draft - lhin home and community carehealthcareathome.ca/champlain/en/who/documents/2017_01... ·...

DRAFT

Outcomes: DM – Decision Making DS – Discussion IE- Information/Education

Strategic Direction: PDC – Person Driven Care EPP – Engaged and Proactive People SHC – Sustainable Health Care

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BOARD OF DIRECTORS’ MEETING DATE: January 18, 2017

TIME: 12:00pm-3:30pm PLACE: Labelle Head Office Boardroom

AGENDA

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12:00-12:10

1.0 Call to Order 1.1 Welcome

1.2 Declaration of Conflict of Interest

Denise Alcock

Denise Alcock

V-B-14

2.0 Approval of Agenda (including consent

agenda) Denise Alcock DM

3.0 Consent Agenda (Any Board Member may

request that any item be removed from consent agenda and moved to the regular agenda)

Denise Alcock

DM

3.1 Minutes from the December 14, 2016

Board meeting 3.1.1 Status of Follow-up/Action Items

from Previous Board Minutes

DM

IE

ALL

ALL

3.2 SPO Performance Management Update

IE ALL

3.3 Action Plan Status Report

IE ALL

3.4 French Language Services Report

IE ALL

12:10-

12:40

4.0 FY 2016-17 Year-End Audit Service Plan

– Deloitte

Doreen Hume

(guest)

IE SHC

12:40-

1:10

5.0 Board Chair and CEO Reports (verbal)

5.1 System Transformation Update (verbal)

Denise Alcock /

Marc Sougavinski

IE ALL

1:10-

1:30

6.0 CSQS Reports

6.1 Medical Assistance in Dying (MAID) Discussion (verbal)

6.2 Summary Scorecard – Quality Indicators

Melody Isinger / Catherine Butler

DS IE

PDC ALL

1:30- 2:00

7.0 Financial Reports 7.1 Summary Scorecard

7.2 Financial and Performance Results

Maria Barrados/

Deryl Rasquinha

IE

IE

SHC

SHC

2:00-2:10

8.0 Governance Reports (verbal) Bill Skinner / Patrice Connolly

IE SHC

DRAFT

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Outcomes: DM – Decision Making DS – Discussion IE- Information/Education

Strategic Direction: PDC – Person Driven Care EPP – Engaged and Proactive People SHC – Sustainable Health Care

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9.0 Other Business 9.1 Public questions and comments

Denise Alcock

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2:10 10.0 In-camera X

Adjournment Denise Alcock DM

Minutes – Champlain CCAC Board of Directors, December 14, 2016

Champlain Community Care Access Centre Centre d’accès aux soins communautaires de Champlain

Head Office

4200 Labelle Street Suite 100 Ottawa ON K1J 1J8 Siège social 4200, rue Labelle Bureau 100 Ottawa ON K1J 1J8

Tel/Tél : 613 745 5525 800 538 0520 Fax/Téléc : 613 745 1422

www.champlain.ccac-ont.ca

MINUTES

Board of Directors Meeting

Held December 14, 2016

Labelle Head Office Boardroom

BOARD

MEMBERS:

Denise Alcock

Abebe Engdasaw

Andrée Durieux-Smith

Bill Skinner

Melody Isinger

Michael Ennis

Robert D’Aoust

Sherryl Smith

Chair

Chair of Governance Committee

Chair of CSQS Committee

REGRETS: Barbara Foulds

Maria Barrados

Treasurer / Chair of Finance & Audit Committee

STAFF

PRESENT:

Marc Sougavinski

Catherine Butler

Deryl Rasquinha

Patrice Connolly

Jennifer Proulx

Chief Executive Officer

Vice-President, Clinical Care

Vice-President, Performance and Strategy

Vice-President, People and Stakeholder Engagement

Director, Quality and Program Evaluation

RECORDER: Linda Stewart Executive Assistant

GUESTS: none

AGENDA ITEM ACTION TO BE

TAKEN

1.0 CALL TO ORDER

1.1 Welcome

Denise Alcock, Board Chair, welcomed everyone to the meeting.

1.2 Declaration of Conflict of Interest

There was no declaration of conflict.

2


2.0 APPROVAL OF AGENDA

It was moved by Abebe Engdasaw, seconded by Sherryl Smith and agreed to approve

the amended agenda (‘6.0 Financial Reports’ was moved to in-camera, and

‘Community Reports’ was added as new item 6.0), including the consent agenda for

the December 14, 2016 meeting.

CARRIED

Motion Carried

12-16-65

3.0 CONSENT AGENDA

The consent agenda for the December 14, 2016 Champlain CCAC Board meeting

contained the following information items and motions:

3.1 That the Champlain CCAC Board approves the minutes of the November

16, 2016 meeting

3.1.1 Status of Follow-up/Action Items from previous Board minutes

3.2 Draft Finance and Audit Committee minutes from the December 5, 2016

meeting, containing Financial Updates and Decisions

3.2.1 Financial Statements

3.3.1 Quality Reports: Quarterly Events Reporting

3.3.2 Quality Reports: Quarterly Complaints Reporting

3.4 Bi-Annual Patient and Caregiver Council Update

3.5 SCOPA Report

Approved by motion 12-16-65

4.0 BOARD CHAIR AND CEO REPORT

The Board Chair reported:

All board chairs participated in a session with Eric Hoskins; his message was a

positive one towards CCACs, acknowledging the CCACs’ contribution to

primary health care, and said that the integration is not a reflection of the

CCACs’ business. His message also included that it was the Ministry’s hope

that the CCAC CEOs would step into the VP Home Care roles

He went on to explain that if there is a position which could be filled by

someone from either the LHIN or the CCAC doing the same/similar role, there

will be a competition. There is much expertise within the CCAC, and there

are many positions in the CCAC that they do not have in the LHIN

It was the Board’s hope that there would be an ethics component in each of the

new organizations

There was concern for possible conflicts of interest within the new business,

i.e., it’s a fundamental, generally expected business process that your payables

person doesn’t also do your receivables; and that if the business wasn’t set up

appropriately, there could be a great potential for the public’s perception of

financial mismanagement. However, the MOHLTC feels that they’re not in a

conflict of interest position

3


The CEO reported:

The transition is expected to commence in May/June 2017

The MOHLTC will be sending consultants to each region to determine

readiness of LHINs and regions – January 10-11 for Champlain (to be

confirmed); vendor hasn’t been announced as of yet

Each LHIN CEO has received the confidential KPMG report – highlights were

provided in the in-camera package. Should any Board member want to view

the full report, please let Linda Stewart know and she will send it

MOHLTC pushing for 5 VP structure; LHIN will be sending org chart

suggestions to MOHLTC by December 23; looking to start filling positions

mid-January

Efficiencies: MOHLTC seeking administrative efficiencies of $800K between

the LHIN and CCAC; the 800K will be taken from the budget of the new

organization on April 1, 2017, put in a provincial bucket, and redistributed for

prioritized clinical services

ACTION: Any Board

member wishing to read

the full KPMG LHIN

Renewal Expansion

report should contact

Linda Stewart to send

5.0 CSQS REPORT

5.1 Adverse Events Status

The Board discussed an adverse event relating to prescription error by a nurse practitioner led to hospitalization of a 60-year old palliative care patient. Suggestions to avoid such errors in the future were discussed.

5.2 Accreditation Update

We were granted the one year deferment; not appropriate to make decision to

go through the next steps (site survey; etc.) as it will be up to the new

organization

At the interest of keeping CCACs part of the program, Accreditation Canada

proposes minimum overhead to continue some programs like hand hygiene,

safety education for staff, QIP etc. They want us to stay the course, pay the

monthly fee, until the LHIN Board makes the decision whether to move ahead

with Accreditation

The work expected is reasonable, since many programs are part of our action

plan initiatives; there has been a lot of good work continuing despite the

uncertainty (i.e., medication management, leadership standards)

CCAC accredited until December 2017

It was moved by Sherryl Smith, seconded by Andrée Durieux-Smith and agreed that

the Board of Directors approve Accreditation Canada’s proposal to maintain the

CCAC’s accreditation status for another year with minimum overhead by continuing

such programs as hand hygiene, safety education for staff, Quality Improvement Plan)

– on the contingency that it’s not full accreditation with site survey.

CARRIED

Motion Carried

12-16-66

4


5.3 QIP Update Q2 FY 2016-17

CCAC has done quite a bit of work on developing change in health status tool;

personal support workers (PSWs) are most often in direct contact with

patients; if PSWs notice a change in health status, they are to use the tool

(incorporated into Automated Provider Reporting (APR)) and report back to

the CCAC. There is opportunity to better leverage technology to elevate

practice. Plan on continuing this on next year’s QIP as area of focus

Given the current climate of change in the home care sector, the core priority

indicators for the home care sector have not been revised for the 2017/18 QIP

submission. The following additional (optional) indicators have been added

for the home care sector: identification of complex patients for Health Links,

and percentage of palliative patients who died in their preferred place of death.

The latter indicator was developed as a result of proactive effort by CCACs,

seven of which (including Champlain) have already pioneered the indicator in

their 2016/17 QIPs

Process for developing, reviewing and approving the FY 2017/18 QIP:

o CCAC and LHIN leadership invited to participate in QIP webinars

(completed in December 2016)

o December 2016 to February 2017: Consultation with internal stakeholders,

patients and caregivers, and SPOs

o February 2017: Review at the internal Quality and Safety Committee and

review/preliminary approval at the Board of Directors

o March 2017: Final approval by the Board of Directors; Translation of QIP

o By April 1 2017: Submission to Health Quality Ontario and posted on our

public website

Medical Assistance in Dying (MAID) could be included in the quality QIP

work around palliative care, however the province is in the process of

establishing quality elements and standardization across the province, so the

CCAC might want to wait for province to develop policies and measures

All hospitals have policies in place regarding MAID/euthanasia administered

by health professional, as opposed to self-administered MAID; the concern is

that if the hospitals take the lead on MAID, the process will become

institutionalized (like childbirth was years ago)

CCAC working closely with The Ottawa Hospital (TOH) on MAID, working

closely with ethicists from TOH; trying to formalize what this needs to look at,

so that we can continue supporting patients’ wishes to die in their home

Continue discussion on MAID at January Board meeting – should include

discussion from a governance standpoint whether the CCAC should be

involved

ACTION: MAID

Discussion to be added

to January 18, 2017

Board meeting agenda

5


6.0 COMMUNITY REPORTS

Bill Skinner provided an update on a strategic planning retreat session he attended at

Arnprior Regional Hospital on November 19, 2016:

Invitation to attend went out to community stakeholders, such as Health Links,

city councilor, local alderman, nursing homes, etc.

Retreat was built around the SOAR (Strengths, Opportunities, Aspirations and

Results) strategy formulation and planning framework

Participants were invited to share opinions and ideas; unanimous agreement in

keeping the strategic framework simple

Sherryl Smith provided an update on a discussion she attended regarding LHIN sub-

region planning (hosted by the SE LHIN), with the following observations:

As everyone is no doubt aware, there are some regional overlaps between SE

and Champlain LHINs

Some pushback from local health decision makers to align; apparently

assigning Mississippi Mills to Lanark, Leeds & Grenville, but would stay

within Champlain LHIN

Creating a lot of angst in the community due to Health Links (HL), it’s aligned

with HL 7; hoping there would be resolution soon

Will be a repeat discussion in January

Takeaway: importance of sub-regions to align from a health services

perspective; the whole issue around natural networking, especially in rural

communities, and how important not to destroy these relationships –

developed over years and years of experience

Not confident message regarding boundaries is having any effect on the

decision makers; it’s important that community is part of the discussion and

decision-making

Sherryl Smith will be meeting with health unit on Friday (December 16) and

will dig a bit deeper

Sherryl Smith also provided her feedback on the December 5 Finance & Audit

Committee meeting:

Concern of the impact on community to patients and SPOs; and the cascading

effect of our decisions

Had opportunity to work with some people in the field in Mississippi Mills, and

asked them to put their feedback on the transition into words: feedback included

overwhelming increase in referrals and many more patients on waitlist

(quadrupling in many cases); frontline people feeling helpless and suffering from

ethical distress because there is nothing they can do to help; positive note that the

care coordinators stay in constant contact and communication

Great concern for patients’ care going forward, and concern for pressures

experienced by frontline agency workers

6


CCAC is bowing to pressure from Ministry and LHIN, and forsaking patient care;

feels very strongly that the CCAC needs to voice feedback, and how it is being

hung out to dry; causing turmoil for everyone and not taking into consideration

patient needs; people bearing the brunt of it are the sick and the elderly, and we’re

not doing anything to stand up for them; the media only sees one piece of it

7.0 GOVERNANCE REPORTS

Bill Skinner reported that there was nothing new to discuss.

8.0 OTHER BUSINESS

8.1 Public Questions and Comments

There were no public questions or comments.

It was moved by Sherryl Smith, seconded by Melody Isinger and agreed to move in-

camera.

CARRIED

It was moved by Andrée Durieux-Smith, seconded by Robert D’Aoust and agreed to

adjourn the meeting.

CARRIED

Motion Carried

12-16-67

Motion Carried

12-16-71

CONFIRMED:_____________________________ _________________________________

DENISE ALCOCK, CHAIR MARC SOUGAVINSKI, CEO AND

BOARD SECRETARY

Champlain CCAC Board – January 18, 2017

Item 3.1.1 – Status of Follow-up/Action Items from Previous Board Minutes PAGE 1

Submission to the Board

Status of Follow-up/Action Items - Previous Board Minutes

January 18, 2017

INFORMATION ITEM

To provide an update on business arising from the previous Board minutes (as of November 16, 2016 meeting).

BACKGROUND/ISSUE

DATE OF MEETING FOLLOW-UP/ACTION REQUIRED UPDATE

December 14, 2016 Any Board member wishing to read the full KPMG LHIN Renewal Expansion report should contact Linda Stewart to send

December 14, 2016 MAID Discussion to be added to January 18, 2017 Board meeting agenda

On January 18, 2017 agenda under CSQS Reports

Linda Stewart, Executive Assistant

CASC de Champlain CCAC

Service Provider Inspection Strategy – Update

Champlain CCAC Board of DirectorsJanuary 18, 2017

Brenda Toonders, Director – PMO and Service Provider Programs


Outline of Presentation

• FY 16/17 Q2 Provider Performance Update

• Inspection (audit) Activities

• Summary of two Recent PSS Provider Inspections

• Next Steps

• Conclusion

2


Provider Q2 Performance Update

note: data available in Feb 2017- Q3 performance data

- YTD Client Experience Survey Results

CASC de Champlain CCAC 4

FYI: Provider Performance Dashboard• Extensive new Performance Dashboard introduced April 1, 2016,

including Provincial and Local Contractual Performance and Operational Quality Indicators

Contractual Performance Metrics – (Provincial & Local metrics) Targets

Acceptance of Offers PSS – General; Palliative; Retirement Homes

Nursing – General nursing, - visits, clinic, shift ; Palliative

Therapies – all disciplines

> 91%> 94%> 95%

Missed Care PSS; Nursing; Therapies (e.g., 99.95% delivered – e.g., with 2.68M PSS visits annually; SPO might miss 13.4K visits, excluding % related to Patient Cancellations/Refusals

< .05%

1st Visit Provisioning • PSS; Nursing – provisioning per 5 days; per CCAC specified dates; per 21 days

• Therapy – provisioning per Service Guidelines; 21 days

> 95%

Wound Care • Healed wounds by specified dates, Re-admission Rates CH Avg %

Client Experience • Satisfaction (targets vary by service type)• Continuity• Patient-Centred Appointments

> 83% - 91%> 85% - 93%> 70 – 85%

Discharge Reports • Nursing and Therapies (e.g., timely reporting of discharge) > 94%

Other • Home to Clinic transfers, Special Billing in Retirement Homes, more..

CH Avg %


F16/17 Q2 SPO Performance ManagementStatus Update – Subset of CH CCAC Indicator Averages

• Missed Care –• Sustained improvements to-date; no incremental in Q2• Outliers - 2 SPOs skewed average; otherwise 1 SPO met

target and others averaged .11 (39% improvement )• Significant improvement initiatives in-progress

• Acceptance –• No improvement over Q1 – primarily due to summer

staffing and partial waitlisting meant significant numbers of new patients were being referred for service

• Met 1st Visit Date Requested by Care Coordinator/Patient • Significant improvement in 12 months (75-90%)

Personal Support

Accept(> 91%)

Missed Care

(< .05%)

CCEE Satisfaction (F1516) *

Overall(80%)

Continuity(80%)

Patient-Centred

Appts(70%)

87 .18

Nursing (Visit)

Accept(> 94%)

Missed Care

(< .05%)


Overall(91%)

Continuity(93%)

Patient-Centred

Appts(82%

96 .02

Allied Health (combined OT / PT only)

Accept(> 91%)

Missed Care

< .05%


Overall(87%)

Continuity(92%)

Patient-Centred

Appts(86%

99 .15

met target

below target

• Missed Care –• No change over Q1

• Acceptance –• No change over Q1

Key Highlights / Focus

• Missed Care –• Decrease over Q1 – due to more stringent measurements

• Acceptance –• No change over Q1


Performance Management

• Formal performance management is actioned via “Quality Improvement Notices” (QIN): • a framework of identification, root cause analysis, action plans, measurable outcomes &

sustainment

• Champlain has the following performance QINs

• Champlain has indicated to providers – meet target or expect performance management

• Missed Care – bedding-in period complete end of Q3

• Acceptance Rate – given waitlisting; significant fewer patients released

• 1st visit provisioning according to Care Coordinator date

6

QIN Status Update

Sep/14 Acceptance Rates

• 1 SPO – outstanding. Volume was reduced in 2015 and again Apr/2016• Q1 2016 - new management indicated new plan to address issues

Plan to Close in Q4

Mar/16 Acceptance Rates, CCEE

• 1 SPO – action plans have resulted in measurable QI improvements Plan to Close in Q4

Dec/16 Handling of Patient Issues

• 1 SPO – still in investigative stage for root causes and potential action plan

TBD


Provider Inspections Update


Inspection MethodologyCompleted Dec 2016 : PSS Contractual Inspection – focus on operations that enable overall patient satisfaction

• 6 of 7 providers have been inspected (7th has been acquired by another existing SPO)

• Methodology –• Inspection Tracers (data is statistically significant with 10% MOE) • Qualitative Analysis / Judgment applied to processes, systems, practices

• Outcome

• Provider 1 met all audit requirements in the areas of: CELS, CCEE and skills matching. Met requirements but with room for improvement billing accuracy and in meeting performance metrics for missed care.

• Provider 2 did not adequately meet the audit requirements associated with CELS and will need to show the CCAC evidence of improvement in this area within predefined periods. Adequately met most components of the CCEE section, but will need to show improvement in patient-centred appointments. Met most audit requirements for provisioning, matching skills and billing.

Clinical Audit –

• Dec/Feb 2017 – 2 Providers reviewed for Falls Prevention Practices and Documentation • Dec-Mar 2017 – All Providers surveyed for information / data for Falls Prevention Practices

and Infusion Acquired Infections


Dimension Question – Follows processes/documentation Tracers Notes / Follow -up

Events / Incidents(CELS)

SPO has an electronic events management system20

events

100% In 3 / 20 events, need more fulsome investigation and follow up.

SPO identifies, investigates and addresses CELS events 85%

Plan in place to address Top 3 CELS event categories 100%

Client Caregiver Experience Evaluation

SPO provides patient-centred appointments 71% (Above CCEE target)

SPO ensure continuity in caregiver 20 patients

100% (and above CCEE target)

Patient experience satisfaction is a key driver in SPO operations 87% (Above CCEE target)

Staff satisfaction surveys are conducted regularly 100% (using Worklife Pulse)

Service Provisioning Metrics

Acceptance Rate FY 15/16

Missed Care (evidence of documentation & correct billing)

20 patients -With 121 visits in Sept’16

100%

5 Day Provisioning (evidence of documentation & good scheduling processes)

100%

Patient : Worker Need : Skill Matching

Patients are scheduled to receive care from SPO staff with the appropriate knowledge, skills and training 100%

Care Delivery Substantiation / Billing Reconciliation

Evidence of the delivery of every episode/encounter of patient care is clearly documented using CCAC accepted methods

100%

CCAC is appropriately billed only for episodes of care successfully delivered to patients 93%

In 9/121 visits; billing correction req’d ONLY to support NEW 45 min visits

Pass Ratio – based on 13 criteria 92%

not met met satisfactorily

Provider 1: Inspection Results Detail

96.6%


Dimension Question – Follows processes/documentation Tracers Notes / Follow -up

Events / Incidents(CELS)

SPO has an electronic events management system20

events

100% SPO to ensure investigation of events, and show that they use CCAC CELS data.

SPO identifies, investigates and addresses CELS events 50%

Plan in place to address Top 3 CELS event categories 65%

Client Caregiver Experience Evaluation

SPO provides patient-centred appointments 64% Patient-centred appointments and experience data from most recent CCEE results: presented Q1

SPO ensure continuity in caregiver 20 patients 100%

Patient experience is a key driver in SPO operations 75%

Staff satisfaction surveys are conducted regularly 100% Using Metrics at Work

Service Provisioning Metrics

Acceptance Rate 91% FY 15/16

Missed Care (evidence of documentation & correct billing)

20 patients -With 121 visits in Sept’16

91%

5 Day Provisioning (evidence of documentation & good scheduling processes)

100%

Patient : Worker Need : Skill Matching

Patients are scheduled to receive care from SPO staff with the appropriate knowledge, skills and training 95%

Sampling of 20 unique patients

Care Delivery Substantiation / Billing Reconciliation

Evidence of the delivery of every episode/encounter of patient care is clearly documented using CCAC accepted methods

98% >100 visits, representing 14 patients (Sep ‘16)

CCAC is appropriately billed only for episodes of care successfully delivered to patients

100%

Pass Ratio – based on 13 criteria 77%

not met met satisfactorily

Provider 2: Inspection Results Detail


• Next Steps

• By Mar 31/2017 • Verify all Providers now comply with recommended changes

resulting from inspections

• By Jun 30/2017• Review Inspection Framework and modify for nursing and/or

allied health• Collaboration with clinical in conjunction with CCAC Reform

plans; determine appropriate next set of inspections

11

Inspection Methodology

Champlain CCAC Board of Directors - Work Status Code

Action Plan Status Report Q3 FY1617 Planned activity

Work in progress, proceeded as expected

Delays/issues but are being addressed

Escalations required to address issues

Completed

Project Name Q2 Q3 Q2 Update ( July,Aug,Sept) Q3 Update ( Oct, Nov, Dec) Q4 Planned Activities

To Maintain Increasingly High Needs Complex Patients at Home, we need to:

Enhance the Care Coordinator Role: through role depth, role intensity, role scope and role expertise

1 Review/balance caseload sizes

Reviewed and finalized plan for CL reduction in

congregate care teams only as Ph 1. Communicated

plan to affected teams.

Implemented caseloads reductions in Congregate Care teams and

changes at TOH Cancer Center and Peds teams. Further develop

implementation plan for Q4 - SS Teams

Plan on implementation of changes to SS Teams to further

provide additional care coordinators to reduce overall caseload

sizes

Limited progress on redefining CC roles/responsibilities

within an integrated team, multi-discipline team & SPO

& Pilot shared decision making framework & tools such

as Coordinated Care Plan Tool.

CCAC and HL are using Coordinated Care Plan Tool.

Continued enhancement of reporting tools and

systems; outcomes, goals & automation focus.

Completed QI on electronic reporting tools.

Completed secondment of Proj Manager to support CSS

initiatives with LHIN.

Plan further roll out of automated provider reporting tools .

3

Improve the training and clinical support for CCAC Care

Coordinators, Therapists and Nurses and development

and support for Clinical Care Managers

Continued work and link support of training &

standardized practice needs with Accreditation work.

Assigned some therapists to professional practice roles and

continued work to standardize roles in alignment with

Accreditation.

4 Enhance development and leadership with Health Links Work in progressSupported 1 more HL as prime; Work in progress with all

operational HL.Dissolve CCAC as prime for all HL.

5

Increase scope of practice and role for Nurse

Practitioners in Palliative program and improving the

Central Referral and Triage (CRT) processes (in

partnership with Bruyère)

Implementation of MAID program and further progress

on relationship with Bruyere going well.

Further work on implementation of MAID program and further

progress on relationship with Bruyere going well.

6Advance Integration with Primary Care across

Champlain region

Launched Integrated Primary Care Enhanced Care

Coordinator Q2 pilot start for further development.

Ended Primary Care Enhanced Care Coordinator Pilot - awaiting

further direction from LHIN Reform prior to restarting new pilot

Advance the engagement of Patients and Caregivers and provide services to support caregivers. :

7 Adopt & apply Carman Patient Engagement Framework Completed Q1

8Develop a “Champlain Caregiver Initiative” to create a

fund exclusively focused on caregivers’ needsOn-Hold On-Hold

9

Adopt Self-Directed Care funding models3 Agreements implemented. Developing a list of all

potential interested candidates.

Provided quality improvement support to the process of expense

claims and financial payment and reconciliation.

Waiting on Ministry to officially launch program prior to full

spread.

Plan on finalizing 2 old SDC clients and support 2 new

additional clients. Waiting on Ministry to officially launch

program prior to full spread.

Completed LEAN analysis for guidance and

development of On-boarding Pilot. Delayed Q2 pilot

start.

Delayed On-boarding Pilot until further notice; due to lack of

resources and potential CCAC/LHIN Reform impacts

Reviewed progress of improvement initiatives in

targeted providers & retirement home sites.

Providers leveraged information on QI initiatives and

planned/implemented spread of successful solutions.

Plan on hearing updates from all Providers about spread

results.

Completed initial deployment of new tools to support waste

reduction in supplies - eg. tracking tool for delivery of supplies

and list of last ordered items.

Plan further roll of automated telephone calling technology

solutions to inform clients of planned delivery times.

11Engage providers to enhance the knowledge, skills and

technical expertise of front line health care workers

Meetings to be planned with college, providers and LHIN to

discuss further.

Action items focused on increased awareness of work in events

tracking & problem solving, trending & communications.

Increased focus on current experience survey results &

provider performance. no work planned due to lack of resources

13

Increase and improve performance oversight of

providers through better clinical and contractual audit

program

Implemented new reporting and analysis efforts of

new contractual performance metrics. Conducted 1

SPO inspection.

Completed 2 PSS SPO inspections. Engaged in a review of Falls

Prevention practices by completing 1 of 2 Provider audits and

surveyed all SPOs. Engaged in a survey of all SPOs regarding

infection rates related to vascular access infusions.

Determine next steps for contractual inspections - strategy /

scope. Will analyze data and make reccommendations from

Falls Prevention and Infusion Infection Surveys..

To Create Sustainability for Growth through effectiveness and innovation, we need to:

14

Continue to restructure our care delivery programs and

relationships between providers and the geographical

areas they serve (“Neighbourhood” Care)

Delayed pending more information on LHIN sub-

regions.Assigned Nursing Prime Providers to all Retirement Homes.

45 minute service visits - Completed May 2016. 45 minute service visits - Completed May 2016.

Work suspended due to: requests from approx. 5

families for SDC funding; planned reorg of Peds team.

Plan to resume flexible care delivery actions once Peds

reorg completed.

Status

15Optimize cost of service and care delivery by aligning

service delivery times and durations with patient needs

2Streamline care coordination initiatives in the region &

standardize care coordination practices

To Modernize the Home and Community Care Delivery Models: through more continuity, more consistency, more quality of care, we need to

10

Implement new service standards for patient centered

clinical care and service delivery and develop new

practices to improve “On-Boarding” of Complex

Patients

12Increase our ability to measure and improve on quality

of patient/caregivers’ experiences

Champlain CCAC Board of Directors - Work Status Code

Action Plan Status Report Q3 FY1617 Planned activity

Work in progress, proceeded as expected

Delays/issues but are being addressed

Escalations required to address issues

Completed

Project Name Q2 Q3 Q2 Update ( July,Aug,Sept) Q3 Update ( Oct, Nov, Dec) Q4 Planned Activities

Status

16

Pilot new models of care delivery that improve patient-

centered care through new service capabilities,

integrated care teams, enhanced care coordination

Delayed Pilot On-Demand (scheduled/unscheduled) Care

Delivery Model Q2 pilot start for further development.

Further delays to be expected with Pilot - due to resources

required for CCAC/LHIN Reform and other priorities.

17

Research and analyze alternative residential care

possibilities for patients with needs between home and

long term care

18

Clarify and communicate CCAC actual capacity and

occupancy rates against our programs for external

partners and stakeholders in the region

Completed June 2016.

Planning and development of Pilots: (1) a

Patient/caregiver solution pilot;

Lab testing (execution of test cases two run-throughs) of NexJ

Connected Wellness complete. Production software environment

delivered. Onboarding process and evaluation questionnaires

completed. Sign-up web site completed and consent form

completed. Pilot geography selection finalized; Service Provider

pilot partner confirmed (Paramed) and training underway.

Patient cohort identified and initial target patient list developed.

Plan to begin Falls field pilot - onboard patients and draft mid-

pilot evaluation report and feature/functional upgrade

requirements

Planning and development of Pilots:;(2) a caregiver

support pilot for caregivers supporting dementia

clients;

Wandering Detection and Diversion' for Patients with Dementia

research project with Alzehiemer's Society of Ottawa and

Refnrew COUnty, Bruyere Research Institite and Carleton

University. Technology design completed using off-the-shelf

technology. In-home technical trial completed successfully in two

residences. Research Ethics Board application completed and

submitted (BRI REB)

For Dementia Clients: Expect REB Approval.Plan to identify

target patients and caregivers with ASORC. Plan to begin

patient in-home deployment.

Planning and development of Pilots: (3) a falls

prediction pilot

A Falls Prediction Pilot started with pilot of Jintronix Rehab

assistant software in Cornwall Stroke Clinic. Jintronix pilot in

stroke clinic continued – limited number of potential patients at

the Stroke Rehab Clinic so use of the system has been limted.

Began Phase 2 testing of GE HealthCare QTUG falls screening

technology in home with staff PT Assistant and developed

agreement with a retirement home for broad screening pilot.

Completed and submitted funding proposal for Phase 3

‘deployment planning’ pilot to OCHIS/Ontario Centre of

Excellence funding program. Successful through evaluation stage

3 – in person presentation. Waiting for final decision.

Plan to complete Jintronix pilot and write evaluation report

and recommendations.

Plan to complete Phase 2 limited pilot of QTUG and develop

evaluation report.

If funding is successful, complete Transfer Payment Agreement

with OCHIS and begin detailed project planning.

ED Notification system: Q1 - 2 hosital roll-outs -

Renfrew & Arnprior. Q2 -Roll-out planning for Deep

River.

Engaged in planning with all hospitals of Champlain Association

of Small Hospitals (KDH, DRDH,CPDMH, AGH, GMH, SFMH) and

representatives of some larger hospitals (Montfort, QCH,

WDMH). Barry’s Bay deployment complete including pass-

through to Primary Care. Reverse message flow (CCAC CHRIS to

Hospital) development and testing underway. Kick-off meeting

held with GMH and OACCAC. Extended eNotification to two CSS

agencies (both users of Community Shared Services Operations

CIMS-HR),

Plan documented, approved, and actioned starting this

spring, and a full progress report is going to the Board

in the next several days (another has gone to Paula for

Accreditation tracking purposes)

Plan documented, approved, and actioned starting this spring,

and a full progress report is going to the Board in the next several

days (another has gone to Paula for Accreditation tracking

purposes)

Staff Conversations held and more activities &

communications planned re: CCAC Reform.

Staff Conversations held and more activities & communications

planned re: CCAC Reform.

19Support innovation and research in home care through

IMPACT Program

20 Increase stability and engagement of our employees

Champlain CCAC Board of Directors – January 18, 2017

Item 3.4 – French Language Services (FLS) Report PAGE 1

Submission to the Board of Directors

French Language Services (FLS) Report

January 18, 2017

ISSUE / PURPOSE

As indicated in the French Language Services (FLS) Committee Terms of Reference, the Committee provides an annual report to the Champlain CCAC Board of Directors Governance Committee. This report provides a status update on the Champlain CCAC’s FLS.

BACKGROUND

On July 1st, 2015, the Champlain CCAC was officially designated under Ontario's French Language Services Act (FLSA). Designation is a legal recognition conferred by the government of Ontario to organizations capable of offering French-language services, in whole or in part, according to the criteria set out by the Ontario Office of Francophone Affairs. This designation indicates that the Champlain CCAC guarantees to meet the needs of Francophone patients by effectively integrating the offer of FLS into its practices. The Champlain CCAC is committed to providing quality services in French on a permanent basis by:

hiring employees with the requisite French language skills where required

ensuring the provisions for effective representation of Francophones on the board of directors and its committees

including these provisions in the administrative by-laws and that these reflect the proportion of the Francophone population within the community served

Part of Champlain’s commitment, and a requirement of the designation, is to ensure there is an ‘active offer’ of services in both official languages to anyone contacting the CCAC, on behalf of all employees.

Active Offer The Champlain CCAC is committed to actively offering patient services in both official languages. By making a verbal active offer on first point of contact, the CCAC assumes the responsibility to determine the official language preference of the person. An active offer presumes that the employee is accountable to determine the patient‘s language preference as opposed to the onus being on the patient to request access to services in either official language. This can be done by inquiring about their preferred official language for service, ensuring they know they can receive services in French, and actively offering these services, and, if need be, transferring them to a colleague who can help them in their official language of preference.



Activities In 2017-18, Champlain CCAC will be reviewing all policies related to FLS and will be preparing its report to the Champlain LHIN using the new standardized reporting template implemented across designated organizations in the Champlain region. Engagement Activities Champlain CCAC continues to be approached by other CCACs and organizations to learn about Champlain CCAC’s FLS designation preparation, processes and practices. There is also continued interest in learning more about our FLS – Active Offer e-learning module, which was developed in-house at Champlain CCAC for employee education. We were recently approached by The Ottawa Hospital regarding our e-learning tool, at which time they requested permission to use our tool as a base for their learning module. We have also been providing some information and guidance to the Erie St-Clair CCAC, who are in the preliminary stages of planning for a partial designation and are interested in our FLS – Active Offer e-learning module. French Language Services Designation and the Coming System Transformation As system changes take place in the coming months, it will be important to operationally maintain FLS, while monitoring legal, structural, and operational changes to assess how the changes may affect the FLS designation and the provision of French languages services more broadly. As part of this process, the Ministry of Health and Long-Term Care has established a number of working groups, with one specific to FLS. Daniel Merritt, Director Organizational Development with the CCAC, participates in the French Language Services Workstream Committee. The FLS Workstream’s goals include supporting access to FLS through LHIN engagement and involving the French Language Health Planning Entities. The workstream is examining opportunities for the Ministry to review existing regulations to align with, support LHIN renewal, and enhance the value of the LHIN Entity model to more effectively set expectations while improving transparency, accountability and access to health care services for the Francophone population of Ontario. New Designation Criteria In, 2014, the Office of Francophone Affairs revised the criteria and process for designating and evaluating public-service agencies under the FLSA. The changes apply to new requests for designation submitted after January 1, 2014 as well as for any evaluation of existing designated agencies to be performed after April 1, 2014. This new criteria will apply to Champlain CCAC’s submission scheduled for 2017/2018. New FLS Planning and Reporting Tool In February, the Champlain LHIN, in collaboration with le Réseau des services de santé en français de l’Est de l’Ontario – the French Language Health Planning Entity for Eastern and South-Eastern Ontario – introduced a new tool to improve the annual FLS reporting process. Information sessions were held to learn more about this new reporting tool, new designation criteria and to clarify the Champlain LHIN’s expectations for future reporting requirements for community agencies.



Annual FLS Reporting allows for:

Provincial performance obligation

Identifying needs and opportunities

Supporting enhancement of FLS within HSPs

Informing planning and integration initiatives We were advised earlier this year that the Champlain CCAC was again exempted from the requirement to provide the Champlain LHIN with an annual report regarding FLS for fiscal 2016- 2017. In the fall of 2016, the new pre-populated reporting template was provided to Champlain CCAC by the Réseau des services de santé en français de l’Est de l’Ontario. This new template will be used for annual reporting to the LHIN, and will be the source document for the designation submission in 2017-2018. Internal French Language Supports The Champlain CCAC encourages all employees to learn, improve, and grow. Employees are encouraged to discuss French language training requests or other learning opportunities with their manager, to ensure alignment with their individual learning and development plan.



French Language Patients – Data Fiscal 2015/2016



Sponsoring Executive: Patrice Connolly, Vice-President People and Stakeholder Engagement

Dear Ms. Bisson:

Deloitte LLP (“Deloitte” or “we” or “us”) is pleased to serve as your auditors for the year ending March 31, 2017. Ms. Doreen Hume will be responsible for the services that we perform for the Champlain Community Care Access Centre (the “Centre”). She will, as considered necessary, call upon other individuals with specialized knowledge, either in this office or elsewhere in our firm to assist in the performance of our services.

In addition to the financial statement audit and program audits, we are engaged to provide under this engagement letter, we would also be pleased to assist the Centre on issues as they arise throughout the year. Hence, we hope that you will call Doreen whenever you believe Deloitte can be of assistance.

We will perform this engagement subject to the terms and conditions set forth herein and in the accompanying appendices.

The objective and scope of the audit You have requested that we audit the financial statements of the Centre (the “Financial Statements”), which comprise the statement of financial position as at March 31, 2017, and the statements of operations, changes in net assets and cash flow for the year then ended, and a summary of significant accounting policies and other explanatory information.

You have also requested that we audit the Personal Support Worker Training Program Financial Reconciliation and the Centre’s Annual Reconciliation Report for the year ending March 31, 2017 as well as perform specified procedures on the Preschool Speech and Language Program (collectively the "Special Reports").

We are pleased to confirm our acceptance and our understanding of this audit engagement by means of this letter. Our audit will be conducted with the objective of our expressing an opinion on the Financial Statements and Special Reports.

Appendix A provides further information about the objective and scope of the audits.

Deloitte LLP 1600 – 100 Queen Street Ottawa ON K1P 5T8 Canada Tel: 613–236–2442 Fax: 613–236–2195 www.deloitte.ca www.deloitte.ca

December 21, 2016

Private and confidential

Ms. Sara Bisson Corporate Controller Champlain Community Care Access Centre 4200 Labelle Street, Suite 100 Ottawa, Ontario KIJ IJ8

http://www.deloitte.ca/

http://www.deloitte.com/

Champlain Community Care Access Centre December 21, 2016 Page 2

The responsibilities of the auditor We will conduct our audits in accordance with Canadian generally accepted auditing standards (“Canadian GAAS”). Those standards require that we comply with ethical requirements and plan and perform the audits to obtain reasonable assurance about whether the Financial Statements are free from material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditor’s judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimates made by management, as well as evaluating the overall presentation of the financial statements.

Because of the inherent limitations of an audit, together with the inherent limitations of internal control, there is an unavoidable risk that some material misstatements may not be detected, even though the audit is properly planned and performed in accordance with Canadian GAAS.

In making our risk assessments, we consider internal control relevant to the entity’s preparation and fair presentation of the Financial Statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. However, we will communicate to you in writing concerning any significant deficiencies in internal control relevant to the audit of the Financial Statements that we have identified during the audit.

The audit of the Financial Statements and Special Reports by Deloitte does not relieve management or the Board of Directors of their respective responsibilities.

Appendix A provides more information about Deloitte’s responsibilities in respect of the audits.

The responsibilities of management and identification of reporting framework Our audit will be conducted on the basis that management, under the oversight of the Board of Directors Board of Directors, acknowledge and understand that they have responsibility:

● For the preparation and fair presentation of the Financial Statements in accordance with the Chartered Professional Accountants of Canada, CPA Canada Handbook – Canadian accounting standards for government not-for-profit organizations ("PSAS-GNPO");

● For such internal control as management determines is necessary to enable the preparation of Financial Statements that are free from material misstatement, whether due to fraud or error; and

● To provide us with:

• Access to all information of which management is aware that is relevant to the preparation of the Financial Statements such as records, documentation and other matters;

• Additional information that we may request from management for the purpose of the audit; and

• Unrestricted access to persons within the entity from whom we determine it necessary to obtain audit evidence.

As part of our audit process, we will request from management written confirmation concerning representations made to us in connection with the audit.

We look forward to full cooperation from your staff during our audit.

Management’s responsibilities in connection with this engagement are further described in Appendix B.


Board of Directors responsibilities and auditor communications As auditors of the Centre, we report directly to the Board of Directors as it is directly responsible for the oversight of our work. We acknowledge that the Board of Directors is also responsible for recommending our appointment and compensation. The Board of Directors is also responsible for reviewing and approving the Centre’s hiring policies regarding current and former partners and employees of Deloitte LLP and Deloitte Touche Tohmatsu Limited, including related member firms and affiliates.

In accordance with Canadian GAAS, we are required to communicate with the Board of Directors about various matters in connection with our audit.

The Board of Directors responsibilities and our communications with the Board of Directors are described in Appendix C.

Inclusion of Deloitte reports in documents and public oral statements or references to Deloitte in other documents and on electronic sites If the Centre intends to publish or otherwise reproduce in any document our report on the Centre’s Financial Statements, or otherwise make reference to Deloitte in a document that contains other information in addition to the audited Financial Statements (e.g., in a periodic filing with a regulator, in a debt or equity offering circular or in a private placement memorandum), thereby associating Deloitte with such document, the Centre agrees that its management will provide Deloitte with a draft of the document to read and obtain our written consent for the inclusion or incorporation by reference of our report, or the reference to Deloitte, in such document before the document is printed and distributed. No other form of document is to be considered to signify our consent. The inclusion or incorporation by reference of our report in any such document would constitute the re-issuance of our report. Management agrees to provide adequate notice of the preparation of any such public documents. The Centre also agrees that it will notify us and obtain our written approval prior to including our report or financial statements with which we are associated on an electronic site. Further, it is agreed that in any electronic distribution, for example on the Centre’s website, management is solely responsible for the accurate and complete reproduction of our report and the subject matter on which we reported.

This engagement letter, and our agreement to perform the services described in this engagement letter, does not constitute our consent to the use of our report in, or our agreement to be associated with any such documents published or reproduced by or on behalf of the Centre. Any request by the Centre to re-issue our report, to consent to its inclusion or incorporation by reference in an offering or other document, or to agree to its inclusion on an electronic site, will be considered based on the facts and circumstances existing at the time of such request. Fees for such services (and their scope) would be subject to our mutual agreement at such time and would be described in a separate engagement letter.

Reporting In accordance with Canadian GAAS, we expect to issue a report at the completion of our audit in the form shown in Appendix D. The form and content of our report may need to be amended in the light of our audit findings.

Our ability to express an opinion and the wording of our opinion will, of course, be dependent on the facts and circumstances at the date of our report. If, for any reason, we are unable to complete the audit or are unable to form or have not formed an opinion, we may decline to express an opinion or decline to issue a report as a result of this engagement. If we are unable to complete our audit or if our auditor’s report requires modification, the reasons therefor will be discussed with the Board of Directors and the Centre’s management.


Fees The chart below sets out the services we will provide to the Centre and an estimate of our professional fees. All fees are subject to applicable taxes.

Year End Fees

CCAC financial statements and Annual Reconciliation Report March 31, 2017 $28,936

Preschool Speech and Language Program March 31, 2017 $2,230

PSW Training Fund Financial Reconciliation March 31, 2017 $3,626

Total $ 34,792

Our fee estimate includes limited research with respect to the financial statement audit but does not include significant research or consultation with respect to nonrecurring items that may arise. Should items of this nature arise, we will advise you and will arrange for appropriate fees before we invest significant professional time.

Other matters This engagement letter, including the appendices A through E attached hereto and made a part hereof, constitutes the entire agreement between the parties with respect to this engagement and supersedes all other prior and contemporaneous agreements or understandings between the parties, whether written or oral, relating to this engagement.

This engagement letter will continue in force for subsequent audits unless amended by the mutual consent of ourselves and the Centre.

Please sign and return a copy of this letter to indicate your acknowledgement of, and agreement with, the arrangements for our audit of the Financial Statements including our respective responsibilities.

Yours truly,

Chartered Professional Accountant Licensed Public Accountants

Enclosure


The services and terms set forth in this letter are accepted and agreed to by the Champlain Community Care Access Centre management:

_________________________________ Signature

_________________________________ Title

_________________________________ Date

Appendix A The objective and scope of a financial statement audit and the responsibilities of the auditor

Champlain Community Care Access Centre December 21, 2016

The objective and scope of a financial statement audit We will plan and perform the audit to obtain reasonable assurance about whether the Financial Statements as a whole are free from material misstatement, whether due to fraud or error. The Financial Statements subject to audit are those of the Centre, prepared by management, with oversight from the Board of Directors. The audit will enable us to express an opinion on whether the Financial Statements are fairly presented, in all material respects, in accordance with PSAS-GNPO. The audit also includes evaluating the appropriateness of accounting policies and the reasonableness of accounting estimates made by management, as well as evaluating the overall presentation of the Financial Statements. Our report on the Financial Statements and communications required by Canadian GAAS will be in accordance with our findings.

It is important to recognize that there are inherent limitations of an audit, where most of the audit evidence obtained is of a persuasive, rather than a conclusive nature. These limitations arise from the nature of financial reporting, the nature of audit procedures and the need for the audit to be conducted within a reasonable period of time and at a reasonable cost.

Financial reporting involves judgment by management in applying the requirements of PSAS-GNPO to the facts and circumstances of the Centre. Many financial statement items will involve a degree of uncertainty, and there may be a range of acceptable interpretations or judgments that may be made.

The audit procedures we perform will be selected based on our judgment, including the assessment of the risks of material misstatement of the Financial Statements, whether due to fraud or error. Because of the nature of fraud, including attempts at concealment and forgery, an audit designed and executed in accordance with Canadian GAAS may not detect a material fraud.

The performance of the audit within a reasonable period of time and at a reasonable cost requires us to plan the audit so that it will be performed in an effective manner, with audit effort directed to areas most expected to contain risks of material misstatement, whether due to fraud or error, and using selective testing and other means of examining populations for misstatements and drawing conclusions thereon.

Internal control over financial reporting An independent audit conducted by Deloitte in accordance with Canadian GAAS is not a substitute for the maintenance of internal control necessary for the preparation of financial statements by management. Management’s acknowledgment of its responsibility for the maintenance of internal control necessary for the preparation of financial statements does not imply that Deloitte will find that the internal control maintained by management has achieved its purpose or will be free of deficiencies.

Appendix A | The objective and scope of a financial statement audit and the responsibilities of the auditor December 21, 2016 Page 2

We obtain an understanding of internal control relevant to the audit however, not all controls are relevant to every audit. We evaluate the design of controls relevant to the audit and determine whether they have been implemented. We are not, however, required to determine whether relevant controls are operating effectively. Although it is not required by Canadian GAAS, we may decide that for a particular engagement, it makes sense to rely on the effective operation of some controls in determining the substantive procedures we will perform. In this case, we would go beyond evaluating the design of relevant controls and determining whether they have been implemented, to also test whether the controls on which we intend to rely are operating effectively. Accordingly, while Canadian GAAS requires us to report to the Board of Directors any significant deficiencies that have come to our attention, we may not be aware of all significant deficiencies in internal control that do, in fact, exist.

Appendix B Management’s responsibilities


Financial statements and the effectiveness of internal control over financial reporting The Centre’s internal control, including its accounting books and records or accounting systems, will reflect the needs of management, the complexity of its businesses, the nature of its risks and relevant laws or regulation. Management must determine what internal control is required, including how it is designed, implemented and maintained to achieve the Centre’s objectives. Internal control, no matter how effective, can provide the Centre with only reasonable assurance about achieving its financial reporting objectives due to the inherent limitations of internal control.

The preparation and overall accuracy of the Financial Statements and their fair presentation in accordance with PSAS-GNPO together with all required disclosures concerning internal control over financial reporting, is the responsibility of the Centre’s management. Among other things, management has the responsibility for:

1. Establishing and maintaining effective internal control over financial reporting necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error and informing Deloitte of deficiencies identified in the design or operation of internal control over financial reporting;

2. Informing Deloitte of any changes in the Centre’s internal control over financial reporting that occurred during the year that have materially affected, or are reasonably likely to materially affect, the Centre’s internal control over financial reporting;

3. Identifying and ensuring that the Centre complies with the laws and regulations applicable to its activities and informing us of any known material violations of such laws or regulations;

4. Adjusting the Financial Statements to correct material misstatements;

5. Safeguarding assets;

6. Providing to us all information of which management is aware that is relevant to the preparation of the Financial Statements including, but not limited to, all financial records and related data including information on the recognition, measurement and disclosure of specific items, and copies of all minutes of meetings of shareholders, and Board of Directors;

7. Providing additional information that we may request from management for the purpose of the audit;

8. Providing us with unrestricted access to persons within the Centre from whom we determine it necessary to obtain evidence; and

9. Informing Deloitte of facts that may affect the Financial Statements, of which management may become aware during the period from the date of the auditor’s report to the date the Financial Statements are issued.

Appendix B | Management’s responsibilities December 21, 2016 Page 2

Representation letter We will make specific inquiries of the Centre’s management about the representations embodied in the Financial Statements and internal control over financial reporting. As part of our audit procedures, we will request that management provide us with a representation letter acknowledging management’s responsibility for the preparation of the Financial Statements in accordance with PSAS-GNPO and that the Financial Statements are fairly presented in accordance therewith.

We will ask management to affirm their belief that the effects of any uncorrected financial statement misstatements aggregated by us during the current audit engagement and pertaining to all the periods presented are immaterial, both individually and in the aggregate, to the Financial Statements taken as a whole and that management has provided us with all relevant information and access as agreed in this engagement letter and has recorded and reflected all transactions in the Financial Statements.

We will require certain written representations from management in accordance with Canadian GAAS and will request additional representations to support other audit evidence relevant to the Financial Statements or one or more specific assertions therein. Those written representations are to be provided in the form of a representation letter addressed to Deloitte, as near as practicable to, but not after, the date of the auditor’s report on the Financial Statements. Such representations will be for all financial statements and periods referred to in the audit report.

The responses to inquiries and related written representations of management required by Canadian GAAS are part of the evidential matter that we will rely on as auditors in forming our opinion on the Centre’s Financial Statements.

Independence matters For purposes of the following two paragraphs, “Deloitte” shall mean Deloitte LLP and Deloitte Touche Tohmatsu Limited, including related member firms and affiliates.

Independence matters as a result of restrictions on providing certain services In connection with our engagement, Deloitte, management, and the Board of Directors will assume certain roles and responsibilities in an effort to assist Deloitte in maintaining independence and ensuring compliance with Canadian independence rules. Deloitte will communicate to its partners and employees that the Centre is an attest client. Management of the Centre will ensure that the Centre, together with its subsidiaries and other entities (including variable interest entities that comprise the Centre for purposes of the Financial Statements, has policies and procedures in place for the purpose of ensuring that neither the Centre nor any such subsidiary or other entity will act to engage Deloitte or accept from Deloitte any service that under Canadian independence rules or other applicable rules would impair Deloitte’s independence. All potential services are to be discussed with Ms. Hume.

Independence matters relating to hiring Deloitte must assess threats to independence created when a former Deloitte partner or member of the engagement team is employed by management. In order to assist Deloitte in maintaining independence, management should notify Ms. Doreen Hume where substantive employment conversations have been had with a former or current Deloitte partner or engagement team member.

Fraud and error Management is responsible for:

1. Designing and implementing programs and controls to prevent and detect fraud and error;

Appendix B | Management’s responsibilities December 21, 2016 Page 3

2. Informing us about all known or suspected fraud affecting the Centre involving (a) management, (b) employees who have significant roles in internal control, and (c) others where the fraud could have a material effect on the Financial Statements;

3. Informing us of its knowledge of any allegations of fraud or suspected fraud affecting the Centre received in communications from employees, former employees, analysts, regulators, short sellers, or others;

4. Informing us of any information it might have regarding any concerns or allegations of potential errors in the selection of accounting policies or the recording of transactions affecting the Centre that have been communicated to it by employees, former employees, analysts, regulators, short sellers, or others, whether written or oral;

5. Informing us of its assessment of the risk that the Financial Statements may be materially misstated as a result of fraud; and

6. Communicating its belief that the effects of any uncorrected financial statement misstatements aggregated during the audit are immaterial, both individually and in the aggregate, to the Financial Statements taken as a whole.

Related parties The Centre agrees that it will provide us with the identity of the Centre’s related parties, including changes from the previous period, the nature of the relationships between the Centre and these related parties and whether the Centre entered into any transactions with these related parties during the period and if so, the type and purpose of the transactions.

Appendix C Board of Directors responsibilities and auditor communications


Board of Directors responsibilities The Board of Directors is responsible for the oversight of the financial reporting process, including management’s preparation of the Financial Statements and monitoring of the Centre’s internal control related to financial reporting and oversight of our work.

Communications with the Board of Directors Canadian GAAS require that we communicate with the Board of Directors about a number of matters that are relevant to the financial reporting process.

Planned scope and timing of the audit Our audit plan will be separately communicated to you at a later date, providing an overview of the planned scope and timing of the audit.

Significant findings from the audit We will communicate our views about significant qualitative aspects of the Centre’s accounting practices, including accounting policies, accounting estimates and financial statement disclosures. Should the need arise, we will communicate to the Board of Directors why we would consider a significant accounting practice that may be acceptable under PSAS-GNPO, not to be the most appropriate to the particular circumstances of the Centre.

We will communicate, in writing, any significant deficiencies in internal control that we identify on the basis of the audit work performed. The purpose of our audit is to express an opinion on the Financial Statements. While the audit will include consideration of internal control relevant to the preparation of the Financial Statements in order to design audit procedures appropriate in the circumstances, it was not performed to express an opinion on the effectiveness of internal control.

In addition, we will communicate:

● any significant matters arising from the audit in connection with the Centre’s related parties;

● any events or conditions identified that may cast doubt on the Centre’s ability to continue as a going concern;

● any significant difficulties encountered during the audit;

● any significant matters arising from the audit that were discussed or subject to correspondence with management;

● written representations we are requesting;

Appendix D - Circumstances affecting timing and fee estimate December 21, 2016 Page 2

● any material uncorrected inconsistencies or misstatements in fact we identify from reading the financial and non-financial information that are included in a document containing audited financial statements and our auditor’s report; and

● any other matters that in our professional judgment are significant to the oversight of the financial reporting process.

Fraud, error and illegal acts If items of the following nature come to our attention, and in our judgment need to be reported to those charged with governance, we will report them directly to the Board of Directors:

1. Any fraud that involves management;

2. Any fraud involving employees who have significant roles in internal control;

3. Any fraud of which we become aware that has resulted or could result in a material misstatement of the Financial Statements;

4. Any other matters related to fraud, which in our judgment, are relevant to the responsibilities of the Board of Directors;

5. Instances of identified or suspected non-compliance with laws and regulations, other than when the matters are clearly inconsequential;

6. Individual uncorrected misstatements identified by us during the audit that were determined by management to be immaterial, both individually and in the aggregate, to the Financial Statements taken as a whole;

7. Uncorrected misstatements related to prior periods in the relevant classes of transactions, account balances or disclosures and the Financial Statements taken as a whole;

8. Questions regarding the honesty and integrity of management;

9. Matters that may cause future financial statements to be materially misstated; and

10. Significant misstatements resulting from error that were corrected by management.

We will also be making inquiries of the Board of Directors of any actual, suspected or alleged fraud affecting the Centre and whether the Centre is in compliance with laws and regulations that may have a material effect on the Financial Statements.

We will inform the appropriate level of management of the Centre and determine that the Board of Directors is adequately informed with respect to illegal acts that have been detected or have otherwise come to our attention in the course of our audit, unless the illegal acts are clearly inconsequential.

The matters communicated will be those that we identify during the course of our audit. Our audit would not identify all matters that may be of interest to management or the Board of Directors in discharging its responsibilities. Communication with the appropriate level of authority in the organization’s management and with those charged with governance will be determined by the type and significance of the matter to be communicated.

We will also make inquiries of the Board of Directors as to whether any subsequent events have occurred that may affect the Financial Statements, including matters discussed at meetings of the Board of Directors after March 31, 2017.

Appendix D

Circumstances affecting timing and fee estimate


The fees quoted for the audit are based on certain assumptions. Circumstances may arise during the engagement that may significantly affect the targeted completion dates and our fee estimate. As a result, additional fees may be necessary. Such circumstances include, but are not limited to, the following:

Audit facilitation 1. Changes to the timing of the engagement at the Centre’s request. Changes to the timing of the

engagement usually require reassignment of personnel used by Deloitte in the performance of services hereunder. However, because it is often difficult to reassign individuals to other engagements, Deloitte may incur significant unanticipated costs.

2. All audit schedules are not (a) provided by the Centre on the date requested, (b) completed in a format acceptable to Deloitte, (c) mathematically correct, or (d) in agreement with the appropriate Centre records (e.g., general ledger accounts). Deloitte will provide the Centre with a separate listing of required schedules, information requests, and the dates such items are needed.

3. Significant delays in responding to our requests for information such as reconciling variances or providing requested supporting documentation (e.g., invoices, contracts, and other documents).

4. Deterioration in the quality of the Centre’s accounting records during the current year engagement in comparison with the prior-year engagement.

5. A completed trial balance, referenced to the supporting analyses, schedules and Financial Statements, is not provided timely by the Centre.

6. Draft Financial Statements with appropriate supporting documentation are not prepared accurately and timely by the Centre’s personnel.

7. Electronic files in an appropriate format and containing the information requested are not provided by the Centre on the date requested for our use in performing file interrogation. Deloitte will provide the Centre with a separate listing of the required files and the dates the files are needed.

8. The engagement team, while performing work on the Centre’s premises, is not provided with access to the Internet for purposes of conducting the engagement.

Significant issues or changes 1. Significant deficiencies are identified in the Centre’s internal control that result in the expansion of our

audit procedures.

2. A significant level of proposed audit adjustments is identified during our audit.

3. A significant number of drafts of the Financial Statements are submitted for our review or we identify a significant level of deficiencies in the draft Financial Statements.

4. Significant new issues or changes arise as follows:

Appendix D - Circumstances affecting timing and fee estimate December 21, 2016 Page 2

a. New accounting issues.

b. Changes in accounting policies or practices from those used in prior years.

c. Events or transactions not contemplated in our budgets.

d. Changes in the Centre’s financial reporting process or IT systems.

e. Changes in the Centre’s accounting personnel, their responsibilities, or their availability.

f. Changes in auditing standards.

g. Change in the Centre’s use of specialists or the specialists and/or their work product does not meet the qualifications required by Canadian GAAS for our reliance upon their work.

5. Changes in audit scope caused by events that are beyond our control.

Appendix E General business terms


The following general business terms (the “Terms”) apply to the engagement except as otherwise provided in the specific engagement letter agreement (the “engagement letter”) between Deloitte LLP (“Deloitte”) and Champlain Community Care Access Centre (the “Centre”) to which these Terms are attached.

1. Timely performance – Deloitte will not be liable for failures or delays in performance that arise from causes beyond Deloitte’s control, including the untimely performance by the Centre of its obligations as set out in the engagement letter.

2. Right to terminate services – If the Centre terminates the engagement or requests that Deloitte resign from the engagement prior to its completion, the Centre will pay for time and expenses incurred by Deloitte up to the termination or resignation date together with reasonable time and expenses incurred to bring the services to a close in a prompt and orderly manner. Deloitte will not be responsible for any loss, cost or expense resulting from such termination or resignation. Should the Centre not fulfill its obligations set out herein or in the engagement letter, and in the absence of rectification by the Centre within thirty (30) days of notification in writing by Deloitte, upon written notification Deloitte may terminate its services immediately and will not be responsible for any loss, cost or expense resulting from such early termination.

3. Fees and taxes – Any fee estimates take into account the agreed-upon level of preparation and assistance from Centre personnel. Deloitte undertakes to advise management of the Centre on a timely basis should this preparation and assistance not be provided or should any other circumstances arise which cause actual time to exceed that estimate. The Centre is responsible for the payment of any applicable federal, provincial or other goods and services or sales taxes, or any other taxes or duties, in connection with the services provided by Deloitte.

4. Expenses – In addition to professional fees, the Centre will reimburse Deloitte for its reasonable out-of-pocket expenses including travel, meals and hotels incurred in connection with this engagement.

5. Billing – Invoices will be rendered periodically as agreed in advance. All invoices shall be due and payable when rendered. Interest shall be calculated at a simple daily rate of 0.0493% (equivalent to 18% per annum). Interest shall be charged and payable at this rate on any part of an invoice which remains unpaid from thirty (30) days after the invoice date to the date on which the outstanding invoice is paid. To the extent that as part of the services to be performed by Deloitte as described in the engagement letter, Deloitte personnel are required to perform the services in the United States of America (“U.S. Business”), the Centre and Deloitte agree to assign performance of the U.S. Business to Deloitte Canada LLP, an affiliate of Deloitte. All services performed by Deloitte Canada LLP shall be performed under the direction of Deloitte which shall remain responsible to the Centre for such services. Deloitte Canada LLP shall invoice the Centre with respect to the U.S. Business and Deloitte will invoice for services performed in Canada (“Canadian Business”). Payment for U.S. Business and/or Canadian Business can be settled with one payment to Deloitte.

Appendix E - General business terms December 21, 2016 Page 2

6. Governing law – The engagement will be governed by the laws of the Province where Deloitte’s principal office performing the engagement is located and all disputes related to the engagement shall be subject to the exclusive jurisdiction of the courts of such Province.

7. Working papers – All working papers, files and other internal materials created or produced by Deloitte related to the engagement are the property of Deloitte. In the event that Deloitte is requested by the Centre or required by subpoena or other legal or regulatory process to produce its files related to this engagement in proceedings to which Deloitte is not a party, the Centre will reimburse Deloitte for its professional time and expenses, including legal fees, incurred in dealing with such matters.

8. Privacy – Deloitte and the Centre acknowledge and agree that, during the course of this engagement, Deloitte may collect, use and disclose personal information about identifiable individuals (“Personal Information”). Deloitte’s services are provided on the basis that the Centre has obtained any required consents for collection, use and disclosure to Deloitte of Personal Information required under applicable privacy legislation. The Centre and Deloitte agree that Deloitte will collect, use, transfer, store, disclose or otherwise process Personal Information on behalf of the Centre solely for purposes related to completing this engagement, related engagements, or providing services to the Centre as otherwise permitted by these Terms.

9. Third parties – Deloitte’s engagement is not planned or conducted in contemplation of or for the purpose of reliance by any third party (other than the Centre and any party to whom Deloitte’s audit report is addressed) or with respect to any specific transaction. Therefore, items of possible interest to a third party will not be addressed and matters may exist that would be assessed differently by a third party, possibly in connection with a specific transaction.

10. Confidentiality – To the extent that, in connection with this engagement, Deloitte comes into possession of Personal Information or any proprietary or confidential information of the Centre (collectively, “Confidential Information”), Deloitte will not disclose such information to any third party without the Centre’s consent, except:

a. as may be required or permitted by legal authority, the rules of professional conduct/code of ethics;

b. to Deloitte Entities (as such term is defined below in section 12), component auditors, permitted subcontractors and third parties that provide services to Deloitte; or

c. to the extent that such information shall have otherwise become publicly available.

Confidential Information may be used, processed and stored outside Canada by Deloitte, Deloitte Entities, component auditors and third party service providers. Deloitte is responsible to the Centre for causing Deloitte Entities, component auditors and third party service providers to comply with the obligations of confidentiality set out in this section. Confidential Information may be subject to disclosure in accordance with laws applicable in the jurisdiction in which the information is processed or stored, which laws may not provide the same level of protection under Canadian law. The Centre also agrees that Deloitte may aggregate Confidential Information and use and disclose that information as part of research and advice, including, benchmarking services, provided that all such information will be rendered anonymous and not subject to Centre with the Client. Except as instructed otherwise in writing, each party consents to properly addressed fax, email (including email exchanged via Internet media) and voicemail communication of both sensitive confidential and non-sensitive documents, information and other communications concerning this Agreement, as well as other means of communication used or accepted by the other. It is recognized that the Internet may be insecure and each party will be responsible for protecting its own systems

Appendix E - General business terms December 21, 2016 Page 3

and interests and, to the fullest extent permitted by law, will not be responsible to the other on any basis (contract, tort or otherwise) for any loss, damage or omission in any way arising from the use of the Internet or from access by any Client or Deloitte personnel, including personnel of Deloitte Entities and third parties that provide services to Deloitte, to networks, applications, electronic data or other systems of the other party.

11. Assignment – Except as provided below in section 12, no party may assign, transfer, or delegate any of its rights or obligations relating to this engagement without the prior written consent of the other parties.

12. Subcontracting – Deloitte may use the services of any of its affiliates or any member firm of Deloitte Touche Tohmatsu Limited (‘DTTL”) and its respective subsidiaries and affiliates, including those operating outside Canada (“Deloitte Entities”), component auditors or any other party. Deloitte remains responsible to the Centre for services performed by Deloitte Entities and other parties under this engagement. Each member firm of DTTL is a separate and independent legal entity operating under the names “Deloitte”, “Deloitte & Touche”, “Deloitte Touche Tohmatsu” or other related names; and services are provided by member firms or their subsidiaries or affiliates and not by DTTL.

13. Survival of terms – The agreements and undertakings of the Centre contained in the engagement letter, together with the appendices to the engagement letter including these Terms, will survive the completion or termination of this engagement.

14. Electronic messaging – In accordance with Canadian anti-spam legislation, the Centre consents to Deloitte contacting the Centre and its personnel through electronic messages relating to Deloitte’s services, products and other matters of interest to the Centre after the completion of this engagement. The Centre may withdraw any such consent by contacting Deloitte at [email protected].

15. Proportionate liability – The Centre and Deloitte acknowledge where the audit is conducted pursuant to a statute governing the Centre that contains proportionate liability provisions that apply to an auditor, such as the Canada Business Corporations Act, the terms of the statute shall apply to this engagement. In the event that the Centre and Deloitte are not subject to such statutory provisions regarding proportionate liability, the Centre agrees that in any action, claim, loss or damage arising out of the engagement, Deloitte’s liability will be several and not joint and several and the Centre may only claim payment from Deloitte of Deloitte’s proportionate share of the total liability based on the degree of fault of Deloitte as finally determined by a court of competent jurisdiction.

16. Client misrepresentation – Deloitte shall not be liable to the Centre, and the Centre releases Deloitte, for all liabilities, claims, damages, costs, charges and expenses incurred or suffered by the Centre related to or in any way associated with the engagement that arise from or are based on any deliberate misstatement or omission in any material information or representation provided by or approved by any member of management of the Centre, officer of the Centre or member of the board of directors of the Centre.

17. Qualifications – Notwithstanding anything herein to the contrary, Deloitte may use the name of the Centre, refer to this engagement and the performance of the services in marketing, publicity materials and other material, as an indication of its experience, and in internal data systems.

mailto:[email protected]

2017 Audit service plan Champlain Community Care Access Centre

For the year ending March 31, 2017 Presented to the Board of Directors January 18, 2017

December 21, 2016

Members of the Board of Directors Champlain Community Care Access Centre 4200 Labelle Street, Suite 100 Ottawa, Ontario K1J 1J8

Dear Members of the Board of Directors:

2017 Audit service plan

We are pleased to provide you with our audit service plan for the Champlain Community Care Access Centre (the “Centre”) for the year ending March 31, 2017. This document describes the key features of our plan including our audit scope and approach, our planned communications with you, our team and an estimate of our fees.

Our commitment to you is straightforward: we will provide you with outstanding professional services delivered by an experienced and dedicated team of specialists. Our professionals will continue providing you with best practices and insights to face the increasingly complex array of issues and challenges encountered by organizations like the Centre.

We look forward to discussing our audit service plan with you and answering any questions you may have.

Yours truly,

Chartered Professional Accountants Licensed Public Accountants

Deloitte LLP World Exchange Plaza 100 Queen Street Suite 1600 Ottawa ON K1P 5T8 Canada

Tel: (613) 236-2442 Fax: (613) 563-3461 www.deloitte.ca

Table of contents

Our audit explained 1

Areas of audit focus 3

Appendix 1 – Audit approach 5

Appendix 2 – Communication requirements 8

Appendix 3 – Highly-talented team 10

Appendix 4 – Timing and communications 11

Appendix 5 – Deloitte resources a click away 12

© Deloitte LLP and affiliated entities. Champlain Community Care Access Centre – 2017 Audit Service Plan 1

Our audit explained

Audit scope and terms of engagement We have been asked to perform an audit of the Centre’s financial statements (the “financial statements”) prepared in accordance with Canadian accounting standards for government not-for-profit organizations (“PSAS-GNPO”) as at and for the year ending March 31, 2017.

We have also been asked to perform an audit the Personal Support Worker Training Program Financial Reconciliation and the Centre’s Annual Reconciliation Report for the year ending March 31, 2017 as well as perform specified procedures on the Preschool Speech and Language Program (collectively the "Special Reports").

Our audits will be conducted in accordance with Canadian generally accepted auditing standards (“Canadian GAAS”).

The terms and conditions of our engagement are documented in our engagement letter, which has been provided under separate cover.

Materiality We are responsible for providing reasonable assurance that your financial statements as a whole are free from material misstatement.

Materiality levels are determined on the basis of forecasted revenues. Our preliminary estimate of materiality for the year ending March 31, 2017 has been set at $3,900,000 (2016, $3,800,000). This materiality level will be revised based on actual figures as at March 31, 2017.

We will inform the Board of Directors of all uncorrected misstatements greater than a clearly trivial amount of 5% of materiality (i.e. $195,000) and any misstatements that are, in our judgment, qualitatively material. In accordance with Canadian GAAS, we will ask that any misstatements be corrected.

Materiality for the Special reports will be determined separately and reported back to the Board of Directors as part of our year-end communication.

Areas of audit focus Through our preliminary risk assessment process, we have identified the areas of audit focus and related audit responses, which are discussed in the Areas of audit focus section of this report.

Scope and terms of engagement Materiality Areas of audit focus


Fraud risk We will develop our audit strategy to address the assessed risks of material misstatement due to fraud. Determining this strategy will involve:

1. Asking people involved in the financial reporting process about inappropriate or unusual activity.

2. Testing a sample of journal entries throughout the period as well as adjustments made at the end of the reporting period.

3. Identifying and obtaining an understanding of the business rationale for significant or unusual transactions that are outside the normal course of business.

4. Evaluating whether your accounting policies may be indicative of fraudulent financial reporting.

5. Evaluating whether the judgements and decisions related to management estimates indicate a possible bias.

6. Incorporating an element of unpredictability in selecting our audit procedures.

We will also ask the Board of Directors for their views about the risk of fraud, whether they know of any actual or suspected fraud affecting the Centre and their role in the oversight of management’s antifraud programs.

If we suspect fraud involving management, we will immediately inform the Board of Directors of our suspicions and discuss the nature, timing, and extent of audit procedures necessary to complete the audit.

Complete engagement reporting Audit reporting Under Canadian GAAS, we are required to communicate certain matters to Members of the Board of Directors. The primary reports and formal communications through which we will address these matters are:

• This Audit Service Plan

• Year End Communication,

• Our Auditor’s Report on the financial statements, and

• Our Auditor’s Reports on the Special Reports

Business Insights We will provide you with insights into the condition of your operations and offer meaningful suggestions for improvement (if any).

Audit fees Our fees include all audit procedures necessary to express an opinion on the financial statements of the Centre for the year ending March 31, 2017 as well as the Centre’s Annual Reconciliation Report and the following two special reports: Preschool Speech and Language Program and PSW Training Fund Financial Reconciliation.

Consistent with our proposal, we propose audit fees of $34,792. All fees are subject to applicable taxes.

Fraud risk Audit fees Conclusion, findings and insights Our audit reports Year-end communication

with the Committee


Areas of audit focus

During our risk assessment, we identified areas of audit focus that will require special audit consideration. These areas, together with our planned responses, are described below.

The following tables set out the areas of audit focus that we identified during our preliminary planning activities, including our proposed response to each area. Our planned audit response is based on our assessment of the likelihood of a risk’s occurrence, the significance should a misstatement occur, our determination of materiality and our prior knowledge of the Centre.

Areas of audit focus Fraud risk

Planned assessment of the design and

implementation of internal controls for

risk assessment purposes

Planned testing of the operating

effectiveness of internal controls

Planned substantive

testing

Management override of controls

Estimates

Expenses including payroll

Specific items

Will be addressed during the audit Not applicable

Management override of controls Audit risk Our proposed audit response

Management is in a unique position to override internal controls, which could allow manipulation of the accounting records that could result in financial statements that are materially misstated. This represents a fraud risk.

• We will discuss fraud with management and the Board of Directors.

• We will test the appropriateness of journal entries recorded in the general ledger and other adjustments made in the preparation of the financial statements.

• We will evaluate the business rationale for any significant unusual transactions.

• We will determine whether the judgments and decisions related to management estimates indicate a possible bias, which will include performing retrospective analysis of significant accounting estimates.


Estimates Risk identified Our proposed audit response

There is a risk that estimates are not valid and not accurately recorded and disclosed as appropriate in the financial statements.

We will obtain:

• An understanding of significant management estimates and judgment areas in the preparation of the 2017 financial statements. Estimates and areas of judgment include: useful life of capital assets, collectability of accounts receivable, legal accruals, the amount of certain accrued liabilities and potential contingencies.

• An understanding of management’s approach to determining the estimates and will assess the reasonableness and appropriateness based on our knowledge of the Centre, independent estimates and other audit work performed.

• Compare actual historical experience to estimates and models employed in such calculations and evaluate the adequacy.

Expenses including payroll Risk identified Our proposed audit response

There is a risk that the cut off of expenses is not appropriate and /or not applicable in accordance with funding agreements.

• Control reliance strategy – the operating effectiveness of controls related to expenses will be tested in the current year.

• We will review the reconciliations and reports prepared by management.

• We will perform a combination of substantive analytical procedures and detailed testing on payroll.

• We reviewed the reconciliations prepared by management.

• We will perform a search for unrecorded liabilities.

Specific items

Risk identified Our proposed audit response

There is a risk that specific events or transactions are not appropriately accounted for and/or disclosed in the financial statements.

Merger with the Champlain LHIN: We will review the status of the potential merger of the CCAC with the Local Health Integration Network to determine any additional disclosure requirements including going concern. Excise tax: We will obtain an update on the status of the excise tax on personal support services from management and involve our indirect tax specialist as required, to ensure that any developments are appropriately reflected in the financial statements.

As we perform our audit procedures, we will inform you of any significant changes to the areas of audit focus discussed above and the reasons for those changes.


Appendix 1 – Audit approach

Deloitte’s audit approach is a systematic methodology that enables us to tailor our audit scope and plan to address the unique issues facing the Centre.

The following steps are not necessarily sequential nor are they mutually exclusive. For example, once we have developed our audit plan and the audit is being performed, we may become aware of a risk that was not identified during the planning phase. Based on that new information, we would reassess our planning activities and adjust the audit plan accordingly.

1. Initial planning The Deloitte audit approach begins with an extensive planning process that includes:

• Assessing your current business and operating conditions

• Understanding the composition and structure of your business and organization

• Understanding your accounting processes and internal controls

• Understanding your information technology systems

• Identifying potential engagement risks

• Planning the scope and timing of internal control and substantive testing that take into account the specific identified engagement risks

2. Assessing and responding to engagement risk Our Audit approach combines an ongoing identification of risks with the flexibility to adjust our approach when additional risks are identified. Since these risks may impact our audit objectives, we consider materiality in our planning to focus on those risks that could be significant to your financial reporting.

Consideration of the risk of fraud When we identify a misstatement or control deficiency, we consider whether it may be indicative of fraud and what the implications of fraud and significant error are in relation to other aspects of the audit, particularly the reliability of management representations.

In determining our audit strategy to address the assessed risks of material misstatement due to fraud, we will:

• Assign and supervise personnel, taking into account the knowledge, skill and ability of individuals with significant engagement responsibilities and our assessment of the risks of material misstatement due to fraud for the engagement.

• Evaluate whether the Centre’s selection and application of accounting policies, particularly those related to subjective measurements and complex transactions, may be indicative of fraudulent financial reporting.

• Incorporate an element of unpredictability when selecting the nature, timing and extent of our audit procedures.

We will inquire directly of the Board of Directors regarding:

• Its views about the risk of fraud

• Whether it has knowledge of any actual or suspected fraud affecting the Centre, and

• The role it exercises in the oversight of fraud risk assessment and the establishment of mitigating controls.


We will also inquire if the Board of Directors is aware of tips or complaints regarding the Centre’s financial reporting and, if so, the Board of Directors’ responses to such tips and complaints and whether it is aware of matters relevant to the audit, including, but not limited to, violations or possible violations of laws or regulations.

If we suspect fraud involving management, we will communicate these suspicions to the Board of Directors and discuss the nature, timing, and extent of audit procedures necessary to complete the audit.

3. Developing and executing the audit plan The performance of an audit includes evaluating the design and determining the implementation of internal controls relevant to the audit, testing the operational effectiveness of the controls we intend to rely on, and performing substantive audit procedures.

Audit procedures The timing of our audit procedures is dependent upon a number of factors including the need to coordinate with management for the provision of supporting analysis and other documentation. Generally, we perform our audit procedures to allow us sufficient time to identify significant issues early, thereby allowing more time for analysis and resolution.

Tests of controls As part of our audit, we will review and evaluate certain aspects of the systems of internal control over financial reporting to the extent we consider necessary in accordance with Canadian GAAS. The main objective of our review is to enable us to determine the nature, extent and timing of our audit tests and establish the degree of reliance that we can place on selected controls. An audit of the financial statements is not designed to determine whether internal controls were adequate for management’s purposes or to provide assurance on the design or operational effectiveness of internal control over financial reporting.

The extent to which deficiencies in internal control may be identified through an audit of financial statements is influenced by a variety of factors including our assessment of materiality, our preliminary assessment of the risks of material misstatement, our audit approach, and the nature, timing and extent of the auditing procedures that we conduct. Accordingly, we gain only a limited understanding of controls as a result of the procedures that we conduct during an audit of financial statements.

Our plan includes an annual review of the design and implementation of key controls of significant transaction flows and testing the effectiveness of those controls using a 3 year rotation plan (summarized below). As indicated in the Areas of audit focus above we will be testing the operating effectiveness of controls related to expenses (inclusive of fixed assets additions) in the current year.

Transaction Flow Design and Implementation

Testing Effectiveness of Controls

Financial Reporting and Closing

Revenue

Expenditure 2017

Payroll 2016

Fixed Assets (additions) 2017

Treasury including investments

We will inform the Board of Directors and management of any significant deficiencies that are identified in the course of conducting the audit.

Substantive audit procedures Our substantive audit procedures consist of a tailored combination of analytical procedures and detailed tests of transactions and balances. These procedures take into account the results of our controls tests and are designed to enable us to obtain reasonable assurance that the financial statements are free from material misstatements. To obtain this assurance, misstatements that we identify while performing substantive auditing procedures will be considered in relation to the financial


statements as a whole. Any misstatements that we identify, other than those that are clearly trivial (the threshold has been set at 5% of materiality), will be reported to management and the Board of Directors. In accordance with Canadian GAAS, we will request that misstatements be corrected.

4. Reporting and assessing performance Perform post-engagement activities We will analyze the results of the audit procedures performed throughout the year and, prior to rendering our report, we will conclude whether:

• The scope of the audit was sufficient to support our opinion, and

• The misstatements identified during the audit do not result in the financial statements being materially misstated.

Independence We have developed important safeguards and procedures to protect our independence and objectivity. If, during the year, we identify a breach of independence, we will communicate it to you in writing. Our communication will describe the significance of the breach, including its nature and duration, the action taken or proposed to be taken, and our conclusion as to whether or not the action will satisfactorily address the consequences of the breach and have any impact on our ability to serve as independent auditor to the Centre.

We are independent of the Centre and we will reconfirm our independence in our final report to the Board of Directors.


Appendix 2 – Communication requirements

Required communication Reference

Audit service plan

1. Our responsibilities under Canadian GAAS, including forming and expressing an opinion on the financial statements

CAS1 260.14

2. An overview of the overall audit strategy, addressing: a) Timing of the audit b) Significant risks, including fraud risks, locations, and planned responsibilities of other

independent public accounting firms or others that perform audit procedures in the audit

CAS 260.15

3. Significant transactions outside of the normal course of business, including related party transactions

CAS 260 App. 2, CAS 550.27

Enquiries of those charged with governance

4. How those charged with governance exercise oversight over management’s process for identifying and responding to the risk of fraud and the internal control that management has established to mitigate these risks

CAS 240.20

5. Any known suspected or alleged fraud affecting the Centre CAS 240.21

6. Whether the Centre is in compliance with laws and regulations CAS 250.14

Year-end communication

7. Fraud or possible fraud identified through the audit process CAS 240.40-.42

8. Significant accounting policies, practices, unusual transactions, and our related conclusions CAS 260.16 a.

9. Alternative treatments for accounting policies and practices that have been discussed with management during the current audit period

CAS 260.16 a.

10. Matters related to going concern CAS 570.23

11. Management judgments and accounting estimates CAS 260.16 a.

12. Significant difficulties, if any, encountered during the audit CAS 260.16 b.

13. Material written communications between management and us, including management representation letters

CAS 260.16 c.

14. Other matters that are significant to the oversight of the financial reporting process CAS 260.16d.

15. Modifications to our opinion(s) CAS 260.A18

16. Our views of significant accounting or auditing matters for which management consulted with other accountants and about which we have concerns

CAS 260.A19

17. Significant matters discussed with management CAS 260.A.19 1 CAS: Canadian Auditing Standards – CAS are issued by the Auditing and Assurance Standards Board of CPA Canada


Required communication Reference

18. Matters involving non-compliance with laws and regulations that come to our attention CAS 250.23

19. Significant deficiencies in internal control, if any, identified by us in the conduct of the audit of the financial statements

CAS 265

20. Uncorrected misstatements and disclosure items CAS 450.12-13

21. Any significant matters arising during the audit in connection with the Centre’s related parties CAS 550.27


Appendix 3 – Highly-talented team

We are led by Doreen Hume, lead client service partner. As a team we are committed to delivering on Deloitte’s client service principles to:

• make and meet our commitments to our clients

• understand our clients’ business and what is important to them

• provide value and build the Centre through technical competence and consistent results

• demonstrate professionalism through effective interaction and communications, and

• provide a no surprises experience.

• The team will assist Doreen Hume in delivering on these commitments. The table below identifies key members of the engagement team:

Doreen Hume Engagement Partner 613-751-5401 [email protected] Doreen is responsible for managing the engagement and for the quality of our services to the Centre. She has served a number of Deloitte’s most prestigious public sector clients and is committed to leading a team dedicated to Deloitte’s client service culture.

Pierre-Charles La Haye Audit & Assurance Manager 613–751–5251 [email protected]

Pierre-Charles is a manager and has extensive knowledge/experience with not-for-profit organizations. He is responsible for developing and managing the audit as well as planning and administering the technical aspects of the audit.

Valérie Renaud Audit & Advisory Senior auditor 613–751–5379 [email protected] Valérie will be responsible for the execution of the audit, and overseeing all fieldwork performed by audit assistants. Valérie has over 3 years of public accounting experience serving public sector organizations including 2 years serving Champlain CCAC.

Paul Corriveau Indirect Taxation Senior Manager 613–254–6820 [email protected] Paul Corriveau is our indirect tax specialist. He will be available to assist both from a financial statement compliance perspective as well as be involved with other indirect tax consultations as required.


Appendix 4 – Timing and communications

The timing of major segments of our work is described below:

January 9, 2017 – Planning, control procedures, and interim field work

• Plan relevant aspects of the audit, including discussions thereon with management regarding audit requirements & fraud assessment.

• Perform interim internal control procedures and other interim fieldwork.

• Discuss preliminary observations with management.

January 18, 2017 – Presentation of the Audit service plan

• Discuss the audit plan with management and the Board of Directors.

May 1, 2017– Year End Field Work Commences

• Perform year-end audit procedures.

June 2017 – Meeting with the Board of Directors

• Meet with management and Board of Directors to discuss the financial statements, our written report on the results of the audit, inclusive of our management letter of recommendations (if any).


Appendix 5 – Deloitte resources a click away

At Deloitte, we are devoted to excellence in the provision of professional services and advice, always focused on client service. We have developed a series of resources, which contain relevant and timely information.

Centre for financial reporting (www.cfr.deloitte.ca)

• Directors • CEO/CFO • Controller • Financial reporting team

Web site designed by Deloitte to provide the most comprehensive information on the web about financial reporting frameworks used in Canada.

Canada’s Best Managed Companies (www.bestmanagedcompanies.ca)

• Directors • CEO/CFO

The Canada's Best Managed Companies designation symbolizes Canadian corporate success: companies focused on their core vision, creating stakeholder value and excelling in the global economy.

Centre for Corporate Governance (www.corpgov.deloitte.ca)

• Audit Committee members

• Board members • CEO/CFO • Internal auditor • Legal counsel

Web site specifically designed to help board members with their responsibilities. It provides the latest information on regulatory and legislative developments, accounting and financial reporting, board roles and responsibilities, and best practices.

Financial Reporting Insights (www.iasplus.com/fri)

• CFO • Controller • Financial reporting team

Monthly electronic communications that helps you to stay on top of standard-setting initiatives impacting financial reporting in Canada.

On the board's agenda • Directors • CEO/CFO

Bi-monthly publication examining a key topic in detail, including the perspectives of a Deloitte professional with deep expertise in the subject matter as well as the views of an experienced external director.

State of change (www.iasplus.com/StateOfChange)

• CFO • VP Finance • Controller • Financial reporting team

Bi-monthly newsletter providing insights into key trends, developments, issues and challenges facing the not-for-profit sector in Canada, with a Deloitte point of view.

Deloitte Financial Reporting Update (www.deloitte.com/ca/update)

• CFO • VP Finance • Controller • Financial reporting team

Learning webcasts offered throughout the year featuring our professionals discussing critical issues that affect your business.

http://www.cfr.deloitte.ca/

http://www.bestmanagedcompanies.ca/

http://www.corpgov.deloitte.ca/

http://www.iasplus.com/fri

http://www.iasplus.com/StateOfChange

http://www.deloitte.com/ca/update

www.deloitte.ca Deloitte, one of Canada's leading professional services firms, provides audit, tax, consulting, and financial advisory services. Deloitte LLP, an Ontario limited liability partnership, is the Canadian member firm of Deloitte Touche Tohmatsu Limited.

Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee, and its network of member firms, each of which is a legally separate and independent entity. Please see www.deloitte.com/about for a detailed description of the legal structure of Deloitte Touche Tohmatsu Limited and its member firms.

© Deloitte LLP and affiliated entities.

http://www.deloitte.com/about

Champlain

Board Scorecard

December 2016

(Data as of November 2016)

Champlain

Operational Dashboard

2

Patients

Financial

Quality

People

Quality Trends Nov-15 FY 2015/16Target (T) / Baseline (B)

Local (L) / Provincial (P)Oct-16 Nov-16 FY 2016/17

Service Wait-time Community (90th

Percentile Days Waiting)**36 57 T: 21 days (P) 34 32 31

2015/16 Q2 FY 2015/16 Target / Baseline 2016/17 Q2 2016/17 Q2 FY 2016/17

5 day wait time – Complex PSS* 75.7% 77.1% T: 95% (P) 81.0% 81.0% 82.3%Adjusted 5 day wait time - Complex PSS N/A N/A T: 95% (L) 89.5% 89.5% 90.0%5 day wait time – nursing* 93.9% 93.5% T: 95% (P) 94.7% 94.7% 94.2%% of Care Visits Delivered 99.87% 99.79% T: 99.95% (P) 99.85% 99.85% 99.81%

2014/15 Q4 FY 2015/16 Target / Baseline 2015/16 Q3 2015/16 Q4 FY 2015/16

Patient Experience* 92.8% 91.5% T: 94.5% (L) 91.7% 93.3% 91.5%*QIP Metrics

** MSAA Metrics

People Trends 2015/16 Q2 FY 2015/16Target (T) / Baseline (B)

Local (L) / Provincial (P)2016/17 Q1 2016/17 Q2 FY 2016/17

Staff Turnover 7.0% 11.0% T: 8.5% (L) 6.0% 5.4% 5.4%

% of Performance Agreements completed on

time

44/216

20.4%

215/217

99.5%

T: 186/371 (L)

50%

21/371

5.7%

81/371

21.8%

81/371

21.8%

Nov-15 FY 2015/16Target (T) / Baseline (B)


Absenteeism annualized rate 12.4 12.1 T: 9 days (L) 12.1 12.1 12.1

Financial Trends Nov-16

FY 2016/17

Variance vs.

Plan

FY 2016/17

Variance vs.

Plan %

FY 2016/17

Projected Deficit

Tracking to Budget Targets +246k -$6,665k -4.03%-$2,500k

(-1%)

FYTD Target

+$0k

Patient Trends Nov-15 FY 2015/16Target (T) / Baseline (B)


Referral Volume 4815 4585 B: 4600 (L) 4915 5019 4868

Monthly CCAC Patient Capacity 106.3% 101.7% T: 100% (L) 102.5% 99.6% 105.5%

% of Patients Reassessed Within Guidelines

of Care (RAI-HC)71% 71% T: 80% (L) 71% 71% 72%

Total Home Care PSS Patients Waitlisted

Fully Waitlisted0 315 T: 0 (L) 712 1085 267

Total Home Care PSS Patients Waitlisted

Partially Waitlisted0 255 T: 0 (L) 976 1068 525

Total Home Care PT Patients Waitlisted 10 102 T: 0 (L) 14 34 40Total Home Care OT Patients Waitlisted 7 174 T: 0 (L) 666 886 330Total School OT Patients Waitlisted 109 385 T: 0 (L) 661 722 527Total School PT Patients Waitlisted 11 34 T: 0 (L) 66 66 55Total School SP Patients Waitlisted 137 187 T: 0 (L) 539 632 346

Champlain

3

Financial

People

Metric Definition Discussion Questions

Referral Volume

The count of new referrals to the CCAC during the time period. Only referrals that initiate Case Management intake Assessments are counted in this indicator.

Is CCAC demand increasing? Is it from hospitals, physicians, or community?

Monthly CCAC Visit Capacity

The count of patients, by population groups, who received direct care visits or S&E as compared to the budgeted number of patients.

Are care plans efficient, ensuring creating additional capacity? Are there alternate parts of the health system to address particular care needs?

% of patients Reassessed Within Guidelines of Care

Percent of patients (per population coding), who receive their RAI reassessments within guidelines. E.g. Complex Population patients are to receive a reassessment every 3-6 months, whereas Community Independence patients are to receive reassessments every 12 months.

Are Care Coordinators focusing their time on assessing patients? Are processes and tools in place to ensure efficiencies in processes, allowing time for Care Coordinators to assess their patients?

Total Personal Support Services (PSS) patients Waitlisted

A snapshot view of the count of the number of PSS patients on the waitlist as at the end of the month, divided by those who are fully waitlisted (having no PSS service), and those that are partially waitlisted (having some PSS service, but assessed for needing more).

What is being done to manage patient risk?

Total Physiotherapy (PT) patients Waitlisted

A snapshot view of the count of the number of PT patients on the waitlist as at the end of the month

How are patient risks being managed?

Total Occupational Therapy (OT) patients Waitlisted

A snapshot view of the count of the number of OT patients on the waitlist as at the end of the month


Total School Therapy Patients Waitlisted by Service

A snapshot view of the count of the number of school patients on the waitlist as at the end of the month


Are we helping to navigate patients to other sources of care (insurance, etc.)?


Tracking to Budget targets Net surplus/deficit as calculated by Revenue minus Expenses, as per plan.

Are we tracking to budget plans? Are our cost/patients to plan? Is demand for service to expectations? What additional actions if any, are required at this time?


Staff Turnover Rate at which employees leave an organization. Calculated as number of permanent employees who terminate or cease employment, divided by the average number of permanent employees on staff

If not as expected, what is the underlying cause and mitigating action plan?

% of Performance Appraisals Completed on Time

FYTD percent of staff whose performance appraisal is completed on time.

Is staff development being appropriately managed?

Absenteeism annualizedRate

Total number of sick hours, paid and unpaid for all permanent and temporary staff (excludes casuals), divided by number of permanent staff.

If not as expected, what is the underlying cause and mitigating action plan?

Patients Quality

Operational Dashboard: Glossary


Service Wait-timeCommunity (90th

Percentile Days Waiting)

Wait time from patient intake / application date for referrals sourced from the community (e.g. Family, Self) to receiving the first direct care service visit, where the patient is an adult patient on Home Care services. The 90th percentile focuses on ensuring that 90% of patients will receive a visit in the targeted time frame, or better.

Should service eligibility or service guidelines be reviewed/reduced? What advocacy should the Board engage in?

5 day wait time –Complex PersonalSupport Services (PSS)

Measures the percent of patients whose 1st PSS visit was achieved within 5 days, from Service Authorization Date to the 1st PSS Visit Date for the episode of care. patients with an “On-Hold” episode between the authorization and 1st visit, are excluded from the measure. (On hold is used, for example, if a patients discharge is delayed from hospital due to complications)

How have Quality Improvement Plan (QIP) action plans improved performance?

Adjusted 5 Day Wait Time-PSS

Measures the percent of patients whose 1st PSS visit was achieved within 5 days, from Service Authorization Date or Patient Availability Date to the 1st PSS Visit Date for the episode of care.

Where are the remaining areas of focus to improve the performance? Is the target achievable?

5 day wait time -Nursing

Measures the percent of patients whose 1st Nursing visit was achieved within 5 days, from Service Authorization Date to the 1st Nursing Visit Date for the episode of care. patients with an “On-Hold” episode between the authorization and 1st visit, are excluded from the measure. (On hold is used, for example, if a patients discharge is delayed from hospital due to complications)

How have QIP action plans improved performance?

% of Care Visits Delivered

Measures the percent of visits provided to patients, of all scheduled visits, for direct care visits. The metric is self reported by SPOs on a quarterly basis.

Are there variances amongst providers or services? Are there adverse affects on patients due to missed care?

patient Experience Measures the percent positive rating for overall satisfaction with care. How have Person Driven Care action plans improved patient experience?

Champlain

Supporting Complex Patients Sustainable Health Care

4

Strategic Dashboard

Supporting Complex Patients Nov-15 FY 2015/16Target (T) / Baseline (B)


Reassessment of Complex Patients within

Guideline87% 88% T: 90% (L) 88% 87% 84%

% of Complex Patients with a Care

Coordinator Contact (tel./FtoF) within 3

months81% 83% T: 85% (L) 77% 77% 80%

% of Complex Patients with 1 Care

Coordinator in past 12 Months90% 92% T: 95% (L) 95% 94% 93%

Oct-15 FY 2015/16 Sep-16 Oct-16 FY 2016/17

% of Complex Patients With a Completed

Mediconciliation72% 74% T: 90% (L) 78% 51% 72%

Sustainable Health Care Trends Sep-15 FY 2015/16Target (T) / Baseline (B)

Local (L) / Provincial (P)Aug-16 Sep-16 2016/17 YTD

ALC Rate 13.7% 12.4% T: 12.7% (P) 13.8% 14.1% 13.3%

2014/15 Q4 FY 2015/16 2016/17 Q2 2016/17 Q2 FY 2016/17

Very High and High MAPLe Score %

supported by Champlain CCAC, compared

to Provincial Averages

59.9%

(2)

56.3%

(1)T: Top Quartile (L)

62.4%

(1)

62.4%

(1)

62.3%

(1)

1.0 1.0T: 'Long Stay (L)

Top Quartile*4.0 4.0 4.0

7.3 7.3T: 'Short Stay (L)

Top Quartile**7.0 7.0 7.0

Nov-15 FY 2015/16 Oct-16 Nov-16 FY 2016/17

% Clinic Visit Utilization 29.5% 27.1% T: 25% (L) 30.0% 30.0% 30.0%

Ranking relative to other CCACs for

average cost/Patient across all Patient

groups

*Champlain is ranked consistently amongst the highest MAPLe proportion provincially. ; Long Stay populations using provincial reference rates.

** Champlain continues to increase special programs, such as NPWT and CHIPP programs, impacting avg. cost; Short Stay Population costs are calculated

using local CCAC rates.

Champlain

Supporting Complex Patients Sustainable Health System

Metrics Definition Discussion Questions

Complex Population Definition

The complex population are patients who are coded in CHRIS as “Complex” using Provincial patient Care Model definitions.The provincial Complex Populations is defined as Long Stay patients having: 1 or more health/chronic conditions with complicating factors; Direct care needs are unstable & unpredictable; The individual or support network is not self-reliant with high risks in more than 1 area; RAI score 17 +; High/intensive case management is required to support patient goals & outcomes; Multiple care partners across sectors; overall poor coping; multiple complex psychosocial issues; unmanageable behavioural/mental health issues;

How do other “complex” patients get identified, such as those in Short Stay populations?

Besides service costs, what are the implications of a growing base of Complex Patients on Case Management and the skills and resources needed?

Reassessment of Complex Patients within Guidelines

Percent of patients (per population coding), who receive their RAI reassessments within guidelines. E.g. Complex Population patients are to receive a reassessment every 3-6 months,.

Are Care Coordinators focusing their time on assessing patients? Are processes and tools in place to ensure efficiencies in processes, allowing time for Care Coordinators to assess their patients?

% of Complex Patients with a Care Coordinator Contact (tel./FtoF) within X Months

Count of the number of complex population patients who have had a Care Coordinator contact within last 3 months out of all complex population patients.

Are complex patients being monitored closely? Are there risks for some patients? If patients do not have a contact within last 3 months, what are the potential impacts?

% of Complex Patients with 1 Care Coordinator in Past 12 Months

Percent of complex patients active in the current month, who have had 1 Care Coordinator consistently assigned to the patient in the past 12 months.

When there are transitions, are Care Coordinators briefing peers effectively? What may cause higher number of assigned Care Coordinators (turnover, reassignments, etc.)?

% of Complex PSS Patients with Targeted Number of SPO Staff Within Past 3 Months

Percent of complex patients active in the current month, who have had the appropriate number of SPO staff assigned to the patient, within the past 3 months.

Is there consistency in care within the PSS care team? Do high numbers of SPO assigned staff create risk or a need for constant retraining? How do SPOs ensure consistency of care within the care team?

% of Complex Patients With aCompleted Medication Reconciliation

% of Complex Population patients with a BPMH completed within 30 days of either a RAI-HC completed with triggers for needing a Medication Reconciliation, or within 30 days of an initial face to face visit by a RRN or MHAN nurse.

Are there risks to patients if the CCAC is not completing a medication reconciliation? Are there other health professionals completing the Med Rec? Are there barriers to completing a Med Rec. ?

Metrics Definition Discussion Questions

ALC Rate New Indicator: Counts the total ALC bed days as a percentage of Total Bed days, during the period. Includes sub-acute (rehab and complex care bed and counts patients not yet discharged).

Are our programs appropriately supporting LHIN-Wide ALC targets? What if any additional actions are required to improve performance?

Very High & High MAPLe Score % supported by Champlain CCAC

The proportion of CCAC patients assessed by a RAI-HC, with a MAPLe Score of High or Very High, out of the total number of patients with a RAI-HC assessment.

What is the financial impact of sustaining higher needs patients? What effects does this have for provincial HBAM funding/

Ranking relative to other CCACs for average cost/patient across all patient groups

Using the LHIN Benchmark report, average costs per patient are reported by population group. Ranking can be achieved through the comparison of average cost per patient, across peers.

Are we delivering appropriate service levels to different patient populations (HBAM neutral or positive) and properly balancing cost & patient risk/safety?

% Clinic Visit Utilization Percent of Clinic Visits out of total Visit Nursing and Clinic Nursing Visits

Strategic Dashboard: Glossary

Champlain CCAC Financial Results – Executive Summary For the month ended November 30, 2016

OVERVIEW This executive summary covers Champlain CCAC’s financial results for the month ending November 30, 2016.

BUDGET ASSUMPTIONS AND UPDATES The F2016/17 budget was refreshed in July 2016 after the receipt of an additional $11.0M in funding.

CONDENSED OPERATING STATEMENT

1 Month 1 Month 1 Month YTD YTD YTD YTD Total Total 15/16

Actuals Budget Variance Actuals Budget Variance Var % Budget Budget

REVENUE

Base Funding 20,965,592 20,672,997 292,594 165,340,260 164,590,849 749,411 0.46% 246,508,010 233,401,895

One-Time Funding 103,398 66,939 36,459 668,010 529,075 138,935 26.26% 791,682 1,067,232

BTI & Other Funding 204,941 43,584 161,357 234,152 348,672 (114,520) (32.84%) 523,019 523,019

TOTAL REVENUE 21,273,931 20,783,520 490,410 166,242,422 165,468,596 773,826 0.47% 247,822,711 234,992,146

EXPENSES

Purchased Client Services 15,205,938 15,011,759 (194,179) 127,999,986 119,532,019 (8,467,967) (7.08%) 178,486,605 166,847,325

Internal Therapies 438,199 436,670 (1,529) 3,256,861 3,475,112 218,251 6.28% 5,258,682 4,866,307

Care Coordination 3,566,484 3,572,238 5,754 28,099,009 28,387,886 288,876 1.02% 42,939,349 42,066,852

Health System Development 93,164 90,676 (2,488) 795,713 727,310 (68,403) (9.40%) 1,096,510 695,603

Nursing Initiatives 260,038 269,989 9,950 2,109,579 2,142,869 33,290 1.55% 3,245,813 3,241,926

Information & Referral 83,193 103,629 20,436 728,291 809,802 81,511 10.07% 1,216,663 1,173,843

Administration 1,381,121 1,298,560 (82,561) 9,838,413 10,393,598 555,185 5.34% 15,579,088 16,100,290

TOTAL EXPENSES 21,028,138 20,783,520 (244,617) 172,827,852 165,468,596 (7,359,256) (4.45%) 247,822,711 234,992,146

TOTAL SURPLUS/(DEFICIT) 245,793 - 245,793 (6,585,430) - (6,585,430) (3.98%) - -

FINANCIAL ANALYSIS NOVEMBER MONTH AND YTD _ REVENUE Base Funding: November base variance of $293K is due to an adjustment revenue: recognition of base was

erroneously understated in Q2. One-time Funding: The favourable variance is due to additional one-time funds received that were not included in the

budget. These additional one-time funds have been matched to expenses. BTI & Other Funding: Revenue is matched to expenses (timing variance and no impact to bottom line). This is for the BTI

computer leases which are charged by Dell but paid by the OACCAC. EXPENSES Purchased Client Services: The unfavourable variances to budget of $195K for the month and $8.5M year-to-date are due to

continued higher demand for PSS and Nursing Services to the end of November as portrayed in the spend rate charts shown below.

Internal Therapies The favourable variances to budget of $218K year-to-date are in salaries and benefits due to vacancies. Care Coordination: The year-to-date favourable variance of $288K is due to vacancies, lower actual rates than budgeted,

fewer maternity leaves and timing differences in other care coordination administrative expenses. Health System Development: The expenses relating to these programs have targeted funding which is matched as expenses are

incurred. Variances are due to timing and programs do not impact the overall CCAC bottom line. Nursing Initiatives and I&R: The year-to-date favourable variance of $115K is due to vacancies and lower actual rates than

budgeted. Administration: The favourable variance in administration year-to-date of $555K is due in part to vacancies and

occupancy savings. However, a portion of this variance is timing related (BTI and other).

FORECAST TO MARCH 31, 2017 YE forecast is slightly above the 1% range, at roughly $3M. There could be a variance of +/- $1M on this forecast, as the forecast is very sensitive to actual realized week over week savings due to the various parallel measures in place. Also, due to the nature of waitlisting being cumulative month/month, the savings in turn cumulate month/month – thus the majority of the savings are back-ended in the fiscal year and will be realized in February and March. In terms of cost controls, the following mechanisms are in place. 1. We have implemented centralized admission controls on PSS service since September 2016. This measure is working well on the patient admission side – continued reduction in PSS costs is dependent on ongoing discharges being maintained at current rates 2. We have reduced expenditures on therapy services since Sept 2016, and are maintaining volumes at a reduced level, but at a level to avoid low volume penalties 3. Nursing services are however still being served to demand to avoid hospital partner impacts – and we are susceptible to demand increases for our nursing services, which in turn would add to costs 4. Administrative cost controls have been in place since May 2016, and continue to contribute positively month over month to the financials We have detailed expenditure tracking in place on a week/week basis that allows us to update our expected YE outcome weekly. Our budget management committee also meets on a weekly basis to discuss results and options for mitigation. In addition, the LHIN is working with the CCAC to clarify if revenues traditionally clawed back if underspent to program/volume commitments, can be used by the CCAC to address current financial pressures – this could positively impact our YE forecast by $1M if confirmed.

ADDITIONAL INFORMATION

CCAC Patient Capacity (Budgeted Number of Patients vs. Actual Patient Counts)

Special Program Costs

Appendix I – Revenue Confirmations PURPOSE The Champlain CCAC has a fiduciary obligation to balance its budget each fiscal year. This log keeps track of changes to in year funding (both one

time and base) as a means of understanding the variance in funding introduced over the year.

Balancing annual budgets is challenging not only due to changes in revenue assumptions, but also by variations in patient demand and acuity as

well as factors impacting other partners which impact CCAC operations.

Measures in place to manage the budget are limited to operational efficiencies and introducing service waitlists or transferring patients to other

community services.

FUNDING CONFIRMATIONS RECEIVED

Date Funding changes Impact to budget presented on monthly

Financial statements

2016/2017 2016/2017 Budget reflects an increase of 0.5% as

confirmed by the LHIN, representing $1.1M plus an additional $1.1M for PSS stabilization

N/A: this is reflected in the original and refreshed budget presented

28-Aug-15 Received funding letter confirming new base funding of

$215,500 for Stroke Rehab Services. N/A: this is reflected in the original and

refreshed budget presented

4-Mar-16 Received funding letter for new one-time funding of

$143,800 for Health Links Primary Care. N/A: this is reflected in the original and


9-Mar-16 Received funding letter for one-time funding of $84,145 for PSS Implementation and Home and Community Care

Resource.




9-Mar-16 Received funding letter for one-time funding of $1,000

for additional program support for Health Links. N/A: this is reflected in the original and


13-Apr-16 Received funding letter for one-time funding of

$150,000 for Implementation of Health Links and Primary Care Networks in the Champlain region.


13-Apr-16 Received funding letter for one-time funding of $72,656

for the first quarter of F2016/17 to support the Prescott-Russell Health Link.


3-Jun-16 Received funding letter for new base funding of

$2,498,500 for Year 3 Wage Enhancement for Personal Support Services.

This is reflected in the refreshed budget (effective July 2016).

15-Jun-16 Received funding letter for one-time funding of $60,000

for the Ottawa East Health Links Business Plan development.


24-Jun-16 Received funding letter for one-time funding reallocation of $795,982 related to F2015/16

underspending in certain programs.


5-Jul-16 Received funding letter for one-time funding of

$220,000 to further support the work of the Shared Services Organization (SSO).


11-Jul-16 Received funding letter for one-time allocation of

$5,000 to support travel expenses for the Early Adopter PSS Community Resource.

+$5,000 but with offsetting expenses



11-Jul-16

Received funding letter for one-time allocation of $120,000 to implement the recommendations outlines in the Champlain Sub Acute Capacity Plan. (One-time

funding also confirmed for 2017/18 and 2018/19)

+120,000 but with offsetting expenses

11-Jul-16

Received funding letter for one-time allocation of $72,766 to hire and equip a decision support/business intelligence analyst for Health Links, Primary are and

LHIN sub-region analysis. (One-time funding also confirmed for 2017/18).

+72,766 but with offsetting expenses

29-Jul-16

Received funding letter for new base funding of $11,015,800 for expanding service provision for high

needs clients, to provide respite services for caregivers, and a base funding adjustment.


5-Aug-16

Received “revised” funding letter to replace the July 5, 2016 letter for new one-time funding of $220,000 to

further support the work of the Shared Services Organization (SSO).


7-Sep-16 Received funding letter for new one-time funding of $60,000 for Community Support Services Projects –

Secondment for Business Analyst.


9-Sep-16 Received funding letter for $850,591 in new base

funding to provide nursing and PSS services in residential hospices.

+$850,591 (to be flowed to hospices)

27-Sep-16 Received funding letter for new one-time funding of $315,000 to expand capacity at Marianhill hospice.

+$315,000 (to be flowed to hospice)

4-Oct-16

Received funding letter for one-time funding of $1,200 to support Prescott-Russell Health Link representatives

to attend the annual HQO Health Links Leadership Summit

+$1,200 (but with offsetting expenses)



4-Oct-16 Received funding letter for one-time funding of $1,200 to support Ottawa East Health Link representatives to

attend the annual HQO Health Links Leadership Summit +$1,200 (but with offsetting expenses)

24-Oct-16

Received funding letter confirming recovery of $3,312 from CSS Exercise and Fall Prevention Initiative funds. These funds will be reallocated to Akwesasne who will

provide the services in their community

-$3,312 (not material)

28-Oct-16 Received funding letter from MOHLTC confirming

additional $17,000 base funding to support Regional Translation Network Program.

+$17,000 (targeted non-LHIN funding)

Appendix II – Statement of Financial Position

November 30, 2016 October 31, 2016 March 31, 2016

ASSETS

CURRENT ASSETS

Cash-CDN $6,010,273 $3,275,142 $11,588,108

Accounts Receivable 351,112 1,033,206 1,516,689

Prepaid Expenses 14,653 21,288 289,133

6,376,038 4,329,636 13,393,930

CAPITAL ASSETS 803,379 803,379 995,228

$7,179,417 $5,133,015 $14,389,158

LIABILITIES

CURRENT LIABILITIES

Accounts Payable and Accrued

Liabilities $12,597,856 $11,110,246 $13,902,384

Due to/(from) MOHLTC 2,285,965 1,973,357 1,339,613

14,883,821 13,083,603 15,241,997

LONG-TERM LIABILITIES

Deferred Contributions - Capital

Assets 803,378 803,378 995,228

15,687,199 13,886,981 16,237,225

NET ASSETS

Carry-over 15/16 (1,848,067) (1,848,067)

Operational (6,659,715) (6,905,899) (1,848,067)

(8,507,782) (8,753,966) (1,848,067)

$7,179,417 $5,133,015 $14,389,158

Appendix III – Cash Flow Forecast

The cash flow forecast presented below takes into consideration the impact of the Waitlisting assumptions presented above.

Date Description

Funding receipts/

(payments)

Cash surplus/

(deficit) position Date Description

Funding receipts/

(payments)

Cash surplus/

(deficit) position

Dec 19 Actual Balance 1,959,650 Feb 6 Payroll Gov't Submissions (524,853) 1,362,110

Dec 22 Payroll (1,321,641) 638,008 Feb 13 Cheque run (3,216,897) (1,854,787)

Dec 26 Cheque run (3,493,276) (2,855,268) Feb 15 Funding 10,421,081 8,566,294

Dec 27 Payroll Gov't Submissions (393,912) (3,249,180) Feb 16 Payroll (1,297,650) 7,268,644

Dec 30 Funding 10,416,249 7,167,069 Feb 20 Cheque run (3,177,414) 4,091,230

Jan 1 Cheque run (643,602) 6,523,467 Feb 21 Payroll Gov't Submissions (524,853) 3,566,377

Jan 2 Cheque run (3,453,793) 3,069,674 Feb 27 Cheque run (3,137,931) 428,446

Jan 3 Funding 119,055 3,188,729 Feb 28 Funding 10,421,081 10,849,527

Jan 5 Payroll (1,297,650) 1,891,079 Mar 1 Funding 119,055 10,968,582

Jan 9 Cheque run (3,414,310) (1,523,231) Mar 1 Cheque run (643,602) 10,324,980

Jan 10 Payroll Gov't Submissions (524,853) (2,048,084) Mar 2 Payroll (1,297,650) 9,027,330

Jan 15 Funding 10,421,081 8,372,997 Mar 5 Payroll Gov't Submissions (524,853) 8,502,477

Jan 16 Cheque run (3,374,828) 4,998,169 Mar 6 Cheque run (3,098,448) 5,404,029

Jan 19 Payroll (1,297,650) 3,700,519 Mar 13 Cheque run (3,058,966) 2,345,063

Jan 23 Cheque run (3,335,345) 365,174 Mar 15 Funding 10,421,081 12,766,144

Jan 24 Payroll Gov't Submissions (524,853) (159,679) Mar 16 Payroll (1,297,650) 11,468,494

Jan 30 Cheque run (3,295,862) (3,455,541) Mar 20 Cheque run (3,019,483) 8,449,011

Jan 31 Funding 10,421,081 6,965,540 Mar 21 Payroll Gov't Submissions (524,853) 7,924,158

Feb 1 Funding 119,055 7,084,595 Mar 27 Cheque run (2,980,000) 4,944,158

Feb 1 Cheque run (643,602) 6,440,992 Mar 30 Payroll (1,297,650) 3,646,508

Feb 2 Payroll (1,297,650) 5,143,342 Mar 31 Funding 10,421,081 14,067,589

Feb 6 Cheque run (3,256,379) 1,886,963

Champlain CCAC

Board Financial Statement

for the Eight Months Ending November 30, 2016

1 Month 1 Month 1 Month YTD YTD YTD Total

Actuals Budget Variance Actuals Budget Variance Budget

REVENUE

Base Funding 20,965,592 20,672,997 292,594 165,340,260 164,590,849 749,411 246,508,010

One-Time Funding 103,398 66,939 36,459 668,010 529,075 138,935 791,682

BTI 206,880 38,918 167,962 228,466 311,344 (82,878) 467,019

Other (1,940) 4,666 (6,606) 5,686 37,328 (31,642) 56,000

Total Revenue 21,273,930 20,783,520 490,410 166,242,422 165,468,596 773,825 247,822,711

EXPENSES

Clinical Care

Purchased Services

Personal Support Services 8,344,655 8,238,405 (106,250) 72,560,180 66,306,031 (6,254,149) 98,625,912

Visit Nursing (includes dialysis) 2,736,380 2,777,874 41,494 22,530,227 21,955,889 (574,339) 32,853,702

Visit Nursing - Clinic 488,979 435,922 (53,057) 3,971,918 3,445,458 (526,461) 5,155,612

Nursing Shifts 859,197 819,357 (39,839) 6,355,656 6,476,074 120,418 9,690,476

Community - OT 275,093 353,464 78,371 2,625,934 2,793,726 167,791 4,180,392

Community - PT 404,390 389,156 (15,234) 3,295,368 3,075,826 (219,541) 4,602,514

Community - Speech 11,899 17,924 6,025 161,092 141,669 (19,423) 211,986

School - OT 222,606 192,299 (30,307) 1,439,328 1,389,250 (50,078) 2,147,736

School - PT 57,107 50,240 (6,867) 321,294 322,410 1,116 519,230

School - Speech 143,861 134,432 (9,429) 941,411 921,819 (19,592) 1,478,517

Social Work 30,477 40,515 10,038 302,409 320,226 17,817 479,170

Nutrition 32,645 39,000 6,355 270,808 308,250 37,442 461,250

Hospice 441,304 375,746 (65,558) 3,567,489 3,005,968 (561,521) 4,508,971

Aphasia 20,833 21,452 618 166,667 169,552 2,885 253,709

Medical Supplies 807,710 1,022,959 215,249 6,764,766 8,085,312 1,320,546 12,098,460

Medical Equipment 326,541 99,381 (227,160) 2,671,692 785,490 (1,886,202) 1,175,368

Recoveries (9,048) (15,207) (6,159) (91,048) (121,656) (30,608) (182,500)

Other 11,311 18,841 7,530 144,793 150,725 5,932 226,100

Total Purchased Services 15,205,938 15,011,759 (194,179) 127,999,986 119,532,019 (8,467,967) 178,486,605

Internal Therapies

Wages 323,880 343,020 19,140 2,343,180 2,623,996 280,816 3,969,045

Benefits 83,876 73,198 (10,678) 729,095 687,500 (41,595) 1,044,137

Travel 28,846 18,414 (10,432) 171,535 147,312 (24,223) 221,000

General Administration Costs 1,597 2,038 441 13,051 16,304 3,253 24,500

Total Internal Therapies 438,199 436,670 (1,529) 3,256,861 3,475,112 218,251 5,258,682

Page 1 of 6

Champlain CCAC




Actuals Budget Variance Actuals Budget Variance BudgetCare Coordination

Wages 2,789,273 2,839,125 49,852 21,577,434 21,737,821 160,387 32,816,917

Benefits 699,354 698,520 (833) 6,258,591 6,373,318 114,727 9,657,253

Travel 41,935 41,666 (269) 312,897 333,328 20,431 500,000

Professional Service 34,600 2,082 (32,518) 39,199 16,659 (22,541) 75,000

Office Supplies 2,262 4,583 2,322 13,994 36,664 22,670 55,000

Printing 9,922 8,333 (1,589) 78,036 66,664 (11,372) 100,000

Photocopy Charges 4,903 9,166 4,263 36,381 73,328 36,947 110,000

Delivery & Courier 1,232 1,666 434 8,850 13,328 4,478 20,000

Courses/Training/Conferences 760 2,166 1,406 10,653 17,328 6,675 26,000

Minor Equipment 83 83 664 664 1,000

Wireless Service 10,780 9,166 (1,614) 81,494 73,328 (8,166) 110,000

Recoveries (29,059) (44,692) (15,633) (251,149) (357,536) (106,387) (536,320)

Other 523 374 (149) 12,629 2,992 (9,637) 4,500

Total Care Coordination 3,566,484 3,572,238 5,754 28,179,009 28,387,886 208,876 42,939,349

Health System Development

Healthlinks-Primary Care 23,172 24,262 1,090 177,685 195,437 17,752 293,800

Healthlinks-HLA1 25,633 23,810 (1,823) 201,593 192,093 (9,501) 290,624

Shared Services 44,359 42,604 (1,756) 416,435 339,781 (76,654) 512,085

Total Health System Development 93,164 90,676 (2,488) 795,713 727,310 (68,403) 1,096,510

Nursing Initiatives

Wages 200,882 209,778 8,896 1,593,545 1,603,733 10,189 2,426,295

Benefits 46,386 48,255 1,869 425,637 443,496 17,858 676,018

Travel 12,552 11,665 (887) 83,023 93,320 10,297 140,000

Recoveries (334) 334

Other 218 290 72 7,708 2,320 (5,388) 3,500

Total Nursing Initiatives 260,038 269,989 9,950 2,109,579 2,142,869 33,290 3,245,813

Information & Referral

Wages 62,351 79,866 17,514 560,365 614,325 53,959 922,822

Benefits 20,842 23,680 2,839 167,298 194,814 27,516 292,841

Travel 83 83 628 664 36 1,000Total for Information & Referral 83,193 103,629 20,436 728,291 809,802 81,511 1,216,663

Total Clinical Care 19,647,016 19,484,960 (162,056) 163,069,439 155,074,998 (7,994,442) 232,243,623

Page 2 of 6

Champlain CCAC




Actuals Budget Variance Actuals Budget Variance BudgetADMINISTRATION

Executive Office

Wages 79,735 88,259 8,524 664,820 666,941 2,121 1,000,164

Benefits 14,647 16,606 1,959 130,729 141,790 11,061 227,110

Travel 880 1,250 370 14,516 10,000 (4,516) 15,000

Legal Services 51,970 25,833 (26,137) 213,119 206,664 (6,455) 310,000

Consultants 416 416 3,328 3,328 5,000

Membership (OACCAC) 30,714 30,833 119 249,817 246,664 (3,153) 370,000

Meeting Expenses 291 291 486 2,328 1,842 3,500

Printed Matter & Subscriptions 166 166 1,328 1,328 2,000

Board Expenses 3,226 2,291 (935) 7,923 18,328 10,405 27,500

Recoveries (342) 342 (2,733) 2,733

Other 291 291 2,328 2,328 3,500

Total for Executive Office 180,830 166,236 (14,595) 1,278,676 1,299,699 21,023 1,963,774

Performance and Strategy

Business Intelligence

Wages 39,056 36,969 (2,087) 284,942 282,713 (2,230) 426,947

Benefits 10,066 7,872 (2,194) 91,083 73,890 (17,193) 113,329

Travel 125 125 1,000 1,000 1,500

Other 83 83 664 664 1,000

Total for Business Intelligence 49,122 45,049 (4,073) 376,025 358,267 (17,758) 542,776

Quality & Program Evaluation

Wages 38,917 38,031 (886) 258,039 290,833 32,794 436,171

Benefits 8,347 7,689 (657) 66,131 72,369 6,238 111,158

Travel 333 333 1,371 2,664 1,293 4,000

Other 12,613 8,102 (4,511) 78,579 64,816 (13,763) 97,250

Recoveries (1,724) 1,724

Total for Quality & Program Evaluation 59,876 54,155 (5,721) 402,395 430,682 28,287 648,579

PMO and Service Provider Programs

Wages 39,782 39,968 186 300,389 305,031 4,642 457,459

Benefits 10,342 8,355 (1,987) 82,760 73,661 (9,100) 111,952

Travel 76 249 173 1,012 1,992 980 3,000

Other 41 41 328 328 500Total for PMO and Service Provider Programs 50,200 48,614 (1,587) 384,161 381,012 (3,149) 572,911

Page 3 of 6

Champlain CCAC




Actuals Budget Variance Actuals Budget Variance BudgetFinance and Payroll

Wages 51,680 51,676 (4) 403,844 393,538 (10,305) 589,186

Benefits 13,364 12,187 (1,177) 136,837 113,212 (23,625) 169,889

Travel 83 83 664 664 1,000

Insurance 6,635 6,731 96 52,347 53,848 1,501 80,773

Audit Services 2,667 2,750 84 21,332 22,000 668 33,000

Other 916 333 (583) 3,532 2,664 (868) 4,000

Total for Finance and Payroll 75,261 73,760 (1,501) 617,892 585,927 (31,965) 877,848

Facilities

Wages 10,969 14,948 3,979 109,081 113,780 4,698 170,362

Benefits 3,125 3,205 80 28,298 27,842 (456) 42,004

Travel 67 500 433 2,314 4,000 1,686 6,000

Office Supplies & Services 339 916 577 2,109 7,328 5,219 11,000

Postage, courier & photocopy services 244 2,083 1,839 16,468 16,664 196 25,000

Building Occupancy 185,965 208,822 22,857 1,562,069 1,670,576 108,507 2,505,864

Office Renovations 1,338 15,833 14,495 35,296 126,664 91,368 190,000

Utilities 4,679 4,583 (96) 30,003 36,664 6,661 55,000

Misc Supplies/Repairs/Cleaning 5,590 5,833 243 45,962 46,664 703 70,000

Equipment Maintenance-Plant 1,645 5,000 3,355 40,104 40,000 (104) 60,000

Furniture & Equipment Purchases (Capital Asset)

Leasehold Improvement Purchases (Capital Asset)

Other 1,835 2,457 622 13,075 19,656 6,581 29,500

Recoveries (374) (13,333) (12,959) (44,527) (106,664) (62,137) (160,000)

Total for Facilities 215,421 250,847 35,426 1,840,252 2,003,174 162,923 3,004,730

IT & System Communications

Wages 121,206 118,236 (2,971) 899,032 899,647 615 1,351,274

Benefits 27,716 28,257 542 236,552 244,348 7,795 370,617

Travel 812 833 21 5,413 6,664 1,251 10,000

Telephone & System Communications 27,601 36,915 9,314 253,698 295,320 41,622 443,000

Telephone Supplies 1,253 3,416 2,163 3,979 27,328 23,349 41,000

Telephone Maintenance & Licenses 2,500 2,500 120,044 114,000 (6,044) 124,000

Telephone System Consultant 158 1,666 1,508 1,739 13,328 11,589 20,000

Equipment Maintenance 2,500 2,500 35,947 20,000 (15,947) 30,000

Software Maintenance & Licenses 4,940 20,499 15,559 214,351 163,992 (50,359) 246,000

System Development Consultant/CHRIS Development 1,041 1,041 18,079 8,328 (9,751) 12,500

Computer Supplies 1,065 5,833 4,768 19,909 46,664 26,755 70,000

Other Equipment Rentals

BTI 206,880 38,918 (167,962) 228,466 311,344 82,878 467,019

Page 4 of 6

Champlain CCAC




Actuals Budget Variance Actuals Budget Variance BudgetBTI Refresh/Growth 431 4,999 4,568 40,367 39,992 (375) 60,000

CCAC eHealth Program 150,494 140,865 (9,629) 1,203,955 1,126,920 (77,035) 1,690,381

Renovations 896 2,083 1,187 5,437 16,664 11,227 25,000

Other 1,686 5,874 4,188 33,209 46,992 13,783 70,500

Recoveries (200) 200 (1,600) 1,600

Equipment Purchases (Capital Asset) 21,451 (21,451) 32,443 (32,443)Total for IT & System Communications 566,391 414,435 (151,956) 3,351,020 3,381,531 30,511 5,031,291

Health Information

Wages 15,020 15,121 100 110,253 115,302 5,049 172,684

Benefits 3,935 3,812 (123) 32,044 32,377 333 48,835

Travel 208 208 409 1,664 1,255 2,500

Shredding & Document Destruction 425 1,250 825 1,844 10,000 8,156 15,000

Scanning Services 83 83 664 664 1,000

Storage 3,990 3,333 (657) 30,818 26,664 (4,154) 40,000

Other 138 (138)

Recoveries (135) 135 (2,129) 2,129

Total for Health Information 23,236 23,807 572 173,376 186,671 13,295 280,019

Total Performance and Strategy 1,039,507 910,667 (128,841) 7,145,122 7,327,264 182,142 10,958,153

People and Stakeholder Engagement

People Services

Wages 66,332 64,674 (1,657) 472,624 493,829 21,205 740,603

Benefits 13,015 14,145 1,130 120,036 133,344 13,308 202,483

Travel 446 833 387 3,432 6,664 3,232 10,000

Consultants - HR 1,150 2,291 1,141 8,227 18,328 10,101 27,500

Labour Relations 1,292 6,666 5,374 11,489 53,328 41,839 80,000

Occupational Health & Safety 577 8,333 7,756 8,182 66,664 58,482 100,000

Advertising 130 4,166 4,036 36,198 33,328 (2,870) 50,000

Employee Assistance Plan 7,159 2,500 (4,659) 21,478 20,000 (1,478) 30,000

Staff Appreciation 500 4,583 4,083 1,100 36,664 35,564 55,000

Total People Services 90,601 108,191 17,590 682,767 862,149 179,382 1,295,586

Organizational Development

Wages 33,607 37,439 3,832 258,610 285,885 27,275 430,164

Benefits 6,483 7,760 1,277 65,273 72,845 7,571 111,860

Travel 527 291 (236) 2,730 2,328 (402) 3,500

Courses/Training/Conferences 6,000 6,000 42,925 48,000 5,075 72,000

Other 4,000 4,000 44,108 32,000 (12,108) 48,000

Recoveries (1,153) 1,153

Total Organizational Development 40,616 55,490 14,874 412,494 441,058 28,564 665,524

Page 5 of 6

Champlain CCAC




Actuals Budget Variance Actuals Budget Variance Budget

Stakeholder Engagement

Wages 21,540 38,624 17,084 211,663 294,293 82,630 441,351

Benefits 4,371 7,813 3,442 54,270 76,807 22,537 116,201

Travel 625 625 1,929 5,000 3,071 7,500

Public Relations 3,162 8,833 5,671 29,111 70,664 41,553 106,000

Translation/Consultants 2,083 2,083 14,329 16,664 2,335 25,000

Other 494 (494) 8,052 (8,052)

Total Stakeholder Engagement 29,567 57,978 28,411 319,353 463,428 144,074 696,052

Total People and Stakeholder Engagement 160,784 221,658 60,874 1,414,615 1,766,635 352,020 2,657,162

Total Administration 1,381,121 1,298,560 (82,561) 9,838,413 10,393,598 555,185 15,579,088

Total Expenses 21,028,137 20,783,520 (244,617) 172,907,852 165,468,596 (7,439,257) 247,822,711

Surplus/(Deficit) 245,793 - 245,793 (6,665,430) - (6,665,430) -

Page 6 of 6

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