RESIDENTIAL CARE FACILITYGUIDELINE
RESIDENTIAL CARE FACILITY GUIDELINEThis guideline has been established as a province wide standard in theadministration of the public health protection licensing requirements forresidential care facilities. This working document is based on existing licensinglegislation, public health legislation and evidence based health protectionstandards, practice and consensus documents. The main purpose of theguideline is to serve as a reference standard for public health inspectors,licensing personnel, licensees, and care providers so that we can protect thehealth and safety of those in care.This is only a guideline. Additional requirements may be required by the PublicHealth Inspector.February 2015
IntroductionThe mission of the Health Protection Unit is to protect the health of Manitobans througheducation and intervention strategies designed to reduce health risks to the public. Public HealthInspectors (PHIs) are the field workers of this unit whose primary focus is to respond toenvironmental health concerns by investigating complaints and inspecting premises to ensurecompliance with Regulations made under The Public Health Act and The Non-Smokers HealthProtection Act.This guideline has been established as a province wide standard in the administration of thepublic health protection licensing requirements for residential care facilities. This workingdocument is based on existing licensing legislation, public health legislation and evidence basedhealth protection standards, practice and consensus documents. The main purpose of theguideline is to serve as a reference standard for PHIs, licensing personnel, licensees, and careproviders so that we can protect the health and safety of those in care.The mandate or legal authority for the administration of public health standards in relation toresidential care facilities is also prescribed in Manitoba legislation specific to the type ofresidential care facility. The Residential Care Facilities Licensing Regulation MR 484/88R underThe Social Services Administration Act outlines requirements for those facilities that areproviding care to adults who are suffering from a disability or disorder which precludes themfrom living independently. The Child Care Facilities (Other than Foster Homes) LicensingRegulation MR 17/99 under The Child and Family Services Act prescribes requirements forthose providing care, supervision and assistance to children, in the temporary or permanentcustody of a child caring agency. There are many common threads between both types ofresidential care facilities. One being that in order to receive and maintain a license to operate,the care facility must meet and maintain minimum public health standards.All proposals for new construction, renovations to an existing facility, or conversion of anexisting building to be used for a residential care facility must be reviewed for compliance by aPublic Health Inspector prior to the construction, renovation or re-construction. The PHI shallprovide a plan review letter to the facility owner and the provincial coordinator for either childcare or adult group homes within 14 working days of receiving the submission. The letter shallindicate approval or disapproval and provide a detailed list of insufficient information orunsatisfactory items. The purpose of this review is to ensure that any new construction orrenovations are completed in accordance with this guideline.
Table of ContentsFood Safety . 5Foodborne Illness . 5Time-Temperature Control Requirements . 6Safe Food Sources. 7Food Storage Requirements . 7Food Preparation . 8Cleaning and Sanitizing Food Contact and Non Food Contact Surfaces . 8Dining Facilities . 12Menu . 12Facility Structure and Maintenance . 12Floor Space . 13Storage of Personal Items . 13Windows & Doors . 14Natural & Mechanical - Heating & Ventilation . 14Mould and Moisture Control . 16Nonsmokers Health Protection Act . 16Radon . 17Lead. 17Asbestos . 18Plumbing Fixtures . 19Hot Water Supply . 19Walls, Floors and Ceilings . 20Stairs, Railings, Landings and Walkways. 20Lighting . 21Recreational Water Facilities and/or Activities . 21Building Exterior . 22Pest Control/Pest Management . 23Onsite Wastewater Management System. 23Potable Water (Monitoring, Reporting & Source Protection) . 24Solid Waste Management . 26Infection Control . 27Reporting and Management of Communicable Disease . 28Handwashing Facilities and Practices . 30Cleaning and Disinfection Procedures and Schedules . 31Toileting and Diapering/Incontinence Care . 32
Pets & Farm Animals . 33Personal Hygiene Items and Practices . 34Laundry . 35Hazardous Product Safety . 36Appendix 1Public Health Inspection Contact Numbers . 37Appendix 2 Preparing Household Bleach Solution For Sanitizing and Disinfecting SodiumHypochlorite . 38
Food SafetyFoodborne IllnessThe Public Health Agency of Canada estimates that each year roughly one in eight Canadians(or four million people) get sick due to domestically acquired food-borne diseases. 1 Foodborneillness may occur by eating or drinking food that is contaminated.Symptoms commonly include stomach cramps, nausea, vomiting, diarrhea and fever. Manymicroorganisms (germs) that cause foodborne illness can be transmitted from person to person.This makes it difficult to tell if an illness is caused by contaminated food, contamination from afoodhandler or from other sources.The symptoms of foodborne illness can range from mild to severe. In most cases many peoplehave mild symptoms and recover within a few days. However food borne illness may causemore serious health problems such as kidney failure or even death.If symptoms persist orbecome severe (i.e. blood or mucus in stool, worsening pain, high fever) contact Health LinksInfo Santé at 788-8200 in Winnipeg or toll-free 1-888-315-9257 or seek medical care as soon aspossible.For a list of organisms and chemicals that can be transmitted by food or water see ManitobaHealth’s Enteric Illness Protocol page 23-28.Residential care facilities are required to provide safe food for persons in care 2 and learningabout safe food handling practices is crucial in achieving this. Most food related illness can beprevented by following the safe food handling practices outlined in this document. Additionally,safe food handling courses are offered throughout Manitoba. These food safety trainingcourses are designed for the food service industry. Courses cover important food and workersafety information including: foodborne illness, receiving and storing food, preparing food,serving food, cleaning and sanitizing.For more information see the following websites:Manitoba Health Certified Food Handler Training vironmentalhealth/protection/foodsafe.htmlManitoba Food Safety Connectionhttp://www.ciphi.mb.ca/FSC.htmlCanadian Partnership for Consumer Food Safety Educationhttp://www.canfightbac.orgGovernment of Canada: Food Safetyhttp://www.foodsafety.gc.caBC Ministry of Health “Caring About Food safety-courses.html1Public Health Agency of Canada Estimates of Food-borne Illness in Canada May 9, 2013 .php2Residential Care Facilities Licensing Regulation, November 1998 MR 484/88 R S. 5
Potentially Hazardous FoodsPotentially hazardous foods are those foods which require time/temperature control to keepthem safe. Some examples of potentially hazardous foods are eggs, meat, poultry, fish,cooked pasta or rice, gravy, soup, and cut fruits and vegetables. Dry, acidic or sweetfoods which have been modified and do not easily support the growth of disease organisms ortoxins are not potentially hazardous foods (i.e. pickles, beef jerky, jam, and cookies). 3Time-Temperature Control Requirements 3Temperature/time is the most common cause of bacterial foodborne illness.The only way to know for sure that you are storing, cooking holding and reheatingpotentially hazardous foods at a safe temperature is to check with a thermometer.The “danger zone”, 4ºC (40ºF) to 60ºC (140ºF), is the temperature range where bacteriamultiply quickly. By limiting the time food is within this temperature range the growth ofbacteria is limited and the risk of foodborne illness is reduced.Store potentially hazardous food in the refrigerator at 4 C (40 F) or colder.Provide and monitor thermometers for each refrigeration unit.Provide adequate refrigerated space for food storage as air flow is important in coolingfood and keeping food cool.Discard potentially hazardous food left un-refrigerated for more than 2 hours 4Hot foods shall be cooled from 60 C (140 F) to 4 C (40 F) within 6 hours. 5 6 To speedup cooling divide food into smaller portions, store in shallow containers and refrigerateimmediately.Freezer temperature shall be -18 C (0 F) or colder to maintain food frozen.Food shall be thawed in the refrigerator, as part of the cooking process, under coldrunning water or in the microwave to prevent it or portions of it from being in the dangerzone.Provide and use a probe thermometer accurately scaled to /- 1 C (2 F) to checkinternal food temperatures.Reheat potentially hazardous food to 74 C (165 F) within 2 hours. 7Ensure potentially hazardous foods are thoroughly cooked (meat and meat mixtures71 C(160 F), whole poultry 85 C (185 F). 8Cooked food shall be held hot at 60 C (140 F) or above.Limit the time food is in the danger zone when purchasing food by doing the groceryshopping last and immediately refrigerate foods.Bagged lunch containing potentially hazardous foods should be stored/maintained atsafe temperatures. Use insulated containers and ice packs to keep hot foods hot andcold foods cold.Food and Food Handling Establishments Regulation, August 1988 MR 339/88 R S. 1Food Retail and Food Services Code Amended September, 2004 Canadian Food Inspection SystemImplementation Group p. 38 http://foodsafe.ca/resources/Food Services Code2004.pdf5FDA Food Code 2009 Chapter FoodProtection/FoodCode/ucm186451.htm6Food Retail and Food Services Code Amended September, 2004 Canadian Food Inspection SystemImplementation Group p. 37 http://foodsafe.ca/resources/Food Services Code2004.pdf7FDA Food Code 2009 Chapter FoodProtection/FoodCode/ucm186451.htm8Canadian Food Inspection Agency, Everyday Safe Food Handling Practices www.inspection.gc.ca4
Safe Food SourcesFood can be contaminated prior to purchasing and to manage risk it is important to follow thesesafety rules when purchasing, storing and preparing food: Only purchase or accept food products from reliable sources.Unless approved by the Director of Food Protection all potentially hazardous foodproducts must originate from government-inspected sources. This includes meat, fish,poultry, dairy products and eggs.Do not use unpasteurized milk and milk products or ungraded eggs.Potentially hazardous food products in hermetically sealed containers must originatefrom government inspected sources (i.e. canned vegetables, canned meat and fish,canned soup).Food products such as home canned jams, jellies and pickles are normally permitted asthey are not considered a potentially hazardous food product. To ensure the low riskfoods are canned in a safe manner refer to Health Canada’s “Food Safety Tips forHome Canning”.Do not use canned food products that are swollen, rusted, pitted or dented especiallyaround the seam or rim.Purchase fresh or frozen potentially hazardous foods (i.e. meat, milk, pre-cut or readyto-eat fruits and vegetables) that are stored at safe temperatures.Do not use food products that are spoiled or foul smelling. “if in doubt throw it out”.Some best before and expiry dates are listed for food quality and some for food safety.As a general rule, unless frozen, potentially hazardous foods should not be purchased orconsumed if they exceed the best before date.Clean and sanitize or launder your reusable bins and grocery bags. Especially if youuse them to carry raw meat, poultry, fish, seafood, or other perishable foods.Make sure that water used for food preparation and consumption is safe or potable.A residential care facility that uses water from tanks or cisterns shall ensure the waterhaulers/suppliers possess a public health permit. 9Food Storage Requirements 9Refrigerate or freeze perishable food products as soon as possible.Refrigerator temperature 4 C (40 F) or colderFreezers temperature must be maintained at -18 C (0 F) or colder to keep food frozen.Store raw meat, poultry and fish separately and below cooked or ready to eat foodproducts (i.e. fruit and vegetables) to prevent cross-contamination.Cover foods to protect from contamination.If repackaging foods, date and label them before storing them. For more information onhow long to keep foods see Government of Canada Safe Food StorageFood storage containers and packaging should be made of materials that will notcontaminate the food. (i.e. garbage bags, used meat trays/boxes, chemical containers)Store food in a location to minimize contamination risk (i.e. clean, dry, on shelves 15cmor 6” off the floor)Always rotate stock (first in, first out).Water Supplies Regulation MR 330/88 s 4, 5
Food Preparation Maintain good personal hygiene while working in the kitchen.Always wash hands before handling food, after handling raw foods, soiled utensils,equipment, garbage or whenever hands become contaminated.Liquid soap and single use hand drying towels shall be provided in the kitchen.Those working in the kitchen should not be ill as this increases the risk of contaminatingfood from infectious agents.Wear clean outerwear while working with food.Wash fresh fruits and vegetables before you eat or cook them even if they are peeledbecause this helps prevent the spread of any disease organisms that may be present.To do this use cool running water. A clean vegetable scrub brush can be used oncarrots, potatoes, melons, squash, and other produce with a firm skin.Foodhandlers should exhibit knowledge of safe food handling practices.Cleaning and Sanitizing Food Contact and Non Food Contact SurfacesMeat, poultry, eggs, fruits, and vegetables may carry disease organisms that cause foodborneillness. As foods are stored and handled surfaces of equipment and utensils that come in directcontact with food (i.e. knives, cutting boards, countertops, high chair tray) may becomecontaminated. Disease organisms can also be transferred from person to person when foodcontact surfaces such as eating utensils are not properly cleaned and sanitized between uses.When something is clean it is free of visible soil including grease, food debris, dirt and dust.When something is sanitized the number of microorganisms, such as bacteria, is reduced to asafe or acceptable level. The process of sanitizing requires the application of very high heat(i.e. 77 C (171 F) or above) or a chemical to kill the disease organisms. Most commonly usedchemicals approved as sanitizers for food-contact surfaces include chlorine (unscentedhousehold bleach which is about 5% - 6.5 sodium hypochlorite), iodine and quaternaryammonium.To prevent the spread of disease organisms that can cause foodborne illness follow thesegeneral rules: Food contact surfaces shall be cleaned and sanitized after each use.Food contact surfaces shall be protected from contaminationIn order for sanitization to be effective a surface has to be clean and rinsed beforesanitizers are applied.Equipment and utensils shall be in good repair so that they can be maintained in a safeand sanitary condition (i.e. free of chips, cracks or other damage)Non-food-contact surfaces of equipment must be kept free of accumulations of dust, dirt,food res
Ensure potentially hazardous foods are thoroughly cooked (meat and meat mixtures 71 C(160 F), whole poultry 85 C (185 F). 8 Cooked food shall be held hot at 60 C (140 F) or above. Limit the time food is in the danger zone when purchasing food by doing the grocery shopping last and immediately refrigerate foods.
Code of Practice for Residential Care Homes (Elderly Persons) CHAPTER 1 . INTRODUCTION . 1.1 General . 1.1.1 The Residential Care Homes (Elderly Persons) Ordinance (Cap. 459) came into full operation on 1 June 1996. 1.1.2 The Residential Care Homes (Elderly Persons) Regulation (Cap.459 sub. leg. A) is made under section 23 of the Residential .
2 Introduction The Residential Care Practice Manual outlines practice requirements and procedures specific to Department for Child Protection and Family Support Residential Group Homes. The Residential Care Practice Manual is the primary reference for residential care workers, but it does not stand alone.
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