Ensuring quality of care is an important issue in long-term care facilities. As mechanisms for quality assurance and improvement, there have been multiple quality indicators for long-term care endorsed. The quality of care for older adults is strongly linked to the performance of nursing staff, who provide direct care for older adults in long-term care facilities. In the current context of the integrated care system, very limited nursing staffs must perform a wide range of tasks and have very busy schedules which can lead to care quality issues in the long-term care facilities. Across many institutions, there is growing attentions on multilevel factors that enhance the quality of care. Multilevel modeling contributes to understand of hierarchical data structures by allowing the analyst to estimate structural and variance. Disaggregating variables conceptualized at institutional level and including them in an analysis with the individual level would generally produce different results. The higher quality of care may depend upon multi-factors, and the issue of quality measurement should be examined in a larger, more complex context, but the research is usually very limited for actual practices in long-term care facilities. A cross-sectional, national-wide study of long-term care hospitals in Japan was conducted before. Questionnaires were utilized to collect data on individual and institutional factors on care processes. A multilevel analysis was conducted to explore which factors were associated with quality of care. Increase the nurses’ work engagement, decrease job burnout and turnover intention in long-term care facilities are recommended to improve the quality of care.