Report 2016-108 Recommendation 7 Responses

Report 2016-108: Department of Developmental Services: It Cannot Verify That Vendor Rates for In-Home Respite Services Are Appropriate and That Regional Centers and Vendors Meet Applicable Requirements (Release Date: October 2016)

Recommendation #7 To: Developmental Services, Department of

To ensure that it is providing oversight in accordance with state law and federal requirements, DDS should ensure that it performs audits of each regional center every two years as required. In conducting these audits, DDS should consistently include a review of in-home respite services.

Annual Follow-Up Agency Response From October 2022

The Department has implemented a more efficient review process whereby RC audit reports are completed, approved, and finalized in a timely manner. The improved process uses a software application to track the current status of the audit reports during the internal review process and streamlines the number of reviewers when no significant issues are identified in an audit report. Furthermore, the Department has consistently ensured that RCs are audited every two years, per the Home and Community-based Services Waiver agreement. These audits include the review of numerous service programs such as in-home respite services as part of the sample testing.

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

DDS provided documentation demonstrating that it performed audits of regional centers every two years as required. Further, its audit program now requires a review of in-home respite services.

Annual Follow-Up Agency Response From October 2021

The Department has implemented a more efficient review process whereby RC audit reports are completed and finalized in a timely manner. The improved process uses a software application to tracks the current status of the audit reports during the internal review process and streamlines the number of reviewers when no significant issues are identified in an audit report. Furthermore, as reported in prior follow-up responses, the Department has consistently ensured that RCs are audited every two years, per the Home and Community-based Services Waiver agreement; these audits include the review of numerous service programs such as in-home respite services as part of the sample testing.

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

Although DDS provided documentation in which it asserts that it performs audits of each regional center every two years as required, we will review available supporting documentation to confirm whether this is indeed the case as part of another audit that should be released before the timing of our next annual assessment. Further, DDS explained that its audits do include a review of in-home respite services; however, it has not incorporated this review into its official audit program to ensure it is consistently performed. Until it does so, we will continue to report the status of this recommendation as not fully implemented.

Annual Follow-Up Agency Response From October 2020

As reported in prior follow-up responses, the Department has consistently ensured that RCs are audited every two years, per the Home and Community- based Services Waiver agreement. The audits are conducted within the two-year timeframe and the current fiscal audits of RCs includes the review of numerous service programs which would include in-home respite services as part of the sample testing. However, for some audits the issuance and posting of the final audit report has been protracted due to the internal review process and evaluation of additional information from the RCs.

Nonetheless, as stated in the audit report, the Department is working to have more efficient review processes, whereby RC audit reports would be completed in a timelier manner. DDS anticipates this will be completed by July 2021.

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

Annual Follow-Up Agency Response From October 2019

As reported in prior follow-up responses, the Department has consistently ensured that RCs are audited every two years, per the Home and Community- based Services Waiver agreement. The audits are conducted within the two-year timeframe and the current fiscal audits of RCs includes the review of numerous service programs which would include in-home respite services as part of the sample testing. However, for some audits the issuance and posting of the final audit report has been protracted due to the internal review process and evaluation of additional information from the RCs.

Nonetheless, as stated in the audit report, the Department is working to have more efficient review processes, whereby RC audit reports would be completed in a timelier manner. DDS anticipates this will be completed by December 2020.

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

Annual Follow-Up Agency Response From November 2018

As reported in prior follow-up responses, the Department has consistently ensured that RCs are audited every two years, per the Home and Community­ based Services Waiver agreement. The audits are conducted within the two-year timeframe and the current fiscal audits of RCs includes the review of numerous service programs which would include in-home respite services as part of the sample testing. However, for some audits the issuance and posting of the final audit report has been protracted due to the internal review process and evaluation of additional information from the RCs.

Nonetheless, as stated in the audit report, the Department is working to have more efficient review process, whereby RC audit reports would be completed in a timelier manner.

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

Annual Follow-Up Agency Response From December 2017

As reported in prior follow-up responses, the Department has consistently ensured that regional centers are audited every two years, per the Home and Community-based Services Waiver agreement. The audits are conducted within the two-year timeframe and the current fiscal audits of the regional centers does include the review of numerous service programs which would include in-home respite services as part of the sample testing. However, for some audits the issuance and posting of the final audit report has been protracted due to the internal review process and evaluation of additional information from the regional centers. Nonetheless, as stated in the audit report, the Department is working to have a more efficient review process, whereby regional center audit reports would be completed in a timelier manner.

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

1-Year Agency Response

The audits are conducted within the two-year timeframe and the current fiscal audits of the regional centers does include the review of numerous service programs which would include in-home respite services as part of the sample testing.

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

Although DDS contends that it is complying with the requirement that it conduct audits of regional centers every two years as required, it could only provide documentation that it initiated these audits. Thus, until it completes and issues audit reports of regional centers to the public every two years, it will continue to not meet this requirement. Further, until DDS provides documentation demonstrating that the completed audits included a review of in-home respite services, we will continue to report this recommendation as not fully implemented.

6-Month Agency Response

The audits are conducted within the two-year timeframe and the current fiscal audits of the regional centers does include the review of numerous service programs which would include in-home respite services as part of the sample testing.

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

Although DDS contends that it is complying with the requirement that it conduct audits of regional centers every two years as required, it could only provide documentation that it initiated these audits. Thus, until it completes and issues audit reports of regional centers to the public every two years, it will continue to not meet this requirement. Further, until DDS provides documentation demonstrating that the completed audits included a review of in-home respite services, we will continue to report this recommendation as not fully implemented.

60-Day Agency Response

The audits are conducted within the two-year timeframe and the current fiscal audits of the regional centers does include the review of numerous service programs which would include in-home respite services as part of the sample testing.

California State Auditor's Assessment of 60-Day Status: No Action Taken

DDS contends in its response that it is complying with the requirement that it conduct audits of regional centers every two years. As we describe on page 33 of our report, DDS has had delays in issuing and completing the required reports. Although DDS indicated in the report it is working to minimize these delays, until it completes and issues audit reports of regional centers to the public every two years, it will continue to not meet the requirement. Further, as we point out on page 33, these audits do not always include a review of vendor files maintained by the regional center or a review of expenditures related to vendors that provide in-home respite services. Thus, until DDS consistently includes a review of in-home respite services in its audits, we remain concerned that any fiscal problems or other issues these audits may otherwise reveal could continue to go undetected.

All Recommendations in 2016-108

Agency responses received are posted verbatim.