Inal Eport San Luis Obispo County Grand Jury

Recommendations 10

• R1

  Page 15
  Even though the PHF second and third shifts meet minimum State standards, staffing levels should be increased for staff, patient, and community safety reasons. Health Agency response: “This recommendation has been partially implemented through the addition of permanent resources to the PHF in each of the past 5 years. The Department will continue to evaluate staffing needs at the PHF.”
• R2

  Page 15
  The San Luis Obispo County Jail should have its own dedicated psychiatric hospital facility, serving only inmates. This would limit the number of inmates admitted as patients in the PHF. When inmates are admitted to the new PHF, a correctional deputy should be assigned. 2 018-2019 San Luis Obispo County Grand Jury Final Report 5 CONTINUITY REPORT Health Agency response: “The recommendation has been partially implemented. The Sheriff’s Office is in the process of establishing a behavioral health unit at the jail for inmates.” Board of Supervisors response: “The Sheriff’s office is in the process of establishing a behavioral health unit at the jail for inmates that will provide intensive day treatment services. The facility is anticipated to open in FY 2018-19. Additionally, through a Request for Proposal (RFP) process for jail healthcare services, the County included an option for proposals to estimate the cost of staffing and operating a psychiatric health facility at the jail.” 2018-2019 Grand Jury notes that the new behavioral health unit will open May 1, 2019. Future Grand Juries should review how the opening of the new behavioral health unit at the jail impacts the PHF. The Health Agency will not implement:
• R3

  Page 16
  The County should find or build a new psychiatric hospital facility, with sufficient room for patient treatment and recovery. Funding could come from reserves sources (County and/or MHSA [Mental Health Services Act]) or pursuing a state grant. Health Agency response: “Recommendation will not be implemented at this time as it is not feasible. If new grants, state, or federal funds become available this option will be evaluated.” Board of Supervisors response: “This recommendation will not be implemented at this time as it is not feasible. If new funding becomes available or current funding can be redirected, this option will be evaluated. The County is committed to maintaining and improving the existing Psychiatric Health facility (PHF).”
• R4

  Page 19
  Combine drug and alcohol treatment with mental health treatment, having all clinicians cross-trained to manage dual-diagnosis patients. Health Agency response: “This recommendation will not be implemented because it is not warranted. The County’s contracts with the State Department of Health Care Services are very prescriptive for the provision, documentation, and billing for mental health and substance use disorder services. Professional certification and licensure for addiction treatment and for mental health treatment are also specialized and require concentration in specific areas of practice. Clients served within behavioral health may present with needs for co-occurring treatment. Other clients may not be impacted by either substance use disorder or serious mental illness and would not require co-occurring treatment. However, the respondent has increased the number of staff who have training in both mental health and substance use disorder treatment and offers trainings in both specialties to all treatment staff, including contract agency staff.” The Grand Jury notes that although the Health Agency rejected the recommendation, they stated they have increased the number of staff who have training in both mental health and substance use 2 018-2019 San Luis Obispo County Grand Jury Final Report 9 CONTINUITY REPORT disorder services and they offer training in both specialties to all treatment staff. We commend them for this proactive approach.
• R5

  Page 20
  Reorganize the agency to concentrate on the complete behavioral health treatment process. Health Agency: “This recommendation will not be implemented because it is not reasonable. The organization of the agency is not a factor on the ability to provide appropriate treatment services. As reflected in Recommendation 4, the County is obligated to provide specific treatment services based on diagnosis and functional needs to clients through highly regulated and monitored processes.” Board of Supervisors response: “This recommendation will not be implemented because it is not reasonable. The County is obligated to provide specific treatment services based on diagnosis and functional needs to clients through highly regulated and monitored processes.”
• R6

  Page 16
  The facility should annex additional area from the adjacent County facilities, adding the treatment and therapy environments to improve effectiveness and safety. 2 018-2019 San Luis Obispo County Grand Jury Final Report 6 CONTINUITY REPORT Health Agency response: “The recommendation will not be implemented, as it is not feasible. If new grants, State, or Federal funds become available this option will be evaluated.” The Grand Jury recognizes the difficulty inherent in obtaining funding, but appreciates the county’s commitment to maintaining and improving the existing facility. REPORT 2: “A Look at County Behavioral Health Services: A Time for Improvement is Now” Link to full report: https://drive.google.com/file/d/1F9Reoi_eBj1ebT1dI34xKNH6lgAA2mOF/view This report examined the San Luis Obispo County Behavioral Health Department. The 2017-2018 Grand Jury investigated the services provided through Behavioral Health by interviewing a wide spectrum of employees, private mental health professionals, and representatives from local non- profit agencies with behavioral health ties. Through these interviews, document review, and facility inspections, the Grand Jury discovered that the County provides programs and services to Medi-Cal beneficiaries among the population of over 5,000 residents with severe mental illness. Twelve findings and seven recommendations were made. The County of San Luis Obispo Health Agency was required to respond to nine findings and seven recommendations. They agreed with six findings and partially agreed with three findings; two recommendations have been implemented and five recommendations will not be implemented. Link to Health Agency response: https://drive.google.com/file/d/1kSM6q2AsX4ipt_gY7qlOEJoJvf-XVIN9/view The San Luis Obispo Board of Supervisors was required to respond to two findings and five recommendations. They agreed with one finding and partially disagreed with one finding; one recommendation will be implemented and four will not be implemented. Link to BoS response: https://drive.google.com/file/d/1_ousUr9hmB3ks3ZgDS63rKDrSBJx9rHr/view 2 018-2019 San Luis Obispo County Grand Jury Final Report 7 CONTINUITY REPORT
• R7

  Page 25
  The Sheriff should construct a psychiatric hospital on the jail campus or elsewhere within the County. 2 018-2019 San Luis Obispo County Grand Jury Final Report 15 CONTINUITY REPORT Sheriff’s response: “This recommendation has not been implemented, but will be implemented in the future.” The Behavioral Health Unit will “encompass the previous medical/behavioral health facility (Stahl Hall) and the Modular buildings.” The newly remodeled Behavioral Health Unit was funded by community members and partners, as well as the County General Fund. “The Behavioral Health Unit is designed to improve on-going services and has the ability to house a Jail Based Competency Treatment (JBCT) program contracted with the State. The JBCT program will provide on site treatment for 1370 felony inmates so they will not have to wait or be transported to a State Hospital bed. The facility can also be used to assist 1370 Misdemeanor inmates, which will help with crowding issues at the County Psychiatric Health Facility (PHF). The facility is not compatible with, designed for, or properly licensed under the Lanterman-Petris-Short Act (LPS) to house or treat subjects being detained for Welfare and Institutions Code 5150. Subjects detained for W&I 5150 are considered detained and not arrested.” Board of Supervisors adopted the response of the Sheriff. The Grand Jury requested follow-up on this matter and in March 2019 an additional response was received: The Behavioral Health Unit is due to open March 29, 2019. Staff will begin using the new unit to treat mentally ill inmates beginning May 1, 2019. They will utilize “part of the Kansas Facility to house JBCT eligible inmates. Minor improvements will be made to accommodate these inmates.” No date has been set for the opening of the JBCT.
• R8

  Page 26
  The Sheriff should increase the staffing for the jail mental health workers to reduce the wait time for appointments from five days to one day or less. Sheriff's response: “This recommendation has not yet been implemented, but will be implemented in the future. The County has a Request for Proposal (RFP) for jail medical and behavioral health services. …The proposal will address proper staffing levels that meet National Accreditation Standards.” 2 018-2019 San Luis Obispo County Grand Jury Final Report 16 CONTINUITY REPORT The Grand Jury notes that the jail has contracted with Wellpath for medical, behavioral, and dental services, which will be overseen by the jail’s Chief Medical Officer. The 2019-2020 Grand Jury should follow-up to determine whether wait times have been reduced. The following recommendation will not be implemented at this time:
• R9

  Page 27
  The Sheriff should increase the staff in excess of the nine positions currently unfilled. Sheriff's response: “This recommendation will not be implemented at this time. Currently all Custody Deputy positions have been filled with someone either hired and in training, or involved in the final stages of the hiring process. More Custody Deputy positions would be welcomed when the County Budget has the ability to fund more positions.” Board of Supervisors response: “This recommendation will not be implemented because it is not warranted at this time.” The Board approved the addition of a Backgrounds Investigation Officer, to decrease the time to recruit officers. If more resources are warranted after full staffing is achieved, the Sheriff would need to submit a request. The following recommendation requires further analysis:
• R10

  Page 28
  The County should procure and install a back-up generator (fixed or portable) on site to provide back-up power in case of an outage. Sheriff's response: “This recommendation will not be implemented at this time. The County has several portable generators on trailers that can be utilized should the Coroner’s Office lose power. A generator on site not only requires the outlay of initial cost, but preventive maintenance and 2 018-2019 San Luis Obispo County Grand Jury Final Report 18 CONTINUITY REPORT testing to ensure the generator will work when needed. The current Sheriff and County generators already have maintenance in place and are available if needed. Adding another generator at this time is not currently budgeted but will be considered in the future when the County has the appropriate funds.” The Grand Jury acknowledges that much has been done in the past years to address problems in San Luis Obispo County Detention Facilities, including a major project to expand the women’s jail, medical unit and deferred maintenance at the jail complex. As this project draws to a close, and our incarcerated population changes, we need to remain vigilant as to future needs. REPORT 4: “Safeguarding the Public’s Health” Link to full report: https://drive.google.com/file/d/1AIEbj40RynSn69fQdZQtKf-ZnF8c29-4/view This report examined the policies and procedures of the Environmental Health Division of the San Luis Obispo County Health Agency in regards to their handling of complaints. The authority of the Environmental Health Division to regulate extends to several activities such as restaurant and food service inspections, petroleum product storage, beach water quality testing, and inspections of public swimming pools, spas, and hot tubs. In addition to their inspections and testing, the Environmental Health Division also conducts public education programs and collaborative mitigations. In its recommendations, the 2017-2018 Grand Jury addressed the risk of Legionnaire’s disease, the risk of a possible Hepatitis A outbreak, and mosquito abatement programs within the County. Six findings (one of which did not require a response) and six recommendations were made. The San Luis Obispo County Public Health Department was required to respond to five findings and six recommendations, all of which were received in a timely manner. They agreed with four of those findings and partially disagreed with one finding; two recommendations have been partially implemented and four will not be implemented. Link to Health Department response: https://drive.google.com/file/d/1MdMY3OpbKejGawojOx9dNxH4JLk4VhKu/view 2 018-2019 San Luis Obispo County Grand Jury Final Report 19 CONTINUITY REPORT The San Luis Obispo County Board of Supervisors was required to respond to two recommendations. They were in agreement with the responses provided by the Department of Public Health. Link to BoS response: https://drive.google.com/file/d/1FyHWJMbtSLU3A9BH0hi-Odf1MgplRG6J/view