Federal Reports

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the White River Junction VA Medical Center, which includes outpatient clinics in New Hampshire and Vermont. The inspection covered key clinical and administrative processes that are associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Registered Nurse Credentialing; Mental Health: Emergency Department and Urgent Care Center Suicide Risk Screening and Evaluation; Care Coordination: Inter-facility Transfers; and High-Risk Processes: Management of Disruptive and Violent Behavior.When the OIG conducted the virtual review, the executive leadership team had worked together for over one year. Employee satisfaction survey results demonstrated satisfaction with leadership and maintenance of an environment where staff felt respected. However, responses also pointed to opportunities for the Director and Chief of Staff to improve employee feelings of moral distress at work. Patient experience survey results indicated satisfaction with the care provided. The OIG’s review of the medical center’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. The executive leaders were knowledgeable about selected data used in Strategic Analytics for Improvement and Learning models and should continue efforts to sustain and further improve medical center performance.The OIG issued two recommendations for improvement in two areas:(1) Quality, Safety, and Value• Surgical work group meetings(2) High-Risk Processes• Disruptive behavior training

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the outpatient settings of the Manchester VA Medical Center. The inspection covered key clinical and administrative processes that are associated with promoting quality care. It focused on Leadership and Organizational Risks; COVID-19 Pandemic Readiness and Response; Quality, Safety, and Value; Registered Nurse Credentialing; Mental Health: Emergency Department and Urgent Care Center Suicide Risk Screening and Evaluation; Care Coordination: Inter-facility Transfers; and High-Risk Processes: Management of Disruptive and Violent Behavior.The leadership team appeared stable, with a vacancy in only one of four key positions. Employee survey data revealed satisfaction with leadership and a workplace where staff felt respected and discrimination was not tolerated. However, the OIG noted opportunities to improve servant leadership behaviors and reduce staff feelings of moral distress at work. Patient experience survey results indicated opportunities to improve female veterans’ satisfaction in the outpatient settings. The OIG’s review of the healthcare system’s accreditation findings, sentinel events, and disclosures of adverse patient events did not identify any substantial organizational risk factors. Executive leaders were generally knowledgeable about selected data used in Strategic Analytics for Improvement and Learning models and should continue to take actions to improve performance.The OIG issued seven recommendations for improvement in three areas:(1) Quality, Safety, and Value• Surgical work group attendance(2) Care Coordination• Monitoring and evaluation of patient transfers• Transfer form completion• Medication list transmission• Nurse-to-nurse communication(3) High-Risk Processes• Disruptive behavior committee attendance• Staff training

The Menlo Park (owned), Excelsior (leased), and Sutter Street (leased) post offices are in the California 1 District. The Postal Service is required to maintain a safe and healthy environment for both employees and customers in accordance with its internal policies and procedures and Occupational Safety and Health Administration (OSHA) safety laws. Our objective was to determine if Postal Service management is adhering to building maintenance, safety and security standards, and employee working condition requirements at post offices.We found that building maintenance, safety, and security at the Menlo Park, Excelsior, and Sutter Street post offices did not meet prescribed standards. We identified 50 deficiencies at the three facilities that ranged from minor to more serious violations.

We performed procedures agreed upon by the U.S. Office of Personnel Management’s (OPM) Office of the Chief Financial Officer. This attestation engagement is an annual requirement of the U.S. Office of Management and Budget.Our objective was to assist the OPM in assessing the reasonableness of Postal Service employee health benefits, life insurance, and retirement withholdings; Postal Service benefit contributions; and enrollment information submitted via the headcount report.

We audited the U.S. Department of Housing and Urban Development’s (HUD) oversight of voucher utilization and reallocation in the Housing Choice Voucher Program based on the HUD Office of Inspector General’s (OIG) report on HUD’s top management challenges for fiscal year 2020 and HUD’s strategic goals and objectives reported in its 2018-2022 strategic plan. In addition, while responding to a congressional inquiry from Senator Chuck Grassley’s office, regarding portability in the Program (audit report number 2020-CH-0006, issued September 9, 2020), we identified that as of September 2019, HUD had more than 300,000 unused vouchers that could potentially be used to house families in need of affordable housing. Our audit objective was to assess HUD’s oversight of voucher utilization and reallocation in the Housing Choice Voucher Program.HUD remains challenged to ensure that the maximum number of eligible families benefits from its Housing Choice Voucher Program. Specifically, while HUD’s voucher utilization rate had decreased, it estimated that as of November 2020, more than 62 percent of public housing agencies in the Program had leasing potential and that leasing potential could increase in 2021. In addition, HUD had not exercised its regulatory authority to reallocate housing choice vouchers and associated funding when public housing agencies were underutilizing their vouchers. HUD remains challenged with voucher utilization because some public housing agencies continue to encounter difficulties that are not within their control to overcome and which negatively impact the agencies’ ability to increase leasing in their service areas. In addition, HUD believed that it could not implement its reallocation regulation because of legislative changes dating back to 2003. As a result, nearly 81,000 available housing choice vouchers could potentially be used to provide additional subsidized housing for eligible families. Further, more than 191,000 authorized vouchers were unused and unfunded, meaning that more than 191,000 additional low- to moderate-income families could possibly benefit from subsidized housing by using these vouchers. However, HUD would need an additional appropriation of nearly $1.8 billion to fund these vouchers. We recommend that HUD’s Office of Field Operations establish and implement a plan to assist public housing agencies in optimizing leasing potential to maximize the number of assisted families and prevent additional vouchers from becoming unfunded. We also recommend that HUD’s Office of Public Housing and Voucher Programs establish and implement a plan for the unused and unfunded vouchers to mitigate or prevent additional vouchers from becoming unused and unfunded.