The assessment, which bitterly disappointed some relatives of the most frail residents of Sunnybrook Veterans Centre, urges the facility to take immediate steps to improve a dysfunctional complaints process.
"Several residents and families expressed their lack of knowledge of how to make a complaint or mistrust of the formal complaints-management system," the audit states.
"In a few cases, there was an expressed hesitancy to bring issues forward for fear of discrimination against their loved one."
According to the audit, residents or families filed 32 formal complaints between April 2011 and the end of last year. Of those, 25 per cent were dissatisfied with the outcome.
In addition, 28 per cent of the files were closed "without an evaluation of the satisfaction with the outcome," according to the audit.
"The final note in many of these files was that final contact with the complainant could not be made."
Veterans Affairs Minister Steven Blaney ordered the audit last November — the first in years — after The Canadian Press documented complaints from several relatives, who said their loved ones were being neglected or mistreated.
Common themes included residents left for hours in soiled diapers, and delayed or missed feedings. Relatives also said their attempts at redress were met with indifference or hostility.
While the audit does not address specific complaints, it does conclude patient care "is aligned with provincial and professional standards, the clinical care is of a high quality, and appropriate monitoring is occurring."
"Results to date indicate excellent performance in several domains. For those areas where results fall below the provincial benchmarks, quality initiatives are put in place and monitored for improvements."
John Marriott, whose elderly father-in-law died at Sunnybrook last spring days after family members discovered one of his teeth had been knocked out, called the document a "whitewash."
"Where are the specific concerns that families expressed?" Marriott said.
"This audit report discards the disturbing testimony of patients and families and tacitly sanctions conditions and occurrences at (Sunnybrook) that have scarred our family."
The 500-bed vets centre, which receives more than $55 million a year in government funding, has always insisted its care is exemplary.
Sunnybrook CEO Dr. Barry McLellan said Thursday he was "encouraged" the audit concluded the level of care is of a high quality and pledged to implement the audit's suggestions.
"We look forward to the opportunity to providing even a higher level of care to our residents and their families," McLellan said.
In written responses to what the audit calls "opportunities for improvement," Sunnybrook management said resolution of some complaints wasn't noted in the central registry examined by auditors.
The facility also said it only "partially" agreed with a recommendation for a "more collaborative approach" to patient care through family conferences and inclusion in decision making.
Jackie Storrison, a 61-year-old grandmother Sunnybrook had escorted out by police after she complained about her father's treatment, said the audit's criticism comes as no surprise and she welcomed its recommendations.
"Three months later, I am still being forced to be accompanied by security guards every night when I come to care for my dad," Storrison said.
"For a long-term-care facility to treat a devoted, loving daughter this way is unconscionable and intimidating to other families."
The probe found up-to-date care plans missing from more than one in four resident charts, something Sunnybrook chalked up to a "documentation issue."
Overall, the audit makes seven recommendations — most aimed at improving complaints handling and communications with residents' families.
Mike Blais, president of Canadian Veterans Advocacy, said the audit — and a review done last month by an external hospital administrator at Sunnybrook's request — are not binding.
"The hospital doesn't have to implement anything that's recommended," Blais said. "That's fundamentally wrong."
While the government has no enforcement power, Blaney spokesman Niklaus Schwenker said the minister expects Sunnybrook to act quickly.
"We expect its recommended areas of improvement to be implemented in a timely fashion so that veterans and their families are always treated with respect and receive the high level of care that they deserve," Schwenker said.
Still, some relatives have continuing complaints about care and say they believe Sunnybrook is simply unwilling to make any improvements.
"These elderly vets continue to be deprived of the basics and robbed of their dignity," Debra Stuart, whose aged father calls the centre home, said Thursday.
"I recently found my father crying, squirming in his wheelchair in tremendous discomfort from sitting in a urine-soaked diaper all day."