El Dorado County Grand Jury
2007-2008
From the annual report
The consolidated year-end volume. The individual investigations it contains are listed separately below.
📑 Year-End Report
The full consolidated volume; individual reports are listed below.
Individual reports (9)
Findings & Recommendations
7 findings
F2:
There is often institutional resistance to changing the status quo of an organization. Consolidation and reorganization are likely to lead to elimination of redundant positions, which typically will not be well received by current employees. Should consolidation occur, these difficulties can be ameliorated by a) selecting at least one director from the district to be a director of the new district, and b) continuing former district volunteer firefighter associations, such as was done with the mergers to form the El Dorado County FPD. While in general consolidations of organizations with a significant number of paid administrative positions will benefit from a reduction in those administrative positions, this is not the case with the LFPD. The LFPD has only a few part time administrative positions. Most of the department staff is operational, of which there is no redundancy that could be offset by consolidation. In fact most of the operational positions are either being done by volunteers or underpaid staff. If the LFPD were to consolidate with another fire district there would not be any significant cost savings. The LFPD believes the examples given for amelioration are not good examples of best practices nor would they result in a positive impact to the community nor a savings to the citizens of El Dorado County, but in fact would decrease services and/or increase costs.
F3:
The County Board of Supervisors supplements revenues for six FPDs on the County west slope and two small districts providing fire protection in the Tahoe Basin, Fallen Leaf Lake CSD and the Meeks Bay FPD. This is a subsidy by the County at large to these particular fire districts. These subsidies raise a fairness issue for taxpayers outside these districts who are supporting their own fire protection district through various taxes while also contributing, through the County's General fund, an extra amount of money to these subsidized districts. These subsidies are based on an agreement between the County Board of Supervisors and the eight districts, "Supplemental Funding Agreement for Rural Fire Districts for Enhanced Fire Protection and Emergency Medical Services." This agreement was amended by an Auditor-Controller memo of October 4, 2001, Board of Supervisors' action on 10-9-01, to provide for a correction in tax rates for fire protection in some of these districts. Under this agreement, the eight districts receiving less than 13 percent of the ad valorem property tax revenue collected within their boundaries will receive a supplemental contribution from the County general fund. This supplement is intended to be sufficient to provide the district with revenue for fire protection services equal to approximately 13 percent of their tax revenue base. The amount of this subsidy is calculated by the Auditor-Controller each year using the final assessed property valuation from the prior year to establish the 13 percent threshold. The difference between the 13 percent threshold and the prior year estimated actual tax revenue plus the prior year subsidy is the basis for the current year subsidy. For the eight subsidized districts, their percentage of total Tax Rate Area (TRA) taxes is always less than 13 percent; whereas for the five non-subsidized fire districts the percentage exceeds 13 percent. Exhibit A, column D, shows the amount of the County supplemental contribution to bring all fire protection districts up to the equivalent of 13 percent of the total TRA taxes for FY 2006/07. The supplemental amounts contributed by the County to all eight subsidized districts in FY 2006/07 totaled $1,188,142. The share of this amount received by the six West slope FPDs was $856,908, which is 72.2 percent of the total subsidy for FY 2006/07. The County supplemental in FY 2006/07 for all eight subsidized districts was $1,188,242. The subsidy for the six FPDs in the present year, FY 2007/08, is $926,948, an 8.2 percent increase over the previous year. The subsidy for all eight districts in FY 2007/08 is $1,300,347, which is a 9.3 percent increase over FY 2006/07. This analysis does not include any effort to understand the value of services provided. There are many factors not properly included such as the frequent response of a district like Latrobe to the adjacent districts. The value of this service is not evaluated. The entire fire protection service evaluation requires a much more sophisticated and detailed approach than is provided here. The use of the terms "subsidized district" and "subsidies" is, in our opinion, a poor choice of words. The augmentation funds are not a subsidy, but an effort to provide for a minimal value of compensation for services. The Grand Jury should have compared the tax basis that all of the fire districts in the county receive. The value of the service to ALL citizens of El Dorado County is clearly not included in this "discussion of numbers". Funds are allocated from a tax revenue pool, based on certain criteria using an allocation basis. This criteria and allocation base is a good faith attempt to allocate funds in a manner as equitable as possible, to enable different districts, ranging from lightly populated rural districts, to densely populated suburban districts, to provide an acceptable level of service under normal day to day conditions. Funding allocations are at best subjective and open to criticism, but in the final analysis, the question should be, "how much does it cost to provide an acceptable level of service?" This question should be the starting point, not the allocation basis used. One size does not fit all. A fire is a moving target recognizing no boundaries, or cost allocation methods. We should be guided by common sense principles rather than rules that give rise to the use of the term "subsidy." There is a finite pool of funds (tax revenues) available, none of which should be looked upon as a "subsidy". Ask the residents of Butte County, Paradise, Concow, and other areas hard hit by fires, and find out how they feel about being subsidized by the services provided by "out of town" districts. A wildfire recognizes no jurisdiction, boundaries, districts, county lines or other man made attempts to divide, allocate, and apportion responsibility for service. This has been eminently demonstrated in the current series of fires engulfing Northern California. Not only are fire districts, including Latrobe, crossing county lines to render assistance, but out of state districts and foreign countries are also providing support.
F4:
All of the subsidized FPDs receive "special taxes" and/or "special assessments" except Pioneer FPD. These funds are not considered when the subsidy calculation is made. These special funds have been previously authorized on a continuing basis by an election of property owners within the districts. Special taxes require a vote of 2/3 of the property parcel owners. Special assessments are "fire suppression assessments," which are allowed under State law and require only a property parcel vote of 50 percent plus one. It is proper that these funds are not included in the analysis because they were put in place by the citizens of the respected communities in order to deal with issues specific to their needs. The LFPD would like to note that while the current State law requires only a simple majority to pass a special tax of this type, at the time the LFPD special assessment as established, State law required greater than a 2/3 majority.
F5:
The tax revenues for FY 2006/07 for the West Slope FPDs are summarized in Exhibit B. The tax revenues for each district, including special taxes and special assessments, are combined in one column. Note that all but Pioneer FPD and Latrobe FPD receive tax revenues exceeding 13 percent of their tax base, and all but Pioneer FPD have total funding including the County Supplemental Contribution that exceeds 13 percent of their tax base. With the exception of Pioneer FPD and Latrobe FPD, the County supplemental is much smaller than the other tax revenue received by the subsidized districts. The LFPD agrees with the statements made in point 5. We do however do not agree that the value of 13% has any bearing on the issue. While the Grand Jury report indicated that all fire districts except for Pioneer and Latrobe receive tax revenues in excess of 13 percent of their tax base that in itself is not sufficient enough to determine need. There are many factors to determine the costs of fire related services. Amongst them are the density of the population (rural versus urban), the call volume, the types of possible incidents, the types of structures in the district, the fire hazard severity zone value, the distance from other possible districts resources, etc. A detailed analysis by knowledgeable persons is required to determine what the tax basis should be for any fire district and cannot be done simply by using the same value across the entire county.
F6:
With advance notification, the Board of Supervisors can discontinue these subsidies. The County has a fiduciary responsibility to minimize them, preferably without degrading fire protection capabilities. Elimination of the subsidies would require these fire protection districts to either find other sources of revenue in a similar amount, or find equivalent budget savings that would not degrade fire protection capability. The LFPD agrees that while it is true that the Board of Supervisors can discontinue these subsidies and perhaps should in certain cases, it should only be done with consideration on how it will affect the level of services to the community. The discrepancy is in what should be the minimal level of service that the county should support and what are the costs are to provide that service? If a fire district has identified a need for funds to support that minimal level of service, then the most logical funding source should be the tax base. The fire services are not a profit motivated business and our funding sources are extremely limited. The LFPD does agree that all the fire districts, including those that do not receive the augmentation funds, should operate in the most efficient manner possible resulting in the best possible savings to the budget. The county should review the requirements and funding for all districts, not just those that are receiving augmentation funds, to determine what tax revenues are used for what services.
F7:
Consolidation of the six West Slope subsidized fire districts, and especially mergers into the three financially stronger fire districts on the West Slope, should allow elimination of the fire chiefs and other administrative positions in the subsidized districts. The potential personnel savings that could result are shown in Exhibit C, where the administrative personnel costs for each fire district are shown in column L, with a total amount of $944,084. The County supplemental contributions for these fire districts are shown in column M, and the total amount is similar to the total administrative personnel costs shown in column L. The LFPD disagrees with the analysis. There is no data to support the result of same or increased levels of service by reducing operational personnel by any title. Small district chiefs and other "Administrative" personnel do not perform "redundant" chores that can be instantly absorbed into a larger organization. These people predominantly perform significant operational activities as well as response operations that still need to be performed regardless of title or agency. In fact evidence through many studies has shown that when consolidation occurs between organizations where much of the services were performed by volunteers in one organization with paid personnel in another organization, costs to the community increase and the level of services decreases. This is the major factor that eliminates most of the potential value of consolidation of special districts. Any consolidation needs to fully analyze the value provided by volunteers or underpaid services as compared to the same services paid for by full market value professionals. A consolidation study must include the total value of all services performed, which services could be eliminated by reduction of redundant positions, and which services might be affected if the current volunteer positions are no longer being provided by the community. Our study has shown that many volunteers will not be interested in performing the roles they are currently providing if those same services are provided by fully funded professional staff in the parent organization. We support, in principle, the idea of consolidation, but we feel that the Grand Jury has been misinformed as to the immediate financial benefits of consolidation. In our opinion, after considering the data for the smaller districts with budgets under $500,000 there would be little, in any, financial savings. Consolidation should result in lower administrative costs, but unless appropriate policies and procedures are revised to meet the newly consolidated organizational structure, the perceived benefits will never materialize. In addition, the operational policies and procedures, which differ from district to district need examining to ensure that there will be operational benefits from future consolidations. In conclusion, it is believed, by some, that if the county is really interested in cost benefits, there should be, in time, a major consolidation of all districts, resulting in one district for the West Slope that would also include ambulance services.
F8:
If supplemental payments to the six West Slope fire protection districts are eliminated, the savings to the County general fund will be recurrent, rather than one-time. Over ten years and with an annual increase of 9 percent, the SAVINGS will amount to $14,018,235. If supplemental payments to all eight subsidized fire districts are eliminated, the SAVINGS over ten years will amount to $19,665,148. We hold serious reservations as to the calculations and assumptions. We believe this analysis is over simplified. The only appropriate approach to evaluating this entire issue would be with a professional group performing the analysis. Professional fiscal evaluation tools need to be coupled with a keen understanding of all levels of fire service delivery operations including the value of volunteer service. For example, as was pointed out above, most of the services provided to the LFPD are done through volunteer or significantly underpaid staff. If the county removed the supplemental payments it would probably result in removing the funding required to provide the minimal level of service to the community. This in turn would prohibit the current staff to operate safely and with state required resources and cause the department to collapse, thus eliminating the services to the Latrobe and surrounding communities. In turn the county would have to provide these services with one or more of the surrounding districts that are predominantly based on paid staff. This in turn would cost the county significantly more money than what is spent today.
Additional Recommendations
1
Not linked to specific findings.
R1:
The El Dorado County Board of Supervisors should discontinue the "Supplemental Funding Agreement for Rural Districts for Enhanced Fire Protection and Emergency Medical Services" as it pertains to the following six fire protection districts: Pioneer, Rescue, Garden Valley, Mosquito, Georgetown, and Latrobe. The LFPD disagrees that the El Dorado County Board of Supervisors should discontinue the "Supplemental Funding Agreement for Rural Districts for Enhanced Fire Protection and Emergency Medical Services" as it pertains to the Latrobe Fire Protection District for the reasons cited in above. LAFCO and the El Dorado County Board of Supervisors should actively encourage consolidation or merger agreements between these presently subsidized fire protection districts and any of the following fire protection districts: El Dorado County Fire Protection District, Diamond Springs-El Dorado Fire Protection District, and El Dorado Hills County Water District. The LFPD is already in discussion with other fire districts to the applicability of consolidation and do not require encouragement from either LAFCO or the El Dorado County Board of Supervisors. The boards of directors of the following nine fire protection districts should make a good faith effort to reach consolidation agreements: Rescue, Pioneer, Mosquito, Latrobe, Georgetown, Garden Valley, El Dorado County, Diamond Springs, and El Dorado Hills. Each of these nine fire protection districts should report the results of their efforts to the Grand Jury within the Penal Code timeframe requirements. We agree that it is always appropriate for a public service agency to periodically evaluate performance delivery. From the LFPD perspective, the evaluation of potential for reorganization with another agency does not, and has never needed a politically motivated Grand Jury report to provide the stimulus to perform the evaluation. The LFPD has historically performed periodic evaluations of service levels and optional approaches to organization and agency affiliation. When the agency was formed in 1981 we had detailed discussions with multiple existing agencies to understand how we could provide the best possible service with virtually no resources available. These
Findings & Recommendations
4 findings
F1:
The respondent agrees with the finding.
F2:
The respondent disagrees wholly or in part with the finding, in which case the response shall specify the portion of the finding that is disputed and shall include an explanation of the reason therefore. RESPONSE TO RECOMMENDATIONS The responding person or entity shall report one of the following actions:
F3:
The recommendation requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a timeframe for the matter to be prepared for discussion by the officer or head of an agency of department being investigated or reviewed. This timeframe shall not exceed six months from the date of publication of the grand jury report. **
F4:
The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. * The time frame needs to be specific and reasonable. ** At the conclusion of this analysis, the recommendation must be responded to as required by items 1, 2, or 4. RESPONSE: TIME, WHERE AND TO WHOM The Penal Code identifies two different response times, depending upon the classification of the respondent (see below), and includes where and to whom the response is directed. Day one begins with the date of the Final Report.
Additional Recommendations
4
Not linked to specific findings.
R1:
The recommendation has been implemented, with a summary regarding the implemented action.
R2:
The recommendation has not yet been implemented, but will be implemented in the future, with a timeframe for implementation.*
R3:
The recommendation requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a timeframe for the matter to be prepared for discussion by the officer or head of an agency of department being investigated or reviewed. This timeframe shall not exceed six months from the date of publication of the grand jury report. **
R4:
The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. * The time frame needs to be specific and reasonable. ** At the conclusion of this analysis, the recommendation must be responded to as required by items 1, 2, or 4. RESPONSE: TIME, WHERE AND TO WHOM The Penal Code identifies two different response times, depending upon the classification of the respondent (see below), and includes where and to whom the response is directed. Day one begins with the date of the Final Report.
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Findings & Recommendations
9 findings
F1:
The respondent agrees with the finding.
F2:
The respondent disagrees wholly or in part with the finding, in which case the response shall specify the portion of the finding that is disputed and shall include an explanation of the reason therefore. RESPONSE TO RECOMMENDATIONS The responding person or entity shall report one of the following actions:
F3:
The recommendation requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a timeframe for the matter to be prepared for discussion by the officer or head of an agency of department being investigated or reviewed. This timeframe shall not exceed six months from the date of publication of the grand jury report. **
F4:
The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. * The time frame needs to be specific and reasonable. ** At the conclusion of this analysis, the recommendation must be responded to as required by items 1, 2, or 4. RESPONSE: TIME, WHERE AND TO WHOM The Penal Code identifies two different response times, depending upon the classification of the respondent (see below), and includes where and to whom the response is directed. Day one begins with the date of the Final Report.
F5:
Very recently, the DOT prepared a prototype handbook (“Zone of Benefit Advisory Committee Manual”) for advisory committee members. This Manual includes information on: ethics, the open meeting law (The California Brown Act), road maintenance and repair (engineering) guidelines, contracting and purchasing, insurance, volunteer work procedures, and budget preparation. This Manual is an excellent product, put together from existing information at DOT in a very short period of time. The Department of Transportation is commended for this effort. This Manual would also be very useful to board directors of road repair districts.
F6:
With advance notification, the Board of Supervisors can discontinue these subsidies. The County has a fiduciary responsibility to minimize them, preferably without degrading fire protection capabilities. Elimination of the subsidies would require these fire protection districts to either find other sources of revenue in a similar amount, or find equivalent budget savings that would not degrade fire protection capability.
F7:
Consolidation of the six West Slope subsidized fire districts, and especially mergers into the three financially stronger fire districts on the West Slope, should allow elimination of the fire chiefs and other administrative positions in the subsidized districts. The potential personnel savings that could result are shown in Exhibit C, where the administrative personnel costs for each fire district are shown in column L, with a total amount of $944,084. The County supplemental contributions for these fire districts are shown in column M, and the total amount is similar to the total administrative personnel costs shown in column L.
F8:
If supplemental payments to the six West Slope fire protection districts are eliminated, the savings to the County general fund will be recurrent, rather than one-time. Over ten years and with an annual increase of 9 percent, the SAVINGS will amount to $14,018,235. If supplemental payments to all eight subsidized fire districts are eliminated, the SAVINGS over ten years will amount to $19,665,148.
F9:
Our investigation indicated that Fleet Management is performing their function well.
Additional Recommendations
13
Not linked to specific findings.
R1:
The Grand Jury recommends that a task force be formed comprised of expert end users and outside vendors, charging them with the responsibility of streamlining the procurement process and improving the customer service level to all internal departments and external vendors. This end user task force should include members from all major County functions. The BOS should champion this process and assign one of the Supervisors to oversee the progress of this task force, with a monthly update from the leader of this task force to him/her and the CAO. We recommend that this task force start with a “blank page,” and identify an appropriate flow process, effective computer systems’ support and lead times that best serve the needs of the County and outside vendors. Significant progress has already been made in identifying the current process, but the challenge to the team is to identify what changes should be made to improve the procurement process. 2. The completed task force report should be written and submitted to the BOS with all recommended changes no later than the end of fiscal year 2008-2009. 3. No additions to personnel should occur until such time as a full review of the procurement process is completed. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05 20 -003 REASON FOR REPORT The El Dorado County Grand Jury received several complaints from citizens of South Lake Tahoe. The complaints centered on the verbally abusive behavior and menacing actions of the South Lake Tahoe Chief of Police. Investigation of these complaints uncovered additional information which prompted the Grand Jury to look further into his managerial and behavioral issues.
R2:
The recommendation has not yet been implemented, but will be implemented in the future, with a timeframe for implementation.*
R003:
The State identified issues “that may prove useful when conducting internal reviews” and help the counties “maintain an accountable and effective program.” DHS has applied the information provided by the State to its internal review process. The Program Manager who oversees the The person who oversees the TCM reimbursement claiming TCM and MAA program reimbursement process is actually a Department Analyst, not a Program claiming processes reviews encounter Manager. progress notes before invoicing the State An internal review of TCM encounters is conducted monthly for reimbursement, but does not review by the Analyst. The internal review determines which client files for overall compliance with encounters meet TCM requirements and will be submitted for program requirements. For example, reimbursement. although the progress notes for encounters TCM does not require annual re-assessments. Re-assessments may be reviewed discretely, the entire on an annual basis are a California Department of Aging client file may not reviewed as a whole, program requirement; annual re-assessments are not a TCM and items that are required of the client compliance requirement. file, such as annual Assessments may not be checked for compliance. 5 http://www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response The Public Guardian provides services that Given that 58.3% of the clients selected by the Auditor were are contingent upon the Office’s representative payees, DHS would expect a statistically appointment as conservator for an significant impact on the results of the audit. While financial individual by the Superior Court or management is mandatory, provision of TCM services requires through its Representative Payee program the cooperation of the client. Representative payee clients for individuals who receive income participate in TCM services but may (and often do) decline through public entitlements, public specific services. Representative payees have the right to benefits programs or other benefits refuse Public Guardian referrals and assistance with any matter programs and voluntarily seek financial that is not financial in nature. management services. For example, although the progress notes for encounters may be reviewed discretely, the entire client file may not reviewed as a whole, and items that are required of the client file, such as annual Assessments may not be checked for compliance. TCM does not require re-assessments. Re-assessments on an 26 The Assessment documentation provided annual basis are a California Department of Aging program by DHS for all but one of the twelve requirement for the Linkages Program (not the Public Public Guardian clients reviewed were Re- Guardian Program). The audit uses the term “re-assessment” assessments rather than the requested to refer to TCM documents that are not utilized by, and are not clients Assessments in effect for the period required to be utilized by, Public Guardian. being reviewed. The Public Guardian’s Re-assessment form contains only four categories: 1) Medical/Mental; 2) Social/Environmental; 3) Financial; and 4) Closing (for comments and summary statements). Most of the Targeted Case Management Due to limitations in the data reviewed, DHS disagrees with records reviewed for Public Guardian the conclusion that most of the TCM records reviewed for clients were found non-compliant with one Public Guardian were found non-compliant. or more aspects of Program regulations. If this pattern holds true for all Public Guardian clients, a good portion of the Department’s Medi-Cal revenues for this program are at risk of being disallowed for non-compliance with Targeted Case Management regulations. On the other hand, records reviewed for TCM regulations do not specify documentation formats or type Linkages program clients were found to be of forms. Linkages documentation conforms to the substantially compliant. These records requirements of the California Department of Aging. were more thorough and structured consistent with Targeted Case Management requirements. Some areas of the Linkages program billing records, however, were found to be noncompliant with program requirements or determinations of compliance could not be made because of the form in which case file records were provided by DHS. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response Assessment and Individual Client Service Plan documents provided by the Department for a number of clients were prepared after the Periodic Reviews provided so it was not possible to determine if service plans and objectives in effect at the time of the Periodic Reviews had been assessed by the case managers. It is true that some of the documents submitted were 25 The second other impairment was that the inadvertently for the most current date and not the encounter Assessment and Individual Client Service date. The Auditor did not communicate to DHS management Plan documents provided for some of the that this was a barrier or work towards resolving the issue. case records were prepared after the Periodic Review documents provided though the request was made for Assessments and Client Service Plans in effect during the review period for each client. Some of the Service Plans provided by DHS were those prepared after the 13 month review period for the case records. Given the rate of non-compliance found The Audit Report does not provide the calculations or define with the sample Targeted Case the methodology substantiating the possible disallowances. Management records reviewed, the DHS disagrees with the audit as to the total number of non- Department of Human Services is at risk compliant TCM encounters and the potential risk of of Medi-Cal disallowances of up to disallowance. $147,747 for Fiscal Year 2006-2007 if the DHS agrees that any amount resulting from potential sample results apply to all Medi-Cal disallowances would be reduced if deficiencies were corrected beneficiary program clients. To the extent to the State’s satisfaction. that deficiencies found can be corrected to the State’s satisfaction, this amount would be reduced. As of January 2008, the Public Guardian It must be clarified that not all Medi-Cal beneficiaries are was serving 327 clients, of which 153 eligible for or receive TCM services. As of February 2008 were Medi-Cal beneficiaries. (not January 2008), the Public Guardian was serving 327 clients, of which 206 were Medi-Cal beneficiaries and of those 206, 153 were eligible for TCM services. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response 1. Needs Assessment. The Assessment It appears this information was extrapolated from the TCM documents the conditions of the client and Provider Manual. These statements omit consideration or supports the selection of services for the discussion of relevancy to the individual in assessing the individual. The Assessment should contain client’s needs. at least the following elements: 1) The more detailed discussion of the Assessment within the medical/mental health; 2) training; 3) TCM Provider Manual states: vocational needs; 4) social/emotional “The documented assessment identifies the issues; 5) housing/physical needs; 6) beneficiary's needs. The assessment family/social matters; and, 7) finances. supports the selection of activities and 26 The purpose of the required TCM assistance necessary to meet the Assessment is to document the client’s beneficiary’s assessed needs and must needs in the following areas: 1) include the following, as relevant to each Medical/Mental Health; 2) Training needs individual: for community living; 3) • Medical/mental condition. The Vocational/Education needs; 4) Physical assessment may require obtaining needs, such as food and clothing; 5) evaluations completed by other providers Social/Emotional status; 5) of service. Housing/Physical environment; and, 6) • Training needs for community living. Family/Social Support systems. • Vocational/educational needs. • Physical needs, such as food and 27 The Public Guardian’s Re-assessment clothing. form contains only four categories: 1) • Social/emotional status. Medical/Mental; 2) Social/Environmental; • Housing/physical environment. 3) Financial; and 4) Closing (for • Familial/social support system.6 comments and summary statements). [Emphasis added.] While some of the other elements required for TCM Assessments are embedded in the For example, a 90-year old assisted living facility resident is four Re-assessment categories (e.g., unlikely to require a vocational needs assessment. Conversely, Family/Social Support Systems is a a mentally retarded 19 year old representative payee living subsection of the Social/Environmental with his or her parents would be unlikely to need a housing category) or may be addressed in summary assessment. written comments, some of the TCM At the time a Periodic Review is performed, the Public required elements such as Training or Guardian case worker prepares an updated Service Plan, even Vocational/Education needs are simply not if there are no changes to the previous Service Plan. This included and could potentially go prompts the case manager to address 19 distinct areas unaddressed in Re-assessments. The identified on the form to be assessed in terms of meeting the Public Guardian could ensure greater client’s needs. compliance with TCM Assessment requirements and greater continuity in client services by revising its Re- assessment standardized forms to include all required Assessment elements. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-1. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response 3. Periodic review. This is an evaluation of the beneficiary’s progress toward achieving goals in Individual Client Service Plans must be assessed at least every six months. The Linkages program requires periodic review at least every 3 months. TCM requirements are for Periodic Reviews at least every six months for the Public Guardian and every three months for the Linkages program. It appears these statements were paraphrased from the TCM 31 The TCM service components and Provider Manual. However, the statements do not fully requirements for the Linkages program is incorporate relevant elements of said document, resulting in a the same as for the Public Guardian with misrepresentation of said facts. The referenced document the exception that Periodic Reviews must actually states: take place at least every three months “The case manager must periodically instead of the Public Guardian requirement reevaluate the beneficiary's progress toward of every six months. achieving the objectives identified in the service plan to determine whether current 33 Though TCM regulations require Periodic services should be continued, modified, or Reviews of program clients at least every discontinued. The review shall be: six months, the Linkages program has a more restrictive requirement that Periodic • Completed at least every six months” 7 Reviews take place at least every three [Emphasis added.] months. There is a separate California Department of Aging requirement for the Linkages Program that a face-to-face 33 As shown in Exhibit 4.7, the majority of contact with the client must occur every three months. This is Linkages Program Period Reviews were a Linkages requirement, not a TCM requirement.8 conducted within the required three month interval requirement. While the case records reviewed showed that most Linkages clients do receive visits from the case managers more frequently than the minimum required four times a year, the fact that certain Linkage and Consultation services are not documented as such has resulted in an absence of TCM required 30 day follow-ups to such services. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-2. Linkages Program Manual, Section 7.E., Monitoring and Follow-Up, . Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response Page Twenty Medi-Cal eligible clients were The cut-off date was actually July 2007, not August 2007. randomly selected for review from the Documentation was not submitted for 8 clients because: 4 had Public Guardian’s client list. DHS did not not received TCM services prior to July 2007, 3 had not submit documentation for eight of the 20 received billable TCM services within the 13 month time requested sets of records for the following frame, and 1 client was erroneously included in the sample list. stated reasons: three had billings after the The Auditor did not request additional client records to bring August 2007 cutoff date, two were the sample size back up to 20. erroneously attributed to the program sample and three had not received services. Consequently, twelve of the twenty requested Public Guardian Medi- Cal beneficiary client case records were reviewed. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response A minority of the twelve randomly DHS disagrees that records that are fully compliant with TCM selected sets of Public Guardian client Program regulations are at risk for Medi-Cal disallowances. records reviewed were found to be fully compliant with TCM program regulations and are thus at risk for Medi-Cal disallowance. The Individual Client Service Plan This statement misquoted the referenced document and did not documents in the sample client records fully incorporate relevant aspects of said document, resulting could be characterized more as checklists in a misrepresentation of facts. The referenced document rather than “written, comprehensive states: individual service plans”2, as required by “written, comprehensive, individualized TCM regulations. Instead of writing, many service plan”9 Plans simply contained checked off boxes All Service Plans are client-specific. The TCM Provider for “Problems or Service Areas” such as Manual actually states that the plan will be individualized to “Financial” with no written commentary or the client. Therefore, some areas may not require written specific objectives or actions to be taken. commentary or specific objectives or actions in need of Many of the Plans reviewed did not attention. For example, a 90-year old assisted living facility identify services the client would be resident is unlikely to require a vocational needs assessment. referred to, as required by TCM Conversely, a mentally retarded 19 year old representative regulations, or were simply comprised of payee living with his or her parents would be unlikely to need notes regarding previous actions taken by a housing assessment. the case manager such as, “Deputy Public Guardian got a temporary card for file.” Checkboxes are a tool used to indicate which areas need attention from the case worker. The Public Guardian case 2 Targeted Case Management Overview, manager prepares the Service Plan, which prompts the case page T-2-1-1, California Department of manager to consider 19 distinct areas identified on the form to Health Care Services. be assessed for meeting the client’s needs. DHS agrees that case notes regarding actions by the case managers could be more directly related to the Service Plan areas and has taken steps to improve both the correlation of the areas and the review by supervisory staff. TCM Service Plans do not have a required format. Service Plans may be designed by each program participating in TCM using the format that works best for them. Check boxes are an acceptable method as evidenced by the State’s use of the forms, which El Dorado County Public Guardian staff participated in the development of, during a Statewide TCM training. In fact, DHS staff informed the Auditor that they had attended Statewide TCM training for Public Guardian providers, that DHS had assisted in the development of the State-accepted forms used during the training, and that DHS staff assisted in training representatives from other Public Guardian offices. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-1. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response When such services, called Linkage and Consultation, are provided, TCM regulations require that the initial referral or consultation be documented and that a documented follow-up occurs within a maximum of 30 days to determine whether the services were provided and whether they met the client’s needs. Linkage and This statement did not fully incorporate relevant aspects of Consultation services are not required but said requirements, resulting in a misrepresentation of facts. when they are provided, they must follow The TCM Provider Manual states: the protocols described. “Linkage and Consultation 29 Documentation of required 30 day follow- TCM services provide beneficiaries with ups to the Linkage and Consultation linkage and consultation and with referral to services were not found in any of the service providers and placement activities. The eleven reported incidents. case manager shall follow up with the beneficiary and/or service provider to 34 TCM regulations require that referral to determine whether services were received and such services be followed up within 30 whether the services met the beneficiary’s days to determine if the services were needs. The follow-up shall occur as quickly as received and whether they met the client’s indicated by the assessed need, not to exceed needs thirty (30) days from the scheduled date of the referral service.”10 [Emphasis added.] 34 None of the case records in which such services are recorded contained 30 day Hence, 30-day follow-ups are only required on referrals with follow-up documentation either. specific, scheduled services and must not exceed 30 days from the scheduled date of service. The 30-day follow up is not 34 While the case records reviewed showed required for referrals with open time frames or for referrals that most Linkages clients do receive visits without a scheduled service. from the case managers more frequently than the minimum required four times a year, the fact that certain Linkage and Consultation services are not documented as such has resulted in an absence of TCM required 30 day follow-ups to such services. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-2. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response Page Since the TCM program has many It is not clear how the Auditor arrived at the opinion that some requirements, some more significant than TCM requirements are “more significant than others” or how others, some judgment was necessary to the Auditor defines “substantial compliance”. define substantial compliance. For The Audit Report acknowledged that the State would likely example, none of the case records offer the Department an opportunity to correct deficiencies reviewed for either the Public Guardian or prior to a finding of disallowance. The Department’s the Linkages program contained the understanding of Medi-Cal programs is that disallowances are frequency or duration of activities not made unless the work was not performed or a duplication recommended for clients in the Individual in services is identified. Client Service Plans, as required by TCM regulations. Using this measure, all encounters billed for during preparation of Client Services Plans are out of compliance with TCM regulations and are therefore subject to Medi-Cal disallowance. A different standard was used though since the absence of frequency and duration of Service Plan activities was not considered as serious a breach of compliance as, for example, lack of compliance with the TCM requirement that a face-to-face Periodic Review of progress be conducted with the client at least every six months. If a case file was found compliant with all Individual billed encounters do not have to contain all TCM TCM requirements except including the components. Only those components specific to the TCM frequency and duration of activities in the encounter being billed are required. Case files typically Individual Client Service Plan, the file was contain additional information relevant to the TCM encounter. considered compliant. If a case file was Full case files were not reviewed by HMR nor were they non-compliant in a variety of areas such requested. as: not specifying activities for the client in Case file compliance cannot be determined based on the the Individual Client Service Plan; not limited number of and types of documents reviewed during the cross-referencing service needs from the Audit. client’s Assessment in the Individual Client Service Plan; and, not specifying the frequency and duration of activities in the Individual Client Service Plan, the case file was considered non-compliant and subject to Medi-Cal disallowance. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3
R3:
The recommendation requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a timeframe for the matter to be prepared for discussion by the officer or head of an agency of department being investigated or reviewed. This timeframe shall not exceed six months from the date of publication of the grand jury report. **
R3A:
The recommendation will not be implemented because it is not warranted. Contractor information is readily available on the internet, yellow pages and other sources. The County should not list specific contractor information in an effort to avoid any appearance of favoritism or a perceived recommendation of a particular contractor. B. References for many specifications that are given in the "Road Maintenance and Repair Guidelines" section of the Manual which will allow users to obtain more detailed specification information when needed. Response to
R3B:
The recommendation will not be implemented because it is not reasonable. References for specifications are available for road projects from contractors when projects go out to bid. Including references for specifications will likely involve the Department of Transportation in projects for which the county has no part. Final Draft Response to the 2007-08 Grand Jury Final Report Part 1 Clean Tahoe Program Case No. GJ 07- 011 REASON FOR REPORT The El Dorado County Grand Jury received a letter from the South Lake Tahoe District Attorney’s Office that prompted an investigation of the Clean Tahoe Program’s procedures for managing its funds. BACKGROUND The Clean Tahoe Program is a non-profit organization funded primarily by the City of South Lake Tahoe and El Dorado County. Its mission is to improve the visual quality of the Tahoe Basin within El Dorado County. Because it is publicly financed, it has a fiduciary responsibility, similar to the City and County, to properly manage its funds. The Clean Tahoe Program performs an important service to the community. This is accomplished through the dedication and hard work of the Clean Tahoe staff. METHODOLOGY The Grand Jury visited the offices in South Lake Tahoe of the Clean Tahoe Program and the South Tahoe Refuse Company (STR) to obtain information. STR is a private corporation with an exclusive franchise from the City and County to gather, sort, recycle, and dispose of refuse in the South Tahoe Basin. The investigation included a review of records, cashed checks, credit cards and the security of petty cash. People Interviewed: • Clean Tahoe Program Board, Two Directors • Clean Tahoe Program Manager • Clean Tahoe Program Outside Bookkeeper • Clean Tahoe Program Treasurer • El Dorado County Assistant District Attorney • South Tahoe Refuse Company Controller • South Tahoe Refuse Company President Documents Reviewed: • Clean Tahoe Program Brochure • Clean Tahoe Program By-laws, Procedures and Personnel Manual • Clean Tahoe Program Financial Documents • Clean Tahoe Program Budget vs. Actual Income and Expenses, October ‘06 through September ’07 5 Final Draft Response to the 2007-08 Grand Jury Final Report Part 1 • Clean Tahoe spreadsheets showing field work assignments • Comparative cost study by STR in 2004 showing cost savings if STR assumed Clean Tahoe Program duties • E-mail memos from Clean Tahoe Program Manager • Mission Statement of Clean Tahoe Program • South Tahoe Refuge Company controller memo (11/16/07) with financial spreadsheets RESULTS OF INVESTIGATION In the investigation of Clean Tahoe's management of funds, financial controls were found to be deficient. However, the deficiencies are in the process of being corrected. The Clean Tahoe Program is small and requires management and overhead functions that are disproportionately high and expensive in small publicly financed organizations. These costs would be lower if shared with similar costs in a larger organization. In principle, this can be achieved either by absorbing Clean Tahoe into a larger organization or by selecting a larger organization to perform the essential services that are now performed by the Clean Tahoe Program. The Grand Jury investigated these possibilities and found the following:
R4:
The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. * The time frame needs to be specific and reasonable. ** At the conclusion of this analysis, the recommendation must be responded to as required by items 1, 2, or 4. RESPONSE: TIME, WHERE AND TO WHOM The Penal Code identifies two different response times, depending upon the classification of the respondent (see below), and includes where and to whom the response is directed. Day one begins with the date of the Final Report.
R5:
The Grand Jury recommends that both OES and EDCOE, as well as individual school sites and districts, keep emergency response records that include dates of training and practice - to be maintained and supervised by EDCOE. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05. 5 -025 REASON FOR REPORT The Fire Protection District Law of 1987, in the State Health and Safety Code §13800, governs all of the Fire Protection Districts (FPDs) in California. Fire protection districts can only provide fire protection and emergency medical services. At the printing of the 3rd edition of “What’s So Special About Special Districts?” there were 386 FPDs in California. El Dorado County has nine FPDs on the West Slope and two FPDs in the Tahoe Basin. The County also has two multi-purpose Community Service Districts (CSDs) that provide fire protection along with other services: Fallen Leaf Lake CSD and Cameron Park CSD. The City of South Lake Tahoe has its own fire department. El Dorado County has a disproportionately high number of fire protection districts compared with the average of other counties in California. El Dorado County would benefit from consolidation. During the Grand Jury investigation, the scope was limited to the West Slope of the County
R6:
The SLTPD’s Strategic Plan should address clearly defined performance measures that include at a minimum the following areas of concern: • Confidence in Senior Management • Cynicism • Morale • Visions and Values of the Department
R7:
The Chief of Police should present a written progress report to the City Council and City Manager annually for public review.
R8:
The City Manager and City Council should maintain an active presence in tracking the Strategic Plan progress.
R9:
The Chief's annual performance evaluation should include the progress of the goals set in the Strategic Plan. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05. 24 -014 REASON FOR REPORT The Grand Jury elected to investigate the County’s Victim Restitution activity to determine if El Dorado County is effectively and efficiently managing victim restitution.
R32-33:
Exhibit 4.6 Review of 10 Individual Client Service Plans Linkages Program Plans with activity frequency, duration ------- they were found not fully compliant with TCM regulations in that none of the Service Plans reviewed described the frequency or nature of the activities and specific services to be performed, as required by TCM regulations. 1 http://www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx. 25
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Findings & Recommendations
9 findings
F1:
The number of correctional officers needed to cover all shifts is 34.
F2:
There is no dedicated general service worker for the facility. It was noted that the facility has been on a waiting list for needed repairs for two years.
F3:
The staff provides many opportunities and programs for inmates to improve their skills as contributing members of society, i.e. BRIDGE, TOPS, GED, culinary arts, counseling, and the Tahoe Mentor Program.
F4:
During the recent Angora Fire, the staff and inmates provided additional resources and comfort to the South Lake Tahoe community as well as to fire and law enforcement agencies.
F5:
The concern for the health of at-risk youngsters incarcerated in a juvenile correctional facility has been thoroughly reviewed. The Grand Jury finds that the probation staff and the educational staff have gone above and beyond what is required. In addition to sending for and receiving complete school records (including proof of immunization) within 24 hours of intake, the probation staff has also initiated a more effective health review upon in-take.
F6:
With advance notification, the Board of Supervisors can discontinue these subsidies. The County has a fiduciary responsibility to minimize them, preferably without degrading fire protection capabilities. Elimination of the subsidies would require these fire protection districts to either find other sources of revenue in a similar amount, or find equivalent budget savings that would not degrade fire protection capability.
F7:
Consolidation of the six West Slope subsidized fire districts, and especially mergers into the three financially stronger fire districts on the West Slope, should allow elimination of the fire chiefs and other administrative positions in the subsidized districts. The potential personnel savings that could result are shown in Exhibit C, where the administrative personnel costs for each fire district are shown in column L, with a total amount of $944,084. The County supplemental contributions for these fire districts are shown in column M, and the total amount is similar to the total administrative personnel costs shown in column L.
F8:
If supplemental payments to the six West Slope fire protection districts are eliminated, the savings to the County general fund will be recurrent, rather than one-time. Over ten years and with an annual increase of 9 percent, the SAVINGS will amount to $14,018,235. If supplemental payments to all eight subsidized fire districts are eliminated, the SAVINGS over ten years will amount to $19,665,148.
F9:
Our investigation indicated that Fleet Management is performing their function well.
Additional Recommendations
13
Not linked to specific findings.
R1:
The Grand Jury recommends that a task force be formed comprised of expert end users and outside vendors, charging them with the responsibility of streamlining the procurement process and improving the customer service level to all internal departments and external vendors. This end user task force should include members from all major County functions. The BOS should champion this process and assign one of the Supervisors to oversee the progress of this task force, with a monthly update from the leader of this task force to him/her and the CAO. We recommend that this task force start with a “blank page,” and identify an appropriate flow process, effective computer systems’ support and lead times that best serve the needs of the County and outside vendors. Significant progress has already been made in identifying the current process, but the challenge to the team is to identify what changes should be made to improve the procurement process. 2. The completed task force report should be written and submitted to the BOS with all recommended changes no later than the end of fiscal year 2008-2009. 3. No additions to personnel should occur until such time as a full review of the procurement process is completed. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05 20 -003 REASON FOR REPORT The El Dorado County Grand Jury received several complaints from citizens of South Lake Tahoe. The complaints centered on the verbally abusive behavior and menacing actions of the South Lake Tahoe Chief of Police. Investigation of these complaints uncovered additional information which prompted the Grand Jury to look further into his managerial and behavioral issues.
R2:
It is recommended that one maintenance worker from General Services be dedicated to the South Lake Tahoe Jail in order to make necessary decisions, provide preventative maintenance and complete critical work in a timely manner. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05. COMMENDATION Despite needing increased personnel and repairs in certain areas of the facility, many programs leading to rehabilitation of inmates were noted, most specifically in the areas of mental health, vocational training and community service. The leadership and staff at the South Lake Tahoe Jail are commended for their rehabilitation programs for inmates. Further, the leadership and staff are commended for their outstanding community response during the Angora Fire. 10 (a) and 919(b) of the California Penal Code requires the grand jury to annually inspect any jail or prison within the county. This includes juvenile correctional facilities.
R003:
The State identified issues “that may prove useful when conducting internal reviews” and help the counties “maintain an accountable and effective program.” DHS has applied the information provided by the State to its internal review process. The Program Manager who oversees the The person who oversees the TCM reimbursement claiming TCM and MAA program reimbursement process is actually a Department Analyst, not a Program claiming processes reviews encounter Manager. progress notes before invoicing the State An internal review of TCM encounters is conducted monthly for reimbursement, but does not review by the Analyst. The internal review determines which client files for overall compliance with encounters meet TCM requirements and will be submitted for program requirements. For example, reimbursement. although the progress notes for encounters TCM does not require annual re-assessments. Re-assessments may be reviewed discretely, the entire on an annual basis are a California Department of Aging client file may not reviewed as a whole, program requirement; annual re-assessments are not a TCM and items that are required of the client compliance requirement. file, such as annual Assessments may not be checked for compliance. 5 http://www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response The Public Guardian provides services that Given that 58.3% of the clients selected by the Auditor were are contingent upon the Office’s representative payees, DHS would expect a statistically appointment as conservator for an significant impact on the results of the audit. While financial individual by the Superior Court or management is mandatory, provision of TCM services requires through its Representative Payee program the cooperation of the client. Representative payee clients for individuals who receive income participate in TCM services but may (and often do) decline through public entitlements, public specific services. Representative payees have the right to benefits programs or other benefits refuse Public Guardian referrals and assistance with any matter programs and voluntarily seek financial that is not financial in nature. management services. For example, although the progress notes for encounters may be reviewed discretely, the entire client file may not reviewed as a whole, and items that are required of the client file, such as annual Assessments may not be checked for compliance. TCM does not require re-assessments. Re-assessments on an 26 The Assessment documentation provided annual basis are a California Department of Aging program by DHS for all but one of the twelve requirement for the Linkages Program (not the Public Public Guardian clients reviewed were Re- Guardian Program). The audit uses the term “re-assessment” assessments rather than the requested to refer to TCM documents that are not utilized by, and are not clients Assessments in effect for the period required to be utilized by, Public Guardian. being reviewed. The Public Guardian’s Re-assessment form contains only four categories: 1) Medical/Mental; 2) Social/Environmental; 3) Financial; and 4) Closing (for comments and summary statements). Most of the Targeted Case Management Due to limitations in the data reviewed, DHS disagrees with records reviewed for Public Guardian the conclusion that most of the TCM records reviewed for clients were found non-compliant with one Public Guardian were found non-compliant. or more aspects of Program regulations. If this pattern holds true for all Public Guardian clients, a good portion of the Department’s Medi-Cal revenues for this program are at risk of being disallowed for non-compliance with Targeted Case Management regulations. On the other hand, records reviewed for TCM regulations do not specify documentation formats or type Linkages program clients were found to be of forms. Linkages documentation conforms to the substantially compliant. These records requirements of the California Department of Aging. were more thorough and structured consistent with Targeted Case Management requirements. Some areas of the Linkages program billing records, however, were found to be noncompliant with program requirements or determinations of compliance could not be made because of the form in which case file records were provided by DHS. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response Assessment and Individual Client Service Plan documents provided by the Department for a number of clients were prepared after the Periodic Reviews provided so it was not possible to determine if service plans and objectives in effect at the time of the Periodic Reviews had been assessed by the case managers. It is true that some of the documents submitted were 25 The second other impairment was that the inadvertently for the most current date and not the encounter Assessment and Individual Client Service date. The Auditor did not communicate to DHS management Plan documents provided for some of the that this was a barrier or work towards resolving the issue. case records were prepared after the Periodic Review documents provided though the request was made for Assessments and Client Service Plans in effect during the review period for each client. Some of the Service Plans provided by DHS were those prepared after the 13 month review period for the case records. Given the rate of non-compliance found The Audit Report does not provide the calculations or define with the sample Targeted Case the methodology substantiating the possible disallowances. Management records reviewed, the DHS disagrees with the audit as to the total number of non- Department of Human Services is at risk compliant TCM encounters and the potential risk of of Medi-Cal disallowances of up to disallowance. $147,747 for Fiscal Year 2006-2007 if the DHS agrees that any amount resulting from potential sample results apply to all Medi-Cal disallowances would be reduced if deficiencies were corrected beneficiary program clients. To the extent to the State’s satisfaction. that deficiencies found can be corrected to the State’s satisfaction, this amount would be reduced. As of January 2008, the Public Guardian It must be clarified that not all Medi-Cal beneficiaries are was serving 327 clients, of which 153 eligible for or receive TCM services. As of February 2008 were Medi-Cal beneficiaries. (not January 2008), the Public Guardian was serving 327 clients, of which 206 were Medi-Cal beneficiaries and of those 206, 153 were eligible for TCM services. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response 1. Needs Assessment. The Assessment It appears this information was extrapolated from the TCM documents the conditions of the client and Provider Manual. These statements omit consideration or supports the selection of services for the discussion of relevancy to the individual in assessing the individual. The Assessment should contain client’s needs. at least the following elements: 1) The more detailed discussion of the Assessment within the medical/mental health; 2) training; 3) TCM Provider Manual states: vocational needs; 4) social/emotional “The documented assessment identifies the issues; 5) housing/physical needs; 6) beneficiary's needs. The assessment family/social matters; and, 7) finances. supports the selection of activities and 26 The purpose of the required TCM assistance necessary to meet the Assessment is to document the client’s beneficiary’s assessed needs and must needs in the following areas: 1) include the following, as relevant to each Medical/Mental Health; 2) Training needs individual: for community living; 3) • Medical/mental condition. The Vocational/Education needs; 4) Physical assessment may require obtaining needs, such as food and clothing; 5) evaluations completed by other providers Social/Emotional status; 5) of service. Housing/Physical environment; and, 6) • Training needs for community living. Family/Social Support systems. • Vocational/educational needs. • Physical needs, such as food and 27 The Public Guardian’s Re-assessment clothing. form contains only four categories: 1) • Social/emotional status. Medical/Mental; 2) Social/Environmental; • Housing/physical environment. 3) Financial; and 4) Closing (for • Familial/social support system.6 comments and summary statements). [Emphasis added.] While some of the other elements required for TCM Assessments are embedded in the For example, a 90-year old assisted living facility resident is four Re-assessment categories (e.g., unlikely to require a vocational needs assessment. Conversely, Family/Social Support Systems is a a mentally retarded 19 year old representative payee living subsection of the Social/Environmental with his or her parents would be unlikely to need a housing category) or may be addressed in summary assessment. written comments, some of the TCM At the time a Periodic Review is performed, the Public required elements such as Training or Guardian case worker prepares an updated Service Plan, even Vocational/Education needs are simply not if there are no changes to the previous Service Plan. This included and could potentially go prompts the case manager to address 19 distinct areas unaddressed in Re-assessments. The identified on the form to be assessed in terms of meeting the Public Guardian could ensure greater client’s needs. compliance with TCM Assessment requirements and greater continuity in client services by revising its Re- assessment standardized forms to include all required Assessment elements. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-1. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response 3. Periodic review. This is an evaluation of the beneficiary’s progress toward achieving goals in Individual Client Service Plans must be assessed at least every six months. The Linkages program requires periodic review at least every 3 months. TCM requirements are for Periodic Reviews at least every six months for the Public Guardian and every three months for the Linkages program. It appears these statements were paraphrased from the TCM 31 The TCM service components and Provider Manual. However, the statements do not fully requirements for the Linkages program is incorporate relevant elements of said document, resulting in a the same as for the Public Guardian with misrepresentation of said facts. The referenced document the exception that Periodic Reviews must actually states: take place at least every three months “The case manager must periodically instead of the Public Guardian requirement reevaluate the beneficiary's progress toward of every six months. achieving the objectives identified in the service plan to determine whether current 33 Though TCM regulations require Periodic services should be continued, modified, or Reviews of program clients at least every discontinued. The review shall be: six months, the Linkages program has a more restrictive requirement that Periodic • Completed at least every six months” 7 Reviews take place at least every three [Emphasis added.] months. There is a separate California Department of Aging requirement for the Linkages Program that a face-to-face 33 As shown in Exhibit 4.7, the majority of contact with the client must occur every three months. This is Linkages Program Period Reviews were a Linkages requirement, not a TCM requirement.8 conducted within the required three month interval requirement. While the case records reviewed showed that most Linkages clients do receive visits from the case managers more frequently than the minimum required four times a year, the fact that certain Linkage and Consultation services are not documented as such has resulted in an absence of TCM required 30 day follow-ups to such services. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-2. Linkages Program Manual, Section 7.E., Monitoring and Follow-Up, . Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response Page Twenty Medi-Cal eligible clients were The cut-off date was actually July 2007, not August 2007. randomly selected for review from the Documentation was not submitted for 8 clients because: 4 had Public Guardian’s client list. DHS did not not received TCM services prior to July 2007, 3 had not submit documentation for eight of the 20 received billable TCM services within the 13 month time requested sets of records for the following frame, and 1 client was erroneously included in the sample list. stated reasons: three had billings after the The Auditor did not request additional client records to bring August 2007 cutoff date, two were the sample size back up to 20. erroneously attributed to the program sample and three had not received services. Consequently, twelve of the twenty requested Public Guardian Medi- Cal beneficiary client case records were reviewed. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response A minority of the twelve randomly DHS disagrees that records that are fully compliant with TCM selected sets of Public Guardian client Program regulations are at risk for Medi-Cal disallowances. records reviewed were found to be fully compliant with TCM program regulations and are thus at risk for Medi-Cal disallowance. The Individual Client Service Plan This statement misquoted the referenced document and did not documents in the sample client records fully incorporate relevant aspects of said document, resulting could be characterized more as checklists in a misrepresentation of facts. The referenced document rather than “written, comprehensive states: individual service plans”2, as required by “written, comprehensive, individualized TCM regulations. Instead of writing, many service plan”9 Plans simply contained checked off boxes All Service Plans are client-specific. The TCM Provider for “Problems or Service Areas” such as Manual actually states that the plan will be individualized to “Financial” with no written commentary or the client. Therefore, some areas may not require written specific objectives or actions to be taken. commentary or specific objectives or actions in need of Many of the Plans reviewed did not attention. For example, a 90-year old assisted living facility identify services the client would be resident is unlikely to require a vocational needs assessment. referred to, as required by TCM Conversely, a mentally retarded 19 year old representative regulations, or were simply comprised of payee living with his or her parents would be unlikely to need notes regarding previous actions taken by a housing assessment. the case manager such as, “Deputy Public Guardian got a temporary card for file.” Checkboxes are a tool used to indicate which areas need attention from the case worker. The Public Guardian case 2 Targeted Case Management Overview, manager prepares the Service Plan, which prompts the case page T-2-1-1, California Department of manager to consider 19 distinct areas identified on the form to Health Care Services. be assessed for meeting the client’s needs. DHS agrees that case notes regarding actions by the case managers could be more directly related to the Service Plan areas and has taken steps to improve both the correlation of the areas and the review by supervisory staff. TCM Service Plans do not have a required format. Service Plans may be designed by each program participating in TCM using the format that works best for them. Check boxes are an acceptable method as evidenced by the State’s use of the forms, which El Dorado County Public Guardian staff participated in the development of, during a Statewide TCM training. In fact, DHS staff informed the Auditor that they had attended Statewide TCM training for Public Guardian providers, that DHS had assisted in the development of the State-accepted forms used during the training, and that DHS staff assisted in training representatives from other Public Guardian offices. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-1. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response When such services, called Linkage and Consultation, are provided, TCM regulations require that the initial referral or consultation be documented and that a documented follow-up occurs within a maximum of 30 days to determine whether the services were provided and whether they met the client’s needs. Linkage and This statement did not fully incorporate relevant aspects of Consultation services are not required but said requirements, resulting in a misrepresentation of facts. when they are provided, they must follow The TCM Provider Manual states: the protocols described. “Linkage and Consultation 29 Documentation of required 30 day follow- TCM services provide beneficiaries with ups to the Linkage and Consultation linkage and consultation and with referral to services were not found in any of the service providers and placement activities. The eleven reported incidents. case manager shall follow up with the beneficiary and/or service provider to 34 TCM regulations require that referral to determine whether services were received and such services be followed up within 30 whether the services met the beneficiary’s days to determine if the services were needs. The follow-up shall occur as quickly as received and whether they met the client’s indicated by the assessed need, not to exceed needs thirty (30) days from the scheduled date of the referral service.”10 [Emphasis added.] 34 None of the case records in which such services are recorded contained 30 day Hence, 30-day follow-ups are only required on referrals with follow-up documentation either. specific, scheduled services and must not exceed 30 days from the scheduled date of service. The 30-day follow up is not 34 While the case records reviewed showed required for referrals with open time frames or for referrals that most Linkages clients do receive visits without a scheduled service. from the case managers more frequently than the minimum required four times a year, the fact that certain Linkage and Consultation services are not documented as such has resulted in an absence of TCM required 30 day follow-ups to such services. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-2. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response Page Since the TCM program has many It is not clear how the Auditor arrived at the opinion that some requirements, some more significant than TCM requirements are “more significant than others” or how others, some judgment was necessary to the Auditor defines “substantial compliance”. define substantial compliance. For The Audit Report acknowledged that the State would likely example, none of the case records offer the Department an opportunity to correct deficiencies reviewed for either the Public Guardian or prior to a finding of disallowance. The Department’s the Linkages program contained the understanding of Medi-Cal programs is that disallowances are frequency or duration of activities not made unless the work was not performed or a duplication recommended for clients in the Individual in services is identified. Client Service Plans, as required by TCM regulations. Using this measure, all encounters billed for during preparation of Client Services Plans are out of compliance with TCM regulations and are therefore subject to Medi-Cal disallowance. A different standard was used though since the absence of frequency and duration of Service Plan activities was not considered as serious a breach of compliance as, for example, lack of compliance with the TCM requirement that a face-to-face Periodic Review of progress be conducted with the client at least every six months. If a case file was found compliant with all Individual billed encounters do not have to contain all TCM TCM requirements except including the components. Only those components specific to the TCM frequency and duration of activities in the encounter being billed are required. Case files typically Individual Client Service Plan, the file was contain additional information relevant to the TCM encounter. considered compliant. If a case file was Full case files were not reviewed by HMR nor were they non-compliant in a variety of areas such requested. as: not specifying activities for the client in Case file compliance cannot be determined based on the the Individual Client Service Plan; not limited number of and types of documents reviewed during the cross-referencing service needs from the Audit. client’s Assessment in the Individual Client Service Plan; and, not specifying the frequency and duration of activities in the Individual Client Service Plan, the case file was considered non-compliant and subject to Medi-Cal disallowance. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3
R3:
An academic component should be added to the educational program (i.e., General Education Development, California High School Proficiency Exam). RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05. COMMENDATION The 2007-2008 El Dorado Grand Jury commends Growlersburg Conservation Camp. The excellent training provided by Growlersburg gives the inmates the opportunity upon release to lead productive lives and become solid members of society. As a result of the training programs, the inmates exhibit skills of qualified professionals in the fields of fire fighting, emergency response and woodworking. The Grand Jury commends Growlersburg for their exceptional community service. Growlersburg is commended for savings incurred by the maintenance of their produce garden. 18 -001 REASON FOR REPORT The El Dorado County Grand Jury received a complaint from a citizen alleging that Mother Lode Union School District (MLUSD) was spending district funds inappropriately. These allegations were limited to expenditures for incremental building space, equipment, travel, and personnel costs for in-house technology services.
R3A:
The recommendation will not be implemented because it is not warranted. Contractor information is readily available on the internet, yellow pages and other sources. The County should not list specific contractor information in an effort to avoid any appearance of favoritism or a perceived recommendation of a particular contractor. B. References for many specifications that are given in the "Road Maintenance and Repair Guidelines" section of the Manual which will allow users to obtain more detailed specification information when needed. Response to
R3B:
The recommendation will not be implemented because it is not reasonable. References for specifications are available for road projects from contractors when projects go out to bid. Including references for specifications will likely involve the Department of Transportation in projects for which the county has no part. Final Draft Response to the 2007-08 Grand Jury Final Report Part 1 Clean Tahoe Program Case No. GJ 07- 011 REASON FOR REPORT The El Dorado County Grand Jury received a letter from the South Lake Tahoe District Attorney’s Office that prompted an investigation of the Clean Tahoe Program’s procedures for managing its funds. BACKGROUND The Clean Tahoe Program is a non-profit organization funded primarily by the City of South Lake Tahoe and El Dorado County. Its mission is to improve the visual quality of the Tahoe Basin within El Dorado County. Because it is publicly financed, it has a fiduciary responsibility, similar to the City and County, to properly manage its funds. The Clean Tahoe Program performs an important service to the community. This is accomplished through the dedication and hard work of the Clean Tahoe staff. METHODOLOGY The Grand Jury visited the offices in South Lake Tahoe of the Clean Tahoe Program and the South Tahoe Refuse Company (STR) to obtain information. STR is a private corporation with an exclusive franchise from the City and County to gather, sort, recycle, and dispose of refuse in the South Tahoe Basin. The investigation included a review of records, cashed checks, credit cards and the security of petty cash. People Interviewed: • Clean Tahoe Program Board, Two Directors • Clean Tahoe Program Manager • Clean Tahoe Program Outside Bookkeeper • Clean Tahoe Program Treasurer • El Dorado County Assistant District Attorney • South Tahoe Refuse Company Controller • South Tahoe Refuse Company President Documents Reviewed: • Clean Tahoe Program Brochure • Clean Tahoe Program By-laws, Procedures and Personnel Manual • Clean Tahoe Program Financial Documents • Clean Tahoe Program Budget vs. Actual Income and Expenses, October ‘06 through September ’07 5 Final Draft Response to the 2007-08 Grand Jury Final Report Part 1 • Clean Tahoe spreadsheets showing field work assignments • Comparative cost study by STR in 2004 showing cost savings if STR assumed Clean Tahoe Program duties • E-mail memos from Clean Tahoe Program Manager • Mission Statement of Clean Tahoe Program • South Tahoe Refuge Company controller memo (11/16/07) with financial spreadsheets RESULTS OF INVESTIGATION In the investigation of Clean Tahoe's management of funds, financial controls were found to be deficient. However, the deficiencies are in the process of being corrected. The Clean Tahoe Program is small and requires management and overhead functions that are disproportionately high and expensive in small publicly financed organizations. These costs would be lower if shared with similar costs in a larger organization. In principle, this can be achieved either by absorbing Clean Tahoe into a larger organization or by selecting a larger organization to perform the essential services that are now performed by the Clean Tahoe Program. The Grand Jury investigated these possibilities and found the following:
R4:
The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. * The time frame needs to be specific and reasonable. ** At the conclusion of this analysis, the recommendation must be responded to as required by items 1, 2, or 4. RESPONSE: TIME, WHERE AND TO WHOM The Penal Code identifies two different response times, depending upon the classification of the respondent (see below), and includes where and to whom the response is directed. Day one begins with the date of the Final Report.
R5:
The Grand Jury recommends that both OES and EDCOE, as well as individual school sites and districts, keep emergency response records that include dates of training and practice - to be maintained and supervised by EDCOE. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05. 5 -025 REASON FOR REPORT The Fire Protection District Law of 1987, in the State Health and Safety Code §13800, governs all of the Fire Protection Districts (FPDs) in California. Fire protection districts can only provide fire protection and emergency medical services. At the printing of the 3rd edition of “What’s So Special About Special Districts?” there were 386 FPDs in California. El Dorado County has nine FPDs on the West Slope and two FPDs in the Tahoe Basin. The County also has two multi-purpose Community Service Districts (CSDs) that provide fire protection along with other services: Fallen Leaf Lake CSD and Cameron Park CSD. The City of South Lake Tahoe has its own fire department. El Dorado County has a disproportionately high number of fire protection districts compared with the average of other counties in California. El Dorado County would benefit from consolidation. During the Grand Jury investigation, the scope was limited to the West Slope of the County
R6:
The SLTPD’s Strategic Plan should address clearly defined performance measures that include at a minimum the following areas of concern: • Confidence in Senior Management • Cynicism • Morale • Visions and Values of the Department
R7:
The Chief of Police should present a written progress report to the City Council and City Manager annually for public review.
R8:
The City Manager and City Council should maintain an active presence in tracking the Strategic Plan progress.
R9:
The Chief's annual performance evaluation should include the progress of the goals set in the Strategic Plan. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05. 24 -014 REASON FOR REPORT The Grand Jury elected to investigate the County’s Victim Restitution activity to determine if El Dorado County is effectively and efficiently managing victim restitution.
R32-33:
Exhibit 4.6 Review of 10 Individual Client Service Plans Linkages Program Plans with activity frequency, duration ------- they were found not fully compliant with TCM regulations in that none of the Service Plans reviewed described the frequency or nature of the activities and specific services to be performed, as required by TCM regulations. 1 http://www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx. 25
Findings & Recommendations
9 findings
F1:
The respondent agrees with the finding.
F2:
The respondent disagrees wholly or in part with the finding, in which case the response shall specify the portion of the finding that is disputed and shall include an explanation of the reason therefore. RESPONSE TO RECOMMENDATIONS The responding person or entity shall report one of the following actions:
F3:
The recommendation requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a timeframe for the matter to be prepared for discussion by the officer or head of an agency of department being investigated or reviewed. This timeframe shall not exceed six months from the date of publication of the grand jury report. **
F4:
The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. * The time frame needs to be specific and reasonable. ** At the conclusion of this analysis, the recommendation must be responded to as required by items 1, 2, or 4. RESPONSE: TIME, WHERE AND TO WHOM The Penal Code identifies two different response times, depending upon the classification of the respondent (see below), and includes where and to whom the response is directed. Day one begins with the date of the Final Report.
F5:
Very recently, the DOT prepared a prototype handbook (“Zone of Benefit Advisory Committee Manual”) for advisory committee members. This Manual includes information on: ethics, the open meeting law (The California Brown Act), road maintenance and repair (engineering) guidelines, contracting and purchasing, insurance, volunteer work procedures, and budget preparation. This Manual is an excellent product, put together from existing information at DOT in a very short period of time. The Department of Transportation is commended for this effort. This Manual would also be very useful to board directors of road repair districts.
F6:
With advance notification, the Board of Supervisors can discontinue these subsidies. The County has a fiduciary responsibility to minimize them, preferably without degrading fire protection capabilities. Elimination of the subsidies would require these fire protection districts to either find other sources of revenue in a similar amount, or find equivalent budget savings that would not degrade fire protection capability.
F7:
Consolidation of the six West Slope subsidized fire districts, and especially mergers into the three financially stronger fire districts on the West Slope, should allow elimination of the fire chiefs and other administrative positions in the subsidized districts. The potential personnel savings that could result are shown in Exhibit C, where the administrative personnel costs for each fire district are shown in column L, with a total amount of $944,084. The County supplemental contributions for these fire districts are shown in column M, and the total amount is similar to the total administrative personnel costs shown in column L.
F8:
If supplemental payments to the six West Slope fire protection districts are eliminated, the savings to the County general fund will be recurrent, rather than one-time. Over ten years and with an annual increase of 9 percent, the SAVINGS will amount to $14,018,235. If supplemental payments to all eight subsidized fire districts are eliminated, the SAVINGS over ten years will amount to $19,665,148.
F9:
Our investigation indicated that Fleet Management is performing their function well.
Additional Recommendations
13
Not linked to specific findings.
R1:
The Grand Jury recommends that a task force be formed comprised of expert end users and outside vendors, charging them with the responsibility of streamlining the procurement process and improving the customer service level to all internal departments and external vendors. This end user task force should include members from all major County functions. The BOS should champion this process and assign one of the Supervisors to oversee the progress of this task force, with a monthly update from the leader of this task force to him/her and the CAO. We recommend that this task force start with a “blank page,” and identify an appropriate flow process, effective computer systems’ support and lead times that best serve the needs of the County and outside vendors. Significant progress has already been made in identifying the current process, but the challenge to the team is to identify what changes should be made to improve the procurement process. 2. The completed task force report should be written and submitted to the BOS with all recommended changes no later than the end of fiscal year 2008-2009. 3. No additions to personnel should occur until such time as a full review of the procurement process is completed. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05 20 -003 REASON FOR REPORT The El Dorado County Grand Jury received several complaints from citizens of South Lake Tahoe. The complaints centered on the verbally abusive behavior and menacing actions of the South Lake Tahoe Chief of Police. Investigation of these complaints uncovered additional information which prompted the Grand Jury to look further into his managerial and behavioral issues.
R2:
The recommendation has not yet been implemented, but will be implemented in the future, with a timeframe for implementation.*
R003:
The State identified issues “that may prove useful when conducting internal reviews” and help the counties “maintain an accountable and effective program.” DHS has applied the information provided by the State to its internal review process. The Program Manager who oversees the The person who oversees the TCM reimbursement claiming TCM and MAA program reimbursement process is actually a Department Analyst, not a Program claiming processes reviews encounter Manager. progress notes before invoicing the State An internal review of TCM encounters is conducted monthly for reimbursement, but does not review by the Analyst. The internal review determines which client files for overall compliance with encounters meet TCM requirements and will be submitted for program requirements. For example, reimbursement. although the progress notes for encounters TCM does not require annual re-assessments. Re-assessments may be reviewed discretely, the entire on an annual basis are a California Department of Aging client file may not reviewed as a whole, program requirement; annual re-assessments are not a TCM and items that are required of the client compliance requirement. file, such as annual Assessments may not be checked for compliance. 5 http://www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response The Public Guardian provides services that Given that 58.3% of the clients selected by the Auditor were are contingent upon the Office’s representative payees, DHS would expect a statistically appointment as conservator for an significant impact on the results of the audit. While financial individual by the Superior Court or management is mandatory, provision of TCM services requires through its Representative Payee program the cooperation of the client. Representative payee clients for individuals who receive income participate in TCM services but may (and often do) decline through public entitlements, public specific services. Representative payees have the right to benefits programs or other benefits refuse Public Guardian referrals and assistance with any matter programs and voluntarily seek financial that is not financial in nature. management services. For example, although the progress notes for encounters may be reviewed discretely, the entire client file may not reviewed as a whole, and items that are required of the client file, such as annual Assessments may not be checked for compliance. TCM does not require re-assessments. Re-assessments on an 26 The Assessment documentation provided annual basis are a California Department of Aging program by DHS for all but one of the twelve requirement for the Linkages Program (not the Public Public Guardian clients reviewed were Re- Guardian Program). The audit uses the term “re-assessment” assessments rather than the requested to refer to TCM documents that are not utilized by, and are not clients Assessments in effect for the period required to be utilized by, Public Guardian. being reviewed. The Public Guardian’s Re-assessment form contains only four categories: 1) Medical/Mental; 2) Social/Environmental; 3) Financial; and 4) Closing (for comments and summary statements). Most of the Targeted Case Management Due to limitations in the data reviewed, DHS disagrees with records reviewed for Public Guardian the conclusion that most of the TCM records reviewed for clients were found non-compliant with one Public Guardian were found non-compliant. or more aspects of Program regulations. If this pattern holds true for all Public Guardian clients, a good portion of the Department’s Medi-Cal revenues for this program are at risk of being disallowed for non-compliance with Targeted Case Management regulations. On the other hand, records reviewed for TCM regulations do not specify documentation formats or type Linkages program clients were found to be of forms. Linkages documentation conforms to the substantially compliant. These records requirements of the California Department of Aging. were more thorough and structured consistent with Targeted Case Management requirements. Some areas of the Linkages program billing records, however, were found to be noncompliant with program requirements or determinations of compliance could not be made because of the form in which case file records were provided by DHS. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response Assessment and Individual Client Service Plan documents provided by the Department for a number of clients were prepared after the Periodic Reviews provided so it was not possible to determine if service plans and objectives in effect at the time of the Periodic Reviews had been assessed by the case managers. It is true that some of the documents submitted were 25 The second other impairment was that the inadvertently for the most current date and not the encounter Assessment and Individual Client Service date. The Auditor did not communicate to DHS management Plan documents provided for some of the that this was a barrier or work towards resolving the issue. case records were prepared after the Periodic Review documents provided though the request was made for Assessments and Client Service Plans in effect during the review period for each client. Some of the Service Plans provided by DHS were those prepared after the 13 month review period for the case records. Given the rate of non-compliance found The Audit Report does not provide the calculations or define with the sample Targeted Case the methodology substantiating the possible disallowances. Management records reviewed, the DHS disagrees with the audit as to the total number of non- Department of Human Services is at risk compliant TCM encounters and the potential risk of of Medi-Cal disallowances of up to disallowance. $147,747 for Fiscal Year 2006-2007 if the DHS agrees that any amount resulting from potential sample results apply to all Medi-Cal disallowances would be reduced if deficiencies were corrected beneficiary program clients. To the extent to the State’s satisfaction. that deficiencies found can be corrected to the State’s satisfaction, this amount would be reduced. As of January 2008, the Public Guardian It must be clarified that not all Medi-Cal beneficiaries are was serving 327 clients, of which 153 eligible for or receive TCM services. As of February 2008 were Medi-Cal beneficiaries. (not January 2008), the Public Guardian was serving 327 clients, of which 206 were Medi-Cal beneficiaries and of those 206, 153 were eligible for TCM services. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response 1. Needs Assessment. The Assessment It appears this information was extrapolated from the TCM documents the conditions of the client and Provider Manual. These statements omit consideration or supports the selection of services for the discussion of relevancy to the individual in assessing the individual. The Assessment should contain client’s needs. at least the following elements: 1) The more detailed discussion of the Assessment within the medical/mental health; 2) training; 3) TCM Provider Manual states: vocational needs; 4) social/emotional “The documented assessment identifies the issues; 5) housing/physical needs; 6) beneficiary's needs. The assessment family/social matters; and, 7) finances. supports the selection of activities and 26 The purpose of the required TCM assistance necessary to meet the Assessment is to document the client’s beneficiary’s assessed needs and must needs in the following areas: 1) include the following, as relevant to each Medical/Mental Health; 2) Training needs individual: for community living; 3) • Medical/mental condition. The Vocational/Education needs; 4) Physical assessment may require obtaining needs, such as food and clothing; 5) evaluations completed by other providers Social/Emotional status; 5) of service. Housing/Physical environment; and, 6) • Training needs for community living. Family/Social Support systems. • Vocational/educational needs. • Physical needs, such as food and 27 The Public Guardian’s Re-assessment clothing. form contains only four categories: 1) • Social/emotional status. Medical/Mental; 2) Social/Environmental; • Housing/physical environment. 3) Financial; and 4) Closing (for • Familial/social support system.6 comments and summary statements). [Emphasis added.] While some of the other elements required for TCM Assessments are embedded in the For example, a 90-year old assisted living facility resident is four Re-assessment categories (e.g., unlikely to require a vocational needs assessment. Conversely, Family/Social Support Systems is a a mentally retarded 19 year old representative payee living subsection of the Social/Environmental with his or her parents would be unlikely to need a housing category) or may be addressed in summary assessment. written comments, some of the TCM At the time a Periodic Review is performed, the Public required elements such as Training or Guardian case worker prepares an updated Service Plan, even Vocational/Education needs are simply not if there are no changes to the previous Service Plan. This included and could potentially go prompts the case manager to address 19 distinct areas unaddressed in Re-assessments. The identified on the form to be assessed in terms of meeting the Public Guardian could ensure greater client’s needs. compliance with TCM Assessment requirements and greater continuity in client services by revising its Re- assessment standardized forms to include all required Assessment elements. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-1. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response 3. Periodic review. This is an evaluation of the beneficiary’s progress toward achieving goals in Individual Client Service Plans must be assessed at least every six months. The Linkages program requires periodic review at least every 3 months. TCM requirements are for Periodic Reviews at least every six months for the Public Guardian and every three months for the Linkages program. It appears these statements were paraphrased from the TCM 31 The TCM service components and Provider Manual. However, the statements do not fully requirements for the Linkages program is incorporate relevant elements of said document, resulting in a the same as for the Public Guardian with misrepresentation of said facts. The referenced document the exception that Periodic Reviews must actually states: take place at least every three months “The case manager must periodically instead of the Public Guardian requirement reevaluate the beneficiary's progress toward of every six months. achieving the objectives identified in the service plan to determine whether current 33 Though TCM regulations require Periodic services should be continued, modified, or Reviews of program clients at least every discontinued. The review shall be: six months, the Linkages program has a more restrictive requirement that Periodic • Completed at least every six months” 7 Reviews take place at least every three [Emphasis added.] months. There is a separate California Department of Aging requirement for the Linkages Program that a face-to-face 33 As shown in Exhibit 4.7, the majority of contact with the client must occur every three months. This is Linkages Program Period Reviews were a Linkages requirement, not a TCM requirement.8 conducted within the required three month interval requirement. While the case records reviewed showed that most Linkages clients do receive visits from the case managers more frequently than the minimum required four times a year, the fact that certain Linkage and Consultation services are not documented as such has resulted in an absence of TCM required 30 day follow-ups to such services. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-2. Linkages Program Manual, Section 7.E., Monitoring and Follow-Up, . Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response Page Twenty Medi-Cal eligible clients were The cut-off date was actually July 2007, not August 2007. randomly selected for review from the Documentation was not submitted for 8 clients because: 4 had Public Guardian’s client list. DHS did not not received TCM services prior to July 2007, 3 had not submit documentation for eight of the 20 received billable TCM services within the 13 month time requested sets of records for the following frame, and 1 client was erroneously included in the sample list. stated reasons: three had billings after the The Auditor did not request additional client records to bring August 2007 cutoff date, two were the sample size back up to 20. erroneously attributed to the program sample and three had not received services. Consequently, twelve of the twenty requested Public Guardian Medi- Cal beneficiary client case records were reviewed. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response A minority of the twelve randomly DHS disagrees that records that are fully compliant with TCM selected sets of Public Guardian client Program regulations are at risk for Medi-Cal disallowances. records reviewed were found to be fully compliant with TCM program regulations and are thus at risk for Medi-Cal disallowance. The Individual Client Service Plan This statement misquoted the referenced document and did not documents in the sample client records fully incorporate relevant aspects of said document, resulting could be characterized more as checklists in a misrepresentation of facts. The referenced document rather than “written, comprehensive states: individual service plans”2, as required by “written, comprehensive, individualized TCM regulations. Instead of writing, many service plan”9 Plans simply contained checked off boxes All Service Plans are client-specific. The TCM Provider for “Problems or Service Areas” such as Manual actually states that the plan will be individualized to “Financial” with no written commentary or the client. Therefore, some areas may not require written specific objectives or actions to be taken. commentary or specific objectives or actions in need of Many of the Plans reviewed did not attention. For example, a 90-year old assisted living facility identify services the client would be resident is unlikely to require a vocational needs assessment. referred to, as required by TCM Conversely, a mentally retarded 19 year old representative regulations, or were simply comprised of payee living with his or her parents would be unlikely to need notes regarding previous actions taken by a housing assessment. the case manager such as, “Deputy Public Guardian got a temporary card for file.” Checkboxes are a tool used to indicate which areas need attention from the case worker. The Public Guardian case 2 Targeted Case Management Overview, manager prepares the Service Plan, which prompts the case page T-2-1-1, California Department of manager to consider 19 distinct areas identified on the form to Health Care Services. be assessed for meeting the client’s needs. DHS agrees that case notes regarding actions by the case managers could be more directly related to the Service Plan areas and has taken steps to improve both the correlation of the areas and the review by supervisory staff. TCM Service Plans do not have a required format. Service Plans may be designed by each program participating in TCM using the format that works best for them. Check boxes are an acceptable method as evidenced by the State’s use of the forms, which El Dorado County Public Guardian staff participated in the development of, during a Statewide TCM training. In fact, DHS staff informed the Auditor that they had attended Statewide TCM training for Public Guardian providers, that DHS had assisted in the development of the State-accepted forms used during the training, and that DHS staff assisted in training representatives from other Public Guardian offices. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-1. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response When such services, called Linkage and Consultation, are provided, TCM regulations require that the initial referral or consultation be documented and that a documented follow-up occurs within a maximum of 30 days to determine whether the services were provided and whether they met the client’s needs. Linkage and This statement did not fully incorporate relevant aspects of Consultation services are not required but said requirements, resulting in a misrepresentation of facts. when they are provided, they must follow The TCM Provider Manual states: the protocols described. “Linkage and Consultation 29 Documentation of required 30 day follow- TCM services provide beneficiaries with ups to the Linkage and Consultation linkage and consultation and with referral to services were not found in any of the service providers and placement activities. The eleven reported incidents. case manager shall follow up with the beneficiary and/or service provider to 34 TCM regulations require that referral to determine whether services were received and such services be followed up within 30 whether the services met the beneficiary’s days to determine if the services were needs. The follow-up shall occur as quickly as received and whether they met the client’s indicated by the assessed need, not to exceed needs thirty (30) days from the scheduled date of the referral service.”10 [Emphasis added.] 34 None of the case records in which such services are recorded contained 30 day Hence, 30-day follow-ups are only required on referrals with follow-up documentation either. specific, scheduled services and must not exceed 30 days from the scheduled date of service. The 30-day follow up is not 34 While the case records reviewed showed required for referrals with open time frames or for referrals that most Linkages clients do receive visits without a scheduled service. from the case managers more frequently than the minimum required four times a year, the fact that certain Linkage and Consultation services are not documented as such has resulted in an absence of TCM required 30 day follow-ups to such services. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-2. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response Page Since the TCM program has many It is not clear how the Auditor arrived at the opinion that some requirements, some more significant than TCM requirements are “more significant than others” or how others, some judgment was necessary to the Auditor defines “substantial compliance”. define substantial compliance. For The Audit Report acknowledged that the State would likely example, none of the case records offer the Department an opportunity to correct deficiencies reviewed for either the Public Guardian or prior to a finding of disallowance. The Department’s the Linkages program contained the understanding of Medi-Cal programs is that disallowances are frequency or duration of activities not made unless the work was not performed or a duplication recommended for clients in the Individual in services is identified. Client Service Plans, as required by TCM regulations. Using this measure, all encounters billed for during preparation of Client Services Plans are out of compliance with TCM regulations and are therefore subject to Medi-Cal disallowance. A different standard was used though since the absence of frequency and duration of Service Plan activities was not considered as serious a breach of compliance as, for example, lack of compliance with the TCM requirement that a face-to-face Periodic Review of progress be conducted with the client at least every six months. If a case file was found compliant with all Individual billed encounters do not have to contain all TCM TCM requirements except including the components. Only those components specific to the TCM frequency and duration of activities in the encounter being billed are required. Case files typically Individual Client Service Plan, the file was contain additional information relevant to the TCM encounter. considered compliant. If a case file was Full case files were not reviewed by HMR nor were they non-compliant in a variety of areas such requested. as: not specifying activities for the client in Case file compliance cannot be determined based on the the Individual Client Service Plan; not limited number of and types of documents reviewed during the cross-referencing service needs from the Audit. client’s Assessment in the Individual Client Service Plan; and, not specifying the frequency and duration of activities in the Individual Client Service Plan, the case file was considered non-compliant and subject to Medi-Cal disallowance. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3
R3:
The recommendation requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a timeframe for the matter to be prepared for discussion by the officer or head of an agency of department being investigated or reviewed. This timeframe shall not exceed six months from the date of publication of the grand jury report. **
R3A:
The recommendation will not be implemented because it is not warranted. Contractor information is readily available on the internet, yellow pages and other sources. The County should not list specific contractor information in an effort to avoid any appearance of favoritism or a perceived recommendation of a particular contractor. B. References for many specifications that are given in the "Road Maintenance and Repair Guidelines" section of the Manual which will allow users to obtain more detailed specification information when needed. Response to
R3B:
The recommendation will not be implemented because it is not reasonable. References for specifications are available for road projects from contractors when projects go out to bid. Including references for specifications will likely involve the Department of Transportation in projects for which the county has no part. Final Draft Response to the 2007-08 Grand Jury Final Report Part 1 Clean Tahoe Program Case No. GJ 07- 011 REASON FOR REPORT The El Dorado County Grand Jury received a letter from the South Lake Tahoe District Attorney’s Office that prompted an investigation of the Clean Tahoe Program’s procedures for managing its funds. BACKGROUND The Clean Tahoe Program is a non-profit organization funded primarily by the City of South Lake Tahoe and El Dorado County. Its mission is to improve the visual quality of the Tahoe Basin within El Dorado County. Because it is publicly financed, it has a fiduciary responsibility, similar to the City and County, to properly manage its funds. The Clean Tahoe Program performs an important service to the community. This is accomplished through the dedication and hard work of the Clean Tahoe staff. METHODOLOGY The Grand Jury visited the offices in South Lake Tahoe of the Clean Tahoe Program and the South Tahoe Refuse Company (STR) to obtain information. STR is a private corporation with an exclusive franchise from the City and County to gather, sort, recycle, and dispose of refuse in the South Tahoe Basin. The investigation included a review of records, cashed checks, credit cards and the security of petty cash. People Interviewed: • Clean Tahoe Program Board, Two Directors • Clean Tahoe Program Manager • Clean Tahoe Program Outside Bookkeeper • Clean Tahoe Program Treasurer • El Dorado County Assistant District Attorney • South Tahoe Refuse Company Controller • South Tahoe Refuse Company President Documents Reviewed: • Clean Tahoe Program Brochure • Clean Tahoe Program By-laws, Procedures and Personnel Manual • Clean Tahoe Program Financial Documents • Clean Tahoe Program Budget vs. Actual Income and Expenses, October ‘06 through September ’07 5 Final Draft Response to the 2007-08 Grand Jury Final Report Part 1 • Clean Tahoe spreadsheets showing field work assignments • Comparative cost study by STR in 2004 showing cost savings if STR assumed Clean Tahoe Program duties • E-mail memos from Clean Tahoe Program Manager • Mission Statement of Clean Tahoe Program • South Tahoe Refuge Company controller memo (11/16/07) with financial spreadsheets RESULTS OF INVESTIGATION In the investigation of Clean Tahoe's management of funds, financial controls were found to be deficient. However, the deficiencies are in the process of being corrected. The Clean Tahoe Program is small and requires management and overhead functions that are disproportionately high and expensive in small publicly financed organizations. These costs would be lower if shared with similar costs in a larger organization. In principle, this can be achieved either by absorbing Clean Tahoe into a larger organization or by selecting a larger organization to perform the essential services that are now performed by the Clean Tahoe Program. The Grand Jury investigated these possibilities and found the following:
R4:
The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. * The time frame needs to be specific and reasonable. ** At the conclusion of this analysis, the recommendation must be responded to as required by items 1, 2, or 4. RESPONSE: TIME, WHERE AND TO WHOM The Penal Code identifies two different response times, depending upon the classification of the respondent (see below), and includes where and to whom the response is directed. Day one begins with the date of the Final Report.
R5:
The Grand Jury recommends that both OES and EDCOE, as well as individual school sites and districts, keep emergency response records that include dates of training and practice - to be maintained and supervised by EDCOE. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05. 5 -025 REASON FOR REPORT The Fire Protection District Law of 1987, in the State Health and Safety Code §13800, governs all of the Fire Protection Districts (FPDs) in California. Fire protection districts can only provide fire protection and emergency medical services. At the printing of the 3rd edition of “What’s So Special About Special Districts?” there were 386 FPDs in California. El Dorado County has nine FPDs on the West Slope and two FPDs in the Tahoe Basin. The County also has two multi-purpose Community Service Districts (CSDs) that provide fire protection along with other services: Fallen Leaf Lake CSD and Cameron Park CSD. The City of South Lake Tahoe has its own fire department. El Dorado County has a disproportionately high number of fire protection districts compared with the average of other counties in California. El Dorado County would benefit from consolidation. During the Grand Jury investigation, the scope was limited to the West Slope of the County
R6:
The SLTPD’s Strategic Plan should address clearly defined performance measures that include at a minimum the following areas of concern: • Confidence in Senior Management • Cynicism • Morale • Visions and Values of the Department
R7:
The Chief of Police should present a written progress report to the City Council and City Manager annually for public review.
R8:
The City Manager and City Council should maintain an active presence in tracking the Strategic Plan progress.
R9:
The Chief's annual performance evaluation should include the progress of the goals set in the Strategic Plan. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05. 24 -014 REASON FOR REPORT The Grand Jury elected to investigate the County’s Victim Restitution activity to determine if El Dorado County is effectively and efficiently managing victim restitution.
R32-33:
Exhibit 4.6 Review of 10 Individual Client Service Plans Linkages Program Plans with activity frequency, duration ------- they were found not fully compliant with TCM regulations in that none of the Service Plans reviewed described the frequency or nature of the activities and specific services to be performed, as required by TCM regulations. 1 http://www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx. 25
Findings and recommendations not yet extracted.
Findings & Recommendations
9 findings
F1:
The respondent agrees with the finding.
F2:
The respondent disagrees wholly or in part with the finding, in which case the response shall specify the portion of the finding that is disputed and shall include an explanation of the reason therefore. RESPONSE TO RECOMMENDATIONS The responding person or entity shall report one of the following actions:
F3:
The recommendation requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a timeframe for the matter to be prepared for discussion by the officer or head of an agency of department being investigated or reviewed. This timeframe shall not exceed six months from the date of publication of the grand jury report. **
F4:
The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. * The time frame needs to be specific and reasonable. ** At the conclusion of this analysis, the recommendation must be responded to as required by items 1, 2, or 4. RESPONSE: TIME, WHERE AND TO WHOM The Penal Code identifies two different response times, depending upon the classification of the respondent (see below), and includes where and to whom the response is directed. Day one begins with the date of the Final Report.
F5:
Very recently, the DOT prepared a prototype handbook (“Zone of Benefit Advisory Committee Manual”) for advisory committee members. This Manual includes information on: ethics, the open meeting law (The California Brown Act), road maintenance and repair (engineering) guidelines, contracting and purchasing, insurance, volunteer work procedures, and budget preparation. This Manual is an excellent product, put together from existing information at DOT in a very short period of time. The Department of Transportation is commended for this effort. This Manual would also be very useful to board directors of road repair districts.
F6:
With advance notification, the Board of Supervisors can discontinue these subsidies. The County has a fiduciary responsibility to minimize them, preferably without degrading fire protection capabilities. Elimination of the subsidies would require these fire protection districts to either find other sources of revenue in a similar amount, or find equivalent budget savings that would not degrade fire protection capability.
F7:
Consolidation of the six West Slope subsidized fire districts, and especially mergers into the three financially stronger fire districts on the West Slope, should allow elimination of the fire chiefs and other administrative positions in the subsidized districts. The potential personnel savings that could result are shown in Exhibit C, where the administrative personnel costs for each fire district are shown in column L, with a total amount of $944,084. The County supplemental contributions for these fire districts are shown in column M, and the total amount is similar to the total administrative personnel costs shown in column L.
F8:
If supplemental payments to the six West Slope fire protection districts are eliminated, the savings to the County general fund will be recurrent, rather than one-time. Over ten years and with an annual increase of 9 percent, the SAVINGS will amount to $14,018,235. If supplemental payments to all eight subsidized fire districts are eliminated, the SAVINGS over ten years will amount to $19,665,148.
F9:
Our investigation indicated that Fleet Management is performing their function well.
Additional Recommendations
13
Not linked to specific findings.
R1:
The Grand Jury recommends that a task force be formed comprised of expert end users and outside vendors, charging them with the responsibility of streamlining the procurement process and improving the customer service level to all internal departments and external vendors. This end user task force should include members from all major County functions. The BOS should champion this process and assign one of the Supervisors to oversee the progress of this task force, with a monthly update from the leader of this task force to him/her and the CAO. We recommend that this task force start with a “blank page,” and identify an appropriate flow process, effective computer systems’ support and lead times that best serve the needs of the County and outside vendors. Significant progress has already been made in identifying the current process, but the challenge to the team is to identify what changes should be made to improve the procurement process. 2. The completed task force report should be written and submitted to the BOS with all recommended changes no later than the end of fiscal year 2008-2009. 3. No additions to personnel should occur until such time as a full review of the procurement process is completed. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05 20 -003 REASON FOR REPORT The El Dorado County Grand Jury received several complaints from citizens of South Lake Tahoe. The complaints centered on the verbally abusive behavior and menacing actions of the South Lake Tahoe Chief of Police. Investigation of these complaints uncovered additional information which prompted the Grand Jury to look further into his managerial and behavioral issues.
R2:
The recommendation has not yet been implemented, but will be implemented in the future, with a timeframe for implementation.*
R003:
The State identified issues “that may prove useful when conducting internal reviews” and help the counties “maintain an accountable and effective program.” DHS has applied the information provided by the State to its internal review process. The Program Manager who oversees the The person who oversees the TCM reimbursement claiming TCM and MAA program reimbursement process is actually a Department Analyst, not a Program claiming processes reviews encounter Manager. progress notes before invoicing the State An internal review of TCM encounters is conducted monthly for reimbursement, but does not review by the Analyst. The internal review determines which client files for overall compliance with encounters meet TCM requirements and will be submitted for program requirements. For example, reimbursement. although the progress notes for encounters TCM does not require annual re-assessments. Re-assessments may be reviewed discretely, the entire on an annual basis are a California Department of Aging client file may not reviewed as a whole, program requirement; annual re-assessments are not a TCM and items that are required of the client compliance requirement. file, such as annual Assessments may not be checked for compliance. 5 http://www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response The Public Guardian provides services that Given that 58.3% of the clients selected by the Auditor were are contingent upon the Office’s representative payees, DHS would expect a statistically appointment as conservator for an significant impact on the results of the audit. While financial individual by the Superior Court or management is mandatory, provision of TCM services requires through its Representative Payee program the cooperation of the client. Representative payee clients for individuals who receive income participate in TCM services but may (and often do) decline through public entitlements, public specific services. Representative payees have the right to benefits programs or other benefits refuse Public Guardian referrals and assistance with any matter programs and voluntarily seek financial that is not financial in nature. management services. For example, although the progress notes for encounters may be reviewed discretely, the entire client file may not reviewed as a whole, and items that are required of the client file, such as annual Assessments may not be checked for compliance. TCM does not require re-assessments. Re-assessments on an 26 The Assessment documentation provided annual basis are a California Department of Aging program by DHS for all but one of the twelve requirement for the Linkages Program (not the Public Public Guardian clients reviewed were Re- Guardian Program). The audit uses the term “re-assessment” assessments rather than the requested to refer to TCM documents that are not utilized by, and are not clients Assessments in effect for the period required to be utilized by, Public Guardian. being reviewed. The Public Guardian’s Re-assessment form contains only four categories: 1) Medical/Mental; 2) Social/Environmental; 3) Financial; and 4) Closing (for comments and summary statements). Most of the Targeted Case Management Due to limitations in the data reviewed, DHS disagrees with records reviewed for Public Guardian the conclusion that most of the TCM records reviewed for clients were found non-compliant with one Public Guardian were found non-compliant. or more aspects of Program regulations. If this pattern holds true for all Public Guardian clients, a good portion of the Department’s Medi-Cal revenues for this program are at risk of being disallowed for non-compliance with Targeted Case Management regulations. On the other hand, records reviewed for TCM regulations do not specify documentation formats or type Linkages program clients were found to be of forms. Linkages documentation conforms to the substantially compliant. These records requirements of the California Department of Aging. were more thorough and structured consistent with Targeted Case Management requirements. Some areas of the Linkages program billing records, however, were found to be noncompliant with program requirements or determinations of compliance could not be made because of the form in which case file records were provided by DHS. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response Assessment and Individual Client Service Plan documents provided by the Department for a number of clients were prepared after the Periodic Reviews provided so it was not possible to determine if service plans and objectives in effect at the time of the Periodic Reviews had been assessed by the case managers. It is true that some of the documents submitted were 25 The second other impairment was that the inadvertently for the most current date and not the encounter Assessment and Individual Client Service date. The Auditor did not communicate to DHS management Plan documents provided for some of the that this was a barrier or work towards resolving the issue. case records were prepared after the Periodic Review documents provided though the request was made for Assessments and Client Service Plans in effect during the review period for each client. Some of the Service Plans provided by DHS were those prepared after the 13 month review period for the case records. Given the rate of non-compliance found The Audit Report does not provide the calculations or define with the sample Targeted Case the methodology substantiating the possible disallowances. Management records reviewed, the DHS disagrees with the audit as to the total number of non- Department of Human Services is at risk compliant TCM encounters and the potential risk of of Medi-Cal disallowances of up to disallowance. $147,747 for Fiscal Year 2006-2007 if the DHS agrees that any amount resulting from potential sample results apply to all Medi-Cal disallowances would be reduced if deficiencies were corrected beneficiary program clients. To the extent to the State’s satisfaction. that deficiencies found can be corrected to the State’s satisfaction, this amount would be reduced. As of January 2008, the Public Guardian It must be clarified that not all Medi-Cal beneficiaries are was serving 327 clients, of which 153 eligible for or receive TCM services. As of February 2008 were Medi-Cal beneficiaries. (not January 2008), the Public Guardian was serving 327 clients, of which 206 were Medi-Cal beneficiaries and of those 206, 153 were eligible for TCM services. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response 1. Needs Assessment. The Assessment It appears this information was extrapolated from the TCM documents the conditions of the client and Provider Manual. These statements omit consideration or supports the selection of services for the discussion of relevancy to the individual in assessing the individual. The Assessment should contain client’s needs. at least the following elements: 1) The more detailed discussion of the Assessment within the medical/mental health; 2) training; 3) TCM Provider Manual states: vocational needs; 4) social/emotional “The documented assessment identifies the issues; 5) housing/physical needs; 6) beneficiary's needs. The assessment family/social matters; and, 7) finances. supports the selection of activities and 26 The purpose of the required TCM assistance necessary to meet the Assessment is to document the client’s beneficiary’s assessed needs and must needs in the following areas: 1) include the following, as relevant to each Medical/Mental Health; 2) Training needs individual: for community living; 3) • Medical/mental condition. The Vocational/Education needs; 4) Physical assessment may require obtaining needs, such as food and clothing; 5) evaluations completed by other providers Social/Emotional status; 5) of service. Housing/Physical environment; and, 6) • Training needs for community living. Family/Social Support systems. • Vocational/educational needs. • Physical needs, such as food and 27 The Public Guardian’s Re-assessment clothing. form contains only four categories: 1) • Social/emotional status. Medical/Mental; 2) Social/Environmental; • Housing/physical environment. 3) Financial; and 4) Closing (for • Familial/social support system.6 comments and summary statements). [Emphasis added.] While some of the other elements required for TCM Assessments are embedded in the For example, a 90-year old assisted living facility resident is four Re-assessment categories (e.g., unlikely to require a vocational needs assessment. Conversely, Family/Social Support Systems is a a mentally retarded 19 year old representative payee living subsection of the Social/Environmental with his or her parents would be unlikely to need a housing category) or may be addressed in summary assessment. written comments, some of the TCM At the time a Periodic Review is performed, the Public required elements such as Training or Guardian case worker prepares an updated Service Plan, even Vocational/Education needs are simply not if there are no changes to the previous Service Plan. This included and could potentially go prompts the case manager to address 19 distinct areas unaddressed in Re-assessments. The identified on the form to be assessed in terms of meeting the Public Guardian could ensure greater client’s needs. compliance with TCM Assessment requirements and greater continuity in client services by revising its Re- assessment standardized forms to include all required Assessment elements. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-1. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response 3. Periodic review. This is an evaluation of the beneficiary’s progress toward achieving goals in Individual Client Service Plans must be assessed at least every six months. The Linkages program requires periodic review at least every 3 months. TCM requirements are for Periodic Reviews at least every six months for the Public Guardian and every three months for the Linkages program. It appears these statements were paraphrased from the TCM 31 The TCM service components and Provider Manual. However, the statements do not fully requirements for the Linkages program is incorporate relevant elements of said document, resulting in a the same as for the Public Guardian with misrepresentation of said facts. The referenced document the exception that Periodic Reviews must actually states: take place at least every three months “The case manager must periodically instead of the Public Guardian requirement reevaluate the beneficiary's progress toward of every six months. achieving the objectives identified in the service plan to determine whether current 33 Though TCM regulations require Periodic services should be continued, modified, or Reviews of program clients at least every discontinued. The review shall be: six months, the Linkages program has a more restrictive requirement that Periodic • Completed at least every six months” 7 Reviews take place at least every three [Emphasis added.] months. There is a separate California Department of Aging requirement for the Linkages Program that a face-to-face 33 As shown in Exhibit 4.7, the majority of contact with the client must occur every three months. This is Linkages Program Period Reviews were a Linkages requirement, not a TCM requirement.8 conducted within the required three month interval requirement. While the case records reviewed showed that most Linkages clients do receive visits from the case managers more frequently than the minimum required four times a year, the fact that certain Linkage and Consultation services are not documented as such has resulted in an absence of TCM required 30 day follow-ups to such services. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-2. Linkages Program Manual, Section 7.E., Monitoring and Follow-Up, . Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response Page Twenty Medi-Cal eligible clients were The cut-off date was actually July 2007, not August 2007. randomly selected for review from the Documentation was not submitted for 8 clients because: 4 had Public Guardian’s client list. DHS did not not received TCM services prior to July 2007, 3 had not submit documentation for eight of the 20 received billable TCM services within the 13 month time requested sets of records for the following frame, and 1 client was erroneously included in the sample list. stated reasons: three had billings after the The Auditor did not request additional client records to bring August 2007 cutoff date, two were the sample size back up to 20. erroneously attributed to the program sample and three had not received services. Consequently, twelve of the twenty requested Public Guardian Medi- Cal beneficiary client case records were reviewed. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response A minority of the twelve randomly DHS disagrees that records that are fully compliant with TCM selected sets of Public Guardian client Program regulations are at risk for Medi-Cal disallowances. records reviewed were found to be fully compliant with TCM program regulations and are thus at risk for Medi-Cal disallowance. The Individual Client Service Plan This statement misquoted the referenced document and did not documents in the sample client records fully incorporate relevant aspects of said document, resulting could be characterized more as checklists in a misrepresentation of facts. The referenced document rather than “written, comprehensive states: individual service plans”2, as required by “written, comprehensive, individualized TCM regulations. Instead of writing, many service plan”9 Plans simply contained checked off boxes All Service Plans are client-specific. The TCM Provider for “Problems or Service Areas” such as Manual actually states that the plan will be individualized to “Financial” with no written commentary or the client. Therefore, some areas may not require written specific objectives or actions to be taken. commentary or specific objectives or actions in need of Many of the Plans reviewed did not attention. For example, a 90-year old assisted living facility identify services the client would be resident is unlikely to require a vocational needs assessment. referred to, as required by TCM Conversely, a mentally retarded 19 year old representative regulations, or were simply comprised of payee living with his or her parents would be unlikely to need notes regarding previous actions taken by a housing assessment. the case manager such as, “Deputy Public Guardian got a temporary card for file.” Checkboxes are a tool used to indicate which areas need attention from the case worker. The Public Guardian case 2 Targeted Case Management Overview, manager prepares the Service Plan, which prompts the case page T-2-1-1, California Department of manager to consider 19 distinct areas identified on the form to Health Care Services. be assessed for meeting the client’s needs. DHS agrees that case notes regarding actions by the case managers could be more directly related to the Service Plan areas and has taken steps to improve both the correlation of the areas and the review by supervisory staff. TCM Service Plans do not have a required format. Service Plans may be designed by each program participating in TCM using the format that works best for them. Check boxes are an acceptable method as evidenced by the State’s use of the forms, which El Dorado County Public Guardian staff participated in the development of, during a Statewide TCM training. In fact, DHS staff informed the Auditor that they had attended Statewide TCM training for Public Guardian providers, that DHS had assisted in the development of the State-accepted forms used during the training, and that DHS staff assisted in training representatives from other Public Guardian offices. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-1. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response When such services, called Linkage and Consultation, are provided, TCM regulations require that the initial referral or consultation be documented and that a documented follow-up occurs within a maximum of 30 days to determine whether the services were provided and whether they met the client’s needs. Linkage and This statement did not fully incorporate relevant aspects of Consultation services are not required but said requirements, resulting in a misrepresentation of facts. when they are provided, they must follow The TCM Provider Manual states: the protocols described. “Linkage and Consultation 29 Documentation of required 30 day follow- TCM services provide beneficiaries with ups to the Linkage and Consultation linkage and consultation and with referral to services were not found in any of the service providers and placement activities. The eleven reported incidents. case manager shall follow up with the beneficiary and/or service provider to 34 TCM regulations require that referral to determine whether services were received and such services be followed up within 30 whether the services met the beneficiary’s days to determine if the services were needs. The follow-up shall occur as quickly as received and whether they met the client’s indicated by the assessed need, not to exceed needs thirty (30) days from the scheduled date of the referral service.”10 [Emphasis added.] 34 None of the case records in which such services are recorded contained 30 day Hence, 30-day follow-ups are only required on referrals with follow-up documentation either. specific, scheduled services and must not exceed 30 days from the scheduled date of service. The 30-day follow up is not 34 While the case records reviewed showed required for referrals with open time frames or for referrals that most Linkages clients do receive visits without a scheduled service. from the case managers more frequently than the minimum required four times a year, the fact that certain Linkage and Consultation services are not documented as such has resulted in an absence of TCM required 30 day follow-ups to such services. TCM Provider Manual, Section 2, Targeted Case Management Program Descriptions, page T.2-1-2. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3 Doc HMR Audit Report Statement DHS Response Page Since the TCM program has many It is not clear how the Auditor arrived at the opinion that some requirements, some more significant than TCM requirements are “more significant than others” or how others, some judgment was necessary to the Auditor defines “substantial compliance”. define substantial compliance. For The Audit Report acknowledged that the State would likely example, none of the case records offer the Department an opportunity to correct deficiencies reviewed for either the Public Guardian or prior to a finding of disallowance. The Department’s the Linkages program contained the understanding of Medi-Cal programs is that disallowances are frequency or duration of activities not made unless the work was not performed or a duplication recommended for clients in the Individual in services is identified. Client Service Plans, as required by TCM regulations. Using this measure, all encounters billed for during preparation of Client Services Plans are out of compliance with TCM regulations and are therefore subject to Medi-Cal disallowance. A different standard was used though since the absence of frequency and duration of Service Plan activities was not considered as serious a breach of compliance as, for example, lack of compliance with the TCM requirement that a face-to-face Periodic Review of progress be conducted with the client at least every six months. If a case file was found compliant with all Individual billed encounters do not have to contain all TCM TCM requirements except including the components. Only those components specific to the TCM frequency and duration of activities in the encounter being billed are required. Case files typically Individual Client Service Plan, the file was contain additional information relevant to the TCM encounter. considered compliant. If a case file was Full case files were not reviewed by HMR nor were they non-compliant in a variety of areas such requested. as: not specifying activities for the client in Case file compliance cannot be determined based on the the Individual Client Service Plan; not limited number of and types of documents reviewed during the cross-referencing service needs from the Audit. client’s Assessment in the Individual Client Service Plan; and, not specifying the frequency and duration of activities in the Individual Client Service Plan, the case file was considered non-compliant and subject to Medi-Cal disallowance. Final Draft Response to the 2007-08 Grand Jury Final Report Part 3
R3:
The recommendation requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a timeframe for the matter to be prepared for discussion by the officer or head of an agency of department being investigated or reviewed. This timeframe shall not exceed six months from the date of publication of the grand jury report. **
R3A:
The recommendation will not be implemented because it is not warranted. Contractor information is readily available on the internet, yellow pages and other sources. The County should not list specific contractor information in an effort to avoid any appearance of favoritism or a perceived recommendation of a particular contractor. B. References for many specifications that are given in the "Road Maintenance and Repair Guidelines" section of the Manual which will allow users to obtain more detailed specification information when needed. Response to
R3B:
The recommendation will not be implemented because it is not reasonable. References for specifications are available for road projects from contractors when projects go out to bid. Including references for specifications will likely involve the Department of Transportation in projects for which the county has no part. Final Draft Response to the 2007-08 Grand Jury Final Report Part 1 Clean Tahoe Program Case No. GJ 07- 011 REASON FOR REPORT The El Dorado County Grand Jury received a letter from the South Lake Tahoe District Attorney’s Office that prompted an investigation of the Clean Tahoe Program’s procedures for managing its funds. BACKGROUND The Clean Tahoe Program is a non-profit organization funded primarily by the City of South Lake Tahoe and El Dorado County. Its mission is to improve the visual quality of the Tahoe Basin within El Dorado County. Because it is publicly financed, it has a fiduciary responsibility, similar to the City and County, to properly manage its funds. The Clean Tahoe Program performs an important service to the community. This is accomplished through the dedication and hard work of the Clean Tahoe staff. METHODOLOGY The Grand Jury visited the offices in South Lake Tahoe of the Clean Tahoe Program and the South Tahoe Refuse Company (STR) to obtain information. STR is a private corporation with an exclusive franchise from the City and County to gather, sort, recycle, and dispose of refuse in the South Tahoe Basin. The investigation included a review of records, cashed checks, credit cards and the security of petty cash. People Interviewed: • Clean Tahoe Program Board, Two Directors • Clean Tahoe Program Manager • Clean Tahoe Program Outside Bookkeeper • Clean Tahoe Program Treasurer • El Dorado County Assistant District Attorney • South Tahoe Refuse Company Controller • South Tahoe Refuse Company President Documents Reviewed: • Clean Tahoe Program Brochure • Clean Tahoe Program By-laws, Procedures and Personnel Manual • Clean Tahoe Program Financial Documents • Clean Tahoe Program Budget vs. Actual Income and Expenses, October ‘06 through September ’07 5 Final Draft Response to the 2007-08 Grand Jury Final Report Part 1 • Clean Tahoe spreadsheets showing field work assignments • Comparative cost study by STR in 2004 showing cost savings if STR assumed Clean Tahoe Program duties • E-mail memos from Clean Tahoe Program Manager • Mission Statement of Clean Tahoe Program • South Tahoe Refuge Company controller memo (11/16/07) with financial spreadsheets RESULTS OF INVESTIGATION In the investigation of Clean Tahoe's management of funds, financial controls were found to be deficient. However, the deficiencies are in the process of being corrected. The Clean Tahoe Program is small and requires management and overhead functions that are disproportionately high and expensive in small publicly financed organizations. These costs would be lower if shared with similar costs in a larger organization. In principle, this can be achieved either by absorbing Clean Tahoe into a larger organization or by selecting a larger organization to perform the essential services that are now performed by the Clean Tahoe Program. The Grand Jury investigated these possibilities and found the following:
R4:
The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. * The time frame needs to be specific and reasonable. ** At the conclusion of this analysis, the recommendation must be responded to as required by items 1, 2, or 4. RESPONSE: TIME, WHERE AND TO WHOM The Penal Code identifies two different response times, depending upon the classification of the respondent (see below), and includes where and to whom the response is directed. Day one begins with the date of the Final Report.
R5:
The Grand Jury recommends that both OES and EDCOE, as well as individual school sites and districts, keep emergency response records that include dates of training and practice - to be maintained and supervised by EDCOE. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05. 5 -025 REASON FOR REPORT The Fire Protection District Law of 1987, in the State Health and Safety Code §13800, governs all of the Fire Protection Districts (FPDs) in California. Fire protection districts can only provide fire protection and emergency medical services. At the printing of the 3rd edition of “What’s So Special About Special Districts?” there were 386 FPDs in California. El Dorado County has nine FPDs on the West Slope and two FPDs in the Tahoe Basin. The County also has two multi-purpose Community Service Districts (CSDs) that provide fire protection along with other services: Fallen Leaf Lake CSD and Cameron Park CSD. The City of South Lake Tahoe has its own fire department. El Dorado County has a disproportionately high number of fire protection districts compared with the average of other counties in California. El Dorado County would benefit from consolidation. During the Grand Jury investigation, the scope was limited to the West Slope of the County
R6:
The SLTPD’s Strategic Plan should address clearly defined performance measures that include at a minimum the following areas of concern: • Confidence in Senior Management • Cynicism • Morale • Visions and Values of the Department
R7:
The Chief of Police should present a written progress report to the City Council and City Manager annually for public review.
R8:
The City Manager and City Council should maintain an active presence in tracking the Strategic Plan progress.
R9:
The Chief's annual performance evaluation should include the progress of the goals set in the Strategic Plan. RESPONSES Response(s) to this report is required in accordance with California Penal Code §933.05. 24 -014 REASON FOR REPORT The Grand Jury elected to investigate the County’s Victim Restitution activity to determine if El Dorado County is effectively and efficiently managing victim restitution.
R32-33:
Exhibit 4.6 Review of 10 Individual Client Service Plans Linkages Program Plans with activity frequency, duration ------- they were found not fully compliant with TCM regulations in that none of the Service Plans reviewed described the frequency or nature of the activities and specific services to be performed, as required by TCM regulations. 1 http://www.dhcs.ca.gov/provgovpart/Pages/TCM.aspx. 25
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4 findings
F1:
Vacancies on the Board of Supervisors / Pre-Charter (prior to 27 December 1994): • 1988-89 Resignation, replaced by Governor Appointment. • May 1990 Resignation, replaced by Special Election.
Related Recommendations (1)
R1:
The recommendation has been implemented, with a summary of the implemented action.
F2:
Vacancies on the Board of Supervisors / Post-Charter (effective 27 December 1994): • April 2003 Death in Office, replaced in Special Election. • July 2005 Resignation, replaced in Special Election. • July 2006 Vacated involuntarily {California Government Code, Section1770(g)}, replacement by General Election. 2 3. Cost of Special Election • The El Dorado County total cost for the July 2003 Special Election was $43,068.28.
Related Recommendations (1)
R2:
The recommendation has not yet been implemented, but will be implemented in the I future, with a timeframe for implementation. ,
F4:
The Election Process • The California Election Code Book is followed with the steps in a special election as follows: a. The Board of Supervisors calls a special election, by passing a resolution and sending it to the Elections Department. b. The Elections Department publishes that a position is open and the filing period which usually is 118 days to 88 days before the election.
F5:
A Special Charter Commission can be convened at anytime by the Board of Supervisors. Findings/Recommendations: 1F. Finding: In the current El Dorado County Charter, Section 203, the word ‘vacancy’ is defined by the California Government Code. The Office of Supervisor becomes vacant because of death, resignation, recall, permanent disability or the inability of the respective officer to otherwise carry out the duties of the office. A supervisor’s failure to discharge duties represents a fiduciary breach to the citizens of El Dorado County. Recently, a Supervisor ceased to discharge the duties of office, making the office involuntarily vacant after three consecutive months under California Government Code, Section 1770 (g). The El Dorado County Charter does not include an additional standard for a shorter time limitation on the failure to discharge duties in office. 1R. Recommendation: Amend Section 203 of the El Dorado County Charter to include its own criteria, which goes beyond California Government Code, Section 1770 (g), in defining standards on when a vacancy occurs for failure to discharge duties of the office. 2F. Finding: In the current El Dorado County Charter Section 203, the process for filling a vacancy at any time within the supervisor’s term requires a special election, unless occurring within a window of 120 days to 90 days of a scheduled election. This requirement is inefficient for a vacancy which occurs in the last year of a supervisor’s term. This inefficiency imposes cost due to required multiple elections within a year’s period. This requirement also creates an associated inefficiency in the political process by confronting potential special election candidates to make a trade off of campaign cost versus a few months in office for the effort. 2R. Recommendation: Amend Section 203 of El Dorado County Charter to provide a different method, rather than a special election, by which a supervisor vacancy can be filled within the last year of a supervisor’s term. A response is required by the Board of Supervisors within ninety (90) days. Appendix I California County Charter Approaches to Vacancies Alameda Sec. 8: Whenever a vacancy occurs on the Board of Supervisors, the Board of Supervisors shall fill the vacancy, provided that, if it shall fail to fill the vacancy within 60 days following its occurrence, the Governor shall fill the vacancy. The appointee shall hold office until the election and qualification of his/her successor. In such case there shall be elected at the next general election a supervisor to fill such vacancy for the unexpired term, unless such term expires on the first Monday after the first day of January succeeding said election. (Amendment ratified June 3, 1986. In effect August 22, 1986.) Butte Art. II, § 7 Vacancies. Whenever a vacancy occurs in the board of supervisors, the governor shall fill such vacancy by appointment, and the appointee shall hold office until the election and qualification of his successor. Such election shall take place at the next general election at which county officers are elected. The person elected shall hold office for the remainder of the unexpired term. El Dorado 202. Term of Offices. The term of office of supervisor is four years. Board members shall be limited to two consecutive terms. No person elected supervisor may serve as such for more than two successive four year terms. Any person elected to the office of supervisor to complete in excess of two years of a four year term shall be deemed, for the purpose of this section, to have served one full term upon the expiration of that term. No person having served two successive four year terms may serve as a supervisor until at least four years after the expiration of the second successive term in office. Any supervisor who resigns with less than two full years remaining until the expiration of the term shall be deemed, for the purpose of this section, to have served a full four year term. The above shall not disqualify any person from running for election to the Board of Supervisors for any term or terms which are not successive. The term of office commences at noon on the first Monday after the January 1st succeeding their election. The supervisor for each of the First, Second and Third Districts shall be elected in 1996. The supervisor for each of the Fourth and Fifth Districts shall be elected in 1994. [Amended by Charter Amendment ratified November 8, 1994, effective December 27, 1994; Stats. 1994, ch. 18] Amended by Charter Amendment ratified November 4, 2004, effective December 14, 2004, Stats. 2004, ch.16] 203. Filling of Vacancies. Whenever a vacancy occurs in the office of supervisor, the unexpired term shall be filled by election. If the vacancy occurs more than 90 days but less than 120 days before a scheduled primary, general, or special election, involving the district in which the vacancy has occurred, then the election to fill the vacancy shall be consolidated with the scheduled election. If the vacancy occurs more than 120 or less than 90 days before a scheduled primary, general, or special election involving the district in which the vacancy has occurred, then the vacancy shall 4 be filled at a special election called by the Board of Supervisors to take place not less than 90 nor more than 120 days after the vacancy occurs. The special election shall be conducted in accord with the provisions of general state law regarding special elections. The candidate with the highest number of votes shall be elected to fill the unexpired term. [Amended by Charter Amendment ratified November 4,2004, effective December 14, 2004, Stats.2004, ch.16] Fresno SECTION 8. Whenever a vacancy occurs in the Board of Supervisors, it shall be filled as follows: (a) In the event such vacancy occurs in the final year of a term, it may be filled by the unanimous vote of the remaining members, provided there are at least three remaining members, and if they fail for a period for twenty-nine (29) days following the occurrence of such vacancy to make such an appointment, the Governor shall fill the vacancy. (b) In the event such vacancy occurs other than in the final year of a term, the Board of Supervisors shall, without delay, call a special election to fill such vacancy to be held not less than seventy-five nor more than ninety days after the call, provided, however, if an election date as provided in Section 2504 of the Elections Code or similar state law falls not less than seventy- five nor more than one hundred twenty days after the call, such special election shall be consolidated with such election. The person appointed or elected to fill such vacancy shall serve for the remaining unexpired term and until the election and qualification of his successor. A person appointed or elected must be a qualified elector of the district in which the vacancy occurs, must have been a resident of the territory therein for at least thirty (30) days immediately preceding the appointment, or immediately preceding the date or filing nominating papers or equivalent declaration of candidacy for the election for which he is a candidate, and must reside therein during his incumbency. (Amended November 3, 1992). SECTION 8.5. In the event an election is held pursuant to Section 8 of this Charter to fill a vacancy in the Board of Supervisors and at such election no candidate receives a majority of all the votes cast and not less than eighteen months remains of said term of office from the date of the creation of such vacancy, a runoff election between the two candidates who have received the most votes shall be had as soon as may be legal and practical. (Amended June 8, 1976). Los Angeles Section 4, No person shall be elected and qualified for the office of member of the Board of Supervisors if such person has been elected or served in such office for three consecutive terms, commencing with a term of office which begins in December, 2002. The limitation on terms shall not apply to any unexpired term to which a person is elected or appointed if the remainder of the terms is less than one-half of the full term of office.9 Section 8. Whenever a vacancy occurs in the Board of Supervisors the Governor shall fill such vacancy, and the appointee shall hold office until the election and qualification of his successor. In such case, a Supervisor shall be elected at the next general election, to fill the vacancy for the unexpired term, unless such term expires on the first Monday in December succeeding said election. Orange 103. Filling of Vacancies. Notwithstanding any other provision of law, whenever a vacancy occurs in the office of supervisor, the vacancy shall be filled as follows: A. If the vacancy occurs in the first 1095 days of the term of office, the vacancy shall be filled by a vote of the electors of that district at a special election to be called by the Board of Supervisors not less than 56 days nor more than 70 days after the vacancy occurs. If the vacancy occurs within 180 days of a regularly scheduled election held throughout the supervisorial district, the election to fill the vacancy may be consolidated with that regularly scheduled election. The person receiving the highest number of votes in that election shall fill the vacancy. B. If the vacancy occurs within the final year of the term, the vacancy shall be filled by the person receiving the highest number of votes for Supervisor in that district in the March primary election that year. If that person for any reason does not assume the office for the remainder of the term, the Board of Supervisors is hereby authorized to appoint a person to fill the vacancy. If the Board of Supervisors does not make such an appointment within 30 days following the certification of the March primary election results or following the failure of that person to assume the office, whichever comes later, the Board of Supervisors shall call a special election to be held not less than 56 nor more than 70 days thereafter to fill the vacancy. The person receiving the highest number of votes in that special election shall fill the vacancy. Placer Sec. Vacancies. If a vacancy occurs on the Board of Supervisors, it shall be filled by the unanimous vote of the remaining members, and if they shall fail to make such appointment within thirty (30) days of the occurrence of any such vacancy, then such vacancy shall be filled by the Governor; provided that any appointment under this section shall be of a person who for at least thirty (30) days prior to his appointment has been a resident of the supervisorial district in which the vacancy exists. Sacramento SECTION 7. VACANCIES. For the purpose of this Section, a vacancy on the Board of Supervisors occurs whenever an incumbent files a resignation with the Clerk of the Board, dies, or becomes ineligible to hold the office for any reason. A resignation, once filed, may not be withdrawn. For the purpose of filling the vacancy pursuant to this Section, a resignation shall be deemed to cause a vacancy immediately on the date the resignation is filed, irrespective of whether a deferred effective date is specified in the resignation. Any such deferred effective date shall not be later than the 30th day following the date on which the resignation is filed. If a later date is specified, the resignation shall be deemed to be effective on the 30th day after the resignation is filed. Whenever a vacancy occurs on the Board of Supervisors, it shall be filled as provided in this Section. (a) If a vacancy occurs during the first 730 calendar days of a term of office, the vacancy shall be filled by a special election. Within ten days after the vacancy occurs, the Registrar of Voters shall select and announce a date for a special primary election and a date for a special run-off election to be used if a run-off election is necessary. The Registrar of Voters shall also select and 6 announce a final filing date for filing to be a candidate, which date shall provide for at least ten days advance notice thereof. The election dates selected shall be the earliest administratively feasible dates available; provided, that the date for the special primary election shall not be more than 60 days after the vacancy occurs and the special run-off election date shall not be more than 28 days after the special primary election date. Except as provided in this Section, the special election shall be conducted in accordance with State law applicable to regular supervisorial elections. If a candidate receives a majority of the votes cast at the special primary election, that candidate shall be elected for the remainder of the term of office. If no candidate receives a majority of the votes, the names of the two candidates receiving the most votes shall be placed on the ballot for the special run-off election at which the candidate receiving the most votes shall be deemed elected for the remainder of the term of office. (b) If a vacancy occurs during or between the 731st and the 1,095th calendar days of a term of office, the vacancy shall be filled for the remainder of the term by appointment by the Board of Supervisors. If within thirty calendar days following the date on which the vacancy occurs an appointment has not been made, the vacancy shall be filled by special primary and run-off elections scheduled in accordance with the procedures and in the manner prescribed by paragraph (a), above; provided that the times within which the elections must be scheduled shall be 90 days after the vacancy occurs for the special primary election, and not more than 28 days after the special primary election for the special run-off election. (c) If the vacancy occurs during or between the 1,096th and 1,399th calendar days of a term of office, the vacancy shall be filled by appointment by the Board of Supervisors. If the Board of Supervisors fails to make an appointment, the vacancy shall be filled by the person elected for the succeeding term at either the June primary or November general election, who shall serve both the remainder of the unexpired term and the next succeeding term for which the person was elected. (d) If the vacancy occurs during or between the 1,400th and 1,460th calendar days of a term of office, the vacancy shall be filled by the person elected for the next succeeding term at the June primary or November general election, who shall serve both the remainder of the unexpired term and the next succeeding term for which the person was elected." San Bernardino SECTION 7. A supervisor may be removed from office in the manner provided by law. Any vacancy in the office of supervisor will be filled by appointment by majority vote of the remaining members of the Board from amongst the qualified electors of the supervisorial district in which such vacancy exists. The appointee shall hold office until the election and qualification of his successor. An ejection shall be held to fill the vacancy for the unexpired term at the next general election unless the term expires on the first Monday of December next succeeding the election. Nomination and election of a supervisor for the unexpired term shall be by district in like manner as hereinbefore provided for such officer. In the event the Board of Supervisors shall not appoint to fill a vacancy within a 30-day period, such appointment shall be made by the Governor. San Diego Section 401.4: In the event a vacancy occurs in the office of supervisor the remaining members of the Board shall within thirty (30) days of the vacancy fill tie vacancy either by appointment for the unexpired term, by appointment until the qualification of a successor elected at a special 7 election or by calling a special election If the remaining members of the Board fail to fill the vacancy within such thirty (30) day period, the remaining members of the Board shall immediately cause a special election to be held to fill such vacancy. A special election to fill a vacancy in tie office of Supervisor shall consist of a special primary election and if necessary, a special general election. A special primary election shall be held in the Supervisorial district in which the vacancy occurred on a Tuesday, at least 56 days, but not more than 63 days, following the adoption of the resolution calling the special election, except that any such special primary election may be conducted within 180 days following the adoption of such resolution in order that the special primary election or special general election may be consolidated with the next regularly scheduled statewide election Candidates at the special primary election shall be nominated in the manner set forth in the Elections Code for tie nomination of candidates for a nonpartisan office for a direct primary election, except that nomination papers shall not be circulated prior to the adoption of tie resolution calling the special election and shall be filed with the Registrar of Voters for examination not less than 39 days before the special primary election If only one candidate qualifies for the special primary election, that candidate shall be appointed to the vacancy by the remaining members of the Board for the unexpired term, shall serve exactly as if elected to such vacancy, and no special primary election or special general election to fill the vacancy shall be held. A candidate who receives a majority of all votes in the special primary election is elected to fill the vacancy for the unexpired term, and no special election shall be held. In the event here are no more than two candidates for a vacancy, the office shall be voted upon at the special primary election, and no special general election shall be held. When no candidate receives a majority of all votes in the special primary election, a special general election shall be held on the fourth Tuesday after the special primary election The two candidates who received the highest number of votes in the special primary election shall be the candidates in the special general election, and the one who receives the higher number of votes in the special general election is elected to fill the vacancy for the unexpired term. In a special election to fill a vacancy in the office of supervisor, the Board may authorize either the special primary election or the special general election, or both, to be conducted wholly by mail, provided that the special primary election or the special general election to be conducted by mail does not occur on the same date as the statewide election with which it Ins been consolidated. In no event may a special primary election or a special general election be conducted on the day after a state holiday. (Repealed and new Section 401.4 added, effective 12- 17-82) (Amended, effective 8-7-86) San Francisco SEC. 13.101.5. VACANCIES. (a) If the office of Assessor-Recorder, City Attorney, District Attorney, Public Defender, Sheriff, Treasurer, or Member of the Board of Supervisors, Board of Education or Governing Board of the Community College District becomes vacant because of death, resignation, recall, permanent disability, or the inability of the respective officer to otherwise carry out the responsibilities of the office, the Mayor shall appoint an individual qualified to fill the vacancy under this Charter and state laws. (b) If the Office of Mayor becomes vacant because of death, resignation, recall, permanent disability or the inability to carry out the responsibilities of the office, the President of the Board 8 of Supervisors shall become Acting Mayor and shall serve until a successor is appointed by the Board of Supervisors. (c) Any person filling a vacancy pursuant to subsection (a) or (b) of this Section shall serve until a successor is selected at the next election occurring not less than 120 days after the vacancy, at which time an election shall be held to fill the unexpired term, provided that (1) if an election for the vacated office is scheduled to occur less than one year after the vacancy, the appointee shall serve until a successor is selected at that election or (2) if an election for any seat on the same board as the vacated seat is scheduled to occur less than one year but at least 120 days after the vacancy, the appointee shall serve until a successor is selected at that election to fill the unexpired term. (d) If no candidate receives a majority of the votes cast at an election to fill a vacated office, the two candidates receiving the most votes shall qualify to have their names placed on the ballot for a municipal runoff election at the next regular or otherwise scheduled election occurring not less than five weeks later. If an instant runoff election process is enacted for the offices enumerated in this Section, that process shall apply to any election required by this Section. (Added November 2001) San Mateo 203, Vacancies If a vacancy occurs on the Board of Supervisors, the Board shall, within 30 days of the effective date of the vacancy, either make an appointment or order the calling of a special election to fill the vacancy. If the Board does not make an appointment or call a special election within 30 days, the county officer responsible for conducting elections shall immediately order a special election to be called to fill the vacancy. The special election shall be held not less than 102 days and not more than 131 days from the order called the election, except that it may be held on an election date regularly established by general law if that date falls within 270 days from the order calling the special election. The election shall be conducted pursuant to the general law governing the direct primary so far as applicable, except the county officer responsible for conducting county elections may prescribe the periods for securing signatures in lieu of a filing fee, for circulating and filing nomination papers, for publishing the notice of election and for applying for absentee ballots. The candidate receiving the highest number of votes is elected for the remainder of the term. Santa Clara Section 203.2 Whenever a vacancy occurs in the office of supervisor, the vacancy shall be filled by appointment by the Board of Supervisors, or, alternatively, by an election called by the Board. If the appointment or call for an election is not made within 45 days from the occurrence of the vacancy, the Governor shall make the appointment. If the Board calls for an election, the primary election date shall be within 120 days after the vacancy occurs and the date for the run-off, if necessary, shall be not more than 56 days thereafter. if a candidate receives a majority of the votes cast at the special primary election, that candidate shall hold office for the remainder of the term. If no candidate receives a majority of the votes, the names of the two candidates receiving the most votes shall be placed on the ballot for the run-off election at which the candidate receiving the most votes shall be elected to the office for the remainder of the term. If the Board makes an appointment, the appointee shall hold office until the election and qualification of the successor. The election of a supervisor to fill an unexpired term shall be held at the next direct primary or general election in each even-numbered year, whichever occurs first. No such election shall be held within 180 days of the occurrence of the vacancy nor within the year preceding the year in which the term expires. The candidate having the highest number of votes shall be elected. Section 203: Amended and ratified by the Voters November 2, 1982; November 4, 1986; November 5, 1996; June 2, 1998. Tehama Did not respond with a copy of their charter. Appendix II LEXSTAT CA GOV CODE 1770 DEERING’S CALIFORNIA CODES ANNOTATED Copyright (c) 2005 by Matthew Bender & Company, Inc. a member of the LexisNexis Group. All rights reserved. *** THIS DOCUMENT REFLECTS ALL URGENCY LEGISLATION ENACTED *** THROUGH 2006 CH. 5, APPROVED 1/30/06 *** GOVERNMENT CODE TITLE 1. GENERAL DIVISION 4. Public Officers and Employees CHAPTER 4. Resignations and Vacancies ARTICLE 2. Vacancies GO TO CALIFORNIA CODES ARCHIVE DIRECTORY Cal Gov Code 1770(2006) § 1770. Events causing vacancy in office An office becomes vacant on the happening of any of the following events before the expiration of the term: (a) The death of the incumbent. (b) An adjudication pursuant to a quo warranto proceeding declaring that the incumbent is physically or mentally in capacitated due to disease, illness, or accident and that there is reasonable cause to believe that the incumbent will not be able to perform the duties of his or her office for the remainder of his or her term. This subdivision shall not apply to offices created by the California Constitution nor to federal or state legislators. (c) His or her resignation. (d) His or her removal from office. (e) His or her ceasing to be an inhabitant of the state, or if the office be local and one for which local residence is required by law, of the district, county, or city for which the officer was chosen or appointed, or within which the duties of his or her office are required to be discharged. (f) His or her absence from the state without the permission required by law beyond the period allowed by law. (g) His or her ceasing to discharge the duties of his or her office for the period of three consecutive months, except when prevented by sickness, or when absent from the state with the permission required by law. (h) His or her conviction of a felony or of any offense involving a violation of his or her official duties. An officer shall be deemed to have been convicted under this subdivision when trial court judgment is entered. For the purposes of this subdivision, ‘trial court judgment” means a judgment by the trial court either sentencing the officer or otherwise upholding and implementing the plea, verdict, or finding. (i) His or her refusal or neglect to file his or her required oath or bond within the time prescribed. (j) The decision of a competent tribunal declaring void his or her election or appointment. (k) The making of an order vacating his or her office or declaring the office vacant when the officer fails to furnish an additional or supplemental bond. 11 (1) His or her commitment to a hospital or sanitarium by a court of competent jurisdiction as a drug addict, dipsomaniac, inebriate, or stimulant addict; but in that event the office shall not be deemed vacant until the order of commitment has become final. I NOTICE TO RESPONDENTS I For the assistance of all Respondents, Penal Code Section 933.05 is summarized as follows: I How to Respond to Findings 1 The responding person or entity must respond in one of two ways: I 1. That you agree with the finding.
Additional Recommendations
1
Not linked to specific findings.
R3:
The recommendation requires further analysis. If the person or entity reports in ths manner, the law requires a detailed explanation of the analysis or study and timeframe I not to exceed six months. In this event, the analysis or study must be submitted to the officer, director or governing body of the agency being investigated. I 4. The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefore. Time to Respond, Where and to Whom to Respond I I Depending on the type of Respondent, Penal Code Section 933.05 provides for two different I response times and to whom you must respond:
* This report's PDF did not contain easily extractable text and required Optical Character Recognition (OCR) for analysis. There may be minor errors in the extracted findings and recommendations due to OCR limitations with scanned documents.