Report 2002-114 Summary - August 2003
Department of Social Services:
Continuing Weaknesses in the Department's Community Care Licensing Programs May Put the Health and Safety of Vulnerable Clients at Risk
As the State's agency for licensing and monitoring community care facilities, the Department of Social Services:
- Has more selectively granted criminal history exemptions since our last review.
- Has been less prompt in communicating exemption decisions.
- Has not adequately managed or investigated subsequent criminal history reports.
- Did not always follow its complaint procedures or make certain that facilities fully corrected identified deficiencies.
- Has adequately reviewed the counties it contracts with to license foster family homes, but has not always corrected identified deficiencies.
- Has prioritized and quickly processed legal actions against facility licensees, but its enforcement of legal decisions was not always timely, consistent, and thorough.
RESULTS IN BRIEF
The Department of Social Services (department), the agency that licenses and monitors community care facilities in California, must protect community care clients' safety by using diligence and sound judgment in its oversight. State law gives the department wide discretion to decide if people with criminal histories should care for or have contact with clients. We found that the department has been more selective when granting criminal history exemptions since we issued our August 2000 report, Department of Social Services: To Ensure Safe, Licensed Child Care Facilities, It Needs to More Diligently Assess Criminal Histories, Monitor Facilities, and Enforce Disciplinary Decisions (child care report).
However, the department could further improve the thoroughness of its criminal history reviews. Moreover, the department has been less prompt in communicating final decisions for exemption requests than it was when we issued the child care report. Although the department's July 2003 emergency regulations will help ensure that individuals with potentially dangerous criminal histories are not present in facilities before it reviews their criminal histories, the department must also be careful not to impede individuals' right to work or facilities' ability to operate by taking an unnecessarily long time to complete its reviews. We also found that the department's management and investigations of subsequent criminal history reports has been inadequate. The background check process is further marred by a gap in its system because the department does not receive information about subsequent criminal activity outside California. Continued weaknesses in the department's process of checking criminal histories may put the safety of vulnerable clients in community care facilities at risk.
The department's investigation of complaints against community care facilities continues to need improvement. For example, licensing offices we reviewed did not always follow procedures when investigating complaints or ensure that facilities fully corrected identified deficiencies. By officially placing annual facility evaluations low on its priority list, the department has chosen to rely on complaint investigations to identify deficiencies, making adequate investigation of all complaints a crucial part of the department's awareness of licensing violations that could harm clients in community care. We also had concerns with the department's process for licensing facilities because licensing offices did not always consider all necessary information when granting applicants' licenses. Therefore, people unfit to care for vulnerable clients may have obtained licenses. Furthermore, the department did not always perform annual facility evaluations and thus may not have been aware of licensing violations that posed dangers to children and adults in community care facilities.
Although the department reviewed the counties it contracts with to license foster family homes, the department may diminish the effectiveness of its reviews by not consistently making sure those counties promptly correct identified deficiencies. Further, the department lacked procedures to review and assess the counties' reports on criminal history exemptions; therefore, the department has reduced assurance that foster children in the contract counties are entrusted to suitable caregivers. Nevertheless, the counties we visited, Fresno and Kern, adequately carried out their licensing and evaluation functions for the facilities we reviewed, although Kern County did not always follow up to ensure foster family homes corrected their deficiencies. Also, when investigating complaints, both counties sometimes left out important procedures, such as discussing with the department's legal staff allegations of abuse that the county cannot validate.
Finally, although the department prioritized and quickly processed cases we reviewed involving legal actions against individuals who failed to comply with licensing laws and regulations, its enforcement of decisions and orders was not always timely, consistent, and thorough. Legal action helps ensure that anyone who will not or cannot comply with licensing laws and regulations does not care for or come in contact with clients in community care facilities.
To ensure that criminal history exemptions are not granted to individuals who may pose a threat to the health and safety of clients in community care facilities, the department should:
- Make certain it has clear policies and procedures for granting criminal history exemptions.
- Ensure staff are trained on the types of information they should obtain and review when considering a criminal history exemption, such as clarifying self-disclosed crimes and vague character references.
- Review its character reference form to be certain the form's instructions are fully consistent with criminal history exemption guidelines.
To process criminal history reviews as quickly as possible so that delays do not impede individuals' right to work or its licensed facilities' ability to operate efficiently, the department should work to make certain that staff meet established time frames for notifying individuals that they must request a criminal history exemption and for making exemption decisions as requested.
To ensure the department can account for all subsequent criminal history reports it receives and that it processes this information promptly, the department should develop and implement a policy for recording a subsequent criminal history report's receipt and train staff on this policy. In addition, upon receiving a subsequent criminal history report with a conviction, the department should ensure that staff meet established time frames for notifying individuals that they need an exemption.
To ensure that complaints are promptly and thoroughly investigated and that facilities correct deficiencies, the department should do the following:
- Continue to emphasize complaint investigations over other duties.
- Require analysts to begin investigations within 10 days of receiving complaints and, whenever possible, to resolve investigations within 90 days.
- Ensure that analysts follow policies requiring them to refer to the investigations unit any serious allegation within eight hours of receipt and to issue citations for serious allegations the investigations unit has substantiated within 10 days of receipt.
- Make sure that abuse allegations that are deemed inconclusive are reviewed with the legal division.
- Require supervisors to review evidence that facilities took corrective action before signing off on a complaint.
To ensure that it issues licenses only to qualified individuals, the department should collect and consider all required information before it grants applicants' licenses, including, but not limited to, health screening reports, administrators' certifications, and necessary background checks.
If the department plans to continue to defer required facility evaluations, it should do the following:
- Seek legislative approval for its deferral plans.
- Ensure staff understand the guidance on visits that qualify for deferral and that they are properly implementing the deferral policy.
- Modify its licensing information system so that when it defers a visit to a child care home, the visit would be deferred for one year—similar to other facility types—as compared to a full three years.
To help ensure that counties contracting with the department to license and monitor foster family homes adequately and promptly respond to complaints and enforce corrective actions, the department should establish a reasonable time frame for liaisons to prepare reports resulting from reviews of the counties and to notify counties of the results of those reviews. It should also establish a reasonable time frame in which all counties must submit and complete their corrective action plans. Finally, the department should create a reliable method for tracking county corrective actions to ensure they are not overlooked.
To help ensure that counties contracting with the department to license foster family homes are making reasonable decisions regarding criminal history exemptions, the department should develop procedures to ensure that it promptly and consistently reviews quarterly reports on exemptions granted by each contracted county.
To be certain they adequately investigate all complaints against foster family homes and ensure that deficiencies are corrected, the counties should follow current policy and any policy changes the department implements as a result of the recommendations in this report.
The department should conduct follow-up visits to ensure that enforcement actions against facilities are carried out. The department should also document its follow-up for enforcement of revocation and exclusion cases.
Overall, the department concurred with the recommendations in this report and outlined some steps it has already begun to take to implement our recommendations, as well as additional steps it plans to take in the future. In addition, the Office of the Attorney General concurred with the recommendations we made for improving Justice's processes related to the department's licensing programs. Fresno County and Kern County described several ways they will address the issues we raised in the audit report; however, Kern County said that it did not necessarily agree with the audit findings in their totality.