Open Recommendations

The Hampton VA Medical Center Director works with the facility Chief of Staff to ensure medical intensive care unit providers have reviewed a clinical practice guideline specific to management of alcohol withdrawal from an accredited source, such as The American Society of Addiction Medicine.

The Hampton VA Medical Center Director confirms completion of a review to assess the current process for communicating unit-based medication shortages and how staff can confirm the availability of shortage medications when use of the medication is key to the patients treatment, and updates the process as warranted.

The Hampton VA Medical Center Director ensures that the facilitys Alcohol Withdrawal Management standard operating procedure aligns with requirements for a standard operating procedure outlined in Veterans Health Administration Notice 2024-09.

The Hampton VA Medical Center Director confirms that training requirements specified in Veterans Health Administration Notice 2024-09 are completed, training attendance is tracked, and a process is in place to monitor accurate and consistent use of the alcohol withdrawal scale identified in the facility standard operating procedure

We recommend the Regional Administrator, FEMA Region IV, complete the insurance review for Jacksonville State and offset and disallow $14.1 million ($10.6 million Federal share) of ineligible duplicate benefits for insurance proceeds received by Jacksonville State not previously reduced from the corresponding project worksheet amounts.

We recommend the Acting Director for ICE review and revise as needed Memoranda of Agreement and the Joint Concept of Operations between ICE and the U.S. Department of Health and Human Services and continue to work on information-sharing agreements related to unaccompanied alien children.

We recommend the Acting Director for ICE develop and implement a formal process to review ICE system data and identify inaccurate and incomplete addresses for unaccompanied alien children and share this information externally with the U.S. Department of Health and Human Services.

We recommend the Acting Director for ICE develop and implement a plan to address the backlog of unserved Notices to Appear for unaccompanied alien children, including a timeframe for reducing the backlog.

We recommend the Acting Director for ICE update existing guidance, such as the Field Office Juvenile Coordinator Handbook, to clarify how ICE ERO officers should elevate concerns regarding the safety or circumstances of unaccompanied alien children and ensure wide dissemination of all updated guidance.

Establish clearly defined, measurable objectives for the ECAP program that align with the expectations in the GAO Green Book and FS policy.

Establish and document a hiring strategy to ensure FS has sufficient qualified staff at all levels of the ECAP Program.

Document a knowledge management plan to ensure all relevant information from ECAP program activities is communicated and provided to successors.

Develop and implement clear guidance for State Administering Agencies (SAA) to help ensure SAAs provide subrecipients with the necessary federal funding information, which will ensure appropriate management of Victims of Crime Act (VOCA) funds that is compliant with the Uniform Guidance and the Department of Justice (DOJ) Grants Financial Guide.

Ensure New York OVS's subaward allocation methodology is compliant with the Uniform Guidance and the DOJ Grants Financial Guide and assess the potential systemic nature of our finding present with other SAAs.

Ensure that Safe Horizon develops and implements written program policies and procedures for compiling and prorating performance data to ensure VOCA-funded program performance reports are supported and accurate.

Ensure that Safe Horizon establishes necessary controls and processes to separately account for federal award funds in compliance with the DOJ Grants Financial Guide and Uniform Guidance.

Ensure that Safe Horizon develops and implements written policies and procedures to ensure: (a) grant management roles and responsibilities are clearly defined for its personnel and (b) reimbursement requests are prepared appropriately.

Ensure Safe Horizon develops and implements written policies and procedures for administering VOCA-funded client assistance in accordance with VOCA Guidelines

Work with New York OVS to develop and implement written policies and procedures in accordance with the Uniform Guidance and OVC best practices to ensure subrecipients are provided with adequate guidance for time and effort reporting.

More clearly define successful prepurchase and postpurchase homeownership counseling outcomes and use these definitions to help establish performance metrics and benchmarks for HUD's Office of Housing Counseling and HUD-approved housing counseling agencies. This should include the types of successful outcomes under the Homeownership Initiative Grant, as well as other positive outcomes for clients that do not involve immediate homeownership.

Implement routine client outcome data analysis to identify trends, quantify performance metrics and benchmarks, and measure the impact of prepurchase and postpurchase counseling on advancing homeownership. This should include routine analysis that HUD's Office of Housing Counseling can implement based on data collected as well as continuing to pursue an updated housing counseling data system to help overcome client outcome data limitations.

Enhance monitoring of HUD-approved housing counseling agencies' performance, to include progress toward the established performance metrics and benchmarks.

We recommend that the USAID/Kenya and East Africa verify that Northern Rangelands Trust corrects the three instances of material noncompliance identified on pages 40, 41 to 47 of the audit report.

We recommend that USAID/Kenya and East Africa determine the allowability of $35,821 in ineligible questioned costs on pages 17 and 22 of the audit report and recover any amount that is unallowable.

We recommend that USAID/Senegal verify that African Center for Advanced Studies in Management corrects the one material weakness in internal control detailed on page 37 of the audit report.