Consequences Of Poor Financial Practices

Recommendations 24

• R1

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  A county leadership team under the direction of the Deputy CEO and including DCFS, DPSS, Probation, DMH and LACOE should develop a new strategic plan to refocus TAY programs on integration, efficiency and effectiveness. “The Department of Children and Family Services (the Department) supports this recommendation and is currently working in partnership with the other agencies. DCSF co-chairs the partnership meeting. In addition, there are community stakeholders that attend the monthly partnership meeting.”
• R2

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  The Deputy CEO should develop and implement a regular and systematic process of program review and evaluation for TAY programs which include a goal of periodic streamlining of operations in DCFS, Probation and DMH. “The Department supports this recommendation and recommends that TAY programs be reviewed and evaluated via a systematic process to be developed by the Deputy CEO in collaboration with DCSF, Probation, and DMH.” 6 www.blueribboncommissionla.com 268 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
• R3

  Page 292
  DCFS, Probation, DMH and DPSS should develop and implement innovative programs to target high risk families and high risk children for proactive early intervention. “The Department has committed to targeting high-risk families and high-risk children for early intervention as part of our prevention strategy by devoting Title IV-E funds for the purpose of Alternate Response, Upfront Assessment and Point of Engagement. Alternated Response targets those families identified by members of the community as being at risk, but who do not meet the criteria for an in-person response by the Department. Rather than not responding to the these families, the Department has partnered with Community Based Organizations (CBOs) to refer families for intervention.”
• R4

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  DCFS, Probation, and DMH should develop a multifaceted organizational plan including a comprehensive mentoring program that increases each child’s level of trust of the system. “The Department supports this recommendation and is working with Probation and DMH in collaborative efforts to provide care for the children under out supervision and improve the level of trust of the system.” “FY 2007-08 the Department and Probation issued a Request for Proposals for Community-Based Mentoring Programs intended to serve both the Department and Probation youth, in recognition of the need for and importance of a continuous, positive relationship with an adult. In addition, to support the commitment to provide needed services to youth in care, DMH entered into agreements with our Department and Probation, co-locating staff in the Department’s regional offices and at Juvenile Hall to provide assessments for youth and to assist staff.”
• R5

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  The Directors of DCFS, Probation, DMH and LACOE should design and implement jointly a curriculum that addresses practical educational skills to better prepare them for independence. “The Department supports this recommendation. The Department will meet with Probation, DMH, and LACOE in order to formulate comprehensive strategies for better meeting the educational needs of TAY youth with the goal of designing a process whereby the departments work together to formulate joint curriculum plans for each youth after assessing his/her to be independent. A standard core curriculum focused on achieving independence should be coupled with a strategic plan individually designed for each youth based on 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 269 his/her strengths and needs. With the collaboration of all involved departments the resources, services and supports within each department can be better leveraged on a short-term and long-tear strategic basis.”
• R6

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  8, to evaluate and make appropriate recommendations to the Los Angeles County Board of Supervisors and affected school districts about school bond indebtedness. 6.10 Los Angeles County should authorize the committee formed in
• R7

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  Under the leadership of the Deputy CEO, DCFS, Probation and DMH in consultation with LACOE and other school districts, should develop a plan and a timetable for a comprehensive information system to capture all records on all children in the system. The plan should include: cost elements to develop and operate the system, a proposal for funding and a timetable for implementation. Progress on development and implementation should be reported every four months to the Board of Supervisors. “The Department agrees with the above recommendation and recommends that school records be made easily accessible to DCSF and Probation. The Department currently has our own system that tracks the educational assessment, referrals to life skills classes and completion, any financial assistance, including transportation to college, even out of state, and appliances CIO/CEO regarding time frames for such automated system.” 270 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT V. RECOMMENDATIONS 12.1 County of Los Angeles and the Department of Children and Family Services should establish more non-Department of Health Services Transitional Age Youth drop in centers which provide showers, meals, internet access, peer support groups, linkage to educational services, employment assistance, medical treatment information and transportation. This should be completed 12.2 Los Angeles County and the Department of Children and Family Services should create financially driven incentive programs which are tied to the academic performance of foster youth. For example, the Department of Children and Family Services should reward foster care providers whose wards graduate from each level including elementary, middle and high school with a “B” average or better. This should be accomplished 12.3 Los Angeles County and the Department of Children and Family Services should create a mobile app which will allow Transitional Age Youth to access the multitude of services available to them. This should be completed 12.4 Los Angeles County and the Department of Children and Family Services should immediately start to reanalyze and implement the recommendations made by the Civil Grand Jury of 2007-2008 pertaining to foster care youth. These recommendations are still valuable. Implementation of these recommendations will ensure greater success for Transitional Age Youth. VI. REQUEST FOR RESPONSE California Penal Code Sections 933(c) and 933.05 require a written response to all recommendations contained in this report. Such responses shall be made no later than ninety (90) days after the Civil Grand Jury publishes its report (files it with the Clerk of the Court). Responses shall be made in accordance with Penal Code Sections 933.05 (a) and (b). All responses to the recommendations of the 2015-2016 Civil Grand Jury must be submitted on or before September 30, 2016, to: Presiding Judge Los Angeles County Superior Court Clara Shortridge Foltz Criminal Justice Center 210 West Temple Street Eleventh Floor-Room 11-506 Los Angeles, CA 90012 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 271 Responses are required from: Los Angeles County: 12.1, 12.2, 12.3, 12.4 Department of Children and Family Services: 12.1, 12.2, 12.3, 12.4 VII. ACRONYMS BOS Board of Supervisors CGJ Civil Grand Jury DCFS Los Angeles County Department of Children and Family Services DHS Los Angeles County Department of Health Services DMH Los Angeles County Department of Mental Health LACOE Los Angeles County Office of Education LAUSD Los Angeles Unified School District TAY Transitional Age Youth VIII. COMMITTEE Rene Childress Co-Chair Rita Hall Co-Chair Heather Preimesberger Secretary Francine DeChellis Edna McDonald Patricia Turner 272 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT RENTER OR LANDLORD: WHO BENEFITS? RENTER OR LANDLORD: WHO BENEFITS? I. EXECUTIVE SUMMARY The City of Los Angeles (City) has an ambitious program that requires a building code inspection of every residential rental unit in the City at least once every three years.1 The Systematic Code Enforcement Program (SCEP) is administered by the Los Angeles Housing + Community Investment Department (HCIDLA). Since inception of SCEP in 1998, the inspection of each unit has not been completed as frequently as the Los Angeles Municipal Code (LAMC) requires. An annual fee to fund SCEP is assessed to the owner of each residential rental property in the City.2 Landlords are permitted to pass on 100% of the fee to their tenants, whether or not a rental unit is inspected on schedule, according to the LAMC.3 Residential rental units in the City that were constructed before 1978 are generally subject to rent control under the Rent Stabilization Ordinance (RSO).4 The LAMC allows automatic annual increases in rental rates by 3% and up to 8% annually depending on economic conditions.5 The percentage increase amount generally correlates with the Consumer Price Index (CPI). There is a 3% floor on annual rent increases because the RSO permits a 3% increase in annual rent even if the CPI is below 3%.6 II. BACKGROUND The 2015-2016 Los Angeles County Civil Grand Jury (CGJ) reviewed the SCEP.7 The focus of the investigation was on the frequency of SCEP inspections. Additionally, the CGJ reviewed the RSO, in particular the provision that defines the amount of annual rent increases that a landlord may charge a tenant in a rent stabilized unit.8 1 LAMC §§161.301 and 161.353. LAMC § 161.352. LAMC § 151.05.1. LAMC §§ 151.00 through 151.30. LAMC § 151.06 (Automatic Adjustments); based on the CPI based on data from the U.S. Department of Labor, Bureau of Labor Statistics for the Los Angeles-Riverside-Orange County area (hereafter “RSO allowable rent increases”). See RSO allowable rent increases. LAMC §§ 161.201 through 161.604. See RSO allowable rent increases. 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 273 A. Systematic Code Enforcement Program Before SCEP was initiated in 1998, rental units were not required to be routinely inspected by the City for critical habitability problems that violated state and local building codes.9 The City’s stated goal in enacting SCEP was, “…to eliminate substandard housing conditions in rental units.”10 HCIDLA is responsible for administering SCEP. The aspirations of SCEP were recognized in 2005, when it earned the City the Innovations in American Government Award.11 Problems such as defective water heaters, poor plumbing and mold are addressed during inspections. CGJ witnessed habitability deficiencies first hand when they accompanied a HCIDLA building inspector on inspections in various locations throughout the City. CGJ noted that many units passed inspection because they were well-maintained by conscientious landlords and tenants. If the SCEP inspector discovers deficiencies, the owner will receive a Notice to Comply with City and state codes. If the violations are not corrected in a timely manner,12 the city will place the property into the Rent Escrow Account Program (REAP).13 When a property is in REAP there may be reductions in the rent that the landlord may collect from a tenant.14 Additionally, a REAP notice is recorded against the property title, and administrative fees are charged to the landlord. The most serious consequence is referral to the Los Angeles City Attorney.15 1. SCEP inspections are behind schedule An inspection of each rental unit is required “...at least once every three years.” 16 There is no authority for longer intervals between inspections. However, according to HCIDLA, after a rental unit is inspected, it takes more than three years to perform a subsequent inspection. HCIDLA has informed the CGJ that SCEP inspections are behind schedule because the department does not have a sufficient number of staff qualified to perform such inspections. California Civil Code § 1941.1.1 et seq. LAMC § 161.353 et seq. (Added by Ordinance No. 172,108, Effective July 15,1998). Presented by the Harvard Kennedy School Ash Center for Democratic Governance. Rent Stabilization Bulletin-THE SYSTEMATIC CODE ENFORCEMENT BULLETIN, p. 3 (“The Owner will be allowed up to 30 days to make the repairs (depending on severity of the deficiencies).” 13 LAMC §§ 162.00-162.12. LAMC § 162.05. LAMC § 162.04. Ibid. 274 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Example: A building passed a SCEP inspection in 2006, the next mandatory inspection was completed in 2011, more than 2 years late. Moreover, the next inspection, due in 2014, was not performed until 2015, according to the LAMC. See Figure 1. Figure 1. FREQUENCY OF INSPECTIONS OF AN ACTUAL SAN FERNANDO VALLEY APARTMENT PROPERTY Cycle Inspection Date Time Since Last Inspection I No data - II 2/19/06 - III 6/13/11 5 years and 4 months IV 3/06/15 3 years and 9 months Source: CGJ with data provided by HCIDLA. HCIDLA publishes a Rent Stabilization Bulletin (Bulletin) to inform the public about various provisions of the program. However, the Bulletin does not inform the public about the three year deadline, “Under SCEP, HCIDLA thoroughly inspects the City’s residential rental properties once every four years.”17 (The Bulletin should accurately inform the public that inspections of each rental unit are required in intervals of every three years.) Alternately, the city should amend the section of the LAMC that defines the mandatory frequency of intervals between SCEP inspections. See LAMC, section 163.353. 2. Accelerated schedule Inspections may also be complaint-based.18 Complaint-based inspections are put on an accelerated schedule, when there are serious risks to health and/or safety such as no heat, gas or water.19 The CGJ witnessed complaint-based inspections first hand and found certain tenant’s living conditions to be deplorable. According to information provided by HCIDLA to the CGJ, once a complaint inspection has confirmed violations, the unit is placed on an accelerated SCEP inspection cycle. 3. 100% of inspection fees may be “passed-through” to tenants The annual SCEP fee for each residential rental unit in the city is $43.32. The fee is assessed to the landlord. However, the LAMC allows a landlord to “pass-through” 100% of the fee to the tenant as a charge of $3.61 per month, in addition to rental payments.20 Information provided to the CGJ by HCIDLA, indicates that a total of 17 Rent Stabilization Bulletin-THE SYSTEMATIC CODE ENFORCEMENT PROGRAM (SCEP), p.1. hcidla.lacity.org/system/files_force/documents/SCEP_English.pdf? 18 LAMC § 161.351. LAMC § 161.353. See also HCIDLA Rent Stabilization Bulletin # 52-3.25.2015; Telephone number for complaints is 866-577- 7368; online complaints may be filed at the HCIDLA website at: http://hcidla.lacity.org in-person at HCIDLA Public Information Counter. Rent Adjustment Commission Regulations § 370.00; Fee allowed provided landlord is not delinquent in the payment of annual fee to HCIDLA; landlord must serve the tenant a 30-day written notice. http://161.149.40.43/hcidla- library?field_document_category_tid=145&combine=RAC+&date_filter%5Bvalue%5D%5Bdate%5D=01%2F01%2F1999&date_filter _1%5Bvalue%5D%5Bdate%5D=08%2F20%2F2015 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 275 approximately $42.5 million in SCEP fees and nearly $500,000 in delinquent fees were collected in the first 4 months of 2016. Property owners are charged the $43.32 fee annually for each rental unit, whether or not the units are inspected in the current year of payment.21 For example, if a unit is inspected once every three years, $129.96 will have been collected. (Calculation: 3 yrs. x $43.32= $129.96.) If the inspection is once every four years, $173.28 in fees will have been collected for each unit. According to HCIDLA the SCEP Trust Fund has not been audited in years. The CGJ interviewed key staff members of the Los Angeles City Controller (Controller), who stated that due to budget constraints and limited staffing of auditors, periodic audits have not been conducted. The CGJ recommends that the City either allocate sufficient funds so that the Controller may begin to perform periodic audits of the SCEP Trust Fund; or amend section 161.352 of the LAMC which sets the frequency of SCEP inspections. B. Rent Control In Los Angeles Rent rate increases in residential rental units in the City built before 1978 are subject to rent control under RSO. Rental units constructed after 1978 are not subject to rent control. Approximately 641,000 units in the city are under rent control.22 1. Allowable automatic rent increase Landlords may increase the rent under RSO by 3% annually, even when there is a downturn in certain economic conditions. When the economy is very strong the annual rent increase percentage may be up to 8%.23 The annual rent increase adjustment normally mirrors the CPI,24 however, there are exceptions. For example, in years when the CPI is below 3%, or even negative, a tenant still may receive a 3% rent increase, at the landlord’s discretion. For example, a tenant with a $2,500 monthly rent may still be subject to a $75 per month increase when the CPI is less than 3% even when it is in negative territory. See Figure 2. LAMC § 161.353. According to data provided to the CGJ by HCIDLA. LAMC § 151.06 (Automatic Adjustments). LAMC § 151.07 A.6. The CPI average for the twelve (12) month period ending September 30 of each year. 276 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Figure 2. ANNUAL RENT INCREASES ALLOWED UNDER THE RSO Beginning % Increased Rent Allowed Rent (July CPI 1 each yr.) 8% $ 2,500 8% $ 2,700 7% $ 2,500 7% $ 2,675 6% $ 2,500 6% $ 2,650 5% $ 2,500 5% $ 2,625 4% $ 2,500 4% $ 2,600 3% $ 2,500 3% $ 2,575 CPI less than 3% 2% $ 2,500 3% $ 2,575 1% $ 2,500 3% $ 2,575 0% $ 2,500 3% $ 2,575 -1% $ 2,500 3% $ 2,575 $ 2,500 3% $ 2,575 Source: CGJ with data provided by HCIDLA It is not uncommon for the CPI to be below 3%. It has been lower than 3% every year since 2010. For example, in 2010 when the CPI was -.062%, the LAMC authorized a 3% increase in annual rents in rent stabilized units. See Figure 3. Figure 3. ALLOWABLE RENT INCREASES SINCE 2006 YEAR CPI INCREASE ALLOWED 2006 4.45% 4% 2007 4.79% 5% 2008 2.97% 3% 2009 4.14% 4% 2010 -0.62% 3% 2011 1.17% 3% 2012 2.24% 3% 2013 2.10% 3% 2014 1.55% 3% 2015 1.19% 3% 2016 0.80% 3% Source: CGJ with data provided by HCIDLA In the CGJ’s opinion, the 3% automatic increase is unfair to low to moderate income tenants when the CPI is below 3%. 2. Property tax break for landlords for declines in market value Property owners may receive property tax reductions on their real estate when the Fair Market Value (FMV) of their property declines. When the FMV is lower than the 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 277 factored base year value (Proposition 13 value), the Assessor is required to enroll the FMV.25 California assessors refer to this as “Decline in Value.” Example: An 18 unit apartment building in the City of Los Angeles that is under rent control received Decline in Value property tax reductions. For example, in 2014 and 2015, the FMV of the property was lower than the Proposition 13 value. Since property taxes are based on the lower of the two values, the property owner received substantial reductions. In 2014 his property tax bill was reduced by an estimated amount of $5,263.69; in 2015 the savings was approximately $5,560.06. See Figure 4. Figure 4. ACTUAL PROPERTY TAX REDUCTIONS FOR A BOYLE HEIGHTS APARTMENT OWNER (RSO PROPERTY)* Proposition 13 Fair Market Enrolled Value Est. Tax Year Value Value (FMV) (lower of FMV or Prop. 13) Savings 2014 $ 1,727,928 $ 1,296,000 $ 1,296,000 $ 5,263.69 2015 $ 1,762,451 $ 1,296,000 $ 1,296,000 $ 5,560.06 APPROXIMATE SAVINGS IN PROPERTY TAXES IN 2014 AND 2015: $10,823.75 *Note: The amounts in Figure 4 include publicly-available information provided to the CGJ by the Los Angeles County Assessor. According to public records in the Los Angeles County Assessor’s Office, in 2014 owners of RSO properties received over $9 million in property tax reductions. In 2015, the reductions were over $6 million. In the same year that a landlord may receive a substantial reduction in property taxes, the tenant may receive an increase in rent. There are no provisions in RSO to reduce a tenant’s rent if the current rent level is higher than current fair market rent. Example: A tenant lives in a large apartment complex of rent stabilized units and the rent has been increased each year under the provisions of the RSO. The rent for his current unit is higher than fair market rent. The choice the property management gives the tenant is to move to another unit in the complex in order to pay fair market rent, or to stay in the unit subject to a 3% increase in the rate, or leave the complex. In this case the tenant had to move within the complex so he would pay fair market rent. California Revenue and Taxation Code § 51(a). 278 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT III. METHODS AND PROCEDURES The CGJ accomplished the following: • interviewed Housing + Community Investment Department General Manager, senior management and the Director of Code Enforcement, • interviewed senior staff of the Los Angeles City Controller’s Office, • accompanied a Housing Inspector during SCEP inspections, • observed a General Manager’s Meeting, • attended a Rent Escrow Account Program Code Enforcement and Billing Information Workshop, • interviewed property managers and tenants, • reviewed system generated Rent Stabilization Cycle Reports, • reviewed various system generated Inspection Reports, • reviewed Los Angeles County Assessor’s Office public data on the assessed values of properties under the Rent Stabilization Ordinance, • reviewed certain HCIDLA procedures, • analyzed Systematic Code Enforcement Program Inspector staffing statistics, • reviewed HCIDLA’s SCEP financial report, • interviewed a Los Angeles City Councilmember, and • reviewed certain sections of the LAMC. IV. FINDINGS 1. SCEP inspections of all rental unit properties in the City of Los Angeles are required at least once every three years per the LAMC. 2. SCEP inspections of each rental unit in the City of Los Angeles have not been performed at least once every three years as required by the LAMC. 3. HCIDLA is responsible for administering the SCEP. 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 279 4. The SCEP Trust Fund has not been audited by the Controller in years. 5. The Rent Stabilization Bulletins omit informing the public that SCEP inspections are required at least once every three years, per the LAMC. 6. The SCEP fees are collected annually from the landlord for each rental unit in the City; 100% of the fees may be passed on to the tenant. 7. HCIDLA does not have sufficient staff to perform timely SCEP inspections. 8. HCIDLA disseminates information to the public on SCEP and the RSO in the Rent Stabilization Bulletin. 9. Under the RSO, annual rent increases from 3% to 8%, depending on the current CPI, are permitted in rent stabilized units. 10. Landlords may be eligible for reductions in property taxes on their rental properties when Fair Market Values decline due to economic conditions. 11. The annual rent increases permitted under the RSO may result in rent that is higher than fair market rent. 12. HDICLA does not have a sufficient number of qualified inspectors to perform SCEP inspections at each rental unit in the City every three years as required by LAMC. V. RECOMMENDATIONS 13.1 The City of Los Angeles Housing + Community Investment Department should inspect each rental unit in the City of Los Angeles at least once every three years as required by the Los Angeles City Municipal Code. or 13.2 The City of Los Angeles should, within three months, amend section 163.352 of the Los Angeles Municipal Code that states the mandatory interval between Systematic Code Enforcement Program inspections. 13.3 The City of Los Angeles Housing + Community Investment Department should, within three months, accurately inform the public that inspections of each rental unit in the City of Los Angeles are required at intervals of every three years. 13.4 The City of Los Angeles should, re-evaluate the 3% floor on automatic annual rental increases, when the CPI is lower than 3%. Allowable rent increases 280 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT should equal the Consumer Price Index when it is lower than 3% but not below 0%. 13.5 The City of Los Angeles should, within three months, provide sufficient funding to the Los Angeles City Controller so that there will be sufficient audit staff to perform periodic audits of the System Code Enforcement Program Trust Fund. 13.6 The Los Angeles City Controller should audit the System Code Enforcement Program Trust Fund within three months. VI. REQUEST FOR RESPONSE California Penal Code Sections 933(c) and 933.05 require a written response to all recommendations contained in this report. Such responses to recommendations shall be made no later than (90) days after the Civil Grand Jury publishes its report (files it with the Clerk of the Court). Responses shall be made in accord with Penal Code Sections 933.05(a) and (b). All responses to the recommendations of the 2015-2016 Civil Grand Jury must be submitted on or before September 30, 2016, to: Presiding Judge Los Angeles Superior Court Clara Shortridge Foltz Criminal Justice Center 210 West Temple Street Eleventh Floor-Room 11-506 Los Angeles. CA 90012 Responses are required from: City of Los Angeles: 13.2, 13.4, 13.5 Los Angeles Housing + Community Investment Department: 13.1, 13.3 Los Angeles City Controller 13.6 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 281 VII. ACRONYMS CGJ Civil Grand Jury CPI Consumer Price Index FMV Fair Market Value HCIDLA Los Angeles Housing + Community Investment Department LAMC Los Angeles Municipal Code REAP Rent Escrow Account Program RSO Rent Stabilization Ordinance SCEP System Code Enforcement Program VIII. COMMITTEE MEMBERS Debra Cohen Chair Francine DeChellis Patricia Turner 282 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT S O S AVE UR ENIORS: NURSING HOME INSPECTIONS SAVE OUR SENIORS: NURSING HOME INSPECTIONS I. EXECUTIVE SUMMARY In all counties of California, except Los Angeles County, the California Department of Public Health (CDPH) conducts inspections of Nursing Home Facilities (NHF) and investigates nursing home complaints. Most of the people in nursing homes are seniors. In Los Angeles County, the Los Angeles County Department of Public Health (DPH) through its Health Facilities Inspection Division (HFID) carries out NHF inspections and complaint investigations in the 396 NHFs located in the county. HFID and Los Angeles County are contracted with the State of California to enforce state and federal laws as they relate to nursing homes. In 2014, two audits were conducted by the State of California and the County of Los Angeles relating to the operations of HFID.1 Both audits made several recommendations to improve the effectiveness and efficiency of HFID operations. The audits uncovered a large backlog of complaints that were not investigated, some of which went back several years. In June 2015, a new contract was entered into between the State of California and Los Angeles County.2 This contract attempted to address many of the deficiencies found in the audits. In 2015, incremental funding of $14 million was provided to HFID to hire more personnel. The new contract attempted to reduce, by thirty percent, the workload of Health Facilities Evaluator Nurses (HFEN), also called surveyors. Additional hires would substantially increase HFID’s ability to reduce the backlog of complaints and complete certification and recertification surveys in a timely manner. It is hoped that when the new hires are assigned to various district offices the backlog of complaints will be reduced. The 2015-2016 Los Angeles County Civil Grand Jury (CGJ) reviewed the HFID’s inspection of nursing homes. Our review showed that the number of complaints against the NHFs was larger in 2015 than in 2014. Despite an increase in the number of complaints being investigated, the backlog continues to be high. The data provided by CDPH shows a backlog of 6,514 pending complaints, with some going back to 2011.3 The CGJ feels that significant time savings can be gained by standardizing and systematizing the surveys and complaints investigating process, fully utilizing laptops and setting up a single point for entry of complaints. The use of laptops by surveyors is sporadic, and some senior surveyors are not fully utilizing this technology. The CGJ also finds that efforts need to be made for improving the communication between senior 1 California State Auditor, Sacramento, CA, October 2014, and County of Los Angeles, Department of Auditor-Controller, April 4 and August 27, 2014. Agreement Number 15-00003, July 2, 2015 (hereafter “Contract”). Email to CGJ from HFID, February 29, 2016, “Data Request.” 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 283 management and the rest of the workforce. Further steps need to be taken to improve the morale of the employees. II. BACKGROUND Skilled Nursing Facilities (SNF), NHFs, and Long Term Care Facilities are all titles used to describe the facilities that have been under review by the Center for Medicare and Medicaid Services (CMS), CDPH, and DPH. In California, Medicaid is called Medi-Cal. As a result of the 2014 audit, HFID was transferred to the Environmental Health Division, reporting ultimately to the Los Angeles County Department of Health Services (DHS).4 A. Staffing 1. Health Facilities Evaluator Nurse (HFEN) HFENs perform a valuable public service by overseeing the quality of healthcare provided to Californians. HFENs conduct complaint investigations and in-depth surveys of health facilities to determine compliance with state and federal laws, and certification requirements of the Medicare and Medicaid programs. Their primary responsibility is enforcement of state and federal laws and rules pertaining to areas affecting total patient care such as nursing, physician care, physical therapy, pharmacy, social services, dental care and related services.5 The HFENs may act as team leaders on surveys and complaint investigations and assist in the training of new staff. They conduct surveys by visiting nursing home facilities, interviewing patients, evaluating the adequacy of patient care through direct observation, inspecting the facility, and reviewing patient and staff personnel records. They evaluate reports prepared by state or county level experts. Survey data is analyzed and recommendations are made to approve or disapprove the certification of nursing homes in accordance with federal, state and local laws and regulations. They issue citations in accordance with deficiencies found.6 2. Registered Environmental Health Specialist (REHS) REHSs work to improve the quality of life and health at nursing homes through environmental and physical inspection of the facility. In accordance with the new contract the REHS cannot now independently conduct surveys.7 4 CDPH website. http//:www.cdph.ca.gov/programs/LNC/pages 5 County of Los Angeles, “Class Specification Bulletin, Heath Facilities Evaluator, Nursing, Class Code 5707,” April 1, 2007. https://agency.governmentjobs./lacounty/default.cfm?action=specbulletin+ClassSpec,1c 6 CGJ interviews with HFID staff. CGJ interviews with HFID supervisors and assistant supervisors. 284 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 3. Health Facilities Supervisors A supervisor is a manager of at least four HFENs at district offices. They engage in supervising surveys for health facility licenses,8 issuing citations and levying civil penalties. Supervisors are involved in determining program flexibility and decisions and reviewing health facilities for participation in Medicare and Medicaid programs. They perform more difficult and complex surveys of nursing homes.9 Supervisors and assistant supervisors are required to review the surveyors’ findings and draft reports to confirm the accuracy of the findings and determine if the evidence supports the findings. Supervisors and surveyors must come to a consensus on the recommended deficiencies found and recommended citations. Surveyors are called to testify when litigation or appeals are made: therefore, it is critical that they are included in all discussions regarding their investigations, especially if their conclusions are changed.10 4. Program Manager Program managers are responsible for overseeing HFID district offices. They may manage individual departments or district offices. B. Complaints Processing 1. Complaints made by the public CDPH has contracted with DPH and HFID to investigate complaints relating to nursing home facilities located within Los Angeles County.11 Complaints are submitted by the general public, family members of residents, staff and residents. In Los Angeles County such complaints are filed with HFID. Complaints made to HFID can be made telephonically, by computer, smart phone, fax and mail. Complaints made electronically to HFID all go to the Information Technology (IT) Center at HFID headquarters in Norwalk, California. At the IT Center, the complaints are entered into the Aspen Complaint Tracking System (ACTS). Complaints made telephonically or by fax, are entered onto an “intake form” and directed to the appropriate district office by the support staff.12 The number of complaints received by HFID in 2014 was 1,527 and increased to 1,866 in 2015. The data shows HFID completed 1,506 complaint investigations in 2014, which increased to 2,235 in 2015.13 See Chart 2. Ibid. CGJ interviews with HFID staff. Ibid. Contract, paragraph A.5.H. CGJ interview with HFID supervisors. Email to CGJ from HFID, February 19, 2016, “Number of Complaints made Each Month, January 1, 2014 – December 31, 2015.” 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 285 2. Entity Reported Incident (ERI) Under State law and regulations, NHFs must self-report events such as epidemic outbreaks, poisonings, fires, major accidents or other catastrophes, or unusual occurrences which threaten the welfare, safety, or health of residents, staff or visitors.14 Alleged or suspected patient abuses are also to be reported. These self-reported complaints are known as ERIs. HFID investigations of ERIs increased from 1,067 in 2014 to 1,343 in 2015.15 ERIs and complaints made by the public are combined to analyze trends and backlog of complaints.16 HFID classifies and prioritizes complaints based on the severity of the event. Complaints are classified as Immediate Jeopardy (IJ) if a facility’s non-compliance has caused or may cause serious injury, harm, impairment, or death to the resident. Complaints classified as non-IJ are situations in which the facility’s noncompliance caused or may cause harm that has limited consequence and does not significantly impair the resident.17 California law provides that IJs will be investigated by HFID within 24 hours of receipt of the complaint. Investigation of all other complaints must be started of receipt.18 14 CDPH, Health Consumer Information System, “Health Information General Questions.” http://hfcis.cdph.ca.gov/faq/General.aspx 15 Email to CGJ from HFID, February 26, 2016, “The number of complaints January 1, 2014, 2014-February 22, 2014.” 16 Ibid. California State Operations Manual, Appendix Q, “Guidelines for Determining Immediate Jeopardy,” paragraph II, February 14, 2014, as well as CGJ interviews with HFID staff. California State Auditor Report 2014-111, October 2014, p. 14. 286 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Chart 1 Monthly Trend of Incoming Complaints (2014-2015) 200 180 160 140 120 100 80 60 40 20 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2014 complaints received 162 110 112 113 122 125 155 137 127 144 113 107 2015 complaints received 163 149 145 134 157 167 181 161 175 151 146 137 Source: Prepared by CGJ based upon data provided in HFID email dated February 26, 2016. 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 287 stnialpmoc fo rebmun 3. Complaints backlogs Despite the increasing number of complaints being investigated, the backlog of complaints continues to be high. The total number of backlogged complaints at the end of 2015 was 6,514 including • 52 complaints from 2011, • 363 complaints from 2012, • 1,146 complaints from 2013, • 2,143 complaints from 2014, and • 2,760 complaints from 2015. Chart 2 is a pictorial representation of the backlog of complaints, created by CGJ based upon information provided by HFID.19 Chart 2 Backlog of Complaints 3000 2500 2000 1500 Backlog of univestigated 1000 complaints 500 0 2011 2012 2013 2014 2015 19 Email to CGJ from HFID, February 22, 2016, “Backlog Pending Investigations.” 288 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT C. Certification And Recertification Surveys In 1986, at the request of Congress, a study was conducted by the federal Institute of Medicine and it found that residents of nursing homes were being abused, neglected and given inadequate care. The Institute proposed reforms be made and subsequently the Nursing Home Reform Act was passed.20 The provisions of the Act were contained in the Omnibus Budget Reconciliation Act of 1987.21 The Act requires that states and the federal government inspect nursing homes to ensure that residents receive quality care and services. The law requires that the states and federal government complete inspections of Skilled Nursing Home Facilities (SNF) and NHFs to certify their compliance. The inspections of SNF and NHF are called surveys and are conducted by HFID.22 Survey teams consist of two or more HFENs and may include REHS, physicians, dieticians and other personnel as needed.23 The initial certification survey of nursing homes focuses on residents and structural requirements.24 The state has contracted with DPH to conduct surveys for recertification and relicensing.25 Recertification surveys are to be completed no later than 15.9 months from the exit date of the previous survey. Over the course of the contract the elapsed time between surveys of each NHF will be reduced so as not to exceed 12.9 months.26 HFID staff is expected to complete two surveys per month.27 D. Citations Under the 2015 contract entered into between the State of California and the County of Los Angeles, DPH and HFID are called upon to issue citations to NHFs when deficiencies are found during inspection (surveys) and complaint investigations.28 The contract also requires HFID to revisit facilities that have received citations to make sure the nursing home has corrected the deficiencies noted.29 Citations are issued by HFID for violations of state or federal law. There are several classes of citations: Class AA – issued when a resident death has occurred and the cause is found to be the responsibility of the nursing home; Class A – issued when a violation presents imminent danger or a substantial probability of death or serious harm; 20 42 CFR § 483.25, “Quality of Care.” 21 Public Law 100-203, December 22, 1987. CGJ interviews with HFID staff. Ibid. Ibid. Contract, Exhibit A, paragraph 5.A. Contract, Exhibit A, paragraph 6.D.(1)b. CGJ interviews with HFID staff. Contract, Exhibit A, paragraph 5.D. Ibid. 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 289 Class B – issued for all other violations. Citations issued by HFID personnel are given to the Citation Desk Supervisor, located at the El Monte district office, within five days after they are issued. The supervisor then enters the citation on the computer into the Electronic Licensing Management System (ELMS) which provides information to state officials.30 All A or AA citations go up the chain of command at HFID and DPH legal for approval. The NHF owner is given a copy. Within 24 hours after being given a citation the nursing home owner must prepare a plan of correction for the deficiencies noted in the citation.31 In 2014, HFID issued 25 Class A citations and four Class AA citations. In 2015, the number of citations issued almost doubled, with 49 Class A and seven Class AA citations issued.32 Citations carry monetary penalties, which are collected by the State of California. Class AA violations draw fines of $25,000 to $100,000. Class A and Class B violations fines range from $2,000 to $20,000. Also, any willful material falsification or willful material omission in the health care record of a patient can result in a fine of $2,000 to $20,000 for each violation.33 Appeals from the issuance of a citation are handled by the State of California, Department of Public Health (CDPH). • To uphold a Class AA citation, HFID must prove that: (1) the violation was a direct proximate cause of the death of a patient; (2) the death resulted from an occurrence the regulation was designed to prevent; and (3) the deceased was among the group intended to be protected by the regulation.34 • In order to uphold a Class A citation on appeal, HFID must prove imminent danger from a deficiency that could cause death or serious harm to a patient or a substantial probability of death or serious harm caused to a patient by the deficiency.35 • Class B citations are upheld on appeal if the violation is found to have a direct relationship to the health, safety or security of a patient.36 30 Interview with HFID Citation Desk staff. Ibid. Information provided by HFID, “List of A and AA citations issued 2014-2015.” 33 California Advocates for Nursing Home Reform, “CA Nursing Homes: Violations Key, October 22, 2015.” http://www.canhr.org/NH_Data/List_Key/ViolationsKey.html 34 Contract, Exhibit A, paragraph 8.D. Ibid. Ibid. 290 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT The Citation Desk has one supervisor and two support staff members. The desk should use more staff members to process citations.37 E. Hiring Los Angeles County, in 2015, received $14 million to hire additional staff as a result of the new contract.38 Inadequate staffing had been identified in the audits as a primary cause of the backlog. Los Angeles County has hired 57 new registered nurses for surveyor positions.39 At present, there are 27 HFENs who are ready to be certified by the federal exam to work in the field independently. Management needs to secure supervision and support staff for these new hires. HFID is on track to meet its hiring target. F. Training Proper training is imperative for the HFID staff to be efficient. This will lead to better morale and efficiency. As a result of our interviews it became clearly evident that the department is not properly training its employees. This makes for very low morale within the department. However, the most disturbing result of this failure to train properly is the well-being of residents of NHF that HFID is hired to protect. The voices of the elderly and ill who reside in the nursing homes are silent and clearly their needs are in jeopardy. New hires go through county orientation and learn what it means to be a county employee. They do this by viewing six weeks of webinars before starting the state training. Several state run academies offer state training and usually have a class size of 30. Reservations must be made for the date and location which is most convenient. The training lasts for three weeks and during this time the new hire learns the state regulations that a surveyor will be enforcing.40 Federal training consists of one week of classes given in Los Angeles County to acquaint the surveyor with the federal regulations (Medicare and Medicaid) he or she will be enforcing. Federal training must be completed before the new hire can take the Surveyor Minimum Qualification Test (SMQT). The federal test is only scheduled a few times a year. New hires may conduct complaint investigations with additional supervision, and may accompany qualified nurses on regular inspections. This on-the- job-training continues until federal training is completed and the SMQT test is passed.41 In order for an employee to do their job there are certain factors that the employer must provide. Among these are proper training and mentoring. From discussions with surveyors and supervisors, the CGJ feels that the training provided is not adequate. Interview with HFID Citation Desk staff. Contract, Exhibit B, paragraph 6.A. 41; Contract between California Department of Public Health and County of Los Angeles dated June 15, 2012, Agreement Number 12-10082, Exhibit B, paragraph 5.A. Comparing the information in these documents, the difference is approximately $14 million. Email to CGJ from CDPH, April 14, 2016, “RE: HFID Surveyor’s Count.” 40 Interview with HFID training staff. Ibid. 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 291 CGJ interviews with HFID personnel lead to the conclusion that HFID staff feels that their training is grossly inadequate. This leads to the question of how HFID is failing to understand and appreciate this situation. This problem should be immediately corrected. The implementation of the use of laptops for investigations has created additional problems. Laptop training at HFID consists of webinars and about 4 hours of classroom work. The new hires have adapted to the integration of these, but the older employees are still writing reports manually and then entering these reports into the laptop when returning to the office. This is not time efficient. Based upon interviews of senior surveyors, laptop training is not adequate. Since the new contract, one trainer has been added to the staff bringing the total to three. These three trainers support all five district offices in Los Angeles County. With the 57 new hires and the 80 existing surveyors, who need to be kept informed of new and changed procedures, the training department is severely understaffed. Other counties in the state have one trainer for each district office.42 HFID should add a trainer to each district office. With this addition, it is hoped that trainers will have sufficient time to gain feedback from surveyors as to the adequacy of training given. A Quality Assurance Committee has been created, consisting of surveyors, supervisors, and senior management. It meets weekly, if possible, to discuss ways to improve methodology of the activities of HFID.43 Emphasis should be given to the work of this committee and senior management should listen and act upon its suggestions. G. Systems CMS maintains a National Database (ND) in Baltimore, Maryland which is the end repository for, among other information, all data pertaining to nursing homes throughout the country. California’s NHF data is maintained in the State Agency (SA) database in Sacramento which is synchronized with ND on a nightly basis.44 ASPEN is a suite of applications used to input and process local data and to interact with the SA database. Within ASPEN, the Aspen Complaint Tracking System (ACTS) is the entry point for complaint and ERI data which is referred to as an ACTS “intake”. Another application is Aspen Central Office (ACO) which manages licensing and certification and is the main collection point for facility information.45 HFCIS is the software used by HFID to track consumer complaints and ERIs. CMS provides qualified users the Certification and Survey Provider Enhanced Reports 42 Ibid. Ibid. Interview with HFID Staff. Ibid. 292 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT (CASPER) for extracting data from ND and for printing reports.46 ACTS Reports Menu provides the same service for the SA database but is not as functional as CASPER. Other tools are available but their use requires significant technical knowledge. During interviews with nurse surveyors, CGJ noted that they were supplied with new laptops. Further discussion unveiled the fact that the laptops were not being used during investigations due to unfamiliarity with the equipment. Questions to the IT department revealed that the new laptops were HP Revolve 810 Tablet PCs and were loaded with a standard California Department of Public Health System which runs on Microsoft Windows 7. This is a solid platform which has eliminated any software bugs found since its introduction. To use this equipment to its full potential, it should be user friendly, and include a new improved template especially developed for surveyors to use during complaints investigation and surveys. Such a template should be developed with major input supplied by the nurse surveyor end user. This template would be downloaded with data for the site being investigated and would ease the input of boilerplate data with most entries being yes/no or other short responses. Additional data can be entered on screen using the One-Note function of Microsoft Office. This change from pen and paper to electronic data entry could dramatically reduce the workload for entering investigative data, but adequate training must be provided. H. Communication There is a communication disconnect between the managers and the line personnel at HFID. The breakdown in communication is contributing to low morale. Several of the surveyors expressed their frustration with the lack of communication when interviewed by the CGJ. When queried as to policies that could be utilized to enhance communication, they readily responded. The staff felt that it would be extremely beneficial for the department head, managers and supervisors to have an open door policy. Additionally, regularly scheduled meetings should be held to ensure that communication is fluid. Information should travel vertically up and down so that all persons are informed and kept in the information loop. Another form of communication they felt was critical to the success of HFID was that the headquarters’ senior management should visit area offices on a regular basis. This would provide them with a ground level perspective to know which policies are working, which ones need improving and which ones are not working and need to be modified or replaced. Surveyors also felt that headquarters’ senior management should accompany a surveyor to observe the details of the job. It was felt that if the upper echelon had firsthand experience doing surveys, they would understand exactly the complexities of 46 Email to CGJ from CDPH, February 4, 2016, “Federal System Support.” 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 293 the job and have a more realistic view of the process. Equipped with this knowledge, the headquarters’ senior management would be able to affect policies to assist the surveyors to effectively and expeditiously do their job. All levels of supervision need to seek the input of surveyors when developing any new policies and or procedures regarding the investigation of complaints. And lastly, the headquarters’ senior management needs to ask the surveyors what tools they need to be more proficient in doing their job. I. Morale It does appear to the CGJ that morale and cooperation at HFID is in need of improvement. This situation seems to relate to a backlog of complaints/workload, surveyors RN/REHS hostility and upper management not being promoted from within. Complaint backlog is at approximately 6,500 complaints, some stemming from 2011.47 This, coupled with the survey schedule has put a great deal of pressure on surveyors. It is hoped that the new hires, once they complete their training, will reduce the work hours and pressure REHS were the majority of surveyors in the past, but, especially with the new contract, all new hires for surveyors are registered nurses (RN) licensed to practice in California.48 RNs starting salaries are greater than for REHS surveyors and that is a problem area for REHS individuals.49 Also, only RNs can lead a survey, although a REHS surveyor on the team may have more experience. In addition, the work of REHS surveyors has been cut back to its present level, even though, before RNs were hired exclusively, the REHS surveyors performed the same duties as RNs do now.50 Based upon interviews and discussions with HFID staff it appears to the CGJ that there is a prevailing view among middle to lower level employees at HFID that, since the headquarters’ senior management came from a different division, they have little or no knowledge of what surveyors or supervisors do on a regular basis. It is also apparent to the CGJ that the fact that headquarters’ senior management does not regularly visit district offices, and does not consult with surveyors and supervisors on policies relating to the conduct of surveys, does not help this feeling. Until each of these issues is dealt with and management recognizes the issue, morale will remain a drain on worker cooperation and pride in accomplishment. See footnote 3, supra . Contract, Exhibit A, paragraph 5.E. CGJ interviews with HFID staff. Ibid. 294 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT III. METHODS AND PROCEDURES The CGJ conducted numerous interviews with senior staff, program managers, HFENs and REHS as well as supervisors and assistant supervisors. CGJ also spoke to staff at the IT, Citation Desk, hiring and training areas. The CGJ obtained reports detailing number and backlog of complaints, the number of “AA” and “A” citations as well as the aging of complaints. The requested information was provided by CDPH. Documents relating to audits were obtained and reviewed including quarterly inspection reports with level “AA” and/or “A” deficiencies since January 2014. Nursing home inspection reports conducted by HFID for the last three quarters were reviewed. IV. FINDINGS 1. Complaints submitted electronically are logged in electronically by the IT staff at the Norwalk location. Complaints submitted via telephone, fax or mail, are sent to the appropriate district office and, after review, it is then entered into ACTS by the district staff. 2. There has been no improvement in the time taken for completing surveys for certification or recertification. It still takes two weeks to complete and report on the surveys. 3. Laptops are not being fully utilized by all surveyors. Some surveyors are first writing the report on paper and then entering it into their laptop. This is a duplication of work. 4. Complaint workload is too high. The target of two surveys a month takes 20 plus days to complete. This leaves only regular and weekend overtime to work on complaints and leads to delays and inefficiencies. 5. Some program managers, supervisors and assistant supervisors lack the proper skills to retrieve timely and pertinent data and reports from SA and ND. 6. New hires are not receiving adequate training to competently complete an investigation in a timely and efficient manner. 7. A disparity exists between HFEN and REHS in terms of wages and responsibilities. 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 295 8. HFID headquarters’ senior management has a background in environmental health while surveyors are RN’s. Surveyors feel that decisions are made without taking their views into account. 9. HFID top management has not made an effort to let the surveyors know that it cares about the job they want the surveyors to do and to succeed. V. RECOMMENDATIONS During the course of the current contract the following recommendations should be implemented: 14.1. The Department of Health Services, the Department of Public Health, and the Health Facilities Inspection Division should develop a process to route all complaints including ERI’s to the IT department in Norwalk to be entered in the ACTS system as they are received. 14.2. The Department of Health Services, the Department of Public Health, and the Health Facilities Inspection Division should form a team to develop a new electronic template to be used by surveyors to input complaints information into ACTS. 14.3. The Department of Health Services, the Department of Public Health, and the Health Facilities Inspection Division should enhance training of surveyors in the use of laptops. 14.4. The Department of Health Services, the Department of Public Health, and the Health Facilities Inspection Division should make it mandatory for surveyors, assistant supervisors and supervisors to use laptops during the conduct of surveys by December 31, 2016. 14.5. The Department of Health Services, the Department of Public Health, and the Health Facilities Inspection Division should ensure that program managers, supervisors, and assistant supervisors should receive adequate training in ASPEN and access to and training on CASPER to enable them to produce timely and informative reports. 14.6. The Department of Health Services, the Department of Public Health, and the Health Facilities Inspection Division should develop a system to monitor new hire post training needs including compliance with mandatory training requirements and competencies. A post training review process that enables 296 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT HFID managers and supervisors to identify when competencies have not been established and refresher training is needed. 14.7. The Department of Health Services, the Department of Public Health, and the Health Facilities Inspection Division should require a senior Health Facilities Evaluator Nurse to accompany a new hire until the new hire feels comfortable completing surveys competently. 14.8. The Department of Health Services, the Department of Public Health, and the Health Facilities Inspection Division should hold weekly staff meetings to discuss investigation problems occurring in the field, potential morale issues and any overall concerns that may affect a well-run efficient organization. 14.9. The Department of Health Services, the Department of Public Health, and the Health Facilities Inspection Division should initiate a study to determine how to reduce the hostilities between Health Facilities Evaluator Nurses and Registered Environmental Health Specialists due to differential in wages and responsibilities. 14.10. The Department of Health Services, the Department of Public Health, and the Health Facilities Inspection Division should make sure a schedule exists for the Chief and Assistant chief of the Health Facilities Inspection Division to visit each district office at least once a month to determine the immediate needs of that office. 14.11. The Department of Health Services, the Department of Public Health, and the Health Facilities Inspection Division should make sure that during each visit of the headquarters’ senior management in the Health Facilities Inspection Division to district offices time is set aside for them to discuss with surveyors, on a one-to-one basis, issues regarding the surveyor job. VI. REQUEST FOR RESPONSE California Penal Code Sections 933(c) and 933.05 require a written response to all recommendations contained in this report. Such responses shall be made no later than ninety (90) days after the Civil Grand Jury publishes its report (files it with the Clerk of the Court). Responses shall be made in accord with Penal Code Sections 933.05(a) and (b). All responses to the recommendations of the 2015-2016 Civil Grand Jury must be submitted on or before September 30, 2016, to: Presiding Judge Los Angeles County Superior Court 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 297 Clara Shortridge Foltz Criminal Justice Center 210 West Temple Street Eleventh Floor-Room 11-506 Los Angeles, CA 90012 Responses are required from: Health Facilities Inspection Division: 14.1, 14.2, 14.3, 14.4, 14.5, 14.6, 14.7, 14.8, 14.9, 14.10, 14.11 Los Angeles County Department of Public Health: 14.1, 14.2, 14.3, 14.4, 14.5, 14.6, 14.7, 14.8, 14.9, 14.10, 14.11 Los Angeles County Department of Health Services: 14.1, 14.2, 14.3, 14.4, 14.5, 14.6, 14.7, 14.8, 14.9, 14.10, 14.11 VII. ACRONYMS ACO ASPEN Central Office ACTS Aspen Complaints Tracking System ASPEN Automated Survey and Processing Environment CASPER Certification and Survey Provider Enhanced Reporting CDPH California Department of Public Health CGJ Civil Grand Jury CMS Centers for Medicare and Medicaid Services DHS Department of Health Services DPH Los Angeles County Department of Public Health ELMS Electronic Licensing Management System ERI Entity Reported Incident HFCIS Health Facilities Consumer Information System HFEN Health Facilities Evaluator Nurses HFID Health Facilities Inspection Division IJ Immediate Jeopardy IT Information Technology NHF Nursing Home Facility ND National Database REHS Registered Environment Health Specialist RN Registered Nurse SA State Agency SMQT Surveyor Minimum Qualification Test SNF Skilled Nursing Facility 298 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT VIII. COMMITTEE MEMBERS Marina LaGarde Co-chair Arun Sharan Co-chair George Zekan Co-chair Judy Goossen Davis Secretary John Anthony Rita Hall Edna McDonald Heather Preimesberger Stephen Press 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 299 This Page Intentionally Left Blank 300 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT THE LOS ANGELES COUNTY PROBATION DEPARTMENT AND TECHNOLOGY THE LOS ANGELES COUNTY PROBATION DEPARTMENT AND TECHNOLOGY I. EXECUTIVE SUMMARY California state statutes passed in the last five years resulted in the number of probationers supervised by the Los Angeles County Probation Department (LACPD) to increase significantly. The population of probationers also continues to increase at about 400 to 500 per month. The department has hired new probation officers to deal with the increase in caseload. This report deals with the status of technology used by the department and seeks to determine if it is sufficient to help the department do its job. Computer hardware is adequate at present, but software is old and will need to be updated and reworked in the next few years. Although a goal of the department is to have a paperless office, without a change in software 70% of all work will continue to be done on paper. At this time, the department should issue laptops or tablets, and also smart phones, to probation officers to take to the field with them. This would increase their efficiency and provide a safer environment. II.
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  The RR/CC’s budget for voter outreach is $500,000 for the fiscal year ending June 30, 2016. The RR/CC is requesting $750,000 for fiscal year 2016-2017. This amount is still not enough to promote the turn-out to vote campaign on television, radio, and other forms of communication mediums.
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  The RR/CC has negotiated package deals with media companies that include placement of turn-out-related “branded” announcements on a range of locations: billboards, kiosks, etc., across a range of businesses in the county.
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  The California Secretary of State has negotiated a deal with Metro to provide coordinated “branded” voter outreach messaging on bus shelters and buses.
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  Vote By Mail (VBM) ballots are most commonly challenged for lack of a voter signature on the return envelope.
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  If a voter’s signature does not compare with the signature affidavit on file (according to the automated signature verification software), the envelope is reviewed manually. Voters in this situation are contacted and provided the opportunity to sign a new affidavit. A new state law, codified in California Elections Code section 3019 (f)(1) (A), permits the RR/CC to request such a new affidavit up to seven (7) days following Election Day.
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  A recent change in California law, codified in California Elections Code section 4103, permits VBM ballots postmarked on Election Day to be counted if they are received no later than three days after Election Day.
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  New VBM ballots are being designed and may be used in the 2018 election cycle.
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  When implemented, the new interactive sample ballot (ISB) is planned to be able to automatically populate a voter’s ballot with his or her choices before the voter enters the vote center. Changes to those choices can be later made by the voter when he or she is using the completely redeveloped ballot marking device (BMD), before the official paper ballot is generated.
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  When implemented, the new voting experience is planned to include the ISB, expanded Early Voting (including weekend voting), Election Day registration, vote centers to replace precinct polling places, and new BMDs.
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  After implementation of the new BMD, Early Voting is planned at numerous locations around the county. For about 10 days before Election Day, there will be many early/weekend vote centers available, the quantity of which will more than double on Election Day.
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  Voting roll books are planned to be replaced by real-time electronic voter rolls to verify voter eligibility. 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 145
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  Many special requirements are planned to be accommodated on the new BMD such as a touchscreen interface, language selection, audio input, headphones, a tactile keypad and ports for voters to connect assistive technology devices. The new BMD is planned to be completely accessible and provide a private voting experience for each voter
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  The new BMD is planned to replace the currently-used InkaVote machines. The new machines are being developed using federal Help America Vote Act (HAVA) funds and will employ computer technology that will create a paper ballot that will be the official ballot of record.
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  The $55 million still available is adequate to complete development and testing of the new BMD.
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  The purchase of new BMD will require additional funding. V. RECOMMENDATIONS 7.1 Los Angeles County should give full financial support to the Registrar Recorder/County Clerk’s efforts to bring the new voting system to fruition. 7.2 Los Angeles County and the Registrar Recorder/County Clerk should make all reasonable efforts to develop and test the new BMD so that the new machines are able to be used county wide no later than the 2020 election. 7.3 Los Angeles County and the Registrar Recorder/County Clerk should offer the new voting system, which is the most up-to-date technological method for secure voting, to other counties throughout the nation for a reasonable fee. 7.4 Los Angeles County and the Registrar Recorder/County Clerk should provide a minimum of five additional, secure Early Voting sites in the county for the 2016 Presidential General Election and also allow VBM ballot drop off at each site. 7.5 Los Angeles County and the Registrar Recorder/County Clerk should allocate funding to provide additional personnel to staff any additional, secure Early Voting or “will call” sites established for the 2016 Primary and Presidential General Elections. 7.6 The Registrar Recorder/County Clerk should institute a “will call” system of Early Voting for the next election after 2016, and determine optimal procedures and voter use. 7.7 Los Angeles County and the Registrar Recorder/County Clerk should take advantage of free publicity on individual city websites and city cable channels to 146 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT promote the upcoming changes in the voting system as each one is implemented. 7.8 The Registrar Recorder/County Clerk should address the public meetings of the Los Angeles County Board of Supervisors and all of the cities in Los Angeles County to discuss opportunities for citizen involvement in voter outreach. 7.9 The Registrar Recorder/County Clerk should expand its use of social media for voter outreach in future elections, and should consider enlisting the public to help create and disseminate voter outreach messages. 7.10 A Registrar Recorder/County Clerk spokesperson should make appearances on morning and evening televised newscasts to discuss and promote the turn-out to vote campaign. 7.11 A Registrar Recorder/County Clerk spokesperson should schedule interviews on radio to promote the turn-out to vote campaign. 7.12 The Registrar Recorder/County Clerk should publicize the fact that VBM ballots can be postmarked on Election Day and still be counted. 7.13 Los Angeles County and the Registrar Recorder/County Clerk should initiate a study and complete it by January 1, 2017, to determine methods to increase the use of VBM ballots, including government payment of return postage and voter outreach regarding VBM procedures. 7.14 The Registrar Recorder/County Clerk should reconsider sending a ballot, using business reply envelopes, to each registered voter. 7.15 The Registrar Recorder/County Clerk should organize a committee, to meet at least once per year, to re-examine the implementation of on-line voting. VI. REQUEST FOR RESPONSE California Penal Code Sections 933 (c) and 933.05 require a written response to all recommendations contained in this report. Such responses shall be made no later than ninety (90) days after the Civil Grand Jury publishes its report (files it with the Clerk of the Court). Responses shall be made in accord with Penal Code Sections 933.05 (a) and (b). 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 147 All responses to the recommendations of the 2015-2016 Civil Grand Jury must be submitted on or before September 30, 2016, to: Presiding Judge Los Angeles County Superior Court Clara Shortridge Foltz Criminal Justice Center 210 West Temple Street Eleventh Floor-Room 11-506 Los Angeles, CA 90012 Responses are required from: Board of Supervisors: 7.1, 7.2, 7.3, 7.4, 7.5, 7.7, 7.13 Registrar-Recorder/County Clerk: 7.2, 7.3, 7.4, 7.5, 7.6, 7.7, 7.8, 7.9, 7.10, 7.11, 7.12, 7.13, 7.14, 7.15 VII. ACRONYMS BMD Ballot Marking Device BOS Board of Supervisors CGJ Civil Grand Jury ISB Interactive Sample Ballot PSA Public Service Announcement RR/CC Registrar-Recorder/County Clerk VBM Vote By Mail VIII. COMMITTEE MEMBERS Molly Milligan Chair Bruce A. Berke Francine DeChellis Victor H. Lesley Stephen Press Cynthia Vance George Zekan 148 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT ICE IN L.A. ICE IN L.A. I. EXECUTIVE SUMMARY The Los Angeles County Civil Grand Jury (CGJ) conducted a study to determine the effectiveness of a new program in the screening of undocumented immigrants in Los Angeles County jails. The primary concern of the CGJ was to ensure that agents of Immigration and Customs Enforcement (ICE) interview, for possible deportation, those undocumented inmates deemed to be a serious public safety threat. The new procedure from the Los Angeles County Sheriff’s Department (LASD) outlined a shift away from the previous policies and procedures. Under the new policy, federal immigration officials are allowed access to inmates who are being released from jail. ICE agents will only be allowed to interview those inmates who have been convicted of serious crimes and are not protected by the California Trust Act. The Trust Act shields immigrant inmates from ICE agents unless they have been convicted of a serious crime. Inmates are advised of their right to consult counsel before they are turned over to ICE agents. Public posting of information is instituted to promote transparency and accountability. Monthly audits make sure only Trust Act qualified inmates are transferred to ICE, and only during the standard time period it would normally take to release an inmate.1 The new procedures in Los Angeles County stand in contrast to those in San Francisco. The Sheriff in San Francisco and other sanctuary cities have banned all collaboration with federal immigration officials except when federal authorities have a court order or a warrant. II. BACKGROUND Seven days prior to any inmate’s release, LASD provides his or her name to ICE agents. The ICE screening process of inmates to be released at the Inmate Reception Center (IRC) consists of computerized database screening such as fingerprints and is not race-based. The LASD personnel verify that the inmate’s conviction is listed in the California Trust Act. Only after all of the relevant steps are completed can an ICE interview occur, 1 Letter from Sheriff Jim McDonnell to Board of Supervisors. September 22, 2015 (hereafter “McDonnell letter”). 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 149 followed by the possibility of an ICE immigration detainer and advice of their right to consult with legal counsel. Figure 1 illustrates the screening process. Some programs identified in it are described in detail later in this report. Figure 1 – Screening Process Diagram No Is there an ICE Yes detainer issued through PERC? No Does inmate meet PEP and Notify inmate of an ICE Trust Act? detainer. Advise inmate of right to consult counsel Inmate will not be Yes available for transfer to ICE Yes No Potential for ICE Does inmate interview meet PEP and Trust Act? Inmate will not be Notify ICE up to seven Notify ICE up to seven available for transfer (7) days prior to release (7) days prior to release to ICE P otential for ICE transfer Potential for ICE transfer 2 CGJ devised this chart based on information received from LASD. The information contained in this simplified diagram is merely for reference use only and not intended as legal advice or direction. No reliance should be placed upon it for making important decisions. 150 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT A. History In 2005 and again in October 2014 the Los Angeles County Board of Supervisors (BOS) authorized LASD to participate in ICE’s 287(g) program. This section of the Immigration and Nationality Act allows local law enforcement officials to perform some of the duties of immigration officers. Five specially trained custody assistants worked with a dozen federal agents within the Los Angeles County jails, interviewing and investigating inmates to determine their immigration status.3 This kind of in-depth screening helped detect deportable inmates whose fingerprints did not show up in the federal database. On May 12, 2015, BOS voted 3-2 to end the program. The Los Angeles Times reported that this vote was the result of years of pressure from advocates who claimed that it led to racial profiling.4 The same day BOS ended the prior agreement, it voted 4-1 to instruct LASD to continue to cooperate with ICE in identifying deportable immigrants being held in the jails which included a new federal initiative called the Priority Enforcement Program (PEP). BOS directed LASD to report back in 90 days on a strategy for implementation while safeguarding the rights of all. Following this action LASD sought input from a variety of community groups, including “ICE out of L.A.,” the Public Defender’s Office, the American Civil Liberties Union, the National Immigration Law Center and other immigration groups. These policies were finalized on September 22, 2015. B. Key LASD practices and principles 6 • LASD will provide ICE with notification up to seven (7) days prior to an inmate’s release. Full access into the County’s jails and databases will also be authorized in order for ICE to conduct thorough investigations, ensuring timeframes and procedures are met. During this period of time, ICE will have the opportunity to interview inmates who have ICE immigration detainers and certain other inmates who meet PEP and Trust Act criteria. • LASD will implement a system for notifying inmates when an ICE detainer is issued. In addition to the notification, inmates will be advised of their opportunity to consult legal counsel. • ICE agents will be allowed to review the status of all inmates who are being released. This effort helps to identify any and all individuals who may pose a danger and who are within the criteria of both PEP and the Trust Act. • LASD will validate an inmate’s qualification under the Trust Act, prior to in- custody transfer to ICE. All crimes allowable by the Trust Act will be eligible for in-custody transfer. The Times Editorial Board. “No Ice in L.A. County jails.” Los Angeles Times 19 May 2015 http://www.lstimes.com/nation/la-ed-ice- agents-in-county-jailos-20150519-story.html 4 Linthicum, Kate. “Immigration agents allowed back in L.A. County jails, with limits.” Los Angeles Times 23 Sept. 2015. http://www.latimes.com/local/lanow/la-me-ln-ice-los-angeles-jails-20150922-story.html 5 Linthicum, Kate. “Immigration agents allowed back in L.A. County jails, with limits.” Los Angeles Times 23 Sept. 2015. http://www.latimes.com/local/lanow/la-me-ln-ice-los-angeles-jails-20150922-story.html 6 McDonnell letter. 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 151 • ICE agents will be authorized to interview specific inmates who do not have ICE immigration detainers issued through Pacific Enforcement Response Center (PERC). • Trust Act/PEP qualified inmates will be transferred to the custody of ICE only during the standard amount of time it would normally take to release an inmate. No inmate will be held beyond the release date based solely on an ICE request. • To promote transparency and accountability, monitoring and public posting of information will be instituted. C. Pacific Enforcement Response Center The Pacific Enforcement Response Center (PERC) is the agency through which ICE issues immigration detainers for immigrants arrested by local law enforcement who are suspected of being in the country illegally.7 The center is a key part of the federal government’s efforts to identify and deport immigrants convicted of serious crimes. Immigration authorities issue immigration detainers based on electronic data after gaining access to fingerprints from jail bookings. This is a result of enhanced law enforcement information-sharing after the 2001 terrorist attacks. D. Priority Enforcement Program 8 On November 20, 2014, the Obama Administration announced the new PEP program regarding immigration enforcement. The new policies took effect on January 5, 2015. The Department of Homeland Security (DHS) PEP enables ICE to work with state and local law enforcement to take custody of inmates who pose a danger to public safety before they are released into our communities. PEP was established at the direction of the DHS Secretary and focuses on convicted criminals and others who pose a danger to public safety. PEP begins at the state and local level when an individual is arrested and booked by a law enforcement officer for a criminal violation and his or her fingerprints are submitted to the FBI for criminal history and warrant checks. This same biometric data is also sent to ICE so that ICE can determine whether the individual is a priority for removal, consistent with DHS enforcement priorities. Under PEP, ICE will seek the transfer of a removable individual who has (1) been convicted of an offense listed under DHS civil immigration enforcement priorities, (2) intentionally participated in an organized gang to further the illegal activity of the gang, or (3) poses a danger to national security. The policy is primarily about reforms to immigration detainers which will now generally be notification requests, not hold requests for extra detention. Taxin, Amy. “Immigration detainers often issued by California Center.” The Associated Press 19 Sept. 2015. http://home.cableone.net/news/read/category/AP%20Top%20News%20-%20US%20Headlines/article/the_associated_press- immigration_detainers_often_issued_by_california_c-ap 8 Department of Homeland Security Website. https://www.ice.gov/pep 152 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT The three civil enforcement PEP priority levels are described below.
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  years 65% 93% Over 65 years 12% 3% Race: White 27% 17% Black 8% 18% American Indian 0.2% <1% Asian/Pacific Islander 15% 12% Latino 48% 47% Other 2% 6% Income: Median Household $55,746 $21,980 Income Average Household $83,104 $37,142 Income Source: 2014 American Community Survey (ACS); Metro 186 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT
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  Properties are declared surplus to individual department needs: then canvassed to other departments. If no department finds a need for them, it is declared surplus to the City needs via a City Council action. Then we try and sell the property through either a direct sale or hire a broker to list & market the property.