Mendocino County Grand Jury • 2011-2012 • Agency Response
Response to: Office of Emergency Services

Response to Report of the 2011-2012 Grand Jury Report

Published: March 07, 2012 11 pages
View Original PDF

Findings and Recommendations 22 findings

F5
The GJ received complaints that two MH staff members reversed police and hospital staff recommendations to hospitalize clients under Health and Safety Code section 5150 (regarding individuals who are a danger to themselves and others). MH PROGRAMS / FINANCE
No recommendations for this finding
F6
MH balanced the operating budget this year.
No recommendations for this finding
F7
The opinions expressed about management direction (by those interviewed) are that if a program is not self-supporting, then it should be eliminated. MH uses general funds only for matching other grant funds to support MH.
No recommendations for this finding
F8
The State conducts annual Medi-Cal audits with a four-year period delay and mistakes accrue penalties during that period. Penalties from Medi-Cal audits have been a huge financial drain to MH.
No recommendations for this finding
F9
MH has lacked internal audits and training to discover Medi-Cal billing errors. However, they have now hired a worker to minimize audit exceptions and maximize reimbursements. MH expects caseworkers to spend 70% of their time working on billable Medi-Cal issues. However, the achievable goal appears to be around 40% because most of their time is used for other non-billable tasks. TECHNOLOGY
Related Recommendations (1)
R9
The Sheriff’s Office has not changed the level of service from last year.  The following Recommendation(s) have not yet been implemented, but will be implemented in the future, attached, as required is a time frame for implementation: Recommendation number nine in part has been implemented. The nursing staff is in place. The psychiatrist will be in place within five weeks. GRAND JURY REPORT RESPONSE FORM PAGE TWO  The following Recommendation(s) require further analysis, and attached as required, is an explanation and the scope and parameters of the planned analysis, and a time frame for the matter to be prepared, discussed and approved by the officer and/or director of the agency or department being investigated or reviewed: (This time frame shall not exceed six (6) months from the date of publication of the Grand Jury Report) __________________________________________________  The following Recommendations will NOT be implemented because they are not warranted and/or are not deemed reasonable, attached, as required is an explanation therefore: I have completed the above responses, and have attached, as required the following number of pages to this response form: Number of Pages attached: ___-1- plus the original report ____ I understand that responses to Grand Jury Reports are public records. They will be posted on the Grand Jury website: www.co.mendocino.ca.us/grandjury. The clerk of the responding agency is required to maintain a copy of the response. I understand that I must submit this signed response form and any attachments as follows: First Step: E-mail (word documents or scanned pdf file format) to:  The Grand Jury Foreperson at: grandjury@co.mendocino.ca.us  The Presiding Judge: grandjury@mendocino.courts.ca.gov Second Step: Mail all originals to: Mendocino County Grand Jury P.O. Box 939 Ukiah, CA 95482 Printed Name: __________________________________________ Title: __________________________________________________ Signed:_________________________ Date: _________ A REPORT ON THE MENDOCINO COUNTY MENTAL HEALTH BRANCH GOING…Going….gone? March 7, 2012
F10
The current Avitar patient computer system meets Health Insurance Portability and Accountability Act (HIPAA) regulations, and client notes are computerized. However, other important client information, such as medications prescribed or details of the last patient appointment, is not computerized and Avitar does not interface well with other external service providers’ systems.
No recommendations for this finding
F11
Retrieval and editing of client notes is extremely slow and requires a lot of personnel time.
No recommendations for this finding
F12
Obtaining specific fiscal and program information is a problem, and financial reports are hard to read and understand by employees, clients, and the public. CLIENT SERVICES 3
No recommendations for this finding
F13
MH has reduced client services to a minimal operating level. Services have been limited to those that are mandated, and the focus of the program has been for Medi-Cal and SMI clients. MH has increasingly re-directed clients to other contracted and non-contracted service providers.
No recommendations for this finding
F14
There is a common check-in window and waiting room for children waiting for immunizations, adults arriving for drug testing, and MH clients waiting for appointments.
No recommendations for this finding
F15
MH re-negotiated a cost-saving contract with prior vendor for transportation of clients. Now services are “on-call” from Napa, resulting in a long waiting period (a minimum of four hours for clients on the Mendocino County coast).
No recommendations for this finding
F16
MH hospitalizations were greatly reduced from the previous year (by 96 patients, 272 to 176), and admissions must now be approved by a supervisor, who may or may not be licensed.
No recommendations for this finding
F17
MH administration has stated that they want to “bring people home” from MH hospitalizations. However, there is a severe lack of local appropriate housing available to achieve this.
No recommendations for this finding
F18
MH services for Juvenile Hall and the Mendocino County jail were greatly reduced, and the psychiatrist in charge left County service. The County is currently contracting with a medical group for services. Prison/jail personnel expect arrival of realignment prisoners will increase the number of MH clients.
No recommendations for this finding
F19
MH has cut services on the Mendocino coast to a minimum operating level.
No recommendations for this finding
F20
Public health clinics are reporting a large increase in their MH client load.
No recommendations for this finding
F21
Two years ago, MH had 125 employees; now there are fewer than 45 active employees. Some large caseloads are not realistic. There are almost no remaining licensed clinicians.
No recommendations for this finding
F22
Remaining caseworkers and some supervisory staff are still dedicated to providing what services they can.
No recommendations for this finding
F23
MH administration and staff have suffered from an enormous turnover of employees, which has resulted in the loss of some highly effective key personnel.
No recommendations for this finding
F24
The GJ has reports that some MH crisis workers have limited experience and others have not received the proper credentials or licensing to assess and diagnose clients.
No recommendations for this finding
F25
It is difficult to recruit and hire high-quality MH employees to Mendocino County. The HHSA Human Resource Department takes months to hire personnel; this is a result of civil service regulations, collective bargaining agreements, and cumbersome hiring systems (e.g. maintaining lists of qualified applicants). FACILITY RELOCATION
No recommendations for this finding
F26
MH moved to a Dora Street facility shared with the Public Health immunization clinic and AODP. The move cost around $100,000 total, of which they spent $20,000 to resize medical record retrieval equipment to fit the new space. As a cost-cutting measure, there is now only one check-in window in a small, inadequate waiting room. Mental health clients, clients coming for drug testing, 4 and children arriving for immunization are required to share a common space. Client confidentiality is difficult to maintain.
No recommendations for this finding