Report 2016-046 Recommendation 7 Responses

Report 2016-046: Board of Registered Nursing: Significant Delays and Inadequate Oversight of the Complaint Resolution Process Have Allowed Some Nurses Who May Pose a Risk to Patient Safety to Continue Practicing (Release Date: December 2016)

Recommendation #7 To: Registered Nursing, Board of

To ensure that BRN resolves complaints regarding nurses in a timely manner, by March 1, 2017, it should establish a plan to eliminate its backlog of complaints awaiting assignment to an investigator.

Annual Follow-Up Agency Response From October 2023

The BRN will continue to implement this recommendation. As stated in response to Recommendation 3 for Investigative Report 12020-0027 (associated to Recommendation 7 for 2016-046), the BRN "has demonstrated a good-faith effort to work with the audit team to develop a satisfactory approach for fully implementing the 2016 audit recommendation, we deem this recommendation fully implemented." The BRN has not received any additional request for information or documentation from CSA but will cooperate with any such requests to demonstrate full compliance.

This recommendation was fully implemented December 2020. The drop down above for the First Month of Full Implementation will not allow the year 2020; therefore, January 2021 was selected.

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

In October 2018, BRN asserted that it had fully implemented this recommendation and provided a report that it represented would support this claim, which caused us, in reliance on those representations, to conclude that this recommendation was fully implemented. However, as discussed at length in report number I2020-0027, we later received a whistleblower complaint alleging that BRN had manipulated data and delivered a falsified report with the intention of misleading the California State Auditor's Office. Our office substantiated that complaint and the full report can be found at http://auditor.ca.gov/pdfs/reports/I2020-0027.pdf. As a result, we have no current assurances that the recommendation has been accurately addressed and, in September 2020, we revised our assessment of the status of this recommendation to pending.

Although BRN has once again asserted that it had fully implemented this recommendation and has made a good-faith effort to work with the audit team to develop a satisfactory approach for implementing this recommendation, we have no assurance that it has actually reduced its investigator caseload and fully implemented this recommendation. Thus, because it was able to falsify data in one of the reports it provided to our office previously, we would need to perform additional work to verify whether it has actually reduced investigator caseloads and fully implemented our recommendation. Therefore, at this time, we are assessing this recommendation status as pending until we are able to perform the additional analysis needed to verify whether the investigator caseloads have actually been reduced.

Annual Follow-Up Agency Response From October 2022

The Board of Registered Nursing (BRN) will continue to implement this recommendation. As stated in response to Recommendation 3 for Investigative Report 12020-0027 (associated to Recommendation 7 for 2016-04), the BRN "has demonstrated a good-faith effort to work with the audit team to develop a satisfactory approach for fully implementing the 2016 audit recommendation, we deem this recommendation fully implemented." The BRN has not received any additional request for information or documentation from CSA but will cooperate with any such requests to demonstrate full compliance.

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

In October 2018, BRN asserted that it had fully implemented this recommendation and provided a report that it represented would support this claim, which caused us, in reliance on those representations, to conclude that this recommendation was fully implemented. However, as discussed at length in report number I2020-0027, we later received a whistleblower complaint alleging that BRN had manipulated data and delivered a falsified report with the intention of misleading the California State Auditor's Office. Our office substantiated that complaint and the full report can be found at http://auditor.ca.gov/pdfs/reports/I2020-0027.pdf. As a result, we have no current assurances that the recommendation has been accurately addressed and, in September 2020, we revised our assessment of the status of this recommendation to pending.

Although BRN has once again asserted that it had fully implemented this recommendation and provided several reports similar to the one it provided in 2018 to support its claim, we have no assurance that it has actually reduced its investigator caseload and fully implemented this recommendation. Specifically, in November 2022, BRN provided several reports indicating that its investigators only have 30 or fewer cases assigned to them. However, because it was able to falsify data in one of these reports previously, we would need to perform additional work to determine whether it manipulated the data in these reports to verify whether it has actually reduced investigator caseloads and fully implemented our recommendation. Therefore, at this time, we are assessing this recommendation status as pending until we are able to perform the additional analysis needed to verify whether the investigator caseloads it reported are accurate.

Annual Follow-Up Agency Response From October 2021

The BRN will continue to implement this recommendation. As stated in response to Recommendation 3 for Investigative Report 12020-0027 (associated to Recommendation 7 for 2016-04), the BRN "has demonstrated a good-faith effort to work with the audit team to develop a satisfactory approach for fully implementing the 2016 audit recommendation, we deem this recommendation fully implemented." The BRN has not received any additional request for information or documentation from CSA but will cooperate with any such requests to demonstrate full implementation.

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

In October 2018, BRN asserted that it had fully implemented this recommendation and provided a report that it represented would support this claim, causing us, in reliance on those representations, to conclude that this recommendation was fully implemented. However, as discussed at length in report number I2020-0027, we later received a whistleblower complaint alleging that BRN had manipulated data and delivered a falsified report with the intention of misleading the California State Auditor's Office. Our office substantiated that complaint and the full report can be found at http://auditor.ca.gov/pdfs/reports/I2020-0027.pdf. As a result, we have no current assurances that the recommendation has been accurately addressed and, in September 2020, we revised our assessment of the status of this recommendation to pending.

Although, in October 2021, BRN once again asserted that it had fully implemented this recommendation and provided a report similar to the one it provided in 2018 to support its claim, we have no assurance that it has actually reduced its investigator caseload and fully implemented this recommendation. Specifically, in December 2020, BRN provided a report indicating that its investigators only have 30 or fewer cases assigned to them. However, because it was able to falsify data in this report previously, we would need to perform additional work to determine whether it manipulated the data in this report to verify whether it has actually reduced investigator caseloads and fully implemented our recommendation. Therefore, at this time, we are assessing this recommendation status as pending until we are able to perform the additional analysis needed to verify whether the investigator caseloads it reported are accurate.

Annual Follow-Up Agency Response From December 2020

The Board of Registered Nursing (BRN) established a plan to eliminate its backlog of complaints awaiting assignments to an investigator by memorializing the expectation that the number of investigations assigned to a Special Investigator does not exceed 30 investigations. Since the BRN memorialized this expectation, management has monitored and ensured that investigators are not assigned more than 30 investigations.

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

In October 2018, BRN asserted that it had fully implemented this recommendation and provided a report that it represented would support this claim, causing us, in reliance on those representations, to conclude that this recommendation was fully implemented. However, as discussed at length in report number I2020-0027, we later received a whistleblower complaint alleging that BRN had manipulated data and delivered a falsified report with the intention of misleading the California State Auditor's Office. Our office substantiated that complaint and the full report can be found at http://auditor.ca.gov/pdfs/reports/I2020-0027.pdf. As a result, we have no current assurances that the recommendation has been accurately addressed and, in September 2020, we revised our assessment of the status of this recommendation to pending.

Although BRN has once again asserted that it had fully implemented this recommendation and provided a report similar to the one it provided in 2018 to support its claim, we have no assurance that it has actually reduced its investigator caseload and fully implemented this recommendation. Specifically, in December 2020, BRN provided a report indicating that its investigators only have 30 or fewer cases assigned to them. However, because it was able to falsify data in this report previously, we would need to perform additional work to determine whether it manipulated the data in this report to verify whether it has actually reduced investigator caseloads and fully implemented our recommendation. Therefore, at this time, we are assessing this recommendation status as pending until we are able to perform the additional analysis needed to verify whether the investigator caseloads it reported are accurate.

Annual Follow-Up Agency Response From October 2018

The BRN has established a plan to eliminate its backlog of complaints awaiting assignment to an investigator.

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

In October 2018, BRN reported that it had fully implemented this recommendation and provided "evidence" to support this claim, causing us, in reliance on those representations, to conclude that this recommendation was fully implemented. However, as discussed at length in report number I2020-0027, we later received a whistleblower complaint alleging that BRN had manipulated data and delivered a falsified report with the intention of misleading the California State Auditor's Office. Our office substantiated that complaint and the full report can be found at http://auditor.ca.gov/pdfs/reports/I2020-0027.pdf. As a result, we have no current assurances that the recommendation has been accurately addressed and, in September 2020, we revised our assessment of the status of this recommendation to pending.

1-Year Agency Response

The BRN has established a plan to eliminate its backlog of complaints awaiting assignment to an investigator.

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

Although BRN claims it has fully implemented this recommendation, it did not provide evidence demonstrating that it has. Until it does so, we will continue to assess the status of this recommendation as pending.

6-Month Agency Response

The BRN eliminated the unassigned case backlog prior to the 60-day response and continues to have no backlog of unassigned cases. 60-day feedback from auditor outlines concerns regarding Investigator workload. BRN believes additional staff will be necessary to address the level of workload assigned to investigators and is in the process of reviewing workload and staffing resources to determine what is needed.

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

BRN did not provide documentation to substantiate its claim of full implementation.

60-Day Agency Response

As of January 17, 2017, the BRN has eliminated any unassigned backlog in the BRN Investigation Unit.

Immediately following release of the audit report, case assignments were increased for all investigators from 20 to 25 each which aided in the elimination of the backlog. The BRN developed procedures requiring a case received by the investigations unit to be assigned to a Supervising Special Investigator (SSI) within 10 business days. The SSI is responsible for reviewing and triaging the incoming case workload of the unit. Cases will remain assigned to the SSI until the field investigator's workload allows the case to be assigned to the field investigator. This process has been updated and included in the policies and procedures for investigations. In addition, the BRN began strictly adhering to the Division of Investigation's CPEI case referral guidelines which has also contributed to elimination of the backlog.

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

BRN indicated that it eliminated its backlog of complaints awaiting assignment to an investigator by assigning them to its investigators. Based on documentation provided by BRN, this increased investigators' caseload, on average, to roughly 24. However, as we describe in our audit report on pages 28 to 29, the chief of investigations acknowledged that a full caseload for BRN's non-sworn investigators is 20 complaints. Therefore, rather than BRN eliminating its backlog, it simply shifted the backlogged complaints by assigning them to its non-sworn investigators who already have full caseloads. Until it can demonstrate that its non-sworn investigators are able to timely resolve complaints, given the increased caseload, we will report this as partially implemented.

All Recommendations in 2016-046

Agency responses received are posted verbatim.