Napa County*

R1

A leadership council should be formed by those government officials and stakeholders who control the most resources directed to the goal of supportive housing. Response, Director, Napa County Housing and Homeless Services: The recommendation has been implemented. The Director of Housing & Homeless Services recognizes the HUD mandate establishing the CoC as the local leadership council controlling the distribution of Federal and many State resources for programs assisting individuals and families experiencing homelessness. The Director values the vital role a single community planning entity plays in establishing and ensuring coordination between programs, applications, and uses of funding to address homelessness in the Napa community and further respects the work of the steering committee of homeless system leaders who led the considerable planning process to develop the 2022 Strategic Plan to Address Homelessness and the five goals it established: 1. Expand access to permanent housing, including permanent supportive housing, rapid rehousing, and other housing opportunities, for people experiencing or at risk of homelessness Prevent households from becoming homeless for the first time, and rapidly rehouse newly homeless households. 3. Expand access to and quality of services for people experiencing homelessness in Napa County. 4. Build upon cross-system partnerships and collaborations to target and serve all people experiencing homelessness in Napa County. 5. Ensure that Diversity, Equity, Inclusion, and Belonging are core considerations in program development and that all members of the community have equal access to care. The Director of Housing & Homeless Services therefore both agrees with the recommendation that resources be directed to supportive housing, one of five goals in the Strategic Plan, and respectfully disagrees with the recommendation to form a second leadership council separate from the CoC. Response, Acting County Executive Officer: The CEO agrees with the Director. Response, Board of Supervisors: The Board of Supervisors agrees with the Director.

R2

The Continuum of Care should compile and inventory of services available to homeless persons to better inform clients and promote increased collaboration and effective delivery of services by providers. Response, Director, Napa County Housing and Homeless Services: The recommendation has been implemented. The Director notes the recommended inventory of services is developed and has been available since 2021, both online and in hard copy. Case management is one of the primary services offered to individuals and families experiencing homelessness. It is a service which typically involves assisting and supporting individuals with developing the skills to access needed medical, behavioral health, housing, educational, employment and other services to meet their basic needs. This includes providing orientation and connections to ongoing community resources, including at times the case manager being a point of contact between clients and their social and medical support system providers. It is a comprehensive and strategic form of service provision designed to meet the individual's needs. Due to limited available funding relative to the scope and scale of the population of individuals and families experiencing homelessness, the Director agrees with the finding that there is an overall deficit in the number of available case managers in the community (across all agencies serving individuals and families at-risk of or experiencing homelessness) compared to the number of individuals who could benefit from services. To address this gap and provide ways for individuals needing services to navigate to available services directly, Napa County Housing & Homeless Services compiled an inventory of services available to those experiencing homelessness in 2021. This information is available online at www.homelessnapa.com as well as via a trifold, full-color pamphlet printed and distributed to service providers and community resource providers (such as schools and libraries). Response, Acting County Executive Officer: The CEO agrees with the Director. Response, Board of Supervisors: The Board of Supervisors agrees with the Director.

R3

County officials need to develop a more detailed program budget which would make it easier to determine how much money is spent toward homelessness on an ongoing basis. Response, Director, Napa County Housing and Homeless Services: The recommendation has been implemented. The Director believes the County has already met the recommendation to provide detailed program budget information for most County expenditures on homelessness response through Fund 2030 within the County budget, and still agrees with the finding that it is difficult to determine the full extent of all resources spent addressing homelessness issues because of the sheer number of organizations, jurisdictions and funding entities across the community involved. Response, Acting County Executive Officer: The CEO agrees with the Director. Response, Board of Supervisors: The Board of Supervisors agrees with the Director.

R4

Homeless Management Information System data should be more easily accessible to all HMIS users from different City and County departments (while maintaining privacy requirements) to improve the efficiency and quality of service delivery. Response, Director, Napa County Housing and Homeless Services: The recommendation has not yet been implemented but will be implemented in Fiscal Year 2022-2023. The Director of Housing & Homeless Services and staff have identified expanded analysis and data- visualization to better track performance measures and outcomes as well as increase service partner and community member understanding of homeless system data as a top priority of Housing & Homeless Programs for Fiscal Year 2022-2023. To accomplish this goal, Housing & Homeless Services will expand a technical service contract with the existing Homeless Management Information System (HMIS) provider this year. Expanded services will include enhanced system administration, direct user support for all HMIS community partners, training and professional development for system users and services and support for retrieving and analyzing HMIS and Coordinated Entry System (CES) data. Data is key to the Napa Continuum of Care's ability to make decisions and design homeless-response systems that advance meaningful change. It is crucial to establish a culture that values it, and an administrative infrastructure that delivers it from quality data entry through analysis and design and presentation of insightful reports. The technical skills and in-depth system and specialized knowledge necessary to support this culture and capacity are unique to the system and therefore difficult to hire and/or develop internally. Securing this technical assistance by contract is a top priority for the Division in the current Fiscal Year. Response, Acting County Executive Officer: The CEO agrees with the Director. Response, Board of Supervisors: The Board of Supervisors agrees with the Director.

R5

The Napa County HHSA should hire additional Mental Health and Substance Abuse counselors to assist in crisis management and outreach efforts for the homeless. In addition, the County should increase the number of beds at The Crisis Stabilization Unit to ensure that crisis cases are not diverted to Queen of the Valley Medical Center. Response, Director, Napa County Housing and Homeless Services: The recommendation to hire additional mental health counsellors to assist in homeless outreach efforts has not yet been implemented by the Housing & Homeless Services Division of the Acting County Executive's Office but will be implemented in Fiscal Year 2022-2023 as part of the Cooperative Joint Powers Agreement between the City and County of Napa for the provision of homeless services. To the extent this recommendation is actually directed to an entirely different County department, Health and Human Services Agency (HHSA), the Director of Housing & Homeless Services has consulted with the Director of Health and Human Services, and both agree that a further understanding of what programs already exist at HHSA would be helpful. While a response was not requested from the Director of HHSA, the Director supplements this response by noting that HHSA, through its Mental Health Division, runs an "Adult Full- Service Partnership (AFSP)" program. The program serves adults who have been diagnosed with a serious and persistent mental illness and homeless or at risk of homelessness. AFSP program provides comprehensive mental health services with intensive case management. Those enrolled in the AFSP program are provided with a case manager skilled in supporting them in the following activities: income, healthcare, employment, education, substance abuse treatment and overall stability in their lives. The program has a total of nine staff that includes a supervisor. HHSA continues to work diligently on recruitment and retention which is a significant issue throughout California and within the behavioral health field; currently, there are two vacancies in this unit. In terms of crisis management, HHSA, also through its Mental Health Division, provides a full continuum of crisis management services including through mental health clinicians embedded with law enforcement staff, mental health clinicians who comprise our Mobile Response Team who provide community-based field response, our Crisis Stabilization Program operated by our contractor Crestwood Behavioral Inc., our Crisis Residential services provided through our contractor Progress Foundation, and HHSA also provides for and manages significant numbers of psychiatric hospital placements and Institutions for Mental Diseases (IMDs) placements. It is hoped that this overview of HHSA's services helps to provide a more comprehensive response. The recommendation to increase the number of beds at the Crisis Stabilization Services Program (CSSA, or "Crisis Stabilization Unit"), again, should be directed to the HHSA which, as explained above, is a different County department. The Crisis Stabilization Services Program (CSSP) is not a program under the Division of Housing & Homeless Services (DHHS) but rather the Mental Health Division of the Health & Human Services Agency (HHSA). Although a response from the Director of HHSA was not requested, the Director is providing a response due to the likely misunderstanding of where this program resides in the County's organizational structure. The Director of HHSA notes that the recommendation has not yet been implemented, but efforts at HHSA are otherwise already underway to explore the feasibility of increasing the number of beds (chairs) at the facility itself. HHSA regularly examines utilization and other data in making evidence-based decisions about programs, both existing and new. This potential expansion requires more than simply adding more chairs and implicates the need for an infrastructure buildout of the physical space. That work requires infrastructure funding, which HHSA anticipates applying for a state grant. Infrastructure grant funding will, in turn, result in a capital improvement project and work needed by other County departments. HHSA has taken steps to position itself for being able to take advantage of such opportunity. Concurrently, HHSA is evaluating the increased operational costs that would come with an expansion of the CSSP as the clinical staffing ratios and overall programmatic costs also increase. That said, HHSA has been actively studying and exploring such an expansion for one year. With grant opportunities for facility infrastructure now available, this is an opportune moment that HHSA intends to take advantage of. The timeline for actual implementation is a function of grant funding timelines, construction feasibility and timelines, and ongoing funding sustainability. Due to the nature of applying for state grant funding, receiving notification of an award, and the related construction work, this is a multi-year initiative, and it is underway. Finally, not all referrals to the Crisis Stabilization Services Program are individuals experiencing homelessness. The program provides immediate response for periods of less than 24 hours to individuals of all ages who are experiencing an acute mental health crisis to stabilize the individual enough to return home or transition to other appropriate longer-term care facilities. Response, Acting County Executive Officer: The CEO agrees with the Director. Response, Board of Supervisors: The Board of Supervisors agrees with the Director.

R6

The Napa County Public Health Division should form a task force, including personnel providing law enforcement, mental health, and emergency medical services, to treat people suffering from drug induced mental disorders, with special emphasis on crisis resulting from the use of P2P methamphetamine and Fentanyl. Response, Director, Napa County Housing and Homeless Services: The Director of Housing & Homeless Services and Director of HHSA refer to the above response to Recommendation 5 and incorporate it by reference. The Directors also note that the CSSP does not fall within the purview of the Public Health Division of HHSA, but instead the Mental Health Division of HHSA. Additionally, it is worth noting the existence of the Napa Opioid Safety Coalition which includes a wide array of members, including HHSA's Public Health Division and Alcohol and Drug Services Division staff, as well as a wide range of healthcare and behavioral healthcare providers and organizations. Since this recommendation is broader than opioids, it requires further analysis and as a matter of purview would fall to HHSA, including its previously reference Alcohol and Drug Services Division, who already works closely with other providers, many of whom are direct contractors, in the provision of a full range of treatment and recovery services. Further, the Napa Continuum of Care adheres to a Housing First model of care, which takes the view that provision of subsidized housing should occur before substance abuse treatment can be effective. Housing First programs provides housing without requirements to complete treatment or abstain from drug, though case management services are offered to clients. Housing retention for clients housed under Housing First is excellent with more than 85% of clients housed locally remaining in housing. Response, Acting County Executive Officer: The CEO agrees with the Director. Response, Board of Supervisors: The Board of Supervisors agrees with the Director.

R7

Napa County Board of Supervisors and County Housing and Homeless Services departments should enact policies and procedures to facilitate the use of land for low income and permanent supportive housing (e.g., the Wine Valley Lodge). Response, Director, Napa County Housing and Homeless Services: The recommendation has already been implemented. The Director of Housing & Homeless Services agrees with the recommendation to continually review and refine policies and procedures to facilitate the development of low income and permanent supportive housing. In the last twenty-four months, the policies and procedures enacted by the Napa County Board of Supervisors have resulted in the following outcomes for low- and very-low-income and permanent supportive housing development: Acquisition and renovation of Wine Valley Lodge to convert an existing motel to 54 units of permanent supportive housing for individuals existing homelessness, opening in the Fall of 2022. Acquisition and renovation of Adrian Court, a 14-unit, very-low-income permanent supportive housing project for individuals exiting homelessness, opened in January 2021. 3. Sale of 34 very-low-income affordable home-ownership housing units at Redwood Grove using $1.6M in Affordable Housing funds, opened in July 2021. 4. Ground-breaking for Heritage Housing and Valle Verde, a low-and very-low-income housing project which will bring a combined total of 88-units of new housing using more than $2.6M in County funding 5. Opening of Manzanita Family Apartments, a 51-unit very-low-income affordable housing complex. 6. Guideline update for the Napa County Proximity Workforce Housing Assistance program increasing down-payment assistance from 10% to 16.5% for low-and very-low- income workforce members with the purchase of a home in Napa County and doubling the annual investment in the program to $2M for Fiscal Year 2022-2023. 7. Authorization for the creation of an Accessory Dwelling Unit (ADU) Loan Program to provide construction-loans for homeowners building ADU's in exchange for covenants restricting the rentals of those units to low-and very-low-income tenants and appropriating $5M in funding for the loan program in Fiscal Year 2022-2023. Finally, the existing County Affordable Housing loan portfolio includes active loans securing more than 1,100 units of affordable and permanent supportive housing in the Napa community. Response, Acting County Executive Officer: The CEO agrees with the Director. Response, Board of Supervisors: The Board of Supervisors agrees with the Director.

R8

City Managers and the County Executive Officer should disseminate more data and information about homelessness to educate Napa residents about the causes and extent of homelessness in Napa and its effects upon persons living on the street. An example would be developing respective government websites to include an information dashboard on homelessness and homelessness prevention. Response, Director, Napa County Housing and Homeless Services: The recommendation has not yet been implemented but will be implemented in Fiscal Year 2022-2023. The Director of Housing & Homeless Services agrees with the recommendation to expand and improve communication strategies to educate Napa residents about the causes and extent of homelessness in Napa. The County has an existing website (<u>www.homelessnapa.com</u>) with information including point- in-time (PIT) count data and social and shelter service provider information. This site can and should be enhanced to include more in-depth data sets, human-centered context surrounding that data, and dashboards tracking performance measures and outcomes as well as the detailed information, recommendations and goals included in the 2022 Strategic Plan to Address Homelessness.

R9

The County CEO and Napa County Director of Corrections should work to convert the current Reentry Facility to transitional housing for the homeless. Response, Director, Napa County Housing and Homeless Services and Director of Corrections: The recommendation has been implemented. The recommendation will require further analysis on whether this repurposing can become permanent. The Acting County Executive Officer, Director of Corrections, Director of Probation and Director of Housing & Homeless Services have been engaged in ongoing conversations with the Board of State and Community Corrections (BSCC) regarding the repurposing or conversion of the Re-entry Facility to house County residents who are either experiencing homelessness or need transitional housing. The CEO and Director initiated a request in April 2022 to the Board of State and Community Corrections to convert the Napa County Re-entry facility into a homeless shelter. As the approving authority of said request, the Department of Finance discussed the request at their standing April meeting. However, due to the complexities of the request, a decision wasn't reached at that time, and the request was re- scheduled for consideration at their May meeting. As of this writing, the Department of Finance has not made a final decision on the request to convert Re-entry into a homeless shelter. The CEO and the Director of Corrections continue to pursue the conversion authorization through the State. Response, Acting County Executive Officer: The CEO agrees with the Director. Response, Board of Supervisors: The Board of Supervisors agrees with the Director.