Report 2021-107 All Recommendation Responses

Report 2021-107: Department of Developmental Services: It Has Not Ensured That Regional Centers Have the Necessary Resources to Effectively Serve Californians With Intellectual and Developmental Disabilities (Release Date: June 2022)

Recommendation #1 To: Developmental Services, Department of

To ensure that regional centers can better meet the required caseload ratios for all consumer groups, DDS should work with the regional centers, the Association of Regional Center Agencies (ARCA), and other state entities as necessary to update the core staffing formula to align with actual regional center staffing costs by June 2023.

Annual Follow-Up Agency Response From June 2024

DDS continues to advocate for regional center Operations funding so they can meet their statutory obligations and provide effective case management to individuals and families. Both the FY 2023-24 and the FY 2024-25 Budget approved by the Legislature include targeted augmentations to support recent service coordinator staffing adjustments at the state equivalent. While most regional centers have made progress in reducing caseload ratios, the staffing crisis has impacted all regional centers' efforts.

Discussions will continue as DDS reviews regional center Operations funding, the current core staffing model and potential alternative methodologies. Regional center Operations funding will likely be a topic of discussion in the development of the Developmental Services Master Plan.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

1-Year Agency Response

DDS continued meeting with the ARCA regarding their input and recommendations on the current core staffing model. This included technical assistance on ARCA's proposal to update the Operations funding model. The 2023-24 Budget approved by the Legislature includes targeted augmentations to support recent service coordinator staffing adjustments at the state equivalent rates.

Discussions will continue as DDS reviews regional center Operations funding, the current core staffing model and potential alternative methodologies.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

As part of the Governor's Budget development, DDS evaluated assumptions used in policy estimates methodologies for updates or corrections based on regional center experience. This will continue with the May Revision development.

Additionally, DDS met with representatives from the Association of Regional Center Agencies this fall to discuss alternatives to simplify the allocation methodology for annual operations.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

DDS had an initial meeting with the Association of Regional Center Agencies regarding their input and recommendations on the current core staffing model. Discussions will continue as DDS reviews regional center Operations funding, the current core staffing model and potential alternative methodologies.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #2 To: Developmental Services, Department of

To ensure that regional centers can better meet the required caseload ratios for all consumer groups, DDS should review and update as necessary the core staffing formula annually to ensure the continued adequacy of regional centers' salaries.

Annual Follow-Up Agency Response From June 2024

Please see response to Recommendation #1.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

1-Year Agency Response

As noted in issue 1, DDS continues to review the current core staffing model and alternative methodologies to include prioritizing adjustments driven by caseload and related Operations resources.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

As noted in issue 1, DDS will continue to review policies for any changes to assumptions for the staff fiscal estimates.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

As noted in issue 1, DDS is reviewing the current core staffing model and alternative methodologies to include prioritizing adjustments driven by caseload and related Operations resources.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #3 To: Developmental Services, Department of

To ensure that regional centers conduct vendor monitoring as state law requires, DDS should, by October 2022, provide an initial training to all regional centers about the statutory requirements for vendor monitoring. This training should include the information the regional centers must assess as part of their quality and qualification reviews for each type of vendor, as well as best practices for ensuring that they complete all required reviews.

Annual Follow-Up Agency Response From June 2024

Training for regional center personnel regarding the monitoring of specialized residential facilities is repeated annually ongoing. This training includes review of statutory and regulatory requirements along with best practices.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

1-Year Agency Response

DDS has developed an additional component to the biennial HCBS Monitoring Review, effective July 1, 2023, that will include monitoring regional centers' compliance with vendor file reviews. DDS will hold a training for regional centers on June 28, 2023, regarding Title 17 requirements.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

DDS hosted a training event on October 24, 2022, for regional centers regarding statutory requirements and best practices related to monitoring of specialized homes - Community Crisis Homes (CCH), Enhanced Behavioral Supports Homes (EBSH), Adult Residential Facilities for Persons with Special Health Care Needs (ARFPSHN) and Group Homes for Children with Special Health Care Needs (GHCSHN).

172 regional center staff attended this training.

Training for regional centers regarding requirements and best practices related to monitoring of specialized homes will be provided annually.

Initial guidance was issued to regional centers on October 27, 2022, and revised on November 2, 2022, requiring regional centers to have a procedure for biennial vendor file reviews.

California State Auditor's Assessment of 6-Month Status: Partially Implemented

DDS provided documentation to support that it trained regional center staff on monitoring specialized homes for quality of services. However, it did not provide any documentation to support that it issued guidance and trained regional center staff on the biennial review of vendor files to ensure that they continue to meet qualifications requirements.

60-Day Agency Response

DDS is hosting a training event on October 24, 2022, for regional centers regarding statutory requirements and best practices related to monitoring of specialized homes, such as Community Crisis Homes (CCHs), Enhanced Behavioral Supports Homes (EBSHs), Adult Residential Facilities for Persons with Special Health Care Needs (ARFPSHNs) and Group Homes for Children with Special Health

Care Needs (GHCSHNs). Information regarding this event will be sent to regional centers by the end of August 2022.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #4 To: Developmental Services, Department of

To ensure that regional centers conduct vendor monitoring as state law requires, DDS should, by October 2022, develop a policy to provide ongoing vendor monitoring training to all regional centers.

6-Month Agency Response

DDS developed a policy for training regional centers on vendor monitoring visits for specialized homes.

California State Auditor's Assessment of 6-Month Status: Fully Implemented

60-Day Agency Response

DDS is developing a policy to outline the provision of ongoing training of regional centers regarding monitoring requirements for specialized homes, such as CCHs, EBSHs, ARFPSHNs and GHCSHNs.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #5 To: Developmental Services, Department of

To ensure that regional centers conduct vendor monitoring as state law requires, DDS should, by January 2023, identify best practices among regional centers for tracking their quality reviews to ensure that they are completed as frequently as state law requires.

Annual Follow-Up Agency Response From June 2024

DDS agreed to develop guidelines for all regional centers to complete all required quality reviews as frequently as state law requires for specialized homes. These guidelines were issued February 16, 2023.

Training for regional center personnel regarding the monitoring of specialized residential facilities is repeated annually ongoing. This training includes review of statutory and regulatory requirements along with best practices.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

1-Year Agency Response

On February 16, 2023, DDS issued correspondence reminding regional centers of their responsibilities regarding monitoring and oversight of specialized homes and to provide guidance in the areas of service coordination, quality assurance, and clinical monitoring.

California State Auditor's Assessment of 1-Year Status: Pending

Although the correspondence that DDS issued reminds regional centers of their responsibilities regarding monitoring and oversight of specialized homes, it does not implement our recommendation to identify best practices among regional centers for tracking their quality reviews to ensure that they are completed as frequently as state law requires. Until it does so, we will assess this recommendation as not fully implemented.

6-Month Agency Response

DDS will develop guidelines for all regional centers to complete all required quality reviews as frequently as state law requires for specialized homes.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

DDS is reviewing tracking systems across all regional centers and will engage regional center representatives in discussion related to monitoring requirements and current practices.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #6 To: Developmental Services, Department of

To ensure that regional centers conduct vendor monitoring as state law requires, DDS should then develop guidelines for all regional centers to follow to ensure that they complete all required quality reviews.

Annual Follow-Up Agency Response From June 2024

The guidance issued by DDS on February 16, 2023, provided specific guidance for all regional centers to follow to ensure that they complete all required quality reviews for specialized residential facilities, including the ARFPSHN, EBSH and CCH.

DDS verifies that regional centers complete all required quality reviews when conducting its semi-annual monitoring of specialized residential facilities.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

1-Year Agency Response

On February 16, 2023, DDS issued correspondence reminding regional centers of their responsibilities regarding monitoring and oversight of specialized homes and to provide guidance in the areas of service coordination, quality assurance, and clinical monitoring.

California State Auditor's Assessment of 1-Year Status: Pending

Although the correspondence that DDS issued reminds regional centers of their responsibilities regarding monitoring and oversight of specialized homes, it does not implement our recommendation to develop guidance for all regional centers to follow to ensure that they complete all required quality reviews. Until it does so, we will continue to report this recommendation as not fully implemented.

6-Month Agency Response

DDS will develop guidelines for all regional centers to complete all required quality reviews as frequently as state law requires for specialized homes.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

DDS is developing written guidelines for regional centers addressing the requirements, process, tracking and documentation for regional center monitoring visits.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #7 To: Developmental Services, Department of

By January 2023, evaluate its processes for monitoring regional centers' performance of quality and biennial reviews to ensure that its processes are sufficient for identifying regional centers' noncompliance.

Annual Follow-Up Agency Response From June 2024

DDS has evaluated the process for monitoring regional center performance of quality assurance reviews for specialized facilities - ARFPSHN, EBSH, and CCH. This data is reviewed on a regular and ongoing basis to ensure compliance.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

The documentation that Developmental Services provided did not demonstrate that it has sufficient processes for monitoring regional centers' performance of quality and biennial reviews to identify regional centers' noncompliance. Until it provides such documentation, we will continue to report this recommendation as not fully implemented.

1-Year Agency Response

DDS has evaluated the process for monitoring regional center performance of quality assurance reviews for specialized facilities - ARFPSHN, EBSH, and CCH.

DDS has developed an additional component to the biennial HCBS Monitoring Review, effective July 1, 2023, that will include monitoring regional centers' compliance with vendor file reviews. DDS will hold a training for regional centers on June 28, 2023, regarding Title 17 requirements.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

DDS has evaluated the process for monitoring regional center performance of quality assurance reviews for specialized facilities - ARFPSHN, EBSH, and CCH.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

DDS is reviewing its current practices related to oversight of regional center quality assurance monitoring and biennial review of vendor files to determine sufficiency of current practices and areas of improvement.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #8 To: Developmental Services, Department of

To ensure that consumers have convenient access to services, DDS should establish standards for measuring consumers' access to services by January 2023.

Annual Follow-Up Agency Response From June 2024

DDS continues its work implementing Regional Center Performance Measures for regional centers and Quality Incentive Program measures for service providers. These measures include reporting of data from the point a service is agreed upon in the Individual Program Plan (IPP) to the start of the service. DDS is working with stakeholder workgroups and in 2024, began incentivizing regional centers and service providers on timeliness of access to services for individuals ages 0-3 in the Early Start program. While this work will continue, lack of data sources may impede DDS' ability to expand these measures to consumers of all ages. Development and implementation of the consumer electronic records management system (CERMS) will provide the necessary data to measure consumers' timely access to services.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

1-Year Agency Response

DDS continues its work implementing Regional Center Performance Measures for regional centers and Quality Incentive Program measures for service providers. These measures include reporting of data from the point a service as agreed upon in the Individual Program Plan (IPP) to the start of the service. DDS is working with stakeholder workgroups on the development of data elements and reporting mechanisms that will be used beginning in FY 2023-24 to determine consumers' timely access to services.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

DDS began implementing Regional Center Performance Measures for regional centers and Quality Incentive Program measures for service providers in FY 2022-23. These measures include reporting of data from the point a service is agreed upon in the Individual Program Plan (IPP) to the start of the service. DDS is working with stakeholder workgroups on the development of data elements and reporting mechanisms that will be used beginning in FY 2023-24 to determine consumers' timely access to services.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

DDS is implementing Regional Center Performance Measures for regional centers and Quality Incentive Program measures for service providers beginning in FY 2022-23. These measures will include reporting of data from the point a service is agreed upon in the Individual Program Plan (IPP) to the start of the service. DDS is working with stakeholder workgroups on the development of data elements and reporting mechanisms that will be used in subsequent years to determine consumers' timely access to services.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #9 To: Developmental Services, Department of

To ensure that consumers have convenient access to services, DDS should should continue to develop its new system for consumer records and ensure that the new system has the capability to allow regional centers to enter specific data elements that will enable them to assess the convenience of consumers' access to services using the established standards.

Annual Follow-Up Agency Response From June 2024

The California Department of Technology (CDT) has approved DDS' Stage 2 Alternatives Analysis packet. The packet included the project charter, financial analysis workbook, mid-level requirements and all project plans combining the consumer electronic records management system (CERMS) project and the uniform fiscal system modernization (UFSM) project.

DDS' project team continues to move forward with Stage 3, Solution Analysis for CERMS and UFSM and will work with CDT to assemble the full procurement packet and obtain approval from CMS. DDS anticipates publishing the primary solicitation by 1/31/2025.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

1-Year Agency Response

DDS is continuing the development of the consumer electronic records management system (CERMS). DDS has begun and will continue to meet with stakeholders, including the Developmental Services Task Force (DS Task Force) and applicable DS Task Force workgroups. Stakeholder input will inform design decisions and we anticipate that CERMS will have the ability to generate the information needed to review and analyze consumer access to services.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

DDS is continuing the development of the consumer electronic record management system (CERMS). DDS has begun and will continue to meet with stakeholders, including the Developmental Services Task Force (DS Task Force) and applicable DS Task Force workgroups. Stakeholder input will inform design decisions and we anticipate that CERMS will have the ability to generate the information needed to review and analyze consumer access to services.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

DDS is continuing the development of the consumer electronic record management system (CERMS). DDS will meet with stakeholders, including the Developmental Services Task Force (DS Task Force) and applicable DS Task Force workgroups. Stakeholder input will inform design decisions and we anticipate that CERMS will have the ability to generate the information needed to review and analyze consumer access to services.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #10 To: Developmental Services, Department of

To ensure that regional centers provide statutorily required information to consumers about how to file a consumer rights complaint, DDS should, by January 2023, require all regional centers to include in their individual program plan document a written acknowledgement that staff discussed the complaint process with the consumer.

1-Year Agency Response

On December 28, 2022, DDS issued correspondence requiring regional centers to include in their IPP templates a written acknowledgment that regional center staff discussed the complaint process with the consumer and, if appropriate, their authorized representative, as required by W&I Code section 4731(f). Regional centers were required to submit modified IPP templates to DDS. All regional centers have provided DDS with their modified IPP templates that include written acknowledgement that regional center staff discussed the complaint process with the consumer and, if appropriate, their authorized representative.

California State Auditor's Assessment of 1-Year Status: Fully Implemented

6-Month Agency Response

DDS is finalizing correspondence to regional centers on the statutory requirement to provide consumers with information about how to file a rights complaint. The correspondence will also require regional centers to include an acknowledgement in the IPP that information pertaining to filing a consumer rights complaint was provided. Additionally, the standard information packets that DDS is developing with stakeholder input, pursuant to Welfare and Institutions (W&I) Code section 4642(a)(3), will include related information.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

DDS is developing guidance to regional centers on the statutory requirement to provide consumers with information about how to file a rights complaint. Guidance will also require regional centers to include an acknowledgement in the IPP that information pertaining to filing a consumer rights complaint was provided. Additionally, the standard information packets that DDS is developing with stakeholder input, pursuant to Welfare and Institutions (W&I) Code section 4642(a)(3), will include related information.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #11 To: Developmental Services, Department of

To ensure that regional centers provide statutorily required information to consumers about how to file a consumer rights complaint, DDS should, by January 2023, to determine whether regional centers are complying with state law, review all the written information that regional centers provide to consumers and the regional centers' procedures for providing this complaint process information to consumers.

Annual Follow-Up Agency Response From June 2024

DDS received from and reviewed all regional centers' written information used to notify consumers and/or their authorized representatives about the W&I Code section 4731 complaint process, and the procedures utilized for providing that information.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

1-Year Agency Response

On September 29, 2022, DDS issued guidance requiring each regional center to submit to DDS by December 31, 2022, written information they use to notify consumers and/or their authorized representatives about the W&I Code section 4731 complaint process, and the procedures utilized for providing that information. DDS received information and procedures from all regional centers.

California State Auditor's Assessment of 1-Year Status: Pending

DDS did not provide documentation to support that it received and reviewed information and procedures from all regional centers as it claimed in its response. Until it does so, we will report this recommendation as not fully implemented.

6-Month Agency Response

DDS reviewed each regional center's website for information posted related to complaint processes. DDS will survey regional centers to determine how information is presented to individuals and families at the time of the IPP and collect any associated materials for review. DDS will evaluate each regional center's process, including any packets or information provided to individuals and families, to confirm the information is accurate and meets statutory requirements. DDS will provide technical assistance to regional centers as needed.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

DDS is reviewing each regional center's website for information posted related to complaint processes. DDS will survey the regional centers to determine how information is presented to individuals and families at the time of the IPP and collect any associated materials for review. DDS will evaluate each regional center's process, including any packets or information provided to individuals and families, to confirm the information is accurate and meets statutory requirements. DDS will provide technical assistance to regional centers as needed.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #12 To: Developmental Services, Department of

To ensure that regional centers complete complaint investigations by the statutory deadline, DDS should issue guidance to the regional centers by September 2022 clarifying that state law does not allow extensions in complaint investigations.

6-Month Agency Response

DDS issued guidance to regional centers on September 29, 2022, reminding the regional centers that state law does not allow extensions to W&I Code section 4731 complaint investigations.

California State Auditor's Assessment of 6-Month Status: Fully Implemented

60-Day Agency Response

DDS is developing guidance reminding regional centers that W&I Code section 4731 consumer rights complaint investigations must be completed within 20 days and that statute does not permit extensions of investigations.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #13 To: Developmental Services, Department of

To ensure that regional centers complete complaint investigations by the statutory deadline, DDS should, by January 2023, develop and issue best practices for the regional centers to follow when conducting a complaint investigation.

1-Year Agency Response

DDS met with several representatives from regional centers on January 11, 2023 to discuss the W&I Code section 4731 complaint response process and best practices when conducting complaint investigations. Subsequent to this meeting, on June 16, 2023, DDS issued guidance to regional centers on best practices to follow when completing complaint investigations.

California State Auditor's Assessment of 1-Year Status: Fully Implemented

6-Month Agency Response

DDS will meet with some regional centers to explore best practices. The group will review how regional centers can streamline internal processes and responses, respond in plain language to claimants in a user-friendly format, and remind and strongly assert that the W&I Code section 4731 complaint process is only to be used to respond to consumer rights complaints and not general complaints or service-related decisions. DDS will issue guidance on best practices for regional centers to complete W&I Code section 4731 responses within the statutory 20-day timeline.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

DDS will meet with some regional centers to explore best practices. The group will review how regional centers can streamline internal processes and responses, respond in plain language to claimants in a user-friendly format, and remind and strongly assert that the W&I Code section 4731 complaint process is only to be used to respond to consumer rights complaints and not general complaints or service-related decisions. DDS will issue guidance on best practices for regional centers to complete W&I Code section 4731 responses within the statutory 20-day timeline.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #14 To: Developmental Services, Department of

To ensure that its staff continue to complete appeal investigations by the statutory deadline, DDS should update its existing appeal investigations policies to reflect its new process by September 2022.

60-Day Agency Response

DDS reviewed internal procedures for W&I Code section 4731 complaints and updated the procedures to reflect the current process. DDS staff received training on the new procedures on August 25, 2022, to ensure that W&I Code section 4731 appeal determinations are completed within the statutory timeline.

All files and folders pertaining to W&I Code section 4731 complaints were transferred to a web-based platform in April 2022 to streamline and improve the review process, as all reviewers have simultaneous access. This has been an efficient and effective method to review relevant documentation and complete investigations within the statutorily required timeline.

California State Auditor's Assessment of 60-Day Status: Fully Implemented

Recommendation #15 To: Developmental Services, Department of

To ensure that the regional centers are completing timely eligibility determinations, DDS should, by September 2022, issue guidance to the regional centers on when to begin measuring the start of the 120-day time frame.

6-Month Agency Response

DDS issued guidance to regional centers on September 30, 2022, regarding when to begin measuring the start of the 120-day time frame for completing timely eligibility determinations.

California State Auditor's Assessment of 6-Month Status: Fully Implemented

60-Day Agency Response

DDS is developing guidance to regional centers outlining the timelines specified in statute for completing intake and assessment.

California State Auditor's Assessment of 60-Day Status: Pending

Recommendation #16 To: Developmental Services, Department of

To ensure that the regional centers are completing timely eligibility determinations, DDS should, by September 2022, revise its monitoring process so that it accurately measures the length of time an applicant must wait for a regional center to complete an eligibility determination.

6-Month Agency Response

DDS revised its monitoring process and is reviewing monthly data on the status of applicants seeking regional center services since July 1, 2022 and ongoing, to determine the length of time applicants were in intake/assessment to eligibility determination. Previously, DDS reviewed data on a semi-annual basis. Moving to a monthly review allows DDS to more accurately determine whether regional centers are completing timely eligibility determinations.

California State Auditor's Assessment of 6-Month Status: Fully Implemented

60-Day Agency Response

DDS is working to identify data sources and a process to accurately monitor the length of time applicants, by regional center, are in intake/assessment to eligibility determination.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2021-107

Agency responses received are posted verbatim.