Los Angeles County Audit Finds Backlog Of Nursing Home Complaints
This KHN story was produced in collaboration with the听
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听Auditor-Controller听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,听or HFID,听do not have set deadlines for completing cases.
鈥淲ithout time frames/benchmarks to complete investigations, HFID is not conveying expectations to their staff and cannot hold them accountable for their performance,鈥 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.听Department officials said surveyors听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 鈥渋mmediate jeopardy,鈥 in which a nursing home鈥檚 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鈥檛 close the case until nearly a year later.
Dr. Jonathan Fielding, who heads the听county听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听roughly $27 million in state funds听in each of the last听two听fiscal years.
Fielding wrote in a memo to the supervisors in response to the audit: 鈥淲e 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.鈥
The public health department also issued a statement late Friday saying that the audit recommended 鈥渟everal helpful strategies to improve case management of complaints and increase the efficiency鈥 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.
鈥淭he reduction of the backlog of open complaint investigations is a high priority,鈥 the statement read.听
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 鈥渆xcuse for extremely poor management practices.鈥
鈥淚t reinforces our concern that there is no accountability whatsoever,鈥 he said. 鈥淭hey have no expectations for their managers.鈥澨
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.
鈥淲e need more, not less staff,鈥 he said. 鈥淵ou just get further and further behind because they keep coming in.鈥
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鈥檚 Office, the auditor received access to investigative files,听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
