El Dorado County Grand Jury • 2001-2002

Mental Health Committee El Dorado County Department of Mental Health Citizen Complaint #01/02-c-018

Published: April 24, 2001 15 pages
View Original PDF

Findings and Recommendations 82 findings

F1
The DMH is organized to deliver services through five program divisions and two administrative divisions. The program divisions are Adult Day Treatment, Adult Services, Children's Services, Mental Health Clinical Services, and the Psychiatric Health Facility (PHF) in Placerville, referred to as the PUFF unit. There are two administrative divisions: 1) Central Administration, and 2) Administration of State Hospital and Institute for Mental Disease (IMD) beds.
No recommendations for this finding
F2
DMH has approximately 99 employees in the County. The department is housed in four separate locations: three in Placerville and one in South Lake Tahoe.
No recommendations for this finding
F3
The position of Deputy Director of DMH was authorized and budgeted in 2000 and filled in January 2001. The Deputy Director has no line authority in the organizational structure of the Department and does not conduct performance evaluations. Program manager’s report directly to the Director. The Deputy Director functions as a coordinator. His job description is non-specific. It appears that the Deputy Director's primary responsibilities are to: · Promote the use of Inter Trac for electronic records; · Improve coordination and communication between the administrative staff in Placerville and the management staff in the Clinic; · Work on the budget and fiscal policy issues; and · Implement improvements in mental health services at Juvenile Hall in Placerville and the anticipated South Lake Tahoe Juvenile Hall.
Related Recommendations (2)
R1
The Deputy Director should have line-authority over program managers in DMH. This should be included in the job description for the position.
R2
The DMH Director and the Board should authorize a new position, Assistant Director, for DMH. The title of Program Manager at the Clinic should be eliminated, and the Assistant Director should be given full authority and responsibility for Clinic programs and facility operations in the South Lake Tahoe area of the County.
F4
The DMH budget for 2001/2002 is approximately $9.75 million, which includes $345,581.00 from the County's General Fund. This General Fund contribution is at the same level of support the Department has received from the County's General Fund (Department 15) during the previous two fiscal years.
No recommendations for this finding
F5
The General Fund contribution of $345,581.00 to the Department provides a $30,000.00 match required by the State of California (State) for mental health services and $315,581.00, primarily for approximately 10 children who require high levels of mental health services in foster care and psychiatric facilities where costs range from $3,000.00 to $12,000.00 per month per child.
No recommendations for this finding
F6
The $315,581.00 contribution is referred to as an "overmatch" in the 2001/2002 Budget/Workplan (P. 237) because the County is not required by the State to provide this additional financial support for the County's mental health programs.
Related Recommendations (1)
R5
The Board should direct the CAO to eliminate the use of the word "overmatch" from budget documents because it implies that the County has no responsibility to provide services to the mentally ill in the County if those services must be provided with discretionary revenues from the General Fund (Department 15).
F7
According to the 2001/2002 Budget/Workplan (P. 238), which was approved by the Board of Supervisors (Board) in September 2001, “beginning in Fiscal Year (FY) 2002/2003 the County will reduce its overmatch by 50%” until in FY 2003/2004 “the County match will include only the required $30,000.00.”
Related Recommendations (2)
R4
The Board has been informed of critical unmet needs in services and facilities for the severely and chronically mentally ill at South Lake Tahoe and the Western Slope of the County. If funding for mental health services is to be a low priority of the Board, as evidenced by the planned elimination of discretionary General Fund support for DMH, the Board should publicly acknowledge that policy in open discussion and written policy directives. It should not be buried in a few small paragraphs in a several hundred-page Budget/Workplan.
R6
The Board should prepare an agenda to introduce a full discussion of the County's responsibility for mental health services to all clients on an equitable and adequate basis.
F8
The Interim Chief Administrative Officer (ICAO) recommended the elimination of the "overmatch" over a two year period based on estimated increases in Sales Tax Realignment revenue for the Department. Sales tax growth projections are calculated by the County's Auditor Controller.
No recommendations for this finding
F9
The ICAO's recommendation to eliminate the "overmatch" and the Board's approval of that recommendation by adopting the 2001/2002 Budget/Workplan, also make the assumption that the County's claims for reimbursement of state-mandated services will be paid according to the requirements of Senate Bill 90 (SB90). The Department received these reimbursement funds for the first time during FY 2001/2002 for mental health related SB90 mandated services. Most of these reimbursement funds were used to relocate the Adult Day Program in Placerville to a new facility on Mallard Lane, a move that was long overdue.
No recommendations for this finding
F10
The State of California and the "claiming counties" have not resolved all of the disputes arising from the interpretation of SB90's requirements and State-mandated services. The State could discontinue reimbursing claims at any time, especially given the State's current budget crisis.
No recommendations for this finding
F11
The Board's allocation of discretionary revenues from the General Fund is a clear indication to the public of the Board's priorities for projects and programs. In adopting the 2001/2002 Budget/Workplan, the Board neither agendized nor discussed a policy decision to eliminate discretionary General Fund support for mental health programs in the County. Nevertheless, except for the County's mandated "match" of $30,000.00, such an elimination will be accomplished no later than FY 2003/2004.
Related Recommendations (2)
R4
The Board has been informed of critical unmet needs in services and facilities for the severely and chronically mentally ill at South Lake Tahoe and the Western Slope of the County. If funding for mental health services is to be a low priority of the Board, as evidenced by the planned elimination of discretionary General Fund support for DMH, the Board should publicly acknowledge that policy in open discussion and written policy directives. It should not be buried in a few small paragraphs in a several hundred-page Budget/Workplan.
R6
The Board should prepare an agenda to introduce a full discussion of the County's responsibility for mental health services to all clients on an equitable and adequate basis.
F12
DMH uses Inter Trac, a computer software tracking system. Inter Trac software is used by every county mental health department in the State. It is primarily a management tool, utilized to record contact information, collect and transmit data, and compile statistical reports. The County obtained 40 licenses with the original software vendor agreement several years ago and pays $50.00 per license per year.
No recommendations for this finding
F13
Inter Trac is currently being used by 72 licensed therapists in DMH, including the PHF unit. Administrative and management personnel can review the number and quality of therapist/client contacts on a regular basis to improve service and to identify discrepancies in the delivery of services. The use of Inter Trac has improved the efficiency of case management. It makes transmittal of records and coordination of services for clients transferring between counties or from the Clinic to Placerville (and vice versa) much easier and faster. This is particularly important in providing crisis intervention services for clients in South Lake Tahoe who are transported to the PHF unit in Placerville. South Lake Tahoe Mental Health Clinic (Clinic)
No recommendations for this finding
F14
The Clinic has been allocated 36 positions out of the 99 total authorized positions in DMH.
No recommendations for this finding
F15
The Clinic, under the South Lake Tahoe Mental Health Program Manager, is organized in seven units: one administrative services unit, one accounting services unit, and five program delivery units,
No recommendations for this finding
F16
The Clinic's Administrative Services unit has three authorized positions: Mental Health Program Manager, Administrative Assistant, and Medical Records Technician.
No recommendations for this finding
F17
The Clinic's Accounting Services unit has two authorized positions for a Senior Fiscal Assistant and a Fiscal Assistant II.
No recommendations for this finding
F18
The Clinic's Medication Services unit consists of two Consulting Psychiatrists, one specializing in adult services and the other in children's services.
No recommendations for this finding
F19
The Clinic program for Adult Emergency (Crisis Services) and Adult Mental Health Services is managed by a Mental Health Program Coordinator II and staffed by two Mental Health Clinicians (one position is vacant) and a Psychiatric Case Manager. Two interns assist this unit.
No recommendations for this finding
F20
Adult and Emergency Services is responsible for providing: · Psychiatric emergency services, 24/7, for all client emergencies, including children, and new emergency calls; · Mental health services, assessment, and counseling for adults; · Case management services to assist clients with obtaining other services as needed; · Medication services for clients; · Coordination of services in liaison with 10 other agencies in the community; · Recruitment, supervision, and training of extra-help staff; and · Cardiopulmonary resuscitation (CPR) and first aid training for staff.
No recommendations for this finding
F21
As of December 2001, Adult and Emergency Services provided services to 150 clients on a regular basis. In addition to providing services to regular clients, Adult and Emergency Services staff must respond quickly to mental health crisis calls. For example, the unit had 142 crises and triage assessments in September 2001 and 120 crises and triage assessments in October 2001.
No recommendations for this finding
F22
The Adult and Emergency Services staff handle crisis line calls on weekdays during regular business hours between 8 a.m. and 5 p.m.. Contract employees handle after hour’s calls between 5 p.m. and 8 a.m. weekdays and on a 24-hour basis on all weekends and holidays.
No recommendations for this finding
F23
After regular business hours, crisis calls are routed through an answering service, where information is collected and forwarded by pager to one contract employee who has been scheduled as the crisis worker for that shift. That crisis worker must then call the answering service back, and then call the person reporting the emergency. Each of these steps requires time and creates delays in the communication process.
Related Recommendations (1)
R10
DMH should improve the crisis-line for Adult and Emergency Services by: · Eliminating the answering service and pager referral system and instituting a system similar to the 911 emergency call system with operators trained in crisis services; and · Providing funds sufficient for trained contract employees to have enough back up to respond to more than one emergency call at a time.
F24
Because of the response time, the mental condition of callers experiencing mental health crises and/or threatening suicide is aggravated by delays inherent in the procedure described in the preceding Finding.
Related Recommendations (1)
R10
DMH should improve the crisis-line for Adult and Emergency Services by: · Eliminating the answering service and pager referral system and instituting a system similar to the 911 emergency call system with operators trained in crisis services; and · Providing funds sufficient for trained contract employees to have enough back up to respond to more than one emergency call at a time.
F25
Typical response time ranges from five to 10 minutes when the after-hours crisis worker responds by telephone to the pager. This type of crisis line response procedure is not adequate, particularly in comparison to the immediate response to 911 calls by trained dispatchers.
Related Recommendations (1)
R10
DMH should improve the crisis-line for Adult and Emergency Services by: · Eliminating the answering service and pager referral system and instituting a system similar to the 911 emergency call system with operators trained in crisis services; and · Providing funds sufficient for trained contract employees to have enough back up to respond to more than one emergency call at a time.
F26
There is an extremely high turnover in crisis workers employed as contract employees. Training is ongoing because of the nature of the work. Crisis workers must have Bachelor of Arts degrees in mental health or a related field. Work experience is not required.
No recommendations for this finding
F27
Contract employees are paid on a standby basis at a rate of $1.20 per hour to carry a pager. They are paid $16.49 per hour if they have to respond to a call. Their time starts at the time they respond to the pager. This payment system is not adequate to recruit and to retain trained contract employees for crisis call responses.
Related Recommendations (1)
R11
DMH should make it a budget priority to provide a pay scale for crisis workers after hours so that the Clinic can retain trained crisis workers.
F28
Prior to 1992, the Adult and Emergency Services unit operated a three-shift system with a professional crisis team of two employees on duty on all shifts. Funding cuts resulting from establishment of the State's Education Revenue Augmentation Fund (ERAF) eliminated the professionally staffed shift system.
No recommendations for this finding
F29
The elimination of the three-shift schedule was a budgetary decision. The original procedure was very effective because it significantly reduced response time for a client in crisis.
No recommendations for this finding
F30
The Adult and Emergency Services unit must rely on the rest of the Clinic staff in other units as back up for crisis intervention. This means that the Clinic staff does crisis work at night and on weekends, in addition to providing mental health services to their regular clients during normal business hours.
Related Recommendations (1)
R10
DMH should improve the crisis-line for Adult and Emergency Services by: · Eliminating the answering service and pager referral system and instituting a system similar to the 911 emergency call system with operators trained in crisis services; and · Providing funds sufficient for trained contract employees to have enough back up to respond to more than one emergency call at a time.
F31
The requirement for immediate response in crisis situations makes it imperative that crisis workers live in the South Lake Tahoe area. Salaries for crisis workers are inadequate because of the cost of living in South Lake Tahoe. This makes recruitment and retention of trained crisis workers very difficult.
Related Recommendations (1)
R3
The DMH Director, the CAO, and the Board should establish new written standards and policies based on published data, to recognize the higher costs of housing, transportation, relocation and other pertinent factors, to adjust salary schedules for employees in South Lake Tahoe. Those standards and policies should provide incentives to attract new qualified employees and to retain employees at South Lake Tahoe.
F32
The Adult Day Rehabilitation and Case Management Unit (Adult Day Treatment) for the severely and chronically mentally ill is managed by a Mental Health Program Coordinator I at the Clinic. This position is filled currently by a new probationary employee. The unit is staffed by a Mental Health Worker II, a Psychiatric Technician II, and a Mental Health Clinician I. The position of Psychiatric Technician II is also filled by a new probationary employee, and the position of Mental Health Clinician I is vacant.
No recommendations for this finding
F33
Adult Day Treatment is an organized daily program that provides therapeutic activities for severely and chronically mentally ill adults who are at risk of hospitalization. This program is conducted at the Clinic site in a room space of less than 400 square feet. The space is inadequate for the current number of participants - 15 to 17 clients and three staff members. Based on current needs and interest, the program could serve up to 15 additional clients each day if adequate space were available. Requests for and attempts to find space for this program have been ongoing for at least four years.
Related Recommendations (2)
R14
The Adult Day Treatment hours should be extended to match program hours in Placerville. The Adult Day Treatment program should encourage volunteers and "consumers" (clients who are compensated for providing peer counseling services) to use their skills by offering clients instructional programs for personal development.
R15
The Adult Day Treatment staff should investigate programs in other counties for new ideas to be used at the Clinic.
F34
According to DMH policy, the Clinic cannot have a petty cash fund on site for staff to use in paying small expenses for Adult Day Treatment, i.e., parking and admission fees at local recreation sites, activities and excursions. The unavailability of a petty cash fund greatly limits participation in Adult Day Treatment.
Related Recommendations (1)
R12
DMH should revise its policy and allow the Clinic to use a petty cash fund. This would give the Adult Day Treatment staff flexibility in conducting activities scheduled for participants, without the need to cancel planned activities because of complicated reimbursement procedures or the lack of a few dollars for admission fees.
F35
Adult Day Treatment has a rehabilitation schedule of planned socialization activities for clients who would otherwise be isolated and non-communicative. They meet four afternoons each week, Monday through Thursday, and are encouraged to participate in the following activities: · Peer support which promotes communal activity; · Community awareness, current events, and resources; · Yoga and range of motion exercises; · Meal preparation; · Bowling and active recreation pursuits; · Outings to the library, parks, and recreation areas; and · Excursions to Carson City and Reno.
No recommendations for this finding
F36
Clients are not participating in some of the "hands-on" experiences described as objectives of Adult Day Treatment activities. For example, clients do not prepare meals, even though these activities are on the schedule, because kitchen facilities are inadequate.
Related Recommendations (1)
R13
The Adult Day Treatment program should provide more varied daily activities with hands-on experiences in cooking, crafts, art, computer use, gardening and painting, similar to those provided at the county facility in Placerville.
F37
The Adult Day Treatment program at the Clinic does not have enough staff, space, or funding to provide mental health services to the increasing number of clients.
Related Recommendations (2)
R14
The Adult Day Treatment hours should be extended to match program hours in Placerville. The Adult Day Treatment program should encourage volunteers and "consumers" (clients who are compensated for providing peer counseling services) to use their skills by offering clients instructional programs for personal development.
R15
The Adult Day Treatment staff should investigate programs in other counties for new ideas to be used at the Clinic.
F38
The Tahoe Opportunity Project (TOP), a state grant-funded program, provides services to mentally ill homeless adults, those who are in danger of becoming homeless, and those who are incarcerated. TOP is managed by a Mental Health Program Coordinator II with a staff of seven. The Coordinator's position is vacant.
No recommendations for this finding
F39
TOP provides these clients with food, clothing, and shelter and helps them obtain treatment for mental health problems, substance abuse, and medical conditions. A psychiatrist at the Clinic provides services to TOP clients up to a maximum of 5 hours per client.
No recommendations for this finding
F40
TOP receives state grant funds of $800,000 annually. The TOP program, led by the Clinic, is a collaborative effort by public agencies, such as the County's Departments of Public Health, Community Services, and Veterans Services, as well as private, non-profit agencies, including the Sierra Recovery Center, Barton Memorial Hospital, and the Family Resource Center.
No recommendations for this finding
F41
TOP recently leased a transition house in South Lake Tahoe, which has five beds and is supervised by a TOP staff member and a live-in house manager. This house serves as a transition site for clients needing a more intensive residential treatment environment before advancing to higher levels of self-sufficiency and independent living. Fifteen clients have used the house since it was leased.
No recommendations for this finding
F42
Children's Mental Health, Day Rehabilitation (Children's Day Treatment) and Primary Intervention Services are managed by a Mental Health Program Coordinator II at the Clinic. This unit is staffed by four Mental Health Clinicians, a Mental Health Social Work Intern, a Parent Partner, and four Primary Intervention Aides.
No recommendations for this finding
F43
Children's Day Treatment does not have a dedicated 24-hour crisis line. Resources such as respite care, licensed foster homes, and group care facilities are inadequate.
No recommendations for this finding
F44
The Clinic has a critical shortage of space for children's services. There is no partitioned space in the waiting room/reception area to separate adult clients from families and children. There is no privacy, play area, or counseling room dedicated to children's use. A play therapy room was recently converted to office space for staff.
No recommendations for this finding
F45
The Clinic does not have enough authorized positions for clinical staff to meet the treatment needs of seriously mentally ill children in the South Lake Tahoe area. Clinic Facilities
No recommendations for this finding
F46
The Clinic is operating in inadequate space of 3,475 square feet. Some of the major concerns are: · Some clients, including children and adults with mental and physical problems, have difficulty negotiating the elevator and the narrow, dark stairway to the Clinic location on the second floor. · There are 36 authorized positions that must share small offices, leaving little privacy for confidentiality between staff and clients. · 300 clients access this facility (not counting parents and others). · The cramped, inadequate space negatively impacts programs. For example, the Adult Day Treatment program has a small room for up to 17 clients and three staff members, limiting important activities and the ability to increase the number of participating clients. · Record storage space is totally inadequate. Some confidential records are stored in the hallway.
Related Recommendations (1)
R7
The Board should provide adequate facilities for the Clinic to accommodate programs, staffing and services. It was unconscionable for the Board to use discretionary funds for Community Enhancement Projects, like the grant of $100,000.00 for the South Lake Tahoe Animal Shelter, while failing to provide adequate space for treatment of the severely and chronically mentally ill clients of the Clinic who are the least able members of our community to fend for themselves.
F47
There are serious fire/life safety issues in the Clinic facility: · Because the Clinic is on the second floor, evacuation would be difficult for everyone, especially mentally impaired clients, in the event of an emergency. The number of clients who access the Clinic is excessive for the square footage. · The building is constructed of wood, and the “combustible load” (all those things that would burn easily) is great. · The building does not have fire sprinklers, smoke detectors, a central fire alarm system, air packs, or an automatic external defibrillator (AED). · Fire drills, including emergency evacuations, are not routinely conducted.
Related Recommendations (1)
R7
The Board should provide adequate facilities for the Clinic to accommodate programs, staffing and services. It was unconscionable for the Board to use discretionary funds for Community Enhancement Projects, like the grant of $100,000.00 for the South Lake Tahoe Animal Shelter, while failing to provide adequate space for treatment of the severely and chronically mentally ill clients of the Clinic who are the least able members of our community to fend for themselves.
F48
The space for Adult Day Treatment is inadequate. For example: · There is one kitchen sink, one stove without a ventilation hood, one small refrigerator/freezer, limited food preparation/counter space, and limited cabinet space to store kitchen supplies. · The activity space is combined with the food preparation space and storage for supplies to serve meals is located in the hallway. · The space is too small for an activity room, and there is not a separate group conference room. · There is not a private access to Day Treatment staff offices; the only access is through the activity room.
Related Recommendations (1)
R7
The Board should provide adequate facilities for the Clinic to accommodate programs, staffing and services. It was unconscionable for the Board to use discretionary funds for Community Enhancement Projects, like the grant of $100,000.00 for the South Lake Tahoe Animal Shelter, while failing to provide adequate space for treatment of the severely and chronically mentally ill clients of the Clinic who are the least able members of our community to fend for themselves.
F49
The County requires property owners to make tenant improvements before the County will enter into any lease. This requirement makes leasing new property almost impossible, given the limited amount of available lease space in South Lake Tahoe.
No recommendations for this finding
F50
The City of South Lake Tahoe has not been helpful in providing "fast track" services to enable the County to meet the City’s requirements for new Adult Day Treatment space. In addition, the Tahoe Regional Planning Authority (TRPA) restricts sites where Clinic services like the Adult Day Treatment program can be located.
No recommendations for this finding
F51
Repeated promises by Clinic staff that the Adult Day Treatment program would be relocated to a more adequate space have not been fulfilled. This has created credibility problems among clients, their families, and staff members.
No recommendations for this finding
F52
The Department of General Services (DGS) and its Real Property Planning and Administration (RPPA) division historically have not responded in a timely manner to opportunities to acquire new lease space for the Clinic and its programs.
No recommendations for this finding
F53
After more than four years of unsuccessful attempts to find adequate space for the Adult Day Treatment program, the County has made arrangements to move both the TOP and Adult Day Treatment programs into adequate space by relocating other county offices from existing county-leased facilities in South Lake Tahoe. The move is scheduled for July 2002. Personnel and Staffing
No recommendations for this finding
F54
The Department Director is responsible for performance evaluations for the Deputy Director and Program Managers. Some Program Managers have not had formal performance evaluations in more than 10 years.
Related Recommendations (1)
R8
The DMH Director should require annual performance evaluations for all employees at every level.
F55
The Deputy Director has not had a formal performance evaluation since being appointed to the position in January 2001.
Related Recommendations (1)
R8
The DMH Director should require annual performance evaluations for all employees at every level.
F56
The Deputy Director does not have line authority to conduct formal performance evaluations for program managers or coordinators.
Related Recommendations (2)
R1
The Deputy Director should have line-authority over program managers in DMH. This should be included in the job description for the position.
R2
The DMH Director and the Board should authorize a new position, Assistant Director, for DMH. The title of Program Manager at the Clinic should be eliminated, and the Assistant Director should be given full authority and responsibility for Clinic programs and facility operations in the South Lake Tahoe area of the County.
F57
Probationary employees in supervisory positions are conducting performance evaluations of probationary employees. It is unclear whether or not they have the experience or training to conduct such evaluations. The County provides no formal training for that purpose.
Related Recommendations (1)
R9
The DMH Director, with the assistance of the Department of Human Resources, should provide training programs for new supervisors and managers to enable them to undertake and complete performance evaluations with accuracy and consistency.
F58
Performance evaluations do not always reflect the actual performance of employees because DMH does not require its managers and coordinators to do so.
Related Recommendations (1)
R8
The DMH Director should require annual performance evaluations for all employees at every level.
F59
There is a lack of communication among the administrators, managers, coordinators and staff of DMH.
No recommendations for this finding
F60
DMH does not always include or involve the South Lake Tahoe Mental Health Clinic Program Manager in decisions relating to programs, budgets, and staffing. Managers have not always been advised or consulted on changes in their own programs and staffing before changes are announced.
Related Recommendations (1)
R2
The DMH Director and the Board should authorize a new position, Assistant Director, for DMH. The title of Program Manager at the Clinic should be eliminated, and the Assistant Director should be given full authority and responsibility for Clinic programs and facility operations in the South Lake Tahoe area of the County.
F61
Staff turnover in the Clinic is high. There were four clinical positions vacant in the past year. These vacancies cause staffing and service delivery problems because positions remain vacant for months. Some of the reasons include: · An acute shortage of psychiatrists exists, not only in South Lake Tahoe, but throughout the State of California. · The high cost of housing in South Lake Tahoe makes it difficult to recruit employees to live in that area. · A salary differential of only $175.00 per month for employees in South Lake Tahoe does not cover the additional cost of housing and transportation. · The County does not pay relocation expenses for new employees. · The required one-year probationary period is an impediment to recruiting prospective new employees for positions in South Lake Tahoe. · Contract employees have no permanent employee status or representation in bargaining units in the County.
Related Recommendations (2)
R3
The DMH Director, the CAO, and the Board should establish new written standards and policies based on published data, to recognize the higher costs of housing, transportation, relocation and other pertinent factors, to adjust salary schedules for employees in South Lake Tahoe. Those standards and policies should provide incentives to attract new qualified employees and to retain employees at South Lake Tahoe.
R17
A management audit of DMH should be conducted to determine the reasons for disparities in workloads and productivity levels between the Clinic and Placerville.
F62
The Clinic's professional staff have private practices and are allowed to use management leave and supervisory leave as compensatory time off to conduct their practices during normal weekday business hours between 8 a.m. and 5 p.m.. These practices conflict with the scheduling of work and caseloads for other employees.
Related Recommendations (1)
R17
A management audit of DMH should be conducted to determine the reasons for disparities in workloads and productivity levels between the Clinic and Placerville.
F63
There is an abuse of sick leave at the Clinic.
Related Recommendations (1)
R17
A management audit of DMH should be conducted to determine the reasons for disparities in workloads and productivity levels between the Clinic and Placerville.
F64
Because of improper management, and for other reasons, employees work through normal breaks and lunch periods.
Related Recommendations (1)
R17
A management audit of DMH should be conducted to determine the reasons for disparities in workloads and productivity levels between the Clinic and Placerville.
F65
Policies regarding work and duty hours are not enforced. Employees are allowed to work at home without accounting for their time, and employees are not always recording work beyond the normal eight hours, for which they are entitled to be paid overtime.
Related Recommendations (1)
R17
A management audit of DMH should be conducted to determine the reasons for disparities in workloads and productivity levels between the Clinic and Placerville.
F66
The Clinic has higher staffing ratios and receives a greater proportion of DMH’s budget, relative to caseloads and costs of services, than the Western Slope.
No recommendations for this finding
F67
Since the position of Deputy Director of DMH was filled in January 2001, the Clinic has received substantially more on-site administrative and management support because of the Clinic's high priority and the interest level of the Deputy Director. Community Resources
No recommendations for this finding
F68
There is currently one volunteer to assist at the Clinic. Privacy issues preclude active volunteer recruitment and participation in mental health programs with clients. Tahoe Cares, a coalition of non-profit community and religious organizations, provides informal support on a case-by-case basis as requested by the TOP Program Coordinator.
No recommendations for this finding
F69
The National Alliance for the Mentally Ill (NAMI) is an active organization in the South Lake Tahoe area, and the NAMI representative works to assure that the laws regarding mental health are being implemented. NAMI also is involved in educating family members of patients regarding the legal rights of the mentally ill.
No recommendations for this finding
F70
The El Dorado County Mental Health Commission at South Lake Tahoe meets monthly to address issues concerning mental health services, such as programs, facilities, staffing, funding and resources.
No recommendations for this finding
F71
Barton Memorial Hospital is a private, non-profit, accredited medical facility which contracts with the County to provide emergency service to mentally impaired persons. Crisis workers from the Clinic evaluate patients in the emergency room to determine immediate needs, assist with diagnoses, and provide referrals for treatment.
No recommendations for this finding
F72
Barton Memorial Hospital has no psychiatric beds and does not admit patients diagnosed with psychiatric illnesses unless they also have medical conditions that warrant hospitalization. The hospital is not equipped to diagnose or treat mentally ill patients or provide mental health services. There is no psychiatrist on staff.
No recommendations for this finding
F73
Members of the Grand Jury toured the hospital emergency rooms and several floors of the facility, and found them to be very clean and well maintained. There is only one examination room in the emergency room area with an observation window. When the examination rooms are full, this particular room, which is preferred for psychiatric observation, may not be immediately available.
No recommendations for this finding
F74
Security at Barton Memorial Hospital is provided by the maintenance staff, who have received special training and who are available on every shift. When restraint is necessary to control mentally ill patients, the preferred method of restraint is medication, rather than physical restraint, to reduce injuries to patients and staff.
No recommendations for this finding
F75
Tahoe Manor Residential Care (Tahoe Manor) is a privately owned, state licensed board and care facility in South Lake Tahoe with accommodations for 49 residents. Fifteen of the residents are clients of the Clinic.
No recommendations for this finding
F76
Tahoe Manor is the only residential care facility in El Dorado County that accepts Supplemental Security Income (SSI) payments for board and care residents. The County contracts with Tahoe Manor for residential care for clients who are also receiving mental health services at the Clinic.
No recommendations for this finding
F77
Grand Jury members toured Tahoe Manor without an appointment. During the visit, no group activities were observed. The physical layout and floor plan are not adequate for group activities and events. Hallways are narrow. There is no designated activity area except a small day room and a dining room. The overall appearance of the facility is drab, but it is moderately clean.
No recommendations for this finding
F78
Tahoe Manor is not licensed to accept residents who have been diagnosed with dementia. A request for a dementia waiver was denied by the Department of Social Services of the State of California in October 2000.
Related Recommendations (1)
R16
DMH should evaluate other facilities in the Lake Tahoe area which have the capability of providing the residential care services needed by clients of the Clinic, for potential contract purposes.
F79
Monthly payments from the County to the contractor at Tahoe Manor were approximately two months in arrears. The County’s requirement that invoices be routed through several different departments slows payment processing and discourages providers from contracting with the County.
No recommendations for this finding
F80
The annual licensing review and evaluation of Tahoe Manor by the State Department of Social Services, called a Facility Evaluation Report and dated April 2000, identified four deficiencies: · Medications were not stored, locked, labeled, and dispersed according to regulations. · Medications were being set up more than 24 hours in advance. · Hazardous areas in the laundry room were accessible to residents. · Staffing was not sufficient to meet state licensing standards.
No recommendations for this finding
F81
The Facility Evaluation Report for Tahoe Manor dated April 2001 showed no deficiencies in the community care licensing standards. The resident census at that time was 35, which was 14 less than the maximum allowed number of 49 residents.
No recommendations for this finding
F82
The 2002 Facility evaluation and inspection of Tahoe Manor has not yet been conducted.
No recommendations for this finding

Commendations 1