Federal Reports

OIG conducted an evaluation of the Volunteer Delivery System to assess the challenges Peace Corps has recently faced in recruiting, selecting, and placing Volunteers. To perform this evaluation, OIG reviewed the agency’s strategic planning and performance documents, recruiting and hiring data, and documentation related to various recruiting strategies. OIG also conducted in-person and virtual interviews with headquarters-based and regional recruitment staff. The evaluation also included an overseas staff survey and a review of relevant documentation. The report contains seven recommendations along with a summary of the effectiveness of Peace Corps’ recruitment strategies and approaches.

To ensure the continued operations of the International Space Station and the safety of the crew, NASA and its spacesuit support contractor must ensure the suits used for spacewalks, designed more than 50 years ago, are well-maintained and reliable. The contractor, Collins Aerospace, has struggled to ensure sufficient life support components for the suits are delivered when needed and within budget and that meet quality expectations. While Collins’ performance over the last several years has declined, NASA has limited leverage to incentivize improved performance.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to determine whether leaders and staff followed required procedures related to suspected elder abuse of a community living center (CLC) resident at the St. Albans VA Medical Center in Queens, part of the VA New York Harbor Healthcare System (system). 

The OIG determined leaders and staff failed to follow procedures to report suspected abuse. A nursing assistant witnessed another nursing assistant allegedly abuse a resident but failed to immediately notify a supervisor, due to being “scared.” Nursing leaders and staff did not immediately ensure the resident’s safety, and did not report the suspected abuse to a unit social worker, VA Police, the resident’s family, and the New York State Department of Health. A nurse practitioner evaluated bruises on the resident and did not document a complete physical exam, consider whether the bruises were related to abuse, or inform the resident’s family. Staff described a culture of silence in the CLC in which staff generally did not report, or underreported, patient safety incidents due to fear of reprisal or administrative burdens. 

Leaders conducted two factfinding investigations into the alleged abuse; however, neither factfinding was thorough, which led to inaccurate conclusions. Factfinding 2 was completed approximately five months after the alleged abuse, exceeding a 14-day completion requirement. An accurate conclusion would have indicated the allegation of patient abuse was plausible and required system leaders to conduct an administrative investigation board. 

The OIG found additional reporting deficiencies related to other incidents of suspected resident abuse; insufficient staff training; substandard documentation by staff, which hindered reviews and investigations; and omissions in Veterans Health Administration and system abuse-related policies. 

The OIG made one recommendation to the Under Secretary for Health, who concurred in principle, and six recommendations to the System Director.
 

Under a contract monitored by this office, the Office of the Inspector General engaged Castro, an independent public accounting firm, to perform the Fiscal Year 2025 Independent Evaluation of the Smithsonian Institution’s Information Security Program. 
 

Smithsonian Enterprises (SE) oversees the majority of the revenue-generating operations of the Smithsonian Institution
(Smithsonian). It is an essential source of unrestricted funds— monies without donor-imposed or legal restrictions on their use. SE provides unrestricted funds to the Smithsonian through the operation of revenue-generating activities.
In SE's fiscal year (FY) 2023, SE generated $150.8 million in net revenue, including more than $63 million from 32 retail stores, approximately $10.7 million of which were cash transactions.

OIG made four recommendations for Smithsonian Enterprises management to improve compliance with policies and procedures related to document retention, audits over cash management, system access for separated employees, and discounts. Management concurred with all four recommendations.