Los Angeles County Grand Jury
2013-2014
From the annual report
The consolidated year-end volume. The individual investigations it contains are listed separately below.
📑 Year-End Report
Continuity Committee
From the consolidated annual report · 60 pages
📑 Continuity Report
School Discipline Practices
From the consolidated annual report · 59 pages
Individual reports (17)
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Additional Recommendations
1
Not linked to specific findings.
R15:
6 Expand the catering services to outside groups, including courts and other municipal and government agencies.
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Findings & Recommendations
17 findings
F1:
Medi-Cal accounts represent the majority of write-offs for the Untimely Billing write-off sub-classification.
F2:
The Department does not use Affinity Adjustment Codes or
F3:
The sample of Untimely Billing write-offs analyzed demonstrates key trends that align with reported problems in interviews. A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION 48 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
F4:
Vendors are not following-up on some denials and information provided by the vendor does not enable DHS to determine causes for the denial.
F5:
Facility Patient Financial Services is not processing some accounts in a timely fashion
F6:
The Department’s Consolidated Business Office is not processing some claims in a timely fashion.
F7:
Facility Utilization Review divisions maintain a substantial backlog on patient medical records in need of review for medical necessity
F8:
Overall, Medicare gross charges of the Incomplete or No Medical Documentation write-offs are the highest among all payers, accounting for $101.6 million in DHS gross charge write-offs between Fiscal Years 2008-09 and 2012-13.
F9:
The audit sample of Incomplete or No Medical Records write-offs demonstrated key trends that aligned with problems reported by DHS staff involved in managing and executing the patient billing processes.
F10:
Approximately $24.5 million in gross charge write-offs between FY 2009-10 and 2012-13 was attributed to physicians without
F11:
Barriers or complications in coding accounts by Health
F12:
Coding backlogs in Health Information Divisions.
F13:
Physicians reportedly scheduling follow-up outpatient services, after basic needs are met through emergency room/urgent care or after a patient has been discharged from the hospital, when the patient does not have prior authorization.
F14:
The Department of Health Services is not obtaining timely authorization for high dollar value inpatient services due to the inability of Patient Financial Services staff to obtain prior authorization or redirect patient’s to facilities in the patient’s health plan’s network prior to all schedule outpatient appointments.
F15:
Insufficient or inadequate allocation of resources and tools for Utilization Review nurses to obtain timely authorization from other health care plans for inpatient.
F16:
Write-offs for Medi-Cal Managed Care patient accounts due to no authorization for services have increased over time. As Medi- Cal Managed Care enrollment is expected to increase over time, it is imperative that DHS improve its business processes to ensure timely authorization and billing for Medi-Cal Managed Care patients.
F17:
Because the Board of Supervisors is able to decrease subsequent fiscal year General Fund contributions to offset increased DHS revenues from prior fiscal years, such Board actions could potentially serve as a disincentive for DHS staff to increase revenue collections.
Additional Recommendations
18
Not linked to specific findings.
R1:
Utilize DHS’s electronic billing system, Affinity Adjustment Codes on all accounts for classifying and better explaining the
R2:
Update the DHS write-off procedure to include all Reason Codes,
R3:
Expand the scheduled availability of Patient Financial Service
R4:
Develop and track a Reason Code classifying write-offs for
R5:
Formalize the point at which Medi-Cal fee-for-service accounts are retrospectively reviewed for patients still in the Department
R6:
Conduct a Utilization Review staffing analysis at county hospitals as an increase in staff may substantially increase Department cash flow by decreasing backlogs and increasing the timeliness of billings.
R7:
Utilize available systems and tools, and require DHS physicians to report their National Provider Identifier (NPI) number and
R8:
Monitor the processing of Medicare claims to ensure that the
R9:
Track the backlog for coding at all facilities through regular
R10:
Perform a staffing analysis in DHS Health Information
R11:
Implement an electronic notification method for alerting
R12:
All physicians must be trained on the new electronic notification
R13:
Require all DHS facilities to regularly pre-screen scheduled
R14:
Evaluate effective and efficient staffing models to support the need for obtaining authorization from third party payers for
R15:
Determine the cost-effectiveness of implementing third party
R16:
Collaborate with Cerner, the Department’s vendor for its new
R17:
Consider the advantages and disadvantages of adopting a
R18:
Allocate a portion of the funds to DHS, if additional revenue is
Findings and recommendations not yet extracted.
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Additional Recommendations
9
Not linked to specific findings.
R1:
The pre-release packet for each inmate scheduled to be released to the County is sent from the CDCR to the Probation Pre Release Center. The Post Released Supervised Person (PSP) packet provides pertinent information, such as release date, criminal history, social history, medical and mental health issues, and legal status. The staff then evaluates the data and develops an individualized case plan. The information is used to determine risk levels, supervision conditions, monitoring requirements, and the verification of address to determine local office designation. Conditions of release, supervision, instruction, and reporting responsibilities are returned to the respective PSP for signature.
R2:
An individualized treatment case plan is finalized during the Screening, Intake and Assessment process. The PSP’s past criminal record is reviewed. The entire record is reviewed to determine the assignment of a risk level. (Tier O – very high; Tier I – high; Tier II – medium; Tier III – Low). The following Risk Level Chart shows the monthly standards for supervision. CHALLENGES OF REALIGNMENT 87 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
R3:
The PSP is mandated to report to one of the four Probation HUBs within two business days of release. The HUB is a collaborative group of agencies, consisting of the Department of Mental Health (DMH), Department of Public Health Services (DPH), and Department of Public Social Services (DPSS). An orientation is conducted with the PSP. During this orientation, referrals are made to Community Based Organizations for mental and physical health services, substance abuse, and the assignment of a Deputy Probation Officer (DPO) is completed. In addition, any other emergent needs (housing and transportation) are identified and addressed. If the PSP requires mental health treatment as a condition of their release, a referral to DMH is completed. The PSP must be registered within five working days to participate in mental health treatment. CHALLENGES OF REALIGNMENT 88 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
R4:
1 The Probation Department must continue to obtain funds and fill staff positions based on the mandated program needs. Post-Release Community Supervision Procedures The LACPD in coordination with the County’s Public Safety Realignment Team developed case intake to case termination procedures. As previously stated, AB 109 legislation modified parole statutes and created a Post-release Community Supervision Program under the auspices of the County. LACPD responsibilities and procedures include the following: 1. The pre-release packet for each inmate scheduled to be released to the County is sent from the CDCR to the Probation Pre Release Center. The Post Released Supervised Person (PSP) packet provides pertinent information, such as release date, criminal history, social history, medical and mental health issues, and legal status. The staff then evaluates the data and develops an individualized case plan. The information is used to determine risk levels, supervision conditions, monitoring requirements, and the verification of address to determine local office designation. Conditions of release, supervision, instruction, and reporting responsibilities are returned to the respective PSP for signature. 2. An individualized treatment case plan is finalized during the Screening, Intake and Assessment process. The PSP’s past criminal record is reviewed. The entire record is reviewed to determine the assignment of a risk level. (Tier O – very high; Tier I – high; Tier II – medium; Tier III – Low). The following Risk Level Chart shows the monthly standards for supervision. CHALLENGES OF REALIGNMENT 87 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
R5:
Medication and medical supplies
R6:
Enrollment fees (e.g. Community College/GED Classes/Vocational Schools)
R7:
Identification fees (e.g. CA driver’s license/ID card, birth records/certificates, social security cards) CHALLENGES OF REALIGNMENT 89 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT If the PSP fails to report, the DPO conducts due diligence and submits a petition for a warrant. The petition is submitted to the courts within five working days. The LACPD assists the PSP in becoming accountable, working towards rehabilitation by case management, supervision, and monitoring. The DPO is responsible for making routine home calls and compliance checks at the reported residence of the PSP. The number of home calls depends on the risk, need level cooperation and adjustment of the PSP in the community. The routine home calls are generally made by two DPOs. The Compliance Checks include additional DPOs and law enforcement that have search, seizure, and arrest authority. The purpose of the home calls are to ensure that the PSP is residing at the reported address. The PSP must be in compliance with conditions of their case plan, participating and receiving their collaborative services. The LACPD has developed a list of violations which is a guideline to ensure that consistent application of sanctions is followed. There must be a balance between rehabilitative casework and the appropriate level of sanction and rewards for compliance and noncompliance. DPOs must address all violations appropriately and comply with supervision conditions. If warranted, the DPOs make referrals to the Court for Revocation proceedings. Sanctions and Revocation can be imposed for failure to comply with any of the following:
R8:
Weapons violation: PSP in presence of weapon
R9:
General Conditions of supervision a. reporting b. residence c. identification d. misdemeanor arrests e. felony arrests f. registration conditions The application of sanctions including verbal, intermediate sanctions and revocation are progressive. All verbal and/or written admonishments are documented. The PSP must be discharged from Probation at 12 months if no custodial violations, sanctions or infractions have occurred. If the PSPs violate the condition of their release, the LACPD may initiate the revocation processes through the court.
Findings & Recommendations
16 findings
F1:
In 2009, First 5 LA adopted a five-year Strategic Plan that called for making significant investments in a Place-Based Strategy. The new plan called for discontinuing funding of initiative-based
F2:
The Implementation Plan called for spending $405 to $540
F3:
The budgeted amount for both Place-Based activities and
F4:
Most of the $61.4 million in actual expenditures went towards
F5:
The new Strategic Plan included a roadmap for ending support to Prior Strategic Initiatives grants. The Agency has not
F6:
During the Agency’s “pause” on Place-Based Strategy funding in FY 2012-13, it appears that the right questions were raised, as to the core results to be achieved for families and communities. It took First 5 LA several years after implementation of the
F7:
The Agency’s own inquiry into implementation of the Place-
F8:
While this audit was underway, the First 5 LA Commission
F9:
The categories used to describe the Place-Based components in
F10:
In Fiscal Years 2012-13 and 2013-14, all budget line items for the Place-Based Strategy were collapsed into a single line item
F11:
Place-Based Strategy budget and actual expenditure information for all years reviewed do not represent Agency operating budget
F12:
Budget and actual expenditure documents presented to the
F13:
Not until FY 2012-13 did budget documents provide a greater
F14:
The Agency provided insufficient evidence to the Commission about the potential effectiveness of and challenges inherent in the Place-Based Strategy and its ability to improve services for children aged 0-5. It cited the work of private foundations, which may not be an appropriate comparison for an agency that receives public funds.
F15:
Documents presented to the Commission prior to the adoption of the Place-Based Strategy did not adequately list the potential impacts involved, including the extended period of time for results to materialize.
F16:
Implementation of the Place-Based Strategy and the Community Capacity Building work in particular, is time-consuming and challenging. It is difficult to measure the effectiveness of the Community Partnerships and their ability to improve services. Some Community Partnership representatives have expressed frustration at the slow pace of development and their concern that the implementation plans will not be funded once completed.
Additional Recommendations
10
Not linked to specific findings.
R1:
Family Strengthening
R2:
Community Capacity Building
R3:
Systems Improvement Initiatives The Strategic Plan also included Countywide Strategies as a separate, but complimentary, component of the plan. In the 2010 Implementation Plan for the 2009-2015 Strategic Plan, the Family Strengthening and Community Capacity Building components are described in greater detail. The Systems Improvement Initiatives were combined with the Countywide Strategies. According to the early strategic documents, First 5 LA envisioned that the Countywide Strategies would develop strong, coordinated and responsive systems to support families and improve outcomes for children prenatal through five years of age. Figure 2.1 presents brief descriptions of the three components of First 5 LA’s Place-Based Strategy. FIRST 5 LA SERVING THE COMMUNITY? 160 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Figure 2.1: Description of the Place-Based Components and Countywide Strategies Strategy Component Description Place-Based Strategy The Place-Based Approach is comprised of the three components below. Family Strengthening Investments to provide intensive, direct services to at-risk families. This component consists primarily of support for the “Welcome Baby!” and other home visitation programs. Community Capacity Building Seen as a vehicle for partnering with communities. Goal is to organize and train residents and organizations to advocate for themselves. Investments in this area have primarily supported the development of 14 Community Partnerships. Systems Improvement Activities designed to impact the larger structures affecting child well-being in the 14 communities. Countywide Strategies The countywide strategies are to consist of investments in seven areas, namely 1) Public Policy, 2) Public Education, 3) Resource Mobilization, 4) Workforce Development, 5) Data Systems Integration, 6) Health Access, and 7) Information Resource and Referral. Source: FY 2009-2015 Strategic Plan and 2010 Implementation Plan The components of the Place-Based Strategy and Countywide Strategies have not been presented consistently in budget and expenditure documents, thus making it difficult to track spending by activity over time. In fact, less detail has been presented over time in the Agency’s budget documents. A review of Agency budgets and expenditure reports illustrates this point. The names given to the Place-Based Initiative components changed between FYs 2010-2011 and 2013-2014. In the final two years, the investments in this category are referred to in a single line item as Best Start. FIRST 5 LA SERVING THE COMMUNITY? 161 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT This change is consistent with the restructuring of the Place-Based Strategy that occurred upon the adoption by the Commission of the Best Start Family Framework in June, 2013. However, collapsing spending records for different program elements into one budget category reduces the transparency of the Agency’s financial documents, as well as the Commission’s ability to provide oversight, and the level of disclosure provided to the public. Figure 2.2 presents budgeted amounts for the various program components that comprised Place-Based Initiatives in FYs 2010-11 through 2013-14, including program components that were transferred in and out of the Place-Based Initiative category. Figure 2.2: Changes in Budget Presentation for Place-Based & other Initiative Expenditures, FYs 2010-11 through 2013-14
R4:
Workforce Development, 5) Data Systems Integration, 6) Health Access, and
R7:
Pacoima/Northeast Valley
R9:
South El Monte/El Monte FIRST 5 LA SERVING THE COMMUNITY? 166 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
R10:
South Los Angeles/Broadway-Manchester
R11:
South Los Angeles/West Athens
R12:
Southeast LA County Cities
R14:
Wilmington Nowhere in First 5 LA’s budget and financial documents are expenditures for the Place-Based Initiatives tracked by the fourteen communities. Staff indicated that they do not have this information readily available for review. Budget Documents Do Not Include Sufficient Detail about Place-Based Expenditures During the course of FY 2012-13, changes were made to the Place- Based Strategy allocation at several points. Figure 2.6 below highlights changes to the allocations that were proposed in the FY 2012-13 budget. Initially, the First 5 LA Board of Commissioners adopted an annual program budget for FY 2012-13 of $31 million for Place-Based Initiatives. In April, the First 5 LA Board took action to identify an allocation amount per community. It approved funding levels of $1.7 million per community, or a total of $23.8 million ($1.7 million per community x 14 communities) over the course of the 2012-13 fiscal year. That total was subsequently reduced by the Commission, to $560,000 per community, or $7.8 million total in July 2012 (when the Agency initiated its internal “pause,” to re-examine the goals of the Place-Based Strategy). This total was significantly below the $31 million initially budgeted for FY 2012-13. In July 2012, additional funding was approved for evaluations, communications, and partnership logistical support, rather than for the full range of activities that were to comprise the Place- Based Strategy. The budget reduction between April and July was due to the Agency’s internal decision to slow the pace of Place-Based Strategy implementation. It is unclear, however, why both the April and July budget allocations in the supplementary documents were lower than the original FY 2012-13 Budget. FIRST 5 LA SERVING THE COMMUNITY? 167 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Figure 2.6: Place-Based Strategy Budget Allocations in FY 2012-13
Additional Recommendations
11
Not linked to specific findings.
R1:
Front gate at Sylmar was aligned correctly to close on impact
R2:
Installed a rain gutter and down spout on the warehouse
R3:
Replaced ice machine in main kitchen area
R4:
Repaired large pothole adjacent to the kitchen
R5:
Installed a freezer condenser and compressor in the kitchen
R6:
Installed electrical conduit and heaters in the warehouse
R7:
Installed razor wire atop communication riser a-b
R8:
Repaired two (2) four inch copper water lines at the North
R9:
Repaired air conditioning unit on Administration building roof
R10:
Installed earthquake valve
R11:
Installed new phone line at North School MAINTENANCE ISSUES AND LIVING CONDITIONS AT JUVENILE HALLS 190 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Additional Recommendations
1
Not linked to specific findings.
R8:
1 The Los Angeles County Assessor and Board of Supervisors
Findings & Recommendations
7 findings
F1:
The Department of Health Services has developed and is implementing an electronic health record system. It will allow all providers within the DHS system to access patient records. The system is known as ORCHID. The first hospital and set of clinics is scheduled to begin implementation of ORCHID in August 2014, with the expectation of full implementation by the end of the first quarter of 2016.
F2:
The Board of Supervisors’ decision to allow DHS up to a 120 day extension on the “Go-Live” date could delay the full implementation of ORCHID beyond the scheduled target completion date.
F3:
Implementation of the DHS’s EHR will greatly improve access to patient data throughout DHS facilities and remove the silo-effect of the six separate entities in their current health information system.
F4:
Through the leadership of the Chief Information Office and the Chief Executive Office, the Countywide Master Data Management system is being developed and will soon be implemented. It will provide a roadmap to identify a “single view of the client”.
F5:
The Department of Health Services, Sheriff’s Department, and Probation Department are each using Cerner as their individual contractor for electronic health records.
F6:
Cerner has a contractual agreement to electronically connect these systems in the afore mentioned departments with minimal or no increased costs. A HEALTH INFORMATION EXPRESSWAY OR LIFE IN THE SLOW LANES 20 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
F7:
In 2009, the Board of Supervisors directed the Chief Executive Office to develop LANES to facilitate a countywide HIE between public and private health care providers. LANES, as it is currently constituted, has implementation limitations, which include: a. Limited resources to implement and sustain LANES; b. Lack of sustainable funding; c. Absence of a full-time director; d. Indeterminate financial support from on-going stakeholders and buy-in from other potential health care providers; and e. Uncertainty as to whether the current Federated technology architecture employed by LANES has the capacity to deliver patient information in a timely fashion.
Findings & Recommendations
17 findings
F1:
Medi-Cal accounts represent the majority of write-offs for the Untimely Billing write-off sub-classification.
F2:
The Department does not use Affinity Adjustment Codes or
F3:
The sample of Untimely Billing write-offs analyzed demonstrates key trends that align with reported problems in interviews. A TIMELY AND CLEAN “BILL” OF HEALTH MAY SAVE $285 MILLION 48 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
F4:
Vendors are not following-up on some denials and information provided by the vendor does not enable DHS to determine causes for the denial.
F5:
Facility Patient Financial Services is not processing some accounts in a timely fashion
F6:
The Department’s Consolidated Business Office is not processing some claims in a timely fashion.
F7:
Facility Utilization Review divisions maintain a substantial backlog on patient medical records in need of review for medical necessity
F8:
Overall, Medicare gross charges of the Incomplete or No Medical Documentation write-offs are the highest among all payers, accounting for $101.6 million in DHS gross charge write-offs between Fiscal Years 2008-09 and 2012-13.
F9:
The audit sample of Incomplete or No Medical Records write-offs demonstrated key trends that aligned with problems reported by DHS staff involved in managing and executing the patient billing processes.
F10:
Approximately $24.5 million in gross charge write-offs between FY 2009-10 and 2012-13 was attributed to physicians without
F11:
Barriers or complications in coding accounts by Health
F12:
Coding backlogs in Health Information Divisions.
F13:
Physicians reportedly scheduling follow-up outpatient services, after basic needs are met through emergency room/urgent care or after a patient has been discharged from the hospital, when the patient does not have prior authorization.
F14:
The Department of Health Services is not obtaining timely authorization for high dollar value inpatient services due to the inability of Patient Financial Services staff to obtain prior authorization or redirect patient’s to facilities in the patient’s health plan’s network prior to all schedule outpatient appointments.
F15:
Insufficient or inadequate allocation of resources and tools for Utilization Review nurses to obtain timely authorization from other health care plans for inpatient.
F16:
Write-offs for Medi-Cal Managed Care patient accounts due to no authorization for services have increased over time. As Medi- Cal Managed Care enrollment is expected to increase over time, it is imperative that DHS improve its business processes to ensure timely authorization and billing for Medi-Cal Managed Care patients.
F17:
Because the Board of Supervisors is able to decrease subsequent fiscal year General Fund contributions to offset increased DHS revenues from prior fiscal years, such Board actions could potentially serve as a disincentive for DHS staff to increase revenue collections.
Additional Recommendations
18
Not linked to specific findings.
R1:
Utilize DHS’s electronic billing system, Affinity Adjustment Codes on all accounts for classifying and better explaining the
R2:
Update the DHS write-off procedure to include all Reason Codes,
R3:
Expand the scheduled availability of Patient Financial Service
R4:
Develop and track a Reason Code classifying write-offs for
R5:
Formalize the point at which Medi-Cal fee-for-service accounts are retrospectively reviewed for patients still in the Department
R6:
Conduct a Utilization Review staffing analysis at county hospitals as an increase in staff may substantially increase Department cash flow by decreasing backlogs and increasing the timeliness of billings.
R7:
Utilize available systems and tools, and require DHS physicians to report their National Provider Identifier (NPI) number and
R8:
Monitor the processing of Medicare claims to ensure that the
R9:
Track the backlog for coding at all facilities through regular
R10:
Perform a staffing analysis in DHS Health Information
R11:
Implement an electronic notification method for alerting
R12:
All physicians must be trained on the new electronic notification
R13:
Require all DHS facilities to regularly pre-screen scheduled
R14:
Evaluate effective and efficient staffing models to support the need for obtaining authorization from third party payers for
R15:
Determine the cost-effectiveness of implementing third party
R16:
Collaborate with Cerner, the Department’s vendor for its new
R17:
Consider the advantages and disadvantages of adopting a
R18:
Allocate a portion of the funds to DHS, if additional revenue is
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Findings and recommendations not yet extracted.
Findings & Recommendations
5 findings
F13:
Physicians reportedly scheduling follow-up outpatient services, after basic needs are met through emergency room/urgent care or after a patient has been discharged from the hospital, when the patient does not have prior authorization.
F14:
The Department of Health Services is not obtaining timely authorization for high dollar value inpatient services due to the inability of Patient Financial Services staff to obtain prior authorization or redirect patient’s to facilities in the patient’s health plan’s network prior to all schedule outpatient appointments.
F15:
Insufficient or inadequate allocation of resources and tools for Utilization Review nurses to obtain timely authorization from other health care plans for inpatient.
F16:
Write-offs for Medi-Cal Managed Care patient accounts due to no authorization for services have increased over time. As Medi- Cal Managed Care enrollment is expected to increase over time, it is imperative that DHS improve its business processes to ensure timely authorization and billing for Medi-Cal Managed Care patients.
F17:
Because the Board of Supervisors is able to decrease subsequent fiscal year General Fund contributions to offset increased DHS revenues from prior fiscal years, such Board actions could potentially serve as a disincentive for DHS staff to increase revenue collections.
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Findings & Recommendations
16 findings
F1:
In 2009, First 5 LA adopted a five-year Strategic Plan that called for making significant investments in a Place-Based Strategy. The new plan called for discontinuing funding of initiative-based
F2:
The Implementation Plan called for spending $405 to $540
F3:
The budgeted amount for both Place-Based activities and
F4:
Most of the $61.4 million in actual expenditures went towards
F5:
The new Strategic Plan included a roadmap for ending support to Prior Strategic Initiatives grants. The Agency has not
F6:
During the Agency’s “pause” on Place-Based Strategy funding in FY 2012-13, it appears that the right questions were raised, as to the core results to be achieved for families and communities. It took First 5 LA several years after implementation of the
F7:
The Agency’s own inquiry into implementation of the Place-
F8:
While this audit was underway, the First 5 LA Commission
F9:
The categories used to describe the Place-Based components in
F10:
In Fiscal Years 2012-13 and 2013-14, all budget line items for the Place-Based Strategy were collapsed into a single line item
F11:
Place-Based Strategy budget and actual expenditure information for all years reviewed do not represent Agency operating budget
F12:
Budget and actual expenditure documents presented to the
F13:
Not until FY 2012-13 did budget documents provide a greater
F14:
The Agency provided insufficient evidence to the Commission about the potential effectiveness of and challenges inherent in the Place-Based Strategy and its ability to improve services for children aged 0-5. It cited the work of private foundations, which may not be an appropriate comparison for an agency that receives public funds.
F15:
Documents presented to the Commission prior to the adoption of the Place-Based Strategy did not adequately list the potential impacts involved, including the extended period of time for results to materialize.
F16:
Implementation of the Place-Based Strategy and the Community Capacity Building work in particular, is time-consuming and challenging. It is difficult to measure the effectiveness of the Community Partnerships and their ability to improve services. Some Community Partnership representatives have expressed frustration at the slow pace of development and their concern that the implementation plans will not be funded once completed.
Additional Recommendations
10
Not linked to specific findings.
R1:
Family Strengthening
R2:
Community Capacity Building
R3:
Systems Improvement Initiatives The Strategic Plan also included Countywide Strategies as a separate, but complimentary, component of the plan. In the 2010 Implementation Plan for the 2009-2015 Strategic Plan, the Family Strengthening and Community Capacity Building components are described in greater detail. The Systems Improvement Initiatives were combined with the Countywide Strategies. According to the early strategic documents, First 5 LA envisioned that the Countywide Strategies would develop strong, coordinated and responsive systems to support families and improve outcomes for children prenatal through five years of age. Figure 2.1 presents brief descriptions of the three components of First 5 LA’s Place-Based Strategy. FIRST 5 LA SERVING THE COMMUNITY? 160 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Figure 2.1: Description of the Place-Based Components and Countywide Strategies Strategy Component Description Place-Based Strategy The Place-Based Approach is comprised of the three components below. Family Strengthening Investments to provide intensive, direct services to at-risk families. This component consists primarily of support for the “Welcome Baby!” and other home visitation programs. Community Capacity Building Seen as a vehicle for partnering with communities. Goal is to organize and train residents and organizations to advocate for themselves. Investments in this area have primarily supported the development of 14 Community Partnerships. Systems Improvement Activities designed to impact the larger structures affecting child well-being in the 14 communities. Countywide Strategies The countywide strategies are to consist of investments in seven areas, namely 1) Public Policy, 2) Public Education, 3) Resource Mobilization, 4) Workforce Development, 5) Data Systems Integration, 6) Health Access, and 7) Information Resource and Referral. Source: FY 2009-2015 Strategic Plan and 2010 Implementation Plan The components of the Place-Based Strategy and Countywide Strategies have not been presented consistently in budget and expenditure documents, thus making it difficult to track spending by activity over time. In fact, less detail has been presented over time in the Agency’s budget documents. A review of Agency budgets and expenditure reports illustrates this point. The names given to the Place-Based Initiative components changed between FYs 2010-2011 and 2013-2014. In the final two years, the investments in this category are referred to in a single line item as Best Start. FIRST 5 LA SERVING THE COMMUNITY? 161 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT This change is consistent with the restructuring of the Place-Based Strategy that occurred upon the adoption by the Commission of the Best Start Family Framework in June, 2013. However, collapsing spending records for different program elements into one budget category reduces the transparency of the Agency’s financial documents, as well as the Commission’s ability to provide oversight, and the level of disclosure provided to the public. Figure 2.2 presents budgeted amounts for the various program components that comprised Place-Based Initiatives in FYs 2010-11 through 2013-14, including program components that were transferred in and out of the Place-Based Initiative category. Figure 2.2: Changes in Budget Presentation for Place-Based & other Initiative Expenditures, FYs 2010-11 through 2013-14
R4:
Workforce Development, 5) Data Systems Integration, 6) Health Access, and
R7:
Pacoima/Northeast Valley
R9:
South El Monte/El Monte FIRST 5 LA SERVING THE COMMUNITY? 166 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
R10:
South Los Angeles/Broadway-Manchester
R11:
South Los Angeles/West Athens
R12:
Southeast LA County Cities
R14:
Wilmington Nowhere in First 5 LA’s budget and financial documents are expenditures for the Place-Based Initiatives tracked by the fourteen communities. Staff indicated that they do not have this information readily available for review. Budget Documents Do Not Include Sufficient Detail about Place-Based Expenditures During the course of FY 2012-13, changes were made to the Place- Based Strategy allocation at several points. Figure 2.6 below highlights changes to the allocations that were proposed in the FY 2012-13 budget. Initially, the First 5 LA Board of Commissioners adopted an annual program budget for FY 2012-13 of $31 million for Place-Based Initiatives. In April, the First 5 LA Board took action to identify an allocation amount per community. It approved funding levels of $1.7 million per community, or a total of $23.8 million ($1.7 million per community x 14 communities) over the course of the 2012-13 fiscal year. That total was subsequently reduced by the Commission, to $560,000 per community, or $7.8 million total in July 2012 (when the Agency initiated its internal “pause,” to re-examine the goals of the Place-Based Strategy). This total was significantly below the $31 million initially budgeted for FY 2012-13. In July 2012, additional funding was approved for evaluations, communications, and partnership logistical support, rather than for the full range of activities that were to comprise the Place- Based Strategy. The budget reduction between April and July was due to the Agency’s internal decision to slow the pace of Place-Based Strategy implementation. It is unclear, however, why both the April and July budget allocations in the supplementary documents were lower than the original FY 2012-13 Budget. FIRST 5 LA SERVING THE COMMUNITY? 167 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Figure 2.6: Place-Based Strategy Budget Allocations in FY 2012-13
Additional Recommendations
11
Not linked to specific findings.
R1:
Front gate at Sylmar was aligned correctly to close on impact
R2:
Installed a rain gutter and down spout on the warehouse
R3:
Replaced ice machine in main kitchen area
R4:
Repaired large pothole adjacent to the kitchen
R5:
Installed a freezer condenser and compressor in the kitchen
R6:
Installed electrical conduit and heaters in the warehouse
R7:
Installed razor wire atop communication riser a-b
R8:
Repaired two (2) four inch copper water lines at the North
R9:
Repaired air conditioning unit on Administration building roof
R10:
Installed earthquake valve
R11:
Installed new phone line at North School MAINTENANCE ISSUES AND LIVING CONDITIONS AT JUVENILE HALLS 190 2013-2014 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
Additional Recommendations
1
Not linked to specific findings.
R8:
1 The Los Angeles County Assessor and Board of Supervisors