Report 2016-108 Recommendation 5 Responses

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

Recommendation #5 To: Developmental Services, Department of

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

Annual Follow-Up Agency Response From October 2022

As indicated in prior updates, the department will not implement this recommendation.

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

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

Annual Follow-Up Agency Response From October 2021

As indicated in prior updates, the department will not implement this recommendation.

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

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

Annual Follow-Up Agency Response From October 2020

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

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

Annual Follow-Up Agency Response From October 2019

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

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

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

Annual Follow-Up Agency Response From November 2018

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

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

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

Annual Follow-Up Agency Response From December 2017

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

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

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

1-Year Agency Response

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

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

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

6-Month Agency Response

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

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

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

60-Day Agency Response

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

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

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

All Recommendations in 2016-108

Agency responses received are posted verbatim.