AgeCare Elmira (11 Herbert Street, Elmira, Ontario) is operated by AgeCare, a for-profit operator of long-term care homes in Canada. There are approximately 50 beds.
AgeCare Elmira is formerly owned and operated by Chartwell, a for-profit operator of senior accommodations in Canada. The facility was previously known as Chartwell Elmira Long Term Care Residence.
Our research team carefully reviewed and summarized inspection reports for AgeCare Elmira. You can read the original copies of the reports in the Government of Ontario website.
Inspection Reports for AgeCare Elmira
Chartwell completed its sale of long-term care homes to AgeCare on September 6, 2023. Inspection results after this date should not be attributed to Chartwell operations.
🔍 January 2024: Inspection
During the course of this inspection, the inspector(s) made relevant observations,
reviewed records and conducted interviews, as applicable. There were no findings
of non-compliance.
Inspection Reports for Chartwell Elmira Long Term Care Residence
Chartwell completed its sale of long-term care homes to AgeCare on September 6, 2023. Inspection results before this date should not be attributed to AgeCare operations.
🔍 July 2023: Inspection
The inspection for Chartwell Elmira Long Term Care Residence, conducted by Kaitlyn Puklicz, focused on a specific intake related to a resident’s fall that led to a hospital transfer and a change in the resident’s status.
- Plan of Care: The issue related to the plan of care for a resident, specifically the use of fall mats. Initially, the resident’s care plan, which required fall mats to be placed bilaterally, was not fully implemented as only one fall mat was in place. Upon observation and staff interview, the issue was corrected, and both fall mats were placed as required by the resident’s care plan.
- Infection Prevention and Control: The licensee failed to carry out a Minister’s Directive related to Infection Prevention and Control (IPAC) audits. The directive mandated that IPAC self-audits be completed every two weeks when not in an outbreak and weekly during an outbreak. The inspection revealed that the necessary IPAC self-audits were not conducted as required for May 2023, indicating a lapse in the home’s preparedness and response measures for a COVID-19 outbreak. This finding was based on a review of the IPAC self-audits provided by the home and interviews with the IPAC Lead.
🔍 February 2023: Inspection
The inspection for Chartwell Elmira Long Term Care Residence, conducted by Katherine Adamski, April Racpan and Mark Molina, covered multiple aspects of resident care and facility operations including Skin and Wound Prevention and Management, Medication Management, Food, Nutrition and Hydration, and Infection Prevention and Control.
- Falls Prevention and Skin and Wound Program Referral Protocols: The facility failed to provide a written description of referral protocols to specialized resources for falls prevention and skin and wound care. The absence of clear referral guidelines could hinder the provision of appropriate care when specialized resources are required, potentially compromising resident safety.
- Continuous Quality Improvement (CQI) Interim Report: Chartwell Elmira did not share the CQI interim report with the Resident’s Council as required, limiting their participation in the home’s quality improvement initiatives. This oversight could affect the council’s ability to contribute to and understand the home’s priorities for quality improvement.
- Resident and Family Experience Survey: The inspection found that the results of the Resident and Family Experience Survey were not effectively communicated to the Resident’s Council. This failure may impact the council’s role and responsibilities in addressing the needs and concerns of residents and their families.
- Housekeeping and Equipment Disinfection: The home did not adhere to the manufacturer’s specifications for cleaning and disinfecting resident care equipment, such as transfer lifts. Improper disinfection practices were observed, posing a risk for the transmission of infectious diseases among residents.
🔍 November 2022: Inspection
During the course of this inspection, the inspector(s) made relevant observations, reviewed records and conducted interviews, as applicable. There were no findings of non-compliance.
🔍 September 2022: Inspection
The inspection for Chartwell Elmira Long-Term Care Home, led by Katherine Adamski, focused on Infection Prevention and Control (IPAC) and the Prevention of Abuse and Neglect, in response to a specific intake related to alleged staff to resident abuse.
- Plan of Care: The care specified in resident #001’s plan, particularly regarding responsive behaviors, was not provided as directed. This resulted in an allegation of staff to resident abuse, highlighting the failure to follow the care plan and lack of intervention for responsive behaviors.
- Infection Prevention and Control Leadership: The facility lacked a dedicated IPAC Lead, compromising the comprehensive implementation of IPAC tasks. The designated Acting IPAC Lead, primarily responsible for another role, could not fully address IPAC duties, impacting the facility’s ability to maintain infection control standards.
- Operational and Policy Directive Compliance: The facility failed to carry out directives related to symptom assessment of residents for COVID-19, showing gaps in temperature and symptom surveillance. Incomplete and inconsistent surveillance records indicated a failure to monitor residents’ health as required, potentially risking unidentified COVID-19 symptoms.
The facility was ordered to ensure compliance with standards for IPAC, specifically around hand hygiene and the use of Personal Protective Equipment (PPE). Required actions included conducting daily audits, re-training staff on routine practices, and maintaining records of reviews and training.
🔍 October 2021: Critical Incident Inspection
The inspection for Chartwell Elmira Long Term Care Residence related to falls prevention and management were examined. The inspection, led by Daniela Lupu, focused on assessing the facility’s adherence to Infection Prevention and Control (IPAC) protocols and falls prevention strategies.
- IPAC Program: The inspection identified that the facility failed to ensure full staff participation in the IPAC program, particularly concerning the proper use of Personal Protective Equipment (PPE) and hand hygiene practices.
- PPE Usage and Hand Hygiene Lapses: Specific instances were observed where staff did not adhere to PPE guidelines and hand hygiene protocols: (i) a PSW entering a resident’s room without wearing eye protection, despite droplet and contact precautions due to COVID-19 directives; (ii) caregivers using cloth masks instead of surgical masks provided by the facility and not covering their nose and mouth properly; and (iii) staff failing to perform hand hygiene after administering medications and after contact with soiled items before interacting with residents.
- Directive #3 Compliance: The facility was required to adhere to Directive #3, revised on July 16, 2021, mandating protective measures including the use of PPE and hand hygiene practices to safeguard residents, staff, and visitors from COVID-19.
The licensee was requested to develop a written plan of correction to ensure compliance with the home’s IPAC program. This plan aimed at enhancing staff participation in IPAC practices, specifically focusing on the correct use of PPE and rigorous hand hygiene protocols.
