State audit critical of nursing home enforcement procedures

Department of Health working to ensure fines are assessed in timely manner


BUFFALO, N.Y. (WIVB) – The New York State Health Department cited a local nursing home for more than two dozen “regulatory violations” following a May inspection.

Among the findings, rodent activity affecting “four of four resident use floors.”

The Department of Health approved a “plan of correction,” but issued no fines or sanctions.”

The Office of State Comptroller Thomas DiNapoli looked at how the state health department handles enforcement actions involving nursing homes — specifically, how and when the agency imposes fines.

According to the audit released in February, which looked at data over a period of eight and a half years, the Department of Health did a good job of doing inspections on a timely basis, but found that the “same diligence was not being applied to the collection of fines.”

“They don’t even consider issuing a fine until six months after the citation has been issued,” said John Buyce, director of state audits. “If you look at the enforcement and fines and actions that they did during the period, those have been steadily declining.”

“The problem that we saw is that many of the things aren’t even considered for monetary fines and when they are it takes a long time for that to happen,” he added.

State auditors found that the state health department chose to “not levy fines for categories of violations that account for almost 85 percent of the problems found.”

“In not doing this, if there is a deterrent effect to a fine you’re really not getting that effect. You’re not getting a sense of urgency to people that that escalation’s not going to happen,” Buyce said.

The state health department tells News 4 Investigates that a “new enforcement process” was implemented by the agency in “April 2015,” and that the agency is “continuing to work” to ensure that fines are assessed in a “timely manner.”

The Department of Health inspects all 627 nursing homes in the state at least once every fifteen months to determine if there are any violations of regulations that protect resident health and safety.

Complaints about nursing home care often result in additional onsite inspections.

According to the Department of Health, federal regulatory parameters require the state to allow providers an opportunity to submit a plan of correction for the cited violations.

In its response to the audit’s findings, the Department of Health stated, “While state fines may play a role in this regard, they should not be viewed independent of the overall regulatory structure, which ensures quality care and service delivery.”

“What they told us is that they like to lead people into compliance as opposed to force people into compliance, and so they like plans of correction and things like that, and they work with facilities to do that and they’d rather do that instead of impose a monetary fine,” Buyce told News 4 Investigates during a recent interview.

The Department of Health maintains that enforcement process issues were recognized before the start of the state comptroller’s audit, and that steps were taken to address them.

The agency states that it “continues to review and refine those actions” to improve the way it processes enforcements.

In response to why the comptroller’s office conducted the audit in the first place, Buyce added:

“The comptroller thinks this is really a critical thing. The people who are in many of these places are elderly citizens that are just trying to live out the rest of their life as comfortably and with as much dignity as they can.”

He said state auditors would likely take another look at nursing home enforcement procedures early next year to gauge the progress made by the Department of Health.

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