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Findings and Recommendations 27 findings
F1
In the spring 2006, the CEO distributed a memo to all staff explaining the intent of creating a HSA.
No recommendations for this finding
F2
HSA management presented The Human Services Work Plan on August 29,
No recommendations for this finding
F3
The HSA is almost self supporting, as it brings in monies from State and Federal sources. HSA accounts for about 45% of total County appropriations. The County allocates approximately nine percent of its limited discretionary appropriations to HSA.
No recommendations for this finding
F4
HSA employs over 50% of the total County workforce: a total of 680 employees of which 120 are clerical.
Related Recommendations (1)
R2
salaries be made competitive for critical staff. (Findings 4, 5, 7, 10, 11, 24)
F5
Staff were assured there would be no layoffs during consolidation. The three departments lost staff only through attrition or resignations, some of which are due to noncompetitive salaries.
No recommendations for this finding
F6
Consolidation created tension and anxiety. Some professionals were afraid of losing autonomy.
Related Recommendations (1)
R1
a thorough evaluation of staff structure, job descriptions, and compensation should be completed and implemented as soon as possible. (Findings 6, 7, 9, 11)
F7
Some management staff perform tasks and assume responsibilities above and beyond their existing job descriptions and pay levels.
No recommendations for this finding
F8
On Aug. 10, 2006, there was a staff memo setting forth the organizational chart, including the Agency Management Team, Administration/Fiscal Services Team, Services Integration Team, and a Reflecting Team which provides a resource for feedback from line staff.
No recommendations for this finding
F9
These four teams ensure staff participation in the consolidation process; however, they are costly and demanding of time and energy.
No recommendations for this finding
F10
Department of Social Services (DSS) positions are funded by the State and fall under the State of California Merit System. Recruitment and testing are regulated by State guidelines. Salaries and benefits are the County’s responsibility.
No recommendations for this finding
F11
An independent consulting firm, specializing in government personnel issues, is re-writing job classifications and evaluating compensation for parity among the three divisions.
No recommendations for this finding
F12
The HSA is better able to access Federal and State funds which permits as much as a million dollars to move between departments.
No recommendations for this finding
F13
Mental Health (MH) operates as an enterprise fund. The County serves as its fiscal agent; they receive no County general funds. The BOS required MH to reduce its costs along with other departments in 2005. This lowered the reimbursement in future years from Medi-Cal.
No recommendations for this finding
F14
As a result of SB90 MH was required to borrow money from the County to pay for State mandated services. Currently MH has budgeted funds to pay down this loan.
No recommendations for this finding
F15
Each department has different funding streams, including public and private grants. Each grant or funding program has its own requirements, e.g. eligibility, evaluation of service, data collection, and financial restrictions.
No recommendations for this finding
F16
The BOS workshop on September 25, 2006, illustrated that leveraging of some funding and the integrating of services, was happening before consolidation, for example the Children's System of Care program.
No recommendations for this finding
F17
The three departments have distinctly different cultures, work climates, personalities, and supervisory structures.
No recommendations for this finding
F18
Departmental Staff Surveys are met with varying degrees of enthusiasm due to overwhelming work loads, past experience, responsibilities, and the belief that their comments will make little difference.
No recommendations for this finding
F19
DSS has 40 different funding streams and 80 categories of Medi-Cal eligibility.
No recommendations for this finding
F20
Twenty-five percent (25%) of the County population (89,369 in 2006) receive money and/or services through State and Federal funded programs administered by DSS.
No recommendations for this finding
F21
MH is in the process of implementing a recovery model, rather than a medical model. Under the medical model the Physician plans and directs treatment. In the recovery model, the client is directly involved in their own treatment and hope of recovery. Employees trained under the medical model are having difficulty adjusting to the change.
No recommendations for this finding
F22
There is a good working relationship between MH and the community health clinics that serve lower income and non-insured persons. HSA is working to “co- locate” services at community health clinic sites.
No recommendations for this finding
F23
Co-location of services lowers costs, and proximity encourages co-operation and some integration of services. Costs are reduced by participating departments sharing the overhead.
No recommendations for this finding
F24
Replacement of critical staff in all departments is difficult because of non- competitive salaries.
No recommendations for this finding
F25
According to testimony: a. Communities and individuals in outlying areas are underserved. b. It is likely that in the new Agency, staff trained as a provider of a particular service will not be replaced with staff trained as generalists. c. It is anticipated there will be no significant change to, or elimination of, existing departmental advisory boards. d. It is projected that integration/consolidation may take ten years and will be an on-going process.
No recommendations for this finding
F26
The Agency Strategic Action Plan was presented to the BOS and approved for implementation on November 14, 2006.
No recommendations for this finding
F27
Animal control is now a division under the Health and Human Services Agency.
No recommendations for this finding
Additional Recommendations 1
These recommendations are not explicitly linked to specific findings.
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R3services to the underserved outlying areas be improved. (Findings 23, 25a) Comments The consolidation process is slow because of the considerable detail in developing and planning the new HHSA. The use of staff time in performing their assigned responsibilities needs to be balanced with tasks involved in the planning process. Despite the difficulties and uncertainties, the process seems worth continuing. The Grand Jury appreciates the care and concern expressed by everyone interviewed. Also impressive is that the staff are willing to suspend judgment and their personal concerns to work towards integrating the disparate functions for the new agency. Response Required Board of Supervisors (Findings 3-5, 7, 10-14, 18-20, 23, 24, 25a, 25c-27; All Recommendations) Chief Executive Office (All Findings; All Recommendations) Health & Human Service Agency Director (Findings 5-9, 11-13, 15-18, 22-25d; All Recommendations ) Social Services Branch(All Findings; All Recommendations) Mental Health Branch (Findings 5-7, 16, 20-25d; All Recommendations) Public Health Branch (Findings 5, 6, 22, 25c, 27; All Recommendations)
Comments 1
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CO1The consolidation process is slow because of the considerable detail in developing and planning the new HHSA. The use of staff time in performing their assigned responsibilities needs to be balanced with tasks involved in the planning process. Despite the difficulties and uncertainties, the process seems worth continuing. The Grand Jury appreciates the care and concern expressed by everyone interviewed. Also impressive is that the staff are willing to suspend judgment and their personal concerns to work towards integrating the disparate functions for the new agency. Response Required Board of Supervisors (Findings 3-5, 7, 10-14, 18-20, 23, 24, 25a, 25c-27; All Recommendations) Chief Executive Office (All Findings; All Recommendations) Health & Human Service Agency Director (Findings 5-9, 11-13, 15-18, 22-25d; All Recommendations ) Social Services Branch(All Findings; All Recommendations) Mental Health Branch (Findings 5-7, 16, 20-25d; All Recommendations) Public Health Branch (Findings 5, 6, 22, 25c, 27; All Recommendations)