Audit Report on the Department for the Aging’s Monitoring of Social Adult Day Care Centers

Executive Summary

The Department for the Aging (DFTA) promotes, administers, and coordinates the development and provision of services for older New Yorkers to help them maintain their independence and participation in their communities. DFTA supports a broad range of services, both directly and through over 500 direct service contracts with community-based organizations.

A social adult day care center (SADC) is a structured program that provides functionally impaired older adults with socialization, supervision, personal care (e.g. assistance with mobility, eating, and toileting), and nutrition in a protective setting. Several hundred SADCs are operating in New York City (City), most of which have no contracts with DFTA and do not receive discretionary grants, although they may receive public funds through Medicaid reimbursements, which are partly funded by the City.  DFTA categorizes the SADCs that receive direct City discretionary funding and enter into contracts with DFTA—currently nine programs—as Social Adult Day Services programs (SADS).

The City Council enacted Local Law 9 of 2015 to establish City oversight, through DFTA, of the several hundred SADCs that operate in the City without receiving discretionary grant funding. The statute requires all SADCs operating in the City to register with DFTA. To carry out certain responsibilities assigned to it by Local Law 9 of 2015, DFTA designated an SADC Ombudsperson and created the Ombuds Office. DFTA, through its Ombuds Office, is responsible under the statute for receiving, investigating, and responding to SADC-related complaints and inquiries. Local Law 9 of 2015 also requires the Ombuds Office to provide a written annual report to the City Council regarding SADCs.

Thereafter, in 2018, the City Council enacted Local Law 9 of 2018, which required DFTA to create an online searchable database of the SADCs operating in the City, including their names, addresses, and hours of operation. In addition, the database is supposed to allow an individual to submit comments or complaints about an SADC electronically to the Ombuds Office.

A 2018 amendment to the Administrative Code of the City of New York further requires DFTA to provide the Department of Health and Mental Hygiene (DOHMH) with a list of all SADCs registered with DFTA. Finally, DFTA is required to make available on its website information about the SADC inspections conducted by DOHMH.

DFTA’s Bureau of Healthcare Connections (HCC) oversees the SADC Ombuds Office, the Caregiver Resource Center, and New York Connects. HCC’s program officers also provide ongoing and ad hoc technical assistance to the SADS and are required to conduct annual assessments to ensure the SADS’ programs are in compliance with New York State Office for the Aging (NYSOFA) standards and the applicable laws, rules and regulations.

The objectives of the audit were to determine whether DFTA: (1) is in compliance with Local Law 9 of 2015 and Local Law 9 of 2018; and (2) adequately monitors the SADSs with which it contracts to ensure that they operate in accordance with certain applicable requirements and policies.

Audit Findings and Conclusions

The audit found that although DFTA complied with certain aspects of Local Law 9 of 2015 and Local Law 9 of 2018, the agency was noncompliant with both laws in several areas. (See Appendix for a listing of the laws’ requirements and our assessment of DFTA’s compliance.) In particular, we found that DFTA did not timely adopt rules establishing civil penalties for violations of applicable laws and regulations by SADCs operating in the City as required by Local Law 9 of 2015. Specifically, DFTA did not publish its proposed rules until November 2019, while this audit was in progress, nearly four years past the deadline that Local Law 9 of 2015 established for the agency to adopt final rules. The rules went into effect on February 8, 2020. In addition, DFTA does not conduct any investigations into complaints it receives against SADCs as required by Local Law 9 of 2015.

We also found that DFTA’s online public searchable database (website) did not, until very recently, include certain SADC related information required by Local Law 9 of 2018, such as an SADC’s corporate structure and ownership, managed long-term care affiliations, and information about SADC inspections conducted by DOHMH. DFTA’s website also does not include information required by Local Law 9 of 2018, such as the following: the number of notices of violations (NOVs) DFTA issued to an SADC; the resolution of any violations issued; and the year and nature of the violations.

We found that DFTA did not consistently track complaint referrals to state oversight agencies and that referrals to these agencies were not performed in a timely manner. Furthermore, we found that DFTA hardcopy files did not contain adequate evidence of complaint processing.

For City-funded SADS, we found insufficient evidence of required self-monitoring, corrective action plans (CAPs) were not submitted in a timely manner by the SADS, and incidents, which occurred at the SADS, were not centrally tracked.

Audit Recommendations

Based on the audit, we make 12 recommendations, including:

• DFTA should ensure that it consistently enforces the recently finalized rules establishing civil penalties that can be assessed against SADCs for violations of Local Law 9 of 2015 and the regulations it references and implement the internal procedures necessary to ensure that notices of violation are issued as warranted.
• DFTA should ensure that it follows the steps outlined in the recently finalized rules for referring and/or investigating complaints against SADCs.
• DFTA should continue to ensure that it posts all required information for SADCs on its website in accordance with the local law, including SADC violations of its recently finalized rules.
• DFTA should draft procedures to help ensure that all complaints are logged and tracked from receipt to disposition and to ensure that when it refers complaints to State and City agencies it adequately documents the referrals and tracks the outcomes.
• DFTA should establish a mechanism to track the timeliness of complaint referrals and to ensure that it makes referrals timely.
• DFTA should ensure that evidence documenting all steps within the complaint process is in the files.
• DFTA should require SADS to complete the NYSOFA Self-Monitoring Tool to ensure compliance with the State standards.
• DFTA should require programs to submit CAPS timely.
• DFTA should establish a mechanism to document all SADS incidents and track the timeliness of incident reports to ensure that SADS are submitting them timely.

Agency Response

DFTA generally agreed with 10 of the audit’s 12 recommendations, although it contends that it already complies with 3 of them (#s 3, 7, and 10), and partially agreed with the 2 remaining recommendations (#s 4 and 6).