Corrective Action Plans

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The Department agrees with the finding and recommendation. A memo will be issued to all Kin-GAP eligibility staff to remind them of their responsibility to ensure that all required Kin-GAP documents and forms are received and reviewed for accuracy prior to the continuance of Kin-GAP funding beyond ...
The Department agrees with the finding and recommendation. A memo will be issued to all Kin-GAP eligibility staff to remind them of their responsibility to ensure that all required Kin-GAP documents and forms are received and reviewed for accuracy prior to the continuance of Kin-GAP funding beyond age 18. The memo will also instruct the eligibility staff to ensure that all required documents are maintained in the Kin-GAP case file. Additionally, the Quality Assurance Eligibility Supervisors (QA/ES) will randomly sample and review additional Non-Minor Kin-GAP case files to ensure all required forms are received, and are appropriately filed in the case file.
View Audit 35126 Questioned Costs: $1
DPH agrees with the finding and recommendations. DPH will continue monitoring subawards upon execution and monthly to identify when a subrecipient surpasses the threshold triggering FFATA reporting. DPH will also retain screenshots or printouts when submitting FFATA reports documenting the submissio...
DPH agrees with the finding and recommendations. DPH will continue monitoring subawards upon execution and monthly to identify when a subrecipient surpasses the threshold triggering FFATA reporting. DPH will also retain screenshots or printouts when submitting FFATA reports documenting the submission date.
DPH agrees with the finding and recommendations. DPH will continue monitoring subawards upon execution and monthly to identify when a subrecipient surpasses the threshold triggering FFATA reporting. DPH will also retain screenshots or printouts when submitting FFATA reports documenting the submissio...
DPH agrees with the finding and recommendations. DPH will continue monitoring subawards upon execution and monthly to identify when a subrecipient surpasses the threshold triggering FFATA reporting. DPH will also retain screenshots or printouts when submitting FFATA reports documenting the submission date.
DPH agrees with the finding and recommendations. DPH will notify its subrecipients about their subawards and include any changes in subsequent subaward modifications. DHSP will strengthen its review processes to complete and include the Notice of Federal Subaward Information form as part of the cont...
DPH agrees with the finding and recommendations. DPH will notify its subrecipients about their subawards and include any changes in subsequent subaward modifications. DHSP will strengthen its review processes to complete and include the Notice of Federal Subaward Information form as part of the contract copy at the time of the contract execution.
The Department of Health Services' Emergency Medical Services Agency (EMS) agrees with the finding and recommendation. EMS will strengthen its report submission process to ensure all reports are submitted by the defined due date and retain documentation evidencing submission of the report. The EMS' ...
The Department of Health Services' Emergency Medical Services Agency (EMS) agrees with the finding and recommendation. EMS will strengthen its report submission process to ensure all reports are submitted by the defined due date and retain documentation evidencing submission of the report. The EMS' HPP Coordinator will identify each sub-awardee that meets the $30,000 FFATA threshold and will provide the information to EMS Finance to review and process payment. Before any payment is completed, EMS will obtain and confirm all Unique Entity Identifier (UEI) numbers from the sub-awardees are active prior to issuing any checks. EMS will log all sub-awardees that have reached the threshold into a report and will submit the FFATA report via SAM.gov before the defined due date. To avoid access issues in retrieving submitted documents via the System for Award Management (SAM.gov) website, EMS will retain copies of all reports that include the submission dates.
DHS agrees with the finding and recommendation. DHS will remind staff via electronic memoranda to ensure compliance with federal and County procurement requirements and maintain records sufficient to detail the history of the procurement.
DHS agrees with the finding and recommendation. DHS will remind staff via electronic memoranda to ensure compliance with federal and County procurement requirements and maintain records sufficient to detail the history of the procurement.
Reference Number: 2022-002 Compliance Requirement: Reporting Type of Finding: Internal Control and Compliance Internal Control Impact: Significant Deficiency Compliance Impact: Nonmaterial Noncompliance Assistance Listing Number(s) and Title: 84.425 ? Higher Education Emergency Relief Fund(HEERF) Fe...
Reference Number: 2022-002 Compliance Requirement: Reporting Type of Finding: Internal Control and Compliance Internal Control Impact: Significant Deficiency Compliance Impact: Nonmaterial Noncompliance Assistance Listing Number(s) and Title: 84.425 ? Higher Education Emergency Relief Fund(HEERF) Federal Awarding Agency: U.S. Department of EducationCorrective Action Plan Coastal Alabama Community College has reviewed and recognizes needed changes be put into place to ensure accurate record keeping for all reported data. Coastal will have the restricted accountant complete the quarterly and annual HEERF reports moving forward and file all data according to the report in an organized and methodical method only after the Director of Accounting has reviewed and signed off on the accuracy of the data being reported. Once the Director of Accounting and/or CFO review the reports and backup data for approval then the approved reports will be filed on-line with the Department of Education via the HEERF site. Expenditures charged against the HEERF funds are reviewed for accuracy and allowable cost through a multi-step purchasing process to ensure allowable cost only and prevent potential for improper spending. The Director of Accounting will make sure that all website required reporting is done in a timely manner moving forward. Anticipated Completion Date: June 15, 2023 Contact Person(s): Jessica Davis, Chief Financial Officer
LITTLE PEE DEE MANOR, INC. MULLINS, SOUTH CAROLINA CORRECTIVE ACTION PLAN March 29, 2023 U. S. Department of Housing and Urban Development 400 W Bay Street STE 1015 Jacksonville, FL 32202 Little Pee Dee Manor, Inc. respectfully submits the following Corrective Action Pla...
LITTLE PEE DEE MANOR, INC. MULLINS, SOUTH CAROLINA CORRECTIVE ACTION PLAN March 29, 2023 U. S. Department of Housing and Urban Development 400 W Bay Street STE 1015 Jacksonville, FL 32202 Little Pee Dee Manor, Inc. respectfully submits the following Corrective Action Plan for the year ended December 31, 2022. Bernard Robinson & Company, L.L.P. 1501 Highwoods Blvd., Suite 300 Post Office Box 19608 Greensboro, North Carolina 27419-9608 Period: Year ended December 31, 2022 The finding from the December 31, 2022 Schedule of Findings and Questioned Costs is discussed below. The finding is numbered consistently with the number assigned in the schedule. Findings and Questioned Costs: Finding 2022-001: Section III - Findings and questioned costs relating to the major programs which are required to be reported as defined by the Uniform Guidance [2 CFR 200.516(a)]: Comments on the Finding and Recommendation: Management concurs with the finding and the auditor's recommendation that the Project should continuously monitor cash balances to ensure that funds are always covered by FDIC insurance limits, collateral agreements are obtained, or funds are invested in government securities. Action Taken: Management is in the process of transferring funds to provide adequate FDIC insurance coverage for all funds. Management will re-evaluate its policies and procedures to determine any necessary changes. If HUD has questions regarding this corrective action plan, please call (336) 544-2300. Sincerely, Hona Moore Partnership Property Management
Views of Responsible Officials: The Center will update their policies and procedures regarding monitoring of sub-recipients to ensure they are complying with 2 CFR 200.331. The Center will also enhance the documentation around monitoring of sub-recipients.
Views of Responsible Officials: The Center will update their policies and procedures regarding monitoring of sub-recipients to ensure they are complying with 2 CFR 200.331. The Center will also enhance the documentation around monitoring of sub-recipients.
Individuals Responsible for Corrective Action Plan: Jason Penegar, BGCA Vice President ? Controller Shelby Mahoney, Accounting Manager - State Alliances Corrective Action: Management will review grant agreements to confirm whether expenditures from pass-through entities are related to federal or st...
Individuals Responsible for Corrective Action Plan: Jason Penegar, BGCA Vice President ? Controller Shelby Mahoney, Accounting Manager - State Alliances Corrective Action: Management will review grant agreements to confirm whether expenditures from pass-through entities are related to federal or state grants, and appropriately include applicable federal grants in the SEFA. Anticipated Completion Date: December 31, 2023
Individual Responsible for Corrective Action Plan: Romero Brown, Virginia Alliance Director Corrective Action: Weekly Monitoring: Management will proactively check the Virginia Portal each week to determine if any payments have been made. This will allow us to stay updated on incoming funds. Cross ...
Individual Responsible for Corrective Action Plan: Romero Brown, Virginia Alliance Director Corrective Action: Weekly Monitoring: Management will proactively check the Virginia Portal each week to determine if any payments have been made. This will allow us to stay updated on incoming funds. Cross Training: Management will initiate cross-training sessions for additional staff members to ensure that Club payments can be processed even in the absence of the current staff. This step will enhance our operational resilience. Calendar Prompts: Management will implement calendar reminders to ensure that payments are promptly presented for processing within five days of receiving the deposit notification. This measure will help us adhere to the required disbursement timeframe. By implementing these actions, we aim to mitigate delays in the disbursement process and establish a more efficient workflow. Anticipated Completion Date: June 30, 2023
Finding Number: 2022-006 ? Approval of Expense Reimbursement Submittals Corrective Action Plan: All expense reimbursements should be approved in writing. The findings occurred at a time when Academica Nevada was shorthanded. Since that time all open positions have been filled. Grant managers send...
Finding Number: 2022-006 ? Approval of Expense Reimbursement Submittals Corrective Action Plan: All expense reimbursements should be approved in writing. The findings occurred at a time when Academica Nevada was shorthanded. Since that time all open positions have been filled. Grant managers send a request for approval for reimbursement to the applicable school. Approval is in writing, typically via email, prior to the submittal of the reimbursement request. Personnel Responsible for Corrective Action: Nachum Golodner, Academica Director of Accounting Anticipated Completion Date: June 30, 2023
Finding Number: 2021-002 and 2022-005 Review and Approval Of the Schedule of Expenditures Of Federal Awards (SEFA) Corrective Action Plan: In 2022, the management office had downsized due to turnover in staff. While a process was in place for reconciling, a secondary review was not performed to ve...
Finding Number: 2021-002 and 2022-005 Review and Approval Of the Schedule of Expenditures Of Federal Awards (SEFA) Corrective Action Plan: In 2022, the management office had downsized due to turnover in staff. While a process was in place for reconciling, a secondary review was not performed to verify accuracy. To strengthen the oversight of financial management in the School, Academica Nevada, the School?s management company, has increased staffing to realign staff responsibilities to reduce individual workloads and provide additional oversight and review. On a monthly basis, reconciliations will be performed on grant submissions and expenditures, and reviewed by the Controller, Director of Accounting, or CFO. The annual SEFA will be reviewed by the Director of Finance or CFO. Personnel Responsible for Corrective Action: Nachum Golodner, Academica Director of Accounting Anticipated Completion Date: June 30, 2023
FINDING 2022-002 Contact Person Responsible for Corrective Action: Karla J. Bauman Contact Phone Number:765-647-4631 Views of Responsible Official: I concur with the finding. Description of Corrective Action Plan: Suspension & Debarment-The Commissioners approved a new process for all contracts bein...
FINDING 2022-002 Contact Person Responsible for Corrective Action: Karla J. Bauman Contact Phone Number:765-647-4631 Views of Responsible Official: I concur with the finding. Description of Corrective Action Plan: Suspension & Debarment-The Commissioners approved a new process for all contracts being paid with Federal money over $25,000 that must occur before they will approve the contract for said services. The department head must get the certification from the Contractor. The commissioners have also approved the Franklin County Internal Control Manual for Grant Administration which addresses the necessary requirements for the Suspension & Debarment. Any department receiving grants on behalf of Franklin County will be required to certify to the Commissioners that they have read the internal control manual for grant administration and that they understand their responsibilities and will follow all required Federal, State and Local regulations. Completed June 28, 2023.
Views of Responsible Officials: APHSA did not intentionally disregard the requirements noted under the Federal Funding Accountability and Transparency Act Subaward Reporting. Now that we are aware of these requirements, internal processes are in place to provide timely registration of first tier sub...
Views of Responsible Officials: APHSA did not intentionally disregard the requirements noted under the Federal Funding Accountability and Transparency Act Subaward Reporting. Now that we are aware of these requirements, internal processes are in place to provide timely registration of first tier subawards of $30,000 or more in the Federal Funding Accountability and Transparency Act Subaward Reporting System (FSRS) and report subaward data through FSRS. Though registering subawards over $30,000 is a requirement as noted, the omission did not affect the financial reporting and thus there are no questioned costs.
Finding 2022-001: Section 232 Mortgage Insurance Nursing Homes, Intermediate Care Facilities, Board and Care Homes and Assisted Living Facilities Loan, ALN 14.129 Anticipated Completion Date: February 8, 2023 Recommendation: It was recommended Cheney Care Community implement internal controls to...
Finding 2022-001: Section 232 Mortgage Insurance Nursing Homes, Intermediate Care Facilities, Board and Care Homes and Assisted Living Facilities Loan, ALN 14.129 Anticipated Completion Date: February 8, 2023 Recommendation: It was recommended Cheney Care Community implement internal controls to ensure that the audited financial statements are filed in accordance with the regulatory agreement. Action Taken: Cheney Care Community will follow the filing requirements of the regulatory agreement going forward.
Name of Contact Person: Fred Miller Corrective Action Plan: Management has hired additional staff to the finance department, in part, to aid in the grant management process as well as implemented a process to monitor compliance with reporting requirements of grants. This process allows for internal...
Name of Contact Person: Fred Miller Corrective Action Plan: Management has hired additional staff to the finance department, in part, to aid in the grant management process as well as implemented a process to monitor compliance with reporting requirements of grants. This process allows for internal controls to be met with multiple oversights to ensure deadlines do not get missed and funds are not misused along with proper reporting. Proposed Completion Date: December 31, 2022
Comment Number: 2022-001 and 2022-004 Comment Title: Segregation of Duties Corrective Action Plan: We have reviewed procedures and plan to make the necessary changes to improve internal control. Contact Person, Title and Phone Number: Denise Larson, Business Manager, (641) 872-2184 Anticipa...
Comment Number: 2022-001 and 2022-004 Comment Title: Segregation of Duties Corrective Action Plan: We have reviewed procedures and plan to make the necessary changes to improve internal control. Contact Person, Title and Phone Number: Denise Larson, Business Manager, (641) 872-2184 Anticipated Date of Completion: Immediately
Recommendation: We recommend that sufficient, competent accounting resources be utilized so that proper and timely account analysis and reconciliation, a fundamental component of effective internal control, can be completed timely, thoroughly and accurately on a consistent basis.
Recommendation: We recommend that sufficient, competent accounting resources be utilized so that proper and timely account analysis and reconciliation, a fundamental component of effective internal control, can be completed timely, thoroughly and accurately on a consistent basis.
EMERGENCY CONNECTIVITY FUND PROGRAM REFERENCE: 2022-001 and 2022-002 CLIENT RESPONSE We concur with the condition. Individual responsible for implementation of corrective action plan: Jonathan Cahal, IT Director Corrective action plan: We will update the ECF asset inventory listing to include...
EMERGENCY CONNECTIVITY FUND PROGRAM REFERENCE: 2022-001 and 2022-002 CLIENT RESPONSE We concur with the condition. Individual responsible for implementation of corrective action plan: Jonathan Cahal, IT Director Corrective action plan: We will update the ECF asset inventory listing to include the names of the students receiving the devices, the date the device is/was provided and returned, or if the device is missing, lost, or damaged. With each student name listed we will have a link to the documentation supporting our assessment that the student had an unmet need. We will also verify the asset inventory listing includes all devices and equipment that were purchased with ECF monies and received. Lastly, for new grants that we apply for, more than one person will review the grant requirements, and we will reach out to grant personnel at other entities or contact our consultants and auditors to help ensure we have access to, and have considered all the necessary compliance requirements. . Estimated completion date: July 15, 2023.
View Audit 34699 Questioned Costs: $1
EMERGENCY CONNECTIVITY FUND PROGRAM REFERENCE: 2022-001 and 2022-002 CLIENT RESPONSE We concur with the condition. Individual responsible for implementation of corrective action plan: Jonathan Cahal, IT Director Corrective action plan: We will update the ECF asset inventory listing to include...
EMERGENCY CONNECTIVITY FUND PROGRAM REFERENCE: 2022-001 and 2022-002 CLIENT RESPONSE We concur with the condition. Individual responsible for implementation of corrective action plan: Jonathan Cahal, IT Director Corrective action plan: We will update the ECF asset inventory listing to include the names of the students receiving the devices, the date the device is/was provided and returned, or if the device is missing, lost, or damaged. With each student name listed we will have a link to the documentation supporting our assessment that the student had an unmet need. We will also verify the asset inventory listing includes all devices and equipment that were purchased with ECF monies and received. Lastly, for new grants that we apply for, more than one person will review the grant requirements, and we will reach out to grant personnel at other entities or contact our consultants and auditors to help ensure we have access to, and have considered all the necessary compliance requirements. . Estimated completion date: July 15, 2023.
Finding Number: 2022-005 - Procurement Compliance Institutional Response: Lander University acknowledges this one sample procurement lacked adequate competitive quotes to support the reasonableness of price. It is believed the procurement was rushed in an effort to have authorized and appropriate P...
Finding Number: 2022-005 - Procurement Compliance Institutional Response: Lander University acknowledges this one sample procurement lacked adequate competitive quotes to support the reasonableness of price. It is believed the procurement was rushed in an effort to have authorized and appropriate PPE available to incoming students. With the purchase equating to $2.03 per compliant cloth mask under the CDC guidance at the time, this purchase was reasonable. The observation is correct that the supporting documentation did not present two additional quotes. This procurement was initiated by the campus bookstore staff, who typically are exempt from state procurement under Section 11-35-710 when purchasing items for resale. While this purchase was not for resale, the staff in the bookstore followed their typically acceptable purchasing structure, not realizing the source of funding placed the procurement back under state requirements. This effort was in support of the institution, but it bypassed the more stringent process of purchases passing through the procurement office. While debarment information is shared via standardized terms and conditions documents associated with purchase orders and solicitations, the department is left to check various websites created for state and federal purposes, listing those vendors the university is not to do business with. Such searches were not documented in the procurement files. Doing so is not a necessary step, but the University is aware it needs to ensure prospective vendors are first reviewed against debarment lists. Corrective Action: Lander University will strive to improve controls. Bookstore employees will be trained on state procurement procedures when using non-exempt funds, although such procurements are extremely rare. The procurement department will engage the staff to make sure they understand which funds and purchases are exempt from state procurement and which are not. The Office of Procurement will create a written procedure on debarments, detailing out how to verify a vendor is clear to do business with Lander University. Lander University will add a section to the procurement requisition form to acknowledge the vendor was thoroughly reviewed against active lists. Responsible department for corrective action: Office of Procurement and the Office of Finance and Administration
Finding 38024 (2022-004)
Significant Deficiency 2022
Finding Number: 2022-004 - Lost Revenue Calculations Institutional Response: Lander University agrees the multiple methodologies used by past administrators may be inconsistent from the guidance stating the same methodology must use a consistent baseline. The University?s lost revenue amounts excee...
Finding Number: 2022-004 - Lost Revenue Calculations Institutional Response: Lander University agrees the multiple methodologies used by past administrators may be inconsistent from the guidance stating the same methodology must use a consistent baseline. The University?s lost revenue amounts exceed the amounts claimed against all three rounds of HEERF. Using two forms of lost revenue as defined by the Lost Revenue Frequently Asked Questions, Published March 19, 2021, the university is able to calculate lost revenues under ?Academic Sources? and as ?a comparison to previously budgeted revenue or projected revenue for the period?? as stated in question #3 and #9, to satisfy all draws of lost revenue. Corrective Action: Lander University will retain the currently documented evidence to support lost revenue as calculated for all monthly and quarterly submissions regarding HEERF expenditures; however, the University will also undertake a secondary calculation that justifies lost revenue draws using a more consistent methodology, also supported through provided guidance. Such calculations will be generated based on Academic Sources, such as ?tuition, fees, and institutional charges (including unpaid student accounts receivable and other student accounts debts) as listed in the FAQ question/answer #3, and the ?comparison to previously budgeted revenue or projected revenue for the period? listed in question/answer #9. Responsible department for corrective action: Office of Accounting and Controls and the Office of Finance and Administration
Finding 38023 (2022-003)
Significant Deficiency 2022
Finding Number: 2022-003 - Allowable Costs Institutional Response: It is Lander University?s position the measures taken to utilize previously leased space to socially distance nursing students, in a simulation lab setting, falls within the guidance provided. While HEERF funding was not to be used ...
Finding Number: 2022-003 - Allowable Costs Institutional Response: It is Lander University?s position the measures taken to utilize previously leased space to socially distance nursing students, in a simulation lab setting, falls within the guidance provided. While HEERF funding was not to be used for construction or capital outlays, an exception was provided in the FAQ regarding, and helping to further define, ?minor remodeling.? The FAQ provides limited, and not all-inclusive, examples of ?minor remodeling.? The most specific examples given were under question #24. ?What are some examples of permissible ?minor remodeling? that HEERF grant funds may support under the definition in 34 CFR ? 77.1?? An excerpt of the answer is provided: ?Some examples of permissible minor remodeling may include, but not limited to: ? The installation or renovation of an HVAC system, to help with air filtration to prevent the spread of COVID-19. ? The purchase or cost of the installation of ?room dividers? within a previously completed building to increase social distancing.? The building in question was preexisting, occupiable, and did not receive structural improvements or additions to the building. The HVAC systems was renovated to meet the CDC and ASHRAE recommendations to improved air quality through a significant increase of bringing in outside make up air. The institution expended $162,535 in direct HVAC costs according to the final pay app - schedule of values with additional associated expenses in both plumbing and electrical, totaling more than $281,000. The institution did partition a large, open space into two separate areas to further divide students for social distancing measures. Taking these measures allowed the institution to keep preparing nurses for the workforce at a critical time during the pandemic. Lander University did not have to reduce class sizes, or resort to limited online learning for lab experience because it had the ability to spread out between two locations: the main nursing building and this extension location for simulation. The simulation space worked to mimic clinical experience with essential equipment for training nursing students. Corrective Action: The University maintains its position the expenses incurred fall within provided guidance; however, should the U.S. Department of Education disagree as part of their auditing procedures, Lander University will work to reach a remedy with the agencies in authority over the HEERF program. Responsible department for corrective action: Office of Accounting and Controls and the Office of Finance and Administration
View Audit 34698 Questioned Costs: $1
Finding 38022 (2022-002)
Significant Deficiency 2022
Finding Number: 2022-002 - Internal Controls over Compliance with Education Stabilization Fund Requirements Institutional Response: The responsibility of ensuring expenditures incurred due to the COVID-19 pandemic met the requirements established under HEERF as eligible reimbursement rested with the...
Finding Number: 2022-002 - Internal Controls over Compliance with Education Stabilization Fund Requirements Institutional Response: The responsibility of ensuring expenditures incurred due to the COVID-19 pandemic met the requirements established under HEERF as eligible reimbursement rested with the former Office of Business and Administration. The vice president and the controller were the two lead finance officers for the institution and the controller was the grant ?Project Director? as defined by G5. Given the volume of purchases and the speed in which institutions had to act, larger committees to review expenditures were not feasible. The procurement department resided with this division, so the review of all anticipated HEERF eligible expenses by the leader of the division and the second most senior ranking in the division seemed adequate. The office also accounted for expenditures to HEERF funding by creating dedicated general ledger funds for only HEERF related expenses that they reviewed. The institution could not have foreseen both positions would be vacant before the closing of the grant period. The review process of each expenditure passing through the direct oversight of the vice president and the controller was still a sound practice that continued through the expenditures reported and claimed against HEERF funding. Corrective Action: While Lander University believes its expenditure review process under HEERF was adequate by establishing direct purchasing oversight with both the vice president and controller position, despite the fact both position were eventually vacated, the University acknowledges that a process or procedure established should continue to be honored. In the event a practice or procedure needs to be altered or updated, additional document supporting the change should also exist. The discontinuation of an internal form used to establish approvals specific to reviewing expenditures associated with HEERF did not impact the process as the upper-management review and sign-off still occurred and all procurements passed through the state procurement process. Lander University will ensure a more robust process of approvals is established for future federal funding should the institution experience turnover in key roles.
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