jswizzle3737/ontario_laws_and_regs huggingface dataset:
“Abuse” — definition
 2. (1) For the purposes of the definition of “abuse” in subsection 2 (1) of the Act, “emotional abuse” means, (a)  any threatening, insulting, intimidating or humiliating gestures, actions, behaviour or remarks, including imposed social isolation, shunning, ignoring, lack of acknowledgement or infantilization that are performed by anyone other than a resident, or (b)  any threatening or intimidating gestures, actions, behaviour or remarks by a resident that causes alarm or fear to another resident where the resident performing the gestures, actions, behaviour or remarks understands and appreciates their consequences; (“mauvais traitements d’ordre affectif”) “financial abuse” means any misappropriation or misuse of a resident’s money or property; (“exploitation financière”) “physical abuse” means, subject to subsection (2), (a)  the use of physical force by anyone other than a resident that causes physical injury or pain, (b)  administering or withholding a drug for an inappropriate purpose, or (c)  the use of physical force by a resident that causes physical injury to another resident; (“mauvais traitements d’ordre physique”) “sexual abuse” means, (a)  subject to subsection (3), any consensual or non-consensual touching, behaviour or remarks of a sexual nature or sexual exploitation that is directed towards a resident by a licensee or staff member, or (b)  any non-consensual touching, behaviour or remarks of a sexual nature or sexual exploitation directed towards a resident by a person other than a licensee or staff member; (“mauvais traitements d’ordre sexuel”) “verbal abuse” means, (a)  any form of verbal communication of a threatening or intimidating nature or any form of verbal communication of a belittling or degrading nature which diminishes a resident’s sense of well-being, dignity or self-worth, that is made by anyone other than a resident, or (b)  any form of verbal communication of a threatening or intimidating nature made by a resident that leads another resident to fear for their safety where the resident making the communication understands and appreciates its consequences. (“mauvais traitements d’ordre verbal”) (2) For the purposes of clause (a) of the definition of “physical abuse” in subsection (1), physical abuse does not include the use of force that is appropriate to the provision of care or assisting a resident with activities of daily living, unless the force used is excessive in the circumstances. (3) For the purposes of the definition of “sexual abuse” in subsection (1), sexual abuse does not include, (a)  touching, behaviour or remarks of a clinical nature that are appropriate to the provision of care or assisting a resident with activities of daily living; or (b)  consensual touching, behaviour or remarks of a sexual nature between a resident and a licensee or staff member that is in the course of a sexual relationship that began before the resident was admitted to the long-term care home or before the licensee or staff member became a licensee or staff member.
“Accommodation” — definition
 3. For the purposes of the Act and this Regulation, “accommodation”, in relation to a long-term care home, means basic accommodation in the home or preferred accommodation in the home; (“hébergement”) “basic accommodation”, in relation to a long-term care home, means lodging in a standard room in the home, housekeeping services, maintenance and use of the home, dietary services, laundry and linen services, administrative services and nutritional support; (“hébergement avec services de base”) “preferred accommodation”, in relation to a long-term care home, means private accommodation in the home or semi-private accommodation in the home. (“hébergement avec services privilégiés”)
“Caregiver” — definition
 4. For the purposes of the Act and this Regulation, other than section 39 of the Act and section 173 of this Regulation, “caregiver” means an individual who, (a)  is a family member or friend of a resident or a person of importance to a resident, (b)  is able to comply with all applicable laws including any applicable directives, orders, guidance, advice or recommendations issued by the Chief Medical Officer of Health or a medical officer of health appointed under the Health Protection and Promotion Act, (c)  provides one or more forms of support or assistance to meet the needs of the resident, including providing direct physical support such as activities of daily living or providing social, spiritual or emotional support, whether on a paid or unpaid basis, (d)  is designated by the resident or the resident’s substitute decision-maker with authority to give that designation, if any, and (e)  in the case of an individual under 16 years of age, has approval from a parent or legal guardian to be designated as a caregiver.
Controlling interest
 5. (1) For the purposes of the Act and this Regulation, without limiting the meaning of controlling interest, a person is deemed to have a controlling interest in a licensee if the person, either alone or with one or more associates, directly or indirectly, has the direct or indirect right or ability, beneficially or otherwise, to direct the management and policies of the licensee. (2) Without restricting the generality of subsection (1), a person is deemed, for the purposes of the Act and this Regulation, to have a controlling interest in a licensee if that person, either alone or with one or more associates, has a controlling interest in a person who has a controlling interest in a licensee, and so on. (3) For the purposes of this section, one person is deemed to be an associate of another person if, (a)  one person is a corporation of which the other person is an officer or director; (b)  one person is a partnership of which the other person is a partner; (c)  one person is a corporation that is controlled directly or indirectly by the other person; (d)  both persons are corporations and one person is controlled directly or indirectly by the same individual or corporation that directly or indirectly controls the other person; (e)  both persons are members of a voting trust where the trust relates to shares or the control of a corporation; (f)  both persons are part of a group of persons who, at substantially the same time, collectively acquired the direct or indirect right or ability, beneficially or otherwise, to direct the management and policies of a licensee; (g)  both persons are parties to an agreement or arrangement to coordinate the exercise of their interests in the licensee; (h)  one person is the parent, sibling, child or spouse of the other person or is another relative who has the same home as the other person; or (i)  both persons are associates within the meaning of clauses (a) to (h) of the same person.
“Drug” — definition
 6. For the purposes of the Act and this Regulation, “drug” means a substance or a preparation containing a substance referred to in clauses (a) through (d) of the definition of “drug” in subsection 1 (1) of the Drug and Pharmacies Regulation Act, including a substance that would be excluded from that definition by virtue of clauses (f) to (i) of that definition, but does not include a substance referred to in clause (e) of that definition.
“Neglect” — definition
 7. For the purposes of the Act and this Regulation, “neglect” means the failure to provide a resident with the treatment, care, services or assistance required for health, safety or well-being, and includes inaction or a pattern of inaction that jeopardizes the health, safety or well-being of one or more residents.
“Regular nursing staff” — definition
 8. For the purposes of subsection 11 (3) of the Act and this Regulation, “regular nursing staff” means a member of the registered nursing staff who works in a long-term care home at fixed or prearranged intervals.
“Veteran” — definition
 9. For the purposes of section 57 of the Act and this Regulation, “veteran” means a veteran as defined in subsection 2 (1) of the War Veterans Allowance Act (Canada).
Out of province physicians and nurses
 9.1 (1) For the purposes of the Act and this Regulation, a “physician” includes an out of province physician. O. Reg. 202/23, s. 2. (2) For the purposes of the Act and this Regulation, a “registered nurse” includes an out of province registered nurse in the general class. O. Reg. 202/23, s. 2. (3) For the purposes of the Act and this Regulation, a “registered nurse in the extended class” includes an out of province registered nurse in the extended class. O. Reg. 202/23, s. 2. (4) For the purposes of the Act and this Regulation, a “registered practical nurse” includes an out of province registered practical nurse. O. Reg. 202/23, s. 2.
Reference to Notice of Assessment, etc.
 10. Where a resident has provided written authorization for their income information for the most recent taxation year to be electronically obtained from the Canada Revenue Agency, any reference in this Regulation to information in a Notice of Assessment or proof of income statement (option “C” print) in a provision is deemed to include a reference to the same information that is electronically obtained from the Canada Revenue Agency. Policies and Records
Policies and Records
nan
Policies, etc., to be followed, and records
 11. (1) Where the Act or this Regulation requires the licensee of a long-term care home to have, institute or otherwise put in place any plan, policy, protocol, program, procedure, strategy, initiative or system, the licensee is required to ensure that the plan, policy, protocol, program, procedure, strategy, initiative or system, (a)  is in compliance with and is implemented in accordance with all applicable requirements under the Act; and (b)  is complied with. (2) Where the Act or this Regulation requires the licensee to keep a record, the licensee shall ensure that the record is kept in a readable and useable format that allows a complete copy of the record to be readily produced. PART II   RESIDENTS: RIGHTS, CARE AND SERVICES Safe and Secure Home
PART II RESIDENTS: RIGHTS, CARE AND SERVICES
nan
Safe and Secure Home
nan
Doors in a home
 12. (1) Every licensee of a long-term care home shall ensure that the following rules are complied with: 1.  All doors leading to stairways and the outside of the home other than doors leading to secure outside areas that preclude exit by a resident, including balconies and terraces, or doors that residents do not have access to must be, i.  kept closed and locked, ii.  equipped with a door access control system that is kept on at all times, and iii.  equipped with an audible door alarm that allows calls to be cancelled only at the point of activation and, A.  is connected to the resident-staff communication and response system, or B.  is connected to an audio visual enunciator that is connected to the nurses’ station nearest to the door and has a manual reset switch at each door. 2.  All doors leading to secure outside areas that preclude exit by a resident, including balconies and terraces, must be equipped with locks to restrict unsupervised access to those areas by residents. 3.  All doors leading to non-residential areas must be equipped with locks to restrict unsupervised access to those areas by residents, and those doors must be kept closed and locked when they are not being supervised by staff. 4.  Any locks on bedrooms, washrooms, toilet or shower rooms must be designed and maintained so they can be readily released from the outside in an emergency. 5.  All alarms for doors leading to the outside must be connected to a back-up power supply, unless the home is not served by a generator, in which case the staff of the home shall monitor the doors leading to the outside in accordance with the procedures set out in the home’s emergency plans. (2) The licensee shall ensure that there is a written policy that deals with when doors leading to secure outside areas must be unlocked or locked to permit or restrict unsupervised access to those areas by residents.
Elevators
 13. Every licensee of a long-term care home shall ensure that any elevators in the home are equipped to restrict resident access to areas that are not to be accessed by residents.
Floor space
 14. Every licensee of a long-term care home shall ensure that each floor of the home on which residents reside has adequate space for, (a)  completion of documentation by staff; and (b)  secure storage of resident records.
Furnishings
 15. (1) Every licensee of a long-term care home shall ensure that the home has sufficient indoor and outdoor furnishings, including tables, sofas, chairs and lamps, to meet the needs of residents. (2) The licensee shall ensure that, (a)  resident beds have a firm, comfortable mattress that is at least 10.16 centimetres thick unless contraindicated as set out in the resident’s plan of care; (b)  resident beds are capable of being elevated at the head and have a headboard and a footboard; (c)  roll-away beds, day beds, double deck beds, or cots are not used as sleeping accommodation for a resident, except in an emergency; (d)  a bedside table is provided for every resident; (e)  a comfortable easy chair is provided for every resident in the resident’s bedroom, or that a resident who wishes to provide their own comfortable easy chair is accommodated in doing so; and (f)  a clothes closet is provided for every resident in the resident’s bedroom.
Privacy curtains
 16. Every licensee of a long-term care home shall ensure that every resident bedroom occupied by more than one resident has sufficient privacy curtains to provide privacy.
Shower grab bars
 17. Every licensee of a long-term care home shall ensure that every resident shower has at least two easily accessible grab bars, with at least one grab bar being located on the same wall as the faucet and at least one grab bar being located on an adjacent wall.
Bed rails
 18. (1) Every licensee of a long-term care home shall ensure that where bed rails are used, (a)  the resident is assessed and the resident’s bed system is evaluated in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices, to minimize risk to the resident; (b)  steps are taken to prevent resident entrapment, taking into consideration all potential zones of entrapment; and (c)  other safety issues related to the use of bed rails are addressed, including height and latch reliability. (2) Subsection (1) applies in addition to any requirements that apply where bed rails are used as a physical device to restrain under section 35 of the Act or as a PASD under section 36 of the Act.
Windows
 19. Every licensee of a long-term care home shall ensure that every window in the home that opens to the outdoors and is accessible to residents has a screen and cannot be opened more than 15 centimetres.
Communication and response system
 20. Every licensee of a long-term care home shall ensure that the home is equipped with a resident-staff communication and response system that, (a)  can be easily seen, accessed and used by residents, staff and visitors at all times; (b)  is on at all times; (c)  allows calls to be cancelled only at the point of activation; (d)  is available at each bed, toilet, bath and shower location used by residents; (e)  is available in every area accessible by residents; (f)  clearly indicates when activated where the signal is coming from; and (g)  in the case of a system that uses sound to alert staff, is properly calibrated so that the level of sound is audible to staff.
Lighting
 21. Every licensee of a long-term care home shall ensure that the lighting is maintained in accordance with the following requirements: 1.  In a home to which a design manual, other than a manual from earlier than 2009, was applicable under a development agreement to which the home was subject, i.  all corridors and enclosed stairways shall have continuous consistent lighting throughout with minimum levels of 322.92 lux, and ii.  all other areas of the home, including resident bedrooms and vestibules, washrooms and tub and shower rooms, shall have lighting with minimum levels of 322.92 lux. 2.  In all other homes, i.  all corridors shall have continuous consistent lighting throughout with minimum levels of 215.28 lux, ii.  all stairways shall have continuous consistent lighting throughout with minimum levels of 322.92 lux, iii.  the bed of each resident, when at the reading position, shall have lighting with minimum levels of 376.73 lux, iv.  each drug cabinet shall have lighting with minimum levels of 1,076.39 lux, and v.  all other areas of the home shall have lighting with minimum levels of 215.28 lux.
Generators
 22. (1) Subject to subsections (2) and (3), every licensee of a long-term care home shall ensure that the home is served by a generator that is available at all times and that has the capacity to maintain, in the event of a power outage, (a)  the heating system; (b)  emergency lighting in hallways, corridors, stairways and exits; and (c)  essential services, including dietary services equipment required to store food at safe temperatures and prepare and deliver meals and snacks, equipment required to store drugs at safe temperatures and to prepare and deliver drugs, the resident-staff communication and response system, elevators and life support, safety and emergency equipment. O. Reg. 246/22, s. 22 (1); O. Reg. 66/23, s. 2. (2) The licensee of a home is not required to comply with subsection (1) until December 31, 2024 if there are beds in the home, other than class A beds or beds under a temporary emergency licence, that are not subject to a design manual applicable under a development agreement to which the home was subject. O. Reg. 246/22, s. 22 (2). (3) The licensee of a home to which subsection (2) applies shall ensure that the home has guaranteed access to a generator that will be operational within three hours of a power outage and that can maintain everything required under clauses (1) (a), (b) and (c). O. Reg. 246/22, s. 22 (3).
Cooling requirements
 23. (1) Every licensee of a long-term care home shall ensure that a written heat related illness prevention and management plan for the home that meets the needs of the residents is developed in accordance with evidence-based practices. O. Reg. 246/22, s. 23 (1). (2) The heat related illness prevention and management plan must, at a minimum, (a)  identify specific risk factors that may lead to heat related illness and require staff to regularly monitor whether residents are exposed to such risk factors and take appropriate actions in response; (b)  identify symptoms of heat related illness and require staff to regularly monitor whether residents exhibit those symptoms and take appropriate actions in response; (c)  identify specific interventions and strategies that staff are to implement to prevent or mitigate the identified risk factors that may lead to heat related illness and to prevent or mitigate the identified symptoms of such an illness in residents; (d)  include the use of air conditioning, cooling equipment and other resources, as necessary, to protect residents from heat related illness; and (e)  include a protocol for appropriately communicating the heat related illness prevention and management plan to residents, staff, volunteers, substitute decision-makers, visitors, the Residents’ Council of the home, the Family Council of the home, if any, and others where appropriate. O. Reg. 246/22, s. 23 (2); O. Reg. 66/23, s. 3 (1). (3) The heat related illness prevention and management plan for the home shall be evaluated and updated, at a minimum, annually in accordance with evidence-based practices. O. Reg. 246/22, s. 23 (3). (4) The heat related illness prevention and management plan for the home shall be implemented by the licensee every year during the period from May 15 to September 15 and it shall also be implemented, (a)  any day on which the outside temperature forecasted by Environment and Climate Change Canada for the area in which the home is located is 26 degrees Celsius or above at any point during the day; and (b)  anytime the temperature in an area in the home measured by the licensee in accordance with subsections 24 (2) and (3) reaches 26 degrees Celsius or above, for the remainder of the day and the following day. O. Reg. 246/22, s. 23 (4). (5)-(10) Revoked: O. Reg. 66/23, s. 3 (2).
Uninstalling portable or window air conditioning
 23.2 (1) Subject to the other provisions of this section, and despite subsections 23.1 (1) and (2), the licensee of a long-term care home shall uninstall a portable air conditioning unit or a window air conditioning unit in a resident’s bedroom at any time at the request of the resident where the licensee is satisfied that it is feasible to do so, as long as the other residents in the room consent to the uninstallation. O. Reg. 66/23, s. 4. (2) Subject to the other provisions of this section, the licensee of a long-term care home may, at its own initiative, uninstall a portable air conditioning unit or a window air conditioning unit in a resident’s bedroom for any of the following reasons: 1.  When implementing cleaning, maintenance or repair that is required pursuant to section 96. 2.  In order to comply with the minimum temperature requirement in subsection 24 (1). 3.  In order to comply with any other requirement under the Act or this Regulation. O. Reg. 66/23, s. 4. (3) Before uninstalling a portable air conditioning unit or a window air conditioning unit in a resident bedroom at the request of a resident, the licensee shall include in the plan of care for each resident in the room, (a)  any specific risk factors that may lead to heat related illness as a result of the uninstallation; and (b)  the specific interventions and strategies that staff are to implement to prevent or mitigate the identified risk factors that may lead to heat related illness. O. Reg. 66/23, s. 4. (4) For the purposes of this section, the licensee shall make and keep written records relating to the uninstallation of the portable air conditioning unit or window air conditioning unit, including the date the unit was uninstalled and the circumstances that led to the unit being uninstalled. O. Reg. 66/23, s. 4. (5) A licensee shall not uninstall a portable air conditioning unit or a window air conditioning unit pursuant to this section if the uninstalling would compromise the licensee’s ability to implement the heat related illness prevention and management plan for the home. O. Reg. 66/23, s. 4. (6) In all cases where portable air conditioning units or window air conditioning units are uninstalled pursuant to this section, the units must remain accessible and available for use, (a)  at the request of any one or more of the residents who reside in the bedroom; or (b)  when required to cool and maintain the temperature of the bedroom for the health, safety and comfort of the residents in that bedroom. O. Reg. 66/23, s. 4. (7) Where a circumstance described in clause (6) (a) or (b) exists, the licensee shall reinstall the unit promptly, unless subsection (2) applies, in which case the licensee shall reinstall the unit immediately upon the resolution of the issue that led to the uninstallation. O. Reg. 66/23, s. 4.
Air temperature
 24. (1) Every licensee of a long-term care home shall ensure that the home is maintained at a minimum temperature of 22 degrees Celsius. (2) Every licensee of a long-term care home shall ensure that the temperature is measured and documented in writing, at a minimum in the following areas of the home: 1.  At least two resident bedrooms in different parts of the home. 2.  One resident common area on every floor of the home, which may include a lounge, dining area or corridor. 3.  Every designated cooling area, if there are any in the home. (3) The temperature required to be measured under subsection (2) shall be documented at least once every morning, once every afternoon between 12 p.m. and 5 p.m. and once every evening or night. (4) In addition to the requirements in subsection (2), the licensee shall ensure that, for every resident bedroom that is not served by air conditioning, the temperature is measured and documented in writing once a day in the afternoon between 12 p.m. and 5 p.m. (5) The licensee shall keep a record of the measurements documented under subsections (2), (3) and (4) for at least one year.
Plumbing
 25. Every licensee of a long-term care home shall ensure that all plumbing fixtures in the home with hose attachments are equipped with a back flow device.
Compliance with manufacturers’ instructions
 26. Every licensee of a long-term care home shall ensure that staff use all equipment, supplies, devices, assistive aids and positioning aids in the home in accordance with manufacturers’ instructions. Care Plans and Plans of Care
Care Plans and Plans of Care
nan
Initial plan of care
 28. (1) Every licensee of a long-term care home shall ensure that, (a)  the assessments necessary to develop an initial plan of care under subsection 6 (6) of the Act are completed within 14 days of the resident’s admission; and (b)  the initial plan of care is developed within 21 days of the admission. (2) A licensee is exempt from subsection 6 (6) of the Act and this section with respect to a resident, (a)  who is being relocated to another long-term care home operated by the same licensee and section 240 of this Regulation applies; or (b)  who is transferring to a related temporary long-term care home, a re-opened long-term care home or a replacement long-term care home operated by the same licensee. (3) A licensee is exempt from section 6 of the Act and from this section with respect to a resident who is admitted to the short-stay respite care program. (4) For greater clarity, an initial plan of care is a “plan of care” for the purposes of the Act and this Regulation.
Plan of care
 29. (1) Every licensee of a long-term care home shall ensure that the requirements of this section are met with respect to every plan of care. O. Reg. 246/22, s. 29 (1). (2) A plan of care, (a)  must identify the resident and include the resident’s demographic information; and (b)  must identify all the persons who participated in the development of the plan of care, and the dates on which they participated. O. Reg. 246/22, s. 29 (2). (3) A plan of care must be based on, at a minimum, interdisciplinary assessment of the following with respect to the resident: 1.  Customary routines. 2.  Cognition ability. 3.  Communication abilities, including hearing and language. 4.  Vision. 5.  Mood and behaviour patterns, including wandering, any identified responsive behaviours, any potential behavioural triggers and variations in resident functioning at different times of the day. 6.  Psychological well-being. 7.  Physical functioning, and the type and level of assistance that is required relating to activities of daily living, including hygiene and grooming. 8.  Continence, including bladder and bowel elimination. 9.  Disease diagnosis. 10.  Health conditions, including allergies, pain, risk of falls and other special needs. 11.  Seasonal risk relating to heat related illness, including protective measures required to prevent or mitigate heat related illness. 12.  Dental and oral status, including oral hygiene. 13.  Nutritional status, including height, weight and any risks relating to nutritional care. 14.  Hydration status and any risks relating to hydration. 15.  Skin condition, including altered skin integrity and foot conditions. 16.  Activity patterns and pursuits. 17.  Drugs and treatments. 17.1  Medication reconciliation. 18.  Special treatments and interventions. 19.  Safety risks. 20.  Nausea and vomiting. 21.  Sleep patterns and preferences. 22.  Cultural, spiritual and religious preferences and age-related needs and preferences. 23.  Potential for discharge. O. Reg. 246/22, s. 29 (3); O. Reg. 66/23, s. 6. (4) The licensee shall ensure that a registered dietitian who is a member of the staff of the home, (a)  completes a nutritional assessment for all residents on admission and whenever there is a significant change in a resident’s health condition; and (b)  assesses the matters referred to in paragraphs 13 and 14 of subsection (3). O. Reg. 246/22, s. 29 (4). (5) A licensee is exempt from this section with respect to a resident who is admitted to the short-stay respite care program. O. Reg. 246/22, s. 29 (5).
Care conference
 30. (1) Every licensee of a long-term care home shall ensure that, (a)  a care conference of the interdisciplinary team providing a resident’s care is held within six weeks following the resident’s admission and at least annually after that to discuss the plan of care and any other matters of importance to the resident and their substitute decision-maker, if any; (b)  the resident, the resident’s substitute decision-maker, if any, and any person that either of them may direct are given an opportunity to participate fully in the conferences; and (c)  a record is kept of the date, the participants and the results of the conferences. (2) A licensee is exempt from the requirement under clause (1) (a) to hold a care conference within six weeks of admission with respect to a resident, (a)  who is being relocated to another long-term care home operated by the same licensee and section 240 of this Regulation applies; or (b)  who is transferring to a related temporary long-term care home, a re-opened long-term care home or a replacement long-term care home operated by the same licensee. (3) A licensee is exempt from this section with respect to a resident who is admitted to the short-stay respite care program. (4) Revoked: O. Reg. 66/23, s. 7.
Plan of care, transitional
 31. Where, immediately before the coming into force of this section, a plan of care under section 6 of the former Act is in place for a resident, the plan of care is continued as a plan of care under section 6 of the Act and, for the purposes of determining when the plan of care must be reviewed and revised, it is deemed to have been developed or revised under section 6 of the Act on the same day it was developed or revised under section 6 of the former Act.
Changes in plan of care, consent
 32. Every licensee of a long-term care home shall ensure that when a resident is reassessed and the resident’s plan of care is reviewed and revised under subsection 6 (10) of the Act, any consent or directive with respect to “treatment” as defined in the Health Care Consent Act, 1996, including a consent or directive with respect to a “course of treatment” or a “plan of treatment” under that Act, that is relevant, including a regulated document under paragraph 2 of subsection 266 (1) of this Regulation, is reviewed and, if required, revised. Targets and Periodic Increases
Targets and Periodic Increases
nan
Applicable calculation period
 33. (1) This section sets the applicable calculation periods for the targets and periodic increases set out in sections 8 and 9 of the Act. (2) For the purposes of paragraphs 2 and 3 of subsection 8 (4) of the Act and subsection 9 (3) of the Act, the applicable calculation period is the period beginning on April 1 in one year and ending on March 31 in the following year. (3) The applicable calculation period for the purposes of paragraph 1 of subsection 8 (4) of the Act and subsection 9 (4) of the Act is the period beginning on January 1, 2022 and ending on March 31, 2022. General Requirements for Programs
General Requirements for Programs
nan
General requirements
 34. (1) Every licensee of a long-term care home shall ensure that the following is complied with in respect of each of the organized programs required under sections 11 to 20 of the Act and each of the interdisciplinary programs required under section 53 of this Regulation: 1.  There must be a written description of the program that includes its goals and objectives and relevant policies, procedures and protocols and provides for methods to reduce risk and monitor outcomes, including protocols for the referral of residents to specialized resources where required. 2.  Where, under the program, staff use any equipment, supplies, devices, assistive aids or positioning aids with respect to a resident, the equipment, supplies, devices or aids are appropriate for the resident based on the resident’s condition. 3.  The program must be evaluated and updated at least annually in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices. 4.  The licensee shall keep a written record relating to each evaluation under paragraph 3 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. (2) The licensee shall ensure that any actions taken with respect to a resident under a program, including assessments, reassessments, interventions and the resident’s responses to interventions are documented. (3) Revoked: O. Reg. 66/23, s. 8. Nursing and Personal Support Services
Nursing and Personal Support Services
nan
Nursing and personal support services
 35. (1) This section and sections 36 to 52 apply to, (a)  the organized program of nursing services required under clause 11 (1) (a) of the Act; and (b)  the organized program of personal support services required under clause 11 (1) (b) of the Act. (2) Every licensee of a long-term care home shall ensure that there is a written staffing plan for the programs referred to in clauses (1) (a) and (b). (3) The staffing plan must, (a)  provide for a staffing mix that is consistent with residents’ assessed care and safety needs and that meets the requirements set out in the Act and this Regulation; (b)  set out the organization and scheduling of staff shifts; (c)  promote continuity of care by minimizing the number of different staff members who provide nursing and personal support services to each resident; (d)  include a back-up plan for nursing and personal care staffing that addresses situations when staff, including the staff who must provide the nursing coverage required under subsection 11 (3) of the Act, cannot come to work; and (e)  be evaluated and updated at least annually in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices. (4) The licensee shall keep a written record relating to each evaluation under clause (3) (e) 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.
Personal care
 36. Every licensee of a long-term care home shall ensure that each resident of the home receives individualized personal care, including hygiene care and grooming, on a daily basis.
Bathing
 37. (1) Every licensee of a long-term care home shall ensure that each resident of the home is bathed, at a minimum, twice a week by the method of their choice and more frequently as determined by the resident’s hygiene requirements, unless contraindicated by a medical condition. (2) For the purposes of this section, “bathing” includes tub baths, showers, and full body sponge baths.
Oral care
 38. (1) Every licensee of a long-term care home shall ensure that each resident of the home receives oral care to maintain the integrity of the oral tissue that includes, (a)  mouth care in the morning and evening, including the cleaning of dentures; (b)  physical assistance or cuing to help a resident who cannot, for any reason, brush their own teeth; and (c)  an offer of an annual dental assessment and other preventive dental services, subject to payment being authorized by the resident or the resident’s substitute decision-maker, if payment is required. (2) The licensee shall ensure that each resident receives assistance, if required, to insert dentures prior to meals and at any other time as requested by the resident or required by the resident’s plan of care.
Foot care and nail care
 39. (1) Every licensee of a long-term care home shall ensure that each resident of the home receives preventive and basic foot care services, including the cutting of toenails, to ensure comfort and prevent infection. (2) Every licensee of a long-term care home shall ensure that each resident of the home receives fingernail care, including the cutting of fingernails.
Transferring and positioning techniques
 40. Every licensee of a long-term care home shall ensure that staff use safe transferring and positioning devices or techniques when assisting residents.
Personal items and personal aids
 41. (1) Every licensee of a long-term care home shall ensure that each resident of the home has their personal items, including personal aids such as dentures, glasses and hearing aids, (a)  labelled within 48 hours of admission and of acquiring, in the case of new items; and (b)  cleaned as required. (2) The licensee shall ensure that each resident receives assistance, if required, to use personal aids.
Notification re personal belongings, etc.
 42. Every licensee of a long-term care home shall ensure that a resident or the resident’s substitute decision-maker is notified when, (a)  the resident’s personal aids or equipment are not in good working order or require repair; or (b)  the resident requires new personal belongings.
Mobility devices
 43. Every licensee of a long-term care home shall ensure that mobility devices, including wheelchairs, walkers and canes, are available at all times to residents who require them on a short-term basis.
Dress
 44. Every licensee of a long-term care home shall ensure that each resident of the home is assisted with getting dressed as required, and is dressed appropriately, suitable to the time of day and in keeping with the resident’s preferences, in their own clean clothing and in appropriate clean footwear.
Bedtime and rest routines
 45. Every licensee of a long-term care home shall ensure that each resident of the home has the resident’s desired bedtime and rest routines supported and individualized to promote comfort, rest and sleep.
End-of-life care
 46. Every licensee of a long-term care home shall ensure that every resident receives end-of-life care when required in a manner that meets their needs.
Communication methods
 47. Every licensee of a long-term care home shall ensure that strategies are developed and implemented to meet the needs of residents with compromised communication and verbalization skills, of residents with cognitive impairment and of residents who cannot communicate in the language or languages used in the home.
Availability of supplies
 48. Every licensee of a long-term care home shall ensure that supplies, equipment and devices are readily available at the home to meet the nursing and personal care needs of residents.
Exemption, small homes at hospitals
 50. The licensee of a long-term care home is exempt from subsections 11 (3) and (4) of the Act with respect to the home, as long as the following conditions apply: 1.  The home has a licensed bed capacity of 39 beds or fewer. 2.  The home adjoins a hospital under the Public Hospitals Act. 3.  A registered nurse is on duty and present anywhere on the site, including the hospital.
Certification of nurses
 51. Every licensee of a long-term care home shall ensure that every member of the staff who performs duties in the capacity of registered nurse, registered practical nurse or registered nurse in the extended class has the appropriate current certificate of registration with the College of Nurses of Ontario or, in the case of an out of province nurse, a current certificate of registration with the governing body of their health profession. O. Reg. 246/22, s. 51; O. Reg. 202/23, s. 4.
Required Programs
nan
Required programs
 53. (1) Every licensee of a long-term care home shall ensure that the following interdisciplinary programs are developed and implemented in the home: 1.  A falls prevention and management program to reduce the incidence of falls and the risk of injury. 2.  A skin and wound care program to promote skin integrity, prevent the development of wounds and pressure injuries, and provide effective skin and wound care interventions. 3.  A continence care and bowel management program to promote continence and to ensure that residents are clean, dry and comfortable. 4.  A pain management program to identify pain in residents and manage pain. O. Reg. 246/22, s. 53 (1); O. Reg. 66/23, s. 10. (2) Each program must, in addition to meeting the requirements set out in section 34, (a)  provide for screening protocols; and (b)  provide for assessment and reassessment instruments. O. Reg. 246/22, s. 53 (2).
Falls prevention and management
 54. (1) The falls prevention and management program must, at a minimum, provide for strategies to reduce or mitigate falls, including the monitoring of residents, the review of residents’ drug regimes, the implementation of restorative care approaches and the use of equipment, supplies, devices and assistive aids. O. Reg. 246/22, s. 54 (1). (2) Every licensee of a long-term care home shall ensure that when a resident has fallen, the resident is assessed and that a post-fall assessment is conducted using a clinically appropriate assessment instrument that is specifically designed for falls. O. Reg. 246/22, s. 54 (2); O. Reg. 66/23, s. 11. (3) Every licensee of a long-term care home shall ensure that the equipment, supplies, devices and assistive aids referred to in subsection (1) are readily available at the home. O. Reg. 246/22, s. 54 (3).
Skin and wound care
 55. (1) The skin and wound care program must, at a minimum, provide for the following: 1.  The provision of routine skin care to maintain skin integrity and prevent wounds. 2.  Strategies to promote resident comfort and mobility and promote the prevention of infection, including the monitoring of residents. 3.  Strategies to transfer and position residents to reduce and prevent skin breakdown and reduce and relieve pressure, including the use of equipment, supplies, devices and positioning aids. 4.  Treatments and interventions, including physiotherapy and nutritional care. O. Reg. 246/22, s. 55 (1). (2) Every licensee of a long-term care home shall ensure that, (a)  a resident at risk of altered skin integrity receives a skin assessment by a member of the registered nursing staff, (i)  within 24 hours of the resident’s admission, (ii)  upon any return of the resident from hospital, and (iii)  upon any return of the resident from an absence of greater than 24 hours; (b)  a resident exhibiting altered skin integrity, including skin breakdown, pressure injuries, skin tears or wounds, (i)  receives a skin assessment by a member of the registered nursing staff, using a clinically appropriate assessment instrument that is specifically designed for skin and wound assessment, (ii)  receives immediate treatment and interventions to reduce or relieve pain, promote healing, and prevent infection, as required, (iii)  Revoked: O. Reg. 66/23, s. 12 (2). (iv)  is reassessed at least weekly by a member of the registered nursing staff, if clinically indicated; (c)  the equipment, supplies, devices and positioning aids referred to in subsection (1) are readily available at the home as required to relieve pressure, treat pressure injuries, skin tears or wounds and promote healing; (d)  any resident who is dependent on staff for repositioning is repositioned every two hours or more frequently as required depending upon the resident’s condition and tolerance of tissue load, except that a resident shall only be repositioned while asleep if clinically indicated; and (e)  a resident exhibiting a skin condition that is likely to require or respond to nutrition intervention, such as pressure injuries, foot ulcers, surgical wounds, burns or a worsening skin condition, is assessed by a registered dietitian who is a member of the staff of the home, and that any changes the registered dietitian recommends to the resident’s plan of care relating to nutrition and hydration are implemented. O. Reg. 246/22, s. 55 (2); O. Reg. 66/23, s. 12. (3) In this section, “altered skin integrity” means potential or actual disruption of epidermal or dermal tissue. O. Reg. 246/22, s. 55 (3).
Continence care and bowel management
 56. (1) The continence care and bowel management program must, at a minimum, provide for the following: 1.  Treatments and interventions to promote continence. 2.  Treatments and interventions to prevent constipation, including nutrition and hydration protocols. 3.  Toileting programs, including protocols for bowel management. 4.  Strategies to maximize residents’ independence, comfort and dignity, including equipment, supplies, devices and assistive aids. 5.  Annual evaluation of residents’ satisfaction with the range of continence care products in consultation with residents, substitute decision-makers and direct care staff, with the evaluation being taken into account by the licensee when making purchasing decisions, including when vendor contracts are negotiated or renegotiated. (2) Every licensee of a long-term care home shall ensure that, (a)  each resident who is incontinent receives an assessment that includes identification of causal factors, patterns, type of incontinence and potential to restore function with specific interventions, and that where the condition or circumstances of the resident require, an assessment is conducted using a clinically appropriate assessment instrument that is specifically designed for assessment of incontinence; (b)  each resident who is incontinent has an individualized plan, as part of their plan of care, to promote and manage bowel and bladder continence based on the assessment and that the plan is implemented; (c)  each resident who is unable to toilet independently some or all of the time receives assistance from staff to manage and maintain continence; (d)  each resident who is incontinent and has been assessed as being potentially continent or continent some of the time receives the assistance and support from staff to become continent or continent some of the time; (e)  continence care products are not used as an alternative to providing assistance to a person to toilet; (f)  there are a range of continence care products available and accessible to residents and staff at all times, and in sufficient quantities for all required changes; (g)  residents who require continence care products have sufficient changes to remain clean, dry and comfortable; and (h)  residents are provided with a range of continence care products that, (i)  are based on their individual assessed needs, (ii)  properly fit the residents, (iii)  promote resident comfort, ease of use, dignity and good skin integrity, (iv)  promote continued independence wherever possible, and (v)  are appropriate for the time of day, and for the individual resident’s type of incontinence.
Pain management
 57. (1) The pain management program must, at a minimum, provide for the following: 1.  Communication and assessment methods for residents who are unable to communicate their pain or who are cognitively impaired. 2.  Strategies to manage pain, including non-pharmacologic interventions, equipment, supplies, devices and assistive aids. 3.  Comfort care measures. 4.  Monitoring of residents’ responses to, and the effectiveness of, the pain management strategies. (2) Every licensee of a long-term care home shall ensure that when a resident’s pain is not relieved by initial interventions, the resident is assessed using a clinically appropriate assessment instrument specifically designed for this purpose. Responsive Behaviours
Responsive Behaviours
nan