Government of Ontario: Ministry of Health and Long-Term Care

Long-Term Care Division
Profile of Long-Term Care Facility












yrs

Strengths and Developments



*Please attach a copy of your organizational chart.

Key Personnel*

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Committees

List internal committees

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7


Orientation tours





Admission interdisciplinary team conference





Annual interdisciplinary team conference





Residents' council





Family council





Family nights



Resident contracts





Other





Structural information

Type of rooms

Type of rooms (this refers to structural layout rather than what is charged as preferred accommodation)





Number of units and beds

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Additional services provided to residents

Emergency medical coverage

Service provided Service provided

Contract for service Contract for service


Pharmacy

Service provided Service provided

Contract for service Contract for service


Laboratory

Service provided Service provided

Contract for service Contract for service


Radiology

Service provided Service provided

Contract for service Contract for service


Physiotherapy

Service provided Service provided

Contract for service Contract for service


Occupational therapy

Service provided Service provided

Contract for service Contract for service


Foot care

Service provided Service provided

Contract for service Contract for service


Ophthalmology/Optometry

Service provided Service provided

Contract for service Contract for service


Audiology

Service provided Service provided

Contract for service Contract for service


Dental

Service provided Service provided

Contract for service Contract for service


Denturist

Service provided Service provided

Contract for service Contract for service


Respiratory technology

Service provided Service provided

Contract for service Contract for service


Mental Health Serv. i.e. psychogeriatrics

Service provided Service provided

Contract for service Contract for service


Transportation

Service provided Service provided

Contract for service Contract for service


Other (specify)

Service provided Service provided

Contract for service Contract for service


Community linkages

Volunteer program

Service provided Service provided


Service groups

Service provided Service provided


Language interpreters

Service provided Service provided


Cultural interpreters

Service provided Service provided


Advisory council

Service provided Service provided


Community board

Service provided Service provided


Faith communities

Service provided Service provided


Other (specify)

Service provided Service provided


Services provided to the community


Shared services (if applicable)


General information

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Term of contract:




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Term of contract:




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Term of contract:




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Term of contract:




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Term of contract:




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Term of contract:




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Term of contract:




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Term of contract:




2308-69 (97/02)*