Sutter County Grand Jury • 2011-2012

Final Report of the 2011-2012 Sutter County Grand Jury*

Published: June 29, 2012 247 pages Consolidated Report

Ver PDF original

⚠️ Aviso de traducción: Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.

⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.

Findings 9 findings

F1 Page 16

an ambulance, acted inadequately in the treatment of the inmate. The JNM did not take any interest or immediate action responding to the inmate's

F2 Page 16

medical emergency which is inconsistent with RN training and not in compliance with the job description to provide professional nursing care. Although the 2010-2011 SCGJ recommended a December 31, 2011 completion date,

F3 Page 16

only about half of the P&P's have been finalized and made available on the intranet. There was no priority after the inmate death to immediately implement a policy that included vital sign parameters indicating when to call for an ambulance. According to the job description, the AD has direct involvement with JMS, not only for

F4 Page 16

oversight of the JNM's performance, but for the purpose of recognizing and improving employee problems. With the discontent amongst the JMS staff with the JNM, the AD is not attune to the problems at the jail medical clinic and/or not taking appropriate, decisive steps to resolve them. The AD violated the conditions of the job description by enabling the JNM to be

F5 Page 16

negligent of duties and responsibilities throughout the JNM's entire tenure. This includes continuous noncompliance by not reviewing and updating P&P's annually (Title 15 sec 1206 CA code), no in-clinic training program to assure standardized treatment procedures, and reluctance to act in the capacity of an RN. There is no in-house training provided to JMS staff that is specific to their job.

F6 Page 16

All JMS Management (JNM, AD, and HO) abrogated their responsibility by not

F7 Page 16

conducting an M&M-like conference following the death of the inmate. M&M-like conferences have not been held after adverse incidents at the JMS clinic.

F8 Page 16

These discussions have been discouraged by the HO. M&M-like conferences are of great value as a teaching tool for patient management. Stifling any discussions of these cases is a detriment to the JMS since it deprives the nursing staff team an outlet to reflect upon and review poor or avoidable outcomes. Both the NCCHC visit and SCGJ investigation independently came to many of the same

F9 Page 16

conclusions concerning issues with the JNP. 6

Recommendations 8

R1
Page 17

Clinical performance of the involved LVN should be evaluated by RN supervisors on a regular basis, and reported to the JNM. The JNM and the AD should then review oversight and performance of the LVN to determine if the LVN meets minimum nursing standards.
R2
Page 17

When present during an emergency situation the JNM should assume full responsibility as the lead RN to ensure professional quality medical care. The JNM should be more accessible when asked for guidance by jail nursing staff regarding inmate care, and be more available to assist as needed.
R3
Page 17

The JNM must ensure all JMS staff is thoroughly familiar with the new JMS Policy #16-506, which outlines parameters for abnormal vital signs and required actions.
R4
Page 17

The AD should evaluate and make changes to ensure the person in the position of JNM is capable of fulfilling all job responsibilities. This could entail periodic feedback from the nursing staff, more direct observation and frequent evaluations of the JNM's leadership abilities.
R5
Page 17

Every effort should be made by the JNM, AD, and HO to finalize and implement all P&P's and makes them available on the intranet. Thereafter, all P&P's should be reviewed and updated annually.
R6
Page 17

The JNM should encourage and foster a learning environment for the nursing staff. They should have opportunities to attend continuing education courses and arrangements should be made for in-house training relating to direct patient care, i.e. man down, suicide prevention, etc.
R7
Page 17

After a death or poor outcome at the jail clinic, the HO should conduct M&M-like conferences with the AD and all JMS staff present. The JNM, AD and HO share the responsibility to schedule these discussions.
R8
Page 17

JMS should implement all NCCHC recommendations. RESPONDENTS Director of Health and Human Services, Tom Sherry Assistant Director of Health and Human Services, Amerjit Bhattal County Medical Officer, Dr. Cummings Jail Nurse Program Manager, Brent Garbett APPENDIX A (Job Descriptions) APPENDIX B (NCCHC Report) 7 APPENDIX A . × 5 3/14/12 8:50 A County of Sutter Established: 1/78 Revised: 01/31/84; 07/30/96; 10/30/01; 12/06/05; 03/27/07 Salary Range: MGT59 FLSA: Exempt HEALTH OFFICER DEFINITION Under administrative direction of the Board of Supervisors and the Assistant Director of Human Services - Health, plans, organizes, directs and coordinates the activities of assigned medical programs; enforces local health orders and ordinances pertaining to protection of public health; assesses the community health status; advises the governing body concerning health issues. CLASS CHARACTERISTICS This is a single position classification that has primary responsibility for the enforcement of orders and ordinances pertaining to public health and sanitary matters. The incumbent also provides treatment and care for patients in the Health Department clinics. Positions at this level require highly specialized knowledge, abilities, skills and experience and exercise independent judgment in the performance of duties. Work requires creative ability, resourcefulness and discriminating judgment in the analysis and solution of complex problems, and the ability to make technical decisions on specialized matters. Work is reviewed in terms of fulfillment of goals, program effectiveness and soundness of judgment. EXAMPLES OF ESSENTIAL DUTIES The following duties are normal for this position. These are not to be construed as exclusive or all-inclusive. Other related duties may be required and assigned. 1. Assists the Assistant Director of Human Services - Health in planning, organizing, and directing the activities and programs of the Health Department and the Outpatient Clinic. 2. Enforces all applicable statutes, orders, regulations and rules relating to public health. 3. Provides direction and advice regarding policies and procedures directed by the state immunization board. 4. Assists in making decisions regarding investigation of communicable diseases, their diagnosis and treatment. 5. Directs the detection and control of communicable diseases, tp://www.co.sutter.ca.us/hr_jobs/showSpec.aspx?spec=/hr_jobs/job_specs/Health%20Officer.xml 3/14/12 8:50 A sexually transmitted diseases, and tuberculosis. 6. Directs the operation of adult, child, crippled children, and school health programs. 7. Directs public health education. 8. Promotes the advancement of maternal and child health. 9. Directs the recording of vital statistics. 10. Acts as medical director of the county jail medical facility; reviews and approves all examination and treatment records initiated by practitioners. 11. Approves all prescriptions dispensed by health department. 12. Performs professional care and treatment of patients in various clinics. 13. Conducts clinics to evaluate patients' health status, provide treatment, and provide advise. 14. Conducts immunization programs. 15. Administers a diagnostic and treatment program for individual patients under jurisdiction of the position. 16. May provide medical services at other county institutions. 17. Confers with members of the public and representatives of federal, state and local agencies regarding health department programs; cooperates with federal and state public health groups in the enforcement of health and sanitary matters. 18. Supervises, directs and evaluates assigned staff, to include assigning work, handling employee concerns and problems, and counseling. 19. Reviews technical requirements, reports and procedures generated by the health department. 20. Prepares public health information materials and news releases. 21. Reviews and countersigns various medical charts, reports and documentation; makes recommendations as appropriate. 22. Consults with physicians, nurses, patients, staff members, other county departments, agencies, or other individuals in the diagnosis of, and investigation of, cases of suspected communicable disease and to exchange information or provide recommendations; takes measures to prevent and control epidemics. 23. Answers the telephone, provides information, takes messages and/or directs calls as appropriate. 24. Responds to requests for information or assistance. 25. Provides education to the public; speaks before interested groups. 26. Serves on Emergency Medical Services Preparations tp://www.co.sutter.ca.us/hr_jobs/showSpec.aspx?spec=/hr_jobs/job_specs/Health%20Officer.xml 3/14/12 8:50 AM Committee. EXAMPLES OF MARGINAL DUTIES 1. Attends professional meetings and conferences. 2. Represents the County on committees, boards, at meetings, or otherwise as assigned. MINIMUM QUALIFICATIONS Knowledge of: Medical science and its applications to public health; the pertinent laws, ordinances, rules and regulations governing public health work; principles and practices of public health administration; operating policies and general functions of the State Department of Health Services; principles and practices of management necessary to plan, analyze, develop, evaluate and direct diverse and complex activities of major health programs; current trends, concepts and advances in public health; causes and modes of transmission of communicable disease; basic principles of budgeting; specialized medical equipment and instrumentation; and standard office equipment. Ability to: Plan, organize and direct public health programs within professional standards, legal requirements and financial constraints; direct and supervise professional and technical personnel; analyze situations accurately and take effective action; interpret laws, regulations and standards pertaining to public health; prepare clear and comprehensive records and reports; maintain accurate records; communicate effectively both orally and in writing; speak effectively in public; establish and maintain effective working relationships with patients, staff members, other departments, agencies, and public groups and organizations; operate a variety of standard and specialized medical equipment; and operate standard office equipment. Education and Experience: Graduation from a recognized medical school approved by the Council of Medical Education and Hospitals of the American Medical Association with a degree of M.D., or graduation from a recognized osteopathic medical school approved by the American Osteopathic Association with a degree of D.O. (Master's Degree in Public Health desirable), and progressive supervisory or administrative experience in a health department. Special Requirements: Essential Duties require the following physical skills and work requirements: Employees must be able to support the weight of patients for brief periods of time in positioning/ transporting and lift and hold babies or very young children; ability to operate and use a variety of health care equipment and tools. Other Requirements: Incumbent shall not have an ownership interest in any corporation, ttp://www.co.sutter.ca.us/hr_jobs/showSpec.aspx?spec=/hr_jobs/job_specs/Health%20Officer.xml 3/14/12 8:50 A partnership, or other entity engaged in any private practice of medicine, nor engage in any private practice of medical service. License or Certificate: Possession of a valid physician's and surgeon's license issued by the State of California either through the Board of Medical Quality Assurance or the Board of Osteopathic Examiners to practice medicine in the State of California. The County of Sutter is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the County will provide reasonable accommodation to qualified individuals with disabilities. Sutter County encourages both incumbents and individuals who have been offered employment to discuss potential accommodations with the employer. tp://www.co.sutter.ca.us/hr_jobs/showSpec.aspx?spec=/hr_jobs/job_specs/Health%20Officer.xml 3/14/12 8:49 A County of Sutter Established: March 1, 1996 Revised: 7/30/96, 10/30/01; 3/27/07 Salary Range: MGT51 FLSA: Exempt ASSISTANT DIRECTOR OF HUMAN SERVICES DEFINITION Under general direction, plans, organizes, and manages the daily operations of a comprehensive social services, bi-county mental health, or community health delivery system within regulatory and fiscal constraints; serves as a member of the department's senior management team; if assigned to the mental health unit, acts as Alcohol and Drug Program Administrator in accordance with Sections 11801 and 11963 of the Health and Safety Code. CLASS CHARACTERISTICS This class has primary authority and responsibility for directing for a functional area of services within the Human Services Department, such as social services, public health, public mental health, primary health, and jail health services. This position is not responsible for technical medical protocols associated with a M.D. Medical protocols and practice are associated with the County Health Officer, a licensed M.D. Work is accomplished within a broad framework of policies. Work requires creative ability, resourcefulness and discriminating judgment in the analysis and solution of complex problems, and the ability to make technical decisions on specialized matters. Work is reviewed in terms of fulfillment of goals, program effectiveness and soundness of judgment. EXAMPLES OF ESSENTIAL DUTIES The following duties are normal for this position. These are not to be construed as exclusive or allinclusive. Other related duties may be required and assigned. 1. Plans, organizes and directs operations of Social Services, the Public Health Department, Mental Health, and/or other human services programs. 2. Develops new programs and expand existing programs to meet community needs and state mandates, in coordination with management staff. 3. Coordinates and integrates program components into a cohesive and effective service delivery system. 4. Develops and implements policies and procedures in compliance with all applicable laws and guidelines. ttp://www.co.sutter.ca.us/hr_jobs/showSpec.aspx?spec=/hr_jobs/job_specs/Assistant%20Director%20of%20Human%20Services.xml 3/14/12 8:49 A 5. Ensures appropriate expenditure of public funds through the efficient operation of programs. 6. Establishes departmental budget and monitors expenditures. 7. Negotiates and monitors various contracted services. 8. Monitors utilization data, work production, and other information related to service delivery; directs operational changes to increase effectiveness and efficiency of operations. 9. Monitors the quality assurance and utilization review process. 10. Reviews clinical charts for proper documentation. 11. May perform studies, special projects or other managerial or administrative functions as assigned. 12. Supervises, directs and evaluates assigned staff, to include assigning work, handling employee concerns and problems, counseling, disciplining and completing employee performance appraisals. 13. Maintains liaison with representatives of state and regional health and service providers, interested community and other county departments. 14. Promotes public education on health issues; ensures dissemination of information regarding health services and department operations, as well as information published by other agencies or organizations to promote general knowledge of health services; makes public presentations upon request. 15. Prepares comprehensive reports related to program operations and activities. EXAMPLES OF MARGINAL DUTIES : 1. Responds to complaints and requests for information or assistance. 2. May act on behalf of the Director of Human Services in absence of same. 3. Acts as a representative of the county and the department on committees, at meetings or as otherwise assigned. 4. Attends meetings and conferences. MINIMUM QUALIFICATIONS Knowledge of: Principles and practices of program design, planning and tp://www.co.sutter.ca.us/hr_jobs/showSpec.aspx?spec=/hr_jobs/job_specs/Assistant%20Director%20of%20Human%20Services.xml 3/14/12 8:49 AM evaluation; federal, state and local laws and regulations governing program operations; principles and practices of management necessary to administer and direct programs; professional program and service delivery standards; methods and techniques of professional networking and interagency liaison; program integration methods of determining and communicating community needs; public information and public speaking techniques; clinical concepts; public relations, and county programs and services; budgeting principles and practices; principles and practices of supervision and employee development; and basic computer applications and techniques. Ability to: Plan, organize and direct comprehensive human services delivery systems within professional standards, legal requirements and financial constraints; understand, interpret and explain laws, regulations and policies governing program operations; research regulations, procedures and/or technical reference materials; coordinate and integrate various program components into a cohesive and effective service delivery system; formulate, promote and implement a variety of health programs; understand program objectives in relation to departmental goals and procedures; develop goals and objectives; evaluate program effectiveness; collect and analyze data to establish/identify needs; determine the appropriate course of action in emergency or stressful situations; make decisions and exercise independent judgment; supervise the work of others; instruct, persuade, negotiate and motivate individuals with diverse backgrounds and interests; establish and maintain effective interpersonal relations with individuals at all organizational levels; conduct liaison and community relations activities; communicate effectively both orally and in writing. Education and Experience: Four years of progressively responsible management and supervisory experience in a social services or clinical community health or mental health agency which included program planning and evaluation, budget management, personnel management and performance evaluation, and policy development; completion of core course work in Social Work, Health Administration, Business Administration, or closely related field; or any combination of education and experience that provides equivalent knowledge, skills and abilities. Special Requirements: Essential Duties require the following physical skills and work requirements: Requires the ability to exert a small amount of physical effort in sedentary to light work involving prolonged sitting, walking or moving from one area of the office to another, and standing for periods of time. Requires the ability to maintain mental capacity which allows the capability of exercising sound judgment and rational thinking under varied circumstances. Other Requirements: The Assistant Director of the Mental Health unit is required to possess one of the following: 1. A medical degree and California license in psychiatry with of http://www.co.sutter.ca.us/hr_jobs/showSpec.aspx?spec=/hr_jobs/job_specs/Assistant%20Director%20of%20Human%20Services.xml 3/14/12 8:49 AM two years of training in psychiatry, one year of which is administrative. 2. Master's Degree in social work and a Clinical Social Worker license, and five years related experience, two of which are administrative. 3. Ph.D. in clinical psychology with a California Clinical Psychologist license. 4. Marriage, Family, Child Counselor license and a masters degree in behavioral sciences and five years mental health experience, two of which are administrative. 5. Masters degree in psychiatric or public health nursing and license as a Registered Nurse in California and five years mental health experience two of which are administrative. 6. Masters degree in hospital administration, public health administration or public administration and at least three years experience, two of which have been in mental health. License or Certificate: Must possess and maintain an appropriate, valid driver's license. The County of Sutter is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the County will provide reasonable accommodation to qualified individuals with disabilities. Sutter County encourages both incumbents and individuals who have been offered employment to discuss potential accommodations with the employer. The County of Sutter is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the County will provide reasonable accommodation to qualified individuals with disabilities. Sutter County encourages both incumbents and individuals who have been offered employment to discuss potential accommodations with the employer. nttp://www.co.sutter.ca.us/hr_jobs/showSpec.aspx?spec=/hr_jobs/job_specs/Assistant%20Director%20of%20Human%20Services.xml 3/14/12 8:51 A County of Sutter Established: 11/9/04 Revised: 03/27/07 Salary Range: MNU44 FLSA: Exempt JAIL NURSE MANAGER DEFINITION Under general direction, to plan, organize, coordinate and manage jail medical services; to supervise nursing staff; to oversee quality assurance and legal compliance issues; and to perform related work as required. CLASS CHARACTERISTICS This is a single position classification having management responsibility for the jail nursing program and staff, reporting to and receiving direction from the Assistant Director of Human Services - Health Division with medical direction from the County Health Officer. This class is distinguished from the Supervising Nurse, which is a first-level supervisory position, and from the Director of Public Health Nursing, which has broader management authority and responsibility for a variety of public health nursing programs. EXAMPLES OF DUTIES The following duties are normal for this position. These are not to be construed as exclusive or all-inclusive. Other related duties may be required and assigned. 1. Plans, organizes and manages jail nursing services; directs operations and staff in the delivery of health services to inmates in the County jail facility. 2. Develops, implements and interprets goals, objectives, policies, procedures and standards, and interprets and implements laws, rules and regulations, to ensure quality of care and compliance with requirements. 3. Represents the jail nursing program and coordinates operations with other County departments, community agencies, boards, commissions and committees. 4. Provides professional nursing care as needed; responds and coordinates inmate emergency and urgent care. 5. Performs Discharge Planning of inmates and coordinates aftercare with other agencies. 6. Monitors and evaluates operations issues, new developments and requirements; develops, recommends and implements courses of action; evaluates, develops and tp://www.co.sutter.ca.us/hr_jobs/showSpec.aspx?spec=/hr_jobs/job_specs/Jail%20Nurse%20Manager.xml 3/14/12 8:51 A oversees implementation of new programs and services. 7. Supervises, directs and evaluates assigned staff; to include assigning work, handling employee concerns and problems, counseling, disciplining, and completing employee performance appraisals. 8. Directs and participates in the interviewing and selection of candidates for employment; directs employee training and development; guides subordinate supervisors in employee performance appraisal and counseling, disciplinary actions, documentation and related personnel actions. 9. Provides clinical and administrative consultation and problem-solving to staff, as needed. 10. Manages quality assurance activities; reviews nursing protocols, procedures and standards to ensure effective patient care and compliance with applicable policies and regulations. 11. Enforces and observes security precautions and requirements. 12. Conducts various staff and committee meetings; disseminates information to staff; confers regularly with superiors regarding policy and operational issues. 13. Participates in the development of the budget. 14. Prepares and maintains a variety of records, reports, studies and statistics related to jail nursing activities. 15. Reassigns and shifts personnel as required. 16. Attends meetings and conferences. MINIMUM QUALIFICATIONS Knowledge of: Principles and practices of management, including goal setting, program development, implementation and evaluation; administration and work planning; principles and practices of personnel management, including hiring, training and supervision; professional nursing principles, practices and techniques, including medical case management, medical/psychological assessment, patient care planning and delivery, patient education and evaluation of outcomes; medical terminology and equipment; principles and techniques of drug administration, uses, effects and adverse reactions to medications and controlled substances; principles, practices and techniques of safety and infectious disease control; laws, rules and regulations governing the practice of nursing in general and within County jail facilities; security issues and challenges of care delivery within a correctional institution; community medical and social agencies and resources; environmental, sociological and psychological problems affecting nursing care within a jail facility; child and elder abuse and neglect and domestic violence reporting laws. tp://www.co.sutter.ca.us/hr_jobs/showSpec.aspx?spec=/hr_jobs/job_specs/Jail%20Nurse%20Manager.xml 3/14/12 8:51 AM Ability to: Plan, organize, direct, schedule, set performance standards and evaluate staff; develop goals, objectives, policies, procedures and protocols; devise and adapt work procedures to meet changing program needs; understand, interpret, explain and apply laws, regulations and policies; perform physical and psycho-social nursing assessments and developing and implementing patient care plans and/or referrals; administer medications and performing skilled nursing treatments and procedures in a high-security setting for dysfunctional, stressed and/or uncooperative patients; assure quality of care and compliance with requirements; establish and maintain a cooperative working relationship with others; prepare and present clear and concise reports, instructions and correspondence; develop and evaluate program policies and procedures and implement as approved; work in an institutional setting and apply institutional rules, policies and procedures; deal effectively with manipulative, hostile and antisocial behaviors; respond effectively in emergency and stressful situations; make effective, reasonable and responsible decisions in emergencies and take appropriate action; deal firmly and fairly with inmates and demonstrate tact and diplomacy; identify alcohol, drug and street drug related symptoms and behaviors; oversee the maintenance of medical records and legally interpret medical records. Education and Experience: Four years of professional nursing experience, including one year of experience in a supervisory capacity; or any combination of education and experience that provides equivalent knowledge, skills and abilities. One year of experience in Discharge Planning or one year experience as a Public Health Nurse is desirable. Core college course work in administration or management is highly desirable. A bachelor's degree in nursing may substitute for one year of the general nursing experience. Special Requirements: Essential Duties require the following physical skills and work requirements: Must be able to apply first aid and CPR which requires stamina and coordination; push heavy objects such as Medical carts, or an occupied wheelchair; rapidly move to an emergency medical situation; distinguish colors of uniforms and armbands to identify inmate access to restricted areas; distinguish verbal and nonverbal sounds in a noisy environment; stand and walk for long periods of time; lift objects weighing up to 16 pounds, such as an emergency bag, portable oxygen tank, and medical card index files; mobility to work in both office and clinical settings, and to travel to various sites; touch in order to conduct physical health assessments; vision to read handwritten and printed materials, computer screens and to examine and observe patients; hearing and speech to converse in person and by telephone; mobility and strength to respond to emergencies. Other Requirements: Must pass a background investigation conducted by the Sheriff's Department. Must be willing and able to accept assignment in a locked jail facility serving clients of various cultural, physical, behavioral and psychological profiles. ttp://www.co.sutter.ca.us/hr_jobs/showSpec.aspx?spec=/hr_jobs/job_specs/Jail%20Nurse%20Manager.xml 3/14/12 8:51 AN License or Certificate: Possession of a valid California Registered Nurse license, a current CPR certificate, and a valid California Class C driver license. The County of Sutter is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the County will provide reasonable accommodation to qualified individuals with disabilities. Sutter County encourages both incumbents and individuals who have been offered employment to discuss potential accommodations with the employer. http://www.co.sutter.ca.us/hr_jobs/showSpec.aspx?spec=/hr_jobs/job_specs/Jail%20Nurse%20Manager.xml APPENDIX B . RECEIVED FEB 0 9 2012 SUTTER COUNTY HEALTH TONAL COMM . NO NO CORREL ; HEALTH TECHNICAL ASSISTANT REPORT OF THE HEALTH CARE SERVICES AT SUTTER COUNTY JAIL Yuba City, CA November, 2011 1 National Commission on Correctional Health Care 1145 W. Diversey Pkwy. Chicago, IL 60614-1318 (773) 880-1460 SUTTER COUNTY JAIL, CALIFORNIA , Introduction The Sutter County Jail, in Yuba City, California, is a design-rated 352-bed facility. The average daily population ranges from 180 to 230 inmates. The Sutter County Health Department provides health services. As is true across the country, the Sutter County Jail is experiencing a rise in health care costs and the number of inmates with health problems entering from the community. As a result, the county recognized a need to review its health-care delivery system in the jail and requested the National Commission on Correctional Health Care (NCCHC) to assess and propose solutions to improve its health care management and costs. In November 2011, the NCCHC conducted an on-site review of the Sutter County Jail. This report reflects our

Conclusions 17

CL1 Page 57

Ensure development of and compliance with policies and procedures.
CL2 Page 57

Approve Nursing Protocols
CL3 Page 57

Assigns Nursing Coordinator as chairperson of the Nursing Protocol Committee. Medical Director Responsibilities
CL4 Page 58

Ensure staff are trained: · Orientation of new staff All staff for new or revised nursing protocols at staff meetings .
CL5 Page 58

Provide for staff to attend committee meetings.
CL6 Page 58

Maintain document of training of Nurse Clinicians in uses of the nursing protocols. Nurse Clinician Responsibilities
CL7 Page 67

Heart sounds? В. LMP?
CL8 Page 68

R.O.M.? Difficulty walking? 9.
CL9 Page 67

Vaginal Discharge or bleeding?
CL10 Page 67

Dipstick urine results? 11.
CL11 Page 67

12. Is pain related to food intake? ASSESSMENT DECISION
CL12 Page 67

Is pain related to food intake? ASSESSMENT DECISION
CL13 Page 212

Have an appraisal done of businesses in question and evaluate the Fair Market Value with the current price structure
CL14 Page 212

Determine a long-range plan to bring those rates up to the FMV
CL15 Page 212

Negotiate long-term leases with those businesses willing to do so, including the rate increases to bring them up to FMV and include a CPI increase annually
CL16 Page 212

Establish a set amount or percentage of General Fund support that the Board of Supervisors is willing to provide
CL17 Page 212

Look at long-term projections and determine if it is possible under the above conditions to maintain the airport in the future 9 0.00% 14.89% 11.41% 0.00% 36.84% 13.13% 0.00% 25.41% 2.64% 0.00% 0.00% 4.04% 0.00% 1.94% 1.94% 0.00% 7.74% Operations % GF - of Contribution 29,899 38,630 12,523 9,204 216,733 409,054 15,733 22,725 34,292 67,773 General 1 Fund S 5 S S 969'08 852,910 189,170 409,670 81,150 261,124 179,765 2,045,573 223,000 2,601,595 259,465 475,081 1,107,712 1,676,337 Operations ı ı Costs Forty-four percent (44%) of all public airports are owned by Counties - the rest are owned by cities. S S S available on Projects -if $ 660,000 $1,755,200 $1,950,000 $6,252,257 budget 5 The average GF contribution as a percentage of total operating budget is 1.94% 921,124 1,836,350 969'08 409,670 2,129,765 189,170 852,910 223,000 8,853,852 1,170,039 259,465 1,107,712 2,045,573 21,060,705 475,081 1,676,337 810,027 Total Annual 1 ı Airport Research Budget Attachment A Picked the counties whose population puts Sutter as the median. S S $ 5 S S 5 5 Employees 3.00 19.50 9 2.00 19.00 8.80 4.00 1.00 1.00 7 ı ı Of the 58 counties, 4 (22%) have no airport responsibility. # One County airport for every 77,013 people on average County owned 43% # of 26 4 00 0 4 7 \vdash 0 77 \forall \vdash 7 2 9 \vdash The average annual budget is $1.170.039 The average GF contribution is $22.725 Airports The average airport has 2 employees Public Total 9 9 \infty 7 2 7 2 \vdash 9 2 6 3 7 7 4 4 3 10 2,002,343 77,013.19 95,878 176,158 182,236 199,066 62,419 64,059 71,929 90,163 99,186 136,704 154,434 179,722 56,799 57,784 132,821 150,887 45,971 46,127 Population 18 22% Mendocino San Benito Tuolumne Calaveras Humboldt El Dorado County Imperial Siskiyou Tehama Nevada Madera Shasta Sutter Napa Kings Lake Yuba Yolo TotalPer AirportAverage 9,408 1,472 76,913 9,393 12,820 74,996 8,731 220,344 4,841 (932) 109,342 48,500 69,064 92,657 313,000 12,085 168,995 10,000 226,353 121 236,353 405,469 92,469 . . 2010 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ S S S S S S $ 5 $ $ $ $ $ $ $ $ $ $ 5 S S (225,174) 10,000 40,000 4,168 6,184 2,051 34,249 472,490 12,163 3,204 20,000 70,232 5,455 490,108 90,601 006'69 248,137 14,141 181,025 671,134 14,117 445,959 177,822 268,137 ı 1 1 . 2009 · · · · · · · · · · · · · · · · · · · S $ *** S $ S S S S S 8 8 8 8 $ (30,590) 12,724 8,660 11,505 78,180 6,072 10,321 978 35,551 44,447 6,036 17,541 12,496 209,430 14,206 2,158 70,328 40,000 66,600 40,000 226,971 153,292 3,089 196,381 1 1 1 ı, 2008 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 *** S S S S S S S v v v v v S $ (72,699) 2,788 32,080 73,850 10,848 4,493 11,267 6,901 37,362 54,794 20,000 5,021 6,584 302,874 4,994 68,048 12,261 11,776 14,323 13,096 100,000 186,138 97,357 248,080 44,037 230,175 1 1 2007 · · · · · · · · · · · · · · · · · · · S 5 5 5 5 5 5 Ş S S S S S S S S S S 5 S $ (79,562) 10,190 111,010 235,843 7,099 67,102 253,131 504,645 15,310 806'99 245,222 9,132 5,2019,957 2,177 10,397 8,091 14,343 251,514 91,028 1,064 425,083 14,104 5,552 245,222 178,797 1 . . 2006 · · · · · · · · · · · · · · · · · · · S S S S S S $ S $ $ $ $ $ $ W W W S S 5 (18,820) (2,657) 2,996 9,533 33,428 1,750 35,000 124,590 17,420 6,1689,5434,128 53,937 16,373 13,908 16,315 7,580 279,834 5,506 68,408 36,750 261,013 14,945 135,097 309 246,405 223,955 1 • 2005 Attachment B - Airport Profit and Loss *** S S s 5 S S S S S S S S $ $ $ $ W W W 5 S 17,558 5,305 13,268 6,484 3,243 8,875 8,028 16,903 218,811 22,931 127,443 11,787 4,837 67,875 144,409 10,000 241,742 8,821 201,908 14,621 231,742 10,000 1 1 Ţ. 1 2004 S · · · · · · · · · · · · · · · · · · · S S S S S S S $ 8 8 8 8 $ 4 4 4 S S S $ 5 19,599 8,218 36,261 103,398 9,300 11,683 6,169 14,064 8,443 201,169 63,326 27,527 14,490 164,909 14,054 5,609 115,354 10,000 5,805 198,343 30,308 45 228,697 1 1 1 1 2003 S 0 0 0 0 0 0 0 0 0 0 0 *** S $ S S S S S S N N N N $ $ S 9,725 184,240 180,699 7,600 197,126 14,896 6,854 62,696 10,000 21,232 8,500 4,832 381,366 140,664 50 402,598 132,007 9,672 5,703 13,801 8,827 225,111 177,437 1 1 1 1 2002 0 0 0 0 0 0 0 0 0 0 0 S S S S S S S S S S S 8 8 8 8 S S S S $ $ 7,600 16,811 10,923 65,913 10,000 244,044 39,352 7,369 11,211 187,882 9,211 204,693 13,439 8,259 146,433 234,044 10,000 129,200 17,800 5,097 6,282 1 1 1 1 1 . • . 2001 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ S S S S S S S $ S W W W S Ξ 4 4 4 4 $ 5 $ (7,502) 10,000 6,320 7,600 9,595 184,776 3,929 0 10,000 177,275 94,713 146,254 21,327 38,522 66,58083,279 7777 16,687 13,487 167,274 4,957 - 1 . 1 • • 1 • 2000 · · · · · · · · · · · · · · · · · · · S S S S S S S s $ $ $ S S S S 5 5 5 5 $ 5 5,318 6,030 172,011 58,096 9,172 10,659 111,545 126,922 9,756 14,484 308,689 11,71456,38975,709 10,000 130,000 190,000 65,882 14,469 50 478,331 420,235 158,281 1 . 1 - 1 . 1999 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ *** S S $ $ $ $ $ $ 4 4 4 4 $ 5 S S Admin - Misc. Depts Profit/(Loss) - URC Revenues Expenses Sp. Dept Expense Operating Plant Acquisition Operating A-87 - Overhead Interest Expense *Miscellaneous Capital Grants Total Revenues Weed Control Total Expenses LT Debt repay LT Debt Proceeds Maintenance Prof Services Total Operating Admin - PW Total Operating Misc. Revenue A-87 - BM Structure Total Capital State Aid Total Grants Utilities Interest Rents CAAP Taxes Fuel Fuel FAA (51,349) 220,344 69,064 48,500 (51,349) (20,564) (30,785) 151,280 (30,785) 2010 $ $ * S $ $ S $ s s S (3,203) (3,203) (332) (332) (2,871) 181,025 177,822 (2,871) 70,232 110,793 2009 S 5 $ $ $ $ $ S 5 $ $ (56,138) (44,557) (11,580) (56,138) 209,430 78,180 (44,557) 131,25086,692 2008 * $ $ $ $ $ $ $ $ s s $ (61,942) 248,080186,138 (61,942) 97,357 (64,586) (64,586) 2,643 150,72486,138 2007 $ 5 5 $ $ S s s S $ $ $ (72,717) (72,717) (52,735) 111,010 (19,982) 251,514 (52,735) 140,504 87,769 2006 $ s s s s 5 S 5 $ $ S (22,451) 246,405 (22,451) (32,958) 124,590135,097 (32,958) 121,816 10,507 2002 Attachment B - Airport Profit and Loss 5 $ 5 s s 5 S S $ 5 5 201,908 127,443 29,834 16,966 29,834 12,868 74,465 12,868 2004 $ 5 $ s s S $ 5 S S S 164,909 198,343 103,398115,354 33,435 33,435 11,957 21,478 61,51182,989 21,478 Equip Maint, Memberships, Office Expenses, Misc Prof Services, Training, Travel, IF Gen Ins, Postage, Printing, 2003 s s $ * s s s s S $ $ $ 184,240 225,111 32,214 132,007 40,871 40,871 52,233 32,214 8,657 2002 *Miscellaneous Expenses - Extra Help, Communications, Household Exp, Copy Service $ $ 5 S S s s 5 $ $ S 187,882 46,162 129,200 17,233 46,162 28,929 58,68287,611 28,929 2001 $ $ S S 5 $ $ 5 S S 12 21,020 (11,434) 146,254 (11,434) 94,713 21,020 32,454 32,454 51,541 83,995 2000 S 5 s s 5 S s s 5 $ $ 111,545 46,735 65,882 46,735 9,827 36,908 9,827 45,663 36,908 1999 S $ $ $ 5 S * 3 True Operating Profit/(Loss) $ $ $ True Operating Profit/(Loss) $ Operating Expense w/o Fuel Operating Profit/(Loss) Operating Profit/(Loss) Operating Revenue Operating Expense Revenue w/o Fuel Fuel Profit/Loss Fuel Profit/(Loss) Fuel Revenue Fuel Expense $168,99 $220,34 $(51,34 2010 $181,02 $177,82 $(3,203 2009 $209,43 $153,29 $(56,13 2008 $248,08 $(61,94 $186,13 2007 $(72,71 $251,51 $178,79 2006 Operating Profit/(Loss) $246,40 $(22,45 $231,74 $223,95 2005 $29,834 $201,90 2004 □Operating Profit/(Loss) | $46,735 | $21,020 | $46,162 | $40,871 | $33,435 $164,90 $198,34 2003 $184,24 $158,28 $167,27 $234,04 $225,11 2002 $187,88 2001 $146,25 2000 13 $111,54 1999 $(50,000) $(100,000) $250,000 $300,000 $150,000 $200,000 $100,000 $50,000 ■Operating Revenue ⊹ ■Operating Expense $34,249 $76,913 $35,422 $1,472 $8,731 $9,941 2010 ş $11,267 | $10,321 | $10,000 $32,080 $35,551 $40,000 $2,051 $4,168 2009 ş $4,493 $12,724 $73,850 $44,447 $8,660 2008 ş $6,901 2007 ş. $17,558 $53,937 $67,102 $9,957 $13,268 $16,373 $10,397 $14,104 $9,132 $8,091 2006 Attachment D - Major Expenses $8,821 $17,420 $9,543 $2,996 $(2,657) 2002 $8,000 $6,484 $3,243 2004 $14,490 $11,683 $9,300 $6,169 2003 ÷ Ś $9,672 $13,801 $8,500 $4,832 2002 Ś ŝ $14,484 $13,801 $17,800 $10,923 $7,369 $6,282 2001 ş Ϋ́ $6,320 $9,777 2000 ŝ Ŷ Ś 14 $6,030 $9,172 1999 ÷ ş Ś Maintenance Utilities — Utilities — Admin - Misc. Depts — Admin - PW — A-87 - Dwerhead $90,000 $80,000 $70,000 $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 $(10,000) ÷ $220,344 ■Operating Revenue $158,281 $167,274 $234,044 $225,111 $198,343 $231,742 $223,955 $178,797 $186,138 $153,292 $177,822 $168,995 $(51,349 2010 $221,151 $(43,329 2009 $236,903 $(83,611 2008 Attachment E - Operating Profit/(Loss) - Extrapolated A-87 $243,777 $(57,639 2007 $255,068 $311,100 $296,571 $(117,77 2006 $(87,145 2005 $(23,325 2004 $164,718 | $201,242 | $238,464 | $229,243 | $219,551 $(21,208 2003 $(4,132) 2002 $(4,420) 2001 15 $(33,967 2000 $(6,438) 1999 Operating Expense $(50,000) $(100,000) $(150,000) $350,000 $300,000 $250,000 $150,000 $200,000 $100,000 $50,000 ş □Profit/Loss 9,408 12,820 109,342 9,941 1,472 35,422 76,913 9,393 74,996 4,841 12,085 (932) 48,500 10,000 69,064 8,731 220,344 313,000 168,995 226,353 121 405,469 92,469 92,657 236,353 ı 2010 · · · · · · · · · · · · · · · · · · · S S S S S S s $ $ $ $ $ $ $ S S S $ $ $ $ (265,300) 12,163 20,000 10,000 2,051 40,000 74,375 472,490 5,455 490,108 711,259 3,204 90,601 248,137 70,232 4,168 6,184 14,141 14,117 006'69 445,959 268,137 177,822 221,151 1 ı 2009 S S S S · · · · · · · · · · · · · · · · · · · $ S S S S S $ S S S S $ $ $ S (58,064) 8,660 11,505 6,036 35,551 12,496 254,445 14,206 70,328 40,000 978 71,921 17,541 2,158 009'99 40,000 78,180 12,724 6,072 153,292 3,089 196,381 10,321 236,903 1 2008 $ $ $ $ $ $ S S ************* S $ $ $ $ $ 5 5 5 5 5 5 5 $ 5 (98,396) 20,000 11,776 10,848 13,096 68,048 12,261 6,584 54,794 298,571 4,994 230,175 4,493 2,788 37,362 100,000 186,138 44,037 97,357 32,080 14,323 5,021 11,267 6,901 69,547 243,777 ۲, 2007 $ S 0 0 0 0 0 0 0 0 0 0 S *** 5 $ A 4 4 4 4 W W W $ $ (124,619) 15,310 10,190 235,843 7,099 549,702 806'99 245,222 425,083 111,010 9,957 67,102 67,252 14,343 253,131 5,552 91,028 1,064 5,201 2,177 296,571 245,222 9,132 10,397 178,797 . . 2006 S S S S S S $ $ $ $ $ $ $ $ $ $ S s S *** S S $ $ (83,514) Attachment F - Airport Profit and Loss - Extrapolated A-87 1,750 35,000 344,528 14,945 309 261,013 13,908 16,315 9,533 7,580 33,428 5,506 36,750 4,128 16,373 65,033 311,100 68,408 124,590 17,420 6,168 9,543 53,937 135,097 223,955 1 2005 s S $ $ $ S s $ *** 5 S S S S S S S S S S $ 5 (30,229) 10,000 241,742 8,875 8,028 271,971 14,621 67,875 8,000 17,558 13,268 11,787 144,409 231,742 10,000 127,443 5,305 62,887 255,068 16,903 4,837 8,821 1 1 ( 1 1 1 1 2004 s S S S S S $ S S S S S S S S S S S S S S S S S S S S S S S $ 5 (27,115) 255,812 14,064 8,218 14,054 63,326 10,000 9,300 8,443 115,354 20,308 45 228,697 103,398 14,490 5,805 11,683 60,811 219,551 19,599 5,609 198,343 30,308 36,261 1 1 ı 1 2003 40 $ $ $ $ $ $ $ $ $ $ $ $ $ S S S S s S S S S S S S S s $ 5 S 5 (23,772) 2,600 426,369 10,000 20 4,832 58,805 9,725 180,699 402,598 5,703 229,243 8,827 197,126 14,896 6,854 62,696 140,664 167,437 132,007 9,672 225,111 177,437 1 - 1 1 2002 $ S S $ $ s $ 5 S $ $ $ $ $ $ $ $ $ $ $ $ $ W W W W S S S S (11,231) 255,275 13,439 10,000 244,044 11,211 7,600 9,211 8,259 65,913 146,433 234,044 129,200 17,800 7,369 10,923 56,864 238,464 16,811 10,000 5,097 1 1 1 1 1 1 2001 16 s S $ $ 5 S S $ $ $ $ $ $ $ $ $ $ $ $ $ S $ $ $ S S S S S 5 5 5 (62,489) 10,000 13,487 0 239,764 3,929 167,274 10,000 177,275 6,320 54,988 16,687 201,242 21,327 7,600 9,595 66,580 83,279 94,713 9,777 38,522 13,801 4,957 1 1 0.00 1 1 2000 S S S Ś 5 5 5 S S *** 5 5 5 5 $ $ 5 S $ 5 4,923 14,469 10,000 10,659 172,011 473,408 75,709 190,000 20 5,318 6,030 9,172 53,173 164,718 9,756 308,689 11,71456,389 158,281 130,000 478,331 14,484 65,882 1 . 1 1999 50000 S S S S S ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 8 8 8 8 8 8 S $ $ S **A-87 - Overhead & BM Admin - Misc. Depts Profit/(Loss) - URC Revenues Expenses Sp. Dept Expense Operating Operating Plant Acquisition Interest Expense *Miscellaneous Capital Grants Total Revenues Weed Control Total Expenses LT Debt repay LT Debt Proceeds Maintenance Prof Services Total Operating Admin - PW Total Operating Misc. Revenue Structure Total Capital State Aid Total Grants Utilities Interest Taxes Rents CAAP Fuel Fuel FAA (51,349) (30,785) (51,349) (20,564) (30,785) 220,344 69,064 151,280 2010 5 3 $ $ $ $ 5 S $ $ $ $ (42,997) (42,997) (43,329) (332) (43,329) 150,919 221,151 177,822 70,232 2009 5 $ 5 S S S $ 5 5 $ 5 (72,031) (72,031) (83,611) (83,611) (11,580) 158,72386,692 236,903 78,180 66,600 2008 $ (60,283) $ $ $ S $ $ 3 $ 5 $ $ (60,283) (57,639) 2,643 243,777 (57,639) 97,357 146,42186,138 2,643 2007 $ (262,76) * S S $ $ $ 5 $ $ $ $ (117,774) (97,792) (19,982) (117,774) 111,010 185,56187,769 296,571178,797 2006 * * $ 5 $ $ $ $ $ 5 $ $ (97,652) (87,145) (97,652) Attachment F - Airport Profit and Loss - Extrapolated A-87 (87,145) 311,100 124,590 186,51088,858 10,507 2002 * S $ $ 5 $ $ 5 $ $ $ $ (40,292) (40,292) (23,325) (23,325) 127,443 127,625 255,068 231,742 16,966 2004 $ S S S $ $ $ $ 5 $ 5 (33,165) (33,165) (21,208) (21,208) 116,154 82,989 219,551198,343 103,398 11,957 Equip Maint, Memberships, Office Expenses, Misc Prof Services, Training, Travel, IF Gen Ins, Postage, Printing, 2003 S * S $ $ $ $ $ $ 5 $ 5 (12,790) (12,790) (4,132)8,657 (4,132) 97,236 229,243 132,007 8,657 2002 *Miscellaneous Expenses - Extra Help, Communications, Household Exp, Copy Service $ S * $ $ S $ 5 s s s s (21,653) (21,653) (4,420) (4,420) 129,200 109,264 87,611 238,464 17,233 2001 17 S 5 $ $ $ S $ $ S $ 5 (22,533) (22,533) applied to all years equally. (33,967) (11,434) 201,242 (33,967) 94,713 106,529 2000 S S $ 5 5 s s 5 S $ 5 (16,265) (16,265) (6,438) (6,438) 98,836 164,718158,281 75,709 65,882 9,827 1999 ** Averaged last 4 years of A-87 and $ $ 5 $ 5 S $ 5 5 $ 3 True Operating Profit/(Loss) True Operating Profit/(Loss) Operating Expense w/o Fuel Operating Profit/(Loss) Operating Profit/(Loss) Operating Revenue Operating Expense Revenue w/o Fuel Fuel Profit/Loss Fuel Profit/(Loss) Fuel Revenue Fuel Expense Taxes, $12,085 Rents, $109,342 Interest, $(932) 2010 2009 Attachment G - Revenues not including Fuel 2008 2007 2006 2002 2004 2003 2002 2001 2000 18 1999 $120,000 $60,000 $20,000 $100,000 $40,000 $80,000 Ş Fuel Expense, $69,064 Fuel Revenue, $48,500 2010 2009 2008 Attachment H - Fuel Expense and Revenue 2007 2006 2002 2004 2003 2002 2001 2000 19 1999 $160,000.00 $120,000.00 $80,000.00 $60,000.00 $40,000.00 $20,000.00 $140,000.00 $100,000.00 $0.00 3 9 $39,824.00 3,686.34 $ 2,182.46 275.10 8,803.20 $24,271.68 605.22 Total Cost per Year S S S S $2,022.64 307.20 733.60 181.87 $3,318.67 per month 22.93 50.44 Total Cost $ S S $ $ per month Labor cost 72.70 43.04 173.60 785.33 478.64 5.43 11.94 Overhead cost = x .31 $ S $ Ş S $ S 138.83 $2,533.33 Labor Cost 38.50 560.00 234.50 $1,544.00 17.50 S S S S Ş 96.00 42.00 42.00 34.00 42.00 42.00 Labor Rate Admin Hours for Public Works $ S S $ $ S 11.00 5.00 160.00 193.00 67.00 49.00 485.00 0.23 Estimated Annual Hours Attachment I 5.58 Estimated 13.33 4.08 40.42 16.08 0.42 0.92 Monthly Hours 242.50 80.00 33.50 24.50 2.50 5.50 96.50 December 31, 2010 through Hours Leases, Insurance, Past Dues Invoices/Rental Payments 20 Customer Service Duties FTE = 2080 hours Management Accounting Accounting Office Assistant II Office Assistant II Deputy Director Position Accountant II Accountant I Accountant I Totals Payroll based on Employees, Claims based Actual costs over or under the budgeted Vendors based on number of Warrents, Accounting is based on Journal Entries, Based on two years prior actual costs maintenance, and administration 469 | Purchasing based on hours spent Actual costs, custodial, grounds, This is a 4% annual increase Payroll based on Employees This is a 3% annual increase on number of Warrents 628 Number of Employees costs for 2 years prior Based on % of salary Based on Employees Mail, printing, copier Based on Warrents Square footage A-87 Costs Explanation 272 1,615 136 52,493 24,420 1,640 782 46,843 108 76,913 76,913 FY 2009-10 FY 2007-08 Attachment J ı S S S S S S S S S S $ $ S S 5 33,846 1,543 72 35,914 583 727 607 291 198 69 40,004 73,850 73,850 FY 2006-07 FY 2004-05 1 S S S S $ S S 5 S $ S 5 S S S 1,338 35 74 19,049 55 4,945 20,230 13,801 39,334 19,104 34,389 37 FY 2001-02 FY 1999-00 1 t S S S S S S S S S S 5 S S S 5 Building Maintenance 21 External Audit Costs Building Allowance County Counsel Central Services Total A-87 costs Budgeted Costs A-87 costs used Carry Forward Year based on Purchasing Difference Personnel Treasurer Auditor CAO ATTACHMENT B · · . a a COUNTY OF SUTTER PUBLIC WORKS DEPARTMENT BOARD MEETING: DECEMBER 7, 2010 PWSS REVIEW: OCTOBER 14, 2010 TO: HONORABLE BOARD OF SUPERVISORS SUBJECT: ADOPT A RESOLUTION ADJUSTING THE RENTS AND FEES CHARGED FOR SUTTER COUNTY AIRPORT LAND FOR COMMERCIAL USE Recommended Action: That the Board of Supervisors conduct a public hearing and, at the conclusion of the hearing, adopt the attached Resolution adjusting the rents and fees charged for airport land used for commercial use effective January 1, 2011; and authorize the not to exceed maximum for the Pooled Treasury / General Fund loan, required to maintain ongoing Airport operations, be increased from $125,000 to $225,000. Background and Discussion: The County Airport budget consists of expenditures and revenues necessary to operate and maintain the Sutter County Airport for general aviation purposes. The Airport facility generates income by charging rental fees for use of the County-owned land, hangars, hangar sites, storage spaces, flight-based commercial land use operations, and tie downs. The Airport operates as a separate enterprise, and as such, must generate revenues to sufficiently cover the costs to operate and maintain the Airport facilities. Over the last several years, the Airport has been using its existing fund balance to balance expenses with revenue; this fund balance was depleted in FY 2008-09. On October 7, 2008, staff presented to the Board of Supervisors a proposal to gradually increase all rates at the Sutter County Airport over an 8-year period with temporary deficits in operation funds covered by a loan from the General Fund. At that time, the Board of Supervisors only approved the proposed rate increase for hangars, private hangars, tie downs and storage spaces. The proposed rate increase for the commercial tenants was deferred to an Ad Hoc Committee. The Ad Hoc Committee met several times with the commercial tenants and reviewed a number of possible commercial rate adjustments. On January 13, 2009, the Board of Supervisors approved the interim commercial rate adjustments recommended by the Ad Hoc Committee, with the understanding that the approved increases were insufficient to bring the operating budget into balance. For this reason, the Ad Hoc Committee recommended that commercial rates for the Sutter County Airport be reviewed again by staff in 2010. An increase in revenue is required to maintain the operations and ongoing maintenance of the Airport and, subsequently, pay back the funds borrowed from the General Fund. The recommended alternative includes an increase in commercial rents over a 5-year period, with temporary deficits in operating funds covered by a loan from the General Fund to be capped at $225,000. This option would increase the monthly rent from the current $.0039 per square foot ($169.88 per acre per month) for land to $.0346 per square foot ($1,507.18 per acre per month) over five years and subsequently, on an annual basis, by the Consumer Price Index (Western Urban Cities - May to April). If the recommended rate increase proposal is approved, it is estimated that the General Fund loan would be repaid by year 9. DEC 0 7 2010 Page 2 of 3 Similar land leases at the Yuba County Airport are charged at the rate of $0.07 per square foot. Additionally the commercial users pay a fuel flowage fee of $0.065 per gallon for fuel they bring onto the airport as a use fee for the airfield. Sutter County does not charge a fuel flowage fee for fuel brought onto the premises, nor is staff proposing one at this time. Yuba County Airport is classified as a regional airport and has a longer runway enabling larger aircraft to use the airport and two runways in total, enabling aircraft to use the airport in more varied weather conditions. There are some additional services available at the airport. Therefore, staff is recommending that the land rental fees not be increased beyond 65% of the Yuba County Airport rate since the value of the Sutter County airport is less to commercial operators. The rents for commercial tenants for office and maintenance bay buildings remain as previously approved and will increase annually by the Consumer Price Index (Western Urban Cities - May to April). The attached spreadsheet showing the revenue increases is based on present values without inflation. No Consumer Price Index increases are proposed for commercial tenants during the phased increases period. The attached resolution only extends to year 4. Rates would have to be revisited in FY 2014-15 for continued adjustment. In order to maintain Airport operations, the Board approved a loan from the Pooled Treasury / General Fund on June 23, 2009 with a not to exceed maximum of $125,000. In FY 2009-10, the Sutter County Airport budget used $102,103 of this loan balance. If the proposed rate increases are approved, the necessary loan amount will increase over the next five years to a not-to-exceed peak of $225,000 at which time the Sutter County Airport will begin to repay the loan. Letters including this staff report and proposed rate increases, along with the date of the Public - Works/Support Services Committee meeting, were sent to the three affected commercial tenants. On August 12, 2010, the Public Works / Support Services Committee (Committee) met with affected airport lease holders. After discussion, the Committee directed staff to look at two additional alternatives. The first alternative considered charging commercial land leases holders solely for the footprint of their buildings and structures. Typically, leases for land include all the land in the lease and rental charges are for the footprint of the land used by the lessee, not the footprint of buildings and structures owned by the lessee. The other airport in the area, Yuba County Airport, leases its land at rates based on the total land used by the lessee. The result of using the buildings/structures footprints also does not provide sufficient revenues to balance the budget for the airport as shown in the attached Rates and Loan Balance Projections. It projects that the Airport Fund would continue to operate at a loss and the debt would climb to $261,164 by year 8. The second alternative reduces the footprint charged to land actually used for buildings, storage, parking, operations, and equipment staging. This is the recommended alternative as it bases the rental fees on the actual land used by the lessee, as is common in practice. The result of using this method to project revenues is included in the attached Rates and Loan Balance Projections. It projects that the airport fund would stop operating at a loss and the General Fund debt would be paid off by year 9. To execute this reduction in leased area, Onstott Dusters leased area would be reduced in 2012-2013. Twin Cities leased area would be reduced in 2016-2017 when their current lease expires. After a second review by the Committee, the Committee recommended approval of the attached rate schedule which assumes some reductions in leased footprints at the times specified above. Page 3 of 3 Prior Board Action: The Board of Supervisors adjusted some of the Airport Commercial rates on January 13, 2009 and instructed staff to review these rates again in 2010. Alternatives: The Board could increase the General Fund loan or grant funds to the Airport. Other Department and/or Agency Involvement: No other County Departments or Agencies would be affected by an adjustment in the Commercial rates at the Airport. Action Following Approval: Direction given by the Board would be implemented by the Public Works Department. Fiscal Impact: Staff estimates the recommended rate increases will, over the 9-year period, increase Airport revenues sufficiently to offset expenses. It is estimated that the Pooled Treasury / General Fund loan supporting ongoing Airport operations would hit its highest level of approximately $225,000 in year 5. The loan would be paid in year 9. Specific estimated annual debt amounts are noted as "debt balance" on the "Rates and Loan Balance Projections" spreadsheet attached. Committee Action: On August 12, 2010, the Public Works / Support Services Committee (Committee) met with affected airport lease holders. After discussion, the Committee directed staff to look at two additional alternatives discussed in the Discussion section above, and return as quickly as possible with the results. The Committee again reviewed this item at its meeting of October 14, 2010 and recommended for approval as an appearance item. The Committee further recommended staff perform an interim review of Airport Commercial rates near the end of calendar year 2012. Prepared by: Robert Starr, Deputy Director for General Services Submitted by, DIRECTOR OF PUBLIC WORKS Attachment: Resolution Rates and Loan Balance Projection P:\ADM\NISTRATION\Staff Reports\Staff Reports FY 11\12 Dec meetings\12-07.2.0 SR Airport Cmcrl rate v3.doc . BEFORE THE BOARD OF SUPERVISORS COUNTY OF SUTTER, STATE OF CALIFORNIA RESOLUTION OF THE BOARD OF ) SUPERVISORS INCREASING THE ) RENT CHARGED FOR RENTING ) RESOLUTION NO. ____ AIRPORT COMMERCIAL LAND ) WHEREAS, The Board has previously adopted Resolution 09-004 on January 13, 2009 establishing the Commercial rents and fees to be charged at the Sutter County Airport; and WHEREAS, The Board of Supervisors desires to revise the rents for land only for commercial tenants adopted in Resolution #09-004. NOW, THEREFORE, BE IT RESOLVED, by the Board of Supervisors of the County of Sutter that the following rents and fees be charged at the Sutter County Airport for commercial tenants renting land only, superseding Resolution 09-004: Effective January 1, 2011 Type Monthly Rent unit Commercial Land - Perimeter / Interior $ 0.0070 square foot Effective July 1, 2011 Type Monthly Rent unit Commercial Land - Perimeter / Interior $ 0.0119 square foot Effective July 1, 2012 Type Monthly Rent unit Commercial Land - Perimeter / Interior $ 0.0191 square foot Effective July 1, 2013 Type Monthly Rent unit Commercial Land - Perimeter / Interior $ 0.0277 square foot Effective July 1, 2014 Type Monthly Rent unit Commercial Land - Perimeter / Interior $ 0.0346 square foot The above commercial rents for land effective July 1, 2014 shall be increased annually by the Consumer Price Index (Western Urban Cities-May to April) effective July 1st of each year thereafter unless otherwise revised by the Board of Supervisors. BE IT FURTHER RESOLVED, by the Board of Supervisors of the County of Sutter, that the following rents be charged at the Sutter County Airport for commercial tenants renting buildings only, superseding Resolution 09-004: Effective July 1, 2010 (current rates) Type Monthly Rent unit Office Building $0.3500 square foot Maintenance Bay Building $0.1200 square foot The above commercial rents for buildings shall be increased annually by the Consumer Price Index (Western Urban Cities-May to April) effective July 1st of each year unless otherwise revised by the Board of Supervisors. BE IT FURTHER RESOLVED, by the Board of Supervisors of the County of Sutter that the following deposits be remitted at the Sutter County Airport for new tenants renting Building Office or Storage Space as follows: Building Office one month rent Storage Space Security Deposit one month rent PASSED AND ADOPTED by the Board of Supervisors of the County of Sutter, State of California, this _____ day of _____, 2010, by the following vote: AYES: NOES: ABSENT CHAIRMAN, BOARD OF SUPERVISORS ATTEST: COUNTY CLERK SUTTER COUNTY ANIMAL CONTROL SHELTER SUMMARY The 2011-2012 Sutter County Grand Jury (SCGJ) conducted several visits to Sutter County Animal Shelter (SCAS) as a follow up to last year's Grand Jury report. During the visits, SCGJ members met with the Animal Control Supervisor and the Assistant Director of Community Services. The SCGJ was also concerned that the SCAS had not implemented a policy addressing the boarding of seized animals outside of the animal control facility.

Comments 2

CO1 Page 122

Check all that apply: □ adequate attention span, □ poor attention span, □distractible, □confused Attention Attitude □ cooperative, □ suspicious, □ guarded, □ hostile, □ uncooperative ☐ normal, ☐ slow, ☐ hesitant, ☐ rapid, ☐ slurred Speech ☐ normal movements, ☐ abnormal movements, ☐ abnormal gait, ☐ motor retardation Movement ☐ normal range (euthymic), ☐ anxious, ☐ imitable, ☐ depressed, ☐ angry, ☐ elated Mood/Affect Thought content $ \Pi $ normal content, $ \Pi $ preoccupations, $ \Pi $ delusions Perception □ no perceptual distortions, □ auditory hallucinations, □ visual hallucinations normal intellectual functioning, a signs of mental retardation Intellect Memory □ no Impairment, □ memory impairment (specify) - □ remote, □ recent, □ immediate no homicidal ideation, D homicidal ideation Homicidal adequate, a mildly impaired, a severely impaired Judgment I have received information describing health services at this facility and understand how to access health care. Offender Signature / Date ___
CO2 Page 124

SUTTER COUNTY ASSESSORS OFFICE SUMMARY The 2011-2012 Sutter County Grand Jury (SCGJ) received several complaints and comments regarding the process of re-appraisal known as Proposition 8. The complaints centered around the timeliness of re-appraisals. The SCGJ found the distribution of information regarding Proposition 8 to property owners was lacking.

Observations 9

OB1 Page 72

Thiamine 100mg PO q day x 30 days; if vomiting, give first dose iM
OB2 Page 72

If patient is continuously vomiting OR displaying signs and symptoms of dehydration, contact the provider.
OB3 Page 72

Contact the provider IMMEDIATELY for the following BEFORE giving Librium:
OB4 Page 72

f. Systolic BP <90 or >180 a. Pregnancy b. Unresponsiveness g. Diastolic BP <60 or >110 c. Changes in mental status h. Heart Rate <60 or >120 d. Seizures i. Respiratory Rate <10 or >24 e. CIWA score >19 j. Temperature >101.1°F Follow the Pathway below for EtOH assessments and Librium dosing:
OB5 Page 72

STEP 1: Perform CIWA-Ar and score appropriately
OB6

mental health provider on-call. . PDate ATIME: ALAGOROL DETOXIFICATION FILTER AND ALAGORITHM AND ALAGORITHM AND ALAGORITHM AND ALAGORITHM AND ALAGORITHM AND ALAGORITHM AND ALAGORITHM AND ALAGORITHM AND ALAGORITHM AND ALAGORITHM AND ALAGORITHM AND ALAGORITH 1) Begin "Infirmary Drug/Alcohol Protocol Monitoring Form" and vital signs q 8 hours 2) Infirmary Admission, Level 1 3) Low bunk, seizure precautions x14 days 4) Begin the following detoxification treatment(s): 5) Vallum (dlazepam) 10mg p.o q 8hrs x 48 hrs; then, Valium 10mg p.o q12hrs x 48hrs; then Valium 10mg p.o QHS x 48hrs; then discontinue HOLD VALIUM IF ASLEEP OR SEDATED 6) Thiamine 100mg p.o daily x3 days 7) Laboratory: CBC, CMP, Magnesium 8) Notify HCP if unable to tolerate oral medications or remaining symptomatic BENZODIAZEPINE OR BÄRBITURATE DE IOXIFICATION. 1) Low bunk, seizure precautions x 14 days 2) Begin the following detoxifications treatment(s): Valium (diazepam) 10mg p.o q 8hrs x 48 hrs; then, Ativan 1.0mg p.o q 8hrs x 48hrs; then Valium 10mg p.o q12hrs x 48hrs; then Ativan 0.5mg p.o q8hrs x 72hrs; then Vallum 10mg p.o QHS x 48hrs; then discontinue Ativan 0.5 mg p.o q12hrs x 72hrs; then Ativan 0.5mg p.o QHS x 48hrs; then discontinue -OR- HOLD VALIUM IF ASLEEP OR SEDATED HOLD ATIVAN IF ASLEEP OR SEDATED Place in Psych RN Clinic (23) in A.M. after meds have started 3) Place in Psych RN Clinic (23) in A.M. after meds have started 4) Notify HCP if unable to tolerate oral medications or remaining symptomatic OPIATE DETOXIFICATION: 1) Low bunk, seizure precaution x 14 days 2) Begin the following detoxification treatment(s): 3) Clonidine as follows: Clonidine 0.1mg p.o TID x 48 hours; then Clonidine 0.1mg p.o BID x 48 hours; then Clonidine 0.1mg p.o QHS x 48 hours; then discontinue Hold Clonidine for systolic BP <100 mmHg or diastolic BP < 70 mmHg 4) Ibuprofen 600mg p.o TID x 72 hours prn muscle aches 5) Phenergan 25 mg IM or po TID x 72 hours (Hold if patient is too sedated) (give IM if vomiting) 6) Bentyl 20mg p.o TID x 72 hours 7) Imodium 4mg p.o. TID x 72 hours 8) Notify HCP if unable to tolerate oral medications or remaining symptomatic 9) Other ORDERED BY: ALLERGIES: Signature: Sex: Facility: Booking Number: D.O.B. Patient Name: 5849 (05/08) marked tremor (can't drink from a cup) Systolic 181-200 or diastolic 105-112 Systolic 161-180 or diastolic 97-104 marked (dothes or bedding soaked) Systolic 140-160 or diastolic 90-96 tremor absent or felt but not visible MULTNOMAH COUNTYHEALTH DEPARTMENTCORRECTIONS HEALTH Systolic < 140 and diastolic < 90 Systolic > 200 or diastolic > 112 librium 25mg (recheck every 4 hrs) librium 50mg (recheck every 4 hrs) librium 75mg (recheck every 4 hrs) librium 75mg (recheck every 2 hrs) (if 10 or more, recheck in 1 hour) moderate visible tremor mild (barely visible) mild visible tremor <99 (degree F) halludnations 100.1 - 101 librium 100mg moderate 100 - 120 99 - 100 91 - 100 agitation no librium > 120 > 101 none CallU < 90 0 2 3 4 0 7 3 0 0 - 7 3 - 7 3 7 - _ 0 3 0 2 - 3 10 or more 2 or less 8-9 4-6 3 7 Blood Pressure Temperature Total Score Sweating Behavior Tremor Pulse
OB7 Page 73

Laboratory: CBC, CMP, Magnesium
OB8 Page 73

Notify HCP if unable to tolerate oral medications or remaining symptomatic BENZODIAZEPINE OR BÄRBITURATE DE IOXIFICATION.
OB9 Page 73

Other ORDERED BY: ALLERGIES: Signature: Sex: Facility: Booking Number: D.O.B. Patient Name: 5849 (05/08) marked tremor (can't drink from a cup) Systolic 181-200 or diastolic 105-112 Systolic 161-180 or diastolic 97-104 marked (dothes or bedding soaked) Systolic 140-160 or diastolic 90-96 tremor absent or felt but not visible MULTNOMAH COUNTYHEALTH DEPARTMENTCORRECTIONS HEALTH Systolic < 140 and diastolic < 90 Systolic > 200 or diastolic > 112 librium 25mg (recheck every 4 hrs) librium 50mg (recheck every 4 hrs) librium 75mg (recheck every 4 hrs) librium 75mg (recheck every 2 hrs) (if 10 or more, recheck in 1 hour) moderate visible tremor mild (barely visible) mild visible tremor <99 (degree F) halludnations 100.1 - 101 librium 100mg moderate 100 - 120 99 - 100 91 - 100 agitation no librium > 120 > 101 none CallU < 90 0 2 3 4 0 7 3 0 0 - 7 3 - 7 3 7 - _ 0 3 0 2 - 3 10 or more 2 or less 8-9 4-6 3 7 Blood Pressure Temperature Total Score Sweating Behavior Tremor Pulse

* 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.