FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS
GUIDELINES NOT FOLLOWED FOR MONITORING HIGH LEAD BLOOD LEVELS IN CHILDREN
The Department contracts with local health departments for lead poisoning
management and follow-up. Based on a Departmental review, a local health department did
not adhere to guidelines providing follow-up visits to children with blood lead levels
greater than 20. Only 54 of 103 received a home visit and only two of the 54 received a
visit within 10 days. According to guidelines in effect during the period reviewed, all
103 children should have received a home visit within 10 days. (Finding 8, page 32)
We recommended the Department continue to work with all subcontractors to ensure the
guidelines prescribed for lead poisoning are followed.
Department officials stated they will conduct a review of the local health department's
Childhood Lead Poisoning Prevention Program within 12 months, and its lead poisoning
follow-up efforts will be closely monitored. Additionally, the Department changed
guidelines to require a home visit within 10 to 20 days for children with blood levels
above 20 because a 10-day requirement was too constraining for large local Public Health
agencies.
MANDATED REPORTS OF ABUSE OR NEGLECT NOT TIMELY
Mandated reporters were not reporting abuse or neglect of residents in a long-term
care facility on a timely basis. Six of ten cases tested were not reported to the
Department within 24 hours after facility administration became aware of the alleged abuse
or neglect. The administrators waited from 2 to 12 days before notifying the Department of
alleged incidents.
State statute requires all reports of suspected abuse or neglect be immediately
reported to the Department and be reported in writing within 24 hours after having
reasonable cause to believe that the condition of the resident resulted from abuse or
neglect. (Finding 5, page 29)
We recommended the Department continue to encourage mandated reporters to contact the
Department on a timely basis and take appropriate action when facilities do not report
timely.
Department officials stated they will continue to encourage mandated reporters to
report within the required time frames and will, if appropriate, take action against those
that do not report timely.
NURSING HOME NEGLECT CASE NOT INVESTIGATED TIMELY
The Department did not properly classify a reported neglect case against a nursing
home and, as a result, did not investigate the case within the required seven-day period.
The complaint alleged patient overdose by a nurse that resulted in the patient's death.
According to Department procedures, if the complaint had been properly classified it would
have been assigned a seven-day investigation period. Due to the misclassification the case
was assigned a thirty-day investigation period and was not investigated for 16 days.
(Finding 9, page 33)
We recommended the Department carefully review complaints to properly classify cases
and ensure investigations are performed within the time frame required by the Nursing Home
Care Act.
Department officials stated they will conduct quarterly meetings between the Long-Term
Care Field Operations personnel and the Central Complaint Registry personnel to improve
communications. During the meetings, special emphasis will be placed on time frames
recommended by the Complaint Registry and submitted to Field Operations in order to assure
that proper time frames are assigned.
NONCOMPLIANCE WITH THE FISCAL CONTROL AND
INTERNAL AUDITING ACT (FCIAA)
The Department's internal audit program does not meet statutory requirements of the
Fiscal Control and Internal Auditing Act (FCIAA) (30 ILCS 10/1001 et seq.). During
our audit we noted the following:
According to Department personnel, these conditions were caused by a lack of sufficient
staff in the Division of Audits. (Finding 1, pages 20-21) This finding has been
repeated since 1987.
Department officials concurred with our recommendation to strengthen its internal audit
program by allocating sufficient resources to its Division of Audits to allow statutory
compliance and adherence to the FCIAA Act. (For previous Department responses see digest
footnote number 1.)
OTHER FINDINGS
The remaining findings were less significant and officials have responded that
corrective action is in progress. We will review progress toward implementation of our
recommendations during our next audit.
Mr. Darrel Balmer, Chief Internal Auditor, provided the Department's responses to our
findings and recommendations.
AUDITORS' OPINION
Our auditors report the financial statements of the Illinois Department of
Public Health as of and for the years ended June 30, 1999 and 1998 are fairly presented in
all material respects.
____________________________________
WILLIAM G. HOLLAND, Auditor General
WGH:GSS:pp
SPECIAL ASSISTANT AUDITORS
Our special assistant auditors for this audit were Kerber, Eck & Braeckel
LLP.
DIGEST FOOTNOTES
#1 NONCOMPLIANCE WITH THE FISCAL CONTROL AND INTERNAL AUDITING ACT (FICAA) -Previous
Department Responses.
1997: "The Department concurs with this finding and recommendation. The Division
of Audits has made progress in meeting the goals and objectives established in the two
year audit plan. However, due to lack of adequate resources, all of the requirements of
the Fiscal Control and Internal Auditing Act have not been met. The Division will continue
to strive to meet the statutory mandates and as additional funding is made available
further improvements can be expected."
1995: "The Department concurs with the finding and recommendation. The Division of
Audits has made progress in meeting the goals and objectives established in the two year
audit plan. However, due to lack of adequate resources, all of the requirements of the
Fiscal Control and Internal Auditing Act have not been met. The Division will continue to
strive to meet the statutory mandates and as additional funding is made available further
improvements can be expected. In regard to the lack of required audit work relative to the
EDP systems, the Department has hired an Information Systems Auditor."
"The Department will examine the feasibility of reassigning the program monitoring
function within its current organizational pattern."
1993: "The Department concurs with the
finding and recommendation. The Division of audits has made progress in meeting the goals
and objectives established in the two-year audit plan. However, due to lack of adequate
resources, all of the requirements of the Fiscal Control and Internal Auditing Act have
not been met. The Division will continue to strive to meet the statutory mandates and as
additional funding is made available further improvements can be accomplished."
"The Department will examine the feasibility of reassigning the program monitoring
function within its current organizational pattern."
1991: "The Department concurs with the finding and recommendation. The Division's
inability to meet all of the requirements of the Fiscal Control and Internal Auditing Act
are attributable to the factors mentioned below and key vacancies within the Division
during a major portion of the audit period. "
"With the filling of two key positions, the Division of Audits anticipates that
additional progress will be achieved in meeting the goals and objectives established in
the Division’s two year audit plan."
"While the Department acknowledges that the internal audit function did not fully
meet the requirements of the Fiscal Control and Internal Auditing Act, several notable
accomplishments were realized during the current audit period. Foremost among these, was
the successful, yet time-consuming, implementation of the certification requirement of
Article 3 of the Fiscal Control and Internal Auditing Act. The Division of Audits assumed
the responsibility for implementing and coordinating this effort." (Response
continues outlining areas in which the internal audit functions has improved).
1989: "The Department concurs in the finding and recommendation. The finding
correctly states that the emphasis during the audit period has been on developing the
foundation for an effective program of internal auditing. The groundwork has now been laid
with the development of a two year audit plan and an audit procedures manual. We have also
pursued an aggressive program of staff professional development. The division has
experienced significant staff variances that have inhibited the quality and quantity of
work necessary to meet the statutory requirements of the Internal Auditing Act."
(Response continues with an explanation concerning changes that are anticipated to be made
in the Internal Audit area).
1987: "The Department concurs in the finding and recommendation. Several changes
have occurred within Audit Operations which address some of the concerns and
recommendations cited." (Response continues with an explanation concerning changes
made in Audit Operations).
