Corrective Action Plans

Finding 32908 (2022-002)

Material Weakness 2022

Fourth Street Housing Development Company 014hh010cany06q901006

NY

Internal Control / Segregation of Duties

Agency?s Response: John Barber, Secretary and Managing Agent will ensure that the Board of Directors meet at least annually. The Agency will also consider separating the duties of the Property Manager and the Managing Agent.

View Audit 29207

Finding 32907 (2022-001)

Material Weakness 2022

Regional Health Reach, Inc.

NY

Eligibility

Management agrees with the finding. Deficiencies in the Sliding Fee Discount program for year ending December 31, 2022 are a direct result of several misfortunes. On top of the COVID pandemic, the organization experienced Unionization, de-Unionization, high staff turnover, including multiple chan...

Management agrees with the finding. Deficiencies in the Sliding Fee Discount program for year ending December 31, 2022 are a direct result of several misfortunes. On top of the COVID pandemic, the organization experienced Unionization, de-Unionization, high staff turnover, including multiple changes in Senior Leadership, a death of an Executive Director, and an office relocation. Since January 2023, significant improvements have been implemented; the office settled into the new location, new staff and senior leaders have been hired, the organization is flourishing post-pandemic, and policies and procedures have been reviewed and updated. After review of the Sliding Fee Discount Program policies and office process, it was clear that previous controls were ineffective and identified gaps in the Sliding Fee Discount program structure. A major gap was the lack of knowledge related to who was in the current program and who continues to be eligible a year after acceptance. This gap was directly related to missing documentation, lack of EMR tracking, and lack of reporting. The previous corrective action for shelter, Street Medicine and Dental teams remains in place; providers who see patients? offsite were trained on the required documentation, which will be submitted to the clinic daily. Additional staff have been assigned to shelters to facilitate the registration process and transportation of the completed forms back to the Clinic for scanning. In mid-February 2023, an audit was completed on the Sliding Fee Discount program to determine clinic compliance. Additional gaps were identified which led to a secondary process of checks and balances. In addition to the current corrective action, a secondary corrective action was implemented. The Clinic staff would collect the application, review eligibility, and enter the approval/denial status, along with the date into the patients EMR, as well as entering the data on a spreadsheet to track yearly eligibility review. In addition, each team is equipped with a draft application that identifies the necessary information for a complete application. The controls currently in place are performed to identify eligibility at each appointment. If no change, the application is then filed until the next appointment or annual review date, whichever occurs first. If a patients income has changed, prior to the yearly review, a new application is completed at the time of visit, the EMR and spreadsheet are updated accordingly, and the application is filed. The current controls are reviewed daily in order to identify eligibility review and compliance.

View Audit 29396

Finding 32906 (2022-001)

None 2022

Nmf Housing I, Inc. (3005 East 12th St.)

TX

Reporting

Finding Reference Number: 2022-001 Concur or Do Not Concur: Concur Agree or Disagree with Auditor Recommendations: Agree Actions Taken or Planned on the Finding: Management agrees with the finding. The replacement reserve deficiency was funded on October 10, 2022 in the amount of $76. Management w...

Finding Reference Number: 2022-001 Concur or Do Not Concur: Concur Agree or Disagree with Auditor Recommendations: Agree Actions Taken or Planned on the Finding: Management agrees with the finding. The replacement reserve deficiency was funded on October 10, 2022 in the amount of $76. Management will ensure that the replacement reserve deposits are made on a timely basis in the future. Completion Date: November 23, 2022

View Audit 28638

Finding 32905 (2022-001)

Material Weakness 2022

Crouse Health System, Inc. & Affiliates

NY

Cash Management

The Hospital agrees with the finding and recommendation. The Dean for the College of Nursing has implemented a plan that all grants & aid the college receives will have the payout details and requirements for payments to students or other vendors in writing and provided to Finance/AP. These process...

The Hospital agrees with the finding and recommendation. The Dean for the College of Nursing has implemented a plan that all grants & aid the college receives will have the payout details and requirements for payments to students or other vendors in writing and provided to Finance/AP. These processes will allow the Hospital to have sufficient procedures in place to comply with the various payment terms surrounding college programs & grants. The above procedures have already been implemented.

View Audit 29395

Finding 32904 (2022-002)

Material Weakness 2022

Schuyler County Hospital District

IL

Allowable Costs / Cost Principles Reporting Matching / Level of Effort / Earmarking

Identifying Number: 2022-002 Finding: For the Hospital?s Period 1 reporting in the HRSA portal, the Hospital inaccurately reported lost revenues and expenses, resulting in an overstatement of lost revenues and an understatement of expenses. Management did not have effective internal controls in pl...

Identifying Number: 2022-002 Finding: For the Hospital?s Period 1 reporting in the HRSA portal, the Hospital inaccurately reported lost revenues and expenses, resulting in an overstatement of lost revenues and an understatement of expenses. Management did not have effective internal controls in place to ensure reporting of lost revenues and COVID-eligible expenses were adequately reviewed before submission. Corrective Action Taken or Planned: Management will segregate the duties, by assigning the generation of reports to the Controller. The Chief Financial Officer will verify all reports are within the correct parameters, prepare the report, and submit to the Chief Executive Officer for final review. Person Responsible: Tammy Gadberry, Chief Financial Officer, Email: tgadberry@sdcmh.org Phone 217-322-5296 Anticipated Completion Date: January, 2023

View Audit 29294

Finding 32903 (2022-002)

Significant Deficiency 2022

Sacred Heart Village II Inc.

DE

HUD Housing Programs Internal Control / Segregation of Duties

Corrective Action Plan: This situation was one that had never arisen before. The assumption was made that the deposited amount had been communicated to the necessary parties. Beginning immediately, any discrepancy between the amount requested and the amount received will be communicated until a f...

Corrective Action Plan: This situation was one that had never arisen before. The assumption was made that the deposited amount had been communicated to the necessary parties. Beginning immediately, any discrepancy between the amount requested and the amount received will be communicated until a final resolution has been reached. This information will be communicated to the CFO, the Controller and the Program Director by the Staff Accountant who initially receives this information and matches the ACH with the submission. Contact Person Responsible for Corrective Action: Karen Smith, CFO Anticipated Completion Date of Corrective Action: Immediately, staff meetings have already been conducted to address this issue.

View Audit 29205

Finding 32902 (2022-001)

None 2022

Sacred Heart Village II Inc.

DE

HUD Housing Programs

Corrective Action Plan: Beginning July 2023, Sacred Heart Village II Inc. will begin increasing its monthly deposits to the reserve for replacement account by $1,000 until the account is fully funded. Contact Person Responsible for Corrective Action: Karen Smith, CFO Anticipated Completion Dat...

Corrective Action Plan: Beginning July 2023, Sacred Heart Village II Inc. will begin increasing its monthly deposits to the reserve for replacement account by $1,000 until the account is fully funded. Contact Person Responsible for Corrective Action: Karen Smith, CFO Anticipated Completion Date of Corrective Action: Approximately 6.5 years

View Audit 29205

Finding 32901 (2022-002)

Significant Deficiency 2022

City of Quincy, Illinois

IL

Allowable Costs / Cost Principles Cash Management HUD Housing Programs

The public safety officials include Police Chief Adam Yates, Fire Chief Bernie Vahlkamp, and 9-1-1 Director Jessica Douglas. These directors do agree with the finding that the daily sign-in sheets do not always get the supervisor?s written approval. However, they do believe the supervisor in each ca...

The public safety officials include Police Chief Adam Yates, Fire Chief Bernie Vahlkamp, and 9-1-1 Director Jessica Douglas. These directors do agree with the finding that the daily sign-in sheets do not always get the supervisor?s written approval. However, they do believe the supervisor in each case is aware of the documented time, even though it is not a written approval. These City officials all agree that each daily time sheet should have a supervisor?s approval prior to the hours being submitted for payroll entry. The City Comptroller has issued a memo that directs the administrative person responsible for time entry to look for any missing approvals on sign-in sheets, time cards, or on daily rosters. The Police Chief, Fire Chief, and 9-1-1 Director will also be reviewing compliance on this. Lastly, the Comptroller?s staff position of Accountant/Payroll Manager (currently vacant) has the responsibility of auditing time cards; this position can also verify that time cards have appropriate supervisor approval.

View Audit 28689

Finding 32900 (2022-004)

Significant Deficiency 2022

Nyos Charter School, Inc.

TX

Allowable Costs / Cost Principles Reporting Significant Deficiency

Finding #2022-004 ? Significant Deficiency and Other Noncompliance Applicable federal program: U. S. Department of Education Passed through Texas Education Agency COVID-19 Education Stabilization Fund ? Elementary and Secondary School Emergency Relief (ARP) Assistance Listing # 84.425U Contract Nu...

Finding #2022-004 ? Significant Deficiency and Other Noncompliance Applicable federal program: U. S. Department of Education Passed through Texas Education Agency COVID-19 Education Stabilization Fund ? Elementary and Secondary School Emergency Relief (ARP) Assistance Listing # 84.425U Contract Numbers: S425U210042, S425U210042 Contract Years: 06/30/21 ? 09/30/23, 11/08/21 ? 08/31/24 Recommendation: Develop policies and procedures to ensure retention of documentary evidence of approved timesheets to ensure accuracy of reporting and allowability. Planned corrective action: The Assistant Director of Human Resources will develop and implement written procedures to ensure that documentation of time worked is reviewed and appropriately retained. Responsible officer: Matthew May, Assistant Director of Human Resources Estimated completion date: January 31, 2023

View Audit 28637

Finding 32898 (2022-006)

Significant Deficiency 2022

State of South Carolina

SC

Subrecipient Monitoring Reporting Significant Deficiency

The South Carolina Adjutant General?s Office respectfully submits the following Corrective Action Plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the number assigned in the schedu...

The South Carolina Adjutant General?s Office respectfully submits the following Corrective Action Plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the number assigned in the schedule. FINDINGS ? FEDERAL AWARD PROGRAM AUDIT United States Department of Homeland Security 2022-006 Public Assistance (Presidentially Declared Disasters) - Assistance Listing No. 97.036 Recommendation: We recommend the Office update their current internal control to include continuous monitoring and reviewing of project obligations to ensure that reports are submitted in compliance with FFATA reporting requirements. Explanation of disagreement with audit finding: The Office concurs with the audit finding. Action taken in response to finding: A. The Public Assistance team has updated the project version workflow in SCEMD?s South Carolina Recovery Grants (SCRecoveryGrants.org; known as SCRG) system to make sure the obligation information is received timely by the Finance and Administration team. The Fiscal Analyst responsible for reporting is now notified via SCRG automated email when a new obligation is made and when an existing obligation is modified. B. The Finance and Administration team began pulling records for FFATA reporting by obligation date instead of pulling records of reimbursements processed in April 2022 in response to a finding in a different Federal Grant program. This corrective action was implemented in all our Federal Grant Programs. FFATA reporting after May 2022 has been reported by the last day of the month following the month that the subaward was made for awards greater than $30,000. C. The Finance and Administration team will continue to save a pdf record of the monthly FFATA reports made. D. The Finance and Administration Team and the Fiscal Analyst responsible for reporting will continue to make efforts to update reporting that was not reported prior to April 2022. We will complete additional reviews of required FFATA reporting through June 30, 2023. Names of the contact persons responsible for correction action: Ms. Jessica Jones, State Public Assistance Officer; Ms. Brittany Hammond, Chief of Finance and Administration Planned completion date for corrective action plan: June 30, 2023

View Audit 28588

Finding 32887 (2022-005)

Significant Deficiency 2022

State of South Carolina

SC

Subrecipient Monitoring Eligibility Significant Deficiency

Department of Health & Human Services Centers for Medicare & Medicaid Services 31 Forsyth Street, SW, Room 4T20 Atlanta, Georgia 30303-8909 The South Carolina Department of Health and Human Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The fin...

Department of Health & Human Services Centers for Medicare & Medicaid Services 31 Forsyth Street, SW, Room 4T20 Atlanta, Georgia 30303-8909 The South Carolina Department of Health and Human Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS ? FEDERAL AWARD PROGRAM AUDIT DEPARTMENT OF HEALTH AND HUMAN SERVICES 2022-005 Medicaid Cluster; Children?s Health Insurance Program (CHIP) ? Assistance Listing No. 93.775, 93.777, 93.778; 93.767 Recommendation: We recommend the Department strengthen controls over eligibility determinations to ensure documentation is maintained and reviewed in accordance with its State plan and federal regulations. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The agency continues to implement an Eligibility Performance and Remediation process, which includes internal Eligibility Quality Assurance (EQA) monthly case reviews, as well as third party case reviews conducted by the University of South Carolina Core for Applied Research and Evaluation (USC CARE). Eligibility Policies and Procedures provide instructions for a worker to ensure the case file is complete for all eligibility criteria based on policy, prior to making a determination. The policy is included in staff training and is evaluated as part of quality assurance activities. Supervisors are responsible for monitoring staff daily by using data available via system of record, the electronic document management system (OnBase), workload management software, as well as through case spot reviews. Supervisors meet monthly with each staff member to review Eligibility Quality Assurance (EQA) findings to identify and address issues that impact performance, as well as to facilitate corrections to incorrect determinations identified through the EQA process. Errors are identified via error codes and descriptions. EQA reviews are conducted and housed in a state-developed tool to allow for creation of reports that can be generated based on supervisor, worker, work type, error code or overall accuracy. The state compares errors identified through audits and federal reviews such as payment error rate measurement with internal and third party EQA error trends and use this monitoring method to identify trends, develop mitigation strategies and to determine impact of those strategies on these errors. During the 4th quarter of calendar year 2022, 15,716 cases were reviewed by EQA with the following results pertaining to missing documentation: Error Description, Q1 CY2022 % Cases Reviewed, Q2 CY2022 % Cases Reviewed, Q3 CY2022 % Cases Reviewed, Q4 CY2022 % Cases Reviewed: The application was not signed, 0.03%, 0.01%, 0.02%, 0.30%; The application could not be located in the case file, 0.02%, 0.03%, 0.01%, 0.03%; Level of care was not in the case file or in Phoenix, 0.02%, 0.01%, 0.01%, 0.01%; The case record was missing SSN or proof of application for SSN, 0.25% 0.36%, 0.26%, 0.00%; In response to these findings, the Eligibility department will conduct email and face-to-face communication with managers, supervisors and staff regarding these findings and a reminder of documentation requirements in policy, as well as to ensure supervisors are assessing for this requirement in casefile spot checks. This will also be discussed on an upcoming Eligibility Supervisor call and shared in the Eligibility, Enrollment, and Member Services Newsletter. These requirements will also continue to be emphasized in new worker and staff refresher training. Name(s) of the contact person(s) responsible for corrective action: Lori Risk Planned completion date for corrective action plan: Email, face-to-face and newsletter communications: June 2023; EQA Procedures, staff training ? Ongoing.

View Audit 28588

Finding 32886 (2022-004)

Material Weakness 2022

State of South Carolina

SC

Subrecipient Monitoring Eligibility Material Weakness

Department of Health & Human Services Centers for Medicare & Medicaid Services 31 Forsyth Street, SW, Room 4T20 Atlanta, Georgia 30303-8909 The South Carolina Department of Health and Human Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The fin...

Department of Health & Human Services Centers for Medicare & Medicaid Services 31 Forsyth Street, SW, Room 4T20 Atlanta, Georgia 30303-8909 The South Carolina Department of Health and Human Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS ? FEDERAL AWARD PROGRAM AUDIT DEPARTMENT OF HEALTH AND HUMAN SERVICES 2022-004 Medicaid Cluster; Children?s Health Insurance Program (CHIP) ? Assistance Listing No. 93.775, 93.777, 93.778; 93.767 Recommendation: We recommend eligibility reviews be performed annually in accordance with the South Carolina Medicaid Policies and Procedures Manual. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The agency will resume standard review processing in April 2023 in response to requirements outlined in the Consolidated Appropriations Act 2023. The state has developed a comprehensive operational plan for completing this work including: ? Policy and procedure updates ? Hiring additional staff in response to attrition during the public health emergency (PHE) and staffing levels needed to complete the anticipated work ? Additional staff augmentation through a third party vendor to assist with specific data entry tasks associated with review processing ? Staff refresher training on eligibility review policies and procedures ? A comprehensive Communication Plan for sharing relevant information regarding unwinding activities with stakeholders such as beneficiaries, agency staff, call centers, providers, managed care plans and community organizations ? Outreach to inform beneficiaries about the review process and how to contact the agency with changes to contact information and questions they may have ? Distribution of reviews. The state has 12 months during the unwinding period to initiate reviews and 14 months to complete the work. ? Workload management plan to react to staffing needed for both application and review processing. Name(s) of the contact person(s) responsible for corrective action: Lori Risk Planned completion date for corrective action plan: June 2024 (End of Unwinding Period)

View Audit 28588

Finding 32881 (2022-016)

Significant Deficiency 2022

State of South Carolina

SC

Subrecipient Monitoring Reporting Significant Deficiency

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the s...

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS?FEDERAL AWARD PROGRAM AUDIT U. S. Department of Health and Human Services 2022-016 Adoption Assistance - Assistance Listing: 93.659 Recommendation: We recommend that the Department continue to review its internal controls to ensure that federal reports are free from error and clearly supported prior to submission. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Management agrees with the finding. Most of the discrepancies found involved current-period activity correctly posted to prior year grants which should have been reported as current quarter activity but was mistakenly reported as prior-quarter adjustments. Through discussions with the Department?s regional IV-E fiscal reporting contact, the Grants Accounting and Reporting staff have further clarified their understanding of when it is appropriate to report activity as a prior-quarter adjustment versus current-period activity, and they now have a clear understanding of the rules. The Department will correct the CB-496 reports for the quarter ending September 30, 2021, for the activity improperly reported as prior quarter adjustments and the amounts improperly reported as current quarter claims on the June 30, 2022, quarter ending report as soon the reports are made available to update in the reporting system by federal authorities. Going forward, as part of the established review process, the Grants Accounting and Reporting manager will specifically review the transactions and supporting documentation to ensure the correct treatment of prior-quarter adjustments and current-quarter activity. Name(s) of the contact person(s) responsible for corrective action: Reshma Parikh, Grants Accounting and Reporting Manager Planned completion date for corrective action plan: March 31, 2023

View Audit 28588

Finding 32875 (2022-018)

Significant Deficiency 2022

State of South Carolina

SC

Subrecipient Monitoring Allowable Costs / Cost Principles Significant Deficiency § 200.303

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the s...

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS?FEDERAL AWARD PROGRAM AUDIT U. S. Department of Health and Human Services 2022-018 Adoption Assistance, CCDF Cluster - Assistance Listing Nos.: 93.659, 93.575, and 93.596 Recommendation: We recommend that the Department regularly review their public assistance cost allocation plan and submit amendments for approval as necessary. Additionally, we recommend consolidating the support documentation for bases with multiple percentages. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Management agrees with the finding. The change involved allocation based on newly-tracked case management time statistics instead of benefit payment statistics. The new time statistics were available for the first time in the quarter tested, and management considers the new method to be preferable to that previously used. Per CFR 45, Part 95, Subpart E, Section 95.515, the Department can implement changes to its cost allocation beginning with the effective date of its request for approval to do so; it is not required to receive the approval first. Management did submit a request for approval of this change with Cost Allocation Services, but the request was effective as of the beginning of the following quarter, thus did not include the quarter in question. The department will recompute the cost allocation for the quarter in which the exception occurred using the previous allocation method and will record an adjustment to correct the amounts allocated. The clerical error referenced would not have occurred had the various base calculation worksheets been integrated with one another as appropriate and with the allocation calculation worksheets. We will link these worksheets beginning with those used in the allocation for the quarter ending March 31, 2023. Name(s) of the contact person(s) responsible for corrective action: David O?Kelly, Controller Planned completion date for corrective action plan: June 30, 2023

View Audit 28588

Finding 32874 (2022-017)

Significant Deficiency 2022

State of South Carolina

SC

Questioned Costs Period of Performance Subrecipient Monitoring

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the s...

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS?FEDERAL AWARD PROGRAM AUDIT U. S. Department of Health and Human Services 2022-017 CCDF Cluster - Assistance Listing: 93.575 and 93.596 Recommendation: We recommend that the Department review and update internal controls to ensure all expenditures charged to federal awards are incurred within the grant's period of performance. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Additional controls have been implemented to ensure the Department?s Grants Accounting and Reporting manager and staff review and research all transactions posted in the liquidation period of a given grant year to ensure they include only those legally obligated as of the obligation date. The transactions incorrectly posted to the 2020 Discretionary Grant have now been correctly moved to the 2021 Discretionary Grant and are being replaced with qualified voucher expenditures previously moved from the 2020 Discretionary grant to the 2020 Mandatory Grant. Name(s) of the contact person(s) responsible for corrective action: Reshma Parikh, Grants Accounting and Reporting Manager Planned completion date for corrective action plan: June 30, 2023

View Audit 28588 Questioned Costs: $1

Finding 32872 (2022-011)

Significant Deficiency 2022

State of South Carolina

SC

Special Tests & Provisions Subrecipient Monitoring Significant Deficiency

US Department of Health and Human Services The South Carolina Department of Health and Environmental Control respectfully submits the following corrective action plan for the year ended 6/30/22. The findings from the schedule of findings and questioned costs are discussed below. The findings are n...

US Department of Health and Human Services The South Carolina Department of Health and Environmental Control respectfully submits the following corrective action plan for the year ended 6/30/22. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS?FEDERAL AWARD PROGRAM AUDIT U.S. DEPARTMENT OF Health and Human Services 2022-011 Immunization Cooperative Agreements ? Assistance Listing No. 93.268 Recommendation: We recommend the Department ensure compliance visits are reviewed in accordance with Department policy. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: To strengthen internal controls, the Department has discussed the finding with staff and stressed the importance of ensuring Centers for Disease Control guidelines are followed. Each person assigned to a site visit will complete the task within a six month signoff time frame. The Vaccines for Children Operations Director will ensure that the regions are up to speed and responsive to complete these tasks within the required timeframe. In addition, the corrective action plan will be communicated to staff at the next in-person regional meeting. Name(s) of the contact person(s) responsible for corrective action: Kim Paradeses Planned completion date for corrective action plan: June 30, 2023

View Audit 28588

Finding 32868 (2022-010)

Significant Deficiency 2022

State of South Carolina

SC

Subrecipient Monitoring Internal Control / Segregation of Duties Reporting

The South Carolina Office of Resilience (SCOR) respectfully submits the following corrective action plan for the year ended June 30, 2022. The finding from the schedule of findings and questioned costs is discussed below. The finding is numbered consistently with the number assigned in the schedule...

The South Carolina Office of Resilience (SCOR) respectfully submits the following corrective action plan for the year ended June 30, 2022. The finding from the schedule of findings and questioned costs is discussed below. The finding is numbered consistently with the number assigned in the schedule. FINDINGS - FEDERAL AWARD PROGRAM AUDIT U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 2022-010 Community Development Block Grant - Assistance Listing No. 14.228 Recommendation: We recommend that the Office implement procedures to ensure reports are submitted in compliance with FFATA reporting requirements. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: SCOR has already designated an employee (SCOR Reporting Manager) to gain knowledge of FFATA and become the FFATA Reporting point of contact. SCOR is currently unable to report grants in the FFATA Subaward Reporting System (FSRS) because FSRS identifies the 2018 CDBG-DR and CDBG-MIT grants reporting entity under a different state agency. Because the information within FSRS is based off data entries within SAM.GOV, only HUD, as the Federal entity that issued the grant, can make changes within the system. SCOR is working with its assigned representative at HUD to identify and make the appropriate changes in SAM.GOV and FSRS. Once SCOR has control of the two grants in FSRS, SCOR will retroactively report on all subrecipient subawards in the CDBG-MIT program. In the future, SCOR will also report in FSRS any other subrecipient awards for CDBG-DR and CDBG-MIT. Name(s) of the contact person(s) responsible for corrective action: Ran Reinhard, Director of Operations Planned completion date for corrective action plan: June 30, 2023

View Audit 28588

Finding 32867 (2022-009)

Significant Deficiency 2022

State of South Carolina

SC

Subrecipient Monitoring Internal Control / Segregation of Duties Reporting § 200.303

The South Carolina Office of Resilience (SCOR) respectfully submits the following corrective action plan for the year ended June 30, 2022. The finding from the schedule of findings and questioned costs is discussed below. The finding is numbered consistently with the number assigned in the schedule...

The South Carolina Office of Resilience (SCOR) respectfully submits the following corrective action plan for the year ended June 30, 2022. The finding from the schedule of findings and questioned costs is discussed below. The finding is numbered consistently with the number assigned in the schedule. FINDINGS - FEDERAL AWARD PROGRAM AUDIT U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 2022-009 Community Development Block Grant - Assistance Listing No. 14.228 Recommendation: We recommend that the Office ensure staff preparing and entering transactions into the accounting system have a good working knowledge of account codes as defined by the South Carolina Comptroller General's Office (CG). In addition, supervisory personnel should closely review transactions to ensure proper classification in the general ledger. Further, the Office should seek guidance from the CG if questions regarding coding of transactions arises. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: SCOR has developed and implemented the use of a Purchase Order Cover Sheet (POCS) (See example #1) to better identify subrecipient projects/vendors requiring the correct use 517 General Ledger Categories. The POCS is a check list of all required information needed to create a shopping cart / purchase order. A recent POCS form update added a field that requires the requester to identify the Project Management team, either State or Subrecipient. This selection will determine the General Ledger Category used by Finance. Since this issue was identified, SCOR Finance has completed a review of FY23 general ledger coding and will post corrective journal entries prior to year end to ensure compliance in future audits. Name(s) of the contact person(s) responsible for corrective action: Andrew DeRienzo, SCOR Finance Director Planned completion date for corrective action plan: June 30, 2023

View Audit 28588

Finding 32866 (2022-008)

Significant Deficiency 2022

State of South Carolina

SC

Reporting Subrecipient Monitoring Significant Deficiency § 200.303

The South Carolina Department of Commerce respectfully submits the following corrective action plan for the year ended June 30, 2022. The finding from the schedule of findings and questioned costs is discussed below. The finding is numbered consistently with the number assigned in the schedule. FI...

The South Carolina Department of Commerce respectfully submits the following corrective action plan for the year ended June 30, 2022. The finding from the schedule of findings and questioned costs is discussed below. The finding is numbered consistently with the number assigned in the schedule. FINDINGS ? FEDERAL AWARD PROGRAM AUDIT U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 2022-008 Community Development Block Grant (CDBG) ? Assistance Listing No. 14.228 Recommendation: We recommend that Department personnel consistently follow policies in place to ensure reports are properly reviewed by supervisory personnel prior to submission. Explanation of disagreement with audit finding: The South Carolina Department of Commerce agrees with the audit finding. Action taken in response to finding: All reports and documents to be submitted on behalf of the State?s Community Development Block Grant Program to the U.S. Department of Housing, Urban and Development (HUD), U.S. Department of Labor and FSRS.gov will follow a formal review process to include using track changes for documents and a final review by a CDBG staff member in a supervisory position. The designee for the final review will be the Deputy Director of Community Development or the CDBG Program Administrator. An acknowledgement of the final review will be documented to ensure the appropriate review has taken place. Name(s) of the contact person(s) responsible for corrective action: Caroline Griffin ? Deputy Director for Community Development Keely McMahan ? CDBG Program Administrator Planned completion date for corrective action plan: As of March 1, 2023, CDBG program management has adopted this corrective action plan to ensure a comprehensive review of reports by supervisory personnel prior to submission to the appropriate Federal agency.

View Audit 28588

Finding 32865 (2022-007)

Significant Deficiency 2022

State of South Carolina

SC

Subrecipient Monitoring Allowable Costs / Cost Principles Significant Deficiency § 200.303

The South Carolina Adjutant General?s Office respectfully submits the following Corrective Action Plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the number assigned in the schedu...

The South Carolina Adjutant General?s Office respectfully submits the following Corrective Action Plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the number assigned in the schedule. FINDINGS ? FEDERAL AWARD PROGRAM AUDIT United States Department of Defense 2022-007 National Guard Military Operations and Maintenance (O&M) Projects Assistance Listing No. 12.401 Recommendation: We recommend the Office consistently adhere to its internal controls including maintaining the approved State Personnel Action form to support the personnel charges and allocations to applicable funding sources. Explanation of disagreement with audit finding: The Office concurs with the audit finding. Action taken in response to finding: A. The missing forms in the personnel files identified in the audit were corrected. Completed as of March 03, 2023. B. The Office is conducting a complete audit of all personnel files to ensure internal control were implemented and files are accurately and adequately documented. The estimated date of completion is March 31, 2023. C. The Office will ensure that established policies and procedures are followed, and all documentation is completed prior to entering actions into SCEIS. Name of the contact person responsible for correction action: Mr. Robert Faulk, State Human Resources Director Planned completion date for corrective action plan: March 31, 2023

View Audit 28588

Finding 32860 (2022-015)

Significant Deficiency 2022

State of South Carolina

SC

Subrecipient Monitoring Procurement, Suspension & Debarment Significant Deficiency

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the s...

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS?FEDERAL AWARD PROGRAM AUDIT U. S. Department of Agriculture 2022-015 Child and Adult Care Food Program - Assistance Listing: 10.558 Recommendation: We recommend that the Department review and update its internal controls to ensure a signed contract agreement containing suspension and debarment terms and conditions is on file for all subrecipients. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Program manager did retain the email and attachments that were sent to the provider with an explanation that their signature and return of the documents was required prior to their program participation, and management believes the document was executed. However, because the document could not be located, the Department and the provider executed a new agreement to correct the documentation deficiency in February 2023. Program staff are now conducting a 100% review of all active providers to ensure their program participation is supported by signed agreements on file. This review and any corrective measures found to be needed will be completed by April 30, 2023. In addition, management will explore with Information Systems staff the possibility of adding new system controls to confirm the uploading of required documents prior to enabling provider access to the system?s claims module. Management expects to complete any enhancements that can be made in this regard by December 31, 2023. Name(s) of the contact person(s) responsible for corrective action: Mary Abney-Young, Early Care and Education Program Manager Planned completion date for corrective action plan: December 31, 2023

View Audit 28588

Finding 32859 (2022-014)

Significant Deficiency 2022

State of South Carolina

SC

Subrecipient Monitoring Significant Deficiency Internal Control / Segregation of Duties

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the s...

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS?FEDERAL AWARD PROGRAM AUDIT U. S. Department of Agriculture 2022-014 Child and Adult Care Food Program ? Assistance Listing: 10.558 Recommendation: We recommend that the Department review its internal controls to ensure timely notifications of application approvals and disapprovals. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Management agrees with the finding. The Department has sound controls in place for tracking notification compliance. These normally function well to assure that all application decisions are made and communicated timely. During the period in which these exceptions occurred, the program manager was away from work for an extended time. Also, during that time two experienced program staff left the Department. The remaining program staff were then temporarily unable to keep up with the volume of required application reviews, determinations and notifications. In the future, if these situations arise additional resources will be directed to keeping up with the timely processing of application reviews and notifications. In addition, program management has requested that Information Systems staff add to the system dashboard metrics a field displaying pending file approval dates. This will further assure that all upcoming deadlines are met. Management expects these dashboard enhancements to be completed by May 31, 2023. Name(s) of the contact person(s) responsible for corrective action: Mary Abney-Young, Early Care and Education Program Manager Planned completion date for corrective action plan: May 31, 2023

View Audit 28588

Finding 32858 (2022-013)

Significant Deficiency 2022

State of South Carolina

SC

Subrecipient Monitoring § 200.332

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the s...

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS?FEDERAL AWARD PROGRAM AUDIT U. S. Department of Agriculture 2022-013 Child and Adult Care Food Program ? Assistance Listing: 10.558 Recommendation: We recommend that the Department follow its established policies and procedures for the program to ensure compliance with federal subrecipient monitoring requirements. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The three-year time frame in which these monitoring reviews were to have occurred included the peak months of the Coronavirus pandemic, when Department staff were working remotely for an extended period and many provider facilities were closed or operating sporadically due to staffing shortages. A significant number of program staff also left the agency during that time. These factors made timely monitoring much more difficult and extended the time required to complete it. The program maintains a worksheet designed to track compliance with this monitoring requirement and reviews, updates and acts upon it monthly. All monitoring reviews are now being conducted within the required time-frame. DSS also has an active project in progress to automate its compliance monitoring processes, and management plans to include a dashboard that displays the detailed status of each provider?s review, from start to completion. It will also report statistics showing the progress toward meeting the required yearly reviews. Management expects to have these system controls in place by December 2023. In the meantime, program staff will maintain the manual monitoring controls now in place to assure compliance. Name(s) of the contact person(s) responsible for corrective action: Mary Abney-Young, Early Care and Education Program Manager Planned completion date for corrective action plan: December 31, 2023

View Audit 28588

Finding 32857 (2022-012)

Significant Deficiency 2022

State of South Carolina

SC

Cash Management Subrecipient Monitoring Significant Deficiency § 200.303

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the s...

The South Carolina Department of Social Services respectfully submits the following corrective action plan for the year ended June 30, 2022. The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS?FEDERAL AWARD PROGRAM AUDIT U. S. Department of Health and Human Services 2022 ? 012 Adoption Assistance, Child and Adult Care Food Program ? Assistance Listing: 93.659, 10.558 Recommendation: We recommend that the Department follow their policies and procedures to ensure that proper documentation is maintained to support the review and approval of a drawdown of funds. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Department?s Grants Accounting and Reporting staff are following the established policies and procedures to ensure proper documentation is maintained to support the review and approval of draws prior to their execution. In every case the exceptions noted were draws that were done following group discussions that included the Department?s regional federal grant program representatives. Discussions were had to confirm the appropriate support and amounts of draws, and the conclusions of those discussions were that the Department should draw the amounts ultimately drawn. The Grants Accounting and Reporting Manager did approve the draws in advance but did not provide specific written approval. In one case the Grants Accounting Reporting Manager emailed the Department?s federal contact confirming the amount of funds we would draw, and the staff interpreted the email as authorization to proceed. Grants Accounting and Reporting staff have been instructed not to draw funds without express written approval, and they are complying with that requirement. Name(s) of the contact person(s) responsible for corrective action: Reshma Parikh, Grants Accounting and Reporting Manager Planned completion date for corrective action plan: Effective immediately

View Audit 28588

Finding 32856 (2022-001)

Material Weakness 2022

Millington Municipal Schools Board of Education

TN

Material Weakness Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties § 200.303 § 200.326

Compliance Procedures: Operations will receive weekly Davis Bason timesheets for all contracted employees performing construction activities on federally funded projects. The timesheets must be signed by the Contractor and submitted to Millington Municipal School District. Internal Control Procedu...

Compliance Procedures: Operations will receive weekly Davis Bason timesheets for all contracted employees performing construction activities on federally funded projects. The timesheets must be signed by the Contractor and submitted to Millington Municipal School District. Internal Control Procedures: Finance will insure prior to making payment to the Contractor for the Applications and Certificate for Payment that all weekly Davis Bacon timesheets have been submitted to Millington Municipal Schools District for federally funded projects where construction services were done. Contact Person: Taurus Currie, CFO Proposed Completion Date: This action was completed by January 31, 2023.

View Audit 34189

Corrective Action Plans

Filters