Mendocino County Grand Jury
• 2011-2012
A Report on the Mendocino County Mental Health Branch GOING…Going….gone?
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 26 findings
F1
Administrators often communicate using top-down directives without adequate explanation or input from employees, stakeholders, or Board members.
Related Recommendations (1)
R1
MH Administrators be trained in MH issues, develop consistent goals, and provide transparent communication to clients, staff, and the public. (Findings 1, 2, 3, 5)
F2
Anyone needing information has reported slow, minimal or no response. However, MH was responsive to requests by the GJ.
No recommendations for this finding
F3
Staff members report that MH administrators: • are unlicensed or often not trained in mental health issues • operate with administrative indecision • provide uneven direction and supervision of employees
No recommendations for this finding
F4
Medical records personnel and case managers have reports of unresolved conflicts regarding their interactions.
Related Recommendations (1)
R2
MH establish and monitor clear interactive roles and responsibilities between medical records and staff. (Finding 4)
F5
The GJ received complaints that two MH staff members reversed police and hospital staff recommendations to hospitalize clients under Health and Safety Code section 5150 (regarding individuals who are a danger to themselves and others). MH PROGRAMS / FINANCE
No recommendations for this finding
F6
MH balanced the operating budget this year.
Related Recommendations (1)
R3
MH use some general funds to help support client services. (Findings 6-9)
F7
The opinions expressed about management direction (by those interviewed) are that if a program is not self-supporting, then it should be eliminated. MH uses general funds only for matching other grant funds to support MH.
Related Recommendations (1)
R3
MH use some general funds to help support client services. (Findings 6-9)
F8
The State conducts annual Medi-Cal audits with a four-year period delay and mistakes accrue penalties during that period. Penalties from Medi-Cal audits have been a huge financial drain to MH.
Related Recommendations (1)
R3
MH use some general funds to help support client services. (Findings 6-9)
F9
MH has lacked internal audits and training to discover Medi-Cal billing errors. However, they have now hired a worker to minimize audit exceptions and maximize reimbursements. MH expects caseworkers to spend 70% of their time working on billable Medi-Cal issues. However, the achievable goal appears to be around 40% because most of their time is used for other non-billable tasks. TECHNOLOGY
Related Recommendations (1)
R3
MH use some general funds to help support client services. (Findings 6-9)
F10
The current Avitar patient computer system meets Health Insurance Portability and Accountability Act (HIPAA) regulations, and client notes are computerized. However, other important client information, such as medications prescribed or details of the last patient appointment, is not computerized and Avitar does not interface well with other external service providers’ systems.
Related Recommendations (1)
R4
Do a preliminary assessment for a new computer system or upgrades to the current system. The goal is significant savings in personnel time and costs. (Findings 10 and 11)
F11
Retrieval and editing of client notes is extremely slow and requires a lot of personnel time.
No recommendations for this finding
F12
Obtaining specific fiscal and program information is a problem, and financial reports are hard to read and understand by employees, clients, and the public. CLIENT SERVICES 3
Related Recommendations (1)
R5
MH administration print financial reports that contain specifically requested information. This information needs to be clear, concise and easily readable by the community. (Finding 12)
F13
MH has reduced client services to a minimal operating level. Services have been limited to those that are mandated, and the focus of the program has been for Medi-Cal and SMI clients. MH has increasingly re-directed clients to other contracted and non-contracted service providers.
Related Recommendations (1)
R6
MH hire additional qualified personnel to serve current and future MH clients in Mendocino County. (Findings 13 , 15 and 18)
F14
There is a common check-in window and waiting room for children waiting for immunizations, adults arriving for drug testing, and MH clients waiting for appointments.
Related Recommendations (1)
R7
MH administration create separate check-in and waiting areas for the diverse client population. (Findings 14 and 26)
F15
MH re-negotiated a cost-saving contract with prior vendor for transportation of clients. Now services are “on-call” from Napa, resulting in a long waiting period (a minimum of four hours for clients on the Mendocino County coast).
No recommendations for this finding
F16
MH hospitalizations were greatly reduced from the previous year (by 96 patients, 272 to 176), and admissions must now be approved by a supervisor, who may or may not be licensed.
Related Recommendations (1)
R8
The County establish suitable local housing for clients returning from MH out of county placements. (Finding 16 and 17)
F17
MH administration has stated that they want to “bring people home” from MH hospitalizations. However, there is a severe lack of local appropriate housing available to achieve this.
No recommendations for this finding
F18
MH services for Juvenile Hall and the Mendocino County jail were greatly reduced, and the psychiatrist in charge left County service. The County is currently contracting with a medical group for services. Prison/jail personnel expect arrival of realignment prisoners will increase the number of MH clients.
Related Recommendations (1)
R9
MH restore to last year’s levels the psychiatric services for jailed youth and adults. (Finding 18)
F19
MH has cut services on the Mendocino coast to a minimum operating level.
Related Recommendations (1)
R10
Mendocino County health clinics that are already serving large numbers of MH clients respond to the HHSA RFP to privatize County MH services when issued. (Findings 19 and 20)
F20
Public health clinics are reporting a large increase in their MH client load.
No recommendations for this finding
F21
Two years ago, MH had 125 employees; now there are fewer than 45 active employees. Some large caseloads are not realistic. There are almost no remaining licensed clinicians.
Related Recommendations (1)
R11
Human Resources use language that is more specific in employment advertisements for qualified MH personnel, particularly licensed clinicians, listing the experience and education requirements for job openings. These explanations need to be in addition to the mandated civil service requirements. (Findings 21- 25) 5
F22
Remaining caseworkers and some supervisory staff are still dedicated to providing what services they can.
Related Recommendations (1)
R11
Human Resources use language that is more specific in employment advertisements for qualified MH personnel, particularly licensed clinicians, listing the experience and education requirements for job openings. These explanations need to be in addition to the mandated civil service requirements. (Findings 21- 25) 5
F23
MH administration and staff have suffered from an enormous turnover of employees, which has resulted in the loss of some highly effective key personnel.
Related Recommendations (1)
R11
Human Resources use language that is more specific in employment advertisements for qualified MH personnel, particularly licensed clinicians, listing the experience and education requirements for job openings. These explanations need to be in addition to the mandated civil service requirements. (Findings 21- 25) 5
F24
The GJ has reports that some MH crisis workers have limited experience and others have not received the proper credentials or licensing to assess and diagnose clients.
Related Recommendations (1)
R11
Human Resources use language that is more specific in employment advertisements for qualified MH personnel, particularly licensed clinicians, listing the experience and education requirements for job openings. These explanations need to be in addition to the mandated civil service requirements. (Findings 21- 25) 5
F25
It is difficult to recruit and hire high-quality MH employees to Mendocino County. The HHSA Human Resource Department takes months to hire personnel; this is a result of civil service regulations, collective bargaining agreements, and cumbersome hiring systems (e.g. maintaining lists of qualified applicants). FACILITY RELOCATION
Related Recommendations (1)
R11
Human Resources use language that is more specific in employment advertisements for qualified MH personnel, particularly licensed clinicians, listing the experience and education requirements for job openings. These explanations need to be in addition to the mandated civil service requirements. (Findings 21- 25) 5
F26
MH moved to a Dora Street facility shared with the Public Health immunization clinic and AODP. The move cost around $100,000 total, of which they spent $20,000 to resize medical record retrieval equipment to fit the new space. As a cost-cutting measure, there is now only one check-in window in a small, inadequate waiting room. Mental health clients, clients coming for drug testing, 4 and children arriving for immunization are required to share a common space. Client confidentiality is difficult to maintain.
No recommendations for this finding
No Responses Found 2
Government entities assigned to respond to this report. No response documents have been linked in our database.
Mendocino County Board of Supervisors
Elected County Office
Mendocino County Sheriff
Elected County Office