2024-114 State Health Care Staffing Contracts
Contract Workers Are a Small but Growing Proportion of Three State Facilities’ Workforces
Published: December 4, 2025
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.
Recommendations to the Legislature
Recommendation 1
To maximize the effectiveness of the State’s recruiting efforts, the Legislature should require CalHR to assemble and coordinate a cross-agency collaborative campaign to recruit medical and mental health care staff for state facilities statewide. CalHR should continue, modify, and improve such efforts until the State can achieve and maintain appropriate vacancy rates, as the Legislature determines. This campaign should include, but not be limited to, the following:
- A total compensation analysis, and adjust as appropriate, to ensure that all medical and mental health care classifications’ compensation is commensurate and competitive with similarly situated recruiting entities.
- The provision of online and in-person assistance for candidates during the application and testing process.
- The implementation of targeted efforts, including development of marketing materials, as appropriate, highlighting the benefits of state employment in California, to recruit candidates for specific job classifications and facility locations that are historically difficult to fill.
- The establishment of measurement metrics to track the results of each type of recruiting activity and test modifications to each strategy. These measurements should include, but not be limited to, the number of candidates who express interest, apply, interview, receive, and accept employment offers.
Agency response status:
Pending
Recommendations to California Department of Corrections and Rehabilitation
Recommendation 2
To improve Salinas Valley’s ability to recruit and retain medical and mental health care employees, CDCR should, by June 2026, do the following:
- Develop and implement a process to measure the effectiveness of each of its recruiting strategies and track those strategies’ costs.
Agency response status:
Pending
Recommendation 3
To improve Salinas Valley’s ability to recruit and retain medical and mental health care employees, CDCR should, by June 2026, do the following:
- Evaluate whether offering affordable housing options would improve Salinas Valley’s ability to recruit new state employees, and if so, explore options to develop or obtain additional affordable housing units for Salinas Valley’s staff and seek a funding allocation from the Legislature to do so.
Agency response status:
Pending
Recommendation 4
By December 2026, CDCR with Salinas Valley should comprehensively assess the technical, financial, legal, and operational impacts of implementing flexible shifts, including but not limited to, 8-, 10-, and 12-hour shift options for staff. Using the results of this assessment, they should develop concrete plans to address employee concerns related to scheduling flexibility to the extent feasible.
Agency response status:
Pending
Recommendation 5
To ensure transparency, increase accountability, and allow adequate oversight, CDCR should immediately require its facilities to establish a system to track, tabulate, periodically report to CDCR, and make publicly available the following:
- Staffing levels by shift, including the individuals’ classifications and whether they are state employees or contract workers.
- The number of shifts during which and the number of staff by which the facility fell short of its required shift-staffing minimums, as well as an explanation for why it missed the minimums.
Agency response status:
Pending
Recommendations to California Department of Developmental Services
Recommendation 6
To improve Porterville’s ability to recruit and retain medical and mental health care employees, DDS should do the following:
- With Porterville, develop and implement a process by June 2026 to measure the effectiveness of their recruiting strategies and track those strategies’ costs.
Agency response status:
Pending
Recommendation 7
To improve Porterville’s ability to recruit and retain medical and mental health care employees, DDS should do the following:
- To ensure that Porterville is competitive in the marketplace for health care professionals, conduct a salary survey, by December 2026, that compares the salaries and benefits it offers its health care workers to those offered by local public health care facilities, private health care facilities, and staffing agencies. DDS should use this survey in its discussions with CalHR and Finance.
Agency response status:
Pending
To improve Porterville’s ability to recruit and retain medical and mental health care employees, DDS should do the following:
- By June 2026, pilot and consider permanently implementing one- to three-day recruiting events that allow candidates to apply, interview, and receive a conditional job offer before the event’s conclusion.
Agency response status:
Pending
To improve Porterville’s ability to recruit and retain medical and mental health care employees, DDS should do the following:
- Evaluate by June 2026 whether offering affordable housing options would improve Porterville’s ability to recruit new state employees, and if so, explore options to develop or obtain additional affordable housing units for Porterville’s staff and seek a funding allocation from the Legislature to do so.
Agency response status:
Pending
Recommendation 10
By December 2026, DDS with Porterville should comprehensively assess the technical, financial, legal, and operational impacts of implementing flexible shifts, including but not limited to, 8-, 10-, and 12-hour shift options for staff. Using the results of this assessment, they should develop concrete plans to address employee concerns related to scheduling flexibility to the extent feasible.
Agency response status:
Pending
Recommendation 11
To ensure that its proposed budget accurately reflects its facilities’ operational needs, DDS should, by June 2026, develop comprehensive policies and procedures for its annual budgeting process that include the requirement that staff use appropriate models to evaluate facility staffing needs and seek adjustments to position authority as necessary.
Agency response status:
Pending
To ensure transparency, increase accountability, and allow adequate oversight, DDS should immediately require its facilities to establish a system to track, tabulate, periodically report to DDS, and make publicly available the following:
- Staffing levels by shift, including the individuals’ classifications and whether they are state employees or contract workers.
- The number of shifts during which and the number of staff by which the facility fell short of its required shift-staffing minimums, as well as an explanation for why it missed the minimums.
Agency response status:
Pending
Recommendations to California Department of State Hospitals
To improve Atascadero’s ability to recruit and retain medical and mental health care employees, DSH should do the following:
- With Atascadero, develop and implement a process by June 2026 to measure the effectiveness of their recruiting strategies and track those strategies’ costs.
Agency response status:
Pending
To improve Atascadero’s ability to recruit and retain medical and mental health care employees, DSH should do the following:
- To ensure that Atascadero is competitive in the marketplace for health care professionals, conduct a salary survey, by December 2026, that compares the salaries and benefits it offers its health care workers to those offered by local public health care facilities, private health care facilities, and staffing agencies. DSH should use this survey in its discussions with CalHR and Finance.
Agency response status:
Pending
To improve Atascadero’s ability to recruit and retain medical and mental health care employees, DSH should do the following:
- By June 2026, pilot and consider permanently implementing one- to three-day recruiting events that allow candidates to apply, interview, and receive a conditional job offer before the event’s conclusion.
Agency response status:
Pending
To improve Atascadero’s ability to recruit and retain medical and mental health care employees, DSH should do the following:
- Evaluate by June 2026 whether offering affordable housing options would improve Atascadero’s ability to recruit new state employees, and if so, explore options to develop or obtain additional affordable housing units for Atascadero’s staff and seek a funding allocation from the Legislature to do so.
Agency response status:
Pending
By December 2026, DSH with Atascadero should comprehensively assess the technical, financial, legal, and operational impacts of implementing flexible shifts, including but not limited to, 8-, 10-, and 12-hour shift options for staff. Using the results of this assessment, they should develop concrete plans to address employee concerns related to scheduling flexibility to the extent feasible.
Agency response status:
Pending
To ensure that its proposed budget accurately reflects its facilities’ operational needs, DSH should, by June 2026, develop comprehensive policies and procedures for its annual budgeting process that include the requirement that staff use appropriate models to evaluate facility staffing needs and seek adjustments to position authority as necessary.
Agency response status:
Pending
Recommendation 19
To ensure transparency, increase accountability, and allow adequate oversight, DSH should immediately require its facilities to establish a system to track, tabulate, periodically report to DSH, and make publicly available the following:
- Staffing levels by shift, including the individuals’ classifications and whether they are state employees or contract workers.
- The number of shifts during which and the number of staff by which the facility fell short of its required shift-staffing minimums, as well as an explanation for why it missed the minimums.
Agency response status:
Pending
