WorkSafeBC 2010 2012 Maples

Obtained by Bob Mackin via Freedom of Information 2010goldrush@gmail.com twitter.
com/bobmackin
OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA
6951 Westminster Highway, Richmond, BC Mailing Address: PO Box 5350, Vancouver BC, V6B 5L5 Telephone 604 276-3100 Toll Free 1-888-621-7233 Fax 604 276-3247
INSPECTION REPORT
WORKER AND EMPLOYER SERVICES DIVISION
An employer who fails to comply with the Occupational Health & Safety Regulation or Board orders or directions is subject to sanctions as prescribed in the Workers Compensation Act. The Occupational Health & Safety Regulation requires that one copy of this report remain posted in a conspicuous place at or near the operation inspected for at least seven days, or until compliance has been achieved, whichever is the longer period. An affected employer, worker, owner, supplier, union or member of a deceased worker's family may, within 90 calendar days of this report, in writing, request the Review Division of the WCB to conduct a review of an order, or the non-issuance of an order, in this report by contacting the Review Division at the Board's Richmond Office. The time limit may be extended in certain circumstances. Employers requiring assistance can contact the Employers' Advisers at 1-800-925-2233--workers can contact the Workers' Advisers at 1-800-663-4261. Date of Issue 2010/11/16 Number 2010070890082 Number of Orders 2 Employer 4000 Location 294 Classification Unit Number 841102 Activity Time Recorded* 6.25 Travel Time Recorded* 1.50
*The Time Recorded reflects only that time which has been charged to this inspection up until the document was printed for delivery. Subsequent time may be added for additional activity related to this inspection. Number of Workers 11 - 50 Project Number Lab Samples Direct Results Taken Readings Presented N N N
Site Visit Date 2010/11/09
Sampling Inspection(s)
Head Office
PROVINCIAL GOVERNMENT WORKERS' COMPENSATION PROGRAMS BC PUBLIC SERVICE A PO BOX 9404 STN PROV GOVT VICTORIA BC V8W9V1 Portion Inspected Violations ETS exposure REFER TO ORDERS ON FOLLOWING PAGE(S) Employer Representative Name Roy Lucken Employer Representative Position Shift Supervisor Phone Number (604) 660-5864 Signature BCGEU Officer of the Board / Signature STEVENSON, JOHN Maples Adolescent Centre Crossroads Program 3405 Willingdon Ave Burnaby BC
Job Site
Accompanied by Employer Representative Ray Lucken Accompanied by Worker Representative

section 22
Organization
For Internal Use Only

Delivery Method: Email Discussed at site with workers and delivered via e-mail to program section 22 coordinator ------------------------------------------------------------
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Inspection Text
Comments issued on: Dec 06, 2010 Conversations with the program coordinator suggest that compliance will be achieved, since the outdoor (but enclosed) court has been closed to tobacco consumption, and the employer stated that control measures will be instituted in other areas on site where ETS exposure remains, including finalizing a NoC. A review of the order cited in this inspection report has determined that further enforcement action is not necessary at this time. This decision relates only to this inspection date, location and order(s) noted on this inspection report. A follow-up inspection will occur and a Notice of Compliance document is required to authenticate compliance with the order(s) noted. Issued on: 2010/11/16 To site per action request AR 2010-017487. Caller concerned about unresolved issue of routine exposure of workers to environmental tobacco smoke (ETS) from resident adolescents. Issue has been discussed with BCGEU and is estimated to be outstanding for 5+ years. Exposures occur under several circumstances: - residents using a secured outdoor courtyard (covered on three sides and overhead by building structure and chain-link fenced on the open face). The access door is occasionally left open permitting easy infiltration of the ETS to the building interior and prevailing wind direction may exacerbate this. In addition, direct supervision of the adolescents may also occur - entering a resident room during and/or soon after smoking (prohibited) has occurred - re-entrainment of ETS due to smoking near cottage door with nearby air intakes The ETS exposure history and profile was discussed with several workers at the site and confirmed. All workers expressed an interest in an effective prohibition or appropriate safe outdoor location that would permit management of resident flight risk. The OHSR guideline G4.81 and 4.82 details compliance considerations and scenarios to facilitate interpretation of the OHSR. Applicable sections include: - restricted smoking within 3 meters from a doorway, window or air intake Employer courtyard - the existing Representative is 'substantially enclosed' Officer of definition) and (see the Board therefore unsuitable as an outdoor smoking area Roy Lucken STEVENSON, JOHN
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- restricted smoking within 3 meters from a doorway, window or air intake - the existing courtyard is 'substantially enclosed' (see definition) and therefore unsuitable as an outdoor smoking area
Orders
Order No.
1
Decision
WCB Reference
OHS4.81
Workers are exposed to environmental tobacco smoke from resident youth at this facility on a routine basis and this is acknowledged to have been an unresolved issue at this site for at least several years. See 'inspection text' notes. The employer has not controlled the exposure of workers to environmental tobacco smoke by (a) prohibiting smoking in the workplace, or (b) restricting smoking to a safe outdoor location that is a minimum of 3 metres from a doorway, window or air intake of an indoor workplace This is in contravention of the Occupational Health and Safety Regulation Section 4.81. The employer must control the exposure of workers at any workplace to environmental tobacco smoke by (a) prohibiting smoking in the workplace, (b) restricting smoking to a safe outdoor location that is a minimum of 3 metres from a doorway, window or air intake of an indoor workplace, subject to section 4.22 (3) of the Tobacco Control Regulation, B.C. Reg. 232/2007, and (c) prohibiting working in an indoor area where smoking is allowed under section 4.23 (2) (a) or (b) of the Tobacco Control Regulation, except as permitted in section 4.82 of this regulation.
Order No.
Decision
WCB Reference
WCA194.(1)
You are required to notify the board in writing by 'Notice of Compliance' (NoC) stating the steps to be taken to correct the deficiencies cited in order no.1. Per Workers' Compensation Act (WCA) s. 194(1), 194(2)(a) and 194(4)(d), the NoC must include an action plan with implementation schedule and be sent to J. Stevenson by December 10, 2010, using either e-mail at Employer Representative Officer of the Board john.stevenson@worksafebc.com, fax at 604.232.5950 or mail:
Roy Lucken 52B17 (R05/2007) STEVENSON, JOHN Page 3 of 4
Workers' Compensation Board of BC Printed: 2012/11/08 08:18 Worker and Employer Services Division Burnaby Work Center 450 - 6450 Roberts Street Burnaby BC, V5G 4E1
INSPECTION REPORT
the NoC must include an action plan with implementation schedule and be sent to J. Stevenson by December 10, 2010, using either e-mail at john.stevenson@worksafebc.com, fax at 604.232.5950 or mail: Workers' Compensation Board of BC Worker and Employer Services Division Burnaby Work Center 450 - 6450 Roberts Street Burnaby BC, V5G 4E1
Employer Representative Roy Lucken 52B17 (R05/2007) Printed:
Officer of the Board STEVENSON, JOHN
2012/11/08 08:18
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INSPECTION REPORT
Head Office
PROVINCIAL GOVERNMENT WORKERS' COMPENSATION PROGRAMS BC PUBLIC SERVICE A PO BOX 9404 STN PROV GOVT VICTORIA BC V8W9V1 Portion Inspected Violations Follow-up to NoC re: ETS REFER TO ORDERS ON FOLLOWING PAGE(S) Employer Representative Name Roy Lucken Employer Representative Position Shift Supervisor Phone Number (604) 660-5864 Signature BCGEU Officer of the Board / Signature STEVENSON, JOHN Maples Adolescent Centre Crossroads Program 3405 Willingdon Ave Burnaby BC
Job Site
Accompanied by Employer Representative Roy Lucken Accompanied by Worker Representative

section 22
Organization

Delivery Method: Email Discussed at site with all parties ------------------------------------------------------------
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Inspection Text
Issued on: 2011/02/28 This was a follow-up inspection to authenticate appropriate compliance with the order(s) noted.
Orders
Order No.
1
Decision
WCB Reference
OHS4.81
THIS IS A FOLLOW UP TO INSPECTION 2010070890082 ORDER 1. Order no. 1 of IR 2010070890082 has been complied with. Continue to ensure per OHSR s. 4.81 that the employer controls the exposure of workers to environmental tobacco smoke by (a) prohibiting smoking in the workplace, or (b) restricting smoking to a safe outdoor location that is a minimum of 3 metres from a doorway, window or air intake of an indoor workplace
Order No.
Decision
WCB Reference
WCA194.(1)
THIS IS A FOLLOW UP TO INSPECTION 2010070890082 ORDER 2. Order no. 2 of IR 2010070890082 has been complied with. The notice-of-compliance (NoC) was received by e-mail on 2010-12-15 and stated that the smoking prohibition zone was to include at least 3 meters distance from: - all enclosed or substantialy enclosed areas such as porches and alcoves of any of the buildings on site as well as the 'cage' - the entire perimeter of the individual building envelopes to ensure that re-entrainment of ETS into any roof-mounted air intakes near the building perimeter walls does not occur
Employer Representative Roy Lucken 52B17 (R05/2007) Printed:
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Head Office
PROVINCIAL GOVERNMENT WORKERS' COMPENSATION PROGRAMS BC PUBLIC SERVICE A PO BOX 9404 STN PROV GOVT VICTORIA BC V8W9V1 Portion Inspected Violations Violence in the Workplace (VitW) REFER TO ORDERS ON FOLLOWING PAGE(S) Employer Representative Name Tom Jensen Employer Representative Position Manager of Treatment Services Phone Number (604) 660-5810 Signature BCNU Officer of the Board / Signature STEVENSON, JOHN Maples Adolescent Centre Crossroads Program 3405 Willingdon Ave Burnaby BC
Job Site
Accompanied by Employer Representative Tom Jensen Accompanied by Worker Representative

section 22
Organization

Delivery Method: In Person section 22 and Ken Moore also present ------------------------------------------------------------
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Inspection Text Comments issued on: May 13, 2011 A review of the order(s) cited in this inspection report has determined that further enforcement action is not necessary at this time. This decision relates only to this inspection date, location and order(s) noted on this inspection report. A follow-up inspection will occur and a Notice of Compliance document was required to authenticate compliance with the order(s) noted.
The NoC was received on 2011-04-14, reviewed and noted as acceptable on 2011-04-26. Issued on: 2011/03/21 Reviewed FirmFile history on 2011-02-24. To site on 2011-02-25 re: action request AR 2011-002161 generated by a BCNU regional safety advocate, that violence related incidents are not sufficiently explored, documented or communicated and that actions arising from them are inadequate. It was stated that there are unresolved issues re: insufficient risk reduction to minimize violence in the workplace, particularly with staff in the Crossroads program, but also Response. The WSBC inspection process was discussed with several line staff from BCGEU and UPN as well as the management team and a request for documents; i.e., incident investigations, joint safety committee minutes and access to policy and procedures was initiated on 2011-03-01 to clarify the issues and establish the extent of any deficiencies. On 2011-03-04, a meeting with the nursing supervisor to discuss the care model and to review documentation occurred. Subsequent meetings on 2011-03-07 with the manager of response services and on 03-08 with the BCNU site representative were convened to review findings. History of violence and context The action request highlighted several violent incidents last year between residents and/or resident to staff, as well as ongoing risk associated with conveying youth to events in vehicles. The nursing supervisor provided a data dump from the CARIS system of the 2010 incident reports. An overview report analyzes the data by type; e.g., danger to self and/or other (72), medical (51), property (31), restraint (31), other (31), illegal substance (25), injury (25) etc. There is overlap of these categories. Injuries to staff and residents are further analyzed as to cause and it is stated that 22 incidents resulted in 26 Employer Of the 26 Officer of off for 1+ staff injuries.Representative worker injuries, 8 required time the Board days. have declined but the data has Tom Jensen In the past 10+ years, staff injuries STEVENSON, JOHN not been rate adjusted nor analyzed by gender. The decline has been 52B17 (R05/2007) Printed: part to the introduction of the attachment care model attributed in 2012/11/08 08:18 philosophy. This data was further summarized by the manager of treatment services into an annual behaviour management report that featured an overview analysis of physical intervention, restraints and/or seclusion of
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analyzed as to cause and it is stated that 22 incidents resulted in 26 staff injuries. Of the 26 worker injuries, 8 required time off for 1+ days. In the past 10+ years, staff injuries have declined but the data has not been rate adjusted nor analyzed by gender. The decline has been attributed in part to the introduction of the attachment care model philosophy. This data was further summarized by the manager of treatment services into an annual behaviour management report that featured an overview analysis of physical intervention, restraints and/or seclusion of clients by program type. These interactions have a higher likelihood of resulting in injury to staff. It was stated by management and confirmed by line workers that all current staff have NVCI training. Training inadequacies may occur in the summer months when casuals make up a higher percentage of the workforce. The incident investigation process was described by the nursing supervisor and confirmed by the manager of response services. A form package example was reviewed. The incident investigation packages (about 30) for all reported injuries last year were provided and a sample of incidents affecting members from each of the three major unions were reviewed. Of 12 incidents reviewed, half involved violence and of those, none had the PSC38 form completed, which is MCFD's root cause analysis form designed to explore contributory factors and report recommendations to reduce likelihood of recurrence. It was stated by the manager charged with oversight for this process that at best, only 10-15 percent of all of the packages had a completed PSC38. The nursing supervisor, a member of the progressive quality improvement team, provided resident behaviour log case notes for the violence related packages. Although not identified as a part of the current investigation review process documents, the case notes are integral to an understanding of antecedent events and must be a routine part of the investigation process for violence-related incidents. The joint safety committee met eight (8) times last year and minutes for the following months were unavailable; 2010-03, 04, 06, 08. The following points are noted: - the format does not differentiate old from new business, nor provide effective tracking of outstanding items with a date identifiable tracking number - no date for actionable items - no times noted re: meeting start/finish - no significant participation from either BCNU or UPN (UPN attended one Employer Representative Officer of the Board meeting in 2010-07) - no detail re: incident investigation findings so of limited or no value Tom Jensen STEVENSON, JOHN to readers outside of meeting participants. 52B17 (R05/2007) Printed: 2012/11/08 08:18 Considerations and outstanding issues - essential to provide adequate information re: triggers to violent
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- no significant participation from either BCNU or UPN (UPN attended one meeting in 2010-07) - no detail re: incident investigation findings so of limited or no value to readers outside of meeting participants. Considerations and outstanding issues - essential to provide adequate information re: triggers to violent behaviour and the approaches to avoid triggering the behaviour - behaviour trend tracking of high risk youth - consideration for FIPPA confidentiality requirements - some incidents investigated on an informal basis - effective documented behaviour logging can be challenging because of computer access availability while undertaking routine youth care responsibilities particularly at shift change - instances where youth have distracted and/or injured the driver when being transported in a vehicle - policy and procedures must be reviewed to ensure they provide adequate direction re: actionable outcomes designed to minimize risk - consideration of pre-cursor events prior to the administration of medication to facilitate regaining control - recognition that individual line workers with different risk tolerance for violence or abusive behaviour (intentional or otherwise), will not self-report the same way unless the process and reporting criteria is clear and is supported by effective supervision Incident investigations and violence prevention program review WSBC's OHSR s. 4.27 - 4.31 and the associated policy items R4.28-1 - R4. 311 link the violence incident investigation process to the general accident investigation process. Completion of the investigation report must include an exploration of contributing factors, recommendations to prevent recurrence, an action plan and communication. See WCA s. 173(1)(b-d), 174(2)(a-c), 175(2)(a-b), and 176(1)(2)(a-b). As this is a joint management/worker investigation, every effort must be made to ensure that the affected worker(s) is/are the first choice as the worker representative(s), and that the process be initiated promptly to ensure effective recollection. The investigation of violence-related incidents must also include those incidents with the potential for serious injury and not just time-loss incidents. Per OHSR policy R4.29-2, the program must be reviewed annually. WCA s. 115(1-2), OHSR s. 3.10 and 4.28(2)(a) collectively require the employer to Employer once a hazard is identified to take corrective actions Officer of the Board reduce risk andRepresentative without delay, including necessarily, the updating of behaviour and safety Tom Jensen STEVENSON, JOHN plans to mitigate risk. 52B17 (R05/2007) Printed: 2012/11/08 08:18 Copies of OHSR policy R4.28-1 - R4.31-1 provided.
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INSPECTION REPORT
115(1-2), OHSR s. 3.10 and 4.28(2)(a) collectively require the employer to reduce risk and once a hazard is identified to take corrective actions without delay, including necessarily, the updating of behaviour and safety plans to mitigate risk. Copies of OHSR policy R4.28-1 - R4.31-1 provided.
Orders
Order No.
1
Decision
WCB Reference
OHS4.28.(1)
It was acknowledged that a site-wide formalized and documented violence in the workplace risk assessment has not been undertaken for some time. A large number of violence-related incidents have not been adequately investigated to MCFD standards and are contrary to WSBC requirements. Line staff in this youth forensic facility report varying degrees of risk perception, due in part to factors of physical size and gender, but also to prior workplace experiences and the associated tolerance for violence risk in those environments. Several line staff expressed frustration with delays in the implementation of a revised call alert system for backup assistance and could not readily locate emergency call numbers. See 'inspection text' notes. A risk assessment has not been performed in a workplace in which a risk of injury to workers from violence arising out of their employment may be present. This is in contravention of the Occupational Health and Safety Regulation Section 4.28(1). A risk assessment must be performed in any workplace in which a risk of injury to workers from violence arising out of their employment may be present. The employer is directed to review: - existing policy and procedures re: measures to eliminate or reduce staff exposure to violence risk - delays in the implementation of a revised emergency backup call system - objective comparison of the existing backup system vs alternatives with evidence of reviews of systems in similar risk environments - the contribution of experience, education, training and supervision to incident response outcomes Employer report form package instructions for continuity with MCFD Officer of the Board - the incident Representative policy Tom Jensen and WSBC mandated investigation actions STEVENSON, JOHN - supplementary instruction to update documents that may require amendment 52B17 (R05/2007) Printed: 2012/11/08 08:18 after analysis of an incident reports; e.g., behaviour logs, safety plans, communication logs to ensure timely and effective risk control communication - the incident report follow-up actions section to determine if corrective
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incident response outcomes - the incident report form package instructions for continuity with MCFD policy and WSBC mandated investigation actions - supplementary instruction to update documents that may require amendment after analysis of an incident reports; e.g., behaviour logs, safety plans, communication logs to ensure timely and effective risk control communication - the incident report follow-up actions section to determine if corrective actions were taken and by whom - consider amendments and/or add-on fields to the CARIS system to better capture root cause analysis and the tracking of recommendations arising and to communicate same to the safety committee - worker survey re: program implementation and violence risk perception - any other relevant documents, procedures, practice methods, service delivery care models, etc. that might inform the risk assessment process and to develop an action plan from the risk assessment which will address per OHSR s. 4.29(a)(b), procedures, policies and work environment arrangements to eliminate the risk to workers from violence or if that is not possible, minimize the risk.
Order No.
Decision
WCB Reference
WCA174.(2)
A sample (12) of incident investigation reports involving workers from each of the three major unions were reviewed. Half of those involved violence and none had the ministry-wide investigation form (PSC38) completed. It was acknowledged that only 10-15 percent of the incidents resulting in injury last year (22+) had a completed form. See 'inspection text' notes. For those violence-related incidents reviewed, cause is frequently ascribed to assault, but the investigations do not thoroughly identify unsafe conditions, acts or procedures that may have contributed to the incident, nor recommend corrective action to prevent similar incidents. This is in contravention of the Workers Compensation Act Section 174 (2). As far as possible, the investigation must: (a) determine the cause or causes of the incident, (b) identify any unsafe conditions, acts or procedures that contributed in any manner to the incident, and Employer Representative Officer of the Board (c) if unsafe conditions, acts or procedures are identified, recommend Tom Jensen STEVENSON, JOHN corrective action to prevent similar incidents.
52B17 (R05/2007) Printed: 2012/11/08 08:18 In addition, ensure that all workplace related incidents with the potential for causing serious injury are investigated per requirements of WCA s. 173(1)(c). Page 6 of 8
INSPECTION REPORT
any manner to the incident, and (c) if unsafe conditions, acts or procedures are identified, recommend corrective action to prevent similar incidents. In addition, ensure that all workplace related incidents with the potential for causing serious injury are investigated per requirements of WCA s. 173(1)(c).
Order No.
Decision
WCB Reference
WCA125
The joint safety committee met eight (8) times last year, minutes for the following months were unavailable; 2010-03, 04, 06, 08 and it was acknowledged that meetings had not occurred in those months. Workers from two unions (BCNU and UPN) providing direct care to youth (and subject to significant violence risk) were not effectively represented on the committee. See 'inspection text' notes. The employer has not maintained a joint health and safety committee in each workplace where 20 or more workers of the employer are regularly employed, and in any other workplace for which a joint committee is required by order. This is in contravention of the Workers Compensation Act Section 125. An employer must establish and maintain a joint health and safety committee: (a) in each workplace where 20 or more workers of the employer are regularly employed, and (b) in any other workplace for which a joint committee is required by order.
Order No.
Decision
WCB Reference
WCA194.(1)
You are required to notify the board in writing by 'Notice of Compliance' (NoC) stating the steps to be taken to correct the deficiencies cited in order no.s 1-3 inclusive. Per Workers' Compensation Act (WCA) s. 194(1), 194(2)(a) of the Board Employer Representative Officer and 194(4)(d), the NoC must include an action plan with an implementation schedule and be Tom Jensen STEVENSON, e-mail at sent to J. Stevenson by April 15, 2011, using either JOHN john.stevenson@worksafebc.com, fax at 604.232.5950 or mail: 52B17 (R05/2007) Printed: 2012/11/08 08:18 Workers' Compensation Board of BC Worker and Employer Services Division Burnaby Work Center
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INSPECTION REPORT
Per Workers' Compensation Act (WCA) s. 194(1), 194(2)(a) and 194(4)(d), the NoC must include an action plan with an implementation schedule and be sent to J. Stevenson by April 15, 2011, using either e-mail at john.stevenson@worksafebc.com, fax at 604.232.5950 or mail: Workers' Compensation Board of BC Worker and Employer Services Division Burnaby Work Center 450 - 6450 Roberts Street Burnaby BC, V5G 4E1
Employer Representative Tom Jensen 52B17 (R05/2007) Printed:
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CR 2011070890015
Jobsite 4000 PROVINCIAL GOVERNMENT WORKERS' COMPENSATION PROGRAMS BC PUBLIC SERVICE A PO BOX 9404 STN PROV GOVT
Name: Address:
Employer
ID: Name: Address:
Maples Adolescent Centre Crossroads Program 3405 Willingdon Ave
City: Province: Postal Code:
VICTORIA BC V8W9V1 294 841102

City: Province:
Burnaby BC
Location: CU:
Project: Latitude: Longitude:
Details
Employer Representative Consulted: Ken Moore Phone Number: Consultation Date: Site Visit: Response Additional Employers:
(604) 660-5811 2011/04/26
Regulations
Regulation Regulation Text
WCA 194.(1)
You are required to notify the Board, in writing, of the steps to be taken to correct the contraventions cited that require a 'Notice of Compliance' [Decision Code will contain the letter N]. The Notice of Compliance shall be delivered to the nearest Board office by month, day, year. This order includes a requirement for a compliance report in accordance with WCA section 194(1).
Text
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Admin Details
Hours Activity: 1.25 Officer Details Name: STEVENSON, JOHN Related Documents: Type: IR WCB Project: Number: 2011070890005 Issue Date: 2011/03/21 Role: PRIMARY ROLE Travel: Activity Type: Contact
Triggered By:
Internal
Referrals: For Internal Use Only:
Issued on: 2011/04/26 Memo to capture the employer NoC dated 2011-04-14. See attachments and comments below provided to firm via e-mail on 2011-04-26: I have reviewed the NoC and you and the team have prepared an excellent response that will guide the process ahead. I'll be frank. This level of detail is most unusual (and refreshing) compared with the majority of section 22 responses that we see, section 22 . I think some challenge may lie with the analysis of near-misses and the process that you establish, but you have a team consensus on this so lets see how it plays out. I'll be interested in the final risk assessment tool that you choose and whether you modify any of the survey questions as noted in the initial e-mail of 2011-03-31 accompanying the inspection report. WCA s. 194.(1) refers. The following cover e-mail is associated with the NoC. Pursuant to your Inspection Report 2011070890005, please find attached a Notice of Compliance letter and an action plan with an implementation schedule. I hope these are acceptable as they stand but, of course, we stand ready for any queries or direction. Once we receive notice that the plan is acceptable we will post it at the workplace. Ken Moore Director, The Maples Adolescent Treatment Centre Office 604.660.5811 section 22 Mobile
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CR 2011070890050
Name: Address:
section 22 section 22
Employer
ID: Name: Address:
Residence

City: Province:
section 22
BC
Location: CU:
Details
Employer Representative Consulted: Phone Number: Consultation Date: Site Visit: Response Additional Employers:
2011/09/20 Activity occurred during core hours.
Text
Admin Details
Hours Activity: 11.75 Officer Details Name: STEVENSON, JOHN Related Documents: Type: IR WCB Project: Number: 2011070890005 Issue Date: 2011/03/21 Role: PRIMARY ROLE Travel:
3.50
Activity Type: Contact
Triggered By:
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Internal
Referrals:
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For Internal Use Only:
Issued on: 2011/09/20 Met with claimant to discuss recent assault involving three workers that occurred on 2011-09-13 at 1420h. The PSC38 and a memo authored on 2011-09section 22 15 by the coordinator of response services to at BCNU providing context and additional detail re: the incident precursors and the planned follow-up actions and these documents were reviewed with the claimant. We discussed the additional content in the memo vs the PSC38 and it was stated that the PSC38 did capture the essential content and would be intelligible to a JOHSCtte member charged with reviewing an AI related to a VitW incident. In the approximately s. 22 years that the resident has been associated with the Crossroads program at Maples, the resident has been involved in significant assaultive behaviour, the most recent previous assault occurring on 2011-05-16 which resulted in three injured female workers. Subsequent to the event and arising out of discussion in the JOHSCtte, the firm agreed to a trial of an additional communication tool; i.e., a 2-way radio. It was stated that on the day of the most recent incident the 2-way radio was inoperative, though it is doubtful that it's presence would have altered outcomes.
section 22 the attachment model used to manage this resident has placed HCWs at excessive risk because it doesn't provide effective section 22 controls. it permits too wide a range of resident section 22 privileges that are subject to individual risk tolerance section 22 . Further, it sets up expectations with the resident that may not be deliverable on a given shift because of the shift staff profile, and this in turn raises frustration, volatility, unpredicability and VitW risk.
The claimant notes the following additional recommendations or comments: - revise criteria for removal from section 22 seclusion and communicate to ensure a more consistent application - seclusion duration is not always linked to the severity of the precursor event leading to isolation - inter-shift communication also needs to evaluate the shift construction; e.g., events, privileges etc. as well as the more obvious behavioural patterns - improve staff shift continuity (ensure a consistent HCW on each shift
During the course of the interview, we also discussed the status of the VitW risk assessment process as ordered in IR 2011070890005. We reviewed the employer's NoC submitted on 2011-04-26 for status of the projected work tasks and the anticipated completion dates. The CCC is conducting a monthly review of SSs weekly report summaries and this data is reviewed by the JOHSCtte and it was stated that this has resulted in changes to the youth management plans. It was also stated that the airing court has again been used as a secure location for resident smoking on at least one occasion and HCWs have expressed concern to management re: ETS exposure and are seeking a permanent resolution to this problem.
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CR 2011070890051
Name: Address:
Employer
ID: Name: Address:

City: Province:
Burnaby BC
Location: CU:
Details
Employer Representative Consulted: Andy MacDonald Phone Number: Consultation Date: Site Visit: Response Additional Employers:
(604) 660-5813 2011/10/06 Activity occurred during core hours.
Regulations
OHS 4.28.(1) A risk assessment must be performed in any workplace in which a risk of injury to workers from violence arising out of their employment may be present.
Text
Admin Details
Hours Activity: 6.50 Officer Details Name: STEVENSON, JOHN Related Documents: WCB Project: Role: PRIMARY ROLE Travel:
1.50
Triggered By:
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CR 2011070890051
Internal
Issued on: 2011/10/06 Meeting with the response services manager on 2011-10-06 to discuss the status of VitW risk assessment issues identified in the notice-ofcompliance (NoC) dated 2011-04-26 and to assess the extent of implementation of the outstanding tasks as well review the discussion points of the meeting highlighted below. We also reviewed the details of an injured worker interview conducted by WSBC for a VitW incident occurring on 2011-05-16. See details in CR 2011070890050 dated 2011-09-20. The details of that interview and some of the worker recommendations arising were also raised at a meeting on 2011-09-22 at MATC with representatives from management as well as BCGEU, UPN, BCNU, the assigned safety specialist from BCPSA, and WSBC convened by BCNU re: the VitW incident mentioned above. Discussion points The draft VitW staff perception survey completed and delivered to the MATC staff on approximately 2011-07-31 was presented to the union representatives either at or shortly before the meeting. The UPN representative advised that some of his member's opinions were not reflected in the survey. The BCNU VitW prevention advocate stated that the survey contained no significant assessment of environmental risk factors, and offered to provide templates of finalized risk assessment undertakings at other worksites, particularly to demonstrate effective documentation and remedial task planning arising out of the process. The BCPSA safety specialist was not involved nor made aware of the planning activities around the risk assessment process or staff perception survey. In the interim, the safety specialist has conducted several training sessions re: incident investigation and employer responsibilities re: safety management. The UPN representative noted that an identified risk factor in the staff perception survey, and also in the incident investigations arising out of assaults with one repeat perpetrator (i.e. insufficient male presence in the caregiver shift makeup on the incident dates) was being ineffectively managed. The management team expressed concerns of a labour union challenge re: gender discrimination if the hiring and/or staffing practice specifically stipulated or increased the ratio of male caregivers. The UPN representative countered with a defense based on the safety component and cited examples of similar decisions. Actions arising The response services manager agreed to complete the environmental risk assessment process and on 2011-10-07 e-mailed completed minutes of the JOHSCtte, and on 2011-10-17 forwarded an updated NoC. OHSR s. 4.28.(1) refers.
INSPECTION REPORT
Head Office
PROVINCIAL GOVERNMENT WORKERS' COMPENSATION PROGRAMS BC PUBLIC SERVICE A PO BOX 9404 STN PROV GOVT VICTORIA BC V8W9V1 Portion Inspected Violations Violence in the Workplace (VitW) REFER TO ORDERS ON FOLLOWING PAGE(S) Employer Representative Name Andy MacDonald Employer Representative Position Manager of Response Services Phone Number (604) 660-5813 Signature UPN Officer of the Board / Signature STEVENSON, JOHN Maples Adolescent Centre Crossroads Program 3405 Willingdon Ave Burnaby BC
Job Site
Accompanied by Employer Representative Andy MacDonald Accompanied by Worker Representative

section 22
Organization

Delivery Method: In Person Meetings at site to review draft report and e-mailed copies ------------------------------------------------------------
52B17 (R05/2007)
Printed:
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Page 1 of 7
INSPECTION REPORT
Inspection Text
Issued on: 2011/11/24 This was a follow-up inspection to authenticate appropriate compliance with the order(s) noted. Violence risk assessment A meeting was convened at MATC by BCNU on 2011-09-22 to explore issues re: a significant VitW incident occurring on 2011-09-13. Representatives from management as well as BCGEU, UPN, BCNU, the assigned safety specialist from BCPSA, and WSBC were present. The MATC VitW staff perception survey was tabled by the management team but by itself does not meet WSBC requirements for a violence risk assessment and this shortcoming was discussed. The BCNU VitW prevention advocate stated that the survey contained no significant assessment of environmental risk factors including but not limited to travel in vehicles. The BCNU representative offered to provide templates of finalized violence risk assessment undertakings at other worksites, particularly to demonstrate effective documentation that includes priorizing of relative risks and the preparation of an action plan arising out of the process. Finalized violenec risk assessment reports have been obtained from VIHA that will be used to guide the report format. The BCPSA safety specialist stated that she was not involved in nor made aware of the planning activities around the risk assessment process or staff perception survey at the outset. In 2011-Q2, the safety specialist conducted several training sessions re: incident investigation and employer responsibilities re: safety management. The draft MATC VitW staff perception survey was distributed to the JOHSCtte in early September and the committee recommends requesting additional analysis by the research assistant into: - staff perceptions of causation such as working alone or enforcing policy where a VitW incident had been experienced - knowledge of and desire for revisons to P&Ps The response services manager agreed to the inclusion of an environmental risk assessment process to augment the staff perception survey and on Employer Representative Officer of the Board 201110-17 forwarded an updated NoC to WSBC. With respect JOHNother outstanding Andy MacDonald STEVENSON, to tasks arising from the risk assessment process, the NoC notes that the 52B17 (R05/2007) Printed: 2012/11/08 08:18 education, training and supervision to contribution of experience, incident response outcomes will be incorporated into the final VitW risk assessment report.
Page 2 of 7
INSPECTION REPORT
risk assessment process to augment the staff perception survey and on 201110-17 forwarded an updated NoC to WSBC. With respect to other outstanding tasks arising from the risk assessment process, the NoC notes that the contribution of experience, education, training and supervision to incident response outcomes will be incorporated into the final VitW risk assessment report. The 2-way radio system continues to present some concerns to users, some of which may be attributable to user competency with the system and some of which is radio system dependent; i.e., batteries without adequate charge for second shift (insufficient charged batteries) and possible dead zones on site. This interim communications system needs support and resolution to any identified issues until alternatives are available. Shared services is currently reviewing alternative systems. The environmental risk assessment was scheduled for completion on 2011-1019 and on 2011-11-24 was reported as complete for the high risk cottages and likely complete for the remainder of the site within approximately one week. It was also stated that the manager of nursing quality control was finalizing a review of the resident behaviour logs for near-misses related to transporting youth in vehicles as a component of the environmental risk scan. Incident investigations The incident investigation order is noted as in partial compliance because all timeloss incidents now have documented evidence of an investigation, however investigation of VitW near-misses has not been adequately integrated into the process. It was stated by the manager of response services that the JOHSCtte would be involved in establishing the criteria for inclusion of and definition of near-misses into a formal incident investigation; i.e., one requiring the use of a PSC38 process. That process has not been finalized but the task was tabled in the committee minutes of 09-20. WCA s. 173(1)(c) refers. The current implementation plan under item 2.0 states that near-misses will be tracked through a monthly review. That frequency is not consistent with regulatory expectation. It is understood that there are degrees of near-misses and not all of them can be evaluated due to time constraints, however the intent of the regulation is to investigate any of these with the potential for serious injury. Assaultive behaviour is to be included in this analysis and investigative process. Alternative review processes are currently used to manage this risk, but require integration with periodic PSC38 style investigations into near-misses meeting the criteria to be established by Officer of the Board the joint Employer Representative committee.
Andy MacDonald STEVENSON, JOHN Page 3 of 7
Assaults to staff occurring on 2011-05-16 and on 2011-09-13 by the same 52B17 (R05/2007) Printed: 2012/11/08 08:18 perpetrator have been documented on PSC38 forms. The content of those forms, particularly cause and contributing factors and corrective measures taken and/or recommendations, was reviewed and has significantly improved relative to completed forms from last year.
INSPECTION REPORT
investigations into near-misses meeting the criteria to be established by the joint committee. Assaults to staff occurring on 2011-05-16 and on 2011-09-13 by the same perpetrator have been documented on PSC38 forms. The content of those forms, particularly cause and contributing factors and corrective measures taken and/or recommendations, was reviewed and has significantly improved relative to completed forms from last year. An e-mail communication between the manager of response services and the BCNU violence prevention advocate re: the second assault noted above was also reviewed. The e-mail contains more detailed analysis and corrective measures that are insufficiently conveyed when brought forward to the PSC38. There are common contributing factors in both incidents and effective controls were not in place to prevent a recurrent event. The analysis of the second incident does not include evidence of an effective exploration of the repeating contributing factors common to the events, nor of the possible role of supervisory decisions in the outcome. The PSC38 must have sufficient detail to effectively communicate the analysis of contributing factors and recommendations with actions arising. All significant information must be available for review by both the JOSHCtte and other interested parties such as the year-end analysis as part of the annual risk assessment process. Documentation of the follow-up actions must also be available. Joint safety and health committee The minutes of the JOHSCtte from 2011-Q2 forward have been reviewed to assess content and quality of the discussion summary notes. The most current three months of minutes must be posted, in addition to WSBC inspection reports (until compliance against any outstanding orders is acknowledged to have occurred). You must also post any notice-ofcompliance responses and updates of same to the same location as the inspection report. In addition, please amend the e-mail distribution contact person at WSBC to: john.stevenson@worksafebc.com.
Employer Representative Andy MacDonald 52B17 (R05/2007) Printed:
2012/11/08 08:18
Page 4 of 7
INSPECTION REPORT
Orders
Order No.
1
Decision
WCB Reference
OHS4.28.(1)
THIS IS A FOLLOW UP TO INSPECTION 2011070890005 ORDER 1. Order no. 1 of IR 2011070890005 has been partially complied with. The violence-in-the-workplace (VitW) risk assessment process has been initiated and the status of some of the tasks identified in the implementation plan are summarized below and noted as completed (C) or in progress (IP): 1.0 - staff perception survey of VitW vetted and approved by JOHSCtte on 2011-09-20 (C) 1.1 - revise policies HS150 and HS160 with inclusion of key security (C) 1.2 - two-way radio pilot tested, issues identified and corrected, system accepted with proviso to continue to monitor alternatives (C) 1.4 - investigation into the contribution of experience, education, training and supervision to incident response outcomes (IP) 1.65 - incident investigation report quality control (C) 2.0 - investigation of near-misses consistent with the process used for serious and/or timeloss incidents (IP) 2.1 - establish a workplace violence prevention program (IP) See inspection text notes for additional comment re: these tasks and especially investigations. The risk assessment process at the time of this inspection has not been finalized in this workplace in which a risk of injury to workers from violence arising out of their employment is present. This is in contravention of the Occupational Health and Safety Regulation Section 4.28(1). A risk assessment must be performed in any workplace in which a risk of injury to workers from violence arising out of their employment may be present. Continue to communicate with the joint safety committee re: the actionable items arising from the risk assessment to address risk controls; i.e., procedures, policies and work environment arrangements to eliminate the risk to workers from violence or if that is not possible, to minimize the risk per OHSR s. 4.29(a)(b).
2012/11/08 08:18
Page 5 of 7
INSPECTION REPORT
An employer who fails to comply with the Occupational Health & Safety Regulation or Board orders or directions is subject to sanctions as prescribed in the Workers Compensation Act. The Occupational Health & Safety Regulation requires that one copy of this report remain posted in a conspicuous place at or near the operation inspected for at least seven days, or until compliance has been achieved, whichever is the longer period. An affected employer, worker, owner, supplier, union or member of a deceased worker's family may, within 90 calendar days of this report, in writing, request the Review Division of the WCB to conduct a review of an order, or the non-issuance of an order, in this report by contacting the Review Division at the Board's Richmond Office. The time limit may be extended in certain circumstances. Employers requiring assistance can contact the Employers' Advisers at 1-800-925-2233--workers can contact the Workers' Advisers at 1-800-663-4261. Date of Issue 2011/11/24 Number 2011070890056 2 Number of Orders 4 C Employer 4000 Location 294 WCA174.(2) Classification Unit Number 841102 Activity Time Recorded* 13.75 Travel Time Recorded* 1.50
Order No.
Decision
WCB Reference
THIS IS A FOLLOW UP TO INSPECTION 2011070890005 ORDER 2. Order no. 2 of IR 2011070890005 has been partially complied with. The approved incident investigation form is now completed for all timeloss incidents. A review of PSC38 forms associated with violent incidents occuring on 2011-05-16 and on 2011-09-13 was conducted. In addition, a supporting memo providing additional detail and context re: the incident precursors and the planned follow-up actions for the second event was reviewed and discussed. See details in 'inspection text'. At present, the PSC38 summarizes the unsafe conditions, acts or procedures that may have contributed to the incident and the recommended corrective actions to prevent similar incidents, but additional detail is required to disclose all significant contributors and clarify the analysis and actionables arising from the recommendations. WCA s. 174(2)(c) refers. In addition, near-misses with a potential for serious injury must be explored and documented using the investigation process. WCA s. 173(1)(c) refers.
Order No.
Decision
WCB Reference
WCA125
THIS IS A FOLLOW UP TO INSPECTION 2011070890005 ORDER 3. Order no. 3 of IR 2011070890005 has been complied with. The joint safety committee has been reinforced and representatives from all unions including BCNU and UPN are now in attendance. Minutes from meetings scheduled in 2011 since revisions have taken place are dated: 0511, 06-07, 07-05, 08-02, 09-06, 09-20 and 10-04. The minutes are either available or in draft as review status. The format has been enhanced significantly with more content and more effective tracking of issues. Continue to maintain an effective joint health and safety committee.
Order No.
Decision
WCB Reference
WCA194.(1)
THIS IS A FOLLOW UP TO INSPECTION 2011070890005 ORDER 4. Order no. 4 of IR 2011070890005 has been complied with.
Employer Representative Andy MacDonald 52B17 (R05/2007) Officer of the Board STEVENSON, JOHN
The employer's notice-of-compliance was e-mailed on 2011-04-26.

Printed:
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Page 6 of 7
INSPECTION REPORT
Order no. 4 of IR 2011070890005 has been complied with. The employer's notice-of-compliance was e-mailed on 2011-04-26.
2012/11/08 08:18
Page 7 of 7
Page 1 of 2
CR 2012070890001
Name: Address:
Employer
ID: Name: Address:

City: Province:
Burnaby BC
Location: CU:
Details
Employer Representative Consulted: Andy MacDonald Phone Number: Consultation Date: Site Visit: Response Additional Employers:
(604) 660-5813 2012/02/13
Regulations
OHS 4.28. (2)(c)
The risk assessment must include the consideration of the location and circumstances in which work will take place.
OHS 4.28.(1) A risk assessment must be performed in any workplace in which a risk of injury to workers from violence arising out of their employment may be present.
Text
Admin Details
Hours Activity: 1.25 Officer Details Name: STEVENSON, JOHN Related Documents: WCB Project: Role: PRIMARY ROLE Travel: Activity Type: Contact
Triggered By:
Page 2 of 2
CR 2012070890001
Internal
Issued on: 2012/02/13 This CR is generated to update FirmFile for outstanding order no. 1 of IR 2011070890005 dated 2011-03-21 for a VitW risk assessment. The order was issued subsequent to a complaint from BCNU re: insufficient incident investigation particularly wrt contributory factors and follow-up actions for circumstances around expressions of violence to custody workers in this youth forensic facility. Significant assistance was provided to the management team and JOHSCtte members with document templates re: the risk assessment process. Despite encouragement to utilize MoCF safety resources, the management team elected unilaterally to proceed with a worker survey linked to a semiannual worker satisfaction process. The survey had intrinsic flaws that delayed the risk assessment process. It did not have an environmental scan integrated with the content evaluating worker risk arising out of interactions with aggressive youth in the program. See details regarding continued violence especially from one youth and the details of the injuries arising in IR 2011070890056 dated 2011-11-24. This IR was generated to update the file for all outstanding orders. Subsequent e-mail correspondence from BCNU, UPN and the safety representative from BCPSA was received by WSBC expressing some minor concerns with perceptions of delays and failures to adequately communicate with and involve the JOHSCtte in the outstanding issues re: the VitW risk assessment process, particularly in the development of risk mitigation strategies. BCNU and UPN elected to work cooperatively with the employer if there was sustained evidence of progress. In e-mail communication dated section 22 2011-12-05, BCNU representative acknowledged some environmental risk reduction measures and the time required to budget for these measures as well as noting a pending move of the physical premises of the most violence risk-prone program to a another building on site. It was acknowledged that WSBC would follow-up in 2012-Q1. Minutes of the JOHSCtte meeting dated 2012-01-10 were received recently and there is a very significant attempt to capture the nuance of discussion. BCNU section 22 violence prevention advocate is attending most of the committee meetings. OHSR s. 4.28.(1) and 4.28.(2)(c) applies.
INSPECTION REPORT
Head Office
PROVINCIAL GOVERNMENT WORKERS' COMPENSATION PROGRAMS BC PUBLIC SERVICE A PO BOX 9404 STN PROV GOVT VICTORIA BC V8W9V1 Portion Inspected Violations Violence in the Workplace (VitW) REFER TO ORDERS ON FOLLOWING PAGE(S) Employer Representative Name Andy MacDonald Employer Representative Position Manager of Response Services Phone Number (604) 660-5813 Signature UPN Officer of the Board / Signature STEVENSON, JOHN Maples Adolescent Centre Crossroads Program 3405 Willingdon Ave Burnaby BC
Job Site
Accompanied by Employer Representative Andy MacDonald Accompanied by Worker Representative

section 22
Organization

Delivery Method: Email Also discussed at site. ------------------------------------------------------------
52B17 (R05/2007)
Printed:
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Page 1 of 5
INSPECTION REPORT
Inspection Text Comments issued on: Jul 24, 2012 A review of the order(s) cited in this inspection report has determined that further enforcement action is not necessary at this time. This decision relates only to this inspection date, location and order(s) noted on this inspection report. A follow-up inspection will occur and notice-of-compliance document is required to authenticate compliance with the order(s) noted.
Contact record CR 2012070890021 dated 2012-07-19 updates the file status. Issued on: 2012/04/19 This was a follow-up inspection to authenticate appropriate compliance with the order(s) noted.
section 22 Discussion on 2012-04-10 with UPN representative to review the file and determine status of the violence-in-the-workplace (VitW) risk assessment. The discussion points were corroborated with the manager of response A. MacDonald on 2012-04-11.
Incident Investigations and Near-misses WSBC's OHSR s. 4.27 - 4.31 and the associated policy items R4.28-1 - R4. 311 link the violence incident investigation process to the general accident investigation process. Completion of the investigation report must include an exploration of contributing factors, recommendations to prevent recurrence, an action plan and communication. See WCA s. 173(1)(b-d), 174(2)(a-c), 175(2)(a-b), and 176(1)(2)(a-b). As this is a joint management/worker investigation, every effort must be made to ensure that the affected worker(s) is/are the first choice as the worker representative(s), and that the process be initiated promptly to ensure effective recollection. The investigation of violence-related incidents must also include those incidents with the potential for serious injury and not just time-loss incidents; so-called near-misses. WCA s. 115(1-2), OHSR s. 3.10 and 4.28(2)(a) collectively require the employer to reduce risk and once a hazard is identified to take corrective actions without delay, including necessarily, the updating of behaviour and safety plans to mitigate risk. The implementation of a near-miss investigation process is incomplete though the criteria for completion of this process has been vetted by the Employer Representative joint committee. It was stated and acknowledged that Officer of the Board are still near-misses not effectively investigated in the Crossroads program and that very few Andy MacDonald STEVENSON, JOHN are initiated. The process is underway in the Response program. This 52B17 (R05/2007) Printed: 2012/11/08 08:18 shortcoming was first identified in IR 2011070890005 dated 2011-03-21 and repeated in IR 2011070890056 dated 2011-11-24. A recent time-loss incident investigation was reviewed at the comittee and
Page 2 of 5
INSPECTION REPORT
though the criteria for completion of this process has been vetted by the joint committee. It was stated and acknowledged that near-misses are still not effectively investigated in the Crossroads program and that very few are initiated. The process is underway in the Response program. This shortcoming was first identified in IR 2011070890005 dated 2011-03-21 and repeated in IR 2011070890056 dated 2011-11-24. A recent time-loss incident investigation was reviewed at the comittee and additional recommendations were made that identified a failure to effectively analyze, log and communicate violence risk propensity with the involved youth. This theme is a recurrent one that features as a contributing factor in many incidents including near-misses. Risk Assessment for Environmental Factors The initial violence risk assessment did not include an adequate environmental risk component. The Crossroads and Dala programs have traded physical space since the initial perception survey was undertaken. Additional assessments have been completed for these areas and the remainder of the site and that information is being compiled and will be rolled into the final risk assessment document as an appendix. Arising out of the risk assessment is the expectation to introduce risk controls that may include procedures, policies and work environment arrangements to eliminate the risk to workers from violence or if that is not possible, minimize the risk. See OHSR s. 4.29(a)(b). Education, Training and the VitW Program The BCNU violence prevention advocate sits (with other local site representatives) on a regional committee that reviews program resource content from other jurisdictions; e.g., from the adult forensic facility as well as the health authorities. It was stated that the PVPP on-line modules and classroom content available through OSH Connect will be audited. Two managers have been selected to attend the upcoming 3rd international conference on violence in the health sector scheduled for October 24-26. A draft VPP (v.3) dated 2012-01-31 was reviewed. It was stated that the work-alone check system procedures are operational. In addition (see p.7 under s.4 risk assessments), the draft must be edited to reflect OHSR policy R4.29-2 which states the VitW program must be reviewed annually. By inference the risk assessment process would be applied in a measured way consistent with the degree of shortcomings identified by the review, to assist in priorizing controls and to close any gaps in the safety Employer Representative Officer of the Board management systems.
Andy MacDonald 52B17 (R05/2007) Printed: STEVENSON, JOHN
2012/11/08 08:18
Page 3 of 5
INSPECTION REPORT
assist in priorizing controls and to close any gaps in the safety management systems.
Orders
Order No.
1
Decision
WCB Reference
OHS4.28.(1)
THIS IS A FOLLOW UP TO INSPECTION 2011070890005 ORDER 1. Order no. 1 of IR 2011070890005 dated 2011-03-21 has been complied with. On 2011-11-24, IR 2011070890056 was issued to capture progress re: the violence-in-the-workplace (VitW) risk assessment process. Some components from the employer's action plan were noted as in progress: 1.4 - exploration of the contribution of experience, education, training and supervision to incident response outcomes 2.0 - investigation of near-misses consistent with the process used for serious and/or timeloss incidents 2.1 - establish a workplace violence prevention program These items remain in progress. See 'inspection text' notes for additional comment re: these tasks and especially investigations. The environmental scan component missing from the initial risk assessment has now been completed and is being incorporated into the final document.
Order No.
Decision
WCB Reference
WCA173.(1).(c)
The investigation of near-miss incidents with the potential for serious injury is still not occurring in the Crossroads program which presents the most high-risk environment for assaultive behaviour. See comments in the 'inspection text' notes. This employer did not immediately undertake an investigation into the cause of the accident/incident that did not involve injury to a worker, or involved only minor injury not requiring medical treatment, but had a potential for causing serious injury to a worker. This is in contravention of the Workers Compensation Act Section 173 (1)(c). An employer must immediately undertake an investigation into the cause of any accident or other incident that did not involve injury to a worker, or involved only minor injury not requiring medical treatment, but had a Employer Representative Officer of the Board potential for causing serious injury to a worker.
Andy MacDonald 52B17 (R05/2007) STEVENSON, JOHN Page 4 of 5
Workers Compensation Act Part 3 Division 10 Subsection 173 (1) does not Printed: 2012/11/08 08:18 apply in the case of a vehicle accident occurring on a public street or highway.
INSPECTION REPORT
involved only minor injury not requiring medical treatment, but had a potential for causing serious injury to a worker. Workers Compensation Act Part 3 Division 10 Subsection 173 (1) does not apply in the case of a vehicle accident occurring on a public street or highway.
Order No.
Decision
WCB Reference
WCA194.(1)
You are required to notify the board in writing by 'Notice of Compliance' (NoC) stating the steps to be taken to correct the deficiencies cited in order no. 2. Per Workers' Compensation Act (WCA) s. 194(1), 194(2)(a) and 194(4)(d), the NoC must include an action plan with implementation schedule and be sent to J. Stevenson by May 11, 2012 at john.stevenson@worksafebc.com.
2012/11/08 08:18
Page 5 of 5
Page 1 of 2
CR 2012070890021
Name: Address:
Employer
ID: Name: Address:

City: Province:
Burnaby BC
Location: CU:
Details
Employer Representative Consulted: Phone Number: Consultation Date: Site Visit: Response Additional Employers:
2012/07/19 Activity occurred during core hours.
Regulations
OHS 4.29.(b) If a risk of injury to workers from violence is identified by an assessment performed under section 4.28 the employer must, if elimination of the risk to workers is not possible, establish procedures, policies and work environment arrangements to minimize the risk to workers.
Text
Admin Details
Hours Activity: 8.25 Officer Details Name: STEVENSON, JOHN Related Documents: WCB Project: Role: PRIMARY ROLE Travel:
3.75
Triggered By:
Page 2 of 2
CR 2012070890021
Internal
Issued on: 2012/07/19 Reviewed FirmFile history and JOHSCtte minutes dated 2012 05-01 and 06-12 prior to meeting with UPN representative to establish status of compliance actions on outstanding order re: near-miss incident investigations cited in IR 2012070890010 dated 2012-04-19. The environmental risk scan first identified as a component missing from the violence risk assessment in CR 2011070890051 dated 2011-10-06 has now been completed for the entire site. The tabularized results organized by building and topic include lighting, stairwells and exits, entrapment sites, sightlines, isolation, staff movement predictors, signage, building perimeter, security system, emergency assistance, vehicle compound, and the medication and file system. The tabularized results are included in the 06-12 minutes and recommendations for each topic deficiency are proposed but have not yet been priorized nor fully integrated into the overall VitW risk assessment. A recent time-loss incident arising out of an assault that occurred at the end of last month is being investigated. The claimant was attacked, bitten and choked seriously enough for transfer by BCAS to BUH. It was stated that the perpetrator was in a heightened state of frustration that had section 22 been escalating for . This is a recognized pattern and the assigned clinical psychiatrist (or psychologist) have validated this observation. The resident has been with MATC for about section 22 and the section 22 agitated behaviour repeats . Only two staff were assigned to the crossroads unit on the shift in which the assault took place, which was provoked in part by a denial for outside access time. The UPN representative was not able to provide documented criteria for the near-miss incident investigation process previously vetted by the JOHSCtte. It was also stated that there is no formalized and regular review process of resident behaviour charts for any indicators or patterns that might be indicative of an escalating propensity for aggressive behaviour. It was noted in CR 2011070890050 dated 2011-09-20 that regarding one exceedingly assaultive youth, the CCC was conducting a monthly review of the shift supervisors' weekly report summaries and that the information was forwarded to the JOHSCtte. WSBC stated that the process of reviewing and analyzing for triggers or patterns of aggressive behaviour as a VitW risk control measure is a requirement arising out of OHSR s. 4.29(b) and applicable to the recent assault. The UPN representative was advised to forward a copy of the incident investigation to WSBC. The UPN representative also stated that she attempted to introduce a VitW risk assessment tool (START) used by FPS staff for the adult population, but MATC management have discouraged the use locally as an inappropriate tool and inconsistent with MATC's attachment model for resident youth care. The 2-way radio system procurement process that involved independent engineering assessment has resulted in recommendations now resident with the senior management committee. The NoC for IR 2012070890010 due on 2012-05-11 has not been received yet though an e-mail update from the manager of response services highlighting some of the actions intended was received on 2012-05-17. The UPN representative was advised WSBC would follow-up in 2012-09.

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Obtained by Bob Mackin via Freedom of Information 2010goldrush@gmail.com twitter.

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

Site Visit Date 2010/11/09

Accompanied by Employer Representative Ray Lucken Accompanied by Worker Representative

For Internal Use Only

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

Employer Representative Roy Lucken 52B17 (R05/2007) Printed:

Officer of the Board STEVENSON, JOHN

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

Site Visit Date 2011/02/25

Accompanied by Employer Representative Roy Lucken Accompanied by Worker Representative

For Internal Use Only

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

Employer Representative Roy Lucken 52B17 (R05/2007) Printed:

Officer of the Board STEVENSON, JOHN

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

Site Visit Date 2011/02/25

Accompanied by Employer Representative Tom Jensen Accompanied by Worker Representative

For Internal Use Only

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

Employer Representative Tom Jensen 52B17 (R05/2007) Printed:

Officer of the Board STEVENSON, JOHN

Maples Adolescent Centre Crossroads Program 3405 Willingdon Ave

City: Province: Postal Code:

VICTORIA BC V8W9V1 294 841102

Project: Latitude: Longitude:

(604) 660-5811 2011/04/26

City: Province: Postal Code:

VICTORIA BC V8W9V1 294 841102

Project: Latitude: Longitude:

2011/09/20 Activity occurred during core hours.

Activity Type: Contact

For Internal Use Only:

Maples Adolescent Centre Crossroads Program 3405 Willingdon Ave

City: Province: Postal Code:

VICTORIA BC V8W9V1 294 841102

Project: Latitude: Longitude:

(604) 660-5813 2011/10/06 Activity occurred during core hours.

Activity Type: Contact

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

Site Visit Date 2011/10/06

Accompanied by Employer Representative Andy MacDonald Accompanied by Worker Representative

For Internal Use Only

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

Employer Representative Andy MacDonald 52B17 (R05/2007) Printed:

Officer of the Board STEVENSON, JOHN

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

Employer Representative Andy MacDonald 52B17 (R05/2007) Printed:

Officer of the Board STEVENSON, JOHN

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

The employer's notice-of-compliance was e-mailed on 2011-04-26.

OF BRITISH WORKERS' COMPENSATION BOARD COLUMBIA

Employer Representative Andy MacDonald 52B17 (R05/2007) Printed: