To determine the extent of implementation of the four recommendations included in our initial audit report, Nursing Home Surveillance (2015-S-26).
The Department of Health (Department) oversees nursing home facilities in New York State through its Division of Nursing Homes and Intermediate Care Facilities for Individuals with Intellectual Disabilities Surveillance (Division). The Division also acts as an agent for the federal government’s Centers for Medicare and Medicaid Services (CMS) in monitoring quality of care in nursing homes. The Division is responsible for ensuring that nursing homes comply with federal and State regulations, which establish standards that govern their operation.
Our initial audit report, which was issued on February 19, 2016, examined whether the Department consistently followed federal and State regulations and procedures for conducting nursing home surveys and whether survey processes, including the issuance of fines and other enforcement actions, were effective in improving the quality of care and safety in nursing homes. We found the Department generally met its obligations to conduct Standard Health and Complaint surveys in accordance with federal and State requirements, but its enforcement policies and procedures needed to be strengthened to better protect the health and well-being of nursing home residents. Inefficiencies in the Department’s processes significantly impaired its ability to assess fines timely, in some cases resulting in delays of up to six years between when the violation was cited and the resulting fine was imposed. Further, the Department did not utilize the full array of enforcement actions available to it, choosing to not levy fines for well over 80 percent of the violations it cited.
We found Department officials addressed the problems we identified in the initial audit, having implemented all four of the prior audit’s recommendations.