Report 2017-109 Recommendation 11 Responses

Report 2017-109: Skilled Nursing Facilities: Absent Effective State Oversight, Substandard Quality of Care Has Continued (Release Date: May 2018)

Recommendation #11 To: Public Health, Department of

To improve the availability and transparency of information, Public Health should upload all inspection findings to Cal Health Find and review ownership data by May 2019.

Annual Follow-Up Agency Response From October 2023

The status update has not changed from the prior response (09/22/2022) except the number of remaining reports to be manually scanned and uploaded to Public Health's website. Out of the 840 surveys pending manual scanning and upload as indicated in the previous report, 796 (95%) surveys have not been uploaded as of 8/24/2023. The Department plans to release these reports in 2023. This is still a work in progress as several reports are being uploaded. Expected date of completion is by the end of the year.

Note: Specifically, CHCQ has created an internal tracker/dashboard showing SNF Survey with violations upload report that is shared with the District Offices for follow up. District Office and Field Operations Branch Chiefs have been reminded previously to review the dashboard and to track monthly progress until all remaining surveys are uploaded. Additionally, a SharePoint folder was also created to make available the event IDs of the 840 pending upload surveys by District Office for an easier and quicker response.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From September 2022

The status update has not changed from the prior response except the number of remaining reports to be manually scanned and uploaded to Public Health's website. Out of the 840 surveys pending manual scanning and upload as indicated in the previous report, 801 (95%) surveys have not been uploaded as of 8/31/2022. The Department plans to release these reports in 2022. This is still a work in progress as several reports are being uploaded. Expected date of completion is by the end of the year.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

This recommendation is pending Public Health uploading all inspection findings to Cal Health Find and completing its review of ownership data.

Annual Follow-Up Agency Response From September 2021

The status update has not changed from the prior response except the number of remaining reports to be manually scanned and uploaded to Public Health's website. Currently, 840 reports remain to be manually scanned and uploaded from the universe of 14,845 identified that required manual scanning and uploading to the Department's website. The Department plans to release these reports in 2022.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

This recommendation is pending Public Health uploading all inspection findings to Cal Health Find and completing its review of ownership data.

Annual Follow-Up Agency Response From May 2021

The work to upload the remaining inspection reports is delayed due to COVID as the staff are working remotely to reduce the occupancy rate in District Offices to mitigate exposure and reduce viral transmission. However, CHCQ is working to have the remaining inspections uploaded by December 31, 2021. Specifically, CHCQ has created an internal dashboard showing SNF Survey with violations upload report that is updated weekly and shared with the District Offices for follow up. Currently, 1,288 reports remain to be manually scanned and uploaded from the universe of 14,845 identified that required manual scanning and uploading to the Department's website. District Office and Field Operations Branch Chiefs have been reminded to review the dashboard and to track monthly progress until all remaining surveys are uploaded.

The license renewal application (LRA) was updated and put into production in the Electronic Licensing Management System (ELMS) database in May 2020. The LRA displays the ownership/licensee/facility profile information on file in ELMS. The licensee is required to review, validate, and sign/date that all profile data on the LRA is correct. If the information is not correct and there are changes to the information, then the licensee is required to submit a report of change (ROC) application to the Centralized Applications Branch (CAB). If a ROC application is needed, the CAB analyst will follow-up with the licensee and monitor that the ROC application is submitted to CAB before processing the license renewal.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

This recommendation is pending Public Health uploading all inspection findings to Cal Health Find and completing its review of ownership data.

Annual Follow-Up Agency Response From October 2020

Our previous response submitted on 6/29/20 is still current.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

Annual Follow-Up Agency Response From June 2020

In October 2018, CDPH completed a reporting dashboard for monitoring compliance with uploading PDF versions of skilled nursing facility inspection reports with violations. As of March 2020, this dashboard shows that CDPH has uploaded 82% of the PDF versions of the inspection reports; 2,665 of 14,845 reports still need to be uploaded.

CDPH has finalized business requirements for adding a section on the license renewal application for owners to validate their information and began user testing. CDPH completed the application development in May 2020. CDPH will implement the license renewal application on July 1, 2020, or soon thereafter, when the FFY 2021 budget is signed. Once implemented, CDPH will validate facility ownership information when licenses are submitted for renewal throughout the year.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

This recommendation is pending Public Health uploading all inspection findings to Cal Health Find and completing its review of ownership data.

1-Year Agency Response

CDPH set up a reporting dashboard in October 2018 to help district offices monitor compliance with uploading inspection reports. As of April 2019, only 1,819 inspection reports still need to be uploaded. CDPH has drafted a revision of its licensing renewal form, adding a section for owners to validate their information. The form is under management review, and is now projected to be implemented by June 2019. The ownership information will be validated as licenses are renewed throughout the year. We anticipate completion of the licensing renewal and owner validation project by May 2020.

California State Auditor's Assessment of 1-Year Status: Pending

This recommendation is pending Public Health uploading all inspection findings to Cal Health Find and completing its review of ownership data. Public Health did not meet our implementation deadline for this recommendation and projects this recommendation will be fully implemented in May 2020.

6-Month Agency Response

California Department of Public Health's (CDPH) plan to reduce the outstanding inspection and Plan of Corrections upload is to offer overtime to district office staff to complete the work, or to hire staff for a limited-term Upload Unit, which would be assigned to help district offices reduce the outstanding volume by April 2019. On September 1, 2018, CDPH set up a web portal (i.e., Upload Report) with summary upload metrics, a detail file with which district offices can manage their work, and guidance related to upload requirements. The outstanding volume of inspection reports that CDPH needs to upload continues to decrease; as of September 19, 2018, 3,739 inspection reports needed to be uploaded, down from 6,421 reports in June 2018.

CDPH has drafted a revision of its licensing renewal form, adding a section for owners to validate their information. The form is under management review, and is now projected to be implemented by November 2018. The ownership information will be validated as licenses are renewed throughout the year. We anticipate completion of the licensing renewal and owner validation project by May 2020.

California State Auditor's Assessment of 6-Month Status: Pending

This recommendation is pending Public Health uploading all inspection findings to Cal Health Find. Public Health projects it will not meet our implementation deadline for this recommendation. It states this recommendation will be fully implemented in May 2020 as opposed to May 2019.

60-Day Agency Response

California Department of Public Health announced the document upload expectations to district offices on May 16, 2018, during a statewide teleconference and provided on May 25, 2018 the project requirements to each district office for redacting and uploading inspection findings to Cal Health Find. On May 31, 2018, California Department of Public Health presented this information at a statewide district office analyst meeting. We have established a reporting web-portal with summary upload metrics and guidance documentation requirements. If necessary and due to workload priorities, California Department of Public Health will use a vendor to assist with uploading needs to ensure we meet the due date. The licensing renewal form is under revision and will be implemented by September 2018. To perform a complete review of ownership data requires the confirmation of facilities' ownership structure. After confirmation, staff will update the database, and we anticipate completion of these tasks by May 2020.

California State Auditor's Assessment of 60-Day Status: Pending

This recommendation is pending Public Health's planned actions to upload all inspection findings and review ownership data.

All Recommendations in 2017-109

Agency responses received are posted verbatim.