Inal Eport San Luis Obispo County Grand Jury P.o. Box 4910 San Luis Obispo, California 93403

SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency

SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency

SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency

SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency

SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency

SLO County Health Agency Agreed

SLO County Health Agency’s Drug and Alcohol Services Partially-agreed by Health Agency

SLO County Health Agency’s Drug and Alcohol Services Agreed

SLO County Sheriff’s Department Agreed

SLO County Health Agency’s Drug and Alcohol Services Disagreed Of the 10 recommendations made by the Grand Jury in the Residential Detox report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response

Of the 10 findings made by the Grand Jury in the Residential Detox report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response F1 SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency F2 SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency F3 SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency F4 SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency F4 SLO County Sheriff’s Department Agreed F5 SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency F5 SLO County Health Agency’s Health Care Services Division Agreed by Health Agency F6 SLO County Health Agency Agreed F6 SLO County Health Agency’s Health Care Services Division Agreed by Health Agency F6 SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency F7 SLO County Health Agency’s Drug and Alcohol Services Partially-agreed by Health Agency F8 SLO County Health Agency’s Drug and Alcohol Services Agreed F8 SLO County Sheriff’s Department Agreed F9 SLO County Sheriff’s Department Agreed F10 SLO County Health Agency’s Drug and Alcohol Services Disagreed Of the 10 recommendations made by the Grand Jury in the Residential Detox report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response R1 SLO County Health Agency Implemented R2 SLO County Board of Supervisors Will be implemented R3 SLO County Health Agency Requires further analysis 27 2017-2018 San Luis Obispo County Grand Jury Final Report R4 SLO County Sheriff’s Department Agrees and implements when and where possible R5 SLO County Sheriff’s Department Requires further analysis R6 SLO County Health Agency Will be implemented R6 SLO County Sheriff’s Department Will be implemented R7 SLO County Health Agency Requires further analysis R8 SLO County Board of Supervisors Will be implemented R9 San Luis Obispo City Council No response R10 SLO County Health Agency Implemented Of the five findings listed for the County Jail Inmate Health and Safety report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response F1 SLO County Sheriff’s Department Partially Disagreed F1 SLO County Health Agency Agreed F2 SLO County Sheriff’s Department Agreed F2 SLO County Health Agency Agreed F3 SLO County Sheriff’s Department Agreed F3 SLO County Health Agency Agreed F4 SLO County Sheriff’s Department Agreed F4 SLO County Health Agency Agreed F5 SLO County Sheriff’s Department Agreed F5 SLO County Health Agency Agreed Of the one recommendation made in the County Jail Inmate Health and Safety report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response R1 SLO County Sheriff’s Department Partially implemented and will provide report to BoS R1 SLO County Health Agency Partially implemented and will provide report to BoS Of the seven findings listed in the Juvenile Hall Surplus Space report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response F1 No Response Required No Response Required F2 SLO County Board of Supervisors Partially disagreed F2 SLO County Probation Department Partially disagreed F3 SLO County Board of Supervisors Agreed F3 SLO County Probation Department Agreed F4 SLO County Board of Supervisors Agreed F4 SLO County Probation Department Agreed 28 2017-2018 San Luis Obispo County Grand Jury Final Report F5 SLO County Probation Department Partially disagreed F6 SLO County Probation Department Agreed F7 SLO County Board of Supervisors Disagreed F7 SLO County Probation Department Disagreed We note stating that the treatment program is operating in accordance with Regulations is not the same as stating it has a written operations manual. We also note the response to finding 7 may not have adequately addressed whether the juvenile hall is currently underutilized and whether money could be saved by addressing that fact. Of the four recommendations made in the Juvenile Hall Surplus Space report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response R1 SLO County Board of Supervisors Will not be implemented R2 SLO County Board of Supervisors Will not be implemented R3 SLO County Probation Department Implemented R4 SLO County Board of Supervisors Will not be implemented We sincerely hope that sometime in the near future the CAO will review whether Juvenile Hall space is underutilized and whether taxpayer money can be saved. Of the six findings listed in the County Capital Projects report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response F1 SLO County Board of Supervisors Agreed F1 SLO County Department of Public Works Agreed F2 SLO County Department of Public Works Partially disagreed F3 SLO County Board of Supervisors Partially disagreed F4 SLO County Department of Public Works Agreed F5 SLO County Board of Supervisors Partially disagreed F5 SLO County Department of Public Works Partially disagreed F6 SLO County Board of Supervisors Agreed F6 SLO County Department of Public Works Agreed Of the three recommendations made in the County Capital Projects report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response R1 SLO County Board of Supervisors Partially implemented R1 SLO County Department of Public Works Partially implemented 29 2017-2018 San Luis Obispo County Grand Jury Final Report R2 SLO County Board of Supervisors Will be implemented R2 SLO County Department of Public Works Will be implemented R3 SLO County Board of Supervisors Will not implement, but will re-evaluate at a later date R3 SLO County Department of Public Works Will not implement, but will re-evaluate at a later date Of the four findings listed in the California Men’s Colony Inspection report (Encouraged to respond, but not required): (Ctrl + Click to see response) (Click on Return to return) # Respondent Response F1 California Men’s Colony (California State prison) No response F2 California Men’s Colony (California State prison) No response F3 California Men’s Colony (California State prison) No response F4 California Men’s Colony (California State prison) No response Of the four findings listed in the Cambria Fire report (Ctrl + Click to see response) (Click on Return to return) # Respondent Response F1 Cambria Community Services District Agreed F2 Cambria Community Services District Agreed F3 Cambria Community Services District Agreed F4 Cambria Community Services District Agreed Of the three recommendations in the Cambria Fire report # Respondent Response R1 Cambria Community Services District Agreed and implemented R2 Cambria Community Services District Agreed and in process of implementing R3 Cambria Community Services District Agreed and in process of implementing The Grand Jury was concerned that for the most part CCSD did not provide deadlines to meet their objectives. The 2017-2018 Grand Jury continues to have grave concerns for Cambria residents and visitors and how the town can reduce its fire risk. On Monday, February 5, 2018, the Cambria Community Services District (CCSD) held an open meeting to discuss a proposal to replace an expiring Federal Grant which funds three full-time firefighters until March 2018. The proposal is to levy a $50 assessment per parcel (or a possible $85 per inhabited parcel assessment) within the CCSD area. This would generate approximately $300,000 per year to fund firefighters. This measure would appear on the June 5, 2018 ballot for Cambria voters to decide. No final decision has been made as of the date of this report. We believe 30 2017-2018 San Luis Obispo County Grand Jury Final Report the residents will want to keep their firefighters and make sure the hydrant inspection and maintenance program continues.

The Grand Jury observations of the PHF show an antiquated facility that does not meet the crisis needs of the County’s mentally ill population. While the staff at the facility is dedicated, there can be insufficient staff present at times to ensure safety and provide optimal treatment.

While the majority of services provided meet the goals of the mission statement, it has come to the attention of prior and current San Luis Obispo County Grand Juries that, at times, County Behavioral Health services provided to clients in crisis fall short of best practices due to lack of funding for sufficient staff and facilities. New services like the Crisis Stabilization Unit and the proposed drug and alcohol services inpatient facility are a big step in the right direction, but more is needed. There are currently three outpatient clinics, three wellness centers, and a single 16-bed PHF to service our entire County’s over 5000 severely mentally ill residents. Behavioral Health is doing an admirable job with the resources it has available but requires more funding. Currently the state and federal governments provide approximately $58M for the behavioral services within our County. The benefit of augmenting the approximately $12M current County contribution with additional resources will be felt almost immediately within our community. Long-term programs, such as the Stepping Up Initiative (the County-adopted, national initiative to help keep people with behavioral health problems out of our judicial system), will have a chance to be more successful by providing more complete treatments aimed at keeping clients out of crisis situations and out of jail. 48 2017-2018 San Luis Obispo County Grand Jury Final Report A LOOK AT COUNTY BEHAVIORAL HEALTH SERVICES: THE TIME FOR IMPROVEMENTS IS NOW The County has the treatment structure required to address these behavioral health problems but is not currently equipped to handle the volume of clients living in the County. This Grand Jury report considers these problems from a perspective of what can and should be done now and the impact it will have in support of some of our County’s most vulnerable citizens. The companion report on the PHF also concludes that the operations at the PHF are being carried out by a dedicated and capable staff, but the facility itself is antiquated and lacks adequate therapy and treatment spaces. While the facts and observations document the basis of numerous continuing problems, these issues are complex, partially because this community has been underserved for so long. Not all of the issues surrounding our treatment of those with mental illness and/or substance abuse can be solved quickly or inexpensively, but now is the time to increase our effort to work toward a long term solution. The position with primary responsibility to garner this support is in the process of change; a strong advocate is needed. This need was reflected in the qualifications requested and responsibilities documented in the search to fill this position. Most of the findings reflect recommendations that are needed but will require additional County funding. Many of these should have been addressed long ago, but budget priorities have caused this segment of the population to be neglected and ignored. Ignoring these problems has been a major contributor to the number of our mentally ill population being involved in the criminal justice system and to the San Luis Obispo County Jail becoming the area’s second largest mental health institution after ASH.

The inspections have identified several problem areas that could be corrected in multiple ways. In addition, there is a lack of long-term planning for the jail facilities.

DPH has the responsibility and authority to regulate sources of pollution and infection which put the public health at risk. EHD conducts inspections, testing, public education programs, and collaborative mitigations to accomplish its mission. The San Luis Obispo County Public Health Department maintains a website which provides disease statistics for the County, restaurant inspection results, mosquito populations, and related information. Based on our investigation, the Grand Jury found the actions of the County Public Health Department exceeded the existing guidelines, and no evidence was found to support the complaint.

The State threw down a gauntlet when it transferred responsibility for rehabilitating lower-level felons from State prisons to county jails. And when Proposition 47 bled county jails of lower-risk offenders, county jails lost their easier-to-manage, easier-to-program inmates. Rome wasn’t built in a day, but the Jail has had seven years to deal with this challenge. AB 109 provided the Jail with a funding stream to build programs known to work which can be offered across classification and housing unit boundaries. The Jail should use this funding stream, the program rooms which opened last year, and the program rooms opening this year to really “move the dial” from a warehouse environment to a programming environment focused on reducing recidivism.

While the East and West facilities are under common management, their inmates and environments are quite distinct. The East facility is a higher security prison, where inmates are locked in cells and generally controlled most of the day. Their programming options are significant, but the vocational training in the CALPIA factories seems to be the most common endeavor. The West facility houses inmates requiring less security and provides them with freedoms commensurate with their status. They more actively participate in programming aimed at benefiting them after their release back into society. They seem to be working toward parole or release rather than just passing time. This parallels the distinctions at our County jail, between the main jail and the honor farm. 105 2017-2018 San Luis Obispo County Grand Jury Final Report INSPECTION REPORT FOR CALIFORNIA MEN’S COLONY

The Stipulated Order of Abatement offers the possibility that substantial remediation efforts may finally be implemented. Several individuals, including members of the Hearing Board and the former APCO, have identified deficiencies in the abatement order and question whether it will ultimately work. In the event that the Particulate Matter Reduction Plan (PMRP) fails to achieve the required attainment of the State and Federal PM air quality standards within the four-year 10 period specified, this would represent an unacceptable health risk to the public. If this were to occur, future BoS and APCD Hearing Boards may act decisively to protect public health, and take actions under the authorities they possess, and drastically restrict riding activity on the La Grande Tract as quickly as possible. 124 2017-2018 San Luis Obispo County Grand Jury Final Report IS THERE A HEALTH RISK FROM THE DUNES? “THE ANSWER, MY FRIEND, IS BLOWING IN THE WIND”

The Grand Jury commends Behavioral Health and its community partners for: a. Operating the Full Service Partnership program, where layered services support patients with severe mental illness b. Eliminating wait lists for most services c. Adding a Crisis Stabilization Unit

The Grand Jury commends the County for acknowledging the desperate need for a residential detox center and their continued support for the center. 51 2017-2018 San Luis Obispo County Grand Jury Final Report A LOOK AT COUNTY BEHAVIORAL HEALTH SERVICES: THE TIME FOR IMPROVEMENTS IS NOW

The management and staff of Juvenile Hall should be commended for their forward- looking approach to rehabilitating the County’s troubled youth.

We commend the Cambria Community Services District on establishing a testing and maintenance schedule for their fire hydrants, but we encourage the pace of the testing be picked up to ensure all hydrants are working. We also commend the County Department of Public Works for undertaking pilot programs for the use of the Design-Build approach to see if taxpayer money can be saved for County capital projects. We look forward to seeing the results of the pilot programs and what suggestions the Department makes to the Board of Supervisors. Finally, we commend the County Health Agency for their work with Community Action Partnership of San Luis Obispo County in bringing the residential detox facility (to serve Medi- Cal and less financially able citizens in San Luis Obispo County) closer to reality. Health Agency is working to meet the deadline they provided to the Grand Jury for Recommendation 1 from the 2016-2017 Residential Detox report. The Grand Jury has written a number of prior reports identifying the need for a residential detox facility in SLO County. SLO County staff is concerned recent federal changes to the Affordable Care Act may cause a reduction in reimbursements thereby affecting service levels and possibly resulting in the closure of the detox facility. Should this happen, we trust the SLO County Board of Supervisors will find the necessary funds to make up any shortfall.

The staff and management of the PHF are commended for their dedication to doing the best possible job with such limited and antiquated resources.

The Grand Jury commends the County of San Luis Obispo Public Health staff for their cooperation, professionalism and thorough responses to our inquiry of this issue.

The Grand Jury commends Jail Administration, Jail Programs Staff, and Jail Correctional Staff for trying to provide inmate access to programming in the face of significant safety, staffing, transport, and program space challenges. Correctional deputies who are actively involved with inmate programs are particularly commended.

The 2017-2018 San Luis Obispo County Grand Jury commends three individuals who have been intimately involved in every aspect of the particulate air quality problem over the past several years. Each of these individuals has played a critically important role in activities that have resulted in the Particulate Matter Reduction Plan (PMRP) described in this report. These persons are the Deputy Director of State Parks, and the previous and current Air Pollution Control Officers. 127 2017-2018 San Luis Obispo County Grand Jury Final Report IS THERE A HEALTH RISK FROM THE DUNES? “THE ANSWER, MY FRIEND, IS BLOWING IN THE WIND”

The Sheriff’s department is building a new medical facility with three additional classrooms for inmate programming. The new medical facility will be 8000 square feet and will provide medical, dental, and routine mental health treatment. No psychiatric hospital facilities are currently available within the jail. Medical staff is currently present at the jail facility 24 hours a day. Behavioral Health staff is present 19 hours a day, and they currently see approximately 600 inmates per month. At any one time, there are between 200 and 300 inmates receiving maintenance medications for psychological disorders. The costs for both medical and mental health services are borne by the County. The County is required by the state to house all inmates declared incompetent to stand trial (Penal Code 1370) in the jail until a bed in a state or county facility is available. This wait for a bed can take months for inmates charged with a felony. (PC 1370 inmates charged with a misdemeanor are treated at the County PHF.) The number of PC 1370 beds available at ASH is going to be reduced by 10% this year as the hospital is remodeling to be able to absorb more difficult patients. In 2017, the jail bed competency treatment facility in San Bernardino was used for most of the felony PC 1370 patients. The San Bernardino facility is now at capacity and will be able to take fewer patients in the future; thus, wait times for PC 1370 felons at the jail will rise above the current average of two-to-three months. The jail transports approximately one inmate a day to local hospitals and approximately 1000 inmates a month to the County courthouse. The jail has no closed-circuit TV capability to allow inmates to participate in hearings remotely. Other inmate transportation requires an additional 500 60 2017-2018 San Luis Obispo County Grand Jury Final Report INSPECTION REPORT FOR SAN LUIS OBISPO COUNTY DETENTION FACILITIES transports monthly, which can include transportation to the County Psychiatric Health Facility (PHF), and other county or state facilities. County Coroner Facility The County Coroner facility was clean and well maintained. All health and safety inspections were up to date. The staff includes both sworn deputies and civilians and includes a full-time Forensic Pathologist. This position was recently transitioned from a part-time contract position to a full- time employee. The staff was knowledgeable of the health and safety requirements as well as the legal requirements of the office. The Coroner’s office must rule on all deaths within the County, approximately 2000 annually, and perform approximately 250 autopsies per year. The process for recording an autopsy is cumbersome and requires extra time from the pathologist and assisting deputy to record. Medical transcription duties following the autopsies fall to the administrative assistant. The Coroner’s office is in a leased building with no back-up generator or other auxiliary power source available on site in the event of a long-term power outage. The current procedure is to bring a generator from the Kansas Avenue Corporation Yard in the event of an emergency.

Housing decisions hamper inmate access to programs.

Expanding programs and services to reach inmates in higher security housing persists as an unmet need. Delivering services on an individual basis is judged too costly, even though the CCP is sitting on about three million dollars in AB 109 reserves.21

Programming emphasizes job training, which is mainly available to the relatively small population of honor farm men. The AB 109 funds used to hire a program manager at the honor farm have supported construction training for only a few men.22

There are no programs specifically targeted to young adult (age 18–25) inmates who could benefit from interventions to change behavior while their brains are still developing. Unsentenced Inmates/Uncertain Length of Stay

When unsentenced inmates—whose length of stay is uncertain—participate in programs with sentenced inmates, as happens with programs delivered inside housing units, the effect can be therapeutically counterproductive due to the “constantly shifting group dynamic.”

Programs like Non-Violent Communication, AVP, and Thinking for a Change, which use intervention to change behavior, are designed for a cohort to move through and complete the program together to have the best chance of success. Unsentenced participants 21 Source: CCP presentation to the BoS July 25, 2017. 22 In late 2017, according to the Sheriff’s Office, the construction program had two graduates and nine enrolled. 92 2017-2018 San Luis Obispo County Grand Jury Final Report MOVING THE DIAL AT THE COUNTY JAIL jeopardize program success since they may not remain in the Jail’s custody long enough to allow the whole cohort to finish. Conducive Programming Space/Jail Layout

Inadequate physical space to conduct programming and the overall layout of the Jail have restricted the amount of programming offered, as well as inmate participation.

A significant change mentioned was bringing programs into the communal areas of housing units. Shifting programs into housing areas was credited with higher and more consistent program participation. However, these areas lack proper facilities and create tension in the units, elevating risk. Staffing Requirements

The Grand Jury knows facilitating inmate access to programs takes staff to do the job: clearing program providers for entry; ensuring program materials do not pose a safety or security risk; escorting inmates to and from classes held outside housing units; searching inmates entering and exiting areas outside housing units to be sure no contraband or unsafe objects are brought in or out…the list goes on.

One correctional deputy can escort no more than five inmates at a time; otherwise two or more deputies are required.

Staffing the Jail to at least minimum standards to ensure there are sufficient personnel available to respond to safety or security issues which might arise at any time means facilitating inmate access to programming necessarily takes a back seat. The Grand Jury has learned correctional deputies are required to work overtime in order to meet minimum standards. You Can Lead a Horse to Water…

Lack of inmate interest in participating is cited as a reason for disappointing outcomes.

On a recent day in early 2018, 226 inmates were offered access to one or more programs. Only 34 chose to participate. 93 2017-2018 San Luis Obispo County Grand Jury Final Report MOVING THE DIAL AT THE COUNTY JAIL

Some classes need a certain threshold of inmates willing to participate in order to run and/or receive funding. The Grand Jury learned it can sometimes be difficult to reach these thresholds.

Attrition plagues long-term programs (e.g., Thinking for a Change, a 24-module program) which need completion of all sessions to have the best chance of success.

Unlike at CMC, no shortened sentence incentives are provided to encourage inmate interest.

Inmate internships served outside the Jail at local businesses haven’t always worked as hoped. Some inmates violated rules while out or brought contraband back in. Environment/Culture

Various reports from Jail administration and providers state resistance from some correctional staff when it comes to facilitating programming.

Mandatory overtime—due to the number of staff retiring, a high rate of turnover among new recruits, and the time it takes to hire and train replacements—is taking a toll on staff morale. Determining What Works

Establishing cause and effect between programs and reduction in offender re-offense is hampered by lack of data needed to measure and report on program performance.

The CCP executive committee acknowledges program availability and capacity need review to ensure the top risk factors affecting criminal behavior are being addressed. Program Focus

The CCP executive committee has recognized the development of new strategies focused on rehabilitating offenders and reducing recidivism is a critical need.23 AB 109 funding provides the means to identify and invest in these strategies. 23 From October 1, 2016 to October 1, 2017, the number of offenders booked into the Jail was 7,351. Thirty-one percent were repeat offenders, with between 2 and 20 different bookings each. The top 10 repeat offenders averaged about 16 bookings each. Source: Sheriff’s Office. 94 2017-2018 San Luis Obispo County Grand Jury Final Report MOVING THE DIAL AT THE COUNTY JAIL

Recognition of the need to provide additional inmate programs, counseling, and education focused on reducing recidivism has been noted in the Sheriff’s budget each fiscal year since at least 2011–2012.

The realigned population, on whom much of the programming was focused, has dropped. As of July 2017, it was 17 percent of the Jail population, down from 29 percent in July 2014.

Facility The PHF facility is licensed by the California Department of Health Care Services (DHCS), who regularly inspect the facility for cleanliness and patient services. The overall facility is old and is not well maintained. The facility houses walk-in patients, W&IC 5150 patients or inmates, and PC 1370 inmates. The inmate patients are generally treated the same as all other patients, except that anyone charged with being a sexual predator is always escorted. Any juvenile residents are housed in an administration area, separated from adult patients. Inmate patients are not accompanied by security personnel, as they would be in a medical treatment facility. The policy has recently changed to not permit juvenile patients if inmates are currently housed. This causes many juvenile patients to be treated out of the County. This can conflict with treatment involving family therapy or counseling. The facility appeared crowded and does not contain dedicated spaces for therapy, physical exercise, or other treatments. The PHF houses up to 16 full time patients and has up to 10 staff members. The 16-bed limit on the PHF is from a Medicaid rule for psychiatric facilities not attached to a hospital. There is no area with sufficient room for normal physical activity as part of therapy or treatment, nor is there an area with dedicated treatment or therapy rooms. The medical examination room doubles as an administrative office, due to the extreme lack of space. There is one conference room and a common area, both of which are also used for therapy. At the time of the inspection, supplies were stacked high enough to impede the pattern of the fire sprinklers, and cleaning supplies were stored near one of the emergency exits. The minor health and safety issues were addressed with the staff and were found to be corrected in the subsequent inspection. There is very limited natural lighting within the facility, and the standard office type lighting contributes to the dingy appearance. The damaged ceiling tiles accentuate this appearance. Video cameras operate within the facility; however, there is only one video monitor in operation and it is at the staff desk. The surveillance system has low resolution and appears to be quite old. The PHF has six emergency exits that are automatically unlocked if the alarm is activated. An evacuation of the facility during the second or third shifts presents a risk to the surrounding 36 2017-2018 San Luis Obispo County Grand Jury Final Report OUR COUNTY CAN DO BETTER: THE CRISIS INSIDE THE WALLS OF THE PSYCIATRIC HEALTH FACILITY community if inmate patients are present. Procedures are in place to sweep the facility from one end to the other, keeping the patients (and inmates) with staff members. During this process or after exiting the facility, the inmates would have a nearly unfettered path for escape. With a ratio of up to four patients to each staff member and without the ability to apply mechanical restraints (such as shackles or handcuffs), there is little to prevent an inmate or group of inmates from deciding to leave. During this time of heightened stress on all patients, the staff is put in an untenable situation: one type of an emergency can cause a second type of emergency. Staff The number and distribution of staff is in accordance with the County practices and procedures and meets the state’s minimum criteria. While the staff appears to be dedicated to the welfare of the patients, this level of staffing can leave as few as three or four mental health professionals on duty for the overnight shifts. There are no Sheriff’s Deputies or Correctional Officers on staff at the facility at any time. The staff is trained in the ProACT de-escalation techniques, which includes 16 hours of training. In the event of a medical emergency with an inmate-patient, the inmate will be accompanied by a member of the PHF staff or local law enforcement, if available. County Policies and Procedures The County policies follow state regulations and allow staff levels as low as three for the third shift (midnights) and four for second shift (evenings). Day shift staff must have at least seven. In the event of an emergency, all six exits are unlocked and staff directs patients to the nearest safe exit. Safety of patients is the main priority; no provisions are made for control or segregation of inmates with respect to other patients. During the second or third shifts, there is not enough staff to monitor the unlocked exits while an emergency evacuation is taking place. Evacuation drills are held monthly to train the staff in dealing with patients in an evacuation scenario. The Behavioral Health staff at the jail now begins treatment prior to transporting inmates to the PHF; immediate communication with the PHF is established concerning inmate care, providing continuity of care for the inmate. 37 2017-2018 San Luis Obispo County Grand Jury Final Report OUR COUNTY CAN DO BETTER: THE CRISIS INSIDE THE WALLS OF THE PSYCIATRIC HEALTH FACILITY