Report 2019-105 Recommendation 8 Responses

Report 2019-105: Childhood Lead Levels: Millions of Children in Medi-Cal Have Not Received Required Testing for Lead Poisoning (Release Date: January 2020)

Recommendation #8 To: Public Health, Department of

To better hold local prevention programs accountable for performing required activities, CDPH should, by June 2020, conduct direct oversight through site visits for each of the local prevention programs, and it should ensure that it continues to do so at least once per contract cycle. In addition, CDPH should use the local prevention programs' biannual progress reports to assess local prevention programs' performance and provide feedback on their strengths and shortcomings.

Annual Follow-Up Agency Response From October 2021

On April 23, 2021, CDPH completed site reviews for the contract cycle that ended in June 2020. CDPH is now conducting monthly site reviews for the current contract cycle, which began July 1, 2020. A schedule is in place to ensure completion of all 49 local prevention program site reviews by June 30, 2023, the end of the current contract cycle. Additionally, CDPH has implemented its improved process of using local prevention programs' biannual progress reports to assess performance and provide feedback on strengths and shortcomings. Attached is the template CDPH used to provide feedback to each local prevention program on progress reports submitted for the first reporting period of the current contract cycle (July 1, 2020-December 30, 2020), populated with feedback to Calaveras County Childhood Lead Poisoning Prevention Program for Scope of Work Objective 2-I for purposes of example. For each Scope of Work objective, the template includes performance measures (i.e., local prevention program performance with respect to Scope of Work performance goals); a comments column for strengths and shortcomings; and an action items column for requesting additional information. Any actions items requested are due within 30 days. CDPH will continue this feedback process for all subsequent reporting periods, further refining the process as needed.

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

1-Year Agency Response

By January 1, 2021, CDPH will have completed 43 of 50 local prevention program site reviews for FY 2017-18 through FY 2019-20. CDPH will review the remaining seven local prevention programs by the end of April 2021, continuing to observe site review safety modifications and working around reductions in local program and CLPPB staffing due to COVID-19 impacts.

In July 2020, CDPH disseminated new progress report templates to local prevention programs for the July-December 2020 reporting period. These reporting templates are Excel workbooks that facilitate tracking of program activities in real-time and will provide CDPH with more robust program performance data. The attached Performance Tracking Fact Sheet describes the components of the report and the next steps. Training sessions, videos, and a guidance document were provided to assist local prevention programs with completing the new progress report templates.

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

CDPH has not yet completed site reviews for the contract cycle that ended in June 2020. In addition, although it describes tools that may result in more consistent and streamlined evaluations of local programs, it did not provide documentation to demonstrate that it performed evaluations using those tools, nor is it clear that the new evaluation process results in an assessment of local prevention programs' performance and feedback on their strengths and shortcomings.

6-Month Agency Response

CDPH had planned to conduct up to three site visits each month to hold local prevention programs accountable for performing required activities. However, all March-April 2020 site reviews had to be cancelled due to local health jurisdiction impacts from COVID-19, including office closures and local health jurisdiction staff redirection to response activities. CDPH is planning to conduct six site reviews from June-July 2020, with social distancing strategies. CDPH remains committed to completing all FY 2017-18 through FY 2019-20 site reviews by April 2021.

Additionally, CDPH developed internal guidance for progress report feedback that will be piloted for the remainder of the current contract period.

For the new contract cycle, CDPH is updating the progress report template to link reporting requirements to the new scope of work. Once the updated template is finalized, the internal guidance for progress report feedback will be updated to include new requirements. The updated report template and updated guidance for report feedback will be implemented for the first reporting period of the new contract cycle, to commence January 2021, covering work performed July-December 2020.

California State Auditor's Assessment of 6-Month Status: Pending

CDPH was behind its schedule for visiting all local program sites before the COVID-19 pandemic, and it did not complete site visits for all local programs before the end of the most recent contract cycle on June 30, 2020. We will review CDPH's new process for providing feedback on progress reports once CDPH has implemented the process.

60-Day Agency Response

CDPH will continue to conduct up to three site visits each month to hold local prevention programs accountable for performing required activities. By April 2021, CDPH will complete all 50 local prevention program site reviews for the current contract cycle (FY 2017-18 through FY 2019-20). CDPH will continue to visit each local program to review work activities for each new contract cycle. CDPH also reaches out on a regular basis to provide technical assistance to these local programs. CDPH will continue to assess local program performance through biannual progress reports by cross walking progress report data against scope of work requirements. CDPH will provide more specific feedback on strengths and opportunities for improvement pertaining to the implementation of contractual activities.

California State Auditor's Assessment of 60-Day Status: No Action Taken

CDPH's expected implementation date indicates that it remains behind schedule on its site visits, and it will not complete all site reviews for the current contract cycle. We will review implementation of this recommendation, including its feedback on strengths and shortcomings in biannual progress reports, once CDPH has begun implementation.

All Recommendations in 2019-105

Agency responses received are posted verbatim.