Report 2012-107 Recommendations and Responses in 2015-041

Report 2012-107: Developmental Centers: Poor-Quality Investigations, Outdated Policies, Leadership and Staffing Problems, and Untimely Licensing Reviews Put Residents at Risk

Department Number of Years Reported As Not Fully Implemented Total Recommendations to Department Not Implemented After One Year Not Implemented as of 2014-041 Response Not Implemented as of Most Recent Response
Department of Developmental Services 2 14 5 4 3
Department of Public Health 2 4 3 3 3

Recommendation To: Public Health, Department of

To conduct licensing surveys at required intervals while minimizing additional workload, Public Health should explore further opportunities to coordinate the licensing and certification surveys. If Public Health questions the value of these surveys, it should seek legislation to modify the surveying requirements.

Response

The status of this recommendation is unchanged.

Recommendation To: Public Health, Department of

To ensure that investigations are conducted on a timely basis across priority levels, Public Health should develop and implement target time frames for the priority levels that lack them. Public Health should ensure that the timelines are being met and, if not, explore new ways to increase efficiency and manage its workload, thereby facilitating timely investigations.

Response

CDPH disagrees that it should develop and implement target timeframes for the priority levels that lack them. The Centers for Medicare and Medicaid Services (CMS) provides prioritization guidance on these lower level complaints and facility reported incidents.

Per CMS, these include allegations which "may cause harm that is of limited consequences and does not significantly impair the individual's mental, physical, and/or psychosocial status or function." CDPH does have a policy to initiate immediate jeopardy complaints and facility reports within 24 hours and non-immediate jeopardy high complaints and facility reports within 10 days.

CDPH does have a policy to initiate immediate jeopardy complaints and facility reports within 24 hours and non-immediate jeopardy high complaints and facility reports within 10 days.

An integral part of prioritizing complaints and facility-reported incidents is making a clinical judgment of their severity. CDPH nurse surveyors and supervisors, using assessment skills learned in federal and state training and survey experience, triage and prioritize complaints and facility-reported incidents based on the information gathered during the intake, their understanding of the potential impact to the client/resident, their knowledge of the facility, and the significance of the possible regulatory violation.

CDPH uses the CMS process and database to track complaints and facility-reported incidents. This database requires a target initiation date for each intake. Although CDPH and CMS policies do not have a prescribed target initiation date for some low priority levels, CDPH generally assigns an initiation date of 45 days. CMS conducts performance reviews of our investigations, which includes reviewing whether we initiated an investigation within the timeframe assigned during the intake. CDPH believes this process is sufficient to assign and monitor timelines

Recommendation To: Public Health, Department of

To improve its enforcement, each year Public Health should evaluate the effectiveness of its enforcement system across all types of health facilities, including those in developmental centers, prepare the required annual report, and, if called for, recommend legislation to improve the enforcement system and enhance the quality of care.

Response

The status of this recommendation is unchanged.

Recommendation To: Developmental Services, Department of

To ensure adequate guidance to OPS personnel, once the department has amended OPS's policies and procedures to reflect the recommendations we have included here, the department and OPS should place a high priority on completing and implementing its planned updates to the OPS policy and procedure manual.

Response

Office of Protective Services (OPS) has completed updating the OPS policy manual using the Lexipol System. The policies have been reviewed and approved by Executive Management and shared with the affected bargaining units. OPS staff is receiving ongoing training on the new policies. OPS is now developing its new procedures manual and identifying policies which require procedures for full implementation.

Recommendation To: Developmental Services, Department of

After the department has implemented a formal OPS recruiting program, if it can demonstrate that it is still having trouble filling vacant OPS positions, the department should evaluate how it can reduce some of the compensation disparity between OPS and the local law enforcement agencies with which it competes for qualified personnel.

Response

The Department's Personnel Section finalized the request for a Recruitment and Retention Pay Differential for the Peace Officer and Investigator staff and supervisors. A recruitment and retention pay differential was approved by the California Department of Human Resources for the Peace Officer I and Peace Officer II classifications effective July 1, 2015.

Recommendation To: Developmental Services, Department of

To minimize the need for overtime, the department should reassess its minimum staffing requirements, hire a sufficient number of employees to cover these requirements, and examine its employee scheduling processes.

Response

DDS is working with the Department of State Hospitals (DSH) regarding its Automated Staff Scheduling and Information Support Tool (ASSIST), which is continuing to be tested. Five of eight state hospitals have implemented ASSIST with the projected date of full implementation for DSH now October 2015. The ASSIST solution will provide automated creation of schedules and tracking of critical personnel information. These data would allow the DDS Developmental Centers Division management to effectively measure overtime usage and determine critical factors for managing overtime. DDS is currently working on its Stage One Business Analysis for the California Department of Technology as a first step in procuring ASSIST. The DSH contract allows for DDS to attach to its program, contingent on approvals and funding.

Recommendation To: Developmental Services, Department of

The department should create specific measurable goals for OPS that include existing and new measures associated with each one, such as staffing, overtime, and the timely completion of investigations. In addition, the department should perform a regular review of the quality of OPS's activities and investigations to achieve those goals. The department should track progress in quality measures over time and adjust its training plans to increase OPS law enforcement personnel's skill and compliance with established policies and procedures.

Response

The Department is working with the newly formed Office of Law Enforcement Support (OLES) at the California Health and Human Services Agency to develop a process to regularly review the quality of OPS investigations involving incidents defined in WIC Section 4427.5. The process will monitor and address any training deficiencies that may be identified in the future. OLES will be providing contemporaneous oversight and monitoring of investigations and will issue annual reports regarding the number, type, and disposition of investigations, and identify the quality of each investigation.

Current Status of Recommendations

All Recommendations in 2015-041