jswizzle3737/ontario_laws_and_regs huggingface dataset:
Physicians and Registered Nurses in the Extended Class
50. (1) A licensee of a nursing home shall appoint a physician as the medical director for the home and shall obtain a written statement signed by the medical director stating that the medical director will advise the administrator of the home on matters relating to medical care in the home, including the quality of medical care provided in the home. O. Reg. 588/94, s. 4. (2) If the licensee is an individual, the licensee shall not appoint himself or herself as the medical director, and if the licensee is a corporation, the licensee shall not appoint any of its directors or officers as the medical director. O. Reg. 588/94, s. 4. (3) If, on December 1, 1994, the physician who has been appointed as the medical director for a nursing home is the licensee of the home or a director or officer of the licensee of the home, the licensee shall revoke the appointment of that physician as the medical director for the home and shall appoint a new physician as the medical director for the home in accordance with subsections (1) and (2). O. Reg. 588/94, s. 4. (4) A licensee of a nursing home shall notify the Director in writing of the name, address, telephone number and date of appointment of the medical director for the home, and whenever there is a change in any of such information provided to the Director relating to the medical director for the home, the licensee shall notify the Director in writing of the change. O. Reg. 588/94, s. 4. (5) A licensee of a nursing home may appoint one or more registered nurses in the extended class for the nursing home, and, if the licensee does so, the licensee shall obtain a written statement signed by each of those registered nurses in the extended class stating that he or she will advise the administrator of the home on care matters in the home that are within the competence of a registered nurse in the extended class. O. Reg. 61/03, s. 5. (6) The registered nurse in the extended class appointed under subsection (5) shall comply with the “Standards for Consultation with Physicians by RN(EC)s” including “Collaboration” set out in the publication of the College of Nurses of Ontario entitled “Standards of Practice for Registered Nurses who hold an extended class certificate of registration” as amended from time to time. O. Reg. 61/03, s. 5. (7) A licensee of a nursing home shall notify the Director in writing of the name, address, telephone number and date of appointment of each registered nurse in the extended class appointed under subsection (5) and, wherever there is a change in any of that information, the licensee shall notify the Director in writing of the change. O. Reg. 61/03, s. 5.
Physicians and Registered Nurses in the Extended Class
51. (1) A resident, or the person who is lawfully authorized to make a decision on behalf of the resident concerning the resident’s personal care, may retain a physician to attend the resident and provide the resident with medical care and, if neither of them retains the physician, the administrator shall do so. O. Reg. 61/03, s. 6. (2) A resident, or the person who is lawfully authorized to make a decision on behalf of the resident concerning the resident’s personal care, may retain a registered nurse in the extended class to attend the resident and provide the resident with care. O. Reg. 61/03, s. 6. (3) The registered nurse in the extended class retained under subsection (2) shall comply with the “Standards for Consultation with Physicians by RN(EC)s” including “Collaboration” set out in the publication of the College of Nurses of Ontario entitled “Standards of Practice for Registered Nurses who hold an extended class certificate of registration” as amended from time to time. O. Reg. 61/03, s. 6. (4) A physician or registered nurse in the extended class who is retained under subsection (1) or (2) shall, (a) visit the resident and review the resident’s medication and diet at least once every three months; (b) make an annual physical examination of the resident and file with the administrator a written report of the examination and his or her findings on the examination; and (c) make any additional attendances, in addition to those referred to in clauses (a) and (b), as the resident’s condition requires. O. Reg. 61/03, s. 6.
Physicians and Registered Nurses in the Extended Class
52. Where a physician or registered nurse in the extended class has been retained to provide a person who is or is to be a resident with care and he or she does not comply with the requirements of section 51, the administrator shall request him or her to comply with the requirements of section 51 and if the physician or registered nurse in the extended class does not do so, the administrator, after consultation with the resident and the person who is lawfully authorized to make a decision on behalf of the resident concerning the resident’s personal care, shall retain another physician and may retain another registered nurse in the extended class to provide the resident with the care. O. Reg. 61/03, s. 6.
Physicians and Registered Nurses in the Extended Class
53.  (1) Every administrator shall make arrangements for a physician to be on call to provide emergency services when a resident’s physician or substitute physician is not available. R.R.O. 1990, Reg. 832, s. 53. (2) An administrator may arrange for a registered nurse in the extended class to be part of the team that is on call to provide emergency services. O. Reg. 61/03, s. 7.
Physicians and Registered Nurses in the Extended Class
54. (1) Where a resident suffers an injury, the administrator shall retain a physician or a registered nurse in the extended class as soon as possible, (a) to examine and report on the condition of the resident; and (b) to provide any necessary treatment. R.R.O. 1990, Reg. 832, s. 54 (1); O. Reg. 61/03, s. 8 (1). (2) Where a resident suffers an injury that, in the opinion of the physician or registered nurse in the extended class referred to in subsection (1), is a serious injury, the administrator shall forthwith give notice of the injury to the person who is lawfully authorized to make a decision on behalf of the resident concerning the resident’s personal care and to such other person as the resident may designate. R.R.O. 1990, Reg. 832, s. 54 (2); O. Reg. 378/93, s. 17; O. Reg. 61/03, s. 8 (2).
Physicians and Registered Nurses in the Extended Class
54.1 Revoked: O. Reg. 333/04, s. 1. Physical Restraints
Physical Restraints
55. (1) An apparatus for restraining a resident shall be applied to a resident only, (a) when necessary to protect the resident from injury to himself, herself or others; and (b) on the written order of a physician who attended the resident and approved the apparatus as appropriate for its intended use in restraining the resident. R.R.O. 1990, Reg. 832, s. 55 (1). (2) Where it is not possible in a situation set out in clause (1) (a) to obtain an order of a physician referred to in clause (1) (b), an apparatus for restraining a resident may be applied on the order of the registered nurse in charge provided that a physician’s order is obtained within twelve hours of the application of the restraint. R.R.O. 1990, Reg. 832, s. 55 (2). (3) Subject to subsection (4), no order for a restraint under subsection (1) or (2) shall be enforced for a period exceeding twelve hours. R.R.O. 1990, Reg. 832, s. 55 (3). (4) Where a situation appears to warrant the use of a restraint on a resident for a period exceeding twelve hours, a reassessment of the need for the restraint shall be carried out by the registered nursing staff of the nursing home and where the reassessment indicates that the continued use of the restraint is warranted, the restraint may be used for a further period of up to twelve hours and a further reassessment shall be carried out for each subsequent twelve-hour period. R.R.O. 1990, Reg. 832, s. 55 (4). (5) Where an apparatus for restraining a person is applied to a resident, the apparatus shall, (a) be designed so as not to cause physical injury to the resident; (b) be designed so as to cause the least possible discomfort to the resident; and (c) be examined and the resident’s position changed at least every hour by a registered nurse or a registered practical nurse. R.R.O. 1990, Reg. 832, s. 55 (5); O. Reg. 61/03, s. 10. (6) Subject to this section, every nursing home shall have written policies and procedures governing the application and use of physical restraints on residents. R.R.O. 1990, Reg. 832, s. 55 (6). Nursing Care
Nursing Care
56. (1), (2) Revoked: O. Reg. 340/96, s. 3. (3) Revoked: O. Reg. 373/94, s. 13. (4) Where a resident’s attending physician or registered nurse in the extended class so requires, a resident’s vital signs shall be observed and recorded regularly by the registered nursing staff and the information shall be reported to the physician or registered nurse in the extended class as he or she directs. O. Reg. 61/03, s. 11. (5) The nursing staff shall provide restorative nursing care to a resident who requires such care and in particular to one who requires bladder or bowel training, gait training, care of weak or paralyzed limbs, or maintenance of range of joint movements. R.R.O. 1990, Reg. 832, s. 56 (5). (6) The nursing staff shall give to a resident who is confined to bed or to a bed-chair, care that includes turning every two hours, positioning and measures to prevent skin disorders or care for skin disorders. R.R.O. 1990, Reg. 832, s. 56 (6). (7) The nursing staff shall instruct residents in the use of self-care devices. R.R.O. 1990, Reg. 832, s. 56 (7). (8) The nursing staff shall ensure that proper and sufficient care of each resident’s body is provided daily to safeguard the resident’s health and to maintain personal hygiene. O. Reg. 237/02, s. 1. (9) Without restricting the generality of any of the requirements of subsection (8), the nursing staff shall ensure that each resident receives at least two baths or showers a week, unless there is a medical reason for the resident not to receive the baths or showers. O. Reg. 339/04, s. 2. (9.1) In subsection (9), “bath” means a tub bath or full body sponge bath. O. Reg. 339/04, s. 2. (10) Each resident’s bed clothing shall be kept clean and free from odours and residents’ bed linen shall be changed at least twice a week. R.R.O. 1990, Reg. 832, s. 56 (10). (11) The nursing staff shall use proper sterile nursing techniques at all times. R.R.O. 1990, Reg. 832, s. 56 (11). (12) All nursing equipment shall be maintained in a good state of repair, be properly cleaned and be readily available for use and a supply of nursing equipment adequate to meet the needs of the nursing home shall be on hand at all times. R.R.O. 1990, Reg. 832, s. 56 (12).
Nursing Care
57., 58.  Revoked: O. Reg. 378/93, s. 20. Nursing and Other Staff
Nursing and Other Staff
59. (1) A licensee of a nursing home shall ensure that twenty-four hour nursing service is available in the home. O. Reg. 378/93, s. 21 (1). (1.1) The licensee of a nursing home shall ensure that at least one registered nurse who is a member of the regular nursing staff of the home is on duty and present in the home at all times. O. Reg. 339/04, s. 3. (1.2) Until August 1, 2005, subsection (1.1) does not apply to a licensee with respect to a nursing home having 80 beds or less. O. Reg. 412/04, s. 1. (2) A licensee of a nursing home shall ensure that the nursing staff of the home is organized into shifts, to be known as the day shift, the afternoon shift and the night shift such that, (a) the day shift shall not commence earlier than 6 a.m. nor later than 2 p.m.; (b) the afternoon shift shall not commence earlier than 2 p.m. nor later than 6 p.m.; and (c) the night shift shall not commence earlier than 10 p.m. or later than 2 a.m. R.R.O. 1990, Reg. 832, s. 59 (2); O. Reg. 378/93, s. 21 (2).
Nursing and Other Staff
60. (1) A licensee of a nursing home shall ensure that the home has a registered nurse who is designated as the director of nurses, and who is responsible for, (a) the organization, direction and evaluation of nursing care; (b) directing the work of the nursing staff in the nursing home; and (c) the organization and direction of in-service training programs for nursing staff. R.R.O. 1990, Reg. 832, s. 60 (1); O. Reg. 378/93, s. 22 (1). (2) Revoked: O. Reg. 588/94, s. 6. (3) A licensee of a nursing home shall ensure that in addition to any time spent on duty as a registered nurse, the director of nurses works in his or her capacity as director of nurses for at least twenty hours a week if the nursing home has sixty beds or less and at least thirty-seven hours a week if the nursing home has more than sixty beds. O. Reg. 378/93, s. 22 (2). (4) During the hours that a director of nurses works in his or her capacity as director of nurses, he or she shall not be considered to be a registered nurse on duty and present in the home for the purposes of subsection 59 (1.1). O. Reg. 339/04, s. 4. (5) Until August 1, 2005, subsection (4) does not apply to a licensee with respect to a nursing home having 80 beds or less. O. Reg. 412/04, s. 2. (5.1) Until August 1, 2005, subsections (4) and (5), as they read immediately before February 1, 2005, continue to apply to a licensee with respect to a nursing home having 80 beds or less. O. Reg. 412/04, s. 2. (6) A licensee of a nursing home shall ensure that there is a sufficient number of registered nurses, registered practical nurses and health care aides on duty in the home at all times to provide the nursing care required by the residents of the home. O. Reg. 340/96, s. 4.
Nursing and Other Staff
61. (1) A licensee of a nursing home shall ensure that there is at least one food services supervisor on the staff of the home and that the minimum combined number of hours worked in a week by all of the home’s food services supervisors in their capacity as such is the number obtained by multiplying the number of meal days in the week by 4/105. O. Reg. 588/94, s. 7. (2) A licensee of a nursing home shall ensure that there is at least one food handler on the staff of the home and that the minimum combined number of hours worked in a week by all of the home’s food handlers in their capacity as such is the number obtained by multiplying the number of meal days in the week by 2/5. O. Reg. 588/94, s. 7. (3) For the purpose of subsections (1) and (2), the number of meal days in a week is the sum of the number of meal days in each day of the week. O. Reg. 588/94, s. 7. (4) For the purpose of subsection (3), the number of meal days in a day is the number obtained using the formula,  in which, “A” is the number of residents the nursing home has that day, and “B” is the number of meals and snacks prepared in the nursing home that day for persons who are not residents of the home. O. Reg. 588/94, s. 7. (5) In this section, “food handler” means an employee whose function it is to prepare or cook food or to clean kitchen equipment or utensils. O. Reg. 588/94, s. 7.
Nursing and Other Staff
61.1 For the purpose of determining whether sections 60 and 61 are being complied with, a person who holds more than one position at a nursing home or who works at a nursing home in more than one capacity shall be considered to be working in only one capacity at any one moment in time. O. Reg. 588/94, s. 7; O. Reg. 9/97, s. 2.
Nursing and Other Staff
61.1.1 A licensee of a nursing home shall ensure that there are sufficient qualified administrative staff to manage and administer the home. O. Reg. 9/97, s. 3. Staff Training
Staff Training
61.2 A licensee of a nursing home shall ensure, (a) that when a person becomes a member of the staff of the home, the person is given in-service training to orient him or her to the home; and (b) that in-service training programs for the purpose of continuing education are conducted for all of the staff of the home. O. Reg. 588/94, s. 7. Dental Care
Dental Care
62. Where a resident, or a physician attending a resident, informs the administrator that the resident is in need of the services of a dentist, the administrator shall arrange for the resident to receive, at the expense of the resident, the services of a dentist. R.R.O. 1990, Reg. 832, s. 62. Administration of Drugs
Administration of Drugs
63. (1) Every administrator is responsible for the administration and enforcement in the nursing home of the provisions of this Regulation relating to drugs. R.R.O. 1990, Reg. 832, s. 63 (1). (2) No drug shall be taken by or administered to a resident except on the individual prescription or written direction of the prescriber attending the resident. R.R.O. 1990, Reg. 832, s. 63 (2). (3) No person except a physician, dentist, registered nurse or registered practical nurse shall administer a drug to a resident. R.R.O. 1990, Reg. 832, s. 63 (3); O. Reg. 61/03, s. 12. (4) No administrator shall permit more than a three months supply of a drug to be stored for a resident. R.R.O. 1990, Reg. 832, s. 63 (4). (5) Every drug of a resident shall be kept in the original container bearing the original label unless transferred to another container or relabelled on the direction of and under the direct supervision of a prescriber or pharmacist, and when the drug is so transferred the second container shall be labelled in accordance with section 64. R.R.O. 1990, Reg. 832, s. 63 (5). (6) Where a drug or drug treatment for a resident is to be temporarily discontinued or modified, the prescriber who directs the discontinuation or modification shall so indicate, in writing, on an order sheet kept for that purpose, and where a permanent change in dosage is ordered, the directions for use on the container label shall be changed in accordance with the new directions. R.R.O. 1990, Reg. 832, s. 63 (6).
Administration of Drugs
64. (1) Every resident’s individual prescription container shall be marked in accordance with section 156 of the Health Disciplines Act.  R.R.O. 1990, Reg. 832, s. 64 (1). (2) Drugs of a resident that are for external use only shall be so labelled. R.R.O. 1990, Reg. 832, s. 64 (2). (3) All drugs that are transferred under subsection 63 (5) and that are not labelled in accordance with the requirements of subsections (1) and (2) shall be destroyed or removed from the nursing home. R.R.O. 1990, Reg. 832, s. 64 (3).
Administration of Drugs
65. (1) A drug for a resident, other than a drug that requires refrigeration, shall be stored in a drug cabinet or storeroom that is in a convenient location for the nursing staff. R.R.O. 1990, Reg. 832, s. 65 (1). (2) A drug that requires refrigeration shall be kept in a locked box in a refrigerator. R.R.O. 1990, Reg. 832, s. 65 (2). (3) Every drug cabinet or storeroom shall be kept locked and the keys shall be under the control of a registered nurse who is on duty or a registered practical nurse on duty or the administrator in the absence of a registered nurse and registered practical nurse. O. Reg. 61/03, s. 13 (1). (4) Every drug shall be stored so that it is protected from heat, light or other environmental conditions that will adversely affect the drug. R.R.O. 1990, Reg. 832, s. 65 (4). (5) Every drug marked “For External Use Only” shall be stored only in a separate, locked cabinet maintained for this purpose and only within the general drug cabinet or storeroom. R.R.O. 1990, Reg. 832, s. 65 (5). (6) Every narcotic and every controlled drug shall be stored in a locked box or cabinet to be known as the narcotic cabinet. R.R.O. 1990, Reg. 832, s. 65 (6). (7) The narcotic cabinet shall be inside the general drug cabinet or storeroom and no other drug or other article shall be kept in the narcotic cabinet. R.R.O. 1990, Reg. 832, s. 65 (7). (8) No resident shall keep or be permitted to keep a drug on his or her person or in his or her room unless authorized by either a physician or registered nurse in the extended class who is in attendance on the resident, and in accordance with any conditions that are imposed by the physician or the registered nurse in the extended class. O. Reg. 61/03, s. 13 (2).
Administration of Drugs
66. Every nursing home shall maintain a book to be known as the drug record book in which shall be recorded the following information concerning drugs that have been requisitioned and received in the nursing home: 1. The date the drug is ordered. 2. The signature of the person placing the order. 3. The name, strength and quantity of the drug. 4. The name of the place from which the drug is ordered. 5. The name of the resident for whom the drug is prescribed, where applicable. 6. The prescription number, where applicable. 7. The date the drug is received. 8. The signature of the person acknowledging receipt of the drug on behalf of the nursing home. R.R.O. 1990, Reg. 832, s. 66.
Administration of Drugs
67. Except as provided in section 68, no prescription drug shall be purchased, kept or used in a nursing home unless it has been prescribed for a resident. R.R.O. 1990, Reg. 832, s. 67.
Administration of Drugs
68. (1) No prescription drug that has not been obtained for a resident on the prescription of a prescriber shall be purchased, kept or used in a nursing home unless the prescription drug is under the direct control of a pharmacist, physician or a registered nurse in the extended class appointed under subsection 50 (5). R.R.O. 1990, Reg. 832, s. 68 (1); O. Reg. 61/03, s. 14 (1). (2) Where a nursing home purchases, keeps or uses a prescription drug referred to in subsection (1), the pharmacist, physician or a registered nurse in the extended class appointed under subsection 50 (5) shall keep or cause to be kept, (a) a record of the name, strength and quantity of the prescription drug; and (b) the records required to be kept by the Regulated Health Professions Act, 1991, the Food and Drugs Act (Canada) and the Controlled Drugs and Substances Act (Canada) for the receipt and sale or disposition of the prescription drug. O. Reg. 61/03, s. 14 (2). (3) A prescription drug referred to in subsection (1) shall be stored in a separate locked drug cabinet or storeroom that is accessible only to a pharmacist, physician or member of the registered nursing staff. O. Reg. 61/03, s. 14 (2).
Administration of Drugs
69. (1) A drug that has been provided for a resident by prescription shall be destroyed by the director of nurses in the presence of an inspector or by a pharmacist, or a physician, or removed from the nursing home by an inspector when the physician attending the resident orders that its use be discontinued or when the resident has been discharged or dies. R.R.O. 1990, Reg. 832, s. 69 (1). (2) Where a resident dies, written approval of the person who has signed the medical certificate of death under the Vital Statistics Act shall be obtained before a drug that was provided for the resident is destroyed or removed. O. Reg. 61/03, s. 15. (3) Where a drug is destroyed or removed, the director of nurses shall make a note in the resident’s records and record in the prescription drug record book, (a) the date of destruction or removal of the drug; (b) the prescription number of the drug; (c) the pharmacy name; (d) the resident’s name; (e) the drug name, strength and quantity; and (f) the reason for destruction or removal, and the director of nurses and the inspector or pharmacist referred to in subsection (1) shall sign the record. R.R.O. 1990, Reg. 832, s. 69 (3). (4) Where a drug is removed from a nursing home the director of nurses shall furnish the inspector referred to in subsection (1) with a copy of the information required in clauses (3) (a), (b), (c), (d) and (e) and such information shall be signed by the director of nurses and the inspector. R.R.O. 1990, Reg. 832, s. 69 (4). (5) Where a resident is discharged or transferred, a drug that has been provided for the resident by prescription may be sent with the discharged or transferred resident after an entry is made in the drug record book that shall be signed by the resident’s physician or dentist, as the case may be, stating, (a) the date; (b) the prescription number; (c) the pharmacy name; (d) the resident’s name; and (e) the words “sent with resident”. R.R.O. 1990, Reg. 832, s. 69 (5). Use of Oxygen
Use of Oxygen
70. (1) No oxygen shall be used in a nursing home or be administered to a resident, except in accordance with this section. R.R.O. 1990, Reg. 832, s. 70 (1). (2) Oxygen shall be given to a resident only on the order of the resident’s attending physician, the medical director or a physician called in an emergency. R.R.O. 1990, Reg. 832, s. 70 (2); O. Reg. 588/94, s. 8 (1). (3) Oxygen shall be administered to a resident only by a physician, a registered nurse or a registered practical nurse. R.R.O. 1990, Reg. 832, s. 70 (3); O. Reg. 61/03, s. 16. (4) The medical director shall ensure that written instructions are maintained in the nursing home that clearly set out the procedures for dealing with all emergency situations that may require oxygen therapy. R.R.O. 1990, Reg. 832, s. 70 (4); O. Reg. 588/94, s. 8 (2). (5) Where the use of oxygen has been ordered, (a) all flammable solvents, cleaning fluids, ether, matches, lighters, candles and other like materials shall be removed from the room where the oxygen is to be used; (b) signs bearing the printed words “DANGER — NO SMOKING — OXYGEN IN USE” shall be placed in the room and at the entrance to the room where the oxygen is to be used; (c) oil or grease shall not be used at any time on oxygen equipment; and (d) the oxygen equipment shall be securely anchored. R.R.O. 1990, Reg. 832, s. 70 (5). (6) All oxygen equipment, together with accessories, including the “DANGER — NO SMOKING — OXYGEN IN USE” signs shall be stored in a readily accessible place so as to be available for immediate use when required. R.R.O. 1990, Reg. 832, s. 70 (6). (7) When oxygen storage containers are not in use, they shall be stored in, (a) a ventilated locked closet in the nursing home and the closet shall be lined with non-combustible material and shall not be used for any other purpose; or (b) a locked closet outside the nursing home. R.R.O. 1990, Reg. 832, s. 70 (7). (8) Every administrator shall establish and include in the fire safety procedures for nursing homes, a written set of instructions on the storage, handling and special hazards of oxygen, including the clear labelling of oxygen storage containers. R.R.O. 1990, Reg. 832, s. 70 (8).
Use of Oxygen
71. Revoked: O. Reg. 588/94, s. 9. Activity Programs
Activity Programs
72. (1) Every administrator of a nursing home shall designate members of the nursing home staff who shall establish and implement on a regularly organized basis, social, physical and recreational activities and programs suitable for residents in a nursing home. R.R.O. 1990, Reg. 832, s. 72 (1). (2) Every administrator shall ensure that residents, (a) are involved in the planning of activities, outings and social functions; and (b) are consulted when decisions are being made regarding menu planning, timing of meals, interior decorating, changes in routine related to resident care, use of volunteers and volunteer programs, and any other matter affecting residents’ life-style. R.R.O. 1990, Reg. 832, s. 72 (2). (3) Every nursing home shall provide and maintain, without charge to the residents, supplies and equipment appropriate for the activities and programs referred to in subsection (1). R.R.O. 1990, Reg. 832, s. 72 (3). Residents’ Council
Residents’ Council
73. (1)-(5) Revoked: O. Reg. 378/93, s. 24 (2). (6) The assistance referred to in clause 29 (1) (b) of the Act shall include but not be limited to, (a) informing the residents and the persons who are lawfully authorized to make a decision on behalf of a resident concerning the resident’s personal care of their right to establish a resident’s council and who may be a member of the resident’s council; (b) providing accommodation with seating that is suitable according to the size of the residents’ council either inside the nursing home or, where suitable space is not available inside the nursing home, outside the nursing home; and (c) providing interested residents with copies of the Ministry of Health guidelines on how to form and operate a residents’ council. R.R.O. 1990, Reg. 832, s. 73 (6); O. Reg. 378/93, s. 24 (3, 4). (7) Where a residents’ council is established in a nursing home the administrator shall only attend meetings of the council when requested by the council. R.R.O. 1990, Reg. 832, s. 73 (7). (8) Where a residents’ council is in existence in a nursing home, the administrator shall make himself or herself available to hear suggestions or complaints from the residents’ council with respect to matters in the nursing home and the administrator shall, where practicable, act on the suggestions or complaints and respond to the residents’ council in writing as to how he or she intends to act on the suggestion or complaint within twenty-one days of receiving the suggestion or complaint. R.R.O. 1990, Reg. 832, s. 73 (8). (9) Revoked: O. Reg. 378/93, s. 24 (5). Nutritional Care
Nutritional Care
74. (1) Every administrator shall ensure that the nursing home has food services staff on duty daily to attend to the nutritional needs of the residents. R.R.O. 1990, Reg. 832, s. 74 (1). (2) Every administrator shall employ a person who shall be responsible for the planning of menus and the management of food services in the nursing home and such person shall have knowledge of nutrition and experience in quantity preparation of food. R.R.O. 1990, Reg. 832, s. 74 (2). (3) Every nursing home shall have on staff a food services supervisor who shall be a person who is eligible for membership in the Canadian Food Service Supervisors Association. R.R.O. 1990, Reg. 832, s. 74 (3). (4) The licensee of the nursing home shall ensure that the following are reviewed and approved in writing at least once a year by the nursing home’s dietitian: 1. The nursing home’s planned menu for all diets, including regular, therapeutic and special diets, texture modification and snacks. 2. The nursing home’s menu cycle. O. Reg. 339/04, s. 5.
Nutritional Care
75. (1) Every administrator shall ensure that, (a) a minimum of three meals is served to each resident daily and that the meals provide sufficient caloric value to maintain each resident’s average weight; (b) there is an alternate choice of food of equal nutrient value for each meal; (c) where modified and therapeutic diets and nutritional supplements are ordered in writing by a physician attending a resident, the diets and supplements ordered are provided to the resident; (d) a full breakfast is available to residents up to 8:30 a.m. in the morning, and the evening meal is not served before 5:00 p.m. in the evening; (e) snacks and fluids are served to residents between meals and at bedtime; and (f) each resident is supplied with an adequate amount of fluids throughout the day to prevent dehydration. R.R.O. 1990, Reg. 832, s. 75 (1). (2) Regular menus and therapeutic modifications of menus for residents for the whole of a current week shall be dated and posted in advance of the current week for reference by persons serving food and for residents, and any change to a meal shall be marked on the posted menu before the preparation of the meal is commenced. R.R.O. 1990, Reg. 832, s. 75 (2). (3) All menus referred to in subsection (2) shall be kept on file in the nursing home for three months. R.R.O. 1990, Reg. 832, s. 75 (3). (4) The same foods shall not be served in the same form on the same day, or on consecutive days nor shall the same food in the same form be served on the same day of consecutive weeks except where a majority of the residents indicate the contrary to the administrator. R.R.O. 1990, Reg. 832, s. 75 (4).
Nutritional Care
76. (1) Each resident shall be provided with at least the following food each day: 1. Milk and Milk Products. 500 millilitres. 2. Fruits and Vegetables. i. Two 125 millilitres servings of vegetables, ii. Two 125 millilitres servings of fruits, or fruit juices fresh, frozen or canned, and iii. One 125 millilitre serving of potatoes. 3. Bread and Cereals. Three to five servings of whole grain or enriched bread and cereals. 4. Meat and Meat Alternates. Two servings one of which is meat, fish, poultry or liver weighing sixty to ninety grams cooked and containing seven grams of protein for each thirty gram serving, and a second serving the same as the first or a meat alternate serving of equivalent protein content. R.R.O. 1990, Reg. 832, s. 76 (1); O. Reg. 373/94, s. 15. (2) In paragraph 1 of subsection (1), whiteners shall not be counted as milk or milk products. R.R.O. 1990, Reg. 832, s. 76 (2). (3) In paragraph 2 of subsection (1), fruit flavoured beverages shall not be counted as fruit or fruit juice. R.R.O. 1990, Reg. 832, s. 76 (3).
Nutritional Care
77. (1) Every nursing home shall have an adequate supply of perishable foods to meet the needs of the residents for at least a twenty-four-hour period, and an adequate supply of non-perishable foods to meet the needs of the residents for at least a three-day period. R.R.O. 1990, Reg. 832, s. 77 (1). (2) All food shall be stored in a sanitary manner and at proper temperature and humidity to prevent contamination or spoilage. R.R.O. 1990, Reg. 832, s. 77 (2). (3) Food that is stored in a freezer in a nursing home shall be freezer wrapped, and labelled to show the identity, amount or weight and the date received. R.R.O. 1990, Reg. 832, s. 77 (3). (4) No powdered eggs shall be given to a resident unless the powdered eggs have been cooked. R.R.O. 1990, Reg. 832, s. 77 (4). (5) Food delivery receipts for food received in the nursing home shall be kept on file in the nursing home for six months from the date of the delivery of the food. R.R.O. 1990, Reg. 832, s. 77 (5). (6) Where there is a conflict between the provisions of Regulation 562 of the Revised Regulations of Ontario, 1990 and the provisions of this Regulation, the provisions of this Regulation shall prevail. R.R.O. 1990, Reg. 832, s. 77 (6). (7) Every nursing home shall keep a copy of Canada’s Food Guide, Revised 1977, posted, (a) in the kitchen; and (b) in a location in the nursing home where it is most likely to be seen by residents of the nursing home. R.R.O. 1990, Reg. 832, s. 77 (7). Communicable Diseases
Communicable Diseases
77.1 (1) A licensee of a nursing home shall ensure that each person who is admitted to the home as a resident is given a skin test for tuberculosis unless, (a) the person was given the skin test in a nursing home, an approved charitable home for the aged under the Charitable Institutions Act or a home under the Homes for the Aged and Rest Homes Act less than one year before the date of admission; or (b) the test is medically contra-indicated. O. Reg. 373/94, s. 16. (2) The licensee shall ensure that the test required under subsection (1) is given, (a) within 14 days after the person’s admission, if the person is admitted for a period of at least 14 days; or (b) within the period for which the person is admitted, if the person is admitted for a period of less than 14 days. O. Reg. 373/94, s. 16.
Communicable Diseases
77.2 If the Ministry of Health gives the licensee of a nursing home a surveillance protocol for a particular communicable disease, the licensee shall implement the protocol. O. Reg. 373/94, s. 16. Deaths
Deaths
78. (1) Where a resident dies in a nursing home, the resident’s death shall be reported immediately to, (a) a coroner by the person in charge of the nursing home at the time of the resident’s death; (b) the resident’s physician; and (c) any registered nurse in the extended class who attended the resident. O. Reg. 61/03, s. 17. (2) Where the attending physician or registered nurse in the extended class is satisfied that the death was from natural causes and the coroner has been informed of the resident’s death, the body of the resident may be moved to a private area in the nursing home. O. Reg. 61/03, s. 17. (3) The attending physician or registered nurse in the extended class shall make a written report indicating the cause and time of death of the resident, and the report shall be retained in the resident’s file. O. Reg. 61/03, s. 17. (4) A report of the time, date and circumstances of the death of a resident, the name and address of the person, if any, who claims the body and the date that notice of death is given to the coroner shall be attached to the deceased resident’s records. R.R.O. 1990, Reg. 832, s. 78 (4). Administrators
Administrators
79. Every nursing home shall have an administrator for the home who shall be responsible for its administration who shall be deemed to be an employee of the nursing home for the purposes of this Regulation. R.R.O. 1990, Reg. 832, s. 79.
Administrators
80. (1) No person shall be employed as an administrator in a nursing home unless, (a) he or she is eighteen years of age or over; and (b) Revoked: O. Reg. 373/94, s. 17. (c) where he or she has not been employed as an administrator in a nursing home in Ontario prior to the 27th day of April, 1972, (i) he or she produces an Ontario Secondary School Graduation Diploma or evidence that the Minister considers equivalent thereto, or (ii) he or she produces evidence satisfactory to the licensee of employment experience in work comparable to the administration of the nursing home for which his or her employment is contemplated. R.R.O. 1990, Reg. 832, s. 80 (1); O. Reg. 373/94, s. 17. (2) Despite subsection (1) and subject to subsection (4), on and after the 1st day of January, 1984, every nursing home shall only employ as an administrator a person who is enrolled in the “Long Term Care Organization and Management Course” given by the Canadian Hospital Association. R.R.O. 1990, Reg. 832, s. 80 (2). (3) The employment of the person referred to in subsection (2) is conditional on successful completion of the course referred to within three years of the enrolment of the person in the course. R.R.O. 1990, Reg. 832, s. 80 (3). (4) A nursing home may, on and after the 1st day of January, 1984, employ as an administrator a person who has, in the opinion of the Minister, equivalent qualifications to those set out in subsections (2) and (3). R.R.O. 1990, Reg. 832, s. 80 (4).
Administrators
80.1 Revoked: O. Reg. 9/97, s. 4.
Administrators
81. Revoked: O. Reg. 9/97, s. 4.
Administrators
82.-84.  Revoked: O. Reg. 373/94, s. 18.
Administrators
85. Revoked: O. Reg. 588/94, s. 11. Closing of a Nursing Home
Closing of a Nursing Home
86. (1) A licensee of a nursing home who intends to close all or some of the beds in the home permanently or temporarily shall, no later than 16 weeks before the date of the closure, give written notice of the licensee’s intention to, (a) the Director; (b) the administrator of the nursing home; (c) the placement co-ordinator designated for the nursing home under subsection 20.1 (3) of the Act; and (d) each resident who will be affected by the closure and the person who is lawfully authorized to make a decision on behalf of the resident concerning the resident’s personal care. O. Reg. 121/02, s. 5. (2) Forthwith after receiving a notice under subsection (1), the placement co-ordinator shall contact each resident who will be affected by the closure and the person who is lawfully authorized to make a decision on behalf of the resident concerning the resident’s personal care, in order to begin the process of authorizing the resident’s admission to another nursing home, an approved charitable home for the aged under the Charitable Institutions Act or a home under the Homes for the Aged and Rest Homes Act. O. Reg. 121/02, s. 5.
Closing of a Nursing Home
87. Where the licensee of a nursing home ceases to operate a nursing home, the licensee shall forthwith on such cessation deliver every resident’s personal file that is kept or maintained in the nursing home to the Director or to such person as the Director may require in writing. R.R.O. 1990, Reg. 832, s. 87. Records and Reports
Records and Reports
88. Every administrator of a nursing home shall create and maintain a written record and file for each resident that shall be contained in the resident’s personal file and that shall include, (a) particulars of admission, transfer, notification of admission to a hospital, discharge, accident or death; (b) a resident’s records of personal health information, including the medical and drug records of the resident; and (c) a written record of all other matters that are relevant to the resident, including a copy of any incident report relating to the resident. O. Reg. 333/04, s. 2.
Records and Reports
89. The medical record of a resident must include a written report of, (a) the resident’s medical history; (b) each physical examination of the resident by a physician or a registered nurse in the extended class; (c) diagnoses of the resident’s condition; (d) orders for the treatment of the resident, including, (i) orders for the administration of drugs, (ii) orders for medication, and (iii) follow-up notes indicating the resident’s condition at each visit, signed by the physician or registered nurse in the extended class attending the resident; (e) a written copy of every telephone order for treatment of the resident given by a physician, together with the signature of the registered nurse or registered practical nurse to whom the telephone order was given and the counter-signature of the physician who gave the telephone order; (f) daily nursing notes that are signed by the nurse in charge of the resident and that record every change in the resident’s condition considered significant in the opinion of the nurse in charge of the resident; and (g) any records required to be kept under the provisions of the Controlled Drugs and Substances Act (Canada) or Part III of the Food and Drugs Act (Canada). O. Reg. 61/03, s. 18.
Records and Reports
90. Except as provided in section 87, the medical records of a resident shall be retained, (a) where the resident is discharged from the nursing home for a period of twenty years after the date of the discharge; or (b) where the resident dies in the nursing home, for a period of five years after the date of the death. R.R.O. 1990, Reg. 832, s. 90.
Records and Reports
91. Every administrator of a nursing home shall maintain general records for the nursing home that shall include, (a) Revoked: O. Reg. 333/04, s. 3. (b) the date of each inspection by an inspector; (c) any written recommendations made by an inspector; and (d) particulars of each fire drill held in the nursing home. R.R.O. 1990, Reg. 832, s. 91; O. Reg. 333/04, s. 3.
Records and Reports
92. Every administrator of a nursing home shall maintain personnel records for the nursing home that include for each person employed in the nursing home, (a) a written application for employment, (i) signed by the employee, (ii) stating the occupation of the employee, (iii) the qualifications of the employee, including the employee’s educational standing, occupational training and previous employment; (b) a health record; and (c) a record of daily hours of work. R.R.O. 1990, Reg. 832, s. 92.
Records and Reports
93. Every administrator of a nursing home shall ensure that, (a) the medical record and written record in the personal file of each resident; (b) the personnel records; and (c) the general records, in the nursing home are kept up-to-date at all times. R.R.O. 1990, Reg. 832, s. 93.
Records and Reports
94. Except as provided in section 87, (a) the personal file of a resident; or (b) the personnel records of the nursing home, shall not be removed from a nursing home by any person other than an inspector. R.R.O. 1990, Reg. 832, s. 94.
Records and Reports
95. (1) The following persons may inspect and receive information from a resident’s medical or drug record and may reproduce such information and retain copies: 1. A person appointed by the Director to collect information to determine the consistency and accuracy of information collected by collectors. 2. A person appointed by the Director to train persons described in paragraph 1. O. Reg. 333/04, s. 4. (2) In subsection (1), “collectors” means persons appointed by the Director to collect information for one or both of the following: 1. To assess and classify residents to determine the level of care required by them. 2. To determine and plan for the care that may be required, in the future, by residents of nursing homes. O. Reg. 333/04, s. 4.
Records and Reports
96. (1) A licensee of a nursing home shall report to the Director in full detail each of the following occurrences in the home: 1. A fire. 2. An assault. 3. An injury in respect of which a person is taken to a hospital. 4. A communicable disease outbreak. 5. A death resulting from an accident or an undetermined cause. O. Reg. 373/94, s. 20. (2) The licensee shall make the report promptly after the occurrence in the form provided by the Minister. O. Reg. 373/94, s. 20.
Records and Reports
97. Where an administrator receives a notice of non-compliance from an inspector that sets out that there has been a contravention of the Act or the regulations with respect to the nursing home, the administrator shall deliver to the Director within seven days of receipt of the notice, a response to the notice that shall set out the proposed steps that will be taken by the administrator to correct the matter and the time within which the corrective action will be taken. R.R.O. 1990, Reg. 832, s. 97; O. Reg. 378/93, s. 27.
Records and Reports
98. (1) Revoked: O. Reg. 378/93, s. 28 (1). (2) A licensee who receives an inspection report under subsection 24 (13) of the Act shall, (a) Revoked: O. Reg. 378/93, s. 28 (3). (b) make a copy of the report available to any person other than a resident of the nursing home to which the report refers on request during normal business hours of the nursing home at a cost not to exceed 25 cents per page; (c) make a copy of the report available without charge to any resident of the nursing home on request; (d) where the licensee wishes to post a comment in writing on the contents of the report in the nursing home, cause a copy of the comment to be delivered to the Director on or before the date when the comments are posted; and (e) where a residents’ council representing the residents wishes to post a comment in writing on the contents of the report in the nursing home, post the comments and send a copy of the comments forthwith to the Director. R.R.O. 1990, Reg. 832, s. 98 (2); O. Reg. 378/93, s. 28 (2-5). Financial Records
Financial Records
99. Revoked: O. Reg. 378/93, s. 29.
Financial Records
100. A nursing home shall keep, (a) complete current books of account for all transactions relating to the nursing home; (b) a separate account of transactions with the licensee’s associates that relate to the nursing home; (c) complete financial statements for the nursing home for the preceding year; (d) the report of the auditor respecting the audit of the accounts of the nursing home for the preceding year; (e) records indicating the amounts residents have been charged for accommodation, care, services, programs and goods; and (f) records that are sufficient to substantiate that residents have received the accommodation, care, services, programs and goods for which they have been charged. R.R.O. 1990, Reg. 832, s. 100; O. Reg. 378/93, s. 30.
Financial Records
101. A licensee shall ensure that the accounts of the nursing home are audited by a person licensed under the Public Accountancy Act. R.R.O. 1990, Reg. 832, s. 101.
Financial Records
102. A licensee shall furnish such information and accounts as the Minister may require. R.R.O. 1990, Reg. 832, s. 102. Trust Accounts