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Accountability

The licensing requirements to which all service providers in the residential services sector are held are contained in legislation, in regulation, and in policy. These set out the minimum requirements to be met by licensed providers of residential care to obtain and retain a license, authority for the Ministry to take action on non-compliance/ un-met standards, and are supported through inspection, enforcement and compliance activities by the Ministry. Requirements are largely the same for all licensed residential programs serving children and youth, across the child welfare, mental health and youth justice sectors. Youth justice has standards in addition to the legislative and regulatory requirements required by all residential programs. (MCYS, nd)

Part IX of the CFSA speaks to the licensing of children’s residential programs which is the primary accountability mechanism applied by the ministry to licensed residential services. Currently, there are two types of licenses issued by the Ministry: 1) license to operate a children’s residence (group homes), which may be operated by either staff (staff work in shifts to care for 3 or more children not of common parentage) or by live-in parent(s) (live-in parents provide care to 5 or more children not of common parentage); 2) license to provide residential care (foster care agency) to 3 or more children not of common parentage. Licenses are issued for residential services that are delivered by either a transfer payment agency directly funded by the Ministry or by a private per diem funded operator. Initially, an applicant is entitled to be issued a license if they apply for a license in accordance with the CFSA and its regulations and pay the prescribed fee, subject to any terms and conditions imposed by the ministry Director. Subsequent compliance and continuance of license is determined through an annual licensing inspection for TPAs and OPRs, and a compliance review for Directly Operated Facilities. A letter of compliance rather than a license is issued to Child and Parent Resource Institute and the YJ facilities that are directly operated by MCYS.

Concerns were raised throughout the consultations, and are echoed by the Panel, that a growing number of residential placements are unlicensed as a result of a legislative gap in the definition of licenses. Please see the section in this chapter pertaining to the Panel’s recommendations on the CFSA.

Five Ministry regional offices across the province monitor compliance with the CFSA. Most licensing activities are regionally based, including requirements for information and reporting, and new staff orientation and training. Although all regions use common software, each region maintains its own database. Questions about the interpretation and application of standards are submitted and responded to regionally by the corporate Clearinghouse. Questions and answers are not aggregated and disseminated to all regions for the collective benefit of licensing staff. The MCYS (2007), Improving Child and Youth Residential Services in Ontario: An Action Plan, in response to the Bay Report Children and Youth Residential Services Review (2006) identified the creation of centralized tools and training to promote common understanding and expectations around licensing across the province, but the Panel found limited evidence that this has occurred.

Licensing staff at the regional offices conduct annual licensing inspections which focus on a physical inspection of the residence, a review of policies and procedures of the licensee, file reviews, and interviews amongst a sample of staff (including foster parents) and residents. Licensees are given advanced notice of the annual inspection. The result of the inspection is a renewal of license with or without terms and conditions (which may provide time to comply), refusal to renew license, revocation of license, or suspension of license. The Panel was advised that the licensing inspection report is the property of the licensee, and that any visits to the residence by a licensing specialist outside the annual inspection period requires a program supervisor to enter the residence unless permission is granted by the service provider.

The Panel consulted extensively with respect to the licencing, licencing renewal and inspection function, receiving feedback from licencing specialists, program supervisors, regional directors, service providers, Children’s Aid Societies, placing agencies and young people. Overwhelmingly, concerns were raised relative to the licencing function and little confidence was expressed that it can be relied upon to ensure that a high standard of services are being provided in residential services. Licencing tools were described as having significant limitations by those who use them and as being inadequate to capture important information.

The absence of measures with respect to quality of care was identified by many as a significant shortcoming of the inspection process. In some cases, Ministry staff reported that they attempt to “be creative” in including concerns about quality as part of the inspection process. Other feedback indicated that on an ad hoc basis in one region, Ministry staff were introducing a quality checklist separate from the licencing checklist in order to address their concerns. The view was expressed that it is critical to assess quality of care in order to have confidence in the provision of care to vulnerable young people, however, we heard repeatedly that Ministry staff do not see themselves as having a mandate for assessing quality of care.

The Panel also heard that there are legislative limitations in the CFSA which act as barriers to licencing specialists conducting unannounced inspections of residences, thereby diminishing the value of the inspections. The Ministry is aware of this issue and will be considering it as part of the policy work underway stemming from the CFSA review.

The Panel also heard that there is a lack of communication and transparency with respect to sharing the results of licencing inspections and monitoring of homes. We were advised that the completed licencing checklist and supporting notes and documents often do not get shared with placing agencies. Some CASs indicated that they are only told whether the licence is renewed without any qualitative information. We also heard that while individual CASs may be aware of investigations or licensing conditions specific to a provider in their area, there are no provincial protocols with respect to continuing to place young people in these homes. Practices with respect to what gets shared with placing agencies appear to be variable across regions. There is no central ministry website with links to licences and reports.

Many people we spoke with indicated that there is a lack of transparency generally about concerns pertaining to residential operators and cited legal issues as impediments. Even between CASs, we were advised that reports and documented concerns about a home or operator are not shared, apparently due to concerns about breaches of privacy or the threat of civil liability. We were also advised that these concerns contribute to a reluctance to act with respect to bad operators and a very high threshold being required to take action. Licensing staff felt that it is extremely difficult for the Director under the Act to revoke a license, at times necessitating actions through means other than the licensing requirements of the CFSA and its regulations.

Accreditation has been recommended in previous reviews of the residential services system in Ontario as a way to evaluate, improve, and ensure quality. At present, accreditation is neither a mandatory requirement nor regular practice among residential service providers. Some private per diem operators and children and youth mental health centres are accredited and others are not. The Panel conducted a review of all publicly available information about accreditation models in Canada, as well as a literature review on the effectiveness of accreditation as a quality mechanism, and found that there is no clear evidence of the impact of accreditation on the quality of care delivered by service providers.