Report 2016-108 All Recommendation 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 for Legislative Action

To ensure that DDS is paying reasonable and appropriate rates to vendors for in-home respite services, the Legislature should clarify whether the rate freeze imposed by the 1998 legislation is still in effect despite the numerous legislative rate adjustments made since then. Further, the Legislature should clarify whether the 2003 legislation that imposed a cap on vendors' hourly payment rates constitutes only a ceiling on increases of in-home respite rates and require DDS to resume collecting cost statements and adjust the rates if appropriate.

Description of Legislative Action

Legislation has not been introduced to address this specific recommendation.

  • Legislative Action Current As-of: December 2017

California State Auditor's Assessment of 1-Year Status: No Action Taken


Recommendation for Legislative Action

To ensure that vendors' in-home respite hourly payment rates are reasonable and appropriate, particularly when compared to their administrative costs and the hourly wages they pay to respite workers, the Legislature should require DDS to conduct an in-depth review of its in-home respite rates by November 1, 2017. In conducting this review, the Legislature should require DDS to perform the following:

- Obtain and analyze all vendors' cost statements to determine their costs of providing services and whether vendors' administrative costs are reasonable.

- Obtain information from vendors on the hourly wages they pay to respite workers and analyze this information to determine whether vendors' hourly rates are reasonable.

- Using information from the cost statements, identify whether vendors' temporary rates should be converted to permanent rates.

- Submit a report to the Legislature on the results of its review, including a proposal on the extent to which legislative changes are needed to ensure that in-home hourly respite rates are appropriate.

Description of Legislative Action

Assembly Bill 1380 (Santiago) would require the California Department of Developmental Services to conduct an in-depth review of in-home respite provider rates by November 1, 2018, and to report the results of that review, on or before January 1, 2020, to the Legislature. This bill is pending in the Senate Appropriations Committee.

  • Legislative Action Current As-of: December 2017

California State Auditor's Assessment of 1-Year Status: Legislation Proposed But Not Enacted


Recommendation for Legislative Action

To ensure the health and safety of individuals with developmental disabilities, the Legislature should require workers who provide in-home respite services to consumers to undergo a criminal background check. For the other services that fall under the Lanterman Act, the Legislature should require DDS to conduct a review of the types of services provided directly to consumers and whether any oversight mechanisms are in place to ensure that workers providing these services do not have criminal backgrounds. The Legislature should require DDS to report the results of this review no later than December 31, 2017, and, using the results of this review, determine whether legislation requiring such workers to undergo criminal background checks is necessary to protect the health and safety of individuals with developmental disabilities.

Description of Legislative Action

Assembly Bill 1380 (Santiago) would require an employer to submit the fingerprints of a prospective in-home respite worker to the Department of Justice for a criminal background check prior to employment, and prohibit employment of an in-home respite worker that has been convicted for, or incarcerated following conviction for, specified crimes, including fraud against a government health program or a serious or violent felony, and would authorize a consumer or an applicant to petition the department for a waiver from these provisions. This bill is pending in the Senate Appropriations Committee.

  • Legislative Action Current As-of: December 2017

California State Auditor's Assessment of 1-Year Status: Legislation Proposed But Not Enacted


Recommendation #4 To: Developmental Services, Department of

To ensure that regional centers are aware of the benefits, including cost savings to the State that can be realized by using FMS vendors, DDS should formally communicate to regional centers regarding the model.

Annual Follow-Up Agency Response From December 2017

DDS will formally communicate to regional centers a reminder that participant-direction of respite, through the use of Financial Management System vendors, is an option for the delivery of this service. The communication will note that, as stated in regulation, "...the regional center may offer Participant-Directed Services to allow the adult consumer and/or family member to procure their own...respite...services."

DDS anticipates this will be completed by January 2018.

  • Estimated Completion Date: January 2018

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


1-Year Agency Response

DDS is in the process of drafting a letter to formally communicate to regional centers a reminder that a participant-direction of respite, through the use of FMS vendors, is an option for the delivery of service.

  • Estimated Completion Date: 12/29/17
  • Response Date: October 2017

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


6-Month Agency Response

DDS is in the process of drafting a letter to formally communicate to regional centers a reminder that participant-direction of respite, through the use of FMS vendors, is an option for the delivery of service.

  • Estimated Completion Date: 6/30/17
  • Response Date: April 2017

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


60-Day Agency Response

DDS is in the process of drafting a letter to formally communicate to regional centers a reminder that participant-direction of respite, through the use of FMS vendors, is an option for the delivery of service.

  • Estimated Completion Date: 4/25/2017
  • Response Date: February 2017

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


Recommendation #5 To: Developmental Services, Department of

To ensure that in-home respite vendors are providing quality services and that vendors are adhering to state requirements, DDS should issue regulations requiring regional centers to conduct periodic and ongoing reviews of vendors' programs, employees, and consumer records.

Annual Follow-Up Agency Response From December 2017

As previously reported, the Department believes there are existing regulations for periodic reviews of some vendor requirements, although perhaps not as expansive as envisioned by the Auditor's recommendations. The Auditor points out in the report that some regional centers reported they previously completed more expanded reviews of all providers but no longer do because of a lack of resources. Therefore, it is likely that compliance with any potential new requirements would pose a significant challenge for regional centers without an associated increase in funding.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement

As stated in our report on page 31, although there are no requirements that regional centers monitor vendors, they are not precluded from doing so, and we found that two regional centers had previously performed reviews of vendors that led to important conclusions. For example, on that same page we describe that in 2011 Inland Regional Center formally conducted quality assurance audits of the program, employee, and consumer records for two of the five vendors we selected for review. One of these audits concluded that the respective vendor should require all routine respite workers to have ongoing training on developmental disability topics and that not all of the employee files contained required documentation, including CPR and first aid certifications. In light of these conclusions and regional centers' minimal monitoring of vendors in general, which we describe on pages 28 through 32, we encourage DDS to identify cost-effective methods to help ensure regional centers conduct periodic and ongoing reviews of vendors to identify key areas for needed improvement in in-home respite service delivery.


1-Year Agency Response

There are existing regulations for periodic reviews of some vendor requirements.

  • Response Date: October 2017

California State Auditor's Assessment of 1-Year Status: Will Not Implement

As stated in our report on page 31, although there are no requirements that regional centers monitor vendors, they are not precluded from doing so, and we found that two regional centers had previously performed reviews of vendors that led to important conclusions. For example, on that same page we describe that in 2011 Inland Regional Center formally conducted quality assurance audits of the program, employee, and consumer records for two of the five vendors we selected for review. One of these audits concluded that the respective vendor should require all routine respite workers to have ongoing training on developmental disability topics and that not all of the employee files contained required documentation, including CPR and first aid certifications. In light of these conclusions and regional centers' minimal monitoring of vendors in general, which we describe on pages 28 through 32, we encourage DDS to identify cost-effective methods to help ensure regional centers conduct periodic and ongoing reviews of vendors to identify key areas for needed improvement in in-home respite service delivery.


6-Month Agency Response

There are existing regulations for periodic reviews of some vendor requirements.

  • Response Date: April 2017

California State Auditor's Assessment of 6-Month Status: Will Not Implement

As stated in our report on page 31, although there are no requirements that regional centers monitor vendors, they are not precluded from doing so, and we found that two regional centers had previously performed reviews of vendors that led to important conclusions. For example, on that same page we describe that in 2011 Inland Regional Center formally conducted quality assurance audits of the program, employee, and consumer records for two of the five vendors we selected for review. One of these audits concluded that the respective vendor should require all routine respite workers to have ongoing training on developmental disability topics and that not all of the employee files contained required documentation, including CPR and first aid certifications. In light of these conclusions and regional centers' minimal monitoring of vendors in general, which we describe on pages 28 through 32, we encourage DDS to identify cost-effective methods to help ensure regional centers conduct periodic and ongoing reviews of vendors to identify key areas for needed improvement in in-home respite service delivery.


60-Day Agency Response

There are existing regulations for periodic reviews of some vendor requirements.

  • Response Date: February 2017

California State Auditor's Assessment of 60-Day Status: Will Not Implement

As stated in our report on page 31, although there are no requirements that regional centers monitor vendors, they are not precluded from doing so, and we found that two regional centers had previously performed reviews of vendors that led to important conclusions. For example, on that same page we describe that in 2011 Inland Regional Center formally conducted quality assurance audits of the program, employee, and consumer records for two of the five vendors we selected for review. One of these audits concluded that the respective vendor should require all routine respite workers to have ongoing training on developmental disability topics and that not all of the employee files contained required documentation, including CPR and first aid certifications. In light of these conclusions and regional centers' minimal monitoring of vendors in general, which we describe on pages 28 through 32, we encourage DDS to identify cost-effective methods to help ensure regional centers conduct periodic and ongoing reviews of vendors to identify key areas for needed improvement in in-home respite service delivery.


Recommendation #6 To: Developmental Services, Department of

To ensure that in-home respite vendors comply with vendor requirements on an ongoing basis, DDS should require the regional centers to develop a process to conduct biennial reviews of the vendor files the regional centers maintain and document the outcome of the review in the files. DDS should require the regional centers to take appropriate action to ensure that vendors comply, up to and including terminating the vendorization, if necessary.

Annual Follow-Up Agency Response From December 2017

Pursuant to Title 17 Section 54332 (b), regional centers are required to review, at least biennially or sooner upon notification by DDS, Department of Health Care Services, or any governing licensing or certification board or entity, all vendor files maintained by the regional center to determine that:

1.The information required for vendorization is current, completed and accurate;

2.At least one consumer has been provided services by the vendor within the last 24 months;

3.The service currently provided by the vendor is the same service approved for vendorization;

4.Vendors meet the minimum program standards as specified in Sections 56710 through 56802 of these regulations, if applicable;

5.The vendor has signed the Home and Community-Based Services Provider Agreement (6/99), if applicable; and

6.The vendor is not in violation of the requirement stated in Section 54314(a)(7).

In response to the concern raised by the Auditor, the Department will send a directive to regional centers reminding them of their responsibility to review vendor files, at least biennially, to ensure compliance with the above section.

DDS anticipates this will be completed by January 2018.

  • Estimated Completion Date: January 2018

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


1-Year Agency Response

The Department will send a directive to regional centers reminding them of their responsibility to review vendor files, at least biennially.

  • Estimated Completion Date: 12/29/17
  • Response Date: October 2017

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


6-Month Agency Response

The Department will send a directive to regional centers reminding them of their responsibility to review vendor files, at least biennially.

  • Estimated Completion Date: 6/30/17
  • Response Date: April 2017

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

DDS's planned action does not fully address this recommendation. Specifically, as we state on page 29 of our report, our review found that regional centers could not demonstrate adequately, if at all, that they conduct reviews of vendor files at least every two years as required to ensure that vendors continue to comply with the vendorization requirements. In its response, DDS states that it will send a directive to regional centers to remind them of their responsibility to review vendor files; however, this action falls significantly short of our recommendation as DDS does not indicate the steps it will take to ensure regional centers develop a process to conduct biennial reviews as required.


60-Day Agency Response

The Department will send a directive to regional centers reminding them of their responsibility to review vendor files, at least biennially.

  • Estimated Completion Date: 4/25/17
  • Response Date: February 2017

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


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 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.

  • Estimated Completion Date: 12/31/2018

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.

  • Completion Date: January 2016
  • Response Date: October 2017

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.

  • Completion Date: January 2016
  • Response Date: April 2017

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.

  • Auditee did not substantiate its claim of full implementation

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.

  • Response Date: February 2017

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.