Success Notification Overlay
Failure Notification Overlay
Image of Susan Montee's Name Image of Name of document Yellow Sheet

Report No. 2007-70
November 2007

Complete Audit Report

More Could Be Done to Protect Clients from Abuse


The departments of Social Services (DSS), Mental Health (DMH), and Health and Senior Services (DHSS) have responsibility to protect clients that receive department services. Because of the importance of protecting the young, elderly, and other clients, we focused review efforts on determining whether improvements are needed to (1) increase protection of clients at DSS, DMH, and DHSS; (2) improve the Family Care Safety Registry (FCSR) registration process, FCSR screenings, and the processing of good cause waivers; and (3) provide opportunities to enhance client protection.

DSS could do more to protect foster children at licensed facilities

Personnel at three of eight DSS licensed residential facilities reviewed had not always performed annual Central Registry checks as required by DSS guidance and state regulations. In addition, DSS policy and state law have not automatically precluded individuals with child abuse charges or criminal convictions from being employed at residential facilities. Instead, the decision of whether anything in a potential employee's background would prevent the individual from being employed at a facility is left to the discretion of the residential facility's executive director. Missouri is one of only a few states that does not disqualify individuals from employment at residential facilities based on criminal history. (See page 11)


Improvements needed to protect DMH clients

Four DMH state-run facilities reviewed did not perform periodic criminal history and Central Registry checks of employees because DMH did not require it. One DMH state-run facility did not conduct all screenings required by state law for new employees. In addition, persons included on DSS's Central Registry have not been disqualified from employment at DMH facilities and providers. Our review disclosed 22 individuals who abused DMH clients also had prior substantiated child abuse or neglect incidents. (See page 14)


Persons with dangerous histories permitted to work in DHSS licensed long-term care facilities

Persons with histories of child abuse or neglect; stealing, theft, and forgery convictions; or pending charges for serious crimes have been permitted to work in DHSS licensed long-term care facilities. Approximately 23 percent of all long-term care facilities have employed at least one individual with a questionable background. (See page 18)


Improvements needed in FCSR registration, screenings, law, and processing waivers

DHSS data disclosed delays in processing initial FCSR registrations. We also found employers are not always required to conduct FCSR screenings for individuals required to register. When FCSR results show problems, potential employees are allowed to request a waiver. However, we found delays in the waiver process, and periodic screenings have not been required for individuals with a waiver. (See page 20)


Opportunities exist to enhance protection for clients

Providers and facilities have not been required to conduct nationwide criminal background checks when hiring new employees. As a result, some persons with out-of-state criminal histories have worked for Missouri providers. The departments should take advantage of additional opportunities to enhance the protection of clients served by (1) requiring facilities and/or providers to conduct nationwide background checks and/or reviewing databases in other states, and (2) using employment and FCSR data to identify problem employees. (See page 24)


Supreme Court ruling prevents DSS from placing substantiated abusers on central registry until criminal charges are resolved

A ruling by the Missouri Supreme Court in March 2007 prevents DSS from placing individuals with substantiated findings of child abuse on the Central Registry if criminal charges are pending. The Supreme Court found an individual is entitled to notice and a hearing with the Child Abuse and Neglect Review Board (CANRB) before being placed on the Central Registry. However, state law does not allow a person who has criminal charges pending to request a review board hearing until after the court's final disposition or dismissal of the charges.


Changing state law to allow individuals with substantiated child abuse charges and related criminal charges to have a CANRB hearing before criminal charges are resolved would improve the effectiveness of the Central Registry. (See page 28)


Complete Audit Report

Missouri State Auditor's Office