Performance Audit : Human Services and Safety

State Government : Performance Audit : Earlier Work

This page contains synopses, links to published reports, and other materials that address issues of health services, vulnerable children and adults, public safety and prisons.

Barriers to Home Care Aide Certification (pdf, 2.1 mb)
November 2016
Summary: Through a survey of applicants who did not become certified, we found that almost two-thirds dropped out due to barriers, many facing problems when signing up for training or the exam.  Respondents said they could not find course times that fit their schedule or a training location or testing site close to home. Respondents who did not speak English would often find language barriers insurmountable and leave the program. Many said it was difficult finding training and exams in their preferred language. The departments of Health and Social and Health Services have taken steps to address these barriers working with their partners to try to increase the number of locations that offer training and exams. View the videocast here (YouTube). Read the two-page summary (pdf, 96 kb)View earlier work around Initiative 1163.

Medical Discipline in Washington (pdf, 1.6 mb)
November 2016
Summary: This performance audit examined the processes around medical discipline in Washington applied by the Medical Quality Assurance Commission (MQAC) and the Board of Osteopathic Medicine and Surgery. Despite similarities in the professions they serve and the issues they review, we found a number of differences in how the two boards manage their affairs and regulate their providers. Our key recommendation, to merge these two boards, would address many of the issues we found and promote consistency. We also noted other areas for improvement, including better communicating their presence and purpose to the public and interacting with complainants. Finally, we identified some elements in the statutes that govern medical discipline that the Legislature and the boards should consider addressing.  View the videocast here (YouTube). Read the two-page summary (pdf, 94 kb).

I-1163: Long-term Care Worker Certification Requirements 2016 (pdf, 213 kb) 
August 2016
Summary: This performance audit continues our series of reports mandated by Initiative 1163. We found the Department of Health and the Department of Social and Health Services have continued to identify and address barriers to home care aide certification. Key improvements include: sharing data to identify trends and monitor applicant progress through certification, helping applicants with limited English proficiency, and streamlining the application itself. View the videocast and earlier report here.

Improving Staff Safety in Washington's Prisons (pdf, 1.9 mb)
March 2016
Summary: Following the death of a corrections officer in 2011, Washington's Department of Corrections implemented a series of initiatives designed to improve the safety of staff working in the state's prisons. Our performance audit found that while no other state has developed and implemented such a comprehensive effort to improve staff safety, opportunities for improvement exist. While each prison had implemented the initiatives to some degree, not all have been fully or consistently put in place in all facilities. Our recommendations, and the detailed information about leading practices, address areas that can help the Department improve further. See the videocast here (YouTube). Read the two-page summary (pdf, 155 kb).

Complaint Resolution Unit at the Department of Social and Health Services (pdf, 1.2 mb)
November 2015
Summary: The Complaint Resolution Unit (CRU) receives and processes complaints regarding provider practice issues and allegations of abuse, neglect and exploitation of vulnerable adults living in residential care settings in Washington. Our audit found that the CRU has improved the timeliness of its intake processing since 2014, but does not track whether it meets time requirements outlined in state law; a lack of clarity in the law complicates CRU's efforts to measure and manage its processes. We also found staff were reasonably accurate when prioritizing complaint severity, but inconsistent assessments were made in a quarter of test cases. CRU lacks a quality assurance process that might help it achieve higher consistency and accuracy. See the videocast hereRead the two-page summary (pdf, 90 kb)

June 2015
Summary: The Department of Social and Health Services' Office of Fraud and Accountability (OFA) investigates allegations of fraud and abuse in public assistance programs. OFA has made several improvements over the last few years, including restructuring the organization and assigning new leadership.  Although its backlog of overpayment investigation referrals is growing, its backlog of early detection referrals is declining.  We wanted to determine how OFA could reduce its backlog, but still comply with its mandate to assess all referrals while doing so cost effectively.  OFA developed tools that help ensure high priority allegations of fraud or abuse in public assistance programs are investigated. However, we found that the Office's lack of important performance measures hampers its ability to make informed decisions about how to best allocate resources.  Our analysis of the available data suggests there are opportunities to use those resources more effectively.​ See the videocast here (YouTube).​ Read the two-page summary (pdf, 90 kb)

Improving Completeness of Washington's Criminal History Records Database (pdf, 1.3 mb)
June 2015
Summary: Criminal history records include information on arrests and the disposition of those arrests. They are used during criminal investigations, for charging and sentencing decisions, and to conduct background checks for jobs and volunteer positions. We found a third of the dispositions reported in the Judicial Information System (JIS) in 2012 were missing from the Washington State Identification System (WASIS). We identified two primary reasons: the person arrested was never fingerprinted, or vital information was not included when the disposition was entered into JIS. We recommend the Washington State Patrol seek changes to state laws and rules to ensure all people arrested are fingerprinted and that all dispositions are properly entered. We also recommend the Patrol work with local law enforcement agencies and courts to identify and improve weaknesses in their processes to report arrests and dispositions. See the videocast here (YouTube). Read the two-page summary (pdf, 105 kb)

New Freedom Consumer-Directed Services (pdf, 451 kb)
December 2014
Summary: Facing a growing aging population and limited financial resources, Washington must evaluate which long-term care models for low-income adults with disabilities and elderly people will provide the highest quality and most cost-effective services. This performance audit evaluated the effectiveness and costs of New Freedom Consumer Directed Services, comparing it to the statewide Community Options Program Entry System (COPES). We found that New Freedom participants take advantage of the program’s unique benefits, and are very satisfied with the program and the services they receive. New Freedom and COPES clients experience comparable health outcomes, for the same cost to the state. However, New Freedom’s individual budget model is not suitable for all long-term care clients, and creates some administrative challenges. With the state’s adoption of the Medicaid option Community First Choice, Washington has an opportunity to apply lessons learned from the implementation of New Freedom to the state’s new long-term care program. See multimedia materials here. Read the two-page summary (pdf, 100 kb)

Initiative 1163: Long-Term Care Worker Certification Requirements  (pdf, 890 kb)
December 2014
Summary: This performance audit found that improvements made by the Department of Social and Health Services and the Department of Health since our earlier audit have helped more applicants obtain home care aide certificates. The percent of applicants achieving certification almost doubled, from 29 percent in early 2012 to 58 percent in 2013. We also found that 96 percent of workers reviewed in our selection of adult family homes met I-1163 requirements, suggesting monitoring efforts are reasonable. See multimedia materials here. Read the two-page summary (pdf, 92 kb)

Electronic Benefit Transfer Cards (pdf, 875kb)
November 2014
The Department of Social and Health Services (DSHS) administers large federal food and financial assistance programs, which provide nearly $2 billion in annual benefits to low–income Washington residents. These program benefits can be abused or paid to persons who do not qualify to receive them. Recent legislation required DSHS to make efforts to address these risks an agency priority. Our audit concluded that DSHS' efforts are effective in those areas examined. We did identify a few areas where DSHS can further improve that effectiveness: using data to more quickly identify program participants who have moved out of state, earned more income than allowed or died while receiving benefits. See multimedia materials here. Read the two-page summary (pdf, 88kb).

Medicaid Managed Care Program Oversight (pdf, 807kb)
April 2014
We conducted an audit of the Health Care Authority's Medicaid Managed Care Program and found that weaknesses in its oversight led managed care organizations to pay more than was appropriate, which in turn may have led the state to pay higher premiums. We provide recommendations to help HCA improve its oversight. Read the two-page summary (pdf, 86kb).

Post-Adoption Services (pdf, 396kb)
February 2014
Most parents who adopted children from foster care said in a survey that they do not need additional post-adoption services. However, some families cannot get all the services they require, especially for the children with the greatest needs. Many parents also had problems finding information about services in their communities. More than half of the families who negotiated their adoption support benefits in the past year gave poor to fair ratings to the state's negotiation process. We reviewed eight states that provide additional services for adoptive families and provide information on their efforts to help Washington determine how to better meet the needs of families adopting from foster care. Read the two-page summary (pdf, 95.7kb).

Developmental Disabilities - Increasing Access and Equality (pdf, 3.1mb)
July 2013
About 35,000 people are eligible and have applied for developmental disabilities services; we found that about 12,000 receive full services, 7,800 receive only partial or limited services, and 15,000 receive no services from the state. We recommended that the Legislature direct the Department of Social and Health Services' Developmental Disabilities Administration to maximize cost-effective types of care. Read the two-page summary (pdf, 392kb).

Developmental Disabilities - Monitoring Payments and Safety (pdf, 1.1mb)
July 2013

This performance audit examined protections against improper payments to businesses providing supported living services to about 3,700 developmentally disabled Washingtonians. We found $11 million in questionable payments and $5.5 million in unauthorized payments, and identified safety concerns relating to caregiver background checks. Read the two-page summary (pdf, 387kb).

Enhancing Background Checks in Washington (pdf, 1.5mb)
May 2013

Washington could improve public safety by retaining fingerprints and implementing an automated background check service. We identified legal barriers to using such a service, and recommended that the Legislature revise state law to permit the retention of civil fingerprints. Read the two-page summary (pdf, 469kb).

Protecting Children from Sex Offenders (pdf, 1.9mb)
August 2012
This performance audit focused on the effectiveness of systems used to ensure convicted sex offenders do not live or work at schools or at homes in which foster care and child care are provided. The audit asked whether Washington's registered sex offender database could enhance monitoring of state-regulated facilities with children.


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