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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.
San Luis Obispo County Grand Jury
• 2017-2018
Inal Eport San Luis Obispo County Grand Jury
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings 10 findings
F1
Page 15
(Return) “Available and affordable detox services are necessary for delivering comprehensive substance abuse treatment in San Luis Obispo County.” The San Luis Obispo County Health Agency (Health Agency) agreed with the finding.
F2
Page 15
(Return) “The opening of the Haven provides needed detox services for County residents who are privately insured or can afford the high costs.” The Health Agency agreed with the finding. 3 2017-2018 San Luis Obispo County Grand Jury Final Report
F3
Page 16
(Return) “There are no detox services available in the County for those with limited financial resources or insurance through Medi-Cal or Medicare.” The Health Agency agreed with the finding.
F4
Page 16
(Return) “The County Jail provides physical detox to newly admitted inmates but fails to provide the additional psychological and social treatments and supportive environment essential for the first phase of addiction treatment: detox-stabilization.” The Health Agency agreed with the finding. The San Luis Obispo County Sheriff’s Office (Sheriff) disagreed in part with Finding 4. They agreed that the County Jail provided physical detox to newly admitted inmates; however, they stated they did not have the expertise to provide any additional treatment; therefore, they were unable to address that portion of the finding. (We note this disagreement appears to affirm the stated finding with which they partially disagreed. We also note that under the County’s bifurcated structure for inmate well-being, the Sheriff has no apparent “say,” or responsibility for that portion of inmate well-being.)
F5
Page 16
(Return) “There are some arrestees currently booked in the County Jail who would be more effectively served by a diversion program, like Law Enforcement Assisted Diversion, and/or receiving treatment in a residential substance-abuse facility.” The Health Agency agreed with the finding.
F6
Page 16
(Return) “There is a lack of integration in how medical and drug/alcohol services are provided at the County Jail.” 4 2017-2018 San Luis Obispo County Grand Jury Final Report The Health Agency agreed with the finding. (The Health Agency appears to have agreed for the Agency’s Drug and Alcohol Services, the Agency’s Health Care Services Division, also, since they did not submit their own responses.)
F7
Page 17
(Return) “The use of medication-assisted approaches for detox and addiction treatment at the County Jail is limited while other jurisdictions have been able to provide such treatments.” The Health Agency agreed with half of Finding 7 but stated they did not have sufficient information about what other jurisdictions are doing relative to providing detox and addiction treatment. (We note the Health Agency claims ignorance on other jurisdictions’ activities. We believe Grand Jury reports should provide questions that encourage agencies to adopt a culture of embracing education on selected subjects within their purview. We appreciate how extensive is the required knowledge for Health Agency’s many responsibilities but remind Health Agency that this is one of their duties.)
F8
Page 17
(Return) “Logistical and environmental challenges at the County Jail make delivery of drug and alcohol treatment services difficult and inefficient due to placement of inmates with substance use disorders.” The Health Agency agreed with the finding. The Sheriff also agreed with the finding and noted that the logistical challenges in the County Jail make it difficult to deliver treatment. The existing jail was not designed for long-term inmate treatment.
F9
Page 17
(Return) “With the opening of the women’s jail, there is unused space in the honor farm which presents an opportunity for alternative program development.” 5 2017-2018 San Luis Obispo County Grand Jury Final Report The Sheriff agreed with the Finding and stated that they would make the space available for alternative programming. He also said two modular units adjacent to the jail are available and could be used for treatment.
F10
Page 18
(Return) “The homeless shelter has no clear plan as to how it will provide its long-anticipated detox beds/service.” While the Health Agency stated they had several staff members participating in the planning committee for the homeless shelter addressing the topic, they could not respond in any definitive way regarding the finding - they were not the entity building the new Homeless Services Center. (Since the Health Agency had representatives at the planning committee meetings reporting back, it seemed unusual that the Health Agency did not have an opinion on this finding. However, the Grand Jury is aware that since this response was given Community Action Partnership of San Luis Obispo County, Inc. (CAPSLO) will within the next two years develop and operate a residential detox center on the site of the new Homeless Services Center. Since CAPSLO does not have the capacity or expertise to operate the detox center, it is looking to the Health Agency, through its Behavioral Health Department, to operate the center or manage a contract with a qualified vendor. The Health Agency has received Board of Supervisors (BoS) support for this plan, although there is still a question of the finances.)
Recommendations 10
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R1Page 18(Return) “The County Health Agency’s Drug and Alcohol Services should resume its concentrated efforts to develop a residential detox service in the County to serve its Medi-Cal and less financially able citizens.” The Health Agency stated the recommendation had been implemented and was expected to meet “network adequacy” in three years. 6 2017-2018 San Luis Obispo County Grand Jury Final Report
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R2Page 19(Return) “The Board of Supervisors should direct the Sheriff and the Health Agency to evaluate the feasibility of and approach to repurposing vacated buildings within the County Jail’s honor farm as a residential detox service. A final report on the feasibility and if indicated the specific steps required to convert this housing to a substance-abuse residential and/or treatment facility should be completed by June 2018.” The BoS stated this recommendation will be implemented. The Health Agency and the Sheriff will work through the SLO County Community Corrections Partnership (CCP) to evaluate repurposing of the vacant buildings as a residential detox facility. The Health Agency and the Sheriff will present a report to the BoS for further consideration in June of 2018.
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R3Page 19(Return) “The County Health Agency’s Drug and Alcohol Services should expand its County Jail programs, including individual and group counseling, to cover inmates who go through withdrawal protocols regardless of AB 109 status.” BoS and the Health Agency stated this recommendation requires further analysis. BoS anticipates the analysis will be complete in January of 2018 and will include a review of inmate addiction status, treatment needs, treatment space requirements, and cost. (We note if the Health Agency completed its analysis, it had not reported to BoS yet, based on the Board of Supervisors’ Agendas and item documents for the month of January. There was a report presented on 12/5/2017 to the BoS regarding a “Stepping Up” initiative which covered only a portion of the recommendation.)
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R4Page 19(Return) “The County Jail should revise inmate classification and cell assignment to take into account the inmate’s substance abuse treatment needs and interest in such when determining cell placement.” 7 2017-2018 San Luis Obispo County Grand Jury Final Report The Sheriff agreed and has tried to do this whenever possible; however, under the present jail conditions, based on configuration and classification of inmates, this can be very difficult to accomplish. With added programming space the placement of inmates may be possible with some exceptions.
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R5Page 20(Return) “The County Jail should house inmates interested and/or involved in drug and alcohol services in such a way as to create groups of addiction-treatment participants (e.g., units or pods) that allow for efficient delivery of treatment services; this includes separation from other inmates who interfere or disrupt treatment participation.” The Sheriff believes this requires further analysis. In principle, the Sheriff agreed with this recommendation; however, he believes this would be difficult to accomplish. With added programming space it may be easier to do.
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R6Page 20(Return) “The County Health Agency and Sheriff should integrate the functions of the jail’s medical and drug and alcohol service providers by locating their offices in close proximity and requiring coordinated care for inmates with substance use disorders.” The Health Agency and the Sheriff stated that while this recommendation has not yet been implemented, it will be when the new medical facility and jail programming space are completed.
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R7Page 20(Return) “The County Health Agency should pilot the usage of medication-assisted treatments, i.e., Buprenorphine and Naltrexone, with a select population of opioid and alcohol addicts at the County Jail.” The Health Agency stated this recommendation requires further analysis. The Health Agency currently provides the continuation of medication-assisted treatment in jail for inmates who are on Methadone treatment when they are jailed. It also initiates Methadone treatment for pregnant 8 2017-2018 San Luis Obispo County Grand Jury Final Report women when that protocol is indicated. The Health Agency is also studying the use of medication- assisted treatment in jails/prisons though the California Healthcare Foundation. The goal is to develop a pilot program with both sustainable costs for staff and medications in the jail. The Health Agency will collaborate with the Sheriff’s Office staff to develop the operational processes. By January 2018 they will have evaluated the need for increased staffing and any additional resources needed. (We note if the Health Agency and the Sheriff’s office completed their analysis, they have not yet reported to BoS, based on the Board of Supervisors’ Agendas and item documents for the month of January. There was a report presented on 12/5/2017 to the BoS regarding a “Stepping Up” initiative which may have taken the place of some of the recommended report, but based on the reporting of the meeting it did not appear to include all of the factors that were to be reviewed.)
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R8Page 21(Return) “The Board of Supervisors should evaluate the Law Enforcement Assisted Diversion program or a similar pre-booking substance abuse diversion for County implementation as a means of motivating and engaging young adult arrestees who are assessed to be primarily substance abusers and not criminally oriented. A written evaluation by the County Administrative Officer should be reviewed at a meeting of Board of Supervisors by June 2018.” The BoS stated they will implement this recommendation. They will have the SLO County Community Corrections Partnership (CCP) examine the Law Enforcement Assisted Diversion program, or a similar program to determine feasibility and the level of inter-agency support required to roll out the program for the County. CCP is to provide its report in June of 2018 to the BoS for further consideration.
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R9Page 21(Return) “The San Luis Obispo City Council should evaluate the Law Enforcement Assisted Diversion program or a similar pre-booking substance abuse diversion for City implementation as a means of motivating and engaging young adult arrestees who are assessed to be primarily substance 9 2017-2018 San Luis Obispo County Grand Jury Final Report abusers and not criminally oriented. A written evaluation by the City Manager should be reviewed at a meeting of the San Luis Obispo City Council, by June 2018.” SLO City has not responded. They have been contacted to provide a response.
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R10Page 22(Return) “The County Health Agency should direct its Drug and Alcohol Services to work with the board of the homeless shelter to develop a plan for operationalizing two detox beds in the yet-to-be-built Homeless Services Center, which could entail the DAS providing onsite outpatient detox services if other treatment options are not viable. This plan is to be developed prior to the opening of the center or by June 2018.” The Health Agency stated this recommendation has already been implemented. Staff members are currently working with the Homeless Services Center. They stated the development and completion of the plan is dependent on the timeline set by CAPSLO. Return to Report List (Ctrl + Click) REPORT: IS IT FIVE MINUTES TO MIDNIGHT IN CAMBRIA? AN UPDATE ON THE RISK OF CATASTROPHIC FIRE This report (one of a number of reports issued over the years on this subject) was conducted to provide an updated assessment of the risk of fire in Cambria, to ensure focus on the imminent danger, to make people aware of the advances Cambria Community Services District (CCSD) has made, and to identify areas that require additional attention. As we have watched the destruction of portions of Northern and Southern California from the fires and their aftermath, we are even more concerned for Cambria. Any fire could become devastating to its citizens and their property. Four findings and three recommendations were made.