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How the Inspection Process Works

The Long-term Care Quality Inspection Program (LQIP)

The Long-term Care Quality Inspection Program (LQIP) is a major transformation of the Ministry of Health and Long-term Care inspection system.  It was developed to comply with the new Long-term Care Homes Act (2007) (LTCHA), which was proclaimed on July 1, 2010.

As in the previous inspection system, LTC home inspectors are required to inspect a home when:

  • a complaint is received;
  • a critical incident is reported; and
  • to follow up on a previous inspection. 

The Act also states that every long-term care home shall be inspected at least once a year.  

The inspectors use the specific MOH LTC Inspection Protocols to determine whether or not the home is compliant with the Act.  Inspection Protocols are tools to guide inspectors and include instructions, probes and questions to determine the status of a home’s compliance with legislation.  

There are five main types of inspections:

  1. Resident Quality Inspections (RQI).  These are the most comprehensive inspections of a long-term care home.  Comparable to the annual inspections under the old Acts but more in-depth, the RQI is a two-stage process.

Stage 1 –a preliminary inspection using interviews, records and observations of 40 randomly selected residents.  This stage also includes interviews with family and staff, as well as residents’ council and family council members

Stage 2 –an in-depth inspection of the care areas targeted based on the stage 1 inspection to determine compliance with the Act and regulations.

  1. Complaint Inspections – Inspectors respond to every complaint with a visit to the home.  Complaints, however, are triaged so that more serious complaints can be handled quickly. During complaint inspections, the protocols used are in accordance with the focus of the complaint.
  2. Critical Incident Inspections – These inspections are initiated as a result of a critical incident in a home.  In these cases the inspection specifically examines whether the home has complied with the regulations around reporting, documenting, and handling the incident.
  3. Follow-up Inspections – Inspectors are required to complete a follow-up inspection whenever there has been an Order issued to ensure compliance.
  4. Other Inspections – these include post-occupancy inspections, inspections initiated by the Ministry when a home has not been inspected during the year, or other special inspections.

Resident Quality Inspections (RQIs) are under the new system commenced in February 2011.  However, Critical Incident, Complaint and Follow-up Inspections have been occurring since July 2010. 

Inspection Reports

Each inspection visit results in a report; which is public and available on the MOH LTC website. Also, every long-term care home is required to post their recent reports in a conspicuous and easily accessible location.  If you don’t see the reports posted when you visit a home, you should ask at the reception desk.

Understanding the Inspection Report

Each type of inspection report gives the date and type of inspection, the purpose of the visit, and the names of the inspectors.  The report also lists whom the inspectors interviewed during the course of the inspection, which protocols were used, and the documents reviewed. 

The report states whether or not the home was found to be in compliance with the Act and Regulations.  

Each non-compliance results in a Written Notification (WN), which states the relevant section/subsection of the Act and the specific findings related to the non-compliance.  The report also lists Additional Required Actions, if any. 

The additional required actions may include the following, depending on the scope and severity of issue:

  • Voluntary Plan of Action (VPC) – the home is requested to voluntarily prepare a written plan of correction for achieving compliance with the specific section of the Act.
  • Compliance Order (CO) or Work and Activity Order –the home is required to comply with the order by a given date.
  • Directors Referral (DR) – the matter is referred to the Director of the Performance Improvement and Compliance Branch for further action.

Under the new Long-term Care Act, the Director, or designate, has the following powers:

  • Cease Admissions – direct the community care access centre to cease admissions to the home;
  • Mandatory Management – require the licensee (the holder of the provincial license to operate the home) to retain someone to manage or assist in managing the home, and
  • Revocation of Licence – revoke or refuse to renew the Home’s license

Note:  Inspection reports refer to the Licensee as the entity which is responsible for the non-compliance and for carrying out the voluntary or required actions.  This is because legally it is the Licensee, not the home administration, who is responsible.  In reality it is, of course, the home administration that carries out the action or order.

Concerned Friends receives electronic copies of every inspection report.  Our volunteers review each report and maintain a data base with the results of the inspections for each home.  In the case of the RQIs, we do a more detailed analysis which allows us to track and compare over time the most frequent areas of non-compliances.  We provide this information to members of the public who contact us.