O. Reg. 66/23: GENERAL
filed April 6, 2023 under Fixing Long-Term Care Act, 2021, S.O. 2021, c. 39, Sched. 1
Skip to contentontario regulation 66/23
made under the
Fixing Long-Term Care Act, 2021
Made: April 5, 2023
Filed: April 6, 2023
Published on e-Laws: April 6, 2023
Printed in The Ontario Gazette: April 22, 2023
Amending O. Reg. 246/22
(GENERAL)
1. (1) The definition of “air conditioning” in section 1 of Ontario Regulation 246/22 is revoked and the following substituted:
“air conditioning” means a mechanical cooling system that can maintain cool temperatures, including in peak summer conditions, and includes central air conditioning with in-room supply air ducts, portable air conditioning units, window air conditioning units, split air conditioning, package type air conditioning and variable refrigerant flow units, or a combination of any of these systems; (“climatisation”)
(2) The definition of “medication incident” in section 1 of the Regulation is revoked and the following substituted:
“medication incident” means a preventable event associated with the prescribing, ordering, dispensing, packaging, storing, labelling, preparing, administering or distributing of a drug, the monitoring of the use of the drug by the resident or the transcribing of a prescription, and includes,
(a) an act of omission or commission, whether or not it results in harm, injury or death to a resident, or
(b) a near miss event where an incident does not reach a resident but had it done so, harm, injury or death could have resulted; (“incident lié à un médicament”)
(3) Section 1 of the Regulation is amended by adding the following definitions:
“college of applied arts and technology” means a college of applied arts and technology established under the Ontario Colleges of Applied Arts and Technology Act, 2002; (“collège d’arts appliqués et de technologie”)
“degree granting institution” means an institution, other than a college of applied arts and technology, private career college, Indigenous Institute or publicly assisted university, that has,
(a) the authority to grant degrees by an Act of the Legislature or an Act of the Parliament of Canada, or
(b) the consent of the Minister of Colleges and Universities under section 4 of the Post-secondary Education Choice and Excellence Act, 2000 to grant the particular degree; (“établissement attribuant des grades”)
“food handler training” means a program of food safety training that is provided by a local board of health or agency of a board of health or that the Ministry of Health has recognized as being equivalent to the food safety training standards established by that Ministry; (“formation à l’intention des manipulateurs d'aliments”)
“glucagon” means a manufactured product that can be administered to raise glucose levels in the blood; (“glucagon”)
“Indigenous Institute” means an Ingenious Institute prescribed for the purposes of section 6 of the Indigenous Institutes Act, 2017; (“établissement autochtone”)
“Ontario post-secondary institution” means,
(a) an Indigenous Institute,
(b) a private career college,
(c) a college of applied arts and technology,
(d) a publicly assisted university, or
(e) a degree granting institution; (“établissement d’enseignement postsecondaire de l’Ontario”)
“private career college” means a private career college within the meaning of subsection 1 (1) of the Private Career Colleges Act, 2005; (“collège privé d’enseignement professionnel”)
“publicly assisted university” means a university that receives regular and ongoing operating funds from the government of Ontario for the purpose of post-secondary education; (“université financée par les fonds publics”)
“severe hypoglycemia” means an incident where a resident is found to have a blood glucose level less than 2.8 millimoles per litre and the resident is conscious; (“hypoglycémie sévère”)
“unresponsive hypoglycemia” means an incident where a resident is found to have a blood glucose level less than 2.8 millimoles per litre and the resident is unconscious; (“hypoglycémie ne répondant pas à un traitement”)
(4) The definition of “topical” in section 1 of the Regulation is revoked.
2. Clause 22 (1) (c) of the Regulation is revoked and the following substituted:
(c) essential services, including dietary services equipment required to store food at safe temperatures and prepare and deliver meals and snacks, equipment required to store drugs at safe temperatures and to prepare and deliver drugs, the resident-staff communication and response system, elevators and life support, safety and emergency equipment.
3. (1) Clause 23 (2) (d) of the Regulation is revoked and the following substituted:
(d) include the use of air conditioning, cooling equipment and other resources, as necessary, to protect residents from heat related illness; and
(2) Subsections 23 (5) to (10) of the Regulation are revoked.
4. The Regulation is amended by adding the following sections:
Air conditioning requirements
23.1 (1) Every licensee of a long-term care home shall ensure that air conditioning is installed, operational and in good working order for the purpose of cooling the temperature in the following areas of the long-term care home during at least the period from May 15 to September 15 in each year:
1. Every resident bedroom.
2. Every designated cooling area, in the case of a home without central air conditioning.
(2) In addition to the time period referred to in subsection (1), the licensee shall ensure that air conditioning is installed, operational and in good working order in each of the areas described in that subsection,
(a) on any day on which the outside temperature forecasted by Environment and Climate Change Canada for the area in which the home is located is 26 degrees Celsius or above at any point during the day; and
(b) any time the temperature in an area in the home measured by the licensee in accordance with subsections 24 (2) and (3) reaches 26 degrees Celsius or above, for the remainder of the day and the following day.
(3) The licensee shall ensure air conditioning is operating, and is used in accordance with the manufacturer’s instructions, in each area of the long-term care home described in subsection (1) in either of the following circumstances:
1. When needed to maintain the temperature at a comfortable level for residents during the period and on the days described in subsections (1) and (2).
2. When the use of air conditioning has been identified in order to protect residents from heat related illness in the heat related illness prevention and management plan.
(4) Every licensee of a long-term care home shall ensure that, if central air conditioning is not available in the home, the home has at least one separate designated cooling area for every 40 residents.
(5) The licensee shall ensure that the designated cooling areas are available for use by residents, as necessary when air conditioning is operating, during the period and on the days described in subsections (1) and (2).
(6) At the request of the Director, the licensee shall obtain and provide to the Director, or to a person specified by the Director, any information, plans and reports in relation to the installation, maintenance, repair or operation of the air conditioning system that the Director considers necessary.
(7) A licensee to whom subsection 23 (8) of this Regulation applied, as that provision read immediately before April 11, 2023, is not required to comply with subsection (1) of this section, in respect of paragraph 1 of that subsection, or subsection (2) or (3) in respect of resident bedrooms, until June 30, 2023.
(8) A licensee is not required to comply with subsection (1), in respect of paragraph 1 of that subsection, or subsection (2) or (3) in respect of resident bedrooms, where the licensee has provided the Director with information, plans or other materials and the Director is satisfied that the licensee has demonstrated to the satisfaction of the Director that,
(a) the existing long-term care home building structure, materials or electrical system cannot support or be reasonably modified to support the provision of air conditioning in resident bedrooms; or
(b) the licensee has entered into an agreement or agreements for the purchase, delivery and installation of equipment or materials, or both, necessary to provide air conditioning in accordance with the requirements of this section, but the delivery or installation of the equipment or materials, or both, has been delayed for reasons beyond the reasonable control of the licensee.
(9) Where the Director is satisfied that a situation described in clause (8) (a) or (b) exists, the Director shall inform the licensee in writing of that fact, and may specify a date by which the licensee must provide the Director with updated information, plans or other materials so that the Director may evaluate whether they continue to be satisfied that subsection (8) is still applicable.
(10) When acting under subsection (9), the Director may also do any or all of the following:
1. Stipulate a date by which the licensee must comply with subsection (1) in respect of paragraph 1 of that subsection, or subsection (2) or (3) in respect of resident bedrooms.
2. Set conditions that the licensee is required to meet during the time that the licensee is not required to comply with subsection (1), in respect of paragraph 1 of that subsection, or subsection (2) or (3) in respect of resident bedrooms.
3. Re-evaluate a previous decision, including a decision made under section 23 as it existed before the coming into force of this section, and amend it, including changing a date, adding new conditions or revoking previous conditions.
Uninstalling portable or window air conditioning
23.2 (1) Subject to the other provisions of this section, and despite subsections 23.1 (1) and (2), the licensee of a long-term care home shall uninstall a portable air conditioning unit or a window air conditioning unit in a resident’s bedroom at any time at the request of the resident where the licensee is satisfied that it is feasible to do so, as long as the other residents in the room consent to the uninstallation.
(2) Subject to the other provisions of this section, the licensee of a long-term care home may, at its own initiative, uninstall a portable air conditioning unit or a window air conditioning unit in a resident’s bedroom for any of the following reasons:
1. When implementing cleaning, maintenance or repair that is required pursuant to section 96.
2. In order to comply with the minimum temperature requirement in subsection 24 (1).
3. In order to comply with any other requirement under the Act or this Regulation.
(3) Before uninstalling a portable air conditioning unit or a window air conditioning unit in a resident bedroom at the request of a resident, the licensee shall include in the plan of care for each resident in the room,
(a) any specific risk factors that may lead to heat related illness as a result of the uninstallation; and
(b) the specific interventions and strategies that staff are to implement to prevent or mitigate the identified risk factors that may lead to heat related illness.
(4) For the purposes of this section, the licensee shall make and keep written records relating to the uninstallation of the portable air conditioning unit or window air conditioning unit, including the date the unit was uninstalled and the circumstances that led to the unit being uninstalled.
(5) A licensee shall not uninstall a portable air conditioning unit or a window air conditioning unit pursuant to this section if the uninstalling would compromise the licensee’s ability to implement the heat related illness prevention and management plan for the home.
(6) In all cases where portable air conditioning units or window air conditioning units are uninstalled pursuant to this section, the units must remain accessible and available for use,
(a) at the request of any one or more of the residents who reside in the bedroom; or
(b) when required to cool and maintain the temperature of the bedroom for the health, safety and comfort of the residents in that bedroom.
(7) Where a circumstance described in clause (6) (a) or (b) exists, the licensee shall reinstall the unit promptly, unless subsection (2) applies, in which case the licensee shall reinstall the unit immediately upon the resolution of the issue that led to the uninstallation.
5. Paragraphs 5 and 6 of subsection 27 (2) of the Regulation are revoked and the following substituted:
5. Drugs and treatments required, including, with respect to drugs, the clinical reason for which the drug is being used, where known.
6. Known health conditions, including allergies, adverse drug reactions and other conditions of which the licensee should be aware upon admission, including interventions.
6. Subsection 29 (3) of the Regulation is amended by adding the following paragraph:
17.1 Medication reconciliation.
7. Subsection 30 (4) of the Regulation is revoked.
8. Subsection 34 (3) of the Regulation is revoked.
9. Clause 52 (2) (a) of the Regulation is revoked and the following substituted:
(a) must meet the program requirements set by the Ministry of Colleges and Universities for an Ontario post-secondary institution or district school board to issue a personal support worker certificate; and
10. Paragraph 2 of subsection 53 (1) of the Regulation is amended by striking out “pressure ulcers” and substituting “pressure injuries”.
11. Subsection 54 (2) of the Regulation is amended by striking out “where the condition or circumstances of the resident require,”.
12. (1) Clause 55 (2) (b) of the Regulation is amended by striking out “pressure ulcers” in the portion before subclause (i) and substituting “pressure injuries”.
(2) Subclause 55 (2) (b) (iii) of the Regulation is revoked.
(3) Clause 55 (2) (c) of the Regulation is amended by striking out “pressure ulcers” and substituting “pressure injuries”.
(4) Subsection 55 (2) of the Regulation is amended by striking out “and” at the end of clause (c), by adding “and” at the end of clause (d) and by adding the following clause:
(e) a resident exhibiting a skin condition that is likely to require or respond to nutrition intervention, such as pressure injuries, foot ulcers, surgical wounds, burns or a worsening skin condition, is assessed by a registered dietitian who is a member of the staff of the home, and that any changes the registered dietitian recommends to the resident’s plan of care relating to nutrition and hydration are implemented.
13. Clause 70 (2) (b) of the Regulation is revoked and the following substituted:
(b) must have at least one year of experience in a health care setting and,
(i) a post-secondary diploma, degree or certificate in recreation and leisure studies, kinesiology, therapeutic recreation or other related field from an Ontario post-secondary institution, or
(ii) a post-secondary diploma, degree or certificate granted in another jurisdiction that, in the reasonable opinion of the licensee, is equivalent to the diploma, degree or certificate described in subclause (i).
14. Subsections 72 (2), (3) and (4) of the Regulation are revoked and the following substituted:
(2) The licensee shall ensure that the designated lead has experience in a health care setting or other relevant setting and,
(a) a post-secondary diploma, degree or certificate in recreation and leisure studies, therapeutic recreation, kinesiology, gerontology or other related field from an Ontario post-secondary institution; or
(b) a post-secondary diploma, degree or certificate granted in another jurisdiction that, in the reasonable opinion of the licensee, is equivalent to the diploma, degree or certificate described in clause (a).
(3) Despite subsection (2), a person employed at a long-term care home as a designated lead for the recreational and social activities program before April 11, 2023 may continue in that role without meeting the requirements in that subsection if, in the reasonable opinion of the licensee, the person has the appropriate skills, knowledge and experience to perform the duties required of that position.
15. Section 73 of the Regulation is revoked and the following substituted:
Recreational and social activities qualifications
73. Every licensee of a long-term care home shall ensure that staff members providing recreational and social activities in the home,
(a) have a post-secondary diploma, degree or certificate in recreation and leisure studies, therapeutic recreation, kinesiology, gerontology or other related field from an Ontario post-secondary institution;
(b) have a post-secondary diploma, degree or certificate granted in another jurisdiction that, in the reasonable opinion of the licensee, is equivalent to the diploma, degree or certificate described in clause (a); or
(c) in the reasonable opinion of the licensee, have the appropriate skills, knowledge and experience providing recreational and social activities to perform the duties required of that position.
16. Section 78 of the Regulation is amended by adding the following subsections:
(8) The licensee shall ensure that, during every hour in which a food service area is operating, there is at least one cook, food service worker or nutrition manager in the food service area who has successfully completed food handler training.
(9) In subsection (8),
“food service area” means the part or parts of a long-term care home where meals or meal portions are prepared.
17. (1) Subsections 81 (2) and (3) of the Regulation are revoked and the following substituted:
(2) The licensee shall ensure that every nutrition manager is an active member of the Canadian Society of Nutrition Management or a registered dietitian.
(3) Despite subsection (2), a person employed at a long-term care home as a nutrition manager before April 11, 2023 may continue in that role without meeting the qualifications of that subsection if they are actively pursuing membership in the Canadian Society of Nutrition Management or registration as a dietitian by the College of Dietitians of Ontario.
(3.1) Despite subsection (2), a person who was working or employed as a nutrition manager in a long-term care home as of July 1, 2010 may continue in that role without complying with subsection (2) or (3).
(2) The definition of “A” in the formula in subsection 81 (5) of the Regulation is revoked and the following substituted:
“A” is, at the option of the licensee, either,
(a) the licensed bed capacity of the home for the week, excluding beds not available for occupancy pursuant to a Minister’s directive, Ministry policy or otherwise at law, or
(b) the number of residents residing in the home for the week, including absent residents.
18. Subsections 82 (2), (3) and (4) of the Regulation are revoked and the following substituted:
(2) The licensee shall ensure that the cook referred to in subsection (1),
(a) has a chef training or culinary management diploma or certificate granted by a college of applied arts and technology or a private career college;
(b) holds a certificate of qualification in the trade of Cook or Institutional Cook that was issued by,
(i) the Director of Apprenticeship under the Apprenticeship and Certification Act, 1998,
(ii) the Registrar of the College under the Ontario College of Trades and Apprenticeship Act, 2009, or
(iii) the Registrar of Skilled Trades Ontario under the Building Opportunities in the Skilled Trades Act, 2021; or
(c) has, in the reasonable opinion of the licensee, appropriate skills, knowledge and experience in the fields of institutional, health care, restaurant or hospitality cooking to perform the duties required of the position.
19. The definition of “A” in the formula in subsection 83 (2) of the Regulation is revoked and the following substituted:
“A” is, at the option of the licensee, either,
(a) the licensed bed capacity of the home for the week, excluding beds not available for occupancy pursuant to a Minister’s directive, Ministry policy or otherwise at law, or
(b) the number of residents residing in the home for the week, including absent residents.
20. (1) Clause 84 (1) (a) of the Regulation is revoked and the following substituted:
(a) have successfully completed or are enrolled in a Food Service Worker program at a college of applied arts and technology or a Food Service Worker program provided by a private career college;
(2) Subsection 84 (1) of the Regulation is amended by striking out “or” after clause (b), by adding “or” after clause (c) and by adding the following clause:
(d) have, in the reasonable opinion of the licensee, appropriate skills, knowledge and experience in the fields of institutional, health care, restaurant or hospitality food service to perform the duties required of the position.
(3) Subsections 84 (2) and (3) of the Regulation are revoked.
(4) Clause 84 (4) (a) of the Regulation is amended by striking out “a food handler training program” at the end and substituting “food handler training”.
(5) Clause 84 (4) (b) of the Regulation is revoked and the following substituted:
(b) persons who meet the qualifications in subsection 81 (2) or 82 (2) or who are exempt from meeting those qualifications as they meet the requirements under subsection 81 (3) or (3.1); or
(6) Subsection 84 (5) of the Regulation is revoked.
21. Subsection 88 (5) of the Regulation is revoked.
22. Subsections 98 (2), (3) and (4) of the Regulation are revoked and the following substituted:
(2) The licensee shall ensure that the designated lead has the skills, knowledge and experience to perform the role, including,
(a) knowledge of evidence-based practices and, if there are none, prevailing practices relating to housekeeping, laundry and maintenance, as applicable; and
(b) experience in a managerial or supervisory capacity or, in the reasonable opinion of the licensee, appropriate skills, knowledge and experience in a health care or relevant setting to perform the duties required of the position.
23. Paragraph 2 of subsection 102 (12) of the Regulation is amended by striking out “influenza” and substituting “influenza and COVID-19”.
24. Subsection 115 (3) of the Regulation is amended by adding the following paragraphs:
6. The use of glucagon that results in a resident being taken to hospital.
7. An incident of severe hypoglycemia or unresponsive hypoglycemia in respect of which a resident is taken to hospital.
25. (1) Clause 124 (3) (b) of the Regulation is revoked and the following substituted:
(b) reviewing reports of any medication incidents, any incidents of severe hypoglycemia and unresponsive hypoglycemia, the use of glucagon and adverse drug reactions referred to in subsections 147 (2) and (3), the factors that contributed to the incident, use of glucagon or drug reaction and all instances of the restraining of residents by the administration of a drug when immediate action is necessary to prevent serious bodily harm to a resident or to others pursuant to the common law duty referred to in section 39 of the Act; and
(2) Section 124 of the Regulation is amended by adding the following subsection:
(3.1) For the purposes of clause (3) (a), and without limiting the generality of this section, the review of drug utilization trends and drug utilization patterns in the home must include trends and patterns associated with the use of glucagon in the home.
26. Paragraph 3 of section 129 of the Regulation is revoked and the following substituted:
3. Risk management and quality improvement activities, including reviews of medication incidents, adverse drug reactions, incidents of severe hypoglycemia, incidents of unresponsive hypoglycemia and drug utilization, including, for greater certainty, glucagon utilization.
27. Subparagraph 2 i of section 139 of the Regulation is revoked and the following substituted:
i. persons, other than personal support workers, who may dispense, prescribe or administer drugs in the home, and
28. (1) Subsections 140 (3), (4) and (5) of the Regulation are revoked and the following substituted:
(3) Subject to subsections (4) and (6), the licensee shall ensure that no person administers a drug to a resident in the home unless,
(a) where the administration involves the performance of a controlled act under subsection 27 (2) of the Regulated Health Professions Act, 1991, the person is authorized to administer the drug by virtue of a health profession Act, the Regulated Health Professions Act, 1991 or any relevant regulation; or
(b) where the administration does not involve the performance of a controlled act under subsection 27 (2) of the Regulated Health Professions Act, 1991, the person is,
(i) a member of a regulated health profession and is acting within their scope of practice, or
(ii) a personal support worker who has received training in the administration of drugs in accordance with written policies and protocols developed under subsection 123 (2), who, in the reasonable opinion of the licensee, has the appropriate skills, knowledge and experience to administer drugs in a long-term care home, who has been assigned to perform the administration by a member of the registered nursing staff of the long-term care home and is under the supervision of that member in accordance with any practice standards and guidelines issued by the College of Nurses of Ontario, and who,
(A) meets the requirements set out in subsection 52 (1) or who is described in subsection 52 (3), or
(B) is an internationally trained nurse who is working as a personal support worker.
(4) A member of the registered nursing staff may permit a nursing student to administer drugs to residents if,
(a) the licensee has verified with the Ontario post-secondary institution that offers the nursing educational program in which the nursing student is enrolled that they have received education or training about the administration of drugs as part of the program;
(b) the nursing student has been trained by a member of the registered nursing staff in the written policies and protocols for the medication management system referred to in subsection 123 (2);
(c) the member of the registered nursing staff who is permitting the administration is satisfied that the nursing student can safely administer drugs; and
(d) the nursing student administers the drugs under the supervision of the member of the registered nursing staff.
(5) For greater certainty, where the administration of a drug to a resident involves a controlled substance, a person may only administer the drug in compliance with any applicable requirements, restrictions or limitations under the Controlled Drugs and Substances Act (Canada) or the Food and Drugs Act (Canada).
(2) Subsection 140 (7) of the Regulation is amended by striking out the portion before clause (a) and substituting the following:
(7) Where a resident of the home may administer a drug to themself under subsection (6), the licensee shall ensure that there are written policies to ensure that the residents who do so understand,
. . . . .
(3) Subsection 140 (8) of the Regulation is amended by striking out the portion before clause (a) and substituting the following:
(8) The licensee shall ensure that no resident who may administer a drug to themself under subsection (6) keeps the drug on their person or in their room except,
. . . . .
(4) The definition of “dentist” in subsection 140 (9) of the Regulation is revoked.
(5) Subsection 140 (9) of the Regulation is amended by adding the following definition:
“internationally trained nurse” means an individual who,
(a) has been trained in a country other than Canada to practice the profession of nursing, and
(b) has held a certificate, licence, registration or other form of official recognition that authorized the individual to practice the profession of nursing in a country other than Canada, and that was granted to the individual by a body authorized in that jurisdiction to grant such a certificate, licence, registration or other form of official recognition.
(6) The definition of “nursing student” in subsection 140 (9) of the Regulation is revoked and the following substituted:
“nursing student” means a person who is,
(a) enrolled in an educational program, the successful completion of which meets the educational requirements for the issuance of a certificate of registration as a registered nurse or registered practical nurse as set out in the regulations made under the Nursing Act, 1991, and
(b) working in the long-term care home as part of the clinical placement requirement of the educational program described in clause (a) pursuant to an agreement between the licensee and the Ontario post-secondary institution that offers the educational program. (“étudiante infirmière ou étudiant infirmier”)
(7) Subsection 140 (10) of the Regulation is revoked.
29. Clause 146 (b) of the Regulation is revoked and the following substituted:
(b) appropriate actions are taken in response to any medication incident involving a resident, any incidents of severe hypoglycemia and unresponsive hypoglycemia and any adverse drug reaction to a drug or combination of drugs, including psychotropic drugs; and
30. Section 147 of the Regulation is revoked and the following substituted:
Medication incidents and adverse drug reactions
147. (1) Every licensee of a long-term care home shall ensure that every medication incident involving a resident, every adverse drug reaction, every use of glucagon, every incident of severe hypoglycemia and every incident of unresponsive hypoglycemia involving a resident is,
(a) documented, together with a record of the immediate actions taken to assess and maintain the resident’s health; and
(b) reported to the resident, the resident’s substitute decision-maker, if any, the Director of Nursing and Personal Care, the Medical Director, the resident’s attending physician or the registered nurse in the extended class attending the resident and, if applicable, the prescriber of the drug and the pharmacy service provider.
(2) In addition to the requirement under clause (1) (a), the licensee shall ensure that,
(a) all medication incidents, incidents of severe hypoglycemia, incidents of unresponsive hypoglycemia, adverse drug reactions and every use of glucagon are documented, reviewed and analyzed;
(b) corrective action is taken as necessary; and
(c) a written record is kept of everything required under clauses (a) and (b).
(3) Every licensee shall ensure that,
(a) a quarterly review is undertaken of all medication incidents, incidents of severe hypoglycemia, incidents of unresponsive hypoglycemia, adverse drug reactions and every use of glucagon that have occurred in the home since the time of the last review in order to,
(i) reduce and prevent medication incidents and adverse drug reactions,
(ii) improve the use of glucagon and to improve the care and treatment of incidents of severe hypoglycemia and incidents of unresponsive hypoglycemia in accordance with evidence-based practices and, if there are none, in accordance with prevailing practices, and
(iii) identify patterns of incidents of severe hypoglycemia and incidents of unresponsive hypoglycemia;
(b) any changes and improvements identified in the review are implemented; and
(c) a written record is kept of everything provided for in clauses (a) and (b).
31. Subclause 148 (3) (a) (ii) of the Regulation is revoked and the following substituted:
(ii) at least one of,
(A) another member of the registered nursing staff appointed by the Director of Nursing and Personal Care,
(B) a physician,
(C) a pharmacist,
(D) a member of the College of Nurses of Ontario who is a registered nurse in the extended class,
(E) a member of the College of Pharmacists who is a pharmacy technician, or
(F) a member of the Royal College of Dental Surgeons who is a dentist in the general class; and
32. Subsection 166 (4) of the Regulation is revoked.
33. The English version of clause 176 (1) (a) of the Regulation is amended by adding “bed” after “their”.
34. (1) Subsection 240.3 (6) of the Regulation is revoked and the following substituted:
(6) In cases where only basic accommodation has been requested by the ALC patient or their substitute decision-maker, if any, or where basic accommodation has been selected by the placement co-ordinator under subsection 240.2 (6), the appropriate placement co-ordinator may authorize the ALC patient’s admission to preferred accommodation in the home and, in such a case, the licensee shall make the accommodation available as basic accommodation.
(2) Subsection 240.3 (8) of the Regulation is revoked and the following substituted:
(8) If the ALC patient is admitted as a resident to preferred accommodation under subsection (6), the licensee is eligible to charge the resident for preferred accommodation in accordance with the Act and this Regulation, including the agreement referred to in paragraph 2 of subsection 94 (1) of the Act, where,
(a) the resident or their substitute decision-maker, if any, refuses an offer to transfer to basic accommodation; or
(b) the resident or their substitute decision-maker, if any, chooses that the resident stay in preferred accommodation.
35. The Regulation is amended by adding the following section:
Imminent closure of home
240.5 (1) In cases where only basic accommodation has been requested by the resident or their substitute decision-maker, if any, a placement co-ordinator may authorize the temporary admission of a resident of a home into preferred accommodation in another home where all of the following circumstances exist:
1. The resident’s current home is facing a closure that has been designated as an imminent home closure pursuant to section 361.1.
2. The second home is one where the resident has applied for admission for basic accommodation only, but only preferred accommodation is available.
3. The resident or the resident’s substitute decision-maker, if any, consents to the admission.
(2) Where a placement co-ordinator has authorized an admission under subsection (1) and the resident moves into the second home, the licensee of the second home shall make the preferred accommodation available to the resident as basic accommodation.
(3) If the placement co-ordinator authorizes placement in preferred accommodation under this section and the resident moves into the home, the licensee shall place them on the internal transfer list in accordance with clause 239 (1) (a) on the date of the resident’s admission even if the resident has not explicitly requested the transfer.
(4) If a resident is admitted to preferred accommodation under this section, the licensee is eligible to charge the resident for preferred accommodation in accordance with the Act and this Regulation, including the agreement referred to in paragraph 2 of subsection 94 (1) of the Act, where,
(a) the resident or their substitute decision-maker, if any, refuses an offer to transfer to basic accommodation; or
(b) the resident or their substitute decision-maker, if any, chooses that the resident stay in preferred accommodation.
36. (1) Subsection 251 (2) of the Regulation is revoked.
(2) Paragraph 6 of subsection 251 (4) of the Regulation is amended by striking out “clinical care” and substituting “medical care”.
37. Subsection 256 (13) of the Regulation is revoked.
38. Subsection 262 (3) of the Regulation is revoked.
39. Subsection 268 (16) of the Regulation is revoked.
40. Subsection 269 (4) of the Regulation is revoked.
41. Subsection 270 (4) of the Regulation is revoked.
42. Subsection 271 (3) of the Regulation is revoked.
43. (1) Subsection 349 (6) of the Regulation is amended by striking out “or” at the end of clause (a), by adding “or” at the end of subclause (b) (ii) and by adding the following clause:
(c) a licensee has failed to comply with subsection 23.1 (1) of this Regulation, resulting in an order being made under section 155 of the Act.
(2) Section 349 of the Regulation is amended by adding the following subsections:
(10) Where an inspector or the Director issues a notice of administrative penalty under clause 6 (c) for the failure to comply with subsection 23.1 (1) of this Regulation, the amount of the administrative penalty is $25,000.
(11) Where an inspector or the Director issues a notice of administrative penalty under clause 6 (c) for a licensee’s second or subsequent failure to comply with subsection 23.1 (1) of this Regulation, resulting in an order being made under section 155 of the Act, the amount of the administrative penalty is,
(a) for the second failure, $50,000;
(b) for the third failure, $75,000;
(c) for the fourth failure, $100,000; and
(d) for each subsequent failure, $125,000
44. Item 48 of the Table to section 349 of the Regulation is amended by adding “or under this Regulation” after “under the Act” in Columns 1 and 2.
45. The Regulation is amended by adding the following section:
Imminent home closure designation
361.1 Where the Director is satisfied that it is appropriate to do so to assist a home to close by the closure date set out in the approved closure plan, the Director may, by written notice to the licensee and the placement co-ordinator, designate the closure as an imminent home closure for the purposes of section 240.5.
46. (1) Paragraph 3 of subsection 369 (3) of the Regulation is amended by striking out “subsection 23 (5)” and substituting “subsection 23.1 (4)”.
(2) Subparagraph 3 ii of subsection 369 (4) of the Regulation is amended by striking out “subsection 23 (5)” and substituting “subsection 23.1 (4)”.
47. (1) Subsection 388 (1) of the Regulation is amended by striking out “12 months” and substituting “18 months”.
(2) Subsection 388 (3) of the Regulation is amended by striking out “13 months” and substituting “19 months”.
48. Section 389 of the Regulation is revoked.
Commencement
49. (1) Except as otherwise provided in this section, this Regulation comes into force on the later of April 11, 2023 and the day this Regulation is filed.
(2) Section 2 comes into force on July 11, 2023.