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DPH Did Not Refer Some Intakes to the Attorney General’s Office (AGO) As Required.

DPH must establish policies and controls over its intake process so AGO is properly notified.

Table of Contents

Overview

In a nonstatistical sample of 40 intakes out of a population of 430 that required DPH to notify the Attorney General’s Office (AGO), DPH did not notify AGO in 2 instances. As a result, AGO was not given the opportunity to review the intake details and determine whether the office needed to take any measures to address the problems.

Authoritative Guidance

According to Section 72H of Chapter 111 of the General Laws, DPH “shall . . . notify the attorney general forthwith upon receipt of an oral or written report” alleging abuse, neglect, or mistreatment of a resident, or misappropriation of a resident’s funds or property, at a nursing home.

Reasons for Noncompliance

DPH does not have adequate policies and procedures in place that define and implement monitoring controls to ensure that all intakes designated for on-site investigation surveys in HCFRS, which include all intakes requiring DPH to notify the AGO, are transcribed into ASPEN. When an intake alleging abuse, neglect, mistreatment, or misappropriation is not transcribed into ASPEN, AGO does not receive the required notification.

Recommendation

DPH should establish policies and procedures that define and implement monitoring controls over its intake process to ensure that all intakes requiring AGO notification are properly transcribed from HCFRS to ASPEN.

Auditee’s Response

In addition to updated long-term care regulations being promulgated during the audit period, CMS implemented new federal regulations for nursing home oversight on November 28, 2017. This was the first update of federal regulations for nursing homes in over twenty years and represented a significant change in oversight monitoring. . . .

Based upon DPH review of the nine intake cases in Finding 1 that were not investigated, only two of the cases were not referred to the AGO as they should have been. Since this oversight was identified, DPH has taken appropriate steps to appropriately refer these two cases. DPH disagrees with OSA’s finding that “DPH does not have adequate policies and procedures in place.” DPH notes that the Complaint Unit’s manual provides detailed policies and procedures for properly triaging intake cases. The purpose of the manual is to provide standardization of the intake process.

Auditor’s Reply

In its response, DPH acknowledges that the two cases that OSA determined should have been referred to AGO were not. Although this number may not represent a significant percentage of the population of cases during our audit period that required DPH to notify AGO, any instance of noncompliance with this statutory requirement denies AGO the opportunity to review the intake details and determine whether it needs to take additional measures to address the problem. Further, although DPH’s Complaint Unit Intake Process Manual may detail policies and procedures for triaging intake cases, we found that DPH did not have sufficient monitoring controls to ensure that all intakes designated for on-site investigation surveys in HCFRS (which include all intakes requiring that DPH notify AGO) are transcribed into ASPEN.

Based on its response, DPH has taken some measures to address these problems, but we urge the agency to implement our recommendations.

Date published: September 11, 2019
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