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ADULT CARE REGULATIONS B.C. Reg 536/80 [includes B.C. Reg. 366/2002 amendments (effective Dec. 19, 2002)] Contents 1. Interpretation 2. Repealed 2.1 Facility exempted from the Act 3. Licence application 4. General regulations 5. Physical requirements 5. 1 Bedroom space requirements 5. 2 Bedroom furnishings 5. 3 Bedroom privacy 5. 4 Bedroom windows 5. 5 Bedroom illumination 5. 6 Room temperature 5. 7 Bathrooms and bathing facilities 5. 8 Bathrooms and bathing facilities in residential care facilities 5. 9 Bathrooms and bathing facilities in residential care homes or specialized residential care facilities 5.10 Water temperature 5.11 Signalling devices 5.12 Mobility and access 5.13 Telephones 5.14 Signage 5.15 Dining area 5.16 Lounges and recreation areas in residential care facilities 5.17 Lounges and recreation areas in residential care homes or specialized residential care facilities 5.18 Outside activity area 5.19 Accessibility in residential care facilities 5.20 Accessibility in residential care homes 5.21 Designated work areas 5.22 Maintenance 5.23 Fire safety requirements in residential care homes 6. Manager 6. 1 Suitability of employees 6. 2 Health of employees 6. 3 Communications 6. 4 Home alone requirement 6. 5 Employee responsible for recreation and leisure services 6. 6 Supervisor of care staff 6. 7 Supervision by health care professionals 6. 8 General staffing coverage and patterns 6. 9 Supplies, employees and operations Page 2 of 31
6.10 Care and supervision 7. Nutrition care plan in facilities with 24 or fewer residents 7. 1 Nutrition care plan in facilities with 25 or more residents 7. 2 Supervisor of food services in facilities with 50 or more residents 7. 3 Preparation and service of food 7. 4 Food service schedule 7. 5 Eating aids and supplements 7. 6 Menu planning 7. 7 Monitoring nutrition needs 7. 8 Nutrition and food services audit program 7. 9 Resident participation in food services 7.10 Training of staff responsible for food services 7.11 Food services records 8. Definitions 8.1 Supervising pharmacist 8.2 Medication safety and advisory committee 8.3 Storage of medication 8.4 Administration of medication 8.5 Changes to directions for use of medication 8.6 Self-administration of medication 8.7 Medication records 8.8 Return of medication to pharmacy 9. Resident care policies 9.1 Access to health services 9.2 Oral health 9.3 Care plans 9.4 Confidentiality 10. 10. to 10.2 Repealed 10. 3 Privacy 10. 4 Firearms 10. 5 Visitors 10. 6 Reportable incidents 10. 7 Investigations 10. 8 Neglect and abuse 10. 9 Restrictions on the use of restraints 10.10 Emergency restraints 10.11 Reassessment 10.12 Monitoring 10.13 Reassessment standards 10.14 Dispute resolution 11. Access to lounge, activity and recreation areas 11.1 Social activities and recreational programs 11.2 Materials and equipment 11.3 Resident or resident/family councils 12. Limited exemption for facilities licensed on or before August 1, 2000 12.1 Unacceptable threat to health or safety 13. Financial and statistical reports Page 3 of 31
14. Notice of change of operation of facility 15. Repealed SCHEDULE 1. Reportable incidents 2. Non-reportable incidents Form A [Provisions of the Community Care Facility Act, RSBC 1996, c. 60, relevant to the enactment of this regulation: sections 14 and 20] Page 4 of 31
Interpretation 1. In these regulations, unless the context requires otherwise: "Act" means the Community Care Facility Act; "adult" means a person who has reached the legal age of majority; "application date" means the date on which the completed application is received by the medical health officer; "British Columbia Building Code" means the National Building Code as adopted, with modifications, by B.C. Reg. 295/98, the British Columbia Building Code Regulation; "contact person" means an individual who is willing to assist in making application for care or is willing to maintain contact in the interest of the applicant's general welfare; "facility" means a community care facility as defined in the Act; "food services" means all of, or those parts of, the operation of a community care facility related to the provision of meals to the residents and includes, but is not limited to, menu planning, food purchasing, food storage and preparation, the serving of meals, space and equipment requirements and sanitation; "funding program" means a program operated by a government, or an agency of a government, under which funds are provided to licensees; "health care provider" means a practitioner who is authorized to provide health care by (a) a regulatory body, listed under section 6 of the Health Professions Regulation, B.C. Reg. 237/92, or (b) the board of registration for social workers established under the Social Workers Act; "interim permit" means a permit issued by the medical health officer to operate a community care facility for a period not exceeding one year; "licence" means a licence issued by the medical health officer to operate a community care facility; "licensee" means a person who holds a current interim permit or licence issued by the medical health officer; "manager" means an individual who (a) has full authority to operate the facility in accordance with the requirements of the Act and this regulation, (b) meets the requirements of section 4 (1) (a) (i) of the Act, and (c) is acceptable to the medical health officer; "medical health officer" means that part of each resident's care plan which assesses the resident's nutrition status and specifies the nutrition care to be provided to that resident; Page 5 of 31
"nutrition care plan" means that part of each resident's care plan which assesses the resident's nutrition status and specifies the nutrition care to be provided to that resident; "premises" means a building or part of a building with its grounds; "registered dietitian-nutritionist" means a person who is a member of the British Columbia Dietitians' and Nutritionists' Association; "resident" means a person who lives in and receives care in an adult community care facility; "residential care facility" means a facility, other than a specialized residential care facility, licensed under the Act to provide care to 7 or more persons; "residential care home" means a facility licensed under the Act to provide care to 3 to 6 persons; "restraint" means any chemical, electronic, mechanical, physical or other means of controlling a resident's freedom of movement in a facility, including (a) isolating the resident, (b) administering any medication that incapacitates the resident, and (c) using, without the resident's permission, any devices, such as belts, bed rails and chair trays, that primarily control the resident's behavior rather than ensuring the resident's safety, but does not include an electronic device that is only used to monitor the whereabouts of a resident in a facility; "specialized residential care facility" means a facility licensed under the Act to provide care to 7 or more persons with an addiction, a physical, mental health or developmental disability, or a chronic or progressive condition, that is not primarily due to the aging process; "specialized residential care home" means a residential care home that provides care for persons with an addiction, a physical, mental health or developmental disability, or a chronic or progressive condition, that is not primarily due to the aging process; "substitute decision maker" means a person who is authorized to make decisions on behalf of a resident; "variance committee" means a person who is authorized to make decisions on behalf of a resident; [am. B.C. Regs. 7/87; 405/87; 179/88; 387/92; 81/93; 22/97; 119/99; 279/2000; 366/2002.] Repealed 2. Repealed. [B.C. Reg. 279/2000] Facility exempted from the Act 2.1 (1.) Supportive recovery residences constitute a class of facility designated not to be a community care facility for the purposes of the Act and this regulation. Page 6 of 31
(2.) For the purpose of subsection (1), a supportive recovery residence is a residence that (a) provides a safe and drug-free environment for persons recovering from drug or alcohol addictions, and (b) does not provide most or all of the services described in section 6.10 (2). [en. B.C. Reg. 294/2001] Licence application 3. (1.) An application for a licence to operate a community care facility under this regulation must be submitted in the form specified by the director. (2.) A licensee must notify the medical health officer within 30 days of any change in the information recorded on the form referred to in subsection (1). (3.) Every application for a licence must be accompanied by (a) three copies of the site plan, drawn to a scale of not less than 1:500, and of the floor plans of the proposed facility, drawn to a scale of 1:100, showing (i) building elevations and grade relationships, (ii) measured sound levels of the proposed site if considered necessary by the medical health officer, (iii) the inside dimensions of each room and the width of each corridor and stair, (iv) the size and location of the fixed equipment in each room, (v) typical room layout for each residential room and bathroom, drawn to a scale of not less than 1:50, (vi) the location, size and height of sill from the floor of all windows, (vii) the location of accommodation reserved for family, (viii) the location of accommodation reserved for staff including staff rooms and washrooms, and (ix) such other information as the medical health officer may from time to time require, (b) a statement of proposed monthly revenue and expenditures which must include the expected cost of staff salaries and benefits, food, supplies, utilities, maintenance, taxes, mortgage principal and interest payments, insurance and programs, (c) a staffing plan setting out (i) the number of full time equivalent care staff the applicant proposes to employ and their qualifications, and (ii) the name, age, professional qualifications and relevant experience of the person who will be in charge of the day to day operations of the facility, (d) if the applicant purchases or rents the premises, a copy of the purchase agreement or lease, and (e) if the applicant is a society, a copy of the constitution and bylaws of the society. (4.) Prior to commencing the construction or renovations of a facility, a licensee or an applicant for a licence must (a) submit all plans for the construction or renovation to the medical health officer, and (b) receive approval of the plans from the medical health officer. [am. B.C. Regs. 26/83; 387/92; 199/96; 264/96, Sch. B; 279/2000.] General regulations Page 7 of 31
4. (1.) The licensee shall comply with the Act and regulations. (1.1) The licensee must establish and follow an admission screening procedure that (a) ensures accommodation only to those persons for whom safe and adequate care can be provided, and (b) takes into consideration (i) staffing, (ii) facility design, construction and equipment, (iii) the health, safety and well-being of other residents, and (iv) any criteria set by the funding program. (2.) The licensee shall maintain in safe keeping a separate and confidential record of each person accommodated which shall show (a) the person's name, date of birth and sex, (b) the person's date of arrival, (c) the name and telephone number of the person's sponsor, contact person or next of kin, (d) the name and telephone number of a person or agency to contact in the event of accident or illness, (e) the name and telephone number of a medical practitioner to contact in the event of accident or illness, (f) any medications and therapeutic diets prescribed by, and any special instructions given by, the person's medical practitioner, dentist or podiatrist, (g) any medical disabilities or pertinent information made known to the licensee by the person, the person's medical practitioner, the next of kin or sponsor, or the contact person, (h) the individual plan of care for each resident, and (i) the departure date of the person, reason for departure and new address. (3.) The licensee shall (a) require that all persons being admitted to a licensed community care facility comply with the immunization program of the ministry and participate in its tuberculosis control program, (a.1) record each resident's compliance with and participation in the program referred to in paragraph (a), (b) maintain a separate record of, and issue receipts for, all effects, money and valuables held in trust or safekeeping for the residents, (c) maintain a record of and obtain receipts for any disbursements made on behalf of the residents, (d) keep records in a manner and on forms acceptable to the medical health officer, (e) keep a record of all effects, monies and valuables returned to the resident, next of kin, sponsor or legal representative at time of discharge or death, and (f) on request, submit to the medical health officer copies of the records including reports and information regarding care and treatment of residents, numbers of staff on duty each day and hours of work, and the maintenance, operation and management of the facility. (4.) The licensee shall (a) notify the medical health officer promptly of any change of address or telephone number, (b) whenever the manager is temporarily absent, ensure (i) that a competent full time adult person approved by the medical health officer is placed in charge, and Page 8 of 31
(ii) whenever the person designated on the licence as being responsible for the operation of the facility resigns or is expected to be absent from duty for more than 21 consecutive days, and (d) Repealed [B.C. Reg. 62/81] (e) ensure that there is at all times an employee on duty who is the holder of a valid first aid certificate acceptable to the medical health officer, (f) provide an approved first aid kit and such special equipment as required by the medical health officer, maintained in good condition and kept in a place that is readily accessible to the person in charge, (g) ensure that a telephone with posted emergency numbers is available to the person in charge in the event of an accident or sudden illness, (h) Repealed. [B.C. Reg. 119/99] (i) ensure that known wanderers carry identification, (j) Repealed. [B.C. Reg. 119/99] (k) Repealed. [B.C. Reg. 119/99] (l) state that the facility is licensed and give the licence number whenever the services of the facility are advertised, and (m) maintain the premises of the facility in a sanitary condition and in good repair. (5.) The licensee shall not (a) provide a service (i) of a type other than that specified on the licence except where, in the opinion of the medical health officer, retention or temporary placement of a person in the facility is in the best interests of the person, (ii) to more than the number of persons specified on the licence, and (iii) to a resident confined to a wheelchair, unless the room, bathroom and dining room facilities assigned to the person have been specifically designed or modified to accommodate a person in a wheelchair, and (b) Repealed. [B.C. Reg. 119/99] (c) other than in an emergency (i) send a resident to a hospital except on the direction of the resident's medical practitioner, and (ii) transfer a resident to another facility without the prior consent of the resident or the prior approval of the next of kin or sponsor. (iii) Repealed. [B.C. Reg. 387/92] (6.) Repealed. [B.C. Reg. 387/92] [am. B.C. Regs. 177/86; 387/92; 464/94; 119/99.] Physical requirements 5. (1.) A licensee must ensure that (a) each bedroom used to accommodate residents is designed, constructed and maintained as a single occupancy bedroom or a double occupancy bedroom, (b) no more than one resident is accommodated in a single occupancy bedroom, (c) no more than 2 residents are accommodated in a double occupancy bedroom, and (d) the number of double occupancy bedrooms does not exceed 5 percent of the maximum number of residents that the facility is licensed to accommodate, as specified in the licence. (2.) The medical health officer may approve alternative arrangements to those specified in subsection (1) in respect of double occupancy bedrooms if, in the opinion of the medical Page 9 of 31
health officer, the alternative arrangements would not increase the risk to the health or safety of the residents. [en. B.C. Reg. 279/2000; am. B.C. Reg. 366/2002.] Bedroom space requirements 5. 1 (1.) A single occupancy bedroom used to accommodate a resident who does not require a walker, wheelchair or other mobility aid must have a useable floor area of not less than 8.00 m2 exclusive of the entranceway or swing of the entrance door, clothes closets, armoires, built in cabinets or en suite washroom. (2.) A single occupancy bedroom used to accommodate a resident who requires a walker, wheelchair or other mobility aid must have a useable floor area of not less than 11.00 m2 exclusive of the entranceway or swing of the entrance door, clothes closets, armoires, built in cabinets or en suite washroom. (3.) A double occupancy bedroom used to accommodate residents who do not require a walker, wheelchair or other mobility aid must have a useable floor area of not less than 14.00 m2 exclusive of the entranceway or swing of the entrance door, clothes closets, armoires, built in cabinets or en suite washroom. (4.) A double occupancy bedroom used to accommodate residents who require a walker, wheelchair or other mobility aid must have a useable floor area of not less than 18.00 m2 exclusive of the entranceway or swing of the entrance door, clothes closets, armoires, built in cabinets or en suite washroom. (5.) Each resident must be provided a separate clothes closet or armoire having not less than 0.50 m2 of floor area in the resident's bedroom. Bedroom furnishings 5. 2 (1.) A licensee, within the limits necessary to maintain the health, safety and wellbeing of all residents of the facility, must permit each resident to bring into the facility, and keep in the resident's room, furniture, ornaments or other personal possessions. (2.) A licensee must provide for the exclusive use of each resident, and maintain in a sanitary condition and in good repair, furnishings which, in the opinion of the medical health officer, are appropriate to meet the needs of the residents. Bedroom privacy 5. 3 (1.) Each bedroom must be directly accessible from a corridor or hallway without passing through any other room. (2.) Alternative arrangements to those specified in subsection (1) apply if the medical health officer approves the alternative arrangements (a) if only for temporary residency programs, as suitable for the temporary residency programs, or (b) as providing protection for the health, safety and wellbeing of residents that is equivalent to the protection provided by subsection (1). (3.) Unless the health, safety or wellbeing of the residents make it unsuitable, a licensee must provide for a resident who requests it a bedroom door that can be locked from inside the bedroom. Bedroom windows Page 10 of 31
5. 4 (1.) Each bedroom must have a window area not less than 10 percent of the floor area of the bedroom required under this regulation. (2.) Each bedroom must have a window that can be readily opened for ventilation, unless (a) the health, safety or wellbeing of the residents make this unsuitable, or (b) the facility is equipped with an air conditioning system or mechanical ventilating system. (3.) If a bedroom is used to accommodate a resident who is non-ambulatory, the bedroom must have at least one window that provides visibility from a sitting position to the outside. (4.) Each bedroom must have window coverings in good repair which maintain the resident's privacy and block out light. Bedroom illumination 5. 5 Each bedroom must, in the opinion of the medical health officer, have sufficient natural or artificial illumination to provide task or reading, bathroom and general illumination sufficient to meet the needs and preferences of each resident accommodated in the bedroom. Room temperature 5. 6 A licensee must maintain (a) a safe and comfortable temperature in the common areas of the facility provided for use by the residents, and (b) a temperature in each bedroom that meets the needs and preferences of the resident. Bathrooms and bathing facilities 5. 7 Resident bathrooms and bathing rooms must be equipped with (a) a door, (b) a door lock that can be opened from the outside in the case of an emergency, (c) slip resistant material on the bottom of each bathtub and shower, and (d) conveniently located and securely attached grab bars of an appropriate type beside each toilet, bathtub and shower, as required to meet the needs and preferences of the residents. Bathrooms and bathing facilities in residential care facilities 5. 8 (1.) The licensee of a residential care facility must provide (a) for a range of residents on a floor and in the same wing indicated in column 1 of the following table, the number of bathing facilities indicated in column 2 to the right of that range: Table Page 11 of 31
COLUMN 1 COLUMN 2 Residents on floor and in wing Bathing facilities on floor and in wing 7 25 2 26 40 3 41 60 4 61 75 5 (b) washbasin and toilet facilities (i) adjacent to the dining, lounge, and recreational areas, and (ii) appropriate to the needs of the residents, (c) a separate washbasin and toilet for the exclusive use of each 2 residents, and (d) despite paragraph (c), for each bedroom used to accommodate a resident over the age of 65 years, a separate washbasin and toilet reserved for the exclusive use of the residents of the bedroom. (2.) The bathing facilities referred to in subsection (1) must, in the opinion of the medical health officer, be of a type that is sufficiently and appropriately equipped to meet the needs of the residents. (3.) The licensee of a residential care facility must ensure that, if a resident requires a walker or wheelchair, the bathroom for the resident is wheelchair accessible. (4.) Alternative arrangements to those specified in subsection (1) apply if the medical health officer approves the alternative arrangements (a) if only for temporary residency programs, as suitable for the temporary residency programs, or (b) as providing protection for the health, safety and wellbeing of residents that is equivalent to the protection provided by subsection (1). Bathrooms and bathing facilities in residential care homes or specialized residential care facilities 5. 9 (1.) The licensee of a residential care home or specialized residential care facility must provide (a) one washbasin and one toilet for each 3 residents, and (b) one bathtub or shower for each 4 residents. (2.) The washbasins, toilets, bathtubs and showers referred to in subsection (1) must, in the opinion of the medical health officer, be of a type that is sufficiently and appropriately Page 12 of 31
equipped to meet the needs of the residents. [en. B.C. Reg. 279/2000; am. B.C. Reg. 366/2002.] Water temperature 5.10 A licensee must ensure that the temperature of the hot water supplied to the bathtubs, showers and handbasins used by the residents will not exceed 49º Celsius. Signalling devices 5.11 If one or more residents require monitoring to ensure health and safety, the licensee must provide a monitoring system, appropriate to the needs of the residents and staff, that will signal staff if a resident requires help and the location of the resident. Mobility and access 5.12 (1.) The bedrooms must be on the ground floor if there is no elevator for residents who require walkers, wheelchairs or other mobility aids. (2.) A licensee must not provide accommodation to a resident who uses a walker, wheelchair or other mobility aid unless the resident has access to at least one conveniently located entrance, exit and bathroom and has access to and may move freely within the dining room, lounge or living room and the resident's bedroom. (3.) Within the limits necessary to maintain the health, safety or wellbeing of all residents, a licensee must ensure that emergency call buttons, panic hardware, telephones, light switches and elevator controls can be accessed readily by all residents. Telephones 5.13 (1.) A licensee must provide at least one conveniently located telephone for use by residents only that (a) has a private line, (b) has adaptations, as necessary, for residents with disabilities, and (c) is accessible to the residents at all times. (2.) Alternative arrangements to those specified in subsection (1) apply if the medical health officer approves the alternative arrangements (a) if only for temporary residency programs, as suitable for the temporary residency programs, or (b) as providing protection for the health, safety and wellbeing of residents that is equivalent to the protection provided by subsection (1). Signage 5.14 A licensee must post and maintain directional signs and provide other means of directional information or assistance that, in the opinion of the medical health officer, are sufficient and appropriate to meet the needs and protect the health, safety and wellbeing of the residents. Dining area 5.15 A licensee must provide one or more dining areas that provide Page 13 of 31
(a) (b) (c) seating to accommodate all residents, not less than 2.00 m2 of floor space for each resident, and sufficient tables designed to accommodate residents in wheelchairs. Lounges and recreation areas in residential care facilities 5.16 The licensee of a residential care facility must provide (a) one or more readily accessible and comfortably furnished lounges, containing, in total, not less than 1.50 m2 of floor area for each resident, (b) one or more readily accessible, suitably equipped and furnished areas where recreational activities may be carried out containing, in total, not less than 1.00 m2 of floor area for each resident, and (c) a sanitary method of dispensing fresh drinking water to residents in the areas referred to in paragraphs (a) and (b). [en. B.C. Reg. 279/2000. Lounges and recreation areas in residential care homes or specialized residential care facilities 5.17 The licensee of a residential care home or specialized residential care facility must provide one or more comfortably furnished lounges or living rooms containing, in total, not less than 2.00 m2 of floor area for each resident. [en. B.C. Reg. 279/2000; am. B.C. Reg. 366/2002.] Outside activity area 5.18 (1.) A licensee must provide one or more readily accessible outside activity areas (a) including, in total, not less than 1.50 m2 in area for each resident, and (b) including a surfaced patio area and comfortable and safe seating. (2.) A reasonable portion of the areas described in subsection (1) must provide shelter from the sun and inclement weather. (3.) If a resident who uses a walker, wheelchair or other mobility aid is accommodated, (a) the licensee must provide access by a ramp to the outside activity area, and, (b) a ramp described in paragraph (a) must comply, except for width, with the requirements for ramps for persons with disabilities as described in the British Columbia Building Code. (4.) Alternative arrangements to those specified in subsection (3) apply if the medical health officer approves the alternative arrangements (a) if only for temporary residency programs, as suitable for the temporary residency programs, or (b) as providing protection for the health, safety and wellbeing of residents that is equivalent to the protection provided by subsection (3). Accessibility in residential care facilities 5.19 Each corridor in a residential care facility that accommodates residents who use walkers or wheelchairs must have a width of not less than 1.83 m. Accessibility in residential care homes Page 14 of 31
5.20 The licensee of a residential care home that accommodates a resident with a disability must ensure that all areas of the residential care home ordinarily used by the resident are accessible if a walker, wheelchair or other mobility aid is used by the resident. [en. B.C. Reg. 366/2002.] Designated work areas 5.21 (1.) A licensee must provide the following appropriately furnished and equipped areas: (a) a work area for administrative work and other staff use; (b) a secure location for medications and resident records; (c) safe and adequate storage areas for cleaning agents, chemical products and other hazardous materials; (d) separate utility areas for clean and soiled work. (2.) Alternative arrangements to those specified in subsection (1) apply if the medical health officer approves the alternative arrangements (a) if only for temporary residency programs, as suitable for the temporary residency programs, or (b) as providing protection for the health, safety and wellbeing of residents that is equivalent to the protection provided by subsection (1). (3.) A licensee must ensure that laundry facilities (a) not for use by residents are secured, and (b) for use by residents have a slip resistant floor surface. Maintenance 5.22 (1.) A licensee must ensure that all rooms and common areas in the facility are well ventilated and maintained in a good state of repair and in a safe and sanitary condition. (2.) A licensee must ensure that emergency exits are not obstructed or secured in a manner that prevents unimpeded exit in an emergency. Fire safety requirements in residential care homes 5.23 The licensee of a residential care home must ensure that the facility has the following, maintained in a good state of repair at all times: (a) interconnected smoke alarms, installed in each bedroom and in each corridor leading to a bedroom; (b) sprinklers which comply with the British Columbia Building Code; (c) emergency lighting which will automatically illuminate the corridors and stairs for a minimum of 30 minutes in the event of a power failure. [en. B.C. Reg. 279/2000; am. B.C. Reg. 366/2002.] Manager 6. (1.) Every community care facility must have a manager, by whatever title known, who, (a) if the licensee is a corporation, is an individual designated by the licensee to be responsible for the day to day operations of the facility, or (b) if the licensee is not a corporation, is (i) the licensee, or (ii) an individual designated by the licensee to be responsible for the day to day operations of the facility. (2.) A manager may manage more than one community care facility if the medical health Page 15 of 31
officer determines that no increase in the risk to the health or safety of the residents of the facilities will result. [en. B.C. Reg. 119/99; am. B.C. Reg. 366/2002.] Suitability of employees 6. 1 The licensee must ensure that each of its employees (a) has a personality and temperament that respects the dignity and maintains the individuality of residents, and (b) is competent to carry out assigned duties. Health of employees 6. 2 The licensee must do all of the following: (a) require each employee, as a condition of employment, unless otherwise authorized by the medical health officer, (i) to submit a medical certificate before beginning employment and at any other times required by the medical health officer, certifying that the person is medically capable of carrying out assigned duties, and (ii) to comply with the immunization program of the Ministry of Health and participate in its tuberculosis control program; (b) record each employee's compliance with and participation in the program referred to in paragraph (a) (ii) and, on request of the medical health officer, make records available to the medical health officer. Communications 6. 3 The licensee must have (a) an employee on duty at all times who can communicate effectively (i) on all matters relating to the care of each resident, and (ii) with community emergency services, and (b) mechanisms in place to facilitate effective communication between residents and staff. Home alone requirement 6. 4 (1.) Section 6.3 does not apply in respect of a resident of a specialized residential care home if (a) the medical health officer has approved the resident s request to stay at the specialized residential care home when staff are not in attendance, and (b) the granting of the approval does not compromise the health, safety and well-being of the resident. (2.) An approval under subsection (1) must be given only in accordance with the resident's care plan. [en. B.C. Reg. 119/99; am. B.C. Reg. 366/2002.] Employee responsible for recreation and leisure services 6. 5 (1.) The licensee must designate at least one employee of a residential care facility, qualified by training and experience, to have specific responsibility to organize and supervise Page 16 of 31
social activities and recreational programs for the residents. (2.) The licensee must provide sufficient time to the employee designated under subsection (1) to carry out the social activities and recreational programs of the facility. Supervisor of care staff 6. 6 The licensee must designate one employee, qualified by training and experience, to have specific responsibility for (a) supervision of the care staff, (b) coordination and monitoring of all activities relating to the day to day care of the residents, and (c) managing unusual situations or emergencies. Supervision by health care professionals 6. 7 (1.) If residents are accommodated who have assessed health needs that require full-time supervision by a health care professional, a licensee must have a sufficient number of health care professionals on duty at all times who have the appropriate experience, training and qualifications to meet the identified needs of the residents. (2.) If residents are accommodated who have assessed health needs that require less than full-time supervision by a health care professional, a licensee must ensure that each resident's health care plan specifies (a) the amount and type of professional supervision required, (b) the identity and qualifications of the health care professional providing the supervision, and (c) the required intervention by the health care professional. General staffing coverage and patterns 6. 8 A licensee must (a) have a sufficient number of employees on duty at all times to meet the needs of the residents and to provide a safe standard of care for the residents, (b) assign duties and responsibilities to care staff that are consistent with their experience, competence and training, (c) maintain staffing patterns that are appropriate to provide for the safety and well-being of the residents, and (d) maintain staffing levels that take into consideration the standards of the funding programs. Supplies, employees and operations 6. 9 The medical health officer may order the licensee to provide additional supplies or employees, or to alter the method of operation, if, in the opinion of the medical health officer, the supplies, employees or operations are inadequate or insufficient to meet the needs of the residents. Care and supervision 6.10 (1.) A licensee must provide to all residents of the facility care and supervision that, in the Page 17 of 31
opinion of the medical health officer, is appropriate to meet the needs of the residents. (2.) For the purposes of subsection (1), care and supervision includes (a) regular assistance with activities of daily living such as eating, mobility, dressing, grooming, bathing or other personal hygiene, (b) administering and monitoring the taking of medication, (c) central storing or distribution of medications, (d) maintenance or management of resident cash resources or property, and (e) monitoring of food intake or therapeutic diets. [en. B.C. Reg. 279/2000; am. B.C. Reg. 294/2001.] Nutrition care plan in facilities with 24 or fewer residents 7. (1.) a licensee of a facility with 24 or fewer persons in residence must ensure that a nutrition care plan is (a) developed for each new resident within 2 weeks of admission, (b) documented in the resident's care plan, (c) reviewed as set out in the resident's care plan and at least once within 14 weeks of admission, (d) monitored to ensure implementation, and (e) revised in response to the resident's needs. (2.) A licensee of a facility with 24 or fewer persons in residence must ensure that the services of a registered dietitian-nutritionist are obtained in response to a resident's needs and on the recommendation of (a) either the resident's primary health care provider or the medical health officer, and (b) the funding program, if any. [en. B.C. Reg. 22/97.] Nutrition care plan in facilities with 25 or more residents 7. 1 A licensee of a facility with 25 or more persons in residence must ensure that a registered dietitian-nutritionist (a) develops a nutrition care plan for each new resident within 2 weeks of admission, (b) documents the nutrition care plan in the resident's care plan, (c) reviews the nutrition care plan as set out in the resident's care plan and at least once within 14 weeks of admission, (d) monitors the nutrition care plan to ensure implementation, and (e) revises the nutrition care plan in response to the changing needs of the resident. [en. B.C. Reg. 22/97.] Supervisor of food services in facilities with 50 or more residents 7. 2 (1.) For the purposes of this section, a supervisor of food services must be (a) a nutrition manager who has membership in the Canadian Society of Nutrition Management, (b) a person who is eligible for membership in the Canadian Society of Nutrition Management, or (c) a registered dietitian-nutritionist. Page 18 of 31
(2.) A licensee of a facility with 50 or more persons in residence must obtain the services of a supervisor of food services to ensure adequate management of food services. [en. B.C. Reg. 22/97.] Preparation and service of food 7. 3 (1.) A licensee must ensure that meals and snacks (a) are nutritious, (b) are of adequate caloric value, based on the most recent edition of Canada's Food Guide to Healthy Eating published by the government of Canada, (c) meet the requirements of each resident depending on age, gender, level of activity and other relevant factors, (d) fulfil the requirements of the resident's nutrition care plan, and (e) fulfil the requirements of any therapeutic diet ordered by the resident's primary health care provider. (2.) A licensee must ensure that a resident receives an adequate amount of fluids throughout the day to ensure hydration. (3.) A licensee must ensure that meals and snacks are prepared and served in a manner which (a) preserves their nutritive value, (b) offers variety, appeal and texture, (c) fulfils the requirements of the resident's nutrition care plan, and (d) as far as is reasonably practical, recognizes the resident's personal dining and food preferences, religious practices, and cultural customs. (4.) A licensee must ensure that meals and snacks are provided in designated dining areas. (5.) Despite subsection (4), meals and snacks may be provided by room tray service where this need has been identified in the resident's care plan or where the resident is unable to attend the dining room. (6.) A licensee must ensure that residents receive ample time to finish meals. (7.) A licensee must apply any additional standards regarding the preparation and service of food set by the medical health officer. [en. B.C. Reg. 22/97.] Food service schedule 7. 4 (1.) A licensee must ensure that (a) a breakfast is available between 7:00 a.m. and 9:00 a.m., (b) a noon meal is available between 11:45 a.m. and 1:00 p.m., (c) an evening meal is served after 5:00 p.m., and (d) a minimum of 2 nutritious snacks are provided, one of which must be provided in the evening. (2.) Despite subsection (1) (a), (b) and (c), if a resident will be absent during a meal period the licensee must ensure that a packed meal is provided if required. (3.) Despite subsection (1) (a) and (b), if residents choose, arrangements may be made for a brunch to be served on weekends and holidays. (4.) Despite subsection (1) (a), (b) and (c), meal times may be varied if, in the opinion of the medical health officer, the variation is in the best interests of the residents. (5.) A snack or packed meal provided under this section must be included in the daily or monthly charge. [en. B.C. Reg. 22/97.] Page 19 of 31
Eating aids and supplements 7. 5 A licensee must provide each resident with (a) any nutrition supplements required by the resident's nutrition care plan or ordered by the resident's primary health care provider, (b) any tube feedings ordered by the resident's primary health care provider, and (c) any eating aids, personal assistance or supervision if required if the resident has difficulty eating or where required by the resident's nutrition care plan. [en. B.C. Reg. 22/97.] Menu planning 7. 6 (1.) A licensee must ensure that (a) a cycle menu written for a minimum of 4 weeks is developed and used, (b) menu substitutions are made from the same food groups and provide similar nutrition value, and (c) any additional standards set by the medical health officer are applied to menu planning. (2.) Despite subsection (1), if a facility offers only emergency or short-term stay programs, a weekly menu may be developed and used. [en. B.C. Reg. 22/97.] Monitoring nutrition needs 7. 7 (1.) A licensee must ensure that (a) the nutrition needs of each resident are monitored to a level acceptable to the medical health officer, (b) the height and weight of each resident is recorded on admission, (c) the weight of each resident is monitored and recorded monthly thereafter, and (d) appropriate intervention is initiated when a resident experiences a significant weight change. (2.) Despite subsection (1), an alternate schedule of monitoring and recording weight may be established with the approval of the medical health officer. [en. B.C. Reg. 22/97.] Nutrition and food services audit program 7. 8 A licensee must ensure that a nutrition and food services audit program acceptable to the medical health officer is in place. [en. B.C. Reg. 22/97.] Resident participation in food services 7. 9 (1.) A licensee must encourage residents to participate in food services activities such as menu planning, meal preparation and related activities as far as is reasonably practical, or if required by a resident's nutrition care plan. (2.) A licensee must ensure that a resident who is involved in the preparation of food is adequately supervised to ensure that the food is safely prepared and handled. [en. B.C. Reg. 22/97.] Training of staff responsible for food services 7.10 A licensee must ensure that staff responsible for food services (a) have the training necessary to ensure that food is safely prepared and handled and meets the nutrition needs of the residents, and Page 20 of 31
(b) receive on-going education regarding food services, nutrition and, where required, assisted eating techniques. [en. B.C. Reg. 22/97, s. 2.] Food services records 7.11 A licensee must maintain a record for at least one year of (a) food purchases, (b) menu plans and menu substitutions, (c) food services audits, and (d) food services education and training programs attended by those individuals involved in providing food services to residents. [en. B.C. Reg. 22/97.] Definitions 8. For the purposes of sections 8.1 to 8.8: "medication" means a drug as defined in the Pharmacists, Pharmacy Operations and Drug Scheduling Act; "medication administration record" means a record of the administration of all doses of medication to a resident; "practitioner" means a person authorized under the Pharmacists, Pharmacy Operations and Drug Scheduling Act to prescribe drugs. [en. B.C. Reg. 268/97.] Supervising pharmacist 8.1 A licensee must appoint a supervising pharmacist to serve on the medication safety and advisory committee and provide consultation to staff members regarding medication-related problems and interactions. [en. B.C. Reg. 268/97.] Medication safety and advisory committee 8.2 (1.) A licensee must appoint a medication safety and advisory committee consisting of, but not limited to, (a) the manager of the facility or person designated by the manager, (b) the supervising pharmacist appointed under section 8.1, and (c) where one is employed by the licensee, the health professional responsible for the immediate supervision of all health care services provided in the facility. (2.) The medication safety and advisory committee must establish and review as required (a) policies and procedures for the safe and effective storage, handling and administration of the resident's medications which comply with the Pharmacists, Pharmacy Operations and Drug Scheduling Act, (b) training and orientation programs for staff members who store, handle or administer medications to residents, and (c) policies and procedures for the immediate response to and reporting of medication errors and adverse reactions to medications. [en. B.C. Reg. 268/97.] Page 21 of 31
Storage of medication 8.3 A licensee must ensure that a resident's medications are safety and securely stored in accordance with the policies and procedures established by the medication safety and advisory committee. [en. B.C. Reg. 268/97.] Administration of medication 8.4 (1.) A licensee must ensure that only medications which have been prescribed by a practitioner or ordered by a health care provider are administered to a resident. (2.) A licensee must ensure that (a) only staff members administer medications to a resident, and (b) if a resident leaves the facility, appropriate arrangements are made for the administration of the resident's medications in accordance with the policies and procedures established by the medication safety and advisory committee. (3.) A licensee must ensure that a staff member who stores, handles or administers medication to residents (a) is 19 years of age or older, and (b) has successfully completed the training programs established by the medication safety and advisory committee. (4.) A licensee must ensure that a pharmacist packages all medications and records all medications on the resident's medication administration record. (5.) A licensee must ensure that, except where authorized by the medication safety and advisory committee, a resident's medications remain in the original labelled container or package provided by the dispensing pharmacist until administered. (6.) A licensee must ensure that a staff member who administers a medication follows the policies and procedures established by the medication safety and advisory committee. (7.) A licensee must ensure that, if an adverse reaction to a medication occurs, a staff member immediately (a) documents the reaction on the resident's medication administration record, (b) notifies the practitioner who prescribed the medication or the health care provider who ordered the medication, (c) notifies the dispensing pharmacist, and (d) follows the policies and procedures established by the medication safety and advisory committee. [en. B.C. Reg. 268/97; am. B.C. Reg. 208/99.] Changes to directions for use of medication 8.5 A licensee must ensure that (a) a staff member does not make handwritten changes to the directions for use of a medication on the medication container or package, and (b) where changes in the directions for use of a medication are made by a practitioner or a health care provider, the changes are promptly recorded on the resident's medication administration record and the supervising pharmacist is promptly notified. [en. B.C. Reg. 268/97.] Self-administration of medication 8.6 (1.) Despite section 8.4 (2) (a), a medical health officer may approve a resident's request to self-administer a medication if, in the opinion of the medical health officer, Page 22 of 31
self-administration is in the best interest of the resident. (2.) The medical health officer may approve a resident's request to self-administer a medication in accordance with a self-medication plan developed by (a) the resident, (b) the medication safety and advisory committee, and (c) the resident's primary health care provider. (3.) A licensee must ensure that a resident who self-administers a medication is provided with (a) the medication as required, and (b) a secure place in the resident's room to store the medication. [en. B.C. Reg. 268/97.] Medication records 8.7 A licensee must ensure that (a) a medication administration record is maintained for each resident and retained for at least one year, and (b) a self-medication plan referred to in section 8.6 (2) is recorded in the resident's care plan. [en. B.C. Reg. 268/97.] Return of medication to pharmacy 8.8 A licensee must ensure that a resident's medication is returned to the dispensing pharmacy when (a) the resident is no longer taking the medication, or (b) the expiry date on the medication has passed. [en. B.C. Reg. 268/97.] Resident care policies 9. A licensee must develop and implement written policies to guide staff actions in all matters relating to the care of residents. [en. B.C. Reg. 329/97.] Access to health services 9.1 A licensee must ensure that a resident is assisted in obtaining health services as required and that an emergency call system for a medical practitioner is in place. [en. B.C. Reg. 329/97.] Oral health 9.2 (1.) For the purposes of this section, dental health care professional means a person who is a member of (a) the College of Dental Surgeons of British Columbia, (b) the College of Dental Hygienists of British Columbia, or (c) the College of Denturists of British Columbia. (2.) A licensee must encourage a resident to obtain an examination by a dental health care professional at least once every year. (3.) A licensee must ensure that a resident is assisted in (a) maintaining daily oral health, (b) obtaining professional dental services as required, and (c) following a recommendation or order for dental treatment made by a dental Page 23 of 31