⚠️ Aviso de traducción: Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 12 findings
F1
The Department of Health Services Fiscal Department lacked formal, written policies and procedures congruent with industry-standard budget development.
Related Recommendations (1)
R1
The CAO’s office create and maintain policy and procedure manuals for each DHS department, and desk manuals for all positions in Fiscal and Behavioral Health Divisions by Dec. 31, 2019 [F1]
F2
BHD failed to establish and audit all CBO performance requirements.
Related Recommendations (1)
R2
DHS prioritize implementation of the Avatar system by Dec. 31, 2019 [F6]
F3
Projected revenue from anticipated programs and contracts continually failed to materialize, but remained in the budget.
Related Recommendations (1)
R3
BHD include all managers in budget development and review by Dec. 31, 2019. [F8]
F4
CSU costs exceeded anticipated revenues for those clients staying longer than the time reimbursable (20 hours) from MediCal for CSU services.
Related Recommendations (1)
R4
BHD institute procedures for effective and respectful staff communication and support at all levels by Dec. 31, 2019. [F8, F9]
F5
Lack of adequate personnel compromised the Compliance Office’s effectiveness. It also posed an independence issue for the Compliance Program staff in any oversight audits. 7
Related Recommendations (1)
R5
DHS continue and expedite the CBO contract evaluation and build performance metrics by Dec. 31, 2019. [F2, F5]
F6
The failure to fully implement the medical record, claims and billing software, Avatar, continues to result in lost revenues
Related Recommendations (1)
R6
DHS and BHD receive continued training in government finance by Dec. 31, 2019. [F3,
F7
Although current leadership understands government finance and budgeting process, the Grand Jury found that past BHD and DHS leadership lacked understanding.
Related Recommendations (1)
R7
DHS hire a CFO who is experienced in government finance and systems. [F7, F12]
F8
Budget development process lacked transparency and staff participation. Section and program managers were not included in budget development.
Related Recommendations (1)
R8
The County Auditor’s Office institute procedures for verifying actual revenue figures, rather than verifying that projected budgets balance, by Dec. 31, 2019. [F12]
F9
Professional communication was limited by management. This led to a lack of transparency between Fiscal and BHD.
Related Recommendations (1)
R9
The Compliance Program be adequately funded and supported, by Dec. 31, 2019. [F5]
F10
Inadequate staffing and insufficiently trained staff in DHS Fiscal led to a severely flawed budget for both FY 16-17 and 17-18.
Related Recommendations (1)
R10
We recommend the BOS review its budget oversight responsibilities by Dec. 31, 2019 8
F11
The budget shortfall caused BHD to reduce vital staffing.
No recommendations for this finding
F12
Auditing procedures designed to detect incorrect revenue information were not evident.
No recommendations for this finding
Conclusions 1
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CL16 Behavioral Health Division has a history of annual budget shortfalls. Starting with Fiscal Year (FY)14/15 the budget deficit was 8.09 million, FY 15/16 was 5.0 million, FY 16/17 was 11.0 million and FY 17/18 was 10 million. Current estimates for FY 19/20 indicate an approximate 8.5 million dollar shortfall. In earlier years, the shortfall was mitigated by revenue from fund balances. In FY 17-18, fund balances were insufficient to meet revenue shortfalls. The Civil Grand Jury consistently and repeatedly requested fiscal policies and procedures within BHD. None were forthcoming. Leadership’s lack of knowledge and understanding of government finance systems contributed to inaccurate forecasts of revenues and expenditures. Significant turnover in Fiscal Service employees in key positions, without replacing them with persons with equivalent knowledge, experience and training, contributed to lack of understanding of vital budget and accounting processes. Section and program managers were excluded from budget development, contributing to inaccurate projections of service needs. This exclusion interfered with the ability to control program expenditures. Professional communication was limited by management. This led to a lack of transparency between Fiscal and BHD.
Commendations 1
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CM1 Page 7The Grand Jury commends the Department of Health Services leadership in addressing the structural problems of past budget development methods and instituting robust and timely changes to ensure that this process remains transparent, accurate and responsive to change. The new cash-based accounting system adopted by Sonoma County in FY 17-18 requires that revenue only be recorded when received. We acknowledge the employees of the BHD who continue to provide quality services to the residents of Sonoma County despite challenging circumstances.
No Responses Found 3
Government entities assigned to respond to this report. No response documents have been linked in our database.
Sonoma County
County
Sonoma County Assessor
Elected County Office
Sonoma County Board of Supervisors
Elected County Office