Sheridan Villa action plan
The annual Resident Experience survey took place in August, 2023 and Family/Caregiver Experience survey took place in October, 2023. Resident surveys were administered in-house with the assistance of volunteers, while family surveys were distributed both by mail as paper copies and via email with a SurveyMonkey link for online completion. Paper surveys were later entered into SurveyMonkey, and the results were compiled.
The analysis of our 2023 Resident Experience Survey results indicated overall satisfaction with the accommodation, care, services, programs, and goods provided to our residents. Additionally, it highlighted specific areas where targeted improvement efforts are needed to further enhance the resident experience.
Dietary Services
Focus of improvement
To improve the dining experience of residents.
Key actions
- Discussing available menu choices with the residents for menu compilation.
- Hosting taste testing of the available menu choices for residents.
Outcomes of action
- Implemented October 2024.
- In progress
Activation Services
Focus of improvement
To increase resident engagement.
Key actions
- Adding 2 more part-time lines for improving resident engagement.
- Improving purposeful engagement with the residents.
- Training to staff regarding butterfly model/emotion-based care for improving resident satisfaction.
Outcomes of actions
- Implemented July 2024.
- Completed
Focus of improvement
To improve physical and mental health of the residents.
Key actions
- Introducing wheelchair yoga program for the residents.
- Introducing additional physical activities on the 4th floor (including basketball, ping pong set, etc.)
Outcomes of actions
- Implemented March 2024.
- Completed
Focus of improvement
To ensure that all residents have access to the information about the activities available to them.
Key actions
- Installing board at the main floor wall for displaying special events and the monthly activation calendar.
- Providing monthly newsletter with activation information to residents and families.
Outcomes of actions
- Implemented July 2024.
- Completed
Focus of improvement
To improve the gardening program.
Key actions
- Introducing “Root in nature” therapeutic horticulture program.
- Building raised garden beds in the home.
- Engaging residents in home wide gardening program for the front garden beds.
Outcomes of actions
- Implemented May 2024.
- Completed
Facility Services
Focus of improvement
To ensure that residents are provided with comfortable and safe environment.
Key actions
- Replacing lounge chairs with seating that can be disinfected.
- Replacing bedside dressers.
- Replacing current beds with new span beds.
- Utilizing Maximo software for easy and early documentation and maintenance.
Outcomes of actions
- Implemented April 2024.
- Completed
Nursing Services
Focus of improvement
To ensure on-request medication is administered in a timely manner.
Key actions
- Conducting medication administration audits at daily, weekly, and monthly basis.
- Monthly education of registered staff by Pharmacist.
Outcomes of actions
- Implemented July 2024.
- Completed
These are the priority areas identified for the year 2024/25. Sheridan Villa’s Quality Improvement Initiatives align with annual submissions of Quality Improvement Plans.
Focus of improvement 1
To reduce the rate of ED visits.
Key actions
- Utilizing PreviewED tool.
- Recertifying PoET project.
- Initiating PDSA project for reducing ED visits.
- Using SBAR tool.
Outcomes of action
Implemented July 2024.
Focus of improvement 2
To ensure staff complete equity, diversity, inclusion, and anti-racism education.
Key actions
- Providing DEI training to staff members.
- Ensuring inclusive leader training.
Outcomes of action
Implemented July 2024.
Focus of improvement 3
To improve communication skills of staff.
Key action
Educating staff on effective communication techniques.
Outcomes of action
- Implemented October 2024.
- In progress
Focus of improvement 4
To reduce the number of residents who are having antipsychotic drugs without diagnosis of psychosis.
Key actions
- Implementing evidence-based interventions, monitor medication practices, and provide targeted education to interdisciplinary teams.
- Implementing an antipsychotic review pathway for new admissions.
Outcomes of action
Implemented July 2024.
The Resident Council holds monthly meetings where members can ask questions, share their expectations, and discuss their preferences for care and treatment. Quality Improvement plans are a standard agenda item at both Resident Council and Family Council meetings. Regular updates on the status of action plans are provided, and feedback from both councils is collected and documented in meeting minutes. Additionally, ongoing updates about the plan's implementation are posted on the information board.
Quarterly Continuous Quality Improvement (CQI) meetings are held to provide progress updates and identify areas needing further attention. CQI is a permanent agenda item at all Committee and Department team meetings. The CQI Committee aids in implementing the action plan by offering recommendations and continuously assessing the effectiveness and sustainability of the actions taken.
Including outcomes based off RES, FCES, and Home’s Priority Areas
Residents: Information was shared to residents through the Resident Council meeting minutes. The action plan was discussed in the Resident Council meeting on March 20, 2024, and the outcomes were communicated on September 25, 2024.
Families: Details were provided to families through the Family Council meeting minutes. The action plan was discussed during the Family Council meeting on May 21, 2024, with outcomes scheduled to be shared on October 15, 2024.
Residents were informed about the action plans through postings on the Resident Council board on September 25, 2024.
Staff: Updates were shared via CLT and CQI meetings, where action plans were discussed regularly. The outcomes were presented during the CQI meeting on August 7, 2024. Ongoing updates regarding plan implementation were posted on the quality board on June 28, 2024.