An Audit Report on Nursing Facility Complaint Processing at the Department of Aging and Disability Services
August 2011
Report Number 11-047
Overall Conclusion
The Department of Aging and Disability Services (Department) promptly screens and accurately prioritizes the complaints it receives about nursing facilities prior to referring complaints to its regional offices for investigation.
Between September 1, 2007, and February 24, 2011, the Department:
- Complied with federal requirements for the timeliness of complaint investigation for 97.1 percent of the high-priority nursing facility complaints it received.
- Complied with state requirements for the timeliness of complaint investigation (which are more strict than federal requirements) for no more than 73.1 percent of high-priority nursing facility complaints it received.
Because the Department's Compliance, Assessment, Regulation, and Enforcement System (CARES) does not capture the time of day when investigators enter nursing facilities, it is not possible to precisely calculate compliance with the state requirement to begin investigations within 24 hours of receiving a high-priority complaint. The Department considers a high-priority complaint investigation to be in compliance with state timeliness requirements if it begins the investigation by the end of the next working day after its intake staff have evaluated the complaint and referred it to the appropriate regional office.
To improve the effectiveness of complaint investigations, the Department should strengthen its monitoring of the complaint investigations that its regional offices conduct. For example, the Department should maintain adequate information in CARES to enable it to monitor regional office compliance with investigation and reporting requirements.
The Department also should strengthen its long-term care ombudsman function to enable it to more efficiently address less serious complaints. The Department contracts with the 28 area agencies on aging (AAAs) in Texas to provide ombudsman services, and it should strengthen its monitoring of AAAs to ensure that they recruit enough volunteers to effectively deliver ombudsman services. The Department also should strengthen coordination between AAAs, volunteers, and Department investigators so that (1) information that AAAs and volunteers gather will be more useful to Department investigators and (2) Department investigators will use the services of the AAAs and volunteers more effectively during their investigations. In addition, the Department should better ensure that the AAAs and volunteers offer sufficient technical support to residents and their family members who wish to form resident and family councils.
The Department takes actions against nursing facilities at which it identifies deficient practices--through imposing administrative penalties, civil monetary penalties, denial of license, involuntary trusteeship, and suspension of admission--but it rarely terminates its contracts with nursing facilities. In fiscal year 2010, the Department recommended contract termination for 372 nursing facilities. However, it reconsidered or rescinded all but one of those terminations. According to the Department, in fiscal year 2011, it referred two high-profile cases involving resident deaths at nursing facilities in Brownfield and Amarillo to the Office of the Attorney General, which filed suits against those nursing facilities to assess state civil penalties. Subsequent to the conclusion of fieldwork on this audit, but before this audit report was released, the Office of the Attorney General also announced indictments of staff of the Brownfield nursing facility on criminal charges.
Auditors communicated other, less significant issues to the Department's management separately in writing.