7. Accreditation is a Good Thing for Your Los Angeles County Coroner

Permanent Supportive Housing provides all support services within a campus setting. Century Housing Villages at Cabrillo is a 27 acre community of living quarters for veterans plus other individuals and families within this Long Beach community. Long Beach obtained this unused property previously used by the Navy for this project. Property title was transferred to Long Beach in 1991 with the understanding that part of the property would be transferred to Century Housing for a development to assist the homeless. The property was acquired by Century Housing in 2000 to be developed into a model public-private partnership. Information is available on the web at www.centuryhousing.org. Century Housing describes themselves as a mission-driven lender, financing multi-family housing throughout` California with acquisition, construction, and permanent housing loans. Century is a California-based private, nonprofit lender and developer building affordable housing targeting low and moderate income wage earners. Century Housing has financed more than 25,000 affordable homes throughout California. In 1989 Century Housing was restructured to become a lender to provide a more efficient development process and to maximize leveraging opportunities with public and private lending sources. The portion of the Long Beach property that passed to Century Housing has been developed in stages to provide housing for homeless persons, including emergency shelters, transitional housing, a substance abuse recovery program operated by the U.S. Department of Veterans Affairs, and permanent supportive housing for households with family members who are disabled. Services are provided by 20 public and private health and employment readiness organizations. In 2016 the property housed over 1,000 previously homeless men, women and children, over half of whom are veterans. More information is available for those interested in private/public partnership involving military or government owned property in the County. To increase capacity for homeless housing at Villages at Cabrillo a new multifamily apartment unit was opened February 2018. There is a Metro Long Beach bus stop within the Village to accommodate transportation throughout Long Beach. The following Exhibits 12 and 13 provide information and photos of Villages at Cabrillo that may be of interest to City Mayors and Mangers, within the County, who may be considering establishing homeless programs in their city. 176 2017-2018 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT Exhibit 12 2017-2018 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 177 Exhibit 13 178 2017-2018 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT B. The Grant Making Process A fundamental role of LAHSA is to serve as a “public foundation” for addressing homeless issues in the County. While LAHSA does provide some direct services through its outreach function, it’s primary function is to provide grant funding to community-based organizations that provide the actual services to the homeless population.

The Grant Making process has improved since the passage of Measure H, but smaller community-based organizations still face challenges in qualifying and applying for funding. Request for Statement of Qualifications Process To fulfill its role as a grantor of funding for homeless services, LAHSA has created a two-step process for soliciting community-based organizations to request funding. The first step is the Request for Statement of Qualifications (RFSQ) process, for the purpose of the RFSQ is to require community-based organizations to “pre-qualify” to bid for program funding under Measure H. The pre-qualification process does not apply to service providers who have existing contracts with LAHSA. The idea behind the RFSQ was to separate the threshold review process that was previously contained within the prior procurement processes thereby allowing agencies who are qualified to submit bids without having to repeat having to be qualified for each new procurement. The RFSQ is the tool used by LASHA to evaluate if submitting agency applicants “possess established threshold levels of 1) Financial Stability, 2) Organizational Experience, Administrative and Fiscal Capacity, 3) Organizational Capacity, and 4) Organizational Experience providing Supportive Services / Housing to homeless persons.” Once qualified, an applicant is recertified on an annual basis, but does not go through the RFSQ process again. Service providers were generally positive about the new RFSQ process, although most of those interviewed had previously done work with LAHSA and did not have to go through the process. Service providers liked the ability to avoid being disqualified from a project based on procedural issues that could be easily rectified, but would then require them to wait an entire year to re-bid on the project. Agencies were also complementary on the assistance offered to them in working through pre-qualification issues. The RFSQ also has the benefit of streamlining the Request for Proposal process by allowing staff to focus solely on the programmatic request and not have to evaluate or re-evaluate an organization’s administrative qualifications to perform the contract. Request for Proposal Process In order to fund the eight Initiatives designated by the County for implementation, LAHSA undergoes a Request for Proposal (RFP) process. The RFP’s are developed by individual strategy and request proposals for community-based organizations to provide services within SPAs. The RFPs define the nature of the services to be provided and the amount of funding dedicated to provide those services within the SPA. The entire process can take six months or longer depending on the scope and complexity of the funding strategy. For example, for the Capital Costs for Crisis and Bridge Housing RFP (Initiative 8), the RFP was officially released in December of 2017 with proposals due in March 2018, approvals in April 2018 with a contract start date of July 2018. Proposers were provided opportunities to attend a proposer’s conference where the RFP and scope of work are reviewed in detail and go through a question and answer period to allow for further clarifications, if necessary. 2017-2018 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 179 Service providers were generally positive about the RFP process. The primary concern expressed by multiple service providers was that the contracting process, following the award, often took longer than anticipated which made efforts to staff-up or acquire new space to meet the new demands of the contract risky. At least two service providers indicated that they were uncomfortable making financial commitments in preparation for contract implementation until they had a signed agreement. Another concern raised by service providers was that despite an improved RFSQ and RFP process, it can still be difficult for smaller service providers to qualify and bid for funding for projects. This is not an uncommon problem for grant making organizations and LAHSA has taken the following steps to try and make the process more viable for small to medium-sized agencies: • LAHSA provides support to agencies in the preparation for the RFSQ process such as working with agencies to identify different means to demonstrate fiscal stability. • LAHSA works with agencies to provide training to new staff and opportunities for some capacity building funding are available as well. • LAHSA agreed to lower its administrative cost ratio to 8% to allow agencies to raise their administrative ratio to 12%. This is a significant help to smaller and medium sized agencies where they do not necessarily have large economies of scale to help keep administrative costs at or below the traditional 10%. • LAHSA is working to offer three-year funding commitments, instead of the traditional one year, which give organizations a longer planning and implementation horizon and a greater level of confidence that investments in staffing, equipment and space are warranted. The procurement process, however, is still time consuming and requires a level of administrative and fiscal sophistication that some smaller nonprofits are not capable of meeting. In public grant making there is a delicate balance between safeguarding public funds by ensuring that organizations have the administrative, financial and programmatic capacity to carry out the desired scope of work and the desire to fund agencies deeply embedded within the community which may have a unique ability to reach the target population. C. Performance Monitoring and Support of Community-Based Providers Since the passage of Measure H, LAHSA has restructured its organization and developed new capacity building initiatives to improve its ability to monitor grantee compliance and improve the ability of their grantees to provide effective services.

LAHSA has developed a comprehensive fiscal and programmatic monitoring program of its service providers. As a pass-through funding entity, a critical function of LAHSA is to provide oversight and administration of contracts. LAHSA’s Fiscal Department is responsible for ensuring that its grantees comply with contractual requirements, including all federal, state and local regulations. The Compliance and Monitoring group performs routine site visits to grantee service providers to ensure that the fiscal and programmatic obligations of Measure H are being fulfilled. Annually, each grantee service provider is appraised using a Fiscal and Programmatic Risk Assessment Matrix to provide an objective evaluation of risk. Grantee service providers that are determined to be “high risk” are subject to annual site visits and monitoring. “Low” and 180 2017-2018 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT “Medium” risk providers are subject to bi-annual visits at LAHSA’s discretion. The following is an overview of the two types of Risk Assessments performed by the Compliance and Monitoring Group: • Fiscal Risk Assessment – The fiscal risk assessment involves an analysis of seven key risk factors. An agency’s performance is ranked using these factors which include: date of the last monitoring visit, timely submission of LAHSA reports, agency staffing capacity, quality and completeness of submitted reports, records retention practices, financial stability analysis and potentially other factors to be determined by the auditor on a case by case basis. • Programmatic Risk Assessment – The programmatic risk assessment is based upon an analysis of seven risk factors. Similar to the fiscal risk assessment, the risk factors are evaluated and the grantees risk level is ranked using the following categories: date of the last monitoring visit, documentation management standards, achievement of performance targets, staffing capacity to ensure programs are administered effectively, facility benchmarks and the existence of grievances or other problems that may have arisen over the course of the contract. The LAHSA agreements with service providers set forth the standards for determining compliance. All compliance audits are scheduled at least thirty days in advance. A list of documents to be reviewed is provided and an internal control questionnaire is to be filled out by the agency. Sample size standards have been set and the list of requested fiscal transactions to be reviewed is sent to the agency prior to the site visit. The fiscal audits are conducted in compliance with Office of Management and Budget A-110, A-122, A-133 and Generally Accepted Accounting Principles. At the conclusion of an audit, a preliminary report is prepared and provided to the agency for review in an exit conference. LAHSA staff then prepare a final Monitoring Report specifying the nature and scope of the review as well as any findings, recommendations and/or corrective actions to be taken by the agency. The grantee agency has thirty days from the final monitoring letter to respond to the report. If corrective actions are required, an agency must reply with its proposed corrective actions which are to be reviewed and responded to by the Monitoring and Compliance officer of LAHSA. Based on the nature of the corrective actions, a subsequent site visit may be scheduled to review the agency’s progress in achieving compliance. All previous findings are reviewed in the subsequent audit.

LAHSA has recently restructured its performance and contract management function and, while it is too early to provide a comprehensive assessment, some minor improvements may be warranted. In addition to formal risk assessments, each grantee service provider is assigned a representative from LAHSA’s Finance Department and the Performance Department. The responsibility of the Finance Department is to respond to questions related to invoicing and budgets. The Performance Department performs the day-to-day contract management function. The LAHSA assigned Performance Manager typically meets with a grantee service provider monthly. During those meetings, the manager reviews the grantee agency’s progress towards the achievement of key outcomes and helps determine whether there are any administrative and/or programmatic issues that need to be addressed. During the course of the year, if a Performance Manager determines that a service provider is having difficulty in any area of programmatic compliance, 2017-2018 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 181 they may take steps to implement corrective action on the part of the agency to avoid a potential finding in the annual compliance review. Overall, the structure of evaluating compliance is well designed. In interviews with service providers, an issue was raised by multiple providers. These providers were, at times, confused as to the role of the Performance Manager, particularly as it relates to the administration of the program budget. Where budget modifications are requested, grantee agencies submit those requests to the Finance Department and not the Performance Manager. It is important for the service providers to have a single point of contact for contract management. More importantly, the function of evaluating a budget modification should be a “program” issue in that the modification should be evaluated based on the impact the modification will have on the ability of the agency to provide efficient and effective services. This should, at least initially, be the role of the Performance Manager who is more familiar with the grantee agency’s programs and can better assess the need for a budget modification.

Some service providers are challenged to find qualified staff to implement their programs. The increase in program funding throughout the County for homeless services has created a significant demand on staff with experience in addressing issues for the homeless. One LAHSA staff person estimated that approximately 1,200 additional positions County-wide will be required within the homeless service sector to meet funding and program expectations. This demand has negatively impacted service providers who are struggling to address staffing needs and may not have the budget to fund salaries at the level of their public sector counterparts. Multiple service providers report losing experienced staff to LAHSA, County Department of Health Services, County Department of Public Social Services and other public agencies. Smaller- and medium-sized agencies even report losing staff to larger agencies. LAHSA has taken steps to assist agencies in addressing their staffing needs by holding job fairs where service providers can attend. The results of these job fairs, as reported by the service providers, has been mixed. The feedback suggests that while there has been some ability to recruit entry-level staff at these job fairs, identifying more experienced staff with the ability to have an immediate impact has been difficult.

LAHSA’s implementation of a County-wide training academy has the ability to impact the effectiveness and productivity of its service providers. The expansion of staff by service providers comes with the additional burden of hiring and training new staff. While none of the service providers indicated that they will be unable to meet new program funding and demands, the challenge to hire, train and retain quality staff is a significant concern moving forward. In order to help grantee service providers, in 2017 LAHSA entered into an agreement with Homeless Health Care Los Angeles to develop and implement a centralized training academy for LAHSA’s service providers. The objective of the trainings is to provide staff development opportunities for grantee service providers focused on three categories of staff: entry-level staff, mid-level direct service staff and supervisory staff. Implementation of the Training Academy began at the end of 2017 and should be fully operational by the middle of 2018. The Training Academy will offer three different types of formal training. Each curriculum offered includes 35 hours of training and participating staff receive a Certificate of Completion 182 2017-2018 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT upon graduation. The curricula focus is on implementing evidence-based practices for addressing the needs of the homeless population including training on practices such as trauma, informed care, cultural humility, housing first, harm reduction, motivational interviewing and critical time intervention. The curricula also addresses different strategies for working with diverse populations including the chronically homeless, families, transitional age youth, LGBTQ, persons with disabilities, domestic violence survivors, human trafficking survivors, the aging and elderly, incarceration and re-entry, and veterans. The following is a brief overview of the three curricula being offered in the next calendar year. Each of the training programs will be held multiple times and are expected to be provided regionally to assure that representatives from each SPA will be able to attend: • Curriculum I: Care Coordination and System Navigation – This training is intended for entry-level staff and staff with limited professional experience in working with the homeless population. This training will occur over a period of one-week with seven-hour classes each day. The focus of the classes will be on making staff familiar with the most current evidence-based practices in the field and will include topics on: the landscape of homelessness, evidence-based practices, boundaries and ethics, housing programs and the core functions of case management. • Curriculum II: Applied Care Coordination and Systems Navigation – This curriculum will be designed for direct service staff who have previous experience in working with the homeless population. This training will be less focused on lecture-time and more interactive with scenario-based training and exercises that can be done in the field between training sessions. Topics will be more focused on detailed evidence-based practices. Examples of topics may include HIPAA requirements, addressing physical and mental health issues including substance abuse and overdose prevention as well as more program focused knowledge related to housing and retention and case management. • Curriculum III: Supervisory Training for Homeless Service Providers – This course will be focused on staff transitioning into to supervisorial roles within their organizations. The course will be divided into three sections: leading people, managing work, and developing self and others. The objective is to prepare the trainees to assume new roles within their organizations managing others. All of the foregoing trainings will be provided by Homeless Health Care Los Angeles. In addition to the Training Academy, LAHSA will occasionally provide their own training focused on particular policies or practices developed by LAHSA. While the service providers interviewed were mostly positive about the Training Academy, a few interviewees expressed concern that the practical approaches advocated in the Training Academy may not represent the same approach taken by all service providers. Some of the larger service providers indicated that they already provide many of the types of training being done by the Training Academy and may not be as interested in sending their staff to programs that require a 35 hour commitment. Some suggested that they would be more likely to send staff to individual training sessions dedicated to topics relevant to their existing services if those were made available instead of extended formal trainings. Despite the foregoing concerns, the implementation of the Training Academy has the ability to have a positive, long-term impact on the homeless service sector within the County. The ability to offer service providers a “boot camp” for staff not previously experienced in the homeless 2017-2018 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 183 service sector will assist agencies who are struggling to find experienced staff and do not have the resources to provide their own training. Moreover, the more in-depth classes have the potential to provide a more consistent and evidence-based approach to providing certain types of services within the County.

LAHSA’s capacity building efforts are designed to be tailored based on the needs of individual service providers. In addition to providing training, LAHSA is committed to further assist service providers by offering a capacity building program. Capacity building is the process of strengthening the ability of service providers to perform their key administrative and programmatic functions. Measure H assigned funding to LAHSA to institute a capacity building program and LAHSA has leveraged that funding by partnering with United Way to assist in the development and implementation. In November of 2017, LAHSA released a Request for Bids (RFB) to request capacity building consulting services from the pool of consultants in the following categories: • Operational Management -- which includes financial management, IT services, HR, contract management, facilities management, policies and procedures, internal controls, risk management, communications and fundraising. • Leadership – including board composition & governance, organizational structure, succession planning, strategic planning and community engagement. • Program Administration – including data reporting, program evaluation and collaboration with partners. The goal of the RFB is to develop a pool of consultants that will be used on an as-needed basis to assist service providers. The basic structure of the capacity building program is two-fold. The first step in the program provides agencies up to $8,000 to conduct a needs assessment. The needs assessment is then used to evaluate what type of assistance the agency could use to improve the efficiency and/or effectiveness in providing homeless services. Based on the assessment, the grantee agencies may request capacity building assistance of up to $40,000 per project from LAHSA. For FY 2017/2018, LAHSA has allocated $2.8 million in capacity building funding with the hope of serving at least 50 service providers. Future budgets for capacity building will be $3 million annually.

Local communities need to recognize the urgent need to build new permanent supportive housing rather than burdening surrounding communities with their homeless population. The Long Beach Villages at Cabrillo is an impressive example of permanent supportive housing in a large multi support campus that in 2016 was housing over 1000 homeless families and individuals. The campus offers a complete range of homeless services provided by many nonprofit agencies that work on a collaborative basis. The campus includes versions of permanent supportive housing for specialized needs. The facilities include innovative incentives to help the former homeless to socialize in a normal community setting. For those businesses and homeowners’ associations throughout the County interested in learning more about how their city, businesses, and community associations can improve their community “quality of life” may want to request a tour of the Villages at Cabrillo facility to learn about 184 2017-2018 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT positive steps that help the homeless recover while also preventing the blight of homeless encampments in their neighborhoods. Exhibit 14 shows a photo sampling of the results of a positive community approach contrasted with what happens when the homeless situation is ignored. There is a new “EVERYONE IN” coalition to support the needs of the homeless in their own community. For more information, those interested can refer to LAHSA web site and look up various articles to learn how others are seeking solutions to homelessness issues in their own communities. Below is a summary of an article about a rally at Echo Park on March 9, 2018. “A coalition termed “EVERYONE IN” for homeless support was held at Echo Park on March 9, 2018. It was sponsored by the United Way of Greater Los Angeles and LAHSA. In attendance were many homeless service providers from all areas of LA County as well as leaders of various cities, business and community associations. Also attending were interested individual residents and businesses to learn how each could participate in providing assistance to homeless families and individuals in their pathway out of their homeless status. They learned what assistance was needed to reach supportive permanent housing, which also improves the quality of life for the residents and businesses. Financial support is being expanded dramatically through the Measure H program provided by the County. The goal of EVERYONE IN is to eliminate homelessness in the County within 10 years.” Support Services are being expanded dramatically through the Measure H program which has a goal to eliminate homelessness in the County within the next 10 years. Cities have been offered funds from the County to study the homeless problem in their own communities to determine how they can participate in the solution. Information on how local community associations of residents and businesses can participate in this “EVERYONE IN” coalition can be obtained by checking the LAHSA’s website at http//www.lahsa.org. 2017-2018 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 185