Care services in senior residences: the 12-point verification checklist

Verifying the quality of care services is crucial. A good care residence can extend independence and quality of life. A poor one can cause rapid decline, medication errors, or avoidable complications. Here are 12 key criteria to inspect during your visit.

The complete checklist

1. Nursing staffing: ratio and coverage

Ask about:

• Total number of nurses and licensed practical nurses (LPNs)? Percentage full-time?
• Resident-to-nurse ratio? (Ideal: 1 nurse per 8–10 residents maximum)
• Schedule: actual hours of nursing presence? (Days, evenings, nights?)
• Overnight coverage: if no nurse overnight, who is available in an emergency?
• Staff turnover: stable team or frequent changes?
• Ongoing training: do nurses receive updated training on protocols and care standards?

Red flag: "One nurse for 30 residents," "on-call nurse only," "no confirmed nursing staff."

2. Actual hours of care coverage

Ask about:

• Nurse physically present: which days and exact hours?
• Weekends and holidays: same coverage?
• Overnight emergencies: exact protocol? How long before a nurse arrives?
• Request the written emergency protocol (should be given to residents and families)

Good sign: Nurse present 7 days/week, at least 9 a.m.–5 p.m. Overnight coverage either on-site or response time under 15 minutes.

3. Medication distribution protocol

Ask about:

• Which system? Blister pack, Dispill (automated dosette), or manual?
• Who supervises distribution: a nurse or LPN?
• Double verification: does someone confirm medications before handing them to the resident?
• Documentation: is there a tracking sheet confirming the resident took their medications? Is it actually filled out?
• Prescription changes: how quickly is the system updated when a doctor changes a prescription?
• Frequency: once a day? Twice? More?

Red flag: "Residents take their medications alone in their room" (= risk of missed or double doses). No documented supervision.

4. Emergency response protocol

Ask about:

• Written document: protocol for cardiac emergency, fall, allergic reaction, calling 911?
• Nurse response time to an emergency call: under 5 minutes? 30 minutes?
• First aid training for staff? CPR certification?
• Automated external defibrillator (AED) on site?
• Hospital/ambulance relationship: formal liaison protocol?
• Signed "care preferences" document for residents: resuscitation? Transfusion?

Good sign: Clear written document, first-aid-certified staff, nurse response under 10 minutes.

5. Care plan updates

Ask about:

• Frequency of care plan review: monthly? Quarterly? When conditions change?
• Who participates: nurse, doctor, resident, family?
• Written document shared: is a copy given to the family and the treating physician?
• Communication with prescribing physician: does the nurse transmit observations to the doctor?
• Adapting goals over time: is the plan updated as the resident's condition progresses or declines?

Red flag: "Care plan never reviewed," "no communication with the external physician."

6. Access to specialists and external care

Ask about:

• Are residents allowed to see an external doctor? (The answer should be YES)
• Is transportation provided for medical, dental, and optometry appointments? At what cost?
• Specialist follow-up: are specialist reports transmitted to the residence's nurse?
• Access to external physio, occupational therapy, speech therapy: permitted and supported?
• Specialist-prescribed medications: will the residence integrate them into the care plan?

Good sign: "Yes, transport is available. We request specialist reports and integrate them into the resident's file."

7. Respite beds and post-hospitalization transitions

Ask about:

• Are there respite beds (short-term) if temporarily increased care is needed?
• Policy: if a resident has a hospitalization crisis and then returns, can they return promptly?
• Post-hospital transition: increased nursing follow-up during the first weeks after discharge?

Good sign: The residence offers flexibility and supports smooth transitions.

8. Dementia and behaviour management capacity

Ask about (only if relevant):

• Experience caring for residents with advanced dementia?
• Staff training in managing aggressive behaviour or wandering?
• Non-pharmacological approach: activities, routine, calm environment?
• Use of behaviour-modifying medications: clear, supervised protocol?

Good sign: Dementia-trained staff, adapted approach, no over-medication.

9. Documentation and medical records

Ask about:

• Resident medical file: accessible to family on request (with consent)?
• Daily nursing observations: documented in substance? (e.g., "general condition good," not just checkbox ticking)
• Incidents and accidents: formally reported? Followed by incident analysis?
• Confidentiality: files properly secured, limited access?
• Archiving: how many years are records kept after a resident departs?

Red flag: "No formal file," "no written observations," incidents that seem to go unrecorded.

10. Billing transparency and costs

Ask about:

• Base monthly price: detailed breakdown of included vs. extra-cost services?
• Possible additional fees: which ones? How much? When are they added?
• Clear billing: sent regularly, itemized, easy to understand?
• Auditing: can you verify charges if you dispute them?
• Price increases: frequency? Notice period? Fair process?
• Written contract: signed before move-in, copy provided to family?

Good sign: Full transparency, detailed contract, no surprise charges.

11. Infection control and hygiene

Ask about and observe:

• Infection protocol: hand hygiene, protective equipment when required?
• On-site observation: are facilities clean? Are sinks accessible? Is soap/hand sanitizer available throughout?
• Isolation of sick residents: protocol for contagious flu or gastroenteritis?
• Urinary/respiratory infection rates: what is the incident rate? How quickly are they managed?

Red flag: Dirty facilities, staff not washing hands, no apparent protocol.

12. Personal fit and environment

Assess for yourself:

• Does the staff seem warm and patient?
• Do residents appear engaged and content, or apathetic and isolated?
• Smells, noise, overall atmosphere: acceptable?
• Visible activities: are residents occupied, or sitting in front of the TV all day?
• Visitor policy: flexible and welcoming, or restrictive?
• Management communication with families: responsive? Proactive when problems arise?

Good sign: Warm environment, evident engagement, accessible staff.

How to conduct the inspection visit

Before the visit

1. Call to schedule an appointment (avoid surprise visits; the residence may do a special cleanup)
2. List the 12 criteria plus your specific questions
3. Bring a notebook and pen for notes
4. Bring your loved one if possible (observe their reaction to the atmosphere)

During the visit

1. Ask to see: a sample room, common areas, the kitchen, the nursing station if accessible
2. Observe: hygiene, staff-resident interactions, activities, overall atmosphere
3. Ask the 12 key questions calmly and note the answers
4. Ask to speak with a nurse or the consulting physician if possible
5. Visit duration: 1–2 hours minimum for a proper overview

After the visit

1. Compare notes with your loved one if they came along
2. Verify MSSS certification (registre.msss.gouv.qc.ca)
3. Call references: a former resident or family member (ask management)
4. Sleep on it — first impressions are not everything
5. Compare with 2–3 other residences before making a final decision

Useful resources and links

• Residences with care — General overview
• Medication distribution — Legal details and protocols
• 24/7 care — When it is essential
• Additional care costs — Detailed breakdown
• MSSS Registry: registre.msss.gouv.qc.ca — Verify certification