Report 94117 Summary - July 1995

Department of Health Services:

The Orange County District Office Needs To Further Improve Its Oversight of Health Care Facilities


While the Orange County District Office has recently improved its enforcement efforts, it:

  • Was late responding to some complaints and in issuing some citations;
  • Did not perform some health facility inspections and was late with others;
  • Incorrectly assessed the priority level for two complaints; and
  • Has not established guidelines for timely investigations and processing of citations and deficiency notices.

Results in Brief

The Licensing and Certification program (L&C) of the Department of Health Services (department) is responsible for enforcing state and federal laws and regulations governing the licensing and certification of health care facilities. To carry out its responsibility, the department sends evaluators from its district offices to the facilities to complete periodic standard inspections and to investigate complaints. The department issues deficiency notices to the facilities for violations. In addition, certain long-term care facilities are subject to California Health and Safety Code citations, which include monetary penalties. The department issues these citations for more severe violations.

Our review focused on whether the Orange County District Office (OCDO) meets its responsibility to help the department ensure that health care facilities provide the highest level of care possible. Specifically, we reviewed the OCDO's compliance with department policies and procedures for processing complaints, performing inspections, and issuing citations. In fact, the OCDO did not effectively use these procedures to the maximum level to ensure health care facilities provide the best care possible. Specifically, the OCDO did the following:

  • responded from one to 213 days late for 35 percent of the complaints reviewed, with late responses in all three fiscal years reviewed, from July 1, 1992, through March 31, 1995;
  • did not perform all required inspections of health facilities during our review period, and performed some inspections late;
  • incorrectly assessed priority levels for 2 of 60 complaints reviewed;
  • issued deficiency notices instead of higher level citations in 4 of 20 cases;
  • issued 29 percent of the citations we reviewed from 2 to 12 days late;
  • has not established guidelines for timely investigations and processing of citations and deficiency notices and, as a result, took longer than allowed to investigate and process them;
  • did not always ensure health care facilities submitted timely plans of corrective action, as required, in 13 of 20 cases we reviewed; and
  • has improved enforcement efforts, as demonstrated by an increase in the number of citations issued in the last two fiscal years reviewed.

When the OCDO fails to assess complaints and issue citations at the appropriate level, it is not using its monitoring procedures and enforcement authority effectively to ensure the facilities provide the best possible care. For example, in one instance, the OCDO assessed a complaint alleging inadequate patient care and possible neglect at priority level three, the lowest level available. The OCDO investigated and reported that a resident experienced substantial weight loss and multiple falls in a short time. If the OCDO assesses a lower priority level, the investigation may not be initiated as promptly as the nature of the complaint warrants. Also, in another instance we reviewed, the OCDO issued a facility a deficiency notice for failure to provide adequate supervision to prevent accidents. As a result of this failure, a resident was found badly bruised with multiple injuries. Because the OCDO issued only a deficiency notice, the facility did not receive the maximum penalty.


The Department of Health Services' Licensing and Certification Division (division) should ensure that the OCDO effectively does the following:

  • monitors health care facilities by responding to complaints promptly, performing all required inspections on time, and assessing complaints correctly at the appropriate level; and
  • uses its enforcement authority to the maximum level by issuing citations when appropriate within statutory timeframes and requiring facilities to submit plans of corrective action within time requirements.

Further, the division should establish guidelines for timely completion of investigations and develop procedures for issuing deficiency notices promptly after complaint investigations.

Agency Comments

The department concurred with the recommendations in the report and provided its plans for improving its oversight of health care facilities.