Committee huMAN Services

Recommendations 10

• R06-27
  THE DEPARTMENT OF AGING AND ADULT SERVICES ADOPT AS POLICY, A REQUIREMENT THAT ADULT PROTECTIVE SERVICES RESPOND TO NON- EMERGENCY REPORTS WITHIN FIVE (5) DAYS. LONG-TERM CARE OMBUDSMAN PROGRAM BACKGROUND The Long-Term Care Ombudsman Program within the Department of Aging and Adult Services is State and Federally funded. It is mandated by State and Federal law to receive, investigate, and work to resolve problems and complaints on behalf of residents in skilled nursing homes and residential care facilities. Ombudsman services are free and confidential. The Ombudsmen are independent, neutral and objective. They are responsible for identifying root causes of a problem and to resolve complaints and concerns. They also observe, suggest, and monitor the care of the patient, and keep them connected to the outside world. California law requires that any Durable Power of Attorney for Health Care and Advanced Directives executed by a resident of a skilled nursing facility must be signed in the presence of an Ombudsman and a second witness. This is done to ensure that the resident understands the meaning of a Durable Power of Attorney for Health Care, and is not coerced into signing the document against his or her will. FINDINGS This program is very important. An Ombudsman is an advocate who gives a voice to the resident and assures that his or her rights will be protected. The Ombudsman Program has two full-contract workers, one full-time County employee, four part-time contract workers, and 27 volunteer Ombudsmen. These 27 Ombudsmen are responsible for over 12,600 individuals living in long-term care facilities in San Bernardino County. The Ombudsmen visit the 56 skilled nursing homes and 241 residential care facilities located throughout San Bernardino County. Visits are required once a quarter to the skilled nursing facilities and twice a year for the residential care facilities. This computes to 31 minutes a year that a volunteer is able to spend in each facility. In addition, a report is required to be filled out on each visit covering the general appearance of the facility, checking for license, food quality, activities, and quality of care and staffing. Ombudsman volunteers must undergo 36 hours of training and 12 more hours throughout each year. They must agree to donate at least 20 hours of service each month. Volunteers receive mileage reimbursement for travel between their homes and their assigned facilities. It is not enough to pay for the high cost of driving their own vehicle. They must provide their own transportation. They receive no compensation for meals or any per diem expense. If the County were to pay someone to do this job, even at minimum wage, it would cost $135 a month per volunteer. That would be $3,645 per month, based on 27 volunteers, for a yearly cost of $43,740. Offering per diem in the way of a meal allowance or stipend would help the Ombudsmen offset their own personal costs. The department is currently recruiting Ombudsman volunteers; the response has been poor. Aging and Adult Services hasn’t had much success in keeping volunteers, and there is a large turnover. At this time they do not survey past volunteers to find out why they left the program. RECOMMENDATIONS
• R06-28
  OFFER PER DIEM, IN ADDITION TO MILEAGE, AS AN INCENTIVE TO ATTRACT MORE OMBUDSMAN PROGRAM VOLUNTEERS.
• R06-29
  SURVEY PAST VOLUNTEERS TO ASCERTAIN WHY THEY LEFT THE OMBUDSMAN PROGRAM. DEPARTMENT OF CHILDREN’S SERVICES CHILD PROTECTIVE SERVICES BACKGROUND The mission of Child Protective Services (CPS) is to protect endangered children, preserve and strengthen families, and develop alternative family settings. CPS works to prevent further harm to children from intentional physical or mental injury, sexual abuse, exploitation or neglect by a person responsible for a child’s health or welfare. Foster Care and Adoption services are available as support for these families. New legislation (AB636) and the mandated Self-Improvement Plan (SIP) have been implemented since January of 2004. San Bernardino County currently has over 5,000 children in placement. FINDINGS There is a standardized method of risk assessment for children: Assess, determine appropriate response, notify regional manager, assign worker, contact family, and start an investigation. Calls to the Child Abuse Hotline (CAHL) take approximately 24 hours to process. If the child is not in immediate danger, the plan of action may take 3 to 4 days to determine, although CPS states they have 10 days to make the first contact. The Intake Staff, who handle emergency responses, average 18 referrals per month. A referral is different than a case. A referral is the abuse/neglect allegation that comes in from the community to the hotline. A worker is assigned to investigate that referral. If an incident is deemed critical, police and a social worker are dispatched to the home within two hours. Children are always removed from the home in critical cases. A court order must be obtained within 72 hours following removal. The Carrier Staff, who handle the ongoing cases after they are adjudicated by Juvenile Court, average 42 cases per worker. They monitor the children in placement and help the birth parents with the service plan that will best help reunify the family. A family is typically given 12 months to reunify. The Carrier Staff also carries the permanency cases; those children who now have a permanent plan of adoption, guardianship or long- term foster care. Every effort is made to keep a child in his or her environment. When a child comes into the system and cannot stay in the home, family members are considered 40 first. These homes must meet the same standards as any other foster homes, and these family members must meet the same standards as other foster care parents. Family-to-Family is a test project in Rialto which brings the community, churches, schools, and the CPS Department together to plan programs for the children, giving them a broader sense of the community and all the help it has to offer. The department is hoping to expand to the city of San Bernardino next. With the implementation of this and other creative program and support services, the department expects to see an increase in reunification rates and support for families of at-risk children. Child Protective Services is currently in the process of developing a standardized risk assessment tool for line staff. This will assess the risk level for potential caregivers and identify early intervention that would benefit the family members. This is planned to be in effect The mandated Self-Improvement Plan gives the department statistics to work with for a measurement of success or failure. The County is not inputting the data in a timely manner. Therefore, the Quarterly Outcome and Accountability Data Reports are running six months behind. RECOMMENDATION
• R06-30
  INPUT THE DATA FROM EACH CONTACT FOR THE OUTCOME AND ACCOUNTABILITY DATA REPORT WITHIN 24 HOURS, TO PROVIDE A MORE TIMELY MEASURE OF DEPARTMENTAL PERFORMANCE. FOSTER HOME SERVICES BACKGROUND The mission of Children’s Services is to protect endangered children, preserve and strengthen their families, and develop alternative family settings. Services, as mandated by law and regulation, are provided in the least intrusive manner with a family-centered focus. This mission is accomplished in collaboration with the family, a wide variety of 41 public and private agencies, and members of the community. Children’s Services is State and Federally funded, with some local matching funds. In 2001 the California State Legislature enacted Assembly Bill 636 (AB636), the Child Welfare System Improvement and Accountability Act. AB636 replaces a process- driven compliance review system with an outcome-driven system. It became effective in San Bernardino County in January of 2004. The key issues that are measured are related to the safety, permanency and well-being of children in the Foster Care System. Along with AB636 came the Self-Improvement Plan (SIP). This is the plan by which Children’s Services plan to achieve measurable outcome improvements called for in AB636. The Department of Children’s Services receives quarterly reports from the State, “The California Child Welfare Outcomes and Accountability County Data Report”, derived from continuous data supplied by the department. FINDINGS The County selection process to become foster parents includes a mandatory Livescan (background check), a health checkup, and a mandated 24-hour training course, along with 20 additional hours per year; the State requires only 8 hours. Anyone frequenting the home on a regular basis is required to have a background check to determine if they may pose a threat to the child. Foster parents today are looked at more and more as potential permanent parents. Thirteen percent (13%) of children in the foster care system are not being seen in a timely manner. According to the January 2006 “Outcome and Accountability County Data Report” only 86.3 percent of the children in foster care were seen in April 2005, 86.2 percent in May 2005, and 87 percent in June 2005. The caseload for Intake Workers is 15–18 referrals per month. Social Workers, who carry cases after adjudication, have 35– 55 cases, depending on the contact and the court requirements for each case. Each allegation of abuse or infraction in a foster care situation is evaluated on a case-by-case situation. The action taken is determined by the severity of the allegation and the findings by the County Licensing Investigator. A plan of correction for the foster parent may involve retraining, followed up with visits by the licensing investigators to insure compliance. There are some highly publicized cases of abuse; however, they make up a very small percentage of cases the department handles. The State mandates that each child is contacted or visited monthly, and a licensing worker make annual visits. Some exemptions may apply for contact compliance. The department does provide some services for undocumented children. At this time there are approximately 20 undocumented children in the care of Children’s Services. They are entitled to limited benefits for childcare, medical, and foster care. Childcare 42 services are limited to undocumented children born to legal residents, which is extremely rare. Under medical, service is restricted to emergencies, such as the patient’s health in serious jeopardy, impairment of bodily functions, or dysfunction of any body part or organ. Under foster care, undocumented children placed under the jurisdiction of the Juvenile Court and/or considered a dependent of the Court are eligible for Permanent Residence Under Color of the Law (PRUCOL). There is an attempt to unite undocumented children with relatives, or Children’s Services assists them in becoming citizens before they reach the age of 18. The Grand Jury has received no evidence of systematic tracking of the cost of services to the undocumented. RECOMMENDATIONS
• R06-31
  ENFORCE THE PLAN BY WHICH EACH CHILD IN FOSTER CARE IS VISITED IN THE TIME MANDATED.
• R06-32
  IMPLEMENT A PROGRAM TO TRACK THE COST TO THE COUNTY OF SERVING THE UNDOCUMENTED. INDEPENDENT LIVING PROGRAM BACKGROUND The Independent Living Program (ILP) is a mostly Federally funded nationwide program designed to provide life skills, career exploration, and job readiness preparation for foster care youth. A small amount of funding comes from the State. Eligible youth, 16 to 21 years of age, learn skills to prepare them to transition to adulthood and live independently. ILP services include workshops, conferences, training career counseling, tutoring, and assistance with scholarships. The department contracts with community groups for many of these services. Most former foster care youth are eligible for full Medi- Cal benefits until their 21st birthday. The County Mission Statement is “The goals of the ILP are to enable eligible youth to achieve self-sufficiency prior to leaving the Foster Care support system and through the continuum of emancipation. Providing independent living skill assessments, basic services, and written Transitional Independent Living Plan for each participating youth assists in achieving the goal.” It is a top priority of the California Department of Social Services to make the Independent Living Program available and 43 accessible to all eligible youth in California. The Grand Jury met with representatives of the County ILP on November 2 and November 16, 2005. FINDINGS All foster care youths are to be identified at 15-1/2 years of age. Case workers and foster families are to notify the youths of the Independent Living Program (ILP). Fliers are also sent to them. Some youths do not receive notification. The department believes this happens because caseworkers quit or transfer to another position, and a lack of information occurs. Youths are sometimes placed in another county. ILP measures success by the youth being employed, having a place to live, and having a “life plan”. Currently, ILP is serving 4,191 youths. The program is voluntary. The County offers incentives (money) and transportation within the county for the youth to attend various workshops or classes. The County offers ten week classes in skills ranging from relationships and self-enhancement, computer skills, handling finances, writing resumes, studying for the Standard Aptitude Tests, and passing the required high school graduation tests. The ILP department believes every youth succeeds at his/her level, and no one fails. The youths evaluate themselves. They can repeat classes if they wish. There are no set standards or measurement for achievement. The department does send an annual program status report to the State. ILP is a State mandated program, but there has been no requirement for tracking success or failure. The recent Self-Improvement Plan (SIP) calls for a system to enable tracking. The department can retrieve data on an individual but cannot give statistics on the program. Data can be found in the State Reports or Berkeley Reports. The department is working with Loma Linda University to develop a system to track the program’s success in the early stages (ages 16 to 18). The department does not track youths who have left the program. Sometimes youths who have left the program contact ILP, and the department can note how those particular past participants are doing. The department believes community involvement is not only helpful, but a necessary component for the Independent Living Program. The new Family-to-Family Program is promising, but it is only a first step in countywide implementation and is limited to a small area of the County. The department stated a need for more mentors, especially male mentors. ILP states they have a Speaker’s Bureau which, at present, consists of the ILP Coordinator. The speaker will go into the community to encourage people to become mentors. ILP does serve the undocumented, but does not keep a record of financial costs. Presently, the department has identified eight undocumented youth in the program. RECOMMENDATIONS
• R06-33
  ESTABLISH STANDARDS FOR MEASURING THE SUCCESS OR FAILURE OF THE PARTICIPANTS IN THE INDEPENDENT LIVING PROGRAM.
• R06-34
  IMPLEMENT AN OVERALL DOCUMENTED STATISTICAL COUNTY TRACKING SYSTEM TO IDENTIFY THE STRENGTHS AND WEAKNESSES OF THE INDEPENDENT LIVING PROGRAM.
• R06-35
  ESTABLISH A COUNTYWIDE ONGOING PROGRAM TO ACTIVELY SEEK MENTORS AND COMMUNITY INVOLVEMENT.
• R06-36
  TRACK THE COST OF PROVIDING SERVICES TO THE UNDOCUMENTED. 45