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the Homes Division Inspections Branch Division des foyers de soins de longue durée Inspection de Ottawa Service Area Office 347 Preston St Suite 420 OTTAWA ON K1S 3J4 Telephone: (613) 569-5602 Facsimile: (613) 569-9670 Bureau régional de services d Ottawa 347 rue Preston bureau 420 OTTAWA ON K1S 3J4 Téléphone: (613) 569-5602 Télécopieur: (613) 569-9670 Public Copy/Copie du public Report Date(s) / Date(s) du apport Mar 23, 2018 Inspection No / No de l inspection 2018_621547_0009 Log # / No de registre 003450-18 Type of Inspection / Genre d inspection Complaint Licensee/Titulaire de permis Revera Long Term Care Inc. 5015 Spectrum Way, Suite 600 MISSISSAUGA ON L4W 0E4 Home/Foyer de Carlingview Manor 2330 Carling Avenue OTTAWA ON K2B 7H1 Name of Inspector(s)/Nom de l inspecteur ou des inspecteurs LISA KLUKE (547) Inspection Summary/Résumé de l inspection Page 1 of/de 6

the The purpose of this inspection was to conduct a Complaint inspection. This inspection was conducted on the following date(s): February 23, 28, 2018 and March 20, 2018 (off-site) This complaint inspection was conducted in relation to the Licensee response to the applicant time lines and reasons for withholding approval of applicant #001's admission to the home. During the course of the inspection, the inspector(s) spoke with the Administrator, a Manager of Client Services with the Champlain Local Health Integrated Network (LHIN) and a Treatment Decisions Consultant with the Public Guardian and Trustee s office representing applicant #001. In addition to these interviews, a review of the documentation of applicant #001's assessments and information that were required to have been taken into account as part of the application requirements for admission to a home and the written notice from the Licensee to the applicant. Ad-hoc notes were used during this inspection. During the course of this inspection, Non-Compliances were issued. 1 WN(s) 0 VPC(s) 0 CO(s) 0 DR(s) 0 WAO(s) Page 2 of/de 6

the Legend NON-COMPLIANCE / NON - RESPECT DES EXIGENCES Legendé WN Written Notification VPC Voluntary Plan of Correction DR Director Referral CO Compliance Order WAO Work and Activity Order WN Avis écrit VPC Plan de redressement volontaire DR Aiguillage au directeur CO Ordre de conformité WAO Ordres : travaux et activités Non-compliance with requirements under the (LTCHA) was found. (a requirement under the LTCHA includes the requirements contained in the items listed in the definition of "requirement under this Act" in subsection 2(1) of the LTCHA). Le non-respect des exigences de la Loi de 2007 sur les foyers de soins de longue durée (LFSLD) a été constaté. (une exigence de la loi comprend les exigences qui font partie des éléments énumérés dans la définition de «exigence prévue par la présente loi», au paragraphe 2(1) de la LFSLD. The following constitutes written notification of non-compliance under paragraph 1 of section 152 of the LTCHA. Ce qui suit constitue un avis écrit de nonrespect aux termes du paragraphe 1 de l article 152 de la LFSLD. WN #1: The Licensee has failed to comply with O.Reg 79/10, s. 162. Approval by licensee Page 3 of/de 6

the Specifically failed to comply with the following: s. 162. (3) Subject to subsections (4) and (5), the licensee shall, within five business days after receiving the request mentioned in clause (1) (b), do one of the following: 1. Give the appropriate placement co-ordinator the written notice required under subsection 44 (8) of the Act. O. Reg. 79/10, s. 162 (3). 2. If the licensee is withholding approval for the applicant s admission, give the written notice required under subsection 44 (9) of the Act to the persons mentioned in subsection 44 (10) of the Act. O. Reg. 79/10, s. 162 (3). Findings/Faits saillants : Page 4 of/de 6

the 1. The Licensee has failed to respond within five business days after receiving applicant #001's request for authorization for admission to the home. The Licensee is required to determine whether to give or withhold approval for the applicant's admission to the home. The Licensee is then required to provide a written notice of their decision under subsection 44 (9) of the Act to the persons mentioned in subsection 44 (10) of the Act, being the applicant, the Director and the appropriate placement coordinator. Applicant #001 had a long-term care application completed and forwarded to the Long- Term care home (LTCH) for request for authorization of admission. This application was prepared and sent by the Champlain Local Health Integrated Network (LHIN) care coordinator on a specified date via their electronic document and communication sharing system with the Licensee. The Licensee forwarded the written notice in a form of a letter to the Champlain LHIN and Director via fax on a specified date to withhold approval of the resident application for admission. The Licensee failed to respond within five business days with the written notice letter to applicant #001 s request for authorization for admission. On this specified date, six business day after the applicant's information and assessments were shared to the Licensee, the written notice letter to the applicant indicated the Licensee was withholding approval for applicant #001 s admission. As such, the Licensee failed to inform the applicant, the Director and the appropriate placement coordinator as required in subsection 44(10) of the Act, when the decision to withhold the applicant from admission by a specified date, five business days after the applicants request was received by the Licensee. [s. 162. (3) 2.] Page 5 of/de 6

the Issued on this 4th day of April, 2018 Signature of Inspector(s)/Signature de l inspecteur ou des inspecteurs Original report signed by the inspector. Page 6 of/de 6