Health & Human Services Committee Ronald C. Fletcher, Chair

Recommendations 29

• R02-36
  REQUIRE A POLICY AND PROCEDURES MANUAL TO BE AVAILABLE IN THE CASH RECEIPTS AREA.
• R02-37
  HIRE LICENSED VOCATIONAL NURSES IN THE ACUTE CARE HOSPITAL.
• R02-38
  PROVIDE A TEAM NURSING SYSTEM ON THE MEDICAL-SURGICAL FLOOR.
• R02-39
  POST BILINGUAL SIGNS THROUGHOUT THE ARMC. 32
• R02-40
  RE-POSITION DIRECTIONAL SIGNAGE ON THE SECOND FLOOR THAT SHOWS THE LOCATION OF PATIENT ACCOUNTS DEPARTMENT.
• R02-41
  PROVIDE ALL VISITORS WITH IDENTIFICATION BADGES.
• R02-42
  PROVIDE AN AREA FOR VISITORS IN THE MAIN ARMC LOBBY THAT IS COMFORTABLE.
• R02-43
  REDUCE NOISE LEVEL IN THE ARMC LOBBY.
• R02-44
  PROVIDE VISIBLE SECURITY IN THE EMERGENCY ROOM AND LOBBY.
• R02-45
  PROVIDE ADDITIONAL SHADE ON THE PATIOS IN THE BEHAVIORAL HEALTH HOSPITAL.
• R02-46
  ACTIVATE THE CAMERAS IN THE BEHAVIORAL HEALTH SECLUSION ROOMS.
• R02-47
  REVIEW THE ADVISABILITY OF A LABOR-DELIVERY-RECOVERY-POST PARTUM (LDRP) UNIT.
• R02-48
  PROVIDE A WARD FOR PRISONERS THAT AVOIDS TRAVERSING PATIENT AREAS.
• R02-49
  EXPAND THE EMERGENCY ROOM WAITING AREA.
• R02-50
  PROVIDE AND IDENTIFY A PUBLIC INFORMATION PERSON IN THE EMERGENCY ROOM WAITING AREA.
• R02-51
  PROVIDE ADDITIONAL PARKING FOR OUTPATIENTS AND VISITORS.
• R02-52
  REQUEST FUNDS FROM THE BOARD OF SUPERVISORS WHEN A SPECIFIC NEED IS CURRENT AND PUT THE FUNDS IN A DESIGNATED ACCOUNT THAT RELATES TO THE REQUEST.
• R02-53
  PROVIDE X-RAY EQUIPMENT AND LABS TO FAMILY HEALTH CENTER CLINICS. DEPARTMENT OF AGING AND ADULT SERVICES (DAAS) BACKGROUND The mission of the Department of Aging and Adult Services (DAAS) is to serve seniors and at-risk individuals and assist them in maintaining or improving choices, independence, and quality of living, while living in the least restrictive environment. DAAS is the designated area agency on aging for the County of San Bernardino and is responsible for administering all funds under Title III and Title VII of the Older Americans Act. DAAS has a staff of 366 and provides employment for approximately 10,000 independent providers (In-Home Support caregivers). DAAS has offices in 14 locations throughout the County and provides a wide range of services and programs for senior citizens and adults with disabilities, including but not limited to: Senior Home and Health Care Adult Protective Services In-Home Supportive Services Ombudsman Program Senior Nutrition Legal Services Senior Employment Transportation Services Care Giver Services DAAS is committed to safeguarding the rights of vulnerable adults, supporting care- givers, promoting prevention of abuse, and providing information and assistance to help solve any problem clients may have. DAAS is also the County department responsible for planning, coordinating and funding programs for all functionally impaired adults and for educating the public on elder/dependent adult issues. The department is required to insure that options are easily accessible to all older individuals, and to have a visible focal point where anyone can go or call for help, information or referral. FINDINGS The Department of Aging and Adult Services (DAAS) is preparing for a budget deficit due to the $14 to $20 billion deficit of the State of California. This comes at a time when the baby boomers are only four years away from joining the 55-60 year senior population grouping. DAAS has joined a nationwide movement by implementing a computerized tracking system, known as SAMS (Social Assistance Management System), to track the types of services delivered to clients. DAAS’ goals have been reassessed and some have either been combined with new ones or deleted. The Department of Aging and Adult Services held public hearings for seniors and young adults with disabilities. The purpose of the hearing was to identify and assess the needs of senior citizens and young adults with disabilities. It also obtained reactions on the present services provided by DAAS and the type of assistance that older persons and younger disabled adults felt were needed. Transportation services that would enable seniors to gain access to community services and resources such as shopping and health visits through specialized transportation are non-existent, especially in rural areas. When available, family, friends and volunteers are used to provide transportation. Whenever possible, they are used to do shopping, keep medical appointments and pay bills. Outlying areas are losing the use of the Transportation Reimbursement Escort Program (TREP) because of insurance problems and under-utilization. DAAS assists when such support is not available. The goal of creating a Senior Network, along the lines of the Children’s Network, has been abandoned. The position of Network Officer, approved by the Board of Supervisors, has been eliminated, as a cost-cutting endeavor. The individual who held that position, along with support staff, have been transferred to vacant positions within DAAS. Low-cost housing is a top concern for seniors and adults with disabilities. The housing for seniors in San Bernardino County is limited. There is a long waiting time for affordable senior housing. Most senior housing is too expensive for low-income individuals on a fixed income. Section 8 funds pay all but 30 percent of a seniors rent, but the wait to be added to the program is currently more than two years as there is a limited amount of resources to pay for the program. There is a great need for more volunteers and paid staff in the Ombudsman Program to visit nursing homes and board and care homes. Ombudsmen are State- certified volunteers who are empowered to investigate and resolve complaints about long- term care facilities in the County. The Senior Employment Program places eligible seniors age 55 or older, and low- income, in on-the-job training positions. Participants are paid minimum wages while training 20 hours per week with government and private agencies. The largest change that DAAS has undergone is in the Long-Term Care Integrated Pilot Project. Early in 1997 the State Department of Health notified DAAS that it had been selected as a Long-Term Care Pilot Project. Goals and objectives were developed and included in the 1997-2001 Area Plan that was approved by the Board of Supervisors in May of 1997. During 1999 changes within the County, and the State Department of Health’s failure to secure critical waivers, prohibited further development of a Long-Term Care program. There are no plans to continue this project. DAAS does not feel that the Long-Term program is achievable. In the future, with the increase of older persons within the State and County, this project may be reconsidered for inclusion in their next area plan. RECOMMENDATIONS
• R02-54
  ESTABLISH AFFORDABLE TRANSPORTATION SERVICE FOR SENIOR CITIZENS.
• R02-55
  RE-ESTABLISH THE PROPOSAL TO DEVELOP A FORMAL “AGING AND ADULT NETWORK”, PATTERNED AFTER THE CHILDREN’S NETWORK.
• R02-56
  ONE MEMBER OF THE BOARD OF SUPERVISORS SERVE ON THE AGING AND ADULT NETWORK BOARD.
• R02-57
  PROVIDE ADDITIONAL FUNDING FOR SECTION 8 FOR AFFORDABLE HOUSING FOR SENIORS AND ADULTS WITH DISABILITIES.
• R02-58
  PROVIDE FUNDING FOR TRAINING AND CERTIFICATION FOR MORE VOLUNTEERS IN THE OMBUDSMAN PROGRAM.
• R02-59
  SUBMIT PUBLIC SERVICE ANNOUNCEMENTS ON THE OMBUDSMAN PROGRAM TO LOCAL NEWSPAPERS AND RADIO AND TELEVISION STATIONS. 36
• R02-60
  DEVELOP PUBLIC INFORMATION PACKETS TO ALERT SENIORS ABOUT JOBS AND JOB TRAINING. DEPARTMENT OF CHILDREN’S SERVICES CHILDREN’S ASSESSMENT CENTER
• R02-61
  DEVELOP A PLAN TO EXPAND THE CHILDREN’S ASSESSMENT CENTER THROUGH THE CHILDREN’S FUND AND PRIVATE BENEFACTORS.
• R02-62
  THE COUNTY OF SAN BERNARDINO DEVELOP AND IMPLEMENT A PLAN FOR THE HIGH DESERT AND OTHER AREAS TO HAVE EASY ACCESS TO THE CHILDREN’S ASSESSMENT CENTER SERVICES. DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FOOD PROTECTION PROGRAM BACKGROUND The Food Protection Program is a division of the Environmental Health Services Department, which operates under the County Public Health Department. It is the largest and most demanding program under Environmental Health Services. The office performs inspections on public eating establishments, oversees the food operations of markets, food concessions, ice cream trucks, and wholesale food establishments. The program monitors safe food handling practices, cleanliness and compliance with the California Health and Safety Code, which this department uses as the standard. FINDINGS There are currently 40 inspectors working in the Food Protection Program, handling approximately 32,260 inspections per year. Of the total staff, one supervisor, seven field inspectors and four clerical staff positions are bilingual. The Food Program’s annual budget is presently $3,377,000. A Bachelor’s degree in Science and 450 hours of training in Environmental Science, or a Bachelor’s degree in Environmental Health, are required to be hired as a food inspector. Journeyman inspectors spend about four months in training before being assigned on their own. Inspections are performed twice per year and inspectors are rotated into new districts approximately every two to three years. Their inspections and records are presently up to date. An accounting verification program is now tracking and computerizing all inspections. In the event the department cannot meet its inspections schedule due to a shortage of inspectors, employees are rotated so that no establishment goes for a year without an inspection. Inspectors use a standard Environmental Code to rate each facility’s inspection. All inspections begin with a score of 100. Violations have point deductions to achieve an overall rating. The final score and all infractions needing correction and modification are physically shown to the manager and each infraction discussed with them. All restaurants are required to display a placard that informs the public that the last inspection report is available for their review. On the inspection report there is a telephone number for the County Food Protection office, date of last inspection and signature of the inspector. In this way, any person can easily verify an establishment’s certification. Mobile lunch wagons with hot food, ice cream trucks and food vendor carts are also inspected once per year and must display a sticker denoting their current status. No food that has been prepared at home is allowed to be sold at any commercial establishment due to the inability of the County to regulate the preparation and the lack of proper equipment. Hairnets are not required for food handlers. Long hair must be pulled back. Gloves must be worn if fingernails are painted or if there is a cut or wound on the hands, but it is not an overall requirement. Proper and thorough hand washing is required. There must be hot water at an establishment or it could be closed down. There are no State requirements for food handlers to possess a health certificate or show proof of any blood tests for possible diseases such as hepatitis or tuberculosis. A Food Handler’s permit is required to work in food establishments and the certificates must be available to the inspector who verifies that employees have them and that they are current. All hot food must be maintained at 140 degrees and cold food maintained at 41 degrees or below. Members of the Grand Jury accompanied two different inspectors at four separate restaurants. Both inspectors did thorough inspections of all areas at these four establishments, including the restrooms. RECOMMENDATIONS
• R02-63
  OBTAIN THE AUTHORITY TO TEST RESTAURANT WORKERS PERIODICALLY FOR TUBERCULOSIS, HEPATITIS OR ANY OTHER COMMUNICABLE DISEASE.
• R02-64
  REQUIRE ALL RESTAURANT AND FOOD HANDLERS TO POSSESS A VALID HEALTH CERTIFICATE. 41