Extendicare West End Villa (2179 Elmira Drive, Ottawa) is operated by Extendicare, a for-profit operator of long-term care homes in Canada. There are approximately 240 beds in private, semi-private and shared rooms.
Inspection Reports for Extendicare West End Villa
Our research team at Caring Magazine carefully reviewed and summarized inspection reports for Extendicare West End Villa. You can read the original copies of the reports in the Government of Ontario website.
🔍 October 2023: 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.
🔍 August 2023: Inspection
The amended inspection report for Extendicare West End Villa was completed by Saba Wardak and Martin Orr.
- Skin and Wound Care: Non-compliance was noted in the skin and wound care policy for a resident. After returning from the hospital, a Registered Practical Nurse (RPN) received the resident but failed to document a head-to-toe assessment as required by the home’s skin and wound management program. This lapse in documentation jeopardized continuity of care and effective communication regarding the resident’s skin integrity status.
- Reporting Certain Matters to Director: The facility did not inform the Director of an incident of alleged physical abuse between residents. The Director of Care (DOC) at the home was aware of the incident and conducted an internal investigation, implementing interventions. However, there was no Critical Incident Report (CIR) submitted to the Director regarding this incident, thereby risking an unreported incident of abuse towards a resident.
🔍 June 2023: Inspection
The inspection conducted at Extendicare West End Villa, led by Mark McGill and Pamela Finnikin, addressed various complaints and critical incidents related to resident care concerns.
- Explanation of Plan of Care: The inspection identified a failure in notifying the resident’s substitute decision-maker about test results as required by the plan of care. The resident had undergone tests, and the results were reviewed by medical staff, but the substitute decision-maker was not informed immediately as per the protocol.
- Pain Management Program: Staff did not comply with the Pain Identification and Management procedure for a resident who had new complaints of pain. No pain assessment was completed for the resident in 2023, despite the presence of new pain complaints, which should have triggered a comprehensive pain assessment. In another instance, staff failed to comply with the Plan of Care and Pain Identification and Management procedures for a resident whose care needs changed due to pain management. The resident’s ongoing pain led to various interventions and treatments, but the care plan was not updated to reflect these changes.
🔍 April 2023: Inspection
The inspection at Extendicare West End Villa, conducted by Cheryl Leach, Sarah Stephens and Shevon Thompson, addressed several intakes related to falls, delayed notification of a resident’s death, family complaints about resident care, an anonymous complaint regarding staff, and a coroner’s complaint regarding the death of a resident.
- Plan of Care for Personal Assistance Service Device: The inspection found that the licensee failed to ensure that the plan of care involving a Personal Assistance Service Device (PASD) was followed for a resident. Specifically, the resident’s care plan required the use of a PASD for safety while in a wheelchair. However, the resident experienced an unwitnessed fall, resulting in injury and significant change in condition, because they were not wearing their PASD at the time of the fall. Interviews with staff members confirmed this non-compliance.
🔍 September 2022: Inspection
The report for Extendicare West End Villa covers an inspection, by Pamela Finnikin, that addressed complaints and critical incidents involving issues of resident care, services, rights, nutrition, medication, and abuse.
- Medication Management System: The licensee failed to adhere to their Medication Management Policy with regard to resident #011. Specifically, the administration of ‘as needed’ medication was not documented in the Medication Administration Record (MAR) on five occasions, and the effectiveness of the drug and the resident’s response were not recorded, impacting the resident’s health negatively.
- Emergency Plans: The facility did not comply with their “Code Yellow – Missing Resident” policy. A resident was not located, and although a search was initiated, the room where the resident was eventually found was not searched. This failure increased the risk to the missing resident.
- Communication and Response System: The call bell system was not easily seen or accessible for residents #013, #014, and #015, which was against the facility’s policy. This issue posed a risk to these residents who could not independently get out of bed and required assistance.
- Infection Prevention and Control: The facility failed to comply with the Minister’s Directive for COVID-19 response, specifically regarding self-isolation and additional precautions for residents returning from the hospital. There were missing self-audit assessments both when the home was in and not in outbreak.
🔍 January 2022: Proactive Compliance Inspection
The Proactive Compliance Inspection at Extendicare West End Villa, by inspectors Heath Heffernan and Megan MacPhail, aimed to assess various aspects of the long-term care home’s operations.
- Safety and Security: The facility failed to comply, concerning doors in the home. Specifically, an exit door in the north corridor on the main level was found unlocked on several occasions. The Director of Care stated that the door was unlocked as an Infection Prevention and Control measure to control the flow of staff movement, while the Manager of Support Services mentioned that a keypad was ordered for the door to keep it locked when closed.