2013-2014 Santa Clara County Civil Grand Jury Report Probate Conservatorship:

Conclusions 11

• CL1 Page 13
  By not assigning account/case numbers immediately upon receipt of referrals, PAGC does not follow Procedure 709.1 updated January 21, 2014, “Screening of Referrals,” of the PAGC’s Policies and Procedures Manual.
• CL2 Page 13
  Acceptance of referrals to PAGC for evaluation for conservatorship, which removes a person’s civil liberties, is decided by one person with the concurrence of upper management.
• CL3 Page 13
  Poor communication and incomplete information sharing from APS to PAGC in non-FAST cases result in inefficiencies and duplication of work.
• CL4 Page 14
  In non-FAST cases, PAGC does not always inform APS about the status of the referral after acceptance of the referral for conservatorship investigation.
• CL5 Page 14
  The Capacity Declaration, a mandatory Judicial Council of California form, is not always completed correctly by the attending physician, resulting in the delay of the conservatorship process.
• CL6 Page 14
  As of March 1, 2014, there are no formalized written training programs for new and current PAGC staff.
• CL7 Page 14
  The current PAGC Policies and Procedures Manual does not reflect current job titles and responsibilities.
• CL8 Page 15
  Background checks of prospective APS personnel, prior to the time of hire into the department, do not include Live Scan screening.
• CL9 Page 15
  Background checks of prospective PAGC personnel, prior to the time of hire into the department, do not include Live Scan screening.
• CL10 Page 15
  PAGC case management statistics are often incomplete, limited in scope, and inaccurate, leading to SSA management’s inability to make effective management and budget decisions.
• CL11 Page 11
  The Grand Jury investigated Adult Protective Services (APS) and the Office of the Public Administrator/Guardian/Conservator (PAGC) from the point of conservatorship intake referral to PAGC to completion of the conservatorship process in Probate Court. The Grand Jury conducted interviews and reviewed documents. Over the past several years in spite of ongoing scrutiny from various sources including an internal audit manager, Santa Clara County Board of Supervisors, and the 2012-2013 Grand Jury, many issues remain unresolved within PAGC. The Grand Jury learned that PAGC has an understanding of several existing problems, and PAGC has offered reasonable solutions for them, but is failing to meet their own deadlines. PAGC does not consistently follow the procedure as outlined in their Policies and Procedures 19 Ibid, 21. 20 Office of the Public Administrator Guardian/Conservator 2013 Annual Report, Social Services Agency Department of Aging and Adult Services, 4. 11 Manual that requires the Probate Intake Unit to record all referrals (APS and community) by giving each an account/case number. This makes the referral nearly impossible to track prior to acceptance because there is no account/case number assigned. This is an area where a proposal for improvement--a new intake screen in the Panoramic Case Management System (PANO) dedicated to entering and tracking incoming referrals--is in the process of being implemented. The decision to accept or reject each new referral presently is at the discretion of one employee; a three-person panel will replace this process. The purpose of the panel is to review the merits of each incoming referral, determine whether the client will be accepted by PAGC for continuing investigation, and create an open forum for the decision-making process that does not currently exist. The Grand Jury learned that this proposal for improvement has recently been initiated. Two-way communication between APS and PAGC needs to be improved. Both entities are under the auspices of the Social Services Agency’s Department of Aging and Adult Services. This department was formed in 1997 in order to facilitate interaction among staff of various units serving seniors and thereby improving the flow of services for these clients. The Grand Jury found that APS and PAGC work cooperatively on urgent cases involving financial risk to the elder (called the FAST team). However, in non-FAST cases, they sometimes provide less than complete information to each other that could make their work more efficient and effective as they serve this very vulnerable and isolated population. No court hearing date can ever be set without a complete Capacity Declaration. This form, filled out by the client's physician, is used to justify the reasons for seeking conservatorship (lack of physical/mental capacity for managing the client's own affairs). It is the responsibility of the PAGC Probate Intake Unit to ensure this form is complete and accurate. However, the Grand Jury identified it as a document that is not consistently filled out properly or is incomplete and must be returned to the physician causing delays in the conservatorship process. Reviewing the form for accuracy and completeness, prior to sending it to County Counsel, would greatly benefit the client by reducing the time to conservatorship. The 2012-2013 Grand Jury identified the lack of PAGC training, including the use of PANO, as an issue. It is an ongoing problem. There is a high staff turnover rate within the Probate Intake Unit, and as of March 1, 2014, there was no formalized training plan in place to train replacement staff. Additionally, the Policies and Procedures Manual of PAGC still has incorrect information and therefore is a questionable training and reference tool. Also of concern to the Grand Jury is the way new hires to APS and PAGC are screened by the Employee Services Agency (Human Resources). The employees of APS and PAGC have access to the homes and property of frail and possibly cognitively impaired individuals, exposing these clients to potential outside abuse. The Grand Jury concludes that all new employees of both departments should receive a higher level of screening, including Live Scan fingerprinting. Very few statistics are routinely kept and reported by PAGC's Probate Intake Unit. In response to the Grand Jury’s request, PAGC had difficulty, but did provide basic statistics (number and sources of referrals, acceptance and rejection rates) for their Probate Intake 12 Unit. The Grand Jury has noted discrepancies in the number of referrals provided to them by PAGC compared to the number of referrals PAGC referenced in the Office of the PAGC 2013 Annual Report. There is a concern that without correct client counts, well-informed decisions regarding staffing and funding cannot be reasonably made. The Grand Jury concludes that there are many hardworking, dedicated employees in PAGC who put forth their best efforts on behalf of their clients. However, they are working at a distinct disadvantage because of the operational deficiencies described in this report. Some of the concerns noted in this report are currently being addressed as a result of the Grand Jury’s investigations. The Grand Jury strongly suggests that the County continue to focus on improving the conservatorship process. Thus, for some of the county's most vulnerable citizens, the current path to conservatorship may eventually become streamlined to maximum efficiency. FINDINGS AND RECOMMENDATIONS: FINDING 1 By not assigning account/case numbers immediately upon receipt of referrals, PAGC does not follow Procedure 709.1 updated January 21, 2014, “Screening of Referrals,” of the PAGC’s Policies and Procedures Manual. RECOMMENDATION 1 The County should require PAGC to follow its new Procedure 709.2 dated May 20, 2014, “Probate Unit Referral Process,” in PAGC’s Policies and Procedures Manual. FINDING 2 Acceptance of referrals to PAGC for evaluation for conservatorship, which removes a person’s civil liberties, is decided by one person with the concurrence of upper management. RECOMMENDATION 2 The County should implement the proposed pilot project of a three-person panel for evaluation of conservatorship referrals in accordance with the new Procedure 709.2 dated May 20, 2014. FINDING 3 Poor communication and incomplete information sharing from APS to PAGC in non-FAST cases result in inefficiencies and duplication of work. RECOMMENDATION 3 The County should require APS and the PAGC to develop efficient and effective methods of communication and information sharing. 13 FINDING 4 In non-FAST cases, PAGC does not always inform APS about the status of the referral after acceptance of the referral for conservatorship investigation. RECOMMENDATION 4 The County should require PAGC to inform APS of any pertinent changes in the client’s status and when conservatorship is granted. FINDING 5 The Capacity Declaration, a mandatory Judicial Council of California form, is not always completed correctly by the attending physician, resulting in the delay of the conservatorship process. RECOMMENDATION 5 The County should devise a process to improve identification of errors and omissions on the Capacity Declaration prior to the acceptance of it. FINDING 6 As of March 1, 2014, there are no formalized written training programs for new and current PAGC staff. RECOMMENDATION 6a The County should develop and implement a formal written case management training program for new and current PAGC staff. RECOMMENDATION 6b The County should develop and implement a formal written training program for the use of PANO for new and current PAGC staff. FINDING 7 The current PAGC Policies and Procedures Manual does not reflect current job titles and responsibilities. RECOMMENDATION 7 The County should require PAGC to correct its Policies and Procedures Manual to reflect current job titles and responsibilities. 14 FINDING 8 Background checks of prospective APS personnel, prior to the time of hire into the department, do not include Live Scan screening. RECOMMENDATION 8 The County should require all prospective personnel of APS to receive Live Scan screening prior to the time of hire into the department. FINDING 9 Background checks of prospective PAGC personnel, prior to the time of hire into the department, do not include Live Scan screening. RECOMMENDATION 9 The County should require all prospective personnel of PAGC to receive Live Scan screening prior to the time of hire into the department. FINDING 10 PAGC case management statistics are often incomplete, limited in scope, and inaccurate, leading to SSA management’s inability to make effective management and budget decisions. RECOMMENDATION 10 The County should require PAGC to research, identify, and report complete, comprehensive, and accurate case management statistics. 15 Appendix A 16 Appendix B 17 18 19 20 21 Appendix C Documents Reviewed C.1 Web Searches Prior Santa Clara County Grand Jury report of PAGC from 2012-2013 Grand Jury reports from other counties dealing with concerns about PAGC California Advocates for Nursing Home Reform (CANHR) probate conservatorships in CA Live Scan fingerprint service Official website for the county government of Santa Clara County for the departments of APS, PAGC, and County Counsel Hiring flow sheet for Santa Clara County United States Department of Census Bureau – January 6, 2014 C.2 Manuals and Codes APS Procedures Manual from the state of California (CA) – no publication date Adult Protective Services Handbook of Santa Clara County – no publication date Financial Abuse Specialist Team Practice Guide, Santa Clara County – December 2010 Policies and Procedures Manual of the PAGC – 2013-2014 County of Santa Clara Superior Court of CA Probate Division Procedures Manual – June 2012 Superior Court Investigator Training Manual from 2006 prepared by CA Association of Superior Court Investigators County of Santa Clara Human Resources Practices Manual – updated January 14, 2009 California Welfare & Institutions Code Sections (W&I) related to the process of conservatorship California Probate Code related to probate conservatorship C.3 Statistics APS and County Services Block Grant Monthly Statistical Report SOC 242 from October 2013 Internal Audit Report of PAGC, Santa Clara County – August 5, 2010, with follow up audit done August 28, 2013 Office of the PAGC 2012 Annual Report to Children, Seniors, and Families Committee – November 21, 2012 Office of the PAGC 2013 Annual Report to Children, Seniors, and Families Committee 22 Vital Signs Report, A Review of Key Performance Indicators for April – June 2013 Vital Signs Report, A Review of Key Performance Indicators for July – September 2013 Vital Signs Report, A Review of Key Performance Indicators for October – December 2013 Probate Intake Tracking Log with the names redacted for 2013 – received by the Grand Jury January 2014 Probate Referrals received for the calendar years 2011-2013 provided at the request of the Grand Jury – received by the Grand Jury January 2014 Temporary and Permanent Probate Conservatorship Petitions filed from 2011- 2013 provided at the request of the Grand Jury – received by the Grand Jury April 2014 C.4 Forms Forms used in the conservatorship process Capacity Declaration GC335 – January 1, 2004 Request to Establish Probate Conservatorship SC-1 – no date Probate/LPS Referral Disposition Request – no date Confidential Supplemental Form (Probate Conservatorship) GC312 – January 1, 2001 Conservatorship Evaluation Report /Recommendation – no date Referral for Court Investigator – Conservatorship – January 2008 Other forms and documents APS organizational work chart – August 7, 2012 PAGC organizational work charts – August 7, 2012 and January 23, 2014 PAGC training update letter – January 23, 2014 Graphics for conservatorship process – no date ESA updated January 14, 2009 23 Appendix D.1 24 Appendix D.2 25

No Responses Found 1

Government entities assigned to respond to this report. No response documents have been linked in our database.