SALT LAKE CITY — Child care facilities accused of violating safety standards can operate as normal during their appeals process, a practice that is putting children at risk, a state audit released Tuesday concludes.
The Division of Family Health and Preparedness' Child Care Licensing program "does not increase monitoring of providers who operate during the appeals process," states the audit, prepared by the Office of the Legislative Auditor General.
"We … found the appeals process improperly delays the use of sanctions, allowing child care providers continued access to children even in a confirmed case of child abuse. We are concerned that current policies for sanctions and appeals leave children at risk," the report states.
In that child abuse case, the licensing office's "complaint investigator substantiated the complaint of child abuse" in December 2016 and reported "there were several instances in which children in care were subjected to physical and emotional abuse," the audit says.
"At the time, the police officer investigating the case told (the agency) he was 'worried for the safety of the other children as they have an open case for child abuse,' yet (the agency) chose not to close the facility. The provider and her husband continued providing care without restrictions or enhanced supervision," according to auditors.
Anndrea Parrish, a lead auditor for the Legislative Auditor General's Office, addressed legislators, echoing her written conclusions.
"We are concerned that providers are allowed to continue during the appeals process without increased monitoring," Parrish told the Legislative Audit Subcommittee. "It is imperative that children are protected throughout the process."
The audit also looked at how other Western states shorten the appeal period depending on the seriousness of the violation. It found that even for standard violations, Utah ranks last among surrounding states for appeals timing.
The report also says the Child Care Licensing program "has broad statutory authority," but that some of the sanctions at its disposal "are rarely used due to insufficient policies."
"There are several weakness in how (sanctions) are applied," Parrish said, and those measures are generally not good at dissuading repeat violations.
The audit reviewed cases in which providers had been sanctioned by the licensing agency at least three times and provided anecdotal examples in which auditors felt the state's response was not rigorous enough.
This included an incident in which the agency took no action after receiving a report of a child confined "in a port-a-crib covered with a trampoline inside a laundry room," despite that home-based care center having received "14 cited findings and 16 repeat cited findings of the most severe level of violation during a four-year period."
Another example given was that of a provider not being cited for three instances of leaving a child unattended at some point in fiscal year 2017, despite nine prior violations since 2014.
"Current policies do not call for the issuing of sanctions unless violations occur in consecutive inspections or accumulate to 15 in one year," the audit states. "This case illustrates our concern that current applications of sanctions have not corrected patterns of violations."
In another case, three people living in a home had not undergone background checks. In that case, officials imposed fines three times over the following three months, but stopped doing so in the two months before the issue was taken care of and didn't conduct any on-site inspections.
Child Care Licensing is a separate entity from Child Protective Services, which is part of the state Department of Human Services. The licensing agency relies too extensively on disciplinary measures handed down by Child Protective Services and law enforcement agencies and needs more clarity about its responsibilities in conjunction with those bodies, the audit states.
The Division of Family Health and Preparedness employs about 270 people with a $122 million annual budget as of fiscal year 2016. The division's director, Paul Patrick, wrote in a response to the Office of the Legislative Auditor General that he agreed with all of the recommendations for improvement.
Patrick wrote that the division is in the process of shortening the appeal process and plans to "conduct monitoring inspections during the appeal."
"Additionally, we will provide online public access to our appeal policies and procedures, as well as implement monitoring processes so that children are still protected during appeals," he wrote.
Patrick also told the Legislative Audit Subcommittee that "we're very committed to stronger sanctions."
"That's something that we feel would be very beneficial to us, to increase the penalties and have a scale where we can increase the fines for repeat violations," he said.
Rep. Brian King, D-Salt Lake City, said he was concerned about how the shortcomings as described by the audit would affect "the most vulnerable citizens in the state."
"I'm troubled by some of the things the audit turned up, quite honestly, because it's a wide range of deficiencies," King said. "I think you've got a lot of work to do."
He added that "you've had the right attitude and accepted the findings, so I appreciate that."
The audit also singled out Health Facility Licensing, another unit that is part of the Division of Family Health and Preparedness, saying officials there are "one year behind in determining whether an employee that has been flagged with a background screening concern should work in a health facility."
"We spoke with one administrator who hired and continuously employed an individual for one year before terminating this person for administering medication via needle without a license," the audit states. "The administrator reported that at least one year after the employee had been fired ... (the state) determined that the individual was not fit to work in a health facility because of a similar offense they performed in a prior facility."
A significant number of health facilities are also failing to ensure all of their employees undergo background checks that are screened with the state database.
In part due to the increasing number of assisted living centers — 216 statewide in 2016, compared to just 183 in 2012 — the audit also found that regulatory surveyors are not reviewing facilities often enough.
While total number of beds in assisted living centers statewide have jumped 39 percent since 2012, the audit reported, the number of state surveyors responsible for overseeing them increased just slightly — from four to five.
Auditors concluded that there was a correlation between increased noncompliance and the decreasing frequency of regulatory reviews, citing an increase in citations since 2012.
"Surveyors inspecting facilities for safety and environmental risks are finding more deficiencies as time between surveys expands, including more serious offenses," the audit stated, placing residents there at risk.
The audit found that there are significantly more health facilities per surveyor in Utah (84) than in bordering states such as Colorado (73), Arizona (71), Idaho (40) and Nevada (21).
Patrick said he was interested in speaking with legislators about using existing division funds to hire additional surveyors.
King urged Patrick to "aggressively go to bat" for that appropriation and other needed funding.
"You have to have additional funding to address these things, whether it's staffing or inspections. .... You need more resources," King said.