Issue | Background | Findings | Conclusions | Recommendations | Responses | Attachments Summary of Health and Human

Transfer two or more social workers who are dedicated to youth in the ILSP, ILP Aftercare Services, THPP, and WIA Youth Education and Employment Services, into Adolescent Services from Children and Family Services.

Increase housing options for Agree. The Board of Supervisors (BOS) Currently the $180,000 authorized by the current and emancipated foster authorized $750,000 to support the BOS for housing assistance is supporting youth. development of a transitional housing unit 40 youths who go to work or school for a for these youth at the June budget hearings. minimum of 30 hours a week. The The BOS also authorized $180,000 in agency is close to buying a 6-9 unit stipends to assist emancipated youth with apartment in South San Francisco for housing, school, training, and employment. transitional housing. The agency is using This program will be implemented over the the $750,000 from the BOS and $750,000 next several months. HSA will be analyzing from the City of South San Francisco the service needs of emancipated youth and Redevelopment Agency to fund the reporting back to the BOS in December purchase. The apartment is scheduled for

Reclassify the Workforce Agree. Two Extra Help positions will be The agency has converted the two Extra Investment Act staff to permanent converted to permanent ESS positions in the Help positions to permanent ESS status. September budget revisions, to be covered by positions as agreed to in the 2005 a combination of Workforce Investment Act recommendation. (WIA) and Children and Family Services funding.

Complete the planned Agree. Adolescent Services completed a As a result of the survey, the ILP includes Adolescent Services survey of all survey with Independent Living Program a weekly class at Canada College and program participants to gauge the (ILP) youth towards the end of the program College of San Mateo (a joint effort effectiveness of the programs and term, with general questions on what they between Foster Youth and Kinship) where find areas where improvements thought about the program. Several youth youth learn independent living skills. The could be made and provide a base focus groups were also held to gauge the rate of participation exceeds 90%. for follow-up. effectiveness of these programs. The results of these surveys were used to improve the curriculum for 2005-2006 ILP training. Assessment of survey information will continue, with changes to be made as necessary. 4 2005 Recommendation Response by Agency 2006-2007 Activity

Provide improved Agree. Current transportation systems will The agency had to recruit to create a list transportation options to be reviewed to develop plans for better of applicants and write a new job Independent Living Skills utilization of existing resources. Expanding description for the new civil service Program participants. the use of bus passes and offering mileage to position they created. The agency is now foster parents could increase the options holding interviews and is expecting to available to older youth to help them become have a transportation officer position more independent and experienced in using filled by the end of the first quarter of the public transportation system. Payment of 2007. A reason for the delay had to do mileage expenses to foster parents for with the need to create a new civil service transporting youth to the evening job description. The agency held Independent Living classes will also be discussions on transportation issues with a explored. special subcommittee of the Foster Parent Association and now has a mileage expense reimbursement policy in place.

Develop better outreach Agree. As the Grand Jury report notes, there The outreach has grown to the point programs to inform and involve has been an increase in the number of youth where there are now over 140 youth in the eligible participants not currently participating in Adolescent Services pre-emancipated program (14-19) and participating in Adolescent Programs. Participants in the ILP have gone over 60 in the Emancipated program (19- Services programs. from 25 to 50 in the last two years. This year, 24). Brochures and information flyers a new contract with College of San Mateo have been developed to inform was completed to further expand the ILP emancipated youth of the availability of program. Another opportunity for growth is financial, housing, counseling, the Transitional Housing Program; brochures employment and education services. and information notices will be developed and sent to emancipated youth and youth currently in active Adolescent Services cases. Children and Family Services 2005 Recommendation Response by Agency 2006-2007 Activity 1.1 The Foster Parent Bill of Agree. The Foster Parents Bill of Rights has The Foster Parents Bill of Rights was Rights should be completed by been completed and was reviewed by the approved by the Board of Supervisors and September 1, 2005. Foster Parent Association as well as Human is online as part of the Foster Parent Services Agency (HSA) staff. It will be Handbook. A copy is available at: submitted to the Board of Supervisors in http://www.co.sanmateo.ca.us/vgn/images/portal/cit_ September. 609/60/36/623831993section_04.pdf 1.2 The Foster Parents’ Manual Agree. Following review by the Board of the The Foster Parent Handbook has been should be completed by Foster Parents’ Association and HSA staff, distributed and is available online. September 1, 2005. the Foster Parent’s Handbook was completed Section 4 of that handbook is directed August 22, 2005. It is anticipated that the specifically to foster parents: Handbook will be distributed in early http://www.co.sanmateo.ca.us/vgn/images/portal/cit_ October, with the information online by 609/60/36/623831993section_04.pdf January 2006. 5 2005 Recommendation Response by Agency 2006-2007 Activity 1.3 Foster parents should be Agree. CFS policy is to provide a Health and With some exceptions the Health and provided with a Health and Education Passport (HEP) to the resource Education Passport is provided to foster Education passport for each foster parent, group home, FFA, etc. as soon as parents within 30 days of placement. child within 30 days of possible but no later than 30 days after initial placement. placement of a child into foster care, in accordance with the Welfare and Institutions Code. This policy has been followed in the Family Reunification and Permanent Placement units. Recent process improvements to further reinforce this policy include development of a Health Passport Interview Form to be used by Social Workers as a template for obtaining health care information for children coming into foster care and inclusion in the HEP, and requesting Supervisors to remind their staff of the policy and to monitor adherence. In the Court Investigations unit, this policy had not been followed since most children in this unit are not technically “placed,” but rather are in sometimes lengthy periods of shelter care awaiting Court jurisdiction and disposition including possible placement in an ongoing home. The Court Investigations unit has now been instructed to provide parents with an HEP within 30 days of the child’s placement in shelter care. 1.4 Assure that each foster child Agree. Every child entering a shelter care CFS verified that each foster child has had a physical and mental home receives a physical exam prior to receives a physical and mental health health assessment at the time of admission. Further, every child receives a assessment at time of placement. Youth placement. Child Health and Disability Prevention receive medical services through Medi- (CHDP) exam within 30 days of a Court Cal. PSHC performs a full mental health dispositional order for placement. Many assessment for each foster child. With children are referred for a psychological few exceptions this is done within 30 days evaluation as a part of the Court of placement. jurisdiction/disposition process. All children who are in out of home placement are referred to the San Mateo County Child Abuse Treatment Program for mental and physical health assessment and treatment services. The Child Abuse Treatment Program collaborates with Partners for Safe and Healthy Children (PSHC), the Edgewood Center for Children and Families, and Youth and Family Enrichment Services (YFES). PSHC is a multidisciplinary team formed in 2005 with members from County Public Health Services, Mental Health Services, Alcohol and Drug, and CFS to provide services for children 0-5 years and their families. Edgewood Center and YFES provides services for children ages 6-18 years and their families. 6 2005 Recommendation Response by Agency 2006-2007 Activity 2.1 Provide a working Agree with recommendations 2.1, 2.2, and The Foster Parent Liaison was hired 1.5 environment with additional 2.3. CFS has worked with the Foster Parent years ago. The upgraded job description privacy to enable the Liaison Association Board over the last year to for this position has been completed. A to speak openly and fairly to improve the effectiveness of the Liaison. neutral area in the 4C’s (Child Care all. The job description and responsibilities have Coordinating Council) offices has been set 2.2 Develop a carefully crafted been upgraded. Conversion of the Liaison to up for parents to meet with the Foster official job description that a supervisory level position, reporting to the Parent Liaison. delineates the Liaison’s Director of CFS, will be recommended in the responsibilities and authority September budget revisions. Following the and grants real authority to hiring process, which will include input from act on behalf of foster parents the Foster Parent Association, the Liaison 2.3 Identify neutral areas away will be relocated by November 2005 to an from CFS, such as an offsite office in the community that will be independent office and accessible to the foster parents. private places in schools, churches or community centers, where the Liaison can meet with foster parents. 2.4 Upgrade the CFS quarterly Agree in part. Beginning in September 2005, The Children and Family Services newsletter to foster parents to a the CFS newsletter to foster parents will be newsletter has been upgraded and is monthly newsletter which would sent out every other month instead of published quarterly. communicate important quarterly. It will focus on changes in policy The goal of publishing a newsletter information, clarify areas of and procedure, Agency changes, and monthly was deemed impractical. CFS confusion, suggest solutions to clarification of any current issues. Updates staff meet monthly with the Foster Parents common problems, encourage to the Foster Parent Handbook will be Association. greater participation in the Foster included in the mailings. Any time-sensitive Parents Association. information between issues will be distributed in special mailings. 3.0 The management of CFS to Agree. All staff have been provided with a The State dictates the procedures so explore possibilities for QuickPad, a portable word processing streamlining is difficult. Two clerical eliminating or simplifying the keyboard device that allows for the recording positions have been added. The job steps involved in writing social of contacts, draft reports, etc. in the field for functions required of social workers still workers’ reports and thereby later transmission to their desktop demand an inordinate amount of data decrease the time spent on those applications. The possibility of filing entry. reports. Suggestions include petitions and other Court documents additional clerical help and use of electronically is being explored with the handheld electronic devices. Juvenile Court. Other technological advances are considered as new devices become available. A specific clerical person in each region has been designated to format and/or finalize court reports when requested. An additional clerical position was added in the June budget revisions to support staff and the court process, and another clerical position will be requested in the September budget revise to help facilitate the out of home placement and payment process. 7 2005 Recommendation Response by Agency 2006-2007 Activity 4.1 The management of CFS to Agree. The curriculum for induction training Training has been expanded. The training evaluate and strengthen the initial will be revised by the end of the year to program is 12 weeks in length with training program for social reflect new best practices, with emphasis additional on the job training. New staff workers. given to the role of Resource Parents as a members spend time with foster parents. support resource for Social Workers, as well CFS has a large intern program (39 this as an ongoing source of information about year) working closely with San Francisco the children that they care for. Starting with State, San Jose State, Hayward State and the next induction training, one day will be UC Berkeley. There is competition for designated as “A Day in the Life of a interns among agencies throughout Resource Parent,” at which Resource Parent California. The interns work with representatives will address the trainees on supervisors that are credentialed. This issues and challenges they face with children program gives CFS an opportunity to in their care and with Social Worker staff. evaluate possible job applicants during the Another new component of the training is the program. Internships are available in “buddy system,” in which Social Worker many areas including receiving homes, trainees are paired with experienced Social Child Protective Services, Family Workers two days a week for three weeks, Resource Centers, Alcohol & Drug first in an emergency response unit and later Services, and Domestic Violence in a family maintenance/family reunification Collaborative and Planning and unit. Evaluation. 4.2 The management of CFS to Agree. HSA has started the accreditation CFS is working on accreditation. This become accredited by October 1, process in response to previous Grand Jury was to have been done by October 2006.

Reports should be made to reports, as a top priority project of the new CFS hopes to be accredited by or before the Grand Jury on progress Planning and Evaluation Manager. A December 2008. No progress reports toward accreditation every quarter consultant has been hired to review a number have been presented to the Board of commencing September 30, 2005. of Agency polices, procedures, and protocols Supervisors. The Planning and and prepare for the Council on Accreditation Evaluations Unit of HAS is coordinating (COA) review process. Following CFS’s accreditation process. implementation plan development, the COA process takes approximately 18 months, with full accreditation expected by Spring 2008. Interim progress reports will be provided to the Grand Jury through the County Manager’s Office. 4.4 The management of CFS to Agree in part. The County requires that Performance reviews are performed in monitor frequency and employee performance evaluations be accordance with County rules. thoroughness of personnel completed for probationary employees, either Performance reviews are required every evaluations to ensure that all three or six months from the initial date of two years; more often for probationary professional staff is evaluated hire. Regular performance evaluations are employees. CFS believes it is in annually. completed for full time, permanent conformance with the rules; however, the employees every two years as required by Grand Jury’s review of documentation on MOU agreements. Starting in 2004, CFS personnel reviews shows that a large management received and reviewed regular percentage of the reviews are overdue and quarterly reports on all past due performance that the tracking system needs evaluations. By December 2004, CFS was in improvement. substantial compliance with the performance evaluation criteria; continued compliance is being monitored. 8 2005 Recommendation Response by Agency 2006-2007 Activity 4.5 The management of CFS to Agree. As noted in our response to A modest amount of progress has been take full advantage of existing recommendation 3.0, the possibility of filing made in the area of increasing the use of technology, such as electronic petitions and other Court documents electronic technology. State processes transmission of reports, electronically is being explored with the and procedures and interfacing with the acceptance of electronic Juvenile Court and other technological Juvenile Court have made it difficult to signatures, and any other support advances are being considered as they adopt and expand technical services within the County. become available. However, the improvements. transmission of electronic reports and acceptance of electronic signatures is a complex issue, as some documents and attachments filed with the Juvenile Court require original signatures. However, CFS will continue to work with the Juvenile Court and service providers to establish processes leading to expanded use of technology. 4.6 The management of CFS to Agree. As a part of the Human Services CFS staff meets with many organizations meet, or continue to meet, Agency, CFS embraces the spirit of on a regular basis. The Grand Jury was regularly with other community community involvement and collaboration. impressed by the number of participating resources, such as LAPP, Family CFS staff participates in numerous organizations and was unable to identify if Service Agency, San Mateo community meetings with schools, private any were omitted. Medical Center pediatricians and community-based agencies and other others to improve the relationship community organizations to support our of CFS with the court, social community partnerships working to develop service agencies, medical additional resources at the community level professionals, foster parents and to support protection, prevention, and associations. permanence for children. This involves a interaction with a wide variety of programs. Adult Protective Services and Public Guardian 2005 Recommendation Response by Agency 2006-2007 Activity 1.0 The Board of Supervisors should direct the Director of Health Services to: 1.1 Identify the office of Public Agree. Staff agrees that separate listings for The Public Guardian Office location in Guardian in its building and in the Public Guardian could improve public the building at 225 37th Street in San directories to improve citizen access to the program. A sign will be posted Mateo is still not well-marked. In fact, awareness and access. to identify the office of the Public Guardian very few of the departments are easy to and other services provided by AAS. The find. There is no reception desk or Public Guardian program is currently listed directory at the building’s entrances; in the government section of the SBC several visitors, including members of the telephone directory under AAS. Staff will Grand Jury, wandered around the building request that the Public Guardian be listed attempting to locate the office of the separately in the next publication of San Public Guardian. Two signs reading Mateo County’s “County and City Telephone “Office of the Guardian” have been Directory.” ordered for posting at the building’s entrances. 9 2005 Recommendation Response by Agency 2006-2007 Activity 1.2. Give proposed conservatees Agree. Personal noticing of proposed AAS has developed a brochure providing an explanation in person and in conservatees and relatives is required by law. an overview of the services provided by writing of their rights at the time In addition to continuing the practice of AAS that addresses a combination of of filing a petition to curtail or verbally informing the proposed conservatee protection, support, prevention and remove their personal and/or of his/her rights, a new one-page advocacy services, and a one-page property rights. informational notice is being developed. informational notice of a conservatee’s This notice will inform proposed rights. conservatees of their right to oppose the Conservatorship, to have an attorney appointed to represent them if they cannot afford to hire an attorney, to have a court trial, or to have a jury trial. This information is always reiterated by the Court Investigator, who personally visits each proposed conservatee. 1.3. Issue specific written Agree. AAS and the Public Guardian are The Department Policy Statement, which policies instructing the publicly and explicitly committed to keeping appears throughout its published Deputy Public Guardians people in their own homes as long as they are communications, asserts that maintaining about Aging and Adult safe and can afford to remain there. AAS a conservatee “at home” is a primary goal Services priorities, including works according to its goal as stated in the for AAS. maintaining the conservatees Division’s informational brochure and on the in their own home if AAS website: “Our goal is to ensure the possible, locating and delivery of client-centered, compassionate, consulting with all family, and fiscally responsible services that foster friends, and neighbors self-determination, meet professional (against whom there is no standards and ethics, and reflect the County’s evidence of abusive actions), statement of beliefs. We will accomplish and providing all needed this by offering services that provide a assistance without delay. combination of protection, support, prevention and advocacy.” This principle of fostering self-determination and supporting the wishes of people to remain in their homes as long as possible is emphasized at staff meetings, unit meetings, case conferences, and individual supervision meetings. AAS will continue to emphasize this guiding principle, both in writing and verbally. The Probate Code and the Welfare and The staff complies with HIPAA Institutions Code, which are the bodies of requirements. law that govern the actions of the Public Guardian, contain specific noticing requirements for all legal actions. The law requires the written noticing of all relatives within the second degree of relationship when legal actions are taken. There are specific confidentiality and privacy restrictions that prevent information being shared with non-relatives. In addition, the Health Insurance Portability and Accountability Act (HIPAA) requirements prevent the disclosure of private health information. The Public Guardian strives to 10 2005 Recommendation Response by Agency 2006-2007 Activity gather all relevant information to support comprehensive and compassionate decision- making. The office maintains names, addresses, and phone numbers of all relatives and significant others, and contact is made whenever it is necessary. The Public Guardian, as addressed in its budget statements, considers, acknowledges and values family members as partners in the Conservatorship program. AAS, including Adult Protective Services Written procedures were timely (APS) and the Public Guardian program, will distributed to staff. continue to provide assistance required by its vulnerable clients without delay. An AAS leadership sub-committee will be convened to recommend improvements to current policies and procedures. Written procedures will be distributed to staff by March 2006. 1.4. Install a plan for regular Agree. There are existing systems for Prior policy required that AAS review the agency oversight and providing regular and close agency oversight conservatorships assigned to Deputy consultation with the Deputy of and consultation with the Deputy Public Public Guardians every two years; it has Public Guardians. Guardians. In AAS there are four units of been changed to an annual review of each Deputy Public Guardians; one unit conservatoree’s financial status. There comprised of three conservatorship are also weekly and monthly reviews for investigators and three units comprised of 16 accuracy as accounts change (monthly Deputy Public Guardians who are assigned financial statements). AAS also uses the continuing conservatorships. Each unit is outside financial advisors to oversee and supervised by a knowledgeable and advise on investment accounts. experienced supervisor who meets with the workers both individually and as a unit. Supervisors are available for immediate consultation as needed. In addition, the supervisors meet individually on a weekly basis with the program manager to review problems and resolve issues. There are frequent interdisciplinary case conferences and weekly meetings with supervisors, managers and County Counsel to review and consult regarding cases. There is a case review system to provide quality assurance and improvement oversight, and there are checks and balances within the accounting functions that provide fiscal support to the Public Guardian. In addition, all Conservatorship cases are reviewed by the Superior Court, and Probate cases receive review by the Probate Court Investigator. 11 2005 Recommendation Response by Agency 2006-2007 Activity There is an annual audit performed by the County’s Auditor/Controller’s office on all cases receiving public benefits, and periodically the County Controller audits all of the work of the Public Guardian. AAS will continue to provide oversight and consultation for the Deputy Public Guardians following the above protocols. 1.5. Eliminate any lag time Agree. The APS program provides One account is left open so that the between the time that all bank intervention activities directed toward conservator can pay routine bills during accounts are frozen and the time safeguarding the well being of elders and the “freeze” period. when provision is made for the dependent adults suffering from or at risk of proposed conservatee’s bills to be abuse or neglect, including self-neglect. paid and supplies and services APS and the Public Guardian are committed made available. to providing timely response to individuals’ needs. Not all bank accounts are frozen; however, there are times when it is necessary for APS to freeze an individual’s assets using Probate Code 2901, which allows for the freezing of bank accounts to prevent losses belonging to proposed conservatees and to prevent abusive dissipation. Usually one account remains available for the use of the proposed conservatee. Provision is made for payment of bills for essential services and supplies such as food and medications. APS has emergency funding available to ensure the individual’s safety during the conservatorship process. Funding is available for such services as attendant care, food, clothing, temporary shelter, medications, and other emergency expenses. The APS Supervisor and Deputy Public Guardian supervisor for investigations monitor these policies and procedures. These policies will continue to be followed. 1.7. Establish written policies for Agree. AAS follows the County of San The process for requests for proposals requests for proposals or contracts Mateo’s written guidelines for RFPs and the already existed at the time of the for in-home caregiver Administrative Memorandum B-1 issued by recommendations. organizations, financial managers, the County Manager for issuing contracts. real estate brokers, et al. RFPs were issued on January 21, 2004 for in- home caregiver agencies, and on December 22, 2003 for contract caregiver services for the IHSS program. An RFP was issued on March 4, 2005 for real estate services for the Public Guardian, and five contracts were awarded. RFPs were issued on March 1, 2004 for financial management services and on August 9, 2004 for tax preparation services. AAS uses County Counsel for attorney services. These policies will continue to be followed. 12 2005 Recommendation Response by Agency 2006-2007 Activity 1.8. Visit conservatees living Agree. The Public Guardian has a written The existing procedure is consistent with independently once a month at a policy and procedure, last updated and the recommendation. minimum. revised in June of 2004, which requires monthly visits to all conservatees who are living independently. Adherence to this procedure is monitored by the Deputy Public Guardian Supervisors who review every visit report for individual conservatees. Additionally, the supervisors monitor monthly reports of all visits made and due to be made. This procedure will continue to be followed. 1.9. Perform an annual audit of Agree. Annual audits are regularly The County’s Auditor/Controller now investment accounts of performed at several different levels. A court audits all accounts on an annual basis. conservatees held by the accounting of each individual conservatee Financial Manager to assure they with investments is prepared and presented are appropriately invested to yearly for review and approval by the Court. meet the account goals and to The Court Investigator reviews each clearly show the annual rate of accounting and submits a report of findings return and commissions on to the Court. The Probate Judge reviews transactions. each report and accounting. Additionally, the Estate Manager meets with the Financial Advisor to review and re- balance each conservatee’s portfolio no less than once yearly. Securities America audits the Financial Advisor’s files and procedures on an annual basis. In addition, the Financial Advisor is subject to announced and unannounced audits by the Securities and Exchange Commission (SEC) and the Department of Corporations. Staff will meet with a representative of the County’s Auditor/ Controller to discuss other possible audit options to ensure that conservatees’ investments are appropriate and meet account goals. The annual rate of return is clearly identified on every quarterly and year-end report received from the Financial Advisor for each conservatee. There are no commissions paid by the Public Guardian or by the conservatees on any transactions, as the Financial Advisor contracted by the Public Guardian is an independent broker. 13 2005 Recommendation Response by Agency 2006-2007 Activity 1.10. Establish additional Agree. The process for calculation of fees The “best practice” standard was already procedures that set rigorous “best currently in use by the Financial Advisor is followed. Fees are calculated by practices” standards for the “best practice” standard as regulated by Securities America using independent calculation of fees and consider the SEC. Fees are calculated by Securities brokers and cost effective methods. requiring that any billing method America (not the Financial Advisor) and are used not include cash or money based on the monthly average, not daily or market accounts as part of the year-end averages which would result in a total investment account, and higher fee. This process includes charging a determine whether there is fee on funds in the money market account. additional compensation, such as However, that account is maintained at the commissions or partial lowest level possible. The money market commissions paid the Financial account is purposefully set up for several Manager as a result of his reasons: funds are set aside in the money affiliation with the broker. market account when it is known at the time of investment that a lump sum payment will be due shortly (such as a capital gains tax on the sale of a residence) and for the monthly management fee. An estimate for one year of fees is set aside every annual review to avoid periodic sales during the year and any associated fees. The Financial Advisor contracted by the Public Guardian is an independent broker; as such he receives no commissions as a result of any affiliation with a brokerage company. Staff will request that the Auditor/Controller’s office review the Division’s practices and procedures related to fee calculation, billing methods, and related areas and will request that office to make recommendations regarding best practices and standards to be followed. Food Inspection in San Mateo County 2004 Recommendation Response by Agency 2006-2007 Activity 1. The Board of Supervisors should Concur. The Division has begun The food inspection division reports to instruct the Director of Health implementing this recommendation and Environmental Health, a department that Services to develop a better will continue to work with the Public is also responsible for toxics and multimedia public awareness Health Education Unit and consumer hazardous material issues. Thus, the food program by November 1, 2004 that groups to evaluate various outreach inspection division may not get sufficient will provide to the public information strategies, options and budgets. priority necessary to comply fully with it needs to avoid becoming ill at this recommendation. home or in the community by eating food that has been improperly A number of consumer education handled, cooked or served. The materials have been created: program should regularly provide the (cid:122) a webpage has been established; public information about: (cid:122) an information brochure is now -Food safety laws and local codes available; and established to protect the public (cid:122) a Powerpoint presentation to enable -Safe handling and storage of food at food inspectors to educate food providers home and at work has been prepared, yet a program for such -Food borne diseases and how they presentations has not been implemented. are transmitted -Common food safety and handling These efforts appear inadequate to meet myths the breadth of consumer’s needs, -Food facility inspections (how and particularly for those who do not have why they occur, how facilities are computer access. There is little rated and results reported, how information available to the public results can be obtained and regarding grocery establishments that interpreted, food facility closures and offer food services. Some food inspection re-openings, etc.) information is available on the webpage -Current relevant topics of interest but it is sparse. -How the public and food facility workers can report suspected food borne illnesses, raise concerns, file complaints and seek additional information. 2.0. The Board of Supervisors should Concur. This recommendation will be The Seal has been redesigned and direct the Director of Health Services implemented as follows. The seal design enlarged, but according to the Division to: and content will be updated to provide and the Grand Jury’s observations, not all 2.1 Redesign and enlarge the Seal by concise and clear information to the restaurants display it. September 1, 2004 to: consumer. In addition, the Division will -provide better visibility; propose a County Ordinance requiring -prominently display the rating that upon issuance of the inspection assigned by inspectors; report, the owner/operator of the food -advise the reader that the latest facility shall post the most recent report in inspection report is available for a location clearly visible and readable by review at the facility and the County; the general public and patrons entering -direct the reader to the Food the establishment Inspection Results Online web page; -advise the reader of the other related County websites; continue to note the date of inspection and phone number of the Food and Consumer Protection Unit of the Environmental Health Services Division. Response by Agency 2006-2007 Activity 2004 Recommendation 2.2 Develop uniform inspection Concur. This recommendation has been County Ordinance No. 04276 has been in guidelines immediately, to assure implemented by including these items effect since September 15, 2005, making that: within the Division’s standardization and it mandatory for food facilities in San audit protocol. Mateo County to post the most recent Seals in all food facilities are routine inspection report in a location that obviously and similarly displayed; is clearly visible. Division staff report The latest inspection reports can be that compliance with the posting conveniently viewed by the public at requirements currently runs about 67% any time. indicating that compliance efforts could be improved. 2.3 Use a news release to inform the Concur. This recommendation will be Press releases to warn the public of food public of the guidelines established implemented by preparing a press release concerns have been placed on the in 4.14.2 above and post them on the and including the release in the “Hot Division’s webpage. Press coverage has County website. Topics” section of the Division been sparse in local papers. homepage. Staff is uncertain what “4.14.2” refers to. 2.4 Develop a hand-out that Concur. This recommendation has been An updated handout for inspectors to inspectors must give to owners implemented through a handout that was provide to food facilities regarding the and/or managers of food facilities prepared and distributed in 2002, posting of the Seal and the inspection that explains their responsibilities to explaining the requirement to provide a report has been implemented. post inspection results and to copy of the latest inspection report. The provide, upon request, a copy of their handout will be updated and made latest inspection report. available to those businesses that are unaware of the requirement. Successful implementation of recommendation 2.1 above will require the inspection report to be posted in plain view. 2.5 Evaluate and consider the Concur. This recommendation of grading A rating system of Poor, Fair, Average, advisability of adopting an A,B,C food establishments has been evaluated Good or Excellent has been initiated. grading system, by November 1, and considered several years ago as a These ratings are incorporated in the 2004. proposal to the Board of Supervisors. inspection details listed for each facility. Staff continues to confer with The Grand Jury suggests that a general representatives of Los Angeles, Riverside description for each rating be prominently and San Diego Counties to identify food displayed on the website that helps the program improvements gained by reader understand the types of infractions implementing a facility grading system. that downgrade a facility. Riverside At this time, staff believe that the posting County has a user-friendly description on of a single grade to inform the public as its website illustrating such a rating to the safety of a food establishment is system. one-dimensional and does not provide the public with the information they need to make an informed decision. By providing access to past inspection results on the Internet and implementing the other Grand Jury recommendations, the public will be given more information and insight into the Division’s activities and the ability to evaluate risk based on personal choices. Response by Agency 2006-2007 Activity 2004 Recommendation 2.6 Develop procedures and Concur in part. The recommendation for There are four inspection regions which practices by October 1, 2004 that will rotation requires further analysis. cover approximately 3,500 food outlets, provide for: Currently, the food inspections are and rotation of inspectors is not practical performed by three teams of staff, with due to required familiarity with food periodic rotation of the County’s each team responsible for a geographic facilities in each region. There is a staff food inspectors; area of the county. These teams share of 13.5 food inspectors to review 3,500 annual unannounced inspections of inspectional load within their area and establishments; obviously inspections are mobile food dispensing trucks and provide peer review and coverage infrequent. All food service inspectors carts. throughout the geographical area. must be licensed and must now have a Additionally, routine program audits and degree in a life science and pass a state standardization by program supervisors exam. adequately addresses any concerns of inappropriate activity of the staff. Approximately 350 mobile food providers Unannounced inspections of mobile food (carts and trucks) are inspected annually. trucks and carts are currently performed The food inspectors have a goal to make with plans to expand these inspections in unannounced visits to 25% of the mobile 2005. vendors while in the field. This means, however, that at least 75% of annual inspections are known in advance. 2.7 Revise the Food Program Concur. This recommendation will be The Official Inspection Report form has Official Inspection Report form to implemented and included during the next an added line indicating whether all allow inspectors to indicate thereon printing of the Official Inspection Report. information is posted as required. that information is posted as required and that a copy of the latest inspection report is on hand. Conclusions With the caveat that several of the prior grand jury reports reviewed for this report dealt with complex issues that were difficult to cover in a summary fashion, this Grand Jury found that most recommendations were implemented as agreed. The Grand Jury commends the Human Services Agency on its efforts to implement the prior grand jury recommendations concerning the integration of emancipated youth into society. Building of transitional housing, which was the most costly and complex recommendation, appears to be moving toward completion this year with the purchase of a small apartment building in South San Francisco. The Grand Jury’s sole criticism concerns the length of time it has taken to recruit a transportation officer. With two exceptions, the Children and Family Services agency has taken action on each of the prior grand jury’s recommendations and should also be commended. The first exception concerns the lack of reports and delays in seeking accreditation by the Council on Accreditation – a goal that was to have been achieved by October 2006 and has now moved to the end of 2008. The second exception concerns the large percentage of overdue personnel reviews in this department. The Grand Jury is impressed by the professionalism of the Aging and Adult Services management staff. The Public Guardian program appears well managed and prior grand jury recommendations were implemented with one exception. Signage at 225 37th Street in San Mateo is still needed to identify not only the office location of the Public Guardian program, but of other County offices located within this building. While implementation of recommendations in the “Food Inspection in San Mateo County” report were generally accomplished, the results in some cases were somewhat disappointing. Public awareness of the need for food safety vigilance is growing at a national level with increasing news coverage of contaminated foods, yet there are but limited local resources committed to consumer education. The Environmental Health portion of the County website was informative with respect to inspection reports of restaurants but lacking in information on grocery establishments and mobile food vendors. Compliance with the posting of seals and/or inspection reports requires ongoing oversight and improvement.