State audit cites flawed disabilities care system

COLUMBIA - The South Carolina agency charged with serving the state's most vulnerable and disabled children and adults falls far short in protecting them, an audit of the agency finds.

The report, issued Tuesday, says the Department of Disabilities and Special Needs fails to follow up on safety violations and doesn't do enough to keep abusers off facility payrolls. The agency oversees local boards and licenses providers that care for children and adults with disabilities around the state.

In the 80-page audit, the Legislative Audit Council questioned whether the agency is firing people, as its policies require, when claims of abuse are substantiated.

Between Jan. 30 and July 30, 2007, the agency had 70 substantiated cases involving staff, but its records showed only 59 resulted in firing, "leaving 11 where the policy was not followed," the audit said. In an 11-page response, the department said action was taken in all cases, but auditors said documentation was lacking to back up the claim.

The audit recommends Disabilities and Special Needs require fingerprinting and FBI national background checks for caregivers, not just a check through the South Carolina State Law Enforcement Division. The agency said it would consider the feasibility of fingerprint checks.

Meanwhile, the agency isn't doing enough to check references. It "does not have an adequate system to ensure that direct caregivers who are dismissed for consumer safety-related disciplinary infractions are not rehired elsewhere in the system," the audit said. The agency said it would revise its reference check system to require more detailed information about applicants.

Auditors also found flaws in the agency's follow-through on problems at licensed facilities. "In our sample of 26 licensing reviews, there were only two follow-up reports for the 25 reviews for which they were needed," the audit said.

In 2007, Disabilities and Special Needs implemented a new policy requiring follow-up visits when inspectors found problems that could jeopardize clients' physical, emotional and financial well being. Auditors sampled nine original reports that cited a total of 100 such violations, including failure to document that medication was given appropriately, missing smoke detectors and water heaters set too hot for residents. "We found no documentation that any follow-up visits to these facilities took place," the report said.

The agency said it would improve its follow-up system.

The report also raised questions about how clients' personal funds are handled. It cited personal checks not filled out correctly and questionable purchases made on the clients' behalf at facilities run by providers. It "found that consumers' funds are often mishandled by disabilities and special needs board staff. DDSN should strengthen its controls to ensure that consumers' funds are handled appropriately," the report said.

The agency said it would improve training.

The agency also has been sluggish in implementing new programs the Legislature mandated and paid for.

For instance, the audit found only $671,917 spent of the $10.5 million earmarked in fiscal 2007 and 2008 to expand intensive therapy for children with autism. "We could not determine how DDSN has used the additional funds it received for the autism program," the report said.

The agency said it must carefully plan spending and take into account whether it can rely on continued funding, to avoid starting services and taking them away later. For instance, the agency noted it has lost more than 11 percent, or $21 million, in state money this year to budget cuts.