Open Recommendations

The Martinsburg VA Medical Center Director conducts a review of actions implemented as a result of the factfinding to include administrative actions and performance improvement plans and ensures quality of care concerns have been remediated, and takes action as warranted.

The Martinsburg VA Medical Center Director evaluates the functionality of emergency room equipment, including an exam table with footrests, for conducting gynecologic examinations with dignity and comfort, and takes action as warranted.

The Martinsburg VA Medical Center Director reviews concerns related to fire department overtime practices, takes action as appropriate, and follows up to ensure compliance.

The Martinsburg VA Medical Center Director reviews the transport delay for the abdominal pain patient, and takes action as appropriate.

The Martinsburg VA Medical Center Director reviews the factfinding related to transportation concerns, ensures an adequate review is conducted, and takes action as warranted.

The Martinsburg VA Medical Center Director ensures all reported patient safety concerns related to emergency transport delays are investigated to identify root causes and contributing factors that require action to prevent future events.

The Martinsburg VA Medical Center Director ensures clear guidance is in place for clinical and administrative staff on the use of facility emergent and non-emergent transport resources.

Reduce improper and unknown payments to below 10 percent for the Pension Program.

Reduce improper and unknown payments to below 10 percent for the Purchased Long-Term Services and Supports Program.

The OIG recommends the Associate Director of Operations ensures staff maintain, inspect, and test medical equipment.

The OIG recommends the Deputy Chief of Staff ensures staff secure all medications from unauthorized access.

The OIG recommends the Associate Director of Patient Care Services ensures staff appropriately store oxygen tanks.

The OIG recommends the Associate Director ensures staff clean all food storage areas.

The OIG recommends the Associate Director of Operations ensures staff remove expired supplies from storage areas.

The OIG recommends the Associate Director of Operations ensures staff mark equipment that needs repair and separate it from equipment available for use and remove dirty items from clean storage areas.

The OIG recommends facility leaders ensure sustained compliance with Joint Commission accreditation standards.

Develop, document, and use a risk-based methodology to analyze agency space needs.

Perform and document a risk assessment on the agency’s space utilization and need for real property.

Design and implement policies and procedures to create an effective real property management program.

Develop and utilize an occupancy renewal schedule that aligns with General Services Administration guidance.

Train employees on the newly developed risk-based methodology.

Establish and operate monitoring activities of the policies and procedures to evaluate if the procedures are operating effectively. Remediate any deficiencies identified during monitoring activities as applicable.

Determine whether the $3.785 million of questioned costs related to the 25,380 useable square feet of space associated with General Services Administration Public Building Service’s 2019 recommendation of space reduction at CPSC headquarters is reasonable and necessary in the circumstances.

Relinquish space equal in value to the $2.258 million of funds put to better use related to the 25,380 useable square feet of space associated with General Services Administration Public Building Service’s 2019 recommendation of space reduction at CPSC headquarters or demonstrate usage in line with General Services Administration’s benchmarks.

Establish and document policies and procedures that ensure only officials with the authority to commit or obligate the CPSC execute occupancy agreements, including a process to keep all delegations of authority available for inspection.