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Los Angeles County public health officials inappropriately closed nursing home investigations and failed to follow state guidelines on prioritizing complaints, according to released this week.

The Los Angeles County auditor-controller also found that even after nursing home inspectors found serious problems, their supervisors downgraded the severity of findings without any explanation or without discussing the changes with the inspectors as required.

“The quality and integrity of investigations is impaired when surveyors’ conclusions are changed without their knowledge,” according to the audit.

The audit was the latest of several reviews showing problems with how the county Department of Public Health oversees residents’ health and safety at about 385 nursing homes. The county, the most populous in the state, contracts with the state and the federal government to inspect the facilities and to investigate complaints from residents, family members and staff.

Earlier this summer, the that the county wasn’t following state policies on inspections, leading to incomplete and delayed investigations. The county in April that documented a lengthy backlog of investigations and concluded that a lack of central oversight contributed to the delay. At the time, about 945 cases, had been open for more than two years.

The scrutiny of the department came after a found the county was instructing inspectors to close cases without fully investigating them.

The most recent audit was based on a review of a small sample of cases — about 20 of the more than 3,044 that were open in March 2014 and 30 of the 1,124 cases that had been closed between July 2012 and April 2014. The audit found that five of the 30 cases were closed inappropriately without “conducting or completing the investigations.”

In addition, supervisors downgraded inspectors’ findings in 12 of the 30 closed cases, meaning that the nursing home got a less serious citation or a smaller fine. In most of those cases, there was no documentation for the reason.

The audit didn’t give many specifics on the problems found at the nursing homes but noted that five cases involved deaths. In one, an inspector found the death could have been prevented. Others involved nursing homes not complying with doctors’ orders or checking whether a patient had negative reaction to medications.

The auditor-controller recommended that the department’s inspectors, managers and doctors improve documentation and communication to “ensure the quality and integrity of their investigations.”

“Without adequate documentation, it is very difficult to ensure that deficiencies and citations are handled in a consistent, thorough and equitable manner,” the audit read.

The audit also found that the public health department failed to reassign a case when an inspector retired.

The county Department of Public Health responded to the audit with a letter saying that it agreed that the documentation was “sometimes lacking” and that improvements were necessary. Officials also said that they had already made several changes, including putting new people in charge of the division responsible for inspections and improving the tracking and prioritization of complaints.

But, as in the past, county public health officials also wrote that the department is underfunded and “severely understaffed.”

The county public health department is responsible for reviewing one-third of the state’s facilities but only receives 15 percent of the funding, according to the response. If the state doesn’t provide “sufficient resources” for the program, county public health officials wrote, the department may not be able to continue its contract to oversee the nursing homes.

The April audit found, however, that the county did not spend  all the money at its disposal — more than $2 million of the roughly $27 million in state funds in each of the last two fiscal years.

agorman@kff.org

This article was produced by Kaiser Health News with support from .