2023-120 Drug and Alcohol Treatment Facilities
Are Sometimes Concentrated In Residential Areas, As Allowed, But State Oversight Is Not Always Timely or Thorough
Published: October 24, 2024
Audit Recommendations Disclosure
When an audit is completed and a report is issued, auditees must provide the State Auditor with information regarding their progress in implementing recommendations from our reports at three intervals from the release of the report: 60 days, six months, and one year. Additionally, Senate Bill 1452 (Chapter 452, Statutes of 2006), requires auditees who have not implemented recommendations after one year, to report to us and to the Legislature why they have not implemented them or to state when they intend to implement them. Below is a listing of each recommendation the State Auditor made in the report referenced and a link to the most recent response from the auditee addressing their progress in implementing the recommendation and the State Auditor’s assessment of auditee’s response based on our review of the supporting documentation.
Recommendations to the Legislature
Recommendation 1
If the Legislature seeks to address concerns about the overconcentration of treatment facilities in residential communities, it could potentially enact legislation to address the issue without violating federal housing and disability law. In one possible example, the Legislature could require Health Care Services to issue regulations under the Administrative Procedure Act for making specific findings of fact when a license applicant’s proposed facility will result in overconcentration, to deny or impose additional requirements on the license when overconcentration would create an institutional setting for residents or impede their integration into the community. In another possible example, the Legislature could amend the statutory exemption from local zoning regulations to exclude new licensees that will effectively have more than six residents, such as closely located facilities that will share owners, directors, and amenities, and have more than six residents in total among them.
Recommendations to Department of Health Care Services
Recommendation 2
To ensure that it inspects all treatment facilities as required by state law, Health Care Services should do the following by October 2025: Provide management with information about the timeliness of compliance inspections. Such reporting should include the license expiration date for each facility, the status of the inspections, and the date by which the inspections must be completed to meet the 90-day inspection target
Status:
Not fully implemented
Date of implementation:
02/28/2025
Evaluator assessment status:
Pending
60-Day Agency Response
The Department of Health Care Services (DHCS) is actively making changes to current processes to ensure all the following are complete by February 2025:
- By February 2025, DHCS will create and implement new protocols and processes as well as schedule and conduct the appropriate trainings to ensure supervisors are closely tracking the programs in need of inspections within their two-year windows. After those protocols are in place, DHCS analysts will be required to update individual tracking logs. Once completed, DHCS will train analysts on updating the tracking methods required for individual caseloads and timelines to include the license expiration date for each facility, the status of the inspections, and the date by which the inspections must be completed to meet the 90-day inspection target.
Recommendation 3
To ensure that it inspects all treatment facilities as required by state law, Health Care Services should do the following by October 2025: Implement a mechanism in its licensing database that notifies its staff of the dates for upcoming compliance inspections for their caseload so they can plan accordingly.
Status:
Not fully implemented
Date of implementation:
02/28/2025
Evaluator assessment status:
Pending
60-Day Agency Response
By December 31, 2024, DHCS will begin utilizing the digital platform “Survey 123.” The platform will be used by analysts to complete onsite inspection reports, which will aid DHCS in sending providers reports more quickly, thereby improving the rate at which assignments are completed. This, in turn, will allow for more frequent site visits and improved timeliness. The development of the second digital platform, the Licensing and Certification Portal (LCP), will continue to progress during the 60-day period. Additional development areas will be completed during the first quarter of 2025.
Recommendation 4
To ensure that it inspects all treatment facilities as required by state law, Health Care Services should do the following by October 2025: Fill its vacant positions.
Status:
Not fully implemented
Date of implementation:
02/28/2025
Evaluator assessment status:
Pending
60-Day Agency Response
On November 15, 2024, DHCS had eight vacant positions; however, six of the vacant analyst positions will be filled by December 16, 2024. Applications for the two remaining vacancies have already been screened and interviews conducted. Candidates have been selected for these positions and are pending final Human Resources (HR) approvals. Recruitment efforts continue to be a priority for DHCS, and all applications are screened within two weeks of receipt from HR. The Licensing and Certification Division prioritizes staff retention. Retention efforts include having a comprehensive and robust training program to develop analysts’ knowledge and confidence, which helps prepare them for leadership roles and positions in the Licensing and Certification Division. The results of these efforts are evident as licensing analysts frequently promote into supervisory positions within the Licensing and Certification Division due to their competence, passion, and commitment to the clients we serve.
Recommendation 5
To ensure that it assigns complaints to analysts for investigation within 10 days as required by regulations, Health Care Services should update its policies and staff training by April 2025 to clarify the requirement.
Status:
Fully implemented
Date of implementation:
Aug. 2024
Evaluator assessment status:
Fully implemented
60-Day Agency Response
DHCS took immediate corrective action during the CSA report drafting period when CSA identified the regulatory requirement to assign all complaints within ten working days. In August 2024, DHCS revised the Complaints Operations Manual (COM) to clarify the requirement for case assignment and updated the complaint intake process. The updated process will support the timely assignment of all complaints within ten working days, as required by regulations (see the substantiation Complaints Operation Manual_Intake_August 2024 document).
Public Reasoning Behind Assessment
Health Care Services’ revision to the Complaint Operations Manual and its training efforts to update staff on the revised policy align with each element of our recommendation.
Recommendation 6
To improve the timeliness of its investigations and align investigations of counselor complaints, which have interim deadlines for key investigation steps, with other complaint types, Health Care Services should implement guidelines by October 2025 that specify the length of time analysts should take to complete key steps in the investigation process for different types of investigations.
Status:
Not fully implemented
Date of implementation:
10/31/2025
Evaluator assessment status:
Pending
60-Day Agency Response
DHCS is actively working to identify specific timelines for analysts to complete specific key steps in investigating complaints and in the review and approval process.
DHCS held meetings with Complaints Section staff and managers on November 6, 2024, to explore staff comments and recommendations and identify feasible timelines going forward. Upon final determination of new processes, the Complaints Section Chiefs will send to the Licensing and Certification Division Chief for approval. If determined necessary, these new processes will be reviewed and approved by the Office of Legal Services to ensure compliance with statutes and regulations.
Once the new processes and guidelines have been finalized, the COM will be updated and training on the new timeframes will be held with all DHCS Complaints Section staff.
Recommendation 7
To ensure that it is conducting thorough investigations of unlicensed treatment facilities, Health Care Services should conduct site visits beginning in December 2024 in all instances in which there is an allegation that an unlicensed facility is advertising or providing treatment services without a license.
Status:
Not fully implemented
Date of implementation:
12/31/24
Evaluator assessment status:
Pending
60-Day Agency Response
DHCS continues to prioritize its procedures of investigating all allegations of licensable services being provided or advertised in an unlicensed setting.
The COM will be updated to require documentation of all attempts made by an analyst or their supervisor to secure a physical address of an alleged unlicensed program, which is advertised as providing licensable services. The additional update to the COM requiring additional research demonstrates DHCS’ commitment to fully reviewing unlicensed allegations. Such updates are estimated to be complete by December 31, 2024.
Recommendation 8
To ensure that unlicensed treatment facilities do not continue to provide services without a license after an investigation substantiates the allegation, by April 2025, Health Care Services should develop and implement a follow-up procedure, such as by performing another site visit, to confirm the unlicensed facility has ceased providing such services.
Status:
Not fully implemented
Date of implementation:
4/30/2025
Evaluator assessment status:
Pending
60-Day Agency Response
DHCS is currently developing and implementing a follow-up procedure to show the Department’s attempts at confirming unlicensed activity has ceased at addresses where unlicensed activity has been substantiated. The COM will be updated to include the requirement for follow-up efforts in addition to documentation of any attempted follow-up visits.
Additionally, DHCS intends to revisit two unlicensed programs identified in CSA’s audit report as having insufficient evidence to show the cessation of unlicensed services, at the request of CSA. Such visits will take place in December 2024.
On November 6, 2024, DHCS Complaints Section Chiefs met to formulate a new process for follow-up investigations. Once this development is complete and the process is finalized, the COM will be updated, and all Complaints Section staff will be trained on follow-up unlicensed complaint visits. DHCS anticipates updates and training will be completed by April 30, 2025.
