Orchard Villa, the Pickering long-term-care home with the most COVID-19 deaths in the province, continued to fail to comply with provincial legislation designed to protect residents – even after more than 70 residents died and military personnel were sent in to assist.
As the pandemic raged on in May and June of this year, inspectors from the Ministry of Long-Term Care acting on a complaint found more than a dozen instances in which the home failed to comply with regulations, including not ensuring staff received infection control training within one week of hire, failing to ensure a resident who had fallen received a proper skin assessment, and failing to stop staff from administering a drug to a resident that was not prescribed.
These findings are in addition to more than 120 citations of failure to comply with the Long-Term Care Homes Act and its regulations between July 2015 and December 2019 recently detailedby the Star.
Since the beginning of the pandemic, 206 residents of the 233-bed Orchard Villa have been infected with COVID-19. Seventy-one residents in the long-term-care home died, and another seven died in the adjacent retirement home. More than 100 staff members have tested positive for the virus. The Durham Region Health Department declared the COVID-19 outbreak at Orchard Villa over on June 11.
In an email to the Star, Jason Gay, executive director of Orchard Villa, said during the four weeks inspectors were at the home, they reviewed a wide range of operations and “found the home to be clean, with adequate PPE and other supplies.”
“When inspectors identified an area of improvement, action was immediately taken and most were resolved before the inspectors left the home. This action included on-going education of staff on our Falls Prevention Policy and the Skin and Wound Care Policy,” he said. “We are currently auditing to ensure compliance with these policies.”
He added that the home’s staff are “hardworking and compassionate people, and they always impress us with their dedication and willingness to learn.”
Sharon Navarro, a spokesperson for Lakeridge Health, which as assumed temporary management of Orchard Villa long-term-care home on June 12 for 90 days at the behest of the provincial government, said work is “well underway” to stabilize the home’s staffing and operations and to “help the facility develop the capacity to meet quality and safety standards.”
In late April, when Durham Region’s medical officer of health asked Lakeridge Health to lead the home’s response to the outbreak, the home was “significantly understaffed,” said Navarro, adding that at one point during the outbreak, Orchard Villa had only 20 per cent of its full staffing complement.
She said staffing levels have now been corrected and meet current standard ratios for long-term-care homes, and that all staff and leaders receive mandatory infection prevention and control training. There is also continuous auditing of environmental cleaning, dietary compliance and hand hygiene, and PPE levels are audited daily to ensure a 30-day supply, Navarro said.
The citations for non-compliance stemming from the May and June inspections are detailed in a July 27 report and describe a wide range of problems touching on different aspects of resident care.
One notice of compliance failure issued by inspectors details the case of a resident sent to hospital after a fall. The inspection report says three staff members lifted the resident off the floor and into bed instead of using a “lifting device” as mandated by the home’s own falls prevention and management policy. In this case, inspectors asked the home to come up with a “voluntary plan of correction.”
Another notice describes a complaint made to the ministry of long-term care about a resident who suffered “multiple injuries” due to falls, one of which resulted in hospitalization. Inspectors reviewing the resident’s clinical notes found that staff did not perform a skin assessment using a “clinically appropriate instrument” on two occasions. They also found that the home failed to ensure that a member of registered nursing staff examined the resident’s skin.
The report also says that while in the home, an inspector witnessed a personal support worker (PSW) helping a resident with a drink while wearing just a cloth mask and goggles – even though a sign posted on the resident’s door directed staff to wear full personal protective equipment (PPE) including a mask, face shield, gown and gloves. The inspector interviewed the PSW, who said that they were aware of the requirements to don full PPE but used their own cloth mask due to sensitive skin to the surgical mask provided by the home.
June Morrison, whose father George died on May 3 at the age of 95 after contracting COVID-19 at Orchard Villa, said she is “not surprised” to learn that the home was found to have further compliance failures.
“I personally think they need their licence revoked. They have proven time after time based on the inspection reports that they fail to live up to regulations and legislation,” Morrison said.
George Morrison was admitted to hospital with apparent anorexia, dehydration and a urinary tract infection before his death, his daughter said.
“I don’t think they’ve learned anything,” said Cathy Parkes, whose father Paul Parkes, an Orchard Villa resident, died on April 15 at age 86. It wasn’t until three weeks after her dad died that Parkes says she learned he had tested positive for COVID-19.
Both Parkes and Morrison have filed lawsuits against Orchard Villa and its owner. They are also among 41 families calling for a criminal investigation into what occurred at the home.
Ministry inspectors also found that Orchard Villa failed to ensure staff received training within one week of hire, as required by amendments to regulations under the Long-Term Care Homes Act made in March to deal with the pandemic. The changes to the regulation mandated that training on such areas as infection prevention and control, the residents’ bill of rights and the home’s policy on abuse and neglect of residents within one week.
Inspectors interviewed several personal support workers and registered practical nurses at Orchard Villa who “confirmed that they had no training” in the areas required by the regulation changes. Some said they had training on donning and doffing of PPE and hand hygiene. The ministry asked the home to write a voluntary plan of correction.
In another instance, inspectors reviewing a resident’s clinical records that the resident was given a medication they were not prescribed.
“The licensee has failed to ensure that no drugs are administered to a resident in the home unless the drug has been prescribed for the resident,” says the inspection report. It does not say what happened, if anything, to the resident.
“Clearly the oversight of that facility has been in my view negligent on the face of it because you see no director’s orders issued, you see no licence revocations, you see no cease admissions. That speaks to oversight that is off the rails,” said Patricia Spindel, former associate dean of health sciences at Humber College and co-founder of Seniors For Social Action Ontario (SSAO), a group of social activists from across Ontario.
A director’s order is issued by the director of performance improvement and compliance at the ministry of long-term care and can include revocations of licence, mandatory management orders and return of funding orders, among other things.
“When you have homes in this kind of trouble and for this period of time and there’s been no licence revocation, that just makes no sense to me,” added Spindel.
Gillian Slogget, a spokesperson for Minister of Long-Term Care Merrilee Fullerton, said the government and its health partners “continue to work around the clock to safeguard the residents and staff at the home.” She said repeated non-compliance is of “serious concern” and can result in “escalated measures and sanctions by the ministry.”
“Long-term care is a huge priority for our government and every option is on the table to make it better. We are forging ahead with the critical work we had underway before this pandemic hit, and will leave no stone unturned as we undertake badly needed system transformation,” Slogget said.
Laura Tamblyn Watts, CEO of CanAge, a national seniors’ advocacy group, says the province must address the conditions we are asking our seniors to live in and that includes looking at what incentives long-term-care home owners have to respond to compliance failures.
“We know that when there’s consistent failure to comply and where outcomes are dangerous to residents, that there needs to be not just appropriate support but appropriate response, which means there needs to be teeth in the inspections and legislation,” she said.
“What we’ve seen with COIVD is not so much a surprise but just an illumination of the problems in the system that we always knew were there. The question is: will we now actually fix it?”