To protect the health, safety, and well-being of residents in long-term health care facilities, Public Health should improve its oversight of complaint processing. Specifically, by May 1, 2015, Public Health should establish a specific time frame for completing facility-related complaint investigations and ERI investigations and inform staff of the expectation that they will meet the time frame. Public Health should also require district offices to provide adequate, documented justification whenever they fail to meet this time frame.
Public Health developed and implemented policies and procedures with targeted time frames to ensure investigations are conducted timely across priority levels that lack them.
Additionally, Public Health developed complaint teams at each Public Health District Office to ensure complaint time frames are being met, increase efficiencies, and manage complaint workload. Public Health holds District Administration and District Managers monthly meetings to inform staff of the policies and procedures and expectation that they will meet the time frame.
Although Public Health has revised its policies and procedures to reflect the new timelines required by Senate Bill 75, Statutes of 2015, for facility-related complaint investigations, it did not provide documentation to demonstrate that it has established time frames for ERI investigations. When we followed-up, Public Health staff acknowledged that it has not established time frames for ERI investigations.
On June 24, 2015, SB 75 chaptered, which created complaint investigation completion timeframes that will be implemented on a phased in basis over the next few years. Specifically SB 75 requires:
- L&C to complete long-term care (LTC) IJ level complaint investigations that are received on or after July 1, 2016 within 90 days of receipt.
- All other LTC complaints received between July 1, 2017 and July 1, 2018, must be completed within 90 days of receipt.
- After July 1, 2018 complaint investigations must be completed within 60 days of receipt.
- These time periods may be extended up to an additional 60 days if the investigation cannot be completed due to extenuating circumstances.
- Any citation issued must be completed within 30 days of the investigation.
- CDPH to annually report data on department's compliance with the complaint investigation completion timelines beginning in 2018-2019.
- If CDPH does not meet the timeframes we must document the extenuating circumstances explaining why and provide written notice to the facility and the complainant, if any, of the basis for the extenuating circumstances and the anticipated completion date.
CDPH is revising its complaint investigation policies and procedures to reflect the revised timeframes. The revision will be published by the end of 2015.
We assessed the status of this recommendation as partially implemented because Public Health states that it is revising its complaint investigation policies and procedures to reflect the revised time frames specified in SB 75, statutes of 2015. Additionally, we followed up with Public Health to clarify why it indicated the status of this recommendation as "will not implement." Public Health indicated although SB 75 establishes time frames for completing investigations of complaints against facilities, ERIs were not part of SB 75 and Public Health does not plan to establish time frames for ERIs. As we state on page 32 of our report, we believe that Public Health's lack of accountability has contributed to its district offices' failure to complete investigations within reasonable time.
On May 8, 2015, CDPH posted district office-specific data to the stakeholder website page. CDPH Branch Chiefs use this district office-specific data with the district office managers to manage performance.
Public Health does not provide any reason for why it will not implement our recommendation to establish a specific time frame for completing facility-related complaints and entity-reported incident (ERI) investigations. As we state on page 32 of the report, we believe that Public Health's lack of accountability has contributed to its district offices' failure to complete investigations within reasonable time. Public Health's response indicates that in May 2015 it posted district office-specific data to the website and that branch chiefs use this data with district office managers to manage performance. However, without first defining specific time frames that it considers to be timely, it is unclear how district office managers will manage performance and effectively ensure that staff promptly complete all investigations.
CDPH is committed to respond to facility-related complaints and ERIs in a timely manner. Rather than establish specific time frames for investigations at this point. CDPH has developed performance metrics that promote staff accountability without compromising the quality and the thoroughness of the work.
On November 7, 2014, CDPH posted on our website performance metrics on the volume, timeliness, and disposition of long-term care health facility complaint and ERI investigations for the first quarter of fiscal year 2014-2015.
By January 31, 2015, CDPH will provide district-specific data to the district offices to use as a management tool. CDPH will work with the district offices to monitor these performance metrics.
Public Health fails to provide any reason for why it does not agree with our recommendation to establish a specific time frame for completing facility-related complaints and entity-reported incident (ERI) investigations. As we state on page 32 of the report, we believe that Public Health's lack of accountability has contributed to its district offices' failure to complete investigations within reasonable time. Public Health states that it will provide data, including data on timeliness, to its district offices as a management tool. However, without first defining what it considers to be timely, the steps that Public Health outlines will be ineffective in ensuring that district offices promptly complete all investigations.
Agency responses received are posted verbatim.