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Two more fines for Sunset Manor bring total to $27,500

Four penalties have been levied to the County of Simcoe since August for ongoing infractions at the Collingwood long-term care home
2022-06-27 Sunset JO-001
Sunset Manor is a long-term care home in Collingwood operated by the County of Simcoe.

The County of Simcoe has been hit with another $16,500 in fines from the province for continued non-compliance with provincial standards at its Sunset Manor Long-Term Care Home in Collingwood. 

Since August, the province has issued $27,500 in penalties to the County for ongoing violations at Sunset Manor. 

A report from the Ministry of Long-Term Care published this month noted two fines, one for $5,500 and one for $11,000 because of repeated non-compliance with provincial standards for skin and wound care, and medication management. 

These administrative monetary penalties, issued under the 2021 Fixing Long-Term Care Act, are in addition to a $5,500 fine issued to Sunset Manor in August for not meeting provincial requirements for medication management and a $5,500 fine in September for issues related to skin and wound care. 

In the latest report, based on inspections that took place throughout August, the two compliance orders were reiterated. In the area of skin and wound care, the inspectors found the home failed to ensure immediate treatment and interventions to promote wound healing for six different residents. 

In their cases, treatments ordered by doctors were not administered, and/or were changed by the staff attending to the patient. The inspector observed the wrong dressings being used, and topical medication prescribed had not arrived from the pharmacy and was not administered, and no report was filed. 

A fine of $5,500 was issued for the non-compliance, because the home already had an existing compliance order dating back to an April 29, 2022 report. At that time, inspectors noted delayed assessments of residents' skin wounds, and worsening wounds not being reported to physicians in a timely manner.

In each case investigated in April and in August, the risk to residents ranged from low to moderate as healing was delayed and some wounds worsened without proper assessment and administration of treatments. 

The county previously received a penalty of $5,500 in August for failing to comply with another section of the Fixing the Long-Term Care Act in the area of skin and wound care.

A fine of $11,000 was also issued to the home in the latest report for failing to comply with provincial standards for medication management, which requires drugs be administered following the directions from the healthcare provider who prescribed them. The inspector’s report details cases where residents missed doses of a prescribed antibiotic, and were not given medication based on instructions for blood pressure. 

The order that goes with the fine requires the county to ensure medication is provided based on the directions issued by the prescriber and make sure staff document, with an incident report, when a drug is not available. 

This is the second fine for this specific section of the medication management standards in the Fixing Long-Term Care Act. The first was issued in July for $5,500.

The deadline to comply with both the orders included in the October report is today (Oct. 24). 

There is currently an active COVID-19 outbreak in Sunset Manor on the Georgian 1 floor. It was declared by the health unit on Oct. 17, 2022. 

“The scrutiny on our home, new protocols and inspections have been challenging; however, our team, our residents and their families know first-hand that Sunset Manor is a great place to work and live,” the county said in a statement sent for a previous story about fines in September.

The home remains closed to new admissions after a director’s order from the ministry of long-term care ordered the home to cease new admissions in June 2021 until it could prove compliance with provincial standards. As of Oct. 24, there were 101 residents at the 148-bed home. The remaining beds are empty while the new admission ban is in place.

The spring 2021 report from the ministry noted “significant areas of non-compliance,” and the director referred to the scope of non-compliance as widespread, representing “systemic failure.” 

He concluded the County of Simcoe “cannot, or will not properly manage the home without assistance.” 

At that time, the county disagreed with the severity of the findings, and called the cease of admissions “excessive.” They blamed what they said was the “bias” of an ex-employee who was now a ministry inspector for tainting the reporting and influencing the director’s decision.

The county filed an appeal with the divisional court, asking for the court to overturn the new admission ban. In the court documents, the province argued that the inspector was not biased, and there was enough other evidence not presented by the ex-employee to warrant the same ban on new admissions. The county appeal was dismissed. 

Since the admission ban was issued, the province has published seven reports based on dozens of days of on-site inspections by various ministry inspectors. Of the findings of non-compliance documented in those reports, there are two compliance orders still remaining. 

By order of the Ministry of Long-Term Care, the county hired Universal Care Canada Inc., a management company, to assist in meeting the requirements for compliance with Ontario long-term care acts. 

In past statements, the county has also noted it has hired additional registered practical nurse (RPN) resources; contracted an enterostomal therapy nurse to help with skin and wound care assessments; purchased a skin and wound care app for documentation, resources and training; and provided comprehensive training and education to all staff, in addition to daily auditing of staff compliance. 

In addition to the two ongoing compliance orders included in the October report, the ministry inspectors also gave Sunset Manor nine written notices for the following matters: 

  • A resident was transported naked across a hallway to the tub room, which is a failure to afford privacy to the resident as is required in the Fixing Long-Term Care Homes Act. 
  • A personal support worker (PSW) informed a second PSW about specific care information for a resident while the second PSW was caring for a different resident. Since names were mentioned, it represents a breach of confidentiality of personal health information. According to the report, the director of resident care followed up with the staff and confirmed private information cannot be discussed in the presence of other residents. 
  • Treatment ordered for a resident by a physician was not applied, and the inspector noted the staff did not understand the order correctly. The home was cited for not having clear direction in the written plan of care, as required by the provincial act. 
  • Another plan of care matter involved a physician’s orders for dressing being documented as having been applied, but found not to have been applied. Additionally, the resident was to receive physiotherapy three times a week but a physiotherapy assistant reported the exercises were missed for multiple residents, and no progress notes were made. 
  • A resident receiving treatment by a physician for three months for multiple skin concerns did not receive skin assessments, which are required weekly and are to be entered in the skin risk management module for the skin and wound app. 
  • The home reported an incident of alleged resident-to-resident abuse, but the inspector noted the resident who was supposed to have extra monitoring did not. The inspector found that 12 days after the incident, the home’s management and the Universal Care Canada Inc. staff were not aware there was no extra monitoring and that an incident had occurred. 
  • The inspector found a contravention of the infection prevention and control standards for long-term care homes when a personal support worker entered a room on droplet and contact precautions wearing a surgical mask instead of the required N95. In a second PPE-related incident a PSW switched from a surgical to an N95 mask without washing their hands between doffing and donning the masks. Other staff members were observed not washing hands between transporting residents to their rooms and before entering a room on droplet and contact precautions. 
  • A resident was not given the proper dose of narcotic medication as per the prescription orders. They were given lower doses than prescribed. 
  • The provincial rules for COVID-19 isolation were not followed when a resident presented symptoms of a cough and runny nose, but were not tested until a day later and their roommate was not immediately placed in isolation. 

There were five other matters noted by the inspectors as not compliant, but the home remedied the issues over the course of the inspections in August to the satisfaction of the inspector. requested comment from the County of Simcoe for this story, but received a response that the publishing deadline could not be met because of the municipal election and they would aim to respond by the end of today (Oct. 24).

In a previous statement, the county said it is the “top priority, and goal, to reopen admissions to our home as soon as possible.”

The County of Simcoe operates four long-term care homes in Simcoe County, including Sunset Manor, Simcoe Manor (Beeton), Georgian Manor (Penetanguishene), and Trillium Manor (Orillia). 

For months, Sunset Manor was the only long-term care home in Ontario under a cease admissions order, but on Sept. 30, 2022, the province banned new admissions to Caressant Care Lindsay Nursing Home, a for-profit home in Lindsay, Ont. 

UPDATE: the County of Simcoe did email a statement after publication of this article reiterating the steps taken to reach compliance and re-open the home, including continued training and education for staff, daily audits of staff compliance, increased management presence, additional registered practical nurse resources, a dedicated skin and wound resource nurse, a full-time nurse practitioner for expertise and support to the home, and attention toward staff recruitment and retention. 

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Erika Engel

About the Author: Erika Engel

Erika regularly covers all things news in Collingwood as a reporter and editor. She has 15 years of experience as a local journalist
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