Carefree Lodge

Carefree Lodge (306 Finch Avenue East, North York) is owned and operated by the City of Toronto. There are approximately 130 beds.

In this article, our Good Caring Canada team has reviewed Carefree Lodge from three essential angles: inspection reports, performance indicators, and resident profiles. You are encouraged to thoroughly review all three angles so you can be more informed about the quality and safety of Carefree Lodge.

Table of Contents:

• Inspection Reports for Carefree Lodge
• Performance Indicators for Carefree Lodge
• Resident Profile of Carefree Lodge

Inspection Reports for Carefree Lodge

Carefree Lodge is regulated by the Ontario Ministry of Health and Long-Term Care. The Ministry conducts inspections of all long-term care facilities to ensure that operations are in compliance with provincial regulations, and that residents receive proper care.

Our Good Caring Canada team has summarized inspection reports for Carefree Lodge. Original copies of the inspection reports can be read in the Government of Ontario website.

🔍  November 2023

During the course of this inspection, the inspector made relevant observations, reviewed records and conducted interviews, as applicable. There were no findings of non-compliance.

🔍  September 2023

There were two inspections.

The primary focus of the first inspection, led by Michael Chan, was to address a complaint related to care concerns and a critical incident involving allegations of neglect to a resident.

The main issue identified was a failure in the integration of assessments and care. The investigation revealed that the staff failed to adequately communicate and document changes in a resident’s condition. This lack of communication led to the resident’s health condition deteriorating without timely medical intervention. It was noted that had the resident’s condition been properly documented and communicated, the attending physician might have provided additional medical care, potentially improving the resident’s outcome.

To address this, the inspector issued a Compliance Order demanding the following actions from Carefree Lodge:

• Educational Initiative: All registered staff must receive education about the incident involving a resident’s deterioration, focusing on the contributing factors and strategies to prevent similar incidents in the future. Records of this education, including attendees, dates, and trainers, must be maintained.
• Audit Requirement: Carefree Lodge is required to conduct weekly audits on a specified floor for three weeks. These audits should review telephone orders and ensure appropriate documentation on the Physician Communication Log.
• Audit Records: Carefree Lodge must keep a detailed written record of these audits, including the residents and staff audited, results, and actions taken in response to the findings.

The second inspection, led by Ann McGregor with additional inspector Maya Kuzmin , focused on several critical incidents, specifically relating to falls prevention and management and an Acute Respiratory Infection (ARI) outbreak, as part of the Infection Prevention and Control (IPAC) protocol.

A significant concern was raised regarding the IPAC program. Carefree Lodge failed to ensure that all staff participated in the implementation of their IPAC program. During an observation, a Personal Support Worker (PSW) was seen entering a resident’s room, which required IPAC measures, without following the proper IPAC practices. This oversight posed a risk of infection transmission. The Long-Term Care Home’s IPAC Practitioner confirmed that the proper procedures were not followed, highlighting the need for strict adherence to IPAC protocols to prevent potential infection risks.

One instance of non-compliance was identified and rectified during the inspection. The issue involved a door leading to a non-residential area that was left open without supervision. This door was supposed to be closed and locked to restrict unsupervised access by residents. The Acting Building Services Managers (ABSM) acknowledged the issue and promptly closed the door, confirming that it was an oversight and the door usually houses nursing supplies and a sink.

🔍  June 2023

The inspection, led by Kim Lee (741072) with additional inspector Joy Ieraci (665), covered various aspects of care and services including skin and wound prevention, medication management, and infection prevention and control, among others.

• Air Temperature: Carefree Lodge failed to comply with O. Reg. 246/22, s. 24 (4), which requires daily temperature measurements in non-air-conditioned resident rooms. A resident’s room lacking air conditioning wasn’t monitored as required, posing a risk of heat-related illness.
• Housekeeping: Carefree Lodge did not adhere to the policy for cleaning a resident’s bedroom. Specifically, wet mopping was done with hot water instead of a disinfectant solution, contrary to the “Daily Resident Room Cleaning” policy.
• Infection Prevention and Control Program: Carefree Lodge failed to ensure that a Registered Nurse (RN) applied the appropriate personal protective equipment (PPE).
• Quarterly Evaluation: Carefree Lodge did not meet the requirement for an interdisciplinary team’s quarterly evaluation of the medication management system. The April 2023 review did not include the pharmacy service provider.
• Medication Incidents and Adverse Drug Reactions: Carefree Lodge failed to document and report every medication incident involving a resident. There was a lack of documentation and reporting to the pharmacy service provider for a medication incident.

🔍  December 2022

This Critical Incident System inspection, led by Fiona Wong (740849) with additional inspectors Ivy Lam (646) and Adam Dickey (643) as assessing mentors, focused on falls prevention and management, as well as infection prevention and control.

• Hand Hygiene Program: Initially, the licensee failed to comply with compliance regarding the hand hygiene program. Specifically, expired Alcohol-Based Hand Rub (ABHR) was found in use. However, this non-compliance was remedied on December 6, 2022, when all expired ABHR was removed.
• Infection Prevention and Control: The licensee did not adhere to the additional requirements of the IPAC Standard for Long-Term Care Homes April 2022. Issues were found with the incorrect donning of PPE by a Personal Support Worker (PSW) and a Registered Practical Nurse (RPN). This non-compliance posed a risk of contamination and infection transmission.
• Plan of Care: The licensee failed to reassess and revise the care plan for a resident at risk for falls. Despite multiple unwitnessed falls, the resident’s care plan wasn’t updated with appropriate fall prevention strategies, leading to the risk of further falls and injuries.

🔍  June 2022

During the course of this inspection, the inspector made relevant
observations, reviewed records and conducted interviews, as applicable. There
were no findings of non-compliance.

🔍  April 2022

The inspection was conducted by Inspector Rodolfo Ramon. This inspection, focused on a complaint, involved assessing various aspects of resident care and facility operations.

The inspectors evaluated continence care, infection prevention and control (IPAC), and prevention of abuse, neglect, and retaliation.

• Infection Prevention and Control Program: The licensee did not ensure staff participation in the IPAC program. The inspector observed failures in hand hygiene practices among staff, posing a risk of disease transmission. An order (CO #001) was issued for corrective action.
• Duty to Protect – Neglect of Resident: The licensee failed to protect a resident from neglect. The resident was found in poor sanitary conditions, and no care was provided for eight hours, leading to a risk of skin breakdown.
• Continence Care and Bowel Management: The licensee did not conduct an assessment for resident #001 using an appropriate instrument for incontinence assessment. Additionally, the plans of care for bowel and bladder continence for residents #001 and #003 were not implemented as required.

🔍  February 2022

An inspection was carried out under the supervision of Inspector April Chan. This Critical Incident System inspection focused on falls prevention and management, as well as infection prevention and control (IPAC).

Conducted on January 19, 20, 21, 24, and 25, 2022, the inspection was intended to assess critical incidents related to falls prevention and management.

• Infection Prevention and Control: Non-compliance was noted in the implementation of the IPAC program. Specifically, a staff member was observed incorrectly wearing an N95 respirator over a surgical mask, contrary to the home’s procedure. This raised concerns about the effectiveness of infection control measures.
• Documentation of Resident Interventions: The licensee failed to document actions related to a resident’s use of an intervention under the fall prevention program. This included a lack of documentation on reassessment, intervention, and the resident’s response to the intervention, especially in the context of falls that led to hospitalization.

🔍  October 2021

An inspection was conducted at Carefree Lodge in North York, Ontario, under the guidance of Inspector Ivy Lam.

The inspection took place from September 16 to 24, 2021, aiming to address a complaint related to falls prevention and assessment, personal support services, nutrition and hydration, and maintaining a safe and secure environment for residents.

• Care Plans: The inspection identified a failure in providing clear directions in the care plans for residents, specifically concerning the use of assistive devices and furniture positioning. This lack of clarity potentially increased the risk of falls for residents.
• Inconsistent Toilet Assistance: A resident’s care plan showed conflicting information regarding their ability to use the toilet independently, leading to an unwitnessed fall. The discrepancy in the care plan underlined the need for clear, unambiguous instructions to staff for providing resident care.

Performance Indicators for Carefree Lodge

Our research team at Good Caring Canada has compiled data on seven key performance indicators for long-term care facilities in Ontario.

We invite you to review each of the below indicators — to compare Carefree Lodge with other long-term care facilities in Ontario.

• 💊  Potential misuse of antipsychotics is measured by the percentage of residents taking antipsychotic drugs, without a diagnosis of psychosis

• 🔒  Potential excessive use of physical restraints is measured by the percentage of residents in daily physical restraints

• 🤕  Fall risk is measured by the percentage of residents who fell in the 30 days leading up to the date of their quarterly clinical assessment

• 🦽  Worsened physical functioning is measured by the percentage of residents who worsened or remained dependent in transferring and locomotion (mid-loss ADLs), less residents who improved or remained independent

• 🩹  Worsened pressure ulcers is measured by the percentage of residents whose stage 2 to 4 pressure ulcer worsened since the previous assessment

• 😣  Pain is measured by the percentage of residents who report to have moderate daily pain or horrible/excruciating pain at any frequency

• ☹️  Worsened depressive mood is measured by the percentage of residents whose mood from symptoms of depression worsened

Resident Profile of Carefree Lodge

Understanding the resident profile of a long-term care facility can help you assess the facility’s appropriateness and compatibility for a patient. Our research team at Good Caring Canada compiled data on three main elements to understand resident profiles. We invite you to review each of the three below elements.

• 👵🏻  Gender profile can be helpful for assessing the gender compatibility of a long-term care facility.

• 👴🏻  Age profile can be helpful for assessing whether a long-term care facility has experience in caring for residents of specific age groups. More residents of advanced age may imply potential challenges to adequate and equitable care for all residents in the facility.

• 💭  The percentage of residents with dementia can be helpful for assessing whether a long-term care facility is aware and ready for dementia care. A higher percentage may imply more relevant care services. A higher percentage may also imply potential challenges to adequate and equitable care for all residents in the facility.