Newfoundland and Labrador’s auditor general released a report condemning the province’s ongoing failure to deliver adequate services in personal care homes.
Auditor General Denise Hanrahan flagged multiple non-compliances between April 2022 and September 2024, such as staff without minimum hiring requirements, resident abuse, food quality and numerous medication-related incidents. Some homes had persistent violations but were not issued a conditional licence.
The Department of Health and Community Services (the department) and Newfoundland and Labrador Health Services (NLHS) were expected to have appropriate standards in place after a similar audit was completed ten years ago.
As it stands, there is uncertainty about when the government will implement its updated operational standards for these facilities. They have been in draft form since 2022.
“We have serious concerns about the oversight and program delivery of the Provincial Personal Care Home Program, Hanrahan wrote. “The Department of Health and Community Services has failed in its responsibilities to maintain modern operational standards, given they have not been comprehensively updated since 2007 and may not adequately reflect the needs of the current personal care home population.”
Non-compliance amid a vulnerable population
Staffing was an area littered with red flags. The audit, conducted across 35 personal care homes, including 13 site visits, found no consistency in employee training. There were 42 employees from six of 13 homes who received minimal training. Other homes offered much less.
During hiring, operators were lazy regarding required minimum qualifications. Out of 65 employees, 43 had at least one instance of non-compliance, such as missing official immunization records or other documentation. Three workers had negative results on their Certificate of Conduct, including assault charges; however, they continued to work.
Operational standards for the storage and administration of resident medications were also slacking; 92 per cent homes had medication-related incidents since March 1, 2024, For instance, in three facilities, medication carts were left unlocked and/or unattended.
Food quality was yet another concern. In several homes, meals did not meet Canada’s Food Guide requirements or match the posted NLHS-approved menu. The audit also noted an absence of vegetables and kitchen cleanliness, and unclear communication regarding food allergies and preferences.
Recommendations for better care
As of September 30, 2024, there are 86 personal care homes operating in the province with 5,208 available beds. The audit lists several recommendations for these spaces going forward, none of which are relatively new suggestions.
The department has had no internal written policies, procedures or processes to handle inquiries, including complaints, or oversight over serious incidents. There also hasn’t been any public disclosure of the nature or number of personal care home instances.
The audit directed the department to update and implement the Provincial Personal Care Home Program Operational Standards to align with best practices and gaps highlighted in the audit. It also advises a timely review of serious incidents with documented resolutions and enhancing publicly available information, including posting inspection results, non-compliance information and licensure status.
The department and NLHS should also execute a formal complaint system and carry out oversight tactics, such as key performance indicators, reporting requirements, documentation standards and serious incident protocols.
To improve food service, kitchen and dining facilities, staff, and serving routines are to follow the operational standards, which should be monitored for consistency across the province. Staffing should meet the appropriate levels and training and satisfy hiring requirements before starting employment
Appropriate staffing levels are crucial and workers should meet hiring requirements before starting employment. necessary training that meets compliance. The audit also advises NLHS to review the licensing and re-licensing processes for personal care homes, including the clear definition and communication of consequences for non-compliance determined from quarterly monitoring and/or annual inspections.
The department and NLHS haven’t been accountable for an ongoing backlog of overdue resident care reassessments. The audit recommends they are completed in a timely manner and any changes in care needs are addressed appropriately. As well, an internal quality control process will ensure that operating standards compliance monitoring is completed consistently across the province.
“Sadly, our Office has highlighted these issues before – they remain outstanding recommendations from our 2015 report on Personal Care Home Regulation,” the auditor general wrote. “Incidents and compliance violations are pervasive in the province’s personal care homes. Relicensing of personal care homes is too subjective, and personal care homes are often relicensed while carrying unresolved compliance issues.”
