Press Release: Audit Finds Systems in Place to Monitor the Oversight of D.C. Nursing Homes

News Release — Office of the DC Auditor

Contact: Diane Shinn

Recommendations include improving some processes to further reduce risks to nursing home residents 

WASHINGTON, September 30, 2019–District of Columbia nursing home residents are being protected through oversight provided by the D.C. Health Regulation and Licensing Administration (HRLA), but the handling of complaints, staffing, and transfers of residents could be improved to enhance the health and safety of some of the city’s most vulnerable residents, according to a new audit from the Office of the D.C. Auditor (ODCA). 

ODCA reviewed samples of nursing home complaints, staffing records, and resident discharge and transfer notices, and looked more closely at six of the District’s 18 nursing homes for repeats of the same problem. 

“Overall, we found that HRLA had systems in place to monitor each aspect of the oversight process,” said D.C. Auditor Kathy Patterson. “At the same time, we identified steps HRLA can take to improve those processes and reduce risks that could seriously impact people’s lives.” 

In written comments HRLA agreed in whole or in part with six of 10 recommendations. Department of Health Director Dr. LaQuandra S. Nesbitt wrote she was pleased the report recognized the agency’s efforts to provide “an effective regulatory framework.” 

The audit found that some nursing homes repeated problems with resident care that HRLA previously had identified and recommended a “root cause” analysis to help eliminate errors. Nursing homes are required to provide a Plan of Correction that outlines how they will fix problems identified by inspectors; out of 42 such plans, ODCA identified eight that did not clearly identify the root cause of the problem as a step in systematically correcting the problem to prevent recurrence. 

The report also found HRLA investigated some complaints late because it did not always prioritize complaints accurately and in a timely manner. For a sample of 20 of the 54 complaints HRLA recorded in FY 2018, ODCA found that HRLA investigated every one within the time requirements for the priority level HRLA had assigned. ODCA identified weakness, however, in the accuracy of complaint priority and the time from complaint assessment to investigation. 

ODCA also found that HRLA sometimes accepts illegible documentation of daily nursing home staffing and recommended that HRLA require nursing homes to keep legible records of staffing to ensure staffing levels will provide appropriate care for the residents. 

Other report findings include: 

• HRLA provides a variety of complaint submission methods but was unable to demonstrate that complaints from all intake methods had been captured and investigated in a timely manner. 
• HRLA completed each annual inspection within required timelines but did not always vary the timing of inspections to ensure that they were unpredictable to the nursing homes. 

ODCA’s other recommendations include: 

• HRLA should train staff with responsibility for reviewing Plans of Correction on how to determine if a Plan of Correction identifies the underlying cause of the problem. 
• HRLA should design, implement, and train staff in policies and procedures for all complaint intake methods. 
• HRLA should use a procedure or automated tool to schedule its inspections, ensuring they are performed in a different sequence each year and considering the order and timing of prior inspections. 

For more information or to download the report, visit www.dcauditor.org. 

# # #