A report released this week (PDF) from the California state auditor's office alleges that state health officials have failed to effectively manage investigations of complaints against long-term-care facilities in the state.
State Auditor Elaine Howle claims that the state health department's Licensing and Certification Division does not provide adequate oversight over its district offices that handle facility complaints, or the Professional Certification Branch, which handles complaints filed against individuals. The department lacks formal policies that would ensure that complaints are handled promptly, Howle said in a letter to Gov. Jerry Brown and leaders of the state's Legislature.
Many facility-related cases remain open for nearly a year, the report said. As of April, the state had 10,000 open complaints against long-term-care facilities and 1,000 against individuals. Many of these cases are categorized as “immediate jeopardy,” meaning a safety risk to patients was implicated.
The report argues that the department needs to better standardize and monitor how its district offices process complaints, as some fail to respond to them in a timely or adequate manner. While some cases reviewed by the auditor were left open for prolonged periods of time, others were closed prematurely without appropriate review by a supervisor.
The audit recommended that the department establish specific timeframes for when cases must be completed. State law mandates how quickly some investigations must be opened but not how promptly they must be closed. The department must conduct an on-site investigation of a facility-related complaint must be conducted within either 24 hours or 10 days, depending on the complaint's severity, but there's no statutory requirement for how quickly investigations regarding individuals must be initiated.
Department staffers also were accused of failing to hear appeals to investigations within the 60 days required by state law and of failing to issue a final verdict in the 30 days required by law. Auditors expressed concern that individuals appealing the department's ruling may still be allowed to work in care facilities while waiting for a determination.
California health officials told the auditor's office that the department does not believe it is subject to the statutory timeframes for appeals cases brought on by individuals. Though the department said it agrees with many of the recommendations outlined in the report, it does not see the need to establish time frames in which investigations must be completed. The department had previously established a goal that facility-related complaints would be completed in 40 days, but dropped that objective in 2009 after offices failed to meet it.
Since it hasn't completed a staffing analysis, the department may not be appropriately allocating staff to district offices to handle the enormous backlog of complaints, the report said. In the course of the investigation, health department staff told the auditor's office that they did not feel like they had enough resources to keep up with the constant flow of complaints.
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