Summary of Findings

Gap Assessment (Stage 1 and 2 Audit Simulation) Summary of Findings

Department of Education – Division of South Cotabato
October 14-16, 2019
Name of Assessor: 1. Denoga, John Joseph D.
2. Liba, Ryan T.
3. Villanueva, Chenier Nicu V.
Date of Assessment: October 14-16, 2019

I. Conformities (C)

Top Management

No. Description of Findings Standard/Criteria satisfied

1 There is an existent and approved Quality Policy, with evidence of communication to 5.2
stakeholders
2 Alignment of Strategic Objectives with Regional Strategic Objectives 6.2.1
3 Revision/updating of SWOT was already seen 4.1
4 Scope of the QMS is relatively clear in the Quality Manual 4.3

CID – EPS/PAPs

No. Description of Findings Standard/Criteria satisfied

1 Complete documentation from Planning to Actual outputs seen from AP, Math, Music 8.1e

PQR

No. Description of Findings Standard/Criteria satisfied

1 Correct clauses identified for Nonconformities raised 8.1e

1
Summary of Findings

II. Non-Conformities (NC)

Top Management

No. Description of Findings Standard/ Classification Recommendation

Criteria (Major or Minor)

1 Annexes stated in the Quality Manual are not attached to 7.5.2 Minor Attach all Annexes to
the document (but still presented) Quality Manual.
Ensure that all
annexes are
updated/latest
versions.
2 Division Memorandum CID no. 96 s 2019 dated 5.1.2 Major Issue Corrigendum
September 27, 2019 on the Distribution of Learning specifying deadline
Resources addressed to the PSDS, PICs, School Heads, for collection of LRs
District Property Custodians, Cluster Property Custodians
does not specify details on deadline for implementation
and implications for the non-compliance to the said
memorandum.
Implication – Storage area remains cluttered, LRs may be
subject to damage due to pests, vapor, etc.
3 Various feedback from process owners on complaints on 5.1.1 Major Discuss with /Inspire
the difficulties brought about by the establishment of the process owners that
organization’s Quality Management System the ISO Journey is
ultimately all for the
benefit of the
students/learners of
SC and that they are
near their goal.
4 No plan presented for the provision of the SDO Resource 4.4.1d Major Formulate 3-year
Management Needs (3-year plan) 5.1.1 Resource

2
Summary of Findings

7.1.3 Management Plan for

10.3 SDO

ICT

No. Description of Findings Standard/ Classification Recommendation

Criteria (Major or Minor)

1 Process Risk for DepEd email maintenance – Correction 6.1.2 Major Review Risk Matrix
– Ask the customer about the date of appointment definition, revise risk
identified does not address the risk (quick fix) matrix
2 No inventory of SDO South Cotabato PCs/Laptops and 8.1 Major Coordinate with
other IT Equipment as basis for creation of the Preventive Property Office for
Maintenance Plan inventory, conduct
Inventory of ICT
equipment and adjust
Preventive
Maintenance Plan
accordingly
3 Customer Satisfaction forms not present at point of use 7.5.3.1a Major Ensure that there are
sufficient copies for
use at the office
4 Attached template in the Operations Manual Annex A-7 7.5.2 Major Ensure that ALL
was not updated Annexes attached to
the Operations
Manual are updated
and complete
5 Data entries in the IT Support Request form were not 8.5.1 Major Review DIT policy
completely filled out as stipulated in the Operations
Manual
6 Preventive Maintenance was not implemented according 8.1e Major Fasttrack completion
to plan, no catch-up plan for failure in timely and approval of
implementation Report

3
Summary of Findings

7 Use of unlicensed Microsoft Office in some offices (DIO, 7.1.3 Major Replace ALL
CID, OSDS) RA 8293 counterfeit software
Microsoft with original software
Office EULA upon completion of
Inventory

DIO

No. Description of Findings Standard/ Classification Recommendation

Criteria (Major or Minor)

1 2019 IPCR was found to have complete rubrics for each 7.5.2a Major Ensure all documents
KRA and KPI. No date of signature have correct dates
2 Operations Manual was not signed by one of the staff 7.5.2c Major Ensure that all
documents in need of
signatures have been
signed prior to use
3 Supporting documents to Operations (Process on Minutes 7.5.3.1 Major 5S Implementation
of Meeting Preparation to Distribution Process) could not
be found immediately
4 OFI in Risk Matrix was not implemented (Establishment of 6.1.2 Major Implement OFIs on
Monitoring Tool on submission of articles, set timelines of the set dates.
preparations of SDO Publication) on the set target date.
5 SCRIBE printed copy does not adhere to the established 8.5.1 Minor Ensure that
Quality Standards succeeding issue
adheres to
established QS,
Revisit QS.

4
Summary of Findings

CID - EPS

No. Description of Findings Standard/ Classification Recommendation

Criteria (Major or Minor)

1 No existing Quality Standard for the Post-Activity Report 7.5.2 Minor Ensure that all
(AP) outputs have quality
standards in the
Operations Manual.
2 Least Mastered Competencies for the LDNA for AP Grade 7.5.2a Minor Ensure that all
4 & 8 were stated in an undated document. documents have
dates and adhere to
the established
format

CID-LMRDS

No. Description of Findings Standard/ Classification Recommendation

Criteria (Major or Minor)

1 Rubrics does not completely address all scenarios in the 6.2.2e Major Implement OFIs on
performance of the employee. set dates
2 OFI in Process Risk – Issuance of Memo designating 6.1.2 Major Revisit Risk Matrix
Master Teacher as Alternate LR Evaluator dated and craft
September 20 was not implemented Memorandum
3 Insufficient and incomplete documentation was presented 8.3.2 Major Review
on Design and Development Planning (e.g. needs documentation
analysis and prioritization, stages in the design and requirements and
development reviews, roles and responsibilities of LRMDS retrieve (make readily
staff in the design and development process, timelines available) MoVs to
and duration for the process, degree of involvement of

5
Summary of Findings

customers in the design and development process, plans provide evidence of

of action in the event of design and development changes conformity
etc.).
Sampled document “Ang Pamilya ni Angela” did not
adhere to the consolidated LR Plan for developing
storybooks for least learned competencies. Missing dates
in the evaluation sheets.
4 Insufficient and incomplete documentation was presented 8.3.3 Major Review
on Design and Development Inputs (e.g. Criteria for the documentation
selection of teacher-writers and illustrators) requirements and
retrieve (make readily
available) MoVs to
provide evidence of
conformity
5 Insufficient and incomplete documentation was presented 8.3.4 Major Fast-track
on the application of Design and Development Controls implementation of
(i.e. Pilot Testing/Dry Run) Reviews and Pilot
Testing prior to
conduct of Stage 2
Certification Audit
6 Project Profile on the Revision and Finalization for 8.3.5 Major Fast-track
Developed Storybooks in English… dated October 29-30, implementation/prepa
2019, as well as memorandum on the conduct of the on ration of the pertinent
mass revision of reviewed LRs was checked. No training documents since the
matrix. Mass revision activity
is to be implemented
within the month.

CID-PAPs

No. Description of Findings Standard/ Classification Recommendation

Criteria (Major or Minor)

6
Summary of Findings

1 Post Activity Reports for both Elementary and Secondary 7.5.2a Minor Ensure that Dates are
Division Math Olympics have no date a part of the
established templates
2 Entry Form for October 11 (Math Olympics) activity is 7.5.3.2c Major Ensure that Annexes
updated (with document code) but the actual document have updated
attached as annex to the Operations Manual is not templates
updated

Inconsistencies in IPCRs presented by the different CID

Staff (EPS vs LRMD vs PAPs)
3 RSPC Cliniquing (English) Process has duplicate pages 7.5.2b Minor Review Documents
71-75 thoroughly prior to
submission for
approval
4 Certificate of ALS Passer sampled did not adhere to the 8.5.1 Major Revisit procedure.
established process in the Operations Manual and the Ensure that ALL
Quality Standards process owners are
aware of the
established
procedure.
5 No established procedure on ALS Literacy Mapping and 8.1 Major Establish procedure
Advocacy Materials as planning for the implementation of ASAP.
the ALS Program for 2019
6 Multigrade Operations Manual has revision 1.0 on ALL 7.5.2a Major Review DIT
pages in spite of being Version 1.0 Procedure on the
Revision of
documents

CID-PSDS

No. Description of Findings Standard/ Classification Recommendation

Criteria (Major or Minor)

7
Summary of Findings

1 Effectivity of actions taken to gain sufficient awareness of 7.3 and 7.4 Major Increase involvement
the QMS and the Operations Manual cannot be of ALL PSDSs and
established as seen during interviews strengthen coaching
from members who
were involved in the
modules from the
beginning
2 No Operations under controlled conditions for both 8.5 Major Increase involvement
processes in the Operations Manual; outputs cannot be of ALL PSDSs and
traced at the time of audit. strengthen coaching
from members who
were involved in the
modules from the
beginning. Implement
processes according
to how they were
written
3 Operations Manual was not signed by 3 PSDSs. 7.5.2c Minor Review Documents
thoroughly prior to
submission for
approval
4 Effectivity Date missing (page 36) 7.5.2a Minor Review Documents
thoroughly prior to
submission for
approval

OSDS-Admin-Property and Supply

No. Description of Findings Standard/ Classification Recommendation

Criteria (Major or Minor)

1 Approval Sheet has not dates of approval from QMR, 7.5.2c Major Have the document
Deputy QMR, and SDS; signed by the

8
Summary of Findings

Use of modified GAM forms (some of which were coded in pertinent top
DIT) management
members
2 Risk Matrix is displayed differently compared to other 7.5.2b Minor Adjust orientation of
Operations Manuals risks to match other
functional divisions’
OM
3 No Customer Satisfaction Rating form available in the 7.5.3.1 Major Clarify with QMR on
office for customers the status of the
official template.
4 No procedure for inventory and Inventory Management, 8.1 Major Regular updating of
No updated Property Tags; Stock Cards, actual count, and stock movements
Inventory System do not tally. should be done by
PSS Staff.
5 No Storage Area Plans/Layout for the storage of supplies, 8.1 Major Create Storage
materials, and equipment. Area/Layout plans for
ALL storage areas to
maximize space
utilization and
improve workplace
organization
6 Expired Unique Toothpaste seen in Storage Area – non 8.1 Major Conduct Inventory
implementation of FEFO (first expiry first out) ASAP; Dispose of the
Expired goods. Install
system/procedure of
checking/taking into
consideration the
expiry of goods for
issuance.

9
Summary of Findings

PQR

No. Description of Findings Standard/ Classification Recommendation

Criteria (Major or Minor)

1 Multiple copies of the PQR Quality Procedure; Effectivity 7.5.2a Major Review DIT policy on
date different from DIT Masterlist multiple copies of
Quality Procedures
2 No approved Audit Programme, Plan 9.2.2f Major Have the documents
Approved by the top
management/leaders
hip
3 Certificates of training (at least 40 hours) could not be 7.2d Major Ensure that ALL
established during the audit Certificates are
correct and readily
available during audit
4 Some CARs and Audit documents were not available 7.5.3.1a Major Return ALL office
during the audit as they were brought home documents to office.
Review DIT
procedure for such,
as there may not be
any policy prohibiting
it.
5 Some sampled Corrective Actions not commensurate to 10.2 Major Conduct
NCs identified; wrong root causes identified for NCs coaching/mentoring/s
mall group discussion
on how root causes
are to be identified by
the process owners
(same with PQR).

10
Summary of Findings

6 Sampled CARs with corrective actions and corrections 9.2.2e Major Include criteria on the
were accepted in spite of having too far off deadlines for review of the
actions submitted corrective
actions for guidance
of PQR members

OSDS-Admin-GSS

No. Description of Findings Standard/ Classification Recommendation

Criteria (Major or Minor)

1 No service records for Isuzu Crosswind. 8.1e Major Follow Operations

Manual procedure.
Ensure that all
documents (OR, CR,
and other MOVs) are
readily available at
points of
use/reference.
Folders for each
vehicle must be
created for easy
retrieval of records.
2 Updated Driver’s license not presented during audit 7.2e Major Secure copies of the
updated Driver’s
License.
3 Non-issuance of Visitor’s ID to and logbook entry for 7.1.4 Major Strictly implement
consultants policy/procedure
4 DepEd Safety Kit located in AO office was found to have 7.1.3 Major Conduct inventory of
Air con vents and pencil sharpener (rotating handle) each DepEd Safety
inside. Kit within the SDO.

11
Summary of Findings

Look for checklist of

what items must be
inside. If there are
medicines or other
supplies such as
betadine, ensure that
these are not
expired/or nearing
expiry.
5 No provision of covered walkway for staff and customers 7.1.3 Major Include this in the 3-
to use during inclement weather year plan for resource
management.
6 Insufficient evidence presented on the implementation of 8.1e Major Follow procedure to
the GSS Maintenance Plan as seen in different SDO the letter and
facilities which need repair consistently.

Insufficient documentation on reporting of

equipment/facilities in need of repair, as well as monitoring
on the continued viability and functionality of equipment

WIT

No. Description of Findings Standard/ Classification Recommendation

Criteria (Major or Minor)

1 Insufficient monitoring of the implementation of the WIT 9.1.1 Major Revisit Quality
standards and 5S; Insufficient policies and steps on the Procedure and add
monitoring of the WIT Standards policies/guidelines for
monitoring (with
frequency) of the

12
Summary of Findings

implementation of the
WIT standards
2 Missing dates and page numbers, wrong effectivity date in 7.5.2 Minor Make necessary
the Quality Procedure (front page) corrections to
document.

OSDS-Legal

Standard/ Classification Recommendation

No. Description of Findings
Criteria (Major or Minor)
1 Based on Procedure on Preliminary Investigation 8.5.1 Major Indicate the date and
Report Issuance – Teaching Personnel (SDO-OM- time once the
OSDS-LEG, Rev0, Sept 3, 2019), the complaint should document has been
be acted within 3 days upon receipt of SDO South received.
Cotabato.

It cannot be established that the complaint of the teacher

(Anonymous) vs. Sto. Nino District was acted within 3
days by the legal office of SDO South Cotabato because
the received date is not indicated on the actual document.

SGOD-HRD

Classification
Standard/ Recommendation
No. Description of Findings (Major or
Criteria
Minor)
1 Process Risk Assessment 6.1 Major If the risk becomes a
problem, strictly
adhere to the

13
Summary of Findings

• Risk: Proposed activity is postponed or may not be correction indicated

pushed through as scheduled due inadvertence of on the PMT
HRD personnel to include it in HRD WFP
• Correction: Issue advisory to all concerned for the
postponement of the activity with apology and
explanation thereof at least 20 working days before
the set date.
• OFI: Include in the OM a control measure that no
project profile of proposed activity shall be approved
if not aligned with applicable approved WFP.

During the time of the audit it was noted that the following
PAPs were postponed but the corrections were not
followed:
1. Training of Teachers on Critical Content in
Mathematics 8 conducted September 26-28, 2019;
2. Division Training in Music and Instructional Materials
Development among Grades IV teachers conducted
last September 9-11, 2019.
2 The year 1 target of the quality objective (KRA5: 6.2 Major Ensure the alignment
Training and Development Records, 5.1 to attain at of the OPCR/IPCR
least 70% of the programs, projects, and activities (PPAs) and Quality
for the year be properly planned and conducted as Standards indicated
scheduled) indicated on the official IPCR of HRD SEPS on the OM
and OPCR of SGOD for year 2019 did not match.

CIP:
• IPCR of HRD SEPS – 70%
• OPCR of SGOD - not indicated
3 No documented procedure presented for changes on the 6.3 Major Once there are
scheduled Project, Programs and Activities for year changes on the
2019. original plan, it should
be requested by the

14
Summary of Findings

The since September 2, 2019 two programs for L and D process owner and
Interventions were conducted but not indicated on the approved again by
original plan. the approving
authority.
CIP: Training of Teachers on Critical Content in
Mathematics 8 conducted September 26-28, 2019;
Division Training in Music and Instructional Materials
Development among Grades IV teachers conducted last
September 9-11, 2019.
4. As indicated on procedure for Division Initiated Activity 8.5.1 Major Strictly adhere to the
management process (SDOSC-OM-SGOD-HRD, established
Versio1, rev00, effective September 3, 2019), the procedure.
expected outputs for the Division Initiated Activity
Management process should be submitted. But the
supporting Documents for Liquidation of
Funds/Payments of Expenses was not presented, and
LDIS was not updated.

CIP: Training of Teachers on Critical Content in

Mathematics 8 conducted September 26-28, 2019
5. The front page post activity report (PAR) attached to the 7.5 Major Double check the
body of the report submitted to the HRD did not match document before
with each other. submission as
retained documented
CIP: Training of Teachers on Critical Content in information.
Mathematics 8 conducted September 26-28, 2019.
6. The period of time, and submission of the training 7.2 Major Indicate in the OM
effectiveness evaluation to HRD after the training has the time frame when
been conducted is not indicated on the procedure for the training
Division Initiated Activity management process (SDOSC- effectiveness
OM-SGOD-HRD, Version1, rev00, effective September evaluation should be
3, 2019) conducted.

15
Summary of Findings

SGOD-SMME

Classification
Standard/ Recommendation
No. Description of Findings (Major or
Criteria
Minor)
1. The quality objective on the equitable distribution of 6.2 Major Consolidate the data
educational resources to schools and LCs by end of to ease the
December 2019 and 100% conformance to standards monitoring of the
and on planned date have no consolidated monitoring overall performance
tool for the entire division to measure the attainment based on quality
of the said quality target. objective targets.
2. The operations manual of SGOD-SMME lacks pages 7.5 Major Ensure that the
118-127, but was reviewed and recommended for completeness of all
approval by the QMR and DPQMR, and approved by the pages of OMs prior to
SGOD Chief and SDS last September 3, 2019. approval.
3. The form used to monitor the result of the consolidated 7.5.1 Major Ensure the
school learning resources utilization, cannot capture the appropriateness of
data on the number of books available in the schools per the instrument used
subject area because only the total number of books is to capture the
indicated on the form which is the basis the equitable needed information
distribution of learning resources to all schools under the
SDO.

CIP: Consolidated school learning resources utilization

Monitoring Result (SDOSC-SGOD-CSLUMR-OIMR-OIR-vr.0ro,
effective September 24, 2019)
4 The SLR monitoring tool was not forwarded to schools to 8.5.1 Major Send the SLR
capture the current number of learning materials in all monitoring tool to
schools under the SDO as instructed by the SDS to the schools as soon as
EPS 2 after the operations manual has been approved. possible.

SGOD-EPS

16
Summary of Findings

Classification
No Standard/ Recommendation
Description of Findings (Major or
. Criteria
Minor)
1. Based on the school improvement plan (SIP) and Annual 6.3 Major Seek for the approval
Implementation Plan (AIP) Monitoring Plan, on October 3, of the catch-up plan
24, 7, 8, 9, and 10, 2019; twelve schools must be as soon as possible.
monitored but as of October 15, 2019 the monitoring
activities have not yet implemented and no approved
catch-up was presented during the time of the audit.

SGOD- Planning and Research

Classification
No Standard/ Recommendation
Description of Findings (Major or
. Criteria
Minor)
1. The specific turn-around time of the resolution of the 8.5 Major Specify the turn-
concerns raised in SDO–SC is not indicated on the around time of the
procedure on Management of Enhanced Basic resolution of the
Education Information System (EBEIS) data concerns raised in
submission to validation process (SDOSC-OM-SGOD- SDO–SC indicated
P, V01, Rev01, Effective September 3, 2019) as basis for on the OM.
the quality of service realization.

CIP: Pupils with pending Issues in enrolment in the LIS

with their pertinent papers for approval of SDO South
Cotabato, from Polomolok Central Elementary School
dated September 23, 2019.
2. No quality objective for service realization (resolution of 6.2 Major Include in the quality
valid concerns 5 days before the planned date) once the objective of Planning
concern has been raised to SDO SC- SGOD-Planning and Research the
and Research from school level. resolution of valid
concerns 5 days

17
Summary of Findings

before the planned

date

SGOD-Social Mobilization and Networking (Partnerships and Linkages)

Classification
Standard/ Recommendation
No. Description of Findings (Major or
Criteria
Minor)
1. The quality objective indicated on the OM of Social 6.2 Major Ensure the alignment
Mobilization and Networking (Partnerships and Linkages of the IPCR, QS,
did not match with the IPCR of EPS1 and OPCR of OPCR, and strategic
SGOD for year 2019. objectives of the
organization.
No monitoring of the current status of the actual
attainment of the quality objectives. Regularly monitor the
status of the
CIP: To provide 100% monitoring reports to partners with attainment of the
implemented PAPs 7 working days after the project quality objectives.
launching, and to provide 100% narrative report on
impact of the completed projects 15 working days after
the project completion.
2. Based on the Procedure on Partnership Project 7.5.3 Major Strictly adhere to the
Monitoring to Evaluation (SDOSC-OMSGOD-SMN, established
version1, Rev1, Effective Sept 3, 2019), the reports procedure.
should be submitted 7 days after launching but no
documented information was presented:

CIP: Outreach program of Helping Hands Fil-Am Inc., last

September 27, 2019 at Sikat, Lake Sebu.

SGOD-DRR

18
Summary of Findings

Classification
Standard/ Recommendation
No. Description of Findings (Major or
Criteria
Minor)
1. No plans and programs (contingency plans) for the 8.5 Major See to it that there
mitigations of possible disasters (such as fire, flood, and are planned
earth quake, and volcanic eruption) that might happen in arrangements to
the office. reduce the impact of
disaster risks.
2. No drills conducted for the mitigations of possible disaster 8.5 Major Develop a plan for
risks (such as fire, flood, earthquake, and volcanic drills to prepare for
eruption) the identified
disasters.
3. No clear plans and programs (Guidelines) for the onsite 8.5 Major Develop an official
municipal wide evaluation of disaster risks in schools plans and programs
within the Division of South Cotabato “Gawad Kalasag”, for the effective
to be implemented on January 2020. evaluation of various
DRR programs.

SGOD-School Health (with Equipment Calibration)

Classification
Standard/ Recommendation
No. Description of Findings (Major or
Criteria
Minor)
1. The personnel complained for toothache, he was 8.5.1 Major Strictly adhere to the
attended by dentist and Ponstan was prescribed last established
October 15, 2019, but during the time of the audit the procedure.
dental record of the said personnel was not updated prior
to the release of the medicine.

No procedure and prescription form being used by the Develop a procedure

dentist as basis for the dental consultation and issuance on the issuance of
of medicine in the SDO pharmacy. medications to SDO
personnel.

19
Summary of Findings

2. No room thermometer installed in the pharmacy to 7.1.5.2 Major Install thermometer to

monitor the storage room temperature of not more than monitor the
30 degrees Celsius as required to preserve the quality of temperature of the
medicines. storage area for
medicines.

SGOD-EFS

Classification
Standard/ Recommendation
No. Description of Findings (Major or
Criteria
Minor)
1. The quality objectives indicated on IPCR of EFS 6.2 Major Ensure the alignment
(Engineer 3) did not match with the quality objectives of the IPCR, QS,
indicated on the OM of Educational Facilities: OPCR, and strategic
objectives of the
CIP: organization.
• EFS Objective indicated on the OM: To attain
100%To attain 100% Accepted School Building
Projects in I conformance to the set quality
standards within the expiry date of the defects
warranty period of Three Hundred Sixty-Five (365)
Days upon issuance of Certificate of Completion.
2. Based on the procedure on the conduct of the final 8.5.1 Major Strictly adhere to the
inspection (SDO-OM-SGOD-EFS, version01, Rev0, established
Effective Sept 3, 2019), there should be a joint DPWH- procedure.
Dep-Ed Final Inspection. But it was conducted only by
Dep-Ed SDO SC without DPWH counterpart.

When Dep-Ed SDO SC conducted the final inspection,

they do not have a copy of the Construction Plan of the
Project as basis for the final inspection.

20
Summary of Findings

CIP:
• Final inspection of the Construction of 3 storey - 6
classroom school building of EL Ranada Elementary
School by Grego Construction and Supply l last
September 27, 2019.

OSDS-Admin-Records

Classification
Standard/ Recommendation
No. Description of Findings (Major or
Criteria
Minor)
1 Based the Operations Manual of SGOD-Records 8.5.1 Major Strictly adhere to the
(SDOSC-OM-OSDS-Admin-Rec, Ver1, Rev0, effective September established
3, 2019), OSDS records-ADAS should receive the procedure.
documents and 3 copies of Transmittal, but during the
time of the audit no transmittal form was presented for
the letter received last October 7, 2019 MC-070-Request
for Substitute for New Cuyapo Elementary School and
forwarded on the same date to SDS Office.
2 The quality objective of the records section is to release 8.5.1 Major Strictly adhere to the
and route 100% of received documents after established
recording within the day from the date of receipt in procedure.
conformance to the set quality standards and
prescribe time, but during the time of the audit, it cannot
be established that the procedure has been followed
because the time of the non-routine communication
received by SDO Office is not indicated on the logbook.

21
Summary of Findings

CIP: Letter received by SDO Records Section last

October 7, 2019 MC-070-Request for Substitute for New
Cuyapo Elementary School

OSDS-Admin-Personnel and PSB

Classification
Standard/ Recommendation
No. Description of Findings (Major or
Criteria
Minor)
1 Checklist of CSC documentary requirements for 8.5.1 Major Strictly adhere to
appointment of newly hired employee was not the established
accomplished, and no official work experience sheet of procedure.
CSC was attached but the “appointment paper was
already prepared”

CIP: Employment Requirements of Mr. Alex F. Floro,

received last September 25, 2019
2 After the signing of the appointment papers of the newly 8.5.1 Major Strictly adhere to
hired employees last October 4, 2019, Personnel section the established
should forward the requirements to the personnel in procedure.
charge of the budget, salary integration, and appointment
in charge, but the Appointment Attendance form was not
signed.
3 Checklist of CSC documentary requirements for 7.5.2 Major Register all forms
appointment of newly hired employee (Teaching and being used in the
Non-teaching), and Signing of Appointment organization
Attendance of Personnel have no control number, and
not registered as official documented information.

22
Summary of Findings

DIT

Classification
Standard/ Recommendation
No. Description of Findings (Major or
Criteria
Minor)
1 The Quality Manual of SDOSC is not included in the 7.5.3 Major See to it that all
Master List of approved documented information. manuals are
indicated on the
master list
2 The document code of the master list of documented 7.5.3 Major See to it that the
information, Operations Manual of Filipino, Operations codes registered in
Manual of Peace Education, Operations Manual of the DIT are the same
Planning and Research, and Operations Manual of the with the approved
Youth Formation did not match with the approved code documented
of the DIT indicated on the Master List of Documented information.
Information.
3 Last October 14, 2019, the documented procedures of 7.5.3 Major Strictly adhere to the
the different offices were taken from the ISO Cabinet but established
some were not logged in the DIT Operations Manual procedure.
Borrower’s Logbook.
All borrowed manuals should have returned within the
day, but the Operations Manuals borrowed last October
14, 2019 were not returned as of October 16, 2019.

23
Summary of Findings

4 SGOD unit requested for a creation of document and it 7.5.3 Major Strictly adhere to the
was received by the DCC last October 15, 2019 but the established
DRAF was not properly filled up. procedure.
- no signature of the one who initiated the creation of
document, and no document title and number and
date.
5 Based on the DIT procedure, only the DCC has an 7.5.3 Major Ensure the security of
access to the ISO cabinet. But upon checking, the ISO ISO documents.
cabinet has no pad lock.
6 Based on SDOSC-QP-DIT-01, the process owners 7.1.3 Major Provide necessary
should be responsible for creating back-up file of soft- and adequate
copies of records, but it cannot be established that the equipment to digitize
organization has the capability to digitize the records. the documents.

OSDS-Finance-Accounting

No. Description of Findings Standard/ Classification Recommendation

Criteria
1 There is no documented procedure presented on the 8.1 Major Review and revise
conduct of review to the liquidation reports prepared and the OM to reflect the
submitted by the Field Offices (ADAS). Furthermore, the process implemented
written process on the Operations Manual “School at the Division Level
Liquidation Document Review to Liquidation Report
Submission Process” is the one implemented/performed
by the ADAS in the Field which is not covered by the
SDOSC QMS scope.
2 No quality objective was set/identified for the 6.2 Major Develop a quality
undocumented process of review of school liquidation objective for the IPCR
reports. and the Quality
Standards section of
the OM
3 The quality objective for the “Monthly Report of 10.2.1 Major Issue a CAR as a
Disbursement Preparation to Submission Process” states result of Service

24
Summary of Findings

No. Description of Findings Standard/ Classification Recommendation

Criteria
that “To achieve 100% complete and accurate submission Realization and do
of Approved Monthly Disbursement Report every 5th of the appropriate correction
following month in conformance to set quality standards”. and corrective action.

However, based on the evidence of DBM transmittal Review other report

presented, the reports for the months of August and obligations and
September 2019 were submitted to the DBM ROXII on ensure conformity to
October 11 at 8:33am with Doc Reference Number of the standards
2019-ROXII-0101809. especially the
timeliness KPI.
Furthermore, even though the said incident of delayed
submission was indicated in the risk assessment the
identified correction was not implemented since no
evidence (notice of late submission thru email) was
presented.
4 It cannot be established that the quality objectives 6.2.1e Major Establish a
concerning report obligations to statutory bodies, for monitoring dashboard
example: “To achieve 100% complete and accurate or a simple matrix to
submission of Approved Monthly Disbursement Report track the submission
every 5th of the following month in conformance to set of reports
quality standards”, are monitored since no evidence of any
monitoring mechanism was presented. Thus, the
consistent compliance to these legal requirements is at
risk.

OSDS-Finance-Budget

No. Description of Findings Standard/ Classification Recommendation

Criteria
1 It cannot be established that the quality objective for the 6.2.1b Major Review and revise
Notice of Cash Allocation (NCA) Request Preparation to the OM to reflect the

25
Summary of Findings

No. Description of Findings Standard/ Classification Recommendation

Criteria
Submission Process which states that, “To achieve 100% correct quality
of request of NCA with complete supporting documents to objective
DBM within 1 working day in conformance to set quality
standards” is completely measurable specifically the
timeliness KPI since no clear description of timing when to
start the NCA preparation (e.g. upon receipt of WFP from
the Program Holder).

2 Based on the presented transmittal notice for the School 8.2.1a Major Issue an addendum
Health Section on the release of availability of Sub-ARO to the communication
dated October 10, deadline of submission of the WFP as indicating the
basis for the Budget Section’s NCA request preparation deadline of
was not indicated in the said communication. Thus, the submission.
receiving party has no clear basis or criteria of subsequent
actions.
3 The presented quality objectives on the Operations 6.2.1 Major Review the IPCRF
Manual for the following processes: (Budget Section
Head) and align it
a. To achieve 100% of request of NCA with complete with the Operations
supporting documents to DBM within 1 working day Manual/KRA
in conformance to set quality standards
b. To achieve 100% issuance of Allotment Availability
within 5 minutes in conformance to set quality
standards

did not match/coincide with the objectives indicated in the

objectives of the IPCRF:

a. Reviews, compute, and prepares, Special Budget

Request and transmit to DBM request for Special
Budgets

26
Summary of Findings

No. Description of Findings Standard/ Classification Recommendation

Criteria
b. Certified availability of allotment, monitors and
records expenditures in appropriate registries

Thus, there is no clear basis of process performance.

4 It cannot be established that the quality objective for the 6.2.1e Major Establish a
Issuance of Allotment Availability Process which states monitoring tool even
that, “To achieve 100% issuance of Allotment Availability a logbook to track the
within 5 minutes in conformance to set quality standards”, incoming and
is monitored since no evidence of any monitoring outgoing transactions
mechanism was presented.

5 The quality objective for the “Obligation Request and 10.2.1 Major Issue a CAR as a
Status (ORS) Validation Process to Transmittal” states result of Service
that “To achieve 100% of the completely filled out and Realization and do
signed ORS within 5 minutes from the date received in appropriate correction
conformance to set quality standards”. and corrective action.

However, based on the evidence (receiving copy) Review other

presented, the 30 ORS for validation (26 ELEM and 4 transactions and
SEC) were received on October 15 at 8:04AM and ensure conformity to
released at 1:10pm. Thus, 11 minutes per ORS was the set standards
consumed for validation. Each ORS was 6 minutes late as especially the
against the set standard of 5 minutes. timeliness KPI.

6 The conformity of outputs for the processes cited in item 5 8.5.1bc Major Establish a
and 6 and their on-going implementation under controlled monitoring tool even
conditions cannot be fully established since no evidence a logbook to track the
of any monitoring mechanism was presented. incoming and
outgoing transactions
since no dedicated
personnel is assigned

27
Summary of Findings

No. Description of Findings Standard/ Classification Recommendation

Criteria
to do solely the
receiving and
releasing.

OSDS-Admin-Cash

No. Description of Findings Standard/ Classification Recommendation

Criteria
1 It cannot be established that the quality objective for the 6.2.1e Major Establish a
Payment Collection to Deposit Process which states that, monitoring tool even
“To achieve 100% OR issuance within 5 minutes after a logbook to track the
payment has been received in conformance to set quality incoming and
standards”, is monitored since no evidence of any outgoing transactions
monitoring mechanism was presented.

2 The presented quality objectives on the Operations 6.2.1 Major Review the IPCRF
Manual for the following processes: (Cash Section Head)
and align it with the
c. To achieve 100% endorsement of Deposit Operations Manual
Attachments to the depository bank until the next
banking day from date indicated in the deposit slip
in conformance to set quality standards.
d. To achieve 100% submission of the Report of
Collections and Deposits (RCD) to the Accounting
Section on or before the 5th day of the following
month in conformance to set quality standards

28
Summary of Findings

No. Description of Findings Standard/ Classification Recommendation

Criteria
did not match/coincide with the objectives indicated in the
IPCRF objectives, specifically the timeliness component of
the KPI.

Thus, there is no clear basis of process performance.

3 The quality objective for the “Payment Collection to 10.2.1 Major Issue a CAR as a
Deposit Process” states that “To achieve 100% result of Service
endorsement of Deposit Attachments to the depository Realization and do
bank until the next banking day from date indicated in the appropriate correction
deposit slip in conformance to set quality standards”. and corrective action.

However, based on the evidence presented, the OR

issued on October 04, 2019 with no. SC-2632813 was
deposited to the bank on October 09, 2019 with Deposit
No. 19-10-060.

The quality objective for the “Reports of Collection and

Deposits Preparation to Submission Process” states that
“To achieve 100% submission of the Report of Collections
and Deposits (RCD) to the Accounting Section on or
before the 5th day of the following month in conformance
to set quality standards”.

However, based on the RCDs for the month of September

2019 with No. 19-09 both for BTr and TRUST were
submitted to the Accounting Office on October 09, 2019 at
3:05pm.

The quality objective for the “Check Preparation to

Issuance Process” states that “To achieve 100% check

29
Summary of Findings

No. Description of Findings Standard/ Classification Recommendation

Criteria
issuance within the day approved DV has been received
in the conformance to set quality standards”.

However, two checks were found to be nonconforming to

the set standard processing time - DV No. 8247 was
received September 09 but check with no. 000971860 was
issued September 10; DV No. 2019-09-8192 was received
September 18 but the check with no. 0000971876 was
issued September 19.

BAC

No. Description of Findings Standard/ Classification Recommendation

Criteria
1 The presented quality objectives on the Operations 6.2.1 Major Review the IPCRF
Manual for the following processes: (BAC) and align it
with the Operations
a. To achieve 100% procurement of Manual
goods/service/infra projects/consulting services
thru AMP compliant to RA 9184
b. To achieve 100% procurement of
goods/service/infra projects/consulting services
thru public bidding compliant to RA 9184

Were not captured in the presented IPCRF;

alignment/consistency cannot be established.

Thus, there is no clear basis of process performance.

2 It cannot be established all pertinent BAC documents are 7.5.3.2a Major Accomplish all the
reviewed properly prior to its use. E.g. no signatures for required fields of the

30
Summary of Findings

No. Description of Findings Standard/ Classification Recommendation

Criteria
the Abstract of Quotation with Quotation No. DSC-19-10- forms and other BAC
159; Notice to Proceed dated September 26, 2019 with documents
reference no. DSC-19-129 (Date to Start and Date of
Completion fields)

OSDS-Admin-PSU

No. Description of Findings Standard/ Classification Recommendation

Criteria
1 The presented quality objectives on the Operations 6.2.1 Major Review the IPCRF
Manual for the following processes: (BAC) and align it
with the Operations
a. To achieve 100% transmittal of verified loans to Manual
PLIs within 20 minutes upon receipt of loan
application in conformance to set quality standards
b. To achieve 100% submission of signed ORS and
DV with complete details to the Budget Office within
1 hour after receipt of attachment from PS in
conformance to set quality standards

Were not captured in the presented IPCRF;

alignment/consistency cannot be established.

31
Summary of Findings

No. Description of Findings Standard/ Classification Recommendation

Criteria
Thus, there is no clear basis of process performance.
2 There is no documented procedure presented on the 8.1 Major Review and revise
preparation of billing of salaries for elementary and the OM to reflect the
secondary teaching personnel process. new process

The use of WEB MSP for the Agency Remittance Advice

Verification to Submission Process as means to transmit
the ARA to GSIS is not included/documented in the
Operations Manual.
3 The quality objective for the “Loan Application Verification 10.2.1 Major Issue a CAR as a
to Verified Loan Transmittal Process” states that “To result of Service
achieve 100% transmittal of verified loans to PLIs within Realization and do
20 minutes upon receipt of loan application in appropriate correction
conformance to set quality standards”. and corrective action.

However, based on the Verifier’s Ledger and email Review other

exchanges presented, the ff transactions exceeded the 20 transactions and
minutes processing time: the loan application received on ensure conformity to
September 3 at 1:56 pm from employee 4456031 was the set standards
forwarded to the PLIs on September 3 at 4:29 pm; another especially the
loan application received on September 20 at 3:50pm from timeliness KPI.
employee 5410008 was forwarded to PLIs on September
20 at 10:22 pm.

32
Summary of Findings

QMR Secretariat

No. Description of Findings Standard/ Classification Recommendation

Criteria
1 It cannot be established that all the Management Review 9.3.2 Major Review the required
inputs required by the ISO standard on 9.3.2 are MR inputs and
discussed during the previously conducted MRs, ensure to discuss
(DEXECOM or monthly Top Mgt meeting). them in the
For the October 7, Minutes of the Meeting presented succeeding MR
- Status of actions from the previous meeting was not meetings
consistently tackled in the MR
- Only the OPCR status of performance was
discussed and not the status of strategic objectives
2 It cannot be established that the MR outputs are attained 9.3.3 Major Review the MR
since no evidence was presented that will clearly outputs consideration

III. Opportunities for Improvement

Legal
1. May improve the timeline of the actions to address the risks to facilitate the evaluation of their effectiveness.
2. May indicate in the process risk assessment the preventive measures to control the risks.

Assistant Schools Division Superintendent (ASDS)

1. May improve the timeline of the actions to address the risks to facilitate the evaluation of their effectiveness.
2. May indicate in the process risk assessment the preventive measures to control the risks.
3. May revisit the procedure on the timeline of the review of the current year’s performance indicated on the OPCR and
IPCR; and the review of commitment for the succeeding year based on Dep-Ed Order No. 2, series of 2015.

33
Summary of Findings

HRD
1. May improve the timeline of the actions to address the risks to facilitate the evaluation of their effectiveness.

SGOD - SMME
1. May improve the timeline of the actions to address the risks to facilitate the evaluation of their effectiveness.

SGOD-EPS
1. May improve the timeline of the actions to address the risks to facilitate the evaluation of their effectiveness.

Planning and Research

1. May improve the timeline of the actions to address the risks to facilitate the evaluation of their effectiveness.
2. May indicate on the operational definition of terms the meaning of “Planned Date” indicated on the OM of
Planning and Research, as basis for the service realization of the concerns raised in the SDO-SC from the school
level.

Social Mobilization and Networking (Partnerships and Linkages)

1. May improve the timeline of the actions to address the risks to facilitate the evaluation of their effectiveness.

DRRM
1. May improve the timeline of the actions to address the risks to facilitate the evaluation of their effectiveness.

Youth Formation
1. May improve the timeline of the actions to address the risks to facilitate the evaluation of their effectiveness.
2. Improve the plans and programs to develop the youth of the division, with division wide impact.

School Health Section

1. May intensify the monitoring of the actual calibration of two weighing scales in the school health section of SDO-SC
because they are not yet calibrated. It is noted that the office has a plan for their calibration as of October 14, 2019
with DOST-Region XI.

SGOD- Records
1. May improve the timeline of the actions to address the risks to facilitate the evaluation of their effectiveness.
2. May scan and retain documents received and forwarded by the records section as retained documented
information for future reference.

34
Summary of Findings

Personnel and PSB

1. May improve the timeline of the actions to address the risks to facilitate the evaluation of their effectiveness.
2. May create a documented information to monitor the timeliness of the services of the Personnel Section for the
“processing of documents of hired employees”.

DIT
1. The organization may wish to consider to distribute a controlled copy to the different process owners of the copy of
the operations manual and quality procedures as reference for the implementation of their standards processes.

OSDS-Admin-Cash

1. May consider the inclusion of the completion date in the timeline to facilitate the evaluation of effectiveness of the
actions taken to address the risks.

OSDS-BAC

1. May consider the inclusion of the completion date in the timeline to facilitate the evaluation of effectiveness of the
actions taken to address the risks.
2. Ensure to complete/regularly update the entries in the PR record book to have reliable source of monitoring
results.
3. Ensure that all pertinent BAC documents are completely accomplished. E.g. signatures of the Abstract of
Quotation with Quotation No. DSC-19-10-159; Notice to Proceed dated September 26, 2019 with reference no.
DSC-19-129 (Date to Start and Date of Completion fields)

OSDS-Admin-PSU

1. May consider the inclusion of the completion date in the timeline to facilitate the evaluation of effectiveness of the
actions taken to address the risks.
2. Ensure to complete the entries in the logbooks. All of the logbooks presented have incomplete entries (e.g. date,
particulars, amount, etc).

35
Summary of Findings

QMR Secretariat

1. Compile all the notice of meetings, attendance sheets and other supporting documents in the planning of the MR,
including for the special MR meetings.
2. May consider to have a more in depth discussion of the agenda items (e.g. external providers; resources,
customer satisfaction qualitative comments)
3. Ensure that the templates being used are the controlled forms/coded forms (e.g. October 7 MoM)

36