County of Sacramento California*

The County could face emergencies from flood, terrorist attack, pandemic, earthquake or any number of unexpected events. After the Governor's declaration it took three days for IHSS to contact approximately 30 percent of its recipients. This result is unacceptable. IHSS has a staff of 150 and it reported that all people not on vacation were available to make calls during the emergency. Had only half of the available staff, or 75 people, along with the 20 temporary hires made just a modest ten calls per houf per person, it could potentially produce a combined total of 950 calls per hour. Department of Health and Human Services Response to Finding #1: Do Not Concur Governor Schwarzenegger directed State Agencies to redouble public safety efforts during the 2006 California heat wave. The Governor did not proclaim a state of emergency. The lack of a formal proclamation prevented Sacramento County from declaring this event an emergency, or activating the Sacramento County Emergency Standardized Management System (SEMS). Communications from the State to the Counties lacked clarity and were ambiguous regarding the level of response or the number of client contacts required. The Governor's press release of July 26, 2006 directed counties to "conduct onsite safety checks of each resident living in single-room occupancy hotels." It also stated that "these visits will be coordinated with In-Home Supportive Services (IHSS) workers who provide assistance to vulnerable seniors and persons with disabilities who do not live in residential care facilities." However, the release did not contain a directive to contact all IHSS recipients. An All County Information Notice (ACIN), # I-53-06, from the California Department of Social Services (CDSS) on July 26th referenced the Governor's press release and requested an assessment of all IHSS recipients and APS clients. However, during a conference call with counties later that day, CDSS instructed counties to prioritize responses to the most vulnerable recipients, as needed. Senior and Adult Services Division (SAS) followed the Sacramento County Department of Health and Human Services (DHHS) Emergency/Disaster Plan and contacted its high- risk recipients. IHSS High-Risk recipients are defined as those identified as critical and urgent on the State's IHSS Caseload Disaster Preparedness Assessment Profile list. For 9 those recipients who could not be reached by phone, staff was deployed to their residences to evaluate their safety and well being. During the heat wave, SAS made 10,016 calls and contacted over 6,000 senior and dependent adults. Of those contacts, 250 were home visits.

DHHS and SAS conducted an Emergency Operation Review after the July 2006 heat wave and identified a number of areas, both in-house and involving coordination with outside agencies that need improvement. Among other items, they specifically addressed the need to operationally define what constitutes an extreme heat situation requiring emergency response. Department of Health and Human Services Response to Finding #2: Concur DHHS and SAS conducted an Emergency Operation Review after the July 2006 heat wave and identified that coordination and support among county and outside agencies was needed to respond to future events of this type. From this process, the Senior and Adult Services Division Emergency/Disaster Plan was revised. SAS also addressed the need to operationally define what constitutes an extreme heat situation requiring emergency response. However, that responsibility does not rest with SAS or DHHS. The County Emergency Operations Office (EOO) takes the lead on preparing the County and its agencies for disasters and is responsible for the operational 10 definition of an extreme heat situation for the County. SAS will partner with the EOO in this effort.

SAS computers depend upon an interface with State computers and do not provide the flexibility and responsiveness required to handle an emergency. Department of Health and Human Services Response to Finding #3: Concur SAS database system is extremely unstable and does not meet the information management requirements needed for the Division. DHHS is currently in the process of implementing a system change to address this issue, as explained in Recommendation #3 below. Sacramento County's IHSS Caseload Disaster Preparedness Assessment Profile list cannot be updated at the local level. This data is maintained by the State.

11 The current SAS policy for allowing individuals to elect not to be notified of an impending emergency does not demonstrate a realistic understanding of an emergency situation. Department of Health and Human Services Response to Finding #4: Do Not Concur Sacramento County does not set policy or regulations for the IHSS Caseload Disaster Preparedness Designations. This policy is determined by the State, and the Counties' operational guidelines are defined in the IHSS/Case Management Information Payrolling System (CMIPS) User's Manual. SAS will continue to advocate for election of notification and educate clients on the consequences of electing non-notification.