New Long-Term Care Home Quality Inspection Program

The Long-Term Care Home Quality Inspection Program (LQIP) safeguards residents’ well-being by continuously investigating complaints, concerns and critical incidents, and by ensuring that all Homes are inspected at least once per year.

The purpose of LQIP is to:

This is achieved by performing unannounced inspections and enforcement measures as required, and ensuring that actions taken by the government are transparent. The MOHLTC conducts complaint, critical incident, follow up, comprehensive and other types of inspections.  Copies of the public version of inspection reports detailing all findings of non-compliance must be publicly posted in LTC Homes and provided to Residents’ and Family Councils. They are also published on the Ministry’s website. To obtain a Home’s inspection report, you can ask the Home directly or find reports on this website.

Key features of LQIP include:

Resident Quality Inspections (RQI)

The Ontario government recognizes the important role of long-term care homes in providing quality care to vulnerable residents.

The Ministry of Health and Long-Term Care is working with long-term care home operators, residents and their advocates, as well as Local Health Integration Networks (LHINs) to ensure continued safety and quality of care for residents.

Inspections include confidential interviews with residents, family members and staff, as well as direct observations of how care is being delivered. All inspections have been scheduled and will be completed by the end of January 2015.

Completed reports are posted publicly after personal information and personal health information are removed, which means there will be a difference in the number of inspections listed as completed below, and the number of final reports appearing online.

Resident Quality Inspections: Status Update as of January 30, 2015

The number below shows progress for these inspections

629 out of 629 Long-term Care Homes (100%)

Please note:  Reports can be found on
publicreporting.ltchomes.net/en-ca/Search_Selection.aspx

More Information on Resident Quality Inspections (RQI)

With the implementation of the LTCHA, all LTC Homes may be subject to an RQI inspection by LTC Home inspectors. An RQI inspection is a comprehensive inspection. During a Comprehensive Inspection, if deficiencies are discovered, further issue specific inspections will be conducted. The following Inspection Protocols are used in all Home inspections:

  • Admission processes
  • Dining
  • Infection prevention and control practices
  • Resident charges
  • Quality improvement practices
  • Resident’s Council Interviews
  • Family Council Interviews.

For all Homes, a standardized sample of residents (typically 40 in number) is randomly selected in advance from a provincial database. The purpose of Stage 1 is to conduct preliminary reviews of the quality of care and quality of life indicators (QCLIs) of these 40 sampled residents using a structured set of questions. This structured process ensures consistent results that are comparable across inspectors and Homes.

The RQI questions cover a wide range of QCLIs. Inspectors collect resident specific information in Stage 1 from observations, interviews (with residents, family, staff), and health records. The frequency of positive and negative responses to such questions as “Do you feel staff treat you with respect and dignity?” is analyzed by comparing them to thresholds shown through research to be predictive of the presence of non-compliance. Through analysis, this enables Inspectors to assess whether deficiencies may be present that warrant inspection in Stage 2.

The extent of an in-depth Stage 2 inspection is based on results of Stage 1 interviews, observations and record reviews. If there are no potential deficiencies from Stage 1, there is no need for the Stage 2 process. Stage 2 is the inspection of the triggered QCLIs from Stage 1. This inspection is conducted by using the corresponding Inspection Protocol and by responding to the relevant questions within the Inspection Protocol(s).

These Inspection Protocols require LTC Home Inspectors to gather the information necessary to determine whether or not standards of care set out in the LTCHA, and its regulations, are in compliance.

Following are some examples of Inspection Protocols which may be triggered:

  • Continence care and bowel management
  • Dignity, choice and privacy
  • Falls prevention
  • Minimizing restraint
  • Nutrition and hydration
  • Pain management
  • Personal support services
  • Recreational and social activities
  • Responsive behaviours
  • Safe and secure home
  • Skin and wound

All findings of non-compliance are documented within the inspection report. Inspectors have a duty under the LTCHA to identify in an Inspection Report all non-compliances found during the course of an inspection.

All inspections are unannounced (with very minor and narrow exceptions set out in s. 298 of Ontario Regulation 79/10 under the LTCHA) and the inspection schedule is randomized.

For each instance where ‘non-compliance’ with the legislation has been identified a decision must be made by the LTC Home inspector on the appropriate action to take, including whether to impose a sanction that is an Order.  At minimum the inspector will issue a Written Notification of Non-Compliance (LTCHA, 2007, C.8 s. 152.1).

Whether further action is required is based on an assessment of the following factors:

  1. The severity of the non-compliance
  2. The scope of the non-compliance
  3. The licensee’s past history of compliance, in any Home, with requirements under the LTCHA and with requirements under the Nursing Homes Act, the Charitable Institutions Act or the Homes for the Aged and Rest Homes Act, the regulations under those Acts and any service agreement required by any of those Acts.  (O. Reg. 79/10 s. 299(1))

Inspectors are required to apply the definitions of severity, scope and history of compliance (see appendix A below) when deciding on other actions that may be taken which may include:

  1. Voluntary Plan of Correction (VPC) – LTCHA, 2007, C. 8, s. 152.2
    • The inspector can make a written request for the licensee to prepare a written plan of correction for achieving compliance to be implemented voluntarily.  The licensee/Home is not required to submit the plan to the ministry.  There is no required compliance date set out in the inspection report.  The ministry expects to see compliance on the next unannounced inspection of the Home.
  2. Compliance Order (CO) – LTCHA, 2007, C.8, s. 153 (1)(a) and (b)
    • The inspector may order a licensee to:
      1. do anything, or refrain from doing anything to achieve compliance with a requirement under this Act or;
      2. prepare, submit and implement a plan for achieving compliance with a requirement under this Act.
    • The licensee/Home is required to follow the Order to achieve compliance with the LTCHA within the timelines for compliance set out in the Order.
  3. Work and Activity Orders (WAO) – LTCHA, 2007, C.8, s. 154 (1)(a) and (b)
    • The inspector may order a licensee:
      1. to allow employees of the ministry, or agents or contractors acting under the authority of the ministry, to perform any work or activity at the LTC Home  that is necessary, in the opinion of the person making the order, to achieve compliance with a requirement under this Act; and
      2. to pay the reasonable costs of the work or activity.
    • The licensee/Home is required to follow the Order to achieve compliance with the LTCHA within the timelines for compliance set out in the Order.
  4. Written Notification and Referral to the Director (WN & Referral) – LTCHA, 2007, C.8, s. 152.4

    The inspector may issue a written notification to the licensee and refer the matter to the Director for further action by the Director

    Other Inspections
    The LQIP also includes other types of inspections, for example, where there are complaints or incident reports or there is a follow-up from a previous inspection. In this case Stage 1 of the RQI or Comprehensive Inspection is not applied. The relevant Inspection Protocols are used to delve directly into the issue and determine if the Home is compliant with the LTCHA and its regulations.

    Inspection Reports:
    There are two versions of the Inspection Reports and Orders issued by the MOHLTC – one is the licensee version (LTC Home operator) and the other a public version.  The public version usually follows after the licensee version, as it requires careful editing to remove as much of the personal health information (PHI) and personal information (PI) as possible.

    Licensee Report – The Licensee copy of the report is given to the licensee which contains all information related to the inspection including resident health information (confidential and not to be shared).

    Public Report - The Public copy contains all information related to the inspection with personal health information removed as much as possible.  This report is given to the Residents’ Council, and Family Council and posted in the Home.  Please note that the MOHLTC removes select information, such as identifying details, from the public version of inspection reports to ensure that LTC residents cannot be identified and in order to respect their right to privacy.

    Note:  Inspection reports are edited in an effort to strike a balance between the government’s commitment to information transparency and the need to protect and respect individual privacy, which involves taking all reasonable steps to respect the privacy of individuals by removing as much of their personal information (PI) and personal health information (PHI) as possible.

Appendix A:
Severity, Scope and Compliance History Definitions

Levels of Severity of Non Compliance

Severity Levels Definitions
Level 1
Minimal harm
This non-compliance has the potential for causing no more than minor or negative impact on the resident(s).
Level 2
Minimal harm or potential for actual harm
This non-compliance results in minimal discomfort to the resident and/or has the potential (not yet realized) to negatively affect the resident’s ability to achieve his/her highest functional status.
Level 3
Actual harm
This non-compliance results in an outcome that has negatively affected the resident’s ability to achieve his/her highest functional status.
Level 4
Immediate jeopardy
This non-compliance places the resident in immediate jeopardy as it caused (or is likely to cause) serious injury, harm, impairment, or death to a resident receiving care in the LTC Home.

Levels of Scope of Non Compliance

Scope Definitions
Level 1
Isolated
When one or the fewest number of residents are affected and/or one or the fewest number of staff are involved, and /or the situation has occurred only occasionally or in a very limited number of locations (or units) in the LTC Home. Five per cent (5%) or less of the affected surveyed population.
Level 2
Pattern
When more than the fewest number of residents are affected and/or more than the fewest number of staff involved, and/or the situation has occurred in several locations, and/or the same resident(s) have been affected by repeated occurrences of the same non-compliance. Greater than 5% or fewer than 33% of the affected surveyed population.
Level 3
Widespread
When the problems causing the non-compliance are pervasive in the LTC Home and/or represent systemic failure that affected or has the potential to affect a large number of the LTC Home’s residents. Widespread scope refers to the entire population at the Home that were surveyed, not a subset of residents or one unit or location that was surveyed. Greater than 33% of the affected surveyed population. Or in the case of an infectious disease outbreak, when the Medical Officer of Health categorizes the situation as an “outbreak”.

Levels of Compliance History

Levels Definitions
Level 1
No previous non-compliance
No previous non-compliance within one full year of the date of the current inspection.
Level 2
Previous unrelated non-compliance
One or more unrelated non-compliance in the last three years (2 full years and current year)
Level 3
Previous related non-compliance
One or more related non-compliance in the last three years (2 full years and current year).
Level 4
Ongoing non-compliance despite previous action taken by ministry
Despite ministry action (written plan of correction to be implemented voluntarily) or issuance of an order, the licensee continues to be in non-compliance with the original area of non-compliance on the third inspection.
Level 5
Multiple non-compliances related and unrelated
Multiple non-compliances, with at least one related to the current area of concern.

If you are ready to locate a Home or view information on Long-Term Care Homes in your area, follow the link below :

View Reports on Long-Term Care Homes / Locate a Home

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