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Corrective Action Plans

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Finding 556016 (2024-002)
Significant Deficiency 2024
Legal Aid Chicago
IL
Eligibility Significant Deficiency Internal Control / Segregation of Duties
Recommendation: We recommend that management implement a control to ensure complete documentation is maintained for all cases that require retainer agreement. Explanation of disagreement with audit finding: There is no disagreement with this finding. Action taken in response to finding: Our Deput...
Recommendation: We recommend that management implement a control to ensure complete documentation is maintained for all cases that require retainer agreement. Explanation of disagreement with audit finding: There is no disagreement with this finding. Action taken in response to finding: Our Deputy Director/General Counsel contacted the person who had failed to sign the retainer that was missing the staff signature to remind them of that requirement. She also held a training on LSC requirements in Q1 2025 in which she reminded staff of the retainer requirement. Name of the contact person responsible for corrective action: Teresa Sullivan, Deputy Director / General Counsel Planned completion date for corrective action plan: Already implemented
View Audit 354747
Finding 556015 (2024-001)
Significant Deficiency 2024
Legal Aid Chicago
IL
Eligibility Significant Deficiency Internal Control / Segregation of Duties
Recommendation: We recommend that management implement a control to review PAI time entries to ensure they are accurate. Explanation of disagreement with audit finding: There is no disagreement with this finding. Action taken in response to finding: In 2024, but after employees logged the two erro...
Recommendation: We recommend that management implement a control to review PAI time entries to ensure they are accurate. Explanation of disagreement with audit finding: There is no disagreement with this finding. Action taken in response to finding: In 2024, but after employees logged the two erroneous PAI entries, we implemented a new PAI time entry system in LegalServer. Employees must now choose the nature of the PAI involvement when they log the time, which would have avoided both of the two erroneous entries, had that been in place. Additionally, our Deputy Director/General Counsel provided an LSC regulations training in Q1 2025 to remind employees of LSC regulations, including the regulation governing PAI time. Name of the contact person responsible for corrective action: Teresa Sullivan, Deputy Director / General Counsel Planned completion date for corrective action plan: Already implemented
View Audit 354747
Wesley Village INC
OH
Questioned Costs Internal Control / Segregation of Duties
Management agreed with the recommendation and will ensure all proper approvals are received prior to any withdrawals from the replacement reserve
Management agreed with the recommendation and will ensure all proper approvals are received prior to any withdrawals from the replacement reserve
View Audit 354743 Questioned Costs: $1
Town of Pembroke
MA
Questioned Costs Procurement, Suspension & Debarment § 200.319
RE: Corrective Action Plan Finding 2024-001 The Town awarded four contracts for engineering services for water projects funded by Federal awards without a competitive procurement process. This was due to a mistaken reliance on State procurement exemptions which do not apply to Federal procurements....
RE: Corrective Action Plan Finding 2024-001 The Town awarded four contracts for engineering services for water projects funded by Federal awards without a competitive procurement process. This was due to a mistaken reliance on State procurement exemptions which do not apply to Federal procurements. Going forward, the Town will implement policies to perform competitive procurement procedures on all applicable contracts for goods and services charged to Federal awards. Sincerely, Michael Buckley, Town Accountant
View Audit 354711 Questioned Costs: $1
Finding 555985 (2024-002)
Significant Deficiency 2024
Dal Housing for the Elderly
OH
Questioned Costs HUD Housing Programs Reporting
Management is currently conducting a comprehensive review of the process to ensure alignment with compliance requirements and identify areas for improvement.
Management is currently conducting a comprehensive review of the process to ensure alignment with compliance requirements and identify areas for improvement.
View Audit 354707 Questioned Costs: $1
Finding 555984 (2024-001)
Significant Deficiency 2024
Dal Housing for the Elderly
OH
Questioned Costs HUD Housing Programs Eligibility
Management is currently conducting a comprehensive review of the process to ensure alignment with compliance requirements and identify areas for improvement. Status of finding: Corrective Action
Management is currently conducting a comprehensive review of the process to ensure alignment with compliance requirements and identify areas for improvement. Status of finding: Corrective Action
View Audit 354707 Questioned Costs: $1
L.w. Fraser Independent Living Project, Inc., Sheridan Court
MN
HUD Housing Programs
CORRECTIVE ACTION PLAN Name of Auditee: L. W. Fraser Independent Living Project, Inc., Sheridan Court HUD Auditee Identification Number: 092-11227 Name of Audit Firm: Boulay PLLP Period Covered by Audit: Year Ended December 31, 2024 CAP Prepared by: Name: James Strickland Position: Controller Teleph...
CORRECTIVE ACTION PLAN Name of Auditee: L. W. Fraser Independent Living Project, Inc., Sheridan Court HUD Auditee Identification Number: 092-11227 Name of Audit Firm: Boulay PLLP Period Covered by Audit: Year Ended December 31, 2024 CAP Prepared by: Name: James Strickland Position: Controller Telephone Number: 612-861-1688 CURRENT FINDING ON THE SCHEDULE OF FINDINGS, QUESTIONED COSTS, AND RECOMMENDATIONS 2024-01: Monthly Deposits to the Replacement Reserve Comments on Finding: The Project is required by HUD to make monthly deposits to the replacement reserve in an amount prescribed by HUD. Payments for a portion of the year were lower than the required deposits, due to missed communication between HUD and the Project. The Project corrected the shortfall during 2024 and began making the required deposits. Statement of Concurrence or Nonconcurrence: We concur with the finding and recommendation. Corrective Action: Management has implemented additional procedures to ensure the monthly deposit to the replacement reserve is timely updated.
View Audit 354698
Finding 555979 (2024-001)
Significant Deficiency 2024
Monmouth Regional High School
NJ
Prior to submitting to the NJ Department of Agriculture, the meals claimed should be verified and agreed to the meal count activity records and edit check worksheets. Responsible officials will review and verify number of meals claimed and category of meals claimed for accuracy.
Prior to submitting to the NJ Department of Agriculture, the meals claimed should be verified and agreed to the meal count activity records and edit check worksheets. Responsible officials will review and verify number of meals claimed and category of meals claimed for accuracy.
View Audit 354693
Finding 555976 (2024-005)
Material Weakness 2024
Big Springs Medical Association D/b/a Missouri Highlands Health Care
MO
Procurement, Suspension & Debarment § 200.319 § 200.320
This error occurred during fiscal year 2022, when the architect for an upcoming project was chosen. We are in a very rural area, where architects are not easy to come by. For this project, we had decided to utilize a local firm we had a good track record with. We presented it to our board for app...
This error occurred during fiscal year 2022, when the architect for an upcoming project was chosen. We are in a very rural area, where architects are not easy to come by. For this project, we had decided to utilize a local firm we had a good track record with. We presented it to our board for approval, and it was approved by them at that time so we originally had thought we could justify with having them as a sole source vendor. At the time, the total amount of the project was unknown, and has even changed significantly since that date. However, come to find out, due to the size of the project it should have been bid out. We have revised our procurement policy since this date and have educated all staff on proper procurement procedures.
View Audit 354688
Finding 555972 (2024-004)
Significant Deficiency 2024
Big Springs Medical Association D/b/a Missouri Highlands Health Care
MO
Questioned Costs Allowable Costs / Cost Principles Internal Control / Segregation of Duties
Education regarding coding of invoices to grants and only picking up current balances due has been done to both grant project directors and accounts payable. Going forward, we will ensure no balances are duplicated and grant directors can ensure the balances charged to their grants as appropriate a...
Education regarding coding of invoices to grants and only picking up current balances due has been done to both grant project directors and accounts payable. Going forward, we will ensure no balances are duplicated and grant directors can ensure the balances charged to their grants as appropriate and approved.
View Audit 354688 Questioned Costs: $1
Finding 555971 (2024-003)
Significant Deficiency 2024
Big Springs Medical Association D/b/a Missouri Highlands Health Care
MO
Subrecipient Monitoring Reporting Internal Control / Segregation of Duties § 200.329
Our quarterly status progress report was inadvertently sent two days past the due date in to our state office. We have corrected this by implementing controls by placing the quarterly due dates on our calendars so these due dates are no longer overlooked going forward.
Our quarterly status progress report was inadvertently sent two days past the due date in to our state office. We have corrected this by implementing controls by placing the quarterly due dates on our calendars so these due dates are no longer overlooked going forward.
View Audit 354688
Finding 555967 (2024-002)
Significant Deficiency 2024
Big Springs Medical Association D/b/a Missouri Highlands Health Care
MO
Cash Management Period of Performance
Management agrees that we did end up having a pause in a project that we had previously drawn grant funds on to cover. However, when this was realized, we did have additional allowable expenditures available to reallocate that draw down over to that had incurred within the audit period, it was just...
Management agrees that we did end up having a pause in a project that we had previously drawn grant funds on to cover. However, when this was realized, we did have additional allowable expenditures available to reallocate that draw down over to that had incurred within the audit period, it was just after the date of the original drawdown and caused the timing issue. The pause on the project was unknown at the time of the original draw, so this would have been very difficult to know ahead of time.
View Audit 354688
Zion Tabernacle Senior Living Center, INC
IN
Questioned Costs Cash Management HUD Housing Programs
Management made the deposit.
Management made the deposit.
View Audit 354678 Questioned Costs: $1
Finding 555963 (2024-001)
Significant Deficiency 2024
Lone Pine Economic Development Corporation and Trust
CA
Reporting Internal Control / Segregation of Duties
Comments: Management agrees with the finding. Actions: Management will make the required monthly transfer to the replacement reserve cash account. Management will transfer $30,528 to the replacement reserve cash account.
Comments: Management agrees with the finding. Actions: Management will make the required monthly transfer to the replacement reserve cash account. Management will transfer $30,528 to the replacement reserve cash account.
View Audit 354676
Finding 555960 (2024-002)
Significant Deficiency 2024
Arirang Housing,inc.
CA
Subrecipient Monitoring Reporting § 200.512
Finding 2024-002: For the year ended June 30, 2023, the Corporation did not submit audited financial statements to the Federal Audit Clearinghouse within 9 months after the end of the audit period. The audited financial statements were submitted to the Federal Audit Clearinghouse on December 5, 2024...
Finding 2024-002: For the year ended June 30, 2023, the Corporation did not submit audited financial statements to the Federal Audit Clearinghouse within 9 months after the end of the audit period. The audited financial statements were submitted to the Federal Audit Clearinghouse on December 5, 2024. Comments on the Finding and Each Recommendation: The Corporation should submit audited financial statements to the Federal Audit Clearinghouse within the time frames required. Action(s) taken or planned on the finding: The audited financial statements have been submitted to the Federal Audit Clearinghouse.
View Audit 354675
Finding 555959 (2024-001)
Significant Deficiency 2024
Arirang Housing,inc.
CA
Questioned Costs Procurement, Suspension & Debarment Subrecipient Monitoring
Finding 2024-001: During the year ended June 30, 2024, the Corporation did not make the required deposits to the reserve for replacements. Comments on the Finding and Each Recommendation: Management should make a deposit to the reserve for replacements for $4,846 for the delinquent deposits. In futu...
Finding 2024-001: During the year ended June 30, 2024, the Corporation did not make the required deposits to the reserve for replacements. Comments on the Finding and Each Recommendation: Management should make a deposit to the reserve for replacements for $4,846 for the delinquent deposits. In future periods, management should fund the reserve for replacements on an annual basis as required by the HUD regulatory agreement or request HUD approval for a suspension of deposits. Action(s) taken or planned on the finding: Management made a deposit of $4,846 on January 3, 2025 for the delinquent deposits.
View Audit 354675 Questioned Costs: $1
Keeneyville School District No. 20
IL
Reporting
The District will implement a process to track the submission time of the data collection form and audit package.
The District will implement a process to track the submission time of the data collection form and audit package.
View Audit 354668
Finding 555947 (2024-001)
Significant Deficiency 2024
Paschall Senior Housing, Inc.
CA
Questioned Costs Subrecipient Monitoring HUD Housing Programs
Finding 2024-001: Comments on the Finding and Each Recommendation During the year ended December 31, 2024, the Corporation withdrew funds totaling $5,562 from the reserve for replacements account without receiving approval from HUD. Management should transfer funds of $5,562 from the operating ca...
Finding 2024-001: Comments on the Finding and Each Recommendation During the year ended December 31, 2024, the Corporation withdrew funds totaling $5,562 from the reserve for replacements account without receiving approval from HUD. Management should transfer funds of $5,562 from the operating cash account to the reserve for replacements account. Action(s) taken or planned on the finding Management concurs with the finding and the auditor's recommendation. Management intends to transfer $5,562 from the operating cash account to the reserve for replacements account.
View Audit 354658 Questioned Costs: $1
The Pinemont Apartments, Inc.
TX
HUD Housing Programs Procurement, Suspension & Debarment Reporting
The financial statements were required to be submitted to HUD’s Real Estate Assessment Center by March 31, 2025, but were not submitted timely. Response: The financial statements were submitted on April 10, 2025. In the future, we will ensure that the financial statements are submitted by the Mar...
The financial statements were required to be submitted to HUD’s Real Estate Assessment Center by March 31, 2025, but were not submitted timely. Response: The financial statements were submitted on April 10, 2025. In the future, we will ensure that the financial statements are submitted by the March 31 deadline.
View Audit 354657
Finding 555945 (2024-003)
Significant Deficiency 2024
The Pinemont Apartments, Inc.
TX
Procurement, Suspension & Debarment HUD Housing Programs Reporting
The operating bank account was not reconciled at year end. A significant audit adjustment was made. Response: Management will implement procedures to ensure bank accounts are properly reconciled on a monthly basis.
The operating bank account was not reconciled at year end. A significant audit adjustment was made. Response: Management will implement procedures to ensure bank accounts are properly reconciled on a monthly basis.
View Audit 354657
Finding 555944 (2024-002)
Significant Deficiency 2024
The Pinemont Apartments, Inc.
TX
Procurement, Suspension & Debarment HUD Housing Programs Reporting
Fixed assets that had been replaced were not removed from the books. A significant audit adjustment was made. Response: Management will implement procedures to ensure all transactions are properly recorded in the future.
Fixed assets that had been replaced were not removed from the books. A significant audit adjustment was made. Response: Management will implement procedures to ensure all transactions are properly recorded in the future.
View Audit 354657
Finding 555943 (2024-001)
Significant Deficiency 2024
The Pinemont Apartments, Inc.
TX
Procurement, Suspension & Debarment HUD Housing Programs Reporting
Certain expenses for mold remediation were capitalized and should have been expensed. A significant audit adjustment was made. Response: Management will implement procedures to ensure all transactions are properly recorded in the future.
Certain expenses for mold remediation were capitalized and should have been expensed. A significant audit adjustment was made. Response: Management will implement procedures to ensure all transactions are properly recorded in the future.
View Audit 354657
Finding 555941 (2024-001)
Significant Deficiency 2024
Dayspring Programs, Inc. and Subsidiaries
MD
Allowable Costs / Cost Principles Reporting Procurement, Suspension & Debarment
Corrective Action: We recognize the importance of ensuring that expenses are incurred within the correct reporting period for grant compliance. To address this issue and prevent future occurrences, we are implementing the following corrective actions: - Adjustment of Financial Reporting: We will w...
Corrective Action: We recognize the importance of ensuring that expenses are incurred within the correct reporting period for grant compliance. To address this issue and prevent future occurrences, we are implementing the following corrective actions: - Adjustment of Financial Reporting: We will work with the grantor agency to secure the appropriate federal approvals for any projects that may extend past the end of our fiscal year if necessary. - Enhanced Internal Controls: Our finance team will implement stricter monitoring of expense recognition, ensuring that only incurred costs are included in grant reimbursement requests. - Vendor Coordination: Going forward, we will attempt to implement a more rigorous project timeline review process with contractors to anticipate and address potential supply chain delays before committing grant funds. We remain committed to fully complying with grant guidelines and to strengthening our financial management processes.
View Audit 354649
Finding 555940 (2024-001)
Significant Deficiency 2024
Manchester Supportive Housing, Inc. D/b/a Page Place
PA
HUD Housing Programs Eligibility
The following represents the Corrective Action Plan related to the audit finding listed in the Schedule of Findings and Questioned Costs included in the December 31, 2024 audited financial statements of Manchester Supportive Housing, Inc. d/b/a Page Place (the “Corporation”). Finding 2024-001: Incom...
The following represents the Corrective Action Plan related to the audit finding listed in the Schedule of Findings and Questioned Costs included in the December 31, 2024 audited financial statements of Manchester Supportive Housing, Inc. d/b/a Page Place (the “Corporation”). Finding 2024-001: Incomplete Documentation of New Residents Condition and Criteria: The Corporation is required to obtain, confirm, and document income information for each resident in Form HUD-50059 upon move-in and recertification. The Corporation was found to have an error in the documented income information for one out of the three residents selected for testwork. Management Response and Corrective Action Plan: Management agrees with the finding. The Corporation is implementing an updated standard review process over the resident files to prevent and detect errors on a timely basis.
View Audit 354634
Finding 555939 (2024-001)
Significant Deficiency 2024
Plum Presbyterian Housing, Inc. D/b/a Plum Creek Acres
PA
HUD Housing Programs Procurement, Suspension & Debarment Eligibility
The following represents the Corrective Action Plan related to the audit finding listed in the Schedule of Findings and Questioned Costs included in the December 31, 2024 audited financial statements of Plum Presbyterian Senior Housing, Inc. d/b/a Plum Creek Acres (the “Corporation”). Finding 2024-0...
The following represents the Corrective Action Plan related to the audit finding listed in the Schedule of Findings and Questioned Costs included in the December 31, 2024 audited financial statements of Plum Presbyterian Senior Housing, Inc. d/b/a Plum Creek Acres (the “Corporation”). Finding 2024-001: Incomplete Documentation of New Residents Condition and Criteria: The Corporation is required to have all new residents sign a Form HUD-9887 and a Resident Rights and Responsibilities document upon move-in. The Corporation did not have these documents signed and maintained in the resident file for one out of four residents selected for testwork. Management Response and Corrective Action Plan: Management agrees with the finding. The Corporation is implementing an updated standard review process over the resident files to prevent and detect errors on a timely basis.
View Audit 354632
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