The Property of Flora Ave Rosebud Av Galfodii Dr*

Recommendations 38

• R1
  F1, F2, F3, F4, Lower the speed limit on the segment of Memorial Drive adjacent to the park to a speed based on a combination of studies and surveys, not just the speed summary.
• R2
  F3, F4, Put in a crosswalk from the playground area to the ballpark entrance.
• R3
  F3, F4, Place calming techniques such as adding plate strips, Bott dots, speed bumps and/or advisory signs, paint the speed limit on the asphalt, yellow flashing lights during events.
• R4
  F3, F4, Attempts should be made to make the motorist aware of non-apparent conditions while driving on Memorial Drive given the presence of events and pedestrians
• R5
  F1, F2, F3, F4, Local government should not wait until a major traffic injury or fatality occurs on the Memorial Drive segment adjacent to Veterans Park before addressing the speed issue. Local government should acknowledge and further evaluate safety and the speed to prevent and not wait to react to accidents. Local government should decide if conditions warrant another E&TS be done before 2017.
• R6
  F1, F2 Conduct further analysis: Determine the number of pedestrians during a typical event and on a regular day. Count the traffic during a typical event and on a regular day. Research the risk of injury based on the number of pedestrians in proximity to the number of cars. Determine if any benefits exist in a speed limit of 40mph. Responses Required: • The San Benito County Board of Supervisors (90 days to respond) • The City Council of Hollister (90 days to respond)
• R7
  F6, All new school fields built should include wire mesh in the cost of construction.
• R8
  F4, F6, F7, F23. The LE, ED and BH Departments and the Jail are key relationships to one another. Policies and procedures between these agencies should be made with particular attention and supported with a close oversight of the BOS that reflects these dependencies to ensure mental health care program efficiency and success.
• R9
  F1, F4, F5, F6, F7, F23. Collaborative effort should begin immediately from all parties for the health and welfare of SBC.
• R10
  F4, F7, F8, F23. SBC BOS establish clear Memorandums of Understanding (MOUs) written by and for the involved agencies, districts that have a separate board, and counties, (i.e. those not operating under the SBC BOS direct authority) to determine and establish agreement upon, and compliance with, local protocol. Also, that the BOS effect policy to maintain these MOUs until superseded by subsequently negotiated agreements.
• R11
  F1, F4, F10, F11, F12, F14, F23. "Stacking" 5150 holds is bad practice, and may be in violation of CA law. SBC should cease taking liberties with CA legislation concerning persons placed on 5150 holds. All methods available to agencies and departments should be implemented to attempt not to exceed the 72-hour maximum elapsed time from when the hold is initiated by LE, or otherwise, until the point of completed disposition of the patient.
• R12
  F1, F4, F10, F11, F12, F14. F15. BH should not look for, or be compelled to find, creative ways to circumvent the law to extend the 5150 72-hour hold due to SBC's lack of psychiatric treatment resources. BH should not "fudge the start time of the 5150 hold" nor argue that the start time or "hold lift time" is ambiguous. BH's good intention is clear, but working with the BOS to gain the facilities for an outstanding mental health program is optimal. Anything else may be counterproductive to achieving a long-term viable and quality program in SBC. If SBC BH does obtain written official temporary authorization to stack 5150s from the state, SBC should still employ a more strict 5150 72 hold time, and county agencies work together to increase our quality of mental health care under this time constraint. If BH obtains formal approval to stack 5150s given our dire lack of resources, BH's use of the temporary waiver should be done so understanding that it to be used in parallel to a dedicated lobby for establishment and implementation of permanent solutions for SBC.
• R13
  F9, F10. Recommended that SBC adopt a model such as Monterey County to consider weekends and holidays as part of the 72-hour period of a 5150 hold regardless of SEIU bargaining demands.
• R14
  F1, F4, F10, F12, F23, F32. Both the ED and BH should be responsible for researching and locate bed availability to transfer 5150 persons who cannot receive needed care in SBC. Both departments should be held equally accountable for delays or wait time in the 72 hours to research and find a bed. This policy should be written in a formalized protocol and enforced by the BOS in oversight of the county mental health care program.
• R15
  F1, F10, F11, F12, F14, F15, F23. If individuals object to being involuntarily held during or beyond the 72 hours on a 5150 hold, then the use of the patient's legal rights to judicial review (filing a writ of habeas corpus) process should be brought (again) to the patient's attention by the ED staff. In particular, when medical clearance has processed but a BH assessment is not complete. That is, according to WIC the patient may be reminded that: "If held longer than 72 hours, you have the right to a lawyer and a qualified interpreter and a hearing before a judge. If you are unable to pay for the lawyer, then one will be provided to you free of charge." Notification by the individual to the County Public Defenders office or any other attorney should not be interfered with or discouraged. The individual may also be reminded that if demanding a writ of habeas corpus, the decision whether to file it lies solely with the SBC Public Defender.
• R16
  F1, F4, F11, F12, F13, F23. The San Benito Health Care District in conjunction with BH and the BOS should develop its own, customized, patient's rights pamphlet to distribute to individuals on a WIC 5150 hold in the ED instead of using what was prepared specifically for Santa Cruz County.
• R17
  F1, F14, F18, F23, F24. The HHH ED should cease developing plans to release individuals in need of psychiatric care by "lifting the hold" on WIC 5150s. Any authorization for the ED to use this type of protocol should be made as a result of the SBHCD Board of Directors and the SBC BOS joint approval following multi-departmental, agency, and district collaborations held with The Director, Behavioral Health. When any release is made, LE is to be notified immediately.
• R18
  F1, F4, F9, F10, F11, F12, F13, F14, F15. Request immediate assistance from the State of CA, Department of Health and Human Services, before SBC has legal issues regarding patients' civil rights for involuntary detainment beyond the 5150 72-hour holds; and failing to admit a patient for evaluation and treatment because SBC does not have a necessary psychiatric treatment facility.
• R19
  F1, F4, F5, F6, F7, F8, F14, F23, F24. Recommend preparation of negotiated agreements among the agencies that share the responsibility of WIC Division 5 management and agreement should include confidentiality in ARTICLE 7. Legal and Civil Rights of Persons Involuntarily Detained [WIC 5325 - 5337] especially Section 5328. This agreement should be established within the meaning of California Civil Code so that one agency may not unilaterally change established procedures which affect any other agency without a new negotiated agreement among the agencies.
• R20
  F17, F19, F23. As the designated treatment facility HHH should provide resources to medically clear 5150 hold patients as soon as possible.
• R21
  F16, F18, F23, F35. HHH should consider setting up a licensed inpatient area and move 5150s to 5151s for an added 72 hours of evaluation for treatment – then, if necessary, transfer the patient.
• R22
  F17, F18 F19 F20, F21, F22, F23, F35. HHH should consider becoming a licensed psychiatric facility with 7 to 10 beds to help alleviate problematic county mental health issues.
• R23
  F1, F17, F18 F19 F20, F21, F22, F23. It is recommended to take pressure off of the ED and BH clinicians by SBC finding at least ten beds for psychiatric care. The SBC BOS and SBHCD Board of Directors should understand that SBC needs to augment mental health care now. El Dorado County has a 10-bed PHF, and Sacramento has a 12-bed PHF; this is a basis to understand CA counties can get the state's support for county mental health care needs.
• R24
  F1, F16, F17, F18, F19, F20, F21. Recommended that BOS capture the attention of the state on the basis of the CA Law WIC 5770 which reads: "Notwithstanding any other provision of law, the State Department of Health Care Services may directly, or by contract, with any public or private agency, provide any of the services under this division [WIC Division 5] when the state determines that the services are necessary to protect the public health, safety, or welfare."
• R25
  F1, F17-24, F35. SBC leadership and elected officials undergoing the impact of this lacking psychiatric mental health care system together implement an immediate and temporary solution. They should establish locations for a psychiatric crisis center for LE to bring 5150 holds needing assessment and a place to admit patients who require mental health evaluation and treatment as a result of the information provided in this report until effecting permanent solutions. R 26. F24 The COH should be involved in and conferred with to play a more active role in collaboration, financing, and in establishing plans for future facilities.
• R26
  F24 The COH should be involved in and conferred with to play a more active role in collaboration, financing, and in establishing plans for future facilities. R27. F1-F8, F16, F25, F26, F27, F28, F29, F30, F31, F34. Recommended that the SBC Sheriff or his SBC Jail representative be present at collaborative meetings when determining SBC mental health care program specifics that include the Jail. A further recommendation is that the Jail update policies and procedures section 609 correctly and reflective of a working mental health care system. R28. F1-F8, F16, F25, F26, F27, F28, F29, F30, F31, F34. BH should no longer provide one-way directives to the jail or other agencies as LE, HHH ED, that significantly impact the other's resources. The January 2016 directive to the Jail should be rescinded and re-negotiated and re-established in a collaborative manner. If this includes union bargaining members, the BOS and its council should be notified, consulted and involved. R29. F1, F25-F31, F34. Recommended that related elected officials consider augmenting Jail psychiatric mental health care, either temporarily or permanently, by expanding the existing CFMG medical health care contract. CFMG currently offers this service and SBC currently is in contract with CFMG for other medical care. R30. F1, F4, F5, F7, F14, F28, F29, F30, F34. The recommendation is that every action is taken to eliminate significant delays at the Jail, including but not limited to, policies that exclude BH from being called into the Jail overnight, weekends or holidays until such time that SBC's mental health care program is viable. Also, until such time when it is determined conclusively by further investigation that WIC 5150s released from the ED are no longer turning up at the jail needing BH to complete a previously truncated assessment and/or from making arrangements for an appropriate psychiatric evaluation and treatment plan. R31. F1, F28, F29, F30, F31, F33, F34. BOS consider looking elsewhere for the Jail's mental health (inpatient or outpatient) needs as it does with other medical needs and establish a contract with an outside private facility to refer patients that will agree to work during the night to meet the SBC goals to work to achieve sound mental health care for inmates. If current BH union staff does not wish to assess inmates as needed, not simply adopting a procedure based on the minimums of related law, other resources should be used or shifted, and perhaps BH staff decreased. R32. F1, F4, F7, F8, F9, F10, F12, F18, F23, F24, F32. Recommend that a milestone be that the 72-hour hold is no longer significantly extended after finding a bed and transportation is the only consideration left. BOS should allocate funds from the county's general fund and request, through the Council of Government, that City of Hollister funds also is allocated this year for either BH or SBHCD (HHH) to manage for transport. After locating a patient bed, transport of mental health patients should be readily accessible, efficient, safe and conducted as soon as possible for the patient. The amount of funds needed annually approximates $300,000. It is understood this expenditure can reduce as state-funded facilities (such as a PHF) are established in SBC and wherein SBC can conduct mental health evaluations locally. R33. F1, F8, F14, F16, F23, F32, F33. BOS establish directed protocol that ensures no mental health patient in SBC will forfeit an available bed in another county, to simply be released from the ED specifically due to lack of transport. R34. F1, F24, F33. BOS and COG evaluate and consult with BH and the Local Transportation Authority (LTA) for possible transport of some types of patients to facilities for voluntary mental health care. R35. F33, F34 Is it recommended that the BOS have research continued to help determine the concerns of the SBC Juvenile Hall (JH) and the SBC Probation Department policies and procedures in mental health care. Both departments should be consulted and interviewed by independent, nonaligned researchers. Both departments should also participate in future collaboration and planning. The mandates and policies for the mental health care for minors held in detention and parolees stayed outside the scope of this report only due to time constraints. Members of the SBC Grand Jury 2015-16 working on this research have volunteered to assist with further impartial research and reporting on the needs and impact on these departments if requested. The SBC Grand Jury Foreperson has 2015-16 has contact information. R36. F36. Recommend that due to the inherent delays associated with the construction of a Homeless Facility that SBC local government together identify and the BOS approve an area and property ready to allow the building of a psychiatric treatment facility as soon as state assistance is secured. R37. The Grand Jury recommends that the BOS, in conjunction with the Council Of Government, evaluate the use of LTA to assist SBC in transportation as part of a temporary or permanent solution to the inherent and problematic logistics of a Mental Healthcare Program in SBC. R38. F5, F6, F7, F24, F27, F30, F32, F33. For the good of our community, the SBC BOS establish a committee with members from HHH, BH, City Council, COG, County Jail, LE, Health and Human Services, SBC Probation Department, and three representative members from or appointed by the BOS. The initial meetings should validate Grand Jury findings and compare existing research and documentation surrounding the various issues relevant to the departments, agencies and special districts about 5150, and general mental health care management in our county. The Grand Jury recommends these committee members (or representative) ratios to explore viable resolutions and report to the county: City of Hollister Police Department (HPD)1 San Benito County Sheriff's Department (SD)1 Board of Directors, Hazel Hawkins Hospital (HHH)2 San Benito County Board of Supervisors (BOS)3 San Benito County Council of Governments (COG)1 Hollister City Council1 SBC Department of Health and Human Services1 San Benito County Probation Department1 Behavioral Health Department2 A formally established Director should be hired as an unbiased county employee consultant to direct the meetings and mediate and negotiate solutions. The BOS should confer with and select an individual to have knowledge, impartial bias, authority, and ability to travel to Sacramento to meet with relevant state authorities to obtain support and meet with all SBC community agencies ensuring their needs met. An ad hoc or permanent committee should be formed as soon as possible, and remain working with authority until formalized solutions for a viable public mental health care system are established from the beginning to end to correctly manage individuals in a temporary involuntary hold placed in SBC's responsibility. No appointees should have cognitive bias from an existing government, agency, or district to avoid counterproductive or ineffective resolution. RESPONSES REQUIRED Deliver responses to the findings and recommendations made in this final report to the Presiding Judge of the Superior Court within the following timeframes: Board of Directors, Hazel Hawkins Hospital (HHH) (90 days) San Benito County Board of Supervisors (BOS) (90 days) San Benito County Council of Governments (COG) (90 days) Mayor of Hollister and the City Council of Hollister (COH) (90 days) City of Hollister, Chief of Police Department (60 days) San Benito County, Sheriff (SD) (60 days) SBC, Director of Health and Human Services (HHS) (60 days) SBC, Director of Behavioral Health (60 days) Executive Director, SBC Local Transit Authority (60 days)
• R27
  F1-F8, F16, F25, F26, F27, F28, F29, F30, F31, F34. Recommended that the SBC Sheriff or his SBC Jail representative be present at collaborative meetings when determining SBC mental health care program specifics that include the Jail. A further recommendation is that the Jail update policies and procedures section 609 correctly and reflective of a working mental health care system.
• R28
  F1-F8, F16, F25, F26, F27, F28, F29, F30, F31, F34. BH should no longer provide one-way directives to the jail or other agencies as LE, HHH ED, that significantly impact the other's resources. The January 2016 directive to the Jail should be rescinded and re-negotiated and re-established in a collaborative manner. If this includes union bargaining members, the BOS and its council should be notified, consulted and involved.
• R29
  F1, F25-F31, F34. Recommended that related elected officials consider augmenting Jail psychiatric mental health care, either temporarily or permanently, by expanding the existing CFMG medical health care contract. CFMG currently offers this service and SBC currently is in contract with CFMG for other medical care.
• R30
  F1, F4, F5, F7, F14, F28, F29, F30, F34. The recommendation is that every action is taken to eliminate significant delays at the Jail, including but not limited to, policies that exclude BH from being called into the Jail overnight, weekends or holidays until such time that SBC's mental health care program is viable. Also, until such time when it is determined conclusively by further investigation that WIC 5150s released from the ED are no longer turning up at the jail needing BH to complete a previously truncated assessment and/or from making arrangements for an appropriate psychiatric evaluation and treatment plan.
• R31
  F1, F28, F29, F30, F31, F33, F34. BOS consider looking elsewhere for the Jail's mental health (inpatient or outpatient) needs as it does with other medical needs and establish a contract with an outside private facility to refer patients that will agree to work during the night to meet the SBC goals to work to achieve sound mental health care for inmates. If current BH union staff does not wish to assess inmates as needed, not simply adopting a procedure based on the minimums of related law, other resources should be used or shifted, and perhaps BH staff decreased.
• R32
  F1, F4, F7, F8, F9, F10, F12, F18, F23, F24, F32. Recommend that a milestone be that the 72-hour hold is no longer significantly extended after finding a bed and transportation is the only consideration left. BOS should allocate funds from the county's general fund and request, through the Council of Government, that City of Hollister funds also is allocated this year for either BH or SBHCD (HHH) to manage for transport. After locating a patient bed, transport of mental health patients should be readily accessible, efficient, safe and conducted as soon as possible for the patient. The amount of funds needed annually approximates $300,000. It is understood this expenditure can reduce as state-funded facilities (such as a PHF) are established in SBC and wherein SBC can conduct mental health evaluations locally.
• R33
  F1, F8, F14, F16, F23, F32, F33. BOS establish directed protocol that ensures no mental health patient in SBC will forfeit an available bed in another county, to simply be released from the ED specifically due to lack of transport.
• R34
  F1, F24, F33. BOS and COG evaluate and consult with BH and the Local Transportation Authority (LTA) for possible transport of some types of patients to facilities for voluntary mental health care.
• R35
  F33, F34 Is it recommended that the BOS have research continued to help determine the concerns of the SBC Juvenile Hall (JH) and the SBC Probation Department policies and procedures in mental health care. Both departments should be consulted and interviewed by independent, nonaligned researchers. Both departments should also participate in future collaboration and planning. The mandates and policies for the mental health care for minors held in detention and parolees stayed outside the scope of this report only due to time constraints. Members of the SBC Grand Jury 2015-16 working on this research have volunteered to assist with further impartial research and reporting on the needs and impact on these departments if requested. The SBC Grand Jury Foreperson has 2015-16 has contact information.
• R36
  F36. Recommend that due to the inherent delays associated with the construction of a Homeless Facility that SBC local government together identify and the BOS approve an area and property ready to allow the building of a psychiatric treatment facility as soon as state assistance is secured.
• R37
  The Grand Jury recommends that the BOS, in conjunction with the Council Of Government, evaluate the use of LTA to assist SBC in transportation as part of a temporary or permanent solution to the inherent and problematic logistics of a Mental Healthcare Program in SBC.
• R38
  F5, F6, F7, F24, F27, F30, F32, F33. For the good of our community, the SBC BOS establish a committee with members from HHH, BH, City Council, COG, County Jail, LE, Health and Human Services, SBC Probation Department, and three representative members from or appointed by the BOS. The initial meetings should validate Grand Jury findings and compare existing research and documentation surrounding the various issues relevant to the departments, agencies and special districts about 5150, and general mental health care management in our county. The Grand Jury recommends these committee members (or representative) ratios to explore viable resolutions and report to the county: City of Hollister Police Department (HPD)1 San Benito County Sheriff's Department (SD)1 Board of Directors, Hazel Hawkins Hospital (HHH)2 San Benito County Board of Supervisors (BOS)3 San Benito County Council of Governments (COG)1 Hollister City Council1 SBC Department of Health and Human Services1 San Benito County Probation Department1 Behavioral Health Department2 A formally established Director should be hired as an unbiased county employee consultant to direct the meetings and mediate and negotiate solutions. The BOS should confer with and select an individual to have knowledge, impartial bias, authority, and ability to travel to Sacramento to meet with relevant state authorities to obtain support and meet with all SBC community agencies ensuring their needs met. An ad hoc or permanent committee should be formed as soon as possible, and remain working with authority until formalized solutions for a viable public mental health care system are established from the beginning to end to correctly manage individuals in a temporary involuntary hold placed in SBC's responsibility. No appointees should have cognitive bias from an existing government, agency, or district to avoid counterproductive or ineffective resolution.