Policy & Procedures Manual

KITIGAN ZIBI HEALTH & SOCIAL SERVICES Policy & Procedures Manual

VERSION APPROVED: JULY 29, 2019 Kitigan Zibi Health & Social Services Policy & Procedures Manual July 29, 2019

Kitigan Zibi Health & Social Services Box 160, 8 Kikinamage Mikan Maniwaki, QC J9E 3B4

All rights reserved. No part of this publication should be reproduced, transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, or stored in a retrieval system, without the written consent of the Kitigan Zibi Anishinabeg.

KITIGAN ZIBI HEALTH & SOCIAL SERVICES Policy & Procedures Manual VERSION APPROVED: JULY 29, 2019

KITIGAN ZIBI HEALTH & SOCIAL SERVICES ORGANIZATIONAL STRUCTURE Kitigan Zibi Anishinabeg COMMUNITY MEMBERS

Kitigan Zibi Anishinabeg BAND COUNCIL

COMMUNITY KITIGAN ZIBI POLICE HEALTH & KZHSS Band Council HUMAN SERVICES EDUCATION FINANCE DEPARTMENT PORTFOLIO HOLDER RESOURCES Director Director SOCIAL SERVICES Director Director Director Coordinator

Public Works KZES Dental Human Safety Ecucation Hygienist HEALTH & SOCIAL Resources Sector Nurse* (contract)* SERVICES Assistant Assistant Director *Positions funded in whole Student or in part by KZHSS but Headstart Coordinator* Services under the supervision of Counsellor* respective sectors

Health Programs Social Development Programs

ENVIRONMENTAL SUPPORT MEDICAL FAMILY ADMIN & MENTAL HEALTH TRANSPORTA- PRIMARY CARE CHILD & FAMILY SERVICES VIOLENCE ASSISTED LIVING HEALTH MAINTENANCE TION PREVENTION

NNADAP Home & Enhanced Family Kiweda Health & Executive Substance Participaction Medical Community Human Violence Coordinator Safety Transportation Community Medical Clerk Prevention Relations Technician Secretary Abuse Worker Dispatcher Health Nurses Care Services Intervention Counsellors Coordinator Coordinator Officer Counsellors (Nurse)

Support Personal KZHSS Psychoeducator Workers Support Receptionist Nicholas Medical Home & Home Care Workers Stevens Centre Endong Cook Transportation Community Clerk Family Youth Monitor Clerk Care Nurse Wellness Prevention Worker Worker

Accreditation Kiweda Cooks Coordinator Nicholas Medical In-Home Care In-Home Care Stevens Centre Endong Server Transportation Workers Special Needs Life Skills Criminal Court Monitor Full Time Worker Coach Diversion Mental Health Worker Social Worker Kiweda Janitor Medical Janitor Transportation Heavy Duty Water Cooler Contract Cleaners Cleaners Admin Worker Drivers

LEGEND: Indeterminate Positions Physicians Psychologists Psychotherapists Contract Positions Not under direct supervision of KZHSS Revised: November 2019 Table of Contents

Part I: Introduction, Definitions & Acronyms Introduction 2 Definitions & Acronyms 4

Part II: Organization Structure & Accountability Kitigan Zibi Anishinabeg 8 KZA Governance Structure 9 KZA Organizational Structure 11 Kitigan Zibi Health & Social Services 12 KZA Code of Ethics and KZHSS Code of Conduct 14 Ethics Framework 20 Clinical Guidelines 29 Escalation Process 32

Part III: Operations - KZHSS Program & Service Delivery Overview KZHSS Administration 34 Director's Office 34 Assistant Director's Office 34

HEALTH PROGRAMS 35 Primary Health Care & Community Public Health 35 Nursing Framework for Practice 35 Nursing Case Management 37 Clinical Supervision 38 Health Promotion & Disease Prevention 39 Maternal Health & Healthy Child Development 41 Prenatal 42 Post-partum & Newborn 42 Maternal Nutrition 43 Fetal Alcohol Spectrum Disorder (FASD) Prevention 44 Infant Formula 44 Children's Oral Health Initiative (COHI) 45 KZ Education Sector Child/Youth Health Program 46 Healthy Living 49 Chronic Disease Prevention Management 49 Diabetes Prevention Management 50 Community Public Health Protection 51 Communicable Disease Control & Management 53 Immunization Program 55 Pandemic Plan 57 Client Primary Care 58 Clinical and Client Care 59 Doctor's Clinics 60 Medical Clerk 60 Home and Community Care Primary Care (*refer to page 65) 61 Medication Management--Clinical and Client Care 62 Home & Community Care 65 Medical Transportation Services 73 National Native Alcohol and Drug Addiction Program (NNADAP) 84 Environmental Health & Safety 87 Mino-Bimadiziwin: Good Life Center 90

SOCIAL DEVELOPMENT PROGRAMS 93 Kiweda Group Home 93 Kiweda CODE OF CONDUCT 98 Medication Management - Kiweda Group Home 100 Procedure for Determining Access to Information 102 Suspected Resident Abuse 103 Fire and Evacuation Plan 104 Procedure for Handling Gifts from Residents 105 Obtaining Legal Documentation from a Resident (DNR) 105 Major Resident Events - Procedures 106

Nicholas Stevens Center 110 NSC Fundraising Committee Terms of Reference 111 Medication Management – Nicholas Stevens Center 112 Enhanced Prevention Services 113 Waseya House 117 Medication Management - Waseya House 120 Evacuation Plan 121 KZA Family Violence Crisis Call Protocol (refer to page 121 Endong Luncheon Meal

Part IV: Client Care Case Management 124 Urgent Clients First 124 Identifying Clients Before Services 126 Client Safety 127 Emergency & Report to Work 130 Risk Management & Quality Improvement 131 Suicide Risk Assessment 131 Client Complaints 134 Workplace Violence Prevention Policy 137 Incident Reporting & Investigation 140 Critical Incidents 142 Disclosing, Investigating and Reporting Adverse Events and Near Misses 143 Monitoring Quality of Services 147 Monitoring Client Satisfaction 149 KZA Multi-disciplinary protocols 151 KZA Family Violence Crisis Call Protocol 152 Kitigan Zibi Kikinamadinan Protocol for Assessing Social/Emotional Needs 154 Student Volunteers Placement Policy 169 Part V: Environment Care Assets & Facilities Maintenance 172 Community Use of Facilities, Grounds & Equipment 172 Home Hazards Assessment 176 Building Inspections & Reporting 178 Dealing with Disasters 179

Infection Prevention & Control 180 Coordination of Infection Prevention & Control Procedures 182 Physical Environment & Accessories 184 Cleaning and Housekeeping 184 Food Preparation Areas 187 Vehicle Interior Maintenance 189 Disinfection & Sterilization 190 Selection, Use & Storage of Disinfectants 191 Reprocessing of Medical Equipment used in Client Care 192 Reprocessing of Loaned Medical Equipment 195 Personal Routine Habits 198 Universal Precautions 198 Hand Hygiene 200 Personal Protective Equipment (PPE) 202 Respiratory Etiquette 204 Specific Circumstances 205 Handling Patient Specimens 205 Handling of Clean, Infectious, or Soiled Linen and Clothing 206 Sharps Safety and Needlestick Injuries 208 Safe Disposal of Infectious or Hazardous Waste 211 Accidental Spills 214 KZHSS Worker - Personal Responsibility 218 Employee Immunization Policy 218 Future Considerations and Infrastructure 219 Selecting and Purchasing of Medical Devices and Equipment 219 Selection of Finishes/Surfaces and New Furnishings 220 Construction/Renovation 222 Infection Prevention and Control Parterships 224 Information Management 225 Information Sharing and Consent 225 Informed Consent 227

Part VI: Organized Activities Healthy Meals and Snacks 230 No Smoking and No Consumption of Alcohol 231 Awarding Prizes 232 Planned Activities for Non-Members 233 Organized Outings and Activities 234 Youth Sponsorship Funding 239

Part VII: Human Resources & Employee Performance Management Human Resources Policy (referenced) 244 Finance Policy (referenced) 245 Employee Performance Management 246 Orientation 246 Staff Meetings and Communication 248 Performance Reviews 250 Employee Training 251 Training Client Safety 252

Part VIII: References And Annexes Evaluation 254 KZHSS Integrated Quality Management 256 Accreditation Canada Required Organizational Practices 257 Forms 262

PART I:

Introduction, Definitions & Acronyms

1. INTRODUCTION

Since the very beginning, Kitigan-Zibi has worked hard at obtaining autonomy over the administration and delivery of their Health and Social Service programs. It has always been the goal of KZHSS to improve the quality of its programs and services for the benefit of all community members who make up its clientele. It is hoped that this Policies and Procedures manual will provide clear direction to both KZHSS staff as well as community members regarding the operations at KZHSS.

These policies and procedures were developed by KZHSS staff members as part of a team effort. The basis of policy development was:

▪ KZA Vision, Values, Mission ▪ Code of Ethics-KZA, KZHSS, Nursing ▪ KZHSS Vision, Mission, Philosophy & Mandate ▪ KZHSS Health Plan ▪ Identified by Accreditation Canada as areas that required development ▪ Identified areas for policy development based on risk-management discussions related to client complaints, incident reports, and adverse event reports. ▪ Applicable KZA Band Council Resolutions and directives, national accreditation standards and provincial and federal laws ▪ Evidence-based and following best practices ▪ The documents were developed by KZHSS staff and sent to Chief and Council, KZA Sector Directors and Health Advisory Council for review and feedback

The KZA Band Council’s authorities and responsibilities relating to policy include: ▪ Make and approve bylaws, regulations, rules, codes, directives, guidelines or other authorizations, standards, declarations, notices, requirements and directions. ▪ Approve policies and objectives and ensure the administrators carry them out. ▪ Communicate with the Administrators in accordance with these regulations and other applicable KZA policies. ▪ Support the Administrators in decisions made in accordance with KZA Band Council Guidelines, regulation and other KZA policies. ▪ Receive advising from the KZHSS administration and front-line services.

Changes made to the manual and annexes should be made in consultation with the KZHSS Team to ensure that it continues to meet applicable KZA standards, national accreditation standards, federal and provincial laws and standards.

This document will be evaluated, monitored and updated to reflect new and revised policies on an annual basis and ad hoc in the case of unintended negative impacts.

The adoption of this policy manual and guidelines regulates operation for KZHSS services.

All of the buildings listed are managed by the Health & Social Services Sector which has been in place since 1991. The KZHSS encompasses many programs which are geared toward the physical and mental health of all community members. From pre-natal nutrition to in-home care programs for seniors, the KZHSS has a variety of services in place. Specific buildings within the community cater to various areas of physical and mental health, such as:

▪ KZHSS Building (Health Centre)

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▪ Òde Wìdòkàzowin Centre (Enhanced Prevention Services) ▪ Kiweda Group Home (Home for Semi-autonomous) ▪ Waseya House (Crisis Shelter) ▪ Nicholas Stevens Centre (for the Multi Disabled) ▪ Community Youth Centre (Activity Centre) ▪ Log Cabin at Wanaki Beach ▪ KZHSS Playgrounds, Rinks and Ballfield ▪ Storage Units

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2. DEFINITIONS & ABBREVIATIONS

Defined for the purposes of this Kitigan Zibi Health and Social Services policy document.

ACCREDITATION The act of being accredited after meeting specific requirements. For KZHSS, it is undergoing an objective evaluation of the care and quality of service provided to clients and comparing these against a set of national and provincial standards.

ACCREDITATION The organization used by KZHSS to assist in achieving and CANADA maintaining accreditation.

ACCREDITATION The KZHSS Director established an Accreditation Team to TEAM (KZHSS) lead in achieving accreditation by undergoing an objective evaluation of the care and quality of service provided to clients and comparing these against a set of KZA and national and provincial standards.

ADVISORY May or may not be in effect according to decisions at Band COUNCIL Council level. KZHSS Advisory Council have their own established Terms of Reference.

CLIENT Kitigan Zibi Anishinabeg Community members who receives professional services from KZHSS or other First Nations persons who meet eligibility criteria.

BAND COUNCIL The Kitigan Zibi Anishinabeg governance system consists of 1 Chief and 6 Councillors. Through the electoral process, the Kitigan Zibi Anishinabeg Band Council is recognized as the official representative of the Kitigan Zibi Anishinabeg Band, therefore, it has the authority to sign any agreements in the name of the Kitigan Zibi Anishinabeg Band.

Council members also negotiate with governments and are responsible for the implementation and monitoring of legislation, finance, management, social and political issues, and other areas that affect the community.

BAND COUNCIL Decisions are made democratically and every effort is made RESOLUTIONS to reach decisions by consensus. Where consensus is not possible, a quorum of at least (4) members of the Band Council is required in any decision making and in order to pass a Band Council Resolution (B.C.R.). B.C.R.’s are a common agreement and are not legally binding.

ESCALATION The process set up to define the steps to be taken when PROCESS service levels do not meet the standards.

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FEDERAL Federal standards as defined by Health and Social Service STANDARDS Programs and Services funded by Health Canada and Aboriginal Affairs and Northern Development Canada.

GUIDELINES Guidelines consist of recommended, non-mandatory controls that help support standards or serve as a reference when no applicable standard is in place. They should be viewed as best practices that are not usually requirements, but are strongly recommended.

HIGH PRIORITY High priority criteria are criteria related to safety, ethics, risk management, and quality improvement.

NATIONAL National standards for Leadership in Aboriginal Health STANDARDS Services, Aboriginal Community Health and Wellness, Aboriginal Integrated Primary Care and Home Care Services as defined by Accreditation Canada.

PERFORMANCE Performance measures are evidence-based instruments MEASURES and indicators that are used to measure and evaluate the degree to which an organization has achieved its goals, objectives, and program activities.

POLICY Policy consists of high level statements relating to health and social services across the organization.

PROCEDURES Procedures consist of step by step instructions to assist workers in implementing the various policies, standards and guidelines. While the policies, standards and guidelines consist of the controls that should be in place, a procedure gets down to specifics, explaining how to implement these controls in a step by step fashion.

PROVINCIAL Provincial standards as defined by the Ministry of Health STANDARDS and Social Services of Quebec, Centre de la Jeunesse de l’Outaouais, Ordre des infirmiers et infirmières du Québec.

REQUIRED Required Organizational Practices (ROPs) are essential ORGANIZATIONAL practices that an organization must have in place to PRACTICES (ROP) enhance client safety and minimize risk.

ROP TESTS FOR MINOR: Minor tests for compliance support a safety culture COMPLIANCE: and quality improvement, yet require more time to be implemented. MAJOR: Major tests for compliance have an immediate impact on safety.

SENIOR A person who is 65 years or older. Certain KZHSS programs may include persons who are 55 and older depending on age requirements outlined in funding agreements and decided by community members.

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YOUTH A person under the age of 18

ACRONYMS

AANDC Aboriginal Affairs and Northern Development Canada ASIST Applied Suicide Intervention Skills Training CHN Community Health Nurse CJO Les Centres Jeunesse Outaouais CLSC Centre Local De Services Communautaires CSSSVG Centre de Sante et Services Sociaux Vallee de la Gatineau DPJ Department Protection Jeunesse FNIHB First Nations Inuit Health Branch GMF Groupe de médecine de famille KZA Kitigan Zibi Anishinabeg KZHSS Kitigan Zibi Health & Social Services OIIQ Ordre des Infirmiers & Infirmières du Québec OMEC Multiclientele Evaluation OTC Over the Counter PIQ Protocole d’Immunisation du Quebec PSW Personal Support Worker RAMQ Regie Assurance Maladie du Quebec ROP Required Organizational Practice TNP Therapeutic Nursing Plan VPD Vaccine Preventable Disease

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PART II:

Organization Structure & Accountability

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A. KITIGAN ZIBI ANISHINABEG (KZA)

VISION

The Kitigan Zibi Anishinabeg through its peoples shall strive to achieve a balanced society where every member has equal opportunity to fulfill their individual potential in a safe sustainable environment on traditional lands, where the spiritual, cultural, physical and mental well-being can be achieved and where basic human needs can be attained.

VALUES

Our community values require Council to: ▪ Maintain as a priority a constant focus on the KZA community; ▪ Support the involvement of all community members who desire to participate in advancing the interests of the KZA community; ▪ Respect KZA history and culture; ▪ Respect various perspectives, opinions and beliefs; ▪ Wisely use a variety of resources to achieve the KZA established goals.

MISSION STATEMENT

The Kitigan Zibi Anishinabeg through the strength of its people and through the principles of cooperation and coordination by its community service sectors shall strive for a healthy community with each sector developing and implementing specific goals through a process which supports the community’s strategic goals.

▪ Establish and maintain a healthy, forward looking community by providing quality governance with fair representation for all Members; ▪ Practice and promote cultural values; ▪ Protect and manage resources; ▪ Operate in a fair, honest and transparent manner; ▪ Mentor and educate the youth, involving them and respecting the unique challenges they face.

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1 GOVERNANCE STRUCTURE: KITIGAN ZIBI CHIEF & COUNCIL

KITIGAN ZIBI ANISHINABEG BAND COUNCIL

The Kitigan Zibi Anishinabeg governance system consists of 1 Chief and 6 Councillors.

Through the electoral process, the Kitigan Zibi Anishinabeg Band Council is recognized as the official representative of the Kitigan Zibi Anishinabeg Band, therefore, it has the authority to sign any agreements in the name of the Kitigan Zibi Anishinabeg Band.

Decisions are made democratically and every effort is made to reach decisions by consensus. Where consensus is not possible, a quorum of at least (4) members of the Band Council is required in any decision making and in order to pass a Band Council Resolution (B.C.R.).

HEALTH AND SOCIAL SERVICES ADVISORY COUNCIL (when in effect, as determined by Band Council)

The mandate of the Health and Social Services Advisory Council is: ▪ to uphold and abide by their established terms of reference as set out by Band Council. ▪ to make recommendations in regards to the improvement of the health and social services in general ▪ to assess the services provided on a regular basis ▪ to establish priorities for action ▪ to inform the Kitigan Zibi Anishinabeg Band Council and the Director of Health and Social Services of the results of the work done by the Health and Social Services Advisory Council and prepare and present an annual report to the community ▪ to assist in the preparation of a semi-annual action plan according to the priorities identified by the Kitigan Zibi Health and Social Services Director ▪ to review and recommend for approval the health and social service annual organizational/operational plan ▪ to participate in staffing issues (e.g. selection and termination staff issues), when required. ▪ to participate in the development of criteria for evaluating the performance of the KZHSS within the established and regulatory framework. ▪ to assist the Director of Health and Social Services in implementing a communication plan on health and social services for the community and make any other recommendations applicable to the effective administration and operations of the health and social services. ▪ to respect confidentiality and due process in health and social matters.

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KZA Governance & KZHSS Administrative Roles using the Dimension of the Governmental Process model

GOVERNANCE Line indicates ADMINISTRATION level of KZA BAND involvement at ADMINISTRATION COUNCIL TASKS KZHSS COUNCIL each stage TASKS

Director analyzes Advise (what city conditions and Determines Determine can do may trends to advise “purpose”, scope “purpose”, scope influence what it Chief & Council on of services, rights of services, should do); community-based of clients and constitutional MISSION analyze conditions Health & Social advocacy. issues and trends Services programming

Develops policy Make and procedures Pass BCR’s, by- Pass laws, recommendations with staff; Director laws, approve approve new on all decisions makes new projects and projects and POLICY formulate budget; recommendations program; ratify program; ratify determine service to Council and budget budget formulas formulates the budget.

Make Make Director and staff implementing implementing Establish practices establish practices decisions (e.g. decisions (e.g. and procedures and procedures site selection); site selection); PROGRAM and make and implements handle handle ADMINISTRATION decisions for policies and complaints; complaints; implementing procedures at the oversee oversee policy front-line level. administration administration

Suggest Suggest Control the human Control the human management management material and resources and changes to changes to information information Director; review manager; review INTERNAL resources of material of KZHSS organizational organizational MANAGEMENT organization to to support policy performance in performance in support policy and and administrative Director’s manager’s administrative functions. appraisal appraisal functions.

Shaded columns are from Dimension of the governmental process – James Svara * SOURCE: “Working Together: A Guide for Elected and Appointed Officials” International City/County Management Association.

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2. KZA ORGANIZATIONAL STRUCTURE

The FOUR ADMINISTRATIVE BODIES found within the Kitigan Zibi Anishinabeg community are: COMMUNITY HEALTH & SERVICES & EDUCATION SOCIAL POLICE SERVICES ADMINISTRATION SERVICES Finance Department KZ School Enhanced Prevention Law & Order KZA Territory Lands, Memberships and Estates Pakinawatik School Services: Police Officers Employment & Training Mokasige Immersion School Youth Protection Maintenance (Police Land Claims Curriculum Development Youth Diversion Station – Equipment Awazibi Sugar Bush Unit Mental Health Social Related) Economic Development Cultural Education Centre Worker Forestry Wazoson Daycare Centre Coordinator C.K.W.E. Radio Odekan Headstart Family Wellness Water & Sewer Educational Counselling Life Skills Coach Roads & Bridges Post-Secondary Student Youth Prevention Heavy Equiplment Maintenace Support Primary Care: Housing Construction & Repairs Technology Community Health Building Maintenance School Bussing Nursing Maintenance (KZES-related) In-Home/Home & Community Care Visiting Doctors Clinics

Education Sector Nursing

Environmental Health & Safety

Fitness Centre

NNADAP Addictions Counselling

Income Assistance

Waseya Crisis Shelter

Kiweda Group Home

Nicholas Stevens Centre

Endong-Senior Citizens Weekly Luncheon

Transportation Services

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B. KITIGAN ZIBI HEALTH & SOCIAL SERVICES VISION

Kitigan Zibi Health and Social Services envisions Kitigan Zibi Anishinabeg members to be healthy throughout all stages in their lives.

MISSION

KZHSS offers a safe, equitable and quality current service practice with qualified community professionals to encourage Kitigan Zibi Anishinabeg community members to take charge of their own health.

PHILOSOPHY

It is up to each individual to take responsibility for their own health, and to live in balance and harmony in their mind, spirit and body. Kitigan Zibi Health and Social Services is here to support community members in a non- judgmental manner in their quest for health to the extent each individual is prepared to help him/herself.

MANDATE

As a community public health provider, KZHSS strives to continually improve community health outcomes by offering public health and primary care and social services by partnering with external health and social service providers. KZHSS ensures KZA members in the non-remote community of Kitigan Zibi will receive client/family centered services provided by a dedicated and well-trained team believing in self-management and the development of personal skills in health and wellness in the following areas:

Community Public Health:

Community Public Health within KZHSS is defined as creative ways of preventing disease, prolonging life and promoting health through the organized efforts of staff and community. Public Health within KZA focuses on community-based health education along with services defined by Quebec Santé-Publique. Functions include: ▪ population health assessment based on community consultation ▪ health surveillance based on health trends data of the community ▪ community-based health promotion ▪ community-based disease and injury prevention ▪ health protection

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Primary Care:

Primary Care within KZHSS is defined as clinical care provided to clients by a Doctor/Nurse through a direct health assessment and/or Doctor’s prescription. Primary Care within KZHSS provides limited services in collaboration with the provincial Medicare system.

Functions include: ▪ restricted management of acute, episodic care and non-urgent routine care; ▪ health teaching on an individual basis in clinic care; ▪ health teaching on an individual basis for specific individual disease and injury prevention; ▪ chronic disease management with the Chronic Care Model.

Social Services:

Social services within KZHSS is defined as service programming preventing and assisting families and individuals from living in crisis.

Functions include: Primary Prevention within KZHSS is a community-based education and programming to prevent high-risk behavior.

Secondary Prevention within KZHSS is intervention programming to prevent experimentation risk behavior on an individual level and to targeted groups;

Tertiary Prevention within KZHSS is intervention programming to treat and reduce established risk behaviors on an individual level.

ORGANIGRAM

Please refer to the inside cover of this manual to see the Organizational structure of Kitigan Zibi Health and Social Services.

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C. KZA CODE OF ETHICS & KZHSS CODE OF CONDUCT

KZHSS Professional Code of Conduct

POLICY DATE DATE Kitigan Zibi OSA-002 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS adheres to the KZA Employee Code of Ethics identified in the KZA Human Resource Policy manual. In addition, a Code of Conduct was designed to guide specific health and social service work of employees of KZHSS.

PURPOSE

The Code of Conduct is based on the vision and values of KZA, the vision, mission and philosophy of KZHSS, and the values of the Canadian Human Rights Act. The Code of Conduct was developed by employees with feedback from the Health Advisory Council and all Sectors of KZA. The standards for this document are guided by pride, trust and respect.

KZHSS RESPONSIBILITY:

KZHSS Staff, Contractors, Visiting Professionals, Volunteers and all those representing KZHSS

Institution: The Kitigan Zibi Health and Social Services is comprised of: ▪ KZHSS Building (Health Centre) ▪ Òde Wìdòkàzowin Centre (Enhanced Prevention Services) ▪ Kiweda Group Home (Home for Semi-autonomous) ▪ Waseya House (Crisis Shelter) ▪ Nicholas Stevens Centre (for the Multi Disabled) ▪ Community Youth Centre (Activity Centre) ▪ Log Cabins at Wanaki Beach ▪ KZHSS Playgrounds, Rinks and Ballfield ▪ Storage Units

Services: This document encompasses all services that may be provided in any of the sites, whether health services, social services or long term residential services.

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Kitigan Zibi Anishinabeg EMPLOYEE WORK CODE OF ETHICS

As a Kitigan Zibi Anishinabeg employee, I hereby agree to become familiar with and abide to the employer’s work-related procedures and policies including the Human Resources Policy, Antiharassment policy and duty to accommodate. I will fulfill my job responsibilities to the best of my abilities, and abide by the policies and procedures of my employer and Service Sector.

I hereby also agree to abide by the following the Work Code of Ethics for Kitigan Zibi Anishinabeg employees:

1. I will carry out the duties of my position conscientiously and honestly, remembering that my primary work task is to serve the Kitigan Zibi Anishinabeg membership. 2. In my actions and words, I will promote and uphold the integrity and dignity of Kitigan Zibi Anishinabeg and its programs. 3. I will be prompt, courteous, and temperate in the performance of my duties. 4. I will use initiative to find ways of consistently improving my work efficiency. 5. I will adopt a positive attitude when dealing with fellow employees, other Kitigan Zibi Anishinabeg members, management, and Band Council. 6. I will follow the instructions of management attentively and co-operate with my co-workers. 7. During my hours of employment, I will work solely on my job responsibilities. 8. Within my sphere of responsibility, I will recommend changes to the policies, priorities or procedures when I believe that such changes would help to meet the objectives of my Service Sector or employer. 9. I will show respect for the authority and jurisdictional structures of Kitigan Zibi Anishinabeg. 10. I will continually work toward self-improvement and professional development, through self-evaluation and availing myself to available literature, upgrading and training when the opportunities arise. 11. I will be punctual each day, unless there is a valid reason for absence or lateness, in which case I will contact my immediate supervisor at the start of the work day and provide an indication of when I expect to return to work. 12. I will attend all meetings, workshops, conferences, etc. when mandated as an official delegate of Kitigan Zibi Anishinabeg and will formally report back to my supervisors and/or the Band Council. 13. I will dress appropriately for my employment position, as I understand that the appearance of employees reflects on Kitigan Zibi Anishinabeg as a whole. 14. I will treat all employees, clients, the general public, and any person with whom I communicate with dignity and respect and will not make derogatory comments or jokes related to their race, national or ethnic origin, skin colour, religion, age, sex, marital status, family status, disability, criminal conviction or pardon, sexual orientation, or any other comment which may be construed as an affront to their dignity or human rights. I will not discriminate against anyone and withhold my personal opinions and views. 15. I will only communicate official and/or confidential information acquired on the job if the release of such information has been authorized in writing by my superior or required by law. 16. I will use information obtained on the job for the intended purpose only, not for my own personal interests. 17. I will use equipment and property of Kitigan Zibi Anishinabeg with appropriate care and for authorized purposes only and will report any problems, abuse or concerns to an appropriate member of management. 18. I will refuse any gifts or other tangibles offered to me by suppliers or contractors because of my work position. 19. I will not publicly criticize other employees, individuals, Service Sectors or the policies of Band Council; if I feel changes are necessary, I will provide constructive criticism and suggestions through proper channels and seek to make the workplace as harmonious as possible. 20. I will attempt to communicate openly with other staff and to settle internal differences in a constructive manner. 21. If my employment position and private interests create a real or potential conflict of interest, I shall declare this to an appropriate member of management and/or Band Council, who will decide how to resolve the matter. 22. Considering my employment position and my responsibilities, I will at all times behave with dignity, non-violence and respect towards Kitigan Zibi Anishinabeg, its members, management and employees 23. I will respect Kitigan Zibi Anishinabeg’s human resource policy on the prohibited use and consumption of intoxicating, mood altering and/or controlled substances during the performance of my duties. 24. Notwithstanding my political preferences, I will remain loyal to my employer and serve the employer to the best of my ability. 25. I will, in my actions and carrying out my duties, be respectful and professional. I acknowledge and read the anti harassment policies and agree to abide by it. . I will not harass others or abuse the authority given to me by virtue of my employment. 26. I understand that the use of social networking sights and the internet is considered public domain. As a result, I will not use social network sites or any other form of communication for the purposes of slander, defamatory expression or lateral violence.

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VALUES

As health care providers and promoters of optimal health within the community, Kitigan Zibi Health and Social Services strives for excellence in offering of professional services based on the following values:

▪ Treat all persons with HONESTY, RESPECT, FAIRNESS, DIGNITY and ACCEPTANCE. ▪ Demonstrate DEDICATION, CONNECTEDNESS and ACCOUNTABILITY. ▪ Act with DUE DILIGENCE, while having HUMILITY to accept we do not have all the answers. ▪ Empower clients to make informed choices.

All KZA workers are required to follow the KZA Code of Ethics. Additionally, all Professionals are required to follow the Code of Ethics outlined in their respective professional order. However, due to the sensitive nature of work performed at KZHSS, an additional Professional Code of Conduct was developed specifically for employees in the health and social service sector, whether acting in a professional capacity or not.

KZHSS PROFESSIONAL CODE OF CONDUCT

As a KZHSS employee working in an organization that deals with sensitive health and social client information and the potential to encounter situations of a sensitive nature, I understand that I must:

1. Recognize the right of human treatment of anyone suffering from all types of health and/or social issues, whether directly or indirectly; 2. Promote wellness and assist in the care and recovery of every person served, assisting them to help themselves, and referring them promptly to other programs or individuals, when in their best interest; 3. Maintain a proper professional/therapeutic relationship with all persons served, assisting them to help themselves, and referring them promptly to other programs or individuals, when in their best interest; 4. Refrain, when possible, from rendering professional service to members of my own family if there is a risk of undermining the therapeutic relationship. Every effort should be made to avoid dual relationships (professional and personal) by having another professional render the care. 5. Respect cultural and traditional or helping teachings that empower clients to choose a healthy lifestyle. 6. Ensure that my behaviour is above reproach between myself and clients, so as not to cross professional boundaries and remain non-exploitive. 7. Protect the confidentiality of all professionally acquired information. Disclosure of such information is done only when required or allowed by law to do so, or when clients have consented to disclosure. This includes all records, materials and communications obtained formally and informally. 8. Give due respect to the rights, views and positions of colleagues and related professionals; 9. Demonstrate loyalty and integrity toward colleagues and at no time betray their good faith, abuse their confidence or act unfairly in their regard;

10. Contribute my professional acquired on-going knowledge regarding client care and share through appropriate channels; 11. Strive to be a role model in all circumstances and refrain from any activities where my personal conduct might diminish my personal capabilities, undermine my professional

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status and/or credibility, constitute a violation of the law, or are contrary to the standards generally recognized within my profession. This includes, but is not limited to, the abuse of alcohol, drugs, or other mood altering chemicals. 12. Avoid claiming or implying any personal capabilities or professional qualifications beyond those I have actually attained, recognizing that competency gained in one field of activity must not be used improperly to imply competency in another; 13. Refrain from intervening in a client’s personal affairs when not qualified to do so. 14. Regularly evaluate my own strengths, limitations, biases, or levels of effectiveness, always striving for self-improvement, and seeking professional development by means of further education and training. 15. Be respectful of, work within, and strive to improve organizational policies and management functions. 16. Ensure the safety and welfare of clients by respecting all applicable laws. 17. Refrain from acting contrary to the standards generally recognized in his/her profession.

Sources: 1. Canadian Addiction Counsellors Certification Federation—Canon of Ethical Principles. 2. First Nations Wellness/Addictions Counsellors Certification Board. 3. Code of Ethics of Nurses—Professional Code (R.S.Q., c, C-26, s.87) 4. “Work Ethics, Conduct and Behaviour” Policy—Kahnawake Shakotiia’takehnhas Community Services. 5. Code of Ethics—Social Workers Professional Order of Ontario.

RIGHTS:

Under the provisions of the Charter of Human Rights and Freedoms and the “Act respecting health services and social services” (R.S.Q. c. S4.2), Kitigan Zibi community members’ rights are as follows:

RIGHT TO RECEIVE SERVICES

Clients have the right to receive quality services, regardless of their age, sex or social status, or that of their families and relatives, and without discrimination. In addition, given the situation of KZHSS, clients have the right: To receive services in English, French or Algonquin. To receive, with continuity and in a personalized and safe manner, services which are appropriate within our control and capabilities. To receive services adapted to their needs, in the best possible time limits.

RIGHT TO INFORMATION

Clients have the right to be informed of available services and resources, and of the conditions governing access to these services and resources. Clients also have the right to know the names of the persons providing the care and services.

Before giving consent to care, every client is entitled to be informed, in understandable terms, of his state of health, and to be acquainted with the various options open to them and the risks and consequences generally associated with each option. Clients are likewise entitled to refuse care and services, in whole or in part, while being made aware of the possible consequences of such a refusal.

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Every client has the right of access to their medical record, in accordance with the conditions set out in the Act. Client’s records are confidential and nobody has the right of access to them, without the written permission of the client.

The client is also entitled to be informed, as soon as possible, of any accident having occurred during the provision of services that has actual or potential consequences for the client’s state of health or welfare and of the measures taken to correct the consequences suffered, if any, or to prevent such an accident from recurring.

For personal viewing of medical record, refer to the Information Management Section – Access to medical files.

A DPJ file (Department de Protection de Jeunesse) is regulated by the Youth Protection Act and therefore cannot be accessed beyond YPA regulations.

RIGHT TO FREEDOM OF EXPRESSION

Clients have the right to be accompanied and assisted when they wish to understand information, to take steps in relation to a service provided or to pursue a remedy. They have the right to file a complaint if they are dissatisfied and to receive a response to their complaint within the time limit specified by this policy. When necessary, clients have the right to be represented for the exercise of their right to give consent, enforce a mandate in case of incapacity or end of life, or exercise the right to pursue a remedy.

RIGHT TO RESPECT FOR THEIR IDENTITY

Clients have the right to be welcomed, assisted and treated with courtesy, respect and attention regardless of their age or condition. They have the right to respect for their dignity, reputation, identity, privacy, physical and moral integrity, and protection from all forms of abuse. Clients are entitled to respect for their human, moral and spiritual values. They have the right to high quality services.

RIGHT TO RESPECT FOR THEIR AUTONOMY

Clients have the right to develop and express their autonomy, including taking the time they need to accomplish certain activities of daily living. They have the right to maintain control of their lives by expressing their opinions, making suggestions and participating in decisions concerning them. They have the right to respect their decisions concerning their health and to the support of their families. They have the right to die in dignity and respect.

RIGHT TO RESPECT FOR THEIR PRIVACY

Clients have the right to respect for their privacy and dignity. If they wish, they can receive personal hygienic care from a person of their chosen gender, within limits of the resources available.

RIGHT TO RESPECT FOR PERSONAL PROPERTY AND RIGHT TO QUALITY OF LIFE

Clients are entitled to a clean, welcoming, calm, sanitary, safe and smoke-free environment. For residential facilities, they are entitled to display personal possessions, pictures, and furnishings in keeping with safety requirements and other residents' rights.

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RIGHT TO CONFIDENTIALITY

The client’s record is confidential. Except in exceptional circumstances, only the client, personnel members who need to see the record for work purposes, and persons who have obtained the client’s authorization, may have access to the client’s record. Any authorization given by the client must be limited in time and scope.

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D ETHICS FRAMEWORK

Ethical Framework

POLICY DATE DATE Kitigan Zibi CC-013 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS uses the Ethical Framework to support Kitigan Zibi Health & Social Service in making decisions through a detailed step-by-step process.

PURPOSE

The Kitigan Zibi Anishinabeg community is made up of a diverse group of members with differing opinions, values, principles, and beliefs. In view of this, encountering ethical dilemmas on a regular basis will be inevitable as Kitigan Zibi Health & Social fulfills its role to provide safe, quality, and equitable health care services and program delivery to its community members.

KZHSS RESPONSIBILITY:

Director,▪ Coordinators, & All staff

PROCEDURES: In the majority of cases, it may be difficult to arrive at a decision where ethical factors are at play. Ethical issues often arise when there is a conflict between competing values or between principles and outcomes. The following ethical framework is intended to serve as a guide when an issue of an ethical nature is encountered.

AN ETHICAL ISSUE MAY INVOLVE:

TERM DEFINITION 1. Ethical Violation When an action that appears to be unethical is being proposed or carried out. 2. Ethical Dilemma When there are competing courses of action both of which may be ethically defensible (e.g. conflicting values) and there is a difference of opinion as to how to proceed. 3. Ethical Uncertainty When it is unclear what ethical principles are at play or whether or not the situation represents an ethical problem. 4. Ethical (Moral) Distress When you find yourself in a situation of discomfort, if you have failed to live up to your own ethical expectations, or if you are unable to carry out what you believe is the right course of action due to organizational or other constraints.

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ETHICAL DILEMMA FRAMEWORK The following framework is meant to specifically handle ethical dilemmas that occur at Kitigan Zibi Health & Social Services. As noted previously, an ethical dilemma is an issue which requires a choice between two or more right actions (typically based on values) that conflict with one another. The dilemma may include, but is not limited to: client care and organizational aspects (such as professional ethics or human resource practices). Ethical dilemmas can often be formulated in questions asking “should”. For example: ▪ Should KZA community members be protected against or made aware of a client considered “at risk”, perhaps because he/she has an STI and has a reputation for being promiscuous? ▪ Should family members receive preferential treatment (receiving services before other clients)? ▪ Should staff refuse to treat clients, either within the home care setting or at the Health Centre clinic, if they feel their personal safety is at risk? ▪ Should services be provided to clients who do not meet the criteria within the bounds of policy but when there is pressure by external sources (ie. Chief & Council, parents, family members) to do so? ▪ Should a Kiweda resident have limitations put on their freedom (ex: not being “allowed” to take walks alone) due to safety concerns? The ethical-decision making framework will support KZHSS staff in determining: ▪ What should be done? ▪ Why it should be done? ▪ How it should be done? CRITERIA FOR HANDLING ETHICAL ISSUES In addition to being used by the Director, the current framework is a useful tool that can be employed by any employee to justify why challenging decisions are made. This framework can be used by the Director and/or Coordinator to handle ethical dilemmas where a situation is affecting one particular client or workplace situation. However, when a group of clients are involved in a situation where ethics are brought into question, the matter will go before an ethics committee under the coordination of the Director. The Kitigan Zibi Health & Social Services Director oversees program and service delivery within the KZA community. As part of her mandate, the Director has the authority, under the Kitigan Zibi Band Council, to resolve critical incidents and concerns experienced by staff or community members. This is done in accordance with various tools at her disposal including the KZA Human Resource Manual, KZA Code of Ethics, KZHSS Professional Code of Conduct and KZHSS Policy & Procedures Manual. While it is left up to the Director’s discretion to handle all decisions, including those of an ethical nature, the following criteria clarifies when further additional support may be required to arrive at a decision.

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1. The Director arrives at a decision by handling each matter individually on a case by case basis.

CRITERIA: • Issue involves a routine matter that Director has authority to handle as part of her mandate and/or job description. • Director has sufficient tools and resources (Policies, BCR’s, Labour Laws etc.) to render and execute justifiable decisions. • The matter is straight-forward, there are no conflicting principles at play.

2. The Director cannot arrive at an informed decision because an issue is outside the scope of her knowledge and experience; the Director therefore gathers required information and has informal discussions with knowledgeable staff members and/or relevant professionals.

CRITERIA: • Current policies are either non-existent or only partially address the issue. • Issue falls outside the scope of the Director’s knowledge/experience, in which case: o Matter may be resolved through additional research or investigation—seeing how a similar situation was handled in another sector, community, context, etc. o Matter may be resolved after consultation with Professionals or human resources (nurses, lawyers, human resource officer)

3. The Director cannot arrive at a decision because of two competing courses of action, each with their own detrimental, ethically-charged impacts; she therefore arrives at a solution based on the recommendations provided by an ethical committee through the ethical framework.

CRITERIA: • Current policies or human resources cannot address the issue OR current policies are conflicting. • A group of clients are involved in a situation where ethics are brought into question. • Increased likelihood of similar situations arising in the foreseeable future, therefore a decision is required to set a precedent. • Decision requires justification before Band Council/Community.

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FORMING AN ETHICAL COMMITTEE – PRELIMINARY STEPS Once established that an ethical committee should be formed, the Director will spearhead the initiative by following the steps as outlined below. STEP 1: Identifying the Ethical Issue. STEP 2: Selection of potential committee members The Director will select potential members to represent multiple disciplines to ensure a cross-section of perspectives is brought forward within the meeting. Selection of individuals will depend on a number of factors including their pertinence to the situation, availability, discretion, and objectivity. All attempts to foresee a conflict of interest should be entertained before contacting individuals. Depending on the context, one representative from each discipline may be selected: • Band Council portfolio holder o It is highly recommended to have band council representation as part of this process. • Nursing Team o When the situation relates to health o May also be a staff member • Social Worker o When the situation relates to social services o May also be a staff member • Coordinator • Police Department • Education Sector • Other professional with a vested interest o Ie. Human Resource officer when dealing with human resource issue or Accreditation Coordinator when dealing with policies. • Guest o May be an elder, concerned community member, or impartial/objective outsider o To maintain the confidentiality of the information discussed, the guest will be required to sign an Oath of confidentiality to that effect.

In order for a worker to properly assess an ethical related situation, knowledge of the certain factors is essential. One must have knowledge and be aware of: ▪ Ethical principles; ▪ Ethical decision making steps; ▪ The facts and context of a situation; ▪ Oneself & one’s own values; ▪ First Nation culture; KZHSS Community Values (Diversity) ▪ KZHSS values and standards. ▪ Timeframes. In addition, all employees are subject to the Kitigan Zibi Anishinabeg Code of Ethics under which clients rights are upheld. Under the provisions of the Charter of Human Rights and Freedoms and the “Act respecting health services and social services” (R.S.Q. c. S4.2), Kitigan Zibi community members’ rights are as follows: ▪ Right to receive services ▪ Right to information ▪ Right to freedom of expression ▪ Right to respect for their identity ▪ Right to respect for their autonomy ▪ Right to respect for their privacy ▪ Right to respect for personal property and right to quality of life ▪ Right to confidentiality

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To that end, this framework as well as a brief summary of the ethical issue to be discussed will be prepared and sent (in a CONFIDENTIAL sealed envelope) to committee members who have agreed to be part of the meeting. The Director will ensure that all logistics are arranged (meeting room booked, copies of all relevant policies/resources will be provided to team members). STEP 3: Ethics committee will meet to use the Ethical Framework as a tool to arrive at a decision regarding an ethical dilemma.

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KZHSS – Ethical Framework Tool

STEP 1

Using explicit and clear language, identify: STATE “What is the ethical issue that has been identified?”

THE -ensure to separate fact from fiction -eliminate assumptions, hearsay, etc FACTS: -focus is placed on evidence -identify relevant information and stakeholders -take on an objective state of mind

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STEP 2

Using explicit and clear language, identify: DETERMINE “What ethical principles are in conflict?” ETHICAL -refer to the KZA Code of Ethics PRINCIPLES IN CONFLICT

1st Principle: Explain the Issue:

2nd Principle: Explain the Issue:

3rd Principle: Explain the Issue:

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STEP 3

Identify alternative potential courses of action to be explored and strengths and weaknesses to be identified. EXPLORE Do they harmonize with the vision, mission and values of the organization? THE Once a decision is decided upon, but previous to taking action, it must be determined what type of revision/appeal process will be undertaken in light of new OPTIONS evidence.

Evaluate negative/positive impact.

May be helpful to do role-playing such as playing Devil’s advocate. Brainstorm repercussions.

OPTION STRENGTHS WEAKNESSES 1.

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STEP 4

Develop an Action Plan: -choose the best available option and develop a plan ACTION Evaluate the plan: DECISION & -what is the outcome of the plan? -are any changes required? EVALUATE Self-evaluation of the decision?

-what could be done differently next time? Action Plan:

Evaluate the Plan:

Self-evaluate your decision

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E. CLINICAL GUIDELINES

Evidence-Based Best Practices

POLICY DATE DATE Kitigan Zibi OSA-001 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS uses the latest research, evidence-based guidelines, and best practice information to improve the quality of its services. It collaborates with partners and other stakeholders to facilitate access to clinical information and develops a comprehensive care plan for each client.

PURPOSE

KZHSS clinical guidelines are designed to support the decision-making process in patient care. The content of a guideline is based on a systematic review of clinical evidence – the main source for evidence-based care. Our services are provided by professionals who work with clients, their support systems, and other providers to help the client achieve the highest level of independence and functioning possible in the least restrictive environment.

KZHSS RESPONSIBILITY:

The entire KZHSS team is responsible to follow clinical guidelines as set out in this policy.

PROCEDURES:

KZHSS will access the latest research, evidence based guidelines and best practice information: ▪ Through professional development meetings, invite resource people and provide training sessions to share up to date practices. ▪ Provide a list of contacts for networking with other centers. ▪ Share information and notify all professionals where the information can be attained (i.e. resource library or on-line). ▪ Updated resources available (paper and electronic). ▪ Hire a summer student to collect data, update and provide a list of current research material.

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Provincial

▪ R.S.Q. Chapter S-4.2 An Act Respecting health and social services ▪ R.S.Q. Chapter A-2 An Act Respecting Access to documents held by public bodies and the Protection of Personal Information ▪ R.S.Q. Chapter P-35 Public Health Protection Act ▪ P-35,r.1 Regulation respecting the application of the Public Health Protection Act ▪ R.S.Q. Chapter E-20.1 An Act to secure the handicapped in the exercise of their rights ▪ R.S.Q. C-81 Public Curator Act ▪ C-81,r.1 Regulation respecting the application of the Public Curator Act ▪ R.S.Q. Chapter P-34.1 Youth Protection Act ▪ Guide d’intervention en maladies infectieuses ▪ Ordre des infirmières et infirmiers du Québec ▪ Canadian Diabetes Association Guidelines ▪ Heart and Stroke Association and First Aid protocols ▪ Protocole d’immunisation du Québec, Santé et services sociaux Québec

Federal

▪ FNIHB Pediatric Clinical Practice Guidelines for Nurses in Primary Care ▪ FNIHB Regional Tuberculosis Control Manual ▪ FNIHB Quebec Region Immunization Protocol

Other

▪ Institute for Human Services, Child Welfare Services: Family Centered Intervention CORE100 ▪ Informed Consent for Counselling at the University of Lethbridge

▪ Dieticians of Canada – Assessment from Birth to Childhood (0-5 years), Basic Data Sheet and Risk Factor Identification

▪ PNF – Family centered approach to a clinical intervention process

▪ CPS – Compendium of Pharmaceuticals and Specialties, The Canadian Drug Reference for Health Professionals ▪ National Aboriginal Diabetes Association of Canada

LIST OF STANDARDS

Provincial

▪ Quebec provincial policies and procedures ▪ Santé publique ▪ Quebec Order of Nurses ▪ Département de Protection de la Jeunesse (DPJ) ▪ Policies and procedures for clinical guidelines also responds to provincial regulations for R.S.Q. Chapter S-4.2, R.S.Q. Chapter A-2, R.S.Q. Chapter P-35, P-35,r.1, R.S.Q. Chapter E-20.1, R.S.Q. C-81, C-81,r.1, R.S.Q. Chapter P-34.1, Guide d’intervention en maladies infectieuses, Ordre des infirmières et infirmiers

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du Québec and Protocole d’immunisation du Québec, Santé et services sociaux Québec.

National:

Policy and procedures for clinical guidelines responds to national standards for Aboriginal Community Health and Wellness, Aboriginal Integrated Primary Care and Effective Organizational Standards for Aboriginal Health Services.

Federal:

In addition KZHSS adheres to federal Health Canada, FNIHB guidelines on Pediatric Clinical Practice Guidelines for Nurses in Primary Care, Regional Tuberculosis Control Manual, Quebec Region Immunization Protocol, Home and Community Care Program, Policies and Procedures Manual and the Kiweda Resident Handbook.

Stakeholders (Internal/External):

KZA Community – KZHSS, KZES, Police Department, KZA Community Services, First Nations of Quebec and Labrador Health and Social Services Commission (FNQLHSSC), Comité responsable des soins infirmiers des premier nations du Quebec (CRSIPNQ), Doctors, Police, Pierre Janet, Pavillon du Parc, CLSC, CSSSG (Maniwaki hospital), CHEO, Pavillon Jellinek, Health Canada, KZES, Wanaki, NAADAP Resource Library, Treatment Centres, Counselling Support Groups.

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F. ESCALATION PROCESS

PROGRAM/ The first level responsibility is with the KZHSS Director SERVICE RESPONSIBILITY to apply the policy in every program and service, second level responsibility is with the program or services person responsible for implementing the policy.

When there are issues/concerns that are not in their ability to resolve in their day to day operations as specified in this manual, to bring these to the attention of the Director. These matters can be brought to the Director’s attention in a formal way using the Client’s concerns form.

DIRECTOR: The Director is responsible for resolving issues/concerns brought to their attention by the program/service person. In order to resolve issues they will liaise with other KZA Sectors, Health Portfolio holder, Health and Social Services Advisory Council, Health Canada, Aboriginal Affairs and Northern Development Canada, Accreditation Canada, Ministry of Health and Social Services of Quebec and others to seek clarification and/or advice and to take appropriate remedial steps. Should issues or concerns, as specified in this manual, be outside of their ability or authority to resolve, they will bring these to the attention of the Health Portfolio holder of the KZA Band Council. These issues or concerns will be brought formally to the KZA Band Council to amend the policy.

BAND COUNCIL Band Council is responsible for approval of new and revised policy and works to resolve major issues or concerns as defined in the KZA Appeals Process Guidelines.

The Portfolio holder must not be in conflict of interest as per the KZA conflict of interest policy.

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PART III:

OPERATIONS – KZHSS Program & Service Delivery Overview

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A. KZHSS ADMINISTRATION 1. DIRECTOR’S OFFICE

The Director’s office is responsible for the administration of KZHSS programs and services, strategic and operational planning, financial and human resource management, federal and provincial reporting, allocations and proposals for funding sources for new programs and services and their implementation and communication with other sectors within the KZA and to Band Council.

The administrative role at our Health Centre involves advising Band Council on programming and policy based on health conditions and trends in the community, make recommendations on all decisions and budgets, establish practices and procedures for implementing policy, and manage the 3R’s of program delivery – material resources, financial resources, and human resources.

The office is also responsible for the administration of KZHSS Planned Activities, client complaints, KZHSS site maintenance and infrastructure, Fitness Centre, Special Community Events and weekly Endong senior’s luncheon, accreditation and quality improvement and policy development.

It also authorizes any KZHSS public communication including flyers, posters, radio announcements, internet, etc.

The first level of responsibility for policy is with the KZHSS Director to apply the policy in every program and service, the second level of responsibility is with the program or services person responsible for implementing the policy. 2. ASSISTANT DIRECTOR

The Assistant Director assists in overseeing the overall management and operational needs of KZHSS program and services. The Assistant Director is also responsible for assuming the role of Acting Health and Social Services Director in the absence of the Director or when there is a conflict of interest while managing grievances or complaints. The Assistant Director oversees: ▪ Nicholas Stevens Center Supervision ▪ Youth Sponsorship ▪ Ice Rinks ▪ Training Needs of Non-clinical staff (Collaborates with Nurse Supervisor who ensures clinical training needs of Nurses are met) ▪ Scheduling, distribution and sign-out of equipment and community building keys ▪ Ensures no equipment is lent out to an event where there will be alcohol ▪ Ensures a janitor is available and inspections are made following the events/activities. ▪ contract staff ▪ helps to ensure policies and procedures are followed.

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B. HEALTH PROGRAMS

1.0 PRIMARY HEALTH CARE & COMMUNITY PUBLIC HEALTH

Primary Health Care is provided through prevention and promotion programs and services that are accessible, culturally meaningful and delivered within a safe atmosphere for Kitigan Zibi Anishinabeg community members. Primary Health Care services which include:

▪ health promotion; ▪ disease/illness/injury prevention (i.e. improving health outcomes and reducing health risks); ▪ community public health protection o primary care where individuals are provided nursing diagnostic, rehabilitative, supportive and referral services o communicable disease prevention. Primary Health Care within KZHSS is delivered under the Nursing Framework for Practice, using efficient case management procedures, and under the clinical supervision of the KZHSS Nurse Supervisor.

1.1 Nursing Framework for Practice

“The practice of nursing consists in assessing health, determining and carrying out the nursing care and treatment plan, providing nursing and medical care and treatment in order to maintain and restore the health of a person in interaction with his environment and prevent illness, and providing palliative care.” Nurses Act, article 36. Nursing is guided by the Nursing Framework for Practice. There are six components to the framework for the professional practice of nursing:

1. SCOPE OF PRACTICE: “The RN [registered nurse] scope of practice refers to the activities that RNs are educated and authorized to perform as set out in legislation and complemented by standards, guidelines and policy positions of provincial and territorial nursing regulatory bodies. The depth and breadth of these activities enable RNs to take on multiple responsibilities and carry out a variety of roles.” (Canadian Nurses Association, 2007). The scope of practice is supported by: the Nurses Act, the 14 activities reserved to nurses, the therapeutic nursing plan, collective prescriptions, the Professional Code, other legislation, and the standards, guidelines and policy positions of the OIIQ. In this regard, the scope of practice is defined by the practice of nursing and, in Quebec, that practice is summarized as: “The practice of nursing consists in assessing a person’s state of health, determining and carrying out of the nursing care and treatment plan, providing nursing and medical care and treatment in order to maintain or restore health, prevent illness, and providing palliative care.”(Nurses Act, article 36, 2003)

▪ Nurses Act (17 activities reserved for nurses, TNP, collective prescriptions, etc.) ▪ Law 90 ▪ An Act to amend the Professional Code and other legislative provisions as regards the health sector

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▪ Our Profession Expands (recent changes to the Nurses Act) ▪ Other legislation and amendments.

2. NURSING CODE OF ETHICS The values of the profession found in the O.I.I.Q. Code of Ethics and which define the professional duties and obligations.

3. MANDATORY TRAINING

Obtaining a Nursing diploma or Nursing Degree. 4. REGISTRATION ON THE ROLL OF THE OIIQ (AUTHORIZATION TO PRACTICE)

Any nurse who practices in Quebec is required to be entered on the roll of the Ordre des infirmières et infirmiers du Québec (OIIQ) and therefore must comply with the legislation and regulations governing their profession.

5. ENTRY‐LEVEL COMPETENCIES ▪ Theoretical knowledge and skills ▪ Judgement ▪ Personal characteristics to practice safely and ethically in a given role or environment

6. CONTINUING COMPETENCE AND DEVELOPMENT OF EXPERTISE TO ENSURE THAT THE PRACTICE OF NURSING IS EVIDENCE‐BASED.

Continuing education activities must be in direct relation to nurse’s professional practice. Must be oriented to developing skills pertinent to nursing or transversal competencies necessary to the practice of nursing. ▪ 20 hours of continuing education yearly ▪ 13 hours of non-accredited hours ▪ 7 hours of accredited hours

FACTORS INFLUENCING THE PRACTICE In addition, there are also certain factors that can influence the practice which need to be taken into consideration:

▪ KZA Policies & Requirements Mandate: Primary Care prevention and promotion

▪ Client Needs

▪ Environment of Practice Health Canada Agreements

Any nurse who practices in Quebec is required to be registered with Ordre des infirmières et infirmiers du Québec (OIIQ) and must comply with the legislation and regulations governing the nursing profession. As part of her functions, the Nurse Supervisor must plan, organize, direct, control and evaluate nursing services and programs.

The Nurse Supervisor is responsible for the quality of professional activities provided by nursing staff to the community members. “By law, nurses are the only professionals who may evaluate the quality

KITIGAN ZIBI HEATLH & SOCIAL SERVICES 36 Policies & Procedures Manual of nursing care and, therefore, nurses must also be members of the OIIQ. Consequently, the Nurse Supervisor has both a moral and legal obligation to report any action or conduct that does not ensure the protection of the public and take measures to correct the situation when necessary.” (User Guide Nursing Competencies Evaluation Tool--A guide for Nurses in Charge (NIC) at Nursing Stations and Health Centres 2011).

Nurses are required to meet certain requirements related to professional supervision and specifically:

1. The requirement for licensure to practice and annual registration with the OIIQ; 2. The requirement for professional liability insurance; 3. The requirement for professional supervision related to the scope of practice and code of ethics; 4. The requirement for training and professional development; 5. The requirement related to policies and procedures governing the practice of nursing (e.g.: confidentiality, handling of drugs, protection of medical records, methods of care, etc.). 6. The Nursing practice may be subject to a medical chart audit at any time. Nurses can be subjected to an evaluation at any time.

1.2 Nursing Case Management

Nursing Case management helps community members link to services and support they need. This includes:

▪ completing the initial individual/family assessment ▪ identifying individual/family strengths and assets ▪ working with community members to identify and prioritize their needs and concerns ▪ organizing an interdisciplinary team meeting ▪ developing a service plan with community members that reflects their goals ▪ identify the need for special needs services and helping to access these ▪ services ▪ facilitating referrals when necessary; ▪ evaluating the individual/family service plan on a regular basis, making adjustments based on the family’s needs and desired outcomes

Various screening and assessment tools are used by nurses to identify the needs of families and to determine the level and type of services that will be of most benefit. The program provides education, linkages to support services, as well as resources needed to reduce high- risk behaviours and promote healthy birth outcomes or identify needed services.

During the home visit, the nurse provides information, education and support on health related issues. Regular and consistent home visiting allows the nurse to establish a solid rapport and trusting relationship with families, thereby increasing the receptiveness of families to new information. This results in meeting family needs, improving family functioning and positive family outcomes.

A skilled interdisciplinary team may include the Health Director, Nurse Supervisor, Treating/Visiting Family Physicians, Registered Nurses, Medical Clerk, Nutritionist and other professionals who collaborate to provide primary health care services to the individuals.

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Working together, this team responds to the factors that impact the health and well-being of the individual. They ensure that clients receive the best possible care through the implementation of a therapeutic plan provided by the professional services.

1.3 Clinical Supervision

The Nurse Supervisor is responsible for overseeing all nursing components in all KZA community services in Kitigan Zibi. The Nurse Supervisor provides Clinical Supervision to the Community Health Nurse, In-Home and Community Care Coordinator, In-Home and Community Care Nurse, Education Sector Nurse, Kiweda Group Home Coordinator (Nursing Component).

Nurse Supervisor Responsibility: HUMAN RESOURCES MANAGEMENT ▪ Supervise the KZA nursing staff, allocate duties, oversee and evaluate the performance of all KZA nurses and student nurses when required ▪ Coordinate and approve yearly personal and/or team developmental/training plans which will ensure quality nursing services and continuous development of nursing competencies. ▪ Assist in the recruitment, orientation and retention of KZHSS nurses ▪ Provide nursing leadership according to KZHSS mandate which entails community health services in prevention and promotion and home care services ▪ Ensure professional nursing standards of practice ▪ Observe current nursing practice and assesses the skill levels of current KZHSS nurses and assign the focused clinical nursing practice to each nurse ▪ Provide professional supervision within the nursing scope of practice according to all provincial nursing governing legislations for nursing health professionals in order to maintain and improve competencies. ▪ Continuously review the delivery of clinical and client care (Quality Assurance) ▪ Ensure the respect of laws, norms, Code of Ethics, collective prescriptions etc. governing the nursing profession. ▪ Develop KZHSS nursing policies and procedures (confidentiality, medical records safeguard, annual registration with the OIIQ, professional supervision requirements etc.) to ensure the quality of nursing services provided. ▪ Ensure patient/client Therapeutic Nursing Plans are developed according to established standards, implemented and followed through while working directly with clients as required ▪ Conduct a weekly, or daily when required, “de-briefing” meeting with nursing staff to discuss client files, schedules, nursing procedures and policies, training, health programming activities, work plans, nursing issues, administrative procedures etc. ▪ Ensure accurate reporting of all nursing components of the Health Plan

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HEALTH SERVICES ▪ Analyze needs and services relevant to the health priorities of the community members and nursing service delivery, submit recommendations ▪ Oversee and coordinate the design and implementation of the nursing components in KZA community public health programs, health promotion and prevention services, home and community care as indicated in the overall KZA Health Plan. ▪ Develop measuring tools for process and health impact indicators, ensure follow-up for health programming plan ▪ Assist with the delivery of other KZHSS promotion and prevention programs and activities as required ▪ Ensure the practice of case management within the caseloads (chronic and acute care) ▪ Act as a resource for staff and community resources on issues relating to nursing services ▪ Responsible for ensuring that adequate quantities of clinic and nursing supplies are maintained and ordered when necessary ▪ Responsible for ensuring monitoring and overseeing medication management and medication reconciliation in KZHSS programs.

HEALTH ORGANIZATION ▪ Provide Health Director with relevant statistical data and reports as required ▪ Report, plan and implement nursing service delivery progress in collaboration with Health Director ▪ Manage health service client concerns in collaboration with the Health Director ▪ Attend meetings, conferences, seminars and workshops as a representative of KZHSS upon request from the Health Director. ▪ Develop and maintain partnerships with other Kitigan Zibi activity sectors such as education, police, social services, etc., as well as, provincial and federal organizations, private and non-profit organizations in order to achieve health outcomes for the community members ▪ Collaborate with the local CSSSVG systems with a memorandum of understanding of what service delivery will be available at KZHSS and what will be available with the local systems for KZA community members

REPORTING

▪ ensures reporting requirements are met and in line with funder’s criteria ▪ collect data and prepare/collate reports

1.4. Health Promotion and Disease Prevention

The Health Promotion and Disease Prevention provides prevention programs through: Healthy Child Development to support healthy development of children and families.

Maternal Health & Healthy Child Development a) Prenatal b) Maternal Nutrition c) Newborn/Post-partum d) FASD prevention e) Infant Formula

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Children’s Oral Health Initiative

Healthy Living to reduce the impact of chronic disease.

a) Chronic Disease Prevention/Management Community Public Health Protection

a) Communicable Disease b) Immunization Program c) Bloodborne HIV/STI’s d) Tuberculosis e) Pandemic Plan

Primary Care

a) Clinical and Client Care b) Home and Community Care

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1.4.1 Healthy Child Development

Maternal Health & Healthy Child Development

POLICY DATE DATE Kitigan Zibi PSD-001 05/09/2016 07/29/2019 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS delivers the Maternal Health and Healthy Child Development program which includes prenatal and post-natal health, nutrition, physical, emotional and mental health, and children’s oral health through preconception, pregnancy, birth and childhood.

The KZHSS Maternal Health & Healthy Child Development Program delivers monitors and evaluates this program based on Health Canada’s Healthy Child Development and Healthy Pregnancy and Early Infancy program framework.

PURPOSE

To ensure the quality care and services during the pre-natal stages and post-natal care of mothers and newborns, as well as infant/child health.

To ensure community members have:

▪ improved accessibility to maternal and child health and healthy child development programs and services. ▪ increased support for women and families with young children from preconception through pregnancy, birth and parenting. ▪ an evidenced-based continuum of care that includes prevention and health promotion (awareness and education) and intervention.

KZHSS RESPONSIBILITY

Community Health Nurse

RESPONSIBILITY OF THE CLIENT

Eligibility Criteria: ▪ Prenatal and Post-partum women who are KZA registered band members and their infants/children aged 0-6 who live on- reserve (proof of child registration to KZA band membership required) ▪ Other First Nations women, with proof of status, living in the community with partners from Kitigan Zibi, expecting a baby to be registered with KZA. The KZA father is required to make the request to KZHSS. ▪ KZA women of childbearing age living on reserve

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▪ Women who do not meet the above eligibility criteria may receive prenatal/postnatal services from the local CLSC.

▪ EXCEPTION: A non-KZA registered band member may pick up Infant Formula purchase orders IF their child is a KZA registered band member.

PROCEDURES

a) PRENATAL

The Community Health Nurse provides support to pregnant women through home/clinic visits to receive prenatal services to maintain physical, mental and social skills. Areas of service delivery focus on:

▪ education, teaching and counseling through one-on-one and/or group sessions o maternal nourishment o parenting skills and knowledge o healthy child development o positive lifestyle changes ▪ screening and health assessments of pregnant women to assess family needs o Recommended schedule is once a month for the first 28 weeks of pregnancy, and every two weeks thereafter until birth ▪ nutrition screening ▪ referrals to health care professionals, treatment services and support resources or social supports

b) POST-PARTUM & NEWBORN

The Community Health Nurse provides support to newborns, post-partum mothers, and their families through home/clinic visits. Areas of service delivery focus on:

▪ education, teaching and counseling through one-on-one and/or group sessions o reproductive and preconception health o parenting skills and knowledge o healthy child development o positive lifestyle changes o post-partum support o breastfeeding support o parental involvement encouragement (e.g. supporting activities such as Baby Week or Lots for Tots) o scheduling injury prevention sessions including but not limited to child car seat safety

▪ follow-up, screening, and nursing health assessments: o Complete post-partum and newborn assessments within 7 days of delivery o Healthy ABC’s Assessments for children 0-2 years of age, and 3-5 years of age o developmental screenings and physical examination of children ages 0 to 6 years o early identification of risk factors

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o promote and administer immunization to identified target groups (routine immunizations 0-6 years)

▪ referrals and case management o access to social supports

c) MATERNAL NUTRITION

The Maternal Nutrition Program is a nutritional subsidy which provides pregnant or breastfeeding KZA registered mothers (KZA baby) with weekly nutritional vouchers to obtain eggs, milk and orange juice from the KZ Store. A set of 4 weekly vouchers are distributed by the Community Health Nurse and can be picked up by the end of each month. The breastfeeding mother is eligible to receive the weekly vouchers from 0-24 months of baby’s age. New mothers who did not receive the maternal nutrition vouchers while pregnant but are breast-feeding infants 12 months of age or younger are eligible for the maternal nutrition voucher.

Pregnant and breastfeeding mothers are strongly encouraged to pick up their vouchers in person at the Health Center as this arrangement provides an opportunity for her to receive a health assessment and on-going maternal support from the Community Health Nurse.

PROCEDURE FOR RECEIVING NUTRITIONAL VOUCHERS:

1. Pregnant or breastfeeding mothers must personally come to see the Community Health Nurse to ensure they meet required eligibility criteria. 2. The Community Health Nurse completes an initial health assessment and inputs the information into the computer spreadsheet (e.g. estimated due date, age of mother, trimester). 3. After the initial visit, the pregnant or breastfeeding mother can receive her first set of weekly vouchers, which lasts until the end of the month. 4. Each maternal nutrition voucher expires on the Sunday of each week. 5. Vouchers are only available to be claimed at the KZ Store for a maximum of $25 per week. Only eggs, milk and orange juice may be obtained with this voucher. 6. The distribution of Maternal Nutrition Vouchers will be discontinued when the mothers stops breastfeeding or up to a maximum of 24 months.

For information on the Infant Formula subsidy, please refer to Section E

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d) FETAL ALCOHOL SPECTRUM DISORDER (FASD) PREVENTION

The Community Health Nurse and Education Sector Nurse in collaboration with Ode Widokazowin and NNADAP provides prevention and promotional education that addresses high-risk behaviours pre-conception and during pregnancy through:

o the development of culturally appropriate and evidence-based prevention and early intervention programs related to FASD o Bi-annual workshops with pre-conception age population and child-bearing population

e) INFANT FORMULA

The Infant Formula initiative is an endeavor by KZA to authorize the basic subsidy for the purchase of infant formula. Information regarding this initiative can be found in Band Council Resolution No. 16, dated June 6, 2006.

A letter is required from the Lands Membership and Estates Administrator determining eligibility of a child to be a registered member to be reimbursed for infant formula.

A KZA registered infant is eligible to receive a monthly $150 purchase order (P.O.) for infant formula up to 9 P.O.’s for a maximum of $1350.

Formula fed infants: In the case where an infant is not being breastfed, the infant is eligible for this subsidy from birth to nine months of age.

Breastfed infants: At any time upon the discontinuation of breast-feeding, an infant will be eligible to receive Infant Formula P.O.’s on a monthly basis, up to a maximum of 9 P.O.’s.

Premature infants and babies diagnosed with failure to thrive are eligible to receive preemie milk formula with a purchase order or reimbursement with a receipt until the month the infant turns 12 months of age plus the number of months the infant is premature. A doctor’s note is required.

Parents living off-reserve will issue duly paid invoices to access reimbursement if the purchase order system is not possible in their region of residence; infant formula receipts cannot exceed the maximum amount of $1350. Original receipts are required for reimbursement and should be sent to the Nurse Supervisor or Executive Secretary.

A Nurse can make a clinical decision on a case-by-case basis to determine whether an individual can access both the eggs/milk program and infant formula program simultaneously.

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1.4.2 Children’s Oral Health Initiative (COHI)

Children’s Oral Health Initiative (COHI)

POLICY DATE DATE Kitigan Zibi PSD-002 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS supports the implementation of the Children’s Oral Health Initiative.

PURPOSE

To ensure KZA children develop good dental hygiene and supportive preventative oral health care.

KZHSS RESPONSIBILITY:

KZ Education Sector Nurse, Nurse Supervisor, Dental Hygenist

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: • Children and Youth of the Pakinawatik, Odekan, Wazoson and the Kitigan Zibi Kikinamadinan. ▪ Children from birth to age 7 ▪ Caregivers of children birth to age 7 ▪ Parents expecting a new baby

The goal of the Children’s Oral Health Initiative is to:

▪ reduce and prevent oral disease through prevention, education and oral health promotion; ▪ provide increased access to oral care.

Prevention and promotion activities include:

▪ awareness/education campaigns; ▪ dental presentations at KZHSS Health Center, Wazoson, Pakinawatik, KZ School and/or other community groups; ▪ providing basic on-site services by a visiting dental health care service provider to offer: o dental screenings; o topical fluoride applications; o placement of dental sealants; o alternative restorative treatment; o oral health information sessions; o referrals to other dental care professionals for treatments beyond their scope of practice.

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1.4.3 KZ Education Sector Child/Youth Health Program

KZ Education Sector Child/Youth Health Program

POLICY DATE DATE Kitigan Zibi PSD-003 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS supports the implementation of a comprehensive school health program for the school-age population.

PURPOSE

To ensure KZA students have the opportunity to receive health education and support to adopt healthy lifestyles and thrive during their developmental school age years within a healthy environment.

KZHSS RESPONSIBILITY:

The Education Sector Nurse is responsible to implement a comprehensive school health program under the administrative supervision of the KZA Education Director and under the professional supervision of the Nurse Supervisor.

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: Children and Youth of the Pakinawatik, Odekan, Wazoson and the Kitigan Zibi Kikinamadinan.

Focus is on the implementation of prevention, early intervention nursing assessments and interventions for all children and youth.

Age of consent is 14 years of age.

ODEKAN

KZA Early Childhood Development promotion and prevention activities are offered as a collaborative effort within three programs:

▪ Education Sector Nurse – offers school-based nursing services at KZ School, Odekan, Wazoson and Pakinawatik. ▪ Odekan Coordinator – offers cultural, developmental, and educational services (under the direction of the KZ Education Sector)

KZ WAZOSON, PAKINAWATIK, KZ KIKINAMADINAN

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Health Promotion & Prevention

▪ present various age appropriate health topics to encouraging healthy lifestyle habits within the school year ▪ Promote self-care through good nutrition, exercise, hygiene ▪ Provide an annual standardized preconception health curriculum. ▪ Promote a healthy environment for safety and injury prevention. ▪ Provide information and resources to school personnel, parents and/or students on a variety of topics that include but not limited to: o Nutrition o Fitness o Safety and injury prevention o Smoking prevention and cessation o Drug and alcohol prevention o Stress management o Allergies and Anaphylaxis (including the use of Epipens) o Puberty o Hygiene o Birth control o Self-esteem o Health sexuality and decision-making o Sexually Transmitted Infections (STI’s) o Eating Disorders and Body Image o Bullying and Violence o Immunizations o Diabetes o Self-Harm

On-Site Nursing Assessments And Primary Health Care

▪ Provide preventative health care nursing services to students for acute illnesses, non- urgent care, and uncomplicated minor illness

Screening And Monitoring

▪ Provides annual physical examinations & hearing tests ▪ Conducts vision and hearing screening ▪ Records results on health records ▪ Referral process and follow-up procedures ▪ Ensures immunizations are up to date ▪ Communicates directly with parents, guardians regarding student health issues. ▪ Addresses communicable disease concerns (e.g. scabies, head lice)

Counseling And Referral Of Students To Needed Services

▪ Health services/medical needs that cannot be provided within the school setting are referred to other health services for continual care

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▪ Collaborates with primary care professionals, physicians, nurses, specialists, and local public health and social agencies to ensure a full spectrum of effective and quality services that sustain children, youth, and their families.

Medication Management In The School Setting

▪ The KZ Education Sector Nurse is responsible for overseeing medication management practices within the school setting in accordance with Law 90 Nursing Scope of Practice, and KZ School procedures (e.g. obtaining appropriate consent).

▪ Ensures that the Request and Authorization for the Distribution of Medication at School form and Release of Liability for Distribution of Medication form are signed and entered into the students file if required to take prescribed medication during school hours.

▪ Ensure the correct methods during administration of the prescribed medication.

▪ Ensure that the prescribed medication is in its original container/dispill with the students name and securely stored in the safe in the nurses office.

▪ During her absence ensure delegated task of teaching the correct methods and distributing of the prescribed medication to a list of alternates.

Section 39.8 of the Professional Code states:

“a person working in a school or another temporary alternative environment for children, may administer prescribed ready-to-administer medications by oral, topical, transdermal, ophthalmic, otic or rectal route or by inhalation, and administer insulin by subcutaneous route.”

▪ Identify all students with allergies and medical conditions that the school must be made aware of and advise all school staff members of the students’ medical condition such as the use of an EpiPen.

Health Support

▪ Assist students with special conditions, such as diabetes, through teaching and monitoring. ▪ Counsel students regarding chronic health conditions, mental health issues, pregnancy, STI’s, substance abuse, and other pertinent topics to facilitate responsible decision– making practices ▪ Consult and coordinate with school staff, acts as a resource to classroom teachers. ▪ Communicates with families via school visits, home visits, phone calls. ▪ Participates in case conferences. ▪ Collaborates with other service or care providers i.e Centre Jeunesse de l’Outaouais, Kitigan Zibi Health & Social Services, CLSC etc..

Administration ▪ Prepares health statistics, monthly reports and documentation of student health information. ▪ Ensures all student health files are up to date ▪ Prepares health promotion and prevention programs

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▪ Orders materials required for health promotion ▪ Organizes guest speakers to present health related topics ▪ Maintains nursing office stocked with necessary medical supplies and equipment. ▪ Assists in the development of health policies, goals objectives. ▪ Supports and replaces at the KZHSS when there is a temporary shortage of nurses. 1.4.4 Healthy Living

Healthy Living is provided through promotion activities that encourage healthy behaviours and supportive environments, particularly in the areas of healthy eating, and physical activity. It provides activities that address chronic disease prevention, screening and management, as well as injury prevention.

Chronic Disease Prevention Management

POLICY DATE DATE Kitigan Zibi PSD-004 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS delivers Chronic Disease Prevention/Management programming

PURPOSE

To improve the health status of KZA members through prevention and promotion education activities.

KZHSS RESPONSIBILITY:

Community Health Nurse

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: KZA Member

PROCEDURES:

The Chronic Disease Prevention/Management program is designed to:

▪ contribute to the promotion of healthy living, self-management through supportive environments; ▪ reduce the prevalence and incidence of chronic diseases ▪ help community members manage chronic diseases that may include but are not limited to Diabetes, Heart Disease, Hypertension, Stroke, Cancer, Respiratory Diseases, Mental Health, Musculoskeletal Diseases.

In an effort to maximize the reach and impact of health promotion and primary prevention activities, the Community Health Nurse networks with external/internal partners to provide evidence-based services and activities for community mobilization. Focus is placed on:

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▪ addressing healthy eating, physical activity and obesity; ▪ increasing awareness of diabetes, its risk factors and complications; ▪ supporting diabetes prevention, screening and management. (e.g. retinopathy program, foot-care clinic and diabetes self-management);

a) DIABETES PREVENTION/MANAGEMENT

The Diabetes Program emphasizes the importance of educating healthy behavior choices with the goal of preventing diabetes and its complications through education of diabetes, self-care and taking charge of one’s’ own health.

The Community Health Nurse monitors and evaluates the diabetes prevention and promotion initiatives, tracks prevalence and incidence rates of diabetics within the community, and supports efforts to build the evidence base for diabetes prevention.

DIABETES COUNSELLING SERVICES ▪ All diabetics are seen by the CHN with appointments and are allocated a time for being assessed. ▪ In order to properly manage the disease, it is important the diabetic understands their recommended ranges for blood glucose levels and how lifestyle choices will affect their overall health. ▪ Diabetic teaching of the tests that are run to monitor diabetes and the drugs that they are taking are done in support with other health professionals. ▪ When diabetics are empowered with knowledge, they are able to make the best decisions for their health.

DIABETES PREVENTION & PROMOTIONAL ACTIVITIES ▪ The diabetics and people at risk are offered activities to promote healthy lifestyles. ▪ Diabetes support group activities are offered to the diabetic population, it gets them out to share interaction and support in their health. ▪ Prevention of diabetes activities are also offered to the community at large. ▪ Fitness trainer for diabetics, seniors and youths that are motivated to have active lifestyles and reducing health problems.

DIABETES EDUCATION ▪ Diabetics are offered educational information on diabetes by resource people involved in diabetes. ▪ The CHN offers health teaching, one-on-one and group sessions as required. Information and equipment is offered at the clinic for all diabetics and their families.

DIABETES RETINOPATHY CLINIC

▪ The Diabetes Retinopathy clinic is a Health Canada initiative in collaboration with the Health Commission. ▪ This clinic is designed to reduce the incidence of blindness and ocular deficiency among diabetics by putting in place screening activities via telehealth. ▪ All diabetics are seen by the CHN with appointments and are allocated a time for being assessed.

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▪ Nursing protocol is followed in the screening for the diabetic retinopathy clinic. ▪ All diabetics are informed of procedures and self-care before and after the screening. ▪ Results of the screening are sent to the diabetic, nurse, doctor and ophthalmologist for follow up consultation and treatment.

1.4.5 Community Public Health Protection

Community Public Health Protection within KZA works closely with the First Nations and Inuit Health Branch (FNIHB), Public Health Agency of Canada (PHAC), Le Centre intégré de santé et de services sociaux de l'Outaouais (CISSSO), FNIHB and other regional health care agencies. Kitigan Zibi Health and Social Services adheres to guidelines and directives as outlined by federal, provincial and municipal partners to offer community public health protection to KZA community members. Public health promotion and prevention activities are offered as a collaborative effort within the following program areas: COMMUNITY PUBLIC HEALTH NURSING

▪ prevent, manage and control human health risks associated with communicable diseases ▪ promotion and education efforts to encourage healthy behaviours ▪ community development and capacity building (e.g. proposal-based funding initiatives).

ENVIRONMENTAL HEALTH

▪ prevent/reduce human health risks associated with exposure to hazards within the natural and built environment.* ▪ ensure food and water safety, and safety of living environments; ▪ research to identify and reduce environmental health risks;

For more information regarding the Environmental Health initiatives, please refer to the Environmental Health section of the policy. Public Health Protection requires a comprehensive and integrated approach. The Medical Officer of Health (MOH) for KZA region is a public health physician with the designated role of public health protection, guided by a provincial legislative framework, under the provincial Public Health Act for the Outaouais region. FNIHB also works in collaboration with partners to address the determinants of health, many of which are beyond the direct control of the public health system.

COMMUNITY PARTICIPACTION FACILITATOR

The Community ParticipACTION Facilitator (CPF) mobilizes the community to encourage as many members as possible to lead healthy lifestyles by organizing sports and leisure activities, promoting fitness, and raising awareness of the benefits of regular exercise for better physical and mental health.

▪ Organizes, facilitates and monitors the overall delivery of sports and leisure projects and activities; ensures activity logistics are properly attended to (e.g. contacting of volunteers, availability and access to buildings/sites, ensuring safe and sanitary premises and facilities). ▪ Mobilizes and engages collaborators (employees, partners and volunteers) to identify and address health and fitness needs within the community.

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▪ Shares and facilitates knowledge transfer of well researched pertinent public education materials (e.g. on the radio, in the flyers, etc.), and builds an on-site resource library/inventory of healthy living & activity materials. ▪ Drafts annual reports, annual work plans addressing program goals/objectives, and regular activity evaluation summaries;

Assists and makes recommendations to the Director or Designee regarding program evaluations, proposal development and implementation, program planning (e.g. a planned calendar of events and associated costs), purchase of future program resources and the inventory/control of existing program materials.

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Communicable Disease Control & Management

POLICY DATE DATE Kitigan Zibi PSD-005 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS delivers the Communicable Disease Control and Management program in collaboration with the Public Health Protection, First Nations and Inuit Health Branch (FNIHB), Public Health Agency of Canada (PHAC), Le Centre intégré de santé et de services sociaux de l'Outaouais (CISSSO), FNIHB and other regional health care agencies.

PURPOSE

To reduce the incidence, spread and human health effects of communicable diseases and improve health through prevention and health promotion activities.

KZHSS RESPONSIBILITY:

Nurse Supervisor, Community Health Nurse

RESPONSIBILITY OF THE CLIENT:

To collaborate with KZHSS and/or other provincial agencies

PROCEDURES:

Communicable Disease Control Management program and initiatives support public health measures to mitigate underlying risk factors by:

▪ preventing, treating and controlling cases and outbreaks of communicable diseases (e.g. immunization, screening, directly observed therapy); ▪ promoting public education and awareness to encourage healthy practices; ▪ strengthening community capacity (e.g., to prepare for and respond to pandemic influenza; ▪ identifying risks (e.g., surveillance, reporting)

In collaboration with the province, CDCM program focuses on:

▪ vaccine preventable diseases – e.g. diphtheria, tetanus, measles etc. ▪ blood borne diseases— e.g. HIV/AIDS, hepatitis, etc. ▪ sexually transmitted infections – e.g. chlamydia, syphilis, herpes, etc. ▪ respiratory infections—e.g. influenza, tuberculosis, etc ▪ local communicable disease emergencies – e.g. West Nile, H1N1, Ebola, etc.

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TUBERCULOSIS PREVENTION/CONTROL/MANAGEMENT program aims to:

▪ reduce the incidence of TB disease by detecting and diagnosing the disease early o enhanced screening, contact investigation ▪ provide treatment via Directly Observed Therapy (DOT) o centralized case management ▪ provide public education and awareness ▪ monitor, collect, and analyze active TB cases and case findings disseminate to appropriate agencies.

The Community Health Nurse and Education Sector Nurse: ▪ Collaborates with Sante’ Publique and First Nations and Inuit Health to receive notices and complete contact tracing and client teaching for reportable diseases ▪ Facilitates community’s response to influenza pandemic including the engagement of leadership as required ▪ Distributes information/ material (pamphlets, fact sheets, posters etc.) to community members to promote awareness and education of influenza pandemic ▪ Ensures sufficient supply of medical supplies (needles, syringes, santizer etc.) to implement a mass immunization for community ▪ Participates in local pandemic planning groups for information exchange and/ or coordination of pandemic response ▪ Completes reporting requirements and client charting

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Immunization Program

POLICY DATE DATE Kitigan Zibi PSD-006 mm/dd/yy mm/dd/yy Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS provides immunization services across community member lifespan.

PURPOSE

To improve coverage rates for routine immunizations, reduce vaccine preventable disease, incidence and outbreaks and the development of an enhanced immunization surveillance system.

KZHSS RESPONSIBILITY:

Community Health Nurse, KZ Education Sector Nurse

RESPONSIBILITY OF THE CLIENT:

▪ A consent form must be signed by clients/parents/guardians for immunization administration. ▪ Clients must share/disclose pertinent immunization/health information (eg. immunizations received elsewhere, allergies, etc.)

PROCEDURES:

The Vaccine Preventable Diseases (VPD) Program supports activities that inform, educate and create awareness on vaccine preventable diseases and immunization. Data is collected and monitored through Quebec’s provincial database system SI-PMI (Système d'information en protection des maladies infectieuses).

The immunization program focuses on :

▪ routine infant series ▪ preschool immunization ▪ routine immunization across the lifespan

KZHSS adheres to the “Protocole d’immunisation du Quebec” (P.I.Q) for all procedures and protocols related to Immunization.

Community Health Nurse and Education Sector Nurse:

▪ improve coverage rates for routine immunizations o ensure access to newly recommended vaccines

▪ reduce Vaccine Preventable Disease (VPD) incidence and outbreaks o Administering vaccines according to PIQ (Protocole d’immunisation du Québec);

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o Refer to the SI-PMI system and/ or client chart to determine client immunization needs. o notifies community members when they are due for vaccines; o Assists client with obtaining immunization records from other health services providers o Completes reporting requirements and charting for adverse events. o Coordinates with other health services staff to offer mass immunization clinics

Community Health Nurse:

▪ Vaccine storage and maintenance o Maintains vaccine cold chain protocols by monitoring temperature and maintaining logs for both the fixed vaccine refrigerator and the portable vaccine coolers. o Ensures vaccine refrigeration equipment is maintained in good working order and arrange for servicing or replacement as required. o Reports vaccine cold chain breaks and record vaccine loss to Sante’ Publique using reporting forms and processes. o Effectively forecasts for vaccine equipment needs while monitoring and documenting wastage.

▪ Report within an enhanced immunization surveillance system. o improve data and understanding of immunization coverage rates, the incidence of vaccine preventable diseases, barriers to immunization and best practices in implementation. o Complete and maintain current training and education requirements for the administering of vaccines as required.

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Pandemic Plan

POLICY DATE DATE Kitigan Zibi PSD-007 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS works closely with the First Nations and Inuit Health Branch (FNIHB), Aboriginal and Northern Development Canada (AANDC), Public Health Agency of Canada (PHAC), Le Centre intégré de santé et de services sociaux de l'Outaouais (CISSSO), FNIHB and other regional health care agencies to collaborate in the delivery and implementation of regional pandemic emergency measures.

PURPOSE

To provide a seamless, comprehensive and coordinated plan and response to communicable disease emergencies.

KZHSS RESPONSIBILITY:

Nurse Supervisor, Community Health Nurse

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria:

The Kitigan Zibi Health and Social Services Pandemic Influenza Preparedness Plan was designed to be incorporated into the Kitigan Zibi Anishinabeg Emergency Preparedness Plan. The KZHSS Pandemic Influenza Preparedness Plan addresses the communities’ response to potential communicable disease emergencies (e.g. influenza, H1N1, ebola, West nile).

Communicable Disease Emergency activities include: ▪ support mass immunization clinics, training, and relevant guidance documents for staff. ▪ ensuring health facilities have access to personal protective equipment (e.g., masks, gloves, gowns) during a pandemic. ▪ education on infection prevention and control.

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1.4.6 Client Primary Care

Client Primary Care is a coordinated system of health services at the first point of individual contact by KZHSS. It is a set of integrated and accessible health care services where health promotion and disease prevention actions are directed towards individuals/families in the course of provision of care by:

▪ identifying cases requiring complex care; ▪ the coordination/and or integration of care; ▪ timely referral to appropriate provincial secondary and tertiary levels of care outside the community.

Primary care is offered as a collaborative effort within two programs: ▪ Community Health Nursing clinical and client care – assessment, rehabilitative, supportive care services. ▪ Home and Community Care – assessment, rehabilitative, supportive, palliative end-of-life care services.

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Clinical and Client Care

POLICY DATE DATE Kitigan Zibi PSD-008 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS provides clinical and client care through an integrative approach by a collaborative health care team

PURPOSE

To provide essential care services for community members by being the first point of individual contact within the Health Center.

KZHSS RESPONSIBILITY:

Community Health Nurse, Medical Clerk

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: Kitigan Zibi community members.

Essential health care services for community members

o Urgent Care: immediate assessment of an injured/ill client to determine type of referral required. o Non-Urgent Care: assessment, identification of problem(s), as well as developing, implementing, and maintaining/follow-up of a client care plan

▪ Access to limited medical equipment, supplies, medication. ▪ ▪ Includes health promotion and disease prevention at the client/family level in the course of treatment ▪ ▪ Education: o provide individual teaching and counseling during screenings, examinations, observations, and during regular course of duties ▪ Preventative care: includes answering health concerns with updated information, health screening, physical exams, immunizations and minor procedures such as basic injections as medically prescribed, suture removal and minor wound care ▪ Provide advocacy for clients to increase access to health services by establishing linkages with other service providers. ▪ includes coordination/referral to appropriate service

▪ provincial secondary and tertiary levels of care (healthcare providers and/or institutions) outside the community. ▪ internal/external health, social and education programs (e.g. Home Care Program, Ode Widokazowin, NNADAP). ▪ therapeutic services (e.g. psychologist) includes physician visits

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▪ Maintains and updates client records, ensures client information is kept confidential ▪ Monitor and maintain registry of clients with chronic and high-risk conditions ▪ Record client encounters and activities in a daily log

Ongoing monitoring, planning, reporting and evaluation is essential for the safe and effective delivery of clinical and client care.

a) Doctor’s Clinics

▪ Ensure RAMQ Medical card is updated. ▪ Show up to all appointments, or call the Medical Clerk to cancel /reschedule the appointment. ▪ Ensure follow-up of instructions regarding referrals (ie. calling for an appointment at the hospital) ▪ The processes of mutual involvement in conducting an interview with the health professional and the individual or family members in order to plan, implement and review the care provided is appropriate, support, and achievable. ▪ To preserve and promote health status by maintaining independence as much as possible by benefitting in performing self-care safely and independently. ▪ To agree to take charge and control of their health needs with assistance of the professional. ▪ Knowledge of services to support implementation of health care services and change if needed with the aid of family members when required.

COMMUNITY HELATH NURSES ROLE IN ASSISTING WITH VISITING PROFESSIONALS

▪ Perform clinical duties within required level of clinical competency. Explain procedures to clients, providing them with support and reassurance. ▪ Collection/handle pathology samples. ▪ Assist doctors with clinical procedures. ▪ Ensure the medical supplies and equipment in the Doctor’s offices and examination rooms are adequately stocked and organized ▪ Conduct preventative/screening procedures i.e vision tests ; assist with patient education and community health promotion activities. ▪ Ensure sterilization and maintenance of clinical equipment. ▪ Maintain stocks of clinical supplies, including correct storage (such as refrigeration), removal of out-of-date stock and ordering supplies. ▪ Maintain awareness of current infection control, sterilization, hazardous materials & safe handling/disposal of medical waste, records management, OHS, and accreditation. Delegate tasks to other non medical staff.

The CHN’s support and replace other Nurses within the other programs when there is a temporary shortage of Nurses

b) Medical Clerk

The Medical Clerk assists the visiting physicians/therapists in the efficient functioning of the medical clinic. The Medical Clerk:

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▪ Greets, responds, and follows-up to client/visitor and health-professionals requests both within the clinic and over the phone. Due to the time-sensitive nature of processing physician/client requests, the Medical Clerk will respond in an efficient, prompt and timely manner, while maintaining professionalism and courtesy. ▪ Oversees and facilitates scheduling (using the Kinlogix database system), client-flow, and clinic logistics on scheduled visiting physician/therapist days. ▪ Processes all necessary pre- and post-clinic visit client documentation: o obtains informed consent forms o reimbursement forms o prescription renewals for the doctor o referrals to applicable persons/agencies o scanning of client records ▪ Manages and maintains accurate and current client medical file information in paper and electronic formats; provides access of specified file information to authorized persons/agencies upon request. ▪ Prepares, cleans and stocks clinic area (doctor’s offices, waiting room) with required medical and stationary supplies. ▪ Works in close collaboration with visiting health care professionals, physicians, residents, nurse practitioner, psychologist, to ensure clients receive required care and/or are referred to appropriate resources. ▪ Supports KZHSS clinical staff in maintenance of the KZHSS Clinic, ▪ Networks with local clinics/agencies including hospitals (CSSSVG, CLSC) and pharmacies (Familiprix and Jean-Coutu) as well as out-of-town health care clinics/organizations. ▪ Interacts with governmental departments and agencies in collaboration with client/health professionals requests including Health Canada (F.N.I.H.B. and Non- Insured Health Benefits), Regie d’Assurances Maladie du Quebec (R.A.M.Q.), Santé Publique.

The Medical Clerk oversees and maintains management of client medical files and ensures protection and confidentiality of sensitive healthcare information. Please refer to the Information Management section for medical records maintenance.

c) Home and Community Care Primary Care

Please see Home and Community Care section for client care.

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Medication Management -Clinical and Client Care

POLICY DATE DATE Kitigan Zibi PSD-008 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS ensures safe medication management practices in relation to the over the counter medication program within the Health Center clinic.

PURPOSE

To ensure quality client care and the safe procedure with regards to medication management, promote compliance.

KZHSS RESPONSIBILITY:

Nurse Supervisor, Community Health Nurse

RESPONSIBILITY OF THE CLIENT:

▪ Follow instructions provided by Health Care professionals. ▪ Clients should always follow directions provided on the medication labels.

The Community Health Nurse with the client and/or family will collect and communicate accurate information about client medication, including over-the-counter medication, vitamins, and supplements and ensure the client and/or family understands that it is a shared responsibility. The CHN advocates to the doctor for client’s needs and liaises with the local pharmacist, when required.

OVER-COUNTER-MEDICATIONS (OTC)

▪ Health Centres are authorized to provide only certain specific over-the-counter medications used to treat occasional health problems (e.g., fever or rash symptoms, lice infections, infected wounds) through Collective Prescription Agreement Procedures with supervising doctor and local health resources. ▪ FNIHB’s “Policies and Procedures – Pharmacy” are the standards of practice followed by the nursing personnel within the clinical setting. ▪ Nursing health assessments are conducted and clients are evaluated and are informed of the use of the over-the-counter medication that is required. ▪ To obtain over-the-counter medications that are not provided at the Health Centre, clients are required to go to their respective pharmacy. ▪ Clients are informed that before going to the pharmacy, they should get a prescription from their doctor (valid for a maximum of one year). It may be necessary for the client to make an appointment with their doctor to evaluate if the over-the-counter medications OTC use is suitable for their health. ▪ Several over-the-counter medications are covered and available free of charge with a valid prescription through Health Canada’s Non-Insured Health Benefits Program.

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▪ Clients may ask the Community Health Nurses if certain over-the-counter medications are covered. ▪ For medication not covered, information regarding over-the-counter drug coverage can be obtained through Health Canada’s Non-Insured Health Benefits Program at 1-877-483- 1575.

CHANGES TO THE PROCEDURES FOR DISPENSING OTC MEDICATIONS

▪ KZHSS is informed by Health Canada of any upcoming changes for dispensing over OTC medications. ▪ Health Canada provides KZHSS with a list of OTC medications.

DRUG INVENTORY

▪ KZHSS uses the Wendake Drug Distribution Centre ProMed program to order limited medications and supplies. ▪ The Community Health Nurse performs a scheduled review, clean-up of expired medications and ordering of OTC medications on a monthly basis.

EXPIRED MEDICATIONS

▪ The Waseya House, Kiweda Group Home, as well as any community member may bring expired/discontinued/unused medications to the Health Centre for disposal. ▪ Expired medications are discarded in the biomedical waste bin by the Community Health Nurse, which is kept locked in a special freezer storage area until the bi-annual scheduled Biomedical Waste Transportation SteriCycle picks it up.

STORAGE

▪ Medications are kept in a controlled, locked location. ▪ Only the Nursing personnel and the Doctor have authorization, no other staff will have access to the area. ▪ Should someone require access (e.g., Medical Clerk, building maintenance workers etc.) they will be accompanied by the Nurse.

MEDICATION SAMPLES:

▪ Doctors may receive pharmaceutical samples for use in their practice. ▪ All samples will be kept in the Doctor’s locked cabinet. ▪ Distribution of samples is only authorized by the Doctor.

REPORTING:

All medication errors, near miss, and adverse drug reactions must be reported. For more details regarding this process, please refer to the Incident Reporting policy.

EVALUATION:

▪ Evaluation of all medication errors, near misses, and adverse drug reaction reports will occur on a quarterly basis by the Accreditation Team.

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▪ Evaluation of ALL Medication Management Practices will be done on an annual basis, led by the Nurse Supervisor and Accreditation Team.

TRAINING:

▪ On-going training regarding roles and responsibilities for medication management activities within the scope of practice will occur on an annual basis, coordinated by the Nurse Supervisor. Examples of training topics that may be addressed in regards to medication management include: o side effects prevention o role of reporting medication errors, near misses, adverse drug reactions o delegated duties o documentation o updated techniques, skills, knowledge

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2.0 HOME AND COMMUNITY CARE

Home and Community Care

POLICY DATE DATE Kitigan Zibi PSD-009 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS provides Home and Community Care services in accordance with FNIHB Home and Community Care Framework.

PURPOSE

To support and promote community member independence and autonomy through family involvement and community resources which will enable the client to live in their own environment as long as possible

KZHSS RESPONSIBILITY:

Clinical Supervision: Nurse Supervisor

In-Home Community Care Coordinator, In-Home Care Nurse, Personal Support Workers, Heavy Duty cleaners, Water Cooler Cleaners, Winter Component Workers

In-Home and Community Care services are offered from Monday to Friday between the hours of 8am to 4pm.

Heavy Duty Cleaners and Winter component workers are required to re-apply every year and pass an annual physical exam.

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: ▪ Registered Kitigan Zibi Anishinabeg Band member living on- reserve ▪ Supported with a medical prescription or referred from other services with proper documentation ▪ Completed MULTI-CLIENTELE AUTONOMY ASSESSMENT, with HCC Coordinator ▪ Support to caregivers who are providing palliative care (end-of- life care) with the collaboration of the CLSC on a case by case basis. ▪ Respite Care: Provide relief to caregivers for short term only on a case by case basis depending on funding availability. ▪ Elderly with loss of autonomy ▪ Disabled person support ▪ KZA Band members who are accidentally injured or with the onset of a serious illness may receive services for a short term period as determined by the assessment. This includes

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members CSST support (Workman Compensation) and SAAQ benefits (Quebec Automobile Insurance) o KZA Band employees on sick leave without pay may be eligible for Home Care Service evaluation with a prescription from the doctor.

ASSESSMENT/EVALUATION PROCESS:

▪ Complete autonomy assessment provide supporting documentation ▪ Complete and sign In-Home Care service agreement. o For the safety of all workers, clients are required to provide complete and accurate information regarding their current health status/situation at the time of their assessment and if/when their situation changes. Failure to do so may result in re- evaluation/disruption of service delivery. ▪ Provide KZHSS Informed Consent Form.

DURING SERVICE DELIVERY:

▪ Be respectful all employees entering the home. Violence (physical/mental) will not be tolerated. ▪ Provide all necessary supplies required for cleaning, meal preparation and personal care. ▪ Ensure equipment (such as vacuum cleaner, electrical equipment) is safe and in good working order and client understands that the workers are not responsible for damage to equipment. ▪ Place personal items of value/importance into supplied basket before the scheduled visit of any worker. This may include: medication, jewelry, glasses, money/change, a cell phone, keys, remote control or any other personal effects. This is to avoid having personal effects misplaced during the cleaning of the client’s home. ▪ If assistance is required with banking, the client must be present. There must be a third party witness to money transactions between the worker and client. ▪ Understand that In-Home Care Workers are directed to follow a care plan and any changes are to be made with the In-Home Care Coordinator in advance. ▪ Understand that In-Home Care Workers are required to adhere to a schedule and should not be expected to remain past the schedule departure time of the scheduled shift. ▪ Be present at home in order to receive services and will notify the Coordinator or leave a message 24 hours in advance when service is not required during a scheduled time. Failure to do so after 5 occasions may result in services being reassessed. ▪ Restrain any animals outdoors or in a room other than where the worker is providing services ▪ Provide a safe and smoke-free environment for the worker. The client, if a smoker, is required to smoke outdoors while the worker is providing services. ▪ When the need for care exceeds what can be provided, or the client’s health status/situation changes (ie. post-hospital discharge), the client may be re-evaluated.

ROLE OF FAMILY/CAREGIVERS:

▪ Be actively involved and supportive to their relative who is accessing In-Home Care services. ▪ Assist client with home management.

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In-Home Care Winter (Outside) services are not provided if there are other family members living within the home capable of conducting own winter maintenance. The opening of the driveway and shoveling of both walkways are the responsibility of the home owner.

PROCEDURES:

Home and Community Care is a coordinated system of home and community-based health care services that enable community members of all ages with disabilities, chronic or acute illnesses and the elderly to receive the care they need in their homes.

Home and Community Care is delivered primarily by the Home Care Coordinator, the Home Care registered Nurse, and trained Personal Support Workers (PSWs). Service delivery is based on assessed need and follows a case management process.

Essential service elements include:

CLIENT ASSESSMENT

▪ using the Multi-clientele assessment tool which determines client needs and service allocation ▪ requires ongoing reassessment ▪ completed within 72 hours of receiving referral ▪

HOME CARE NURSING

▪ direct service delivery ▪ supervision and teaching to PSW’s ▪ providing personal care services ▪ medication reconciliation ▪ support to family caregivers

CASE MANAGEMENT

▪ care planning, referrals and service linkages to existing internal/external services

HOME SUPPORT

▪ personal care services such as bathing, grooming, dressing, transferring and care of bed-bound clients ▪ home management assistance services such as general household cleaning, meal preparation, laundry and shopping

IN-HOME CARE RESPITE

This service is only provided upon evaluation for short term purposes and only if financial resources are available. Family or caregivers are in charge to find the resources for the time allotted at the minimum rate based on the Salary Scale.

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LINKAGES AND REFERRAL, AS NEEDED, TO OTHER HEALTH AND SOCIAL SERVICES;

▪ may include coordinated assessment processes, referral protocols and service links with such providers as hospitals, physicians, respite, therapeutic services, gerontology programs and cancer clinics

PROVISION OF AND ACCESS TO SPECIALIZED MEDICAL EQUIPMENT AND SUPPLIES FOR CARE

▪ specialized to client needs within home and community care ▪ Medical equipment available at the Health Center for short term use ▪ Medical equipment for long term use requires a medical prescription

A SYSTEM OF RECORD KEEPING AND DATA COLLECTION

▪ program monitoring, ongoing planning, reporting and evaluation activities and to provide safe storage and handling of confidential client health records.

COMPLEMENTARY SERVICES

▪ in-home palliative care in collaboration with the CLSC; ▪ foot care is provided only if the schedule of the Foot Care Nurse allows Services for preliminary first stage care of feet such as: ▪ General awareness information on proper foot care. ▪ Basic foot health assessment, hygiene and nail cutting. ▪ Early identification and referral of other foot problems. ▪ Basic foot care service is provided and referrals will be made to orthopedic professionals beyond

▪ occasional specialized health promotion & wellness projects such as health and safety fairs, falls prevention activities.

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THE HOME AND COMMUNITY CARE COORDINATOR

The Home and Community Care Coordinator is accountable and responsible for the development, delivery, evaluation and administration of the program and its services.

The Home And Community Care Coordinator ensures:

▪ budget is properly monitored and maintained ▪ through continual assessment that services delivered are effective, cost efficient and client centered. ▪ equitable access to the services in collaboration with the multi-disciplinary teams involved ▪ confidentiality of information concerning clients and staff ▪ staff has the necessary knowledge, skills, ability, and certification required to deliver quality services ▪ reports are made to funding agencies and to community leadership ▪ meets and evaluates new and current staff, provides orientation, and conducts weekly meetings ▪ supports and educates family members as to their role in the client evaluation, and caregiving ▪ assesses client satisfaction ▪ supports and replaces other Nurses when there is a temporary shortage

THE HOME AND COMMUNITY CARE NURSE PROVIDES:

▪ Client Assessment (individual and home safety) ▪ Health maintenance (teaching, vital signs, monitoring and physical assessment). ▪ Medication reconiciliation ▪ Referrals and/or follow-ups to medical professionals and external service delivery agencies ▪ Pre/Post Hospitalization (basic dressings, evaluations and medications). ▪ End of life care (oxygen, hydration, medications and pain control with collaboration of the C.L.S.C.). ▪ Short-term acute care (injections, dressings and crisis intervention). ▪ Updates and maintains client’s file and Therapeutic Nursing Plan (TNP) ▪ Works with others as a team ▪ Reports to the Home and Community Care Community Coordinator

HOME NURSING VISITS

▪ Scheduled nursing home visits are determined by the case management procedure. Scheduled services will occur in accordance with changes in health status as verified in case management. For example, if the health of the client gradually improves and stabilizes, the home nursing visits are adjusted to bi-weekly, monthly or as needed basis. Additionally, the need for a scheduled home visit may not be necessary if the client sees their family Doctor within the same week.

▪ The Home Care Nurse assists in maintaining a safe environment to allow the client to stay in their home/residence if they wish and to promote independent living as long as possible.

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▪ When a client does not answer the door when a home visit is scheduled to occur, a Nurse/Worker will follow-up with a phone call to the client, and perhaps family members to ensure the client’s safety. The In-Home Care Coordinator will also be kept informed. ▪ Provides medication reconciliation and management assistance. See Medication Management Section for further details.

For Kiweda Nursing home visits, please refer to the Kiweda Group Home section of this policy.

HOME & COMMUNITY CARE CLERK

Distributes approved schedules to In-Home Care, Heavy Duty and Winter Component Workers. - Prepares and distributes weekly service delivery schedules to workers; - Assists with assigning and scheduling workers to individual HCC clients; - Manages changes to client service schedules; - Responds to daily inquiries from HCC clients regarding programs and services; - Assists with monitoring workers regarding adherence to schedules/attendance; - Issues safety equipment and material to workers in accordance to safety kit standards; - Maintains communication with HCC Coordinator or designate identifying any concerns or occurrences involving persons or property by following reporting protocols.

Administrative: - Collects time sheets/books for processing payroll; - Maintains a detailed and accurate records management and filing system; - Assists in the completion of program reporting requirements including clinical data entry as required and adheres to reporting deadlines; - Maintains and replenishes inventory of office and medical supplies as required; - Obtains estimates and purchases seasonal supplies (i.e.) salt, cleaning supplies, equipment; - Arranges for Lifeline System Program for clients; - Assists in preparation for meetings, Health Fair and Safety Fair; - Reports pertinent information to the HCC Coordinator.

Management of Medical Equipment Loans. - Oversees the daily loaning and cleaning of medical equipment requested by community members; - Records loaned, broken and new equipment into the red beam database; - Coordinates training for workers on sanitizing equipment and records usage and maintenance; - Acquires cost estimates for new and equipment and associated repairs.

Medical Clerk Replacement as per schedule: - Undertakes various clerical tasks in support of clinics during scheduled visiting physician days such as: greet and follow-up with clients on-site and over the phone; photocopying; hospital mail delivery; email responses to doctors, etc.

General Duties: - Completes other job related duties assigned by the HCC Coordinator or designate in relation to office and program support.

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HOME AND COMMUNITY CARE WORKER

▪ Must have Personal Support Worker (PSW) certification ▪ May have to provide assistance with daily living activities: o Hygiene care and grooming o Assistance with physiotherapy ▪ Promotes independence by providing home management and personal care assistance. ▪ Provides assistance with daily activities. o No household cleaning will be done for other family members ▪ Provides assistance with Respite and Palliative Care. ▪ Seniors visits in institutions, hospitals, Kiweda, etc. ▪ Must pass an annual physical capacity test. ▪ Ensure that Home Care Support Program In-Home Care Maintenance Services Report is completed. ▪ Attends Monday morning meetings ▪ Responsible to update First Aid, CPR and any course offered for this program

IN-HOME CARE WORKER:

▪ Meal preparation, home maintenance (eg. dishes, laundry, clean bathroom, etc.) and errands. ▪ Cares for client’s individual personal space within the home. ▪ Provides assistance with Respite and Palliative Care. ▪ Ensures that Home Care Support Program In-Home Care Maintenance Services Report is completed ▪ Attends Monday morning meetings ▪ Responsible to update First Aid, CPR and any course offered for this program

The In-Home and Community Care Program staff are NOT authorized to provide the following services: ▪ Pick-up or transport medications from the pharmacy, or administer any prescription or non-prescription medications. ▪ Handling of personal finances, cash, cheques, credit/debit card, lottery tickets and valuables. If any banking activities must be done, the client must be present. There must be a third party witness to money transactions between the worker and client. ▪ Sign or witness legal documents (ie. wills, estates, etc.) or provide advice regarding all personal financial and/or business matters. ▪ Perform personal services for family including care of minor children or pet care. (ie. running errands, doing dishes, ironing, paying bills, cooking, doing laundry and cleaning rooms or spaces belonging to other family members that may be living in the home) ▪ Manage the woodstove by lighting a fire, putting in wood, or cleaning out ashes, cleaning the chimney or any other related wood stove tasks. ▪ Accompany/escort clients to the dentist, doctor visits, or to the hospital (Medical Transportation is responsible for this.) ▪ Yard work, gardening, cleaning gutters, auto maintenance, splitting or bringing in firewood, shoveling driveways (Snow removal is limited to entrance steps and porch only)

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▪ Taking clients for leisurely rides (i.e. joyriding) ▪ Go to stores for browsing only (e.g. the Mall or the Flea Market)

IN-HOME CARE SEASONAL WINTER WORKER (OUTSIDE):

▪ Assists eligible clients to address issues regarding winter (outside) needs. ▪ Shoveling and sanding of the main porch and alternate exit, as well as a path to the vehicle. ▪ Ensures snow removal and salting of access/exits/steps at the Kiweda Group Home and Community Hall. ▪ Ensures that Home Care Support Program In-Home Care Maintenance Services Report is completed ▪ Attends Monday morning meetings ▪ May be assigned other related task(s) by the Home and Community Care Coordinator or alternate.

IN-HOME HEAVY-DUTY CLEANING SEASONAL SUMMER WORKER:

▪ Provides heavy duty house cleaning (e.g. thorough washing of walls, windows, floors etc.) to ensure a clean and safe environment for eligible clients. ▪ All supplies are provided by KZHSS ▪ Ensures that Home Care Support Program In-Home Care Maintenance Services Report is completed ▪ Attends Monday morning meetings

WATER COOLER CLEANING WORKER:

▪ Provides water cooler cleaning for eligible clients once per year for homes where water delivery occurs by KZA services. ▪ Ensures that Home Care Support Program In-Home Care Maintenance Services Report is completed ▪ Attends Monday morning meetings

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3.0 Medical Transportation Services

Medical Transportation Services

POLICY DATE DATE Kitigan Zibi PSD-010 05/09/2016 07/29/2019 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS administers the Medical Transportation program within Kitigan Zibi Anishinabeg according to the terms and conditions outlined within the Non-Insured Health Benefits Medical Transportation Policy Framework.

PURPOSE

To assist clients to access medically required health services, whether insured through a provincial health insurance (e.g. RAMQ) plan or Non-insured Health Benefits provided through Indigenous Services Canada (ISC).

KZHSS RESPONSIBILITY:

MEDICAL TRANSPORTATION DISPATCHER:

Coordinates, schedules and organizes logistics of medical transportation: • establishes daily, weekly, and weekend work schedules; • develops and maintains a diverse roster of competent and qualified medical drivers with proof of required documentation who are safe, productive and efficient when operating a KZHSS vehicle and completing their functions; • dispatches drivers while accounting for client condition/status, inclement weather conditions, and other pertinent factors (e.g. age and gender); • arranges for an escort; maintains communication between client and driver regarding medical trip details (i.e. time and place of pick-up/drop off) and wherever possible, ensures efficient practices (e.g. maximum number persons to a vehicle); ensures drivers compliance to submitting of daily logs/reports; ensures client eligibility criteria is met and confirms validity of medical trips;

Monitors and evaluates work performance and driver competencies: • ensures compliance to KZHSS policies, procedures and reporting/documenting requirements (e.g. when vehicle sustains damage, incident reporting) • ensures driver’s compliance to clean their respective vehicle with proper infection prevention and control techniques; • updates drivers of current problems, concerns, changes, and new developments through periodic meetings; • trains drivers in the areas of occupational health and safety, infection prevention and control, quality improvement and confidentiality ; • co-ordinates First Aid/CPR training; • makes recommendation for resolutions, changes and improvements to prevent accidents/injuries.

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Establishes and monitors fiscal budget and reporting system: ▪ adjusts payroll to account for overtime considerations; ▪ prepares cheque requisitions, travel advances, financial and statistical reports for appropriate clients, drivers, supervisors and agencies; ▪ maintains effective relationship with First Nations counterparts, federal and provincial agencies; ▪ ensures compliance to Health Canada’s Annual Administrative Contribution agreement.

Purchases, maintains, registers and insures fleet of KZHSS vehicles: - networks with the dealerships and researches various factors in selection of new vehicles based on price and vehicle suitability to the program requirements; - ensures prompt adherence to (un)scheduled vehicle repair/maintenance (e.g. damages, oil changes, winter/summer tire rotation); - assists in discarding (sale) of older vehicles through community call-for-bids process.

MEDICAL TRANSPORTATION CLERK

Under the Supervision of the Medical Transportation Dispatcher, the Medical Transportation Clerk provides administrative and logistical support in a courteous and professional manner. As part of the Health and Social Services Team, the objective is to ensure quality service delivery to clients in an efficient manner.

Administrative Duties: - collects time sheets/books for processing payroll; - maintains a detailed and accurate records management and filing system; - assists in the completion of program reporting requirements including data entry, scheduling and reporting; - collates documents and prepares client reimbursement lists for approval; and, - reports pertinent information to the Medical Transportation Dispatcher.

Medical Transportation Dispatcher Replacement as per schedule: - undertakes various clerical tasks in support of transportation services: greet and follow-up with clients on-site and over the phone; photocopying; hospital mail delivery; email responses to doctors, etc.; - assists in determining client eligibility for medical transportation services; - communicates general information to clients in the absence of the Medical Transportation Dispatcher; - participates in staff meetings, focus groups and planning meetings; - assists in the coordination of training for drivers; - attends training as required; - in the absence of the Medical Transportation Dispatcher, ensures regular care and maintenance of vehicles; and, - in the absence of the Medical Transportation Dispatcher, schedules and coordinates medical trips and holiday driving schedules.

General Duties: - completes administrative and office support duties assigned by the Medical Transportation Dispatcher or designate in relation to office and program support.

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MEDICAL TRANSPORTATION DRIVER

Both local and out-of-town Medical Transportation drivers have the same underlying duties, with the main difference between them being the distance that they cover. Local drivers generally stay within the community, town of Maniwaki, and within a 10 km radius of the area. Out-of-town Medical Transportation Drivers exceed the 10km radius and are required to travel long distances and within major cities.

Medical Transportation drivers must drive the trips assigned to them by the Medical Transportation Dispatcher.

1. Operational Duties involving the CLIENT: - Ensures logistics of local medical transportation is carried out according to client needs/appointments; - Operates medical vehicle using extreme caution, ensures passenger safety at all times by using defensive driving techniques and maintaining strict adherence to traffic laws. - Assists elderly or disabled passengers with embarking and disembarking the vehicle and provides door-to-door accompaniment; uses proper procedures when transporting a wheelchair-bound client to ensure the passenger is properly secured once inside the vehicle and the passenger is properly received by a responsible individual before leaving the destination; - Takes meal breaks for diabetics at regularly scheduled intervals, upon request of the client. - Ensures every client receives/submits their duly completed, stamped and signed/initialed preauthorization form for same day trips in accordance with the Medical Transportation Policy - Picks up medical equipment when required.

2. Maintenance Duties involving the VEHICLE: - Performs daily and periodical vehicle maintenance and visual inspection (e.g. verifies tire pressure, gas, oil and fluid levels) and reports any malfunction or maintenance attention to the dispatcher; - Performs visual inspection (circle check around the vehicle) and completes the safety checklist prior to each trip; - Ensures vehicle interior is cleaned according to proper infection, prevention and control procedures and that the vehicle is properly equipped (e.g. First Aid, mask, gloves, flashlight, garbage can of disinfectant/deodorizer). - Ensures the vehicle is returned with a full tank of gas to the Health Center at the end of each trip (unless pre-authorized for alternate arrangements with the Medical Dispatcher).

3. Administrative Duties toward the MEDICAL TRANSPORTATION DISPATCHER: - Complies with service delivery requirements such as submitting daily logs/reports in a complete and organized fashion and on time; keeps abreast of problems, changes, new developments through periodic meetings with the dispatcher/supervisor; - Ensures client eligibility criteria is met and confirms validity of medical trips; - Ensures all gas receipts are signed, legible and contains all required information (e.g. licence plate);

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- Compliance of reporting/documenting requirements (e.g. when vehicle sustain damage, incident reporting) in accordance with KZHSS policies and procedures. - Remains current in the areas of occupational health and safety, infection prevention and control and quality improvement. - Makes all trips assigned by the Medical Transportation Dispatcher within the allocated schedule of a 40 hour work week period, and which may include evenings and/or weekends.

4. Additional Duties for Drivers assigned Dialysis clients: • Ensures vehicle is warm in the winter time; • Accompanies dialysis clients to/from homes to the vehicle, and to/from their scheduled appointment within the dialysis unit; • Accompanies dialysis client to other areas of the hospital, as required;

5. Personal Responsibility of all Medical Transportation Drivers: - All Medical Drivers are required to sign an updated job description, Professional Code of Conduct, Oath of Confidentiality and Employee Work Code of Ethics at the beginning of every contract period.

- All medical drivers are required to submit a “Fitness to Drive a Vehicle – Medical Exam Form” completed by their family doctor once per year. A contract with the employee will not be signed until the Medical Form attesting that the individual is “Fit to Drive” is received by the Medical Transportation Dispatcher. An employee will be eligible to receive a reimbursement up to $40, for a professional fee associated with the completion of the form; a receipt must be provided to the Medical Dispatcher.

- KZHSS may additionally require a “Fitness to Drive a Vehicle – Medical Exam Form” whenever there is a change in the driver’s health status, or, when KZHSS observes that a medical assessment may be warranted.

- KZHSS is not responsible for any consequences related to the failure to comply to the Highway Safety Code and/or all relevant laws related to operating a vehicle. It is the Driver’s individual responsibility to pay any type of ticket or infraction (e.g. speeding tickets, use of a cell phone while driving) as a result of their conduct/behavior while driving. RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: In order to receive Medical Transportation services through KZHSS, a client must be a Canadian resident and registered or eligible to be registered under a provincial health insurance plan and have the following status: - Registered KZA Band members on-reserve; - An infant less than 18 months old whose parent is a registered KZA Band member; - Registered KZA band members residing within a 10 kilometer radius;*

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- Other First Nations member with proven residency within the KZA community on-reserve. For the purposes of this policy, a person’s residence is defined as per the Kitigan Zibi Anishinabeg Residency Policy, when in effect. *Community members living outside of the 10km radius may be eligible for Medical Transportation services through Indigenous Services Canada Regional Office

Clients are responsible to abide by the rules as set out in this policy. Clients will inform the Medical Transportation Dispatcher of any special circumstances required for travel regarding the state of their health.

1. OVERVIEW & PROCEDURES:

Medical Transportation services are administered by KZHSS and coordinated by the Medical Dispatcher at the Health Center. Medical Transportation is provided to assist clients access medically required health services that cannot be obtained on the reserve. 1.1. KZHSS provides medical transportation for clients to access the following types of medically necessary health services:

- Insured medical services provided by the Province (e.g. doctor appointments, hospital care); - Diagnostic tests and medical treatments ordered by a doctor and covered by the provincial health plan; - Alcohol, solvent, drug abuse and detox treatment centers that are publicly funded; - Traditional healers; - Non-insured health benefits (vision, dental, mental health, medical supplies & equipment); - Preventative screening that is publicly funded, eg. Breast cancer screening - Supervised pharmacy treatments for clients using methadone or suboxone.

1.2. KZHSS dispatches a medical transportation driver and a designated vehicle for client medical trips. However, in the absence of available medical transportation vehicles, a client may use his/her private vehicle and be reimbursed a per kilometer allowance. All travel with the use of a private vehicle requires pre-authorization by the Medical Dispatcher.

In both circumstances, the following applies:

1.2.1. Medical Transportation Services are used when a client is not eligible to receive services from other funding sources, including provincial health plans (RAMQ), publicly funded programs (e.g. SAAQ, CNSST) or private insurance plans;

In circumstances when a patient is admitted to a hospital and requires a transfer to another hospital for tests/exams, the hospital is responsible for covering the cost of the transportation;

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1.2.2. If it is determined the client’s required services are not available within the community, travel is provided to the nearest appropriate health professional or facility, using the most economical and efficient means of transportation. This may include the use of a private vehicle, a band vehicle, a bus or in some cases, a commercial taxi. Proof of a referral to a health specialist will be required prior to the trip being dispatched for out-of-town appointments.

1.2.3. All travel is coordinated to ensure maximum cost-effectiveness. Whenever possible, clients traveling to the same location will be transported in the same vehicle. When more than one family members needs to access a medically required service, where practical, travel arrangements should be scheduled for the same day.

1.2.4. All medical trips must be pre-approved by the Medical Dispatcher. Reimbursement of eligible expenses may only occur after-the-fact in an emergency situation, and when clients provide appropriate documentation to justify the medical emergency.

1.3. MEDICAL TRANSPORTATION WITH KZHSS VEHICLE & DRIVER: Clients wishing to schedule a medical trip must adhere to the procedures as outlined within this policy:

1.3.1. Nearest Facility: Clients must access the nearest appropriate health professional or health facility. (If health professionals are brought into the community to provide the service, the community will be considered the nearest appropriate facility).

1.3.2. Scheduling a Medical Trip: Clients who require medical transportation must give the Dispatcher 48 hours notice before the scheduled appointment. The Dispatcher has the right to request the client to re-schedule appointments if or when required.

Clients must understand in Emergency situations where 48 hours notice before the scheduled appointment is not possible, will be decided on a case by case basis by the Medical Transportation Dispatcher and then reported to the Director.

1.3.3. Pick-up: It is the responsibility of passengers/clients to be ready and prepared to embark at the point of pick-up. The driver will not be waiting parked for more than five (5) minutes, unless the passenger is in a wheelchair, although they should be ready for pick up. A client who has missed pick up will be placed back on a list, therefore, possibly missing an appointment.

The last minute refusal or cancellation of trip coordinated by the Dispatcher will not be eligible for private trip reimbursement.

All passengers/clients are responsible for the maintenance of their own private stairs, ramp and driveway. If the medical transport driver feels he/she cannot drive into the private driveway, it is expected that the passenger/client to be waiting along the roadside. In such cases, the client will be contacted for

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arrangements with the Driver to be picked up.

1.3.4. Extra Passengers

a. The driver’s family members (including but not limited to their spouse, children, grandchildren) and/or friends are not authorized as passengers on another client’s medical trip.

b. “Ghost Riders” (persons who do not have an authorized medical appointment) may be authorized to be a passenger on another client’s medical trip, provided that the travel is for medically-related reasons and is granted solely at the discretion of the Dispatcher.

1.3.5. Proof of attendance at a Medical Appointment: Clients will be provided with the Medical Visit Attestation voucher form. This form must be dated, stamped and signed by the health professional and contain the name, address and full coordinates of the health professional. Business cards are not accepted as proof of attendance at the medical appointment.

1.3.6. General Rules: Clients taking advantage of medical transportation services must adhere to the following rules as outlined within this policy:

a. All clients and their children must ensure seat belts be attached and worn. Young children and infants must be properly restrained in a current (ie. not expired), approved child/infant seat which can be provided by the Kitigan Zibi Medical Transportation Services. b. No smoking is allowed within the medical transportation vehicles. See KZHSS No Smoking Policy. c. Clients and minors may have a prepared meal within the medical van. Carefully monitored drinking is permitted in the vehicle. Only non-alcoholic beverages are permitted within the medical transportation vehicle. d. The medical van will stop at a restaurant when a diabetic client is required to eat at a regularly scheduled interval. e. Clients are required to pick up their own garbage before leaving the vehicle. f. There are no personal errands such as shopping, side trips, or other unscheduled stops etc., permitted for clients. Only medical unscheduled stops will be authorized. g. Clients or passengers that are in emergency or crisis situations during transportation are obligated to inform the Medical Driver, immediately. The Medical Driver will pull over as quickly and safely as possible and call 911 for immediate assistance. h. Clients may be denied services if intoxicated or under the influence of mood-altering drugs, or demonstrating any type of unacceptable or unruly behavior. i. It is prohibited to use a syringe or perform any kind of injection within a medical vehicle. j. Drivers will not be responsible for handling the personal belongings of any clients in the client’s absence. A driver is not permitted to drop off/pick up a client’s personal belongings at another location. (e.g. welfare cheque, backpack, etc.)

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1.4. PRIVATE VEHICLE USE: In the absence of available medical transportation vehicles, a client may use his/her private vehicle with the following conditions:

1.4.1. All travel by private vehicle must be preauthorized by the Medical Transportation Dispatcher, who will in turn complete a pre-authorization form with the details of the medical trip. Pre-authorization must occur before the scheduled appointment. 1.4.2. To be reimbursed for costs associated with a private medical trip, the client must provide a Medical Visit Attestation, duly completed, stamped and signed by the health professional as proof of attendance at a medical appointment, along with any other original receipts to the Medical Transportation Dispatcher. 1.4.3. Reimbursement of a medical trip is established annually at a set rate by Indigenous Services Canada. This includes payment for the trip, as well as reimbursement of parking upon receiving receipts. Reimbursements for expenses related to a Private Vehicle claim can occur for up to one year from the Medical appointment. Payment by cheque occurs once a month, on a date set by the KZA Finance department; the schedule for the payment day can be consulted on the office door of the Medical Transportation Dispatcher. 1.4.4. There will be no private transportation advances for same day appointments. At the discretion of the Dispatcher, an advance may be made for exceptional circumstances or emergencies.

1.5. MEALS & ACCOMODATIONS: An allowance for meals and/or accommodations may be available when these expenses are incurred while in transit for approved medical trips with the following conditions:

1.5.1. Meals will only be covered for daily medical trips when the client is either a diabetic; is undergoing dialysis treatments; or for an escort with a client undergoing day surgery/treatment, provided that this occurred at a hospital facility. 1.5.2. Reimbursement for breakfast is not eligible on the day of departure 1.5.3. For medical travel that requires an overnight or extended stay away from the client’s home, the most economical hotel/accommodations will be chosen. 1.5.4. A set accommodation rate as determined by Indigenous Service Canada, including all taxes, may be paid in the following situations:

• The client has written proof of an out-of-town hospital appointment for treatment and/or surgery between (6:00 - 7:00 a.m.). In this case, meals/accommodations will be reimbursed for the night before the appointment. • The client has written proof of out of town specialists’ appointment requiring the client to stay overnight due to another treatment or follow-up surgery. • The client is hospitalized and has written referral (proof) from attending specialists requiring an immediate family member or friend to be at the bedside to assist the client. Meals/accommodations will be paid for one person, family member or medical escort only.

1.5.5. When a pregnant client is referred out-of-town for a birth of a child, meals/accommodations for the client and one accompanying individual will be advanced five days before the due date only or in certain situations where the

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specialists request in writing that the client has to relocate much earlier than the due date.

1.5.6. For a KZHSS driver required to make an overnight trip, the KZA Travel Policy shall apply.

1.6. TRAVEL ADVANCE CLAIMS: All travel advance forms will be authorized and completed by the Medical Transportation Dispatcher.

1.6.1. When it is confirmed, by a medical specialist, that a client requires an “overnight” stay out-of-town, an advance of the costs of meals/lodging may be advanced to the client with the appointment(s). 1.6.2. Medical Drivers and/or Clients requesting/receiving a travel advance have a one month period to produce official proof/documentation and/or receipts to confirm the travel was completed. Otherwise, an accounts receivable will automatically be setup in the claimant’s name and will be deducted accordingly. 1.6.3. Where it is not possible for 48 hours notification, the Medical Transportation Dispatcher can issue a travel advance during regular business hours. 1.6.4. Travel advances are only be issued to KZA band members. Non-KZA band members, including individuals from other First Nations are not eligible to receive any type of advanced form of payment.

1.7. TRADITIONAL HEALER SERVICES TRAVEL: Medical transportation benefits, within the clients region/territory of residence, may be provided for clients to travel to see a traditional healer or, where economical, for a traditional healer to travel to the community.

1.7.1. When the traditional healers selected by the clients are outside of the client’s region/territory of residence, travel costs will be reimbursed for travel to the region/territorial border only. 1.7.2. The following criteria must be considered prior to approving medical transportation benefits for traditional healer services: • The traditional healer is recognized as such by the local Band, Tribal Council or health professional; • The traditional healer is located in the client’s region/territory of residence. 1.7.3. KZHSS Medical Transportation Program does not pay for any associated honoraria, ceremonial expenses or medicines. These costs remain the sole responsibility of the client. 1.7.4. To ensure the safety and validity of the service, an inquiry to verify the traditional healer service requested by the client may be made by the Medical Transportation Dispatcher prior to a trip.

1.8. RESIDENTIAL ADDICTIONS TREATMENT TRAVEL: 1.8.1. Clients are required to meet all treatment centre entry requirements prior to medical transportation benefits being authorized by the NNADAP Program. 1.8.2. Only the most efficient and economical method of transportation will be authorized, taking into account the medical condition of the client. 1.8.3. Trips home during the course of treatment are exceptional and can only be authorized by the Director.

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1.8.4. Family sessions to the treatment facility will not be authorized unless it is a documented part of the treatment and approved prior to starting treatment. 1.8.5. Travel to access additional treatment within a one year period requires approval from the Director.

1.9. WEATHER: Considering safety must come first, the Medical Transportation Dispatcher is responsible for deciding if transportation should be cancelled due to poor driving conditions. A driver may make a decision mid-trip to return to the community in bad weather situations. KZHSS will not be held responsible to pay for a missed appointment under such circumstances. Clients are responsible to reschedule their own appointments.

1.9.1. In exceptional cases of freezing rain or heavy snowstorms, the Dispatcher may make arrangements for alternate vehicles to be used for a trip; a 4X4 vehicle may be rented for the trip, or an employee may use their personal vehicle, if a 4X4, and be reimbursed. Alternate vehicle arrangements will require the Medical Transportation Dispatcher authorization.

1.10. CLIENT ESCORT SERVICES: A provision may be made for a family/member to act as an escort with the prior authorization from a Doctor provided to the Medical Transportation Dispatcher.

1.10.1. Client escort must be 18 years of age and older. 1.10.2. Client escorts must be physically able to care for the needs of the client. 1.10.3. Client escorts will be compensated for their meals and accommodations only.

1.11. EXCLUSIONS: Certain types of travel, benefits and services are NOT to be provided as benefits under the Kitigan Zibi transportation services under any circumstances and are not subject to the appeal process. These include assistance with: - Court-ordered treatment/assessment, or as a condition of parole, coordinated by the justice system; - Travel from a jail to treatment; - Travel for clients residing in an off-reserve location where the appropriate health services are available locally; - Travel for funeral services; - Travel for the purposes of a third-party requested medical examination; - Payment of professional fee(s) for preparation of doctor’s note/document preparation to support provision of benefits.

2. MISUSE AND ABUSE OF KZHSS MEDICAL TRANSPORTATION SYSTEM:

2.1. KZHSS reserves the right to withhold medical transportation services from individuals who are found to be misusing or abusing the KZHSS Medical Transportation System. Examples include:

- using the service for rides not medically necessary or as a taxi service; - picking up non-medical documentation at the Health Center (e.g.cheque); - committing a theft while on a medical trip; - picking up and/or transporting drugs and/or alcohol.

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When a client misuses or abuses the Medical Transportation System, the following will apply:

- 1st time offence: 1 week ineligible for transportation services - 2nd time offence: 1 month ineligible for transportation services - 3rd time offence: 3 months ineligible for transportation services

The Medical Transportation Dispatcher will ensure that all instances of abuse/misuse are well-documented.

Gravity of the incident, egregious.

If an incident occurs where a service provider has to file an official complaint with authorities, the client will be denied services.

If criminal activity occurs during the trip, (e.g. police involved or driver needs to call the police) medical trip ceases immediately. driver needs to file a report. If another client has a trip, arrangements will be made for another driver.

3. REFERENCES 1. Contribution Agreement. 2. Non-Insured Health Benefits (NIHB) Medical Transportation Policy Framework (Interim), Health Canada, April 2017. 3. First Nations and Inuit Health Branch Program Plan

Box 160, 8 Kikinamage Mikan, Maniwaki, QC J9E 3B4 KZHSS  819.449.5593/1.866.660.5593 (toll-free) Fax: 819.449.7411/819.449.6916 (Clinic) Medical Transportation www.kzadmin.com Coordinator

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4.0 NATIONAL NATIVE ALCOHOL AND DRUG ADDICTION PROGRAM (NNADAP)

National Native Alcohol and Drug Addiction Program (NNADAP)

POLICY DATE DATE Kitigan Zibi PSD-011 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS provides drug and alcohol addictions services through the National Native Alcohol and Drug Addiction Program (NNADAP)

PURPOSE

To reduce and prevent alcohol, drug and solvent abuse within KZA.

The National Native Alcohol and Drug Addiction Program (NNADAP) strives to reduce the levels of alcohol and drug abuse within the community. Three (3) main components are:

PREVENTION To provide culturally appropriate programs to educate and promote healthy living and addictions free lifestyles to target populations.

INTERVENTION To provide support and guidance to minimize harm in crisis situations, and to provide appropriate assessment and referrals to services for individuals for preparation and entry into rehabilitation services.

AFTERCARE To provide maintenance in the continuum of care to individuals returning from treatment and to maintain networks of support regarding their care and progress.

KZHSS RESPONSIBILITY:

NNADAP WORKERS:

▪ Develop treatment plans for individuals and their families. ▪ Provide counselling and support in a transition to a healthy lifestyle. ▪ Being consistently positive role models in the community in accordance with NNADAP certification. ▪ Being certified as an addictions counsellor with a recognized certification body. ▪ Reports and record keeping. ▪ Evaluations and assessments. ▪ Case planning. ▪ Organizing sober activities and events. ▪ School visits. ▪ Referrals. ▪ Networking and teamwork. ▪ Pre- and post-vention counselling. ▪ Education and awareness campaigns targeting specific populations. ▪ Newsletters and articles. ▪ Relapse prevention. ▪ Networking with treatment centres, nurses, and hospitals. ▪ Client support. ▪ Being visible and available in emergencies. ▪ Individual, family or group counselling. ▪ Update skills development and training. ▪ Work with social services, probation, courts and the penal system. ▪ Provide transportation for support meetings. ▪ Regular check-ins and home visits for clientele. ▪ Screening.

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: ▪ The desire to make change ▪ Registered KZA band members ▪ Other First Nations living with a registered Kitigan Zibi community member

▪ Motivation to change. ▪ To be ready for appointments and home visits ▪ Understanding of the recovery process. ▪ Accepting personal responsibility of themselves. ▪ Willing to develop personal wellness plans. ▪ The will to recognize and resolve personal issues. ▪ To be goal oriented. ▪ Have a valid medical card. ▪ To have financial, legal and medical responsibilities met before entering treatment. ▪ Family members should be willing to support their addicted loved one during and after treatment.

PROCEDURES:

Please refer to Medical Transportation section for further NNADAP transportation procedures.

DETOXIFICATION AND REHABILITATION TREATMENT CENTRE REFERRALS

▪ First Nations Treatment Centres of Quebec ▪ First Nations Treatment Centres of Ontario ▪ Accredited centres pre-approved by Health Canada in the province of Quebec ▪ Following within the rules of Treatment Centres and KZHSS Medical Transportation, assistance to help in accessing any other Treatment Centres not covered by Health Canada at the discretion of and paid by the individual.

DETAINEES AND THE COURT SYSTEM

▪ Detainees can call NNADAP Workers collect for substance abuse counselling.

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▪ NNADAP Workers will not interfere or override the penal system service delivery and will follow the rules of the institutions. ▪ NNADAP Workers will not visit clients who are detained. ▪ Detainees will use the resources that are offered by the Institution they are in ▪ Letters of support requested by the client will be accurate and according to NNADAP files. ▪ If time permits, NNADAP Workers may issue a letter for appearing in court.

Box 160, 8 Kikinamage Mikan, Maniwaki, QC J9E 3B4  819.449.5593/1.866.660.5593 (toll-free)/819.449.2323 Fax: 819.449.7411/819.449.2390 NNADAP WORKERS www.kzadmin.com

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5.0 ENVIRONMENTAL HEALTH & SAFETY

Environmental Health & Safety

POLICY DATE DATE Kitigan Zibi PSD-012 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS provides public education of environmental health & safety issues through the Environmental Health and Safety program.

PURPOSE

To maintain a healthy and safe environment in the KZA community.

This includes water quality monitoring in accordance with Health Canada protocols; the distribution of procedures and proper maintenance of water coolers & safe handling of water bottles.

The Environmental Health and Safety Technician also carries out inspections in public buildings, homes, workplaces and playgrounds.

KZHSS RESPONSIBILITY:

ENVIRONMENTAL HEALTH AND SAFETY TECHNICIAN

WATER QUALITY MONITORING

▪ Monitor water quality (bacteriological, chemical and physical) according to Health Canada’s protocols and by following Canadian Guidelines for Drinking Water Quality. ▪ Provide all copies of results to Health Canada’s Environmental Health Officer by entering results on H2O website and send copies to homeowners. ▪ Provide public education to community residents about safe drinking water and risk prevention. ▪ Provide quarterly reports and annual reports to KZHSS Director, Chief and Council and Health Canada. ▪ Notify proper departments and send out boiling advisories as required. ▪ Monitor recreational water. ▪ Notify community members of the quality of the beaches for swimming.

INDOOR AIR QUALITY INVESTIGATIONS/ MOLD INSPECTIONS

▪ Carry out indoor air quality investigations and mold inspections according to ASHRAE standards and CMHC protocols. ▪ Provide reports to homeowners and other pertinent departments. ▪ Provide public education to community members about prevention & risk management.

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PLAYGROUND INSPECTIONS

▪ Carry out inspections according to CSA Standard Z614 – for children’s play spaces and equipment. ▪ Provide reports & recommendations (written and/or verbal) to playground operators on the safe operation and maintenance of the play spaces.

SANITARY INSPECTIONS AND FOOD SAFETY

▪ Assist E.H.O. in carrying out sanitary and food safety inspections of the public buildings (schools, stores, restaurants, etc...) according to Food Safety Code of Practice. ▪ Carry out follow up inspections and ensure that recommendations are completed. ▪ Coordinate Food Handling and Safety training sessions. ▪ Provide the community with food recall notifications and food handling safety information.

HEALTH & SAFETY INSPECTIONS

▪ Carry out workplace health & safety inspections and follow ups of the KZA public buildings in compliance with Canada Labour Code, National Building Code, National Fire Code & National Plumbing Code. ▪ Provide reports to proper departments and services directors. ▪ Maintain and update all required Material Safety Data Sheets for KZHSS buildings. ▪ Provide assistance to visiting inspectors (Health Canada, Labour Canada Fire Safety, smoke/fire alarm company, etc…) ▪ Carry out Environmental Health & Safety Inspections as required or upon request by community members and/or directors.

RADON MONITORING

▪ Carry out testing/follow up monitoring and analysis of results in accordance to the USEPA and Health Canada Guidelines. ▪ Provide reports and recommendations to the home owners and proper departments.

BIOMEDICAL WASTE

▪ Coordination of Biomedical waste pick-up in accordance with the Règlements sur les déchets Biomédicaux, Ministère du developpement des parcs QC. ▪ Provide training to staff on the safe handling and disposal of biomedical waste. WATER COOLERS

▪ Deliver water coolers to new houses or replace as needed. ▪ Keep track of inventory. ▪ Instruct individuals on the importance of proper handling and maintenance of the water cooler in order to prevent illness from occurring. ▪ Water coolers are not for individuals and must remain at the house address. ▪ When a person rents their homes, the landlord is responsible for the replacement in the event of breakage, loss or theft.

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TRAINING/INFORMATION SESSIONS

▪ Provide health & safety training sessions to employees and/or target groups as required. ▪ WHMIS (workplace hazardous material information system) in accordance to Canada Labour Code. ▪ Hand Washing in accordance to the Food Safety Code of Practice & Health Canada. ▪ Young Workers Safety in accordance to Canada Labour Code. ▪ Mold Clean up in accordance to CMHC and Health Canada guidelines. ▪ Workplace Safety

COMMUNICABLE DISEASES

▪ Provide advice, guidance and supply public education and working with nurses and other programs and services in the prevention or control of communicable diseases.

FIRE SAFETY

▪ Plan, organize and monitor fire drills for the KZHSS buildings in accordance to Canada Labour Code. ▪ Maintain and update fire and emergency escape plans. ▪ Provide public education to community members about fire safety.

EMERGENCY PREPAREDNESS

▪ Updating the Emergency Preparedness Plan on an annual basis and the coordination of meetings and training of the plan.

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: Registered KZA members on-reserve Residing/Operating on-reserve

▪ Responds to advice, reports and recommendations provided by the Environmental Health and Safety Technician. ▪ Attends all relevant training and education.

PROCEDURES: All above mentioned duties are performed in accordance with Health Canada protocols. Box 160, 8 Kikinamage Mikan, Maniwaki, QC J9E 3B4  819.449.5593/1.866.660.5593 ENVIRONMENTAL HEALTH & (toll-free)/819.449.2323 SAFETY TECHNICIAN Fax: 819.449.7411/819.449.2390 www.kzadmin.com

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6.0 FITNESS CENTER: MINO-BIMADIZIWIN: GOOD LIFE CENTER

Mino-Bimàdiziwin (Good Life Center)

POLICY DATE DATE Kitigan Zibi PSD-013 05/09/2016 07/29/2019 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS provides and maintains the locale and equipment of the Mino-Bimadiziwin center for use by community members.

PURPOSE

To encourage community members to achieve and maintain a healthy/fit lifestyle through physical activity.

KZHSS RESPONSIBILITY:

KZHSS DIRECTOR AND DESIGNATE ASSISTANT DIRECTOR

▪ Adequate funding is allocated for Mino Bimadiziwin Center. ▪ Accountable and responsible for the Mino Bimadiziwin Center. ▪ Responsible to implement approved policies and maintaining the annual budget. ▪ Responsible to maintain equipment. ▪ Responsible for overall safety of Mino Bimadiziwin Center. ▪ Responsible for authorizing specialized activity group training.

KZHSS RECEPTIONIST

▪ Membership list and fees are maintained. ▪ Distributes chip keys. ▪ Ensures all members have the proper orientation and forms completed.

FITNESS CENTER JANITOR

▪ Responsible to maintain a safe and clean environment at the Mino Bimadiziwin Center. ▪ The janitor will maintain and report any damages to the facility or the equipment. ▪ Disinfect the equipment during the weekdays. ▪ Ensures all equipment is operating properly (batteries changed). ▪ Maintains an inventory of janitorial supplies ▪ Ensures the water coolers are full all the time and to order water if required.

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RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: ▪ Registered KZA band members who pay the chip key and monthly membership fees. ▪ Other First Nations residing in the community who will pay the additional membership fee. ▪ Members between the ages of 12 to 17 will have special conditions with regards to access of the center. ▪ Parents must sign the KZHSS Release of Liability and Waiver form for youth 12 to 17. ▪ A successful completion of the PAR-Q and Fitness Center Adult Liability Waiver forms. ▪ Youth 12-14 can have access if they are accompanied by their parent/guardian. Both the youth and the parent need a membership.

▪ Members must NOT allow access to non-paying members. Anyone found to be granting access to non-paying members will have their key automatically disabled. ▪ Clients acknowledge that cameras and chip keys are set up for monitoring in the building. KZHSS can monitor whether members are allowing access to non-members and whether equipment/weights are returned to their proper place. ▪ At the discretion of the KZHSS Director, specialized group activities and memberships can be REVOKED if rules are not followed. ▪ Complete a Par-Q form along with the liability waiver. ▪ Take the gym orientation with an authorized fitness facilitator, and provide a signed PROOF OF FITNESS CENTER ORIENTATION form to the KZHSS receptionist. ▪ Pay membership fees on a monthly basis and a chip key fee. In the event that a chip key is automatically disabled due to improper use of the gym or a failure to follow the gym rules, another request for payment to KZHSS will be required to have access to the gym. ▪ No smoking, alcohol or drugs to be permitted in the center. ▪ No food shall be brought into the fitness center. ▪ Disrupting and interfering with the workout of another member will not be tolerated. ▪ No vandalism or abusing of the equipment. ▪ Members are expected to clean off all equipment once they are done using them. ▪ After using the equipment (weights) members are expected to return them to proper storage units. Failure to do so, may result in having their key automatically disabled. ▪ Dumbbells and weight plates cannot be dropped on the floor. ▪ Time limits of 20 minutes on cardio machines will be respected when others are using the facility. ▪ Organized group training will require prior approval by KZHSS in order to gain access to the fitness center. ▪ Gym members are to wear appropriate exercise attire at all times, for example, clean sneakers.

▪ Outside footwear is not to be worn inside. ▪ No offensive language.

Chip Key and Membership Fee Holders

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▪ Chip Keys and Monthly Membership Fee o Initial Cost to purchase the chip key is $20

MONTHLY FITNESS CENTER FEES

KZ Band Members or Other First Nations Regular Rate $25 Student Rate $10 Pensioner Rate $15 Social Assistance Rate: $10

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C. SOCIAL DEVELOPMENT PROGRAMS 1.0 KIWEDA GROUP HOME

Kiweda Group Home

POLICY DATE DATE Kitigan Zibi PSD-014 05/09/2016 07/29/2019 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS provides intermediate resource residential care for semi-autonomous community members requiring level 1 & 2 care as categorized by INAC.

PURPOSE

To provide assisted living program within a group home setting.

KZHSS RESPONSIBILITY:

The Kiweda Group Home Coordinator supervises the clinical and administrative components within the AANDC Level 1 & 2 care, 9 bed facility; the Coordinator oversees provision of quality care through the development and implementation of individualized care plans and promotion of therapeutic activities for the health and benefit of the Kiweda residents.

For the ADMINISTRATION component, the Kiweda Group Home Coordinator:

▪ Plans and oversees daily operations and logistical details for the Kiweda Group Home which includes the care, maintenance, and upkeep of the facilities; safety and security of the premises, (e.g. meeting building code requirements), general housekeeping, stock and purchasing of necessary supplies/equipment, meal planning from dietician- approved menus, as well as enforcing Kiweda Group home rules.

▪ Plans, manages and monitors the Kiweda personnel; participates in the staffing and orientation process, guides personnel in client-care practices, sets personnel scheduling, enforces policies and procedures, performs personnel work-performance evaluations, and implements corrective measures if/when required.

▪ Assists with the preparation, implementation, and monitoring of annual budgets; tracks and gathers required statistical information, drafts proposals for sustainable funding initiatives and prepares various required reports (e.g. annual reports, incident/adverse events) for leadership and funders.

▪ Ensures client’s activities of daily living are performed (e.g. personal hygiene) and their personal needs, as determined by their individualized care plan, are met.

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▪ Assists and advocates on clients’ behalf to enhance or promote client autonomy; provides information to clients regarding self-care, wellness, problem prevention, rehabilitation and comfort measures that promote independence and a healthy lifestyle; supports clients in accessing/obtaining eligible benefits, services (e.g. filling out proper forms) or medical helping aides, equipment and devices;

▪ Encourages client participation in local social/recreational activities/outings that promote well-being, and coordinates associated client arrangements (e.g. transportation, dietary requirements, adequate clothing); assists clients in developing informal support networks.

For the NURSING component, the Kiweda Group Home Coordinator:

▪ Oversees, manages, and monitors client’s on-going clinical care and case management; performs complete nursing assessments using pertinent tools (ie. ISMAF), develops and regularly updates individualized care plans (ie. TNP) as per set schedule (upon admission/intake with follow-up revaluation of health status occurring at a 3 month interval or post-hospitalization) and with pertinent partners (e.g. health care professionals, family members) when necessary.

o Upon intake to KZA assisted-living programs, clients must provide informed consent for medication assistance. o Arrange the Kiweda home visit with client and formal care giver to complete assessment o Provide an objective Multi-Clientele ISMAF assessment of the medical, functional and home safety needs of the client o Develop a goal based Care Plan /Therapeutic Nursing Plan o Perform client reassessments as scheduled or required o Collaborate with client and family to determine the personal care plan which may include personal support needs. o Attend case management meetings with pertinent care providers to report nursing assessment findings or provide client updates o Determine the Plan of Care required based on the Assessment, the Physicians orders and /or the Discharge Summary o Identify factors that may interfere with or impede a client’s ability to be as independent as possible and initiate appropriate actions, such as referrals to address the concern.

▪ Provides and documents direct and indirect nursing interventions; maintains meticulous record-keeping of client medical information/documentation; schedules client’s health care appointments; identifies particular client needs and makes/obtains referral for specialized services (e.g. physical therapy, psychological testing), and coordinates medical transportation.

o Provide direct and indirect nursing interventions to meet the needs of the client based on collaborative plan of care o Provide information and teaching to clients and caregivers regarding self care, wellness, problem prevention, rehabilitation and comfort measures that promote independence and healthy lifestyle. o Maintain appropriate client records and ensure confidentiality of all information relating to the client.

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o Consult with the client’s Physician or other health care professionals as necessary. o Provide strong advocacy for the client.

▪ Assigns, supervises, teaches, and evaluates Personal Support Workers (PSW) to execute specific delegated tasks (i.e. entrusted acts within parameters set out in Law 90) dependent on the client’s condition, the nature of the procedure(s), the resources available and the PSW’s degree of competence. o The Kiweda Coordinator/Nurse will teach the PSW in Kiweda to perform personal assistance services, invasive care assistance with activities of daily living and administration of prescribed medications, within the parameters of Law 90 including Articles 39.7 and 39.8 of the professional code and within the Care Techniques for Non-Professionals from the L'association Québécoise D'établissements de Santé et de Services Sociaux (AQESSS ) o The HCC Nurse ensures that the client receives safe, effective and ethical care when assigning, supervising or teaching delegated tasks to Personal Support Workers based on the client’s condition, the nature of the procedure(s), the resources available in the setting and the degree of competence of the person being supervised. o Ensure that personal support workers are informed and understand the task assigned with regard to clients needs. o Responsible for the overall assessment, determination of client status, care planning, interventions and care evaluation when tasks are delegated/assigned to the PSW. o Ensure PSW has sufficient training, supervision and support to perform the delegated/assigned task safely. o Reassess the Care Plan whenever the client’s condition changes, is hospitalized, or the caregiver changes. o Maintain communication with staff to ensure client’s needs are being met.

▪ Training arrangements for Nurses, and PSW’s, will be coordinated by the Nurse Supervisor. Evaluations, training, and/or shadowing will occur on a regular basis to ensure all pertinent staff are confident to carry out medication-related tasks,

▪ Ensures proper and effective medication management practices and medication reconciliation are implemented within the Kiweda Group Home.

▪ Keeps abreast of current and leading nursing practices, skills, techniques, and any applicable legislation related to the geriatric population or nursing field.

PERSONAL SUPPORT WORKERS:

Within the parameters of Law 90 including Articles 39.7 and 39.8 of the professional code within Care Techniques for Non-Professionals from the l'association québécoise d'établissements de santé et de services sociaux (AQESSS) , the Personal Support Worker (PSW) in Kiweda may perform personal assistance services, invasive care assistance with activities of daily living and administration of prescribed medications in collaboration with the Kiweda Coordinator/Nurse in order to maintain health, restore and prevent disease.

A PSW working in Kiweda may administer prescribed ready-to-administer medications by oral, topical, transdermal, ophthalmic or otic route or by inhalation, and administer insulin by

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subcutaneous route based on the following the PSW must:

▪ have learned how to perform the activities within their training program or with the Kiweda Coordinator/Nurse from the Health Centre ▪ hold an official document issued by their training program certifying to the mastery of the skills related to the activities; ▪ be supervised, the first time she/he engages in those activities by the Kiweda Coordinator/Nurse ▪ have access at all times to the Kiweda Coordinator/Nurse .

The PSW is also responsible to:

▪ Promote healthy lifestyles and assist the residents in maintaining independence to the fullest extent possible. ▪ Pass an annual physical capacity screening test. ▪ Respond in a timely way for delivery of care. ▪ Treat residents with respect. ▪ Protect the privacy of residents and maintain confidentiality of all information gathered about residents. ▪ Report and record care delivered using the appropriate forms. ▪ Responsible to ensure all doors and windows are locked after 4:00pm. ▪ Wear the Lifeline Emergency Bracelet during the night shift.

KIWEDA COOKS

▪ Plan, prepare, maintain and purchase meals for the Kiweda according to the Canada Food Guide. ▪ Meet the needs of the residents and provide for specialized diets. ▪ Follow a menu plan and maintain the allocated budget. ▪ Maintain kitchen areas as set by the Food Safety Code of Practice. ▪ WHMIS training required.

JANITOR

▪ Sanitize the kitchen and dining room. ▪ Maintain and ensure that all resident rooms are cleaned according to a list of duties. ▪ Report any safety hazards and equipment malfunctions. ▪ Maintain kitchen areas as set by the Food Safety Code of Practice. ▪ WHMIS training required.

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: ▪ Registered KZA band members. Priority will be given to registered KZA band members. ▪ Other Algonquin bands providing there is space available and the approval of stipulated conditions ▪ Other First Nations residing in the community providing there is space, approval of stipulated conditions. Special permission from band council is required.

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▪ Other First Nations with special permission from KZA council and with approved stipulated conditions and if any room is available ▪ 18 years of age and over ▪ Have a completed Multi-Clientele Autonomy Assessment form ▪ A person who requires minor assistance (level 1 and 2 care) and supervision with activities of daily living ▪ Valid Quebec Medical Card ▪ Has an appointed Guardian to be responsible for medical and financial care ▪ If resident cannot obtain a guardian, a social worker will be assigned to the individual

▪ The involvement of the resident and family is essential to the plan of care in order to achieve goals and objectives, and also to help with maintaining dignity. ▪ Provide written consent to care. ▪ Must possess a valid Quebec Medical Card at all times. ▪ Clients are responsible to obtain a family doctor with the assistance of the Nurse, if required. ▪ Responsible to arrange transportation to doctor appointments. ▪ Assistance will be offered to make arrangements. ▪ Administer their own finances OR o Have an appointed guardian(s) to handle personal affairs (e.g. banking). ▪ Pay monthly Kiweda Rent. ▪ Arrangements with the pharmacy must be made to transfer all medications to a dispill system. ▪ Responsible for all costs related to medication. ▪ Supply their own personal hygiene requirements (e.g. shampoo, shaving gear, etc.).

▪ Abuse (physical, sexual or verbal) by residents towards staff or other residents is strictly prohibited. ▪ The building is to be respected by all residents no vandalism. ▪ Residents and visitors ensure that courtesy and regulations are respected at all times. ▪ Alcohol is not permitted at Kiweda Group Home. ▪ KZHSS reserves the right to evict residents for unruly behavior and disturbances and when policies are not followed. ▪ Illegal Drugs are not permitted at the Kiweda Group Home. ▪ For the safety of all clients, no firearms and hunting tools will be permitted at the Kiweda Group Home. ▪ Baths: All residents must take a bath at least twice a week. ▪ Meals at Kiweda are for the residents only. On special occasions family members may be invited to join in celebrations.

SMOKING:

▪ Smoking is only allowed on the back porch at the Kiweda group home. Smoking is prohibited within client bedrooms and all other Kiweda rooms. ▪ Employees are not permitted to buy cigarettes for clients. ▪ Clients must store their cigarettes at the Front Desk and ask for their cigarette from the PSW on duty. ▪ If the client consistently chooses not to follow the rules, may be requested to leave the Kiweda group home permanently.

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KIWEDA CODE OF CONDUCT

The Kiweda Code of Conduct outlines how all people are expected to treat each other while at the Kiweda Group Home. In Algonquin, Kiweda means “let’s go home”, a nice reminder for staff and families that this is, first and foremost, a person’s home. Therefore, residents, staff and visitors are to treat each other with RESPECT while at Kiweda. The Kiweda Coordinator ensures that residents and staff are aware of the Kiweda Code of Conduct and receive training where necessary.

RESPECT 1. Residents have the right to be addressed in a warm and friendly manner. Gentleness, kindness, politeness and courtesy are encouraged. 2. Residents have the right to be treated with fairness and understanding, and with respect for their dignity, autonomy, and needs. 3. Staff will address residents in a formal manner, using Mr. or Mrs. with the last name of the resident, unless a resident has expressed the desire to be addressed informally and called by their first name. In this case, this information must be recorded in the resident’s file. 4. Staff will always wear attire that is appropriate and decent.

THE RIGHT TO INFORMATION AND FREEDOM OF EXPRESSION 1. Staff members will assist residents who wish to be represented or to exercise a recourse. 2. Staff members will facilitate access to information, and to the support or assistance of a resident’s close relatives or any person of the resident’s choice. 3. Staff members will allow residents access to their file and any required explanations (either to the resident or their legal representative) to understand the contents. 4. Staff members will help residents to maintain their contacts outside of Kiweda. 5. Staff members will make it easy for residents to express their opinions, criticisms, or any suggestions concerning life at Kiweda.

THE RIGHT TO CONFIDENTIALITY 1. All information about a resident must be treated with confidentiality. 2. Staff members must not divulge information regarding the private life or state of health of a resident, other than what is required in the context of their work.

DISCRETION 1. Staff must show discretion in regard to residents and not utter complaints in their presence. 2. Staff members will avoid personal conversations, as well as confidential information about family or financial problems, or problems related to their work or Kiweda’s internal operations. 3. Staff members will be very discreet regarding information confided by a resident, and will not under any circumstances, divulge the information.

GIFTS, LEGACIES AND SOLICITATION 1. A staff member who is neither a spouse or close relative may not accept a donation, or a legacy, if made at the time the donor or testator was receiving care at Kiweda. 2. Staff must not solicit gifts of any nature from the residents.

WELL-TREATMENT Well-treatment is “a culture that inspires individual actions and collective relationships within an institution or service”.

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1. Staff will recognize the resident’s dignity, uniqueness, physical and emotional needs, pace, and history. 2. Staff will be non-judgmental and positive in their approach. 3. Staff will pay attention to any refusal or non-compliance of a resident. 4. Staff will value resident empowerment.

RESIDENT’S RESPONSIBILITY 1. Residents must always conduct themselves with respect for the rights of others, the property of others, and the normal rules of civility and politeness. 2. Residents must participate in the care and services that concern them by collaborating with staff. 3. Residents must respect the Kiweda rules.

EMPLOYEE ENGAGEMENT: I, ______the undersigned, acknowledge that I have been informed of the residents’ rights and this Code of Conduct put in place by KZHSS, and undertake to respect my roles and responsibilities in respect of them.

PROCEDURES:

The center operates 7 days a week, 24 hours a day, 365 days per year.

KZHSS with the client and/or family will collect and communicate accurate information about client medication, including over-the-counter medication, vitamins, and supplements and ensure the client and/or family understands that it is a shared responsibility. Liaison with the local pharmacist is often required. Workers will also advocate to the doctor for client’s needs.

Training arrangements for Nurses, and PSW’s, will be coordinated by the Nurse Supervisor. Evaluations, training, and/or shadowing will occur on a regular basis to ensure all pertinent staff are confident to carry out medication-related tasks,

Post Hospital Care is available for individuals who have been discharged from a health care facility and require twenty-four hour monitoring recovery and care for pain management and assistance with mobility. Respite Care is available for short term primary care to provide relief to care givers.

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a) B. Medication Management – Kiweda Group Home

PLANNING MEDICATION MANAGEMENT ACTIVITIES

(Safe and Secure System for Administration of Medication pursuant to (39.6 s, 39.7, 39.8 Professional Code and Care Techniques for Non-Professionals from the l'association québécoise d'établissements de santé et de services sociaux (AQESSS) in collaboration with the Home Care Nurse)

▪ The Kiweda Coordinator (Nurse) has access to all client medical information and is responsible to reconcile all medication. ▪ The PSW and Nurse are responsible for reviewing medication profiles every Monday afternoon. ▪ Every Wednesday, the Nurse ensures all medication orders are complete and arrangements are made with Jean Coutu pharmacy for the delivery of medication. ▪ All medication will be dispensed in each resident’s room to decrease any chance of errors ▪ When administering/assisting with medication, ensure that the client shows two client identifiers.

Client identifiers: • Picture on their door • Certificate of Indian Status • Facial Recognition • Name • Medical card • Drivers’ license • Bracelet

▪ Personal Support Worker will be responsible to document all medication that has been provided to resident. A medication management form must be completed in black or blue ink. For the daily recording of medication, use of the record sheet provided for this purpose by the resident’s pharmacy is recommended. ▪ Once the resident takes medication the Personal Support Worker will be responsible to monitor any side effects. ▪ If a resident leaves the premises overnight or longer they will bring their scheduled medications with them. ▪ Annual medication management evaluations will be performed by the Nurse Supervisor

PHARMACY ARRANGEMENTS

▪ To ensure client safety, efficient and consistent medication management practices, the Kiweda Group Home utilizes the exclusive pharmacy services of Jean Coutu. ▪ Residents or care providers are responsible for managing all of their medications and making arrangements with Jean Coutu pharmacy.

▪ ALL Medications must be prepared in dispill packaging by the Jean Coutu and ready to administer by oral, topical, transdermal, ophthalmic or otic route or by inhalation or insulin.

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▪ Jean Coutu must provide the up-to-date medication list. ▪ Prescribed medications from Jean Coutu are delivered to each clients room. ▪ Under no circumstances will a KZHSS employee pick-up a client’s prescribed medication for them

MEDICATION STORAGE AND DISPOSAL

▪ Prescribed medications are stored in a locked cabinet in each residents room. ▪ The locked cabinet contains the resident’s name, resident’s picture, info-santé phone number, resident chart and necessary health information/reminders. ▪ Medications that need to be refrigerated must be stored inside a locked box kept inside the refrigerated unit.

▪ Any unused, expired, or discontinued medications will be stored in the locked cabinet in the Coordinator’s office. ▪ The Coordinator will bring expired and unused medications for disposal to the designated area for bio-medical waste within the Health Center on a regular basis. ▪ Bi-annual biomedical waste pick-up is coordinated by the Environmental Health & Safety Technician in accordance with the Règlements sur les déchets Biomédicaux, Ministère du developpement des parcs QC.

MEDICATION ERRORS

Every medication error or near miss must be documented using the medication error form. Examples might include a dropped pill, a resident taking a medication at the wrong time or overmedicating of a PRN, a pharmacy-related error, etc.

▪ The PSW will immediately contact the Kiweda Coordinator when a medication error occurs. ▪ The Kiweda Coordinator will take steps to minimize the risk or harm the error may have caused. This may include contacting the pharmacy, the Doctor, or 811, or monitoring the situation. ▪ Any medication error or near miss must be documented and reported to the Kiweda Coordinator. ▪ All medication error forms will be examined by the Accreditation Team as part of the Risk-Management Framework. Actions to implement will be proposed to prevent or decrease the chances of a similar incident occurring in the future.

SELF-ADMINISTRATION OF MEDICATION

▪ Prescribed medications will be stored in each resident’s room for self-administering purposes, and stored in such a way that the medication is not easily accessible to the other residents.

▪ The PSW’s will encourage residents to take their medication. A medication distribution service must not be imposed on a resident who wishes to manage his or her own medication.

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DISTRIBUTION OF MEDICATION

1. The Kiweda Coordinator offering medication distribution or administration services must: o Informs residents that the medication distribution service is restricted to simply handing over medication prescribed in their name and prepared by a qualified professional (pharmacist). o Designates a staff member responsible for distributing the medication during each work shift. o Ensures that the medication distribution service is provided by authorized persons (e.g. a nurse, PSW) authorized under sections pursuant to section 39.9 of the Professional Code) o Ensures that the person designated to perform the service holds the necessary training to carry out this task safely, with a view to minimizing the risks of incidents or accidents.

b) Procedure for Determining Access to Information

All information at the Kiweda Group Home is considered confidential. Only certain individuals have the right to access information. They are:

▪ The Kiweda Supervisor ▪ The Kiweda Home Visiting Nurse ▪ The Kiweda PSW’s ▪ The Director of Kitigan Zibi Health and Social Services ▪ The Medical Clerk employed by the Kitigan Zibi Health and Social Services ▪ Nursing Documentation: Only the home visiting Kiweda Nurse has access to the information located in the client’s chart filed at the Kitigan Zibi Health Center. These notes consist of Nursing observations, vital signs and nursing interventions applied.

PSW Documentation: These notes are accessible to the Kiweda Group Home PSW’s, Nurse and Supervisor of the Kiweda Group Home. These notes consist of observations of activities of daily living, monitors observations, along with behavioural and feeling states of each client during each shift.

DNR, Living Will, Legal documentation: These documents are accessible only to the Nurse Onsite, and to the Supervisor of the Kiweda Group Home. PSW’s will be given access to the DNR information. These are legal documents and may also be accessed by the clients Doctor or Ambulance drivers in case of illness, injury or death. Medication Profile/Vital Signs Chart The medication profile will consist of the current medications as provided by the pharmacy. These documents are prepared and maintained by the Onsite Nurse. The PSW’s have access to the medication profile at all times for documentation purposes. Requests made by clients to obtain copies of the vital signs charts or medication profiles are to be released only by the PSW’s, Onsite Nurse or Supervisor. These are usually the only documentation that the client can obtain copies of for medical purposes.

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Care Plan Each client has a careplan located in his or her charts. These care plans are maintained only by the onsite Nurse, and are used as guides for care for the PSW’s. The PSW’s, Nurse and Supervisor all have access to the care plans. The care plans are updated daily or weekly by the Onsite Nurse.

Access to Residents Chart when a Resident passes away

After a client has passed away, and all documentation has been performed, the residents chart is to be transported to the Kitigan Zibi Health and Social Services Archives center. The Onsite Nurse or the Supervisor will perform transportation of the clients file. Upon arrival, the Kitigan Zibi Health Center Nurses are the only individuals with access to the chart. The medical clerk may also access the chart for filing purposes only.

c) Suspected Resident Abuse

Definition of Abuse:

Physical abuse involves inflicting physical discomfort, pain or injury. It includes behaviours such as slapping, hitting, punching, beating, burning, sexual assault and rough handling.

Psychological abuse diminishes the identity, dignity and self-worth of the older person. Examples are name calling, yelling, insulting, threatening, imitating, swearing, ignoring, isolating, excluding from meaningful events and deprivation of rights.

Financial abuse, also known as material or property abuse, involves the misuse of money or property. Examples include stealing money or possessions, forging a signature on pension cheques or legal documents, misusing a power of attorney, and forcing or tricking an older adult into selling or giving away his or her property.

Neglect is the failure of a caregiver to meet the needs of an older adult who is unable to meet those needs alone. It includes behaviours such as denial of food, water, medication, medical treatment, therapy, nursing services, health aids, clothing and visitors.

Any suspected resident abuse should be immediately reported to the Kiweda Coordinator.

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d) Fire and Evacuation Plan

The safety of the Kiweda residents and staff will be promoted through use of a written fire and evacuation plan. The plan will be coordinated with the local community fire authority. In fact, the authority may assist in the development of the plan and related processes and procedures. The Kiweda Group Home supervisor will ensure compliance of the plan with any fire codes and regulations.

All fire safety concerns identified by staff will be reported immediately to the Kiweda Group Home supervisor. All concerns will be documented.

The fire and evacuation plan will identify the following and should be developed with input from the community fire authority:

▪ Frequency and documentation of workplace safety inspections ▪ Frequency and documentation of inspection of the physical structure where the Kiweda Group Home staff are located ▪ Frequency and documentation of inspection of fire extinguisher equipment used on the premises ▪ Frequency and documentation of fire and/or evacuation drills ▪ Who is responsible to initiate the fire and evacuation plan ▪ Education and training of staff about their responsibilities in the event of a fire and/or evacuation ▪ Floor plan of the office space ▪ List of the items kept at the First Aid Station and its location ▪ Define who is in charge of inspecting the First Aid Station ▪ List of hazardous products that are kept in the office space

PROCESS GUIDELINES

During orientation, all staff will be made fully aware of the fire and evacuation plan. This orientation will include an explanation of:

▪ The procedure to be followed in the event of a fire and/or evacuation occurring at the Kiweda Group Home. ▪ How practice drills and exercises will be reported and recorded ▪ How fire safety concerns will be reported, recorded and monitored for any trends ▪ Staff responsibility in initiating a fire and/or evacuation response ▪ Use of fire extinguishing equipment ▪ Types of fire extinguishing equipment located at the Kiweda Group Home. ▪ Identification of hazardous products, including the use of WHMIS labels and MSDS sheets ▪ Regular fire and evacuation practice exercises will be carried out in partnership with the community fire authority. In fact, the authority may assist in the development of the plan and related processes and procedures. ▪ Reports will be completed to record these activities and they will be reviewed on a regular basis to identify any changes that should be made to the fire and evacuation plan.

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e) Procedure for Handling Gifts from Residents

It is the policy of the Kiweda Group Home that gifts bought intentionally for an employee by a resident, that does not exceed a reasonable price value, is considered acceptable. (Scarves, socks, picture frames, books, key chains, Coffee Mugs, etc.)

However, if the resident has purchased an overly valuable item for an employee, the employee must decline accepting the gift (rings, earrings, necklaces, TVs, cars, etc). The Employee must kindly explain why he/she cannot accept the gift, and ensure that the resident’s kind gesture is remarked and shown gratification for their thoughtfulness.

ABSOLUTELY NO MONEY or CHEQUES ARE TO BE ACCEPTED AT ANYTIME AS A GIFT.

The Employee, will NOT AT ANY TIME borrow from or lend a resident money of any kind, such as cash, valuable items, cheques, etc. The Supervisor will take disciplinary measures if an employee is suspected of borrowing money from a resident at the Kiweda Group Home.

Some residents may be insulted if their gift is not accepted. If the resident becomes angry, sit with the person and explain why you cannot accept their gift, and inform your Supervisor of the situation. If needed, get the Supervisor to explain Kiweda’s policy concerning handling of gifts from residents.

f) Obtaining Legal Documentation from A Resident (DNR)

Legal Documentation at the Kiweda Group Home is known as:

▪ DNRs (Do not resuscitate order) ▪ Mandate in case of incapacitation

DNR:

If a Kiweda resident wishes to have a DNR, he/she may discuss with the Family Doctor. If a client wishes to not be resuscitated by the employees at the Kiweda Group Home, they must provide the documentation signed by a doctor in order for the employees to abide by the residents wishes. This documentation will be situated inside the residents file, or posted on the wall in the resident’s room for easy access.

A written request by the resident, which is not signed by the doctor or notarized, will not be acceptable and resuscitation will be performed regardless of the residents written or verbal request.

Residents residing at the group home, which have been diagnosed by a doctor as in the palliative phase of their disease process, are suggested to sign a DNR, to prohibit resuscitation. The Group Home does NOT promote resuscitation of palliative clients, and require legal documentation (DNR) prior to admission for palliative care. Resuscitation will occur if the resident has not provided a DNR signed by a doctor or notary. Upon arrival, the DNR must be provided to the paramedics to prohibit resuscitation or intubation of the resident.

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MANDATES IN CASE OF INCAPACITATION:

The Residents are encouraged to fill out a mandate concerning their wishes in case of incapacitation. These forms are available at the Kiweda Group Home and will be kept in each residents chart for accessibility.

Assistance with filling out the form will be provided at the Group Home if needed.

*MAKE a copy for the wall and update regularly with current info:

g) Major Resident Events - Procedures

PROCEDURE TO FOLLOW IN THE EVENT OF DANGER TO A RESIDENT’S LIFE OR INTEGRITY

Procedure: 1. Assess the situation, (alert other staff for assistance, use the call button). 2. Call 9-1-1 immediately, giving all relevant information about the nature of the emergency. 3. Notify the resident’s emergency contact. 4. Prepare required information for ambulance personnel (main diagnosis, list of medication, allergies, etc.) 5. Record a description of circumstances and facts in the resident’s file. 6. Notify Kiweda Coordinator regarding the nature of the emergency. 7. Complete an accident/incident report.

PROCEDURE TO FOLLOW IN THE UNEXPECTED DEATH OF A RESIDENT:

1. Call 9-1-1 immediately. 2. Inform the Kiweda Group Home Coordinator. 3. Call attending physician. 4. Contact emergency contact.

36. Unless he has reasonable cause to believe that a coroner, a physician or a peace officer has already been informed, every person having knowledge of a death must immediately notify a coroner or a peace officer where it appears that the death has occurred as a result of negligence or in obscure or violent circumstances or where the identity of the deceased person is unknown to him. 1983, c. 41, s. 36; 2011, c. 27, s. 36.

CASE OF PALLIATIVE CARE:

The list of persons to be contacted is as follows:

1. Client ’s family members 2. Supervisor and on site nurse

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3. CLSC nurse (she/he will contact the doctor) 4. Employees (PSW’S, cook, janitor)

UNCONCIOUS CLIENT

If you find a client unconscious, without a pulse or respirations, you must perform CPR if there is no DNR. If there is a DNR, you do not resuscitate the client.*

List of important contact numbers: 1. Kiweda Coordinator 2. Community Health Nurse 3. CLSC nurse - (between 8am- 4pm weekdays): 441-2600 (a nurse will respond and will notify the nurse on that particular shift to call you) 4. CLSC nurse - (after 4pm weekdays, and weekends): 1-819-770-9059 5. Family members: a list will be formulated upon admission and will be placed in the client’s chart. 6. Ambulance: 911 7. McConnery’s funeral home – 449-2626: they are to be contacted only after the doctor has filled in the death certificate, and the family is ready to let their loved one be transported to the morgue. The death certificate must be given to the porter from McConnery’s funeral home upon their arrival. 8. Employees – a list of employee contact numbers is located on the wall beside the nursing station.

PROCEDURE TO FOLLOW IN THE EVENT OF THE UNEXPLAINED ABSENCE OF A RESIDENT

1. Question staff as to possible reasons for resident’s absence and place where they might be found. (e.g. on a walk, at a friend’s etc). 2. Search the entire premises of the residence, and the land and surrounding area. 3. Notify the emergency contact to see if they know where the resident may be found. 4. Notify the Kiweda Coordinator. 5. Call KZPD to report the disappearance to the Police. 6. Complete and give police “General Resident Profile” Info Sheet, along with a recent photo of the resident. 7. Complete an accident/incident report. 8. If the resident is found, notify the emergency contact, and the police. 9. To prevent a reoccurrence, take necessary measures together with the resident and their family if the person is prone to wandering.

PROCEDURE TO FOLLOW IN CASE OF A HEAT WAVE ADVISORY

Extreme heat conditions announced by Environment Canada. • The air temperature reaches or exceeds 30°Celsius

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• The humidex (combined temperature and humidity index) reaches or exceeds 40° Celsius. • A heat wave advisory is based on forecast for three consecutive days with highs of 31°C, lows of 16°C and a humidex of 37°C.

Special measures need to be taken for the benefit of the residents • Distribute cool drinks and water frequently during the day. • Discourage consumption of highly caffeinated drinks (coffee, tea, cola) or very sweet drinks (sodas) because they are dehydrating. • The cook may allow for adapting menus and serving cold meals (fruit, raw food, salads). • Rule out all physical activity from the scheduled recreational activities and advise resident going outside to stay in the shade, or to go out later in the day. Residents are encouraged to wear a hat and/or apply sunscreen. • Invite residents to gather in the cooler rooms, like the dining area, or TV area where there is air conditioning. • Advise residents to dress as lightly as possible (loose-fitting, or light garments) • Advise residents to take a shower or bath with tepid water to refresh themselves. • Plan on measures to check resident’s physical condition tours of bedrooms. • If a resident shows signs of deteriorating physical condition, call 9-1-1.

Special measures to take to adapt the physical environment • Ensure that are enough fans are set up in the common areas and, where possible, in bedrooms. • Ensure that the residence is supplied with water and ice. • Early in the morning, close the blinds or curtains and windows, especially those on the sides of the residence that are exposed to the sun. Keep them closed until the outside temperature falls. • Early in the evening, or when the outside temperature falls below the temperature inside the residence, open the windows as wide as possible to created drafts. • Make rounds to check the rooms.

PROCEDURE TO FOLLOW WHEN A RESIDENT SHOWS SIGNS OF AN INFECTIOUS DISEASE

1. The resident’s situation will be monitored to ensure their comfort and progress. 2. The janitor will be alerted for heightened infection prevention and control measures. 3. The resident is encouraged to remain in their own room while considered infectious, meals will be served to the resident in their room. 4. If the resident’s condition worsens, medical attention will be sought.

PROCEDURE TO FOLLOW IN THE EVENT OF POTENTIALLY HARMFUL BEHAVIOUR

1. Ensure the safety of the resident and those around them using diversionary measures to calm the situation.

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2. Ensure that Kiweda is supervised by a staff member of another person until the situation returns to normal. 3. In an extreme emergency, or if the situation gets out of control, call the KZPD. 4. Notify the person’s emergency contact. 5. Notify the Kiweda Group Home Coordinator. 6. Document the situation. 7. Keep the information sheet separately in the resident’s file to allow for quick consultation. 8. Comply with instructions from the Kiweda Group Home Coordinator regarding measures to be taken, including possible control measures, recommended supervision and provisions for relocating the resident, if applicable.

ALTERNATIVE MEASURES FIRST Alternative measures are actions or approaches to use to reduce the manifestations of potentially harmful behaviors or behavior disorders. They are designed to reduce unusual and unexpected behavior while keeping the person and those around them safe. Use of an alternative measure requires regular observation of the person’s life habits to determine the causes that contributed to the manifestation of signs that take various forms. At all times, approaches must be subject to an assessment and an intervention plan that recommends non- pharmacological interventions (without the use of chemical substances). Staff training and an adapted environment are considered the most effective means of reducing behavior disorders. The following appropriate actions and approaches can be used: ▪ Maintain a regular timetable of activities of daily living, with particular regard to elimination and meal times; ▪ Maintain socialization activities; ▪ Provide frequent rest periods; ▪ Ensure that the resident assumes a comfortable position; ▪ Monitor the effects of medication and request adjustments as needed; ▪ Monitor the resident’s general state of health and advise a doctor’s appointment, as needed.

Box 160, 8 Kikinamage Mikan, Maniwaki, QC J9E 3B4  819.449.5593/1.866.660.5593 Kiweda Coordinator (toll-free)/819.449.2323 Fax: 819.449.7411/819.449.2390 www.kzadmin.com

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2.0 NICHOLAS STEVENS CENTER

Nicholas Stevens Center

POLICY DATE DATE Kitigan Zibi PSD-015 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS provides disabled adults within the KZA community day center services and programming.

PURPOSE

To provide stimulating educational and inclusion activities to disabled adults who require assistance and guidance to meet daily needs.

KZHSS RESPONSIBILITY:

KZHSS ASSISTANT DIRECTOR:

▪ The KZHSS Assistant Director is accountable and responsible for the development, delivery, evaluation and administration of the Nicholas Stevens Center. ▪ Monitors the achievement of the goals and objectives of the Nicholas Stevens Center. ▪ Monitors the delivery of the Nicholas Stevens Center activities. ▪ Ensures equitable access to the services. ▪ Ensures client assessments are completed. ▪ Ensures that essential Nicholas Stevens Center elements and standards are maintained and that the KZHSS policies are followed. ▪ Hires, trains, coordinates, and supervises the ongoing development of staff. ▪ Provides supplies and ensures the building is safe and equipment is operational to meet the designated health and safety standards. ▪ Ensures proper administration of the Budget. ▪ Coordinates Nicholas Stevens Centre services with other community programs and services and the promotion of building good working relationships. ▪ Prepares and communicates reports to the community leadership, AANDC and for the operational plan, as required (e.g. statistics). ▪ Identifies unacceptable behaviour that could put the participant and others in danger. To ensure that different conflicts and situations are acted upon. ▪ Establishes and maintains sanitary conditions in the center as well as promotes personal hygiene. ▪ Protects participants and does not expose participants to any activities which may result in injuries. This includes activities organized outside the center. ▪ Ensures the participants are following proper health measures with regards to diet and exercise.

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NICHOLAS STEVENS CENTRE FUNDRAISING COMMITTEE TERMS OF REFERENCE

▪ Assist the KZHSS with operational and repair cost through its fundraising activities. ▪ The Committee does not have any decision-making responsibilities or authority with regards to operation of the Centre. ▪ The Nicholas Stevens Centre fundraising group will produce and report annually all the financial records to the Kitigan Zibi Band Council of fundraising efforts for auditing purposes. ▪ Friends and/or family members wishing to accompany a participant on a field trip will be required to cover their personal expense of attending organized events (ie. Concert tickets). ▪ If one family member is required as an escort, the expense for the activity will be covered by the Nicholas Stevens Centre. ▪ The Assistant Director will organize a yearly meeting with the NSC Committee and the KZHSS Director. ▪ The Committee will abide by all KZHSS policies and procedures. ▪ Funds raised for outings and activities will be made available to all students attending the NSC. Family members of the committee/participants are responsible to cover their own expenses to attend the event/activity. ▪ Outings organized by the committee will extend invitations to all students.

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: ▪ Registered KZA band members ▪ Person must be autonomous in personal care and require minor assistance with activities of daily living. ▪ A multi-clientele autonomy assessment must be completed. ▪ Minimum age of 18 years. ▪ Persons who are assessed as being violent and aggressive or who are found to be after being accepted to the Nicholas Stevens Center will be denied access. ▪ Free from air-born contagious diseases.

▪ Person must be autonomous in personal care and require minor assistance with activities of daily living. ▪ Participants must administer their own medication. ▪ No one under the influence of drugs or alcohol will be allowed entry to the Nicholas Stevens Center. ▪ No foul language shall be permitted or endured whether on the bus or in the center. ▪ No aggressive or abusive (mental /physical) behaviour will be tolerated at the Nicholas Stevens Center. ▪ Telephone access and use will be restricted to the center’s related information and emergencies. ▪ Each person will be expected to participate in daily activities that are planned with the Nicholas Stevens Center monitors. This includes daily chores that are designated to each individual. ▪ Participants will be expected to bring all appropriate attire when going out on activities.

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▪ No junk food will be offered in the center and no participants should bring in any either. Certain days and field trips will be designated for treat days where certain junk food will be permitted for the day. ▪ The consumption of alcohol and/or drugs is NOT allowed at the Centre or on outings/field trips organized by the NSC. This includes on the part of participants, accompanying monitors/supervisors and drivers.

MEDICATION MANAGEMENT

▪ Participants are encouraged to take their medications at home, when possible. However, those who require medication during NSC hours can be assisted by the monitors. ▪ All prescribed/OTC medications will be stored in a locked cupboard with the name of the medication and individual clearly marked on the label. ▪ If a monitor is not able to assist the participant, they may contact a community health nurse.

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3.0 ENHANCED PREVENTION SERVICES

Enhanced Prevention Services

POLICY DATE DATE Kitigan Zibi PSD-016 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS provides prevention services at the primary, secondary, and tertiary level to prevent or divert families to reach a crisis state, throughout all stages of life.

PURPOSE

To decrease the number of youth going into group homes and/or foster care and detention centres.

KZHSS RESPONSIBILITY:

▪ Director ▪ Enhanced Prevention Services Coordinator ▪ Life Skills Coach ▪ Family Wellness Worker ▪ Youth Prevention Worker ▪ Youth Protection Human Relations Officer, Social Worker under the clinical supervision of the Centre Jeunesse de l’Outaouais ▪ Youth Diversion Worker ▪ Mental Health Social Worker

COORDINATOR:

▪ Responsible in coordinating intakes and referrals for client case management plans (aiding in the development with stakeholders (therapist, psychologist and/or medical personnel, youth protection and youth diversion workers), and helping with the follow-up and/or changes to be made if necessary on the case management plan. ▪ Responsible in coordinating different activities, researching information on various topics of at risk activities and obtaining information from the various sources for distribution amongst the community members. ▪ To aid and amass statistical data.

LIFE SKILLS COACH:

▪ Parental coaching. ▪ Family counseling. ▪ Community education on parenting. ▪ Life skills teaching for different age groups.

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▪ Support group work. ▪ Financial coaching and guidance. ▪ Community education on family issues. ▪ Stress Counselling ▪ Youth groups

FAMILY WELLNESS WORKER

▪ Family violence prevention counseling. ▪ Rape victims support. ▪ First steps to trauma counseling. ▪ Stress counseling. ▪ Counselling for friends/relatives of persons experiencing stress. ▪ Support group work. ▪ Stress counselling.

YOUTH PREVENTION WORKER

▪ Youth counseling. ▪ Community youth activities focusing on prevention. ▪ Youth groups ▪ First steps to trauma counseling. ▪ Stress counselling.

YOUTH PROTECTION HUMAN RELATIONS OFFICER, SOCIAL WORKER under the clinical supervision of Centre jeunesse de l’Outaouais:

▪ Provide services under the Youth Protection Act. ▪ Provide counselling and referral services. ▪ Provide parental support. ▪ Youth protection family/client information is restricted to workers delegated under the Youth Protection Act. ▪ Multi-sectoral agreement concerning sexual abuse. ▪ Meeting of significant individual’s facilitator’s guide. ▪ Uses clinical tools such as the Grid to Assist in Making Emergency Removal Decisions and Discontinuity and Instability Risk Screening Grid. ▪ Stress Counselling.

YOUTH DIVERSION WORKER:

▪ To divert youth from offending and re-offending. ▪ Works closely with the youth delegate under the Youth Criminal Justice Act. ▪ Provide KZA youth with opportunities to make positive changes in their lives. ▪ Address underlying behaviours (pre-existing conditions, circumstances that lead to offending behaviour). ▪ Community services hours placements for youth and adults ▪ Stress Counselling.

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MENTAL HEALTH SOCIAL WORKER: ▪ Provide family support and counseling ▪ Provides general mental health support for all age groups ▪ Provides referrals to other services ▪ Support group work ▪ Networks with visiting therapists and physicians. ▪ Stress Counselling.

CRIMINAL COURT DIVERSION WORKER The Criminal Court Diversion Worker delivers early intervention and preventative initiatives to divert clients’ behaviour from factors that could lead to crime-related lifestyles (e.g. anti-social behaviour, social exclusion, recidivism). ▪ Mentors, guides, educates, supports and engages “at-risk”/socially disengaged clients through one-on-one sessions or in innovative group activities that focus on healthy lifestyles (e.g. fitness, education, culture), positive personal development (skills, attitudes, assets competencies and resiliency) and effective communication strategies or other activities that divert youth from engaging in criminal behaviours; positive role models; ensures clients have access to such programs and/or similar resources inside/outside the community. ▪ Collaborates with partners (multi-disciplinary team) to advocate on behalf of clients, provide programs that encourage success, foster connectedness (e.g.. to culture, nature, community), and provide crisis intervention; Develops a network of community services for clients to access ▪ Accompanies, attends, and advocates on behalf of clients; works with authorized bodies to develop alternatives to court action; ▪ Develops and delivers public education workshops for clients, families, and other service providers; obtains feedback regarding design, implementation and evaluation from stakeholders regarding programs. ▪ Assists, guides, and supports clients through capacity-building activities (e.g. parenting skills, stress management and substance-abuse prevention strategies; promotes and encourages parental involvement; ensures clients understand and comply with court decisions. ▪ Will also be required to work with offenders in facilitating reintegration back into the community based on conditions of early release (e.g. community service work). ▪ Maintains clear, precise and appropriate information in confidential case files, documents participation/involvement in activities, shares with pertinent agencies when appropriate;

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: ▪ Registered KZA Band members ▪ Youth Protection: Registered KZA Band members on-reserve ▪ Youth Diversion: Registered KZA Band members aged 12-17 ▪ All KZA families and youth

PROCEDURES: Enhanced Prevention Services develops a plan of intervention with the client and their families. The plan will name the KZHSS workers, therapists, medical personnel responsible for each part of the intervention and follow-up on a regular basis for a specific period of time. And, change plan accordingly with the different needs of the client. It also develops prevention activities that

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will aid in the prevention of at risk behaviour in the community. They provide the community with current information on various topics by using intervention/case management plans from referrals made to the service. Prevention activities are carried out within the community to distribute current information of at-risk behaviour and provide educator services to families.

Youth Protection provides services according to the Health and Social Services Act, Youth Protection Act of Quebec and Federal Youth Criminal Justice Act.

The Youth Diversion Program works with youth who are in conflict with the law or who are involved in the justice system.

Please see other relevant KZHSS Policies and Procedures.

Enhanced Prevention Services Coordinator Département de la justice Òde Wìdòkàzowin 1-800-567-6810 315 Fafard, P.O. Box 160 Maniwaki, Quebec J9E 3B4 Centre jeunesse de l’Outaouais Telephone: 819-449-2323 1-800-449-4880 Youth Protection Human Relations Youth Diversion Worker Social Worker Telephone: 819-449-5593 Telephone: 819-449-5593 ext. 231 Secure Fax: 819-449-7927 Fax: 819-449-7411 1-866-660-5593 1-866-660-5593

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4.0 WASEYA HOUSE

Waseya House

DATE DATE Kitigan Zibi POLICY CODE: PSD-017 05/09/2016 05/09/2016 Health & APPROVED: REVISED: Social Services

POLICY

KZHSS provides shelter, intervention, and counselling to First Nations’ families experiencing family violence.

PURPOSE

To provide a safe environment for community members/families experiencing family violence.

KZHSS RESPONSIBILITY:

Waseya house first opened its doors in March 1991. It has three bedrooms with private bathrooms (one bedroom is wheelchair accessible), a common living room, and dining room, kitchen and laundry facilities. The House is completely furnished and equipped to make families feel comfortable and at home.

WASEYA HOUSE FAMILY VIOLENCE CRISIS INTERVENTION WORKERS:

Responsible for maintaining client files: ▪ Obtains client consent to share information with other services as required. ▪ Ensures that files are locked at all times and maintains confidentiality. ▪ Makes sure that client statistics are submitted on a yearly basis.

Responsible for ensuring delivery of Waseya House Services:

▪ Workers will share a varied work schedule based on who is scheduled to carry the cell phone for emergency services. ▪ Fills out Intake forms with resident. Will inquire as to past criminal offenses, court appearances, current or pending charges, and past involvement with the penal system. ▪ Explains House Rules and Procedures to Resident during Intake. ▪ Familiarizes Residents with available resources, legal rights, housing, employment and training opportunities. ▪ Assists the family in the development of an appropriate and safe physical environment for the children so their growth and development are enhanced by applying parenting skills. ▪ Encourages resident to notify the Income Security Officer of their change of residency status. ▪ Discusses with the Resident and prepares a menu plan to ensure that it includes three healthy meals daily and snacks. ▪ Purchases groceries based on menu planning. ▪ Escorts Residents to appointments such as doctor, dentist, lawyer, etc. ▪ Introduces and initiates a recreational program for the benefit of the child(ren) at the Waseya House. ▪ Organizes social and recreational activities for the Residents on an ongoing basis. ▪ Counsels clients within the Waseya House and others by telephone. ▪ Ensures cleanliness and upkeep of the House. ▪ Cleans rooms after departure of Residents. ▪ Maintains an updated list of Support Workers.

Responsible for providing the community with information on family violence:

▪ Works with NNADAP to prepare a seasonal newsletter. ▪ Prepares and delivers awareness prevention programs to reduce and eliminate child abuse and neglect (physical, sexual, emotional), elder and spousal abuse.

Responsible for communicating with proper authorities:

▪ Communicates with Social Services to advise them of new Residents so they can meet with them to evaluate the services needed. ▪ Communicates with the Kitigan Zibi Police Department to inform them of new Residents at the House for security purposes. ▪ Communicates with frontline workers in the other Algonquin communities so that we can provide assistance to them.

WASEYA HOUSE SUPPORT WORKER:

▪ To provide support and assistance to Waseya House Staff. ▪ To ensure the safety, security and confidentiality of the Residents and their child/children at all times. ▪ To ensure that the Residents follow the rules of the House.

Duties of the Waseya House Support Worker: ▪ Do groceries, ▪ Do house cleaning chores, ▪ Transport Residents, ▪ Assist with Child Care, ▪ Answer the phone, ▪ Fill out Incident Report as needed, ▪ After each shift to ensure that the windows and doors are locked and secured.

The Support Worker is responsible for referring to the Waseya House Worker for the following: ▪ Emergency Calls: during their shift if they receive a call from police officers, social workers or other referral agents, they will record the name and phone number, and contact the Waseya House worker on call. ▪ Counseling or Interventions: depending on the circumstance to write their concerns or to contact a Waseya House worker. ▪ Terminations: if the Resident breaks a major House Rule, to contact a Counselor and the Waseya House worker. ▪ Decides to Depart: if the Resident decides to leave (permanently) Waseya House, to contact a Waseya House worker. They will inform the Support Worker how to proceed.

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RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: ▪ Algonquin and First Nation women and men with or without their child(ren) who are experiencing family violence. ▪ Status Indian registered in an Algonquin community (must be prepared to present a copy of a valid status card as proof). ▪ Must be experiencing family violence. Other criteria may include a woman who is vulnerable to abuse, such as a woman in difficulty, facing homelessness, or one that is awaiting a mental health intervention. ▪ Can be accompanied by child(ren). ▪ Must be 18 years old (with the exception of a young parent who has physical custody of child(ren) and lives independently from parents). ▪ Referred by a police officer (KZPD, SQ, or other community police). ▪ Referred by a social worker (KZHSS, CJO, or other). ▪ Referred by a community front line services worker, NNADAP, Community Nurse or Quebec Native Women’s Association. ▪ Referred by Halte Femme (if not a status Indian we can accept them for a maximum of 48 hours) or other shelter. ▪ Men experiencing family violence who are single or who have physical custody of their child(ren), providing there are no women currently residing within the shelter (short term).

Waseya House is NOT a medical facility, and is therefore not equipped to meet the needs of or accept clients: ▪ With severe psychological conditions ▪ Who are experiencing withdrawal symptoms ▪ Who have serious charges that have not been dealt with ▪ Who have air borne contagious diseases requiring hospitalization. ▪ Who have serious illness requiring hospitalization.

Please note that the above-mentioned cases should be referred to hospital-type institutions.

Waseya House can refuse to admit clients or terminate their stay based on: ▪ Lack of space (room availability) ▪ Someone who does not fit the Criteria for Admission ▪ Former residents who refused to follow the Waseya House Rules and Regulations. ▪ Dishonesty on the client’s part upon request of required personal information. ▪ Proven illegal drug use within the house; ▪ Client threatening staff and/or residents.

WASEYA HOUSE CLIENT:

▪ Maintain confidentiality of the Clientele using the services at Waseya House. ▪ Clients are responsible to manage their own medications and are responsible for giving any medication to their children, as required. ▪ Fully and honestly divulge any information requested by the counselors.

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▪ Follow House Rules. ▪ Keep their rooms clean for sanitary purposes. ▪ Daily chores:  Dishes - wash and put away.  Vacuum - bedroom, hallway, play area.  Bathroom - clean and empty garbage.  Floors - sweep and wash (when needed).  Garbage/recycle - pick up and bring to the bins. ▪ Cooking healthy meals. ▪ Residents are responsible for their child/children. ▪ Must be able to stay alone during the night, if not arrangements can be made. ▪ Out of town clients are responsible for their own transportation to and from the Waseya House (some communities will provide transportation). ▪ Residents are responsible for local transportation for personal reasons such as visiting family or friends. ▪ Residents may receive visits from family or friends at the Waseya House with the consent of the staff. ▪ If a client leaves the premises, they must advise Waseya House workers of their whereabouts. If the person does not contact the Waseya House within a period of 48 hours, the police will be informed. If the client has children, the DPJ will be notified. ▪ Take initiative to seek housing with the assistance of the Waseya House workers. ▪ KZA income security clients have the responsibility to inform the KZHSS Income Security Officer.

PROCEDURES:

a) Medication Management – Waseya House

▪ Upon intake to KZA assisted-living programs, clients must provide informed consent for medication assistance. ▪ Clients are responsible for managing all of their medications and making arrangements with their respective pharmacy. Upon intake, while residing at the Waseya House, and upon departure, a client will fill out the Waseya House Client--Medication Management Form. ▪ It is the residents’ responsibility to administer their own medication as prescribed by their doctor. ▪ Upon intake, each client will place all of their prescribed and over-the-counter medications in their assigned basket which will be stored in a locked cabinet in the Waseya House workers office. ▪ When a client requires access to their medication, they will ask the Waseya House Worker for their basket. Clients will return the basket to the worker once they have taken their medication, and will sign the medication form. ▪ The Waseya House worker will ensure that the client has any required medication dose available to them during their absence (ie. evenings/night). As a last resort, the client may call the worker who may need to come in to provide access to the client medication. ▪ If a resident leaves the premises overnight or longer they will sign out all of their medications. ▪ An over-the-counter (OTC) waiver will be signed by clients and the Counselor for clients who need OTC medications overnight and weekends.

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▪ If a resident requires an over-the-counter medication such as Tylenol or Children’s Tylenol and does not have any in their possession, a Waseya house worker will provide a single dose until the client can purchase some. ▪ Waseya House workers will keep any of their personal medications within the locked cabinet. ▪ Any medication left behind by the client will be picked up by the pharmacy, and the Driver will sign the departure form. ▪ If a pill is found within the Waseya House, it will be brought to the police station for verification and/or disposal. ▪ If a resident requires medication management education, a KZHSS nurse can be called to assist. ▪ Waseya workers will document behaviors related to medication management. ▪ UNDER NO CIRCUMSTANCES will a KZHSS employee pick-up a client’s prescribed medication for them. A client or family member will pick up their own medication or it will be called in and delivered by the pharmacy. ▪ Clients will not be allowed to share medications with other clients. ▪ Misuse of medication, can warrant dismissal from the Waseya House.

b) Evacuation Plan ▪ In the case of an emergency (ie. Gas leak, fire/smoke, or any other health hazard situation), clients/residents will be temporarily relocated. ▪ In a hydro blackout situation, all efforts must be made to conserve energy from the generator. ▪ In case of sudden, urgent evacuations during nights and weekends, clients/residents must go to the Kiweda Group Home. The Kiweda Group home will contact the police and then the Waseya House Worker.

c) KZA Family Violence Crisis Call Protocol

Please refer to the KZA Family Violence Crisis Call Protocol in the Shared Community Protocol section of the Policy Manual.

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5.0 ENDONG LUNCHEON

Endong Luncheon Meal

POLICY DATE DATE Kitigan Zibi PSD-018 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS offers a weekly meal subsidy activity for senior community members through the weekly Endong luncheon.

PURPOSE

To encourage socialization and benefit from a nutritious meal.

KZHSS RESPONSIBILITY:

Director, Endong worker, Transportation Driver

RESPONSIBILITY OF THE CLIENT:

Must be a registered KZA community band member who is 55 years or older.

Transportation can be arranged for clients wishing to attend the Endong luncheon.

All Endong workers receive proper training in Safety courses, food handling preparation, and WHMIS.

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PART IV:

Client Care

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A. CASE MANAGEMENT 1.0 URGENT CLIENTS FIRST

Urgent Clients First

POLICY DATE DATE Kitigan Zibi CC-001 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS responds to client’s needs in a timely fashion implements the process for establishing most urgent clients first.

PURPOSE

To ensure client safety, KZHSS prioritizes clients in an emergency or crisis situation.

KZHSS RESPONSIBILITY:

Nurse Supervisor, Counselors, Nurses, Supervisors, Coordinators

RESPONSIBILITY OF THE CLIENT:

Clients in non-urgent situations respect KZHSS policy to prioritize urgent clients/cases.

PROCEDURES:

Examples of KZHSS emergency situations (not limited to or in any particular order and notwithstanding any medical emergencies): ▪ Client is a threat to self or others ▪ Police referrals ▪ Clients have a file with the Département de jeunesse ▪ Children in placement or requiring potential placement ▪ Teenagers who are living outside their parental home ▪ Teenagers who request our help or are referred to us by a community member or others ▪ Client is suicidal ▪ Clients who require detoxification ▪ Client requires palliative care ▪ Family violence cases referred by police or social workers ▪ All family violence clients to the extent that there are available rooms

NNADAP Most urgent clients first are those that are a threat to their self or others and police referrals. ▪ If a person is suicidal, they are taken to the hospital for an assessment. ▪ If a client feels they are in crisis and need treatment immediately, their only option is to refer them to detoxification.

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IN-HOME AND HOME AND COMMUNITY CARE AND COMMUNITY HEALTH NURSES

Most urgent clients first are those identified as in need of palliative care.

▪ The nurses meet with the client in pairs to complete the assessment (Multi-Clientele Autonomy Assessment or Short Term Care Evaluation). ▪ They meet as a team with the Supervisor, In-Home and Home and Community Care, after the assessment to discuss the needs of the client. ▪ If the client needs palliative care, a call is made to CLSC. ▪ As a follow-up, the team meets every week or at least every two weeks to report to the Supervisor on the client.

WASEYA For the crisis shelter, family violence cases referred by police or social workers and all family violence clients to the extent that there are available rooms are identified as most urgent clients first. ▪ Accepts all family violence cases regardless of the degree or extent providing there is space. ▪ Other clients/women accepted if they are referred by police or social workers. ▪ If there is no space available, we will look for accommodations in another shelter.

ÒDE WÌDÒKÀZOWIN As a support service, Òde Wìdòkàzowin most urgent clients are those that have a file with the Département de jeunesse, children in placement or requiring potential placement, teenagers who are living outside their parental home, teenagers who request our help or are referred to us by a community member or others. ▪ Team meetings are scheduled once every two weeks. ▪ The team is kept abreast of the client. ▪ Once a month the team meets with the KZHSS Social Worker.

KIWEDA Most urgent clients are clients requiring urgent life threatening emergency care.

MEDICAL TRANSPORTATION Most urgent clients are clients requiring urgent life threatening emergency care.

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2.0 IDENTIFYING CLIENTS BEFORE SERVICES

Identifying Clients Before Services

POLICY DATE DATE Kitigan Zibi CC-002 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS uses two client identifiers to identify the client is the right person and that the right procedure or service is for the right client.

PURPOSE

To reduce the risk of providing procedures or services to the wrong client.

KZHSS RESPONSIBILITY:

Nurses, Doctors, Specialists, Counselors, Supervisors

RESPONSIBILITY OF THE CLIENT:

Clients will comply with KZHSS workers request to confirm their identity.

PROCEDURES:

▪ Obtain two client identifiers in the case of admission, transfer, end of service and before administering medication. ▪ Client identifiers: o Certificate of Indian Status o Facial Recognition o Name o Medical card o Drivers’ license o Bracelet o Picture on their door

▪ Obtaining two client identifiers are identified in medication management procedures.

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B. CLIENT SAFETY

Client Safety

POLICY DATE DATE Kitigan Zibi CC-003 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS will meet its responsibilities for the health and safety of the members of its community by complying with relevant health and safety standards and legislative requirements, and by assigning general and specific responsibilities for workplace health and safety.

KZHSS is committed to the prevention of illness and injury through the provision and maintenance of a healthy and safe environment.

KZHSS takes all reasonable steps to acquaint its clients/employees with their rights and duties in the workplace and applicable regulations and procedures for protecting their health and safety. KZHSS establishes policies and programs to assist in maintaining safe conditions and work practices and facilitating employee participation in health and safety activities.

PURPOSE

All individuals shall protect their own health and safety by complying with existing regulations and standards and with safe practices and procedures established by KZHSS.

KZHSS RESPONSIBILITY:

Director, Building Supervisors, Transportation Coordinator, Environmental Health and Safety Technician

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria:

PROCEDURES: KZHSS employees adhere to the regulations outlined in the following KZA Safety Booklets that is applicable to their job position: ▪ Administration and Front-line Workers; ▪ Construction Workers; ▪ Custodial Workers; ▪ Food Service Workers; ▪ In-Home Care Workers; ▪ Public Works and General Labour; ▪ Transportation Workers.

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WORKPLACE HEALTH AND SAFETY

▪ KZHSS Environmental Health and Safety Technician conducts annual workplace health and safety inspections of all KZA buildings and ensures corrective measures are followed through.  Workplace health and safety inspection checklist  Deficiency Report: ▪ Employees must report any health hazards and unsafe conditions and practices to building supervisor/Environmental Health and Safety Technician for corrective action, as defined under the Occupational Health and Safety Act. ▪ Reporting can be done formally and informally. ▪ Workplace accidents reports must be forwarded to Human Resources Coordinator (CSST). ▪ In emergency situations requiring immediate attention the appropriate authorities will be contacted (ex: police, ambulance, fire dept., hydro and any other emergency services).

Building Supervisors: KZHSS Health Center: Director Fitness Center: Director Storage Containers/Trailer Director Rink Building: Director Wanaki Log Cabins: Director Kiweda/NSC: Supervisor Òde Wìdòkàzowin Centre Coordinator Youth Center Coordinator Waseya House: Counsellor Transportation Vehicles Coordinator Environmental Health and Safety Technician

IN-HOME AND HOME AND COMMUNITY CARE: MULTI-CLIENTELE AUTONOMY ASSESSMENT – QUEBEC

▪ KZHSS Nurses and Social Workers will conduct a hazard assessment on the first visit to a client’s home. ▪ The environmental assessment of hazard will be administered with consent. ▪ Conduct the Quebec provincial Multi-clientele Autonomy Assessment. ▪ Document the findings. ▪ A multidisciplinary team consisting of a doctor, nurse, occupational therapist, physiotherapist, psychologist, social worker, nutritionist, or any other relevant health-care professional form part of the team that direct the client to the services needed. ▪ Share data with the client. ▪ Provide clients with teaching through educational material, pamphlets and safety procedures. ▪ Recommendations for changes in the home will be made if resources are available through KZA and/or KZHSS. ▪ Re-evaluate the assessment. ▪ Make recommendations for client’s home safety according to home safety evaluation forms.

HOME HAZARDS OBSERVATIONS: Responsibility: All Programs and Services that conduct home visits

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▪ If home safety observations are noticed fill out the Home Safety Observations form and submit it to the Environmental Health and Safety Technician. ▪ Depending on the severity or urgency of the observation, it could go directly to other departments or services, for example the band office or social worker. ▪ The Environmental Health and Safety Technician will write a Recommendation for Changes letter that is sent to the client.

PREVENTION AND PROMOTION ▪ Education and awareness of client safety prevention programs to the community. ▪ Community flyers ▪ Pamphlets. ▪ Radio ▪ Promotional health fairs ▪ Safety classes (CPR, First Aid, WHMIS, etc.)

List of reference documents: Règlement sur les déchets biomédicaux - Quebec Canada Labor Code National Fire Code National Building Code Guide d’intervention en maladies infectieuses KZA Workplace Safety Prevention Plan KZA Emergency Preparedeness Plan KZHSS Pandemic Influenza Plan Multi-Clientele Autonomy Assessment - Quebec

STANDARDS: Policy and procedures for client safety is a required organizational practice and responds to Effective Organizational Standards for Aboriginal Health Services. It also follows provincial requirements for Règlement sur les déchets biomédicaux, Guide d’intervention en maladies infectieuses and the Multi-Clientele Autonomy Assessment.

There are other national requirements that are followed under the Canada Labor Code, National Fire Code and the National Building Code.

KZHSS also follows policy and procedures documents in the KZA Workplace Safety Prevention Plan, the KZA Emergency Preparedness Plan and the KZHSS Pandemic Influenza Plan.

KITIGAN ZIBI HEATLH & SOCIAL SERVICES Policies & Procedures Manual 129

2.0 EMERGENCY AND REPORT TO WORK

Emergency and Report to Work

POLICY DATE DATE Kitigan Zibi CC-004 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS employees may be required to report to work in emergency situations (not limited to or in any particular order and notwithstanding any medical emergencies).

PURPOSE

To ensure continuity of health and social services particularly of essential services during a crisis or emergency situation.

KZHSS RESPONSIBILITY:

▪ When approached by a client after hours, employees have the discretion on whether or not to engage with the client in their own personal environment. ▪ All work situations outside office hours needs to be reported to the Director. ▪ Report for Work Overtime will be compensated according to policies and procedures in the KZA “Human Resource Policy”. ▪ All Report to Work situations should be done at a KZHSS location or in a public environment.

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: ▪ Responsible for understanding why standards and policies are in place and how they can ensure appropriate care.

PROCEDURES: Access to all programs and services in emergency and report to work situations include:

▪ Client is a threat to self or others ▪ Police referrals ▪ Clients have a file with the Département de jeunesse ▪ Children in placement or requiring potential placement ▪ Teenagers who are living outside their parental home ▪ Teenagers who request our help or are referred to us by a community member or others ▪ Client is suicidal ▪ Clients who require detoxification ▪ Client requires palliative care ▪ Family violence cases referred by police or social workers ▪ All family violence clients to the extent that there are available rooms

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D. RISK MANAGEMENT 1.0 SUICIDE RISK ASSESSMENT

Suicide Risk Assessment

POLICY DATE DATE Kitigan Zibi CC-005 05/09/2016 07/29/2019 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS employees adhere to Suicide Risk Assessment Policy and follow any time an employee is made aware of a potential suicide attempt.

PURPOSE

To ensure the safety and security of all.

KZHSS RESPONSIBILITY:

KZHSS Staff members ensure their Suicide Prevention Training (ASIST) is up-to-date and can recognize client distress signs. KZHSS employees ensure compliance to the Suicide Risk Assessment Policy and follow-up steps.

RESPONSIBILITY OF THE CLIENT:

Clients aware of situations that can potentially result in a suicide are strongly encouraged to seek help with trained KZHSS staff or through immediate professional assistance at the local hospital.

PROCEDURES: KZHSS Staff assesses the risk of suicide through ongoing internal discussion, one-on-one counseling, and debriefing. During these discussions, individuals at risk are identified. This consists of determining the needs of the client at that time.

A multidisciplinary youth protocol was developed to identify KZ School students who may be having suicide ideation or demonstrating self-harm behaviours. Please see Part V-Section F for to refer to the KZA Multidisciplinary Protocol.

Based on worker observations, identified situations when the risk of suicide and depression related to suicide ideation may be higher within KZA are:

• After the Christmas holidays for the rest of the Winter season; • September – when children return to school; • After the death of a family member; • When clients are living with chronic pain; • After an overdose occurs in the community; • After a traumatic experience (e.g. family break-up).

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Staff receives training on a regular basis for prevention, intervention and post-vention methods. The risk-assessment tool assesses the following:

1. Are you thinking of killing yourself? 2. Do you have a plan? 3. Safety person we can tell you to stay with?

Any person who has suicide ideation and dealing with safety issues in the home must be referred to the hospital first, before accessing Waseya House services.

If a youth 17 and under is having suicide ideation, the parent should be notified. If the situation warrants a signalement to be made to the DPJ, a call must be made to signal (1.800.567-6810)

All KZHSS Staff (both full-time and/or contract workers) are required to comply with this policy.

In any circumstances where a person has homicidal thoughts, intentions or threats along with suicidal thoughts (eg. “I am going to kill this person and then kill myself ”, the police must be immediately called.

An ambulance/police will be called for any person demonstrating suicidal behaviours who appears to be under the influence of drugs, alcohol or has any other impaired ability. In certain cases, the person may be in the process of overdosing and will require immediate medical assistance.

SUGGESTED RESPONSE TO ADDRESS IMMEDIATE NEEDS LEVEL OF RISK DESCRIPTION SUGGESTED RESPONSE Non-Existant No identifiable suicidal • Monitor risk periodically or thoughts, plans, or intent when indicated

Mild/Low: Suicidal thought of limited • Review frequency frequency, intensity and • Identify potential duration. No plans or intent, supports/contacts and mild dysphoria, no prior provide contact details attempts, good self-control (ie. with permission from the Subjective or objective), few clients. risk factors, identifiable • Write a contract with client protective factors to seek immediate assistance if fleeting thoughts become more serious or depression deepens Moderate: Frequent suicidal thoughts • Ask the client if they with limited intensity and would be open to see a duration, some plans but no visiting therapist or intent (or some intent but no healthcare worker plans), limited dysphoria, some

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risk factors present, but also • Continue contract as some protective factors above • Review daily Severe/High: Frequent, intense and • Based on assessment of enduring suicidal thought. safety of the situation, call Specific plans, some intent, appropriate transportation method is available/accessible, services to the hospital some limited preparatory such as ambulance, behaviour, evidence of police, family impaired self-control, severe member/friend or medical dysphoria, multiple risk factors driver present, few if any protective • Meet the client at the factors, previous attempts. hospital. Person is depressed, suicidal • Consult with a colleague or homicidal. or supervisor for guidance and support • Call 811 Healthline for mental health support. • File an incident report, after the situation has been handled. Extreme/Very Frequent, intense, enduring • Based on assessment of High: suicidal thoughts and clear safety of the situation, call intent, specific/well thought- appropriate transportation out plans, access available services to the hospital method, denies social support such as ambulance, and sees no hope for future, police, family impaired self-control, severe member/friend or medical dysphoria, previous attempts, driver many risk factors, and no • Meet the client at the protective factors. . Person is hospital. depressed, suicidal or • Follow hospital guidelines homicidal. and inform Doctor with information. • File an incident report after the situation has been handled.

Required Employee Follow-up

1. Debrief with Director, and a co-worker (as needed) for guidance and support. 2. Network with hospital or other relevant services as required. Referral for NNADAP services, KZHSS visiting therapists, Mental Health Worker, or KZES Student Counsellor, according to client wishes and with proper consent. 3. When possible, and with proper consent, have client information related to the situation forwarded to the client medical file. When the client does not consent, their information will be documented and securely kept on file with the front-line worker. 4. In the case of a hospital intervention, fill out an incident-report and hand in to Director. 5. Next day: Follow-up with the Client, either in the hospital, or at his/her home.

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Client Complaints

POLICY DATE DATE Kitigan Zibi CC-006 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

KZHSS welcomes constructive feedback from clients and implements the complaint process to address issues and concerns in a timely fashion.

PURPOSE

The intent of this policy is two-fold: first, to inform clients of the proper steps which are to be followed when lodging a complaint; second, to equip KZHSS staff with an effective process to handle complaints in a prompt and efficient manner. The ultimate goal of this policy is to ensure client satisfaction by consistently improving client services received through constructive community feedback.

KZHSS RESPONSIBILITY:

Director and Coordinators

RESPONSIBILITY OF THE CLIENT:

Clients wishing to lodge a complaint must do so by following the proper procedure as outlined in this policy.

PROCEDURES:

DEFINITION Under the scope of this policy, a complaint is considered to be: A written statement from the client regarding the dissatisfaction with a particular action or behavior of a KZHSS employee or the dissatisfaction of the quality of service received.

PROCEDURE

Rights of Kitigan Zibi Anishinabeg Community Members KZA community members have the right to lodge complaints in reference to a particular action or behavior of a KZHSS staff member and the quality of services provided/decisions made by KZHSS.

The action or behavior of the KZHSS employee is limited to instances where they are acting in their professional capacity. Complaints regarding the personal lives of employees will not be considered, unless it is demonstrated that their action/behavior outside of working hours has a direct bearing on the quality of service provided to community members.

When the incident has resulted in legal action against a staff member, the Director will investigate and with findings based on legal opinion and severity of the incident, action may or may not occur at the discretion of the KZHSS Director.

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When the incident is against the Director, the complaint will be sent to the Health Portfolio holder.

COMPLAINTS PROCEDURE Every effort should be made to resolve an issue with a KZHSS employee before a complaint is filed.

Step One – Review the Policy The complainant and his/her advocate should review any policies (if applicable) related to the concern to ensure that there is a cause for complaint.

When the incident is against the Director, the complaint will be sent to the Health Portfolio holder.

Step Two – Raising the Issue with Staff Member, Immediate Supervisor The client must raise the issue with the staff member or his/her immediate supervisor.

Step Three – Raising the Issue with the Director If the solution recommended by the supervisor is still not satisfactory, then the issue must be brought to the attention of the Director.

Step Four – Director Involvement The immediate supervisor and/or the complainant will bring the issue to the attention of the KZHSS Director for resolution. If the solution is still not satisfactory, the complainant can file a KZHSS Complaint Form.

Step Five-Chief and Council Involvement If the complainant is not satisfied with the concern at the Director level, it may be brought forward to the Chief and Council once the previous steps have been followed. Chief and Council will NOT accept a complaint form unless the first four preliminary steps outlined above, and all documentation (i.e. KZHSS Client Complaint Form) has been signed and completed.

RESPONSIBILITIES OF THE COMPLAINANT In order for a complaint to be considered, a KZHSS Complaint Form must be fully completed, signed and dated. The form requests the following information: ▪ Date of incident/concern ▪ Name of Complainant (must be clearly identified) ▪ Address and Phone Number of where complainant can be reached for a follow-up ▪ Subject and Description of Concern ▪ Clearly state the complaint ▪ What are you hoping will change by making this complaint? ▪ Indicate the Program Manager’s name and any other staff that were involved ▪ Provide evidence upon which the complaint is based ▪ Document all steps taken to resolve the matter with the employee(s) & supervisor involved A complaint may be submitted by mail or fax: Kitigan Zibi Health & Social Services Box 160, 8 Kikinamage Mikan Maniwaki, Quebec J9E 3B4 Fax: (819) 449-7411

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A signed Complaint form may also be sent as a PDF file to the KZHSS Director at: [email protected]

REVIEWING THE COMPLAINT

Within five (5) business days of receiving the complaint, the KZHSS Director shall confirm receipt of the form to the complainant. The Director will NOT accept a complaint form unless the first four preliminary steps outlined above have been completed.

The Director will investigate and report back to the client.

In the event that the complainant appeals the decision, the complaint will be passed on to the Band Council for review.

OTHER GUIDELINES

KZHSS shall maintain a file on each written complaint filed. These files will be kept in a locked cabinet in the archives. Upon conclusion of the investigation, the complainant will be provided with an opportunity to respond in writing. This written response will be included in the file.

If a complaint against an individual employee is found to be valid, a copy of the investigation package will be kept in the employee’s personnel file and will be considered during the employee’s annual evaluation.

Once a complaint has been reviewed and a conclusion made, remedies to rectify the situation will be sought and implemented by KZHSS.

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3.0 MANAGING AGGRESSIVE AND VIOLENT CLIENTS

Workplace Violence Prevention Policy

POLICY DATE DATE Kitigan Zibi CC-007 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

All individuals are to be treated with dignity and respect

Please note that for our safety and the safety of our clients, the following conduct will not be tolerated in all areas of Kitigan Zibi Health and Social Services locations:

▪ Threatening or aggressive behavior ▪ Displaying or exhibiting extreme anger or hostility ▪ Bullying or intentional harmful teasing ▪ Possessing a dangerous weapon that is prohibited ▪ Causing damage to property ▪ Physical injury to another person ▪ Intoxication

Note: All physical assaults will be reported to police.

PURPOSE

To ensure the safety and security of all community members.

KZHSS RESPONSIBILITY:

Director implements and monitors the Workplace Violence Prevention Policy.

The Director ensures that ALL STAFF (i.e. full-time employees, contract workers etc.) are aware that personal safety is a priority when providing services. Services may be denied to a client when there is potential for a violent situation. When service is denied, an incident report must be completed by the worker who will not be subject to disciplinary measures for denying a service. The concept of “Safety First!” will always prevail and be supported within all situations in KZHSS.

All KZHSS Staff will contribute to a safe workplace environment.

All KZA employees adhere to the Workplace Anti-Harassment Policy and Procedures and Respect in the Workplace Policy.

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RESPONSIBILITY OF THE CLIENT:

Clients are required to treat all individuals with dignity and respectful conduct when dealing with employees or other community members, while on the telephone with KZHSS employees, or while receiving KZHSS services (e.g. In-Home care, Medical Transportation).

PROCEDURES: The employees who work at KZHSS and circumstances in which the work activities take place are what make each work place unique. Factors such as face-to-face interaction with clients, working alone, working in remote locations, dealing with valuables, and working at night will likely increase the risk of workplace violence.

KSHSS provides specific training on managing aggressive violent clients, cultural and gender specific issues, family related issues, mental health issues, specific pharmacological treatments; high-risk issues such as harassment reduction, non-violent crisis intervention, and de-escalation techniques due to a higher than average risk of antisocial behaviors in those who misuse substances. An increased risk of clients entering programs in an impaired state requires training on specific care and interventions.

KZHSS employees who are assaulted by either clients or other employees must provide a statement to the KZPD.

PANIC BUTTONS

All full-time KZHSS staff are issued personal panic buttons by the Environmental Health & Safety Technician. The personal panic buttons must be worn at all times when staff is in the building.

In any situation where a worker is threatened or there is a potential for violence, the first step for all employees is to press their panic button.

An employee who hears the alarm bells ring in the hallways, should check the areas close to their location to see if they need to come to the assistance of a fellow employee. Only assigned individuals should check the panel for the source/location of the alarm.

GUIDELINES FOR MANAGING AGGRESSIVE VIOLENT CLIENTS

Common factors that contribute to workplace violence include:

▪ Threatening behavior towards others, including threats made verbally or in writing (e.g., e-mails). ▪ Bullying ▪ Intentional harmful teasing ▪ Aggressive behavior in the work place ▪ Intentional damage of property belonging to others.

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Employers can learn from past experiences, such as incidents that may have occurred in similar work places, as well as from employee reports. It is vital to take these experiences into account in implementing proper controls.

There are steps that you can take to reduce such incidents in your work place. The following suggestions are from a guide entitled “Violence in the Workplace” from the Canadian Centre for Occupational Health and Safety (1999).

In order to remind and emphasize the importance to clients and employees about aggressive behavior, a code of behavior will be posted in all KZHSS locations.

A guideline for managing aggressive violent clients based on HRSDC, Guide to Violence Prevention in the Workplace and the Canadian Centre for Occupational Health and Safety (1999) will form part of this manual.

The employees who work at KZHSS and circumstances in which the work activities take place are what make each work place unique. Factors such as face-to-face interaction with clients, working alone, working in remote locations, dealing with valuables, and working at night will likely increase the risk of workplace violence.

KZHSS will also include specific training on managing aggressive violent clients, cultural and gender specific issues, family related issues, mental health issues, specific pharmacological treatments; high-risk issues such as harassment reduction, non-violent crisis intervention, and de-escalation techniques due to a higher than average risk of antisocial behaviour in those who misuse substances. An increased risk of clients entering programs in an impaired state requires training on specific care and interventions.

KZHSS acknowledges that employees have a right to a safe work environment. Employees do not need to fear loss of employment when protecting their own safety as long as the following steps are taken:

o Remove yourself from the situation o Call the police if required o Report to the supervisor/coordinator o File an incident report o Debrief with supervisor/coordinator

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4.0 INCIDENT REPORTING AND INVESTIGATION

Incident Reporting & Investigation

POLICY DATE DATE Kitigan Zibi CC-008 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS follows a process to document all incidents, and follow up with prompt investigation. It is mandatory to fill out an incident report when:

i) Any accident that results in a workplace injury (no matter how slight) and any incident that could have caused a workplace injury must be reported immediately to the employee’s immediate supervisor.

ii) An event occurs that is contrary to a written policy, or is illegal.

Examples include but not limited to seeing:

▪ KZHSS property, including vehicles, being used for personal use; ▪ A KZHSS vehicle that is being driven dangerously; ▪ Any illegal activities on KZHSS property or where KZHSS property is being used such as vehicles. ▪ Any accident/damage that occurs with a KZHSS vehicle or to KZHSS property, regardless of how minor. ▪ Witnessing an attack, an assault, or any form of abuse on KZHSS in the workplace, including homes, or within a KZHSS vehicle, whether involving an employee or not. ▪ Anything that would constitute a breach of confidentiality. ▪ When any type of alarm goes off – ie. Fire, panic button.

PURPOSE

This policy and procedure is intended to provide for safe, appropriate and consistent reporting of workplace incidents and accidents. This Policy and Procedure is intended to ensure compliance with requirements to document and report certain incidents and to notify the necessary authorities within prescribed time limits.

KZHSS RESPONSIBILITY:

Each employee is responsible for immediately reporting any workplace incident or accident to his or her immediate supervisor. Each coordinator is responsible for ensuring, as the first priority, that employees receive proper medical treatment when injured, and, secondarily, for investigating an accident or workplace injury for the purpose of implementing corrective action to minimize any opportunity for a recurrence of the accident or injury.

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RESPONSIBILITY OF THE CLIENT:

Clients who witness an incident are asked to cooperate with KZHSS employees by providing details of the occurrence.

PROCEDURES: Complete an incident report form even when it doubt as to whether an event would merits it.

A person unable to complete an incident report due to literacy competency should notify their immediate supervisor to provide a verbal statement. The supervisor will read the statement to the witness and have the person provide their signature

REPORTING

An incident report shall be completed immediately when possible, or no later than 72 (seventy- two) hours of the incident or accident by the complainant(s) (victim(s). If the complainant is unable to complete the report, a staff witness shall complete it. Once the incident report is signed by the complainant, it should be given to the coordinator for review and sent to the Director.

ASSAULT/ATTACKS: The Kitigan Zibi Police must be called if an attack or assault occurs. The Coordinator and Director must also be notified. Medication/Treatment Errors The Nurse Supervisor should be made immediately aware of the incident that occurred. The Director must also be notified.

PROPERTY The Environmental Health & Safety Officer must be made aware of the incident. She will follow- up with the maintenance person or others concerned. The Director must also be notified. -

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5.0 CRITICAL INCIDENTS

Critical Incidents

POLICY DATE DATE Kitigan Zibi CC-009 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

Any KZHSS employee who is involved in or witnesses a critical incident must immediately contact the KZ Police Department (819-449-6000).

PURPOSE

To ensure the safety, security and protection of all.

KZHSS RESPONSIBILITY:

Each employee is responsible for immediately reporting any critical incident or accident to his or her immediate supervisor.

Each coordinator is responsible for ensuring, as the first priority, that employees receive proper medical treatment if injured, and, secondly, for investigating a critical incident to implement corrective action to reduce the chance for a related reoccurrence.

RESPONSIBILITY OF THE CLIENT:

Clients who witness an incident are asked to cooperate with KZHSS employees by providing details of the occurrence.

PROCEDURES: A critical incident is a serious event that warrants a police phone call. Examples may include a medical emergency, death, attempted suicide, extreme violence, or events of this nature.

Upon being involved in or witnessing a critical incident:

1. Observe immediate surroundings and assess the situation. 2. Keep yourself safe at all times. If it is unsafe leave immediately. 3. Call KZ Police Department immediately. Follow police protocol as instructed. 4. Contact supervisor or designate to inform them of the incident as soon as possible. 5. Fill out an Incident report form and submit to supervisor or designate.

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6.0 DISCLOSING, INVESTIGATING AND REPORTING ADVERSE EVENTS & NEAR MISSES

Disclosing, Investigating and Reporting Adverse Events & Near Misses

POLICY DATE DATE Kitigan Zibi CC-010 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS professionals will provide full and frank disclosure of adverse outcomes and events to clients as soon as reasonably possible, as it is their ethical and legal responsibility to do so. (Disclosure does not imply assignment of blame or acceptance of fault.)

PURPOSE

To fulfill legal and ethical requirements, and to be accountable to and transparent towards community members.

KZHSS RESPONSIBILITY:

Visiting professional, all KZHSS employees providing the service and the Director

If an employee discovers that a preventable adverse event or incident has not been disclosed to a client, then the employee must inform his or her supervisor or director as appropriate. The responsible supervisor or director will investigate, and this policy will be followed.

RESPONSIBILITY OF THE CLIENT:

Not applicable.

PROCEDURES:

KZHSS will make every reasonable effort to eliminate accidents, incidents or near misses. There are legal requirements in relation to reporting certain accidents or incidents, where to report them and individual responsibilities. The importance of reporting adverse events and near misses is important to enable the Centre to investigate the causes for them so that remedial action can be taken. In time this can lead to improved systems and services.

An adverse event is defined as a bad outcome of care. An injury that was caused by health care management rather than the patients underlying disease; also called harm, injury, or complication. Bad outcomes of care include disability, death, prolonged hospital stay. Health care management refers to all aspects of the health care system, not just the action or decisions of physicians and nurses.

A near miss is defined as an event or error that could have caused harm but did not reach the patient because it was intercepted.

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KZHSS requires that for all adverse outcomes and events, disclosures involves at a minimum a discussion between the professional, the Director and the client, and that this discussion be documented in the client’s record. Consideration should also be given to conducting a second meeting once the client has had the opportunity to review the information provided, as there may be additional questions or a need for clarification.

For the most part, this policy and its procedures were adopted from the Administration Policy for Reporting of Adverse Events from the Sahtu Health and Social Services Authority of the Greater Northwest Territories.

This policy does not apply to Grade 1 incidents (Incidents that do not harm or injure the client (for example, near misses)). These particular occurrences may not require disclosure to clients in all cases.

DISCIPLINARY ACTION

KZHSS must support and encourage the reporting of mistakes and disciplinary action should not form part of an immediate response to the reporting of an adverse event or near miss except where one or more of the following applies: ▪ Where there is repeated professional misconduct involving the same individual following education and/or training; or ▪ Where the incident has resulted in a police investigation of the employee; or ▪ Where, in the view of any professional registration body, the action constitutes gross professional misconduct; or ▪ Where there is failure to report an adverse event in which a member of staff was involved or about which they were aware.

SEVERITY GRADING Adverse events will be graded between 1 and 3 depending on the significance of the outcome. Near misses are eventually graded as 1 after investigation as there was no actual harm, loss or damage.

GRADE ACTIONS WHEN Grade 1 Investigation. Within 10 days Incidents that do not harm or Clients meeting not required. injure (near misses) Adverse Events Report Grade 2 Investigation. Within 5 days Loss of personal identifiable Clients meeting required. data Adverse Events Report Grade 3 Investigation. Immediate action Harm, injury or death Clients meeting required. Adverse Events Report

IMMUNIZATION

▪ Nurses are obliged to report to the province any adverse reactions related to immunization.

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▪ They must fill in the Questionnaire pour determiner les contre-indications et les precautions and submit it to the Quebec Ministry of Health and Social Services and provide follow-ups as required. ▪ In addition, the Nurses are obliged to fill in the Adverse Events Report and follow the process for reporting adverse events.

ALL OTHER ADVERSE EVENTS

Any employee who becomes aware of an adverse outcome, event, or critical incident will immediately report the occurrence to his or her supervisor. This is in addition to the required reporting identified Client Safety.

The supervisors and coordinators, in collaboration with senior management will conduct an initial investigation, and decide how to proceed.

The responsibility for disclosing an adverse event, adverse outcome or critical incident to the client rests with the attending professional AND the Director.

There may be situations where the attending professional will not, cannot, or should not take a role in the disclosure discussions: ▪ The professional is unavailable; ▪ He or she refuses to participate in disclosure discussions; ▪ The professional does not have the requisite communication skills; ▪ The professional’s relationship with the client is seriously impaired or compromised.

In such situations, the Director will conduct disclosure, and any subsequent communications with the client.

Initial disclosure to the client will occur as soon as is reasonably possible after the adverse outcome, adverse event or critical incident has occurred and the client’s immediate needs have been met.

The first priority is to do whatever is necessary to prevent further harm to the client. The disclosure of every Grade 2 and 3 incidents shall be made: ▪ To the affected client; ▪ If the affected client is incapable, to the client’s substitute decision maker; ▪ If the affected client has died, o To the person who was the substitute decision maker immediately prior to the client’s death, or who would have been so authorized if the client had been incapable, or o To the client’s estate trustee (executor), or to the person who has assumed responsibility for administration of the client’s estate, if the estate does not have an executor. DISCLOSURE DISCUSSIONS CONCERNING ADVERSE EVENTS SHALL INCLUDE

▪ The material facts of the event; ▪ Impact and consequences for the client of the occurrence, as they become known; ▪ The actions taken and recommended to be taken to address the consequences to the client, including any health care or treatment that is advisable; ▪ The disclosure, including date and time of disclosure, must be documented in the Health Record using the Adverse Events Report form.

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ADDITIONAL CONSIDERATIONS FOR DISCLOSURE AND DOCUMENTING DISCLOSURE SHOULD INCLUDE:

▪ Offers of non-financial assistance; ▪ Information that is objective and factual, free from speculation or blame, and presented in a caring and compassionate manner; ▪ The cause of the event, if known; ▪ Expression of regret that the adverse event or adverse outcome occurred, as appropriate. Providing an apology or saying “sorry” are not an admission of guilt nor an acceptance of blame; ▪ Plans for a review to identify causal factors and prevent its recurrence; ▪ Names of individuals present at the disclosure meeting and relationship to the client; ▪ Discussion points including reaction/questions of participants; a statement indicating that the client will be kept informed of new information as it becomes available; ▪ Whether the client refuses to receive the disclosure information; ▪ Access to the clients’ health record as permitted by Access to Information legislation.

FOLLOW-UP WITH THE CLIENT

At an appropriate time following disclosure of an adverse event, the Director shall further disclose any systemic steps that KZHSS is taking or has taken in order to avoid or reduce the risk of similar incidents. The content and date of this further disclosure shall be recorded in the health record.

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7.0 MONITORING QUALITY OF SERVICES AND CLIENT SATISFACTION

Monitoring Quality of Services

POLICY DATE DATE Kitigan Zibi CC-011 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS Staff are accountable and responsible for monitoring performance indicators that measure both clinical and administrative structures, processes and outcomes to ensure that continuous quality improvement activities are regularly conducted for ongoing Program development. The Director will conduct with all KZHSS programs annual monitoring reviews. This accountability measures the movement in quality dimensions of population focus, accessibility, safety, work-life, client-centered services, continuity of services, effectiveness and efficiency.

PURPOSE

To promote positive client outcomes and client satisfaction by measuring the movement of quality dimensions in population focus, accessibility, safety, work-life, client-centered services, continuity of services, effectiveness and efficiency and to ensure such services and processes meet contract obligations, legislation, standards of practice and best practices.

KZHSS RESPONSIBILITY:

The staff member who is organizing and conducting the service and/or activity is responsible for carrying out the monitoring procedure according to the service provision. The services KZHSS offers require different monitoring procedures. Each service will have a standard form to adapt to each program to be reviewed annually with the Director.

RESPONSIBILITY OF THE CLIENT:

Clients feedback to improve the quality of services is welcome through the KZHSS suggestion box or participation in KZHSS surveys.

PROCEDURES:

The KZHSS Program Quality Monitoring Form will be filled out by the staff members conducting continuing services and scheduled activities. The forms will be reviewed annually for quality monitoring, assessment and improvement. Any other tools used to evaluate services and activities are to be presented with the completed forms at an annual review as set by the Director.

Tools may include: ▪ Client Satisfaction Surveys

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▪ Planned Activities Surveys ▪ Informal interviews with clients, families, staff, other providers and community members ▪ Incident monitoring ▪ Manual chart audits (supervision) ▪ Direct Observation of Clinical Practice.

The annual Quality Monitoring Review process will consist of the Director setting a meeting for annual program reviews wherein the completed monitoring forms will be used to have program staff discuss the strengths and weaknesses of the services delivered. Changes will be made with program staff input and consideration of financial, material and human resources availability.

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Monitoring Client Satisfaction

POLICY DATE DATE Kitigan Zibi CC-012 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS annually monitors community perspectives on the quality of its community health and wellness services.

PURPOSE

To monitor the quality of services and client satisfaction based on the results received from client questionnaires.

KZHSS RESPONSIBILITY:

Director▪

RESPONSIBILITY OF THE CLIENT:

Clients are encouraged to provide feedback by participating in KZHSS questionnaires

PROCEDURES: ▪ It is an Accreditation Canada requirement to complete client questionnaires before scheduled Accreditation Canada survey visits. ▪ KZHSS will adopt the questionnaire and modify as appropriate after the first year. ▪ To prepare and inform the community, a flyer will be sent out letting them know what it is, and when the door to door will begin. ▪ Meet with students who are hired to distribute questionnaires and go over Student Instructions. ▪ Distribute Accreditation Canada client questionnaire to a minimum of 30 clients. ▪ Accreditation Canada will evaluate the responses received and provide KZHSS with a report on the Organizational Portal. ▪ Share data: Internally. ▪ Prioritize suggestions and implement changes. ▪ In order to monitor, evaluate and implement changes, the questionnaire will be administered on a yearly basis. ▪ Re-evaluate the questionnaire and modify as required. ▪ Goal reached (client satisfaction).

NATIONAL STANDARDS: Policy and procedures for the informed consent respond to national standards for Aboriginal Integrated Primary Care, Aboriginal Substance Misuse Services and Service Excellence Standards.

PROVINCIAL STANDARDS: Centre Jeunesse de l’Outaouais Quebec School Immunization

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FEDERAL: Health Canada

STAKEHOLDERS (internal/external): Police, treatment centres, KZES, Santé publique, OIIQ, Centre Jeunesse de l’Outaouais

All employees of KZHSS will obtain informed consent to the treatment/service plan before any treatment or service is initiated.

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E. KZA MULTI-DISCIPLINARY PROTOCOLS

KZA Multidisciplinary Work

POLICY DATE DATE Kitigan Zibi CC-014 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS staff will collaborate with any established multi-disciplinary community protocols.

PURPOSE

To maximize resource sharing within the community, and ensure that all KZA sectors are “on the same page” when dealing with diverse situations, various protocols have been developed through collaborative efforts of the KZA sectors concerned.

1.0 KZA FAMILY VIOLENCE CRISIS CALL PROTOCOL

The KZA Family Violence Crisis Call Protocol outlines the course of action for the Family Violence Crisis Intervention Worker when a crisis call is made to the KZPD. It clarifies, in particular, the course of action when children are involved in crisis situations. Furthermore, it details possible follow-up courses of action and serves as a concise reference guide for accessing local resources. 2. 0 KITIGAN ZIBI KIKINAMADINAN PROTOCOL FOR ASSESSING SOCIAL EMOTIONAL NEEDS

The Kitigan Zibi Kikinamadinan Protocol for Assessing Social Emotional Needs was developed after group discussions with the KZ Education Sector. This protocol outlines the type of coordinated support that can be provided to “at-risk” youths through collaboration with the Student Services Counsellor (Education Sector) and the Enhanced Prevention Services Coordinator (KZHSS). This protocol also includes the role of police when criminal activity is present. Finally, it outlines expectations and/or options that parents may choose to follow in collaborating with the community resources involved.

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KZA Family Violence Crisis Call Protocol KZPD assesses the situation: Ambulance: KZHSS worker gets the crisis • Physical/Sexual Assault In cases where medical call. Should call the police • Drug.Alcohol Use attention is required: 819-449-6000 • Mental Health Call 911

**IN ALL CASES WHERE CHILDREN ARE PRESENT CALL DPJ 1-800-567-6810

No PHYSICAL or PHYSICAL or SEXUAL ASSAULT SEXUAL ASSAULT WITH WITHOUT WITH WITHOUT

children children children children

Call DPJ -Call Waseya House Staff Call DPJ -offer to bring victim to the 1-800-567-6810 emergency contact number 1-800-567-6810 hospital and provide 819-449-7425 Waseya House card Note: Bring child to or Note: Bring child to extended family member 819-449-0838 extended family member -if officer cannot bring the with parent’s permission, with parent’s permission, victim call the Ambulance if notify DPJ. notify DPJ. victim agrees -If there is a room available, escort woman and/or -offer to bring victim to the -courtesy call to Waseya -Call Waseya House Staff children to Waseya House hospital and provide House staff to advise that a emergency contact number Waseya House card victim is at the hospital and 819-449-7425 might require Waseya or -No space available : -if officer cannot bring the House services 819-449-0838 Contact Halte Femme victim call the Ambulance if 819-449-4545 victim agrees or phone a friend/family -If there is a room available, member -courtesy call to Waseya escort woman and/or House staff to advise that a children to Waseya House victim is at the hospital and might require Waseya House services -No space available : Contact Halte Femme 819-449-4545 or phone a friend/family member Revised: November 12, 2014

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UNDER THE INFLUENCE OF DRUGS & MENTAL HEALTH ALCOHOL WITH WITH WITHOUT children WITHOUT children children children

-Officer needs to assess -need to find a place to -Police intervene under P- -Police intervene under P- how coherent the parent is sober up, and transport 38 if the person is 38 if the person is them there dangerous for themselves dangerous for themselves Call DPJ or others or others 1-800-567-6810 -give Waseya House services card Note: Bring child to Call DPJ extended family member -courtesy call to Waseya 1-800-567-6810 Call DPJ with parent’s permission, House staff to advise that a 1-800-567-6810 notify DPJ. victim is at the hospital and Note: Bring child to might require Waseya extended family member Note: Bring child to -give Waseya House House services with parent’s permission, extended family member services card notify DPJ. with parent’s permission, notify DPJ. --courtesy call to Waseya House staff to advise that a victim is at the hospital and -give Waseya House might require Waseya services card House services

FOLLOW-UP • All Police procedures and protocols will be followed. Police will ensure victim has necessary support services, either through Kitigan Zibi Health & Social Services or External Resources in the region. • During Court proceeding if victim needs support services, police will inform victim to contact KZHSS • The CSSSVG may refer victim to further services as deemed necessary. • DISCLOSURE Guidelines: If a victim wishes to disclose abuse through the SQ, the SQ will correspond with KZPD • A victim may refuse to press charges after a Family Violence incident; however, an arrest may be made by KZPD if there are reasonable and probable grounds to make an immediate arrest. • INTERNAL RESOURCES EXTERNAL RESOURCES ODE WIDOKAZOWIN: CAVAC - Centre d’aide aux victims d’actes Family Wellness Worker criminels Enhanced Prevention Worker Rape crisis Crime Victims Assistance Centre counselling 1.866.LE CAVAC 1.866.532.2822 Drop-in: Youth Prevention Worker 819.449.2323 Assistance Centre against Sexual Agression CALACS- NNADAP 1.888.933.9007 -Referrals for Drug & Alcohol addictions. Centre d’aide et de lutte contre les 819.449.5593 aggressions a caractere sexuel

Center for treatment of sexual abuse and childhood trauma 613-233-4929

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KITIGAN ZIBI KIKINAMADINAN PROTOCOL FOR ASSESSING SOCIAL EMOTIONAL NEEDS ▪ All suspected behaviours related to this assessment must be reported IMMEDIATELY to the Principal. ▪ All professionals and employees must report about everyone involved with behaviours related to the protocol. Failure to disclose any incident and all of those involved may be followed-up with disciplinary actions. ▪ EVERY ACT DEEMED A CRIMINAL OFFENCE WILL BE REPORTED TO THE POLICE ▪ In cases where concerns and complaints are brought directly to the Band Council, the Chief and/or portfolio holder will address the pertinent sector involved, and will follow the protocol. ▪ In cases of a conflict of interest, a neutral front-line service provider will be assigned by the Director of the respective sector to investigate or follow-up with the remaining steps ▪ All interventions will be documented. ▪ Confidentiality is essential; therefore, what we HEAR, DISCUSS, or LEARN about in the process of work must not be talked about outside the workplace. ▪ The multi-disciplinary assessment tool will be used when a youth has been referred for social and emotional needs. ▪ If a DISCLOSURE occurs during a discussion, listen to the youth, let the youth explain, but DO NOT ASK QUESTIONS. Let the youth know that authorities will need to be contacted. Document the meeting. Call Youth Protection immediately 1-800-567-6810. ▪ All incidents occurring at the school will be coordinated through the Student Services Counselor. ▪ All incidents occurring out of the school will be coordinated through the Enhanced Prevention Coordinator.

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Steps HEALTH & SOCIAL POLICE EDUCATION SECTOR PARENTS SERVICES DEPARTMENT Ensure children do not come to 1 school with drugs. A Student will be sent to Available to provide a Receive report the Nurse for a Health physical Nursing from the Principal Assessment to check for Assessment if the or designate drug use (e.g. check for Education Sector dilated pupils, etc.) Nurse is not present. Conduct an investigation. If student refuses a Health Assessment, he/she is suspended for the remainder of the day. 2 If the parents cannot be contacted, the student will have an in-school suspension.

Parents are contacted

after two different staff members suspect a student of drug use.

If the Nurse confirms Suspected DRUGUSE: suspicions, the student will receive a suspension 3 for the remainder of the day plus a 1-day suspension. Parents will have the Parents may option to arrange for a choose to have a drug test from the drug-test hospital. In the case of a administered to 4 negative test, a letter of their child if they apology will be provided deem it necessary. by the Principal to the student. If it is found that a NNADAP Counsellor student has used drugs will have a one-to-one at school, a no-substance meeting to make contract will be youth suspected of 5 developed with the drug use aware of the parent, student and dangers. guidance counsellor.

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Steps HEALTH & EDUCATION POLICE Steps SOCIAL PARENTS SECTOR DEPARTMENT SERVICES Police are called. Receive report from Any inquiries KZ School policy is the Principal or regarding the implemented. designate investigation by Conduct an authorities should When an investigation investigation. be directed to the is initiated by the If drugs are found, Police or Youth Police or Youth young offender will Protection. 1 Protection, the School be arrested. staff will cooperate with the relevant authorities and all further information is

kept confidential. Parent is required to Parents will be Parent must meet meet with School contacted after as soon as Administration investigation. (Any possible with the

CONFIRMED DRUG USE following a youth, 13 and older, school following a suspension. If a parent can refuse to have a drug-related does not immediately parent, lawyer, or suspension, 2 meet with the significant other otherwise, the administration, the person present). student cannot student cannot return return to school to school. until the meeting occurs.

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Student Services Enhanced If required by the If support services Counsellor will provide Prevention situation, Youth are needed, a letter to parents Coordinator will Protection may be parents are informing them that a be given the contacted. obligated to multi-disciplinary Release of cooperate in approach will be Information form seeking support applied to assess their and will provide services for their child’s needs. support. child. Parents are required to work Student Services with the Student Counselor begins the Services screening process Counsellor, with the assessment informing and tool with KZES, providing KZHSS, and possibly evidence of KZPD, if required. service care.

If needed, the student If the parent does is referred to not agree to appropriate access support professional services services, the child (e.g. the Enhanced will be expelled Prevention from School, and Coordinator) to begin will not be allowed multi-disciplinary to return to KZ support. School, and Youth Protection will be If parents decide to called. 3 seek external services, the Student Services Counsellor will follow up with the parents by obtaining a Release of Information and any necessary documentation from the chosen support service.

The Student Services Counsellor will follow up with selected external services; otherwise the student will not be allowed to attend KZ School.

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HEALTH & EDUCATION POLICE Steps SOCIAL PARENTS SECTOR DEPARTMENT SERVICES Student Services Upon completion Parent participates in Counsellor will of assessment “circle of care” for coordinate the “circle tool, the their child. of care” meeting with Enhanced the student and Prevention pertinent players. Coordinator will a. Parent agrees make a “circle of to the care” with the appropriate appropriate treatment for partners. their child.

b. Parent participates in 4 the creation of an intervention plan for their child.

c. Parent helps with the

implementation

of the intervention

plan. Confirmed DURGUSE Referrals to Parent supports the appropriate child in attending a external treatment program resources will be (e.g. Portage) included in the “circle of care”: Out-patient treatment service Counselling at Enhanced 5 Prevention Services Impact Centre de réhabilitation en indépendances Elder at KZ School Portage

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HEALTH & EDUCATION POLICE Steps SOCIAL PARENTS SECTOR DEPARTMENT SERVICES Disciplinary measures at the discretion of the School will be administered. 6 Voluntary treatment outside of the school

is recommended. Student may return to KZ School upon Parent provides documented proof of readiness confirmed completion (documentation) of treatment program. for student to return to School 7 and/or a reference from an outside professional (Doctor, Psychologist).

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EDUCATION HEALTH & SOCIAL POLICE Steps PARENTS SECTOR SERVICES DEPARTMENT Principal and/or Parent and child will Student Services Available to provide meet with the Student Counsellor nursing care if the Services Counsellor investigates Education Sector Nurse and/or Principal. reported case. is not present. Parents follow up with Wounds are verified any medical care by Nurse. Care required. 1 provided and documented within the individual student chart.

Parents are contacted by the Nurse. Student Services Enhanced Prevention Counsellor meets Coordinator will be given with the parent and the Release of

SELF HARM: SELF child. Information form to begin

Cutting & Cutting Burning Student Services the screening process Counselor with the assessment tool. determines the 2 need for a Release Upon completion of of Information form assessment tool, the and/or the Enhanced Prevention Assessment Tool. Coordinator will make a “circle of care” with the appropriate partners Student Services Counsellor or Nurse reports incident to 3 DYP if necessary.

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An after-care plan is Referrals to appropriate Parent participates in created which can external resources will be “circle of care” for include referrals for included in the “circle of their child. counselling. care”: Out-patient treatment service a. Parent agrees to a. Counselling at the appropriate Enhanced Prevention treatment for their Services child. b. Impact c. Centre de b. Parent participates 4 Rehabilitation en in the creation of independance an intervention d. Elder at KZ School plan for their child. Portage c. Parent helps with Provide formal support the implementation groups/therapy groups of the intervention and provide plan. transportation to and from these groups.

Post-Care Treatment (after an extended absence):

EDUCATION HEALTH & SOCIAL POLICE Steps PARENTS SECTOR SERVICES DEPARTMENT

Student Services Counselor will network to

coordinate reintegration plan for the youth to return to 5 the school:

• scheduling of courses • follow-up counselling

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HEALTH & POLICE Steps EDUCATION SECTOR SOCIAL PARENTS DEPARTMENT SERVICES Parent has a responsibility to inform the school of their student’s situation or 1 mental health status so that support can be given.

If it comes to the attention KZPD may assess the of school personnel, situation and may Principal and/or Student contact an intervener Services Counsellor and ambulance. investigates reported case. May bring student to Parents are contacted and the hospital. KZPD may be called if there is a need to go to the May call the DYP if hospital. school hasn’t called. 2

If parent decides to take

charge of the situation with their child, a follow-up call will be done by the School, the Police, or the DPJ to

SELF HARM: SELF ensure the child was Suicide Ideation Suicide brought to a hospital.

The Student Services Enhanced Will try to obtain Counsellor or Education Prevention Release of Information Sector Nurse will Coordinator will form from the accompany child to the be given the individual to follow-up emergency room, if the Release of with KZHSS. parent cannot be Information form contacted or if the parent to begin the 3 wants support. screening process with the Student Services assessment tool. Counsellor determines the need for the Release of Information form and/or Assessment Tool. A report will be made to the Department of Youth Protection. 4

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HEALTH & POLICE Steps EDUCATION SECTOR SOCIAL PARENTS DEPARTMENT SERVICES Student Services Upon completion Counsellor will coordinate of assessment the “circle of care” tool, the meeting with the student Enhanced and pertinent players. Prevention Coordinator will make a “circle of care” with the appropriate partners and will do a follow-up according to KZHSS Suicide protocol.

Referrals to appropriate external

resources will be included in the “circle of care”. 5

Mental Health Social Worker will share hospital report with partners and school. All partners must participate in intervention meeting. For the school the person responsible to attend the meeting with the Mental Health Social Worker will be the Director of Education.

Post Care Treatment

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Student will be re- Mental Health admitted to school when Social Work will Parents should proof of mental stability participate in the provide the necessary is provided by an outside integration and documentation to professional. meeting to share ensure student’s information with the readiness to be in school and partners school.

6 with the consent of the parent(s), guardian(s) and/or youth.

Student Services Work with Student Counsellor will work with Services the student and parents Counselor to ensure to re-integrate the after-care. student into the school setting by providing Mental Health academic support. (e.g. Support Worker 7 tutoring). provides parental and/or family Student Services support for after- counsellor monitors care. follow-up and ensures after-care is in place.

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EDUCATION HEALTH & SOCIAL POLICE Steps PARENTS SECTOR SERVICES DEPARTMENT Verbal incident report Parents with a prepared by staff student under member. 12 who wishes to lay an assault Principal investigates charge against incident (interviews another student witnesses and must documents). accompany their child to the Students involved will Police Station. be separated in 1 different rooms. Students who are 12 and over Parents are informed. and who wish to

press charges ht

Students are sent against another ig home for the rest of student can go the day and receive an to the police additional 1 day station.

suspension . AGRESSION: AGRESSION:

students in a f a in students 2 2 Student Services Enhanced Prevention Counselor meets with Services determines the student and appropriate service: determines the need for using the • Youth Diversion Assessment Tool and worker obtains the Release of • Psychologist Information if • NNADAP Worker 2 necessary. • Enhanced Prevention Student Services Worker Counsellor refers student to Enhanced Prevention Services.

Parents informed. Responsible to investigate

Incident report sent to complaint assault

the police and follow procedure/process Student may get a 3-

1threats

Assault, Assault, day suspension

AGRESSION;

Criminal offences: offences: Criminal Sexual Abuse, Uttering Uttering Abuse, Sexual

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Student Services Counselor meets with the student and determines the need for using the Assessment Tool and obtains the Release of Information if 2 necessary.

Student Services Counsellor refers student to Enhanced Prevention Services.

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EDUCATION HEALTH & SOCIAL POLICE Steps PARENTS SECTOR SERVICES DEPARTMENT Verbal incident report prepared by staff member

Principal investigates incident (interviews witnesses and 1 documents)

Disciplinary measures

to be dispensed by the

m, school at their is

discretion. ur

Student Services Enhanced Prevention

Counselor meets with Services determines the student and appropriate service:

AGRESSION: AGRESSION: determines the need for using the • Youth Diversion

Inappropriate dialogue: Inappropriate Assessment Tool and worker Sexual Nature, Voye Sexual obtains the Release of • Psychologist Information if • NNADAP Worker necessary. • Enhanced 2 Prevention Student Services Worker Counsellor refers student to Enhanced Under 12 years of age Prevention Services. the Mental Health Social Worker or the KZHSS Social Worker will be called.

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HEALTH & SOCIAL POLICE EDUCATION SECTOR PARENTS SERVICES DEPARTMENT Parents should call the school to justify 1 student’s absence.

Parents can provide Attendance and lates are documentation from monitored according to the a professional if Attendance policy. there are medical reasons for missing 2 Home room teachers are school. responsible for calling

student’s home to indicate problem attendance or lates.

After 5 consecutive days of

absences, the Principal will organized with the parents 3 and/or guardians and student to discuss a plan for improving attendance.

Chronic Absences and Lates Chronic Enhanced After 10 consecutive days of Prevention Worker absences, the Principal will may work with the send a letter to parents student and/or informing them that the family with parent’s student is being referred to consent if the youth 4 the Enhanced Prevention is under 13 years of Services and DYP. age. If the youth is 14 years of age, a Release of Information must be signed by them.

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F. STUDENT/VOLUNTEERS

Students/Volunteers Placement Policy

POLICY DATE DATE Kitigan Zibi CODE: PSD-013 APPROVED: 05/09/2016 REVISED: 05/09/2016 Health & Social Services

POLICY

KZHSS supports the use of students or volunteers within the Health Center with defined boundaries?

PURPOSE

KZHSS ensures that students/volunteers are managed and supported in line with KZHSS policies in order to have an opportunity for meaningful service, experience skill development, career exploration and personal growth.

KZHSS RESPONSIBILITY:

KZHSS ensures that students/volunteers are supervised by an assigned staff member. The assigned staff member will provide an orientation regarding the site and all applicable and relevant KZHSS policies proportionate to the duration of their placement.

Upon acceptance of a student placement by the KZHSS Director, a designated worker will be assigned to make necessary arrangements, ensure communication among student, institution that they are from, and within KZHSS, and provide follow-up as required.

PROCEDURES:

A specific staff member will be assigned to each student/volunteer.

In the case of medical residents, the physician is responsible to supervise the student’s activities.

KZHSS volunteers and/or students are expected to comply with the same policies as those for staff. A copy of the KZHSS Policies and Procedure manual is available for consultation at the reception of each KZHSS building and can be found online at www.kzadmin.

The supervising staff member will ensure to familiarize the student/volunteer with the building/site (e.g. location of assigned office space, bathroom, break room, etc.) as well as ensure that all relevant/pertinent policies are reviewed with the student/resident proportionate to the duration of their placement. Relevant policies may include, but are not limited to: confidentiality/privacy policies; infection, prevention and control policies; violence in the workplace policies and incident reporting procedures.

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A contract will be signed by the Student and KZHSS, which will include the following elements:

1. Type of service provided. 2. Arrangement regarding compensation, if any. Note: Where students serve as a volunteer, or as part of a training course, compensation will not be provided. 3. KZHSS reserves the right to opt out of the Student Placement arrangement at any time, due to unforeseen circumstances or if the arrangement is not feasible for either party. 4. The student is expected to abide by the KZHSS Code of Conduct, and sign the Code of Ethics and Oath of Confidentiality.

Supervisors must ensure their student placements respects and complies with the level of work they are allowed to do by their institution and professional order of their field of study.

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PART V:

Environment Care

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A. ASSETS & FACILITIES MAINTENANCE 1.0 COMMUNITY USE OF FACILITIES, GROUNDS & EQUIPMENT

Community Use of Facilities, Grounds & Equipment

DATE DATE Kitigan Zibi POLICY CODE: EC-001 05/09/2016 05/09/2016 Health & APPROVED: REVISED: Social Services

POLICY

KZHSS ensures the safe and efficient management of specific community buildings and clarifies the administration and regulations of the facilities/grounds. These buildings include the Kitigan Zibi School Gymnasium (after school hours), Youth Centre, Wanaki Cabin and Rink Snack Shack.

PURPOSE

To ensure community resources are properly and efficiently maintained, regulated, and are safe for community use; and that fair and consistent rules are applied for community member use.

KZHSS RESPONSIBILITY:

DIRECTOR: ▪ Discretion to accept other events/activities and in consultation with KZE for the school gymnasium when necessary.

ASSISTANT DIRECTOR: ▪ Scheduling, distribution and sign-out of equipment and community building keys. ▪ Ensures that no equipment is lent out to an event where there will be alcohol ▪ Ensures a janitor is available and inspections are made following the events/activities. ▪ Collecting rental fees, depositing fees to accounts receivable, and ensuring receipts are issued.

RESPONSIBILITY OF THE CLIENT:

ELIGIBILITY CRITERIA: Registered KZA band members

BUILDING USE ELIGIBILITY The following are the types of events (but not limited to) that are eligible to rent the above- mentioned buildings: ▪ Events related to healthy living ▪ Physical activity ▪ Band Council meetings ▪ Tournaments

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▪ Fund raising ▪ Social events ▪ Birthday parties ▪ Baby and wedding showers ▪ Weddings ▪ Special occasions ▪ Community meals ▪ Priority use of the Rink Snack Shack is for youth ventures ▪ Non-profit events ▪ Other (at the discretion of the KZHSS Director and in consultation with KZES for the school gymnasium) ▪ Fundraising activities must be pre-approved by the KZHSS Director. ▪ Time periods of the activities must be pre-approved by the KZHSS Director.

BUILDING USE NON-ELIGIBILITY ▪ No alcohol related event will be considered. ▪ Rink Snack Shack is not for private business.

CLIENT RESPONSIBILITY

KZHSS Building Use ▪ User is required to pick up, sign-out and return building keys to the Health Center Receptionist during regular hours of operation. Failure to pick up keys during regular hours of operation may result in not having access to the building the client wishes to use (i.e. particularly on a weekend). o User agrees to provide a deposit of $150 for use for all buildings (in the case of KZ Gym use, please see policy below). o The deposit will be returned to the user after inspection of the building occurs. o Lender will make payment in advance to the Health Center Receptionist to secure facilities. Proof of payment will be provided and the KZA Finance policy will be applied. ▪ The deposit will be retained by KZHSS when: o Damage to the building occurs. o Signed out keys are lost and locks require replacing. o The building requires cleaning. ▪ The user agrees to follow all KZHSS rules and regulations. ▪ Any costs incurred relating to payment of damages or replacements of keys/locks that exceed the initial deposit of $150, must be paid by the user. If the user cannot immediately provide the difference, an Account Receivable (AR) will be set up at the Band Office in the client’s name until the full amount can be recovered.

Use of School Gym on Weekends: ▪ Use of gym on weekends requires a $100 deposit, and an additional fee of $50. o The $50 fee is retained by KZHSS to offset the cost of inspecting the gym at the beginning and end of each weekend day to determine whether janitorial services will be required or not. This amount is not returned to the lender.

o If inspection of the gym is satisfactory, the $100 deposit will be returned to the lender.

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o In cases where a janitor is required, the entire amount of $150 making up the deposit and fee will be retained to pay for the additional cleaning services. ▪ Lenders agree to follow all KZHSS rules and regulations, as well as KZES polices within Education Sector buildings. (i.e. gym) ▪ Only one event per day can occur at the School Gym. Clients may reserve the gym on a first-come, first-served basis.

Equipment Use: ▪ Persons wishing to borrow Health Center equipment may reserve and pick up an equipment use slip from the Ode Widokazowin Receptionist and/or Enhanced Prevention Services Coordinator during regular hours of operation. The equipment use slip will be required when picking up equipment at the location where the items are stored. KZHSS workers will ensure that the client has provided the equipment slip before providing the client with the requested equipment. ▪ Any loaned KZHSS equipment requires a pre-determined deposit amount based on the percentage of the value it would cost to replace the item. A set amount for replacing loaned equipment items is established by KZHSS ▪ All equipment must be returned in the same condition that it was borrowed. ▪ All equipment must be promptly returned no later than the agreed upon date at the time of borrowing. ▪ Any equipment damaged or not returned is the responsibility of the borrower to replace. Any costs incurred to repair, clean, or replace equipment that exceeds the initial deposit must be paid by the user. If the user cannot immediately provide the difference, an Account Receivable (AR) will be set up at the Band Office in the clients name, until the cost of the item(s) can be recovered.

PROCEDURES: ▪ Related to this and KZES policies. ▪ Cost for damages is the responsibility of the client. An Account Receivable (AR) will be set up at the Band Office to cover the cost of damages (i.e. deposit + remaining balance). ▪ An accounts receivable will be set up to pay for any damages including equipment.

RULES AND REGULATIONS: ▪ NO activities shall be held in any of the facilities/grounds which involves ANY sale or consumption of alcohol or drugs. ▪ NO private for-profit activities will be allowed within the KZHSS buildings or grounds without prior written approval from Band Council. ▪ NO activities shall be held in any of the facilities/grounds that is a liability considered to be of a risky nature of which is not covered by the Band’s insurance. ▪ All requested use of facilities/grounds must be done on the KZHSS Rental of Facilities/Grounds ▪ NO smoking shall take place within any facility. THERE ARE NO EXCEPTIONS. ▪ Making copies of keys is a criminal offence, NO duplication of keys. ▪ Refunds will not be made for keys that are not returned. ▪ All facilities/grounds must be left in the same condition that it was upon entry. ▪ KZHSS reserves the right to refuse the use of the facility/grounds if it determines the request is not in conformity of established guidelines.

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▪ KZHSS reserves the right to cancel the agreement without warning if it deems that it is in the best interest of the Sector and/or the community. ▪ KZHSS reserves the right to cancel or postpone the agreement if the facilities/grounds are required for KZHSS related activities.

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2.0 Home Hazards Assessment

Home Hazards Assessment

POLICY DATE DATE Kitigan Zibi EC-001 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS uses the provincial “Multi-clientele Autonomy Assessment” as a single assessment tool for adult and elderly clientele with loss of autonomy.

PURPOSE

To ensure client safety by using a standardized hazard assessment tool on the first visit to a client’s home by identifying their functional autonomy, their disabilities and their needs, while taking into account the resources of their environment.

KZHSS RESPONSIBILITY:

Nurse Supervisor, In-Home and Home and Community Care Nurses, Social Workers

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: All clients within the In-Home & Community Care Program are subject to an evaluation using the Multi-Clientele Autonomy Tool.

PROCEDURES:

MULTI-CLIENTELE AUTONOMY ASSESSMENT PROCEDURE:

▪ KZHSS Nurses and Social Workers will conduct a hazard assessment on the first visit to a client’s home. ▪ The environmental assessment of hazard will be administered with consent. ▪ Conduct the Quebec provincial Multi-clientele Autonomy Assessment. ▪ Document the findings. ▪ A multidisciplinary team consisting of a doctor, nurse, occupational therapist, physiotherapist, psychologist, social worker, nutritionist, etc. form part of the team that direct the client to the services needed. ▪ Share data with the client. ▪ Provide clients with educational material, pamphlets and safety procedures. ▪ Recommendations for changes in the home will be made if resources are available through KZA and/or KZHSS. ▪ Re-evaluate the assessment. ▪ Make the client’s home “safe”.

HOME HAZARDS OBSERVATIONS PROCEDURE:

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NATIONAL STANDARDS: Accreditation Canada self-assessment survey report identified this as an area that required new or revision of existing policy.

PROVINCIAL STANDARDS: Multi-clientele Autonomy Assessment form required by the Ministère de la santé et des services social.

STAKEHOLDERS (internal/external): CLSC- Ordre des Infirmiers et des Infirmières du Quebec

A multidisciplinary team consisting of a doctor, nurse, occupational therapist, physiotherapist, psychologist, social worker, nutritionist, etc. form part of the team that direct the client to the services needed. -

KITIGAN ZIBI HEATLH & SOCIAL SERVICES Policies & Procedures Manual 177

3.O BUILDING INSPECTIONS AND REPORTING

KZA Public Building Inspections and Reporting

POLICY DATE DATE Kitigan Zibi EC-003 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS uses the Canada Labour Code and Occupational Health and Safety regulations as a reference to complete annual safety inspections and follow-up evaluations of all KZA public buildings. Follow up inspections are carried out to ensure corrective measures have been implemented within the recommended time frame given by the building inspectors.

PURPOSE

To ensure the safety of all staff, clients and community members when using community buildings.

KZHSS RESPONSIBILITY:

Environmental Health and Safety Technician

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: Clients are required to comply with all safety measures taken to ensure building safety. This may include using appropriate entrances/exits, and following all safety signs posted within community buildings/grounds.

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4.0 DEALING WITH DISASTERS

Dealing with Disasters

POLICY DATE DATE Kitigan Zibi EC-003 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS follows the KZA Emergency Preparedness Plan which outlines the emergency response of the designated KZA community members to disasters.

PURPOSE

To promote and ensure the protection and safety of all community members including clients, families and staff members. (The Occupational Health and Safety Act of Canada is used as a reference for the development of the Emergency Preparedness Plan.)

KZHSS RESPONSIBILITY:

All four KZA Directors, Environmental Health & Safety Technician

RESPONSIBILITY OF THE CLIENT:

PROCEDURES: The Environmental Health and Safety Technician will be responsible for applying the plan, ensuring the annual updating and coordinating of meetings and training of the plan.

The Plan:

▪ Identifies who is responsible to initiate and coordinate a disaster response for the Program ▪ Outline the policies, processes and procedures to be followed for various types of Disasters ▪ Includes the Program’s role in working with community leadership and others in the community on activities related to disaster response ▪ Identifies the orientation, education and training required by staff and community members to ensure they are able to effectively respond in a disaster situation ▪ Outlines how to access client’s lists in a disaster situation ▪ Explains how to set priorities regarding the care needs of clients and families during a disaster ▪ Identifies ways of protecting and transporting clients records during a disaster ▪ Identifies ways to communicate with clients, with staff and with the others in the community, should a disaster occur ▪ KZHSS Health Centre is the designated building for an emergency response situation.

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B. INFECTION, PREVENTION & CONTROL

Everyone within KZHSS is responsible for using proper and effective Infection Prevention & Control practices on a routine basis in order to maintain a safe environment for staff, clients, and community members. Infection prevention and control strategies are designed to protect clients and healthcare providers by following infection prevention and control practices at all times and use risk assessment, critical thinking and problem solving in managing clinical situations.

Infection Prevention & Control procedures within KZHSS involve keeping the physical environment clean, ensuring personal routine habits are followed to prevent the spread of infection and taking precautionary measures in specific circumstances.

The policies addressed within this section are based on best practices and have been adapted for KZHSS programs from:

1. First Nations and Inuit Health Manitoba Region – Infection Prevention & Control Field Manual 2. Nunavut Infection Prevention and Control Manual 3. Public Health Ontario – Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings – 2nd edition

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CHAIN OF INFECTION:

In order for a microbe or infectious disease to be spread from person to person, all six links of the chain of infection must be present. Infection prevention and control procedures are in place to break the chain at any of the links, at which point the spread of infection will be stopped.

Chain of Infection

Infectious Agent (the bug) An organism or germ that can cause an infection or disease: viruses, bacteria, fungi, parasites

Susceptible Host Reservoir (the next sick person) (hiding places)

Person who cannot fight off the germ Places where germs can live resulting in them getting the infection or and reproduce such as disease; this might happen if not humans, animals, water, vaccinated against the germ, doorknobs, tables. very young or very old, or if they have a weakened immune system.

Portal of Entry Portal of Exit (the way in) (the way out)

The way a germ gets into Ways germs can get out of a person such as cuts or the reservoir such as in breaks in the skin, blood, saliva, feces. breathing, eating, rubbing eyes. Mode of Transmission (how germs spread)

Ways germs are carried from place to place, such as on hands, toys, equipment, water, air.

Infection Prevention and Control Field Manual, FNIH Manitoba Region, March 2010

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Coordination of Infection Prevention & Control Procedures

DATE DATE Kitigan Zibi POLICY CODE: IPC-001 05/09/2016 05/09/2016 Health & APPROVED: REVISED: Social Services

POLICY

KZHSS uses leading practices when planning, developing and supporting infection prevention and control activities within the scope of program and service delivery.

PURPOSE

To reduce the risk of spreading infection to clients, staff, visitors, and the entire community.

KZHSS RESPONSIBILITY:

1. All staff are responsible to: a. support Infection Prevention and Control activities within the scope of KZHSS program and service delivery. b. perform proper hand-washing techniques (eg. hand-washing) at appropriate times/locations, and support the KZHSS hand-hygiene strategy in collaboration with the Environmental Health and Safety Technician. c. take personal responsibility for their health and safety by wearing personal protective equipment when required and taking advantage of immunization opportunities offered by KZHSS (or external health service providers). d. exercise necessary precautions when sick or have a communicable illness. e. attend up-dated training sessions

2. The Director ensures that infection prevention and control policies and procedures are developed, implemented and enforced within the scope of KZHSS program and service delivery and that the necessary financial, material, and human resources are available to support and maintain such activities.

3. The Environmental Health & Safety Technician ensures: a. the proper monitoring of the infection prevention and control procedures within the physical environment; b. the development and implementation of a hand-hygiene strategy including education, awareness, audits and compliance measures. c. the safe handling, storage, use and disposal of hazardous wastes and materials according to the Occupational Health and Safety Act and the Environmental Health and Safety Act.

4. The KZHSS Janitor ensures: a. proper and regular cleaning of the physical environment, common areas, offices and washrooms with specific attention to high-touch areas (eg. handles, doorknobs, light switches, countertops, etc.)

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b. soap dispensers and alcohol-based gels dispensers (eg. Purell) are replenished on a continuous basis and ensures such products are not expired;

5. The Nurse Supervisor ensures: a. monitoring and audits of thorough cleaning of exam rooms and nursing labs; b. monitoring and audits proper decontamination of equipment procedures are followed; c. ordering and proper storage and distribution of personal protective equipment (PPE); d. training needs of nursing staff with regards to infection prevention and control practices are met and are in line with leading practices;

6. The Community Health Nurses ensures: a. proper cleaning and documentation of exam rooms, and nursing labs. b. proper aseptic techniques are employed when administering injections.

7. The In-Home Community Care Coordinator ensures: a. proper cleaning, sterilization and reprocessing of medical devices used in patient care. b. proper monitoring and supervision of the cleaning, sterilization and reprocessing of loaned medical devices;

8. The In-Home & Community Care Nurse ensures: a. proper and regular cleaning of nursing bag and contents(medical devices); b. proper handling and transportation of sharps containers;

9. The Personal Support Workers ensure: a. practice safe and hygienic procedures when preparing or serving food to clients;

10. The Medical Transportation Coordinator ensures: a. KZHSS vehicles are properly stocked with tissue, purell wipes, and similar supplies are stocked within each of the KZHSS vehicles. b. proper and professional cleaning occurs after an incident where the vehicle becomes soiled with bodily fluids.

RESPONSIBILITY OF THE CLIENT:

Clients are asked to collaborate with KZHSS staff in their efforts to coordinate Infection Prevention and Control activities.

PROCEDURES:

Please see the rest of this section for specific infection prevention and control policies and procedures.

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1.0 PHYSICAL ENVIRONMENT & ACCESSORIES

Cleaning and Housekeeping

POLICY DATE DATE Kitigan Zibi IPC-001 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS maintains and cleans all areas, furnishings, and equipment, medical and otherwise, within the scope of program and service delivery on a regular basis, as each situation requires, by the appropriate worker.

PURPOSE

To eliminate the risk of the transmission of pathogens between clients and/or health care workers

KZHSS RESPONSIBILITY:

1. All KZHSS Staff promotes and maintains a clean and safe environment within service delivery areas. Each staff member ensures all areas, especially those used for patient care, are kept clean and disinfected on a regular basis.

In addition, procedures for specific areas may be required after each client visit by staff workers concerned.

2. The KZHSS Janitor will provide general house-keeping in all areas of KZHSS buildings, with particular attention to areas where patient and client care occurs.

3. The In-Home and Community Care Coordinator will coordinate thorough, in- depth cleaning of all exam rooms and patient care areas twice a year to be carried out by Heavy Duty cleaners.

4. The Nurse Supervisor will monitor and ensure that exam rooms are cleaned as required (minimum cleaning after each client and a thorough cleaning on a regular basis).

5. The Medical Transportation Coordinator will ensure a regular cleaning schedule is followed for vehicle cleaning.

6. Waseya House Workers will ensure the daily cleaning schedule is followed and that each worker follows through with assigned cleaning tasks.

7. Nicholas Stevens Centre Workers will ensure the daily cleaning schedule is followed and that each worker follows through with assigned cleaning tasks.

8. Kiweda workers will ensure the daily cleaning schedule is followed and that each worker follows through with assigned cleaning tasks.

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RESPONSIBILITY OF THE CLIENT: Clients should ensure to bring all their personal belongings with them when they leave the a KZHSS building or vehicle. Any garbage, used tissues, used drinking cups should be placed in garbage containers.

PROCEDURES:

The KZHSS Janitor is the main person responsible for cleaning and maintenance of common areas of the facility not necessarily limited to areas where there is direct patient care. This includes public areas such as the waiting rooms, offices, hallways, stairways and service areas. ▪ Floors, baseboards, walls, ceilings, doors, mirrors and windows should be free of all visible stains, handprints, visible dust, etc. ▪ All horizontal surfaces including furniture, countertops, and window ledges should be free of visible dust. ▪ Waste will be disposed of after each work-day. ▪ Washrooms will be cleaned after each work-day: o Disinfecting the toilet bowl/urinal, cleaning toilets, countertops, sinks, and faucets, and baby-changing station. o Emptying trash receptacles. o Ensure toilet paper, hand soap and paper towels are replenished as required.

WASHROOMS

All washrooms will have at the disposal of the employees, soap or other cleaning products, paper towels or hand dryers, and waste paper baskets. All washrooms will be provided with toilet paper and kept in good working order. Cracked or damaged toilet seats will be replaced immediately. The sanitary facilities will be accessible, and maintained in sanitary condition (which includes being cleaned and washed before each shift, and disinfected daily. O.C. 885-2001, ss. 161-165

High-traffic areas within each building require more attention and includes:

Waiting Rooms (at both entrances) Clinic areas – Exam Rooms Staff Room Medical Transportation Vehicles & Bus Main areas at Kiweda Group Home, Nicholas Stevens Centre, Waseya House & Youth Centre

RECOMMENDED DISINFECTANTS:

KZHSS requires that work surfaces be cleaned with an "appropriate disinfectant." Appropriate disinfectants include a diluted bleach solution and EPA-registered antimicrobial products such as tuberculocides, sterilants, products registered against HIV/HBV, and Sterilants/High Level Disinfectants for equipment sterilization. Fresh Solutions of diluted household bleach made up

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every 24 hours is considered appropriate for disinfection of environmental surfaces and for decontamination of sites. Contact time for bleach is generally considered to be the time it takes for the product to dry.

EQUIPMENT AND WORKING SURFACES:

All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials. Some equipment, if grossly contaminated, must be cleaned with soap and water prior to decontamination.

Cleaning

Potential Hazards ▪ Exposure to hazardous cleaning chemicals found and used in the laundry or housekeeping process. ▪ Soaps and detergents may cause allergic reactions and dermatitis. ▪ Broken skin from soap or detergent irritation may provide an avenue for infection or injury if exposed to chemical or biological hazards. ▪ Mixing cleaning solutions that contain ammonia and chlorine will form a deadly gas.

Recommended Cleaners:

1. Septotal: This is a bath/shower disinfectant. It is recommended use: bathtubs, shower walls, and bathroom tiles. 2. Stride: This is a general all-purpose disinfectant. It is recommended for use on floors, walls, and must remain wet for at least 10 minutes to ensure effective disinfection. 3. Barbicide: This product is also a disinfectant, but is used for hairbrushes, combs, chairs along with the arms of the chairs, countertops and other metal equipment (scissors, tweezers, doorknobs) that does not come into contact with the eyes or mouth. Its efficiency depends on if the product is left to air dry for 10 minutes. Do not dry until the product has sat for 10 minutes.

Any harsh smelling products are NOT recommended at the Kiweda Group Home. The Elderly clients often find that strong smelling products are offensive and can cause respiratory problems.

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Food Preparation Areas

POLICY DATE DATE Kitigan Zibi IPC-002 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

All KZHSS employees practice safe and hygienic procedures when preparing or serving food to clients.

PURPOSE

This policy is intended to prevent any type of contamination or spread of food-borne illnesses

KZHSS RESPONSIBILITY: All KZHSS workers handling food are responsible to abide by this policy, which includes:

▪ Kiweda kitchen staff and servers ▪ Nicholas Stevens monitors ▪ Endong workers ▪ Waseya House ▪ KZHSS Staff involved in activities where meal/snack preparation occurs

RESPONSIBILITY OF THE CLIENT:

Clients are responsible to ensure proper hand hygiene, particularly when common items are shared at a table (ie. salt/pepper shakers).

PROCEDURES:

All employees should maintain proper personal hygiene which includes daily bath/shower, clean clothes, clean nails as well as good dental hygiene.

Proper hand washing is imperative to avoid the spread of germs and transmitting contaminants to food. Hands should be washed after: ▪ eating or drinking ▪ smoking ▪ taking out garbage ▪ touching the face, mouth or nose area ▪ blowing one’s nose ▪ using the washroom ▪ handling raw food, particularly meat or poultry

Gloves will be worn if the worker has any type of cut or infection on their hands. Gloves should be changed if they touch anything that requires washing hands afterwards.

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Workers will ensure to keep hair out of the food by wearing a hairnet or hat, or by keeping long hair tied back.

Utensils will be used to serve food and touching food with bare hands will be kept to a strict minimum.

A clean spoon will be used each time the food is sampled.

Using hot water and soap, the Kitchen staff will ensure to thoroughly clean the following after every use:

Surfaces: countertops, stoves, and sinks Cutting Boards: especially after cutting raw meat or poultry Serving Trays: all dishes, utensils, can openers, platters and containers Kitchen Tools: such as blenders, food processors, etc.

Using hot water and soap, the Kitchen staff will ensure to regularly clean:

Pantry areas Inside and outside of fridge Inside and outside of microwave

KIWEDA GROUP HOME

Residents are not permitted to in the Kitchen area. Residents who wish to return their dirty dishes to the kitchen may place them on the trolley for this purpose.

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Vehicle Interior Maintenance

POLICY DATE DATE Kitigan Zibi IPC-002 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS strives to provide safe environments for all clients and staff, which includes within KZHSS vehicles.

PURPOSE

This policy ensures that infection prevention and control procedures will be used within KZHSS vehicles to keep the spread of germs and contamination to a minimum.

KZHSS RESPONSIBILITY: KZHSS will provide clean and safe vehicles for transportation for all clients and staff. KZHSS drivers will be trained in cleaning out vehicles used for transport. Alcohol-based gel as well as garbage containers or bags will be provided and replenished regularly for client and driver use within each vehicle.

RESPONSIBILITY OF THE CLIENT: It is the responsibility of the client to bring all personal belongings with them after being transported in a KZHSS vehicle. Clients should use the garbage container within the vehicle to discard used tissues or garbage.

PROCEDURES: Routine cleaning will occur following each transport to ensure: ▪ Any waste is in waste receptacles ▪ High-touch areas, such as hand rails (or poles in the bus) will be wiped down.

Whenever a vehicle is soiled with bodily fluids (vomit, diarrhea, urine, blood, etc), the vehicle will be immediately sent for deep cleaning. It will NOT be used to transport any other clients until this cleaning occurs. ▪ Wearing proper protective equipment, clean area that is visibly soiled ▪ Remove all contents of the vehicle ▪ Clean and vacuum the floor ▪ clean and disinfect all interior surfaces including doors, dash, windows, and car interior ▪ clean and disinfect seats and seatbelts ▪ remove scuff marks ▪ empty, clean and disinfect waste containers

TRANSPORT EQUIPMENT:

Transport equipment such as walkers or wheelchairs that are used for more than one client should be disinfected after each use with a hospital-grade disinfectant or after the equipment becomes visibly soiled.

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Disinfection and Sterilization

POLICY DATE DATE Kitigan Zibi IPC-003 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS deems it essential to reprocess non-critical multi-use equipment and devices consistently, safely and appropriately, by utilizing an approved ‘hospital-grade’ low- level disinfectant which must have a Health Canada Drug Information Number (DIN).

PURPOSE

To protect clients, staff, and and/or residents from contracting any type of infection due to the transmission of microorganisms from medical equipment or devices.

KZHSS RESPONSIBILITY:

Wherever possible, KZHSS will ensure to use single use devices.

It is the shared responsibility of all staff involved with small equipment to ensure that effective reprocessing takes place.

RESPONSIBILITY OF THE CLIENT:

Not applicable.

PROCEDURES:

Cleaning and disinfection of visibly soiled items and/or non-critical items should occur as soon as possible after the items have been used.

CLEANING DISINFECTION STERILIZATION Removal of foreign material Process used to kill Process achieved by applying from a surface or object. microorganisms on inanimate one or more of the following: surfaces/objects. heat, chemicals, irradiation, Mechanical action or friction high pressure and/or filtration. removes micro-organisms or Used to kill most disease- debris when used with water causing microorganisms. Used to kill all forms of and detergents. microbial life.

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Selection, Use and Storage of Disinfectants

POLICY DATE DATE Kitigan Zibi IPC-004 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS selects ‘hospital-grade’ low- level disinfectants which have a Health Canada Drug Information Number (DIN) for use at KZHSS, and stores the products in appropriate areas.

PURPOSE

To ensure proper strength of disinfectant is selected and used for the proper surface, and that the product remains effective during its shelf life.

KZHSS RESPONSIBILITY:

All staff involved in house-keeping, cleaning and disinfection procedures will ensure to use the appropriate cleaning and disinfection products required for each specific task.

RESPONSIBILITY OF THE CLIENT:

Not applicable.

PROCEDURES:

The following factors will be considered when selecting cleaning or disinfection products: The product is approved by Health Canada for use in that particular circumstance, and has either a drug identification number (DIN) or a natural product number (NPN) in the case of alcohols.

▪ The product is being used as intended by the manufacturer ▪ That manufacturer’s instructions are complied with, including recommendations for dilution, temperature, water hardness and use. ▪ The product is suitable to clean the designated surface ▪ The product is effective against particular organisms (including microbiological activity and contact time to kill microorganisms)

Additional considerations: Ideally, products should require little or no mixing and diluting; Products with low irritancy and allergenic characteristics are more likely to be used by Staff (ie. non-toxic and non-irritating) Ideally, selected products should be safe for the environment. All cleaning products will be clearly marked with their original labels. To ensure a regular rotation of cleaning and disinfection products, newer products will be placed at the back of the stock. Products will be verified regularly to ensure products are not passed their expiry date.

MSDA sheets will be updated on regular basis.

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Reprocessing of Medical Equipment used in Client Care

POLICY DATE DATE Kitigan Zibi IPC-005 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS will properly reprocess (clean, disinfect, sterilize and store) all reusable medical devices and equipment for client use.

PURPOSE

To prevent the transmission of micro-organisms from client to client.

KZHSS RESPONSIBILITY:

1. Nurse Supervisor ensures the proper monitoring of medical device and equipment reprocessing. 2. The In-Home Care Coordinator is solely responsible for reprocessing medical devices and equipment used within the Home and Community Care Program and Foot Care program. 3. The Community Health Nurse (CHN) is responsible for reprocessing medical devices and equipment used within the Doctor’s and Nurses’ clinic. The CHN will ensure that the proper receptacles are in the exam rooms to receive medical devices to be reprocessed.

RESPONSIBILITY OF THE CLIENT:

Not applicable.

PROCEDURES:

BLOOD PRESSURE CUFF:

Cuff covers should be washed at least once a week in a washing machine or a sink.

A disinfectant may be used on the cuff if there is no obvious soiling, however, this is not as effective as cleaning the cuff in addition to disinfecting it. Spray cuff with disinfectant and let it stay visibly wet for 10 minutes. Dry off the cuff with a clean towel before use.

Instructions for cleaning soiled cuffs:

In a sink, by hand:

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4. The bladder can be washed with soapy water and then rinsed. However, do not get water inside the bladder or tubing. 5. Fill a sink with warm water (but not hot). 6. Delicately scrub the fabric with a soft toothbrush or hand brush without damaging the fabric (as torn fabric can host microorganisms). 7. Rub the cuff material together until clean. 8. When there is no visible contamination, place the cuff under a running faucet to remove all of the soapy water. 9. Roll the cuffs tightly to drain excess water without twisting them. Open the end of the cuff where the bladder goes and hang to dry.

In a washing machine:

1. Put on (non-sterile) surgical gloves. 2. Remove the bladder from the cuff. 3. If the cuff is grossly contaminated with blood, use an enzyme detergent on heavily soiled area to remove organic material. The cuff may need to soak in soapy water. 4. The bladder can be washed with soapy water and then rinsed. However, do not get water inside the bladder or tubing. 5. Add laundry soap or mild detergent to cold or warm water (but not hot) and put the cuff covers in. 6. Wash cuffs on a gentle cycle. 7. Remove cuffs from the washing machine. Open the end of the cuff where the bladder goes and hang to dry.

OPHTHALMOSCOPE:

Soak a cloth in a 70% isopropyl alcohol solution or use a hospital-grade disinfecting wipe. Wipe down the head and handle, and clean all external surface areas. Ensure that excess liquid does not seep into the components.

NOTE: Solution residue on the magnifying lens may decrease the performance of the device, be sure to wipe clean all surface areas.

OTOSCOPE:

NOTE: Solution residue on the magnifying lens may decrease the performance of the device, be sure to wipe clean all surface areas. The lenses of the instrument head may be cleaned with a lint-free cloth or lens paper.

Do not submerge the otoscope in water or other liquids or subject in to steam sterilization.

GLUCOMETER:

Recommendations for Cleaning and Disinfection of Glucometers taken from: “North Carolina Statewide Program for Infection Control and Epidemiology (SPICE)”

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1. Clean glucometer surface when visible blood or bloody fluids are present by wiping with a cloth dampened with soap and water to remove any visible organic material.

2. If no visible organic material is present, disinfect after each use the exterior surfaces following the manufacturer’s directions using a cloth/wipe with either a detergent/germicide with a tuberculocidal or HBV/HIV label claim, or a dilute bleach solution of 1:10 (one part bleach to 9 parts water) to 1:100 concentration.

NOTE: If the cloth is too saturated, it could allow liquid to get inside the glucometer and cause damage. Screens and ports currently are not sealed on these devices. Therefore, using a bleach-only disinfecting wipe is less likely to cause damage.

1. High-level Disinfection (HLD) will be used to reprocess semi-critical medical equipment (equipment that comes into contact with non-intact skin or mucous membranes but do not penetrate them.) 2. New devices will be inspected and put into proper use before being available for use within the clinic. 3. All devices will be reprocessed according to manufacturer’s instructions.

SPECULUM: 1. CHN will ensure that the proper receptacle (with cover) is in each exam room to receive a vaginal speculum post-exam. 2. The speculum will be placed within the receptacle with tepid water and an enzymatic cleaner to prevent any organic material from drying. 3. CHN will wear gloves to transport the receptacle to the Lab (Room #126). 4. The designated “dirty” area is to the right of the sink. The designated “clean area” is to the left of the sink. 5. Using a small, nylon bristle brush, and a detergent solution manually clean any organic debris. 6. Thoroughly rinse the speculum under running water to remove residue. 7. Allow speculum to air dry or wipe-dry. (This will prevent spotting and will prevent the dilution of chemical disinfectants.) 8. Place speculum in sterile bag and follow standard autoclave procedure. 9. Inspect brushes and other tools after use. Clean, disinfect, dry and store tools used in cleaning. 10. Clean and disinfect countertop and sink.

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Reprocessing of Loaned Medical Equipment

POLICY DATE DATE Kitigan Zibi IPC-006 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

Note: For the purpose of this policy, “medical equipment” shall refer to medical aids, medical accessories, technical aids and other support equipment that is loaned on a temporary basis from KZHSS to community members.

POLICY

KZHSS will properly reprocess (clean, disinfect, sterilize and store) all loaned medical equipment for client use.

PURPOSE

To prevent the transmission of micro-organisms from client to client when using borrowed medical equipment from KZHSS.

KZHSS RESPONSIBILITY:

1. Nurse Supervisor ensures the proper monitoring of loaned medical reprocessing. 2. The In-Home Care Coordinator assigns a designated medical equipment reprocessing worker to clean, disinfect, sterilize and store returned medical equipment 3. The assigned medical equipment reprocessing worker is responsible for following leading practices in infection prevention and control procedures when reprocessing medical equipment. 4. The KZHSS Janitor is responsible to ensure that the Used Equipment Bin is emptied on a daily basis, and that all medical equipment is brought to the Medical Equipment Reprocessing Trailer.

RESPONSIBILITY OF THE CLIENT:

In order to borrow medical equipment and/or accessories, the client will:

1. Sign the Medical Equipment & Accessories Form and adhere to the borrowing conditions as set out on the form. 2. Handle and maintain the medical equipment with necessary care and for the client’s personal use. 3. Advise KZHSS if the medical equipment requires repair. 4. Not lend, share or sell medical equipment with/to another person. 5. Use the designated doors at the “Endong Building” for pick-up of medical equipment. 6. Return medical equipment to the Bin outside the Health Center and inform the receptionist.

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PROCEDURES:

BORROWING OF MEDICAL EQUIPMENT:

All requests to borrow medical equipment will be directed to the In-Home Care Coordinator. The Coordinator will fill out the Medical Equipment form with the client.

The In-Home Care Coordinator will arrange to meet the client at the “Endong Building” at DOOR B– Equipment Pick Up.

RETURNING MEDICAL EQUIPMENT:

When a client returns medical equipment Clients returning medical equipment can bring the medical equipment to the bin for this purpose outside the Health Center.

Once a day, all returned medical equipment will be brought to the designated reprocessing area.

REPROCESSING MEDICAL EQUIPMENT: The assigned medical reprocessing worker will:

1. Perform hand hygiene. 2. Wear appropriate Personal Protective Equipment (PPE). At a minimum, gloves will be worn when reprocessing the medical equipment. 3. The worker will ensure proper ventilation within the reprocessing area by turning on the fan. 4. The worker will ensure to follow the manufacturer’s recommendations for the cleaning of equipment. 5. Any gross soil will be removed before being brought into the reprocessing building. 6. All equipment will be cleaned before disinfection or sterilization can occur. 7. The equipment will be dried after the cleaning process. 8. If a worker experiences a break in his/her skin while reprocessing medical equipment, it should be immediately assessed by a health care professional.

MEDICAL REPROCESSING BUILDING RULES

1. Only authorized people will be allowed to circulate within the medical equipment reprocessing building. 2. This site will be used only to reprocess non-critical medical equipment. This includes equipment that only touches intact skin (not mucous membranes) or does not directly touch the patient. 3. Any type of single use equipment will be disposed of immediately after use. It will not be cleaned or reprocessed. 4. Eating, drinking, smoking, applying of cosmetics or handling contact lenses is prohibited within the reprocessing building.

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5. All cleaning products and solutions will be stored in the locked cabinets for this purpose. 6. Only disinfectants with a Health Canada DIN (Drug Infection Number) will be used. 7. Material Safety Data Sheets (MSDS) will be provided for each of the products. 8. Products for disinfection will be used, and mixed according to the manufacturer’s instructions. 9. Check expiry dates on the product. 10. Follow the manufacturer’s instruction for the duration of use.

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2.0 PERSONAL ROUTINE HABITS

Universal Precautions

POLICY DATE DATE Kitigan Zibi IPC-007 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS uses Universal Precautions whenever there is a possibility of contact with blood or bodily fluids of another person. EVERY PERSON is considered as POTENTIALLY infectious.

PURPOSE

To provide simple and basic precautions against the transmission of disease.

KZHSS RESPONSIBILITY:

KZHSS will provide supplies and equipment needed to practice universal precautions. Disposable gloves and barrier masks will be provided to all employees and volunteers whose duties may involve contact with blood and body fluids.

RESPONSIBILITY OF THE CLIENT:

Clients are asked to immediately advise a KZHSS staff member of any incident that occurs involving blood or bodily fluids within KZHSS activities or within one of its buildings.

PROCEDURES: Universal precautions apply if you are exposed to blood and certain other body fluids including semen, vaginal secretions, body tissues, and amniotic fluid. Universal precautions need not apply if you are exposed to saliva, feces, nasal secretions, sputum, sweat tears, urine, and vomit. If it is difficult to identify the specific body fluid or when body fluids are visibly contaminated with blood, then universal precautions are ALWAYS to be applied. Barrier protection should be used at all times to prevent skin and mucous membrane contamination with blood, body fluids containing visible blood, or other body fluids (cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids, semen and vaginal secretions). Barrier protection should be used with ALL tissues. The type of barrier protection used should be appropriate for the type of procedures being performed and the type of exposure anticipated. Examples of barrier protection include disposable lab coats, gloves, and eye and face protection. Gloves are to be worn when there is potential for hand or skin contact with blood, other potentially infectious material, or items and surfaces contaminated with these materials. Wear face protection (face shield) during procedures that are likely to generate droplets of blood or body fluid to prevent exposure to mucous membranes of the mouth, nose and eyes.

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Wear protective body clothing (disposable laboratory coats (Tyvek)) when there is a potential for splashing of blood or body fluids. Wash hands or other skin surfaces thoroughly and immediately if contaminated with blood, body fluids containing visible blood, or other body fluids to which universal precautions apply. Wash hands immediately after gloves are removed. Avoid accidental injuries that can be caused by needles, scalpel blades, laboratory instruments, etc. when performing procedures, cleaning instruments, handling sharp instruments, and disposing of used needles, pipettes, etc. Used needles, disposable syringes, scalpel blades, pipettes, and other sharp items are to be places in puncture resistant containers marked with a biohazard symbol for disposal. Clean-up procedure for blood/bodily fluids: 1. Put on disposable gloves 2. Wipe up blood or body fluids with absorbent paper towels 3. Place contaminated paper towels in a new plastic garbage bag 4. Clean and rinse area with usual disinfectant 5. Wipe the surface with a 1:10 dilution of household bleach in water. This concentration can be achieved by mixing 1 ounce of household bleach with 9 ounces of tap water (1:10 dilution). This disinfectant will have a shelf life of one shift ONLY. 6. Dispose into the same plastic garbage bag: the cloths used to wipe up and your gloves, removing gloves last. 7. Secure bag with tie 8. Dispose of plastic garbage bag. 9. Wash hands

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Hand Hygiene

POLICY DATE DATE Kitigan Zibi IPC-008 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

All KZHSS staff will consistently and correctly perform proper hand-hygiene practices on a routine basis, and at specified moments before procedures (eg. patient care) or after specific activities (eg. using the washroom). All health care providers including nurses, physicians, contracted services, volunteers, and students in the clinic setting will perform hand hygiene at the closest point of care to the client.

PURPOSE

To prevent the spread of communicable diseases or infections by removing or killing microorganisms on contaminated hands.

KZHSS RESPONSIBILITY:

1. All KZHSS staff are responsible to ensure compliance with the hand-hygiene policy.

2. Environmental Health and Safety Technician will provide annual hand-hygiene education to all staff and conduct compliance checks.

3. The Director, Coordinators and Supervisors are responsible to ensure new employees receive an orientation to hand-hygiene policies and practices.

RESPONSIBILITY OF THE CLIENT:

Clients are responsible to help prevent the risk of spreading germs and micro-organisms by washing their hands after using the washroom, sneezing, coughing or part of any other activities that could contaminate their hands.

PROCEDURES:

PROPER HAND WASHING:

Since front-line workers may deal with different clients in various environments, they should be aware of the necessity to practice effective hand washing regularly to avoid the spread of germs and bacteria which could cause or spread to themselves and others.

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MECHANICAL CLEANING WITH SOAP AND WATER:

For effective hand washing, follow these steps:

1. Remove any rings or other jewelry 2. Use warm water and wet your hands thoroughly 3. Use soap (1-3 ml) and lather very well 4. Scrub your hands, between your fingers, wrists, and forearms with soap for 20 seconds 5. Scrub under your nails 6. Rinse thoroughly 7. Turn off the taps/faucets with a paper towel 8. Dry your hands with a single use towel or air dryer 9. Protect your hands from touching dirty surfaces as you leave the bathroom

USE OF ALCOHOL-BASED HAND RUBS:

1. Remove any rings or other jewelry. 2. Make sure your hands are dry, as wet hands will dilute the product. 3. Use enough product to cover all the surfaces of your hands and fingers. 4. Scrub your hands, between your fingers, wrists and under your nailsuntil the product has evaporated.

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Personal Protective Equipment (PPE)

POLICY DATE DATE Kitigan Zibi IPC-009 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS employees will don the proper personal protective equipment in situations where this is required.

PURPOSE

To prevent contact with blood, bodily fluids and/or other harmful pathogens.

KZHSS RESPONSIBILITY:

KZHSS will provide employees with proper personal protective equipment.

RESPONSIBILITY OF THE CLIENT:

All persons who have fever and a cough are asked to wear a mask during their time at the Health Centre.

PROCEDURES:

GLOVES:

Gloves should be worn in the following circumstances: • when hands will be exposed to blood or bodily fluids • when touching non-intact skin • when the health care provider has lesions on their own hands • when handling devices/equipment that have been soiled with bodily fluids.

Gloves should be changed between patients or when moving from dirty to clean procedures on the same patient.

Putting on gloves:

1. Perform hand hygiene with an alcohol-based hand rub. 2. Inspect gloves before wearing checking for any holes or tears.

Taking off gloves:

1. Take hold of the first glove at the wrist. 2. Fold it over and turn it inside out. Once the glove is off, hold it with your gloved hand.

To remove the other glove, place your bare fingers inside the cuff without touching the glove

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MASKS:

Procedural masks are provided at both entrances of the Health Centre clinic. All persons who have fever and a cough are asked to wear a mask during their time at the Health Centre. Should a person refuse to do so, the Health care worker should wear a mask when treating the client or when within 6 feet of a coughing/sneezing client.

A mask should be changed if it gets wet as if will no longer be an effective barrier.

Procedural masks should be worn to protect the mucous membranes of the nose and mouth.

Putting on a procedural mask:

1. Secure the ties or elastic bands around your head so the mask stays in place. 2. Fit the movable band to the nose bridge. Fit snugly to your face and below chin.

Taking off a procedural mask:

1. Bend forward slightly. 2. Carefully remove the mask from your face by touching only the elastic bands or ties. 3. Discard mask in the garbage.

Putting on an N95 respirator:

1. Pre-strectch the top and bottom straps before placing the respirator on your face. 2. Cup the N95 respirator in your hand and place under chin with the nose piece up. 3. Secure the elastic band around your head so that the respirator stays in place. 4. Mold the metal band around the bridge of your nose, using both hands. 5. Fit check the N95 respirator.

Taking off an N95 respirator:

1. Bend forward slightly. 2. Carefully remove the mask from your face by touching only the elastic bands or ties. 3. Start with the bottom tie, then remove the top tie. 4. Discard mask in the garbage.

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Respiratory Etiquette

POLICY DATE DATE Kitigan Zibi IPC-010 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS practices proper respiratory etiquette techniques

PURPOSE

To prevent the transmission and spread of pathogens to others.

KZHSS RESPONSIBILITY:

All Staff are responsible to: ▪ practice proper respiratory etiquette. ▪ Ensure that all buildings are equipped with sanitization stations including: alcohol- based rub, tissues, and mask. ▪ Ensure that all alcohol-based products used to prevent the spread of germs contain the recommended percentage of alcohol, that the product is not expired, and that the stations containing the product are filled on a regular basis. ▪ Provide visual client/visitor/staff education (such as posters) regarding respiratory etiquette.

RESPONSIBILITY OF THE CLIENT:

Clients and visitors to the Health Centre are asked to help prevent the spread of infection within KZHSS buildings by practicing proper respiratory etiquette.

PROCEDURES:

Visitors, staff, and clients will practice respiratory etiquette when coughing and sneezing:

▪ Turn your head away from others when you cough or sneeze. ▪ If possible, cover your mouth and nose with a tissue. If not possible, sneeze or cough into the elbow of your sleeve. ▪ Discard any used tissues in the garbage can. ▪ Use hand sanitizer or wash hands after blowing your nose. ▪ Persons with a cold or the flu will be asked to wear a mask. If a client refuses to wear a mask or finds it difficult to breathe with a mask on, the healthcare worker will wear a mask and eye protection.

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3.0 SPECIFIC CIRCUMSTANCES

Handling Patient Specimens

POLICY DATE DATE Kitigan Zibi OSA-001 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS will ensure the proper handling of laboratory specimens (e.g. pap smears and culture swabs).

PURPOSE

To prevent the risk of exposure of an infectious/contaminous agent to a healthcare worker.

KZHSS RESPONSIBILITY:

1. The Community Health Nurse and/or Medical Clerk will wear necessary PPE when handling laboratory specimens.

RESPONSIBILITY OF THE CLIENT:

Not applicable.

PROCEDURES:

All clinical specimens are considered potentially infectious and must be handled carefully to avoid contamination.

Patient Specimens:

1. Wear gloves when handling specimens. 2. Place specimen in appropriate receptacle for transport: a. For pap smears, place specimen into a container with a closed lid. b. For culture swabs, place the specimen into a plastic, closable (e.g. zip-lock) bag. 3. Ensure contamination does not occur outside of the container/bag. 4. Always place the requisition outside the container/bag that the specimen is shipped in. 5. Remove gloves and perform hand hygiene.

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Handling of Clean, Infectious, or Soiled Linen and Clothing

DATE DATE Kitigan Zibi POLICY CODE: IPC-012 05/09/2016 05/09/2016 Health & APPROVED: REVISED: Social Services

POLICY

Linens used within KZHSS program service delivery areas will be handled, transported, and stored properly.

PURPOSE

To ensure the risk of disease transmission is minimized when handling soiled/infectious clothing or linen and to ensure the safe supply, storage and delivery of clean linen.

KZHSS RESPONSIBILITY:

All staff who are responsible to handle soiled linen will do so with proper care and wear proper protective equipment as required.

KZHSS will provide necessary supplies as well as personal protective equipment (PPE), namely gloves, to workers handling soiled linen.

RESPONSIBILITY OF THE CLIENT:

Clients will adhere to the rules of the applicable to their situation:

1. Kiweda residents will use their own designated hampers.

2. Waseya house residents will respect the designated schedule to launder their clothing and linens.

PROCEDURES:

Site Type of soiled linen KZHSS Dressing gowns in the Doctor’s office. Rags and Mopheads Waseya House Bed linens Kitchen linens Kiweda Resident’s clothing Bed linens Kitchen linens

GENERAL PROCEDURES:

1. All persons assigned to manipulate soiled laundry will wear gloves when doing so.

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2. Soiled laundry should be handled with caution to prevent the spread of airborne infection. 3. Linen that is grossly contaminated with blood, body fluids or other potentially infectious materials should be gathered with the minimum amount of disturbance and placed in a plastic bag at the point-of-care. a. The bag and its contents will be placed in another plastic bag to minimize the risk of cross-contamination in transporting the bag to the washer and dryer area cleaned. b. Gross soil (such as feces, or vomit) should be removed with a gloved hand and be disposed of in the toilet. 4. Bags of laundry should not be squeezed or held close to the body in order to avoid punctures from improperly discarded syringes or sharps. 5. Hand hygiene should be followed after handling soiled laundry. 6. Any clean linen dropped on the floor accidentally is considered soiled and must be placed in the soiled linen hamper. 7. Use water temperatures of at least 160°F and 50-150 ppm of chlorine bleach to remove significant quantities of microorganisms from grossly contaminated linen. Normal washing and drying cycles including "hot" or "cold" cycles are adequate to ensure client safety. Instructions of the manufacturers of the machine and the detergent or wash additive should be followed closely.

KZHSS:

1. An assigned Nurse will handle the laundering of the gowns from the clinic area on a weekly basis. 2. Soiled gowns will be transported to the laundry area within the hamper. 3. The hamper will be cleaned and disinfected after each use.

WASEYA HOUSE:

1. Clients are responsible to launder their own clothes using the washer and dryer at Waseya House. At a minimum of once a week, clients are expected to clean their own bedding and towels. Detergent and laundry products are provided. 2. Upon a guest’s departure, Waseya House workers will wear gloves when stripping the beds and gathering towels and facecloths. Linens will be laundered according to the above procedures.

KIWEDA:

1. Each Kiweda resident has their own hamper for their personal clothes and 3 sets of designated linens within their room. 2. Each Kiweda resident has a designated area in their closet to store clean linen. 3. PSW’s will handle the change the bed clothes, and collect the towels and facecloths weekly. 4. At no time will resident’s laundry be mixed with environmental cleaning items such as mops or rags. 5. To reduce the risk of cross-contamination, PSW’s will establish ongoing health teaching measures to discourage individuals from sharing their linen, clothing, hats or shoes. 6. Perform hand hygiene before handling clean linen.

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Sharps Safety and Needlestick Injuries

POLICY DATE DATE Kitigan Zibi IPC-013 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS Nurses use safe practices when handling Sharps containers and when using needles/syringes in client care within the Health Centre and on home visits

PURPOSE

To reduce the exposure to bloodborne pathogens and risk of transmission of infection.

KZHSS RESPONSIBILITY:

KZHSS provides approved Sharps containers at point-of-care patient areas and for clients who require the use of needles/syringes in their medication management.

RESPONSIBILITY OF THE CLIENT:

When provided with a Sharps container in the home, the client ensures the following is respected.

1. Sharps are placed within the container immediately after use. 2. Ensure the container is kept in a safe location out of the reach of children. 3. The container is only filled up to the filling line (about ¾ of the way full). 4. No liquids should be added to the container. 5. Do not burn the container. 6. Bring the full container to the Health Center to receive a new one. 7. Contact the Health Center if there are any questions.

PROCEDURES:

Needle stick injuries are wounds that are caused by needles that puncture the skin. Front-line workers may come across needles or syringes in the various home and/or work environments that they find themselves in. Therefore, it is important to be aware of this type of injury so as to avoid contracting any infectious diseases or blood borne illnesses.

KIWEDA:

1. Kiweda residents who use insulin are provided with individual Sharps containers in their room. 2. When the container is ¾ full the Kiweda Coordinator or Personal Support Worker will lock the container and bring it to be stored in the locked designated area. 3. The Coordinator will call the Community Health Nurse to pick up the container

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WASEYA-HOUSE:

1. A locked Sharps container is kept in the Family Violence Worker’s office for client use. 2. When the container is ¾ full, the Family Violence Worker will call a Community Health Nurse to pick up the container and replace it with an empty one. 3. The Community Health Nurse will bring the Sharps container to the Health Centre where it will be stored in the designated locked area.

SHARPS CONTAINER DISPOSAL:

1. Full Sharps containers are considered biomedical waste and will be stored in the designated locked area of the Health Center basement. 2. The Environmental Health and Safety Technician will arrange to have the Sharps containers disposed of

RECAPPING AND DISPOSAL PROCEDURE:

Never move an exposed needle tip towards an unprotected hand. Lay the cap on a flat surface and scoop it onto the tip of the syringe held in one hand, keeping the free hand away from the exposed needle. Needles should be disposed of in wide-mouth, puncture proof containers. Do not overfill the containers for this purpose.

WHAT TO DO IN THE CASE OF EXPOSURE TO BLOOD

Anybody’s blood must always be regarded as contaminated.

1. Administer or receive first aid.

Exposure of the skin:

▪ Immediately bleed the cut, bit, prick, scrape or scratch (without traumatizing the skin around the wound.) ▪ Clean the exposed area as soon as possible (using water and mild soap, or sanitary wipes.) without rubbing the area. ▪ If water is not available, use a waterless soap (but wash with water and soap as soon as possible.)Exposure of the mucous membranes (eyes, lips, mouth, inside the nose) ▪ Rinse thoroughly with water as soon as possible.

2. Dispose of the offending object in a safe manner (syringe, knife)

3. Notify the Nurse Supervisor, who will then:

▪ Take charge of the person who has been exposed. ▪ Write down the name and address of the source person, and send them to emergency medical personnel.

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▪ Fill in the Quick Assessment form (located on wall inside client’s rooms or near nursing station) with the help of the person who has been exposed.

4. Go immediately to a hospital emergency department (it is essential to be seen within two hours after exposure, or as soon as possible.)

5. Take your immunization booklet with you (or your health record) if possible.

6. Tell the emergency admission staff that work related exposure to blood is involved.

7. Obtain a medical assessment of the exposure:

If no risk is deemed present: Discharge: No other action is required.

If a risk is deemed to be present: Investigation: Blood tests must be done on the exposed person and the source person, and their immunization status assessed. Treatment: Antibodies, vaccinations and/or medications, information, test follow-up and treatments.

Treatments: Hepatitis B: Not vaccinated: injection of antibody or 1st vaccination or both Vaccinated: depends on proof of vaccine efficacy.

Hepatitis C: No effective preventive treatment. AIDS: Drugs exist, but they have significant side effects and therefore are selectively Prescribed. Their effectiveness is increasingly recognized.

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Safe Disposal of Infectious or Hazardous Waste

POLICY DATE DATE Kitigan Zibi IPC-014 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS properly handles, stores and disposes of all hazardous waste generated on site as part of an effective environmental management program.

PURPOSE

To ensure the health and safety of all staff, clients, and visitors and to reduce the risk of exposure to potential infectious/contaminated waste.

KZHSS RESPONSIBILITY:

1. The KZHSS Environmental Health & Safety Technician ensures: a. safe disposal of all hazardous waste & also coordinates the pick-up of biomedical waste bi-annually, as defined under the Environmental & Workplace Health Act. b. maintenance and updating of Material Safety Data Sheets c. training is provided to target groups (e.g.: WHMIS, Transportation of dangerous goods, etc.) d. education is provided to workers/target groups on the proper handling and disposal of hazardous waste. e. all relevant legislation is followed

i. National standards: Customized Infection Prevention and Control for Aboriginal Health Services and Infection Prevention and Control For Aboriginal Substance Misuse Services ii. Provincial standards: Règlement sur les déchets biomédicaux - Quebec article 22, Guide d’intervention en maladies infectueuse iii. Federal standards: Canada Labour Code, Health Canada - Environmental & Workplace Health

RESPONSIBILITY OF THE CLIENT:

Not applicable.

PROCEDURES:

Hazardous waste is defined as all waste that poses substantial or potential threats to public health or the environment. This also bio-medical waste or items which are contaminated by bodily fluids.

All individuals shall protect their own health and safety by complying with existing regulations and standards and with safe practices and procedures established by KZHSS.

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PROCEDURE FOR SAFE HANDLING/STORAGE OF HAZARDOUS MATERIAL

Six Stages of a Safe Management System 1. Classifying biomedical waste 2. Sorting at the source 3. Disposal of biomedical waste 4. Packaging 5. Storage 6. Shipping and disposal

Definition of a Biomedical Waste: The regulations define these wastes as follows: ▪ Any human anatomical waste consisting of a body part or an organ other than appendages of the skin (such as nails, hair) blood or biological fluids. ▪ Any animal anatomical waste consisting of a body or one of its organs other than appendages of the skin, blood and biological fluids. ▪ Any non-anatomical waste consisting of one of the following items: 1. A pointed, sharp or breakable object used in medical, dental or veterinary care or any such object used in thanatopraxis (embalming). 2. Biological tissue, a cell structure, a microbial culture or disposable material in contact with this tissue or this culture coming from a medical, biological or veterinary laboratory. 3. A live vaccine strain. 4. A container of blood or material that has been soaked in blood, coming from medical care or medical-biological laboratory or from thanatopraxis. 5. Any other waste coming from outside Quebec.

Packaging Guidelines:

1. Single use containers (sharps containers) ▪ Containers for sharp or pointed objects ▪ Sturdy enough to resist perforation ▪ Color coded (yellow) and bears the biohazard symbol. ▪ Have covers with which they can he hermetically sealed. ▪ Are marke3d with a maximum fill line (no more than ¾ full)

2. Plastic Biomedical waste bags ▪ Sturdy enough to resist perforation ▪ Colour coded yellow: - must be doubled - never compress bags by hand - always wear gloves when handling them

3. Cardboard Boxes (2types)

Shipping by Ground • Sturdy enough to withstand the shipping process • Colour coded and bear the biohazard symbol • Resist leakage

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Shipping by Air • Comply with transport Canada’s 4G standard

Biomedical Waste ▪ All insulin-dependant diabetic patients should have a sharps container in their rooms for sharp objects provided by the onsite Nurse or by the Health Center. ▪ Once filled, the monitors or onsite Nurse should bring the container to the Health Center to get a new one. ▪ It is recommended to dispose of blood soaked dressings and gauze pads and gloves in a green garbage bag, to close the bag securely, then place it in the cleaning rooms waste garbage can. ▪ In order to avoid that the sharp containers given to the clients represent a hazard for them and to make sure that the container will be adequately destroyed, an information sheet should be provided or a sticker should be placed on the containers. It is also recommended to do a follow-up of those containers.

The following precautions should be taken to ensure safe disposal of these products: 1. Do not force sharps into the container. Fill the container only to the maximum filling line indicated on the outside of the box or to about ¾ full. 2. No liquids should be added to the container. 3. Ensure that the container is kept in a safe location.

Storage of Biomedical Waste ▪ Storage areas for biomedical waste must be completely separated from other storage rooms. The facility should only be used to gather biomedical waste and expired drugs, plus shipping and packaging materials. ▪ Such rooms should be locked with access restricted to authorized personnel only. ▪ The BIOHAZARD symbol should appear in plain sight (on the room door). ▪ All biomedical waste should be refrigerated at a temperature a 4 degrees Celsius or less if they must be kept for more than 4 days. ▪ Before the freezer is filled to capacity, someone should make sure to notify your Environmental Health Officer so the waste can be picked up. ▪ A cold room or freezer identified with the biohazard symbol on it should be equipped with a lock. ▪ The facility should be kept clean at all times. ▪ In the event of a spill or leakage of infectious waste, gloves must be worn and disinfectant used for cleaning.

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Accidental Spills

POLICY DATE DATE Kitigan Zibi IPC-015 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS ensures employees are able to minimizes the risk when a potentially harmful substance accidentally spills.

PURPOSE

To ensure safe procedures are followed to clean up an accidental spill.

KZHSS RESPONSIBILITY:

Environmental Health and Safety Technician, Janitor

RESPONSIBILITY OF THE CLIENT:

To immediately report any spill to a KZHSS employee.

PROCEDURES:

An “incidental and/or minor” spill is defined as a spill that does not pose a significant safety or health hazard to employees in the immediate vicinity, does not pose a significant threat to the environment and does not have the potential to become an emergency within a short time frame. If the spill exceeds the scope of the employee’s experience, training, equipment or willingness to respond, the employee must follow the appropriate procedures to obtain assistance.

In order to develop a successful spill containment program, an assessment should be conducted of the site conditions, current operations, and planned activities. The assessment should carefully examine all hazardous materials on site for where and how the materials are:

Stored (e.g., location, type of container), Handled (e.g., processed, used, transferred), and Transported (e.g., mode, routes).

As part of the assessment, each area or activity should be analyzed for potential accidental releases or spills. Examples of situations that have potential for spill or release are:

Bulging or corroded containers, Transfer line connections (e.g., leaking seals, misaligned connections), Metal fatigue of storage tanks, Leaking or inoperable valves, and Poor housekeeping (e.g., drums improperly staged).

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Many potential spills can be avoided through application of proper engineering controls to hazards identified in the assessment. In areas where storage, handling, and transportation activities occur, preplanning to contain the largest volume of material that could be released in the area will minimize worker exposure. The containment measure should be appropriate to the hazardous material(s) identified and should be installed in the area or located nearby. The following examples are measures most frequently used: Absorbent materials, (e.g., pads, booms, powders); Salvage containers (e.g., over-packed drums); Lined pads; Concrete pad Inflatable containment (e.g., "kiddie" pools, bladders); and Associated equipment (e.g., pumps, hoses, shovels, hoists).

Reporting and Initial Personnel Safety Upon discovery of a hazardous substance spill, personnel should be instructed to: Immediately summon help by notifying the Supervisor, the Director of KZHSS, and the employees; Take action to ensure the safety of nearby personnel; Proceed to a safe location; If anyone is seriously injured, immediately contact emergency medical services; and Keep unauthorized personnel out of the area.

Initial Spill Action

Factors that limit the employee's response at the site of a spill are:

Level of training, Personal safety, Available personal protective equipment (PPE), and Knowledge of the substance.

Employees should limit their actions to:

Shutting off equipment or pumps, Closing valves, Blocking drains within the path of the spill, and Using spill kit materials to dam or impede the flow of the spill.

Unauthorized persons should be excluded from the area.

Spill Response Evaluation The identity and hazards of the spilled material should be determined before decisions regarding spill containment and control are made. The Kiweda Supervisor or Director of KZHSS should evaluate the hazards associated with the spill and decide whether employees or external response organizations should conduct the cleanup. If the Supervisor determines that response personnel cannot safely perform the spill cleanup, the Supervisor should notify and request the assistance of, the Emergency Response Coordinator. Spill Cleanup Procedures

After care of injured personnel, containment of the released hazardous material should be the next consideration to limit its effect on the safety of personnel, the public, and the environment.

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The KZHSS should determine the methods of control which depend upon the nature and extent of the spill. Decontamination and disposal of contaminated materials should meet all regulatory requirements. All items (including clothing, equipment, liquids) used in the decontamination procedure that cannot be completely decontaminated should be considered radioactive, hazardous, or mixed waste, as appropriate. Clothing and equipment should be collected, treated, stored, and disposed of based on the type and level of contamination according to applicable federal and provincial laws. Drainage and/or collection systems for contaminated liquids should be established and approved containers should be used. Wash water should be collected for proper disposal. Procedures to contain contaminated water or decontamination fluids (i.e., collection of contaminated runoff, containment of overspray) should be developed and included as part of the decontamination plan.

Equipment used for Decontamination of Site

The type of decontamination equipment, materials, and supplies are generally selected on the basis of availability, the ease of decontamination, and disposability. Most equipment and supplies can be easily procured. Some commonly used articles are:

* Soft-bristle scrub brushes or long-handled brushes to remove contaminants;

* Buckets of water or garden sprayers for rinsing;

* Large galvanized washtubs, stock tanks, or children's wading pools for washing and rinsing solutions;

* Large plastic garbage cans or similar containers lined with plastic bags for the storage of contaminated clothing and equipment;

* Metal or plastic cans or drums for the temporary storage of contaminated liquids; and

* Paper or cloth towels for drying protective clothing and equipment.

Standard Operating Procedures to Minimize Worker Contact

The minimization of worker contact with contaminants during decontamination actually starts with Standard Operating Procedures. Site workers who use general safe work practices are less likely to be contaminated than site workers who do not use these practices. Workers can take steps to minimize their exposure during decontamination through using contact minimization techniques such as:

* Remote handling, * An outer layer of disposable clothing, * Encasing tools/equipment in plastic, and. * General safe work practices.

The KZHSS should incorporate all of the appropriate contact minimization techniques addressed in the site-specific decontamination plan.

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Once workers reach the decontamination line, they should strictly adhere to proper doffing procedures. This includes minimizing contact (grabbing, holding, touching, etc.) between contaminated site workers and decontamination line workers.

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4.0 KZHSS WORKER PERSONAL RESPONSIBILITY

Employee Immunization Policy

POLICY DATE DATE Kitigan Zibi IPC-016 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS supports employee health by providing vaccines an annual workplace influenza immunization program and encouraging all employees to obtain the seasonal influenza vaccine.

PURPOSE

To protect health care professionals and staff against the risk of exposure to communicable diseases through contact with individuals (or material from individuals) with infections both diagnosed and undiagnosed.

KZHSS RESPONSIBILITY:

1. KZHSS will provide vaccines and time required to have them administered for all KZHSS employees.

RESPONSIBILITY OF THE CLIENT:

Not applicable.

PROCEDURES:

Employees can see the Community Health Nurse to make arrangements for their immunization.

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5.0 FUTURE CONSIDERATIONS AND INFRASTRUCTURE

PLANNING, SELECTION AND PURCHASING

Selecting and Purchasing of Medical Devices & Equipment

POLICY DATE DATE Kitigan Zibi IPC-017 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS will purchase single-use medical devices; a device used on a single client, for a single procedure. In exceptional cases where this is unavoidable, KZHSS will ensure any device purchased can be properly cleaned and sterilized within the clinic, before the device is purchased.

PURPOSE

To prevent the transmission of microorganisms from client to client.

KZHSS RESPONSIBILITY:

1. Nurse Supervisor will ensure medical devices purchased are either disposable or can be cleaned and sterilized within the clinic before such purchases are made.

RESPONSIBILITY OF THE CLIENT:

Not applicable.

PROCEDURES:

The Nurse Supervisor will purchase medical devices and equipment based on the requests of the physicians, and to meet the needs of KZHSS programs and services.

Purchases will be made through the Wendake Distribution Center for Health-Canada approved items and devices.

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Selection of Finishes/Surfaces and New Furnishings

POLICY DATE DATE Kitigan Zibi IPC-018 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS selects all new finishes/surfaces and furnishings for areas where health care is delivered so that it may easily cleaned and disinfected, and is compatible with cleaning and disinfecting agents used within KZHSS buildings.

PURPOSE

To ensure that finishes/surfaces and furnishings are not susceptible to harbour micro-organisms that could spread infections.

KZHSS RESPONSIBILITY:

1. The Executive Secretary will ensure purchases of furnishings and selection of finishes/surfaces for health care areas are in accordance with proper Infection Prevention and Control principles.

RESPONSIBILITY OF THE CLIENT:

Not applicable.

PROCEDURES:

When selecting new finishes or surfaces, consideration will be given to:

• Ease of maintenance and repair. ▪ Avoid fabrics that could easily tear, be scratched or chipped that would facilitate the hosting an accumulation of microorganisms. • Cleanability: ▪ furnishings, walls & equipment must be able to withstand cleaning and be compatible with hospital-grade cleaners. • Unable to support microbial growth: ▪ materials such as metals or hard plastic are less likely to support microbial growth than materials that hold moisture(e.g. fabric) or are wet organic substrates (e.g. wood). • Surface porosity: ▪ microorganisms have been shown to survive on porous fabrics such as cotton, cotton terry, nylon and polyester, and on plastics such as polyurethane and polypropylene.

• Absence of seams:

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▪ seams may trap bacteria and are difficult areas to clean.

• be seamless or have double-stitched seams • be easily accessed for cleaning • have removable covers for cleaning • have foam cores resistant to mould • not be damaged by detergents or disinfectants • be quick drying • be maintained in good repair

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Construction/Renovation

POLICY DATE DATE Kitigan Zibi IPC-019 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS will maintain proper Infection Prevention and Control principles when planning and/or implementing changes to the physical working environment for the duration of the planned construction period.

PURPOSE

To prevent construction/renovation related infections to staff, clients, and visitors through the consistent and constant attention to infection prevention and control principles in temporary circumstances.

KZHSS RESPONSIBILITY:

1. The Director will ensure: a. any proposed changes to the physical environment will occur after consultation with relevant parties to ensure that infection prevention and control principles are integrated into the new design concept. b. Construction/maintenance workers hired are willing to carry out their assigned duties in compliance with relevant policies and procedures.

2. The Environmental Health and Safety Technician will a. perform a risk-assessment of proposed activities and provide advice and recommendations to the Director for all proposed changes to the physical environment. b. provide routine project monitoring to ensure compliance to Infection Prevention and Control procedures. c. ensure proper signs are posted to redirect clients, visitors and staff away from the construction area.

3. The KZHSS Janitor will: a. increase the frequency of cleaning adjacent to the construction area. b. disable the ventilation system and seal duct openings in the construction area until the project is completed.

4. The Nurse Supervisor and Community Health Nurses will: a. minimize client’s exposure to the construction/renovation area. b. ensure client care equipment and supplies are protected from dust exposure.

5. All KZHSS Staff will be compliant with any safety measures put into place for the temporary duration of construction.

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RESPONSIBILITY OF THE CLIENT:

Clients are requested to cooperate with any safety measures put into place for the duration of any temporary construction work within KZHSS buildings and sites.

PROCEDURES:

CONSTRUCTION AREA:

▪ Close off all windows and unused doors. Seal off air vents in the construction area and if possible disable until construction completed ▪ Use drop sheets to control dust. ▪ Place walk off mat outside of entrance of construction area to trap dust from the equipment and shoes of personnel leaving the area. ▪ Wet mop and /or vacuum (with HEPA filtered vacuum) at end of day as well as when the mat is visibly soiled. ▪ Walk off mats shall be of sufficient size to ensure that constructors have to place both feet on the mat at least once on exiting the construction area. ▪ Water mist work surfaces to control dust while cutting (note: caution should be exercised when such techniques are used on cellulose or fibre based materials that are intended to stay in place following construction work) ▪ Contain debris in covered containers or cover with a moistened sheet before transporting it for disposal. ▪ Place supplies and equipment in covered containers during transportation through the healthcare facility to prevent contamination in other areas. ▪ Remove debris in the evening once staff, clients and visitors have left. If this is not possible debris should be removed at the end of the work day. ▪ Wipe work surfaces with a hospital approved disinfectant at end of project.

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Infection Prevention and Control partnerships

POLICY DATE DATE Kitigan Zibi IPC-020 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS will collaborate with internal and external community partners when planning, developing and implementing Infection Prevention and Control activities.

PURPOSE

To ensure open communication and effective resource sharing with partners for the public safety of all community members.

KZHSS RESPONSIBILITY:

1. KZHSS will collaborate with KZA Community Services, KZA Police Department, and the KZA Education Sector when required as outlined in the KZA Emergency Preparedness Plan and KZA Pandemic Plan or in shared community protocols.

2. KZHSS will follow the direction of relevant federal, provincial and other First Nations agencies (ie. Health Canada, Santé Publique, Aboriginal Affairs and Northern Development Canada, The First Nations of Quebec and Labrador Health and Social Services Commission) when appropriate and/or required to do so. Direction may come in the form of health advisories, information in the event of an epidemic/outbreak, health promotion and prevention training opportunities, resource sharing, and other such forums in the interests of promoting health and preventing disease within the community.

3. Wherever possible, KZHSS will clarify the roles, responsibilities and expectations of agencies (ie. CLSC, CISSSO) that provide shared services to community members.

4. KZHSS will maintain good business practices with local businesses providing resources and services that support infection prevention & control activities.

RESPONSIBILITY OF THE CLIENT:

Clients are expected to collaborate with KZHSS as well as their internal/external partners when they are the recipient of shared services or resources.

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INFORMATION MANAGEMENT 1.0 INFORMATION SHARING AND CONSENT

Information Sharing

POLICY DATE DATE Kitigan Zibi IM-001 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS employees must obtain client consent to receive services; information may be shared among pertinent KZHSS employees, if required.

PURPOSE

To ensure the best interests of the client.

KZHSS RESPONSIBILITY:

When a client provides consent for receiving services from KZHSS, it should be understood that all KZHSS employees may internally share information in the best interests of the client on an “as-needed basis” only, as per the regulations and guiding principles of the Confidentialite de l’etablissement.

RESPONSIBILITY OF THE CLIENT:

▪ Clients acknowledge implied consent when requesting services. ▪ Clients may be required to sign a consent form when accessing different services (internal/external) when a file needs to be shared. ▪ Clients will respect restricted areas and will not freely roam the hallways within the building.

PROCEDURES:

Due to the nature of the work done within the Health Center programs, a client’s personal and sensitive issues may be discussed. In order to maintain a client’s trust in service delivery and to adhere to the privacy laws, and code of ethics for professionals as defined by the particular Order to which a professional belongs, discretion is necessary.

All staff members will adhere to the KZA Code of Ethics. Every new employee is required to sign an Oath of confidentiality. Coordinators will ensure that their workers and volunteers have a signed Oath of confidentiality. It is also expected that any sensitive information to which the employee was privileged during the duration of their employment should be kept confidential when no longer an employee of KZHSS.

All KZHSS staff, both professional and non-professional, including full-time and part-time, contract workers, students and volunteers, are required to keep information confidential when

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they have been privileged to information through voluntary or involuntary means. Client health information/files will only be discussed in office areas, or in private areas, on an as- needed basis only.

Information will be shared within the Health Centre according to the Order of professional occupation which program service delivery is followed.

▪ Nurses will follow l’Ordre des Infirmieres du Quebec. ▪ Social workers will follow the Order of Social workers in the province of Quebec. ▪ NNADAP workers will follow the guidelines under the First Nations Wellness Addictions Counselor Certification Board (FNWACCB).

Nurses: A nurse shall abide by the rules set forth in the Professional Code (Chapter C-26) in regard to the obligation to preserve the secrecy of confidential information that becomes known to her or him in the practice of her or his profession and the cases where she or he may be released from the obligation of secrecy.

Exceptions: 1. A person provides implied consent. 2. A person is in imminent danger, threatening their own life or those of others; 3. Suspected child abuse; 4. Under oath in a courtroom; 5. Under the Road Security Act, information may be divulged to the S.A.Q.

Human Relations Officer: Information sharing under Youth Protection, including access to file information is regulated through the Youth Protection law, under the Youth Protection Act.

Part-time employees Part-time employees are required to abide by the KZA Human Resource policy for term- contract employees under Section 18-Confidentiality.

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Informed Consent

POLICY DATE DATE Kitigan Zibi IM-002 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

All employees of KZHSS will obtain informed consent to the treatment/service plan before any treatment or service is initiated. Furthermore, when divulging information to various provincial agencies/workers, all employees of KZHSS will ensure that an informed consent form is signed before the information is shared.

PURPOSE

To ensure that clients are aware of the risks and benefits of treatment and services, and the consequences of declining treatment and services.

KZHSS RESPONSIBILITY:

All KZHSS staff providing the service

RESPONSIBILITY OF THE CLIENT:

Understand his/her rights when receiving treatment and signing a Release of Information form.

PROCEDURES:

All staff of KZHSS are responsible to ensure that informed consent is obtained for the planned treatment/service. This includes clients that are new or returning to KZHSS as well as those clients who are currently receiving Program services.

All staff of KZHSS are required to ensure that the client’s informed consent is documented in the client record. Staff are also required to ensure informed client consent form is updated as circumstances change, such as changes in the client’s condition or a change in the client’s wishes.

In order to obtain informed consent from the client, all staff must consider: ▪ The capability/ability of the client to understand the nature of the treatment/services being proposed. ▪ Literacy challenges the client may face. ▪ Language requirements of the client. ▪ Cultural needs of the client.

KZHSS Informed Consent Guideline:

Informed consent consists of reviewing service information and the consent form with the client; making the client aware of the available options; providing time for the client to reflect and ask questions before asking for consent; respecting the client’s rights, culture and values, including the right to refuse consent at any time; and recording the client’s decision in the client records.

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Implied consent occurs when providing services where written consent is not needed, such as when clients present themselves to the clinic and request services, ask to have blood pressure taken, or present their arm to have blood drawn.

When dealing with minors such as children and youth under the age of 14, the primary care team's consent process includes involving the minors as much as possible in decision-making about their service, intervention, or treatment; valuing their questions and input; and obtaining informed consent from a legal guardian or other representative before proceeding.

At times, informed consent is obtained and sent to other agencies and departments such as legal aid, treatment centres, detoxification centres, etc. by fax, e-mail or electronically.

The following are a list of forms used by KZHSS for informed consent. Other than the provincial forms required for Centre Jeunesse de l’Outaouais, Health Canada and the school immunization forms, a new document was developed to standardize KZHSS Informed Consent. It replaces similar forms used by several different sections.

Provincial Consent Forms Les Centres Jeunesse de l’Outaouais (Authorization to obtain or transmission of documents or information) Free Vaccination Program Grade 4 (Authorization for Vaccination)

Federal Consent Forms Medical Services Branch, Health Canada, Request for funding/private center referral protocol (Authorization for release of confidential information)

New Standardized Consent Form for all Programs KZHSS Informed Consent

PROVINCIAL STANDARDS: Centre Jeunesse de l’Outaouais Quebec School Immunization

FEDERAL: Health Canada

STAKEHOLDERS (internal/external): Police, treatment centres, KZES, Santé publique, OIIQ, Centre Jeunesse de l’Outaouais ACCESS TO MEDICAL FILES Records may be difficult to interpret and may mislead or alarm a client or authorized staff member. Therefore, upon client’s request a KZHSS authorized staff member will review the records with the client; the client may find this review sufficient without obtaining copies of their personal records. If the client wishes to read the original records, the authorized staff member must be present to ensure that original records are not altered or removed, and access will be noted in the file. More information can be found on the AGISQ (Association des Gestionnaires de l’information de Santé du Quebec) website.

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PART VI:

Organized Activities

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1.0 HEALTHY MEALS AND SNACKS

Healthy Meals and Snacks

POLICY DATE DATE Kitigan Zibi OA-001 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS promotes healthy meals and snacks when delivering services in health and social service organized activities.

PURPOSE

To promote a healthy lifestyle and exemplary nutrition habits.

KZHSS RESPONSIBILITY:

Activity organizers or monitors of KZHSS community events will promote snacks and drinks provided at these activities that are wholesome and nutritious.

KZHSS staff will refrain from serving or purchasing energy drinks and/or alcoholic beverages during activities they are responsible for organizing.

RESPONSIBILITY OF THE CLIENT:

We ask clients not to bring junk food to activities.

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2.0 NO SMOKING AND CONSUMPTION OF ALCOHOL

No Smoking & No Consumption of Alcohol

POLICY DATE DATE Kitigan Zibi OA-002 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS prohibits smoking inside any KZHSS vehicle or in KZHSS buildings. Where a designated smoking area exists, smoking may be permitted in this area only.

The consumption of alcohol is strictly prohibited in ALL KZHSS buildings and at events and locations where KZHSS is facilitating programming.

PURPOSE

To discourage harmful and addictive habits such as smoking and to avoid any complications associated with immoderate use and/or negative consequences associate with alcohol-consumption.

KZHSS RESPONSIBILITY:

KZHSS workers ensure strict adherence to this policy and ensure compliance of staff and clients.

RESPONSIBILITY OF THE CLIENT:

Clients will refrain from smoking and consuming alcohol at KZHSS organized activities/events and will refrain from bringing alcohol onto KZHSS premises.

If a client is found to be in possession of, or consuming illegal drugs during a KZHSS event or while using the facilities/grounds, the KZPD will called.

Any employee found smoking in a KZHSS vehicle or building will be subject to disciplinary procedures. Additionally, smoking is not permitted by clients or staff within 3 meters of entrances/exits of all KZHSS buildings.

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3.0 AWARDING PRIZES

Awarding Prizes

POLICY DATE DATE Kitigan Zibi OA-003 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS is open, honest and fair in the awarding of prizes as it relates to KZHSS employees and their families for Health and Social Services organized activities.

PURPOSE

To ensure that there is no conflict of interest (perceived or otherwise) of employees when awarding prizes for Health and Social services organized activities.

KZHSS RESPONSIBILITY:

Director and KZHSS activities/events organizers

KZHSS organizers will do their best to ensure all conflicts are avoided in awarding of prizes.

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: ELIGIBLE TO RECEIVE PRIZES

▪ Children and adult children regardless of the KZHSS parents’ employment status (full-time, part-time, contract, etc.) are eligible to receive prizes. ▪ KZHSS Employees, including contract workers, not directly involved in organizing the specific event. ▪ All spouses (common-law/spouses/married couples) of KZHSS employees when that employee is not directly involved in organizing that specific event.

NOT ELIGIBLE TO RECEIVE PRIZES

▪ Full-time KZHSS employees are not eligible to receive prizes if directly involved in preparing the activity. ▪ Contract workers who are directly involved in organizing events that award prizes are not eligible to receive prizes for that particular event. ▪ Contract workers organizing and carrying out the activity will remind KZHSS Staff directly involved in organizing the event are not eligible to win a prize during KZHSS activities.

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4.0 PLANNED ACTIVITIES FOR NON-MEMBERS

Planned Activities for Non-Members

POLICY DATE DATE Kitigan Zibi OA-004 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS may provide certain activities for non-KZA members who are affiliated with a KZA family provided that activity administration/material costs are covered.

PURPOSE

To provide an inclusive, family-oriented approach when providing health and social activities/events to meet the reality of blended and extended families living within KZA, but may not all be KZA registered community members.

KZHSS RESPONSIBILITY:

Director

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: KZA members can participate in all KZHSS activities, provided they meet the criteria for that activity (e.g. based on age “Seniors activities”, gender “Girls group, etc.).

Non-KZA members who are affiliated with the immediate family of a KZA member may pay a set amount per activity depending on the cost of the activity. This includes father/mother, son/daughter and sibling, as well as step-father, step-mother, step-son, step-daughter, and half brother/sister.

NOTE: For activities with a limited amount of spaces or resources, priority will always be given to KZA members.

PROCEDURES: ▪ Depending on program/budget, access to planned activities will be made available to non-members who meet the above criteria. ▪ The family may be required to provide a written statement regarding their affiliation. ▪ A set fee per event/activity will be determined by the activity coordinator and approved by the Director, the method of how/when payment will be collected will be determined at that time. In all cases, receipts will be issued and the KZA Finance Policy will be applied. ▪ The fees will be affordable, and will be used to off-set administrative and material costs. ▪ Additional costs to the individual include any additional costs for planned activity fees paid by other KZA members.

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5.0 ORGANIZED OUTINGS AND ACTIVITIES

Organized Outings and Activities

POLICY DATE DATE Kitigan Zibi OA-005 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS regularly organizes out-of-town activities for community members; this may include activities with Seniors, activities with participants of the Nicholas Stevens Centre as well as activities with Youth (aged 17 and under).

PURPOSE

To ensure the safety and security of all participants (i.e. Students, participants, monitors and/or volunteers) for all outings organized by KZHSS.

KZHSS RESPONSIBILITY:

Outings Organizers – Monitors, NSC workers, Òde Wìdòkàzowin workers, Community Health Nurse

RESPONSIBILITY OF THE CLIENT:

1. Adherence to the KZHSS Policy & Procedures manual for on- or off-reserve excursions will be in force for all KZHSS approved organized activities. 2. The consumption, purchase or any other use of alcohol beverages or drugs by students, monitors or any other individual participating in the activity is strictly forbidden. 3. Any funds raised by KZHSS which uses the KZHSS logo is NOT to be used for the purchase of any alcohol beverages or for any illegal substances or for any activity which is deemed unsafe.

PROCEDURES:

GENERAL REGULATIONS

Safety and well-being of the participants must take priority on all KZHSS organized trips. Good judgement and fair consideration must be given to situations that may arise.

All KZHSS organized outings shall have 1 designated HEAD MONITOR who shall be responsible for the general activities of the outing which includes overseeing the well-being and safety of the group, whether there is only one group or multiple groups.

Every outing must have one full-time indeterminate KZA Staff member.

All monitors must be informed in writing as to their duties and procedures to follow prior to the trip.

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The Head Monitor will ensure that a Head Count is performed and all participants are accounted for.

The Head Monitor will ensure to have a charged CELL PHONE on him/her at all times in areas where there is cell phone reception. (Please note that it may not be possible to reach monitors for outings occurring in the LaVerendrye Park, due to “dead zones”.)

Should a SERIOUS INCIDENT or situation occur where an immediate decision/action is required, the Head Monitor has the authority to decide on the course of action and his/her decision will take priority. He/she may also wish to consult with other monitors. a) In the event of a serious incident, the Head Monitor will immediately contact the KZHSS Director. Upon return to the community, a full report of all incidents will be required by the head monitor and any other monitors involved. b) Should a serious incident occur on a trip involving a participant which requires follow-up from KZHSS, family members of the involved participant, or parents (of youth) will be asked to come to KZHSS to discuss the incident in a fair and reasonable resolution. c) An incident report will be filled out when there is an incident that disrupts the itinerary of the organized trip or medical attention is required (physical/verbal altercations, injuries). d) Parents/Guardians of youth shall be informed by the Head monitor of all incidents of a serious nature (injuries, physical altercations) which occurs on a trip where action was taken with a participant.

The consumption and use of alcohol and illegal drugs by students or monitors is strictly forbidden under any circumstances on all KZHSS trips.

Smoking shall NOT take place on the school bus or any vehicle used to transport participants, or in any other enclosed area where participants/monitors are gathered.

Drivers are to abide by Road Safety laws and the will respect speed limits. All participants transported in KZHSS vehicles will wear seatbelts.

REGULATIONS FOR YOUTH 17 AND UNDER:

In addition to the above-mentioned General Reguations, the following will also apply when an outing is organized for Youth aged 17 and under.

1. All participants must have a signed permission slip from their parent/guardian prior to a planned trip. ANY STUDENT WITHOUT A SIGNED PERMISSION SLIP WILL NOT BE ALLOWED TO ATTEND. 2. Under no circumstances will youth participants be left unattended, alone, or unsupervised. 3. All KZHSS authorized field trips must have one KZHSS staff member attend, and who shall be responsible to monitor students and ensure that basic KZHSS regulations are followed.

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PARTICIPANT ORGANIZED TRIP MONITORING

1. The Head Monitor will refer to the “Procedure for KZHSS Employees who are involved in monitoring an activity with youth outside the KZA” and will ensure that a head count is taken BEFORE departing all locations (returning home, bathroom breaks, etc) for the duration of the trip. 2. At times more than one vehicle may be used to transport youth to a destination. Participants may be assigned to a vehicle for the duration of the trip. For safety purposes, switching of vehicles will not be permitted. 3. Monitors who are assigned a group of youth must remain with that group throughout the day. Monitors must know where their participants are at all times. 4. All KZHSS overnight trips must have one adult monitor per room (or connecting room) where the youth sleep. 5. A youth who must leave the room must be accompanied by a designated monitor. 6. When participating in an overnight trip or daytrip, monitors/participants are required to be back in their hotel room or school bus no later than 10:00pm. 7. Youth on an overnight fieldtrip shall not be permitted to purchase pay-per-view movies unless prior approval has been given by the head monitor who will ensure the movie is appropriate, ie. Rated for their age group. 8. Youth who are 18 years or older and who participate in a KZHSS trip must follow all the rules that apply to the rest of the group including monitoring and respecting of curfew hours. 9. KZHSS Organized trips shall not include overnight stays or visits to particular areas of a city or location considered “unsafe”. 10. When parents accompany their own children on a trip, the parent is responsible to follow all rules of the trip, and the assigned KZHSS monitors must be available to parents/guardians at all times to deal with situations that could arise. 11. KZHSS organized trips will not include dangerous activities or ones that could promote violence. However, it is recognized that inherent risks are part of certain activities where culture is promoted. 12. All funds that have been raised for the purpose of a trip will be utilized for the purpose for which they were raised and not be used for personal gain. 13. All monitors shall be provided sufficient funds to cover their group’s expenses (meals, entry fees, etc) and will be accountable to the Head Monitor at the end of each day. Any unused funds will be returned to the Head Monitor at this time.

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Youth Outings – Prohibited Items

POLICY DATE DATE Kitigan Zibi OA-006 05/09/2016 07/26/2019 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS does not tolerate the use of illegal/illicit drugs (including paraphernalia) or any potentially dangerous or harmful items during any KZHSS programs, activities or outings.

PURPOSE

KZHSS ensures that outings/activities are safe and secure for all participants.

KZHSS RESPONSIBILITY

KZHSS will make every possible effort to ensure that prohibited items are not brought into activities hosted by KZHSS, while maintaining the privacy and dignity of all participants.

KZHSS has the responsibility to report any illegal activity to the Kitigan Zibi Police Department, including the possession/use of illegal drugs.

CLIENT RESPONSIBILITY:

Parents and students are responsible to ensure that all personal belongings brought on outings comply with KZHSS rules and regulations.

PROCEDURES

1. Each participant will receive a consent participation form to participate in any KZHSS organized outing or activity. Parents will be required to provide consent for a worker to do a general search of the youth's bag in the presence of the parent.

2. Alcohol, drugs and/or paraphernalia, weapons and/or any other item that could potentially affect the safety of the other youth are strictly prohibited.

3. Before leaving on an outing, two workers, one of each gender will be assigned to search bags for any illegal/illicit substances.

a. Workers will wear gloves to perform the search. b. Male workers will check boys belongings and female workers will check the girls belongings. c. The bag search will occur in a private area in the presence of the youth and the parent/guardian. Any closed or zipped item will be opened by the youth to show the contents.

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d. Workers can ask youth if they have anything in their pockets. However, at no time will a body search be performed on the youth.

4. If a youth takes medication, please keep the medication in original packaging. Prescription pills should contain the original pharmacy label with the youth's name on it. KZHSS workers will not administer any medication.

PROCEDURE IF DRUGS ARE FOUND BEFORE THE TRIP

▪ Youth will not be allowed to attend the outing and the parent will be required to bring the youth home. ▪ In order to return to day camp, the youth would have to see a NNADAP worker or Counselor and bring a signed confirmation. ▪ As a consequence, the youth will not be allowed to attend the next trip. ▪ If drugs are found, police will be called to handle the situation.

PROCEDURE IF DRUGS ARE FOUND WHILE ON THE TRIP

If drugs are found once the youth is already on the trip:

▪ Youth would not be allowed to continue with the activity. o If an activity is held within a reasonable distance (e.g. Ottawa or closer) a full-time staff member of the same gender would bring the youth home. o If an activity is held outside a reasonable distance (e.g. Montreal), the youth would not be participating in the activity. The full-time worker would bring them back to the accommodations or make alternative plans with the youth. o Whenever possible with the parent, arrangements can be made to meet half-way.

▪ Parent will be contacted, kept updated on developments of the situation. ▪ In order to return to day camp, the youth would have to see a NNADAP worker or Counselor and bring a signed confirmation. ▪ As a consequence, the youth will not be allowed to attend the next trip. ▪ The guidelines of the park/venue will be followed in the event that drugs are found. In some cases, the regional police may be called. ▪ If it is the park's policy to return a confiscated item (e.g paraphernalia), the item will be disposed of. Such items are not allowed to be brought in KZHSS vehicles.

If ALCOHOL is found: If a youth is found with alcohol, the worker will confiscate and dispose of it immediately. The parent will be contacted to pick up their child.

1. In order to return to day camp, the youth would have to see a NNADAP worker or Counselor and bring a signed confirmation. 2. As a consequence, the youth will not be allowed to attend the next trip.

For a repetitive occurrence by an individual youth, options will be provided as to how to put a plan in place to assist and support the youth.

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6.0 KZA YOUTH SPONSORSHIP FUNDING

KZA Youth Sponsorship Funding Requests

POLICY DATE DATE Kitigan Zibi OA-006 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS adheres to the following Youth Sponsorship Funding request policy as provided by KZA Chief and Band Council.

PURPOSE

To provide financial support per fiscal year (April 1st to March 31st) to KZA youth ages 2-17 years of age, on or off reserve, to encourage active participation in various organized recreational and/or leisure activities.

KZHSS RESPONSIBILITY:

KZHSS processes and monitors the Youth Sponsorship fund annually, depending on funding availability.

The KZHSS Assistant Director is responsible for overseeing the Youth Sponsorship fund.

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: Individual:

▪ Must be a KZA registered youth – ages 2-17. ▪ Youth must have a parent/guardian who will accept full responsibility of the application and waive any responsibility from the KZA, KZHSS, KZES or KZPD of any theft, injury, loss or behavior related to the activity. ▪ All activities require proven registration fees and will be sponsored up to a $200.00 limit. ▪ Youth hockey players will be granted the full $200 at one time upon request with proven registration. ▪ A parent/guardian of the youth requesting sponsorship must complete the application with written proof of registration fees, dates of activities or receipts of payment. Failure to secure written proof of registration fees or receipt of payment will constitute an automatic refusal of sponsorship.

Team:

▪ A KZA team registration fee up to $500 for sponsorship in a youth event may be applied for by

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the KZA band member Coach on behalf of the KZA team to a maximum of twice per fiscal year. The Coach will be responsible for ensuring fees are paid providing a receipt to KZHSS or ensuring that the funds provided are immediately returned to KZHSS if the team forfeits or if the event is cancelled. ▪ A KZA team participating in an event away from the KZA community may be sponsored for related costs when applied for by the Team KZA band member Coach. A maximum of $150.00 may be made available per youth for an activity requiring a 1-night stay with a maximum of $300.00 for 2 nights or more. The Coach will be responsible for ensuring payments are made or that the funds provided are immediately returned to KZHSS if the team forfeits or if the event is cancelled. ▪ Receipts will need to be returned for all funds provided and spent. ▪ Requests for funding sponsorship for a team event will be considered only once per fiscal year (April-March).

Summer Hockey School:

▪ Parents wishing to receive funding support (maximum: $3,500) for weekly transportation for the summer hockey camp are required to submit a letter with the names of all youth registered for the camp as well as names of parents of the youth. This must be forwarded at least 30 days prior to the activity taking place. ▪ A maximum of 15 youth is required. The maximum amount, if approved, will be paid directly to the transporter.

PROCEDURES: ▪ KZHSS will be the Sector to process all Sponsorship requests. All sponsorship requests submitted to Band Council and/or other Sectors will not be considered. ▪ All requests will be reviewed by a committee of three (3) KZHSS designated workers (NOT in a conflict of interest in regards to the request) and a report will be submitted to the Band Council on a quarterly basis. ▪ A mid-year review will be conducted to determine demand versus funding availability and to determine funding modifications, if any, for the subsequent fiscal year. ▪ Identified funds are to be made available only in their identified areas and to the limit of that allocation. Requests may be denied due to funding limitations.

KZA does not receiving specific funding from any government agency for the Sponsorship initiative.

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BUDGET:

• Individual Sponsorship: A maximum budget of $20,000.00 may be made available per fiscal year for individual sponsorships with a maximum of up to $200.00 per individual youth. The budget for individual sponsorship will be on a first-come, first-serve basis until the $20,000.00 is spent, or, before March 31st, whichever comes first.

• Team Sponsorship: A maximum budget of $3,000.00 may be made available per fiscal year for KZA youth team events with a maximum of $500.00 per event. Only 2 requests per team, per year may be considered.

• Summer Hockey School: A maximum budget of $3,500.00 may be made available for summer hockey school transportation with a registration of 15 youth or more.

• Team Tournaments: A maximum budget of $5,000.00 may be made available for costs related to attendance at tournaments, away from the community. A maximum of $150.00 may be made available per youth for an activity requiring a 1-night stay with a maximum of $300.00 for 2 nights or more. Requests for funding support will only be considered once per fiscal year (April to March).

TYPES OF ACTIVITIES NOT SPONSORED:

▪ Due to the high risk of serious injury, extreme sports will not be considered for sponsorship. Extreme sports include any kind of racing with a motor vehicle or any other sport wherein life threatening injury is highly likely to occur. These types of activities are the sole responsibility of the parents. ▪ Any activity involving firearms or weapons will not be considered. These types of activities are the sole responsibility of the parents. ▪ Youth involvement in adult competitions or adult team tournaments will not be considered.

FUNDRAISING:

▪ KZHSS IS NOT RESPONSIBLE FOR APPROVING FUNDRAISING AT THE KZ FRESHMART INTERSECTION/LIGHTS. ▪ Requests for fund raising at the lights must be made in writing to the Community Services Sector and must be submitted 14 days prior to the fundraising activity itself. ▪ Fundraising at the lights can only take place a maximum of 2 times per group, per targeted activity. ▪ A written report of the monies raised during a fundraising event must be submitted to the Community after the activity has taken place.

SPONSORSHIP CHEQUES:

▪ All requests will be processed once a week only. Cheques may be available one or two weeks after the request is received. ▪ The parent/guardian on the request form will be called from the Health Centre when the check is ready.

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▪ All monies issued towards individual youth, team or hockey school will be recorded in a database. ▪ Checks for sponsorship are issued to the parent/guardian who is taking full responsibility on the request form. ▪ Payments issued to parents and parental custody issues are the responsibility of the parent(s)/ guardian(s) concerned and not that of KZHSS.

If the parent/guardian who submitted the request proves to have applied for sponsorship monies under false pretences, or is proven to have committed fraud using the child’s name, the amount allotted will be sent to KZA’s Accounts Receivable under the applicant’s name. The amount will have to be paid back, and the child will not be eligible for further funding until the issue is resolved. The Sponsorship Funding is administered by KZHSS on behalf of all Sectors.

Contact Information:

Assistant Director KZHSS, 8 Kikinamage Mikan, Maniwaki, Quebec J9E 3B4 Telephone: 819-449-5593 Fax: 819-449-7411 Toll Free: 1-866-660-5593

Please see the two attached forms in the Annex or request one at the KZHSS Reception Desk.

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PART VII:

Human Resources & Employee Performance Management

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A. HUMAN RESOURCES POLICY

KZHSS adheres to human resource policies as outlined in the Kitigan Zibi Anishinabeg Human Resource Policy document.

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B. FINANCE POLICY

KZHSS adheres to financial policies as outlined in the Kitigan Zibi Anishinabeg Finance Policy document. 1. Under no circumstances will KZHSS employees handle individual personal finances for any client. 2. Any money received for KZHSS activities, rental/user fees, will be immediately deposited with Accounts Receivable at the Band Office.

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C. EMPLOYEE PERFORMANCE MANAGEMENT 1.0 ORIENTATION

KZHSS Orientation Process

DATE DATE Kitigan Zibi POLICY CODE: EPM-001 05/09/2016 05/09/2016 Health & APPROVED: REVISED: Social Services

POLICY

Kitigan Zibi Health and Social Services is committed to welcoming, supporting and recognizing employees when they start a new position.

PURPOSE

To provide new employees with organization, program, and job-specific information to help employees understand their role in the organization, preparing them for success in their new position.

KZHSS RESPONSIBILITY:

Director, Supervisors, Coordinators

RESPONSIBILITY OF THE CLIENT:

Not applicable.

PROCEDURES:

All professionals should understand that they are required to maintain their certification according to the order they belong to. All individuals are subject to audit at any time.

The following explains the task of KZHSS employees assisting in the orientation process of a new staff member.

Human Resource Coordinator:  Explanation of Human Resources Policies & Procedures o Explanation of Time Off, Overtime, Health Insurance, Pension Plan.  Explanation of proper procedures for filling out Forms (Travel, Time-Off, Cheque Requisition)  A copy of their Job Description  A copy of Human Resources booklet  A copy of Code of Ethics and Professional Behaviour  Sign Oath of Confidentiality  Collect Payroll information

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Director:  Inform Staff of New Employee (Name, Title, Start Date)  Welcoming/Expectations/Job Overview/Possible challenges  Provide overview of KZHSS function, use Organizational Chart and relationship with other sectors  Relevant Public Drive content: KZHSS Policy and Procedures Manual, Forms  Explanation of Paper forms, location, how to fill them out.  Tour of Buildings, Staff/Client Introductions  Location of Office Supplies & Equipment  Tour of Assigned Work Space  Complete Payroll Information Form for submission to Band Council/Finance

Environmental Health & Safety Technician:  Review of Fire and Emergency procedures/Panic Button use  KZHSS Hand Hygiene Strategy explanation  Sign employee up for next Training Sessions, as/if required (e.g.CPR/First Aid, WHMIS)

Executive Secretary:  Provide keys to the building(s)/office space  Receive door access codes  Assigned telephone long-distance code  Coordinate assigned e-mail account with Matrix  Make a copy of employee’s driver’s license to keep on file  Have ID tag made or ordered  Provide a cell phone (if required in position)  Review sign-out procedures, sign-out of vehicles, etc.  Telephone Set-up (Voice Mailbox)  Order business cards.

Employee:  Send out letter of Introduction to community

Once all steps are completed in the welcome section, the folder will be given to the KZHSS Executive Secretary to be kept with the Employee Personnel file for the duration of employment with KZHSS.

 Oath of Confidentiality

 Updated KZHSS Telephone List with Intercom Numbers  KZHSS Vision, Mission & Mandate  Updated Organization Chart  Sample Form letter for Introduction to the Community

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2.0 STAFF MEETINGS AND COMMUNICATION

Staff Meetings & Communication

POLICY DATE DATE Kitigan Zibi EPM-002 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS employees are required to participate regularly in various types of staff meetings.

PURPOSE

To ensure quality services and promote effective communication within KZHSS, regular meetings will be scheduled.

KZHSS RESPONSIBILITY:

Director, Coordinators, All Staff

RESPONSIBILITY OF THE CLIENT:

Not applicable

PROCEDURES:

Staff meetings: All staff is mandated to attend scheduled staff meetings and other mandated training. Any absence from a staff meeting must be pre-approved by the Director. Staff attendance will be taken at each meeting and KZA disciplinary measures will apply for those not in attendance. All staff meetings will follow an outlined agenda that will be prepared by the Executive Secretary. All topics should be forwarded to the Executive Secretary beforehand. An agenda will be forwarded to all staff before the meeting.

Each agenda will contain the items to be discussed. The agenda will contain an item where Coordinators will provide an update on programs and services for their sector. In addition, a varia section will be left open for participants to bring forth any additional issues.

Coordinator’s meeting: The Director will meet with the Medical Transportation Coordinator, Enhanced Prevention Coordinator, Nurse Supervisor, In-Home Care Coordinator and one of the Waseya House workers (rotation system), on a weekly basis which is scheduled for Monday of each week from 11:00 am – 12:00pm. In cases where Monday is a holiday, the meeting will occur on the following workday. Coordinators will provide all of their worker contracts to the Director in the morning before the meeting. Topics discussed at this weekly meeting will be updating the Director and raising questions/concerns regarding respective programs.

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Accreditation meeting: The Accreditation Team will have scheduled quarterly meetings throughout the year in January, April, June, September. Topics of the meetings will prioritize any policy, procedure or protocol work that would need to be accomplished to maintain an accreditation standing with Accreditation Canada. Additionally, incident reports will be reviewed at this time as part of the risk-assessment framework.

The Accreditation Coordinator will arrange for the date and time of the meeting, and provide an agenda of topics for discussion. Additional meetings will be scheduled as required.

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3.0 PERFORMANCE REVIEWS

Performance Reviews

POLICY DATE DATE Kitigan Zibi EPM-003 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS regularly conducts objective performance appraisals, documents performance, and develops individual plans based on strengths, opportunities for improvement, and individual goals and career plans.

PURPOSE

To provide constructive feedback to employees with the goal of improving the quality of service delivery.

KZHSS RESPONSIBILITY:

Director, Supervisors, Coordinators

RESPONSIBILITY OF THE CLIENT:

Not applicable.

PROCEDURES: ▪ Review and update of job descriptions ▪ Conduct Appraisal Reviews as per the KZA Human Resource Policy and do a trial run ▪ Have a clinical specialist available for evaluations with the Director (when required). ▪ The Appraisals will be administered on a yearly basis during new fiscal year projections. ▪ Re-evaluate the Appraisal document and provide KZA with recommendations as required.

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4.0 EMPLOYEE TRAINING

Employee Training

POLICY DATE DATE Kitigan Zibi EPM-004 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS regularly provides staff training and continuous education on an annual basis.

PURPOSE

To promote safety and security in the workplace while increasing employee competence and confidence in the areas pertinent to their particular line of work.

KZHSS RESPONSIBILITY:

Directors, Assistant Director, Coordinators, Nurse Supervisor & Staff

RESPONSIBILITY OF THE CLIENT:

Not applicable

PROCEDURES: The Assistant Director oversees the training needs of the Staff. This involves regular and updated training of:

▪ First Aid & CPR ▪ A.S.I.S.T. Applied Suicide Intervention Skills ▪ prevention of workplace violence ▪ Food Handling Safety ▪ WHMIS ▪ Client Safety Training ▪ Human resource related training ▪ Motivational Interviewing ▪ Technology

The Nurse Supervisor oversees the clinical training needs of the Nursing staff. ▪ Medication management ▪ Wound management

For training regarding Youth Protection, clinical supervision and training is provided by the Chef Territorire.

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Training Client Safety

POLICY DATE DATE Kitigan Zibi EPM-005 05/09/2016 05/09/2016 Health & CODE: APPROVED: REVISED: Social Services

POLICY

KZHSS adheres to the KZA Human Resource Policy on training.

The annual Employee Performance Reviews includes education, training and development needs.

PURPOSE

To ensure specific training on client safety is available to all.

KZHSS RESPONSIBILITY:

Director, Program Coordinators, Supervisors, All Staff

RESPONSIBILITY OF THE CLIENT:

Eligibility Criteria: All staff are eligible for general safety training as coordinated by the Environmental Health & Safety Technician.

Specific training may be provided as required, based on the perceived need by worker/Director, and according to Funding availability.

PROCEDURES: The employer recognizes the value of job-specific work-related education and training. Therefore, employees may; upon application; be granted leave to attend work-related training courses or seminars. Such leave may be with or without pay and is granted at the discretion of the Service Director, depending on the importance, benefit, timeliness and duration of the training. Such leave will be granted only if the employer can afford to arrange the release of the employee and if overtime does not become an issue in regards to the proposed training and development.

KZHSS ensures training and/or delivers specific types of education such as: - hand washing - maintaining and sanitizing equipment - First Aid, maintaining First Aid kits, C.P.R. - training related to managing aggressive violent clients - training related to Aboriginal community health and wellness such as the recent training on diabetic retinopathy - quality improvement workshops, conferences, courses - training on fire safety, WHMIS, etc. - mold clean-up procedures

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PART VIII: References & Annexes

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A. EVALUATION

Changes made to the manual and annexes should be made in consultation with the KZHSS Accreditation Team to ensure that it continues to meet applicable KZA standards, national accreditation standards, federal and provincial laws and standards.

This document will be evaluated, monitored and updated to reflect new and revised policies on an annual basis and ad hoc in the case of unintended negative impacts.

Any necessary changes will be documented.

On May 9, 2016, the Kitigan Zibi Health & Social Services Policy & Procedures manual was ratified by the Kitigan Zibi Anishinabeg Chief & Band Council (BCR No.10). Any new or ammended policies introduced after this date are listed below. The new/ammended policies are considered to be approved by Chief and Council and can be implemented in line with the other KZHSS policies and procedures as part of the manual. The new/ammended policies listed below supercede any of the former or older versions of the policy.

1. Medical Transportation Policy - Ammended

Reason for ammendment: The Medical Transportation Policy was completely revamped to be in line with the Non-Insured Health Benefits (NIHB) Medical Transportation Policy Framework (Interim).

Date(s) reviewed by Chief & Council: September 24, 2018 & December 17, 2019 Date approved by Chief & Council: March 21, 2019

2. Infant Formula Policy – Ammended

Reason for amendment: Non-registered band members are not eligible for the eggs, milk and orange juice voucher but may receive similar services through the OLO program at the CLSC in the town of Maniwaki.

A Nurse will make a clinical decision with individual mothers to decide whether she is eligible for both eggs/milk/orange juice simultaneously with the infant formula vouchers.

Decision made was based on following the requirements of the agreement.