The July 2011 disclosures by San Diego's Channel 8 News that Department of Social Services (DSS) is investigating bribery allegations against three Licensing Program Analysts (LPAs) from San Diego's Community Licensing (CCL) Residential Care Facility for the Elderly (RCFE) unit, should be a wakeup call for DSS/CCL to evaluate its management metrics. According to the 760 KFMB AM Talk Radio's story posted 1 July 2011, "Records Released in State Licensing Bribery Investigation" the licensing inspector Conchita Valero "repeatedly cleared complaints filed against the operation of a Mira Mesa," RCFE.
This revelation, while perhaps startling, is not news. Beginning in 2009, CARR initiated a detailed review of the public records for a random sample of 354 RCFEs in San Diego and Imperial counties, and subsequently reported its findings in “An Exposition of Irregularities in Residential Care Facilities for the Elderly (RCFE) in San Diego and Imperial Counties,” (Montezuma Press, 2011).
CARR's early research included capturing and coding approximately 5,500 discrete inspection reports and violations from 2000 – 2009. From this coded data, clear enforcement patterns by individual inspectors emerged; one inspector in the sample alone wrote over 40% of all citations, and was responsible for more citations than the combined citation count of the next 8 inspectors.
There were other patterns too: some inspectors issued more Type A citations, than Type B’s, and some more frequently investigated complaints with an outcome of “Unfounded” instead of “Substantiated. In view of the bribery allegations against Ms. Valero, CARR returned to its database to examine Valero's particular citation and complaint investigation track record.
CARR extracted all reports for the five LPAs who worked contemporaneously with Ms. Valero for the period 2/2007 through 6/2009, the end of the sample period. CARR hen reviewed all complaint actions by individual LPA, and calculated how many of each type of outcome (Unfounded, Inconclusive, and Substantiated) each LPA had accumulated. From there, percentages could be determined. Ms. Valero ranked first in Unfounded Complaints: 78% of all her complaints were “Unfounded” - found in favor of the Licensee, and against the complainant. The mean all LPA profiles of ‘Unfounded’ complaints was 37%, and the median was 30%. By either measure, Ms. Valero’s record was over twice as high.
In CARR's experience families don't frivolously file complaints with CCL against assisted living facilities. Most complainants we know have filed legitimate complaints out of concern for the health and safety of their resident or other residents in the facility, not out of malice or spite. So for Ms. Valero to have racked up a 78% track record of unfounded complaints seems to CARR highly suspect; surely there must have been some reasonable basis for families to have filed complaints? but apparently Ms. Valero couldn't identify what that might have been 78% of the time.
What CARR does know is that the data for this simple metric – easily obtained from the public record in 2009, was most certainly available to CCL’s management had they been taking the time to collect the data. Each report written by an LPA, is signed by that LPA’s Licensing Program Manager. Why, if Ms. Valero’s record was more than twice as high as both the average and the mean of her peers, didn’t any of her Licensing Program Managers notice, and perhaps refuse to sign off on the report until questions had been asked? CARR wonders why CCL isn't collecting performance metrics for its inspectors, then using those metrics as sanity-checks against the performance of the individual inspectors?
After spending many hours at CCL reviewing the public files of RCFEs CARR"s view is that CCL has developed an insular, perhaps even symbiotic relationship with the RCFE owners, to the exclusive detriment of the residents of assisted living – the clients they are responsible for protecting.
Perhaps the department’s culture of insularity prevents CCL’s managers and inspectors from remembering who their work is intended to protect?