The Ontario Ministry of Long-Term Care, citing "systemic failure," has prohibited the County of Simcoe from accepting any new residents to Sunset Manor nursing home amid concerns the county "cannot or will not properly manage the home without assistance."
The Ontario Ministry of Long-Term Care has prohibited the County of Simcoe from accepting any new residents to Sunset Manor nursing home until multiple compliance issues observed over the last three years are resolved.
The ministry stated its order was issued because there is “risk of harm to the health or well-being of residents of the home or persons who might be admitted.”
Jane Sinclair, the county’s general manager of health and emergency services, said the order is “extremely excessive.”
The ministry recently released its 13-page report on the county-owned and operated Collingwood long-term care home, detailing incidents of non-compliance observed by ministry inspectors since May 2019.
Based on the report, the ministry made its latest order because of “significant areas of non-compliance,” relating to reports of abuse and neglect of residents; improper skin and wound care; discouraging of staff from disclosing information to inspectors; delaying mandatory reporting to the provincial director; and lack of written records and plans for preventing altercations, administering nutrition and hydration programs, and specialized plans of care.
The county has been ordered to hire a new manager for the home and must have the new staff member approved by the ministry. No admissions are permitted until compliance with the ministry’s orders is achieved.
“I want to be clear that we disagree with the severity of the ministry’s findings, we find it excessive,” Sinclair told CollingwoodToday this afternoon. “And we feel there are other circumstances at play.”
The county is alleging a conflict of interest at the ministry because one of the inspectors, they say, is a former employee of the County of Simcoe.
“We ask you to consider in the middle of a global pandemic, where this home, in particular has fared so well … this home has such an incredible reputation in the community. Why now are we receiving such a significant report that is creating such a negative impact on our residents, their families, and our staff?” asked Sinclair.
The report notes a history of “frequent leadership turnover for the past three years,” representing “instability within the home at the management level.”
Between July 2018 and May 2021, the home has had a total of 17 inspections resulting in 74 written notifications, 35 voluntary plans of correction, 23 compliance orders, and four director referrals.
“The scope of non-compliance is identified as widespread in the home and represents systemic failure,” states the report. “When taking all of the information into account, there are reasonable grounds to believe that the licensee [the County of Simcoe] cannot or will not properly manage the home without assistance.”
Allison Trumbley, spokesperson for the Service Employees International Union that represents 175 Sunset Manor staff, said the report is "very concerning."
“While I would like to say it came as a surprise to me, it didn’t, because the concerns were raised in 2019,” said Trumbley.
In particular, the union rep said the reports of staff being intimidated for reporting issues to ministry inspectors should “scream alarm bells.”
“It’s an environment (where) you need to have the ability to bring any concerns forward,” she said. “If you don’t have the ability to raise your concerns with management about things that are happening and have support, that’s very problematic.”
The county, according to Sinclair, welcomes input and opportunities to strengthen and improve the care delivered in its long-term care homes.
Sinclair said there are areas for improvement at Sunset Manor, but the “level of seriousness” applied to the incidents that were reviewed is excessive.
Abuse and neglect
According to the ministry report, compliance orders were issued to the county as recently as April 2021 regarding reports of injuries to a resident from another resident, lack of process to monitor a now-deceased resident’s chronic medical condition, and administration of treatment not prescribed and not within the scope of practice of the staff member.
In one case, a resident told a physician they asked to use the toilet and were told to use their diaper instead. The resident felt intimidated and did not have a bowel movement throughout the day.
Other written notifications were sent to the county in 2020 and 2019 claiming staff were not documenting or reporting incidents of resident’s medical deterioration or harm to family, primary-care providers, and/or the ministry in a timely manner or at all.
In a case identified by the ministry in 2021, a resident with an infected wound did not receive a wound assessment or antibiotics until seven days after the infection was first reported by a staff member. The report states the wound worsened.
In October 2019, the ministry issued a non-compliance finding after multiple residents with wounds or altered skin integrity did not receive the required weekly assessments. A resident with three separate wounds did not receive assessments for “several weeks,” according to the report that indicates all three wounds worsened.
The ministry issued four consecutive orders to the county for Sunset Manor failing to meet skin and wound care requirements. The home met compliance requirements on Jan. 18, 2021.
“Although the licensee (County of Simcoe) was able to bring itself into compliance, it is most concerning that within less than three months, multiple very serious issues related to the treatment and assessment of wounds were identified,” states the report.
Sinclair acknowledged the home has challenges with policies and practices surrounding skin and wound care.
“We have worked tirelessly to address them, strengthen our practices, and build our policies,” said Sinclair.
There were also reports of missed doses of medications with concerns raised about the transcription and processing of drug orders and the reporting of medication incidents.
Sinclair noted the drug incidents were self-reported, and that the home’s staff gives 3,350 medications per day at the 150-bed home.
“We have an error rate of .007 per cent,” said Sinclair. “That’s well within industry standards.”
The ministry issued a compliance order to the county after finding staff from a variety of program areas and departments in the home “noted feeling intimidated and fearful to provide information to inspectors.”
The report states staff said they were interrogated by management if they spoke with inspectors at Sunset Manor, and were advised by management that issues should be dealt with “in-house.”
“This had the effect of staff being fearful to speak with inspectors and had the effect of discouraging staff to provide relevant information to inspectors during the inspection,” states the report.
Sinclair claimed the county was not consulted or spoken to about potential concerns raised by staff.
“There was no evidence provided, no consultation with any of the leadership in the home, nor corporately,” said Sinclair. “And when you look at our history … we’ve never had, in any of our homes, any history of assertions like this or compliance findings.”
She said the county has a whistleblower policy and reviews it annually with long-term care and senior care staff.
“This particular situation requires a more fulsome and comprehensive investigation, and again we disagree with the severity of these findings based on an incomplete review of the situation,” she said. “We take all concerns very seriously. We value our staff.”
The report states there have been three directors of care and three assistant directors of care over the past three years at Sunset Manor. The executive director, who has had the job since the fall of 2018, is on extended leave.
The ministry stated the vacancies represent instability in the home and contribute to the inability for senior leadership to provide direction and expertise to effectively understand compliance issues and correct them.
“The home, despite internal supports provided by [the county], has not created a culture of accountability and improvement with respect to compliance,” states the report.
According to Sinclair, the long-term care industry in Ontario has long been dealing with issues in recruitment and retention, and Sunset Manor has seen the same challenges.
The Ministry of Long-Term Care’s director of operations has ordered the county to hire one or more persons to take over management of Sunset Manor. The new hire or hires have to be vetted and approved by the ministry.
If new management is not hired within 14 days of the county’s receipt of the order, the ministry will select the person and the county will be responsible to pay their salary.
“The county’s position is we provide great care at Sunset Manor, we have for many years,” said Sinclair. “We know this is a temporary pause on admissions. This gives us an opportunity to stay focused on these issues of compliance.”
Asked whether the county would be appealing the province’s order and report, Sinclair said the county is still weighing its options.
Sunset Manor is one of four long-term care homes operated by Simcoe County. The others include Trillium Manor in Orillia, Georgian Manor in Penetanguishene, and Simcoe Manor in Beeton.
You can read the June 10 director's order to cease admissions online here.
-With files from Jessica Owen