Corrective Action Plans

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The Agency updated procedures for developing the SEFA in accordance with 2 CFR 200.502 which states, “The determination of when a federal award is expended must be based on when the activity related to the Federal award occurs.”The Agency is required to comply with 2 CFR 200.403 which indicates that...
The Agency updated procedures for developing the SEFA in accordance with 2 CFR 200.502 which states, “The determination of when a federal award is expended must be based on when the activity related to the Federal award occurs.”The Agency is required to comply with 2 CFR 200.403 which indicates that allowable costs must be determined in accordance with accounting principles generally accepted in the United States of America (GAAP). The Agency updated procedures for developing the SEFA in accordance with both 2 CFR 200.502 and 2 CFR 200.403 to include the following process improvement: The agency has modified its current process to ensure the direct and indirect costs charged to the federal programs include only the costs incurred during the current fiscal year.
View Audit 334071 Questioned Costs: $1
The District acknowledges this finding. Invoices are reviewed by the Administration and Board of Education monthly. Additional reviews by administration will be put into place. The Board of Education shall approve the pay rates annually and appropriate documentation kept.
The District acknowledges this finding. Invoices are reviewed by the Administration and Board of Education monthly. Additional reviews by administration will be put into place. The Board of Education shall approve the pay rates annually and appropriate documentation kept.
Condition: The District submitted the Sp. Ed. IDEA Preschool 2024 grant budget late and claimed costs preceding the budget submission date, resulting in questioned costs of $4,646. Recommendation: The District should take steps to submit grant applications in a timely manner to ensure that they are ...
Condition: The District submitted the Sp. Ed. IDEA Preschool 2024 grant budget late and claimed costs preceding the budget submission date, resulting in questioned costs of $4,646. Recommendation: The District should take steps to submit grant applications in a timely manner to ensure that they are able to claim all expenses as budgeted. We recommend reviewing the general ledger to the expenditure reports before submitting for more accurate reporting. Management Response: The District will take steps to submit grant applications in a timely manner. The District will review the general ledger to the expenditure reports before submitting.
View Audit 334048 Questioned Costs: $1
Condition: The District submitted the Title I 2024 grant budget late and claimed costs preceding the budget submission date, resulting in questioned costs of $114,912. Recommendation: The District should take steps to submit grant applications in a timely manner to ensure that they are able to claim...
Condition: The District submitted the Title I 2024 grant budget late and claimed costs preceding the budget submission date, resulting in questioned costs of $114,912. Recommendation: The District should take steps to submit grant applications in a timely manner to ensure that they are able to claim all expenses as budgeted. We recommend reviewing the general ledger to the expenditure reports before submitting for more accurate reporting. Management Response: The District will take steps to submit grant applications in a timely manner. The District will review the general ledger to the expenditure reports before submitting.
View Audit 334048 Questioned Costs: $1
Condition: To determine that an accurate final expenditure report was filed with the Illinois State Board of Education. The District submitted budgeted expenditures for reimbursement instead of actual expenditures for ESSER II. Recommendation: We recommend reconciling the budgeted amount to the gen...
Condition: To determine that an accurate final expenditure report was filed with the Illinois State Board of Education. The District submitted budgeted expenditures for reimbursement instead of actual expenditures for ESSER II. Recommendation: We recommend reconciling the budgeted amount to the general ledger totals and reconciling those to expenditure reports before submitting. Management Response: The District will review the budgeted cost of items and the amount recorded in the general ledger against the expenditure reports before submitting.
View Audit 334048 Questioned Costs: $1
Condition: To determine that an accurate final expenditure report was filed with the Illinois State Board of Education. The District reported expenses on the final ESSER II November 11, 2023 expenditure report that were claimed twice in different grants. Recommendation: We recommend to review for d...
Condition: To determine that an accurate final expenditure report was filed with the Illinois State Board of Education. The District reported expenses on the final ESSER II November 11, 2023 expenditure report that were claimed twice in different grants. Recommendation: We recommend to review for duplicate or unallowable expenses before entering into the expenditure report and submitting. Management Response: The District will review the general ledger for duplicate or unallowable expenses before submitting quarterly reports.
View Audit 334048 Questioned Costs: $1
The District will enhance internal controls to provide reasonable assurance that all personnel expenses charged to federal awards are accurately documented and approved. This will involve implementing a systematic internal review process for time and effort reporting. The process will include regula...
The District will enhance internal controls to provide reasonable assurance that all personnel expenses charged to federal awards are accurately documented and approved. This will involve implementing a systematic internal review process for time and effort reporting. The process will include regular checks and approvals by supervisory personnel to ensure that all charges are properly allocated and compliant with established accounting policies. Additionally, the District will integrate these reviews into the official records of the District, ensuring that all activities compensated by the District are accurately reflected. To support this, the District will provide training for staff on the updated procedures and the importance of maintaining accurate records for personnel expenses charged to federal awards. Furthermore, the District will conduct periodic internal audits to monitor compliance with the updated procedures and identify any areas for improvement These audits will help ensure that all documentation of personnel expenses meets the standards required by federal regulations. The actions to remedy this finding are currently in effect as of December 11, 2024.
Finding 516124 (2024-001)
Significant Deficiency 2024
Views of Responsible Officials and Corrective Action Plan: Proper implementation of the sliding fee policy is a critical component of operating a successful FQHC. Project HOME’s sliding fee policy complies with all local, state, and federal funding or regulatory requirements, including those define...
Views of Responsible Officials and Corrective Action Plan: Proper implementation of the sliding fee policy is a critical component of operating a successful FQHC. Project HOME’s sliding fee policy complies with all local, state, and federal funding or regulatory requirements, including those defined by HRSA as part of the Health Center Program pursuant to Section 330 of the Public Health Service Act. The policy and related procedures were reviewed and found to comply at the most recent HRSA site visit in March 2024. To address the identified deficiencies in oversight and effectiveness of controls related to the sliding fee discount income verification process, will implement the following actions: 1. Re-Training: Conduct comprehensive re-training sessions for all front desk team members on the sliding fee policies and procedures to ensure full understanding and compliance within 10 days for approved corrective action plan. Conduct an annual refresher training in the month of June. 2. Adherence to Controls: Reinforce adherence to all established controls outlined in the procedures, including the thorough review of all sliding fee discount program applications and income documentation. a. ACCT Sliding Fee Discount, Fee Waiver, and Payment Plan Policy b. ACCT Sliding Fee Discount, Fee Waiver, and Payment Plan Procedure 3. Monthly Audits: The Director of Operations will conduct monthly audits of the sliding fee discount program. This will involve random selection of applications to verify the accuracy of program documentation. Any identified errors will be promptly communicated to the VP of Health Services. All samples will be submitted to VP of Health Services for review. 4. Ongoing Audits: A designated member of the Project HOME accounting team will audit newly implemented sliding fee arrangements with patients. Any identified errors will be promptly communicated to the VP of Health Services and the Director of Operations. 5. Timely Re-Training: Upon identification of errors, necessary re-training for affected front desk team members will be addressed within one week of communication to ensure continuous compliance and improvement. 6. Corrective Action: Employees that are woefully non-compliant are subject to disciplinary action in accordance with Project HOME’s employee handbook. These actions aim to enhance oversight and ensure adherence to sliding fee policies and procedures, ultimately improving the effectiveness of the income verification process.
Findings Reference Number: 2024-002 Federal Agency: Department of Labor Federal Program: WIOA Cluster Assistance Listing Numbers : 17.258, 17.259, 17.278 Management’s response: Management concurs with the finding. Corrective Action Plan: Management will reimburse the appropriate grantors for the ...
Findings Reference Number: 2024-002 Federal Agency: Department of Labor Federal Program: WIOA Cluster Assistance Listing Numbers : 17.258, 17.259, 17.278 Management’s response: Management concurs with the finding. Corrective Action Plan: Management will reimburse the appropriate grantors for the questioned costs and re-evaluate the controls over cost identification. Implementation Date: Immediately.
View Audit 333910 Questioned Costs: $1
Audit Finding Reference: 2024-001 Department's Response: We concur. Views of Responsible Officials and Corrective Action: There were not sufficient controls to ensure accurate payroll expenditures were submitted for reimbursement. Payroll in excess of $31,565 was charged to the grant. CCEOK has i...
Audit Finding Reference: 2024-001 Department's Response: We concur. Views of Responsible Officials and Corrective Action: There were not sufficient controls to ensure accurate payroll expenditures were submitted for reimbursement. Payroll in excess of $31,565 was charged to the grant. CCEOK has implemented a more robust review process that includes all payroll expenditures billed to the grant are traced back to supporting details. CCEOK will reimburse the overbilled amounts to the funder. Name of Contact Person: Lisa Wheeler, CPA Director of Finance Lwheeler@CCEOK.org 918-508-7118 Date of Implementation: October 2024
View Audit 333690 Questioned Costs: $1
Finding #2024-001 – Inability to Produce Supporting Report to Confirms the Accuracy of the Verification Report Sample Contact for corrective action: Dr. Gregg Klinginsmith, Superintendent District’s response: Concur Anticipated completion date: December 31, 2024 Corrective Action: The District agree...
Finding #2024-001 – Inability to Produce Supporting Report to Confirms the Accuracy of the Verification Report Sample Contact for corrective action: Dr. Gregg Klinginsmith, Superintendent District’s response: Concur Anticipated completion date: December 31, 2024 Corrective Action: The District agrees with this finding and will implement the following: • Data Integrity Verification: o Implement a data review process to ensure data completeness and accuracy prior to sampling. • Staff Training: o Conduct training sessions for staff involved to ensure the accuracy of reports produced by the software used to select samples. o Obtain training from the software provider to understand how the software pulls reports, ensuring sample accuracy. • Internal Review Process o Establish periodic reviews to confirm all required documentation is retained and accurately represents the population.
Finding 2024-002: Time and Effort Requirements (50000) Assistance Listing No. 93.600 HeadStart U.S. Department of Health & Human Services Passed through Los Angeles County Office of Education (LACOE) Dear Sir/Madam: Please find enclosed El Monte City School District Corrective Action Plan for the ...
Finding 2024-002: Time and Effort Requirements (50000) Assistance Listing No. 93.600 HeadStart U.S. Department of Health & Human Services Passed through Los Angeles County Office of Education (LACOE) Dear Sir/Madam: Please find enclosed El Monte City School District Corrective Action Plan for the Time and Effort Finding cited in the District's 2023-24 Single Audit. El Monte City School District Corrective Action Plan: Time and Effort Finding (2024-002) Goal: To ensure compliance with federal regulations for time and effort documentation and prevent recurrence of findings related to restricted funding sources. Action Steps: Staff Training and Awareness: • Conduct retraining sessions for relevant staff on federal time and effort reporting requirements. Include specific topics such as: o Record retention requirements for documentation supporting salary and wage charges. o Utilize scenarios and examples related to long tenn leave and benefit payouts with federal programs to enhance understanding. o Require attendees to sign acknowledgment fonns confirming participation and understanding of training content. Enhanced Review Mechanisms: • Establish additional internal controls to ensure compliance, including: o Periodic spot-check audits of time and effort records by the grants compliance officer or designee. o Use a checklist to verify completeness and accuracy of documentation. o Escalate issues to supervisors for prompt resolution before charges are applied to federal grants. Monitoring and Evaluation: • Develop a monitoring plan to ensure ongoing compliance: o Quarterly reviews of time and effort documentation by district leadership. o Solicit feedback from staff on challenges with compliance and address concemi promptly. Responsible Personnel: • Fiscal Area: Assistant Superintendent, Business Services Jose Herrera - Oversight of corrective action implementation and training. • Program Area: Juan Castillo, Director of Child Development- Regular monitoring of compliance for Time and Effort Documentation. Timeline for Implementation: • By March 31, 2024: Complete staff retraining sessions and re-distribute policies bulletins. • By April 30, 2024: Implement enhanced review mechanisms. • Quarterly (Ongoing): Conduct internal reviews and monitoring. By following this corrective action plan, the District aims to fully address the finding and ensure compliance with federal time and effort reporting requirements.
View Audit 333492 Questioned Costs: $1
We recommend the Agency review its cost transfers procedures and implement additional procedures to monitor federal awards period of performance.There is no disagreement with the audit finding. The Agency agrees that additional cost transfer procedures are needed to ensure expenses incurred against ...
We recommend the Agency review its cost transfers procedures and implement additional procedures to monitor federal awards period of performance.There is no disagreement with the audit finding. The Agency agrees that additional cost transfer procedures are needed to ensure expenses incurred against an award fall within the award period of performance, but believes there are adequate procedures in place to monitor the actual award period of performance. Starting immediately, Grants will implement procedures to review expenses moved into projects via the Manual Transaction process (Also referred to as Miscellaneous Transaction) to ensure the expenses fall within the award period of performance. See updated procedure: Miscellaneous Transaction Procedures. To further mitigate the chance of this issue occurring, grants will minimize the transfer of labor costs to new awards if a project goes over budget. Instead, Grants will return the expenses back to the cost center. Grants has also been working with IT to put controls in our time keeping system, Kronos that would minimize the chance of labor expenses for over budget projects to be processed into Oracle.
View Audit 333334 Questioned Costs: $1
To strengthen internal control measures and mitigate risk, the following procedures have been implemented in an effort to eliminate the significant deficiency identified in the audit. The corrective actions will help to ensure the supporting payroll documentation from Paychex matches the Access data...
To strengthen internal control measures and mitigate risk, the following procedures have been implemented in an effort to eliminate the significant deficiency identified in the audit. The corrective actions will help to ensure the supporting payroll documentation from Paychex matches the Access database that is used for reimbursement of payroll costs of the federal award: 1. Project Learn's operation manager will verify entries in the Access database, where employee hours are entered by type and job function, against the payroll report from Paychex. 2. Project Learn's executive director will verify the Access database entries of the Operations Manager as part of the monthly drawdown reimbursement process against the payroll report from Paychex. 3. The executive director and operations manager will use the filter feature in Access to ensure all payroll dates are correct. 4. The Access database will be reviewed for accuracy and backed up quarterly by the operations manager and the executive director. 5. The executive director will review the Access database for accuracy for a final time during the last monthly drawdown reimbursement process of the fiscal year.
View Audit 333255 Questioned Costs: $1
Finding 2024-003 Lack of Internal Control over Activities Allowed or Unallowed and Allowable Costs/Cost Principles Name of Contact Person: Ralph Watkins, Superintendent Corrective Action Plan: All payroll reports will be reviewed for correct coding to district grants. Proposed Completion Date: ...
Finding 2024-003 Lack of Internal Control over Activities Allowed or Unallowed and Allowable Costs/Cost Principles Name of Contact Person: Ralph Watkins, Superintendent Corrective Action Plan: All payroll reports will be reviewed for correct coding to district grants. Proposed Completion Date: June 30, 2025
Finding 514614 (2024-004)
Significant Deficiency 2024
For ALN 93.558, a Master Treatment Plan was not completed for 5 of the 40 clients tested within the established timeframe. As a corrective action, the program director will provide training to the team members of the program's proper established timeframe to complete a Master Treatment Plan. In addi...
For ALN 93.558, a Master Treatment Plan was not completed for 5 of the 40 clients tested within the established timeframe. As a corrective action, the program director will provide training to the team members of the program's proper established timeframe to complete a Master Treatment Plan. In addition, SMA will monitor the program by completing internal record reviews. The results will be provided to the program director and if a 90% or higher is not achieved for 2 months, a written corrective action will be required, and a verbal will be required at the quarterly Quality Assurance Committee meeting.
Finding 514613 (2024-002)
Significant Deficiency 2024
For ALN 93.959, a Financial Assessment Form was not properly signed for 1 of the 60 clients tested. Additionally, 2 of the 60 clients tested had service dates that did not fall within one year of the Financial Assessment Form completion date. Obtaining a client's signature on the form has been chall...
For ALN 93.959, a Financial Assessment Form was not properly signed for 1 of the 60 clients tested. Additionally, 2 of the 60 clients tested had service dates that did not fall within one year of the Financial Assessment Form completion date. Obtaining a client's signature on the form has been challenging, particularly during recent years as use of telehealth services has expanded. As a corrective action, team members will be trained in how to properly document receipt of verbal approval. Our internal tracking of completion of the Financial Assessment Form at admission indicates that compliance with this requirement occurs about 89% of the time. As a corrective action plan, SMA will include the completion of the Financial Assessment Form both at admission and annually to be reviewed monthly by the programs. In addition, an action plan will be required to be present at the quarterly Quality Assurance Committee meeting if not at 100%.
Finding 514612 (2024-001)
Significant Deficiency 2024
For ALN 93.958, the discount fee that was shown on their Financial Assessment Form was not used for 7 of the 60 clients tested. Additionally, 8 of the 60 clients tested had service dates that did not fall within one year of the Financial Assessment Form. Our internal tracking of completion of the Fi...
For ALN 93.958, the discount fee that was shown on their Financial Assessment Form was not used for 7 of the 60 clients tested. Additionally, 8 of the 60 clients tested had service dates that did not fall within one year of the Financial Assessment Form. Our internal tracking of completion of the Financial Assessment Form at admission indicates that compliance with this requirement occurs about 89% of the time. As acorrective action, the Client Service Specialist will be trained to ensure data is entered accurately. SMA will also include the completion of the Financial Assessment Form both at admission and annually to be reviewed monthly by the programs. In addition, an action plan will be required to be present at the quarterly Quality Assurance Committee meeting if not at 100%.
Response and Corrective Action Plan: The District will annually prepare the indirect cost charged to the program based on the actual fiscal year trial balance. The District will provide an estimate to the Board each June to ensure proper approval of fund transfers.
Response and Corrective Action Plan: The District will annually prepare the indirect cost charged to the program based on the actual fiscal year trial balance. The District will provide an estimate to the Board each June to ensure proper approval of fund transfers.
Corrective Action Plan: The District will complete a cross-check of all Medicaid claims to ensure we are not also claiming those costs to other federal grants. Anticipated Corrective Action Plan C...
Corrective Action Plan: The District will complete a cross-check of all Medicaid claims to ensure we are not also claiming those costs to other federal grants. Anticipated Corrective Action Plan Completion Date: November 2025 Contact Information: For additional information regarding this finding please contact Bill Trewyn, Business Manager, at 262-741-9143.
View Audit 332869 Questioned Costs: $1
When reallocation occurs, a spreadsheet shall be created to document the changes and the Finance Director will ensure that the invoices reflect the changes accordingly.
When reallocation occurs, a spreadsheet shall be created to document the changes and the Finance Director will ensure that the invoices reflect the changes accordingly.
To ensure that employees are using the correct timesheet, the Office Manager now reviews the timesheets each pay period for grant allocation, formatting and hours prior to executing payroll.
To ensure that employees are using the correct timesheet, the Office Manager now reviews the timesheets each pay period for grant allocation, formatting and hours prior to executing payroll.
Lack of Documentation of Exit Counseling Planned Corrective Action: Current SIS is set to trigger the Exit Counseling to all students that are coded anything other than E (Enrolled). The Registrar updates all student files with any enrollment changes triggering the email to go to the student. The FA...
Lack of Documentation of Exit Counseling Planned Corrective Action: Current SIS is set to trigger the Exit Counseling to all students that are coded anything other than E (Enrolled). The Registrar updates all student files with any enrollment changes triggering the email to go to the student. The FA Director will run a report in the middle of each term to pick up any students that may have been missed by the Registrar. Person Responsible for Corrective Action Plan: Stephanie Castillo, Director of Financial Aid Anticipated Date of Completion: Fall 2024
HOUSING AUTHORITY OF NATCHITOCHES PARISH, LOUISIANA CORRECTIVE ACTION PLAN YEAR ENDED JUNE 30, 2024 NATCHITOCHES PARISH HOUSING AUTHORITY 525 4th St. Natchitoches, LA 71457 Phone No. (318) 357-0553 Fax No. (318) 352-2086 Corrective Action Plan Finding: Finding 2024-001-Administrative Eq...
HOUSING AUTHORITY OF NATCHITOCHES PARISH, LOUISIANA CORRECTIVE ACTION PLAN YEAR ENDED JUNE 30, 2024 NATCHITOCHES PARISH HOUSING AUTHORITY 525 4th St. Natchitoches, LA 71457 Phone No. (318) 357-0553 Fax No. (318) 352-2086 Corrective Action Plan Finding: Finding 2024-001-Administrative Equity Deficit, and Related Large Interfund Payable Condition: At June 30, 2024, the Housing Choice Voucher (HCV) Fund owes the General Fund $101,216. Corrective Action Planned: I am Rhonda Kay, Executive Director and Designated Person to answer this finding. We will carefully review them again, as the auditor recommends. Person responsible for corrective action: Rhonda Kay, Executive Director Telephone: (318) 357-0553 Housing Authority of Natchitoches Parish Fax: (318) 352-2086 525 4th St Natchitoches, LA 71457 Anticipated Completion Date: June 30, 2025
Recommendation: We recommend that the District retain supporting documentation on file as required by federal guidelines for all transactions related to federal grants. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to f...
Recommendation: We recommend that the District retain supporting documentation on file as required by federal guidelines for all transactions related to federal grants. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The District will implement policies to ensure all documentation is kept. Name of the contact person responsible for corrective action: Phan Tu, Business Manager Planned completion date for corrective action plan: June 30, 2025
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