The state Department of Health is investigating 64 care homes operating without licenses.

The DOH said that it has improved oversight of adult residential care homes following a scathing state audit released last month that found an inordinate number of Hawaii’s nearly 500 homes were operating in 2016 and 2017 either without a license or with “hastily issued” permits — sometimes without even being inspected.

Lawmakers, citing concerns over the safety of vulnerable seniors and disabled residents, scheduled a legislative briefing Thursday following claims that the Health Department did not routinely follow up with deficient care homes even after discovering some operators mislabeled medications, gave clients wrong drug dosages or discontinued medications without a physician’s order.

The audit also found there were no consequences for homes with violations and no clear policies or record keeping. The department did not cite a single care home operator or terminate a license from 2007 to 2017, even for those with substantial or repeat deficiencies.

“The criticism is legitimate. We gave out licenses before inspections were complete. There’s no question in our minds they found problems that we recognized in some cases and did not recognize in others,” Health Director Bruce Anderson told lawmakers. “We agree with most of what the auditor has said. This has been an ongoing problem. (But) I believe the current situation is far different than it was in 2016. There has been a remarkable change I only can attribute to having more staff and more resources.”

Health Department officials said great strides have been made this year: Only 15 percent — compared with 40 percent in 2017 — of care homes went without timely inspections.

“Patient safety is a big concern of ours, certainly,” said Keith Ridley, chief of the Office of Health Care Assurance, adding that the goal for 2019 is to complete 100 percent of inspections on time.

State Auditor Les Kondo questioned health officials’ assertion that the care homes are safe.

“My question is, How do they know if they haven’t done (all the) inspections?”

The 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 460 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.

Beginning in July, the DOH will have the authority to conduct unannounced inspections.

It is also working on automating inspection reports by the end of 2019, as well as creating policies for fines and license suspensions.

“They’ve improved a lot. However, they’ve got a long way to go,” said state Rep. John Mizuno (D, Kalihi Valley). “We’re talking about a person’s life — our kupuna and our disabled — and they’re vulnerable, so we need to do a better job. Even though they’ve improved vastly in 2018, at the end of the day … it’s still 15 percent that was not timely. What if my mom or your mom or dad were in one of those homes that were not checked up on timely and they had a number of deficiencies? It’s scary.”