Regulatory oversight of human services licensing agencies: risk-based approaches for California

Thesis (M.P.P.A., Public Policy and Administration) -- California State University, Sacramento, 2011.California???s Department of Social Services, Community Care Licensing Division is responsible ensuring the health and safety of up to 1.4 million vulnerable Californians. However, the agency has suffered from resource problems that have jeopardized the wellbeing of the clients receiving services in the settings under its jurisdiction. By examining regulatory agencies in four other states (Pennsylvania, Texas, Virginia, and Wisconsin) with similar oversight responsibilities, this study identifies alternative approaches to the traditional comprehensive routine visit approach. Alternative approaches identified include risk-based differential monitoring, abbreviated inspections, and automated systems to predict compliance with regulations and provide appropriate interventions.\ud Sources of Data\ud Using information gained from interviews with state licensing agency staff, information was gathered on how each state approaches licensing inspection visits. Information collected included visit frequency, inspector qualifications and training, oversight methods, and methods used to achieve increased compliance. Interviewees included agency directors and management staff with direct involvement in forming policies and procedures related to inspection protocols. \ud Conclusions Reached\ud Results of the case study research revealed that many states are using innovative approaches to balance the dual responsibilities of ensuring appropriate oversight and ensuring health and safety of those under their jurisdictions. The states in this study have utilized differential monitoring to focus their efforts primarily on poorly performing licensees rather than a ???one size fits all??? approach. Achieving greater consistency in enforcement actions is the primary motivating factor for implementation of more formalized approaches in many states. Workload reduction was cited as a side benefit that allowed agencies to focus efforts to reduce risk of harm. States that utilize abbreviated or key indicator inspections generally use this approach for licensees with good compliance. Most notably, many of the inspection methods are part of an integrated approach that use risk reduction strategies.Public Policy and Administratio