Updated on April 6.
A lack of central oversight of nursing home investigations in Los Angeles County has contributed to a backlog of hundreds of complaints, according to an audit released late Friday.
The Los Angeles County Auditor-Controller determined that there were 3,044 open investigations as of March 14, including 945 that have been open for more than two years. The auditor found that there is no central management of the investigations and that surveyors within the Health Facilities Inspections Division, or HFID, do not have set deadlines for completing cases.
“Without time frames/benchmarks to complete investigations, HFID is not conveying expectations to their staff and cannot hold them accountable for their performance,” the audit stated.
The county health department oversees safety and quality at the nursing homes on behalf of the state and federal governments.
The L.A. County Board of Supervisors ordered the audit after an investigation by Kaiser Health News was published by the Los Angeles News Group revealing that the county health department was telling inspectors to close cases without fully investigating them. Department officials said surveyors investigate the cases but that there are often delays in completing the final reports.
The audit noted that public health officials could not identify the number of people doing investigations and has overstated how many staff members are needed to complete inspections.
The report recommended that the department set time frames for completing investigations and require managers to explain delays. The auditor also recommended that managers evaluate the varying amounts of time it takes to complete investigations. Inspectors in one district, for example, take more than 16 hours, while inspectors in another take about six hours.
The county must start investigations within 10 days but does not have any deadline for finishing them, according to the audit.
The auditor found that delays occurred in a wide range of cases, including those classified as “immediate jeopardy,” in which a nursing home’s actions could cause serious injury or death to a resident. In one case, the auditor determined that the inspector initiated an investigation the same day but didn’t close the case until nearly a year later.
Dr. Jonathan Fielding, who heads the county Department of Public Health, has said that the backlogs are due to a lack of resources. He told the county supervisors last month that he needs about $7 million more annually to meet the state and federal requirements. But the audit determined that the department did not spend more than $2 million of the roughly $27 million in state funds in each of the last two fiscal years.
Fielding wrote in a memo to the supervisors in response to the audit: “We have already taken actions to improve program management and oversight. However it will require additional resources for DPH to effectively close out investigations in a timely manner.”
The public health department also issued a statement late Friday saying that the audit recommended “several helpful strategies to improve case management of complaints and increase the efficiency” of the inspection division. The county is continuing to try to get additional resources from the state to address the large number of open complaints, the statement read.
“The reduction of the backlog of open complaint investigations is a high priority,” the statement read.
Michael Connors, an advocate with California Advocates for Nursing Home Reform, said he believes the audit shows the department is using insufficient funding as an “excuse for extremely poor management practices.”
“It reinforces our concern that there is no accountability whatsoever,” he said. “They have no expectations for their managers.”
But Al Thompson, who recently retired after about 11 years with the health facilities inspection division, said the investigations are often complex and there are not enough evaluators to keep up with the workload. Higher priority complaints frequently come in while inspectors are working on other cases, he said.
“We need more, not less staff,” he said. “You just get further and further behind because they keep coming in.”
The audit did not address the quality of the investigations because, it said, the state and federal government raised privacy concerns about specific case reviews. After involving the County Counsel’s Office, the auditor received access to investigative files, plans to review them within two weeks and issue a separate report. That report is also expected to include suggestions for addressing the backlog.
This article was produced by Kaiser Health News with support from The SCAN Foundation