YELLOW SHEET Office of the State Auditor of Missouri Claire McCaskill

Report No. 2006-13

March 2006

The following findings were included in our audit report on the Department of Mental Health, Hawthorn Children's Psychiatric Hospital.

Hawthorn Children's Psychiatric Hospital (HCPH) personnel have not identified the reasons for the differences between the facility's internal receivable system and the Department of Mental Health's (DMH) receivable system.  The July 31, 2005 reconciliation had an unreconciled difference between the two systems of approximately $193,600.

The HCPH did not solicit bids or retain bid documentation for some expenditures, including: furniture, $24,223; sprinkler and fire inspections, $3,820; and locksmith tools and supplies, $8,762, as required by state law.  Also, HCPH management has not established a formal written policy for conducting annual physical inventories of capital assets, and current physical inventory procedures are not adequate.  The physical inventories in fiscal year 2005 indicated 188 items, costing approximately $132,200, were not found.

In three of the ten incident reports reviewed, the decision of whether or not to substantiate a charge of abuse or neglect was not always made within 10 working days after receiving the final investigative report, as required.  Additionally, HCPH personnel were unable to locate an incident report or final investigative report for an incident recorded in the Incident and Investigation Tracking System (IITS).  Facility personnel indicated this incident report was incorrectly entered into the IITS; however, there was no documentation to support this statement.  Our office released a department-wide audit regarding abuse and neglect in September 2005 (Report no. 2005-62).

The DMH established a revolving fund to be used for facility supplies and patient outings. HCPH management has not established a formal written policy for revolving fund expenditures for meals and patient activities.  As a result, HCPH management has no documented basis to determine that meal and patient activity expenditures are appropriate. Also, individuals who actually receive patient monies are not required to sign, documenting receipt of the monies, nor is the purpose of the expenditures noted on the request form.  In addition, documentation of patient expenditures is not filed with HCPH to support purchases by social workers.

The audit also includes some matters related to state vehicles, meals, and the employee relations committee upon which the hospital should consider and take appropriate corrective action. 

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