Monterey 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
The full consolidated volume; individual reports are listed below.
Individual reports (12)
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Findings & Recommendations
6 findings
F1:
County IT Department. These hosting costs are borne by the County IT Department. With central direction and input as to the content desired from the County Public Information Officer (PIO), the IT department creates and maintains the home page and initial basic access and design features.
F2:
Some of the County departments appear to create and maintain their own sections of the website, and some even host those sections elsewhere than on the Monterey County IT servers, at third party sites. The IT department staff of technicians, web developers and graphic artists is available for technical assistance to the County departments upon request, for a fee chargeable to the requesting agency.
F3:
In our review process of the Monterey County website, we felt it valuable to compare our user experience with that website to our experiences with three other California counties, representing a cross section of size, population and economies. We were also interested in how the website activities were funded. We arbitrarily selected the Kern County, Marin County and Placer County websites as examples. Kern is twice the population of Monterey County but has similar sized businesses and agricultural activities, cities, and large unincorporated areas under county jurisdiction. Marin has half the population of Monterey County and fewer agricultural areas, but has similar major governmental concerns. Placer County was selected since it has nearly the same population, business and agricultural activities as Monterey County and has an excellent, well presented website that we felt Monterey County could learn from by example. Monterey County Website Issues
F4:
From this review we also learned that Placer County has created, and apparently maintained, an Administrative Services Department, within which IT exists as a General Fund Division with responsibility for maintaining and operating the Placer County website. While we do not suggest that the IT department should be part of another larger department, we do think it useful to quote and consider the clear purposes stated in the 2013-14 Placer Proposed Budget. It says: "In order to maintain the level of service the County provides to its citizens, future investment in technology replacement will be an important consideration for ensuring the County's continuity of operation. For example, progress on the County's website redesign and functionality from a Department-centric site to a Public-centric site continues. Last year alone the website had over 2.4 million visits, resulting in more than 7.7 million pages being viewed. The website will focus on helping people accomplish their primary tasks quickly and easily. Content will be consolidated, organized, and user intuitive. Menus and navigation tools will be organized in a way that simplifies the use of the County's website." . In our judgment, this budgeting approach, as opposed to Monterey's Zero-based budgeting, creates an environment that is more conducive of cooperation and consistency of the website because of cost sharing, while this budget method also places on each department content responsibility and determining for itself what the citizens need from it. It allows the website to serve not only the public but also its county employees, in sections of the website created solely for them and not available to the public. On the other hand the Monterey County method of funding costs, quoted on its County website, discourages this cooperative environment.
F5:
The Monterey County Budget 2013-14 document describes the current method of funding the Information Technology Department ("ITD") as follows: "ITD is a zero General Fund Contribution department where its budget is solely based on the revenue generated through the services rendered to its clients."
F6:
We also feel that the Marin and Kern county websites are more representative of what the CGJ believes the Monterey County website should look like and how it should function, once some standard principles of development and operation, and rules for responsibility for information accuracy, are adopted and applied. We acknowledge that this will take considerable time and patience on the part of the many people and departments involved.
Additional Recommendations
6
Not linked to specific findings.
R1:
This CGJ is not an advocate of complex sets of rules and procedures imposed on each of the County departments and agencies, since this creates time consuming and expensive Monterey County Website Issues requirements that makes government less responsive to its citizens. However, in this situation there needs, at least, to be: (a) a commonly agreed upon set of written principles governing the creation and design, information presentation and templates to be used; (b) a provision for review by some designated party, such as the IT website head, for compliance before posting of new sections; and (c) a requirement that each department regularly review, and correct errors, in those materials that have been posted for accuracy and currency of the information. These principles need to be worked out by a representative committee consisting of managers of IT functions in each department, and the CAO or one of his deputies, and chaired by the IT department representative who is most likely to have the technical expertise necessary. The guiding principle should make clear that it is up to each department to decide what
R2:
public information about its operations is relevant and useful for posting. This then places the responsibility on departmental management for their portion of the County website. There is, however, certain minimum information that should always be there -- such as listing department functions and services available to the public, contact information in the form of telephone numbers and at least one central email address to reach the department, physical addresses of facilities, and perhaps a location map. Most departments should also list the names and functions of its personnel so the public can ascertain whom to contact within a given group.
R3:
In order to create and operate a departmental section of the website, these rules need to provide permission for each department to contract out the development and/or operation of their section of the County site where necessary or more cost effective, but that any such development/operation entity contractually be required to conform with the template and technical specifications adopted by the website study committee. The contracts entered into with third party developers must also obligate them to follow the County general website rules and procedures, including Privacy and Data Breach laws as previously established by County Counsel and the IT department for protection of the County and its citizens. These rules should specify that the IT department, on behalf of the County, has the right
R4:
to examine all developed materials and changes, other than merely updated data, prior to posting or use, and to certify or reject the proposed materials and changes for failure to comply with the common standards. New materials or sections that do not comply may need to be modified. In order not to delay important changes, time limits for review and compliance need to be established. In all instances of development and operation of the various departmental website
R5:
sections, including the initial entry page to the website, careful consideration needs to be given to compliance with the multitude of Federal and State Privacy and Data Breach laws. The cost of non-compliance in the form of penalties, fines and class action litigation that might be incurred can be significant, to the point that in worst case situations, a major data breach of the County website and/or the IT department could bankrupt the County. We therefore suggest that a standing procedure for regular consultation with County Counsel be established, so that Counsel is aware of what legal notices are posted, what third party development and operation contracts exist or are contemplated, and that the departments are promptly apprised of the continual changes in these complex Privacy laws.
R6:
Finally, we believe that the Board of Supervisors and the CAO should consider changing the current Zero Basis Budgeting of the IT department, for its duties involving website presentation and development, by adopting the so-called Enterprise Funding method. Under this method, each department would be required to pay at least a portion of the cost of development and of changes to the ITD for each budget year (based on head count). This would ensure a stronger financial incentive for the County Departments to work with the IT department rather than with outside developers. In addition, in most cases it makes no sense for the various departments to electronically host their own sections of the website or to contract out such duties to third party vendors. It is also far more cost effective to have the IT department serve as the central contact point for the website and to have the obligation of maintaining the initial, opening pages, which pages likely have general comments on how the County is organized, much of which information will likely be provided by the CAO and the County PIO. (See, the example above of how the Placer County website handles this.)
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Findings & Recommendations
8 findings
F1:
During the past eight or more years the Monterey County government has not devoted adequate attention to compliance with the California and Federal Privacy laws, and must now immediately change this attitude to strict attention and compliance, if it is to avoid serious financial consequences for potential violations.
Related Recommendations (1)
R1:
The Monterey County Board of Supervisors and their staff should carefully study this Report on Privacy problems, in conjunction with its CAO, the County Counsel and his Privacy Deputy, and the Director of County Information Technology and her Security Chief and other IT personnel. These are key people since they directly work in the field of privacy, prevention of data breaches, and in coordinating the design and operation of the County website. The study of these issues has a dual purpose of understanding the significant penalties and financial risks to the County government due to the complexity of the laws, and realizing that there are some expensive and complex technical issues in this aspect of County business operations.
F2:
The present old and defective Privacy and Data Breach Notification Policies are to be replaced immediately and the newly developed 2014 versions disseminated promptly to all Department heads now that they have been approved by the Board of Supervisors. This must be quickly followed-up by education of all County employees as to these new rules, and the appropriate conduct required when using or operating County IT and communication systems.
Related Recommendations (1)
R2:
The Board of Supervisors should consider the immediate need for additional funding to be provided both to County Counsel and the IT Department in order to improve existing and continuing compliance with California and Federal Privacy laws, rules and regulations. The CGJ believes funding at least one additional full time legal position for the County Counsel's office is imperative at this point, to help protect the County and its citizens. The IT Department also needs more funds to acquire and use various protective software packages that warn of impending attempts at data intrusion and stop them; and perhaps for one additional key person to head and direct the development and continuing maintenance of the County website on behalf of its many departments and agencies. Privacy & Security of County On-Line Data and Information Systems
F3:
County Counsel's office has not been adequately aware of these Privacy issues in the past, in part because of inadequate staffing and education of its lawyers, but it is now actively trying to change this situation within its budget limitations. However, it clearly needs additional funding to address these issues and to assist the IT Department and other County departments with this complex area of the law.
Related Recommendations (1)
R3:
County Counsel's office should promptly take all steps necessary to formally designate one of its lawyers as "County Privacy Law Counsel" and to provide for that person's continuing legal education in this extremely complex area of the law. This should include education to the point of certification of his or her knowledge in this field by the IAPP, the standard of this industry. We have been told portions of such proposed actions are currently underway.
F4:
The County IT Department needs to continue its active pursuit of software and hardware means of preventing intrusions, and to keep the Chief Administrative Officer (CAO) and his staff fully aware of the extent of this problem and the costs involved in complying. This activity may require that the CAO recommend changing some aspects of the Zero- based budgeting methods currently used to allocate funds to the IT Department to pay for necessary personnel and software. This possible change in budgeting methods is something that should not be postponed beyond the current fiscal year.
Related Recommendations (1)
R4:
The duties of such Privacy Counsel should encompass working closely on a continuous basis with the IT Privacy Directors and County Department managers on existing and future Privacy Policies, and on all proposed contracts where vendors may have access to County records, and on all software licenses with third-party vendors. Privacy Counsel also needs to monitor closely these ever-changing laws to be certain that when changes in such laws occur these modified legal obligations and requirements are promptly communicated to responsible County personnel; so that they can be reflected quickly in then existing Policies; and so that follow-up educational meetings can be made for County personnel who must comply with these new laws.
F5:
Everyone involved must realize that this area of the law is in a constant state of change, both at the state and federal level, and that there may even be some aspects of international Privacy laws that come into play at times, even for locally stored data.
Related Recommendations (1)
R5:
The County Information Technology Department Director and the Chief Security & Privacy Officer, working with the Security and Privacy Officers in other Departments, should be commended for the recent massive revision of Monterey County Privacy and Security Policies. This critical project has been on-going for more than for six years, in order to replace the existing, obsolete 2002-2004 versions. Unfortunately, these old Policies, as of May 2014, were still posted on the IT Department website, as well as a 2008 version which apparently still exists but is accessible only internally. In an effort to reduce County exposure for failure to comply with existing California and Federal Laws, and in fairness to Monterey County residents, prompt completion and dissemination of these revised Privacy and Security Policies should be a priority, especially since large amounts of Personally Identifiable Information ("PII") could otherwise be at risk of illegal disclosure.
F6:
Of particular concern should be those Privacy laws relating to health records used or maintained by County agencies like Natividad Medical Center and the County Health Department since the provisions of the Federal HIPAA law are particularly burdensome and the penalties very expensive if violated.
Related Recommendations (1)
R6:
Finally, the CGJ strongly recommends that the subject of education about compliance by all County employees and their departments with California and Federal Privacy and Security laws be taken more seriously. We understand that existing County Policies call for such education efforts in the form of providing and requiring attendance at biennial educational programs. Several CGJ members actually attended the current educational program, which was well presented and current. However, employees from the highest to the lowest level of County government must be made to realize that, while these Policies, rules and laws may seem burdensome and inconvenient, failure to comply may not only result in loss of their jobs, but also in massive and punitive penalties and legal fees Privacy & Security of County On-Line Data and Information Systems incurred by the County if any such violations were to be litigated. This educational process is not an easy, nor inexpensive, task, but it must not be minimized.
F7:
County departments and those agencies and personnel involved in acquisition of communications, software and almost every other type of goods and services, must insist both contractually and in practice that all vendors at every level comply with required Privacy and Breach Notice laws when dealing with County owned or controlled personal Privacy & Security of County On-Line Data and Information Systems data and information. Unfortunately, many commercial vendors and businesses are not currently in compliance, worldwide, as can be seen from the numerous data breaches recently reported in the U.S. news media.
F8:
Finally, Monterey County is not unique in dealing with these critical Privacy problems, according to a story in the IAPP newsletter in late May 2014. This publication reported that the Los Angeles (LA) County Board of Supervisors recently voted to direct its county staff to promptly develop a plan to require third-party contractors hired by the County to "encrypt sensitive information on their computers as a condition of their contracts." This followed the February 2014 breach of data on eight computers holding 342,000 patients' medical records taken from the offices of contractor Sutherland Healthcare Solutions. LA County already mandates that county laptops be encrypted. These new rules now also require that all county department's computer workstations' hard drives are to be encrypted.
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Additional Recommendations
1
Not linked to specific findings.
R99-01:
00-02 01-03 02-04 03-05 04-06 05-07 06-08 07-09 08-10 17 years and less 13.4 13.0 13.1 12.5 12.5 12.3 13.0 13.5 13.1 12.5 18 to 24 years 125.7 126.7 128.2 128.2 129.3 130.3 129.7 127.2 120.7 111.6 25 to 34 years 119.7 116.7 119.9 122.3 125.7 127.1 129.5 130.3 129.3 125.6 35+ years 21.1 21.9 22.3 22.6 23.6 24.0 24.6 24.4 24.6 24.7 Source: California Department of Public Health, Health Information and Research Section, Birth Statistical Master File 1999-2010; statistical analyses performed by Monterey County Health Department, Surveillance and Epidemiology Unit. In the last three time periods measured (2006-2010 inclusively), rates of births to women in the 25 to 34 year age group surpassed rates for the 18 to 24 year age group. Rates of births to women age 17 and less remained relatively unchanged from 1999 through 2010. Monterey County 2013 Community Health Assessment 50
Additional Recommendations
1
Not linked to specific findings.
R18-64:
years 29.7 25.1 Never 65+ years 20.6 19.6 Source: California Health Interview Survey, 2013. In 2009, 25% of adult residents under age 64 and nearly 20% of residents 65 and older reported never having had a sigmoidoscopy. Exhibit 263. Never had a sigmoidoscopy for colorectal cancer by gender Percent 2007 2009 Male 33.4 22.2 Never Female 20.1 23.6 Source: California Health Interview Survey, 2013. In 2009, 22% of males and 24% of females reported never having had a sigmoidoscopy. Monterey County 2013 Community Health Assessment 183
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Additional Recommendations
3
Not linked to specific findings.
R11-15:
years 5.8 4.5 4.3 2.8 2.3
R12-17:
Years 33.7 15.6 Monterey County 45.7 33.5 Source: California Health Interview Survey, 2013. Reported bike helmet use for both children and teens decreased from 2001 to 2003; bike helmet use decreased by half for teens. In 2003, children ages 6 to 11 were more than three times more likely than teens ages 12 to 17 to use a bike helmet. Exhibit 197. Children and teens who report they always wear a bike helmet, by race/ethnicity Percent 2001 2003 Asian/Pacific Islander (nH) 61.4* 56.8* Black (nH) 73.1* 100.0* Hispanic/Latino, any race 38.7 27.7 Multiple/Other races (nH) 26.5* 63.0* Native American/ Native − − Alaskan(nH) White (nH) 60.5 33.8 (nH)=non-Hispanic * Statistically unstable; interpret with caution. - (hyphen) = Estimate is less than 500 people Source: California Health Interview Survey, 2013. Bike helmet use by White, non-Hispanic and Hispanic/Latino children and teens were lower in 2003 compared to 2001; data for other race/ethnic groups were statistically unstable. Exhibit 198. Persons killed and injured in alcohol-related collisions Number 2006 2007 2008 2009 2010 Injured 312 301 272 241 237 Killed 16 15 29 8 15 Source: Statewide Integrated Traffic Records System, 2013. The number of persons injured in alcohol-related collisions gradually decreased from 2006 to 2010. The number of persons killed in alcohol-related collisions was very high in 2008. Monterey County 2013 Community Health Assessment 140
R16-17:
years 4.0 3.2 2.1 1.9 1.6 Monterey County 6.2 4.8 3.9 3.6 3.1 Source: UC Berkeley: Child Welfare Dynamic Reporting System; Retrieved February 2013 from http://cssr.berkeley.edu/ucb_childwelfare/ Substantiated reports of child maltreatment were consistently higher for those under one year of age compared to other age groups. Rates of substantiated child maltreatment were far less in 2011 compared to 2007; rates for 16 to 17 year olds decreased by more than half. Monterey County 2013 Community Health Assessment 137
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Additional Recommendations
3
Not linked to specific findings.
R20-34:
years 95,005 83,080 94,558 97,501 24 21 23 23
R35-44:
years 61,978 53,654 54,820 54,964 15 14 13 13
R45-64:
years 77,691 85,411 96,472 98,701 19 22 23 23 65+ years 40,299 39,419 44,422 47,693 10 10 11 11 TOTAL 401,762 389,004 415,057 426,762 100 100 100 100 Source: US Census Bureau, American Community Survey, 2000, 2005, 2010, 2012 Children ages 0-19 were the largest proportion of the county in 2000 to 2012 (30 to 33% of the total population), followed by young adults ages 20-34 (21 to 24%), and adults ages 45-64 (19 to 23%). The population of older adults ages 45 to 65+, however, increased while the population of children ages 0- 19 and adults ages 35-44 has decreased. Exhibit 4. Population by race/ethnicity Number Percent 2000 2005 2010 2012 2000 2005 2010 2012 Asian/Pacific Islander 24,245 26,852 27,329 29,674 6 7 7 7 (nH) Black (nH) 15,050 9,691 12,785 12,120 4 2 3 3 Hispanic/Latino, any 187,969 201,127 230,003 240,870 47 52 55 56 race Multi-Race/Other 8,251 6,669 3,041 5,578 2 2 1 1 Native American/ 4,202 1,801 5,464 2,304 1 0 1 1 Native Alaskan (nH) White (nH) 162,045 142,864 136,435 136,216 40 37 33 32 TOTAL 401,762 389,004 415,057 426,762 100 100 100 100 (nH) = non-Hispanic Source: US Census Bureau, American Community Survey, 2000, 2005, 2010, 2012 The largest race/ethnic group in the county from 2000 to 2012 was Hispanic (increasing from 47 to 57%), followed by White non-Hispanic (decreasing from 40% to 32%). The Hispanic population increased (from 47% to 55 % of the total population), while the White non- Hispanic population decreased (from 40% to 33%). The population of Asian/PI, Black, Native American/Alaskan, and multi-ethnic groups fluctuated by a few percentage points over the last 12 years. Monterey County 2013 Community Health Assessment 19
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Additional Recommendations
1
Not linked to specific findings.
R99-01:
00 - 02 01 -03 02 -04 03 -05 04 -06 05 -07 06 -08 07 -09 08-10 Hispanic/Latino, any race Black, non-Hispanic Multi Race/Other White, non-Hispanic Asian/Pacific Islander, non-Hispanic Monterey County Source: California Department of Public Health, Health Information and Research Section, Death Statistical Master File 1999- 2010; statistical analyses performed by Monterey County Health Department, Surveillance and Epidemiology Unit. Exhibit G. Age-adjusted heart disease mortality rates per 100,000 by race/ethnicity 300 250 200 150 100 50 0
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Additional Recommendations
1
Not linked to specific findings.
R99-01:
00-02 01-03 02-04 03-05 04-06 05-07 06-08 07-09 08-10 <1 year 569.1 611.9 597.2 561.5 534.8 501.0 514.1 493.9 514.6 489.2 1 to 14 years 18.6 19.7 20.7 21.0 20.7 17.6 14.5 15.0 15.9 17.2 15 to 24 years 70.4 68.2 70.0 74.9 72.2 72.3 60.2 66.6 71.4 78.4 25 to 44 years 99.4 106.3 111.8 109.3 110.8 112.6 107.0 97.6 96.1 90.5 45 to 64 years 490.9 480.7 484.8 485.5 469.4 469.4 457.2 463.0 454.1 456.2 65+ years 4,517.4 4,414.9 4,373.9 4,246.5 4,199.4 4,176.1 4,110.1 3,959.7 3,757.7 3,710.7 Monterey 743.9 727.0 717.7 693.8 677.1 667.0 646.7 622.8 594.9 586.7 County Sources: California Department of Public Health, Health Information and Research Section, Death Statistical Master File 1999-2010, Birth Statistical Master File 1999-2010; statistical analyses performed by Monterey County Health Department, Surveillance and Epidemiology Unit. Mortality rates for the county overall decreased over the last decade for all age groups except for 15-24 year old residents, although this trend was not statistically significant. Exhibit 209. Age-adjusted mortality rates per 100,000 by race/ethnicity 1200 *Note: Statistically unstable data are noted in the table below. 1000 800 600 400 200 0 99 - 01 00 - 02 01 - 03 02 - 04 03 - 05 04 - 06 05 - 07 06 - 08 07 - 09 08 - 10 Hispanic/Latino, any race Black, non-Hispanic Multi Race/Other White, non-Hispanic Asian/Pacific Islander, non-Hispanic Monterey County Age-adjusted rate per 100,000
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Additional Recommendations
3
Not linked to specific findings.
R00-02:
01 - 03 02 -04 03 -05 04 -06 05 -07 06 -08 07 -09 08 -10 Hispanic/Latino, any race Black, non-Hispanic *Note: Statistically unstable data are Multi Race/Other White, non-Hispanic noted in the table below. Asian/Pacific Islander, non-Hispanic Monterey County Rate per 100,000
R06-08:
07-09 08-10 09-11 <5 years 6.5* 4.7* 6.6* 5.7* 5 to 19 years 3.1* 2.4* 2.0* 0.7* 20 to 49 years 5.6* 4.9* 3.9* 5.4* 50+ years 8.6 6.9 7.9 7.7 Monterey County 5.9 4.8 4.7 4.8 *Statistically unstable; interpret with caution. Source: Monterey County Health Department, Tuberculosis Control Unit; data are current as of June 15, 2012 Between 2006-2008 and 2009-2011, tuberculosis infection rates were significantly lower for residents aged 5 to 19 years compared to the referent group (20-49 years). Tuberculosis infection rates appeared to decrease slightly from 2006-2008 to 2009-2011 for all age groups. Exhibit 104. Tuberculosis infection rates per 100,000 by race/ethnicity 35 30 25 20 15 10 5 0
R99-01:
00 - 02 01 -03 02 -04 03 -05 04 -06 05 -07 06 -08 07 -09 08-10 Hispanic/Latino, any race Black, non-Hispanic *Note: Statistically u nstable data are Multi Race/Other White, non-Hispanic noted in the table b elow. Asian/Pacific Islander, non-Hispanic Monterey County Age-adjusted rate per 100,000
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Additional Recommendations
2
Not linked to specific findings.
R00-02:
01-03 02-04 03-05 04-06 05-07 06-08 07-09 08-10 09-11 0 to 14 years 0.3* 0.3* 0.0* 0.0* 0.0* 0.0* 0.3* 0.7* 1.0* 0.7* 15 to 24 years 27.0 30.4 34.7 26.3 30.8 31.8 38.4 42.9 44.8 48.7 25 to 44 years 204.4 198.8 167.7 135.2 174.8 218.6 315.8 350.2 385.5 343.0 45 to 64 years 271.2 256.0 210.7 191.9 250.1 317.2 456.9 546.7 613.6 582.3 65+ years 49.4 44.5 29.7 29.2 43.3 60.9 73.2 76.8 83.6 80.1 Monterey County 126.0 121.1 102.1 87.9 114.4 144.3 206.2 238.1 264.6 245.2 *Statistically unstable; interpret with caution. Source: Monterey County Health Department, Communicable Disease Unit; June 15, 2012; statistical analyses performed by Monterey County Health Department, Surveillance and Epidemiology Unit. Persons ages 25 to 64 had the highest rates of chronic hepatitis C infection between 2000-2002 and 2009-2011 than other age groups. The rate of chronic hepatitis C significantly increased across all age groups, except 0-14 year olds, from 2000- 2002 and 2009-2011. Exhibit 81. Newly diagnosed chronic hepatitis C cases per 100,000 by race/ethnicity 700 600 500 400 300 200 100 0
R99-01:
00-02 01-03 02-04 03-05 04-06 05-07 06-08 07-09 08-10 Asian/Pacific Islander (nH) 82.8 84.2 86.2 88.8 88.4 87.5 84.7 83.1 81.9 80.3 Black (nH) 83.5 83.2 82.9 80.7 78.3 79.9 80.4 78.9 75.4 74.1 Hispanic/Latino, any race 76.2 79.9 81.3 80.7 78.0 77.0 75.4 74.0 72.9 71.5 Multiple/Other races (nH) 80.0 82.6 83.7 84.9 84.7 86.9 83.4 81.4 82.1 82.5 White (nH) 90.4 91.5 91.6 92.0 91.0 90.5 88.6 87.0 86.2 86.0 Monterey County 80.0 82.7 83.8 83.7 81.4 80.4 78.4 76.9 75.8 74.6 (nH) = non-Hispanic Source: California Department of Public Health, Health Information and Research Section, Birth Statistical Master File 1999-2010; statistical analyses performed by Monterey County Health Department, Surveillance and Epidemiology Unit. White, non-Hispanic women were the most likely to enter into prenatal care in the first trimester (86% in 2008- 2010) from 1999 through 2010; Hispanic women of all races were the least likely (71% in 2008-2010) and significantly lower. The rate of entry into first trimester care for all race/ethnic groups combined dropped slightly between the early 2000s and 2010, although not statistically significant. Exhibit 69. Entry into prenatal care during the first trimester disparity and trend analysis Population Groups Disparity, 2008-2010 Time Trend, 1999-2010 17 years and less Significantly lower Not statistically significant 18 to 24 years Significantly lower Not statistically significant Monterey County 2013 Community Health Assessment 60
Findings & Recommendations
3 findings
F1:
At the order of the Alisal Union School District Board of Directors, new procedures for credit card usage have been developed and implemented.
F2:
These procedures are being followed.
F3:
The CGJ noted that acceptable expenditure levels were not provided to credit card users.
Additional Recommendations
2
Not linked to specific findings.
R1:
Additional procedures should be developed to control credit card expenditures, such as having a list of acceptable expenditures with limits, depending on the cost and nature of the expenditures.
R2:
More than one credit card should be made available as needed for staff travel, using the same established controls. RESPONSES Pursuant to Penal Code Section 933.05, the Grand Jury requests a response as indicated below from the following governing bodies: Alisal Union School District Board: All Findings and Recommendations Alisal Unified School District Credit Card Use 2 30 MONTEREY COUNTY WEBSITE — THE PERFECT STORM INFORMATION ACCESS AND POSSIBLE RE-DESIGN ISSUES Image by Rock1997, used under the terms of the Creative Commons Attribution-Share Alike 3.0 Unported license. 31 32 33 34 35 36 37 38 39
Findings & Recommendations
5 findings
F1:
MPUSD made changes to the transcripts of 93 students.
F2:
MCOE carried out an investigation of these transcript changes and directed that they be corrected.
F3:
MCOE also determined that policy and administrative requirements used by MPUSD pertaining to student grade, course, and graduation issues contained serious inconsistencies and were partly to blame for the transcript problems.
F4:
The current Interim Superintendent is aware of the issues and has a firm grasp on the importance and timeliness of carrying out all of the recommendations of the Report. 9934
F5:
The Board is focused on the issues raised by the Report, intent on making the grade, curricular and policy changes recommended, and is fully supportive of the efforts of the Interim Superintendent in that regard.
Additional Recommendations
3
Not linked to specific findings.
R1:
The Board should fully implement all of the MCOE recommendations.
R2:
The Interim Superintendent should be commended for his focused attention to the issues raised in the Report.
R3:
The Board should assure that the Interim Superintendent is charged with the responsibility for implementing the MCOE recommendations though their completion.
* 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.