Department of Health: Criminal History Background Checks ...

[Pages:217]New York State Office of the State Comptroller Thomas P. DiNapoli Division of State Government Accountability

Criminal History Background Checks of Unlicensed Health Care

Employees Department of Health

Report 2016-S-65

June 2017

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Executive Summary

Purpose

To determine if the Department of Health (Department) effectively oversees and monitors efforts by Nursing Homes, Adult Care Facilities (ACF), and Home Health Care (HHC) providers to adequately safeguard patients through requests for required criminal history background checks when hiring unlicensed persons in direct care positions. Our audit covered the period of April 1, 2014 through March 3, 2017.

Background

The Department, through its Criminal History Record Check (CHRC) Legal Unit, is responsible for conducting criminal history background checks of unlicensed persons in Nursing Homes, ACFs, and HHCs. Providers submit an electronic background check request through the CHRC system to the Department. The Department, in turn, submits a fingerprint request on behalf of the applicant if he/she has not previously been submitted through CHRC. These fingerprint results are sent electronically to the Federal Bureau of Investigation (FBI) and the New York State Division of Criminal Justice Services (DCJS), which, in turn, send any criminal history results to the Department. If the person has been fingerprinted before, the CHRC Legal Unit reviews the case using information from its initial request and any subsequent New York State arrest information. Between April 1, 2014 and December 7, 2016, the Department received 563,548 CHRC submissions. Of these, nearly 83 percent did not have a criminal history. For the approximately 17 percent with a criminal history, the CHRC Legal Unit conducted a review and made an employment eligibility determination. About 3.5 percent (19,622) of the CHRC submissions resulted in applicants being denied employment eligibility.

Key Findings

? The Department is generally meeting its obligations for conducting background checks on unlicensed employees of Nursing Homes, ACFs, and HHCs, according to State requirements. However, we did identify 24 CHRC applicants whose determination letters were not completed timely and, as a result, the individuals could have been allowed to work for periods ranging from 2 months to as long as 28 months. Of these, eight applicants (who were ultimately denied eligibility) actually worked on a provisional basis, for periods between 3 and 14 months while their background checks were pending.

? We also found that providers were unable to provide required documentation to support that three of these applicants were adequately supervised during the period when the background checks were pending, thereby potentially placing vulnerable persons at risk.

? Department officials promptly issued determination letters as a result of us bringing the 24 instances to their attention. Going forward, Department officials stated they will utilize this same analysis as a monitoring tool to ensure determination letters are sent timely.

Key Recommendation

? Continuously monitor and analyze CHRC data to ensure determination letters are sent to applicants and employers timely for all rap sheets that staff have reviewed and perfected.

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Other Related Audit/Report of Interest

Department of Health: Nursing Home Surveillance (2015-S-26)

2016-S-65

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2016-S-65

State of New York Office of the State Comptroller

Division of State Government Accountability

June 8, 2017

Howard A. Zucker, M.D., J.D. Commissioner Department of Health Empire State Plaza Corning Tower Albany, NY 12237

Dear Dr. Zucker:

The Office of the State Comptroller is committed to helping State agencies, public authorities, and local government agencies manage government resources efficiently and effectively and, by so doing, providing accountability for tax dollars spent to support government operations. The Comptroller oversees the fiscal affairs of State agencies, public authorities, and local government agencies, as well as their compliance with relevant statutes and their observance of good business practices. This fiscal oversight is accomplished, in part, through our audits, which identify opportunities for improving operations. Audits can also identify strategies for reducing costs and strengthening controls that are intended to safeguard assets.

Following is a report of our audit entitled Criminal History Background Checks of Unlicensed Health Care Employees. This audit was performed according to the State Comptroller's authority under Article V, Section 1 of the State Constitution and Article II, Section 8 of the State Finance Law.

This audit's results and recommendations are resources for you to use in effectively managing your operations and in meeting the expectations of taxpayers. If you have any questions about this report, please feel free to contact us.

Respectfully submitted,

Office of the State Comptroller Division of State Government Accountability

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Table of Contents

Background Audit Findings and Recommendation

Background Check Monitoring Recommendation Audit Scope, Objective, and Methodology Authority Reporting Requirements Contributors to This Report Agency Comments State Comptroller's Comments

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State Government Accountability Contact Information: Audit Director: John Buyce Phone: (518) 474-3271 Email: StateGovernmentAccountability@osc.state.ny.us Address:

Office of the State Comptroller Division of State Government Accountability 110 State Street, 11th Floor Albany, NY 12236

This report is also available on our website at: osc.state.ny.us

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Background

The Department of Health (Department) is responsible for conducting criminal history background checks of unlicensed persons seeking employment with Nursing Homes, Adult Care Facilities (ACF), and Home Health Care (HHC) providers. The background check process is the same for all three types of facilities. Licensed professionals, such as doctors and nurses, are exempt from these requirements. Providers are allowed to provisionally hire applicants while background checks are pending, but only subject to specific direct supervision requirements if the employee is to have direct contact with either patients or their property.

The Criminal History Record Check (CHRC) system is used to process all CHRC applications for unlicensed staff with patient or patient property contact at all health care facilities subject to CHRC regulation. Providers submit an electronic background check request through the CHRC system to the Department. The Department, in turn, submits a fingerprint request on behalf of the applicant if he/she has not previously been submitted through CHRC. These fingerprint results are sent electronically to the Federal Bureau of Investigation (FBI) and the New York State Division of Criminal Justice Services (DCJS), which, in turn, send any criminal history results to the Department. If the person has been fingerprinted before, the CHRC Legal Unit reviews the case using information from its initial request along with any subsequent New York State arrest information. The FBI does not have the capability to send only subsequent arrests at this time.

Records indicate that, for the applicants subject to the CHRC system, about 83 percent do not have a criminal history and therefore do not require further review by the CHRC Legal Unit. In these cases, a positive employment eligibility letter is automatically generated to the employer. For the approximately 17 percent of applicants with a criminal history, the CHRC Legal Unit conducts further review, including reaching out to courts nationwide when necessary, and makes an employment eligibility determination.

Within the CHRC Legal Unit, legal assistants go through a process to "perfect" the criminal history records (i.e., "rap sheets") received, which involves reviewing the rap sheet and conducting additional research to ensure the charges and convictions are correct and fairly represented. Once a rap sheet has been perfected, a lawyer reviews the CHRC file and makes a legal employment determination. If the employee is given a positive legal determination, the provider is sent a letter with the decision. After receiving this letter, the provider then has the choice whether to employ the individual or not. If the employee is given a negative legal determination, a pending denial letter is issued to the provider and employee. The employee must then be removed from direct care responsibilities while awaiting a final decision, and is given 30 days to show why he/she should be considered eligible for employment.

The Department monitors providers to ensure they subject unlicensed employees to background checks, as required. Each of the Department's three divisions that oversee these services (Nursing Homes, ACF, and HHC) conducts surveys and on-site inspections to ensure that CHRC and other policies are being carried out on a day-to-day basis.

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CHRC policies also include specific requirements for providers to supervise any temporary employees until their legal determination is made. For Nursing Homes and ACFs, on-site supervision occurs until the temporary employee's background check is cleared or the provider receives a pending denial notice to remove the temporary employee from direct care. For HHC, on-site supervision is provided for the first week of employment. After the first week, on-site and off-site supervision must be provided and documented in alternating weeks. Department officials stated that the off-site supervision is usually via a phone call by the HHC supervisor to the patient or patient's family.

The Department documents providers' compliance using a survey checklist to determine whether or not the provider is in compliance with CHRC policies and procedures. This checklist includes, but is not limited to: analyzing if the provider has appropriate CHRC policies in place, ensuring the authorized person at the provider allowed to view the criminal history is still an active employee, and sampling both new hires and negative determination letters to determine if the provider is submitting employees and responding to determinations appropriately. The Department's survey teams also review the provider's supervision logs to ensure supervision of employees is documented as required. Even though the Department verifies the logs are completed as required, Department officials stated that the responsibility of supervising temporary employees rests with each provider and not the Department.

The survey teams communicate any deficiencies to the providers while on site at the facility, as well as provide a written statement of deficiencies. Providers are required to respond to this statement and submit an appropriate plan of correction that the Department reviews and must find acceptable. The Department attempts to ensure the corrective actions will not only fix the issue found, but also prevent the same problems from occurring in the future. This helps monitor the providers to ensure the problems are resolved.

These surveys are required for Nursing Homes every 9-15 months, ACFs every 12-18 months, and HHCs at least once every three years. To ensure that the Department is complying with the required time frames for inspections, each oversight division (Nursing Homes, ACF, and HHC) has an employee responsible for monitoring the required time frames and scheduling when the inspections occur.

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Audit Findings and Recommendation

We found that the Department generally met its obligations for conducting criminal history background checks of unlicensed employees across all three types of providers, according to State requirements. However, our analyses identified 24 CHRC applicants whose determination letters were not completed timely and, as a result, these individuals could have been allowed to work provisionally from 2 months to 28 months without final clearance. These errors occurred because the CHRC database is not currently able to track when applicants' files are returned by the Department's lawyers to the legal assistants for additional follow-up. This weakness could lead to individuals who should have been denied eligibility nonetheless having unsupervised direct care contact. Further review found that eight of these applicants, whose eligibility was ultimately denied, actually worked for periods of 3 to 14 months while their background checks were pending.

Because we brought this to the Department's attention, determination letters were sent to each facility for all 24 applicants. Subsequent investigation found that providers were unable to produce required documentation to support that 3 of the 24 applicants were properly supervised during the period while their background checks were pending, thereby potentially placing vulnerable persons at risk. Furthermore, Department officials stated that they intend to utilize this same analysis as a future monitoring tool, and that the CHRC database is expected to be upgraded by June 2017 to include additional monitoring and tracking to address this weakness.

Background Check Monitoring

From April 1, 2014 through December 7, 2016, the Department received a total of 563,548 CHRC submissions, including 467,498 applicants with no criminal history and 96,050 applicants who did have a criminal history. For about 3.5 percent (19,622) of the total submissions, Department staff determined that the applicants should not be employed in direct care positions. Of the 96,050 applicants with a criminal history, 76,428 (80 percent) were issued a positive determination (see Table 1).

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