jswizzle3737/ontario_laws_and_regs huggingface dataset:
Responsive behaviours
 58. (1) Every licensee of a long-term care home shall ensure that the following are developed to meet the needs of residents with responsive behaviours: 1.  Written approaches to care, including screening protocols, assessment, reassessment and identification of behavioural triggers that may result in responsive behaviours, whether cognitive, physical, emotional, social, environmental or other. 2.  Written strategies, including techniques and interventions, to prevent, minimize or respond to the responsive behaviours. 3.  Resident monitoring and internal reporting protocols. 4.  Protocols for the referral of residents to specialized resources where required. (2) The licensee shall ensure that, for all programs and services, the matters referred to in subsection (1) are, (a)  integrated into the care that is provided to all residents; (b)  based on the assessed needs of residents with responsive behaviours; and (c)  co-ordinated and implemented on an interdisciplinary basis. (3) The licensee shall ensure that, (a)  the matters referred to in subsection (1) are developed and implemented in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices; (b)  at least annually, the matters referred to in subsection (1) are evaluated and updated in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices; and (c)  a written record is kept relating to each evaluation under clause (b) that includes the date of the evaluation, the names of the persons who participated in the evaluation, a summary of the changes made and the date that those changes were implemented. (4) The licensee shall ensure that, for each resident demonstrating responsive behaviours, (a)  the behavioural triggers for the resident are identified, where possible; (b)  strategies are developed and implemented to respond to these behaviours, where possible; and (c)  actions are taken to respond to the needs of the resident, including assessments, reassessments and interventions and that the resident’s responses to interventions are documented. Altercations and Other Interactions
Altercations and Other Interactions
nan
Altercations and other interactions between residents
 59. Every licensee of a long-term care home shall ensure that steps are taken to minimize the risk of altercations and potentially harmful interactions between and among residents, including, (a)  identifying factors, based on an interdisciplinary assessment and on information provided to the licensee or staff or through observation, that could potentially trigger such altercations; and (b)  identifying and implementing interventions. Behaviours and Altercations
Behaviours and Altercations
nan
Behaviours and altercations
 60. Every licensee of a long-term care home shall ensure that, (a)  procedures and interventions are developed and implemented to assist residents and staff who are at risk of harm or who are harmed as a result of a resident’s behaviours, including responsive behaviours, and to minimize the risk of altercations and potentially harmful interactions between and among residents; and (b)  all direct care staff are advised at the beginning of every shift of each resident whose behaviours, including responsive behaviours, require heightened monitoring because those behaviours pose a potential risk to the resident or others. Palliative Care
Palliative Care
nan
Palliative care
 61. (1) Every licensee of a long-term care home shall ensure that a resident’s palliative care needs are met in accordance with this section. (2) The licensee shall ensure that the interdisciplinary assessment of the resident’s palliative care needs for their plan of care considers the resident’s physical, emotional, psychological, social, cultural, and spiritual needs. (3) The licensee shall ensure that the resident, the resident’s substitute decision-maker, if any, and any other person or persons designated by the resident or their substitute decision-maker are provided with an explanation of the palliative care options that are available based on the assessment of the resident’s palliative care needs, which may include, but are not limited to, early palliative care and end-of-life care. (4) The licensee shall ensure that, based on the assessment of the resident’s palliative care needs, the palliative care options made available to the resident include, at a minimum, (a)  quality of life improvements; (b)  symptom management; (c)  psychosocial support; and (d)  end-of-life care, if appropriate. (5) For greater certainty, the licensee shall ensure that the resident’s consent is received pursuant to section 7 of the Act before taking any actions set out in this section and before palliative care is provided to the resident. Restorative Care
Restorative Care
nan
Restorative care
 62. Sections 63 to 70 apply to the organized interdisciplinary program with a restorative care philosophy required under subsection 13 (1) of the Act.
Integrating restorative care into programs
 63. Every licensee of a long-term care home shall ensure that, (a)  restorative care approaches are integrated into the care that is provided to all residents; and (b)  the restorative care approaches are co-ordinated to ensure that each resident is able to maintain or improve their functional and cognitive capacities in all aspects of daily living, to the extent of their abilities.
Transferring and positioning
 64. Every licensee of a long-term care home shall ensure that when transferring and positioning residents, staff shall use devices and techniques that maintain or improve, wherever possible, residents’ weight bearing capability, endurance and range of motion.
Therapy services
 65. Every licensee of a long-term care home shall ensure that therapy services for residents of the home are arranged or provided under section 13 of the Act that include, (a)  on-site physiotherapy provided to residents on an individualized basis or in a group setting based on residents’ assessed care needs; and (b)  occupational therapy and speech-language therapy.
Space and supplies — therapy services
 66. (1) Every licensee of a long-term care home shall ensure that there is safe and appropriate space in the home for the provision of therapy services. (2) The licensee shall ensure that there is a sufficient supply of therapy equipment available at all times to meet the needs of residents.
Therapy services staff qualifications
 67. (1) Subject to subsection (2), every licensee of a long-term care home shall ensure that the therapy services referred to in section 65 and that the licensee arranges or provides under section 13 of the Act are only provided by therapists who have a current certificate of registration with the appropriate college of a regulated health profession. (2) Therapy services provided by the licensee may be provided by support personnel who are members of the staff of the home who work under the direction of a member of the appropriate regulated health profession and the supervision of the designated lead required under section 70 and who, (a)  subject to subsection (3), have successfully completed a training program in restorative care, or are enrolled in such a program; or (b)  have successfully completed a relevant training course provided by the licensee that is designed and supervised by a qualified therapist who is a member of the appropriate college of a regulated health profession. (3) The licensee shall cease to employ as support personnel a person who was required to be enrolled in a program described in clause (2) (a) if the person ceases to be enrolled in the program or fails to successfully complete the program within three years of being hired. (4) Therapy services arranged by the licensee may be provided by support personnel of a regulated health professional referred to in subsection (1) working under the direction and supervision of that regulated health professional.
Social work and social services work
 68. Every licensee of a long-term care home shall ensure that there is a written description of the social work and social services work provided in the home and that the work meets the residents’ needs.
Social work and social services work qualifications
 69. Every licensee of a long-term care home shall ensure that social workers or social service workers who provide services in the home are registered under the Social Work and Social Service Work Act, 1998.
Designated lead
 70. (1) Every licensee of a long-term care home shall ensure that the home’s restorative care program, including the services of social workers and social service workers, are co-ordinated by a designated lead. O. Reg. 246/22, s. 70 (1). (2) The designated lead, (a)  must have a current general certificate of registration with a college of a regulated health profession or the Ontario College of Social Workers and Social Service Workers; or (b)  must have at least one year of experience in a health care setting and, (i)  a post-secondary diploma, degree or certificate in recreation and leisure studies, kinesiology, therapeutic recreation or other related field from an Ontario post-secondary institution, or (ii)  a post-secondary diploma, degree or certificate granted in another jurisdiction that, in the reasonable opinion of the licensee, is equivalent to the diploma, degree or certificate described in subclause (i). O. Reg. 246/22, s. 70 (2); O. Reg. 66/23, s. 13. Recreational and Social Activities
Recreational and Social Activities
nan
Recreational and social activities program
 71. (1) This section and sections 72 and 73 apply to the organized recreational and social activities program for the home required under subsection 14 (1) of the Act. (2) Every licensee of a long-term care home shall ensure that the program includes, (a)  the provision of supplies and appropriate equipment for the program; (b)  the development, implementation and communication to all residents and families of a schedule of recreation and social activities that are offered during days, evenings and weekends; (c)  recreation and social activities that include a range of indoor and outdoor recreation, leisure and outings that are of a frequency and type to benefit all residents of the home and reflect their interests; (d)  opportunities for resident and family input into the development and scheduling of recreation and social activities; (e)  the provision of information to residents about community activities that may be of interest to them; and (f)  assistance and support to permit residents to participate in activities that may be of interest to them if they are not able to do so independently.
Designated lead
 72. (1) Every licensee of a long-term care home shall ensure that there is a designated lead for the recreational and social activities program. O. Reg. 246/22, s. 72 (1). (2) The licensee shall ensure that the designated lead has experience in a health care setting or other relevant setting and, (a)  a post-secondary diploma, degree or certificate  in recreation and leisure studies, therapeutic recreation, kinesiology, gerontology or other related field from an Ontario post-secondary institution; or (b)  a post-secondary diploma, degree or certificate granted in another jurisdiction that, in the reasonable opinion of the licensee, is equivalent to the diploma, degree or certificate described in clause (a). O. Reg. 66/23, s. 14. (3) Despite subsection (2), a person employed at a long-term care home as a designated lead for the recreational and social activities program before April 11, 2023 may continue in that role without meeting the requirements in that subsection if, in the reasonable opinion of the licensee, the person has the appropriate skills, knowledge and experience to perform the duties required of that position. O. Reg. 66/23, s. 14. (4) Revoked: O. Reg. 66/23, s. 14.
Recreational and social activities qualifications
 73. Every licensee of a long-term care home shall ensure that staff members providing recreational and social activities in the home, (a)  have a post-secondary diploma, degree or certificate in recreation and leisure studies, therapeutic recreation, kinesiology, gerontology or other related field from an Ontario post-secondary institution; (b)  have a post-secondary diploma, degree or certificate granted in another jurisdiction that, in the reasonable opinion of the licensee, is equivalent to the diploma, degree or certificate described in clause (a); or (c)  in the reasonable opinion of the licensee, have the appropriate skills, knowledge and experience providing recreational and social activities to perform the duties required of that position. O. Reg. 66/23, s. 15. Nutritional Care and Hydration Programs
Nutritional Care and Hydration Programs
nan
Nutritional care and hydration programs
 74. (1) This section and sections 75 to 84 apply to, (a)  the organized program of nutritional care and dietary services required under clause 15 (1) (a) of the Act; and (b)  the organized program of hydration required under clause 15 (1) (b) of the Act. (2) Every licensee of a long-term care home shall ensure that the programs include, (a)  the development and implementation, in consultation with a registered dietitian who is a member of the staff of the home, of policies and procedures relating to nutritional care and dietary services and hydration; (b)  the identification of any risks related to nutritional care and dietary services and hydration; (c)  the implementation of interventions to mitigate and manage those risks; (d)  a system to monitor and evaluate the food and fluid intake of residents with identified risks related to nutrition and hydration; and (e)  a weight monitoring system to measure and record with respect to each resident, (i)  weight on admission and monthly thereafter, and (ii)  body mass index and height upon admission and annually thereafter.
Weight changes
 75. Every licensee of a long-term care home shall ensure that residents with the following weight changes are assessed using an interdisciplinary approach, and that actions are taken and outcomes are evaluated: 1.  A change of 5 per cent of body weight, or more, over one month. 2.  A change of 7.5 per cent of body weight, or more, over three months. 3.  A change of 10 per cent of body weight, or more, over 6 months. 4.  Any other weight change that compromises the resident’s health status.
Dietary services
 76. Every licensee of a long-term care home shall ensure that the dietary services component of the nutritional care and dietary services program includes, (a)  menu planning; (b)  food production; (c)  dining and snack service; and (d)  availability of supplies and equipment for food production and dining and snack service.
Menu planning
 77. (1) Every licensee of a long-term care home shall ensure that the home’s menu cycle, (a)  is a minimum of 21 days in duration; (b)  includes menus for regular, therapeutic and texture modified diets for both meals and snacks; (c)  includes a choice of beverages at all meals and snacks; (d)  includes a minimum of one entrée and side dish at all three meals and dessert at lunch and dinner; (e)  includes a choice of other available entrées and side dishes at all three meals and a choice of other desserts at lunch and dinner, to meet residents’ specific needs or food preferences; (f)  includes a choice of snacks in the afternoon and evening; and (g)  provides for a variety of foods every day, including fresh produce and local foods in season. O. Reg. 246/22, s. 390 (1). (2) The licensee shall ensure that, prior to being in effect, each menu cycle, (a)  is reviewed by the Residents’ Council for the home; (b)  is evaluated by, at a minimum, the nutrition manager and registered dietitian who are members of the staff of the home; and (c)  is approved for nutritional adequacy by a registered dietitian who is a member of the staff of the home, and who must take into consideration, (i)  subsection (1), (ii)  the residents’ preferences, and (iii)  current Dietary Reference Intakes (DRIs) relevant to the resident population. O. Reg. 246/22, s. 390 (1). (3) The licensee shall ensure that a written record is kept of the evaluation under clause (2) (b) that includes the date of the evaluation, the names of the persons who participated in the evaluation, a summary of the changes made and the date that the changes were implemented. O. Reg. 246/22, s. 390 (1). (4) The licensee shall ensure that each resident is offered a minimum of, (a)  three meals daily; (b)  a between-meal beverage in the morning and afternoon and a beverage in the evening after dinner; and (c)  a snack in the afternoon and evening. O. Reg. 246/22, s. 390 (1). (5) The licensee shall ensure that the planned menu items are offered and available at each meal and snack. O. Reg. 246/22, s. 390 (1). (6) The licensee shall ensure that an individualized menu is developed for each resident whose needs cannot be met through the home’s menu cycle. O. Reg. 246/22, s. 390 (1). (7) The licensee shall ensure that meals and snacks are served at times agreed upon by the Residents’ Council and the Administrator or the Administrator’s designate.
O. Reg. 246/22, s. 390 (1). (8) The licensee shall ensure that food and beverages, including water, that are appropriate for the residents’ diets are accessible to staff and available to residents on a 24-hour basis. O. Reg. 246/22, s. 390 (1).
Food production
 78. (1) Every licensee of a long-term care home shall ensure that there is an organized food production system in the home. O. Reg. 246/22, s. 78 (1). (2) The food production system must, at a minimum, provide for, (a)  a 24-hour supply of perishable and a three-day supply of non-perishable foods; (b)  a three-day supply of nutritional supplements, enteral or parenteral formulas as applicable; (c)  standardized recipes and production sheets for all menus; (d)  preparation of all menu items according to the planned menu; (e)  menu substitutions that have similar nutritional value; (f)  communication to residents and staff of any menu substitutions; and (g)  documentation on the production sheet of any menu substitutions. O. Reg. 246/22, s. 78 (2). (3) The licensee shall ensure that all food and fluids in the food production system are prepared, stored, and served using methods to, (a)  preserve taste, nutritive value, appearance and food quality; and (b)  prevent adulteration, contamination and food borne illness. O. Reg. 246/22, s. 78 (3). (4) The licensee shall maintain, and keep for at least one year, a record of, (a)  purchases relating to the food production system, including food delivery receipts; (b)  the approved menu cycle; and (c)  menu substitutions. O. Reg. 246/22, s. 78 (4). (5) If any food or beverages are prepared in the long-term care home for persons who are not residents of the home, the licensee shall maintain, and keep for at least seven years, records that specify for each week, (a)  the number of meals prepared for persons who are not residents of the home; and (b)  the revenue and internal recoveries made by the licensee relating to the sale or provision of any food and beverage prepared in the home, including revenue and internal recoveries made from cafeteria sales and catering. O. Reg. 246/22, s. 78 (5). (6) The licensee shall ensure that the home has, (a)  sufficient storage capacity to support the home’s menu requirements; (b)  institutional food service equipment with adequate capacity to prepare, transport and hold perishable hot and cold food at safe temperatures; and (c)  institutional food service equipment with adequate capacity to clean and sanitize all dishes, utensils and equipment related to food production and dining and snack service. O. Reg. 246/22, s. 78 (6). (7) The licensee shall ensure that the home has and that the staff of the home comply with, (a)  policies and procedures for the safe operation and cleaning of equipment related to the food production system and dining and snack service; (b)  a cleaning schedule for all the equipment; and (c)  a cleaning schedule for the food production, servery and dishwashing areas. O. Reg. 246/22, s. 78 (7). (8) The licensee shall ensure that, during every hour in which a food service area is operating, there is at least one cook, food service worker or nutrition manager in the food service area who has successfully completed food handler training. O. Reg. 66/23, s. 16. (9) In subsection (8), “food service area” means the part or parts of a long-term care home where meals or meal portions are prepared. O. Reg. 66/23, s. 16.
Dining and snack service
 79. (1) Every licensee of a long-term care home shall ensure that the home has a dining and snack service that includes, at a minimum, the following elements: 1.  Communication of the seven-day and daily menus to residents. 2.  Meal service in a congregate dining setting unless a resident’s assessed needs indicate otherwise. 3.  Monitoring of all residents during meals. 4.  A process to ensure that food service workers and other staff assisting residents are aware of the residents’ diets, special needs and preferences. 5.  Food and fluids being served at a temperature that is both safe and palatable to the residents. 6.  Sufficient time for every resident to eat at their own pace. 7.  Course by course service of meals for each resident, unless otherwise indicated by the resident or by the resident’s assessed needs. 8.  Providing residents with any eating aids, assistive devices, personal assistance and encouragement required to safely eat and drink as comfortably and independently as possible. 9.  Proper techniques to assist residents with eating, including safe positioning of residents who require assistance. 10.  Appropriate furnishings and equipment in resident dining areas, including comfortable dining room chairs and dining room tables at an appropriate height to meet the needs of all residents and appropriate seating for staff who are assisting residents to eat. (2) The licensee shall ensure that, (a)  no person simultaneously assists more than two residents who need total assistance with eating or drinking; and (b)  no resident who requires assistance with eating or drinking is served a meal until someone is available to provide the assistance required by the resident.
Registered dietitian
 80. (1) Every licensee of a long-term care home shall ensure that there is at least one registered dietitian for the home. (2) The licensee shall ensure that a registered dietitian who is a member of the staff of the home is on site at the home for a minimum of 30 minutes per resident per month to carry out clinical and nutritional care duties. (3) Where a registered dietitian for the home is also a nutrition manager for the home, any time spent working in the capacity of nutrition manager does not count toward the time requirements under subsection (2).
Nutrition manager
 81. (1) Every licensee of a long-term care home shall ensure that there is at least one nutrition manager for the home, one of whom shall lead the nutritional care and dietary services program for the home. O. Reg. 246/22, s. 81 (1). (2) The licensee shall ensure that every nutrition manager is an active member of the Canadian Society of Nutrition Management or a registered dietitian. O. Reg. 66/23, s. 17 (1). (3) Despite subsection (2), a person employed at a long-term care home as a nutrition manager before April 11, 2023 may continue in that role without meeting the qualifications of that subsection if they are actively pursuing membership in the Canadian Society of Nutrition Management or registration as a dietitian by the College of Dietitians of Ontario. O. Reg. 66/23, s. 17 (1). (3.1) Despite subsection (2), a person who was working or employed as a nutrition manager in a long-term care home as of July 1, 2010 may continue in that role without complying with subsection (2) or (3). O. Reg. 66/23, s. 17 (1). (4) The licensee shall ensure that a nutrition manager is on site at the home working in the capacity of nutrition manager for the minimum number of hours per week calculated under subsection (5), without including any hours spent fulfilling other responsibilities. O. Reg. 246/22, s. 81 (4). (5) For the purposes of subsection (4), but subject to subsection (6), the minimum number of hours per week shall be calculated as follows: M = A × 8 ÷ 25 where, “M”  is the minimum number of hours per week, and “A”  is, at the option of the licensee, either, (a)  the licensed bed capacity of the home for the week, excluding beds not available for occupancy pursuant to a Minister’s directive, Ministry policy or otherwise at law, or (b)  the number of residents residing in the home for the week, including absent residents. O. Reg. 246/22, s. 81 (5); O. Reg. 66/23, s. 17 (2). (6) The Director may take into consideration the hours in a week, if any, devoted to producing meals and other food and beverages for non-residents for the sole purpose of determining, (a)  whether the licensee is in compliance with subsection (4); and (b)  whether any of the minimum staffing hours under subsection (4) are being devoted to producing meals and other food and beverages for non-residents. O. Reg. 246/22, s. 81 (6).
Cooks
 82. (1) Every licensee of a long-term care home shall ensure that there is at least one cook who works at least 35 hours per week in that position on site at the home. O. Reg. 246/22, s. 82 (1). (2) The licensee shall ensure that the cook referred to in subsection (1), (a)  has a chef training or culinary management diploma or certificate granted by a college of applied arts and technology or a private career college; (b)  holds a certificate of qualification in the trade of Cook or Institutional Cook that was issued by, (i)  the Director of Apprenticeship under the Apprenticeship and Certification Act, 1998, (ii)  the Registrar of the College under the Ontario College of Trades and Apprenticeship Act, 2009, or (iii)  the Registrar of Skilled Trades Ontario under the Building Opportunities in the Skilled Trades Act, 2021; or (c)  has, in the reasonable opinion of the licensee, appropriate skills, knowledge and experience in the fields of institutional, health care, restaurant or hospitality cooking to perform the duties required of the position. O. Reg. 66/23, s. 18. (3), (4) Revoked: O. Reg. 66/23, s. 18.
Food service workers, minimums
 83. (1) Every licensee of a long-term care home shall ensure that there are sufficient food service workers for the home to meet the minimum staffing hours as calculated under subsection (2) for, (a)  the preparation of resident meals and snacks; (b)  the distribution and service of resident meals; (c)  the receiving, storing and managing of the inventory of resident food and food service supplies; and (d)  the daily cleaning and sanitizing of dishes, utensils and equipment used for resident meal preparation, delivery and service. O. Reg. 246/22, s. 83 (1). (2) For the purposes of subsection (1), but subject to subsection (3), the minimum staffing hours shall be calculated as follows: M = A × 7 × 0.45 where, “M”  is the minimum number of staffing hours per week, and “A” is, at the option of the licensee, either, (a)  the licensed bed capacity of the home for the week, excluding beds not available for occupancy pursuant to a Minister’s directive, Ministry policy or otherwise at law, or (b)  the number of residents residing in the home for the week, including absent residents. O. Reg. 246/22, s. 83 (2); O. Reg. 66/23, s. 19. (3) An inspector may take into consideration the hours in a week, if any, devoted to producing meals and other food and beverages for non-residents for the sole purpose of determining, (a)  whether the licensee is in compliance with subsection (1); and (b)  whether any of the minimum staffing hours under subsection (1) are being devoted to producing meals and other food and beverages for non-residents.  O. Reg. 246/22, s. 83 (3)
Food service workers, training and qualifications
 84. (1) Every licensee of a long-term care home shall ensure that food service workers other than cooks to whom section 82 applies, (a)  have successfully completed or are enrolled in a Food Service Worker program at a college of applied arts and technology or a Food Service Worker program provided by a private career college; (b)  have successfully completed an apprenticeship program in the trade of Cook, Institutional Cook or Assistant Cook under the Apprenticeship and Certification Act, 1998, the Ontario College of Trades and Apprenticeship Act, 2009, or the Building Opportunities in the Skilled Trades Act, 2021; (c)  have entered into a registered training agreement in the trade of Cook, Institutional Cook or Assistant Cook under the Apprenticeship and Certification Act, 1998, the Ontario College of Trades and Apprenticeship Act, 2009 or the Building Opportunities in the Skilled Trades Act, 2021; or (d)  have, in the reasonable opinion of the licensee, appropriate skills, knowledge and experience in the fields of institutional, health care, restaurant or hospitality food service to perform the duties required of the position. O. Reg. 246/22, s. 84 (1); O. Reg. 66/23, s. 20 (1, 2). (2), (3) Revoked: O. Reg. 66/23, s. 20 (3). (4) Subsection (1) does not apply with respect to, (a)  students hired on a seasonal or part-time basis, who have successfully completed food handler training; (b)  persons who meet the qualifications in subsection 81 (2) or 82 (2) or who are exempt from meeting those qualifications as they meet the requirements under subsection 81 (3) or (3.1); or (c)  persons who have a post-secondary diploma in food and nutrition management or a post-secondary degree in food and nutrition. O. Reg. 246/22, s. 84 (4); O. Reg. 66/23, s. 20 (4, 5). (5) Revoked: O. Reg. 66/23, s. 20 (6). Medical Services
Medical Services
nan
Medical services program
 85. Sections 86 to 90 apply to the organized program of medical services for the home required under section 16 of the Act.
Availability of medical services
 86. Every licensee of a long-term care home shall ensure that residents have access to medical services in the home 24 hours a day.
Individualized medical directives and orders
 87. Every licensee of a long-term care home shall ensure that no medical directive or order is used with respect to a resident unless it is individualized to the resident’s condition and needs. Attending Physicians and RNs (EC)
Attending Physicians and RNs (EC)
nan
Attending physician or RN (EC)
 88. (1) Every licensee of a long-term care home shall ensure that either a physician or a registered nurse in the extended class, (a)  conducts a physical examination of each resident upon admission and an annual physical examination annually thereafter, and produces a written report of the findings of the examination; (b)  attends regularly at the home to provide services, including assessments; and (c)  participates in the provision of after-hours coverage and on-call coverage. (2) The resident or the resident’s substitute decision-maker may retain a physician or registered nurse in the extended class to perform the services required under subsection (1). (3) If the resident or substitute decision-maker does not retain a physician or a registered nurse in the extended class, the licensee shall appoint one for the resident, in consultation with the Medical Director, the resident, and the resident’s substitute decision-maker, if any. (4) The licensee shall enter into the appropriate written agreement under section 89 or 90 with every physician or registered nurse in the extended class retained or appointed under subsection (2) or (3). (5) Revoked: O. Reg. 66/23, s. 21.
Agreement with attending physician
 89. Where a written agreement between a licensee and a physician is required under subsection 88 (4), the agreement must provide for, at a minimum, (a)  the term of the agreement; (b)  the responsibilities of the licensee; and (c)  the responsibilities or duties of the physician, including, (i)  accountability to the Medical Director for meeting the home’s policies, procedures and protocols for medical services, (ii)  provision of medical services, and (iii)  provision of after-hours coverage and on-call coverage.
Agreement with registered nurse in extended class
 90. Where a written agreement between a licensee and a registered nurse in the extended class is required under subsection 88 (4), the agreement must provide for, at a minimum, (a)  the term of the agreement; (b)  the responsibilities of the licensee; and (c)  the responsibilities or duties of the registered nurse in the extended class, including, (i)  accountability to the Medical Director for meeting the home’s policies, procedures and protocols for medical services, (ii)  provision of services, (iii)  informing the licensee of the name of the physician with whom the registered nurse in the extended class has a consultative relationship, and (iv)  provision of after-hours coverage and on-call coverage. Religious and Spiritual Practices
Religious and Spiritual Practices
nan
Religious and spiritual practices
 91. (1) This section applies to the organized program for the home to give residents reasonable opportunity to practise their religious and spiritual beliefs required under section 18 of the Act. (2) Every licensee of a long-term care home shall ensure that the program includes arrangements to provide worship services, resources and non-denominational spiritual counselling on a regular basis for all residents who desire them based on availability within the community. (3) The licensee shall ensure that, (a)  mechanisms are in place to support and facilitate residents’ participation in the program; (b)  arrangements are made for one-to-one visitation, according to the resident’s wishes, based on availability within the community; and (c)  arrangements are made to facilitate the participation in the program of residents who have hearing or visual impairments, based on availability within the community. (4) The licensee shall ensure that there is a designated lead for the program who has sufficient knowledge and experience to co-ordinate religious services and spiritual care in a multi-faith setting. Accommodation Services
Accommodation Services
nan
Accommodation services programs
 92. (1) This section and sections 93 to 98 apply to the organized programs required under subsection 19 (1) of the Act. (2) Where services under any of the programs are provided by a service provider who is not an employee of the licensee, the licensee shall ensure that there is in place a written agreement with the service provider that sets out the service expectations. (3) The licensee shall ensure that there are written policies and procedures to monitor and supervise persons who provide occasional maintenance or repair services to the home pursuant to the agreement referred to in subsection (2). (4) The licensee’s policies and procedures under subsection (3) may take into account whether the person is subject to the requirements for a police record check and declarations set out in sections 252 and 253.
Housekeeping
 93. (1) Every licensee of a long-term care home shall ensure that housekeeping services are provided seven days per week. (2) As part of the organized program of housekeeping under clause 19 (1) (a) of the Act, the licensee shall ensure that procedures are developed and implemented for, (a)  cleaning of the home, including, (i)  resident bedrooms, including floors, carpets, furnishings, privacy curtains, contact surfaces and wall surfaces, and (ii)  common areas and staff areas, including floors, carpets, furnishings, contact surfaces and wall surfaces; (b)  cleaning and disinfection of the following in accordance with manufacturer’s specifications and using, at a minimum, a low level disinfectant in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices: (i)  resident care equipment, such as whirlpools, tubs, shower chairs and lift chairs, (ii)  supplies and devices, including personal assistance services devices, assistive aids and positioning aids, and (iii)  contact surfaces; (c)  removal and safe disposal of dry and wet garbage; and (d)  addressing incidents of lingering offensive odours. (3) The licensee shall ensure that the infection prevention and control lead designated under subsection 102 (5) is involved in selecting the disinfectant referred to in clause (2) (b). (4) The licensee shall ensure that a sufficient supply of housekeeping equipment and cleaning supplies is readily available to all staff at the home.
Pest control
 94. (1) As part of organized programs of housekeeping and maintenance services under clauses 19 (1) (a) and (c) of the Act, every licensee of a long-term care home shall ensure that an organized preventive pest control program using the services of a licensed pest controller is in place at the home, including records indicating the dates of visits and actions taken. (2) The licensee shall ensure that immediate action is taken to deal with pests.
Laundry service
 95. (1) As part of the organized program of laundry services under clause 19 (1) (b) of the Act, every licensee of a long-term care home shall ensure that, (a)  procedures are developed and implemented to ensure that, (i)  residents’ linens are changed at least once a week and more often as needed, (ii)  residents’ personal items and clothing are labelled in a dignified manner within 48 hours of admission and of acquiring, in the case of new clothing, (iii)  residents’ soiled clothes are collected, sorted, cleaned and delivered to the resident, and (iv)  there is a process to report and locate residents’ lost clothing and personal items; (b)  a sufficient supply of clean linen, face cloths and bath towels are always available in the home for use by residents; (c)  linen, face cloths and bath towels are kept clean and sanitary and are maintained in a good state of repair, free from stains and odours; and (d)  industrial washers and dryers are used for the washing and drying of all laundry. (2) Despite clause (1) (d), the licensee may provide residential washers and dryers within the home that are, (a)  accessible to residents and family members; and (b)  available to address the laundry needs arising from programs if industrial sanitation is not necessary to meet those needs.
Maintenance services
 96. (1) As part of the organized program of maintenance services under clause 19 (1) (c) of the Act, every licensee of a long-term care home shall ensure that, (a)  maintenance services in the home are available seven days per week to ensure that the building, including both interior and exterior areas, and its operational systems are maintained in good repair; and (b)  there are schedules and procedures in place for routine, preventive and remedial maintenance. (2) The licensee shall ensure that procedures are developed and implemented to ensure that, (a)  electrical and non-electrical equipment, including mechanical lifts, are kept in good repair, and maintained and cleaned at a level that meets manufacturer specifications, at a minimum; (b)  all equipment, devices, assistive aids and positioning aids in the home are kept in good repair, excluding the residents’ personal aids or equipment; (c)  heating, ventilation and air conditioning systems are cleaned and in good state of repair and inspected at least every six months by a certified individual, and that documentation is kept of the inspection; (d)  all plumbing fixtures, toilets, sinks, grab bars and washroom fixtures and accessories are maintained and kept free of corrosion and cracks; (e)  gas or electric fireplaces and heat generating equipment other than the heating system referred to in clause (c) are inspected by a qualified individual at least annually, and that documentation is kept of the inspection; (f)  hot water boilers and hot water holding tanks are serviced at least annually, and that documentation is kept of the service; (g)  the temperature of the water serving all bathtubs, showers, and hand basins used by residents does not exceed 49 degrees Celsius, and is controlled by a device, inaccessible to residents, that regulates the temperature; (h)  immediate action is taken to reduce the water temperature in the event that it exceeds 49 degrees Celsius; (i)  the temperature of the hot water serving all bathtubs and showers used by residents is maintained at a temperature of at least 40 degrees Celsius; (j)  if the home is using a computerized system to monitor the water temperature, the system is checked daily to ensure that it is in good working order; and (k)  if the home is not using a computerized system to monitor the water temperature, the water temperature is monitored once per shift in random locations where residents have access to hot water. (3) The licensee shall ensure that the home’s mechanical ventilation systems are functioning at all times except when the home is operating on power from an emergency generator.
Hazardous substances
 97. Every licensee of a long-term care home shall ensure that all hazardous substances at the home are labelled properly and are kept inaccessible to residents at all times.
Designated lead — housekeeping, laundry, maintenance
 98. (1) The licensee shall ensure that there is a designated lead for each of the housekeeping, laundry services and maintenance services programs, but the same person may be the designated lead for more than one program. O. Reg. 246/22, s. 98 (1). (2) The licensee shall ensure that the designated lead has the skills, knowledge and experience to perform the role, including, (a)  knowledge of evidence-based practices and, if there are none, prevailing practices relating to housekeeping, laundry and maintenance, as applicable; and (b)  experience in a managerial or supervisory capacity or, in the reasonable opinion of the licensee, appropriate skills, knowledge and experience in a health care or relevant setting to perform the duties required of the position. O. Reg. 66/23, s. 22. (3), (4) Revoked: O. Reg. 66/23, s. 22. Pets
Pets
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Pets
 99. Every licensee of a long-term care home shall ensure that there are in place written policies respecting pets in the home. Volunteers
Volunteers
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Volunteer program
 100. (1) This section and section 101 apply to the organized volunteer program required under subsection 20 (1) of the Act. (2) Every licensee of a long-term care home shall ensure that a staff member monitors or directs a volunteer whenever it is necessary to ensure the safety of a resident.
Designated lead
 101. (1) The licensee shall ensure that there is a designated lead for the volunteer program who is a member of the staff. (2) The designated lead must have, (a)  at least one year of experience with seniors in an organized program or one year of experience with persons in a health care setting; and (b)  experience or knowledge in recruitment, selection, orientation, placement and supervision of volunteers. Infection Prevention and Control Program
Infection Prevention and Control Program
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Prevention of Abuse and Neglect
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Policy to promote zero tolerance
 103. Every licensee of a long-term care home shall ensure that the licensee’s written policy under section 25 of the Act to promote zero tolerance of abuse and neglect of residents, (a)  contains procedures and interventions to assist and support residents who have been abused or neglected or allegedly abused or neglected; (b)  contains procedures and interventions to deal with persons who have abused or neglected or allegedly abused or neglected residents, as appropriate; (c)  identifies measures and strategies to prevent abuse and neglect; (d)  identifies the manner in which allegations of abuse and neglect will be investigated, including who will undertake the investigation and who will be informed of the investigation; and (e)  identifies the training and retraining requirements for all staff, including, (i)  training on the relationship between power imbalances between staff and residents and the potential for abuse and neglect by those in a position of trust, power and responsibility for resident care, and (ii)  situations that may lead to abuse and neglect and how to avoid such situations.
Notification re incidents
 104. (1) Every licensee of a long-term care home shall ensure that the resident’s substitute decision-maker, if any, and any other person specified by the resident, (a)  are notified immediately upon the licensee becoming aware of an alleged, suspected or witnessed incident of abuse or neglect of the resident that has resulted in a physical injury or pain to the resident or that causes distress to the resident that could potentially be detrimental to the resident’s health or well-being; and (b)  are notified within 12 hours upon the licensee becoming aware of any other alleged, suspected or witnessed incident of abuse or neglect of the resident. (2) The licensee shall ensure that the resident and the resident’s substitute decision-maker, if any, are notified of the results of the investigation required under subsection 27 (1) of the Act, immediately upon the completion of the investigation. (3) Despite subsections (1) and (2), a licensee is not required to, but may, notify a person of anything under this section if the licensee has reasonable grounds to believe that the person is responsible for the alleged, suspected or witnessed incident of abuse or neglect of the resident.
Police notification
 105. Every licensee of a long-term care home shall ensure that the appropriate police service is immediately notified of any alleged, suspected or witnessed incident of abuse or neglect of a resident that the licensee suspects may constitute a criminal offence. O. Reg. 246/22, s. 105, 390 (2).
Evaluation
 106. Every licensee of a long-term care home shall ensure, (a)  that an analysis of every incident of abuse or neglect of a resident at the home is undertaken promptly after the licensee becomes aware of it; (b)  that at least once in every calendar year, an evaluation is made to determine the effectiveness of the licensee’s policy under section 25 of the Act to promote zero tolerance of abuse and neglect of residents, and what changes and improvements are required to prevent further occurrences; (c)  that the results of the analysis undertaken under clause (a) are considered in the evaluation; (d)  that the changes and improvements under clause (b) are promptly implemented; and (e)  that a written record of everything provided for in clauses (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 and improvements were implemented is promptly prepared. Reporting and Complaints
Reporting and Complaints
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Complaints procedure: licensee
 107. Every licensee of a long-term care home shall ensure that the written procedures required under clause 26 (1) (a) of the Act incorporate the requirements set out in section 108 of this Regulation.