We conducted a limited review of nursing home owners to identify their operational challenges and needs of nursing homes in responding to the Coronavirus Disease 2019 (COVID-19) pandemic.  Our objective was to determine the biggest challenges operators of Section 232 nursing home facilities face related to the COVID-19 pandemic and whether nursing homes are prepared to meet their future financial obligations.  Most of the…

We audited the U.S. Department of Housing and Urban Development’s (HUD) monitoring of the financial performance of Section 232 nursing homes based on the size of their program, the inherent risks in the program, the length of time since our last audit, and the inclusion of this review in the annual audit plan.  Our audit objective was to determine whether HUD had sufficient financial information and used this information to…

We audited the Federal Housing Administration-insured nursing home, Middlesex Health Care Center in Middletown, CT, because we identified profitability and solvency issues during ongoing work with the Section 232 program.  Additionally, the U.S. Department of Housing and Urban Development (HUD) identified the project as potentially troubled as of November 2017.  Our audit objective was to determine whether the project was…

Very low REAC scores are not prevalent across ORCF’s portfolio.  The majority of RCFs that received a REAC score scored at least 80 on their last inspection, and more than three quarters scored at least 60.  Despite the small percentage of RCFs that scored below 31, we noticed an overall decline in REAC inspection scores across ORCF’s portfolio from 2000 to 2016. REAC has adopted an inspection process that applies uniformly…

We audited Health Concepts Ltd., a management agent that administers six Federal Housing Administration (FHA)-insured nursing homes.  We conducted this audit based on our review of the Pine Grove Health Center.  The review found that Pine Grove’s owners paid salaries for onsite staff that were covered under the management agreement and charged for services that should have been included in the management fee.  Our…

Sons of Divine Providence did not properly oversee the HUD-insured nursing home to ensure that it operated in accordance with its regulatory agreement.  By not informing HUD of the lawsuits, the changes in management agents, and the loans, Sons of Divine Providence did not provide HUD the necessary data to understand the risk to the HUD insurance fund.  However, when Sons of Divine Providence sold the nursing home and paid…

We audited Folts, Inc.’s management of the Folts Adult Home and Folts Home projects to address our concern with U.S. Department of Housing and Urban Development (HUD)-assisted health care facilities.  We selected this auditee as the result of a risk assessment of nursing homes located in New York State, which considered HUD’s risk indicators and factors such as loan default; internal control issues; and financial statements not…

The Office of Hospital Facilities (OHF) provides mortgage insurance for acute care hospitals.  The insurance it provides reduces risk to lenders and lowers borrowing costs for hospitals.  As of May 2016, the unpaid principal balance for its 105 insured mortgages was approximately $7 billion. OHF collects and generates many records to support its mission.  These records include application materials, internal reports,…

We are conducting an audit survey of Saltillo Assisted Living (project) based on a referral from the U.S. Department of Housing and Urban Development’s (HUD) Departmental Enforcement Center and the activities included in our 2015 annual audit plan.  Our survey objective is to determine whether the owners and management agents of Saltillo Assisted Living complied with the executed regulatory agreement and HUD’s requirements.…

We audited Morris Park Nursing and Rehabilitation Center based on a risk assessment we performed on nursing homes located in New York and New Jersey.  Morris Park has a Section 232 HUD-insured loan in the amount of $7.4 million.  The objective of the audit was to determine whether Morris Park officials managed funds in compliance with the regulatory agreement and applicable HUD requirements. Morris Park officials generally…

As part of the U.S. Department of Housing and Urban Development (HUD), Office of Inspector General’s annual audit plan, we audited the Belle Maison Nursing Home.  We selected the facility for review based on a risk analysis.  Our objective was to determine whether the facility complied with the executed owner and operator regulatory agreements and HUD requirements.  The facility generally complied with the terms of the…

Based on a request by the U.S. Department of Housing and Urban Development’s (HUD) multifamily housing Kansas City hub office, we started an audit of three related nursing facilities on August 2008: • Bartlesville Health Care Center, Inc., doing business as Silver Lake Care Center; • Mannford Health Care Center, Inc., doing business as Cimarron Pointe Care Center; and • Owasso Nursing Center, Inc., doing…

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General reviewed HUD’s Section 242 Mortgage Insurance for Hospitals program to determine whether HUD established controls to approve and administer projects under the Section 242 program and whether HUD used an updated handbook to administer its Section 242 program and used and provided to program participants written guidance that had been approved through…

The U.S. Department of Housing and Urban Development (HUD), Office of Inspector General, reviewed Blue Mountain Hospital (Hospital) based on a request from the Office of Healthcare Programs. The objective of our review was to determine whether the Hospital had adequate written procedures for collecting, dispersing, and accounting for project funds. The Hospital did not have adequate written procedures for collecting, disbursing, and…

We audited the U. S. Department of Housing and Urban Development’s (HUD) Section 232 program as part of the Office of Inspector General’s (OIG) goal of contributing to the improvement of HUD’s execution and accountability of fiscal responsibilities. Our objective was to determine whether HUD had implemented adequate controls to properly monitor Section 232-insured mortgages. We found that HUD’s Office of Healthcare Programs had taken…

At the request of the Region X Multifamily Hub, we audited the John C Cannon Retirement and Assisted Living Residence (project) to determine if the project owner used project funds in accordance with the regulatory agreement. We found that the project owner failed to get HUD approval for leases costing $189,000, used project funds to obtain unneeded equipment costing $10,700, and failed to keep adequate documentation to support…