Finding 1191761 (2025-003)

Reference Number: 2025-003 Federal Program Title: Immunization Cooperative Agreements Federal Assistance Listing Number: 93.268 Federal Agency: U.S. Department of Health and Human Services Pass-Through Entity: California Department of Public Health (CDPH) Federal Award Number and Year: 22-11039 July 1, 2022 – June 30, 2027 Name of Department: Department of Public Health, Immunization Program Category of Finding: Reporting and Special Tests and Provisions Type of Finding: Significant Deficiency in Internal Control Over Compliance Criteria In accordance with the Scope of Work (SOW) of the grant agreement and the related statutes under the California Health & Safety Code sections: • 120130 requires the Local Health Officer to properly report to CDPH those diseases listed as reportable, which include vaccine-preventable diseases. • 120175 requires the Local Health Officer to take measures as may be necessary to prevent the spread or occurrence of additional cases of reportable diseases (which includes reportable vaccine-preventable diseases). • 120350 requires Local Health Officers to organize and maintain a program to make available the immunizations required for admittance to childcare facilities and schools. The County of Los Angeles Department of Public Health (DPH) is responsible for monitoring each program component: 1) Vaccine Accountability and Management; 2) Access to and Utilization of Quality Immunization Services; 3) California Immunization Registry (CAIR); 4) Perinatal Hepatitis B Prevention; 5) Education, Information, Training, and Partnerships; 6) Prevention, Surveillance and Control of Vaccine Preventable Disease (VPD); 7) Childcare and School Immunization Entry Requirements; 8) Influenza; and 9) COVID-19 Vaccination. Under each of these component areas, there are objectives and required activities to be performed to meet the objectives. On a semi-annual basis, the Los Angeles County Vaccine Preventable Disease Control Program (VPDCP) will report to CDPH on the progress for the pertinent objectives and activities, as delineated in the grant SOW. Condition During our audit of DPH Immunization Cooperative Agreement program’s Access to and Utilization of Quality Immunization Services component, we noted that VPDCP was unable to provide the supporting log of Medi-Cal members’ access to immunization problems resolved at the local level or reported to CDPH. Cause The log documenting Medi-Cal members’ access to immunization problems could not be located. VPDCP management indicated that, due to staff turnover, the file may have been saved on an individual employee’s local drive rather than in a shared directory accessible to the program. Effect The absence of required documentation prevents validation of the reported progress and undermines assurance that the objective was achieved as stated. Questioned Cost Questioned costs were not identified. Context In the Biannual Progress Report for January 1, 2025, to June 30, 2025, VPDCP reported that Component Area 2, Goal 2.1b had been met. The performance measure for this activity requires VPDCP to maintain a log of access problems resolved at the local level or reported to CDPH. VPDCP was unable to provide this log, preventing confirmation that the activity was completed as reported. Recommendation VPDCP should require all required program documentation be stored in a centralized shared location and implement oversight procedures, including transition checklists and periodic reviews, to ensure documentation is consistently maintained and accessible. These actions will help ensure that required evidence is consistently retained and available to support reported progress to the CDPH.