Job Specification

Purpose of Position :

The LTC Homes Assessment/Triage Officer, as a member of a highly trained inter-disciplinary inspection team is responsible to:
• promote the health, safety, comfort and rights of Long-Term Care (LTC) Home residents through the assessment of LTC homes information to determine requirements for inspections and potential non-compliance with the applicable legislation, regulations and standards
• have primary responsibility for obtaining detailed information, assessing the information to establish risk and triaging complaints and other reports from external/internal informants, critical incident system report management including review of report submissions by LTC Homes, decision making and follow-up
• initiate and follow the process by which information (complaints, reports etc.) about a home's operations coming from the public, residents and others, is received, recorded, logged and triaged to determine severity and risk to residents/staff
• determine the inspection program's response time and action
• support and conduct offsite inspections as required
• prepare correspondence, briefing notes and other materials as required
• promote and strengthen the quality of LTC Homes inspections
• support the Service Area Office and provincial inspection team.

Duties / Responsibilities :

The Performance Improvement and Compliance Branch is responsible for ensuring compliance with the LTC Homes Act, by reviewing information received for potential non-compliance, scheduling inspections based on risks presenting to residents, inspecting Long Term Care homes to identify non-compliance and then follow up to ensure compliance. This position works under the general supervision of the Manager, Quality, Intake and Innovation, Performance Improvement and Compliance Branch, and is responsible for performing the following functions in the English and French languages.

Intake/ Assessment and Triage 75%
• To receive external/internal calls, emails, Critical Incident Reports, complaints regarding LTC Homes, through the province's INFOline, correspondence and other pieces of information.
• To analyze received information and conduct inquiries under the Long-Term Care Homes Act, 2007, to determine the nature of all information. The position must quickly formulate detailed and appropriate questions related to many medical/clinical conditions in order to determine if the information provided indicates there is a risk to resident(s), including the degree of risk , and whether it falls within the legislative jurisdiction of the Long-Term Care Homes Act, 2007 and associated regulations, applicable service agreements or other policy or procedural requirement of the Ministry
• Provide information back to persons requesting information about general operations in the LTC Home and contextual information in regards to the clinical care provided to persons in LTC Homes, as it relates specifically to nursing.
• To gather information from the complainant / informant or other source of the information to enable an effective assessment of the situation.
• To manage contentious complaints/complainants and have effective and advanced skills in dealing with persons in emotional distress
• To have primary responsibility for tracking and triaging the intake of all information to quickly identify those issues which require immediate inspections or other types of inspections, to ensure compliance as required under the Long-Term Care Homes Act, 2007.
• Support and conduct requests for additional information/inquiry/ off-site inspections when required or when there is sufficient information to demonstrate an on-site inspection by an inspector is not required
• Evaluate, assess and document the immediate risk of potential harm to resident health, safety and welfare, including actions of long-term care home providers in relation to the provision of wound care, restraint application, falls management, declining resident health status, implications of medication errors and care provided in emergency situations, etc., and assign based on the information to the appropriate service area office/manager/lead for action to be taken.
• Use and apply professional clinical nursing knowledge, judgment and critical thinking to determine the questions required to gather sufficient information to then be able to make an assessment of the level of harm or risk of harm posed to residents and to allow for appropriate triaging of inspections. For example, this clinical knowledge and judgment would be applied to areas of resident care such as (including but not limited to the following examples): resident abuse and neglect, medication administration, skin and wound care; continence care and bowel management; pain management; use of restraints (physical, chemical, etc.); resident mobility and ambulation; dementia care; resident responsive behaviours; and infection prevention and control.

Example: Complainant calls re LTC Home not providing medication for diabetes management for his/her mother. Assessment/Triage Officer needs to ask questions and probe to understand mother's clinical condition and plan of care requirements, e.g., complainant explains mother saw specialist and requires new form of insulin that is given in the evenings on a sliding scale. Assessment/Triage Officer needs to understand what sliding scales are, medication requirements, blood sugar testing requirements, etc is and what the risks would be if the resident is not getting the medication and appropriate testing as required. Without this information and the clinical knowledge to understand and probe appropriately, inspections would not be prioritized and triaged appropriately leading to increased risks to residents.

• Complete intake documentation following all LQIP documentation principles with particular emphasis on ensuring information is clear, evidence based and comprehensive
• Provide information as the government agent to general inquires from the public about LTC Homes and the Long-Term Care Homes Act, 2007
• Communicate with complainants, residents, families, LTC Home staff and operators, Community Care Access Centres, Local Health Integration Network (LHIN) representatives, Coroners office, Ministry or other OPS staff, and other stakeholders to obtain details related to any piece of information about compliance with the legislation and identification of risk to a vulnerable population in over 640 long-term care homes within the province.

Advisor to the Managers and Directors of the Long-Term Care Homes 20%
• Provide expert technical and clinical knowledge regarding resident care, with a particular focus on the health care that is not appropriate or presents a risk/ threat to the quality of care of the residents in Long-Term Care Home settings
• Compile data, analyses, evaluate and prepare reports summarizing the analyses (e.g. trends and patterns of issues, Risk Indicator reports, etc.)
• Responds to LQIP program related requests, e.g., equipment purchases, HINF requests that require clinical evaluation, short term authorization requests, etc
• Contribute to briefing notes and other issues management functions, including providing details to manager of potentially contentious issues

Staffing and Licencing :

• Current registration as a Registered Practical Nurse (at minimum) with the College of Nurses of Ontario
• Willingness to travel small distances on a periodic basis for training and education

Knowledge :

• In-depth knowledge and experience of long-term care or health care operations. Staff must be able to understand the complexities of resident care in long-term care homes including the psychological, physical, social and medical impact a licensee's non-compliance could have on a resident and family members. Staff in this position must apply their clinical nursing skills to assess information and to discuss/interview persons on the care received by residents and how situations may be related to the care provided by the licensee vs the medical condition/disease process.

The following are some examples of resident care clinical and practice areas requiring an excellent knowledge and understanding of:
1. Resident abuse and neglect – legislative requirements, definitions, as well as prevailing practices and protocols in prevention and interventions, and steps LTCHs must take in reporting, investigating and communication;
2. Medication administration – medications used in the LTCH setting and the consequences of errors in medication administration, such as the interdependence of glucometer readings on sliding scale dosages of insulin or the possible side-effects that either narcotics or hypnotics might have when administered in error to the wrong resident;
3. Skin and wound care – skin/wound conditions affecting LTCH residents and the ability to distinguish between presentation of decubitus ulcers of various stages, skin tears, bruising and other wounds as well as contributing factors leading to the development of skin/wound conditions;
4. Continence care and bowel management – practices, interventions and protocols used in the management and support of residents' needs in continence care;
5. Pain management – practices, interventions and protocols used in resident pain management;
6. Restraints (physical, chemical, etc.) – legislative requirements, definitions, as well as prevailing practices, interventions and protocols in the use of restraints;
7. Mobility and ambulation – practices and protocols in physiotherapy and other interventions which support and optimize resident mobility and physical independence;
8. Dementia care – understanding the various types of dementias, including Alzheimer's, manifestations of symptoms and prevailing practices in care;
9. Responsive behaviours – understanding triggers for residents' responsive behaviours and a knowledge of potential preventative measures and interventions;
10. Infection prevention and control – knowledge of prevailing practices and approaches to the management and organization of preventative measures to address infection control and management.

• Clinical nursing skills and judgment, indicated in above examples, are required to determine if there is true risk of harm to residents and discuss medically complex situations and current clinical best practices articulately with other LTC Home regulated health professionals when conducting off-site inquiries or inspections.
• Apply clinical skills and judgement to determine what areas of the legislative requirements may be in non-compliance, identify the level of risk and triage the information accordingly to determine time frames for inspection.
• Knowledge of the various Acts and regulations governing LTC Homes, including the Long-Term Care Homes Act, 2007, the Provincial Offences Act and relevant Ministry/Division and program policies and procedures related to inspections and investigations
• Knowledge of current nursing clinical theories, practices and initiatives as they relate to the provision of care to residents in LTC Homes.

Skills :

• Extensive experience in communicating with clients about complex health care issues.
• Exceptional communication, listening and interviewing skills
• Excellent interviewing, assessment, triage and judgement skills
• Excellent problem-solving and conflict resolution skills and ability to diffuse and resolve contentious and highly sensitive issues
• Maturity, tact, flexibility, resourcefulness, assertiveness in effectively communicating with the complainants, the stakeholders, the public and LTC Home staff.
• Strong computer skills a necessity including utilizing word processing, database and spreadsheet applications, email, websites and electronic calendars
• Excellent written skills, including correspondence and briefing notes
• Exceptional ability to perform in a highly stressful change-oriented environment with minimum of supervision and to exercise initiative and independent sound judgement
• Ability to identify opportunities for the development of corporate supports, policies and programs such as Continuous Quality Improvement and Risk Management Program
• Ability to work collaboratively with staff in the Service Area Offices and with the provincial team.

Freedom of Action :

The position is responsible for promoting the health, safety, comfort and rights of residents by effectively and accurately gathering, documenting, assessing and triaging of information that is sent to the Director under the Act to ensure inspections are conducted within the time frames required by the Long-Term Care Homes Act, 2007. This information includes extensive complaints, critical incidents, correspondence, INFOline concerns, mandatory reports under the Act and other information.

This position requires judgment in dealing with contentious issues, sensitive personal health information, and complainants who are often upset or angry. Significant judgment is required to respond to client complaints appropriately and to prepare ministerial responses to client care issues.