Corrective Action Plans

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VIEWS OF RESPONSIBLE OFFICIALS It is recommended, among other things, to establish internal controls that provide certainty, effective monitoring, data validation, and accountability for those employees who execute the reporting processes. To this end, the personnel responsible will be convened and ...
VIEWS OF RESPONSIBLE OFFICIALS It is recommended, among other things, to establish internal controls that provide certainty, effective monitoring, data validation, and accountability for those employees who execute the reporting processes. To this end, the personnel responsible will be convened and written processes will be issued to expedite the information requests and ensure their rapid submission. This will be in accordance with both state and federal regulations. Once the agreements are finalized, they will be submitted to the auditing firm. IMPLEMENTATION DATE During Fiscal Year 2025-2026. RESPONSIBLE PERSON Administration for Socioeconomic Development of the Family (ADSEF, by its Spanish Acronym)
VIEWS OF RESPONSIBLE OFFICIALS The Department of the Family has initiated several corrective actions. Since the first months of Fiscal Year 2024, the Accounting Department has started a review of unliquidated obligations on a monthly basis, canceling any invalid obligations and reporting them in the...
VIEWS OF RESPONSIBLE OFFICIALS The Department of the Family has initiated several corrective actions. Since the first months of Fiscal Year 2024, the Accounting Department has started a review of unliquidated obligations on a monthly basis, canceling any invalid obligations and reporting them in the FY 2024 SSA-4513 report. In fact, Budget and Finance staff had multiple working sessions with PR-DDS personnel to identify and write-off unliquidated obligations that were no longer current. Also, we conducted training for finance and budget staff on accounting controls and administrative cost reporting to ensure compliance with federal regulations. Includes a review of 2 CFR Part 225 on allowable costs (direct allowable and indirect allocable, the difference between direct and indirect costs), reasonable and allocable costs. In addition, we addressed issues of unliquidated obligations (Consultative Examinations (CE) and Medical Evidence of Record (MER), among others). Nevertheless, beginning the first quarter of FY2026, following recent staffing changes in the Finance Department, we are in the process of re-training our team to ensure that unliquidated obligations are reviewed every month and invalid commitments are promptly canceled. To reinforce these practices, the Department of the Family will also deliver a series of new workshops to relevant staff outlining the procedures and best practices for SSA-4513 preparation and POMS compliance. IMPLEMENTATION DATE September 2025 RESPONSIBLE PERSON Office of the Secretariat
VIEWS OF RESPONSIBLE OFFICIALS Draft and approve eligibility criteria in accordance with federal reporting requirements. Implement monthly reconciliations between TANF and internal records. Establish a report review committee with designated personnel. It’s important to note that administrative expe...
VIEWS OF RESPONSIBLE OFFICIALS Draft and approve eligibility criteria in accordance with federal reporting requirements. Implement monthly reconciliations between TANF and internal records. Establish a report review committee with designated personnel. It’s important to note that administrative expenses are listed under Letter F of the Family Preservation program. Other expenses that could be considered administrative under different letters—such as materials, payroll, etc.—are related to direct services, since the employees being paid under these accounts are social workers and the materials are used for activities that are part of the direct service. IMPLEMENTATION DATE During Fiscal Year 2025-2026. RESPONSIBLE PERSON Administration for Families and Children (ADFAN, by the Spanish Acronym)
VIEWS OF RESPONSIBLE OFFICIALS ADSEF has controls and procedural manuals related to data collection. As part of the digitization project process, ADSEF seeks to standardize procedures and ensure the organization and proper location of documents within the files. Annexes IMPLEMENTATION DATE Up to Dat...
VIEWS OF RESPONSIBLE OFFICIALS ADSEF has controls and procedural manuals related to data collection. As part of the digitization project process, ADSEF seeks to standardize procedures and ensure the organization and proper location of documents within the files. Annexes IMPLEMENTATION DATE Up to Date RESPONSIBLE PERSON Administration for Socioeconomic Development of the Family (ADSEF, by its Spanish Acronym) AUDITORS’ COMMENT ADSEF did not provide us with a manual describing the data collection process as requested during the auditing procedures. An unsigned and undated Manual was attached to the Corrective Action Plan. Also, ADSEF was required to provide us with the corresponding participant worksheet appendix and the physical file to corroborate the information included in the report. ADSEF provided us with evidence of the hand-completed forms; however, we were not provided with the physical files to validate the information included in each document. This represents a scope limitation.
VIEWS OF RESPONSIBLE OFFICIALS It is recommended, among other things, to establish internal controls that provide certainty, effective monitoring, data validation, and accountability for those employees who execute the reporting processes. To this end, the personnel responsible will be convened and ...
VIEWS OF RESPONSIBLE OFFICIALS It is recommended, among other things, to establish internal controls that provide certainty, effective monitoring, data validation, and accountability for those employees who execute the reporting processes. To this end, the personnel responsible will be convened and written processes will be issued to expedite the information requests and ensure their rapid submission. This will be in accordance with both state and federal regulations. Once the agreements are finalized, they will be submitted to the auditing firm. IMPLEMENTATION DATE During Fiscal Year 2025-2026. RESPONSIBLE PERSON Administration for Socioeconomic Development of the Family (ADSEF, by its Spanish Acronym)
VIEWS OF RESPONSIBLE OFFICIALS It is recommended, among other things, to establish internal controls that provide certainty, effective monitoring, data validation, and accountability for those employees who execute the reporting processes. To this end, the personnel responsible will be convened and ...
VIEWS OF RESPONSIBLE OFFICIALS It is recommended, among other things, to establish internal controls that provide certainty, effective monitoring, data validation, and accountability for those employees who execute the reporting processes. To this end, the personnel responsible will be convened and written processes will be issued to expedite the information requests and ensure their rapid submission. This will be in accordance with both state and federal regulations. Once the agreements are finalized, they will be submitted to the auditing firm. IMPLEMENTATION DATE During Fiscal Year 2025-2026. RESPONSIBLE PERSON Administration for Socioeconomic Development of the Family (ADSEF, by its Spanish Acronym)
VIEWS OF RESPONSIBLE OFFICIALS As part of the digitization project process, ADSEF seeks to standardize procedures and ensure the organization and proper location of documents within the files. For this Digitalization project we have available matching funds of approximately 7 million dollars. IMPLEM...
VIEWS OF RESPONSIBLE OFFICIALS As part of the digitization project process, ADSEF seeks to standardize procedures and ensure the organization and proper location of documents within the files. For this Digitalization project we have available matching funds of approximately 7 million dollars. IMPLEMENTATION DATE Awaiting System Implementation RESPONSIBLE PERSON Administration for Socioeconomic Development of the Family (ADSEF, by its Spanish Acronym)
VIEWS OF RESPONSIBLE OFFICIALS ADSEF will assess and develop, together with program directors and program specialists, retraining sessions aimed at technical staff and supervisors. As part of its ongoing digitization efforts, ADSEF has incorporated the replacement of the Social Security number with ...
VIEWS OF RESPONSIBLE OFFICIALS ADSEF will assess and develop, together with program directors and program specialists, retraining sessions aimed at technical staff and supervisors. As part of its ongoing digitization efforts, ADSEF has incorporated the replacement of the Social Security number with a unique identification number. IMPLEMENTATION DATE December 2025 RESPONSIBLE PERSON Administration for Socioeconomic Development of the Family (ADSEF, by its Spanish Acronym) continue
VIEWS OF RESPONSIBLE OFFICIALS ADSEF will assess and develop, together with program directors and program specialists, retraining sessions aimed at technical staff and supervisors. As part of its ongoing digitization efforts, ADSEF has incorporated the replacement of the Social Security number with ...
VIEWS OF RESPONSIBLE OFFICIALS ADSEF will assess and develop, together with program directors and program specialists, retraining sessions aimed at technical staff and supervisors. As part of its ongoing digitization efforts, ADSEF has incorporated the replacement of the Social Security number with a unique identification number. Anexes: • Comunicación Límite de tiempo de Beneficios Categoría C • Comunicación sobre periodo de certificación Categoría C, próximos a cumplir los 60 meses. IMPLEMENTATION DATE December 2025 RESPONSIBLE PERSON Administration for Socioeconomic Development of the Family (ADSEF, by its Spanish Acronym)
VIEWS OF RESPONSIBLE OFFICIALS Establish a peer or supervisory review process for a percentage of eligibility determinations prior to final approval and implement a common error log to identify areas requiring further training or adjustment of procedures. IMPLEMENTATION DATE During Fiscal Year 2025-...
VIEWS OF RESPONSIBLE OFFICIALS Establish a peer or supervisory review process for a percentage of eligibility determinations prior to final approval and implement a common error log to identify areas requiring further training or adjustment of procedures. IMPLEMENTATION DATE During Fiscal Year 2025-2026. RESPONSIBLE PERSON Sidnia Vélez, Child Care Program Administration for the Care and Comprehensive Development of Children (ACUDEN, by its Spanish Acronym)
View Audit 363366 Questioned Costs: $1
VIEWS OF RESPONSIBLE OFFICIALS ADSEF will assess and develop, together with program directors and program specialists, retraining sessions aimed at technical staff and supervisors. As part of its ongoing digitization efforts, ADSEF has incorporated the replacement of the Social Security number with ...
VIEWS OF RESPONSIBLE OFFICIALS ADSEF will assess and develop, together with program directors and program specialists, retraining sessions aimed at technical staff and supervisors. As part of its ongoing digitization efforts, ADSEF has incorporated the replacement of the Social Security number with a unique identification number. IMPLEMENTATION DATE December 2025 RESPONSIBLE PERSON Administration for Socioeconomic Development of the Family (ADSEF, by its Spanish Acronym)
VIEWS OF RESPONSIBLE OFFICIALS Based on the audit report submitted, it is recommended that the Cash Management Section Procedures Manual be amended, and that the segregation of employee duties be identified. To this end, work has begun on reading and amending the Manual. It will be updated consideri...
VIEWS OF RESPONSIBLE OFFICIALS Based on the audit report submitted, it is recommended that the Cash Management Section Procedures Manual be amended, and that the segregation of employee duties be identified. To this end, work has begun on reading and amending the Manual. It will be updated considering both state and federal regulations. IMPLEMENTATION DATE During Fiscal Year 2025-2026. RESPONSIBLE PERSON Administration for Socioeconomic Development of the Family (ADSEF, by its Spanish Acronym)
VIEWS OF RESPONSIBLE OFFICIALS In Process Develop an operational procedures manual for each program under Uniform Guidance. Include flow outlining key processes. Assign personnel responsible for each function and establish periodic review mechanisms. IMPLEMENTATION DATE During Fiscal Year 2025-2026....
VIEWS OF RESPONSIBLE OFFICIALS In Process Develop an operational procedures manual for each program under Uniform Guidance. Include flow outlining key processes. Assign personnel responsible for each function and establish periodic review mechanisms. IMPLEMENTATION DATE During Fiscal Year 2025-2026. RESPONSIBLE PERSON Administration for Families and Children (ADFAN, by the Spanish Acronym)
VIEWS OF RESPONSIBLE OFFICIALS It is recommended, among other things, to establish internal controls that provide certainty, effective monitoring, data validation, and accountability for those employees who execute the reporting processes. To this end, the personnel responsible will be convened and ...
VIEWS OF RESPONSIBLE OFFICIALS It is recommended, among other things, to establish internal controls that provide certainty, effective monitoring, data validation, and accountability for those employees who execute the reporting processes. To this end, the personnel responsible will be convened and written processes will be issued to expedite the information requests and ensure their rapid submission. This will be in accordance with both state and federal regulations. Once the agreements are finalized, they will be submitted to the auditing firm. IMPLEMENTATION DATE During Fiscal Year 2025-2026. RESPONSIBLE PERSON Administration for Socioeconomic Development of the Family (ADSEF, by its Spanish Acronym)
Finding 2023-004 Late Reporting and Noncompliance with Reporting Requirements Name of Contact Person: Cindy Sharp, Deputy Finance Director Corrective Action Plan: Management will carefully review report deadlines and ensure that submission of reports is made before they are due. Management will...
Finding 2023-004 Late Reporting and Noncompliance with Reporting Requirements Name of Contact Person: Cindy Sharp, Deputy Finance Director Corrective Action Plan: Management will carefully review report deadlines and ensure that submission of reports is made before they are due. Management will also carefully review reporting requirements and ensure that requirements are adhered to. This includes the following programs: US Department of the Interior, US Department of the Treasury Federal Payment in Lieu of Taxes (PILT) and Coronavirus State and Local Fiscal Recovery Funds. Proposed Completion Date: Fiscal year 2024.
Management’s Response/Corrective Action Plan (Unaudited): Management agrees to address the finding in its capital asset tracking schedule. The Organization and its outsourced accountant have discussed the finding and will implement procedures on tracking capital assets funded with federal grants. Th...
Management’s Response/Corrective Action Plan (Unaudited): Management agrees to address the finding in its capital asset tracking schedule. The Organization and its outsourced accountant have discussed the finding and will implement procedures on tracking capital assets funded with federal grants. This tracking will be incorporated to the current capital asset tracking schedule. Planned Completion Date: June 2025 Contact Person Responsible for Correction Action: Adam Courtney
Finding 2023-005 Name of Responsible Individual: Carolina Liriano, Grant Manager; Holly Forester, Controller; Sheri Brady, VP and Chief Program Officer Corrective Action: CDF will enhance its internal processes and staffing to ensure the timely submission of future Single Audit Reporting Packages...
Finding 2023-005 Name of Responsible Individual: Carolina Liriano, Grant Manager; Holly Forester, Controller; Sheri Brady, VP and Chief Program Officer Corrective Action: CDF will enhance its internal processes and staffing to ensure the timely submission of future Single Audit Reporting Packages. In January 2025, CDF hired an Outsourced Grant Manager dedicated to overseeing federal grant management, including the coordination and timely submission of all required audit and reporting packages. Key actions include:  Establishing and maintaining a robust timeline for audit activities, closely collaborating with both the accounting team and external auditors to guarantee adherence to submission deadlines.  Implementing a cross-training program within the accounting and compliance departments to mitigate the risk of disruption due to staff turnover, ensuring multiple staff members are proficient in handling audit-related tasks.  Scheduling regular internal audits and compliance checks to proactively identify and address potential issues well in advance of filing deadlines. Anticipated Completion Date: December 31, 2025.
Finding 2023-004 Name of Responsible Individual: Carolina Liriano, Grant Manager; Holly Forester, Controller; Sheri Brady, VP and Chief Program Officer Corrective Action: CDF will conduct a thorough review and update of its reporting policies and procedures to ensure alignment with the requiremen...
Finding 2023-004 Name of Responsible Individual: Carolina Liriano, Grant Manager; Holly Forester, Controller; Sheri Brady, VP and Chief Program Officer Corrective Action: CDF will conduct a thorough review and update of its reporting policies and procedures to ensure alignment with the requirements of Federal Awards. In January 2025, CDF hired an Outsourced Grant Manager responsible for overseeing the preparation, review, and submission of all grant-related reports. Key actions include:  Ensuring compliance with GAAP and federal regulations for timely and accurate submission of quarterly financial and progress reports.  Coordinating with relevant departments, managing grant accounting processing system submissions, and acting as the primary point of contact for grantor agencies regarding reporting matters.  Conducting mandatory training sessions for existing staff on the updated reporting procedures and compliance with federal requirements, with detailed instructions on Financial Reporting Forms emphasizing accuracy and timeliness.  Implementing a tracking system to monitor deadlines and the submission status of all required reports.  Scheduling regular internal audits to verify adherence to these reporting protocols and identify potential gaps in compliance. Anticipated Completion Date: December 31, 2025.
Finding 2023-003 Name of Responsible Individual: Carolina Liriano, Grant Manager; Holly Forester, Controller; Sheri Brady, VP and Chief Program Officer Corrective Action: CDF hired an Outsourced Grant Manager starting January 2025 who will assume comprehensive oversight of all facets of grant adm...
Finding 2023-003 Name of Responsible Individual: Carolina Liriano, Grant Manager; Holly Forester, Controller; Sheri Brady, VP and Chief Program Officer Corrective Action: CDF hired an Outsourced Grant Manager starting January 2025 who will assume comprehensive oversight of all facets of grant administration and compliance. The grant manager's duties will include ensuring that all reimbursement requests are substantiated by adequate documentation, such as actual invoices, payroll registers, and payment records. Key actions include:  Establishing a systematic process for the collection, organization, and retention of all requisite documents.  Implementing internal review and approval procedures to guarantee that every reimbursement request undergoes thorough vetting and receives approval prior to submission, with explicit documentation of the review process.  Instructing both existing and new personnel on these newly instituted procedures to prevent future inconsistencies. Anticipated Completion Date: December 31, 2025.
St. John’s Lutheran Home of Albert Lea submits the following corrective action plan for the year ended September 30, 2023. Name and address of independent public accounting firm: Lethert, Skwira, Schultz & Co. LLP, 170 E 7th Place, Saint Paul, MN 55101 Audit period: October 1, 2022 – September ...
St. John’s Lutheran Home of Albert Lea submits the following corrective action plan for the year ended September 30, 2023. Name and address of independent public accounting firm: Lethert, Skwira, Schultz & Co. LLP, 170 E 7th Place, Saint Paul, MN 55101 Audit period: October 1, 2022 – September 30, 2023 The findings from the September 30, 2023 schedule of findings, questioned costs and recommendations. FINDINGS - FINANCIAL STATEMENT AUDIT Finding 2023-001 - Auditor Preparation of the Financial Statements Material Weakness Finding Summary: The Organization does not have an internal control system designed to provide for the preparation of the complete consolidated financial statements, including the accompanying footnotes, as required by GAAP. We were also requested to draft the financial statements and accompanying notes to the financial statements. Corrective Action Plan: It is not cost effective to have an internal control system designed to provide for the preparation of financial statements and accompanying notes. We requested that our auditors Lethert, Skwira, Schultz & Co. LLP, prepare the financial statements and the accompanying notes to the financial statements as a part of their annual audit. We have designated a member of management to review the drafted financial statements and accompanying notes. Responsible Individuals: Heather King, Director of Finance, 507-473-1066 Anticipated Completion Date: Ongoing
Subject: Timeliness in Reporting: Criteria or Specific Requirement: Touchstone Behavioral Health d/b/a Touchstone Health Services must submit their financial and federal award information to the Federal Audit Clearinghouse within 30 days after Touchstone Behavioral Health d/b/a Touchstone Health S...
Subject: Timeliness in Reporting: Criteria or Specific Requirement: Touchstone Behavioral Health d/b/a Touchstone Health Services must submit their financial and federal award information to the Federal Audit Clearinghouse within 30 days after Touchstone Behavioral Health d/b/a Touchstone Health Services receives the audit report or within 9 months from Touchstone Behavioral Health d/b/a Touchstone Health Services’ fiscal year end. Condition: The fiscal 2023 financial statements, single audit reporting package and data collection form were not completed and submitted to the Federal Audit Clearinghouse until after June 30, 2024. Name of Contact Person: Janae Ben-Shabat, CFO Phone Number: 480-516-3116 Anticipated Completion Date: July 31, 2024 View of Responsible Officials and Corrective Actions: Touchstone Behavioral Health d/b/a Touchstone Health Services will establish additional policies and procedures and identify and dedicate specific personnel resources to ensure that system changes or other significant operational changes can occur without a significant disruption to reporting requirements.
Condition: No documentation of employee time approval by supervisors could be provided. The payroll clerk processes the payroll and finance director approves through the releasing of the payroll. However, there is no formal documentation of the overall review of the payroll process and the supervi...
Condition: No documentation of employee time approval by supervisors could be provided. The payroll clerk processes the payroll and finance director approves through the releasing of the payroll. However, there is no formal documentation of the overall review of the payroll process and the supervisors' approval to time recorded by employees. Corrective Action Planned: The Organization has implemented a new payroll process using the ADP system. Employees are now required to approve their own time within the ADP portal, and this approval is documented. Following this, supervisors review and approve their employee's time, which is also documented in the portal. Human Resources then prepares the payroll, reviewing all entries and initialing a shared file of payroll items and providing backup for changes. Once HR confirms accuracy, they notify Finance. Finance then reviews the payroll, with the Finance Manager providing the final approval within ADP once all items are confirmed. The entire process is fully documented, with approvals recorded within the ADP by employees and supervisors and the shared file drive where HR and Finance intimal off on the reviewed payroll times, ensuring a traceable record of the entire payroll approval process. Person Responsible for Corrective Action: Joe Derry, Chief Financial Officer. Anticipated Completion Date: Implemented.
Condition: The Organization lacks consistently applied processes and procedures related to the application of the sliding fee scale. The Organization also lacks a clear review process related to the sliding fee scale to identify errors quickly to allow for corrections to be made in a timely manner....
Condition: The Organization lacks consistently applied processes and procedures related to the application of the sliding fee scale. The Organization also lacks a clear review process related to the sliding fee scale to identify errors quickly to allow for corrections to be made in a timely manner. Corrective Action Planned: The Organization has hired a new Chief Financial Officer as well as additional supporting staff within the finance department. The Billing and Collections Policy was updated to waive co-pays for students in the School-Based Program. The Billing Department is in the process of auditing and implementing quarterly feedback & training sessions for the Operations Department for training and compliance for the Sliding Fee Discount Program. This process was implemented in 2025. Person Responsible for Corrective Action: Joe Derry, Chief Financial Officer. Anticipated Completion Date: Implemented.
Finding Number: 2023-003 Planned Corrective Action: City Auditor will stay in contact with Municipal Court Administrator and the Police Captain to ensure they submit Quarterly Reports on a timely basis. Anticipated Completion Date: July 3, 2025 Responsible Contact Person: City Auditor Sherri Hess
Finding Number: 2023-003 Planned Corrective Action: City Auditor will stay in contact with Municipal Court Administrator and the Police Captain to ensure they submit Quarterly Reports on a timely basis. Anticipated Completion Date: July 3, 2025 Responsible Contact Person: City Auditor Sherri Hess
Finding Number: 2023-002 Planned Corrective Action: City Auditor has confirmed the ARPA 3/31/24 and 3/31/25 Project and Expenditure Reports submitted agree to City Accounting records. Anticipated Completion Date: July 3, 2025 Responsible Contact Person: City Auditor Sherri Hess
Finding Number: 2023-002 Planned Corrective Action: City Auditor has confirmed the ARPA 3/31/24 and 3/31/25 Project and Expenditure Reports submitted agree to City Accounting records. Anticipated Completion Date: July 3, 2025 Responsible Contact Person: City Auditor Sherri Hess
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