Report 2007-121 All Recommendation Responses

Report 2007-121: Veterans Home of California at Yountville: It Needs Stronger Planning and Oversight in Key Operational Areas, and Some Processes for Resolving Complaints Need Improvement (Release Date: April 2008)

Recommendation #1 To: Veterans Affairs, Department of

To meet the requirements of federal ADA regulations, the Veterans Home should develop and update as needed a plan that identifies areas of noncompliance and includes the appropriate steps and milestones for achieving full compliance.

Annual Follow-Up Agency Response From October 2014

The California Department of Veterans Affairs (CalVet) completed a property wide Americans with Disabilities Act of 1990 ("ADA") survey and analysis of the Veterans Home of California, Yountville. The analysis of the property and buildings was completed in 2010. The estimated cost of the renovation of the property is estimated to be $10,100,000. CalVet has identified milestones and prioritized areas of compliance as well as a tentative construction schedule. When the budget process allows, CalVet plans to submit a budget request to the Department of Finance to address funding of the identified ADA modifications that need to be made on the property. CalVet is in the process of completing more than $1,000,000 worth of the renovations, using existing funds that have become available.

Additionally, the Yountville Veterans Home has established formal grievance procedures to address and meet requirements of ADA. The grievance procedures may be used by anyone who wishes to file a complaint related to The Veterans Home of California, Yountville and its everyday functionality and operations.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Auditee did not address all aspects of the recommendation.

Annual Follow-Up Agency Response From October 2013

The California Department of Veterans Affairs (CalVet) completed a property wide Americans with Disabilities Act of 1990 ("ADA") survey and analysis of the Veterans Home of California, Yountville. The analysis of the property and buildings was completed in 2010. The estimated cost of the renovation of the property is estimated to be $10,100,000. CalVet has identified milestones and prioritized areas of compliance as well as a tentative construction schedule. When the budget process allows CalVet plans to submit a budget request to the Department of Finance to address funding of the identified ADA modifications that need to be made on the property.

Additionally, the Yountville Veterans Home has established formal grievance procedures to address and meet requirements of ADA. The grievance procedures may be used by anyone who wishes to file a complaint related to The Veterans Home of California, Yountville and its everyday functionality and operations.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Annual Follow-Up Agency Response From September 2012

As soon as CalVet is approved for funding, completion of the project will take place within 5 years' time. Once CalVet receives funding for any phase of construction, including but not limited to the full amount of $10,100,000, the Department will begin the process of ADA compliance implementation. Due to the budget constraints, CalVet has been unable to fully implement the recommendations set forth in the Bureau of State Audits.

California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented

Recommendation #2 To: Veterans Affairs, Department of

In addition, the Veterans Home should develop grievance procedures and identify a specific employee as its ADA coordinator.

1-Year Agency Response

According to Veterans Affairs, the Veterans Home assigned an employee as ADA coordinator, and has updated its grievance policy to include handling of grievances related to accessibility. In addition, an ADA survey is being contracted for as part of the Veterans Homes development of a strategic infrastructure plan. (2010-406, p. 29)

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

Recommendation #3 To: Veterans Affairs, Department of

To improve its ability to fill vacancies in key occupations, the Veterans Home should develop a comprehensive plan for recruitment and retention that establishes goals and strategies for reducing chronic vacancy rates and sets timelines and monitoring activities to keep recruiting efforts on track. To maximize its efforts to recruit high-need staff, the Veterans Home should ensure that the recruitment efforts of all its departments are coordinated through a centralized position or program. In addition, the Veterans Home should implement the remaining steps it has currently identified to better recruit and retain health care staff.

1-Year Agency Response

The Veterans Home stated that it has developed a facility recruitment plan and is executing it. It has published an examination plan and is training all service chiefs on the recruitment process and timelines. The Veterans Home further stated it has developed and implemented a recruitment calendar, regularly participates in area career fairs and recruitment events, and conducts exit interviews of staff who resign and evaluate the results. Under the Veterans Home’s recruitment strategy, recruitment plans will be monitored on a monthly basis and the annual recruitment plan will be renewed each year in January. In addition, under the Veterans Affairs’ recruitment program, supervision of recruiting efforts is vested at the Veterans homes. Veterans Home administrators designate a recruitment coordinator, ensure managers and supervisors are aware of their recruiting assignments, and monitor recruiting achievements. Veterans Homes’ recruitment coordinators are responsible for reporting on the conduct of annual recruitment at their respective home and developing and maintaining rapport with community groups who may serve as a resource for recruitment. (2010-406, p. 27)

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

Recommendation #4 To: Veterans Affairs, Department of

To prevent its nursing staff from working excessive overtime, the Veterans Home should consider adopting a formal policy for distributing overtime more evenly among nurses, establishing a cap on how much overtime nursing staff may work, and monitoring overtime usage for compliance with these policies.

Annual Follow-Up Agency Response From January 2011

The Veterans Home created and implemented a new overtime policy. (2010-041, p. 134)

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

Recommendation #5 To: Veterans Affairs, Department of

If Veterans Affairs is concerned that its ability to serve California veterans is limited by a regulation stating that less than 75 percent of skilled nursing beds must be occupied before it can admit new patients directly to that level of care, it should consider changing or eliminating that regulatory requirement.

1-Year Agency Response

In response to our recommendation that it consider changing or eliminating the requirement that less than 75 percent of skilled nursing beds must be occupied before the Veterans Home can admit new patients directly to that level of care. Veterans Affairs eliminated the requirement. (2010-406, p. 28)

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

Recommendation #6 To: Veterans Affairs, Department of

To help ensure that newly hired employees at the Veterans Home can start work as soon as possible, the Veterans Home should monitor its new process for completing preemployment physicals. If the process is not resulting in new employees starting work more quickly, the Veterans Home should consider contracting with a vendor to provide the physicals.

1-Year Agency Response

According to Veterans Affairs, the Veterans Home is monitoring its hiring process, including a new process for completing preemployment physicals. Veterans Affairs indicated that staffing changes in the ambulatory care clinic have resulted in a 50 percent reduction in the number of days from the physical being requested to the examination being conducted. (2010-406, p. 28)

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

Recommendation #7 To: Veterans Affairs, Department of

To bolster recruitment efforts at the Veterans Home, Veterans Affairs should continue to develop its department-wide recruiting plan and oversee the recruiting plan the Veterans Home is implementing to ensure that it meets department-wide goals.

1-Year Agency Response

Veterans Affairs created a department-wide recruiting program that includes its recruiting mission and goals, as well as information about program coordination, roles and responsibilities, and recruitment techniques and strategies. The recruiting program also establishes a recruitment program officer to coordinate Veterans Affairs’ recruitment efforts. Among other things, the recruitment program officer is responsible to assist offices and divisions and the Veterans Homes with focused recruitment, monitoring recruitment costs, preparing reports regarding recruitment goal attainment, and developing Veterans Affairs’ annual recruitment plan. (2010-406, p. 28)

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

Recommendation #8 To: Veterans Affairs, Department of

To ensure the Veterans Home’s medical equipment is maintained as prescribed by the equipments’ manufacturers, the Veterans Home should take the steps necessary to ensure the medical equipment inventory, on which maintenance activities are based, is accurate.

1-Year Agency Response

The Veterans Home stated it has completed an inventory update involving the contractor, the nursing service, the property department, and plant operations, the latter of which is the contract monitor. In addition, inventory is now periodically reviewed with service area managers and compared to the revised inventory submitted by the contractor. (2010-406, p. 28)

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

Recommendation #9 To: Veterans Affairs, Department of

To ensure payments to the maintenance contractor are appropriate, the Veterans Home should require the contractor to provide records of inspections and maintenance work performed prior to authorizing these payments.

1-Year Agency Response

The Veterans Home modified its agreement with the contractor to revise the preventive maintenance schedule and reporting requirements. Veterans Affairs indicated that the Veterans Home is also using a new contract billing report to help ensure payments to the contractor are appropriate and has developed a new approach to monitoring the contractor's performance for compliance with the contract. (2010-406, p. 28)

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

Recommendation #10 To: Public Health, Department of

To promptly resolve complaints it receives against the Veterans Home, Public Health should monitor its system for processing complaints.

1-Year Agency Response

Public Health has developed a report from an existing complaint and incident tracking system that will identify complaints needing closure as of 30 days from receipt of the complaint to ensure Public Health is in compliance with its recommended time frame for resolving complaints. (2010-406, p. 30)

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

Recommendation #11 To: Veterans Board, California

To ensure that all complaints against the Veterans Home submitted to the Veterans Board are promptly resolved, the Veterans Board should specify a time frame for resolving complaints in its new policy for complaint resolution and ensure it implements the policy.

1-Year Agency Response

The Veterans Board revised its policy concerning complaints to specify a time frame for resolving complaints. Under its revised policy, the board chair will respond to the complainant through the board executive officer within 10 business days if the complaint does not require board deliberation and action. If board action is required, the response will be provided within 10 days following the next board meeting. If the board chair deems that the complaint requires more urgent action, a special meeting by teleconference may be convened. If the complaint concerns Veterans Affairs’ operations, it will be forwarded to the deputy secretary for resolution. The revised policy calls for Veterans Affairs to provide a response to the complainant with a copy to the board within 10 business days of Veterans Affairs’ receipt of the complaint. (2010-406, p. 30)

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

Recommendation #12 To: Veterans Affairs, Department of

To ensure that complaints against the Veterans Home are processed so there is accountability in the complaint resolution process, Veterans Affairs should enforce its policy of using routing slips with complaints.

1-Year Agency Response

According to Veterans Affairs, it revised its policy for tracking complaint resolution to ensure closure of complaints with accountability. The revised policy, which requires the use of a routing slip, has been distributed to the relevant staff at Veterans Affairs. (2010-406, p. 30)

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

Recommendation #13 To: Veterans Affairs, Department of

To appropriately address issues raised at resident council meetings, the Veterans Home needs to better document such issues, ensure that the relevant department resolves them, and promptly communicate resolutions to all members.

1-Year Agency Response

According to Veterans Affairs, the Veterans Home will record the minutes of all resident council meetings, and complaints and concerns of residents are to be routed to the appropriate supervising registered nurse for resolution. Therapeutic Activities at the Veterans Home is to follow up to ensure all complaints and concerns are addressed and communicated to the residents. (2010-406, p. 31)

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

Recommendation #14 To: Veterans Affairs, Department of

To handle alleged violations of the code of conduct consistently and equitably, the Veterans Home should ensure that staff responsible for investigating the allegations completely document the investigations and their results.

1-Year Agency Response

Veterans Affairs revised the code of conduct policy for clarity and the Veterans Home plans to train all staff who investigate code of conduct violations to improve the quality and consistency of investigations. In addition, the Veterans Home will be monitoring investigations for completeness. (2010-406, p. 32)

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

Recommendation #15 To: Veterans Affairs, Department of

To ensure that members of the Veterans Home receive treatment for drug abuse when necessary, staff of the Veterans Home should follow its policy to refer members who use illegal drugs to the drug treatment program.

1-Year Agency Response

The Veterans Home updated and strengthened its polices requiring staff to refer members who use illegal drugs to the appropriate treatment professional or medical provider at the Veterans Home. (2010-406, p. 32)

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

All Recommendations in 2007-121

Agency responses received after June 2013 are posted verbatim.