Series: Health and Safety Standards in Social Services for Adults

Announced on 11/21/2022 | Last Modified on 12/02/2025 | Series Number: W-00-24-31503

Status

Completed

Agency

Centers for Medicare and Medicaid Services

OBJECTIVE

State agencies operate elderly waiver programs under a 1915(c) waiver to their Medicaid State plan. Adult day centers are center-based facilities directly licensed by the State agency. They provide adult day services to functionally impaired adults on a regular basis for periods of fewer than 24 hours during the day in a nonresidential setting. As the licensing agency for adult day care centers, the State agency must ensure that adult day centers follow applicable licensing standards to protect the health and safety of adults receiving services at these facilities. Recent OIG reports have identified numerous instances of noncompliance in regulated child care facilities and family adult foster care homes. We will determine whether regulated adult day centers comply with applicable Federal, State, and local regulations and standards on ensuring the health and safety of adults in their care, including infection control for conditions such as coronavirus disease 2019 (COVID-19) and other coronaviruses.

There are 7 projects in this series.

COMPLETED PROJECTS IN THIS SERIES (7)

New Jersey

Project A-02-24-01009 • Completed on December 2, 2025

South Carolina

Project A-04-24-00137 • Completed on October 29, 2025

Maryland

Project A-03-24-00201 • Completed on May 15, 2025

Audit of the State of Ohio's Adult Day Care Services

Project A-05-23-00006 • Completed on April 10, 2025

Audit of the State of Texas Adult Day Care Services

Project A-06-23-05000 • Completed on March 7, 2025

Review of Health and Safety Standards for Adult Day Centers in Florida

Project A-04-23-00135 • Completed on December 26, 2024

Review of Health and Safety Standards for Adult Family Homes in Washington State

Project A-09-23-02002 • Completed on November 13, 2024

TIMELINE

November 21, 2022

Series Number W-00-24-31503 Assigned
November 21, 2022

Project Announced
Audit of the State of Ohio's Adult Day Care Services - A-05-23-00006
December 19, 2022

Project Announced
Review of Health and Safety Standards for Adult Day Centers in Florida - A-04-23-00135
April 6, 2023

Project Announced
Review of Health and Safety Standards for Adult Family Homes in Washington State - A-09-23-02002
April 10, 2023

Project Announced
Audit of the State of Texas Adult Day Care Services - A-06-23-05000
November 15, 2023

Project Announced
Maryland - A-03-24-00201
December 11, 2023

Project Announced
South Carolina - A-04-24-00137
April 23, 2024

Project Announced
New Jersey - A-02-24-01009
November 13, 2024

Project Complete - A-09-23-02002
Review of Health and Safety Standards for Adult Family Homes in Washington State has been marked as complete. This audit resulted in 3 recommendations.
December 26, 2024

Project Complete - A-04-23-00135
Review of Health and Safety Standards for Adult Day Centers in Florida has been marked as complete. This audit resulted in 3 recommendations.
March 7, 2025

Project Complete - A-06-23-05000
Audit of the State of Texas Adult Day Care Services has been marked as complete. This audit resulted in 3 recommendations.
April 10, 2025

Project Complete - A-05-23-00006
Audit of the State of Ohio's Adult Day Care Services has been marked as complete. This audit resulted in 3 recommendations.
May 15, 2025

Project Complete - A-03-24-00201
Maryland has been marked as complete. This audit resulted in 3 recommendations.
October 29, 2025

Project Complete - A-04-24-00137
South Carolina has been marked as complete. This audit resulted in 3 recommendations.
December 2, 2025

Project Complete - A-02-24-01009
New Jersey has been marked as complete. This audit resulted in 3 recommendations.
December 2, 2025

Series Complete
Health and Safety Standards in Social Services for Adults has been marked as complete.

7 REPORT PUBLISHED

New Jersey Did Not Ensure Providers Complied With Federal and State Requirements at All 20 Adult Day Health Services Facilities Audited (A-02-24-01009)

New Jersey did not ensure that ADHS providers that serve Medicaid managed care enrollees complied with Federal and State requirements. All 20 ADHS providers that we reviewed did not comply with 1 or more health and safety and administrative requirements. We found a total of 348 instances of noncompliance with these requirements at the 20 providers.
New Jersey’s inspections of facilities were insufficient to ensure a continuously

26-A-02-017.01 to CMS - Open Unimplemented

Update expected on 06/01/2026

We recommend that the New Jersey Department of Human Services work with the New Jersey Department of Health to ensure providers correct the 348 instances of noncompliance identified in this report.

26-A-02-017.02 to CMS - Open Unimplemented

Update expected on 06/01/2026

We recommend that the New Jersey Department of Human Services work with the New Jersey Department of Health to improve its oversight and monitoring of all providers, including conducting timely surveys.

26-A-02-017.03 to CMS - Open Unimplemented

Update expected on 06/01/2026

We recommend that the New Jersey Department of Human Services work with the New Jersey Department of Health to work with providers to improve their facilities, staffing, and training.

View in Recommendation Tracker

Maryland Did Not Comply With Federal Waiver and State Requirements at 20 Adult Day Care Facilities Audited (A-03-24-00201)

25-A-03-063.01 to CMS - Closed Implemented

Closed on 10/09/2025

We recommend that Maryland's Department of Health verify that providers correct the 253 instances of provider noncompliance identified in this report.

25-A-03-063.02 to CMS - Closed Implemented

Closed on 09/24/2025

We recommend that Maryland's Department of Health improve its oversight and monitoring of providers.

25-A-03-063.03 to CMS - Closed Implemented

Closed on 09/29/2025

We recommend that Maryland's Department of Health collaborate with providers to enhance their facilities, staffing, and training.

View in Recommendation Tracker

Florida Did Not Comply With Federal Waiver and State Requirements at 18 of 20 Adult Day Care Facilities Reviewed (A-04-23-00135)

25-A-04-035.01 to CMS - Open Unimplemented

Update expected on 05/04/2026

We recommend that the Florida Agency for Health Care Administration ensure that providers correct the 120 instances of provider noncompliance identified in this report.

25-A-04-035.02 to CMS - Open Unimplemented

Update expected on 05/04/2026

We recommend that the Florida Agency for Health Care Administration improve its oversight and monitoring of providers.

25-A-04-035.03 to CMS - Open Unimplemented

Update expected on 05/04/2026

We recommend that the Florida Agency for Health Care Administration work with providers to improve their facilities, staffing, and training.

View in Recommendation Tracker

South Carolina Did Not Comply With Federal Waiver and State Requirements at 19 of 20 Adult Day Care Facilities (A-04-24-00137)

South Carolina did not fully comply with Federal waiver and State requirements in overseeing providers that serve adults receiving adult day care services because of insufficient inspections that did not ensure a continuously safe and nonhazardous environment. As a result, adults were at risk in numerous instances.

We found 204 instances of noncompliance with health, safety, and administrative requirements among 19 of the 20 providers we reviewed.
Of the 20 providers, 17 did not comply with 1 or more health and safety requirements and 18 did not comply with 1 or more administrative requirements.

26-A-04-007.01 to CMS - Open Unimplemented

Update expected on 06/15/2026

We recommend that the South Carolina Department of Health and Human Services work with the South Carolina Department of Public Health to ensure that providers correct the 204 instances of provider noncompliance identified in this report.

26-A-04-007.02 to CMS - Open Unimplemented

Update expected on 06/15/2026

We recommend that the South Carolina Department of Health and Human Services improve its oversight and monitoring of providers.

26-A-04-007.03 to CMS - Open Unimplemented

Update expected on 06/15/2026

We recommend that the South Carolina Department of Health and Human Services work with providers to improve their facilities, staffing, and training.

View in Recommendation Tracker

Ohio Did Not Comply With Federal Waiver and State Requirements at 18 of 19 Adult Day Care Facilities Audited (A-05-23-00006)

25-A-05-061.01 to CMS - Closed Implemented

Closed on 09/30/2025

We recommend that the Ohio Department of Medicaid ensure providers correct the 117 instances of provider noncompliance identified in this report.

25-A-05-061.02 to CMS - Open Unimplemented

Update expected on 03/30/2026

We recommend that the Ohio Department of Medicaid improve its oversight and monitoring of all providers.

25-A-05-061.03 to CMS - Open Unimplemented

Update expected on 03/30/2026

We recommend that the Ohio Department of Medicaid work with providers to improve their facilities, staffing, and training.

View in Recommendation Tracker

Texas Did Not Fully Comply With Federal Waiver and State Health, Safety, and Administrative Requirements at All 20 Adult Day Activity Health and Service Facilities Audited (A-06-23-05000)

25-A-06-055.01 to CMS - Closed Implemented

Closed on 06/24/2025

We recommend that the Texas Department of Health and Human Services ensure that providers correct the 253 instances of provider noncompliance identified in this report.

25-A-06-055.02 to CMS - Closed Implemented

Closed on 05/14/2025

We recommend that the Texas Department of Health and Human Services improve oversight and monitoring of providers.

25-A-06-055.03 to CMS - Closed Implemented

Closed on 05/14/2025

We recommend that the Texas Department of Health and Human Services work with providers to improve their facilities, staffing, and training.

View in Recommendation Tracker

Washington State’s Oversight Could Better Ensure That Adult Family Homes Comply With Health and Safety and Administrative Requirements (A-09-23-02002)

25-A-09-013.01 to CMS - Closed Implemented

Closed on 03/26/2025

We recommend that the Washington State Department of Social and Health Services' Aging and Long-Term Support Administration work with the 20 adult family homes to correct the 214 instances of noncompliance identified in this report.

25-A-09-013.02 to CMS - Closed Implemented

Closed on 02/04/2025

We recommend that the Washington State Department of Social and Health Services' Aging and Long-Term Support Administration reissue to all adult family homes the notification of requirements for a written succession plan.

25-A-09-013.03 to CMS - Closed Implemented

Closed on 02/04/2025

We recommend that the Washington State Department of Social and Health Services' Aging and Long-Term Support Administration improve its oversight of adult family homes to ensure that relicensing inspections are conducted within the required timeframes and evaluate all applicable compliance areas, including succession plans, resident assessments, and negotiated care plans.

View in Recommendation Tracker

Work Plan Type

Office of Audit Services

HHS Agencies

Centers for Medicare and Medicaid Services

Issue Areas

Quality of Care

Target Groups

Financial Groups

Medicaid

Series: Health and Safety Standards in Social Services for Adults

OBJECTIVE

COMPLETED PROJECTS IN THIS SERIES (7)

New Jersey

South Carolina

Maryland

Audit of the State of Ohio's Adult Day Care Services

Audit of the State of Texas Adult Day Care Services

Review of Health and Safety Standards for Adult Day Centers in Florida

Review of Health and Safety Standards for Adult Family Homes in Washington State

TIMELINE

7 REPORT PUBLISHED

New Jersey Did Not Ensure Providers Complied With Federal and State Requirements at All 20 Adult Day Health Services Facilities Audited (A-02-24-01009)

Recommendation Details (3)

Maryland Did Not Comply With Federal Waiver and State Requirements at 20 Adult Day Care Facilities Audited (A-03-24-00201)

Recommendation Details (3)

Florida Did Not Comply With Federal Waiver and State Requirements at 18 of 20 Adult Day Care Facilities Reviewed (A-04-23-00135)

Recommendation Details (3)

South Carolina Did Not Comply With Federal Waiver and State Requirements at 19 of 20 Adult Day Care Facilities (A-04-24-00137)

Recommendation Details (3)

Ohio Did Not Comply With Federal Waiver and State Requirements at 18 of 19 Adult Day Care Facilities Audited (A-05-23-00006)

Recommendation Details (3)

Texas Did Not Fully Comply With Federal Waiver and State Health, Safety, and Administrative Requirements at All 20 Adult Day Activity Health and Service Facilities Audited (A-06-23-05000)

Recommendation Details (3)

Washington State’s Oversight Could Better Ensure That Adult Family Homes Comply With Health and Safety and Administrative Requirements (A-09-23-02002)

Recommendation Details (3)