REPORT DIGEST

ILLINOIS DEPARTMENT OF HUMAN SERVICES

COMPLIANCE EXAMINATION
FOR THE TWO YEARS ENDED JUNE 30, 2019

Release Date:  July 7, 2020

FINDINGS THIS AUDIT:  38

CATEGORY:  NEW -- REPEAT -- TOTAL
Category 1:  6 -- 21 -- 27
Category 2:  2 -- 9 -- 11
Category 3:  0 -- 0 -- 0
TOTAL:  8 -- 30 -- 38

FINDINGS LAST AUDIT: 42

Category 1: Findings that are material
weaknesses in internal control and/or a
qualification on compliance with State
laws and regulations (material
noncompliance).
Category 2: Findings that are significant
deficiencies in internal control and
noncompliance with State laws and
regulations.
Category 3: Findings that have no
internal control issues but are in
noncompliance with State laws and
regulations.

State of Illinois, Office of the Auditor
General
FRANK J. MAUTINO, AUDITOR GENERAL

To obtain a copy of the Report contact:
Office of the Auditor General, Iles Park
Plaza, 740 E. Ash Street, Springfield, IL
62703
(217) 782-6046 or TTY (888) 261-2887

This Report Digest and Full Report are
also available on the worldwide web at
www.auditor.illinois.gov

INTRODUCTION

Because of the significance and
pervasiveness of the findings described
within the report, we expressed an
adverse opinion on the Department’s
compliance with the assertions which
comprise a State compliance examination.
The Codification of Statements on
Standards for Attestation Engagements
(AT-C § 205.72) states a practitioner
“should express an adverse opinion when
the practitioner, having obtained
sufficient appropriate evidence,
concludes that misstatements,
individually or in the aggregate, are
both material and pervasive to the
subject matter.”

Further, the digest covers our Compliance
Examination of the Department for the two
years ended June 30, 2019. A separate
Financial Audit as of and for the year
ended June 30, 2019, was previously
released on April 28, 2020. In total,
this report contains 38 findings, 12 of
which were reported in the Financial
Audit.

SYNOPSIS

• (19-13) The Department was unable to
provide adequate records substantiating
the completeness of populations for one
or more laws, regulations, or other
requirements selected for testing.
Therefore, we concluded the Department’s
population records were not sufficiently
precise and detailed under the
Attestation Standards promulgated by the
American Institute of Certified Public
Accountants (AT-C § 205.35).

• (19-20) Internal control weaknesses
were identified in the Department’s Home
Services Program.

INTRODUCTION

This report presents our Department-wide
compliance attestation examination for
the two years ending June 30, 2019.  At
June 30, 2019 the Department operated 6
Developmental Centers, 7 Mental Health
Centers, 1 combined Mental Health and
Developmental Center, and 3
Rehabilitation Services Facilities.  The
findings are presented in the report
beginning at page 42.

FINDINGS, CONCLUSIONS, AND
RECOMMENDATIONS

COMPLETE POPULATIONS NOT PROVIDED

The Department of Human Services
(Department) was unable to provide
adequate records substantiating the
completeness of populations for one or
more laws, regulations, or other
requirements selected for testing, as of
the end of fieldwork. Due to these
conditions, we concluded the Department’s
population records were not sufficiently
precise and detailed under the
Attestation Standards promulgated by the
American Institute of Certified Public
Accountants (AT-C § 205.35) to test the
Department’s compliance with the
following:

Specifically, some of the more important
issues we noted were:

• While testing compliance with user
access to the Payroll Timekeeping System
(PTS), we requested user listings from
the Central office and individual
facilities in order to determine the
accuracy and completeness of the
populations. While Elgin Mental Health
Center, Ludeman Developmental Center, and
Illinois Center for Rehabilitation and
Education provided listings, we were
unable to verify the accuracy and
completeness of these populations because
users were not consistent between the
Central office and facility listings.

• While testing obsolete or unused
property at Elgin Mental Health Center,
we noted the facility does not maintain a
tracking mechanism for its obsolete or
unused property.  Due to this condition,
we could not conclude that Elgin Mental
Health Center's population records were
sufficiently precise and detailed to test
the obsolete or unused property.

• While testing compliance with various
Mental Health and Developmental
Disabilities Administrative Acts at the
State Operated Mental Health and
Development Disabilities facilities, we
noted the following:
– Ludeman Developmental Center was unable
to provide adequate records
substantiating the population of
restraints issued during the examination
period.
– Murray Developmental Center was unable
to provide adequate records
substantiating the population of clients
released from the facility during the
examination period.
– Ann M. Kiley Developmental Center,
Ludeman Developmental Center, McFarland
Mental Health Center, John J. Madden
Mental Health Center, and Murray
Developmental Center were unable to
provide adequate records substantiating
the populations of visitor entry logs
(for visitors who visited the facilities'
residents) during the examination period.
– John J. Madden Mental Health Center was
unable to provide adequate records
substantiating the population of all
recipients who received dental treatment
during the examination period as the
reports are only able to be generated
once an individual has been discharged
from the Center. As such, any individuals
who had been treated during the
examination period, but still resided at
the facility, would not have been
included in the population provided.
– The Illinois Center for Rehabilitation
and Education was unable to provide
adequate records substantiating the
population of instances of suspected
patient abuse or neglect. The reports
provided included instances ranging from
minor bumps and bruises to cases of
suspected abuse or neglect.

Even given the population limitations
which hindered our ability to conclude
whether the selected sample was
representative of the population as a
whole, we obtained the population
provided by the Department for each of
the areas the Department could not
substantiate, selected a sample, and
tested for compliance. Noncompliance for
those samples selected are reported in
Findings 2019-014 through 2019-017.
(Finding 13, page 80-83)

We recommended Department management and
staff strengthen controls over records
maintenance for each area in which a
compliance requirement is present.  To
every extent possible, population records
should be sequentially numbered.

The Department accepted the
recommendation and stated it will (1)
work to strengthen its controls over
records maintenance, (2) work to ensure
Contract Administration Obligations Unit
staff follow the monthly SC14 process and
procedures, (3) work to develop a means
of identifying electronic devices
assigned to separated employees, (4)
implement a tracking system to monitor
obsolete or unused property at the Mental
Health Centers, (5) ensure proper
tracking of employees trained to use
restraints, (6) enhance visitor entry
logs, (7) investigate system changes that
would assist in tracking patient details
prior to discharge from a Mental Health
Center, and (8) the Ludeman Center will
implement a corrective action plan
including retraining of staff and
implementation of consistent reviews of
the Center’s PTS access. SODC Operations
will work with these Centers to provide
re-training and monitoring to ensure
compliance. Finally, the Department
stated the Central Payroll office has
recently filled a position to manage and
oversee agency timekeeping/payroll access
and security.

INTERNAL CONTROL WEAKNESSES IN THE HOME
SERVICES PROGRAM

Internal control weaknesses were
identified in the Department of Human
Services’ (Department) Home Services
Program managed by the Department’s
Division of Rehabilitation Services.

Specifically, we noted the following:

• There was insufficient monitoring of
case files to ensure program objectives
were being met. There was an average of
31 supervisors at 46 field offices to
monitor Home Services Program activities.
On average, each supervisor was
responsible for approximately 1,055 case
files during FY 2019. There was an
average of 125 counselors during FY 2019
and 137 counselors during FY 2018. There
was an average of 262 case files per
counselor during FY 2019 and 213 during
FY 2018.

• A required increase in hourly wage paid
by the Department to Home Services
Program personal assistants and
individual maintenance home health
workers was to be effective by August 5,
2017 but was not implemented until April
1, 2019, or 604 days late. For the
compliance period ending June 30, 2019,
the Department paid back wages in the
amount of $28.6 million.

• The Department did not provide
documentation of interagency agreements
between the Department and the Department
on Aging regarding the intake procedures
and eligibility criteria for persons who
may need long term care.

• The Department could not document that
it sufficiently monitored third party
providers who perform prescreening for
Home Services Program eligibility on the
Department's behalf, in order to
determine if the processes are being
reasonably performed in accordance with
Department policy. (Finding 20, page
105-106)

We recommended Department management and
staff strengthen internal controls and
compliance over the Home Services Program
by assigning additional staff resources
or by enacting alternative means for
monitoring program activities (including
third party designees), annually
obtaining and assessing a SOC 1 Type 2
report for functions performed by the
pre-screening service provider, or
perform a review of the service provider
using Department staff who have the
requisite expertise, and establishing an
interagency agreement with the Department
on Aging.

The Department accepted the
recommendation and stated it will
continue to review staffing levels to
ensure levels are appropriate for
workloads in the Home Services Program.
Furthermore, the Department will
establish an Intergovernmental Agreement
with the Department on Aging and work to
increase reviews of pre-screening service
providers.

OTHER FINDINGS

The remaining findings are reportedly
being given attention by Department
personnel.  We will review the
Department’s progress towards the
implementation of our recommendations in
our next audit/examination.

AUDITOR’S OPINION

The financial audit report was previously
released. The auditors stated the
financial statements of the Department as
of and for the year ended June 30, 2019,
are fairly stated in all material
respects.

ACCOUNTANT’S OPINION

The accountants conducted a compliance
examination of the Department for the two
years ended June 30, 2019, as required by
the Illinois State Auditing Act.  Because
of the effect of the noncompliance
described in Findings 2019-001 through
Finding 2019-038, the accountants stated
the Department did not materially comply
with the requirements described in the
report.

The financial audit and this compliance
examination was performed by RSM US LLP.

JANE CLARK
Division Director

This report is transmitted in accordance
with Section 3-14 of the Illinois State
Auditing Act.

FRANK J. MAUTINO
Auditor General

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