REPORT HIGHLIGHTS PROGRAM AUDIT OF THE DEPARTMENT OF HUMAN SERVICES OFFICE OF THE INSPECTOR GENERAL PROGRAM AUDIT Release Date: December 4, 2024 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, 400 West Monroe, Suite 306, Springfield, IL 62704-9849 (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 BACKGROUND: The Department of Human Services Act (Act) directs the Auditor General to conduct a program audit of the Department of Human Services, Office of the Inspector General on an as-needed basis. Section 1-17(w) of the Act that establishes the authority for this audit can be seen in Appendix A. The Act specifically requires the audit to include the Inspector General’s compliance with the Act and effectiveness in investigating reports of allegations occurring in any State-operated facility or community agency (20 ILCS 1305/1-17(w)). The Office of the Auditor General has previously conducted 13 program audits of DHS OIG. The first audit was released in 1990 and the most recent in 2021, which covered FY18 through FY20. This audit covers FY21 through FY23. KEY FINDINGS: The Department of Human Services Act requires the Office of the Inspector General (OIG) to investigate allegations of abuse and neglect that occur in mental health and developmental disability facilities operated by the Department of Human Services (DHS). The Act also requires the OIG to investigate allegations of abuse and neglect that occur in community agencies licensed, certified, or funded by DHS to provide mental health and developmental disability services. During FY23, there were a total 394 community agencies with 4,217 program sites that were under the investigative jurisdiction of the OIG. In addition, there were also 13 State-operated facilities under the investigative jurisdiction of the OIG. OIG investigators in many cases are responsible for hundreds of program sites covering large areas of the State, as well as State-operated facilities. • The total number of allegations in FY21 (2,423) was the lowest number of allegations received since FY11 (2,255). However, the total number of allegations increased to 2,772 in FY22 and 3,281 in FY23. For FY11 through FY23, community agency allegations accounted for 59 to 73 percent of all reported allegations of abuse or neglect. For FY21, FY22, and FY23, community agency allegations accounted for 61 percent, 62 percent, and 59 percent of all reported allegations of abuse or neglect, respectively. • Cases took an average of 205 calendar days to complete during FY23, or an increase of 25 days, when compared to the FY20 audit. • For FY23, 22 percent of cases were completed within 60 calendar days, which represents an 8 percent decrease in timeliness from the prior audit and a 14 percent decrease when compared to FY21 (36%) and FY22 (36%). • The timeliness of case file reviews has worsened since the FY20 audit. During FY20, it took the OIG on average 41 days to complete a supervisory review of substantiated cases. During this audit period, the average number of calendar days to review substantiated cases for FY21 was 71 days, for FY22 was 66 days, and for FY23 was 86 days. • The Department of Human Services Act and the OIG’s administrative rules require that allegations be reported to the OIG Hotline within four hours of initial discovery of the incident of alleged abuse or neglect. For FY21 through FY23, the percentage of allegations not reported within the statutorily required four hours for community agencies was between 15 and 16 percent. For State-operated facilities during the same time period, the number of allegations not reported within the four- hour time frame was between 7 and 10 percent. • For FY21 through FY23, auditors found that 20 of the 42 (48%) unannounced site visit reports were sent outside of 60 days. No supporting documentation could be provided to show that an OIG employee was on site for the second unannounced site visit date at each State-operated facility for FY22 and FY23. • During the audit period, FY21 through FY23, the OIG requested to hire for 38 positions. Of these 38 hiring requests, 17 positions had been filled as of August 17, 2023, and 21 were still vacant. Once the position was posted, two positions were filled within three months, ten positions took between 4 and 6 months to fill, and five positions took between 7 and 12 months to fill after the hiring request was made. • For FY23, DHS reported that 5,024 of 7,206 (70%) State-operated facility employees had overtime. The 5,024 employees accumulated 1,606,962 hours of overtime during FY23; 793 of these employees accumulated between 501 and 997 hours of overtime, and 330 employees accumulated over 1,000 hours of overtime during FY23 (318 of these 330 were employees with a direct care job title). These 318 employees accumulated a total of 443,527 hours of overtime during FY23. Multiple academic studies have found that excessive amounts of overtime can have a detrimental effect on the care provided to residents or patients, as well as the health care workers providing the care. KEY RECOMMENDATIONS: The audit report contains 12 recommendations including: • The Office of the Inspector General should work to improve the timeliness of investigative case completion by identifying the barriers that are preventing timely completion and seeking the appropriate remedies for the issues identified. • The Office of the Inspector General should work to improve the timeliness of OIG conducted interviews, and State-operated facility and community agency liaison conducted statements, including: ­ ensuring initial written statements are taken within 72 hours per OIG directive; and ­ ensuring the complainant and/or required reporter and the victim and/or guardian are interviewed by an OIG investigator within 15 working days of assignment per OIG directive. • The Office of the Inspector General should ensure that investigations are reviewed by the Investigative Team Leader or Bureau Chief within fifteen working days of receipt absent extenuating circumstances as required by OIG directives. • The Department of Human Services should ensure that all employees at State-operated facilities receive training in prevention and reporting of abuse, neglect, and exploitation as required by administrative rules, and the Department of Human Services Act (20 ILCS 1305/1-17(h)). • The Office of the Inspector General should take steps to ensure that unannounced site visit reports are sent to State-operated facilities within 60 days of the site visit being completed as required by OIG Directive. • The Office of the Inspector General and the Department of Human Services should work together to identify and mitigate the bottlenecks in the hiring process and address pay structure imbalances for management positions. • The Department of Human Services should conduct a staffing analysis to determine if staffing levels at State-operated facilities are adequate. The staffing analysis should take into consideration the need to reduce excessive amounts of employee overtime, especially for direct care employees. This performance audit was conducted by the staff of the Office of the Auditor General.