Report 2012-107 Recommendation 11 Responses

Report 2012-107: Developmental Centers: Poor-Quality Investigations, Outdated Policies, Leadership and Staffing Problems, and Untimely Licensing Reviews Put Residents at Risk (Release Date: July 2013)

Recommendation #11 To: Developmental Services, Department of

To minimize the need for overtime, the department should reassess its minimum staffing requirements, hire a sufficient number of employees to cover these requirements, and examine its employee scheduling processes.

Annual Follow-Up Agency Response From November 2018

In 2017-18, the Department (DDS) implemented a new allocation methodology for staffing required to care for residents, operate facilities, and to meet state licensing and Centers for Medicare and Medicaid Services (CMS) settlement agreement requirements for continued federal funding. The budget now presents Unit Staffing, with staff necessary to meet licensing requirements for different unit acuity levels based on resident placements into the community and also identifies separate Program Support Staffing, with the staff necessary to support all other operations including food service, protective services, pharmacy operations, administration, etc. Unit Staffing levels are driven by the number of units operated; Program Support Staffing levels are driven by overall resident population.

DDS notes that adding temporary help and overtime (OT) amounts is another change from previous years' estimates. In 2017-18, the budget did not include funds for temporary help or OT costs, but factored in the number of staff positions needed to cover for undelivered staff and adequate care for residents. The new budget methodology results in reduced OT. Recruitment plans are in place at Porterville Developmental Center (PDC) Secure Treatment Program and at the Canyon Springs Community Facility to meet the new minimums. The facilities in the closure process PDC General Treatment Area, Sonoma Developmental Center and Fairview Developmental Center) have ongoing, changing staffing needs that will be monitored based on population and residences in service managed with the new KRONOS Workforce Management System (KRONOS) and layoff planning.

DDS contracted with KRONOS in May 2017 and began training and system programming. The KRONOS system has fully automated shift scheduling, OT scheduling, time use tracking, and leave management for level of care staff to more efficiently schedule and assign staff.

KRONOS was fully implemented in January 2018.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

The department provided documentation for its new staffing model and automated shift scheduling. Further, the department provided data showing that the actions it has taken has resulted in a 39 percent reduction in overtime at its developmental centers between July 2016 and March 2018.

Annual Follow-Up Agency Response From December 2017

In 2017-18, DDS implemented a new allocation methodology for appropriate staffing required to care for residents, operate facilities and meet state licensing and Center for Medicare and Medicaid Services settlement agreement requirements for continued federal funding. The budget now presents Unit Staffing necessary to meet licensing requirements for different unit acuity levels (i.e., ICF, General Acute Care, Skilled Nursing, and Crisis), based on the timing of resident placements into the community. The budget also identifies separate Program Support Staffing necessary to support all operations including food and protective services, pharmacy, facilities and maintenance, administration, etc.

The 2017-18 budget doesn't include funds for temporary help or overtime costs, but factors in the number of staff positions needed to cover for undelivered staff and adequately care for residents. The new budget methodology, with increased minimum staffing requirements, will result in reduced overtime. Recruitment plans are in place at Porterville Developmental Center (PDC) Secure Treatment Program and Canyon Springs Community Facility to meet the new minimums. The facilities in the closure process (PDC General Treatment Area, SDC and FDC) changing staffing needs will be ongoing based on client placements, staff attrition, etc., which will be monitored based on population and residences in service, and managed with the new workforce management system (KRONOS) and layoff planning. KRONOS is expected to be in by January 2018.

California State Auditor's Assessment of Annual Follow-Up Status: Partially Implemented

Although DDS appears to have made progress in implementing this recommendation, it is too early to determine whether its new allocation methodology and budget process, and its January 2018 implementation of its new workforce management system, will reduce overtime in its developmental centers.

Annual Follow-Up Agency Response From October 2016

DDS worked with the Department of State Hospitals (DSH) to use its Automated Staff Scheduling Support Tool (ASSIST). After further discussions with the DSH it was determined that based on the actual timeline of implementation it was not feasible for DDS to purse the ASSIST, especially with the announcement of the Developmental Centers (DCs) closures. The Department is exploring options with shorter implementation timelines for staff scheduling of the one remaining DC and one State-Operated Community Facility. In addition, each DC has developed its recruitment plan to strategize the recruitment and hiring needs for filling staffing gaps due to the high attrition rate after the closure announcement. DCs are in the process of implementing their recruitment plans. The estimated time for DCs to fully implement their recruitment plans is December 2017. Meanwhile, all DCs have converted to centralized staffing to improve staff scheduling, especially after DC closures were announced. DDS plans to finalize the study of the other options by December 31, 2016.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Annual Follow-Up Agency Response From September 2015

DDS is working with the Department of State Hospitals (DSH) regarding its Automated Staff Scheduling and Information Support Tool (ASSIST), which is continuing to be tested. Five of eight state hospitals have implemented ASSIST with the projected date of full implementation for DSH now October 2015. The ASSIST solution will provide automated creation of schedules and tracking of critical personnel information. These data would allow the DDS Developmental Centers Division management to effectively measure overtime usage and determine critical factors for managing overtime. DDS is currently working on its Stage One Business Analysis for the California Department of Technology as a first step in procuring ASSIST. The DSH contract allows for DDS to attach to its program, contingent on approvals and funding.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Annual Follow-Up Agency Response From October 2014

DDS is working with the Department of State Hospitals (DSH) regarding its Automated Staff Scheduling and Information Support Tool (ASSIST), which is currently scheduled for user acceptance testing from October 6 to 10, 2014, and pilot testing on October 27, 2014, for Napa and Atascadero State Hospitals (67 days for the pilot). The projected date of full implementation for DSH is now March 2015. The ASSIST solution will provide consistent application of business rules, automated creation of schedules and tracking of critical personnel information. These data would allow the DDS Developmental Centers Division management to effectively measure overtime usage and determine critical factors for managing overtime. DDS is having regular meetings with DSH to review the Feasibility Study Report and monitor DSH implementation progress, so that DDS can make informed decisions regarding how it should proceed.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

1-Year Agency Response

The Department has fully implemented the new overtime authorization procedures noted in the six-month response. Following this implementation, the DC system has seen a 16 percent decrease in the amount of overtime accrued.

DDS continues to work with the Department of State Hospitals (DSH) regarding its Automated Staff Scheduling and Information Support Tool (ASSIST) as noted in the six-month response, which is anticipated to be implemented in November 2014. DDS plans to join this contract with the DSH ASSIST, if approved, once full implementation at DSH is completed.

The DCD continues to conduct a random sampling review of high earners of overtime and the reporting documents at all facilities. Following the results of these audits, each DC has been notified of the corrections, changes or actions needed, to ensure follow-up is completed where warranted.

Additionally a new overtime authorization form has been developed and implemented at all facilities to ensure compliance with the State Controllers timekeeping rules and to allow for improved management and monitoring of overtime. This form was fully implemented for the June pay period.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

Minimum staffing requirements are regularly assessed at all DCs, not only to address staffing needs and reduce reliance on overtime, but to assure the staffing sufficiently meets the acuity needs for all residents. Each DC regularly reviews the staffing complement to determine whether there are enough staff to provide the services and supports to the residents in each residential/program area.

The Department is currently focusing its hiring activities in areas where the number of employees are insufficient to avoid significant reliance on overtime. As indicated in the audit, non-OPS employees at Sonoma DC had the highest use of overtime as a percent of total earnings for the period of 2009 through 2012. Since March 2013, over 200 employees have been hired with continued, ongoing, aggressive recruitment at the facility. This corrects an error in the prior 60-day response which overstated the number of hires. More than 100 additional candidates are currently undergoing the extensive background clearance process.

DDS is working with the Department of State Hospitals (DSH) regarding its Automated Staff Scheduling and Information Support Tool (ASSIST), which is currently out for bid. The ASSIST solution will provide consistent application of business rules, automated creation of schedules and tracking of critical personnel information. The data would allow DCD management to effectively measure overtime usage and determine critical factors for managing overtime. DDS is having regular meetings with DSH to review the Request for Proposal, so that DDS can make informed decisions regarding how it should proceed.

California State Auditor's Assessment of 6-Month Status: Partially Implemented

60-Day Agency Response

DDS is implementing this recommendation. Minimum staffing requirements are regularly assessed at all developmental centers, not only to address staffing needs and reduce reliance on overtime, but to assure the staffing sufficiently meets the acuity needs for all residents. Each developmental center regularly reviews the staffing complement to determine whether there are enough staff to provide the services and supports to the residents in each residential/program area.

The Department is currently focusing its hiring activities in areas where the number of employees are insufficient to avoid significant reliance on overtime. As indicated in the audit, non-OPS employees at Sonoma had the highest use of overtime as percent of total earning for the period of 2009 through 2012. Since May 2013, aggressive hiring has resulted in nearly 200 new employees with approximately 90 additional candidates currently underway through the extensive background clearance process.

The Department is also exploring the use of an automated staff scheduling software, currently under development at the Department of State Hospitals, to assist in streamlining staffing assignments.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2012-107

Agency responses received are posted verbatim.