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Extracted from Consolidated Report

This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.

Lake County Grand Jury • 2006-2007

Public Health and Social Services Committee Reports

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Findings 66 findings

F1 Page 75
Grand Juries in other counties have been given access to CPS files while investigating complaints or performing oversight. The Solano County Grand Jury filed a petition and gained access to all files for a 6-month period just 2 years ago. There are similar situations throughout California in the past several years relative to Grand Jury access.
F2 Page 75
California DSS investigated Lake County CPS at the request of the Federal Department of Health and Human Services. The fol- lowing are some of the operational procedures jointly developed by the California DSS and Lake County DSS: − Implement plan for better documentation to support decision- making process. − Establish a uniform process for ongoing provider feedback. − Work with Regional Training Academy to identify staff training needs for Emergency Response and Family Maintenance, develop a training plan, and provide training. − Plan and implement Structured Decision Making software. (This creates a link for decision-making based on a standardized safety assessment model). − Provide administrative oversight to assure uniform standard of practice in Emergency Response. − Reinforce the policy and procedures for Child Welfare Services authority to place children into protective custody for physical and sexual abuse. − Clarify, with staff, agency role in responding to physical and sex- ual abuse referrals.
F3 Page 75
Since this Committee is still unable to access confidential files, the committee only has the “word” of the California DSS that these operational procedures have been corrected. 75 2006-2007 Lake County Grand Jury Final Report Public Health and Social Services Committee
F4 Page 76
Even after Lake County CPS/DSS received a review and com- pleted a Corrective Action Plan from California DSS, this Grand Jury continues to receive complaints about Lake County CPS into May 2007.
F5 Page 76
Lake County CPS appears to be self-governing with minimal over- sight from the State but ultimately, the Director of DSS answers to the Board of Supervisors.
F6
Staffing is an ongoing problem. Management and supervisory positions consume much of the manpower and budget leaving critical staff vacancies chronically empty. As of the writing of this report, the Children’s Services Program was budgeted for 21 so- cial workers, but there were currently 8 vacancies. However, there was a Director, a Deputy Director of Adult and Children’s Services, a Program Manager of Children’s Services, and two su- pervisors in this division. The department staffing appears dis- proportionate.
F7 Page 76
The Chief of the California Children’s Services Operations and Evaluation Branch thought there was a huge pay gap between Lake County social workers and its administration. In fact, the Chief stated Lake County is “at the top of the worst” for social workers as far as compensation is concerned. A Social Worker I requires a bachelor’s degree and receives compensation from $2,192.00 to $2,664.00 per month. A Social Worker IV requires a master’s degree and receives compensation from $2,937.60 to $3,571.20. The Director of DSS, on the other hand, receives compensation from $7,120.31 to $8,654.78 per month (figures from the 2006-2007 Lake County Final Budget).
F8 Page 76
Lake County CPS recently implemented “Structured Decision Making,” software designed to improve risk assessment.
F9 Page 76
Earlier this year, it was proposed to the Board of Supervisors that Lake County work to re-establish the CASA (Court Appointed Special Advocates) Program. Approval was granted to proceed with the first phase of the process, applying for a Planning and Development grant for $10,000. At the writing of this report, the application was on track to be filed by the July 6, 2007 deadline (Additional information about CASA is available at www.nationalcasa.org).
F10 Page 76
Revised petitions have been submitted to the District Attorney for refilling using the suggestions of the Juvenile Judge.
F11 Page 76
Many California counties employ a paid ombudsman for DSS. The ombudsman can be contacted by individuals or agencies who are having difficulty reaching CPS or require assistance with un- derstanding CPS policies and procedures. Many complainants / witnesses this committee met with may have initially had their complaint resolved had there been such a mediator. 76 2006-2007 Lake County Grand Jury Final Report Public Health and Social Services Committee
F12 Page 77
This committee was constantly advised by individuals and agen- cies that calls to CPS were not returned in a timely manner.
F13 Page 80
The Department of Social Services’ decision in this grievance was mailed to the complainant on January 30, 2006.
F14 Page 80
The “Reasons for Decision” of the Department were accurately made in accordance with the Welfare and Institutions code 306.5.
F15 Page 80
There is no reason to indicate why this decision, a matter of pub- lic record, could not have been made available by the Department of Social Services to the Grand Jury in a more timely manner. 80 2006-2007 Lake County Grand Jury Final Report Public Health and Social Services Committee
F16 Page 84
ICWA Monthly Round Tables - monthly meetings that are hosted on a rotating basis by the seven Lake County tribes at the various tribal headquarters around the county. In addition to tribal repre- sentation, other social and legal service agencies (AODS, LCOE, Easter Seals, CILS, LCJC attorneys etc.) also attend. Ideas are shared and issues are addressed in a non-confrontational man- ner. Although it appears Lake County CPS attended in the past, there was a period when Lake County CPS was not represented, or that information disseminated at these meetings was not shared with all the social workers. This Committee is gratified to see that Lake County CPS Administrative Staff is now attending these Round Table meetings and bilateral conversations are oc- curring. However, it would be beneficial if the employees/ supervisors who are responsible for the implementation of these mandated duties also be allowed to attend the Round Tables.
F17 Page 84
The California DSS has established two ICWA specialist positions. These positions are the point of contact for ICWA issues. As a major resource for county child welfare, Indian tribes and tribal organizations, they provide technical assistance and clarification regarding the importance of compliance with ICWA. They also fa- cilitate the ICWA Quarterly Work Groups.
F18 Page 84
ICWA Quarterly Work Groups - meetings facilitated by the Cali- fornia DSS ICWA Administration and held at the California DSS headquarters in Sacramento. Counties and tribes throughout the state are invited to attend. ICWA issues are discussed and infor- mation is shared regarding new procedures and upcoming train- ing. This Committee was advised that Lake County DSS does not attend.
F19 Page 84
State ICWA Training – formal, comprehensive training is available to social workers at the UC Davis Regional Training Academy. Ongoing formal training can be developed to meet individual county needs. Technical assistance is always available, but must be requested. The California DSS training unit will come to coun- ties to provide training at no cost to the county, if requested. For- mal or individualized training is provided. A Handbook on ICWA, which includes sources of information and support to aid in the implementation of ICWA, was developed as a resource guide that is provided to all training participants. 84 2006-2007 Lake County Grand Jury Final Report Public Health and Social Services Committee
F20 Page 85
Casey Family Programs Peer TA - a technical assistance ap- proach that rapidly disseminates information about successful practices, policies, and tools related to a defined issue, con- cern, or challenge. Peer TA is solution-focused and occurs through a process of joint problem-solving between a team of individuals who is requesting assistance and a team of peer consultants who has first-hand experience related to the tar- geted issue. Peer TA teams are brought to the program re- questing assistance at no cost (see Appendix B). Lake County tribes have indicated to this Committee that they are enthusi- astic about participating in this program with the county.
F21 Page 85
Directors’ Meetings - information regarding these and other available resources is distributed at monthly CWDA meetings. County Welfare Directors and other administrative personnel are encouraged to attend these meetings. The California DSS ICWA Administrator, who spoke with the Grand Jury Commit- tee, does not recall Lake County DSS attending these meetings on a regular basis. By not taking advantage of these meet- ings, the state administrator felt that it leaves Lake County so- cial workers at a disadvantage and results in Lake County’s isolation and uninformed disinterest in the ICWA mandate.
F22 Page 85
Currently, Lake County DSS has a working procedural document when handling ICWA cases. We found this document to be in- adequate, and it does not provide the necessary services to com- ply with ICWA.
F23 Page 85
Although ICWA is the federal and state law and must be complied with, the Committee learned this is not the case in numerous In- dian child custody cases in Lake County and in California.
F24 Page 85
According to the interviews with the Tribal ICWA Representatives, the required 10-day notice for Indian child custody proceedings is routinely ignored by Lake County DSS. Tribal ICWA workers generally receive last minute telephone notification, not the ten- day written notice as stipulated in the law, and in the Lake County DSS Operations Manual.
F25 Page 85
This Committee has been attending the monthly ICWA Round Ta- bles for the past six months. The same issues, particularly where “notice” is concerned, are brought to the attention of all parties. The tribal ICWA Representatives repeatedly have advised the Lake County CPS administrators that the law is not being fol- lowed.
F26 Page 85
CPS was attending the Round Tables at the beginning of this year after a lengthy absence; however, they have missed the last sev- eral meetings. 85 2006-2007 Lake County Grand Jury Final Report Public Health and Social Services Committee
F27 Page 86
Attending each Round Table has been the Deputy Director for Adult and Children’s Services and the Program Manager for Chil- dren’s Services. At each meeting both indicate they will return to their agency and “kick-around” these issues. At the February 2007 Round Table, these individuals indicated they were unsure of the notice process themselves, but thought the Lake County CPS supervisors who manage the employees who perform this function, were aware of it. These procedures are definitively out- lined in the California DSS CWS Manual/ICWA Special Require- ments.
F28 Page 86
According to both ICWA Representatives and the legal counsel from CILS, the use of “expert witnesses” does not appear to be taken seriously by the Lake County DSS. In some cases, a Lake County DSS social worker acted as the expert witness, rather than the Indian agent for the tribe, as the law requires.
F29 Page 86
It was discovered that most Lake County DSS social workers were not familiar with ICWA requirements. When questioned, the Lake County DSS Deputy Director and Program Manager were not aware if ICWA training was included in the core training that all social workers attend.
F30 Page 86
While interviewing both ICWA Representatives and the clients in- volved, this Committee learned that social workers did not always follow a particular case to the end; instead, there could be a number of Lake County DSS social workers assigned to the same ICWA case—some understood, but some did not, the nature of the law. This not only created inconsistencies, but also resulted in workers having to “catch up” or learn about the ICWA law, so they could proceed with the case.
F31 Page 94
At the time of intake, inmates receive a handbook that explains medical services available to them and how to obtain them.
F32 Page 94
Seven nurses provide 24-hrs/day, 7-days/week coverage on a ro- tating basis. Although CFMG provides a licensed vocational nurse based program, three of the nurses are registered nurses.
F33 Page 94
A physician is available 3 times a week for routine non- emergency visits.
F34 Page 94
A nurse practitioner is available Monday through Friday during normal business hours. The examining room has three examin- ing tables—one in need of repair.
F35
There is no “sick bay-infirmary.” Inmates are transferred to Sut- ter Lakeside Hospital if hospitalization is required. 94 2006-2007 Lake County Grand Jury Final Report Public Health and Social Services Committee
F36 Page 95
A dentist and dental assistant provide services on Fridays for four hours.
F37 Page 95
Psychiatric services are available through video-conferencing with personnel located in Carmel.
F38 Page 95
A Mental Health Worker—psychiatric nurse—is available 20-30 hours a week. Many inmates have mental health issues. Cus- tody staff can request the Mental Health Worker to visit with in- mates, especially those on suicide watch.
F39 Page 95
An x-ray technician is available one day-a-week, who uses a portable unit. Otherwise, the inmate is transported to Sutter Lakeside Hospital.
F40 Page 95
CFMG utilizes a pharmacy in Southern California, buying in bulk. Medications and supplies are sent overnight from Moor- park. Over-the-counter medications (such as antacids and ibu- profen) may be purchased by the inmate at the commissary.
F41 Page 95
There is a $3 charge/co-pay to see the nurse practitioner, how- ever, the inmate is seen regardless of their ability to pay. The fee goes into the county general fund and not to CFMG.
F42 Page 95
Services provided are not as comprehensive as those provided in the California State prisons.
F43 Page 95
For routine sick calls, sick call slips are available in each inmate section, are completed by the inmate and put into a “sick call” box. This box can only be opened by the nurse. A nurse reviews the slips, pulls the inmates’ charts, and schedules them to see the nurse practitioner.
F44 Page 95
In emergency situations, the nurse assesses the situation and contacts the physician immediately, or has the inmate immedi- ately transported by jail van or patrol car to Sutter Lakeside Hos- pital, which is less than a mile away. Depending on the emer- gency, paramedics are sometimes called to handle the situation.
F45 Page 95
At the inmate’s intake, a medical questionnaire is completed and a basic “triage” evaluation is conducted. If the situation war- rants, the inmate is transported directly to Sutter Lakeside Hos- pital.
F46 Page 95
If an inmate is dissatisfied with the medical services provided, or lack of services, he or she can complete a Grievance Form which is available in all inmate sections. The completed grievance is forwarded from the custody officer to the sergeant, who routes it to the Lake County Medical Program Manager, who has three days to respond.
F47 Page 95
In 2006, 76 grievances were filed relating to jail medical services. The majority were related to the $3 per visit charge. Others in- cluded requests for stronger medication, requests for sleeping medication, requests for a different diet, requests for an inhaler on the inmate’s person (not allowed unless the inmate is asth- matic), or requests to see personal physicians. Grievances are 95 2006-2007 Lake County Grand Jury Final Report Public Health and Social Services Committee allowed in some cases—the inmate can see his or her own physi- cian, etc.
F48 Page 96
CFMG’s medical staff will communicate with the inmates’ per- sonal physicians, if necessary. CFMG will contract with special- ized physicians, i.e. cardiologists, orthopedic surgeons, obstetri- cians and gynecologists, if necessary.
F49 Page 96
Family members of inmates are not advised regarding routine sick calls. In emergency situations, the individual the inmate has indicated as his “contact” person will be notified.
F50 Page 96
Family members or visitors who believe an inmate needs some medical care may contact the Chief Custody Officer. A fellow in- mate may also report an illness.
F51 Page 96
There has been a significant increase in maternity cases.
F52 Page 96
Quarterly quality assurance meetings are conducted with all the appropriate parties—CFMG, Jail personnel, Juvenile Hall person- nel, Public Health, Mental Health, Sutter emergency room physi- cians etc. are all invited. Sutter Lakeside Hospital personnel do not regularly attend. These meetings are not open to the public; however they take comments and suggestions.
F53 Page 96
The relationship between the Public Health Department and the correctional facilities is satisfactory, per both parties.
F54 Page 96
The relationship between the Mental Health Department and the correctional facilities is not satisfactory, per the Chief Custody Officer. The Chief Custody Officer has requested membership on the Mental Health Advisory Board to share concerns, but was ad- vised there was not a position.
F55 Page 96
The jail population averages 276 inmates per month. In 2006, 6408 inmates were seen at “sick call,” of those, 65 (1%) were seen by a physician. 1546 inmates saw the mental health worker and 143,633 medications were dispensed.
F56 Page 96
There is not a comprehensive plan in place regarding the dis- charge of inmates with mental health issues, especially those on medications.
F57 Page 99
A monthly District Board Meeting, held every fourth Tuesday at 9:30 a.m., is open to the public.
F58 Page 99
An independent audit of the District is conducted each year and the outcome is available to the county.
F59 Page 99
In the fiscal year ending June 2006, the District received $687,363 from county property taxes and $35,000 from invest- ment income.
F60 Page 99
In the fiscal year ending June 2006, the District awarded grants totaling $585,339.
F61 Page 99
In the fiscal year ending June 2006, the District administrative expenses were $52,920, or approximately 8% of their budget. This includes a grand total of $7,500 that was paid to the Direc- tors in this fiscal year.
F62 Page 99
Organizations must submit a Request for Assistance (RFA) before being considered for a grant. This includes proof of their non- profit status if they are other than a public agency.
F63 Page 99
Unless otherwise approved by the District, the basic structure of the award is a one-time, non-renewable grant. 99 2006-2007 Lake County Grand Jury Final Report Public Health and Social Services Committee
F64 Page 100
Once a grant is awarded, the District requires follow-up reporting on the progress and financial performance of the programs funded, as well as compliance with the conditions of the grant.
F65 Page 100
During the period studied by the committee, the grants awarded by the District Board met the criteria of the “Health Care Dis- tricts’” directives.
F66 Page 100
Property owner’s taxes would not be reduced by the dissolution of the District. Proposition 13 taxes will continue to be collected at the same rate, but would simply not be distributed to the District.

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