Corrective Action Plans

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2024-001 Reporting - Federal Funding Accountability and Transparency Act 2024-001 Reporting - Federal Funding Accountability and Transparency Act Federal Agencies: U.S. Department of State/Bureau of Population and Refugees and Migration, and U.S. Agency for International Development Program Titles a...
2024-001 Reporting - Federal Funding Accountability and Transparency Act 2024-001 Reporting - Federal Funding Accountability and Transparency Act Federal Agencies: U.S. Department of State/Bureau of Population and Refugees and Migration, and U.S. Agency for International Development Program Titles and ALN Numbers: 1.ALN #19.517: Overseas Refugee Assistance Programs for Africa 2.ALN #98.001: United States Foreign Assistance for Programs Overseas Federal Grant Numbers: 1. SPRMCO23CA0106 - Advancing access to integrated life-saving assistance and protection services to promote self-reliance and resilience for refugees and host communities in Uganda 2. 720BHA22GR00304 - Holistic prevention and response services to support people affected by forced displacement to restore and rebuild their lives Contact Person: Rick Estridge, Controller, rick.estridge@rescue.org, (443)890-0915 Corrective Action: The following corrective action will be taken to ensure timely FFATA reporting of all applicable subgrant details in SAM.Gov: 1.IRC will update its onboarding process descriptions and checklists to ensure all staff responsible for FFATA reporting are provided the Sam.Gov credentials required for entering data into the system within 15 days of starting. 2.All staff responsible for entering FFATA details in Sam.Gov will be provided additional training and user guides detailing FFATA reporting requirements and processes. The updated process requirements will require obtaining screenshots when system errors/access prevents entering details within the required 30 days. 3.Quarterly detective review processes will be put in place to monitor compliance with all FFATA compliance and corrective actions will be taken with staff who are not performing to standard. Anticipated Completion Date: September 30, 2025
Corrective Action Planned: Twin City Mission recognizes internal control documentation weakness as it relates to the Documentation of Fair Market Rent Reasonableness Test Calculation as required by Uniform Guidance (2 CFR 200.303a) and (24 CFR 982.507). The matter of Material Weakness 2024-001 was b...
Corrective Action Planned: Twin City Mission recognizes internal control documentation weakness as it relates to the Documentation of Fair Market Rent Reasonableness Test Calculation as required by Uniform Guidance (2 CFR 200.303a) and (24 CFR 982.507). The matter of Material Weakness 2024-001 was brought to the attention of management and Board of Directors dudng annual Federal Single Audit of HOME ARP Program fiscal year ending August 31, 2024. Direct Program staff conducted rent reasonableness calculations as evidenced by file notes, email correspondence, and rent reductions; however, failed to document and certify that the assessment was performed. A Rent Reasonableness Checklist and Certification Form has been implemented into Direct Program Staff Procedures, and will be retained within corresponding client files effective May 2, 2025. Additionally, program staff will be training on these procedures and a periodic internal review process will be implemented to confirm compliance with Uniform Guidance.
Corrective Action Plan Single Audit FY24 May 5, 2025 In regards to finding # 2024-001, contracts with subrecipients did not include portions of required disclosures; the Chief Financial Officer will work directly with Chief Operating Officer and Contracts Department to identify any subrecipients dur...
Corrective Action Plan Single Audit FY24 May 5, 2025 In regards to finding # 2024-001, contracts with subrecipients did not include portions of required disclosures; the Chief Financial Officer will work directly with Chief Operating Officer and Contracts Department to identify any subrecipients during the budget process and throughout the fiscal year. Contracts department will then issue a contract in compliance with 2 CFR 200.332. The Chief Operating Officer will oversee and monitor compliance with 2 CFR 200.332 prior to the close of the next fiscal year (September 30, 2025). They will then be responsible for reviewing and issuing appropriate contracts to subrecipients going forward. Taylor J. Good Chief Financial Officer
Legal Services Corporation CFDA #09-742018 Legal Services Corporation - Basic Field - General CFDA #09-742018 Legal Services Corporation - Basic Field - Native American Special Tests & Provisions - Accounting Requirements Material Weakness in Internal Control over Compliance Condition: The Organiz...
Legal Services Corporation CFDA #09-742018 Legal Services Corporation - Basic Field - General CFDA #09-742018 Legal Services Corporation - Basic Field - Native American Special Tests & Provisions - Accounting Requirements Material Weakness in Internal Control over Compliance Condition: The Organization has not performed an annual risk assessment since 2021, nor tested an emergency disaster prevention and recovery plan. Management's Response: DPLS contracted with an outside vendor during December 2024 to conduct an annual risk assessment. The IT Audit and Risk Assessment was completed during quarter 1 2025 and DPLS is awaiting the final report. Upon receipt of the final report, DPLS will review and work to satisfy all recommendations and findings. In addition, DPLS will perform a test of an emergency disaster prevention and recovery plan during 2025 to ensure compliance with Section 2.5.3 of the LSC Financial Guide. Responsible Individuals: Tom Mortland, Executive Director, Lori Stanford, Deputy Director, Jana Gray, Director of Development & Special Projects Anticipated Completion Date: July 2025
CORRECTIVE ACTION PLAN FOR FINDINGS REPORTED UNDER UNIFORM GUIDANCE East Valley School District No. 361 September 1, 2023 through August 31, 2024 This schedule presents the corrective action the District is planning to take for findings included in this report in accordance with Title 2 U.S. Code of...
CORRECTIVE ACTION PLAN FOR FINDINGS REPORTED UNDER UNIFORM GUIDANCE East Valley School District No. 361 September 1, 2023 through August 31, 2024 This schedule presents the corrective action the District is planning to take for findings included in this report in accordance with Title 2 U.S. Code of Federal Regulations (CFR) PArt 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Finding ref number: 2024-001 Finding caption: The District did not have adequate internal controls and did not comply with time-and-effort requirements. Name, address, and telephone of District contact person: Neale Rasmussen, Executive Director of Business Services 3830 North Sullivan, Building 1 Spokane Valley, WA 99216 (509) 241-5042 Corrective action the auditee plans to take in response to the finding: The District has already updated time and effort processes to ensure mid-year additions or corrections are included on time and effort documentation. We have also added a secondary time and effort review process to ensure all employees charged to the Federal program are included on time and effort documentation. Anticipated date to complete the corrective action: Correction already completed.
Finding 2024-002 – Student Financial Aid Cluster, Assistance Listing # 84.063 and 84.268 Limestone University utilizes Jenzabar software to extract and report enrollment data to the National Student Clearinghouse (NSC). However, in some instances, the data reported was incorrect. Since the occurrenc...
Finding 2024-002 – Student Financial Aid Cluster, Assistance Listing # 84.063 and 84.268 Limestone University utilizes Jenzabar software to extract and report enrollment data to the National Student Clearinghouse (NSC). However, in some instances, the data reported was incorrect. Since the occurrence of this issue, the University hired a new Registrar in August 2024. After reviewing the findings, the Registrar implemented the use of the NSC Edit Student Data Records window, in addition to the NSC Edit Registration Transactions window. This change allows a special status on the NSC Edit Student Data Records window to override the status on the Registration Transactions window, providing more precise monitoring of withdrawal dates and ensuring the accuracy and timeliness of the data reported to NSC. To ensure ongoing accuracy, the Registrar now reports enrollment status changes to NSC on a monthly basis. Additionally, the University reviewed the students identified in the findings, along with other students who had the same status (withdrawn) and made adjustments as necessary to ensure that all student data was accurately reported.
Planned Corrective Action: Health Projects Center will address the finding by taking the steps outlined below: 1. Health Projects Center has already contracted a financial consultant in the absence of our Director of Finance, who will provide the expertise needed to oversee internal controls. 2. Hea...
Planned Corrective Action: Health Projects Center will address the finding by taking the steps outlined below: 1. Health Projects Center has already contracted a financial consultant in the absence of our Director of Finance, who will provide the expertise needed to oversee internal controls. 2. Health Projects Center will finalize the year-end trial balance sooner in order to begin the audit sooner. This will prevent the repeat of time restrictions for completion. Person Responsible for Corrective Action Plan: John Beleutz, Executive Director Anticipated Date of Completion: June 30, 2025 fiscal year-end
Corrective Action: Coastal Harvest will begin tracking all inventory on hand by source, including receipts, distributions, waste/loss, and any other adjustments, and will perform periodic reconciliations of amounts recorded in the inventory system and amounts recognized in the general ledger to ensu...
Corrective Action: Coastal Harvest will begin tracking all inventory on hand by source, including receipts, distributions, waste/loss, and any other adjustments, and will perform periodic reconciliations of amounts recorded in the inventory system and amounts recognized in the general ledger to ensure accurate USDA food commodities inventory recordkeeping compliance. Further, Coastal Harvest will include specific inventory policies and procedure in the manual discussed in the corrective action for finding 2022-001. Anticipated Completion Date: June 30, 2025
Finding 560026 (2024-104)
Material Weakness 2024
Assistance Listings number and name: Award numbers and years: Assistance Listings number and name: Award numbers and years: Federal agency: 21.023 COVID-19 - Emergency Rental Assistance Program 1505-0270, May 5, 2021 through September 30, 2025 23*019, May 5, 2021 through September 30, 2025 23*056, M...
Assistance Listings number and name: Award numbers and years: Assistance Listings number and name: Award numbers and years: Federal agency: 21.023 COVID-19 - Emergency Rental Assistance Program 1505-0270, May 5, 2021 through September 30, 2025 23*019, May 5, 2021 through September 30, 2025 23*056, May 5, 2021 through September 30, 2025 23*064, May 5, 2021 through September 30, 2025 21.027 COVID-19 - Coronavirus State and Local Fiscal Recovery Funds 1505-0271, March 3, 2021 through December 31, 2024 19418, May 31, 2023 through September 30, 2023 U.S. Department of the Treasury Name of contact person: Ken Walker, Director (Interim), Grants Management & Innovation; Art Cuarón, Director, Finance and Risk Management Anticipated completion date: June 30, 2026 Response: Concur. The Pima County Department of Grants Management & Innovation (GMI) acknowledges the finding related to noncompliance with federal reporting requirements for the Emergency Rental Assistance (ERA) and Coronavirus State and Local Fiscal Recovery Funds (SLFRF) programs. We recognize the critical importance of maintaining accurate, complete, and well-documented reporting in accordance with federal regulations, and we are committed to addressing the deficiencies noted in this finding. GMI recently adjusted the scope and activities of one of its decisions to address this concern. The division’s new title is Monitoring, Analysis, and Performance (MAP) and its responsibility is to ensure that required reporting documentation is appropriately collected and retained and that related policies and procedures are up-to-date and followed. Corrective Actions Taken and Planned: 1. Documentation and Retention Procedures The Department has implemented a formalized process to ensure that all program reports are supported by comprehensive documentation. This includes: o Capturing and retaining system-generated reports, screenshots, and data queries used in the preparation of ERA and SLFRF quarterly submissions. Each grant specific folder contains subfolders for: • Relevant emails • Screenshots of uploaded information and portal submissions • A copy of the Departmental Approval Form (review form acknowledging the review and agreement to submit programmatic and financial reports into its respective portal.) • A downloaded PDF of the data submitted for the respective quarter. o Establishing a secure digital repository to store supporting documentation for each report, ensuring accessibility and retention in accordance with 2 CFR §200.334 and the County’s record retention policies. • Reporting Guidance • Compliance Supplements • Resources (programmatic and/or service codes, definitions, etc.) • Copies of raw data provided and coding scripts for applicable data sets. o Conducting periodic internal audits to verify documentation compliance. • The MAP Monitoring manager will oversee periodic internal audits for all federal grants. 2. Policy and Procedure Development The Department is finalizing written policies and procedures that establish clear internal controls over the federal reporting process. These policies will require: o A formal reconciliation process of reported expenditures against the County’s general ledger prior to submission. o An independent review and documented approval of all reports to ensure accuracy and compliance with federal guidelines. o Designated accountability roles within the reporting workflow, with approvals required at each stage. This includes electronic approvals within Amplifund and Workday. Amplifund is now the central repository of all grant documentation and Workday is the County’s system of financial records. 3. Training and Staff Development In response to staff turnover, which created institutional knowledge gaps, the Department has launched a training initiative to ensure all relevant personnel are familiar with ERA and SLFRF reporting requirements. Training covers: o Reporting timelines and content requirements, o Use of the U.S. Treasury’s reporting portals, and o Internal compliance expectations, including documentation standards and retention policies. The performance of staff assigned to these tasks will be monitored and corrective action, including re-training, will be taken to address any failures. 4. Reporting Calendar and Tracking Mechanism To improve timeliness and oversight, the Department has initiated a centralized reporting calendar and task-tracking system (Amplifund). This system: o Sends automated reminders of upcoming reporting deadlines, o Tracks task completion by staff, and o Tracks workflows 5. Coordination with Federal Grantor The Department is actively engaging with the U.S. Department of the Treasury to determine whether any corrections can be submitted for previously reported ERA and SLFRF data. U.S. Treasury staff has informed grantees that they are to correct mistakes made in a previous report in the current report. So, while federal guidance currently limits the ability to resubmit reports after the reporting deadline, the County is exploring whether exception-based resubmissions are permissible in cases of material reporting error. Conclusion The County is committed to enhancing and upholding best practice internal controls and fully aligning with federal grant requirements. Staff recognize the impact of these reporting deficiencies and are taking decisive steps to improve accountability and audit readiness across all federal programs. The corrective actions outlined above are designed to address the current finding and to mitigate similar risks for other grant programs administered by the County.
Finding 560023 (2024-102)
Material Weakness 2024
Assistance Listings numbers and names: 17.258 WIOA Adult Program 17.259 WIOA Youth Activities 17.278 WIOA Dislocated Worker Formula Grants 21.027 Coronavirus State and Local Fiscal Recovery Funds 97.024 Emergency Food and Shelter National Board Program 97.141 Shelter and Services Program Name of con...
Assistance Listings numbers and names: 17.258 WIOA Adult Program 17.259 WIOA Youth Activities 17.278 WIOA Dislocated Worker Formula Grants 21.027 Coronavirus State and Local Fiscal Recovery Funds 97.024 Emergency Food and Shelter National Board Program 97.141 Shelter and Services Program Name of contact person: Ken Walker, Director (Interim), Grants Management & Innovation Anticipated completion date: June 30, 2026 Response: Concur. The Pima County Department of Grants Management & Innovation (GMI) has re-organized its structure to include a division called Monitoring, Analysis, and Performance (MAP), which is now the lead on monitoring of all County sub-recipients and has begun the process of improving its sub-recipient monitoring processes and practices. The new process combines a more robust analysis of each subrecipient’s required core documents including the entity’s most recent financial audits as well as relevant policies and procedures with an updated fiscal and programmatic compliance review protocol that is aligned with specific award terms and with federal regulations. For example, 1. GMI has institutionalized the use of standardized written communication and timelines regarding monitoring all sub-recipients - e.g., entrance letters, corrective action requests, and exit letters. 2. GMI is currently piloting a new risk assessment methodology. Once it is finalized the County will communicate the new methodology to all subrecipient entities with an explanation of the revised system elements. The new methodology includes first-hand scoring of the degree to which the materials provided by each entity align with grantor and federal requirements. 3. GMI is developing a standardized method for initiating special terms and conditions with out-of-compliance sub-recipients. Corrective action steps will be incremental and may include increased meeting or reporting frequencies, technical assistance, and/or required training completion to help the entity attain regulatory compliance. Serious, on-going issues or refusal to correct may result in suspending payment until the items are corrected and contract termination as a last resort. 4. MAP will work with its Grants Data Management division colleagues to integrate monitoring scheduling and activities, results, and documents into Amplifund, the County’s new grants management plug-in to its new ERP, Workday. Additionally, to address the ongoing challenge of geometric growth in subrecipients over the last several fiscal years without added personnel capacity, GMI is working to achieve efficiency through the County’s new grants management database, AmpliFund, as the centralized data repository for all subrecipient related reporting. Since go-live of the County’s new ERP in July 2024, GMI has been providing training to all County subrecipients regarding how to interact with AmpliFund to be responsive to GMI monitoring and federal compliance. The County continues to work on the implementation of the full functionality of the new ERP software and its ancillary systems. Full functionality will allow real time updates to track subrecipient monitoring activities with visibility for both County departments and subrecipient entities.
Comments on the Finding and Each Recommendation: The Form SF-SAC Single Audit Data Collection Form for the year ended June 30, 2024, was not submitted within the required timeframe to the federal audit clearinghouse. Action(s) taken or planned on the finding: Agree. Form SF-SAC Single Audit Data ...
Comments on the Finding and Each Recommendation: The Form SF-SAC Single Audit Data Collection Form for the year ended June 30, 2024, was not submitted within the required timeframe to the federal audit clearinghouse. Action(s) taken or planned on the finding: Agree. Form SF-SAC Single Audit Data Collection Form for the year ended June 30, 2024 was submitted to the federal audit clearinghouse. No further action is required.
Teenage Pregnancy Prevention Program – Assistance Listing No. 93.297 Recommendation: We recommend the Organization enhance its policies and procedures to ensure adequate oversight and monitoring of subrecipients throughout the subaward period, including reviewing audit reports on a timely basis, act...
Teenage Pregnancy Prevention Program – Assistance Listing No. 93.297 Recommendation: We recommend the Organization enhance its policies and procedures to ensure adequate oversight and monitoring of subrecipients throughout the subaward period, including reviewing audit reports on a timely basis, actively following up with subrecipients on any audit findings to verify corrective action is being taken, and clearly documenting an annual desk review. Additionally, the Organization should ensure it provides subrecipients with clear information on the federal award, including the federal assistance listing number, as well as the federal requirements applicable under the agreement. This information should be written into the subaward agreement and signed by both parties. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: PPNCS has been made aware of performing annual subrecipient audits and has begun this process. Name of the contact person responsible for corrective action: Randy Drager, CFO Planned completion date for corrective action plan: May 1, 2025
2024-002 – REPORTING Auditee’s Response and Planned Corrective Action The Medford Housing Authority Fee Accountant has informed the Authority that she attempted to submit the Authority’s FDS Report in a timely manner. She further stated that she was unable to do so on December 15, 2024, as the HUD c...
2024-002 – REPORTING Auditee’s Response and Planned Corrective Action The Medford Housing Authority Fee Accountant has informed the Authority that she attempted to submit the Authority’s FDS Report in a timely manner. She further stated that she was unable to do so on December 15, 2024, as the HUD computer system was down thereby preventing her from timely submitting the report. Planned Implementation Date of Corrective Action: September 30, 2025 Person Responsible for Corrective Action: Jeffrey Driscoll, Executive Director
The district will consult with legal counsel on future capital projects requiring prevailing wage in order to ensure proper contracts and recording of wages.
The district will consult with legal counsel on future capital projects requiring prevailing wage in order to ensure proper contracts and recording of wages.
To Health Resources and Services Administration Care Alliance Health Center, Inc. respectfully submits the following corrective action plan for the year ended October 31, 2024. CohnReznick LLP 350 Church Street Hartford, CT 06103 Audit Period: October 31, 2024 The findings from the October 31, 2024 ...
To Health Resources and Services Administration Care Alliance Health Center, Inc. respectfully submits the following corrective action plan for the year ended October 31, 2024. CohnReznick LLP 350 Church Street Hartford, CT 06103 Audit Period: October 31, 2024 The findings from the October 31, 2024 schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the number assigned in the schedule. Federal Award Findings: Finding 2024.001 - Special Tests and Provisions - Sliding Fee Scale Documentation Recommendation The Organization should establish a system of internal controls to ensure that all sliding fee discounts are properly calculated and supported based on family size and income. Action Taken We will invest the time and resources into improving all areas related to the Sliding Fee Scale. We will implement the following steps to our process to ensure all federal guidelines and requirements are met. 1. Documented Process: Design and implement an internal control process to ensure sliding fee discounts are accurately calculated based on family size and income. 2. Documented Procedures: Establish clear procedures and guidelines for front desk staff to follow when determining discounts, including appropriate documentation requirements, eligibility criteria, and fee structure. These procedures will be aligned with our written policy to ensure consistency and accuracy in discount calculations. 3. Training and Education: Provide training to front desk staff members responsible for determining eligibility and applying sliding fee discounts to ensure they understand the process. 4. Regular Reviews: Implement regular reviews and monthly audits to verify that all discounts are properly supported and documented. Quarterly reviews will be conducted to verify compliance, identify areas for improvement, and evaluate the effectiveness of the sliding scale fee program to ensure it meets our patients’ needs and complies with all federal guidelines. Care for you. Care for me. Care for all. Our mission is to provide high-quality, comprehensive medical and dental care, patient advocacy and related services to people who need them most, regardless of their ability to pay. info@carealliance.org • www.carealliance.org Responsible Parties: 1. The Controller and revenue cycle staff will develop the written procedure. 2. The Clinical Support Supervisor and revenue cycle staff will oversee the training. 3. The Revenue Cycle Manager will monitor adherence to the procedure, conduct regular monthly audits, and report results to the Controller. 4. The Controller will conduct quarterly documentation reviews of the internal audit results.
CORRECTIVE ACTION PLAN FOR FINDINGS REPORTED UNDER UNIFORM GUIDANCE Central Valley School District No. 356 September 1, 2023 through August 31, 2024 This schedule presents the corrective action the District is planning to take for findings included in this report in accordance with Title 2 U.S. Code...
CORRECTIVE ACTION PLAN FOR FINDINGS REPORTED UNDER UNIFORM GUIDANCE Central Valley School District No. 356 September 1, 2023 through August 31, 2024 This schedule presents the corrective action the District is planning to take for findings included in this report in accordance with Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Finding ref number: 2024-001 Finding caption: The District did not have adequate internal controls and did not comply with federal wage rate requirements Name, address, and telephone of District contact person: Mathew Knott, Director of Business Services 2218 N. Molter Road Liberty Lake, WA 99019 509-558-5437 Corrective action the auditee plans to take in response to the finding: The district paid its final invoices toward these projects on October 10, 2023 for work that was performed through September 2023. While we realize there was a communication breakdown, and federal certified payroll reports were not collected, the District has put internal controls in place to ensure it complies with federal wage rate requirements. The District’s Purchasing Manager is responsible for creating all purchase orders related to capital projects, including those using federal funds. Prior to any purchase order being created the Purchasing Manager will ensure all required paperwork from the vendor is submitted and reviewed. That includes communication to the vendor on the district’s expectations around submitting weekly certified payroll reports. The Purchasing Manager will track and document this weekly during the life of the project. Anticipated date to complete the corrective action: 4/1/2025
Condition During our procedures over Return to Title IV requirements, the following deficiencies were noted: 􀁸 7 of 13 Return to Title IV calculations were performed outside of the allowable time frame. 􀁸 1 of 13 withdrawn students did not have a Return to Title IV calculation performed. 􀁸 2 of 6 in...
Condition During our procedures over Return to Title IV requirements, the following deficiencies were noted: 􀁸 7 of 13 Return to Title IV calculations were performed outside of the allowable time frame. 􀁸 1 of 13 withdrawn students did not have a Return to Title IV calculation performed. 􀁸 2 of 6 instances where funds were returned beyond the required time frame. Corrective Action(s): Community Christian College has established the following procedure to ensure timely and compliant processing of Return to Title IV (R2T4) calculations: The College will conduct bi-weekly Change in Status meetings to proactively monitor and identify any enrollment changes within the active student population. This process enables the timely identification of students who have recently withdrawn or are pending withdrawal. By doing so, the institution is able to initiate the R2T4 process promptly and ensure its completion within the federally mandated 30-day timeframe, thereby maintaining compliance and upholding institutional accountability. The bi-weekly Change in Status meetings will begin May 2025 and will continue as such, with adjustments made as needed. Additional measures: Community Christian College’s Registrar will notify respective parties of any enrollment changes; this ensures no changes go unnoticed between biweekly meetings.
The Central Iowa Regional Housing Authority (CIRHA) agrees with the finding. The Executive Director (E.D.) will discuss details of the finding with the Fee Accountant and take any necessary steps. Monthly/annual financial reports and/or submissions will be reviewed at a more in depth level by the ...
The Central Iowa Regional Housing Authority (CIRHA) agrees with the finding. The Executive Director (E.D.) will discuss details of the finding with the Fee Accountant and take any necessary steps. Monthly/annual financial reports and/or submissions will be reviewed at a more in depth level by the E.D. The above corrective actions will be completed by May 15, 2025.
Identification: 93.889 United States Department of Health and Human Services, COVID-19 National Bioterrorism Hospital Preparedness Program, Significant Deficiency; Eligibility Requirement. Corrective Action Plan: The Association will implement controls related to future awards so that federal fundin...
Identification: 93.889 United States Department of Health and Human Services, COVID-19 National Bioterrorism Hospital Preparedness Program, Significant Deficiency; Eligibility Requirement. Corrective Action Plan: The Association will implement controls related to future awards so that federal funding is only provided to eligible recipients once a signed subaward agreement is on file. Anticipated completion date: The Association anticipates completion in 2025.
Identification: 93.889 United States Department of Health and Human Services, COVID-19 National Bioterrorism Hospital Preparedness Program, Noncompliance Finding/Material Weakness; Reporting Compliance Requirement. Corrective Action Plan: The Association will strengthen controls of federal grant rep...
Identification: 93.889 United States Department of Health and Human Services, COVID-19 National Bioterrorism Hospital Preparedness Program, Noncompliance Finding/Material Weakness; Reporting Compliance Requirement. Corrective Action Plan: The Association will strengthen controls of federal grant reporting for future awards so that any FFATA reporting requirements are completed in a timely manner. The Association will also modify the amount of the two subawards that were reported incorrectly in the Federal Funding Accountability and Transparency Act Subaward Reporting System. Anticipated completion date: The Association anticipates completion in 2025.
Finding 2024-002 -- Child and Adult Care Food Program, Passed Through New York State Department of Health, AL #10.558; for the Year Ended December 31, 2024 Recommendation: The Organization should have review processes in place to ensure that provider monitoring visits are entered in the database in...
Finding 2024-002 -- Child and Adult Care Food Program, Passed Through New York State Department of Health, AL #10.558; for the Year Ended December 31, 2024 Recommendation: The Organization should have review processes in place to ensure that provider monitoring visits are entered in the database in a timely manner, and the number of monitoring visits performed are accurately recorded and reviewed by management. Action Taken: The Organization has put new procedures in place requiring the data for visits completed each week to be entered into the database every Friday, along with completing the mileage form. Supervisors will monitor completion each Friday. Data from all visits for a month must also be entered into the database no later than the last workday of the month. The five-month report will be generated on the first workday of each month to ensure there are no more than five months between visits for all providers to ensure the CACFP requirement of no more than six months between visits for all providers is met. The Director of CACFP Program will be responsible for implementing this updated process and it will be fully implemented by June 30, 2025.
Finding 2024-001 -- Child and Adult Care Food Program, Passed Through New York State Department of Health, AL #10.558; for the Year Ended December 31, 2024 Recommendation: The Organization should ensure that provider monitoring visits are entered in the database in a timely manner, and the number o...
Finding 2024-001 -- Child and Adult Care Food Program, Passed Through New York State Department of Health, AL #10.558; for the Year Ended December 31, 2024 Recommendation: The Organization should ensure that provider monitoring visits are entered in the database in a timely manner, and the number of monitoring visits performed are accurately recorded and reviewed by management. Action Taken: The Organization has put new procedures in place requiring the data for visits completed each week to be entered into the database every Friday, along with completing the mileage form. Supervisors will monitor completion each Friday. Data from all visits for a month must also be entered into the database no later than the last workday of the month. The five-month report will be generated on the first workday of each month to ensure there are no more than five months between visits for all providers to ensure the CACFP requirement of no more than six months between visits for all providers is met. The Director of CACFP Program will be responsible for implementing this updated process and it will be fully implemented by June 30, 2025.
Finding 2024-010 Program: COVID-19 Health Center Program Cluster Assistance Listing No.: 93.224; 93.527 Federal Grantor: U.S. Department of Health and Human Services Passed-through: N/A Award No.: 4 H8GCS48295-01-01 Year: 12/01/2022 – 12/31/2023 Compliance Requirement: Procurement and Suspension and...
Finding 2024-010 Program: COVID-19 Health Center Program Cluster Assistance Listing No.: 93.224; 93.527 Federal Grantor: U.S. Department of Health and Human Services Passed-through: N/A Award No.: 4 H8GCS48295-01-01 Year: 12/01/2022 – 12/31/2023 Compliance Requirement: Procurement and Suspension and Debarment Type of Finding: Material Weakness in Internal Control over Compliance and Material Non-Compliance Department’s Management Response: Ventura County Health Care Agency (VCHCA) Management agrees with the recommendation for the County to strengthen its policies and procedures to ensure that the verification of the debarment and suspension is documented and retained, the history of procurement transactions is documented and retained in its official records, and that contracts include all applicable provisions of 2 CFR 200 Appendix II. View of Responsible Officials and Corrective Action: VCHCA Management will implement documentation procedures to support the evaluation and selection of vendors. These procedures will include, but are not limited to, ensuring that debarment and suspension verifications are properly documented and retained, procurement transaction histories are maintained in official records, and all contracts include the applicable provisions required under 2 CFR 200 Appendix II. Name of Responsible Persons: Mike Taylor, HCA CFO Theresa Cho, HCA Director Implementation Date: June 2025
Finding 2024-009 Program: CDBG-Entitlement/Special Purpose Grants Cluster Assistance Listing No.: 14.218 Federal Grantor: U.S. Department of Housing and Urban Development Passed-through: Direct Award and Pass-Through City of San Buenaventura Award No.: B-20-UC-06-0507, B-20-UW-06-0507, B-21-UC-06-05...
Finding 2024-009 Program: CDBG-Entitlement/Special Purpose Grants Cluster Assistance Listing No.: 14.218 Federal Grantor: U.S. Department of Housing and Urban Development Passed-through: Direct Award and Pass-Through City of San Buenaventura Award No.: B-20-UC-06-0507, B-20-UW-06-0507, B-21-UC-06-0507, B-22-UC-06-0507, B-23-UC-06-0507, 95-6000807 Year: 2024 Compliance Requirement: Other - Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) §200.510(b) - Schedule of Expenditures of Federal Awards Type of Finding: Material Weakness in Internal Control over Compliance Department’s Management Response: Management agrees with the recommendation that the County enhance internal controls to ensure payments to subrecipients are appropriately reported on the SEFA. View of Responsible Officials and Corrective Action: To ensure compliance with §200.510(b) of the Uniform Guidance, the Auditor-Controller’s Office will provide additional detailed instructions when requesting departmental information for the County’s SEFA including obtaining expenditure details to support costs reported for subrecipients. In addition, a countywide training session will be conducted to assist departments in accurately completing the request. Name of Responsible Persons: Jason McGuire, Deputy Director, Auditor-Controller Implementation Date: August 2025
Finding 2024-008 Program: CDBG-Entitlement/Special Purpose Grants Cluster Assistance Listing No.: 14.218 Federal Grantor: U.S. Department of Housing and Urban Development Passed-through: Direct Award and Pass-Through City of San Buenaventura Award No.: B-20-UC-06-0507, B-20-UW-06-0507, B-21-UC-06-05...
Finding 2024-008 Program: CDBG-Entitlement/Special Purpose Grants Cluster Assistance Listing No.: 14.218 Federal Grantor: U.S. Department of Housing and Urban Development Passed-through: Direct Award and Pass-Through City of San Buenaventura Award No.: B-20-UC-06-0507, B-20-UW-06-0507, B-21-UC-06-0507, B-22-UC-06-0507, B-23-UC-06-0507, 95-6000807 Year: 2024 Compliance Requirement: Reporting Type of Finding: Material Weakness in Internal Control over Compliance and Material Noncompliance Department’s Management Response: The County Executive Office’s Community Development Management agrees with the recommendation that the County implements internal controls to ensure subaward information is reviewed by management and submitted timely in accordance with the FFATA. View of Responsible Officials and Corrective Action: The County’s CDBG Policies and Procedures Manual was revised in April 2025 to address the review and timely submission of reports to ensure compliance with program requirements. CDBG program reports shall be reviewed by an independent staff member prior to submission, and documentation of this review and timely submission shall be maintained in the program’s official files. Name of Responsible Persons: Mary Ann Guariento, CDBG Program Management Analyst Kimberlee Albers, Deputy Executive Officer Implementation Date: April 7, 2025
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