of Investigation Imperial County Behavioral Health Service

Recommendations 14

• R01
  It is recommended that the Imperial County Board of Supervisors take note that agencies under its umbrella have a serious lack of cohesion and agreement. While this jury does not fault the Board of Supervisors directly or at all, it is believed that they can ensure that the needed meetings take place with the heads of the individual agencies.
• R1
  It is recommended that the prison attempts to increase the number of staff that are assigned to track gang members and their activities.
• R02
  It is recommended that the county hire a Psychiatric Social Worker III for the jail, and do so soon. That person needs to be accountable to jail administration and not just another arm of BH.
• R2
  It is recommended that CAL continue to expand the useful vocational programs in place, including finishing the auto paint shop overhaul. Response Required: No response is required as Calipatria State Prison is a part of a state agency. 2015-2016 Imperial County Civil Grand Jury Final Report of Findings Subject of Investigation: Centinela State Prison Justification: California State Law Penal Code Section 919 (b) mandates that the Civil Grand Jury (CGJ) shall inquire into the condition and management of the public prisons within the county. Background: Centinela State Prison (CEN) is operated by the California Department of Corrections and Rehabilitation. The prison was opened in October 1993, and the prison began receiving inmates immediately thereafter. The prison was originally designed to house 2,208, and has held more than double that amount, over 5,100 inmates. Currently there are approximately 3,200 in the inmate population. Overview: A committee of the Imperial County Civil Grand Jury conducted an inspection of the prison facilities in November 2015. The CGJ was greeted by the Community Resource Manager (CRM) and the Administrative Assistant/Public Information Officer (AA/PIO) lieutenant. The CRM and the AA/PIO were professional, accommodating, and open to CGJ questions and requests for information concerning CEN. The CGJ committee was encouraged to visit any department or to observe any activity taking place during the inspection. The CGJ learned that at the time of the visit, November 3, 2015, one of the CEN facilities, Facility B, is being converted to a Level 4 facility. CEN has had three Level 3 facilities and a Level 4 facility. This would change it to two each. This was being done in order to accommodate the influx of Level 4 prisoners. Facility B shower doors are to being converted from the current partial doors to metal, full sized, lockable doors. Additionally, work was planned to construct a support fence for additional security. The yard program would be cancelled during the days the fence is being worked on. Once the facility receives the Level 4 inmates, the Level 4 program would commence. Last year’s CGJ report indicated that there was an ongoing plan to return the facility to no higher than a Level 3. However, this current report recognizes the new facility level changes. Tour: The CGJ committee visited with the officers working in the investigations unit of the prison. It was observed that there are very few investigators considering the size of the prison and that many more validated gang members were placed on the prison mainline due to court orders. They expressed frustration about being understaffed. Their work load has increased significantly with no additional officers to shoulder the load. The CGJ inspected the visitation facility associated with Facility B and its yard. Passing by the visitation area we met two K-9 unit officers and their dogs. We spoke with them briefly asking them about their duties. The committee also asked them if the visitation areas were inspected during visiting hours. They replied that although it has not been approved yet, they agreed that inmate drug possession and drug usage would decrease if this inspection were allowed during visiting hours. The CGJ also inspected Facility B, including the kitchen, serving and eating area, a housing unit, and a gym facility. • The kitchen provides three meals per day for the inmates in Facility B. Each inmate are provided with two hot meals and one bag lunch. Food is not cooked in the facility kitchen. All cooking is done in the central kitchen, then distributed daily to each facility. However, each facility is responsible for the heating and serving the correct portions to each inmate. The dining area is consistent with the standard of all CEN facility kitchen/eating area combinations. • The CGJ committee inspected a housing unit in Facility B. It consists of 100 two person cells and six shower facilities. There are three shower facilities on the top floor and three on the bottom floor. There are three correctional officers per unit in the prison; two on the floor with the inmates and one in the control booth officer that opens and closes all of the doors. Education: Education operations were observed in progress. Classroom teachers are all credentialed by the State of California. Inmate grade levels are assessed upon entry and inmates are expected to attain at least a sixth grade level. Graduate Equivalency Diploma (GED) certificates are offered to those who have not completed high school. Inmates are also offered the opportunity to earn college degrees. The officer assisting with the educational portion of the tour pointed out that the substance abuse program offered to inmates at the facility has a high success rate. Medical Care: The prison includes an Outpatient Housing Unit (OHU) for inmates needing emergency or short term medical care. Inmates requiring long term care are transferred to prisons better equipped to handle long term medical needs. The medical treatment includes accredited health care doctors, nurses, a dentist, a dental technician, psychological techs, and six contracted psychiatrists. Physicians utilize a Tele- Med system to assist in diagnosis and treatment. There are times when inmates need to be transported to Pioneers Memorial Hospital (PMH). There is an on-grounds medical transport vehicle for prison use only. Other: Toward the end of the prison tour, the CGJ committee was able to have an informal question and answer session with the Warden. He answered questions freely as they were asked. The committee did not speak with any inmates other than simple greetings. No issues with inmates were observed. The prison supports the local community through donations, when appropriate needs are identified. CEN considers itself a partner in local law enforcement and community endeavors. Conclusion: CGJ members determined that CEN appears to be a well run prison. CEN staff were very willing to answer questions with no difficulties. The general climate of the institution came across as being positive.
• R03
  It is recommended that there be a single uniform HIPAA release form that all relevant local agencies use within this county. Critical information must be shared when needed.
• R3
  Jail administrators work with county supervisors and administrators to seek the needed funding to ensure that medical care keeps up with the increase of long term inmates. Response Required: The Imperial County Civil Grand Jury requires a written response from the Imperial County Sheriff’s Office within ninety (90) days from the issuance of the report. 2015-2016 Imperial County Civil Grand Jury Final Report of Findings Subject of Investigation: Imperial County Juvenile Hall Justification: California State Law mandates that the Civil Grand Jury (CGI) investigate and report on the state prisons and jail facilities on a year basis, this mandate includes Juvenile Hall (JH). Background: Juvenile Hall is part of the Imperial County Probation Department. The facility is a secure facility consisting of five (5) dorms to house juvenile Wards, a central control center, classrooms, medical room, recreation areas, cafeteria and other offices used for services offered to the wards. On October 29, 2015, a committee of the Imperial County Civil Grand Jury (CGJ) members met with the Juvenile Hall Facility Manager and other staff members. They provided a tour of the facility and responded to our questions regarding procedures and programs for minors detained at the facility. Working with JH are 10.5 Probation Officers. Six dedicated to the field, one to truancy at schools, and three fulltime plus one half- time position dedicated to Placement. Overview: The Imperial County Juvenile Hall (ICJH) can house a total of seventy-two (72) Wards in five (5) dorms within the facility. On the day of our tour there were eight (8) Wards residing in the facility. The average population this year is thirteen (13) Wards with an average stay of eight (8) days. After their stay in JH, minors may be put on probation, enter a Foster/Group Home or go the Department of Juvenile Justice (DJJ) facility run by the state. Foster/Group Homes are located outside of Imperial County; they are often 6 bed homes and are not locked down facilities. The length of stay in a Foster/Group Home can be a year or two. The DJJ is a longer term for a minor who has committed a serious or violent crime. Currently Imperial Valley has no minors in a DJJ facility. Security: Security consists of locked entry/exit doors, security cameras and reinforced fencing. Standards set by Title 15 of the California Penal Code require one (1) staff member for every ten (10) minors in detention. The facility manager and correctional officers provide structure, support and supervision to detained minors. Once minors are detained they are called Wards. Staff: Staff members attend to discipline, security, personal hygiene, mental health and drug/alcohol counseling, recreation and exercise programs. Continuing the education of the Wards at the level they are currently in school is also provided. This is accomplished by the JH teachers coordinating with the Ward’s teachers in the public school system. There are currently five (5) probation officers assigned to juveniles. One (1) officer deals with truancy and the schools. The other four (4) officers handle the individual cases. Field Supervision: There are currently seven officers assigned to Field Supervision. One officer each is assigned to ICOE Academies (formerly known as Community Schools), DEJ, and Wraparound Services. In addition, there are three officers assigned to Moderate to High Risk Youth and one officer and a probation assistant assigned to the Evening Learning Center. There are also four officers assigned full time to investigations. Auxiliary and Volunteer Programs: In addition to paid staff of the JH the Wards have access to on call Behavioral Health Services if deemed appropriate by the staff or court. There is also a Grandparent Volunteer Program that has been very successful in helping the Wards adjust to problems in their personal lives. These Grandparent Volunteers are seniors that have extensive experience at JH. They listen to what the Wards have to say and provide advice and counseling as needed. They also help with schoolwork as a parent or grandparent might do in a home environment. On the day of our visit there were two Grandparent Volunteers present. Intake Procedures: When minors first arrive at JH they go through an intake process, which is held in private in one of the dorms not currently being used for housing Wards. The process includes an assessment of their mental health using a computer program, which asks yes/no questions called Massachusetts Adolescent Youth Screening Instrument (MAYSI). The program is being used successfully in several counties in California. JH also uses a computerized Detention Risk Assessment Instrument (DRAI) in the intake process. This program evaluates the minor based on prior and current convictions and offenses. This assessment tool helps determine whether a minor should be detained, released to his/her guardian prior to the court date, or placed on probation without staying at ICJH. The intake process is fairly lengthy but it seemed appropriate due to the amount of subjects and variables to be covered. As part of the intake process, Wards are given a detailed Orientation Manual which covers Juvenile Hall rules and regulations, behavioral consequences, grievance procedures, minor’s legal rights, information on court procedures. It also covers access to legal services, health care, housing, and other issues Wards need to know. All material is available in Spanish and English. Food Service: As part of the tour, the jury also visited the kitchens where the food is prepared for the Wards. It was clean and had recently passed inspections by other state/county departments. The food is transported to the cafeteria inside the JH facility. There it is kept warm with working food-warming stations until served to the Wards. The cafeteria is clean and bright. The food looked appetizing. Medical Services: In the JH facility there is a nurse’s station with a nurse on duty. A doctor can be called or a Ward can be transported to a hospital if more serious medical attention is warranted. On call Behavioral Health Services are also available. Educational Services: There are two education classrooms, and both have teachers with valid California Teaching Credentials. The classroom had well equipped computers but access to the Internet was limited due to security concerns. Access is allowed for a particular assignment. JH is in compliance with California state educational standards and offers a high school diploma program or the General Equivalency Diploma (GED). Since the stay for each Ward is fairly short, the teachers try to keep the Wards working on the same subjects, as they would be learning in the home school, including actual assignments that can go back with them to their school. Housing Procedures: Wards are responsible for keeping their rooms clean and have specific work responsibilities assigned to them in the facility. ICJH staff uses a point rewards program to control behavior in a positive way. Wards may accumulate daily points based on behavior, attitude, work performance, grooming, manners and room maintenance. The majority of the Wards, after a short stay, go on to probation. The judge determines this, with a recommendation from the JH staff, as well as other factors. The number of Wards in the JH facility could increase dramatically if a different judge deemed it appropriate to prioritize detention over probation. Currently there are 243 juveniles on probation. Conclusion: CGJ members on this committee concluded that the staff of Juvenile Hall is doing an excellent job and have implemented policies that give the Wards a clear understanding of what is expected of them during their stay while trying to prepare them for returning home.
• R04
  It is recommended that there be training for all relevant (custody/arrest/mental and medical health care) local agencies on just what HIPAA means and what may be released, including under exigent circumstances. If needed, request clarification and/or training from the federal agency that created and implements HIPAA, the U.S. Department of Health & Human Services.
• R4
  Consider establishing a program providing transportation vouchers to be used by clients to attend necessary appointments and services or an arrangement with IV Transit for a van or small bus transportation system that can be scheduled and relied on to be on time. Response Required: A written response is required ninety days from the date of public release of this report. 2015-2016 Imperial County Civil Grand Jury Final Report of Findings Subject of Investigation: County Office of Emergency Services Justification: The Imperial County Civil Grand Jury investigates various agencies and special districts on a rotating cycle. The Imperial county Office of Emergency Services (OES) is the subject of this review, this cycle. The civil Grand Jury selected the agency, County Office of Emergency Services to determine their readiness status as to being able to respond to catastrophic issues that may occur within the Imperial County area. Background: The Office of Emergency Services (OES) first established in 1963, provides emergency management services for the County/Operational Area including its seven cities/towns and special districts. OES coordinates emergency operations activities among all the various local jurisdictions and develops written guidelines for emergency preparedness, response, recovery and mitigation to natural / man-made disasters, and technological disasters. Overview: The Civil Grand Jury as a body was interested in determining the status of the OES in its capability, readiness and functionality to deal with a disaster happening in their jurisdiction. Tour: The Grand Jury committee met with the Chief of Emergency Services and his immediate staff to be informed as to how they function and the process of response to Emergencies such as earthquakes, fires, floods and all other major disasters that might occur in the Imperial County area. The Chief explained his total expenditures for this year are shown to be approximately $384.901.00. The State funds 228.08100, this is through Emergency Management Preparedness Funds (EMPF) there is another $156.820.00 assessed by the County and a couple of other small funding sources to assist. This doesn’t include the funds that the county ads to pay 50% of two salaries as well, said salaries amount was not disclosed. He indicated that the funding was based on population and not territory which in prospective, was not near what it should be, based on the vast territory required to serve. Budget issues are a concern but they are able to get the job done with the limitations that the budget imposed. In order to meet additional needs of Imperial county OES has written and received Grants from Homeland Security (HLS) and other State/Federal Sources. They recently received a grant for a HAZARDOUS MATERIAL RESPONSE UNIT, in the amount of $259,635.00 The total cost paid for the HAZ-MAT Unit was $288.000.00. The balance of the cost being $28.365.00 coming from an additional revenue source. They also received a Grant for an EARTHQUAKE EARLY WARNING SYSTEM for fire, police, hospitals and schools. These Grants come with additional responsibilities, such as audits on the use of the funds granted. The four (4) people that make up the (OES) is structured as follows: OES Coordinator, a part time position of the Fire Chief, who reports to the Imperial County Board of Supervisors (CBOS); Manager of Emergency Services, a full time position reporting to the Fire Chief; and an Office Technician, a position that supports the OES on a shared basis. The CGJ extended its investigation of the OES to the Imperial County Sheriff’s Dispatch Unit which is a vital part of the OES. The committee found that with the Mobil Communications Command Post and the current capabilities that they have will be fully able to meet the need it will be pressed to provide within the Imperial County area. This important communication unit is well prepared to function at its highest level. People forming important elements of the organization are the Disaster Council, which meets quarterly and insures the County is prepared. In addition the OES department members include: representatives from State OES, Field Incident Command Post (ICP) and Department Operation Center (DOC) consisting of Police, Sheriff, Fire, California Department of Corrections, Public Works, Public Health, Social Services and other Special Districts such as all school districts. All Imperial County cities/towns EOC’s (17), Imperial Irrigation District (IID), IV Transit, Volunteer Ham Radio Group, Non Profit groups such as American Red Cross and Federal Military are also members. In the event of an emergency in which the County OES deems outside assistance is needed the OES Coordinator, with approval from CBOS, requests assistance from the State of California Office of Emergency Services, who after reviewing the nature of the emergency, requests assistance from Federal Emergency Management Agency (FEMA). The CGJ also saw that there is a great need of public outreach and awareness in this area of concern. While the (OES) has some extensive programs involving the schools and agencies, with limited staffing it is a hard task to enlighten the masses with information to keep citizens informed as to where to go and what to do in a disaster situation. There is emergency information provided by way of radio, TV, phone services. There is emergency broadcast over radio station KXO. There are also 911 and reverse 911 services available and also a new system is now operational, 211, is a notice to selected areas and communities that will alert them to specific issue of possible safety and pending disasters. Conclusion: The Civil Grand Jury finds that the OES is doing a very good job of being ready for a potential disaster happening in their jurisdiction. They could be even more prepared if additional funding was available to them.
• R05
  It is recommended that if there is a lack of cooperation due to believed HIPAA rules, then the local agency needing important health information should pursue it further and even have subpoenas issued through the court if needed.
• R06
  It is recommended that persons with behavioral health info, and specifically within BH, attend court sessions when there are people with mental health issues there, particularly if there are questions as to the mental condition of such persons. The court may make orders concerning persons under BH care and direct that records be provided as deemed necessary.
• R07
  It is recommended that all of the named agencies and others in this county ensure they are doing all they can to see that the general public is safe from harm in general. Attention should also be paid to persons that may need to be placed or remain in custody, where the jail may not always be the best option. The jury acknowledges that there is not always a better option immediately available.
• R08
  It is recommended that county personnel contact staff at the CDCR diagnostics program and also contact staff at Patton State Hospital. Based on information provided by persons the jury spoke with during the interviews of this inquiry, these may be good models for learning.
• R09
  It is recommended that a larger and/or more secure place for persons with mental health issues that cannot otherwise be released from custody be found or created. As jail personnel correctly stated, jail is not in itself a cure-all, and it should not be.
• R10
  It is recommended that better arrangements should be made to send persons in custody with severe mental issues to places outside the county in the meantime until a larger and/or more secure place can be established locally. Miscellaneous Information: This is a partial list but not complete information provided by the U.S. Department of Health & Human Services as related to HIPAA: Who Must Follow These Laws We call the entities that must follow the HIPAA regulations “covered entities.” Covered entities include:  Health Plans, including health insurance companies, HMOs, company health plans, and certain government programs that pay for health care, such as Medicare and Medicaid.  Most Health Care Providers—those that conduct certain business electronically, such as electronically billing your health insurance—including most doctors, clinics, hospitals, psychologists, chiropractors, nursing homes, pharmacies, and dentists.  Health Care Clearinghouses—entities that process nonstandard health information they receive from another entity into a standard (i.e., standard electronic format or data content), or vice versa. ==EDIT== Examples of business associates include:  Companies that help your doctors get paid for providing health care, including billing companies and companies that process your health care claims  Companies that help administer health plans  People like outside lawyers, accountants, and IT specialists  Companies that store or destroy medical records ==EDIT== Who Is Not Required to Follow These Laws Many organizations that have health information about you do not have to follow these laws. Examples of organizations that do not have to follow the Privacy and Security Rules include:  Life insurers  Employers  Workers compensation carriers  Most schools and school districts  Many state agencies like child protective service agencies  Most law enforcement agencies  Many municipal offices http://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html Patton State Hospital is operated by the Department of State Hospitals located in San Bernardino County. Their web site states the following (in part): The four primary commitment categories of patients treated at DSH-Patton are described below: » Incompetent to Stand Trial (PC 1370) » Mentally Disordered Offenders (Penal Code Section 2962/2972) » Not Guilty by Reason of Insanity (PC 1026) » Conservatees (LPS & Murphy) http://www.dsh.ca.gov/Patton/ Response Required: No response is required from any of the agencies contacted. End of Report