Incident investigation·August 12, 2021

Licensing Program Analyst's Fernandes-Goes and Hansen conducted an unannounced case management and met with Stacy Vermeulen – General Manager. The purpose of the case management visit was to obtain additional information regarding incident report that occurred on 7/27/2021 for resident R1. LPAs interviewed Stacy V. General Manager and Kehley McKenzie – Health & Wellness Director, acquired more information and discussed regarding visitors sign in & out when residents are not allowed to be out in the community unassisted. In addition, LPAs are requesting facility written program plan on how facility will ensure that all exits are being monitor for the safety of residents that are not allowed to leave facility unassisted. Facility to submit a written plan by August 19, 2021. The following documentation is required for a change of administrator: LIC 200 (original - must be mailed or delivered to the Regional Office) LIC 308 Designation of Facility responsibility (designation of who is the administrator) Administrator Certificate First Aid Certificate Administrator Resume LIC 500 Personnel Report LIC 610 Emergency Disaster Plan for Residential Care Facilities for the Elderly LIC 501 Personnel Record LIC 503 Health Screening Report - personnel (keep on facility staff file to be reviewed) TB test that shows "negative" (keep on facility staff file to be reviewed) Copy of Board of Directors' Resolution meeting minutes signed (required for all corporations) No deficiencies cited during today’s visit.