A General Accounting Office report has found fault with virtually every area of care and management at St. Elizabeths Hospital, the federal psychiatric facility that serves residents of the District of Columbia.

GAO officials say the study on which their report is based was completed about 18 months ago, and they concede there have been marked improvements at the sprawling facility in Southeast Washington since then.

Among the problems cited by the GAO -- the investigative arm of Congress -- were:

A lack of comprehensive planning of mental health services by the District government.

Lack of coordination and communication between the city and federal government in the management of St. Elizabeths.

Wasteful spending on unneeded surgical staff.

Shortage of staff in some areas at the mental hospital.

Scheduling of care for patients that appears more geared to the convemence of St. E's staff members than patient needs.

Inadequate and inefficient management of property, equipment and personnel at the hospital.

Much has happened at St. Elizabeths since the GAO study was completed in May 1977.

Health, Education and Welfare Secretary Joseph A. Califano Jr. launched a "St. Elizabeths Initiative" to improve conditions at the hospital, which had lost its accreditation in 1975.

Since then, the hospital has acquired a new director, and Califano has named former Newark, N.J., human resources director James A. Buford to coordinate the federal effort to improve St. Elizabeths as well as District-federal efforts to improve mental health care for city residents.

"Given the fact the GAO report is a year-and-a-half old, substantial progress has been made in correcting deficiencies," said Buford yesterday. "We are in no way satisfied that we have reached a state of completion, but neither are we dragging our feet."

The hospital is now involved in a $50 million physical improvement program, and has worked out an arrangement to have Georgetown University Medical Center provide physical health care for St. Elizabeths, 2,000 patients at a maximum cost of $2.9 million a year.

Relations between the District and federal government have improved, Buford said. The city "has been extremely cooperative in the last 14 months. They have expressed a willingness to cooperate and have demonstrated in many ways that they are ready to cooperate to" provide and improve mental health services.

Frank Ackley, one of the authors of the GAO report, acknowledged that there have been improvements at St. Elizabeths since the report's completion, but said that "to know how much better it is, you'd really have to go in again."

"I think a lot of (what is in the GAO report) is still true," said Margaret Ewing, the attorney handling a long-standing federal class-action law-suit filed on behalf of St. Elizabeths patients.

Ewing said there are still several hundred patients at St. Elizabeths who belong in less restrictive community settings.