#	Recommendation	Management Response	Est Comp Date	Status Updates (In Progress; Pending; Complete; Requires Resolution)
2	That the Branch review the MOHLTC standard for mandatory training, measure adherence and revise accordingly with the goal of meeting the expectation that 100% of staff are attending all annual mandatories as defined by MOHLTC standards.	Management agrees with this recommendation. However, it is important to note that there is a difference between mandatory training requirements of the Ministry of Health and Long Term Care and developmental training provided by the LTC branch.		December 2009: Pending. In an effort to improve delivery and effectiveness of mandatory training programs, management reviewed a training delivery model that would ensure 100% completion of training by all full-time, part-time and casual staff members. The estimated costs of this model are $195,000 for staff attendance and $90,000 for implementation. Funding for this model will be brought forward as an identified pressure in the LTC 2010 budget.
7	That the Branch’s three year cycle for policy review include a work plan highlighting the policies to be reviewed and target dates.	Management agrees with this recommendation. Work plans highlighting policy review target dates are coordinated by each functional team area, which maintains approval authority for the policies and procedures. LTC will review the centralization of these work plans in Q1 2009 and will include this requirement in the functional team terms of reference. In addition, a requirement to report on progress will be incorporated into quarterly LTC reporting requirements. As a result of this review, the branch may need to request funding in the next budget for a centralized FTE to fulfill this role.	Q1 2009	December 2009: In Progress. Functional teams are preparing their departmental policy and procedure workplans for Branch Management Team approval to ensure consistency with the new LTC Homes Act. Timeline for completion is Q3 2010.
8	That the Branch review its Health and Safety policies to align them with the Health Care Regulations in order to assist the Branch to respond more succinctly to a Ministry of Labour Inspection and ensure that it meets operating requirements.	Management agrees with this recommendation. The Occupational Health and Safety division will assist LTC with a review of their health and safety policies by the end of Q2 2009, in an effort to better align them with Health Care Regulations.	Q2 2009	December 2009: In Progress. Policies and procedures will be modified as required in January 2010. Once the LTC Homes Act is proclaimed, the policy and procedures will once again be reviewed to ensure compliance. Timeline for completion is Q3 2010.
12	That the Branch adopt the practice that has been employed at Champlain for the “Journal interne Soins infirmiers”.	Management disagrees with this recommendation. There are branch and home templates for staff, resident and family newsletters. The practice at Champlain represents a diversion from branch policy and a duplication of work. This practice represents an inconsistency in staff communication and the branch director would like to see it discontinued by Q4 2008. Elements of the Champlain newsletter will be incorporated into the templates. The required process will be documented as part of a long term care comprehensive communication program for staff.		December 2009: Requires Resolution. In accordance with management response, a long term care comprehensive Communication Plan has been developed and was implemented in June 2009. A monthly newsletter is distributed to all staff in all service areas from the Long Term Care Branch.
15	That the City complete the procedures in the Managers Tool Kit and combine the various manuals into one key binder as well as update the OZONE intranet site.	Management disagrees with this recommendation. The ‘LTC Managers Tool Kit’ was developed as an orientation tool for new managers in LTC. The toolkit is a reference manual, not a policy and procedure manual and refers managers to Ozone for various types of information. The toolkit is updated regularly, as new information becomes available via e-mails to managers. It is the individual responsibility of each manager to insert the revised information into their respective manual. This process will be reviewed and the reassignment of this task to the same responsibility centre for revisions to other policy and procedures manuals in each home will be considered. The toolkit has been shared at a departmental level. It is outside the scope of authority for the LTC branch to make this toolkit a corporate resource.		December 2009: Requires Resolution. A manager’s toolkit has been assigned to the Manager of LTC Support and will be reviewed on a quarterly basis to ensure information is up to date. A first quarter review was completed in November 2009.
17	That the Branch and FSU develop a consistent mechanism to analyze the gapping requirement against the Service Delivery Model and quality indicators such that the impact of the practice on residents can be assessed.	Management agrees with this recommendation. A new Corporate Vacancy Allowance policy has been approved by Executive Management Committee, which established a gapping rate of 1.6% per department. LTC, Financial Services and Human Resources will enhance current gapping reports to improve gap analysis so that quality indicators such as impact of the policy on service delivery can be assessed. This will be implemented by Q4 2009.	Q4 2009	December 2009: In Progress. Assistance in analyzing and running ad hoc reports from SAP with data on hours and cost is currently being provided by the FSU when requested. FSU has received feedback from the client that the information currently provided is acceptable to allow them to effectively manage their resources. Investigation is underway into the availability of reports through the recently implemented Telestaff software to augment current analysis. The Finance Department’s FMIS group has included in its 2010 workplan, a review of the Personnel Cost Planning (PCP) tool maintained by the Human Resources Department to identify opportunities for additional reporting functionality.
18 18	That the Branch and FSU develop a preferred accommodation policy and associated procedures to be shared with the Community Care Access Centre in order to provide clarity and an avenue for communication to continue to improve preferred revenue income.	Management disagrees with this recommendation. LTC currently has policies and procedures in place to notify the Community Care Access Centre when bed vacancies arise. This policy has been shared with the CCAC to ensure that preferred accommodation is maximized. It requires that the type of accommodation available (preferred or basic) be identified at the time of notification. LTC complies with regulation 39.0.1 under the Homes for the Aged and Rest Homes Act which states that, “a home shall ensure that no more than 60 per cent of the bed capacity of the home is set aside as preferred accommodation”. Collectively, preferred accommodation revenue was at 96% for 2006, 97% for 2007 and is at 99% as of the end of August 2008.		December 2009: Requires Resolution.
27	That the Branch, in concert with the FSU, develop policies and procedures for the management of trust accounting that are reflective of MOHLTC program standards and provincial legislation and regulations and which clearly define the accountabilities and responsibilities of the Branch and the FSU.	Management agrees with this recommendation. LTC and the FSU currently comply with policies and procedures regulated under the Homes for the Aged and Rest Homes Act. Each year a third party financial audit is conducted to ensure compliance with specified ministry guidelines. Financial Services and LTC will formalize and document current policies and procedures by Q4 2009	Q4 2009	December 2009: In Progress. The FSU in concert with LTC Branch Administration will formalize current policies and procedures related to the financial administration of Resident Trust Accounts for approval by the City Treasurer by Q3 2010.
33	That the Branch review its accountability framework as it relates to financial requirements and move to an integrated budgeting approach in conjunction with the CPS Department and City as a whole.	Management disagrees with this recommendation. The Auditor General has concluded that Corporate Finance provides guidelines and parameters for budgets and this practice leaves fewer opportunities for decision-making at the branch level. Management receives budget guidelines and parameters from City Council, not Corporate Finance. Yearly targets are identified through the branch hierarchy and are then reviewed at a branch/departmental level prior to being presented in the draft budget. The Long Range Financial Plan also allows the branch to identify required needs within the City Operations department and the City as a whole.		December 2009: Requires Resolution.
41 41	That the Branch work with the FSU to improve financial reporting and ensure PSAB compliance.	Management agrees with this recommendation. Financial Services will continue to provide monthly operating and capital reports and ad hoc variance reporting as required. Finance will comply with the PSAB 3150 requirement, coming into effect on 1 January 2009, for reporting on the 2009 financial statements by mid 2010. New reporting standards are currently being developed by Financial Services and training of appropriate staff has commenced.	Q3 2009	December 2009: In Progress. Financial Services will continue to provide monthly and quarterly reports to the LTC Management Team as well as ad hoc reports when required. Monthly accruals are processed for compensation and significant contacts (i.e. Aramark Food Services for Champlain). The FSU also participates in Financial Benchmarking Surveys requested by OANHSS (Ontario Association of Non-Profit Homes and Services for Seniors). Pre-2009 City assets have been valued, approved, and loaded into the TCA solution and SAP production. 2009 asset transactions have been requested and will be included as part of the 2009 financial reporting.
44	That the Branch review its fundraising activities to assess possible revenue sources on behalf of residents.	Management disagrees with this recommendation. The homes do not have a fundraising role. However, commencing February 2009, LTC will have staff representation on the new Long Term Care Prosperity Fund Board of Directors. This is a new community-based initiative with the intent to leverage community funds for supplemental long-term care programs.		December 2009: Requires Resolution.
47	That the Branch develop improved access card procedures, particularly with respect to the issuance of cards to residents/families and to the processes for after hours cancellation.	Management disagrees with this recommendation. Effective procedures are currently in place with respect to access cards. In addition, there is a process in place for immediate cancellation of cards after hours. The Power of Attorney for personal care has the authority to contact the Home’s administrator to verbally change the access hours for a card during a situation of end of life care. The facility charge nurse has the authority to contact the administrator or their designate to authorize a change in card access after hours as per policy and procedure (reference no.: 750:25 Access cards – Families and Residents). This policy will be reviewed with staff in Q2 2009.	Q2 2009	December 2009: Requires Resolution. Policy and procedure was re-communicated to staff in May 2009 via email and was reviewed at a staff meeting.
51	That during the next round of strategic planning for CPS the Branch take on a more active role to ensure the vision of the Branch is reflected in the CPS Plan.	Management disagrees with this recommendation. LTC is actively involved in departmental planning and believes that the branch vision is adequately reflected in the City Operation department’s plan. Since 2001, LTC has had a strong focus on resident/customer satisfaction. Both the departmental and corporate plans reflect this vision.		December 2009: Requires Resolution.
55	That the Branch assess the risk of absence of the sole staff member responsible for the Balanced Scorecard indicators and respond with an appropriate contingency plan.	Management disagrees with this recommendation. This function is not that of a sole staff member. All managers are responsible for entering their program data into the balanced scorecard templates and there is a manager with oversight responsibility for the program. To date there have been no issues		December 2009: Requires Resolution.
56 56	That respective roles and responsibilities of the FSU, RPAM, Employee Services, Branch staff and home staff be documented within a service agreement with performance standards and expectations.	Management agrees with this recommendation. Service level agreements currently exist, but will be updated to reflect specific roles and responsibilities, performance standards and expectations. Human Resources will work with LTC to update their service level agreement by the end of Q2 2009. RPAM will begin work with LTC to develop a service level agreement in Q3 2009. With respect to the FSU, roles and responsibilities will be documented as organizational restructuring develops. This will be completed by Q1 2010.	Q1 2010	December 2009: Pending. Service Level Agreements for Shared Services are currently being reviewed by the ODP department. Finance will use the results of this broader discussion as input into determining a departmental approach. FSU has received feedback from the client that the service level is acceptable.
57	That the orientation program provided for new City Councillors incorporate a segment that outlines their responsibilities under the LTC Act and the OHS Act.	Management agrees with this recommendation. As part of the next new Councillor orientation program, LTC will review information provided and will ensure that materials are updated to reflect any changes with respect to the new Long Term Care Homes Act by Q3 2010. In addition, Occupational Health and Safety (OH&S) will incorporate an overview of the employer's responsibilities under the OH&S Act.	Q3 2010	December 2009: In Progress.
59	That, following the implementation of Telestaff, the Branch and FSU work together to produce staffing reports to measure against effectiveness of the Service Delivery Model.	Management agrees with this recommendation. LTC, Financial Services and Human Resources will develop reports to measure service delivery model effectiveness following implementation of Telestaff in Q3 2009.	Q3 2009	December 2009: In Progress. The last Home (CAC) was implemented in September 2009. Q4 2009 will focus on identifying reporting needs and implementation. Assistance in analyzing and running ad hoc reports from SAP with data on hours & cost is currently being provided by the FSU when requested. FSU has received feedback from the client that the information currently provided is acceptable to allow them to effectively manage their resources. Investigation is underway into the availability of reports through the recently implemented Telestaff software to augment current analysis. The Finance Department’s FMIS group has included in its 2010 workplan a review of the Personnel Cost Planning (PCP) tool maintained by the Human Resources Department to identify opportunities for additional reporting functionality.
65	That the Branch review the requisite skills and roles of the social worker position to determine the best use of this staff position from the joint perspectives of its contribution to the interdisciplinary care to residents and cost effectiveness.	Management agrees with this recommendation. This position is presently under review to identify the elements of the position that are administrative and the elements of the position that draw on social work expertise. Job evaluation results are expected to be complete by Q1 2010.	Q1 2010	December 2009: In Progress. The Long Term Care Branch is awaiting the detailed regulation to accompany the new LTC Homes Act with respect to anticipated changes regarding the social worker position and role (Q1 2010).
68	That upon implementation of the Telestaff system, the Branch and FSU work together to develop a regular schedule of reports and variance analyses that will assist managers in determining appropriate staffing levels.	Management agrees with this recommendation. LTC, Financial Services and Human Resources will develop reports to measure service delivery model effectiveness following implementation of Telestaff in Q3 2009.		December 2009: In Progress. The last Home (CAC) was implemented in September 2009. Q4 2009 will focus on identifying reporting needs and implementation. Assistance in analyzing and running ad hoc reports from SAP with data on hours & cost is currently being provided by the FSU when requested. FSU has received feedback from the client that the information currently provided is acceptable to allow them to effectively manage their resources. Investigation is underway into the availability of reports through the recently implemented Telestaff software to augment current analysis. The Finance Department’s FMIS group has included in its 2010 workplan a review of the Personnel Cost Planning (PCP) tool maintained by the Human Resources Department to identify opportunities for additional reporting functionality.
71 71	That the Branch, in consultation with RPAM, develop a long-range asset management plan that encompasses a replacement plan over a minimum 20-year horizon for all buildings and equipment	Management agrees with this recommendation. As the Corporate Landlord, RPAM has conducted the necessary condition reviews on Carleton Lodge, Centre d’Accueil Champlain and Peter D. Clark Home in order to establish a long-range capital lifecycle renewal plan and comprehensive asset management plan for the City’s long-term care facilities. The results of these condition reviews have been factored into the overall lifecycle renewal plan over the next 20 years with a significant investment already being made, most notably, at Carleton Lodge. As it is a newer facility, a condition review of the Garry J. Armstrong Home will take place in five years time and the result will be incorporated into the overall lifecycle renewal program.		December 2009: In Progress. LTC will be meeting with RPAM to discuss life cycle renewal in April 2010.