YELLOW SHEET Office of the State Auditor of Missouri Claire McCaskill

June 30, 2003

Report No. 2003-68

The following problems were discovered as a result of an audit conducted by our office of the Department of Mental Health, St. Louis Psychiatric Rehabilitation Center.

The Auxiliary of the St. Louis Psychiatric Rehabilitation Center (SLPRC) operates a canteen that sells food, beverages, cigarettes, and other miscellaneous items to clients and employees.  Our review of canteen operations noted:

• The Auxiliary has not entered into formal written agreements with the vendors.
  
  
• Five client accounts, within the canteen fund, had negative balances.  These negative balances result when clients are allowed to make purchases at the canteen without sufficient monies in their accounts.  Disbursements made on behalf of these five clients were made using, or borrowing, other clients' monies.  In addition, thirty-eight of the client accounts within the canteen fund, totaling approximately $630, have been inactive for over six months.  Client account balances become inactive when the client is no longer able to use the canteen or when a client leaves the facility or dies.
  
  
• Differences noted in the monthly bank reconciliations are not adequately investigated and resolved.

The SLPRC purchases various statutorily-defined psychiatric services from private and public vendors under the authority of state law.  The Department of Mental Health (DMH), through its facilities, has entered into contracts with vendors to provide these services and has developed guidelines by which these programs must be operated.  State law requires the DMH to monitor the contracts to ensure the services are cost and benefit effective.  We visited four vendors and noted some client files reviewed did not contain complete and current Individual Treatment Plans, progress notes that met the established requirements, and did not contain a current Standard Means Test.  In addition, some client files reviewed showed units billed in excess of the maximum units allowed for a one month period.

The DMH purchases residential care in community-based facilities through the Community Placement Program (CPP) for clients who would otherwise require institutionalization.  The SLPRC is responsible for monitoring the CPP vendors for compliance with contractual terms and quality of care.  Our review of four CPP vendors found incomplete and inaccurate quarterly reports, inadequate client fund records, and the facilities not remitting client personal funds exceeding $200 to the SLPRC as required.

The SLPRC operates a Client Work Program (CWP) under a certificate issued by the federal Department of Labor.  The certificate requires certain records to be kept in the participating client's files.  Client records do not always indicate their productivity at periodic intervals, including documents explaining how the productivity and hourly wage of the client was determined.  In addition, the amounts paid to clients did not always agree to the commensurate wage rates recorded in the client files, hours recorded on the timesheets approved by the clients' supervisor did not always agree to the hours for which the client was paid, and hourly wage rates of the clients have been reduced to compensate for the cost of care and treatment which is prohibited by federal regulations.

Five of fifteen state-owned vehicles were driven less than 5,000 miles during the year ended June 30, 2002.  Low mileage can often indicate that a facility has too many vehicles or is not using them efficiently.  During the two years ended June 30, 2002, personnel received mileage reimbursements when using their personal vehicles for business travel instead of utilizing state-owned vehicles.  In addition, vehicle logs were not always complete.

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