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DPH Did Not Always Prioritize and Conduct Investigations for High-Priority Intakes Within the Required Timeframes.

During the audit, DPH took an average of 41 working days to begin an onsite investigations of cases.

Table of Contents

Overview

We found significant problems with how DPH prioritizes and investigates intakes it deems high priority. First, out of a statistical sample of 200 intakes from a population of 1,567 that DPH designated for on-site investigation at priority level Non–Immediate Jeopardy (Non-IJ) High during our audit period, 142 were not prioritized for on-site investigation surveys within the required two working days. Projecting our sample results to the population, we determined with a 95% confidence level that between 64.6% and 76.8% of these 1,567 intakes were not properly prioritized for investigation.

In addition, in the same statistical sample of 200 intakes, 148 were not investigated within the required period of 10 working days. DPH took an average of approximately 41 working days to begin an on-site investigation survey from the time these 148 intakes were prioritized. Projecting our sample results to the population, we determined with a 95% confidence level that between 67.8% and 79.5% of these 1,567 intakes were not investigated within the required period of 10 working days.

When DPH does not prioritize and investigate intakes within the required timeframes, significant issues involving the health and safety of residents in these nursing homes may exist for prolonged periods and could result in physical or financial harm to residents.

Authoritative Guidance

According to Chapter 5 of CMS’s State Operations Manual,

For all non–immediate jeopardy situations, the complaint/incident is prioritized within two working days of its receipt, unless there are extenuating circumstances that impede the collection of relevant information.

The manual also states that intakes with a Non-IJ High priority code must be investigated at the nursing home within 10 days of their prioritization.

Reasons for Noncompliance

DPH staff members informed us that they did not have enough personnel to perform these activities in a timely manner in every instance and that there was therefore a significant intake backlog during our audit period.

Recommendation

DPH should review staffing needs and make any further adjustments that are needed to ensure that the prioritization and investigation survey processes are completed in the required timeframes.

Auditee’s Response

During the audit period, July 1, 2016 through June 30, 2018, there was a backlog of intake cases. To address the backlog, in 2018 additional staff were hired in the Complaint Unit. As of December 2018, due to hiring additional staff there is no longer a backlog of intake cases. . . .

Our analysis of all of the non-IJ high on-site investigations for this period yields a finding that 65.3% were not prioritized within two working days when tracking from HCFRS receipt date to the Aspen Complaint Tracking System (ACTS) assignment. Using the calculation, 65.3% is at the lower end of the range estimated by the Office of the State Auditor based on their sample.

Auditor’s Reply

As noted above, OSA determined that between 64.6% and 76.8% of the 1,567 intakes in question were not prioritized within the required period of two working days. Regardless of the actual percentage, both OSA’s and DPH’s own analyses indicate that during the audit period, there was a significant problem in this area.

Based on its response, DPH has taken measures to address the problems we identified in this area.

Date published: September 11, 2019
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