HARRISBURG - A new audit shows that the state Department of Health is not effectively enforcing nursing home staffing levels, Pennsylvania's fiscal watchdog said Tuesday.

The office of Auditor General Eugene DePasquale reported that the department lacked policies for how it reviews staffing levels at approximately 700 nursing homes it regulates."In some cases, we also found that when (the department) completed its staffing reviews, insufficient documentation was obtained to support the analysis, leaving us guessing as to how the facility complied with Pennsylvania's mandated regulatory staffing requirement," auditors wrote.During the audit period, from Jan. 1, 2014, through Oct. 31, 2015, the department rescinded a policy of rejecting anonymous complaints. As a result, complaints received by the department increased by 63 percent, the audit said.The policy of rejecting anonymous complaints "likely compromised (the department's) ability to adequately receive and investigate complaints," the audit said.Pennsylvania requires nursing homes to provide at least 2.7 hours of direct nursing care per resident per day, though the auditor general's office suggested that standard may be too low.Nursing homes that were not complying with that standard were not always cited, the audit said. The department cited facilities 13 times out of more than 7,200 inspections during the audit period for failing to meet the state staffing standard, it said.The department also never required a nursing home to increase its staffing levels despite finding numerous instances of poor quality of care, it said.The department responded that it had introduced a new policy in April, motivated by the audit, but it also disputed some of the audit's findings.For instance, it told the auditor general's office in a response letter that it would not be "appropriate or required" to examine staffing hours during some inspections."For example, a survey in response to a complaint about water temperature would provide no reason for a surveyor to calculate staffing hours," the department wrote.It also said that a facility that was not cited for inadequate staffing might still have been cited for a failure to provide adequate care.The auditor general's office criticized the department's response, saying that an examiner could still document other deficiencies when reviewing another aspect of a nursing home's operations.The department's argument underscores its need to look at nursing home compliance more systematically "and not just myopically addressing complaint issues as they 'pop up,' " the auditor general's office said.