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Pennsylvania’s fiscal watchdog says a new audit shows the state Department of Health isn’t effectively enforcing nursing home staffing levels.

Auditor General Eugene DePasquale’s office reported Tuesday that the department lacked even policies for how it reviews staffing levels.

Pennsylvania requires nursing homes to provide at least 2.7 hours of direct nursing care per resident, per day. All of York County's 16 nursing home facilities are currently providing at least three hours of nursing care per resident, per day, according to the Department of Health.

However, in October 2015, Dallastown Nursing Center was cited for providing only 2.42 hours of direct nursing care per resident, per day. The citation was said to be caused by under-staffing in the facility. That has since been corrected, according to the Dec. 23, 2015, review of the facility.

But the audit says facilities that weren’t complying weren’t always cited. It says the department cited facilities 13 times during 2014 and 2015 for failing to meet the state standard for staffing levels. That’s out of more than 7,200 inspections.

It says the department never required a nursing home to increase its staffing levels. That’s despite finding numerous instances of poor quality of care.

The department says it introduced a new policy in April and disputed some of the audit’s findings.

A review of the health department's oversight rules was last conducted in 1998, led by now-Sen. Bob Casey, D-Pa. DePasquale said the rules haven't been updated since 1999.

Each of York County's nursing home facilities has been cited for at least one state or federal infraction in the last year. Most of those citations don't result in any sort of fine, though, said Dr. Karen Murphy, secretary of the Department of Health.

DePasquale had an issue with how many facilities hadn't been fined for clear violations of standards.

"What this tells me is that the Department of Heath wasn't looking for these violations," he said. "We didn't know what was happening, and that's the problem."

During the 22-month-long audit period, the health department cited 9,189 federal deficiencies in nursing homes across the commonwealth. These citations resulted in more than $2 million in fines. DePasquale said in the same time period, the department cited 47 state sanctions, resulting in $172,350 in fines.

"That's a very broad discrepancy," DePasquale said. "That's all I'm saying."

It's unclear if any of the fines issued by the state affected York County nursing homes.

— Reach Katherine Ranzenberger at kranzenberger@yorkdispatch.com or on Twitter at @YDKatherine.

The Associated Press contributed to this story.

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