Report 2012-107 All Recommendation Responses

Report 2012-107: Developmental Centers: Poor-Quality Investigations, Outdated Policies, Leadership and Staffing Problems, and Untimely Licensing Reviews Put Residents at Risk (Release Date: July 2013)

Recommendation #1 To: Developmental Services, Department of

The department should provide a reminder to staff about the importance of promptly notifying OPS of incidents involving resident safety.

60-Day Agency Response

The Department of Developmental Services (DDS or Department) has implemented this recommendation. On May 29, 2013 a written reminder was issued to all developmental center staff requiring prompt incident reporting to the Office of Protective Services (OPS). Immediate notification of all suspected cases of abuse and neglect are a requirement in each developmental center's policies. This notification requirement was incorporated into a revised statewide developmental center policy and distributed to all facilities on May 31, 2013.

Completion Date: June 2013
Response Date: September 2013

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

Recommendation #2 To: Developmental Services, Department of

Within 60 days, the department should make the following amendments to its policies and procedures for OPS:
-Clarify who is responsible for deciding whether to make district attorney referrals.
-Clarify that the final decision to initiate a specialized medical examination for an alleged victim of sexual assault rests with OPS, not with health care staff.
-Require OPS investigators to document their efforts to communicate with alleged victims of abuse, including nonverbal clients, and require supervisors to verify that such efforts have been made when approving investigation reports.
-Direct its investigators to record the potential violations of law or facility policy they identify and consider during each investigation.

60-Day Agency Response

DDS implemented this recommendation. OPS developed a draft policy manual in mid-July 2013 utilizing OPS personnel and external law enforcement consultants. Prior to its release, the Department entered into a two-year Interagency Agreement for a California Highway Patrol (CHP) Chief to lead OPS. The new OPS Chief has reviewed the draft manual, consisting of 50 policies, and is consulting with legal experts specializing in law enforcement to ensure it is consistent with current law enforcement best practices; federal, state, and local laws; and court decisions that affect law enforcement operations and investigations.

Additionally, the new Chief of OPS issued a directive on August 30, 2013 reiterating the following:

When a resident is a suspect, a meeting between the Deputy Director of the Department's Developmental Center's Division, the Chief of OPS, and the Executive Director must be held prior to referral of a case to the District Attorney. The final decision authority rests with the Chief of OPS.

OPS has the final determination on whether to send a potential victim for a forensic medical examination, after consulting with the treating physician.

Investigators must note the resident or victim's diagnosis, Activities of Daily Living capabilities, and any information concerning the resident's ability to be interviewed. Additionally, the investigator must document in their report all measures taken to communicate with the individual.

OPS employees must note potential violations at the start of each investigation; reconcile with final violations (if any); and ensure reports clearly articulate how the evidence substantiates the violation.

Completion Date: August 2013
Response Date: September 2013

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

Recommendation #3 To: Developmental Services, Department of

To ensure adequate guidance to OPS personnel, once the department has amended OPS's policies and procedures to reflect the recommendations we have included here, the department and OPS should place a high priority on completing and implementing its planned updates to the OPS policy and procedure manual.

Annual Follow-Up Agency Response From October 2016

The Department's Office of Protective Services (OPS) completed updating the OPS policy manual using the Lexipol System. All OPS employees have received initial training as well as ongoing Daily Training Bulletins to stay abreast of OPS policies. OPS has also completed its Procedures Manual which was released on June 30, 2016. This recommendation is fully implemented.

Completion Date: August 2016

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

We confirmed that OPS' updated policy and procedures manual addresses the concerns we identified in our report. For instance, it includes a policy for district attorney referrals, investigative procedures that clearly define which OPS personnel are responsible for ordering a medical exam for an alleged victim of sexual assault, and a policy for officers to report attempts to bridge communication difficulties with developmental center residents.

Annual Follow-Up Agency Response From September 2015

Office of Protective Services (OPS) has completed updating the OPS policy manual using the Lexipol System. The policies have been reviewed and approved by Executive Management and shared with the affected bargaining units. OPS staff is receiving ongoing training on the new policies. OPS is now developing its new procedures manual and identifying policies which require procedures for full implementation.

Estimated Completion Date: June 30, 2016

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

Annual Follow-Up Agency Response From October 2014

OPS staff has completed training from Lexipol to use the Knowledge Management System platform. Staff is in the process of updating the OPS policy manual using the System. Once updated, the policies will be reviewed and approved by Executive Management, a meet and confer will be held with affected bargaining units, and OPS staff will be trained on the new policies.

Estimated Completion Date: June 30, 2015

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

1-Year Agency Response

On April 28, 2014, OPS entered into a contract with Lexipol, LLC, for a subscription to Lexipol's Law Enforcement Policy Manual and Daily Training Bulletins. Lexipol is a nationally-recognized provider of law enforcement and risk management policies. OPS staff is currently receiving training from Lexipol to use the web-based Lexipol Knowledge Management System Platform. Once trained, OPS staff will use the System to update the OPS Policy Manual.

Estimated Completion Date: December 31, 2014
Response Date: June 2014

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

6-Month Agency Response

DDS is implementing this recommendation. OPS developed a draft policy manual in mid-July 2013 utilizing OPS personnel and external law enforcement consultants. Prior to its release, the Department entered into a two-year Interagency Agreement for a Chief from the California Highway Patrol (CHP) to lead OPS. The new OPS Chief has reviewed the draft manual, consisting of 50 policies, and has consulted with legal experts specializing in law enforcement.

At the recommendation of the new OPS Chief and legal experts, DDS is currently in the process of establishing a contract with a nationally-recognized provider of law enforcement and risk management policies. When the contract is completed, the contractor will provide OPS with: 1) A policy manual that is consistent with federal, state, and local laws, and reflect up-to-date, applicable industry standards and best practices. A schedule will be developed for a phased rollout of the policies as they are completed; 2) Daily scenario-based training material for OPS staff that reinforces approved policies and procedures; and 3) Regular updates to OPS policies as statutes, case law, and regulations change.

Estimated Completion Date: June 30, 2014
Response Date: January 2014

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

60-Day Agency Response

DDS is implementing this recommendation. OPS developed a draft policy manual in mid-July 2013 utilizing OPS personnel and external law enforcement consultants. Prior to its release, the Department entered into a two-year Interagency Agreement for a CHP Chief to lead OPS. The new OPS Chief has reviewed the draft manual, consisting of 50 policies, and is consulting with legal experts specializing in law enforcement to ensure it is consistent with current law enforcement best practices; federal, state, and local laws; and court decisions that affect law enforcement operations and investigations.

The rollout of OPS policies will occur in phases based upon prioritization of policies, with training catered to meet the needs of personnel. These policies will be routinely updated, utilizing the contract with law enforcement legal experts, as changes in laws and best practices occur.

Estimated Completion Date: December 31, 2013
Response Date: September 2013

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

Recommendation #4 To: Developmental Services, Department of

OPS should provide additional training to its law enforcement personnel on how to conduct an initial incident investigation, particularly regarding collection of written declarations and photographs of alleged victims following an incident.

6-Month Agency Response

DDS supports the need for additional specialized training for its law enforcement officers. The new OPS Chief established a formal training plan in November 2013 to ensure all uniformed OPS personnel receive initial and ongoing training in all aspects of their jobs. Priority has been given to the areas noted in the audit, and specific subject matter in those areas is included in the curricula.

From May 1 through November 30, 2013, OPS personnel have attended 416 individual training sessions related to Child Abuse Investigations, Sexual Assault Investigations, Core Investigations Courses, Homicide Investigations, Property and Evidence Room Training, Interview and Interrogation, Internal Affairs Investigations, Background Investigations, Team Approach to Child Abuse Investigations, Supervisory Course, and other law enforcement-specific subjects. An additional 160 sessions are scheduled in the coming months. As an ongoing responsibility, training needs will be regularly reviewed, and ongoing training will be provided.

Completion Date: December 2013
Response Date: January 2014

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

60-Day Agency Response

DDS is implementing this recommendation and supports the need for additional specialized training for its law enforcement officers. The new Chief of OPS will have a formal training plan by September 30, 2013, to ensure officers receive initial and ongoing training in all aspects of their jobs. Prioritization will be given to areas noted in the audit.

In May 2013, a comprehensive course on "Conducting Serious Incident Investigations" was provided to OPS investigators representing all developmental centers, including all investigators at Sonoma.

Additionally, since May 1, 2013 OPS personnel have attended 165 individual training sessions related to Child Abuse Investigations; Sexual Assault Investigations; Core Investigations Course; Homicide Investigations; Property and Evidence Room Training; Interview and Interrogation; Internal Affairs Investigations; Background Investigations; Team Approach to Child Abuse Investigations; Supervisory Course; and other Law Enforcement specific subjects. An additional 101 sessions are scheduled in the coming months.

Estimated Completion Date: December 31, 2013
Response Date: September 2013

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

Recommendation #5 To: Developmental Services, Department of

To avoid jeopardizing the integrity of its criminal investigations with compelled statements acquired through administrative admonishments, the department should require that different OPS investigators conduct the administrative investigation and the criminal investigation when they involve the same incident.

1-Year Agency Response

On May 16, 2014, OPS issued Policy 9.9, Criminal Investigative Procedures. The new policy states the following:

If any allegations of sexual assault, abuse, or neglect could rise to the level of criminal conduct, or in any other instance where a crime is alleged to have occurred, then the criminal and administrative investigations must be bifurcated, and will require reports by separate investigators. When staffing impedes the ability to assign the bifurcated cases to two separate investigators, the Commander shall coordinate with his fellow Commanders and/or the Chief to obtain temporary assistance/support from another investigator to ensure the cases remain bifurcated.

Completion Date: May 2014
Response Date: June 2014

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

6-Month Agency Response

DDS is committed to implementing best practices and is conducting further research on this recommendation. Although separating the administrative and criminal investigations was noted as an "industry" standard in the 2002 Attorney General's report, throughout the extensive process of seeking input from law enforcement experts for policy development since 2002, DDS has received conflicting guidance as to the appropriateness of requiring different investigators for administrative and criminal investigations of the same incident.

As reported in Recommendation 3, DDS is in the process of establishing a contract with a nationally recognized provider of law enforcement policies to develop the OPS Policy and Procedure Manual. Once the contract is in place, DDS will seek advice from the contractor on this issue. Prior to completion of the manual, DDS will make a final policy decision regarding the appropriate method of addressing administrative and criminal investigations of the same incident. The decision will be incorporated into the policy manual and implemented statewide.

Estimated Completion Date: June 30, 2014
Response Date: January 2014

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

60-Day Agency Response

DDS is committed to implementing best practices and is currently in consultation with external law enforcement legal experts for input on the appropriate method of addressing this recommendation. Before implementing any change, the issue needs to be thoroughly researched, policies and procedures carefully developed, and organizational impacts addressed. Although separating the administrative and criminal investigations was noted as an "industry" standard in the 2002 Attorney General's report, throughout the extensive process of seeking input from law enforcement experts for policy development, DDS has received conflicting guidance as to the appropriateness of requiring different investigators for administrative and criminal investigations of the same incident. DDS will continue to evaluate implementation of the recommendation and will provide an update in its next scheduled response to the State Auditor.

Estimated Completion Date: May 31, 2014
Response Date: September 2013

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

Recommendation #6 To: Developmental Services, Department of

As soon as possible, the department should hire a permanent OPS director and permanent OPS commanders that are highly qualified staff capable of performing the administrative functions these positions require.

Annual Follow-Up Agency Response From October 2014

As reported in the six-month response to this recommendation, the Department entered into an Interagency Agreement with the California Highway Patrol for Kenneth Hill to serve as the Director of the Office of Protective Services (OPS). With all OPS command positions filled, as reported in the one-year response, all positions covered by this recommendation are now filled.

Completion Date: May 2014

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

1-Year Agency Response

The external candidate who had previously been tentatively selected to be the commander at Sonoma DC did not successfully complete the hiring process. With no other viable candidates for the position, DDS entered into a renewed two-year Interagency Agreement with the CHP for a CHP Lieutenant to serve as the Commander at Sonoma DC. Lieutenant Aaron Goulding was appointed as the Commander of Sonoma DC on April 1, 2014.

DDS also entered into a two-year Interagency Agreement with the CHP for a CHP Captain to serve as the Commander at Porterville DC. Captain Eric Jennings was appointed as the Commander of Porterville DC on May 1, 2014.

Currently all OPS command positions are filled.

Completion Date: May 2014
Response Date: June 2014

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

Although filling all command positions is important, Developmental Services also needs to hire a permanent OPS director to fully satisfy this recommendation.

6-Month Agency Response

DDS is implementing this recommendation. DDS entered into a two-year Interagency Agreement for a CHP Chief to lead OPS. Kenneth Hill was appointed Chief of OPS on July 22, 2013. Before the end of the two-year contract period, DDS will renew recruitment efforts for this position.

As reported previously, the Department had tentatively selected an individual for the Commander position at Porterville DC; however, the candidate did not successfully complete the hiring/background process.

To enhance hiring efforts, DDS entered into a contract with Cooperative Personnel Services to develop and implement an assessment center examination for the Commander classification (Supervising Special Investigator II). The examination was administered in November 2013, and the certification list was published on November 25, 2013, with 13 candidates on the list. Interviews were held on December 9, 2013, to fill three vacancies (Fairview, Porterville and Sonoma DCs). One candidate from within OPS was selected for the position at Fairview DC: David Corral was appointed on January 1, 2014. A background investigation was initiated on an external candidate tentatively selected for Sonoma DC. There were no viable candidates for Porterville DC, so further recruitment is necessary.

Estimated Completion Date: March 31, 2014
Response Date: January 2014

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

60-Day Agency Response

DDS is implementing this recommendation. The Department initiated an extensive nationwide recruitment for the Chief of OPS, including notifications sent to all California and national law enforcement organizations. After completing this review, the Department entered into a two-year Interagency Agreement for a CHP Chief to lead the OPS. Kenneth Hill, appointed Chief of OPS on July 22, 2013, brings over 24 years of experience with the CHP including assignments in the Office of the Commissioner and the Office of Internal Affairs. Most recently he served as the acting commander of the CHP's Valley Division, providing leadership to 20 CHP commands and over 900 employees. Before the end of the two-year contract period, DDS will renew recruitment efforts for this position.

Additionally, Sonoma DC has an Interagency Agreement with the CHP for a Captain and Lieutenant to provide OPS law enforcement leadership at the facility. The Department conducted hiring interviews for the remaining two vacant Commander positions and has selected an individual for the Commander position at Porterville DC, who is currently going through a background investigation.

The Department will continue its efforts to fill leadership positions when vacancies occur. To enhance recruitment efforts, DDS entered into a contract with Cooperative Personnel Services to develop and implement an assessment center, similar to what is used by the CHP and the Department of Justice, for the examination process of the Commanders and first-level OPS supervisory positions. Upon completion, this process will be used to fill the remaining Commander vacancies.

Estimated Completion Date: December 31, 2013
Response Date: September 2013

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

Recommendation #7 To: Developmental Services, Department of

To help ensure the quality of OPS investigations, the department should revise its OPS training policy to require its law enforcement personnel to attend annually specialized trainings that address their specific needs. At least initially, the department should focus the additional trainings on communicating with residents, writing effective investigative reports, and collecting investigative evidence. To further develop the leadership skills of OPS management, the department should consider having experienced or particularly skilled members of its OPS management provide this annual training.

1-Year Agency Response

As previously reported in the six-month response, a formal training plan was established in November 2013 to ensure all uniformed personnel receive initial and ongoing training in all aspects of their jobs. The following courses are identified as Job-Required in the training plan: Child Abuse Investigation; Sexual Assault Investigation; Homicide/Death Investigation; Interview and Interrogation; Crisis Intervention Training (dealing with the Mentally Disabled); and Report Writing. POST Supervisory and Management Courses are also Job-Required for applicable classifications. The subject matter of communicating with residents, writing investigative reports, and collecting investigative evidence are part of the training curricula.

From May 1, 2013 through May 31, 2014, OPS personnel have attended 753 individual training sessions related to these courses. An additional 114 sessions are scheduled in the coming months.

DDS has elected to utilize outside training to accomplish its training goals.

Completion Date: May 2014
Response Date: June 2014

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

6-Month Agency Response

DDS supports the need for additional specialized training for its law enforcement officers. A formal training plan was established in November 2013 to ensure all uniformed personnel receive initial and ongoing training in all aspects of their jobs. The following courses are identified as "Job-Required" in the training plan: Child Abuse Investigation; Sexual Assault Investigation; Homicide/Death Investigation; Interview and Interrogation; Crisis Intervention Training (dealing with the Mentally Disabled); and Report Writing. POST Supervisory and Management Courses are also "Job-Required" for applicable classifications. The subject matter of communicating with residents, writing investigative reports, and collecting investigative evidence are part of the training curricula.

From May 1 through November 30, 2013, OPS personnel have attended 416 individual training sessions related to these courses. An additional 160 sessions are scheduled in the coming months.

At this juncture, DDS is utilizing outside training to accomplish its training goals. OPS staff are being developed internally who will provide leadership, expertise and training in the future.

Estimated Completion Date: June 30, 2014
Response Date: January 2014

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

60-Day Agency Response

DDS agrees with the intent of this recommendation and supports the need for additional specialized training for its law enforcement officers. The new Chief of OPS will have a formal training plan by September 30, 2013, to ensure officers receive initial and ongoing training in all aspects of their jobs. Prioritization will be given to areas noted in the audit and OPS will utilize internal resources to conduct training, as appropriate.

In May 2013, a comprehensive course on "Conducting Serious Incident Investigations" was provided to OPS investigators representing all developmental centers, including all investigators at Sonoma.

Additionally, since May 1, 2013 OPS personnel have attended 165 individual training sessions related to Child Abuse Investigations; Sexual Assault Investigations; Core Investigations Course; Homicide Investigations; Property and Evidence Room Training; Interview and Interrogation; Internal Affairs Investigations; Background Investigations; Team Approach to Child Abuse Investigations; Supervisory Course and other Law Enforcement specific subjects. An additional 101 sessions are scheduled in the coming months.

Estimated Completion Date: December 31, 2013
Response Date: September 2013

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

Recommendation #8 To: Developmental Services, Department of

To ensure that it has adequate numbers of staff to properly and promptly investigate developmental center incidents, the department should address the high number of vacancies within OPS by instituting a formal recruitment program in accordance with the guidance provided in the California State Personnel Board's Merit Selection Manual, as well as using input from OPS law enforcement personnel.

1-Year Agency Response

OPS established an Internet Web site with specific information about the Department, exam information, and position vacancies. The new webpage was fully implemented January 16, 2014.

The Department posts all OPS vacancies to the California Peace Officers Association, the California State Sheriffs Association, and the Commission on Peace Officer Standards and Training (POST) websites.

Updated recruitment pamphlets were distributed to all OPS commands on

March 27, 2014 to assist with ongoing local recruitment efforts.

After further evaluation, OPS has elected not to pursue establishing a recruitment page on Facebook because OPS officers and investigators are required to possess a Basic POST Certificate and Facebook does not provide the ability to identify and reach the target audience.

On November 27, 2013, DDS revised the examination process for the Peace Officer I classification. It was changed from a traditional Qualifications Appraisal Panel to a new Training and Experience Examination. This has expedited the examination process and allowed the Department to administer quarterly examinations. During the fourth quarter of 2013, OPS received 28 applications for the examination. During the first quarter of 2014, it received 13 more applications.

Between July 1, 2013 and May 31, 2014, a total of 37 candidates were selected for positions within OPS after a hiring interview. Of those 37 candidates, 10 were hired, 16 did not successfully complete the background/medical/psychological processes, and 11 candidates are currently in various stages of a background investigation. During this same period, 14 OPS employees separated from the Department.

Completion Date: January 2014
Response Date: June 2014

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

6-Month Agency Response

With the assistance of Cooperative Personnel Services, the OPS Chief instituted a Formal Recruitment Plan on September 27, 2013. Accordingly, recruitment pamphlets and brochures have been updated.

The Department has increased access to all OPS vacancies by posting them on the California Peace Officers Association and the California State Sheriff's Association websites.

OPS has established an Internet webpage with specific information about the Department, exam information, and position vacancies. The new webpage will be fully implemented in January 2014.

Ongoing recruitment efforts include: regularly visiting law enforcement academies to connect with potential recruits; and establishing a presence on social media (Facebook). Other elements of the recruitment plan are underway and ongoing.

It is important to note that as of December 2, 2013, the OPS vacancy rate has been reduced by nearly 15 percent, from the reported 42.8 percent to 28.2 percent (adjusted for investigator vacancies that will not be filled due to the declining population and closure status of Lanterman Developmental Center [DC]), with an additional seven candidates currently undergoing a background investigation.

Estimated Completion Date: June 30, 2014
Response Date: January 2014

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

60-Day Agency Response

DDS is implementing this recommendation. It is important to note that as of September 1, 2013, the OPS vacancy rate has been reduced by nearly 10 percent, from the reported 42.8 percent to 33.3 percent, with an additional eight candidates currently undergoing a background investigation.

The developmental centers have experienced difficulty in attracting qualified candidates for Peace Officer and Investigator positions due to the facility locations, declining resources, and the potential downsizing of jobs resulting from a moratorium on admissions and a decrease in the number of individuals residing in developmental centers. The Department, with the assistance of Cooperative Personnel Services (CPS), developed and implemented a Formal Recruitment Plan for the Peace Officer and Investigator classifications. OPS and the Human Resources Section of DDS worked closely with CPS to identify the critical skills, knowledge and abilities for these positions and explored various options for focused recruitment of well-qualified candidates. The Department has also increased access to all OPS vacancies by posting them on the California Peace Officers Association and the California State Sheriff's Association Web sites.

Estimated Completion Date: December 31, 2013
Response Date: September 2013

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

Recommendation #9 To: Developmental Services, Department of

After the department has implemented a formal OPS recruiting program, if it can demonstrate that it is still having trouble filling vacant OPS positions, the department should evaluate how it can reduce some of the compensation disparity between OPS and the local law enforcement agencies with which it competes for qualified personnel.

Annual Follow-Up Agency Response From September 2015

The Department's Personnel Section finalized the request for a Recruitment and Retention Pay Differential for the Peace Officer and Investigator staff and supervisors. A recruitment and retention pay differential was approved by the California Department of Human Resources for the Peace Officer I and Peace Officer II classifications effective July 1, 2015.

Completion Date: July 2015

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

Annual Follow-Up Agency Response From October 2014

To provide for improved recruitment and retention of qualified staff for OPS, the Department's Personnel Section is finalizing the request for a Recruitment and Retention Pay Differential for the Peace Officer and Investigator staff and supervisors. The request will be sent to the California Department of Human Resources for approval in October 2014.

Estimated Completion Date: December 31, 2014

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

1-Year Agency Response

Although OPS has successfully increased its applicant pool for Peace Officer I and Investigator classifications, it is still struggling to attract qualified Peace Officer I applicants. The vast majority of applicants to date have not been able to successfully pass the background investigation, psychological examination, or medical examination. It appears that compensation disparity is a key factor in the challenge to attract qualified candidates.

To reduce some of the compensation disparity, the Department is currently preparing a request to the California Department of Human Resources for Recruitment and Retention (R&R) pay for the Peace Officer I classification at Sonoma DC, Porterville DC, and Fairview DC.

Estimated Completion Date: July 31, 2014
Response Date: June 2014

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

6-Month Agency Response

As reported previously, DDS has notified the California Department of Human Resources of the State Auditor's recommendation. The Department will explore appropriate remedies if the recruitment plan is not successful in reducing vacancies in OPS. However, hiring efforts continue and as of December 2, 2013, the OPS vacancy rate has been reduced by nearly 15 percent, from the reported 42.8 percent to 28.2 percent (adjusted for investigator vacancies that will not be filled due to the declining population and closure status of Lanterman DC), with an additional seven candidates currently undergoing a background investigation.

Estimated Completion Date: June 30, 2014
Response Date: January 2014

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

60-Day Agency Response

DDS has notified the California Department of Human Resources of the State Auditor's recommendation. The Department will explore appropriate remedies if the recruitment plan is not successful in reducing vacancies in OPS. However, hiring efforts continue and the OPS vacancy rate has been reduced by nearly 10 percent, from the reported 42.8 percent, with an additional eight candidates currently undergoing a background investigation.

Estimated Completion Date: ongoing
Response Date: September 2013

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

Recommendation #10 To: Developmental Services, Department of

To make certain that residents receive an adequate level of care and are protected from harm, the department should encourage Human Resources—which is responsible for negotiating labor agreements with employee bargaining units—to include provisions in future collective agreements to cap the number of voluntary overtime hours an employee can work and/or require departments to distribute overtime hours more evenly among staff. If, in the next round of negotiating bargaining unit agreements, Human Resources does not include provisions to cap the number of voluntary overtime hours an employee can work, the department should continue to advocate for these changes for future agreements. In the meantime, the department should adjust its overtime scheduling and monitoring practices to strengthen, where possible, procedures designed to ensure that staff working overtime do not compromise residents' health and safety.

1-Year Agency Response

The Department has fully implemented the new overtime authorization procedures noted in the six-month response. Following this implementation, the DC system has seen a 16 percent decrease in the amount of overtime accrued.

The Department continues to closely monitor overtime, both mandatory and voluntary, to ensure guidelines are adhered to and each facility monitors its need. There have been no changes to the bargaining unit agreements related to overtime; however, managers and supervisors continue to monitor overtime usage to ensure employees working overtime are alert and able to perform the functions of the job.

In addition, the DCD continues to work directly with each Administrative Services Director (ASD) at each facility to explore the roots of overtime need and undelivered staffing including the impact of the Family Medical Leave Act, sick leave, NDI, IDL and other types of approved leave including bid vacation increases and ad hoc calendar impacts.

Completion Date: January 2014
Response Date: June 2014

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

6-Month Agency Response

As reported previously, DDS has notified the California Department of Human Resources of the State Auditor's recommendation. Also, DDS is closely tracking the use of both voluntary and mandatory overtime through monthly monitoring of overtime at each facility.

The DDS Human Resources Branch coordinated a statewide effort to develop standardized timekeeping procedures related to receiving, reviewing, posting and keying leave time and overtime. Procedures were formalized and the process was implemented in September 2013. Attendance Reporting training was provided to all DC Personnel Offices between September and October 2013.

The Developmental Centers Division (DCD) conducted a review of high earners of overtime and their reporting documents at all facilities. As a result of the audit findings, DCD is working with DC Administrative Services Directors and Clinical Directors to explore the roots of the high usage of overtime, including undelivered staff, and to determine if alternatives are available to managers and supervisors before approving overtime, especially for those individuals identified as high overtime users. In addition, based on the audit findings and to better document the overtime authorization approval and reporting, immediate recommendations were made and Timekeeping Procedures were developed by the DDS Human Resources Branch which were implemented statewide, as described above. A Timekeeping Policy is also being developed to establish further expectations and supplement the current Timekeeping Procedures.

Estimated Completion Date: Ongoing
Response Date: January 2014

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

60-Day Agency Response

DDS has notified the California Department of Human Resources of the State Auditor's recommendation. DDS is closely tracking the use of both voluntary and mandatory overtime, through monthly monitoring of overtime at each facility. Additionally, the Deputy Director of the Developmental Centers Division issued a directive to all facilities on May 14, 2013 requiring them to review overtime procedures and standardize overtime record keeping. As noted in our initial response, the Department's Human Resources Office is coordinating a statewide effort, working with facility Personnel Offices, to develop a standardized timekeeping process related to receiving, reviewing, posting and keying all time, including overtime. This process will be finalized with training occurring during the month of September 2013.

The Developmental Centers Division is conducting a review of high earners of overtime at all facilities and is working with the Executive Directors to develop action plans, as needed, to manage individual overtime hours and ensure resident safety.

The Department is committed to recruitment and hiring to fill vacant positions at the developmental centers, working to reduce reliance on overtime, and to provide essential services to residents.

Estimated Completion Date: ongoing
Response Date: September 2013

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

Recommendation #11 To: Developmental Services, Department of

To minimize the need for overtime, the department should reassess its minimum staffing requirements, hire a sufficient number of employees to cover these requirements, and examine its employee scheduling processes.

Annual Follow-Up Agency Response From November 2018

In 2017-18, the Department (DDS) implemented a new allocation methodology for staffing required to care for residents, operate facilities, and to meet state licensing and Centers for Medicare and Medicaid Services (CMS) settlement agreement requirements for continued federal funding. The budget now presents Unit Staffing, with staff necessary to meet licensing requirements for different unit acuity levels based on resident placements into the community and also identifies separate Program Support Staffing, with the staff necessary to support all other operations including food service, protective services, pharmacy operations, administration, etc. Unit Staffing levels are driven by the number of units operated; Program Support Staffing levels are driven by overall resident population.

DDS notes that adding temporary help and overtime (OT) amounts is another change from previous years' estimates. In 2017-18, the budget did not include funds for temporary help or OT costs, but factored in the number of staff positions needed to cover for undelivered staff and adequate care for residents. The new budget methodology results in reduced OT. Recruitment plans are in place at Porterville Developmental Center (PDC) Secure Treatment Program and at the Canyon Springs Community Facility to meet the new minimums. The facilities in the closure process PDC General Treatment Area, Sonoma Developmental Center and Fairview Developmental Center) have ongoing, changing staffing needs that will be monitored based on population and residences in service managed with the new KRONOS Workforce Management System (KRONOS) and layoff planning.

DDS contracted with KRONOS in May 2017 and began training and system programming. The KRONOS system has fully automated shift scheduling, OT scheduling, time use tracking, and leave management for level of care staff to more efficiently schedule and assign staff.

KRONOS was fully implemented in January 2018.

Completion Date: January 2018

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

The department provided documentation for its new staffing model and automated shift scheduling. Further, the department provided data showing that the actions it has taken has resulted in a 39 percent reduction in overtime at its developmental centers between July 2016 and March 2018.

Annual Follow-Up Agency Response From December 2017

In 2017-18, DDS implemented a new allocation methodology for appropriate staffing required to care for residents, operate facilities and meet state licensing and Center for Medicare and Medicaid Services settlement agreement requirements for continued federal funding. The budget now presents Unit Staffing necessary to meet licensing requirements for different unit acuity levels (i.e., ICF, General Acute Care, Skilled Nursing, and Crisis), based on the timing of resident placements into the community. The budget also identifies separate Program Support Staffing necessary to support all operations including food and protective services, pharmacy, facilities and maintenance, administration, etc.

The 2017-18 budget doesn't include funds for temporary help or overtime costs, but factors in the number of staff positions needed to cover for undelivered staff and adequately care for residents. The new budget methodology, with increased minimum staffing requirements, will result in reduced overtime. Recruitment plans are in place at Porterville Developmental Center (PDC) Secure Treatment Program and Canyon Springs Community Facility to meet the new minimums. The facilities in the closure process (PDC General Treatment Area, SDC and FDC) changing staffing needs will be ongoing based on client placements, staff attrition, etc., which will be monitored based on population and residences in service, and managed with the new workforce management system (KRONOS) and layoff planning. KRONOS is expected to be in by January 2018.

Completion Date: May 2017

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

Although DDS appears to have made progress in implementing this recommendation, it is too early to determine whether its new allocation methodology and budget process, and its January 2018 implementation of its new workforce management system, will reduce overtime in its developmental centers.

Auditee did not substantiate its claim of full implementation

Annual Follow-Up Agency Response From October 2016

DDS worked with the Department of State Hospitals (DSH) to use its Automated Staff Scheduling Support Tool (ASSIST). After further discussions with the DSH it was determined that based on the actual timeline of implementation it was not feasible for DDS to purse the ASSIST, especially with the announcement of the Developmental Centers (DCs) closures. The Department is exploring options with shorter implementation timelines for staff scheduling of the one remaining DC and one State-Operated Community Facility. In addition, each DC has developed its recruitment plan to strategize the recruitment and hiring needs for filling staffing gaps due to the high attrition rate after the closure announcement. DCs are in the process of implementing their recruitment plans. The estimated time for DCs to fully implement their recruitment plans is December 2017. Meanwhile, all DCs have converted to centralized staffing to improve staff scheduling, especially after DC closures were announced. DDS plans to finalize the study of the other options by December 31, 2016.

Estimated Completion Date: December 2017

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

Annual Follow-Up Agency Response From September 2015

DDS is working with the Department of State Hospitals (DSH) regarding its Automated Staff Scheduling and Information Support Tool (ASSIST), which is continuing to be tested. Five of eight state hospitals have implemented ASSIST with the projected date of full implementation for DSH now October 2015. The ASSIST solution will provide automated creation of schedules and tracking of critical personnel information. These data would allow the DDS Developmental Centers Division management to effectively measure overtime usage and determine critical factors for managing overtime. DDS is currently working on its Stage One Business Analysis for the California Department of Technology as a first step in procuring ASSIST. The DSH contract allows for DDS to attach to its program, contingent on approvals and funding.

Estimated Completion Date: June 30, 2016

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

Annual Follow-Up Agency Response From October 2014

DDS is working with the Department of State Hospitals (DSH) regarding its Automated Staff Scheduling and Information Support Tool (ASSIST), which is currently scheduled for user acceptance testing from October 6 to 10, 2014, and pilot testing on October 27, 2014, for Napa and Atascadero State Hospitals (67 days for the pilot). The projected date of full implementation for DSH is now March 2015. The ASSIST solution will provide consistent application of business rules, automated creation of schedules and tracking of critical personnel information. These data would allow the DDS Developmental Centers Division management to effectively measure overtime usage and determine critical factors for managing overtime. DDS is having regular meetings with DSH to review the Feasibility Study Report and monitor DSH implementation progress, so that DDS can make informed decisions regarding how it should proceed.

Estimated Completion Date: June 30, 2015

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

1-Year Agency Response

DDS continues to work with the Department of State Hospitals (DSH) regarding its Automated Staff Scheduling and Information Support Tool (ASSIST) as noted in the six-month response, which is anticipated to be implemented in November 2014. DDS plans to join this contract with the DSH ASSIST, if approved, once full implementation at DSH is completed.

The DCD continues to conduct a random sampling review of high earners of overtime and the reporting documents at all facilities. Following the results of these audits, each DC has been notified of the corrections, changes or actions needed, to ensure follow-up is completed where warranted.

Additionally a new overtime authorization form has been developed and implemented at all facilities to ensure compliance with the State Controllers timekeeping rules and to allow for improved management and monitoring of overtime. This form was fully implemented for the June pay period.

Estimated Completion Date: January 30, 2015
Response Date: June 2014

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

6-Month Agency Response

Minimum staffing requirements are regularly assessed at all DCs, not only to address staffing needs and reduce reliance on overtime, but to assure the staffing sufficiently meets the acuity needs for all residents. Each DC regularly reviews the staffing complement to determine whether there are enough staff to provide the services and supports to the residents in each residential/program area.

The Department is currently focusing its hiring activities in areas where the number of employees are insufficient to avoid significant reliance on overtime. As indicated in the audit, non-OPS employees at Sonoma DC had the highest use of overtime as a percent of total earnings for the period of 2009 through 2012. Since March 2013, over 200 employees have been hired with continued, ongoing, aggressive recruitment at the facility. This corrects an error in the prior 60-day response which overstated the number of hires. More than 100 additional candidates are currently undergoing the extensive background clearance process.

DDS is working with the Department of State Hospitals (DSH) regarding its Automated Staff Scheduling and Information Support Tool (ASSIST), which is currently out for bid. The ASSIST solution will provide consistent application of business rules, automated creation of schedules and tracking of critical personnel information. The data would allow DCD management to effectively measure overtime usage and determine critical factors for managing overtime. DDS is having regular meetings with DSH to review the Request for Proposal, so that DDS can make informed decisions regarding how it should proceed.

Estimated Completion Date: June 30, 2014
Response Date: January 2014

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

60-Day Agency Response

DDS is implementing this recommendation. Minimum staffing requirements are regularly assessed at all developmental centers, not only to address staffing needs and reduce reliance on overtime, but to assure the staffing sufficiently meets the acuity needs for all residents. Each developmental center regularly reviews the staffing complement to determine whether there are enough staff to provide the services and supports to the residents in each residential/program area.

The Department is currently focusing its hiring activities in areas where the number of employees are insufficient to avoid significant reliance on overtime. As indicated in the audit, non-OPS employees at Sonoma had the highest use of overtime as percent of total earning for the period of 2009 through 2012. Since May 2013, aggressive hiring has resulted in nearly 200 new employees with approximately 90 additional candidates currently underway through the extensive background clearance process.

The Department is also exploring the use of an automated staff scheduling software, currently under development at the Department of State Hospitals, to assist in streamlining staffing assignments.

Estimated Completion Date: ongoing
Response Date: September 2013

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

Recommendation #12 To: Developmental Services, Department of

To ensure that staff who work overtime are paid the correct amount, developmental center management should require all staff to submit not only overtime approvals, but also the department's standardized form showing time off and overtime hours. Additionally, the department should establish a written guide to help ensure that timekeeping staff follow the overtime provisions of the various laws, regulations, and bargaining unit agreements.

1-Year Agency Response

DDS developed a written matrix and guide of the various overtime provisions and on April 30, 2014, provided the information to all timekeeping staff to ensure compliance with laws, regulations, and bargaining unit agreements.

Completion Date: April 2014
Response Date: June 2014

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

6-Month Agency Response

DDS is implementing this recommendation. The DDS Human Resources Branch coordinated a statewide effort to develop standardized timekeeping procedures related to receiving, reviewing, posting, and keying leave time and overtime. The Timekeeping Procedures were disseminated to all facilities in September 2013. The procedures provide guidance and identify responsibilities for monitoring accuracy and accountability in all steps related to the timekeeping process. Training on the new Timekeeping Procedures was completed in October 2013 for all DCs. The Timekeeping Procedures will be supplemented with guidelines for calculating overtime which are under development.

Estimated Completion Date: June 30, 2014
Response Date: January 2014

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

60-Day Agency Response

DDS is implementing this recommendation. The Deputy Director of the Developmental Centers Division issued a directive to all facilities on May 14, 2013 requiring them to review overtime procedures and standardize overtime record keeping. As noted in our initial response, the Department's Human Resources Office is coordinating a statewide effort, working with facility Personnel Offices, to develop a standardized timekeeping process related to receiving, reviewing, posting and keying all time, including overtime. This process will be finalized with training occurring during the month of September 2013.

The developmental centers have corrected the four overtime calculation errors identified by the Auditor and have recovered the $300 in total overpayments.

The Developmental Centers Division is reviewing high earners of overtime at all facilities to ensure accuracy and is working with the Executive Director at each developmental center to develop action plans, as needed, to manage individual overtime hours and ensure resident safety.

Estimated Completion Date: September 30, 2013
Response Date: September 2013

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

Recommendation #13 To: Developmental Services, Department of

The department should create specific measurable goals for OPS that include existing and new measures associated with each one, such as staffing, overtime, and the timely completion of investigations. In addition, the department should perform a regular review of the quality of OPS's activities and investigations to achieve those goals. The department should track progress in quality measures over time and adjust its training plans to increase OPS law enforcement personnel's skill and compliance with established policies and procedures.

Annual Follow-Up Agency Response From October 2016

Under the guidance of a strategic planning consultant from California State University, Sacramento, OPS developed a strategic plan including its vision, mission, values, and goals. Additionally, DDS worked collaboratively with the Office of Law Enforcement Support (OLES) at the California Health and Human Services Agency to develop a process to regularly review the quality of OPS investigations. The process with OLES identifies and addresses deficiencies within OPS. This recommendation is fully implemented.

Completion Date: May 2016

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

OPS implemented a strategic plan that includes goals that measure the quality of OPS activities and investigations. In October 2016, OLES (the department who began OPS oversight reporting in January 2016) will issue its first report on the quality of OPS investigations and their outcomes. According to the OPS Chief, once the report is released, OPS will use the report to set performance baselines and will be able to monitor performance towards performance goals through subsequent OLES reports. Because OPS has issued a strategic plan with some measurable goals, has a new state mandated program in place with the OLES to review the quality of its activities and investigations, and plans to use the OLES reviews to set additional measurable goals, we consider this recommendation fully implemented.

Annual Follow-Up Agency Response From September 2015

The Department is working with the newly formed Office of Law Enforcement Support (OLES) at the California Health and Human Services Agency to develop a process to regularly review the quality of OPS investigations involving incidents defined in WIC Section 4427.5. The process will monitor and address any training deficiencies that may be identified in the future. OLES will be providing contemporaneous oversight and monitoring of investigations and will issue annual reports regarding the number, type, and disposition of investigations, and identify the quality of each investigation.

Estimated Completion Date: June 30, 2016

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

Annual Follow-Up Agency Response From October 2014

A Strategic Planning Workshop was held at the California State University, Sacramento, on August 12-14, 2014. At this workshop, with the guidance of the strategic planning consultant, staff from OPS developed vision, mission, values, and goals. Through follow-up meetings and breakout groups, specific measurable objectives were outlined to meet the goals. The strategic plan is pending approval from Executive Management.

Additionally, the Department is working collaboratively with the newly formed Office of Law Enforcement Assistance (OLEA) at the California Health and Human Services Agency to develop a process to regularly review the quality of OPS investigations. The process with OLEA will also identify and address any training deficiencies that may be identified in the future.

Estimated Completion Date: June 30, 2015

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

1-Year Agency Response

On June 11, 2014, OPS entered into an Interagency Agreement with California State University, Sacramento, for a strategic planning consultant to facilitate the development of a strategic plan to clearly delineate the goals of OPS. The strategic plan will identify the data needs and any other performance indicators necessary to measure progress toward achieving those goals.

Estimated Completion Date: June 30, 2015
Response Date: June 2014

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

6-Month Agency Response

DDS is implementing this recommendation. The Department tracks and evaluates data associated with staffing, overtime utilization, and investigations. OPS is finalizing an Interagency Agreement with California State University, Sacramento, for a strategic planning consultant to facilitate the development of a strategic plan to clearly delineate the goals of OPS. The strategic plan will identify the data needs and any other performance indicators necessary to measure progress toward achieving those goals.

The Department continues to refine the newly implemented incident reporting system (IRIS) to provide greater standardization and assist in measuring OPS case investigations and findings. A revision to the IRIS database was completed in November 2013, which includes a customized component to enter and track data related to investigations and findings.

In November 2013, the new OPS Chief established a formal training plan to ensure all uniformed personnel receive initial and ongoing training in all aspects of their jobs. Training priorities are focused on the areas noted in the audit, as well as other issues identified through internal quality reviews.

Additionally, after issuance of the new policy manual, the new OPS Chief will establish an Inspection Program for regular review of the quality of OPS activities and investigations.

Estimated Completion Date: June 30, 2014
Response Date: January 2014

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

60-Day Agency Response

DDS is implementing this recommendation. The Department tracks and evaluates data associated with staffing, overtime utilization, and investigations. The new Chief of OPS, working with his command staff, is formalizing the organization's mission statement and developing a strategic plan to clearly delineate the goals of OPS. The strategic plan will identify the data needs and any other performance indicators necessary to measure progress toward achieving those goals.

The Department continues to refine the newly implemented incident reporting system (IRIS) to provide greater standardization and assist in measuring OPS case investigations and findings. The revision to the IRIS database is expected to be completed in October 2013, and DC and OPS staff will be subsequently trained on the new data elements.

The new Chief of OPS will have a formal training plan by September 30, 2013, to ensure officers receive initial and ongoing training in all aspects of their jobs. Additionally, the new Chief of OPS is establishing an Inspection Program for regular review of the quality of OPS activities and investigations. Training priorities will focus on the areas noted in the audit, as well as, other issues identified through internal quality reviews.

Estimated Completion Date: ongoing
Response Date: September 2013

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

Recommendation #14 To: Developmental Services, Department of

To allow for the creation of consistent performance measures and comparisons of resident abuse data across all developmental centers, the department should ensure that each of its centers consistently uses the same data fields in IRIS.

6-Month Agency Response

As previously reported, IRIS was installed at all DCs in the latter part of 2012, and the Department continues to refine the use of IRIS. A revision to the IRIS database was completed in November 2013, which includes a customized component to enter and track data related to investigations and findings, and an input form that will provide for more standardization in the reporting.

Although DC employees have received initial training on the use of IRIS, retraining continues to be provided to employees individually and collectively to ensure consistency and accuracy of the data. Entries into IRIS are reviewed daily by DCD staff with immediate feedback provided to the facilities when corrections are necessary.

The IRIS software enforces data integrity rules to improve consistency in reporting. The Department has also provided a Wiki that contains online documentation and instructional information with rules defining incident types and how they are to be reported. Whenever changes to the system are implemented, immediate instructional information goes out via Wiki to all DC staff concerning reporting changes.

Even though over time there will be system modifications and improvements, DDS has implemented ongoing training, monitoring and feedback for using IRIS. DDS has achieved reasonable data consistency and will continue to support efforts toward improved data quality.

Completion Date: December 2013
Response Date: January 2014

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

60-Day Agency Response

DDS is implementing this recommendation. As previously reported, IRIS was installed at all developmental centers in the latter part of 2012 and the Department continues to refine the use of IRIS. For example, the Reporting and Notification of Incidents and Unusual Occurrences Policy was finalized and distributed in May 2013, which expanded the criteria for types of incidents to be reported along with definitions. The tools used by staff for entering the incident data into the system are being adjusted accordingly and data is being reviewed for accuracy and compliance with the new policy. Additionally, on May 14, 2013 the Deputy Director of the Developmental Centers Division provided direction to all the developmental centers requiring standardized use of the data fields within the IRIS.

Although developmental center employees have received initial training on the use of IRIS, retraining continues to be provided to employees individually and collectively as needed to ensure consistency and accuracy of the data.

Entries into IRIS are reviewed daily by the Developmental Centers Division staff with immediate feedback provided to the facilities when corrections are necessary.

Following a DC Leadership meeting in July 2013 to review the IRIS implementation, the Department worked with the system developer (Therap) in August 2013 to further customize an input form that will provide for more standardization in the reporting. This modification is expected to be completed in October 2013 with staff training to follow.

Estimated Completion Date: December 31, 2013
Response Date: September 2013

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

Recommendation #15 To: Public Health, Department of

To conduct licensing surveys at required intervals while minimizing additional workload, Public Health should explore further opportunities to coordinate the licensing and certification surveys. If Public Health questions the value of these surveys, it should seek legislation to modify the surveying requirements.

Annual Follow-Up Agency Response From August 2016

In January 2016, Public Health implemented a new state Skilled Nursing Facility (SNF) Relicensing Survey. By March 2016, all Public Health District Offices were using this new survey process and will survey 50% of their SNFs in 2016 and the other 50% in 2017. By 2018 and going forward, all SNFs will have a relicensing surveys conducted no less than every two years.

Additionally, Public Health has completed all required state licensing surveys for all Intermediate Care Facilities operated by the California Department of Developmental Services. On June 1, 2016, Public Health emailed supporting documentation to the California State Auditor.

Completion Date: June 2016

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

Our 2013 report found that Public Health was not conducting all of its state licensing surveys at developmental centers on time or at all. According to information provided by Public Health, the department is now up to date on licensing surveys for the developmental centers. Although the department's Deputy Director for Health Care Quality confirmed that it has not yet coordinated the federal certification surveys and the state licensing surveys for the developmental centers, they have begun to coordinate the surveys for other types of facilities and intend to begin coordination after the new regulations are completed. Because the transition to coordination has begun and the surveys are all up to date, we assess this recommendation as Resolved.

Annual Follow-Up Agency Response From October 2015

The status of this recommendation is unchanged.

Estimated Completion Date: 10/2015

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

Annual Follow-Up Agency Response From October 2014

The status of this recommendation is unchanged.

Estimated Completion Date: 9/2015

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

1-Year Agency Response

The California Department of Public Health (CDPH) agrees with this recommendation and is developing a survey protocol that coordinates the licensing and certification surveys.

In July 2014, CDPH began reviewing its licensing survey methodologies for long-term care facilities to focus on eliminating redundancies between licensing and certification surveys. Once a streamlined licensing survey protocol is in place for long-term care facilities, CDPH will work on extending a similar new protocol to developmental centers. This will entail conducting a separate crosswalk of state and federal requirements specific to intermediate care facilities for the developmentally disabled, the licensing category for the developmental centers.

Estimated Completion Date: December 2017
Response Date: October 2014

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

6-Month Agency Response

On August 26, 2013, CDPH fully executed a contract with Hubbert Systems Consulting for an organizational assessment of the effectiveness and performance of the Licensing and Certification (L&C) program. On October 31, 2013, Hubbert Systems Consulting delivered an in-person presentation of the preliminary analysis and assessment findings. On January 31, 2014, Hubbert Systems Consulting will provide the next contract deliverable, a final report of the findings associated with the program assessment. Beginning in January 2014, the consultants will conduct an in-depth gap analysis.

Hubbert Systems Consulting will provide final recommendations in June 2014.

Estimated Completion Date: June 2014
Response Date: January 2014

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

60-Day Agency Response

On August 2, 2013, CDPH signed a contract with the Hubbert Systems Consulting, Inc. for an organizational assessment of the effectiveness and performance of the Licensing and Certification (L&C) program. Hubbert Systems Consulting will:

Identify concerns and issue related to the timely annual completion of L&C's state licensing and federal certification workloads;

Prepare actionable recommendations for corrective measures including process and/or quality improvement initiatives;

Identify further opportunities to coordinate and streamline licensing and certification surveys;

Prepare a comprehensive implementation work plan that includes options for performing the work in stages; and

Identify barriers to timely workload completion.

The contract has been approved by the California Department of General Services. The contract will begin immediately and will expire on June 30, 2014.

Estimated Completion Date: June 30, 2014
Response Date: August 2013

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

Recommendation #16 To: Public Health, Department of

To ensure that the facilities Public Health monitors take timely corrective action on deficiencies, Public Health should comply with CMS's 45-day revisit requirement. If the 45-day revisit time frame is not possible due to the extent of the corrections required at particular facilities, Public Health should seek exemptions from CMS as appropriate. For facilities whose deficiencies are not severe enough to require an on-site revisit, Public Health should direct its staff to complete desk reviews within 60 days.

60-Day Agency Response

L&C has created and implemented a tracking log to monitor this performance metric. L&C maintains the log in a common electronic repository known as a "collaboration site," to allow headquarters staff to view current field operation activities seamlessly. In addition, L&C provided directions and training during staff meetings to all District Office staff to ensure compliance with the tracking log. Each District Office is responsible for updating the tracking log on a daily basis. Each week, CDPH Headquarters evaluates the tracking log and provide findings to the District Office managers. Exhibit A is a copy of the tracking log.

If L&C is unable to complete a revisit within CMS' 45-day requirement, L&C will notify CMS by e-mail and request an exemption or extension to the revisit requirement.

Completion Date: August 2013
Response Date: August 2013

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

L&C is the Department of Public Health's Licensing and Certification unit.

Recommendation #17 To: Public Health, Department of

To ensure that investigations are conducted on a timely basis across priority levels, Public Health should develop and implement target time frames for the priority levels that lack them. Public Health should ensure that the timelines are being met and, if not, explore new ways to increase efficiency and manage its workload, thereby facilitating timely investigations.

Annual Follow-Up Agency Response From August 2016

Public Health has 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.

Completion Date: August 2016

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

Based on information it provided to us, Public Health has updated its policy and procedure manual and has demonstrated a high level of compliance in meeting those targets. Specifically, the department updated its Licensing and Certification Policy and Procedure manual to include target time frames for applicable priority levels that lacked them. Further, for fiscal year 2015-16, Public Health initiated 97 percent of both immediate jeopardy complaints and non-immediate jeopardy complaints within the target time frame of 24 hours and 10 days respectively. In addition, the metrics show that in the same time period, Public Health initiated 94 percent of immediate jeopardy self-reported incidents within the target time frame of 24 hours.

Further, the department established complaint teams to, among other things, ensure complaint time frames are being met. Complaint teams are established in district offices that fail to complete 95 percent of their investigations within the required time frames. The policies also state that complaint team supervisors are responsible for reviewing complaint files and triaging complaints in the tracking system. Moreover, Supervisors are required to conduct weekly group and individual meetings that discuss the status of all open complaints and the entire team's workload and updates to help manage complaint workloads.

Annual Follow-Up Agency Response From October 2015

CDPH disagrees that it should develop and implement target timeframes for the priority levels that lack them. The Centers for Medicare and Medicaid Services (CMS) provides prioritization guidance on these lower level complaints and facility reported incidents.

Per CMS, these include allegations which "may cause harm that is of limited consequences and does not significantly impair the individual's mental, physical, and/or psychosocial status or function." CDPH does have a policy to initiate immediate jeopardy complaints and facility reports within 24 hours and non-immediate jeopardy high complaints and facility reports within 10 days.

CDPH does have a policy to initiate immediate jeopardy complaints and facility reports within 24 hours and non-immediate jeopardy high complaints and facility reports within 10 days.

An integral part of prioritizing complaints and facility-reported incidents is making a clinical judgment of their severity. CDPH nurse surveyors and supervisors, using assessment skills learned in federal and state training and survey experience, triage and prioritize complaints and facility-reported incidents based on the information gathered during the intake, their understanding of the potential impact to the client/resident, their knowledge of the facility, and the significance of the possible regulatory violation.

CDPH uses the CMS process and database to track complaints and facility-reported incidents. This database requires a target initiation date for each intake. Although CDPH and CMS policies do not have a prescribed target initiation date for some low priority levels, CDPH generally assigns an initiation date of 45 days. CMS conducts performance reviews of our investigations, which includes reviewing whether we initiated an investigation within the timeframe assigned during the intake. CDPH believes this process is sufficient to assign and monitor timelines

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

1-Year Agency Response

"CDPH disagrees that it should develop and implement target timeframes for the priority levels that lack them. The Centers for Medicare and Medicaid Services (CMS) provides prioritization guidance on these lower level complaints and facility reported incidents.

CDPH does have a policy to initiate immediate jeopardy complaints and facility reports within 24 hours and non-immediate jeopardy high complaints and facility reports within 10 days.

Response Date: October 2014

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

Public Health correctly quotes a portion of the Centers for Medicare and Medicaid Services (CMS) guidance but neglects to address CMS guidance indicating that prevention is one of the objectives of the complaint and incident management system. As we discuss on page 66 of our audit report, federal guidance explains that the investigation of these events, even ones that are designated as less serious, is designed to identify and correct less serious issues to prevent them from becoming more serious problems. By not addressing lengthy delays in investigations—like some of the delays shown in Figure 7 on page 65 of our audit report—Public Health appears to be missing opportunities to prevent in a timely manner the potential escalation of problems within the developmental centers. In addition, although we understand that clinical judgment is essential in the process of prioritizing complaints and facility reported incidents, we do not believe that this specialized expertise negates the need for accountability within Public Health. Thus, we stand by our recommendation that Public Health establish target time frames across priority levels.

6-Month Agency Response

As stated in our 60-day response:

Per CMS, these include allegations which may cause harm that is of limited consequences and does not significantly impair the individuals mental, physical, and/or psychosocial status or function. CDPH does have a policy to initiate immediate jeopardy complaints and facility reports within 24 hours and non-immediate jeopardy high complaints and facility reports within 10 days.

Response Date: January 2014

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

60-Day Agency Response

Response Date: August 2013

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

By not implementing our recommendation, CDPH does not have a clear measure to assess the timeliness of its reviews.

Recommendation #18 To: Public Health, Department of

To improve its enforcement, each year Public Health should evaluate the effectiveness of its enforcement system across all types of health facilities, including those in developmental centers, prepare the required annual report, and, if called for, recommend legislation to improve the enforcement system and enhance the quality of care.

Annual Follow-Up Agency Response From July 2019

California Department of Public Health (CDPH) executed a contract with the selected vendor in March 2019. The vendor began the initial assessment of CDPH's enforcement system designed to improve the quality of care provided by long-term health care facilities. Consistent with the project timeline, the vendor is meeting with internal stakeholders and identifying data sources. The vendor will also contribute to the initial annual report.

Estimated Completion Date: July 2020

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

After nearly six years, CDPH took its first significant step to implement this recommendation, which mirrors an existing requirement in state law.

Annual Follow-Up Agency Response From October 2018

CDPH submitted its last annual follow-up in July 2018. No further changes have been made since the last response. However, CDPH anticipates to fully implement CSA's recommendations by July 2020 as stated in the last response.

Estimated Completion Date: July 2020

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

Annual Follow-Up Agency Response From July 2018

California Department of Public Health (CDPH) completed the scope of work for a "request for proposal" to solicit the services of a vendor that will conduct an initial assessment of CDPH's enforcement system designed to improve the quality of care provided by long-term health care facilities. The vendor will also contribute to the initial annual report. CDPH anticipates the contractor's work will begin by October 2018.

Estimated Completion Date: July 2020

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

Annual Follow-Up Agency Response From July 2017

Public Health is moving forward with efforts to determine a methodology to comply with the reporting requirement in Health and Safety Code section 1438 to address the effectiveness of the enforcement system in maintaining and improving the quality of care provided by long-term health care facilities. This will include an internal review of staff capacity/skills within CDPH to frame the methodology for the program evaluation and may include a Request for Offer to further define the methodology and/or conduct the assessment.

Additionally, Public Health completed two quality improvement projects which resulted in the development of periodic metrics under SB75 to track complaint investigations and post the results to the CDPH website. Citation processing improvement was achieved and ongoing monitoring efforts include quality and process measurements to ensure the current capacity will meet the mandatory requirements established in the legislation as well as produce reports for the legislature.

Estimated Completion Date: June 2019

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

Annual Follow-Up Agency Response From August 2016

Public Health is exploring funding to support ongoing research and reporting on effectiveness of the enforcement system in maintaining the quality of care provided by long-term health care facilities.

Additionally, Public Health initiated two quality improvement projects that evaluate complaint investigations and citation processes for long-term health care facilities. The projects focused on the Public Health District Offices success in completing investigations and if applicable, issuing citations, in a specified timeframe. The two projects resulted in new procedures that are in the pilot phase for the testing for eventual statewide implementation.

Estimated Completion Date: June 2018

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

Annual Follow-Up Agency Response From October 2015

The status of this recommendation is unchanged.

Estimated Completion Date: 10/2015

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

Annual Follow-Up Agency Response From October 2014

The status of this recommendation is unchanged.

Estimated Completion Date: 9/2015

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

1-Year Agency Response

CDPH expanded its fiscal year (FY) 2014-15 Annual Fee Report to include additional enforcement related information than we reported in previous years. See pages 17 and 18 of the FY 2014-15 fee report at http://www.cdph.ca.gov/pubsforms/fiscalrep/Documents/LicCertAnnualReport2014.pdf.

In addition, SB 857 (Chapter 31, Statutes of 2014) requires CDPH to post performance and enforcement metrics on its website. CDPH will begin posting these metrics by October 30, 2014.

Estimated Completion Date: October 30, 2014
Response Date: October 2014

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

6-Month Agency Response

CDPH, through Hubbert Systems Consulting, will identify appropriate enforcement metrics to be evaluated for inclusion in the 2015 annual fee report, which CDPH submits to the Legislature on or before February 1 of each year.

Estimated Completion Date: February 2015
Response Date: January 2014

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

60-Day Agency Response

CDPH has partially implemented this recommendation. CDPH is engaged in a continuous process of building its quality improvement program which empowers and trains its staff to effectively enforce state and federal requirements. Additionally, CDPH is in the process of refining its quality improvement program to enhance the skill, knowledge and ability of its staff in evaluating the effectiveness of its enforcement system across all types of health facilities, particularly developmental centers.

CDPH will incorporate additional workload and enforcement activity information into the Health Facility License Fees Annual Report that CDPH submits to the Legislature on or before February 1st of each year.

In addition, we anticipate the recommendations from Hubbert Systems Consulting Group will identify additional reporting opportunities and identify opportunities to further improve the effectiveness of enforcement activities.

Estimated Completion Date: June 30, 2014
Response Date: August 2013

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

All Recommendations in 2012-107

Agency responses received are posted verbatim.