jswizzle3737/ontario_laws_and_regs huggingface dataset:
Dealing with complaints
 108. (1) Every licensee shall ensure that every written or verbal complaint made to the licensee or a staff member concerning the care of a resident or operation of the home is dealt with as follows: 1.  The complaint shall be investigated and resolved where possible, and a response that complies with paragraph 3 provided within 10 business days of the receipt of the complaint, and where the complaint alleges harm or risk of harm including, but not limited to, physical harm, to one or more residents, the investigation shall be commenced immediately. 2.  For those complaints that cannot be investigated and resolved within 10 business days, an acknowledgement of receipt of the complaint shall be provided within 10 business days of receipt of the complaint including the date by which the complainant can reasonably expect a resolution, and a follow-up response that complies with paragraph 3 shall be provided as soon as possible in the circumstances. 3.  The response provided to a person who made a complaint shall include, i.  the Ministry’s toll-free telephone number for making complaints about homes and its hours of service and contact information for the patient ombudsman under the Excellent Care for All Act, 2010, ii.  an explanation of, A.  what the licensee has done to resolve the complaint, or B.  that the licensee believes the complaint to be unfounded, together with the reasons for the belief, and iii.  if the licensee was required to immediately forward the complaint to the Director under clause 26 (1) (c) of the Act, confirmation that the licensee did so. (2) The licensee shall ensure that a documented record is kept in the home that includes, (a)  the nature of each verbal or written complaint; (b)  the date the complaint was received; (c)  the type of action taken to resolve the complaint, including the date of the action, time frames for actions to be taken and any follow-up action required; (d)  the final resolution, if any; (e)  every date on which any response was provided to the complainant and a description of the response; and (f)  any response made in turn by the complainant. (3) The licensee shall ensure that, (a)  the documented record is reviewed and analyzed for trends at least quarterly; (b)  the results of the review and analysis are taken into account in determining what improvements are required in the home; and (c)  a written record is kept of each review and of the improvements made in response. (4) Subsections (2) and (3) do not apply with respect to verbal complaints that the licensee is able to resolve within 24 hours of the complaint being received. (5) Where a licensee is required to immediately forward a complaint under clause 26 (1) (c) of the Act, it shall forward it in a form and manner acceptable to the Director, and, (a)  during the Ministry’s normal business hours, to the Director or the Director’s delegate; or (b)  outside normal business hours, using the Ministry’s after hours emergency contact method.
Additional requirements, s. 26 of the Act
 109. (1) A complaint that a licensee is required to immediately forward to the Director under clause 26 (1) (c) of the Act is a complaint that alleges harm or risk of harm, including, but not limited to, physical harm, to one or more residents. (2) For the purposes of subsection 26 (2) of the Act, the licensee shall also ensure that it provides to the Director, in a manner acceptable to the Director, a copy of the part of the documented record the licensee is required to keep under subsection 108 (2) that is related to the complaint.
Transitional, complaints
 110. Where a complaint was made before the coming into force of this section, but not finally dealt with, the complaint shall be dealt with as provided for in section 108 to the extent possible.
Complaints — reporting certain matters to Director
 111. (1) Every licensee of a long-term care home who receives a written complaint with respect to a matter that the licensee reports or reported to the Director under section 28 of the Act shall submit a copy of the complaint to the Director along with a written report documenting the response the licensee made to the complainant under subsection 108 (1). (2) The licensee shall comply with subsection (1) immediately upon completing the licensee’s investigation into the complaint, or at an earlier date if required by the Director.
Licensees who report investigations under s. 27 (2) of Act
 112. (1) In making a report to the Director under subsection 27 (2) of the Act, the licensee shall include the following material in writing with respect to the alleged, suspected or witnessed incident of abuse of a resident by anyone or neglect of a resident by the licensee or staff that led to the report: 1.  A description of the incident, including the type of incident, the area or location of the incident, the date and time of the incident and the events leading up to the incident. 2.  A description of the individuals involved in the incident, including, i.  names of all residents involved in the incident, ii.  names of any staff members or other persons who were present at or discovered the incident, and iii.  names of staff members who responded or are responding to the incident. 3.  Actions taken in response to the incident, including, i.  what care was given or action taken as a result of the incident, and by whom, ii.  whether a physician or registered nurse in the extended class was contacted, iii.  what other authorities were contacted about the incident, if any, iv.  whether a family member, person of importance or a substitute decision-maker of any resident involved in the incident was contacted and the name of such person or persons, and v.  the outcome or current status of the individual or individuals who were involved in the incident. 4.  Analysis and follow-up action, including, i.  the immediate actions that have been taken to prevent recurrence, and ii.  the long-term actions planned to correct the situation and prevent recurrence. 5.  The name and title of the person making the report to the Director, the date of the report and whether an inspector has been contacted and, if so, the date of the contact and the name of the inspector. (2) Subject to subsection (3), the licensee shall make the report within 10 days of becoming aware of the alleged, suspected or witnessed incident, or at an earlier date if required by the Director. (3) If not everything required under subsection (1) can be provided in a report within 10 days, the licensee shall make a preliminary report to the Director within 10 days and provide a final report to the Director within a period of time specified by the Director.
Application of duty
 112.1 Exempted out of province health professionals are prescribed for the purposes of paragraph 3 of subsection 28 (4) of the Act. O. Reg. 202/23, s. 6.
Non-application re certain staff
 113. Paragraph 4 of subsection 28 (5) of the Act does not apply to a staff member who, (a)  falls under clause (b) or (c) of the definition of “staff” in subsection 2 (1) of the Act; (b)  only provides occasional maintenance or repair services to the home; and (c)  does not provide direct care to residents.
Transitional, investigation and reports
 114. (1) Section 27 of the Act and section 112 of this Regulation apply with respect to incidents that the licensee knew of or that were reported to the licensee after the coming into force of this section, even if the incident occurred before the coming into force, unless the incident was investigated and resolved before the coming into force. (2) Section 28 of the Act applies only with respect to matters that occurred or may occur after July 1, 2010. (3) Section 29 of the Act applies with respect to information received by the Director after that section comes into force, even if the information is with regard to a matter that occurred before that section came into force. (4) Section 30 of the Act applies with respect to retaliation that occurs after the coming into force of that section, even if the retaliation relates to something that was disclosed or given in evidence before the coming into force of that section including anything with respect to which section 26 of the former Act applied.
Misuse of Funding
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Misuse of funding
 116. For the purposes of paragraph 5 of subsection 28 (1) and paragraph 6 of subsection 29 (1) of the Act, “misuse” of funding means the use of funding provided by the Ministry, the Agency or a local health integration network, (a)  for a purpose other than a purpose that was specified as a condition of the funding; or (b)  in a manner that is not permitted under a restriction that was specified as a condition of the funding. Whistle-Blowing
Whistle-Blowing
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Entities, s. 30 of the Act
 117. The following are prescribed entities to which clause 30 (1) (c) of the Act applies: 1.  Residents’ Councils. 2.  Family Councils, if any. Minimizing of Restraining
Minimizing of Restraining
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Policy to minimize restraining of residents, etc.
 118. Every licensee of a long-term care home shall ensure that the home’s written policy under section 33 of the Act deals with, (a)  use of physical devices; (b)  duties and responsibilities of staff, including, (i)  who has the authority to apply a physical device to restrain a resident or release a resident from a physical device, (ii)  ensuring that all appropriate staff are aware at all times of when a resident is being restrained by use of a physical device; (c)  restraining under the common law duty pursuant to subsection 39 (1) of the Act when immediate action is necessary to prevent serious bodily harm to the person or others; (d)  types of physical devices permitted to be used; (e)  how consent to the use of physical devices as set out in section 35 of the Act and the use of PASDs as set out in section 36 of the Act is to be obtained and documented; (f)  alternatives to the use of physical devices, including how these alternatives are planned, developed and implemented, using an interdisciplinary approach; and (g)  how the use of restraining in the home will be evaluated to ensure minimizing of restraining and to ensure that any restraining that is necessary is done in accordance with the Act and this Regulation.
Requirements relating to the use of a PASD
 120. (1) Every licensee of a long-term care home shall ensure that a PASD used under section 36 of the Act to assist a resident with a routine activity of living is removed as soon as it is no longer required to provide such assistance, unless the resident requests that it be retained. (2) Every licensee shall ensure that a PASD used under section 36 of the Act, (a)  is well maintained; (b)  is applied by staff in accordance with any manufacturer’s instructions; and (c)  is not altered except for routine adjustments in accordance with any manufacturer’s instructions.
Prohibited devices that limit movement
 121. For the purposes of section 38 of the Act, every licensee of a long-term care home shall ensure that the following devices are not used in the home: 1.  Roller bars on wheelchairs and commodes or toilets. 2.  Vest or jacket restraints. 3.  Any device with locks that can only be released by a separate device, such as a key or magnet. 4.  Four point extremity restraints. 5.  Any device used to restrain a resident to a commode or toilet. 6.  Any device that cannot be immediately released by staff. 7.  Sheets, wraps, tensors or other types of strips or bandages used other than for a therapeutic purpose.
Evaluation
 122. Every licensee of a long-term care home shall ensure, (a)  that an analysis of the restraining of residents by use of a physical device under section 35 of the Act or pursuant to the common law duty referred to in section 39 of the Act is undertaken on a monthly basis; (b)  that at least once in every calendar year, an evaluation is made to determine the effectiveness of the licensee’s policy under section 33 of the Act, and what changes and improvements are required to minimize restraining and to ensure that any restraining that is necessary is done in accordance with the Act and this Regulation; (c)  that the results of the analysis undertaken under clause (a) are considered in the evaluation; (d)  that the changes or improvements under clause (b) are promptly implemented; and (e)  that a written record of everything provided for in clauses (a), (b) and (d) and the date of the evaluation, the names of the persons who participated in the evaluation and the date that the changes were implemented is promptly prepared. Drugs
Drugs
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Medication management system
 123. (1) Every licensee of a long-term care home shall develop an interdisciplinary medication management system that provides safe medication management and optimizes effective drug therapy outcomes for residents. (2) The licensee shall ensure that written policies and protocols are developed for the medication management system to ensure the accurate acquisition, dispensing, receipt, storage, administration, and destruction and disposal of all drugs used in the home. (3) The written policies and protocols must be, (a)  developed, implemented, evaluated and updated in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices; and (b)  reviewed and approved by the Director of Nursing and Personal Care and the pharmacy service provider and, where appropriate, the Medical Director.
Quarterly evaluation
 124. (1) Every licensee of a long-term care home shall ensure that an interdisciplinary team, which must include the Medical Director, the Administrator, the Director of Nursing and Personal Care and the pharmacy service provider, meets at least quarterly to evaluate the effectiveness of the medication management system in the home and to recommend any changes necessary to improve the system. O. Reg. 246/22, s. 124 (1). (2) Where the pharmacy service provider is a corporation, the licensee shall ensure that a pharmacist from the pharmacy service provider participates in the quarterly evaluation. O. Reg. 246/22, s. 124 (2). (3) The quarterly evaluation of the medication management system must include at least, (a)  reviewing drug utilization trends and drug utilization patterns in the home, including the use of any drug or combination of drugs, including psychotropic drugs, that could potentially place residents at risk; (b)  reviewing reports of any medication incidents, any incidents of severe hypoglycemia and unresponsive hypoglycemia, the use of glucagon and adverse drug reactions referred to in subsections 147 (2) and (3), the factors that contributed to the incident, use of glucagon or drug reaction and all instances of the restraining of residents by the administration of a drug when immediate action is necessary to prevent serious bodily harm to a resident or to others pursuant to the common law duty referred to in section 39 of the Act; and (c)  identifying changes to improve the system in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices. O. Reg. 246/22, s. 124 (3); O. Reg. 66/23, s. 25 (1). (3.1) For the purposes of clause (3) (a), and without limiting the generality of this section, the review of drug utilization trends and drug utilization patterns in the home must include trends and patterns associated with the use of glucagon in the home. O. Reg. 66/23, s. 25 (2). (4) The licensee shall ensure that the changes identified in the quarterly evaluation are implemented. O. Reg. 246/22, s. 124 (4). (5) The licensee shall ensure that a written record is kept of the results of the quarterly evaluation and of any changes that were implemented. O. Reg. 246/22, s. 124 (5).
Annual evaluation
 125. (1) Every licensee of a long-term care home shall ensure that an interdisciplinary team, which must include the Medical Director, the Administrator, the Director of Nursing and Personal Care, the pharmacy service provider and a registered dietitian who is a member of the staff of the home, meets annually to evaluate the effectiveness of the medication management system in the home and to recommend any changes necessary to improve the system. (2) Where the pharmacy service provider is a corporation, the licensee shall ensure that a pharmacist from the pharmacy service provider participates in the annual evaluation. (3) The annual evaluation of the medication management system must, (a)  include a review of the quarterly evaluations in the previous year as referred to in section 124; (b)  be undertaken using an assessment instrument designed specifically for this purpose; and (c)  identify changes to improve the system in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices. (4) The licensee shall ensure that the changes identified in the annual evaluation are implemented. (5) The licensee shall ensure that a written record is kept of the results of the annual evaluation and of any changes that were implemented.
Medical directives and orders — drugs
 126. Every licensee of a long-term care home shall ensure that, (a)  all medical directives or orders for the administration of a drug to a resident are reviewed at any time when the resident’s condition is assessed or reassessed in developing or revising the resident’s plan of care as required under section 6 of the Act; and (b)  no medical directive or order for the administration of a drug to a resident is used unless it is individualized to the resident’s condition and needs.
Information in every resident home area or unit
 127. Every licensee of a long-term care home shall ensure that the following are available in every resident home area or unit in the home: 1.  Recent and relevant drug reference materials. 2.  The pharmacy service provider’s contact information. 3.  The contact information for at least one poison control centre or similar body. Pharmacy Service Provider
Pharmacy Service Provider
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Retaining of pharmacy service provider
 128. (1) Every licensee of a long-term care home shall retain a pharmacy service provider for the home. (2) The pharmacy service provider must be the holder of a certificate of accreditation for the operation of a pharmacy under section 139 of the Drug and Pharmacies Regulation Act. (3) There must be a written contract between the licensee and the pharmacy service provider setting out the responsibilities of the pharmacy service provider. (4) The written contract must provide that the pharmacy service provider shall, (a)  provide drugs to the home on a 24-hour basis, seven days a week, or arrange for their provision by another holder of a certificate of accreditation for the operation of a pharmacy under section 139 of the Drug and Pharmacies Regulation Act; and (b)  perform all the other responsibilities of the pharmacy service provider under this Regulation.
Responsibilities of pharmacy service provider
 129. Every licensee of a long-term care home shall ensure that the pharmacy service provider participates in the following activities: 1.  For each resident of the home, the development of medication assessments, medication administration records and records for medication reassessment, and the maintenance of medication profiles. 2.  Evaluation of therapeutic outcomes of drugs for residents. 3.  Risk management and quality improvement activities, including reviews of medication incidents, adverse drug reactions, incidents of severe hypoglycemia, incidents of unresponsive hypoglycemia and drug utilization, including, for greater certainty, glucagon utilization. 4.  Developing audit protocols for the pharmacy service provider to evaluate the medication management system. 5.  Educational support to the staff of the home in relation to drugs. 6.  Drug destruction under clause 148 (3) (a) if required by the licensee’s policy. O. Reg. 246/22, s. 129; O. Reg. 66/23, s. 26.
System for notifying pharmacy service provider
 130. Every licensee of a long-term care home shall ensure that a system is developed for notifying the pharmacy service provider within 24 hours of the admission, medical absence, psychiatric absence, discharge, and death of a resident. Obtaining and Keeping Drugs
Obtaining and Keeping Drugs
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Purchasing and handling of drugs
 131. (1) Every licensee of a long-term care home shall ensure that no drug is acquired, received or stored by or in the home or kept by a resident under subsection 140 (8) unless the drug, (a)  has been prescribed for a resident or obtained for the purposes of the emergency drug supply referred to in section 132; and (b)  has been provided by, or through an arrangement made by, the pharmacy service provider or the Government of Ontario. (2) Subsection (1) does not apply where exceptional circumstances exist such that a drug prescribed for a resident cannot be provided by, or through an arrangement made by, the pharmacy service provider.
Emergency drug supply
 132. Every licensee of a long-term care home who maintains an emergency drug supply for the home shall ensure, (a)  that only drugs approved for this purpose by the Medical Director in collaboration with the pharmacy service provider, the Director of Nursing and Personal Care and the Administrator are kept; (b)  that a written policy is in place to address the location of the supply, procedures and timing for reordering drugs, access to the supply, use of drugs in the supply and tracking and documentation with respect to the drugs maintained in the supply; (c)  that, at least annually, there is an evaluation done by the persons referred to in clause (a) of the utilization of drugs kept in the emergency drug supply in order to determine the need for the drugs; and (d)  that any recommended changes resulting from the evaluation are implemented.
Drug supply
 133. Every licensee of a long-term care home shall ensure that drugs obtained for use in the home, except drugs obtained for any emergency drug supply, are obtained based on resident usage, and that no more than a three-month supply is kept in the home at any time.
Monitored dosage system
 134. (1) Every licensee of a long-term care home shall ensure that a monitored dosage system is used in the home for the administration of drugs. (2) The monitored dosage system must promote the ease and accuracy of the administration of drugs to residents and support monitoring and drug verification activities.
Packaging of drugs
 135. Every licensee of a long-term care home shall ensure that drugs remain in the original labelled container or package provided by the pharmacy service provider or the Government of Ontario until administered to a resident or destroyed.
Changes in directions for administration
 136. Every licensee of a long-term care home shall ensure that a policy is developed and approved by the Director of Nursing and Personal Care and the pharmacy service provider and, where appropriate, the Medical Director, to govern changes in the administration of a drug due to modifications of directions for use made by a prescriber, including temporary discontinuation.
Sending of drugs with a resident
 137. Every licensee of a long-term care home shall ensure that a policy is developed and approved by the Director of Nursing and Personal Care and the pharmacy service provider and, where appropriate, the Medical Director, to govern the sending of a drug that has been prescribed for a resident with them when they leave the home on a temporary basis or are discharged.
Safe storage of drugs
 138. (1) Every licensee of a long-term care home shall ensure that, (a)  drugs are stored in an area or a medication cart, (i)  that is used exclusively for drugs and drug-related supplies, (ii)  that is secure and locked, (iii)  that protects the drugs from heat, light, humidity or other environmental conditions in order to maintain efficacy, and (iv)  that complies with manufacturer’s instructions for the storage of the drugs; and (b)  controlled substances are stored in a separate, double-locked stationary cupboard in the locked area or stored in a separate locked area within the locked medication cart. (2) Subsection (1) does not apply with respect to drugs that a resident is permitted to keep on their person or in their room in accordance with subsection 140 (8).
Security of drug supply
 139. Every licensee of a long-term care home shall ensure that steps are taken to ensure the security of the drug supply, including the following: 1.  All areas where drugs are stored shall be kept locked at all times, when not in use. 2.  Access to these areas shall be restricted to, i.  persons, other than personal support workers, who may dispense, prescribe or administer drugs in the home, and ii.  the Administrator. 3.  A monthly audit shall be undertaken of the daily count sheets of controlled substances to determine if there are any discrepancies and that immediate action is taken if any discrepancies are discovered. O. Reg. 246/22, s. 139; O. Reg. 66/23, s. 27.
Natural health products
 141. (1) Every licensee of a long-term care home shall ensure that where a resident wishes to use a drug that is a natural health product and that has not been prescribed, there are written policies and procedures to govern the use, administration and storage of the natural health product. (2) Nothing in this Regulation prevents a resident from using, in accordance with the licensee’s policies and procedures as required by subsection (1), a natural health product that has not been prescribed. (3) Sections 123 to 140 and 145 to 149 do not apply with respect to a natural health product that has not been prescribed. (4) In this section, “natural health product” means natural health product, as that term is defined from time to time by the Natural Health Products Regulations under the Food and Drugs Act (Canada), other than a product that is a substance that has been identified in the regulations made under the Drug and Pharmacies Regulation Act as being a drug for the purposes of that Act despite clause (f) of the definition of “drug” in subsection 1 (1) of that Act.
Recreational cannabis
 142. (1) Every licensee of a long-term care home shall ensure that there are written policies and procedures to govern, with respect to residents, the cultivation, acquisition, consumption, administration, possession, storage and disposal of recreational cannabis in accordance with all applicable laws, including, without being limited to, the Cannabis Act (Canada) and the Cannabis Regulations (Canada). (2) Nothing in this Regulation prevents a resident from cultivating, acquiring, consuming, administering, possessing, storing or disposing of recreational cannabis in accordance with the licensee’s policies and procedures as required by subsection (1). (3) Sections 123 to 141 and 143 to 149 do not apply with respect to recreational cannabis.
Medical cannabis
 143. (1) Every licensee of a long-term care home shall ensure that there are written policies and procedures to govern, with respect to residents, the cultivation, acquisition, consumption, administration, possession, storage and disposal of medical cannabis in accordance with all applicable laws, including, without being limited to, the Cannabis Act (Canada) and the Cannabis Regulations (Canada). (2) Sections 131, 135, 138, 139, 140 and 148 do not apply with respect to medical cannabis.
Industrial hemp and derivatives
 144. Sections 123 to 143 and 145 to 149 do not apply with respect to, (a)  industrial hemp within the meaning of the Industrial Hemp Regulations (Canada); or (b)  a derivative or a product made from a derivative that is exempt from the application of the Cannabis Act
(Canada) under the Industrial Hemp Regulations (Canada) and that is not a natural health product within the meaning of section 141 of this Regulation.
Drug record (ordering and receiving)
 145. Every licensee of a long-term care home shall ensure that a drug record is established, maintained and kept in the home for at least two years, in which is recorded the following information, in respect of every drug that is ordered and received in the home: 1.  The date the drug is ordered. 2.  The signature of the person placing the order. 3.  The name, strength and quantity of the drug. 4.  The name of the place from which the drug is ordered. 5.  The name of the resident for whom the drug is prescribed, where applicable. 6.  The prescription number, where applicable. 7.  The date the drug is received in the home. 8.  The signature of the person acknowledging receipt of the drug on behalf of the home. 9.  Where applicable, the information required under subsection 148 (4).
Residents’ drug regimes
 146. Every licensee of a long-term care home shall ensure that, (a)  when a resident is taking any drug or combination of drugs, including psychotropic drugs, there is monitoring and documentation of the resident’s response and the effectiveness of the drugs appropriate to the risk level of the drugs; (b)  appropriate actions are taken in response to any medication incident involving a resident, any incidents of severe hypoglycemia and unresponsive hypoglycemia and any adverse drug reaction to a drug or combination of drugs, including psychotropic drugs; and (c)  there is, at least quarterly, a documented reassessment of each resident’s drug regime. O. Reg. 246/22, s. 146; O. Reg. 66/23, s. 29.
Medication incidents and adverse drug reactions
 147. (1) Every licensee of a long-term care home shall ensure that every medication incident involving a resident, every adverse drug reaction, every use of glucagon, every incident of severe hypoglycemia and every incident of unresponsive hypoglycemia involving a resident is, (a)  documented, together with a record of the immediate actions taken to assess and maintain the resident’s health; and (b)  reported to the resident, the resident’s substitute decision-maker, if any, the Director of Nursing and Personal Care, the Medical Director, the resident’s attending physician or the registered nurse in the extended class attending the resident and, if applicable, the prescriber of the drug and the pharmacy service provider. O. Reg. 66/23, s. 30. (2) In addition to the requirement under clause (1) (a), the licensee shall ensure that, (a)  all medication incidents, incidents of severe hypoglycemia, incidents of unresponsive hypoglycemia, adverse drug reactions and every use of glucagon are documented, reviewed and analyzed; (b)  corrective action is taken as necessary; and (c)  a written record is kept of everything required under clauses (a) and (b). O. Reg. 66/23, s. 30. (3) Every licensee shall ensure that, (a)  a quarterly review is undertaken of all medication incidents, incidents of severe hypoglycemia, incidents of unresponsive hypoglycemia, adverse drug reactions and every use of glucagon that have occurred in the home since the time of the last review in order to, (i)  reduce and prevent medication incidents and adverse drug reactions, (ii)  improve the use of glucagon and to improve the care and treatment of incidents of severe hypoglycemia and incidents of unresponsive hypoglycemia in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices, and (iii)  identify patterns of incidents of severe hypoglycemia and incidents of unresponsive hypoglycemia; (b)  any changes and improvements identified in the review are implemented; and (c)  a written record is kept of everything provided for in clauses (a) and (b). O. Reg. 66/23, s. 30.
Restraining by administration of drug, etc., under common law duty
 149. (1) A registered nurse may order the administration of a drug for the purposes of subsection 39 (3) of the Act. (2) Every licensee shall ensure that every administration of a drug to restrain a resident when immediate action is necessary to prevent serious bodily harm to the resident or to others pursuant to the common law duty described in section 39 of the Act is documented, and without limiting the generality of this requirement, the licensee shall ensure that the following are documented: 1.  Circumstances precipitating the administration of the drug. 2.  Who made the order, what drug was administered, the dosage given, by what means the drug was administered, the time or times when the drug was administered and who administered the drug. 3.  The resident’s response to the drug. 4.  All assessments, reassessments and monitoring of the resident. 5.  Discussions with the resident or, where the resident is incapable, the resident’s substitute decision-maker, following the administration of the drug to explain the reasons for the use of the drug. Absences
Absences
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Absent residents
 151. The requirements under this Regulation respecting the care and treatment of a resident do not apply with respect to a resident who is on a medical absence, a psychiatric absence, a casual absence or a vacation absence.
Recording of absences
 152. Every licensee of a long-term care home shall ensure that each medical absence, psychiatric absence, casual absence and vacation absence of a resident of the home is recorded.
Licensee to stay in contact
 153. (1) Every licensee of a long-term care home shall maintain contact with a resident who is on a medical absence or psychiatric absence or with the resident’s health care provider in order to determine when the resident will be returning to the home. (2) Every licensee of a long-term care home shall be in contact with a long-stay resident of the home who is on a vacation absence in order to determine when the resident will be returning to the home.
Care during absence
 154. Every licensee of a long-term care home shall ensure that before a long-stay resident of the home leaves for a casual absence or a vacation absence and before a short-stay resident of the home leaves for a casual absence, (a)  a physician or a registered nurse in the extended class attending the resident or a member of the registered nursing staff of the home sets out in writing the care required to be given to the resident during the absence; and (b)  a member of the licensee’s staff communicates to the resident, or the resident’s substitute decision-maker, (i)  the need to take all reasonable steps to ensure that the care required to be given to the resident is received by the resident during the absence, (ii)  that the licensee will not be responsible for the care, safety and well-being of the resident during the absence and that the resident or the resident’s substitute decision-maker assumes full responsibility for the care, safety and well-being of the resident during the absence, and (iii)  the need to notify the Administrator of the home if the resident is admitted to a hospital during the absence or if the date of the resident’s return changes.
Where interim bed resident considered to be long-stay resident
 155. For the purposes of the following provisions of this Regulation, a resident in the interim bed short-stay program shall be considered to be a long-stay resident: 1.  Section 150. 2.  Subsection 153 (2). 3.  Section 154. Discharge
Discharge
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Restriction on discharge
 156. No licensee of a long-term care home shall discharge a resident from the long-term care home unless permitted or required to do so by this Regulation.
When licensee may discharge
 157. (1) A licensee of a long-term care home may discharge a resident if the licensee is informed by someone permitted to do so under subsection (2) that the resident’s requirements for care have changed and that, as a result, the home cannot provide a sufficiently secure environment to ensure the safety of the resident or the safety of persons who come into contact with the resident. (2) For the purposes of subsection (1), the licensee shall be informed by, (a)  in the case of a resident who is at the home, the Director of Nursing and Personal Care, the resident’s physician or a registered nurse in the extended class attending the resident, after consultation with the interdisciplinary team providing the resident’s care; or (b)  in the case of a resident who is absent from the home, the resident’s physician or a registered nurse in the extended class attending the resident. (3) A licensee of a long-term care home may discharge a resident if, (a)  the resident decides to leave the home and signs a request to be discharged; (b)  the resident leaves the home and informs the Administrator that they will not be returning to the home; (c)  the resident is absent from the home for a period exceeding seven days and the resident has not informed the Administrator of their whereabouts, and the Administrator has been unable to locate the resident; (d)  in the case of a long-stay resident, the total length of the resident’s casual absences during the period between midnight on a Saturday and midnight on the following Saturday exceeds 48 hours and the resident does not have any remaining vacation absence days available in the calendar year; or (e)  in the case of a short-stay resident, the total length of the resident’s casual absences during the period between midnight on Saturday and midnight on the following Saturday exceeds 48 hours. (4) Clause (3) (e) does not apply to a resident in the interim bed short-stay program and the resident shall be considered to be a long-stay resident for the purposes of clause (3) (d).
Discharge when beds closed
 159. (1) A licensee may discharge a resident whose bed is closed if it is not possible to transfer the resident to another bed in the home. (2) Subsection (1) does not apply if, (a)  notice was required under section 357 but that section was not complied with; (b)  the Director agreed, under subsection 357 (7), to a shorter notice period, or to dispensing with notice and, as a result, less than 16 weeks notice was given to the persons described in clause 357 (3) (a); or (c)  section 358 applied when the resident was transferred to the bed but that section was not complied with.
Discharge during pandemic
 160. (1) During a pandemic a licensee of a long-term care home shall discharge a long-stay resident if the resident or the resident’s substitute decision-maker provides a written request to be discharged because of the pandemic. (2) Every licensee of a long-term care home shall ensure that before a long-stay resident leaves the home pursuant to a request under subsection (1), (a)  a physician or a registered nurse in the extended class attending the resident or a member of the registered nursing staff of the home sets out in writing the care required to be given to the resident once the resident has left the home; and (b)  a member of the licensee’s staff communicates to the resident, or the resident’s substitute decision-maker, (i)  the need to take all reasonable steps to ensure that the care required to be given to the resident is received by the resident after the resident leaves the home, (ii)  that the licensee will not be responsible for the care, safety and well-being of the resident once the resident is discharged, and the resident or the resident’s substitute decision-maker assumes full responsibility for the care, safety and well-being of the resident once the resident is discharged, and (iii)  that when the resident is ready to return to the home, the resident, the resident’s substitute decision-maker or another person acting on behalf of the resident will need to contact the placement co-ordinator to arrange for re-admission. (3) A resident in the interim bed short-stay program shall be considered to be a long-stay resident for the purposes of this section.
Requirements on licensee before discharging a resident
 161. (1) Except in the case of a discharge due to a resident’s death, every licensee of a long-term care home shall ensure that, before a resident is discharged, notice of the discharge is given to the resident, the resident’s substitute decision-maker, if any, and to any other person either of them may direct, (a)  as far in advance of the discharge as possible; or (b)  if circumstances do not permit notice to be given before the discharge, as soon as possible after the discharge. (2) Before discharging a resident under subsection 157 (1), the licensee shall, (a)  ensure that alternatives to discharge have been considered and, where appropriate, tried; (b)  in collaboration with the appropriate placement co-ordinator and other health service organizations, make alternative arrangements for the accommodation, care and secure environment required by the resident; (c)  ensure the resident and the resident’s substitute decision-maker, if any, and any person either of them may direct is kept informed and given an opportunity to participate in the discharge planning and that their wishes are taken into consideration; and (d)  provide a written notice to the resident, the resident’s substitute decision-maker, if any, and any person either of them may direct, setting out a detailed explanation of the supporting facts, as they relate both to the home and to the resident’s condition and requirements for care, that justify the licensee’s decision to discharge the resident. (3) Before discharging a resident from the home under clause 157 (3) (a), (b) or (d) or subsection 160 (1), the licensee shall offer to, (a)  assist the resident in planning for discharge by identifying alternative accommodation, health service organizations and other resources in the community; and (b)  contact appropriate health service organizations and other resources in the community or refer the resident to such organizations and resources.
Responsibility of placement co-ordinator
 162. The appropriate placement co-ordinator shall, if a resident to whom subsection 157 (1) or clause 158 (7) (a) applies so desires, assist in arranging alternative accommodation, care or services for the resident.
Licensee to assist with alternatives to long-term care home
 163. Every licensee of a long-term care home shall offer to contact the appropriate placement co-ordinator for the purpose of providing information about alternatives to living in a long-term care home to a resident whose condition has improved to the extent that the resident no longer requires the care and services provided by the long-term care home, as set out in the resident’s plan of care.
Transitional, absences and discharges due to absences
 164. Where, during the calendar year that this section comes into force, a resident of a home under the former Act had taken an absence from the home in accordance with the regulations under that Act before the coming into force of this section or was on such an absence at the time this section came into force, the absences shall be counted as if they had been taken while this Regulation was in force. Part III   Quality
PART III QUALITY
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Continuous quality improvement initiative
 165. This Part applies to the continuous quality improvement initiative for a home required under section 42 of the Act.
Continuous quality improvement committee
 166. (1) Every licensee of a long-term care home shall establish a continuous quality improvement committee. (2) The continuous quality improvement committee shall be composed of at least the following persons: 1.  The home’s Administrator. 2.  The home’s Director of Nursing and Personal Care. 3.  The home’s Medical Director. 4.  Every designated lead of the home. 5.  The home’s registered dietitian. 6.  The home’s pharmacy service provider, or where the pharmacy service provider is a corporation, a pharmacist from the pharmacy service provider. 7.  At least one employee of the licensee who is a member of the regular nursing staff of the home. 8.  At least one employee of the licensee who has been hired as a personal support worker or provides personal support services at the home and meets the qualification of personal support workers referred to in section 52. 9.  One member of the home’s Residents’ Council. 10.  One member of the home’s Family Council, if any. (3) Every continuous quality improvement committee has the following responsibilities: 1.  To monitor and report to the long-term care home licensee on quality issues, residents’ quality of life, and the overall quality of care and services provided in the long-term care home, with reference to appropriate data. 2.  To consider, identify and make recommendations to the long-term care home licensee regarding priority areas for quality improvement in the home. 3.  To coordinate and support the implementation of the continuous quality improvement initiative, including but not limited to, preparation of the report on the continuous quality improvement initiative. (4) Revoked: O. Reg. 66/23, s. 32.
Continuous quality improvement designated lead
 167. (1) Every licensee of a long-term care home shall ensure that the home’s continuous quality improvement initiative is co-ordinated by a designated lead. (2) The licensee shall ensure that the designated lead is a member of the staff.
Records of improvements
 169. Every licensee of a long-term care home shall ensure that the continuous quality improvement initiative required under section 42 of the Act includes a record maintained by the licensee setting out the names of the persons who participated in evaluations of improvements in the report required under section 168 of this Regulation. Part iv   Admission of residents
PART IV ADMISSION OF RESIDENTS
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Definition
 170. In this Part, “partner” means either of two persons who have lived together for at least one year and who have a close personal relationship that is of primary importance in both persons’ lives.
Information to be provided by placement co-ordinator
 171. (1) When a person who wishes to seek admission to a long-term care home contacts a placement co-ordinator, the placement co-ordinator shall provide the person with information about alternative services that the person may wish to consider. (2) The placement co-ordinator shall also provide the person with information about a resident’s responsibility for payment for charges for accommodation and the maximum amounts that may be charged by a licensee for accommodation. (3) The placement co-ordinator shall advise the person that a resident may apply to the Director for a reduction in the charge for basic accommodation and that a resident who makes such an application is required to provide supporting documentation including, (a)  the resident’s Notice of Assessment issued under the
Income Tax Act (Canada) for the resident’s most recent taxation year; (b)  the resident’s proof of income statement (option “C” print) from the Canada Revenue Agency for the resident’s most recent taxation year; or (c)  the resident’s written authorization to electronically obtain income information for the resident’s most recent taxation year from the Canada Revenue Agency. (4) When a person is determined eligible for admission, the placement co-ordinator shall provide the person with information about, (a)  the length of waiting lists and approximate times to admission for long-term care homes; (b)  vacancies in long-term care homes; and (c)  how to obtain information from the Ministry about long-term care homes. Eligibility for Admission
Eligibility for Admission
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Criteria for eligibility, long-stay
 172. (1) A placement co-ordinator shall determine a person to be eligible for long-term care home admission as a long-stay resident only if, (a)  the person is at least 18 years old; (b)  the person is an insured person under the Health Insurance Act; (c)  the person, (i)  requires that nursing care be available on site 24 hours a day, (ii)  requires, at frequent intervals throughout the day, assistance with activities of daily living, or (iii)  requires, at frequent intervals throughout the day, on-site supervision or on-site monitoring to ensure their safety or well-being; (d)  the publicly-funded community-based services available to the person and the other caregiving, support or companionship arrangements available to the person are not sufficient, in any combination, to meet the person’s requirements; and (e)  the person’s care requirements can be met in a long-term care home. (2) In this section, “nursing care” means nursing and other personal care given by or under the supervision of a registered nurse or a registered practical nurse.