Federal Reports

We reviewed the Northlake Homeless Coalition’s Continuum of Care Program (CoC) based on a hotline complaint alleging impropriety in Northlake’s selection of grant award recipients and as part of our annual audit plan. The objective of our review was to determine whether Northlake administered its CoC in accordance with the U.S. Department of Housing and Urban Development’s (HUD) and its own program requirements.The hotline complaint did not have merit. However, Northlake did not always administer its CoC in accordance with HUD’s and its own requirements, as it did not always (1) monitor its program partners, (2) maintain adequate supporting documentation for disbursements, and (3) follow procurement requirements. In addition, Northlake did not always ensure that its board members (1) executed code-of-conduct and conflict-of-interest forms, (2) met monthly, (3) maintained written documentation of board meetings, and (4) updated its charters annually. This condition occurred because Northlake was not fully aware of requirements and lacked adequate policies and procedures and staff. As a result, Northlake could not provide reasonable assurance to HUD that its program met its purpose or that it followed HUD’s and other requirements, putting more than $2 million in CoC funds allocated to its program partners at risk of mismanagement. In addition, Northlake paid more than $120,000 in questioned costs. We recommend that the Director of HUD’s New Orleans, LA, Office of Community Planning and Development require Northlake to (1) develop and implement written procedures and take actions to ensure that its program partners better spend more than $2 million, (2) support or repay $128,692, (3) annually monitor its CoC recipients as required, and (4) develop and implement procedures to ensure that its CoC is administered in accordance with HUD’s and its own requirements.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to assess anonymous allegations involving multiple quality of care and leaders’ failures at the facility. Many of the allegations were largely unfounded; however, the OIG identified concerns including clinical staff members who did not feel supported by the leadership team and who described communication styles that were not consistently viewed as professional, positive, or oriented toward problem-solving. The hiring process was inefficient and problem-prone, and nurse staffing in the critical care unit (CCU) was problematic. Communication about, and understanding of, certain facility policies was inadequate. The OIG team identified deficits in completion and documentation of CCU nurse competency assessments, and found that the facility did not respond adequately to a 2018 sentinel event. Poor nursing morale was attributed to inadequate nurse staffing levels, guidance, and accountability. Emergency department nurse staffing issues had not been adequately addressed. The OIG identified other emergency department issues related to security, availability of laboratory services, and unclear policies regarding patient transfers that potentially placed emergency department patients at risk. Communication surrounding the use of a connecting bridge between the facility and Augusta University Medical Center was a confusing and contentious problem for staff of both institutions. Despite the facility’s complex designation, various clinical services were periodically reduced or unavailable. The OIG made 27 recommendations involving communication, hiring processes, staffing in the CCU and emergency department, policy development and communication, nurse competencies, nasogastric tube procedures, provider privileges, and emergency department security, among other areas.

We audited Bank2’s origination of Section 184 Loan Guarantees for Indian Housing program loans. We selected Bank2’s Section 184 program because (1) an internal audit report and corrective action verification determined that the U.S. Department of Housing and Urban Development (HUD) lacked proper oversight of the program and lenders did not underwrite loans in accordance with HUD requirements 2) Bank2 is one of the largest Section 184 lenders, and (3) reviews of Section 184 lenders were aligned with the goals of our annual audit plan. Out audit objective was to determine whether Bank2 originated Section 184 Loan Guarantees for Indian Housing Loans in accordance with HUD’s processing guidelines.Bank2 originated all 14 loans reviewed in accordance with Section 184 Loan Guarantees for Indian Housing program processing guidelines. Specifically it ensured that borrowers met income, debt, and credit requirements; property values were supported; and the borrower and properties were eligible for the program. Because the 14 loans reviewed met the processing guidelines, there was not an increased risk to HUD’s Loan guarantee Fund.This report contains no recommendations.