REPORT DIGEST

TINLEY PARK MENTAL HEALTH CENTER

LIMITED SCOPE

COMPLIANCE EXAMINATION

For the Two Years Ended:

June 30, 2005

Summary of Findings:

Total this audit                          2

Total last audit                          1

Repeated from last audit           0

Release Date:

June 13, 2006 

State of Illinois

Office of the Auditor General

WILLIAM G. HOLLAND

AUDITOR GENERAL

To obtain a copy of the Report contact:

Office of the Auditor General

Attn:  Records Manager

Iles Park Plaza

740 E. Ash Street

Springfield, IL 62703

(217) 782-6046 or TTY (888) 261-2887

This Report Digest and the Full Report are also available on the worldwide web at

http://www.state.il.us/auditor

SYNOPSIS

u      The Center did not file performance evaluations in a timely manner.

u      The Center had inadequate maintenance of patient files.

{Expenditures and Activity Measures are summarized on the reverse page.}

EXPENDITURE STATISTICS

FY 2005

FY 2003

FY 2002

   Total Expenditures (All Appropriated Funds)..

$23,470,440

$23,670,197

$24,816,235

     OPERATIONS TOTAL................................

         % of Total Expenditures........................

         Personal Services...................................

$23,280,490

99.2%

$16,160,263

$23,468,697

99.1%

$16,529,591

$24,686,824

99.5%

$17,210,178

                % of Operations Expenditures...........

                Average No. of Employees............

                Average Salary Per Employee.......

69.4%

219

$73,791

70.5%

295

$56,033

69.7%

297

$57,947

         Other Payroll Costs (FICA, Retirement)..

                % of Operations Expenditures.......

$3,652,837

15.7%

$3,198,110

13.6%

$3,611,322

14.6%

         Contractual Services...............................

                % of Operations Expenditures.......

$810,434

3.5%

$1,013,172

4.3%

$1,019,783

4.1%

         Commodities...................................................

                % of Operations Expenditures...................

$2,432,865

10.4%

$2,421,710

10.3%

$2,626,755

10.7%

         All Other Items......................................

                % of Operations Expenditures........

$224,091

1.0%

$306,114

1.3%

$218,786

0.9%

     GRANTS TOTAL..........................................

         % of Total Expenditures.........................

$189,950

0.8%

$201,500

0.9%

$129,411

0.5%

    Cost of Property and Equipment..................

$52,096,000

$52,146,699

$52,071,518

SELECTED ACTIVITY MEASURES               (Not Examined)

FY 2005

FY 2004

FY 2003

    Average Number of Residents..............................

109

127

136

    Ratio of Employees to Residents...........................

2.01/1

2.32/1

2.18/1

    Cost Per Year Per Resident.................................

*

$225,154

$208,592

*Department had not calculated at the close of fieldwork.

FACILITY DIRECTOR

     During Audit Period:  Ms. Brenda Hampton

     Currently:  Ms. Brenda Hampton

For 20 of 50 (40%) personnel files examined performance evaluations were completed late or not at all

Documentation required to be in patient files was missing

FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS

UNTIMELY FILING OF PERFORMANCE EVALUATIONS

      Written performance evaluations were not prepared and submitted on an annual basis.

      For 20 of the 50 (40%) employee personnel files examined, performance evaluations had been completed late or not at all.  Seven employees had performance evaluations that were performed between 25 and 120 days late and 6 over 120 days late.  Seven employees were missing performance evaluations for one of the two years in the engagement period. (Finding 1, page 9)

      The Department agreed with our recommendation that the Center prepare and submit performance evaluations in accordance with DHS Administrative Directives and the Illinois Administrative Code.

INADEQUATE MAINTENANCE OF PATIENT FILES

      In our testing of State mandates regarding documentation required to be included in patient files, we noted the following instances of missing documentation.

Of the 20 patient files tested:

·     8 of the 20 (40%) patient files did not contain either a notice of discharge form as required or a signed patient voluntary discharge form.

·     2 of the 12 (17%) patient files for female residents of child bearing age did not contain proof that a pregnancy test had been performed or the patient had signed a test refusal form as required. (Finding 2, page 10)

      The Department agreed with our recommendation that the Center ensure the timely filing of patient documents.

AUDITORS’ OPINION

      We conducted a compliance examination of the Center as required by the Illinois State Auditing Act.  This was a limited scope compliance examination.  The Center’s accounting records will be covered by the audit of the entire Department of Human Services.  Financial statements for the entire Department will be presented in that report.

____________________________________

WILLIAM G. HOLLAND, Auditor General

WGH:KMC:drh

SPECIAL ASSISTANT AUDITORS

      Our special assistant auditors for this audit were Duffner & Company, P.C.