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.

Other Related Audit/Report of Interest

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