A majority of complaints filed against nursing care administrators and managers are dismissed because the complaints are too old to pursue, a state audit of the Board of Nursing Care Institution Administrators and Assisted Living Facility Managers has found.

The Office of the Auditor General released the 74-page report on Dec. 30. The report includes a two-page letter and an eight-page formal response from Victoria Martin, executive director of the Board of Nursing Care.

Ms. Martin stated in her official response that she didn’t necessarily agree with all 17 recommendations for improvement, but in most cases, the board will implement the recommendations, although sometimes in a different manner than the audit report suggests.

The report has four central findings:

• The board should improve complaint processing.

• Board practices restrict access to public information.

• The board should improve oversight of operations.

• State requirements of the board are not always followed.

The board was created in 1975 to fulfill a federal requirement that nursing care institution administrators be licensed and regulated in order for the state to receive federal Medicaid funding, the Auditor General report states. In 1990, the Legislature added certification of assisted living facility managers to the board’s responsibilities in order to ensure minimum care standards for residents of assisted living facilities.

As of November 2004, the board had five fulltime staff members and two part-time investigators regulating 2,726 licensed long-term care professionals, Ms. Martin stated in a letter to Auditor General Debra Davenport. The board had a budget of about $350,000 in the 2004 fiscal year, of which nearly $181,000 was raised through licensing fees.

“The board needs to take several steps to ensure that complaints are investigated and adjudicated in an appropriate and timely manner,” the audit report states.

’Untimely Investigations’

“During fiscal years 2003 and 2004, the board had to dismiss numerous complaints due to untimely investigations,” the report continues. “During that time, board staff forwarded 61 complaints for adjudication that had been received in fiscal years 1999 through 2002. The board dismissed 53 of these complaints. Many were dismissed because so much time had passed that either the manager’s or administrator’s credentials had expired or no further investigation could be conducted because necessary information and access to witnesses were no longer available. As a result, the board’s ability to protect the public was decreased.”

“Board staff have continued to conduct untimely investigations for complaints received in fiscal years 2003 and 2004,” the audit report states. More than 100 of the 126 complaints the board received in that period remained open as of July 2004. “Auditors reviewed 19 of the closed complaints and found that all but three had been investigated and resolved within 180 days. However, a review of 25 randomly selected complaints still unresolved as of July 2004 showed that they had been open between 260 and 680 days.

“These lengthy processing times are a concern because information needed to adjudicate complaints may become hard to obtain as time passes and administrators and managers named in the complaints are able to continue to practice unchecked,” the report states.

In one case, the board received a complaint from the state Department of Health Services in September 1999 that alleged the manager of an assisted living facility abused and neglected the residents, the report states. The manager was accused of not having enough food in the facility and keeping the temperature of the facility at 90 degrees for one week. The Department of Health Services substantiated the allegations in August 1999; nonetheless, “the manager maintained an active certificate [license] for almost two more years until June 2001, when she allowed it to expire, and therefore was eligible to manage another facility until that time,” the report states. “Board staff did not submit this complaint to the board for its review and adjudication until November 2003. This was over four years after the complaint had been filed, and the board could not take action because the manager’s certificate had long since expired.”

Response: ‘An Unprecedented Level Of Scrutiny.

Ms. Martin stated in a letter to the auditor general that the board has made numerous improvements over the past couple of years, but has been burdened in 2004 by the six-month audit by the Auditor General’s Office and a Department of Administration audit.

“This was an unprecedented level of audit scrutiny for a small … board and was a great financial and administrative burden for the board,” Ms. Martin stated. “It effectively brought our rebuilding efforts to a standstill. But the audits did not find any missing funds, misappropriated funds or malfeasance.” —