Report 2014-111 Recommendation 12 Responses

Report 2014-111: California Department of Public Health: It Has Not Effectively Managed Investigations of Complaints Related to Long-Term Health Care Facilities (Release Date: October 2014)

Recommendation #12 To: Public Health, Department of

To ensure that its district offices properly investigate complaints and ERIs, Public Health should make certain that all district offices follow procedures requiring supervisory review and approval of complaint and ERI investigations. If the district offices do not have a sufficient number of supervisors to review investigations they did not conduct, Public Health should arrange to assist the districts until such time that they do have a sufficient number of supervisors.

Annual Follow-Up Agency Response From December 2017

Public Health redirects resources to district offices that demonstrate a need for support and an ability to hire health facilities evaluator supervisors. Public Health continues to reinforce the supervisor's role in reviewing and approving investigation findings. A standardized report template specifically identifies all complaint types and volume and allows each branch chief to discuss workload priorities and policy and procedure compliance to ensure supervisors are available to review and approve the documents. District offices have multiple supervisors to provide review of complaints and ERIs. The supervisor position vacancies are declining; as of September 30, 2017, 16 of 110 positions are vacant (15% vacancy rate); the functional vacancy rate is approximately one supervisor vacancy per district office. Public Health collaborated with the Human Resources Branch to increase the frequency of the supervisor's eligibility exam processing so that Public Health can quickly promote eligible candidates who are ready for a supervisor position. The exams dates are listed on the department's website.

Public Health continues to conduct periodic reviews of ERIs and complaints for quality and adherence to policy. In September and November 2016, the Quality Improvement (QI) team conducted the Abbreviated Survey Review project. We selected 19 abbreviated surveys for review, and found all 19 to comply with state and federal case closure requirements.

  • Completion Date: September 2017

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

Public Health has not made certain that all district offices follow procedures requiring supervisory review and approval of complaint and ERI investigations. Although Public Health's response states that it continues to conduct periodic reviews, it only demonstrated reviews of compliance in the fall of 2016. Further, based on the documentation provided from those compliance reviews, Public Health reviewed only one sample at each district and therefore we do not believe this is a sufficient review for the basis of its conclusion that it has fully implemented this recommendation to make certain that district offices follow procedures requiring supervisory review and approval of complaint and ERI investigations.

  • Auditee did not substantiate its claim of full implementation

Annual Follow-Up Agency Response From November 2016

Public Health has filled most of the Health Facilities Evaluator Nurse supervisor positions. District offices are 81% staffed and recruiting and hiring is ongoing.

On August 4, 2016, Public Health released updated policy and procedures for the Abbreviated Standard Survey (federal complaint process) in Skilled Nursing/Nursing Facilities. These policy and procedures provide specific guidance to all district offices on timelines, investigation, documentation, and completion using best practices for consistent and efficient processing of entity-reported incident. These policies include quality measures for continuing monitoring and evaluating performance according to these policy and procedure.

Licensing and Certification's district office supervisors received training on these updated policy and procedures between January-July 2016.

This topic was also discussed at an all-state District Administrator/District Manager meeting in August 2016, which reinforced the role of the supervisor in triage and review of prioritization as well as the quality of the process for timely completion.

  • Estimated Completion Date: January 2017

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

1-Year Agency Response

CDPH continues to remind supervisors of their review obligations, most recently in the District Administrator/District Manager Academy in August 2015. We are developing a sign-off sheet to document supervisory review as part of the complaint investigation documentation. By January 31, 2016, we will prepare a District Office Memo communicating this new procedure.

The 2015-16 Budget Act increased CDPH's funding for 240 positions and $14.85 million for LA County to conduct L&C work. The new positions included 24 new supervisors. CDPH has scheduled new supervisor academies for January, March, and June 2016 for the newly hired supervisors to assist with their orientation and staff development.

  • Estimated Completion Date: January 31, 2016
  • Response Date: November 2015

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

6-Month Agency Response

CDPH continues to review complaints and ERI for appropriate prioritization level, timely onsite visit, and investigations. These reviews are currently conducted for LA County District offices. After April 2015, the review will expand to the other district offices ensuring all district offices are reviewed each quarter.

The Governor's 2015-16 Budget, updated at the May Revision, includes a request for funding for 237 state positions, including 24 new supervisors, to conduct L&C state and federal work.

In addition, CDPH is developing and implementing plans to assist district offices that have vacancies of supervisors by redirecting work to neighboring offices.

  • Estimated Completion Date: 10/31/2015
  • Response Date: June 2015

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

Public Health has not yet provided documentation of the actions noted in its response.

60-Day Agency Response

On October 28, 2014, CDPH issued a reminder to all district office managers during the face-to-face District Administrator/District Manager meeting about the importance to investigate properly complaints and ERIs. Additionally, it included a web link to the most current complaint policies and procedures, which include supervisory review.

CDPH has developed criteria for reviewing complaint and ERI prioritization and quality of investigations. Beginning May 2014, CDPH has used these criteria to conduct monthly reviews of a sample of complaint and ERI investigations in LA County. CDPH prepares a quarterly report of these reviews. These reviews will continue in LA County until April 2015.

By April 2015, CDPH will add criteria for reviewing plans of correction and supervisory review to the LA County monthly reviews. By October 2015, CDPH will use the criteria to monthly review a sample of the investigations in district offices statewide.

  • Estimated Completion Date: 10/31/15
  • Response Date: December 2014

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

All Recommendations in 2014-111

Agency responses received are posted verbatim.