An inordinate number of Hawaii’s nearly 500 adult residential care homes were operating in 2017 either with no license or with “hastily issued” permits — and sometimes without even being inspected, according to a scathing audit of the agency charged with ensuring health and safety standards.

The Department of Health’s Office of Health Care Assurance is required under state law to conduct inspections as part of the annual license renewal process for the state’s 493 care homes. Some care homes take in up to five residents in need of around-the-clock help, while others take in six or more residents who require a higher level of care up to that of skilled- nursing facilities.

The audit was conducted from January 2016 to December 2017, specifically examining the license renewal process in a sampling of 214 care homes.

“Most of the time, OHCA simply renewed a care home’s license,” said state Auditor Les Kondo in the report, adding that there were no annual relicensing inspections for six care homes in 2017 and 22 in 2016. “We found that OHCA’s primary objective is to support the continued operations of those care homes, not to ensure the health, safety, and welfare of the facilities’ residents as mandated by statute.”

Of the 214 care homes that came under the auditor’s review, 116 of them — or 54 percent — were relicensed before the inspection process was completed. At least eight had 20 or more deficiencies but were relicensed anyway, the report said.

The audit also noted that the DOH did not cite a single care home operator or terminate a care home license from 2007 to 2017, even for those with substantial or repeat deficiencies. It also had no written enforcement policies for operators who do not comply with the quality-of-care standards.

In a written response DOH Director Bruce Anderson said that the department has since corrected deficiencies and improved inspections that are now “more timely and up-to-date.”

“Our first and foremost obligation as a regulatory agency is to ensure residential care homes comply with all applicable laws and provide quality care in a safe environment,” he said. “The need for residential care is anticipated to increase as Hawaii’s population ages. After reading the audit, many families may erroneously conclude that adult residential care homes may be unsafe for their loved ones. … Any risks to the safety, health and wellbeing of older adults in an adult residential care home are immediately investigated and appropriate action taken.”

As the audit was being conducted, OHCA was short-staffed and couldn’t meet its statutory obligations, he said. Additional positions were approved in 2017.

“These new staff positions along with clear policies and procedures will ensure the sustained support needed to meet current and future workload requirements so that inspectors can consistently complete inspections and the license renewal process in a timely manner,” Anderson said.

The DOH said it has also improved oversight and enforcement and completed all annual inspections in 2017.

The Health Department said it is on track to complete required inspections in 2018 and is developing a system to track workload and staff assignments; transition to an electronic inspection process from paper-based; create an automated system to post inspection reports online; and update policies and procedures to ensure consistency.

Audit of the Office of Health Care Assurance’s Adult Residential Care Homes Program by Honolulu Star-Advertiser on Scribd