2018-2019 Continuity Report - California Grand Jury Reports

Note: Missing finding numbers detected: F4, F6

Findings 5 findings

F1

The District does not have an effective system to follow-up with the public, schools, medical clinics, hospitals, or those who sign up to receive AirAware Alerts and Better Breather Alerts. APCD response: The following active communication programs related to alerting the public during air quality events include: • AirAware Text Notification Program • Better Breather Alert • Advertising the AirAware Alert System • Follow-up system for AirAware Alert System The Grand Jury acknowledges the improvements made by the APCD after the 2017-2018 Grand Jury pointed out that schools were not proactively notified.

F2

The PHF facility is woefully inadequate for a psychiatric hospital. Health Agency response: “The respondent disagrees partially with the finding. The Psychiatric Facility has consistently passed all licensing reviews for both condition and safety.”

F3

There is not enough room for the programs and therapies required towards a goal of recovery; a separate and dedicated area is lacking for both treatment rooms and physical exercise. Health Agency response: “The respondent partially disagrees with this finding. The Psychiatric Facility has consistently passed all licensing reviews for both condition and safety.”

F5

In the event of an emergency requiring evacuation during the night or evening, the required staffing is insufficient for the safety of the patients, staff, and community. In an area-wide emergency, law enforcement may not be able to respond. Health Agency response: “The respondent disagrees with this finding. The Psychiatric Facility has consistently passed all licensing reviews for both condition and safety.” The Grand Jury considers that staff and patient safety are a concern during the night shift. Law enforcement response to an emergency may not be timely and minimal staff are available to manage patients during an emergency. The Health Agency partially implemented:

F7

The outdoor area is inadequate for the number of patients served and doesn’t provide space for exercise. Health Agency response: “The respondent partially disagrees with this finding. The Psychiatric Facility has consistently passed all licensing reviews for both condition and safety.” Submitted May 21, 2019 4 The Grand Jury recognizes the PHF meets licensing requirements but suggests that an expansion of space could provide a more therapeutic environment for patients and staff. The responses do not address the issues raised by the Grand Jury. The Health Agency disagreed with:

Recommendations 5

R1

Even though the PHF second and third shifts meet minimum State standards, staffing levels should be increased for staff, patient, and community safety reasons. Health Agency response: “This recommendation has been partially implemented through the addition of permanent resources to the PHF in each of the past 5 years. The Department will continue to evaluate staffing needs at the PHF.”
R2

The San Luis Obispo County Jail should have its own dedicated psychiatric hospital facility, serving only inmates. This would limit the number of inmates admitted as patients in the PHF. When inmates are admitted to the new PHF, a correctional deputy should be assigned. Submitted May 21, 2019 5 Health Agency response: “The recommendation has been partially implemented. The Sheriff’s Office is in the process of establishing a behavioral health unit at the jail for inmates.” Board of Supervisors response: “The Sheriff’s office is in the process of establishing a behavioral health unit at the jail for inmates that will provide intensive day treatment services. The facility is anticipated to open in FY 2018-19. Additionally, through a Request for Proposal (RFP) process for jail healthcare services, the County included an option for proposals to estimate the cost of staffing and operating a psychiatric health facility at the jail.” 2018-2019 Grand Jury notes that the new behavioral health unit will open May 1, 2019. Future Grand Juries should review how the opening of the new behavioral health unit at the jail impacts the PHF. The Health Agency will not implement:
R3

The County should find or build a new psychiatric hospital facility, with sufficient room for patient treatment and recovery. Funding could come from reserves sources (County and/or MHSA [Mental Health Services Act]) or pursuing a state grant. Health Agency response: “Recommendation will not be implemented at this time as it is not feasible. If new grants, state, or federal funds become available this option will be evaluated.” Board of Supervisors response: “This recommendation will not be implemented at this time as it is not feasible. If new funding becomes available or current funding can be redirected, this option will be evaluated. The County is committed to maintaining and improving the existing Psychiatric Health facility (PHF).”
R5

Reorganize the agency to concentrate on the complete behavioral health treatment process. Health Agency: “This recommendation will not be implemented because it is not reasonable. The organization of the agency is not a factor on the ability to provide appropriate treatment services. As reflected in Recommendation 4, the County is obligated to provide specific treatment services based on diagnosis and functional needs to clients through highly regulated and monitored processes.” Board of Supervisors response: “This recommendation will not be implemented because it is not reasonable. The County is obligated to provide specific treatment services based on diagnosis and functional needs to clients through highly regulated and monitored processes.”
R7

The Sheriff should construct a psychiatric hospital on the jail campus or elsewhere within the County. Submitted May 21, 2019 15 Sheriff’s response: “This recommendation has not been implemented, but will be implemented in the future.” The Behavioral Health Unit will “encompass the previous medical/behavioral health facility (Stahl Hall) and the Modular buildings.” The newly remodeled Behavioral Health Unit was funded by community members and partners, as well as the County General Fund. “The Behavioral Health Unit is designed to improve on-going services and has the ability to house a Jail Based Competency Treatment (JBCT) program contracted with the State. The JBCT program will provide on site treatment for 1370 felony inmates so they will not have to wait or be transported to a State Hospital bed. The facility can also be used to assist 1370 Misdemeanor inmates, which will help with crowding issues at the County Psychiatric Health Facility (PHF). The facility is not compatible with, designed for, or properly licensed under the Lanterman-Petris-Short Act (LPS) to house or treat subjects being detained for Welfare and Institutions Code 5150. Subjects detained for W&I 5150 are considered detained and not arrested.” Board of Supervisors adopted the response of the Sheriff. The Grand Jury requested follow-up on this matter and in March 2019 an additional response was received: The Behavioral Health Unit is due to open March 29, 2019. Staff will begin using the new unit to treat mentally ill inmates beginning May 1, 2019. They will utilize “part of the Kansas Facility to house JBCT eligible inmates. Minor improvements will be made to accommodate these inmates.” No date has been set for the opening of the JBCT.

Conclusions 1

CL1

The 2018-2019 Grand Jury reviewed six reports from the 2017-2018 Grand Jury. In our review, we examined 38 findings and 30 recommendations. The Board of Supervisors and the various agencies that responded to these reports adopted 16 of the recommendations. We recognize and appreciate our leaders, as they show their dedication to improving our county services. Submitted May 21, 2019 35

Agency Responses 4

Government agencies' official responses to this report's findings and recommendations. Click on a response to see the structured breakdown.

Aff Housing - City of SLO Resp

September 19, 2019 • 4 pages • 3 responses • Score: -1 (+0, 0, -1) View Details ▾

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3 responses to findings and recommendations

R1

Even though the PHF second and third shifts meet minimum State standards, staffing levels should be increased for staff, patient, and community safety reasons. Health Agency response: “This recommendation has been partially implemented through the addition of permanent resources to the PHF in each of the past 5 years. The Department will continue to evaluate staffing needs at the PHF.”

Response: Unknown

Score: 0

The recommendation is constantly being looked at and the City maintains a Continuous Improvement Team that looks at any opportunities to efficiently analyze project consistently with federal, state, and local planning and building code requirements. The City of San Luis Obispo offers two different ways to expedite a permit during the plan check process. A determinate processing agreement can be developed that assigns responsibilities and deadlines for applicant submittals and for City plan check comments. This manner of expediting the issuance of a permit includes responsibilities on both side...

R5

Reorganize the agency to concentrate on the complete behavioral health treatment process. Health Agency: “This recommendation will not be implemented because it is not reasonable. The organization of the agency is not a factor on the ability to provide appropriate treatment services. As reflected in Recommendation 4, the County is obligated to provide specific treatment services based on diagnosis and functional needs to clients through highly regulated and monitored processes.” Board of Supervi...

Response: Unknown

Score: 0

The recommendation will be considered once we receive the results of our Affordable Housing Nexus Study and also considered during the development of the 2020- 2028 Housing Element. The recent update of the City's Zoning Regulations includes new provisions for tiny homes on wheels in the backyard of a site with an owner-occupied single-family residence. The City expects that the results of the Affordable Housing Nexus Study will inform any need for the addition of non-traditional housing options.

F7

The outdoor area is inadequate for the number of patients served and doesn’t provide space for exercise. Health Agency response: “The respondent partially disagrees with this finding. The Psychiatric Facility has consistently passed all licensing reviews for both condition and safety.” Submitted May 21, 2019 4 The Grand Jury recognizes the PHF meets licensing requirements but suggests that an expansion of space could provide a more therapeutic environment for patients and staff. The responses do...

Response: Disagree Score: -1

Disagree. The City of San Luis Obispo has been committed to providing timely and efficient building permit review times. Staff review submitted building plans to evaluate that proposed structures are designed in compliance with standard regulations, including the building code, planning approvals, and engineering standards. It is often the case that lengthy building permit review processes result when multiple rounds of these reviews occur. In 2018, the City took an average of 4 weeks to review the first round of submittals for new single-family units, and 5 weeks to review the second round of...

Dev Fee - SLO Office of Ed

August 01, 2019 • 3 pages View Details ▾

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Fire Risk - City of SLO Resp

September 19, 2019 • 3 pages • 1 response View Details ▾

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1 response to findings and recommendations

R4

Combine drug and alcohol treatment with mental health treatment, having all clinicians cross-trained to manage dual-diagnosis patients. Health Agency response: “This recommendation will not be implemented because it is not warranted. The County’s contracts with the State Department of Health Care Services are very prescriptive for the provision, documentation, and billing for mental health and substance use disorder services. Professional certification and licensure for addiction treatment and f...

Response: Unknown

Score: 0

The recommendation will be further investigated as an option to community fuel reduction projects as part of the recently completed San Luis Obispo City Community Wildfire Protection Plan (CWPP). The CWPP addresses fuel reduction as part of Strategic Policy FL1.4 Identify private/public partnerships for fuel reduction projects, and FL12.3 Create and maintain defensible space for critical infrastructure. Fuel reduction projects to create defensible space may incorporate the use of chipping as part of the removal technique. The City of Atascadero program provides residents in the Intermix area c...

Jail Insp - SLO PD

July 15, 2019 • 1 pages View Details ▾

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No Responses Found 1

Government entities assigned to respond to this report. No response documents have been linked in our database.

San Luis Obispo County Board of Supervisors Elected County Office