. ii. EM MS Designatted Delivery y Agent - CTAS C 1 68% percent p of the t time, wiithin 8 minu utes from th he time amb bulance dis spatch conv veys the ca all informatiion to the paramedic, p t County the y of Fronten nac will endeavour to have h a PAR RAMEDIC as a defined by the Amb bulance Actt and duly equipped e att the locatio on of a patient determined to be CTAS 1. iii. EM MS Designa ated Deliverry Agent - CTAS C 2, 3, 4, 5 The County C of Frontenac will w endeavo our to have a PARAME EDIC as de efined by the e Ambu ulance Act and a duly eq quipped at the t location n of a patien nt determin ned to be CT TAS 2, 3, 4, 4 5 within a period of time determ mined apprropriate by the t DDA an nd noted be elow in Tab ble 1, or as resources permit (lev vel of effort)):

CTAS 2, 3, 3 4, 5 EMS S Delivery Agent A Com mmitment CTA AS 2 3 4 5

Targe et Time from m Paramedic Received d Until on Scene S 10 minutes 10 minutes 10 minutes 10 minutes

Target 65% 65% 65% 65%

The im mage below w speaks to o the fact th hat 98.49% of our resp ponses during the 1st quarte er of 2014 were w deem med emerge ency ambula ance respo onses comp pared to 66% % in 2000.. Non-urge ent transfers s have beco ome a very y small perc centage (1.5 5%) of our worklo oad compa ared to 33% % in 2000. This T was ou ur goal whe en we estab blished Minim mum Emerg gency Cove erage (MEC C) in the earrly 2000s.

Infformation Repo ort to Council Em mergency and Transportation n Services – 20 014 1st Quarter Activity Update Ap pril 16, 2014

Emergency and Transportation Services

Page 3 of 5

Page 113 of 182

AgendaItem#5b)

The im mage (belo ow) illustrate es the type of emergen ncy calls we responde ed to during g the 1st quarter.

Q Ischemic Q4 c Chest Pain (131 calls s—50% clin nical improv vement)

Q Operatio Q4 ons - Key Pe erformance e Indicators (KPI) During 2012, our entire D e ambulance e fleet was outfitted with the new w ACETECH H software. The so oftware has s two eleme ents to it:

Au utomatic Ve ehicle Locator (AVL) which w is ourr GPS syste em
EC CO-RUN which is the program th hat monitors s battery vo oltage and inside temperatures s The report below, b extra acted from the t software e, shows on ne ambulan nce’s performance (Un nit

within the ECOR RUN softwarre. The four sha aded boxes s show the total t saving gs for the fle eet of fifteen ambulanc ces for the 1st qu uarter of 20

Infformation Repo ort to Council Em mergency and Transportation n Services – 20 014 1st Quarter Activity Update Ap pril 16, 2014

Emergency and Transportation Services

Page 4 of 5

Page 114 of 182

AgendaItem#5b)

Th he system m has saved th he County of Frontenac F EMS S $897.37 in fu uel costs from m January to March, M 20 014 based on $1.25/litre.

Infformation Repo ort to Council Em mergency and Transportation n Services – 20 014 1st Quarter Activity Update Ap pril 16, 2014

Emergency and Transportation Services

Page 5 of 5

Page 115 of 182

AgendaItem#5b)

Report 2013-226 ADMINISTRATIVE REPORT To:

Warden and Council Members of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/Treasurer

Prepared by:

Paul J. Charbonneau Director of Emergency & Transportation Services/Chief of Paramedic Services

Date prepared:

November 27, 2013

Date of meeting:

December 18, 2013

Re:

Emergency & Transportation Services – Land Ambulance Services Grant (LASG) Transfer Payment Framework Agreement

Recommendation BE IT RESOLVED THAT the Council of the County of Frontenac receive this Emergency and Transportation Services – Land Ambulance Services Grant (LASG) Transfer Payment Framework Agreement report for information; and FURTHER THAT the Council of the County of Frontenac authorize the Warden and Clerk to execute the agreement with the Ministry of Health and Long Term Care, Emergency Health Services Branch.

Background Through negotiations with representatives from the Association of Municipalities Ontario (AMO), the City of Toronto, the Northern Ontario Service Deliverers Association (NOSDA), the District Social Services Administration Boards (DSSABs), and the Ontario Association of Paramedic Chiefs (OAPC), the Ministry has reached consensus on a final draft of the Land Ambulance Services Grant (LASG) Transfer Payment Framework Agreement. This agreement is required to be compliant with the Transfer Payment Accountability Directive (TPAD). The Directive requires a signed agreement with each Administrative Report Emergency and Transportation Services – Land Ambulance Services Grant (LASG) Transfer Payment Framework Agreement December 18, 2013 Page 1 of 2

Emergency and Transportation Services

Page 116 of 182

AgendaItem#5b)

of the Upper Tier Municipalities (UTMs)/Designated Delivery Agents (DDAs) that deliver land ambulance services. The agreement, for the most part, documents existing accountability mechanisms which includes current LASG calculation methodology and financial reporting requirements. Many of the UTMs/DDAs have existing transfer payment agreements in place with the Emergency Health Services Branch (EHSB) for programs such as funding for Dedicated Nurses for Offload Delays. There are also agreements with other areas of the ministry and other ministries for a number of other programs and services (e.g., Public Health Boards of Health).

Comment Stakeholder representatives and the Ministry met on several occasions and the group undertook a clause-by-clause review of the proposed agreement and arrived at mutually agreeable content. This agreement balances the needs of the Upper Tier Municipalities/Designated Delivery Agents (UTMs/DDAs) in the delivery of land ambulance services with the provincial requirements. Included in the agreement is the Service Plan and Final Program Report template (Appendix 4), with the purpose to demonstrate accountability in the use of public funds and value-for-money. The Service Plan and Final Program Report template was based upon stakeholder consultations and current availability of the data. In the future, the Ministry will consult with the stakeholders to enhance reporting requirements through the development of standardized benchmarks and key performance indicators (KPIs) that the UTMs/DDAs and Ministry can use for consistent comparison and service/fiscal planning. A Final draft of the document is appended to the report. Financial Implications None Organizations, Departments and Individuals Consulted and/or Affected Association of Municipalities Ontario (AMO) Northern Ontario Service Deliverers Association (NOSDA) District Social Services Administration Boards (DSSABs) Ontario Association of Paramedic Chiefs (OAPC)

Administrative Report Emergency and Transportation Services – Land Ambulance Services Grant (LASG) Transfer Payment Framework Agreement December 18, 2013 Page 2 of 2

Emergency and Transportation Services

Page 117 of 182

AgendaItem#5b)

FINAL DRAFT THIS AGREEMENT effective as of the 1st day of January, 2014 BETWEEN: HER MAJESTY THE QUEEN IN RIGHT OF ONTARIO, as represented by the Minister of Health and Long-Term Care (the “Province”)

and ● (the “UTM/DDA”)

Background: The Ambulance Act provides that every UTM/DDA shall be responsible for ensuring the proper provision of Land Ambulance Services. The Act also provides that every UTM/DDA shall be responsible for all costs associated with Land Ambulance Services and that the Minister may make grants pursuant to section 4(3) of the Act for the purpose of providing or ensuring the provision of Land Ambulance Services. The Parties acknowledge that the Act also provides that the Minister has the duty and the power to establish, maintain and operate Communication Services, alone or in cooperation with others, and to fund such services. The Minister also has the duty and the power to ensure the existence of a balanced and integrated system of Ambulance Services and Communication Services used in dispatching Ambulances. This Agreement sets out the terms and conditions governing the Grant, and the delivery of the Program. Consideration: In consideration of the mutual covenants and agreements contained herein and for other good and valuable consideration, the receipt and sufficiency of which are expressly acknowledged, the Parties agree as follows: ARTICLE 1 INTERPRETATION AND DEFINITIONS 1.1

Interpretation. For the purposes of interpretation: (a) words in the singular include the plural and vice-versa; (b) words in one gender include all genders; (c) the background and the headings do not form part of the Agreement; they Page 1

Emergency and Transportation Services

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AgendaItem#5b)

are for reference only and shall not affect the interpretation of the Agreement; (d) any reference to dollars or currency shall be to Canadian dollars and currency; and (e) “include”, “includes” and “including” shall not denote an exhaustive list. 1.2

Definitions. In this Agreement, the following terms shall have the following meanings: “Act” means the Ambulance Act, R.S.O. 1990, c.A. 19. “Agreement” means this agreement entered into between the Province and the UTM/DDA, and includes all of the schedules to the agreement listed in section 23.1. “Ambulance” has the same meaning as defined in the Act. “Ambulance Service” has the same meaning as defined in the Act. “BPSAA” means the Broader Public Sector Accountability Act, 2010 (Ontario), including any directives issued pursuant to that Act. “Communication Service” has the same meaning as defined in the Act. “DDA” and “Designated Delivery Agent” has the same meaning as defined in the Act. “Effective Date” means the date set out at the top of the Agreement. “Emergency Health Services Branch” and “EHSB” means the Emergency Health Services Branch of the Ministry of Health and Long-Term Care. “Event of Default” has the meaning ascribed to it in section 12.1. “Funding Year” means: (a)

in the case of the first Funding Year, from the Effective Date to December 31st; and

(b)

in subsequent Funding Years, from January 1 to December 31st.

“Grant” means the grant provided to the UTM/DDA by the Province pursuant to section 4(3) of the Act and this Agreement. The Grant is: i)

fifty per cent (50%) of the approved operating costs of Land Ambulance Services provided by the UTM/DDA; and

ii)

one hundred percent (100%) of the approved operating costs of Land Ambulance Services provided by the UTM/DDA to a First Nations community or communities; and/or Page 2

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AgendaItem#5b)

iii)

one hundred percent (100%) of the approved operating costs of Land Ambulance Services provided by the UTM/DDA to a territory or territories without municipal organization (“TWOMO”);

for a Funding Year as calculated in Schedule “B”. “Indemnified Parties” means Her Majesty the Queen in Right of Ontario, Her ministers, agents, appointees and employees. “Land Ambulance Services” has the same meaning as defined in the Act. “Minister” means Her Majesty the Queen in Right of Ontario as represented by the Minister of Health and Long-Term Care. “Notice” means any communication given or required to be given under this Agreement, as described in Article 14. “Notice Period” means the period of time within which the UTM/DDA is required to remedy an Event of Default, and includes any such period or periods of time by which the Province considers it reasonable to extend that time. “Parties” means the Province and the UTM/DDA. “Party” means either the Province or the UTM/DDA. “Payment Plan” means the payment plan set out in Schedule “C”. “Personal Health Information” means the personal health information as defined in the Personal Health Information Protection Act, 2004, S.O. 2004, c.3, Schedule A. “Program” means the undertaking described in Schedule “A”. “Regulations” means the regulations made under the Act. “Reports” means the reports described in Schedule “D”. “Service Plan” means the UTM/DDA’s plan for the provision of Land Ambulance Services and includes but is not limited to deployment plan(s) for ambulance and emergency response vehicles and any other initiatives that form part of the Program. “Standards” means the standards developed by the Province and incorporated by reference in Ontario Regulation 257/00. “TWOMO” means a territory or territories without municipal organization. “Upper-Tier Municipality” and “UTM” has the same meaning as defined in the Act. “UTM/DDA” means the Upper-Tier Municipality or Designated Delivery Agent.

Page 3

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AgendaItem#5b)

ARTICLE 2 REPRESENTATIONS, WARRANTIES AND COVENANTS 2.1

2.2

2.3

General. The UTM/DDA represents, warrants and covenants that: (a)

it is, and shall continue to be for the term of the Agreement, a validly existing legal entity with full power to fulfill its obligations under the Agreement;

(b)

unless otherwise provided for in this Agreement, any information the UTM/DDA provided to the Province in support of its requests for a Grant was true and complete at the time the UTM/DDA provided it and shall continue to be true and complete for the term of this Agreement, unless otherwise reported in writing by the UTM/DDA to the Province.

Execution of Agreement. The UTM/DDA represents and warrants that: (a)

it has the full power and authority to enter into the Agreement;

(b)

it will fulfill the obligations set out in the Schedules to this Agreement in accordance with their terms;

(c)

it will deliver the Program and will comply with the Agreement, the Act, the Regulations and the Standards;

(d)

it has taken all necessary actions to authorize the execution of the Agreement including, where required, passing a board resolution or municipal by-law authorizing the UTM/DDA to enter into the Agreement with the Province.

Governance. The UTM/DDA represents, warrants and covenants that it has, and shall maintain, in writing, for the period during which the Agreement is in effect: (a)

a code of conduct and ethical responsibilities for all persons at all levels of the UTM/DDA’s organization;

(b)

procedures to ensure the ongoing effective functioning of the UTM/DDA;

(c)

decision-making mechanisms;

(d)

procedures to provide for the prudent and effective management of the Grant;

(e)

procedures to enable the successful completion of the obligations set out in the Schedules to this Agreement;

(f)

procedures to enable the timely identification of risks to the UTM/DDA’s ability to perform its obligations under this Agreement and strategies to address the identified risks;

(g)

procedures to enable the preparation and delivery of all Reports required pursuant to Article 6; and Page 4

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AgendaItem#5b)

(h)

2.4

procedures to deal with such other matters as the UTM/DDA considers necessary to ensure that the UTM/DDA carries out its obligations under the Agreement.

Supporting Documentation. Upon request, the UTM/DDA shall provide the Province with proof of the matters referred to in this Article 2. ARTICLE 3 TERM OF THE AGREEMENT

3.1

Term. The term of the Agreement shall commence on the Effective Date and shall continue unless terminated pursuant to Article 10, Article 11 or Article 12.

3.2

Term of Schedules. A Schedule, or parts thereof, may apply for only part of the Term of this Agreement, where a Schedule indicates such in writing.

3.3

Revised and Additional Schedules. The Parties may, at any time during the Term of the Agreement, recommend changes to the Schedules. The Province may, at any time, upon consultation with the UTM/DDA provide additions or revisions to the Schedules, and a new Program, a new Grant, a new Payment Plan, and/or new Reports, which shall be deemed to replace the Program Description in Schedule “A”, the Grant in Schedule “B”, the Payment Plan in Schedule “C”, and the Reports in Schedule “D”. ARTICLE 4 GRANT

4.1

Grant Provided. The Province shall: (a) provide the UTM/DDA a Grant for the purpose of carrying out the obligations set out in the Act, the Regulations, the Standards, and this Agreement including the Schedules to this Agreement; (b) provide the Grant in accordance with the provisions of the Payment Plan; and (c) deposit the Grant into an account designated by the UTM/DDA provided that the account resides at a Canadian financial institution.

4.2

Limitation on Payment of the Grant. Despite section 4.1, the Province: (a)

is not obligated to provide any Grant to the UTM/DDA until the UTM/DDA provides a valid certificate of insurance or other proof as provided for in section 9.2;

(b)

is not obligated to provide instalments of the Grant until it is satisfied with the progress of the obligations set out in this Agreement and the Schedules;

(c)

may adjust the amount of the Grant it provides to the UTM/DDA in any Funding Year based upon the Province’s assessment of the information provided by the UTM/DDA pursuant to section 6.1; Page 5

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(d)

4.3

if, pursuant to the provisions of the Financial Administration Act (Ontario), the Province does not receive the necessary appropriation from the Ontario Legislature for payment under the Agreement, the Province shall not be obligated to make any such payment, and, as a consequence, the Province may: (i)

reduce the amount of the Grant; or

(ii)

terminate the Agreement pursuant to section 11.1 and cease providing Grant funding for a period or periods specified by the Province.

Use of Grant Funding. The UTM/DDA shall: (a)

use the Grant only for the provision of the Program described in this Agreement and the Schedules;

(b)

carry out the obligations in the Schedules:

(c)

(i)

in accordance with the terms and conditions of the Agreement; and

(ii)

in compliance with all federal and provincial laws and regulations, all municipal by-laws, and any other orders, rules and by-laws related to any aspect of the Program;

spend the Grant only in accordance with Schedule “B”.

4.4

No Capital Costs. The Parties acknowledge that capital costs are excluded from this Agreement and that the Grant cannot be utilized towards any capital costs that may be incurred by the UTM/DDA.

4.5

No Changes. The UTM/DDA shall not make any changes to Schedules, and/or the use of the Grant without the prior written consent of the Province.

4.6

Interest Bearing Account. If the Province provides the Grant to the UTM/DDA prior to the UTM/DDA’s immediate need for the Grant, the UTM/DDA shall place the Grant in an interest bearing account in the name of the UTM/DDA at a Canadian financial institution.

4.7

Interest. If the UTM/DDA earns any interest on the Grant, the Province may deduct an amount equal to the interest from any further instalments of the Grant, or it shall pay an amount equal to the interest to the Province as directed by the Province.

4.8

Rebates, Credit and the Grant. The UTM/DDA shall not use the Grant for any costs, including taxes, for which it has received, will receive, or is eligible to receive a rebate, credit or refund.

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ARTICLE 5 CONFLICT OF INTEREST 5.1

5.2

5.3

No Conflict of Interest with use of the Grant. The UTM/DDA shall carry out the obligations set out in this Agreement and use the Grant without an actual or potential conflict of interest. Conflict of Interest Includes. For the purposes of this Article, a conflict of interest includes any circumstances where: (a)

the UTM/DDA; or

(b)

any person who has the capacity to influence the UTM/DDA’s decisions, has outside commitments, relationships or financial interests that could interfere with the UTM/DDA’s objective, unbiased and impartial judgment relating to its obligations under this Agreement and the use of the Grant.

Disclosure to Province. The UTM/DDA shall: (a)

disclose to the Province, without delay, any situation that a reasonable person would interpret as either an actual or potential conflict of interest; and

(b)

comply with any terms and conditions that the Province may reasonably prescribe as a result of the disclosure. ARTICLE 6 REPORTING, ACCOUNTING AND REVIEW

6.1

6.2

Preparation and Submission. The UTM/DDA shall: (a)

submit to the Province at the address provided in section 14.1 or at any other address specified by the Province, all Reports in accordance with the timelines and content requirements set out in Schedule “D”;

(b)

submit to the Province at the address provided in section 14.1, or at any other address specified by the Province, any other reports requested by the Province in accordance with the timelines and content requirements specified by the Province;

(c)

ensure that all Reports and other reports are completed to the satisfaction of the Province; and

(d)

ensure that all Reports and other reports are signed on behalf of the UTM/DDA by an authorized signing officer.

Record Maintenance. The UTM/DDA shall keep and maintain: (a)

all financial records (including invoices) relating to the Grant in a manner consistent with generally accepted accounting principles for a period of not less than seven (7) years; and

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(b)

6.3

all non-financial documents and records relating to the Grant and the Schedules in accordance with applicable law and the UTM/DDA’s policies.

Inspection. The Province, its authorized representatives or an independent Auditor identified by the Province may, at its own expense, upon forty-eight hours’ Notice to the UTM/DDA and during normal business hours, enter upon the UTM/DDA’s premises to review the UTM/DDA’s expenditure of the Grant, and for these purposes, the Province, its authorized representatives or an independent auditor identified by the Province may: (a)

inspect and copy the records and documents referred to in section 6.2; and

(b)

conduct an audit or investigation of the UTM/DDA in respect of the expenditure of the Grant.

This inspection is in addition to and separate from the inspection under section 18 of the Act. 6.4

Disclosure. To assist in respect of the rights set out in section 6.3, the UTM/DDA shall disclose any information requested by the Province, its authorized representatives or an independent auditor identified by the Province, and shall do so in a form requested by the Province, its authorized representatives or an independent auditor identified by the Province, as the case may be, subject to applicable law.

6.5

No Control of Records. No provision of the Agreement shall be construed so as to give the Province any control whatsoever over the UTM/DDA’s records.

6.6

Auditor General. For greater certainty, the Province’s rights under this Article are in addition to any rights provided to the Auditor General pursuant to section 9.1 of the Auditor General Act (Ontario). ARTICLE 7 FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY

7.1

FIPPA. The UTM/DDA acknowledges that the Province is bound by the Freedom of Information and Protection of Privacy Act, 2004 (Ontario) (FIPPA) and that any information provided to the Province in connection with the Agreement may be subject to disclosure in accordance with FIPPA.

7.2

MFIPPA. The Province acknowledges that the UTM/DDA is bound by the Municipal Freedom of Information and Protection of Privacy Act (Ontario) (MFIPPA) and that any information provided to the UTM/DDA in connection with the Agreement may be subject to disclosure in accordance with MFIPPA.

7.3

Confidentiality of Records - UTM/DDA. The UTM/DDA shall ensure that all personal information or personal health information in its custody or under its control is managed in accordance with the provisions of the Act, the Regulations, the Standards, the Municipal Freedom of Information and Protection of Privacy Act and its regulations, the Personal Health Information Protection Act, 2004 and any other applicable legislation.

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7.4

Confidentiality of Records - Province. The Province shall ensure that all personal information or personal health information in its custody or under its control in connection with this Agreement is managed in accordance with all applicable legislation. ARTICLE 8 INDEMNITY

8.1

Indemnification. The UTM/DDA hereby agrees to indemnify and hold harmless the Indemnified Parties from and against any and all liability, loss, costs, damages and expenses (including legal, expert and consultant fees), causes of action, actions, claims, demands, lawsuits or other proceedings (“Claims”), by whomever made, sustained, incurred, brought or prosecuted, in any way arising out of or in connection with the Program or otherwise in connection with the Agreement, to the extent that the Claims are not caused, or contributed by, the negligence, or other (wilful or otherwise) misconduct of the Province. ARTICLE 9 INSURANCE

9.1

9.2

UTM/DDA’s Insurance. The UTM/DDA represents and warrants that it has, and shall maintain for the term of the Agreement, at its own cost and expense, with insurers having a secure A.M. Best rating of B+ or greater, or the equivalent, all the necessary and appropriate insurance that a prudent person carrying out programs and services similar to the programs and services covered by this Agreement would maintain, including comprehensive general liability insurance on an occurrence basis for third party bodily injury, personal injury and property damage, to an inclusive limit of not less than five million dollars ($5,000,000) per occurrence. The policy shall include the following: (a)

the Indemnified Parties as additional insureds with respect to liability arising in the course of performance of the UTM/DDA’s obligations under, or otherwise in connection with, the Agreement;

(b)

a cross-liability clause;

(c)

contractual liability coverage; and

(d)

a 30 day written notice of cancellation, termination or material change.

Proof of Insurance. The UTM/DDA shall provide the Province with proof of insurance in the form of a valid certificate of insurance that confirms the insurance coverage as required in section 9.1. The UTM/DDA shall provide a copy of the certificate of insurance to the Province prior to the receipt of Grant funding under this Agreement. ARTICLE 10 TERMINATION ON NOTICE

10.1

Termination on Notice. The Province or the UTM/DDA may terminate the Agreement at any time upon giving at least one year’s Notice to the other Party.

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10.2

Consequences of Termination on Notice by the Province. If the Province terminates the Agreement pursuant to section 10.1, the Province may: (a)

cancel all further instalments of the Grant; and/or

(b)

demand the repayment of any Grant remaining in the possession or under the control of the UTM/DDA. ARTICLE 11 TERMINATION WHERE NO APPROPRIATION

11.1

Termination Where No Appropriation. If, as provided for in section 4.2(d), the Province does not receive the necessary appropriation from the Ontario Legislature for any payment the Province is to make under the Agreement, the Province may terminate the Agreement immediately by giving Notice to the UTM/DDA.

11.2

Consequences of Termination Where No Appropriation. If the Province terminates the Agreement pursuant to section 11.1, the Province may: (a)

cancel all further instalments of the Grant; and/or

(b)

demand the repayment of any Grant funds remaining in the possession or under the control of the UTM/DDA. ARTICLE 12 EVENT OF DEFAULT, CORRECTIVE ACTION AND TERMINATION FOR DEFAULT

12.1

Events of Default. Each of the following events may constitute an Event of Default at the sole option of the Province: (a)

(b) 12.2

the UTM/DDA breaches any representation, warranty, covenant or other material term of the Agreement, including failing to do any of the following in accordance with the terms and conditions of the Agreement: (i)

carry out its obligations in the Schedules;

(ii)

use or spend the Grant; and/or

(iii)

provide, in accordance with section 6.1, Reports or such other reports as may have been requested pursuant to section 6.1(b);

the UTM/DDA ceases to operate, is merged or otherwise dissolved.

Opportunity to Remedy. If there is an Event of Default, the Province shall provide the UTM/DDA with an opportunity to remedy the Event of Default, and shall provide Notice to the UTM/DDA of: (a)

the particulars of the Event of Default; and

(b)

the Notice Period. Page 10

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12.3

UTM/DDA not Remedying. If: (a)

the UTM/DDA does not remedy the Event of Default within the Notice Period;

(b)

it becomes apparent to the Province that the UTM/DDA cannot completely remedy the Event of Default within the Notice Period; or

(c)

the UTM/DDA is not proceeding to remedy the Event of Default in a reasonable manner,

the Province may extend the Notice Period, or initiate any one or more of the actions provided for in sections 12.4 (a), (b), (c) or (d). 12.4

12.5

Consequences of Events of Default and Corrective Action. If an Event of Default occurs and the UTM/DDA does not remedy the Event of Default the Province may, at any time, take one or more of the following actions: (a)

initiate any action the Province considers necessary in order to facilitate the successful continuation or completion of the UTM/DDA’s obligations under this Agreement;

(b)

suspend, reduce or cancel the payment of the Grant for such period as the Province determines appropriate;

(c)

demand the repayment of an amount equal to any Grant the UTM/DDA used for purposes not agreed upon by the Province;

(d)

terminate the Agreement at any time, including immediately, upon giving Notice to the UTM/DDA.

When Termination Effective. Termination under this Article shall take effect as set out in the Notice. ARTICLE 13 RETURN OF THE GRANT

13.1

Return of The Grant. If, under the terms of this Agreement, the Province requests in writing the repayment of the whole or any part of the Grant, the amount requested shall be deemed to be a debt due and owing to the Province and the UTM/DDA shall pay the amount immediately, unless the Province directs otherwise.

13.2

Method of Return. The Province may recover the Grant requested in section 13.1 through a cash-flow adjustment. If a cash-flow adjustment is not possible, the UTM/DDA shall repay the amount payable by cheque payable to the Minister of Finance and mail it to the Province at the address set out in Article 14.

13.3

Interest Rate. The Province may charge interest on any amount owing by the UTM/DDA at the then current rate charged by the Province on accounts receivable. Interest shall accrue 30 days after Notice has been provided under section 13.1 for repayment of the Grant. Page 11

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13.4

Unused Grant. The UTM/DDA agrees that it shall report to the Province in writing any part of the Grant that has not been used or accounted for by the UTM/DDA in accordance with the Reports requested in Schedule “D”.

13.5

Return of Unused Grant. Without limiting any rights of the Province under Article 11, or sections 13.1 or 13.2, if the UTM/DDA has not spent all of the Grant allocated for the Funding Year as provided for in the Schedules, the Province may: (a) demand the return of the unspent Grant; or (b)

adjust the amount of any further instalments of the Grant accordingly. ARTICLE 14 NOTICE

14.1

Notice in Writing and Addressed. Notice shall be in writing and shall be delivered by postage-prepaid mail, personal delivery or facsimile, and shall be addressed to the Province and the UTM/DDA respectively as set out below or as either Party later designates to the other by Notice:

To the Province: Ministry of Health and Long-Term Care Emergency Health Services Branch 5700 Yonge Street, 6th Floor Toronto, ON, M2M 4K5 Attention: Director Fax: (416) 327-7879 To the UTM/DDA : UTM/DDA Attention: Fax: 14.2

14.3

Notice Given. Notice shall be deemed to have been received: (a)

in the case of postage-prepaid mail, seven days after a Party mails the Notice; or

(b)

in the case of personal delivery or facsimile, at the time the other Party receives the Notice.

Postal Disruption. Despite section 14.2(a), in the event of a postal disruption: (a)

Notice by postage-prepaid mail shall not be deemed to be received; and

(b)

the Party giving Notice shall provide Notice by personal delivery or by Facsimile.

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ARTICLE 15 CONSENT BY PROVINCE 15.1

Consent. The Province may impose any terms and conditions on any consent the Province may grant pursuant to the Agreement.

ARTICLE 16 SEVERABILITY OF PROVISIONS 16.1

Invalidity or Unenforceability of Any Provision. The invalidity or unenforceability of any provision of the Agreement shall not affect the validity or enforceability of any other provision of the Agreement. Any invalid or unenforceable provision shall be deemed to be severed. ARTICLE 17 WAIVER

17.1

Waivers in Writing. If a Party fails to comply with any term of the Agreement, that Party may only rely on a waiver of the other Party if the other Party has provided a written waiver in accordance with the Notice provisions in Article 14. Any waiver must refer to a specific failure to comply and shall not have the effect of waiving any subsequent failures to comply. ARTICLE 18 INDEPENDENT PARTIES

18.1

Parties Independent. The UTM/DDA acknowledges that it is not an agent, joint venturer, partner or employee of the Province, and the UTM/DDA shall not take any actions that could establish or imply such a relationship. ARTICLE 19 ASSIGNMENT OF AGREEMENT OR THE GRANT

19.1

No Assignment. The UTM/DDA shall not assign any part of the Agreement or the Grant without the prior written consent of the Province.

19.2

Agreement to Extend. All rights and obligations contained in the Agreement shall extend to and be binding on the Parties’ respective heirs, executors, administrators, successors and permitted assigns. ARTICLE 20 GOVERNING LAW

20.1

Governing Law. The Agreement and the rights, obligations and relations of the Parties shall be governed by and construed in accordance with the laws of the Province of Ontario and the applicable federal laws of Canada. Any actions or proceedings arising in connection with the Agreement shall be conducted in Ontario.

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20.2

Conflicts. In the event of a conflict between this Agreement and the Act, the Regulations, or the Standards, the Act, the Regulations or the Standards prevail.

20.3

Conflicts – Municipal. In the event of a conflict between any requirement of this Agreement and any municipal or local requirement at law to which the UTM/DDA is subject, the UTM/DDA shall comply with the stricter requirement. ARTICLE 21 FURTHER ASSURANCES

21.1

Agreement into Effect. The Parties shall do or cause to be done all acts or things necessary to implement and carry into effect the terms and conditions of the Agreement to its full extent. ARTICLE 22 SURVIVAL

22.1

Survival. The provisions in Article 1, Article 4, Article 5, 6.1 (to the extent that the UTM/DDA has not provided the Reports or other reports to the satisfaction of the Province), 6.2, 6.3, 6.4, 6.5, 6.6, Articles 8, sections 11.2, 12.2, 12.3, 12.4(b), (c), Articles 13, 14, 16, 20, 22, 23, 25 and 27, and all applicable Definitions, cross-referenced provisions and Schedules shall continue in full force and effect for a period of seven years from the date of expiry or termination of the Agreement. ARTICLE 23 SCHEDULES

23.1

Schedules. The Agreement includes the following Schedules: (a) Schedule “A” – Program; (b) Schedule “B” – Grant; (c) Schedule “C” – Payment Plan; and (d) Schedule “D” – Reports. ARTICLE 24 COUNTERPARTS

24.1

Counterparts. The Agreement may be executed in any number of counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. ARTICLE 25 JOINT AND SEVERAL LIABILITY

25.1

Joint and Several Liability. Where the UTM/DDA is comprised of more than one entity, all such entities shall be jointly and severally liable to the Province for the fulfillment of the obligations of the UTM/DDA under the Agreement. Page 14

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ARTICLE 26 BPSAA 26.1

BPSAA. For the purposes of clarity, if the UTM/DDA is subject to the BPSAA and there is a conflict between any of the requirements of the Agreement and the requirements of the BPSAA, the BPSAA shall prevail. ARTICLE 27 ENTIRE AGREEMENT

27.1

Entire Agreement. The Agreement constitutes the entire agreement between the Parties with respect to the subject matter contained in the Agreement and supersedes all prior oral or written representations and agreements.

27.2

Modification of Agreement. The Agreement may only be amended by a written agreement duly executed by the Parties. The Parties have executed the Agreement on the dates set out below.

HER MAJESTY THE QUEEN IN RIGHT OF ONTARIO as represented by the Minister of Health and Long-Term Care

Name: Richard Jackson Title: Director, Emergency Health Services Branch

Date

NAME OF UTM/DDA

Name: Position:

Date

Name: Position:

Date

We have the authority to bind the UTM/DDA

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SCHEDULE A PROGRAM A1.

Program Objective

The UTM/DDA shall ensure the proper provision of Land Ambulance Services in the geographic area of (name of UTM/DDA) in accordance with the Act, the Regulations, the Standards and this Agreement. A2.

Scope of Program

The UTM/DDA prepares an annual Service Plan in order to ensure that Land Ambulances Services are delivered in a safe and efficient manner. The Service Plan is attached at the end of this Schedule. The UTM/DDA acknowledges that the Grant will be used solely for the purposes set out in this Schedule A.

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SCHEDULE B LAND AMBULANCE SERVICES GRANT UTM/DDAs:_______________________ 2014 Approved Land Ambulance Operating Costs per PSAB Less any one-time costs

(1)

Less: 2014 Base Funding at 100%

(2)

2014 Sharable Land Ambulance Operating Costs

(3)=(1)-(2)

Add: 2015 Incremental Increase

(4) = __% of (3)

2015 Approved Shareable Land Ambulance Operating Costs

(5) = (3) + (4)

2015 Land Ambulance Services Grant 50:50

(6) = (5) x 50%

Less: 2014 Land Ambulance Services Grant 50:50

(7)

2015 Land Ambulance Services Grant 50:50 Increase/(Decrease)

(8) = (6) - (7)

Add: 2014 Land Ambulance Services Grant 50:50

(7)

Add: 2014 Base Funding at 100%

(2)

2015 Land Ambulance Services Grant (50:50 and 100%)

(9) = (8) + (7) + (2)

Please note that all funding adjustments are contingent upon government approval. Page 17

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AgendaItem#5b)

SCHEDULE C PAYMENT PLAN The Province shall provide the Grant in semi-monthly payments in the middle and the end of each month.

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SCHEDULE D REPORTS The UTM/DDA is required to provide the following Reports:

Name of Report

Reporting Period

Due Date

Financial Planning Report

For the next Funding Year

August 31 of each Funding Year

Service Plan

For the next Funding Year

March 31 of each Funding Year

Financial Information Return (FIR) Year End Report

For the entire Funding Year

May 31 of the following Funding Year

Audited Financial Statements

For the entire Funding Year

May 31 of the following Funding Year

Final Program Report

For the entire Funding Year

March 31 of the following Funding Year

DDA Report

For the entire Funding Year

March 31 of each Funding Year

Response Time Performance Plan

For the upcoming Funding Year

October 31 of each Funding Year

Response Time Performance Report

For the entire Funding Year

March 31 of each Funding Year

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AgendaItem#5b)

Report Details

Financial Planning Report The UTM/DDA shall submit a Financial Planning Report in the format set out as Appendix 1 to Schedule “D”.
Service Plan The UTM/DDA shall provide an annual Service Plan which contains details about how it will carry out the Program in each Funding Year in the format set out as Appendix 4 to Schedule “D”.
FIR Year End Report The UTM/DDA shall submit a FIR Year End Report in the format set out as Appendix 2 to Schedule “D”. The FIR Year End Report will also include the Attestation attached as Appendix 3 to Schedule “D”.
Audited Financial Statements The UTM/DDA shall prepare the Audited Financial Statements in accordance with Canadian generally accepted accounting principles, and attested to by a licensed public accountant.
Final Program Report The UTM/DDA shall: (a)

provide a Final Program Report which contains details about whether it has met all of the requirements in the Service Plan, as well as any other details requested by the Province;

(b)

ensure that the Final Program Report is signed on behalf of the UTM/DDA by the signing officers who have authority to bind the UTM/DDA

in the format set out as Appendix 4 to Schedule “D”. 6. DDA Report If requested by the Province, the DDA shall submit a DDA Report which includes an approved budget (excluding capital and one-time costs), the TWOMO budget, and apportionment if applicable.

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AgendaItem#5b)

Response Time Performance Plan The UTM/DDA shall submit a Response Time Performance Plan for each Land Ambulance Services operator, if applicable, in accordance with subsection 6(8) of the Act.
Response Time Performance Report The UTM/DDA shall submit a Response Time Performance Report in accordance with subsections 23(7) and (8) of O. Reg. 257/00.

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Emergency and Transportation Services

APPENDIX 1 – Financial Planning Report Emergency Health Services Branch Land Ambulance Financial Planning Report UTM/DDA:______________________________________ (1) 2013

(2) 2014

(3) 2014

(4) 2014 Forecasted Expenditures (12 mths)

Actual Expenditures

Council ApYear-to-date proved for the period Budget AdJan 1 - July 31 justed 2014 for PSAB COST SUMMARY ——————————————-Prepared on PSAB Basis———————————–OPERATING COSTS $ $ $ $ Part A: Exclude One-time and Dedicated Nurses (reported in Part B) Salaries, Wages & Benefits (Complete Section 3) Interest Expense (Do not include any principal portion) Materials Contracted Services - Other than Cross Border payments

Cross Border payments Rents and Financial Expenses Annual Amortization (Complete Section 1) Overhead Allocation (Complete Section 2) Council Approved Budget adjusted For PSAB Submitted to EHS

110 111 112 113 114a 114b 115 116 117

Part B: One-time and Dedicated Nurses One-time costs (non-recurring costs not expected every year) Costs for Dedicated Nurses to Receive Ambulance Patients

118 119 125

Total Operating Costs

130 131 132

LESS:

133 134 140

Revenue Revenue for Dedicated Nurses to Receive Ambulance Patients Other Revenue: Interest Income Other Revenue: (e.g. User Fees, Recoveries, Other Government, etc.) Other Revenue: Cross Border

NET LAND AMBULANCE OPERATING COSTS

Name of CAO: ______________________________________ Print Name Name of Treasurer: __________________________________ Print Name

Date: ___________ signature Date: ___________ signature

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I certify that this Land Ambulance Report has been accurately prepared in accordance with the attached instructions and in accordance with approvals from Council/Board. All reports are subject to audit by the Province.

Emergency and Transportation Services

APPENDIX 1 – FINANCIAL PLANNING REPORT SECTION 1 AMBULANCE SERVICE OPERATIONS - TANGIBLE CAPITAL ASSETS for the year ended December 31, 2014

COST

AMORTIZATION 8

2014 Opening Net Book Value $

2014 Opening Cost Balance $

Write Downs $

2014 Closing Cost Balance $

2014 Opening Amortization Balance $

Annual Amortization *

$

11 9

Purchases/ Betterments $

Disposals $

Vehicles Equipment Ambulance Stations TOTAL

$

$ $ $ $

Amortization Disposals $

$

2014 Closing Amortization Balance $ $ $ $ $

zation report in Col (2) – Line 116 of the Land Ambulance Financial Planning Report

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Annual amorti-

2014 Closing Net Book Value $ $ $ $ $

AgendaItem#5b) APPENDIX 1 – FINANCIAL PLANNING REPORT LAND AMBULANCE 2014 UTM/DDA

SECTION 2

OVERHEAD ALLOCATION: METHODOLOGY AND CALCULATION(S) for the year ended December 31, 2014 OVERHEAD ALLOCATION

METHODOLOGY (Please list methodologies / policies used for overhead allocation)
CALCULATIONS (Please provide calculation(s) used in arriving at the reported amount in for Overhead Allocation - Column (2) - Line 117 of the Financial Planning Report.

Description Amount to be allocated

Pro-ration Faction

Overhead Amount

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AgendaItem#5b)

APPENDIX 1 – FINANCIAL PLANNING REPORT LAND AMBULANCE 2014 UTM/DDA

SECTION 3

SALARIES, WAGES & BENEFITS DETAILS for the year ended December 31, 2014 Please provide information on the following:

If there are service enhancements included in the 2014 Council Approved Budget, please provide details of the enhancements including implementation date, FTEs, and Salaries &Wages.

Increase in Salaries, Wages, and Benefits (2014 Council Approved Budget compared to 2013 Council Approved Budget): a. Management and administrative salaries increase: Please provide the details including the percentage increase and amounts

Collective agreement increase: Please provide the effective date and amounts

Please indicate amounts for retroactive wages and costs that were included in the 2014 Council Approved Budget.

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AgendaItem#5b) APPENDIX 1 - FINANCIAL PLANNING REPORT Instructions SECTION 4 COST SUMMARY Operating Costs • Land ambulance operating costs must not include capital costs, such as vehicles, stations, or other capital items with a life of more than one year. • Costs associated with ambulance dispatch should not be included. • If applicable, operating costs related to First Nations, territories without municipal organization (TWOMO), etc. should be included. • One-time costs should be reported in Line 118 of Part B of the operating costs • Dedicated Nurses: If applicable, include expenditures in Line 119 of Part B: One-time and Dedicated Nurse, and related provincial funding in Line 131. Ministry’s 50% cost sharing portion will not allow provision for prior years’ operating costs or future years' operating costs, such as operating costs of service expansion, collective agreements or other additional capital purchases to be incurred in future years and prior or future years’ liabilities or accruals. Additional information may be required to support and clarify amounts. 111

Salaries, Wages and Benefits • Salaries, wages and benefits include expenses incurred for full-time, part-time and temporary employee salaries, wages and benefits. This includes regular, overtime, shift premiums and any other remuneration to employees. • Benefits include employer’s contribution payments to Canada Pension Plan (CPP), Ontario Municipal Employee Retirement System (OMERS), Employer’s Health Tax, Employment Insurance (EI), Workplace Safety and Insurance Board (WSIB) and any other insurance plans, such as supplementary health and dental. • Include clothing, moving, tuition, housing and any other employee benefits and allowances paid.

112

Interest Expenses • Report interest paid on long term liabilities and for leased tangible capital assets (capital leases). • Do not include any principal repayment.

113

Materials (and any other expenses not reported on other lines) • Report materials purchased by the land ambulance operations for its own use and / or disposal. • Include materials purchased that are subsequently provided to a third party for delivery of land ambulance services. • Include all other expenses not reported in other lines. For example, include expenses for insurance, photocopying and reimbursement of travel mileage.

114

Contracted Services • When land ambulance operations contracts out service delivery in whole or in part, to an arms length service provider, report any payments to the service provider as contracted services. • If services are provided in part by an arms length service provider and in part by land ambulance operations staff, report payment to contractor as contracted service. Services provided by land ambulance operations staff are reported using other object categories of expenses. • For contracts that extend beyond the current fiscal year, report only the portion of the contract relating to the current fiscal year. • Costs related to cross border charges from other UTMs should be reported separately in Line 114b. • Costs related to contracted services for Dedicated Nurses to receive ambulance patients should be reported in Line 119. Page 26

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AgendaItem#5b) 115

Rents and Financial Expenses • Rents and financial expenses paid to external parties. Include the rental / lease payments for ambulance stations land, machinery, equipment and engineering structures (Note: Stations and other assets under operating leases are not to be amortized), . • Where a contracted service includes a separate and easily identifiable rental component, report the rental component as rents and financial expenses. • Financial expenses include: short-term borrowing costs, bank and credit card service charges, annual payments associated with financing leases not deemed to be capital tangible lease and any other financial costs from external sources. • Do not include interest paid on long term liabilities. Interest on long term liabilities should be reported on Line 112. • Do not include any principal repayment. • Internal leasing is not an operating expense. A portion of amortization, as allowed under PSAB standards, on the municipally owned asset (e.g. building), which is attributable to land ambulance services (land ambulance operating cost), may be claimed as amortization on Line 116.

116

Annual Amortization • The cost, less any residual value, of a tangible capital asset with a limited life should be amortized over its useful life in a rational and systematic manner appropriate to its nature and use by the Municipal/DDA. • The leased tangible capital asset (meeting the PSAB criteria of leased tangible capital asset) would typically be amortized over the period of expected use of the asset, on the basis that is consistent with the UTM/DDA amortization policy for other similar tangible capital assets. • Consistent with MMAH FIR reporting requirements, EHS will follow PSAB standards and permit amortization of the leased tangible capital asset as an expense. The actual lease payment will not be included in the determination of land ambulance operating costs. For further details, please refer to PSAB guideline PSG-2, Leased Tangible Capital Assets. • The amortization of the costs of tangible capital assets should be accounted for as an expense in Line 116. • Land has an unlimited life and should not be amortized. • No amortization should be charged on fully amortized tangible capital assets. • The amortization method and estimate of the useful life of the remaining unamortized portion of a tangible capital asset should be reviewed on a regular basis and revised when the appropriateness of a change can be clearly demonstrated. Ministry’s 50% cost sharing portion will not allow provision for prior years’ operating costs or future years' operating costs, such as operating costs of service expansion, collective agreements or other additional capital purchases to be incurred in future years and prior or future years’ liabilities or accruals.

117

Overhead Allocation - should be reasonable and consistently applied and directly related to operating the land ambulance program.

125

Total Operating Costs = Sum of Lines 111 to 119.

140

Net Land Ambulance Operating Costs = Line 125 - (Sum of Lines 131 to 134).

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AgendaItem#5b) APPENDIX 2 – FIR YEAR END REPORT LAND AMBULANCE 2013 UTM/DDA Name:

FORM A

Asmt Code:

GENERAL INFORMATION

MAH Code:

for the year ended December 31, 2013

REPORTING FOR EHS LAND AMBULANCE SHOULD BE CONSISTENT WITH MMAH FIR. ALL CATEGORIES OF OPERATING COSTS REPORTED IN FORM B SHOULD BE CONSISTENT WITH HEALTH SERVICES - AMBULANCE SERVICES OF THE MMAH FIR FILING. WHERE IT IS NOT CONSISTENT, PLEASE EXPLAIN DIFFERENCES. DECLARATION OF THE UPPER-TIER MUNICIPALITY / DESIGNATED DELIVERY AGENT The following Land Ambulance Forms are requested by the Ministry of Municipal Affairs and Housing on behalf of the Ministry of Health and Long-Term Care:

FORM A:

GENERAL INFORMATION

FORM B:

FINANCIAL INFORMATION

SECTION 1 (A & B): AMBULANCE SERVICE OPERATIONS - TANGIBLE CAPITAL ASSETS SECTION 2: OVERHEAD ALLOCATION SECTION 3: RESERVE FUNDS For the purposes of this Land Ambulance Report, the amounts disclosed on the attached Forms are in agreement with the books and records of the UTM/DDA and its consolidated entities. I certify that this Land Ambulance Report has been accurately prepared in accordance with the attached instructions (SECTION 4). Name of CAO / Treasurer Date

Name (print)

I. GENERAL INFORMATION

Signature 1 LIST

010

How is Land Ambulance Service provided. . . . . . . . . . . . . . .

II. CONTACT INFORMATION

Questions related to the Forms should be addressed to: 020

Contact Name . . . . . . . . . . . . . . . . . . . . . . . .

022

Telephone . . . . . . . . . . . . . . . . . . . . . . . . . .

024

Fax . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

028

Email (Required) . . . . . . . . . . . . . . . . . . . . . . .

030

Chief Administrative Officer / Treasurer . . . . . . . . . . . . . . .

032

Telephone . . . . . . . . . . . . . . . . . . . . . . . . . .

038

Email . . . . . . . . . . . . . . . . . . . . . . . . . . . .

040

Name of External Auditor . . . . . . . . . . . . . . . . . . . .

042

Telephone . . . . . . . . . . . . . . . . . . . . . . . . . .

048

Email . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Emergency and Transportation Services

APPENDIX 2 – FIR YEAR END REPORT - LAND AMBULANCE 2013 UTM/DDA Name:

FORM B

Asmt Code:

FINANCIAL INFORMATION

MAH Code:

for the year ended December 31, 2013

I. COST SUMMARY 1 Costs Excluding Column 2 & 3 $

110

OPERATING COSTS

111

Salaries, Wages & Benefits

…………………

112

Interest Expense (Do not include any principal portion)

…………………

113

Materials

…………………

114

Contracted Services

…………………

Rents and Financial Expenses

…………………

116

Annual Amortization (Section 1A)

…………………

117

Overhead Allocation (Section 2) TOTAL OPERATING COSTS

…………………

115

120

…………………

3 Dedicated Nurses $

2 One-Time $

N/A

TOTAL (Column 1 to 3) $

N/A

$ $

N/A

LESS: 130a

Revenue for Dedicated Nurses to Receive Ambulance Patients

…………………………………………………………………………………………..

130b

Other Revenue: Interest Income

…………………………………………………………………………………………..

Other Revenue: (e.g. User Fees, Recoveries, Other Government,

…………………………………………………………………………………………..

Other Revenue: Cross Border

…………………………………………………………………………………………..

130c 130d 140

etc.)

NET LAND AMBULANCE OPERATING COSTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

OPERATING COSTS REPORTED IN TOTAL COLUMN SHOULD BE CONSISTENT WITH HEALTH SERVICES - AMBULANCE SERVICES AS REPORTED ON SCHEDULE 40 OF THE MMAH FIR FILING. WHERE IT

II. RESERVE FUNDS Complete Details in Section 3.

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IS NOT CONSISTENT, PLEASE EXPLAIN DIFFERENCES.

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APPENDIX 2 – FIR YEAR END REPORT - LAND AMBULANCE 2013 UTM/DDA Name:

SECTION 1A

Asmt Code:

AMBULANCE SERVICE OPERATIONS - TANGIBLE CAPITAL ASSETS

MAH Code:

for the year ended December 31, 2013

SUMMARY COST 1

2013 Opening Net Book Value $

2013 Opening Cost Balance $

Purchases/ Betterments $

Disposals $

Vehicles

Equipment

SUBTOTAL: Vehicles and Equipment Ambulance Stations TOTAL: Vehicles & Equipment and Ambulance Stations

AMORTIZATION

Write Downs $

2013 Closing Cost Balance $

2013 Opening Amortization Balance $

Annual Amortization $

Amortization Disposals $

2013 Closing Amortization Balance $

2013 Closing Net Book Value $

TOTAL: Vehicles & Equipment and Ambulance Stations SHOULD BE CONSISTENT WITH HEALTH SERVICES - AMBULANCE SERVICES AS REPORTED ON SCHEDULE 51 OF THE MMAH FIR FILING. WHERE IT IS NOT CONSISTENT, PLEASE EXPLAIN DIFFERENCES.

AgendaItem#5b)

Page 147 of 182 Page 30

APPENDIX 2 - FIR YEAR END REPORT - LAND AMBULANCE 2013 Emergency and Transportation Services

UTM/DDA Name:

SECTION 1A

Asmt Code:

AMBULANCE SERVICE OPERATIONS - TANGIBLE CAPITAL ASSETS

MAH Code:

for the year ended December 31, 2013

VEHICLES

ID #

Description (Please list each item)

Year of Purchase (YYYY)

Years of Useful Life

2013 Opening Net Book Value $

2013 Opening Cost Balance $

Purchases/ Betterments $

Disposals $

Write Downs $

2013 Closing Cost Balance $

2013 Opening Amortization Balance $

Annual Amortization $

Amortization Disposals $

2013 Closing Amortization Balance $

2013 Closing Net Book Value $

Page 31

AgendaItem#5b)

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APPENDIX 2 - FIR YEAR END REPORT - LAND AMBULANCE 2013 Emergency and Transportation Services

UTM/DDA Name:

SECTION 1A

Asmt Code:

AMBULANCE SERVICE OPERATIONS - TANGIBLE CAPITAL ASSETS

MAH Code:

for the year ended December 31, 2013

AMBULANCE STATIONS

ID #

Description (Please list each item)

Year of Purchase (YYYY)

Years of Useful Life

2013 Opening Net Book Value $

2013 Opening Cost Balance $

Purchases/ Betterments $

Disposals $

Write Downs $

2013 Closing Cost Balance $

2013 Opening Amortization Balance $

Annual Amortization $

Amortization Disposals $

2013 Closing Amortization Balance $

2013 Closing Net Book Value $

Page 32

AgendaItem#5b)

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AgendaItem#5b)

APPENDIX 2 - FIR YEAR END REPORT LAND AMBULANCE 2013 UTM/DDA Name:

SECTION 1B

Asmt Code:

AMBULANCE SERVICE OPERATIONS – TANGIBLE CAPITAL ASSETS: CONSTRUCTION-IN-PROGRESS

MAH Code:

for the year ended December 31, 2013

CONSTRUCTION-IN-PROGRESS DETAILS Please provide details as required in table: TOTAL CONSTRUCTION-IN-PROGRESS DETAILS SHOULD BE CONSISTENT WITH HEALTH SERVICES - AMBULANCE SERVICES AS REPORTED ON SCHEDULE 51 OF THE MMAH FIR FILING. WHERE IT IS NOT CONSISTENT, PLEASE EXPLAIN DIFFERENCES.

Description

2013 Opening Balance $

Add Capital Expenditure $

Less Assets Capitalized $

2013 Closing Balance $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

TOTAL

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AgendaItem#5b)

APPENDIX 2 - FIR YEAR END REPORT LAND AMBULANCE 2013 UTM/DDA Name:

SECTION 2

Asmt Code:

OVERHEAD ALLOCATION: METHODOLOGY AND CALCULATION(S)

MAH Code:

for the year ended December 31, 2013

OVERHEAD ALLOCATION 1.

METHODOLOGY Please list methodologies / policies used for overhead allocation. (Text will wrap. Use ALT +Enter to force a new line.)

CALCULATION(S) Please provide calculation(s) used in arriving at the reported amount for Overhead Allocation as reported on Line 117 of FORM B.

Description

Amount to be allocated

Pro-ration Factor

Overhead Amount 0 0 0 0 0 0 0 0 0 0 0 0

Total as reported on Line 117 of FORM B

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AgendaItem#5b)

APPENDIX 2 - FIR YEAR END REPORT LAND AMBULANCE 2013 UTM/DDA Name:

SECTION 3

Asmt Code:

RESERVE FUNDS DETAIL

MAH Code:

for the year ended December 31, 2013

1 2 2013 Opening Balance/ 2012 Closing Balance $

Reserve Funds

Stations Vehicles & Equipment Severance Other (enter details below) SUBTOTAL: Stations, Vehicles & Equipment, Severance and Other 100% Municipal/DDA Financed and Other non-provincial sources TOTAL

Additions $

Payments $

2013 Closing Balance $

n/a

1 Other Reserve Fund Description (Please list each item / group)

2013 Opening Balance/ 2012 Closing Balance $

n/a

Payments $

2013 Closing Balance $

n/a

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AgendaItem#5b)

APPENDIX 2 - FIR YEAR END REPORT

Instructions 2013

SECTION 4

REPORTING FOR EHS LAND AMBULANCE SHOULD BE CONSISTENT WITH MMAH FIR. ALL CATEGORIES OF OPERATING COSTS REPORTED IN FORM B SHOULD BE CONSISTENT WITH HEALTH SERVICES – AMBULANCE SERVICES OF THE MMAH FIR FILING. WHERE IT IS NOT CONSISTENT, PLEASE EXPLAIN DIFFERENCES. Upper-Tier Municipalities (UTMs) / Designated Delivery Agents (DDAs) should complete Forms A and B and Sections 1, 2, and 3 using MS Excel. Once completed, this File should be SAVED and submitted via email to:

Your Senior Financial Analyst at Emergency Health Services Branch - Ministry of Health and Long-Term Care Upper-Tier Municipalities (UTMs) / Designated Delivery Agents (DDAs) are reminded to SAVE work periodically. All information contained in Form A, B and Schedules should be completed in accordance with the following Instructions:

FORM A: GENERAL INFORMATION I. GENERAL INFORMATION 010

From the LIST in column 1, Upper-Tier Municipalities (UTMs) / Designated Delivery Agents (DDAs) should select the item which describes how Land Ambulance is provided in the Municipality. LIST Options Provided Directly by UTM / DDA Only Provided by UTM / DDA and Contracted Provider(s) Provided by Contracted Provider(s) Only

II. CONTACT INFORMATION 020 to 028

Upper-Tier Municipalities (UTMs) / Designated Delivery Agents (DDAs) should enter information for a Contact Person should any questions related to the Forms arise. The contact person will be the first point of contact should any concerns arise.

030 to 038

The contact information of the Chief Administrative Officer or Treasurer should be provided.

040 to 048

The contact information of the External Auditor should be provided.

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AgendaItem#5b) FORM B: FINANCIAL INFORMATION I. COST SUMMARY Operating Costs • • • • • •

111

Include the cost of operating land ambulance services by the Upper-Tier Municipality / Designated Delivery Agent in Column 1. One-time costs should be reported in Column 2. Land ambulance operating costs must not include capital costs, such as vehicles, stations, or other capital items with a life of more than one year. Costs associated with ambulance dispatch should not be included. Operating costs related to First Nations, territories without municipal organization (TWOMO), etc. should be included. Dedicated Nurses: If applicable, include expenditures in Column 3 and related provincial funding in Line 130a on Form B.

•

Salaries, Wages and Benefits Salaries, wages and benefits include expenses incurred for full-time, part-time and temporary employees’ salaries, wages and benefits. This includes regular, overtime, shift premiums and any other remuneration to employees. Benefits include employer’s contribution payments to Canada Pension Plan (CPP), Ontario Municipal Employee Retirement System (OMERS), Employer’s Health Tax, Employment Insurance (EI), Workplace Safety and Insurance Board (WSIB) and any other insurance plans, such as supplementary health and dental. Include clothing, moving, tuition, housing and any other employee benefits and allowances paid.

•

Interest Expenses Report interest paid on long-term liabilities and for leased tangible capital assets (capital leases).

•

Do not include any principal repayment.

• •

112

113

• • •

114

• • • •

Materials (and any other expenses not reported on other lines) Report materials purchased by the land ambulance operations for its own use and / or disposal. Include materials purchased that are subsequently provided to a third party for delivery of land ambulance services. Include all other expenses not reported in other lines. For example, include expenses for insurance, photocopying and reimbursement of travel mileage. Contracted Services When land ambulance operations contracts out service delivery in whole or in part, to an arms length service provider, report any payments to the service provider as contracted services. If services are provided in part by an arms length service provider and in part by land ambulance operations staff, report payment to contractor as contracted service. Services provided by land ambulance operations staff are reported using other object categories of expenses. For contracts that extend beyond the current fiscal year, report only the portion of the contract relating to the current fiscal year. Costs related to contracted services for Dedicated Nurses to receive ambulance patients should be reported in Column 3 (Dedicated Nurses) of Line 114.

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AgendaItem#5b) 115

• • • • • •

116

• • •

• • • •

Rents and Financial Expenses Rents and financial expenses paid to external parties. Include the rental / lease payments for ambulance stations (Note: assets under operating leases are not to be amortized), land, machinery, equipments and engineering structures. Where a contracted service includes a separate and easily identifiable rental component, report the rental component as rents and financial expenses. Financial expenses include: short-term borrowing costs, bank and credit card service charges, annual payments associated with financing leases not deemed to be capital tangible lease and any other financial costs from external sources. Do not include interest paid on long-term liabilities. Interest on long term liabilities should be reported on Line 112. Do not include any principal repayment. Internal leasing is not an allowable operating expense; however a portion of amortization and incremental direct costs may be reported on the appropriate lines. Reasonable operating costs related to municipally owned assets (e.g. buildings) that are recognized under PSAB and not included in any other operating cost lines (line 111 to 117) of form B, can be reported as long as they are attributable to land ambulance services. Annual Amortization (Section 1A) Amortization: The cost, less any residual value, of a tangible capital asset with a limited life should be amortized over its useful life in a rational and systematic manner appropriate to its nature and use by the UTM / DDA. The leased tangible capital asset (meeting the PSAB criteria of leased tangible capital asset) would typically be amortized over the period of expected use of the asset, on the basis that is consistent with the UTM / DDA amortization policy for other similar tangible capital assets. Consistent with MMAH FIR reporting requirements, EHS will follow PSAB standards and permit amortization of the leased tangible capital asset as an expense. The actual lease payment will not be included in the determination of land ambulance operating costs. For further details, please refer to PSAB guideline PSG-2, Leased Tangible Capital Assets. The value of a leased tangible capital asset should be reported in Section 1A. The amortization of the costs of tangible capital assets should be accounted for as an expense in Line 116 of Form B and Section 1A (Column 8). Land has an unlimited life and should not be amortized. The amortization method and estimate of the useful life of the remaining unamortized portion of a tangible capital asset should be reviewed on a regular basis and revised when the appropriateness of a change can be clearly demonstrated.

Ministry’s 50% cost sharing portion will not allow provision for future years’ operating costs, such as operating costs of service expansion, collective agreements or other additional capital purchases to be incurred in future years. 117

Overhead Allocation - should be reasonable and consistently applied and directly related to operating the land ambulance program. Please provide details of methodology and calculations used on Section 2.

120

Total Operating Costs = Sum of Lines 111 to 117

130b

Revenue: Interest income arising from all sources, including interest income from reserves, should be reported in the period in which it is earned.

140

Net Land Ambulance Operating Costs = Line 120 - Line 130a, b, c, d

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AgendaItem#5b)

II. RESERVE FUNDS (Complete Details in Section 3) Provide reserve funds information in 2013 FIR and future years until the reserve amount is fully utilized VEHICLES and EQUIPMENT Reserve Fund 2013 Opening Balance/2012 Closing Balance 2013 Opening Balance should equal to 2012 Closing Balance. PLUS: Additions Record any additions to fund. LESS: Payments Report the total cost of all Land Ambulance vehicles and equipment purchased. 2013 Closing Balance 2013 Closing Balance is equal to the 2013 Opening Balance PLUS Additions LESS Payments. 2013 closing balance should not be a negative amount. STATIONS Reserve Fund 2013 Opening Balance/2012 Closing Balance 2013 Opening Balance should equal to 2012 Closing Balance. PLUS: Additions Record any additions to fund. LESS: Payments Report the total cost of all Stations purchased / built. 2013 Closing Balance 2013 Closing Balance is equal to the 2013 Opening Balance PLUS Additions LESS Payments. 2013 Closing Balance should not be a negative amount. SEVERANCE Reserve Fund When a land ambulance employee is severed, amount may be drawn down from this reserve fund. 2013 Opening Balance / 2012 Closing Balance 2013 Opening Balance should equal to 2012 Closing Balance. PLUS: Additions (if any) LESS: Payments Report the total amount of severance paid to land ambulance employees up to remaining fund balance.

Closing Balance, end of year 2013 Closing Balance is equal to the 2013 Opening Balance PLUS Additions LESS Payments. 2013 closing balance should not be a negative amount.

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AgendaItem#5b)

OTHER Reserve Fund Other Reserve Fund established previously for specific purposes. Provide detailed breakdown with associated purposes. 2013 Opening Balance / 2012 Closing Balance 2013 Opening Balance should equal to 2012 Closing Balance. LESS: Payments Report the total amount of payments related to land ambulance services which were not reported in the Vehicles & Equipment, Stations or Severance Reserve Fund. A brief description of the purpose should be provided. Closing Balance, end of year 2013 Closing Balance is equal to the 2013 Opening Balance LESS payments from accounts. 2013 Closing Balance should not be a negative amount. •

100% UTM / DDA Financed Reserve Fund The UTM / DDA Reserve Fund is a fund set aside for land ambulance purposes which only include 100% UTM / DDA and non-provincial funds. Funds reported in this section are not to be reported as operating costs on Line 111 to 140.

ADDITIONAL FORMS FOR COMPLETION SECTION 1 (A & B): Ambulance Service Operations - Tangible Capital Assets SECTION 2: Overhead Allocation - Methodology and Calculations SECTION 3: Reserve Funds – Details

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AgendaItem#5b) APPENDIX 3 - ATTESTATION TO:

The Province

FROM:

Chief Administrative Officer/Treasurer of _____________________

DATE:

RE:

2014 Funding Year

On behalf of the UTM/DDA, I attest that the UTM/DDA acknowledges and confirms receipt of the Grant from the Province totaling _____________________ for the 2014 Funding Year. I attest on behalf of the UTM/DDA that the funds provided under the Grant by the Province were for approved operating costs incurred for the purposes of carrying out the Program. Any amount of the Grant that is in excess of fifty percent (50%) of the approved operating costs to fund the portion of the Program for Land Ambulance Services, with the exception of the portion of the Grant referred to below, shall be due to the Province, and recoverable in accordance with the terms and conditions contained in the January 1, 2014 Agreement entered into by the Province and the UTM/DDA. In addition, any amount of the Grant that is in excess of one hundred percent (100%) of the approved operating costs to fund the portion of the Program for Land Ambulance Services to First Nations and/or a territory or territories without municipal organization shall be due to the Province, and recoverable in accordance with the terms and conditions contained in the January 1, 2014 Agreement entered into by the Province and the UTM/DDA. In making this attestation, I have exercised the care and diligence that would reasonably be expected of a Chief Administrative Officer/Treasurer in these circumstances, including making due inquiries of UTM/DDA staff that have knowledge of this matter. As Chief Administrative Officer for the UTM/DDA, I am executing this attestation confirming that the aforementioned statements are true and represent the disposition of the Grant. I further confirm the accuracy and completeness of the Reports submitted pursuant to Schedule D of the Agreement during the applicable Funding Year.

Name: Title: Chief Administrative Officer/Treasurer I have authority to bind the _________________________________ (Name of UTM/DDA)

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AgendaItem#5b) APPENDIX 4 - SERVICE PLAN AND FINAL PROGRAM REPORT UTM/DDA Service Plan for Funding Year______ and Final Program Report for Funding Year ______ UTM/DDA ________________________________________________________________________ This Service Plan/Final Program Report is established as referenced in the Land Ambulance Grant Transfer Payment Agreement, Schedule D, Appendix 4. The Service Plan details your UTM/DDA’s plans about how it will carry out the Program in each Funding Year. The Final Program Report contains details about whether it has met all of the requirements in the Service Plan, as well as any other details requested by the Province. In addition to your UTM/DDA’s Deployment Plan (please forward updates when changes are made during the applicable calendar year), please provide your UTM/DDA’s mission and values statement (also forward updates as applicable). Please also complete the following table: Service Plan and Final Program Report Service Number

Service Name

Coverage Area Square kms. Patient Transports by Demographic Group (prior year actuals)

Population Base <1

117 Prior Year Planned

1844

4564

Prior Year Actuals

Staffed Operational Hours Primary Care Paramedics Advanced Care Paramedics Critical Care Paramedics Total Staffed Hours Full Time Equivalents Unionized FTEs Non-Unionized FTEs Total FTEs Hourly Salary Rate Ranges Primary Care Paramedics Advanced Care Paramedics Critical Care Paramedics Collective Agreement Term: Paramedic Service Fleet

Ambulances

Emerg. Response Units

Emerg. Support Units

Special Purpose Ambs

Administrative Vehicles

Total Training above RBH certification/CME Provide description of service training delivered. Quality Assurance (BLS Patient Care) Provide a description of your service’s BLS quality assurance program.

65-79

Prior Year Variance

80+

Current Year Planned

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AgendaItem#5b)

Definitions: Where readily available, provide prior year actuals for Patient Transports by Demographic Group. “Prior Year Planned” refers to the targets and goals set at the start of the calendar year preceding the reporting year. For example, for the 2014 calendar reporting year, 2013 planning targets and goals set at the start of 2013 relating to performance should be entered. “Prior Year Actuals” refers to the actual year end performance and data related to the goals set, or planned for, at the start of the calendar year preceding the reporting year. For example, for the 2013 calendar year, you may have planned to have completed 1,000 code 4 calls, but actually performed 1,100. “Prior Year Variance” refers to the variance between the Prior Year Planned and Prior Year Actuals. Where variances exceed 5% + or – please provide rationale. “Current Year Planned” refers to the targets and goals set at the start of the calendar reporting year. For example, for the 2014 calendar year enter the planned hours of training per paramedic. Staffed Operational Hours refers to the total staffing hours related to direct patient care by paramedics at the given classification. This includes superintendents who regularly respond to calls for service. For example, one 24 hour/day 365 days a year ambulance (i.e.: staffed by 2 paramedics) constitutes 17,520 hours. Additionally, one paramedic in an emergency response vehicle 24 hours/day, 365 days a year would constitute 8760 hours. Full Time Equivalents refers to the hours an individual is compensated, reflected as an FTE. For example, an employee working 40 hours a week, 52 weeks of the year would constitute 1 FTE. A part time staff member who works only 1040 hours a year would constitute .5 FTE. “Hourly Salary Rate Ranges” refers to the hourly wage rate for the applicable classification from the bottom to the top hourly rates. Please utilize the hourly rates being paid at the time the report is completed. Please note your service’s collective agreement term (i.e.: effective and expiry dates). Ambulance vehicle definitions have the same meaning as those outlined in the Ambulance Act, its Regulations and the Ontario Provincial Land Ambulance & Emergency Response Vehicle Standard (Version 4.0). Training refers to training outside of annual Regional Base Hospital certification and continuing medical education that is delivered by paramedic services or others (e.g.: equipment training, individual service HR training, etc) Quality Assurance (BLS Patient Care) refers to reviews of ACRs conducted on patient care indicated in the Basic Life Support Patient Care Standards, Version 2.0.

I certify that I have the authority to bind the UTM/DDA indicated above:

Signed by: ____________________________

Date: _________________________________

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AgendaItem#5b)

Report 2014-040 RECOMMEND REPORT TO COUNCIL To:

Warden and Council of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/Director of Corporate Services/Treasurer

Prepared By:

Paul J. Charbonneau Director of Emergency & Transportation Services/Chief of Paramedic Services

Date Prepared:

March 1, 2014

Date of Meeting:

March 19, 2014

Re:

Emergency and Transportation Services – 2013 Legislated Response Time Standard Performance Plan Reporting to MOHLTC

Recommendation RESOLVED THAT the Council of the County of Frontenac receive this Emergency and Transportation Services – 2013 Legislated Response Time Standard Performance Plan Reporting to MOHLTC for information, AND FURTHER THAT the 2013 Response Time Standard Performance Plan outcomes for the County of Frontenac be reported to the Director, Emergency Health Services Branch, Ministry of Health and Long term Care as required by legislation. Background At its meeting on September 12th, 2012, County Council passed the following resolution: Motion #: 256-12

Moved By: Seconded By:

Councillor McDougall Councillor Davison

RESOLVED THAT the Council of the County of Frontenac accept the Emergency and Transportation Services – Legislated Response Time Performance Plan report; Recommend Report Emergency and Transportation Services – 2013 Legislated Response Time Standard Performance Plan Reporting to MOHLTC March 19, 2014 Page 1 of 3

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AND FURTHER THAT Council direct the Clerk to introduce a by-law later in the meeting adopting the response time standards as outlined in the report. CARRIED The County of Frontenac set the following criteria under Regulation 257/00, as amended, for its response time targets for 2013: For the calendar year of 2013, from January 1 to December 31, i. Designated Delivery Agent (DDA) - SUDDEN CARDIAC ARREST 48% percent of the time, within 6 minutes from the time ambulance dispatch conveys the call information to the paramedic, the County of Frontenac will endeavour to have a responder equipped and ready to use an AED at the location of a patient determined to be in sudden cardiac arrest. ii. EMS Designated Delivery Agent - CTAS 1 68% percent of the time, within 8 minutes from the time ambulance dispatch conveys the call information to the paramedic, the County of Frontenac will endeavour to have a PARAMEDIC as defined by the Ambulance Act and duly equipped at the location of a patient determined to be CTAS 1. iii. EMS Designated Delivery Agent - CTAS 2, 3, 4, 5 The County of Frontenac will endeavour to have a PARAMEDIC as defined by the Ambulance Act and duly equipped at the location of a patient determined to be CTAS 2, 3, 4, 5 within a period of time determined appropriate by the DDA and noted below in Table 1, or as resources permit (level of effort): Table 1, CTAS 2, 3, 4, 5 EMS Delivery Agent Commitment CTAS 2 3 4 5

Target time from paramedic received until on scene 10 minutes 10 minutes 10 minutes 10 minutes

% Target 65% 65% 65% 65%

Comment The County of Frontenac met and in fact exceeded all of the response time targets set under our 2013 Response Time Standard Performance Plan.

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Sustainability Implications Good stewardship of the County’s financial resources allows for the most appropriate care of our residents and visitors when in need of paramedic services. Financial Implications None at this time. Organizations, Departments and Individuals Consulted and/or Affected

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Report 2014-059

ADMINISTRATIVE REPORT To:

Warden and Council Members of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/Director of Corporate Services/Treasurer

Prepared by:

Paul J. Charbonneau Director of Emergency Paramedic Services

Transportation

Services/Chief

Date prepared:

April 7, 2014

Date of meeting:

April 16, 2014

Re:

Emergency and Transportation Services Paramedicine in Ontario Application

–

Community

Recommendation RESOLVED the Council of the County of Frontenac accept this Emergency and Transportation Services – Community Paramedicine in Ontario Application report for information; AND FURTHER BE IT RESOLVED the Council of the County of Frontenac hereby approve the submission of the attached application for community paramedicine initiatives funding under the Community Paramedicine in Ontario Application Process; AND FINALLY BE IT RESOLVED that the Council of the County of Frontenac commit to ongoing operational support of the Community Paramedicne wellness clinics in Frontenac at a cost of approximately $5,600 per year.

Background On January 21, 2014 Minister of Health Deb Matthews released the following: “Ontario is supporting the expansion of community paramedicine programs to improve access to home care and community support services for seniors and other patients with chronic conditions. The province is investing $6 million to support the expansion and development of community paramedicine initiatives across the province. These Administrative Report Emergency and Transportation Services – Community Paramedicine in Ontario Application April 16, 2014

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programs allow paramedics to apply their training and skills beyond the traditional role of emergency response, and can include: • • •

Providing home visits to seniors known to call emergency services frequently, to provide a range of services such as ensuring they are taking their medications as prescribed. Educating seniors in their homes about chronic disease management and helping to connect them to local supports, such as Diabetes Education Teams. Helping refer patients to their local Community Care Access Centre (CCAC) so that they can be provided with appropriate home care services.”

Comment The goal of the proposed Community Paramedicine Project by the County of Frontenac is to establish a solid framework for future core Community Paramedicine Programs within the geographical areas of the County of Frontenac and City of Kingston. Of critical importance is the development of a comprehensive communication plan, within the framework, between Paramedics and other healthcare providers. This will ensure that all healthcare workers involved in the care of patients in the project area are informed so that patients receive the right care, in the right place, at the right time, in a fiscally responsible manner with no duplication of services. There are four primary components of this project:

Paramedic referrals. A process, policies and procedures must be developed to initiate a Paramedic Referral (e.g. CREMS/PERIL) Program.
Development of communication links between Paramedics and other healthcare providers involved with the patient.
Home visits by Paramedics. Processes, policies and procedures will be developed to identify appropriate patients and to set guidelines for Community Paramedic Home Visits.
Wellness Clinics. The opportunities to provide Wellness Clinics in appropriate locations will be investigated. The Community Paramedicine project, attached as Appendix A, will be set up in a way that meets the requirements of the local partners and ensures effective communication. The key requirement for this project is the acquisition of a Community Paramedicine Project Developer in a term position. The Developer will investigate and make recommendations for the appropriate programs and establish essential communication links to ensure the success of this program.

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Sustainability Implications Directions for Our Future, under Capacity Building and Governance on page 36, states: “Strong links ensure seamless relationships between community and municipalities.” This work also contributes to the sustainability indicator – number of collaborative projects developed and implemented with two or more municipalities and many outside stakeholders in the primary health care field.

Financial Implications The total funding request is: Community Paramedicine Project Developer

$116,298

Project Coordination

$33,000

Expansion of Wolfe Island Wellness Clinic Pilot project (2 volunteer Paramedics x $75 each per clinic x 12 clinics) Wellness Clinic Pilot Project north County of Frontenac (2 paramedics x $53.25/hour x 12 3-hour clinics) Paramedic training hours (new policies and protocols, form completion, etc. $53.25/hour x 4 hours x 140 medics KFL&A Public Health - to set up flu directive/medical oversight

$1,800

Legal Fees (regarding patient consents, etc.)

$3,834 $29,820 $5,000 $5,000

TOTAL FUNDING REQUESTED

$194,752

The ongoing costs, post project, would be the Wellness Clinic projects; this would total approximately $5,600 per year. Organizations, Departments and Individuals Consulted and/or Affected Rural Kingston Health Link Kingston Health Link South East Community Care Access Centre (SECCAC) Southern Frontenac Community Services Corporation (SFCSC) North Frontenac Community Services (NFCS) South East Local Health Integrated Network (SELHIN) Kingston General Hospital (KGH) Kingston Frontenac Lennox & Addington (KFL&A) Health Unit

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Appendix “A”

COMMUNITY PARAMEDICINE “IDENTIFYING AND FILLING THE GAPS TOGETHER”

April 17, 2014

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Contents SECTION 1—LEAD CONTACT INFORMATION…………………………………………………………………… 3 SECTION 2—THE PROPOSED CP ACTIVITY/ACTIVITIES ……………………………………………………. 6 SECTION 3—DEMONSTRATED NEED …………………………………………………………………………….. 8 SECTION 4—TARGET POPULATION ………………………………………………………………………………. 9 SECTION 5—COOPERATION AND PARTNERSHIPS …………………………………………………………. 10 SECTION 6—PROMOTE COMMUNICATION ……………………………………………………………………. 13 SECTION 7—TRACKING AND MONITORING …………………………………………………………………… 14 SECTION 8—SUSTAINABILITY PLAN ……………………………………………………………………………. 15 SECTION 9—ESTABLISHED GOVERNANCE AND ACCOUNTABILITY ………………………………….. 15 SECTION 10—NO INTERFERENCE WITH EMERGENCY RESPONSE……………………………………. 15 SECTION 11—FUNDING REQUESTED …………………………………………………………………………… 16 SECTION 12—ADDITIONAL INFORMATION ……………………………………………………………………. 16 APPLICATION DECLARATION……………………………………………………………………………………… 17

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SECTION 1—LEAD CONTACT INFORMATION Gale Chevalier Deputy Chief of Performance Standards Frontenac Paramedic Services 2069 Battersea Road Glenburnie, ON K0H 1S0 613-548-9400 ext. 420 gchevalier@frontenaccounty.ca

SECTION 2—THE PROPOSED CP ACTIVITY/ACTIVITIES The goal of the proposed Community Paramedicine Project by the County of Frontenac is to establish a solid framework for future core Community Paramedicine Programs within the geographical areas of the County of Frontenac and the City of Kingston. Of critical importance is the development of a comprehensive communication plan, within the framework, between Paramedics and other healthcare providers. This will ensure that all healthcare workers involved in the care of patients in the project area are informed so that patients receive the right care, in the right place, at the right time, in a fiscally responsible manner with no duplication of services. There are four primary components of this project: 5. Paramedic referrals. A process, and policies and procedures must be developed to initiate a Paramedic Referral (e.g. CREMS/PERIL) Program. 6. Development of communication links between Paramedics and other healthcare providers involved with the patient. 7. Home visits by Paramedics. Processes, policies and procedures will be developed to identify appropriate patients and to set guidelines for Community Paramedic Home Visits. 8. Wellness Clinics. The opportunities to provide Wellness Clinics in appropriate locations will be investigated. The Community Paramedicine project will be set up in a way that meets the requirements of the local partners and ensures effective communication. The key requirement for this project is the acquisition of a Community Paramedicine Project Developer in a term position. The Developer will investigate and make recommendations for the appropriate programs and establish essential communication links to ensure the success of this program.

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Working closely with the Community Partners, the functions of this Project Developer would include: • • • • • • •

Establishing guidelines for patient identification and developing procedures for the Paramedic Referral Process Investigating and building the critical communication links between the Paramedics and Community Partners Determining legal requirements regarding information sharing and developing appropriate consents Identifying patients who would benefit from Community Paramedic follow up, (e.g. Wellness Clinics, home visits) and developing guidelines for this process Investigating needs and opportunities for Wellness Clinics Determining training requirements Initial data analysis and recommendations

The Community Paramedicine Project Developer will be the primary team member for the first year, responsible for recommending, developing and implementing the core programs and communications, in consultation with essential Community Partners who will be involved in the programs (see section 5). The Deputy Chief of Performance Standards will be the key member of the team at Frontenac Paramedic Services. The Community Paramedicine Project Developer will report to the Deputy Chief, with ongoing consultation being a crucial component of the process. At the end of the term of the Community Paramedicine Project Developer, the Deputy Chief, along with the Supervisory staff of Frontenac Paramedic Services, will administer the Community Paramedicine Project. Paramedics will play an essential role in the project. Core Community Paramedicine programs will be established in order to identify and refer appropriate patients to the resources they need. The first step may include Paramedic Referral programs such as CREMS and PERIL. Communication links will be established to provide feedback to ensure that appropriate referrals are being made, that referred patients are receiving the resources they require, and that other healthcare providers involved in the patient’s care are informed. After applicable referrals are made, a process will be developed for follow up of appropriate patients via Community Paramedicine Wellness Clinics, adhoc home visits or “aging at home” visits using Paramedics. The communication process for this referral must be established and feedback provided to the physician and/or other Community Partners.

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SECTION 3—DEMONSTRATED NEED Consultation was held with our Community Partners: • Rural Kingston Health Link, • Kingston Health Link, • South East Local Health Integrated Network, • Northern Frontenac Community Services, • Southern Frontenac Community Services, • Community Care Access Centre • Kingston General Hospital. • Kingston Frontenac Lennox & Addington (KFL&A) Health Unit The most significant gap identified was the lack of communication between the agencies providing services for the patients. It was recognized that Paramedics have a unique opportunity to identify patients who require assistance and who have not yet been connected with the appropriate resources. The Community Partners were supportive of a system where Paramedics could make a referral for these patients. It was agreed that it is important that there is communication which allows Paramedics to find out if their referrals were appropriate and that the patient is receiving recommended supports. Another identified communication gap includes the family physicians who are often unaware of ambulance calls to their patients for events such as “lift assists” or other patients who do not require acute interventions and transportation to hospital. It is unanimously agreed that these communication links need to be established. It was also agreed that Community Paramedic Wellness Clinics, adhoc home visits and/or “aging at home” visits would be most beneficial if Community Partners could be involved in identifying appropriate patients, and, most importantly, receive information regarding the results of these visits. This would be an important part of the project. The County of Frontenac is a geographically diverse area of 3,996 square kilometres with a population of 26,375 people. A round trip to Kingston for assessment from some parts of the County can take up to five (5) hours. By ensuring that patients have the supports they need (Paramedic Referral) and visiting patients in their homes (“aging at home”, adhoc visits), this travel could be avoided, which may lead to greater patient compliance with treatment plans and improved patient satisfaction. The City of Kingston is 534 square kilometres with a population of 123,363. There are currently more than 600 patients on a waiting list for a family physician. The potential role of Paramedics in this urban setting will be investigated.

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SECTION 4—TARGET POPULATION An important role of the Community Paramedicine Project Developer will be to work with the Community Partners to identify the appropriate patients for the Community Paramedicine Programs. Frontenac Paramedic Services Ambulance Call Report (ACR) data for the County of Frontenac and the City of Kingston was reviewed from 2013 and demonstrated the following: Patient Age

53.5

47 40

Percentage

53.5% of patients were 60 or older 47% were 65 or older 40% were 70 or older 25% were 80 or older

60 40

25 20 0 60 or older

65 or older

70 or older

80 or older

While the Kingston Health Link Business Plan estimates that 16% of their patient population is over the age of 65, these patients represent 47% of ambulance calls in the County of Frontenac. The potential benefit of “aging at home” visits will be considered. High Utilization Patients Thirty-six (36) patients had ten (10) or greater ambulance visits, resulting in a total of 681 ambulance calls. These 36 patients represented 6% of total ambulance calls for 2013. It is believed that these patients frequently call 911 because they have no other resources available to them. Through Paramedic referral programs, these patients could be connected with required resources. As well, strong communication links will ensure that family physicians and other caregivers are notified, ensuring appropriate continuing care. The potential use of Wellness Clinics and home visits will be investigated. Primary Complaint Lift Assist Only

Code 72 calls (patient refused transport) indicate: 20% were for lift assist only 8% were for mental health issues 17% had “no complaints”

17%

20%

Mental Health Issues No Complaints

The reasons these patients are calling an ambulance must be investigated to see what measures can be taken to reduce these calls. Again, ensuring appropriate referrals are made, and that other healthcare providers are aware of these non-transport calls, will potentially decrease 911 calls. Administrative Report Emergency and Transportation Services – Community Paramedicine in Ontario Application April 16, 2014

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OTHER Data from The Rural Kingston Health Link Business Plan (2011/2012) estimates that with an expected growth rate of 3.9% annually, the projected patient population over age 65 by 2021 will be 25.2% in the rural area of Frontenac County. These older adults would benefit from programs to assist them to stay healthy in their homes and this will be investigated. The Rural Kingston Health Link has noted that 31% of their patients have identified mental health issues—often seniors with depression, anxiety and dementia who may benefit from Community Paramedic home visits. The report also shows that almost 10% of Emergency Room visits to the hospitals in the County of Frontenac were for CTAS 1 and 2 patients. Opportunities to reduce these calls will be explored. In conjunction with the Rural Kingston Health Link, resources available through Community Care Access Centre, Northern and Southern Frontenac Community Services, and family health teams are currently working to address the needs of these patients. The data indicates that gaps exist, especially in the elderly population. A Wellness Clinic Pilot Project was established on Wolfe Island in 2013. It has been very successful and patient surveys indicate that hospital visits have potentially been avoided by the clinic. We would like to extend this pilot project through 2014 and increase the frequency to monthly (currently every six (6) weeks). The opportunity to hold Wellness Clinics in other parts of the County will be researched. The Kingston Health Link reports 131 family physicians caring for more than 132,000 patients. Their goal is to improve access and care for patients with multiple, complex conditions, reduce avoidable emergency room visits, and reduce unnecessary readmission to hospitals shortly after discharge. Areas identified as needing attention includes mental health, addictions and palliative care, along with improved coordination of patient care. The opportunities to establish Community Paramedicine Programs to assist with these identified issues will be reviewed by the Community Paramedicine Project Developer and recommendations made. SECTION 5—COOPERATION AND PARTNERSHIPS The proposed Community Paramedicine Project would utilize established resources within the County, with enhanced communication being a key factor. The anticipated roles of these partners include:

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Frontenac Paramedic Services Paramedics who are called via 911 will identify patients for referral (CREMS/PERIL) and make appropriate recommendations. They may also identify patients who would benefit from adhoc home visits. Once the patient has been referred to appropriate resources, and consents obtained, patients identified by family health teams, mental health services or Community Care Access Centre can be visited by Paramedics through home visits, with feedback provided to the referring partner and family physician. Rural Kingston Health Link The Rural Kingston Health Link’s Business Plan (February 2013) includes Frontenac Paramedic Services as one of its Community Partners. The proposed Community Paramedicine program ties in with the four (4) essential drivers of change identified in this Business Plan: □ Integration of the continuum of patient care is the driving force for Health Links in the current Ministry of Health initiative. Improved integration, in turn, will drive a more cost-effective and patient-care-effective health care system. □ Focus: Innovative approaches that focus particularly on delivery of patient care to complex patients with comorbid conditions must first serve to improve patient experience and quality of life. At the same time, these approaches can assist with cost containment, smarter investments, and new patient-sensitive efficiencies. □ Sustainability: Where existing resources are marginal, changes to achieve ongoing sustainability will be an issue but one worth the effort. To achieve progress, it will take time, willing partners and a series of creative, adaptive actions that build on our strengths and are responsive to our patients’ behaviours — leading with a “lean strategy” approach. □ CSR Alignment: The design of Rural Kingston Health Link’s business plan seeks alignment with key initiatives in the Clinical Service Roadmap developed by the SELHIN — particularly in the areas of Cardiovascular Disease Services, Emergency Department Wait Times, and Mental Health and Addictions Services.

The Business Plan has a focus on “older high-risk target populations in the rural areas with a view to assisting them to remain at home”. This is, in fact, the essence of the Community Paramedicine initiative. This focus includes prevention, early detection or intervention, addressing unmet needs among complex patients and working with patients proactively for self-management of their own health. One of the three major programs proposed in the Business Plan is called “Transitions” which aims to decrease admissions and readmissions to hospital, and to decrease Emergency Room visits. Paramedics can assist with this through early referrals of patients identified during emergency calls, wellness clinics and home visits.

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Kingston Health Link The goal of the Kingston Health Link is “to work together as system partners to facilitate a coordinated approach for seniors and others with complex health conditions to improve access, reduce avoidable emergency room visits and improve the patient’s experience with the health care system. The Kingston Health Link represents over 132,500 patients and over 100 family physicians and is comprised of over 14 organizations”. The Kingston Health Link has identified an opportunity to work together by analyzing our emergency call database for high users and investigating ways to reduce that number. South East Community Care Access Centre (SECCAC) SECCAC will receive Paramedic referrals and attempt to provide appropriate resources to the patients. Communication links will help ensure that appropriate referrals are being made, and that the patient needs are being addressed. The possibility that some requests for follow-up by Paramedics could be initiated by SECCAC will be investigated through this project Northern and Southern Frontenac Community Services Both Northern and Southern Frontenac Community Services recognize that there are many patients in the County of Frontenac who are not receiving the supports they require. Community Social Services is involved in providing services such as Meals on Wheels, Diners Clubs, Transportation, Foot Care, Home Help, Respite, Hospice Services, Caregiver Support and Adult Day Programs. It has been suggested that with appropriate training Paramedics could play an important role in helping to keep these patients functioning in their homes. South East Local Heath Integrated Network (SELHIN) The SELHIN Clinical Services Roadmap was “designed to find better ways of providing improved access to care for residents across this region; to cut down on the red tape patients have to deal with in moving from one caregiver to another; and to ensure that hospitals and the SECCAC can integrate their services to fill the gaps and deliver a more seamless continuum of care region-wide”. It identifies Emergency Department wait times, Mental Health and Addiction Services and Restorative care as areas for improvements to streamline and improve health service delivery in the region. Through identifying and referring appropriate patients, reducing ambulance transports to hospital and assisting patients to remain healthy in their homes, the Community Paramedicine project aligns itself with the SELHIN roadmap. The SELHIN’s Aging at Home Strategy includes that there must be a shift in thinking to service provision “driven by needs” which will be supported by this Community Paramedicine initiative.

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Kingston General Hospital KGH KGH is working on a continuous improvement process that will focus on understanding readmissions to hospital and aims to work with community partners to design steps to minimize this. Their plan involves improving coordinated discharge planning and this will fit in well with Community Paramedicine referral process where paramedics could identify potential risks to be considered when sending patients home. Kingston Frontenac Lennox & Addington Health Unit (KFL&A) The KFL&A Health Unit has identified that a gap exists in providing flu shots to shut-ins who are at risk of exposure to the flu through caregivers who come into their homes. KFL&A Medical Director is in favour of developing a medical directive and providing oversight to allow Paramedics to provide this service for identified patients. Community Partners Summary The above Community Partners have been engaged in discussions regarding the potential Community Paramedicine projects, have reviewed the application and provided input. Letters of support have been provided. The Community Paramedicine Project Developer will continue to work with the partners to investigate and establish the appropriate Community Paramedic referral processes, communication links and home visiting procedures. Once established, this Community Paramedicine Program will be able to run with existing resources. Paramedic referrals originate through emergency 911 calls using existing staff. Current efforts and modified workers will be utilized to perform home visits. Ongoing communication is important throughout the development of the Community Paramedicine Project and once programs are established. The Community Paramedicine Project Developer will work with the Community Partners to establish ongoing communication methods that meet the needs of each partner. It is anticipated that periodic meetings would be held to facilitate discussion.

SECTION 6—PROMOTE COMMUNICATION Core team members including CCAC, Rural Kingston Health Links, Kingston Health Link, Northern Frontenac Community Services, Southern Frontenac Community Services, Kingston General Hospital and the LHIN were identified as being essential to the delivery of the proposed project, and were involved in initial meetings regarding the project. Each partner recommended the appropriate person from their organization to participate in discussions, and as the process developed, additional participants were added. Moving forward, the Community Paramedicine Project Developer will continue to evaluate the members who need to be involved. The root of this Community Paramedicine project is about communication. The primary gap identified was the communications between agencies. The recruitment of a Project Developer to establish processes and communication links will ensure this communication occurs. Administrative Report Emergency and Transportation Services – Community Paramedicine in Ontario Application April 16, 2014

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SECTION 7—TRACKING AND MONITORING The first milestone of the project will be to hire the Community Paramedicine Project Developer. The goal is to achieve this in one month (now). Once the Community Paramedicine Project Developer begins work on the project, initial goals will be: • • • •

Establishing working relationships with the Community Partners (now) Researching the specific needs of the target population and determining the best methods to address these needs (<3 months) Developing the Paramedic Referral process, including guidelines and protocols (>3 months) Investigating and establishing a communications system between Community Partners (>3 months)

Monthly reports outlining progress and recommendations will be submitted. These can be shared with the Community Partners to ensure all are aware of progress and can identify concerns early. The Wolfe Island Wellness Clinic is already established. Patients have identified that they would like to see the Clinic occur monthly. As an ongoing Pilot Project, we would be able to increase the frequency to monthly immediately, and monitor patient usage and patient satisfaction. The Community Paramedicine Project Developer will be responsible for making recommendations on whether another Wellness Clinic in the north part of the County would be recommended and this would be established as a pilot project, with patient usage and satisfaction monitored. We would like to see the establishment of the Paramedic Referral program within six months. Optimization of the communication links involved with this process will be ongoing. Through the communication links established, data will be collected to track success of the program. The specific key performance metrics that will be used and how this information will be obtained will be established through the work of the Community Paramedicine Project Developer, but are anticipated to include: • • • • •

Decrease in 911 calls by target populations e.g. elderly, high utilization patients, mental health, (evaluated through analysis of FPS iMEDIC data) Improved access to homecare and community supports (data obtained from community partners) Decreased hospital admissions/readmissions (data from KGH) Increased attendance at Wellness Clinic(s) Patient satisfaction surveys

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SECTION 8—SUSTAINABILITY PLAN Once the core Community Paramedicine programs, processes and communication links have been established, the program will run utilizing existing resources, within current efforts and modified workers. Frontenac County Council has been supportive of Community Paramedicine initiatives in the County, and has approved funding for the Wellness Clinic pilot project on Wolfe Island. If further Wellness Clinics or other initiatives prove to be of value to the citizens of the County, and economic benefits can be shown, County Council would have to make further decisions regarding additional future funding. SECTION 9—ESTABLISHED GOVERNANCE AND ACCOUNTABILITY The core programs of this Community Paramedicine Project do not require paramedics to use skills beyond their current scope of practice, or any delegated medical acts, therefore medical oversight is not required. The one exception to this would be if Paramedics are used to deliver flu shots to shut-in patients. In this case, Dr. I. Gemmill, Medical Officer of Health, or his designate, would be responsible for developing a medical directive and providing medical oversight. The estimated cost associated with this project is included in the budget. The Community Paramedicine Project Developer, and the Paramedics involved in delivering the programs, will be overseen by the Deputy Chief of Performance Standards, reporting to the Chief of Frontenac Paramedic Services. Quality review processes will be established to ensure safe, high-quality care is being provided through Community Paramedicine projects. Ultimately, Frontenac County Council makes the final decision regarding the Community Paramedicine Projects that will be undertaken. The Community Paramedicine Project Developer will provide regular updates to the Deputy Chief of Performance Standards. Monthly reports will be provided to the Senior Management Team of the County of Frontenac, and the Chief of Paramedic Services will provide quarterly reports to Frontenac County Council. SECTION 10—NO INTERFERENCE WITH EMERGENCY RESPONSE This Community Paramedicine project will not impact core business of providing emergency response. Paramedics will immediately respond to emergency calls within the legislated time parameters regardless of whether they are responding from their Station or any other mobile location, including a home-visit residence. Chute times and RTS timeframes will be tracked and monitored to ensure there is no negative impact on the core business of providing emergency response.

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SECTION 11—FUNDING REQUESTED

Community Paramedicine Project Developer

$116,298

Project Coordination

$33,000

$1,800

Legal Fees (regarding patient consents, etc.) TOTAL FUNDING REQUESTED

$3,834 $29,820 $5,000 $5,000 $194,752

SECTION 12—ADDITIONAL INFORMATION In his report, Living Longer, Living Well, Dr. Samir K. Sinha, Provincial Lead, Ontario’s Seniors Strategy, makes a key recommendation that “The Ministry of Health and LongTerm Care, in collaboration with Local Health Integration Networks (LHINs) and local municipal Emergency Medical Services (EMS) programs, should explore the development and expansion of Community Paramedicine programs across Ontario, especially in northern and rural communities. These programs could better support high-users of EMS to avoid emergency department (ED) visits and hospitalizations and potentially delay entry into a long-term care home as well.” The County of Frontenac’s Community Paramedicine Project aligns with this key recommendation as it will strive to establish a solid framework for future core Community Paramedicine Programs within the County and develop a comprehensive communication plan between Paramedics and other healthcare providers.

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AgendaItem#5b)

APPLICATION DECLARATION On behalf of and with the authority of the Applicant, I/we:

Certify that the information that the Applicant has supplied in support of its application is true, correct and complete in every respect.
Certify that the proposed Community Paramedicine activity does not interfere with core emergency response and service delivery.
Agree that if this Application to deliver a community paramedicine initiative is selected, the Applicant will agree to amend any applicable Service Accountability Agreement or other relevant funding agreement that the Ministry may provide or enter into a new Service Accountability Agreement or other funding agreement as applicable relating to this initiative. Name(s), Title(s) and Signature(s) of Authorized Project Leads:

Name and Signature of EMS Chief:

Name of Partner Organizations:

Date: ___________________________________________________

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AgendaItem#5b)

Report 2014-039

RECOMMEND REPORT TO COUNCIL To:

Warden and Council Members of the County of Frontenac

From:

Marian VanBruinessen Acting CAO/Director of Corporate Services/Treasurer

Prepared by:

Paul J. Charbonneau Director of Emergency Paramedic Services

Transportation

Services/Chief

Date prepared:

March 1, 2014

Date of meeting:

March 19, 2014

Re:

Emergency and Transportation Services – Election to Paramedic Chiefs of Canada (PCC) Board of Directors Executive of the Chief of Paramedic Services

Recommendation RESOLVED THAT the Council of the County of Frontenac accept the Emergency and Transportation Services – Election to Paramedic Chiefs of Canada (PCC) Board of Directors Executive of the Chief of Paramedic Services report for information; AND FURTHER the Council of the County of Frontenac support the Chief of Paramedic Services’ election to the Executive of the Paramedic Chiefs of Canada for the period of June 13, 2014 to June 12, 2015.

Background At the meeting of January 16, 2013 County Council passed the following: Motion #: 18-13

Moved By: Seconded By:

Councillor Purdon Deputy Warden Clayton

RESOLVED THAT the Council of the County of Frontenac accept the Emergency and Transportation Services – Election to Paramedic Chiefs of Recommend Report Emergency and Transportation Services – Election to Paramedic Chiefs of Canada (PCC) Board of Directors Executive of the Chief of Paramedic Services March 19, 2014 Page 1 of 2

Emergency and Transportation Services

Page 181 of 182

AgendaItem#5b)

Canada Board of Directors of the Chief of Paramedic Services report for information; AND WHEREAS the Council of the County of Frontenac Paramedic Service is a longstanding member of the Paramedic Chiefs of Canada; AND WHEREAS both the Chief of Paramedic Services and other staff members have engaged in the business of the Association in many roles over the years; NOW THEREFORE the Council of the County of Frontenac support the Chief of Paramedic Services’ election to the position of “President-Elect” of the Paramedic Chiefs of Canada for the period of January 16 to June 13, 2013. CARRIED

Comment The County of Frontenac Paramedic Services has been a member of the Paramedic Chiefs of Canada (PCC) since 2004. The Chief of Frontenac Paramedic Services has been the Tier 1 Voting Member for the County of Frontenac since 2005, an elected member of the Board of PCC since 2007 and has served on various committees and as Treasurer of the association for two years and, most recently, Vice-President since January 16th, 2013. Additionally, Deputy Chiefs have served on various working groups and task forces in support of national initiatives such as Emergency Medical Services Week, Leadership Development and Research Leads. The value to membership are the opportunities to participate in a formal research agenda, access to a national research database, community of practice standards and policies, community paramedicine papers and roundtable forums, membership services including access to membership list serve, monthly webinars delivered by subject matter experts, PCC newsletter, on-line forums and the annual general meeting and conference. In addition, there is also the opportunity to share in best practices from across the country, which turns performance standards issues into opportunities.

Sustainability Implications Being active in and having influence with the PCC allows staff to provide first person reporting, back to County Council, on developments within the industry provincially and nationally, thereby enhancing the quality service provided to our community.

Financial Implications The PCC will cover any travel costs, for work undertaken on behalf of the PCC and when representing the PCC, therefore no travel costs are associated with election to the PCC Executive. Recommend Report Emergency and Transportation Services – Election to Paramedic Chiefs of Canada (PCC) Board of Directors Executive of the Chief of Paramedic Services March 19, 2014 Page 2 of 2

Emergency and Transportation Services

Page 182 of 182

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