2025-109 Kindergarten Oral Health Assessment

Audit Recommendations Disclosure

When an audit is completed and a report is issued, auditees must provide the State Auditor with information regarding their progress in implementing recommendations from our reports at three intervals from the release of the report: 60 days, six months, and one year. Additionally, Senate Bill 1452 (Chapter 452, Statutes of 2006), requires auditees who have not implemented recommendations after one year, to report to us and to the Legislature why they have not implemented them or to state when they intend to implement them. Below is a listing of each recommendation the State Auditor made in the report referenced and a link to the most recent response from the auditee addressing their progress in implementing the recommendation and the State Auditor’s assessment of auditee’s response based on our review of the supporting documentation.

Audit Recommendations Disclosure

When an audit is completed and a report is issued, auditees must provide the State Auditor with information regarding their progress in implementing recommendations from our reports at three intervals from the release of the report: 60 days, six months, and one year. Additionally, Senate Bill 1452 (Chapter 452, Statutes of 2006), requires auditees who have not implemented recommendations after one year, to report to us and to the Legislature why they have not implemented them or to state when they intend to implement them. Below is a listing of each recommendation the State Auditor made in the report referenced and a link to the most recent response from the auditee addressing their progress in implementing the recommendation and the State Auditor’s assessment of auditee’s response based on our review of the supporting documentation.

Recommendation 2

To ensure regular evaluation of the KOHA program, the Legislature should amend state law to specify the frequency of DPH’s program evaluation and the specific elements that evaluation should include. These elements should also take into consideration DPH’s recommendations for improvements to the program. For example, the Legislature could specify evaluations should occur once every three years and contain an analysis of specified oral health indicators, such as caries experience, that determines the rates of the oral health indicators among assessed students and compares those rates to historical rates to establish a trend. The Legislature could also specify that the evaluation include information about how many school districts report KOHA program results.

Recommendation 24

To provide clarity on the department responsible for overseeing the KOHA program’s performance, the Legislature should amend state law to identify DPH as the state entity responsible for oversight of the KOHA program.

Recommendation 38

To clarify and streamline the requirements for school districts that host districtwide oral health assessments, the Legislature should amend state law to achieve the following:

• Create the option for school districts to meet the KOHA program requirements exclusively through partnerships with qualified dental professionals who provide on-site assessment services for the districts’ students.
• Clarify that districts that elect to comply with the KOHA program requirements through on-site assessments are not subject to the same notification requirements as districts that elect to have families obtain their own oral health assessments. Specifically, the law should allow districts that offer on-site assessment programs to be exempt from the requirement to provide families with a form to take to their own dental provider or a form for waiving the oral health assessment requirement. The law should also require these districts to provide families with a form that informs them of the on-site assessment and allows families the opportunities to opt out of the assessment.
• Require that districts that elect to comply with the KOHA program requirements through on-site assessments notify parents of the assessment results, including any health issues identified by the assessor, and of the importance of having their child visit a dentist.
• Specify that districts that elect to comply with the KOHA program requirements through on-site assessments must report the following information at the end of each year:
  • The number of students subject to the oral health assessment requirement.
  • The number of those students who were assessed.
    • The number found through an assessment to have visible decay.
    • The number found through an assessment to have caries experience.
  • The number who submitted an opt-out form and therefore were not assessed.

Recommendations to CA Dept. of Public Health

Recommendation 3

To ensure that the State, local governments, and other stakeholders have access to as much KOHA program data as possible, DPH should, by March 2027, develop and propose for CDE’s approval a standardized KOHA program form that includes both the oral health assessment and the waiver component. This form should replace the existing separate oral health assessment and waiver forms.

Recommendation 4

To ensure that school districts submit reasonable KOHA program results, DPH should annually compare districts’ reports to SCOHR with CDE enrollment data starting January 2027 to identify district reports that fall outside of a tolerable range. Based on this information, DPH should annually do the following:
– Identify the districts with significant variances from the CDE enrollment data.
– Notify these districts that they may have submitted incorrect data, explain the basis for the notice, and request they complete any necessary revisions to their reports.
– Notify the county programs associated with these districts and request them to offer technical assistance with improving the district’s reporting procedures.

Recommendation 5

To ensure that the KOHA program data are as complete as possible, DPH should, beginning in January 2027, and at least annually thereafter, contact districts that did not report KOHA program data to remind them of their reporting obligations and encourage them to report as required. If DPH believes that contact from county programs would be more effective, it should work in coordination with the county programs to ensure that this communication occurs. DPH should also publish a list of nonreporting districts on its website and update that list annually.

Recommendation 6

To ensure that stakeholders have access to the data that DPH established would be used to measure progress in meeting the State’s oral health goals, DPH should, by March 2027 begin regularly publishing on its website annual analyses of the KOHA program data in the areas of caries experience and visible decay. These analyses should explain any limitations of the data that DPH believes are important. After the first annual analysis, subsequent analyses should include trends from the previous years such that the public can determine whether oral health conditions are improving year-over-year.

Recommendation 37

To provide for complete funding for KOHA support activities, DPH should submit a budget change proposal to the Legislature seeking funding for county program grants. DPH should describe the current level of Prop 56 funding the department provides to county programs for KOHA program support activities and a proposal for how much additional annual funding would be necessary to fully fund KOHA program support activities, including activities that address the concerns detailed in this audit report.

Recommendations to LA Unified School District

Recommendation 7

To ensure that it records complete and accurate KOHA program data that facilitate its compliance with reporting requirements, Los Angeles should take the following actions by March 2027:

• Adopt procedures to regularly review whether staff are entering complete and accurate KOHA program information in its data system.
• Modify its data system to track the assessment results of caries experience and visible decay as separate results.

Recommendation 13

To ensure that its annual reports provide the State, local governments, and other stakeholders with correct KOHA program data, Los Angeles should, by March 2027, correct the issues that cause its data system to overstate the number of its KOHA-eligible and assessed students.

Recommendation 18

To ensure that they identify opportunities to improve KOHA program participation and their own compliance with KOHA program requirements, Los Angeles should, by March 2027, adopt procedures to review their KOHA program data at least twice a year to identify students that have yet to complete an assessment so that the district may provide reminders to those students about the assessment requirement.

Recommendation 25

To ensure that families are provided with all required information regarding the KOHA program, Los Angeles should do the following by January 2027:

• Revise its enrollment materials for TK, kindergarten, and first-graders to include all of the standardized forms published by CDE.
• Adopt procedures that direct staff to verify annually that the standardized forms the districts are using are the most up-to-date versions.
• Include translations of the standardized forms in all languages for which the district is required to provide information to families.

Recommendation 31

To ensure that they address any barriers that families may face in obtaining an oral health assessment, Los Angeles should, by January 2027, adopt procedures for tracking whether families have returned oral health assessment forms or waivers and reminding those who have not done so to submit either form. The procedures should also direct staff to contact families that submit waivers indicating barriers to accessing care and offer them dental health care resources.

Recommendations to Merced City School District

Recommendation 8

To ensure that it records complete and accurate KOHA program data that facilitate its compliance with reporting requirements, Merced should, by March 2027, adopt procedures to regularly review whether staff are entering complete and accurate KOHA program information in its data system.

Recommendation 19

To ensure that they identify opportunities to improve KOHA program participation and their own compliance with KOHA program requirements, Merced should, by March 2027, adopt procedures to review their KOHA program data at least twice a year to identify students that have yet to complete an assessment so that the district may provide reminders to those students about the assessment requirement.

Recommendation 26

To ensure that families are provided with all required information regarding the KOHA program, Merced should do the following by January 2027:

• Revise its enrollment materials for TK, kindergarten, and first-graders to include all of the standardized forms published by CDE.
• Adopt procedures that direct staff to verify annually that the standardized forms the districts are using are the most up-to-date versions.
• Include translations of the standardized forms in all languages for which the district is required to provide information to families.

Recommendation 32

To ensure that they address any barriers that families may face in obtaining an oral health assessment, Merced should, by January 2027, adopt procedures for tracking whether families have returned oral health assessment forms or waivers and reminding those who have not done so to submit either form. The procedures should also direct staff to contact families that submit waivers indicating barriers to accessing care and offer them dental health care resources.

Recommendations to Milpitas Unified School District

Recommendation 9

To ensure that it records complete and accurate KOHA program data that facilitate its compliance with reporting requirements, Milpitas should take the following actions by March 2027:

• Adopt procedures to regularly review whether staff are entering complete and accurate KOHA program information in its data system.
• Ensure that the oral health assessment results that it accepts from screening providers and families include all of the information needed to report all required data.

Recommendation 14

To ensure that its annual reports provide the State, local governments, and other stakeholders with correct KOHA program data, Milpitas should, by March 2027, adopt procedures for reporting KOHA results to SCOHR that rely directly on the data in its data systems.

Recommendation 20

To ensure that they identify opportunities to improve KOHA program participation and their own compliance with KOHA program requirements, Milpitas should, by March 2027, adopt procedures to review their KOHA program data at least twice a year to identify students that have yet to complete an assessment so that the district may provide reminders to those students about the assessment requirement.

Recommendation 27

To ensure that families are provided with all required information regarding the KOHA program, Milpitas should do the following by January 2027:

• Revise its enrollment materials for TK, kindergarten, and first-graders to include all of the standardized forms published by CDE.
• Adopt procedures that direct staff to verify annually that the standardized forms the districts are using are the most up-to-date versions.
• Include translations of the standardized forms in all languages for which the district is required to provide information to families.

Recommendation 33

To ensure that they address any barriers that families may face in obtaining an oral health assessment, Milpitas should, by January 2027, adopt procedures for tracking whether families have returned oral health assessment forms or waivers and reminding those who have not done so to submit either form. The procedures should also direct staff to contact families that submit waivers indicating barriers to accessing care and offer them dental health care resources.

Recommendations to Oakland Unified School District

Recommendation 10

To ensure that it records complete and accurate KOHA program data that facilitate its compliance with reporting requirements, Oakland should, by March 2027, adopt procedures to regularly review whether staff are entering complete and accurate KOHA program information in its data system.

Recommendation 16

To ensure that its annual reports provide the State, local governments, and other stakeholders with correct KOHA program data, Oakland should, by March 2027, adopt procedures for reporting annually as required.

Recommendation 21

To ensure that they identify opportunities to improve KOHA program participation and their own compliance with KOHA program requirements, Oakland should, by March 2027, adopt procedures to review their KOHA program data at least twice a year to identify students that have yet to complete an assessment so that the district may provide reminders to those students about the assessment requirement.

Recommendation 28

To ensure that families are provided with all required information regarding the KOHA program, Oakland should do the following by January 2027:

• Revise its enrollment materials for TK, kindergarten, and first-graders to include all of the standardized forms published by CDE.
• Adopt procedures that direct staff to verify annually that the standardized forms the districts are using are the most up-to-date versions.
• Include translations of the standardized forms in all languages for which the district is required to provide information to families.

Recommendation 34

To ensure that they address any barriers that families may face in obtaining an oral health assessment, Oakland should, by January 2027, adopt procedures for tracking whether families have returned oral health assessment forms or waivers and reminding those who have not done so to submit either form. The procedures should also direct staff to contact families that submit waivers indicating barriers to accessing care and offer them dental health care resources.

Recommendations to San Luis Coastal School District

Recommendation 11

To ensure that it records complete and accurate KOHA program data that facilitate its compliance with reporting requirements, San Luis Coastal should, by March 2027, adopt procedures to regularly review whether staff are entering complete and accurate KOHA program information in its data system.

Recommendation 15

To ensure that its annual reports provide the State, local governments, and other stakeholders with correct KOHA program data, San Luis Coastal should, by March 2027, adopt procedures for reporting KOHA results to SCOHR that rely directly on the data in its data systems.

Recommendation 22

To ensure that they identify opportunities to improve KOHA program participation and their own compliance with KOHA program requirements, San Luis Coasal should, by March 2027, adopt procedures to review their KOHA program data at least twice a year to identify students that have yet to complete an assessment so that the district may provide reminders to those students about the assessment requirement.

Recommendation 29

To ensure that families are provided with all required information regarding the KOHA program, San Luis Coastal should do the following by January 2027:

• Revise its enrollment materials for TK, kindergarten, and first-graders to include all of the standardized forms published by CDE.
• Adopt procedures that direct staff to verify annually that the standardized forms the districts are using are the most up-to-date versions.
• Include translations of the standardized forms in all languages for which the district is required to provide information to families.

Recommendation 35

To ensure that they address any barriers that families may face in obtaining an oral health assessment, San Luis Coastal should, by January 2027, adopt procedures for tracking whether families have returned oral health assessment forms or waivers and reminding those who have not done so to submit either form. The procedures should also direct staff to contact families that submit waivers indicating barriers to accessing care and offer them dental health care resources.

Recommendations to Woodland Joint Unified School District

Recommendation 12

To ensure that it records complete and accurate KOHA program data that facilitate its compliance with reporting requirements, Woodland should, by March 2027, begin recording waiver information as part of its KOHA program.

Recommendation 17

To ensure that its annual reports provide the State, local governments, and other stakeholders with correct KOHA program data, Woodland should, by March 2027, adopt procedures to report information about all oral health assessments that it receives from students and not report absent students as having received an oral health assessment through its on-site assessment program.

Recommendation 23

To ensure that they identify opportunities to improve KOHA program participation and their own compliance with KOHA program requirements, Woodland should, by March 2027, adopt procedures to review their KOHA program data at least twice a year to identify students that have yet to complete an assessment so that the district may provide reminders to those students about the assessment requirement.

Recommendation 30

To ensure that families are provided with all required information regarding the KOHA program, Woodland should do the following by January 2027:

• Revise its enrollment materials for TK, kindergarten, and first-graders to include all of the standardized forms published by CDE.
• Adopt procedures that direct staff to verify annually that the standardized forms the districts are using are the most up-to-date versions.
• Include translations of the standardized forms in all languages for which the district is required to provide information to families.

Recommendation 36

To ensure that they address any barriers that families may face in obtaining an oral health assessment, Woodland should, by January 2027, adopt procedures for tracking whether families have returned oral health assessment forms or waivers and reminding those who have not done so to submit either form. The procedures should also direct staff to contact families that submit waivers indicating barriers to accessing care and offer them dental health care resources.