Client care seems to be well down on the list of Joplin Regional Center priorities, according to an audit posted on Missouri State Auditor Claire McCaskill's website Wednesday.
"The Joplin Regional Center has not taken adequate steps to ensure clients receive the best care possible," the audit said. "Unsatisfactory living conditions were observed during a visit to two individualized supported living (ISL) homes and one group home. In addition, we identified concerns related to unsatisfactory living conditions for a client living in her natural home."
The audit noted that the Regional Center has a quality management team consisting of a supervisor, four specialists, and a nurse. "Despite these monitoring procedures, clients still may not be receiving the best care possible." During inspections of these homes, state auditors uncovered serious violations that were not even mentioned in Regional Center reports, the audit says.
Homes with rodent and insect problems, mildew in the showers, damaged furniture, doors, and appliances, and serious wiring problems, were noted in one home, while an inspection of another home found badly stained carpets, damaged walls, and broken appliances.
"Given these conditions, we found it quite disturbing that a regional center service coordinator had visited both of the aforementioned homes on March 16, 2006, and the coordinator's notes contained no mention of these concerns. In addition, we found that regional center service coordinators had not visited the second home to perform service monitoring as required. For example, required monthly service monitoring was not performed for six different months between January 2005 and February 2006."
The audit indicates that after auditors told Regional Center officials about these problems, "the JRC subsequently took steps to move the three clients from the homes."
The auditors' inspection of a group home uncovered broken furniture, holes in the walls, broken appliances, and unsanitary conditions.
Regional Center officials, in their response, indicated they will have their quality management team go through more training.
Problems with handling of clients' funds
The audit uncovered instances in which no adequate documentation was made for various expenditures. Client funds were not deposited in a timely fashion, the audit said, and two facilities "did not maintain spending ledgers to track all client spending activity.
One facility used client funds to pay for the home's operating expenses. "We noted four instances where this occurred, and the amounts were not always reimbursed to the client on a timely basis
The audit also said:
-The JRC spent more than $19 million in fiscal year 2005, but it could "better manage costs by monitoring service providers' actual and past costs of operation and by reviewing rates for consistency.
-The activities of one provider, not named, were not adequately controlled. "This provider was paid over $1 million during the two years ended June 30, 2005, for services provided to the Southwest Project, which includes the Joplin and Springfield regional centers." Despite this, the audit says, "the quality management team does not perform any type of quality assurance review of this provider."