LA County Audit Finds Backlog in Nursing Home Complaints

A recent audit by the Los Angeles County Auditor-Controller has turned up an alarming backlog of hundreds of unresolved nursing home complaints. Kaiser Health News reports that the audit of the county’s Health Facilities Inspections Division (HFID) found nearly a thousand complaints that had been open for more than two years.

The HFID, part of the county health department, oversees nursing home safety and quality on behalf of the state and federal governments. The audit found the problems to be caused in general by a lack of central oversight.

The audit was ordered by the Los Angeles County Board of Supervisors after an investigation by Kaiser Health News. That investigation revealed the county health department was instructing inspectors to close cases without fully investigating them. Department officials responded that surveyors do investigate the cases but that there are often delays finalizing the reports.

Among the audit’s findings:

• 3,044 open investigations as of March 2014;
• This includes 945 complaints that have been open for more than two years;
• No central management of the investigations; and,
• Surveyors from the Health Facilities Inspections Division (HFID) don’t have set deadlines for completing cases.

The auditor emphasized that certain deadlines and time frames and benchmarks were necessary to convey to staff expected outcomes. In addition, written standards provide a framework for accountability, both for the division as a whole and for individual units and staff.

The audit revealed a wholesale lack of accountability or written standards. Managers could not even identify the number of staff who were assigned to investigate nursing home complaints. In addition, there are no standards for conducting investigations. For example, the audit noted that inspectors in one district take more than 16 hours to review a complaint, while inspectors in another district take about six hours. The county has a requirement that it start investigations within 10 days, but there is no deadline for completing them.

The delayed investigations were found across a variety of types of complaints – including those classified as “immediate jeopardy,” which means the home’s actions could cause serious injury or death to a resident.

The doctor who heads the County Department of Public Health has claimed that the backlogs are due to a lack of funds. However, Kaiser reports, the audit found that the department left millions unspent in its budget for each of the last two fiscal years.