Is Your Favorite Restaurant Clean?*

The County has about 4,700 food providers of which about 1,900 are restaurants. The others consist of grocery stores and retail outlets selling pre- packaged foods, for example. Response: Concur

At the conclusion of each passed inspection, a new placard, inspection report, and summary report are issued. Re-inspection information is provided when applicable on the inspection and summary reports available at the food facility. Violations noted on follow-up inspections are posted on the EHD website. Based on the concern brought by the Grand Jury, when a follow-up inspection is warranted, a notation that a re-inspection is required will be posted along with the violations noted on the inspection.

The EHD restaurant inspection program is funded by the County General Fund; however, these are "revenue offset operations," in that the fees generated from licensing are adequate to cover all costs of the inspection program. Fees are set annually by the County of Ventura Board of Supervisors (BOS), based on recommendations from the EHD. Response: Concur.

It is noted that grading systems such as the Los Angeles County system do not provide reinspection information. EHD does not concur with the fourth bullet. Depending on the nature of the uncorrected violations, EHD staff will either immediately suspend the facility permit to operate, issue a Notice of Violation, take other appropriate enforcement actions such as impounding equipment and embargoing food, schedule a hearing, schedule a re-inspection, or, for very minor violations, review compliance status at the next routine inspection. EHD does not concur with the fifth bullet. See response above. EHD does not concur with the last bullet. As noted, a new placard and summary report is issued at each inspection. F-22 The EHD does not currently assign numeric values (points) to the various elements of the inspection process. Response: Concur. F-23 The EHD uses the Envision System from Decade Software for restaurant inspections. This software will support a point value system. Response: Concur F-24 The EHD is in the process of assigning numeric scores for specific violations. This is planned to be completed by September 2009. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 Response: Disagree. EHD is not in the process nor has any plans of assigning numeric scores for specific violations. F-25 Each EHS uses a laptop computer to input observations during inspections and print out the results on site for review with the owner or manager. This information is later uploaded to the Envision System on the EHD server. Response: Concur. F-26 The EHD plans major Envision System upgrades, estimated by June 2009. This will give EHSs wireless capability to connect to the EHD server from the field. Response: Concur. The Envision upgrades are estimated to be installed by September 2009. F-27 Public complaints regarding a restaurant's sanitary condition result in an immediate investigation by EHD. Response: Concur. F-28 During a Grand Jury inspection observation, it was noted that a number of adjacent restaurants were in different inspection districts. Response: Disagree. Adjacent food facilities are not located in different inspection districts. Food facilities are grouped into geographic districts to ensure equal and efficient workload for inspection staff. Streets, roads, and highways are often used to define the boundaries of inspection districts. Additionally, the cities of Oxnard, Simi Valley, Thousand Oaks, and Ventura have multiple inspection districts due to the number of food facilities located in these cities. Although the district boundaries are carefully drawn to avoid food facilities being on opposite sides of a boundary and thus being in different districts, there are a few examples in the cities with multiple districts where this is the case. We also believe Grand Jury members may have observed inspection placards in adjacent food facilities that were issued by different inspectors and assumed these facilities were in different districts. In fact, the usual reason for this situation is that multiple inspectors are at various times assigned to perform inspections in unstaffed districts, which results in inspection placards being issued by different inspectors until permanent staffing is restored. This was explained to several Grand Jury members during our interviews. F-29 Cal Code requires that each food establishment have one employee or the owner be certified in food handling and sanitation. [Ref-01] McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 Response: Concur. F-30 The County may impose more stringent standards than Cal Code requires; each city in the County may accept or reject the more stringent requirements. Response: Disagree. The State Food Code (Health and Safety Code (HSC) Section 113705) expressly precludes counties and cities from imposing more stringent requirements related to retail food facility health and sanitation standards. It is noted that the Food Code (HSC Section 113709) also authorizes county boards of supervisors and/or city councils to adopt at their discretion evaluation or grading systems for retail food facilities operating in their respective jurisdictions. However, locally adopted requirements associated with such systems cannot alter the health and sanitation standards set forth in the Food Code. F-31 Fifteen cities in Los Angeles County (L.A. County) did not initially adopt the "A B C" grading system when instituted in 1998. Currently, all of these cities have adopted this grading system. Response: Disagree. The cities of Long Beach, Pasadena, and Vernon have Environmental Health departments independent of Los Angeles County and do not post grades in retail food facilities. It is our understanding there are currently eight other cities in Los Angeles County that have not adopted the grading ordinance. F-32 After the initiation of the grading system, the L.A. County Department of Public Health (DPH) reported a 13% decrease in hospital admissions for food- borne illness. State-wide levels remained constant during the same time frame (1993-2000). [Ref-02] Response: Concur in part. An examination of the State Health Department report concerning foodborne hospital admission rates for the time period of 1995-1999 revealed that foodborne illness admission rates for all of California dropped 27% from 4.1 to 3.0 per 100,000 population. F-33 The most common causes of food-borne illness in restaurants are: [Ref-03] poor personal hygiene (hand washing, etc.) improper holding temperature ٠ food from unsafe sources Response: Concur. F-34 Many counties in California and other parts of the country have adopted rating systems using numerical scoring on the basic elements of the inspection requirements. [Ref-03 through Ref-05] Response: Concur in part. In a statewide survey conducted in 2002, only 19 of the 62 (30%) county and city environmental health agencies indicated that they rate, score, or grade food facilities. Of these, only 5 issue letter grades. F-35 While L.A. County's grading system has been used as a model for many jurisdictions, other variations and approaches are used to establish rating or awards of excellence. [Ref-03] Response: Disagree. It is an over-statement to say that "many" counties have adopted grading systems modeled after Los Angeles County's system. Since Los Angeles County's grading system was implemented in 1998, only Kern and San Bernardino Counties have adopted ordinances requiring posting of letter grades. Seven other counties and cities have adopted substantially different posted public notification systems: Ventura, Monterey and Orange Counties post an inspection placard, Sacramento and Merced Counties post color coded placards, and San Francisco and Long Beach post an inspection report/summary. F-36 In the last few years, numerous studies have been conducted about the effect of rating systems on restaurant sanitation. A recent study by the Center of Science in the Public Interest (CSPI) was issued in August 2008. All of these studies concluded that restaurants are cleaner and that there are health benefits to the public attributable to restaurant grading systems. [Ref-02, Ref-05] Response: Disagree. The CSPI study results cited actually found that Las Vegas, one of the two cities included in the study which posts grade cards, to have a greater severity of violations found on inspections (risk factors for foodborne illness) than 12 of the 20 other cities studied. St. Louis, the other city included in the study which posts grade cards, was higher than 4 of the 20 cities. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 Furthermore, the City of Wichita, Kansas did away with a 30-year-old grading system because they felt it gave patrons a false sense of security. The City of Wichita Environmental Services Department, like Ventura County, now provides access on their website to more complete inspection information that is specific to the violation. F-37 In January 2008, the DPH issued a ten-year status review of its grading system to the L.A. County Board of Supervisors. This report concluded that public health had improved, public information on restaurant conditions was improved, and most importantly, restaurants were cleaner. [Ref-02] Response: Concur in part. When Los Angeles County began its restaurant grading system, it also implemented several other program enhancements that may have lead to the noted improvements. The County increased inspection staff, enhanced training for staff, increased the number of inspections performed, created a risk-based approach to inspection priorities, increased public access to inspection results through the County website, and increased industry education relating to safe food handling practices. Each of these actions on its own could lead to improved inspection results. It would be unsupported and likely inaccurate to claim that posting grading placards was the sole cause of the improved inspection results. F-38 The DPH has also noted that, as a result of the grading system, restaurants shifted from a reactive approach to violations to a proactive approach in order to achieve higher grades. [Ref-02] Response: Disagree. As detailed in the referenced report, a major component of the Los Angeles County grading system was working with restaurant and retail market owners to ensure they have the knowledge and capacity to maintain safe and clean facilities. Concurrent with the adoption of letter grading, the Los Angeles County Board approved an action plan requiring restaurant managers and workers to participate in a food safety training program. Starting in 1999, at least one individual who has successfully completed the four-hour Certified Food Handler training program is required by Los Angeles County to be on duty while the establishment is open to the public. Similarly, beginning in January 1999, a new State law required that food facilities throughout California that prepare, handle, or serve non-prepackaged potentially hazardous food have an owner or employee who has passed an approved and accredited food safety certification examination. There is currently legislation that would require that every restaurant employee be certified. Since January 1999, Ventura County EHD staff has verified during inspections that there is a certified individual at each facility where required by State law. In our view, this education component of the food inspection program has contributed more than any other component to improving the proactive nature of food facility owners and operators. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 F-39 Economists Leslie and Jin reported in 2003, in the Quarterly Journal of Economics, that incentives work. Grading systems forced restaurants to improve because lower-graded establishments lost business while the highest-graded places gained customers. Response: Disagree. The referenced report related grading to revenue, not numbers of customers. The findings, based on revenue data covering two years before and one year after the grade cards, were that, restaurants obtaining an A-grade obtained an average of 5.7% higher revenue than before grade cards. For B-grade restaurants, there was a 0.7% increase, and for C-grade restaurants, revenue decreased by 1.0%. It was noted that during the one year that the grade cards were initiated, there was a general trend of increasing revenue for all restaurants. EHD is not aware of any follow-up or current information regarding the long term effects of grading on revenue. A Los Angeles Times article dated September 28, 2005, reported that in the San Gabriel Valley, home to the nation's largest Chinese American community, the letter-grade system is often viewed as little more than a minor intrusion on a proud cuisine - if diners consider it at all. According to this article, restaurants with C-grades are filled with customers. F-40 In San Diego County, EHSs issue a Self-inspection Checklist to each restaurant as part of the routine inspection procedure. (Att-02) Response: Disagree. According to San Diego County staff, the Self-Inspection Checklist attached to the report is part of an Operator Guide that is given to each restaurant when a new permit is issued. The checklist is not handed out at all routine inspections. San Diego County advises the restaurant to use their inspection report as a self-inspection checklist. Ventura County EHD staff also provides this advice. F-41 A random survey conducted by the DPH in 2001 showed that over 91% of the 2,000 respondents liked and used the grading system. A follow up survey of 8,600 respondents in 2005 showed similar results. A national survey in 2007 conducted by the CSPI showed comparable results. [Ref-02, Ref-03] Response: Disagree. The 2001 survey results referenced by the Grand Jury indicated that only 65% of respondents were influenced in their selection of food facilities by letter grades always or most of the time. The national survey in 2007 referenced actually found that 50 percent of consumers said that a letter grade synopsis of the most recent inspection results posted in a restaurant window would be most useful to them in deciding where to dine. This survey also found that 85 percent of respondents said that knowing the results of a restaurant's most recent health inspection would affect their decision of McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 whether to dine at that establishment. Ventura County's posting of the placard, availability of the summary report at the facility and availability of inspection results on line provide the consumer with ready access to the results of a restaurant's most recent inspection. CONCLUSIONS C-01 No system of restaurant inspections is of any value unless it is properly staffed with EHSs who are competent, properly educated, and motivated. The Grand Jury concludes that the Ventura County EHD meets these criteria. Response: Concur. C-02 The ultimate responsibility for restaurant food safety rests with the management of the establishment; they must ensure employees are properly trained and follow the highest food safety standards at all times. Response: Concur. C-03 The first priority of the EHD is to ensure that restaurants and other food providers throughout the County are sanitary and safe for the dining public. Response: Disagree. The first priority of the EHD with respect to retail food facilities is to ensure compliance with applicable sections of the Food Code so that public health is safeguarded and consumers are provided food that is safe, pure, and unadulterated. C-04 The pass/fail system used by the EHD ensures an acceptable level of sanitation is achieved to meet State requirements. Meeting State minimum requirements, by definition, means the restaurant is safe for the dining public. Response: Concur with the following comments. EHD staff's responsibility is to determine if a food facility complies with the requirements of the Food Code. It is unclear what the Grand Jury means by the terms "level of sanitation" and "safe." EHD staff assures a retail food facility complies with the Food Code section 113980, which states: All food shall be manufactured, produced, prepared, compounded, packed, stored, transported, kept for sale, and served so as to be pure and free from adulteration and spoilage; shall have been obtained from approved sources; shall be protected from dirt, vermin, unnecessary handling, droplet contamination, overhead leakage, or other environmental sources of contamination; shall otherwise be fully fit for human consumption; and shall conform to the applicable McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 provisions of the Sherman Food, Drug, and Cosmetic Law (Part 5 (commencing with Section 109875)). When an inspector completes an inspection and determines that the facility operation is substantially in compliance with the Food Code requirements, a placard is issued that indicates the facility passed the inspection on that date. If an imminent health hazard is found during an inspection that can not be immediately corrected, the facility "fails" the inspection, the permit is suspended and the facility is closed until that hazard can be corrected. C-05 Grading systems provide incentives for a restaurant to maintain more than the minimum level of sanitation; the pass/fail system does not. Response: Disagree. We are unsure what the Grand Jury means by "minimal level of sanitation." In our view, Food Code Section 113980 (text included in response to C-04) describes the standards under which food is to be stored, prepared, cooked and otherwise handled. We are unaware of any documentation that grading systems provide incentives for food facilities to exceed Food Code Section 113980. In fact, in the five California counties that currently post grades, food facilities can maintain an "A grade" while violating Section 113980. C-06 The Grand Jury agrees with most professionals in this field, that a cleaner more hygienic environmental benefits the public. Response: Concur. C-07 The Grand Jury concludes that the EHD's second priority should be consumer notification of actual restaurant sanitary conditions. The EHD needs to improve in this area. Response: Disagree. We cannot agree with this conclusion without knowing what the Grand Jury means by "actual restaurant sanitary conditions." Moreover, EHD provides information to consumers about the compliance status of food facilities through issuance of a placard, posting closure and re-opening information on the EHD website, and providing inspection reports that are available for public viewing at each food facility as well as online. C-08 The EHD website does not provide a sufficiently clear, easy, and direct path to restaurant inspection information. Response: Disagree. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 There are two links on the EHD home page that quickly link to restaurant inspection information. The first link is the Restaurant/Food Facility Compliance Status & Closures which is one of eleven clearly listed "buttons" under Environmental Health Updates. The second is on the Quick Links pull down menu under Restaurants and Markets. The link to the Inspection Results has its own icon on the top of the Consumer Food Protection program page. EHD has been informed by numerous individuals that they check on the compliance status regularly: and no one has indicated that they have difficulty finding the information. The link has been published numerous times in the Ventura County Star also. Based on our latest review, approximately 106,000 people have accessed the web site information over the last year. C-09 The placard is the consumer's primary source of information concerning a restaurant's most recent inspection. Response: Disagree. The placard (see enclosure) provides information about the most recent inspection, including the date and name of the inspector, which a letter grade does not provide. The placard primarily provides the consumer with information about the availability of the most recent inspection report at the facility and on-line. C-10 The dining public would be better served if the County had a system that incentivizes restaurants to shift to a proactive stance on sanitation. Response: Disagree. Ventura County's retail food regulatory program provides incentives to owners/operators to maintain a proactive stance regarding Food Code compliance. No owner/operator wants public disclosure that their food facility was closed by EHD. In addition, no owner/operator wishes to have any negative inspection results posted on the EHD website. Additionally, for over ten years, EHD staff has been offering free food handler training emphasizing the proactive approach. This training has been well-received by industry. For example, from January 1, 2009 through July 31, 2009, 276 employees attended this training. C-11 Adding numerical scoring to the EHDs basic inspection procedures for restaurants will provide the department metrics with which it can determine trends and track past performance. The Envision software program used by the EHD fully supports adding numerical scoring. Response: Disagree. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 This statement inappropriately suggests that the EHD does not currently determine trends and track past performance using the current version of Envision. Reports are readily available to identify current and historical trends related to the violations observed during inspections and are used to determine when administrative enforcement is appropriate. These reports are also used to review inspector performance and evaluate consistency in citing violations. Reporting on each violation individually provides more accurate metrics than numerical scoring. C-12 The planned upgrade to a wireless connection of the laptop computer can reduce the number of required visits to the County Government Center. It is inefficient to have all EHSs report daily to the Government Center for their assignments and to pick up their County vehicles. Response: Disagree. We disagree that wireless connections for laptop computers will reduce the number of required "visits" to the County Government Center. Generally, inspectors are required to report to their assigned work site at either the Government Center or East County Courthouse at the beginning and end of each work day. This enables staff to receive training and direction, respond to public inquiries, prepare and file reports, and perform vehicle permit inspections. C-13 A review of the recently redrawn inspection district boundaries may yield additional efficiencies. Response: Disagree. See response to finding F-28. C-14 The dining public will be better served if, prior to entering a restaurant, they could see a placard that gives more definitive information on the sanitary condition as of the last inspection. Response: Disagree. Not all restaurants have entrances that allow for placard posting that is visible from the outside of the facility. Moreover, the placards issued by EHD staff provided definitive information including that the food facility passed the inspection, the date of the inspection, the name of the inspector, and directions for accessing the details of the inspection history of the facility. C-15 The EHD has the tools to develop an incentive/performance/graded rating system. Response: Disagree. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 It is erroneous to assume EHD has the "tools" to develop an "incentive/performance/graded rating system" simply because EHD uses a software program that can support a point value system (see responses to findings F-23 and F-24). Many complex and labor intensive tasks must be completed to fully adopt and implement an "incentive/performance/graded rating system". EHD does not currently have sufficient staffing or funding to take on this additional workload. To illustrate the magnitude of this workload, Orange County Environmental Health Division staff recently determined the development and implementation of a food facility grading program in their county would increase costs by approximately $528,000 during the first year and $344,000 during subsequent years. C-16 It would be beneficial for EHSs to issue self-inspection checklists to restaurants, similar to the ones used in San Diego County. Response: Disagree. See response to Finding F-40.

The EHD maintains a website (www.ventura.org/rma/envhealth) on which it posts summary inspection data. Restaurant closures and re-openings are also posted. Some Grand Jurors found this site difficult to navigate. Response: Concur in part. We agree that restaurant closures and re-openings are posted on the EHD website. However, a complete listing of the violations found on food facility inspections is also posted on this website, not just a summary.

There are from between 5 and 90 visits to the above website daily with the normal range between 30 and 40. Response: Concur.

There are 18 authorized EHS positions, four of which were filled in 2008; placing the division at full staff. In early 2009, one of the EHSs was promoted, creating a vacancy. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 Response: Concur.

All EHS positions require a college degree in the appropriate sciences and are California State Registered Environmental Health Specialists. Response: Concur.

The primary function of the EHS is to ensure that restaurants and other food providers meet the requirements of the Cal Code. [Ref-01] Response: Concur.

The average inspection takes one to two hours and only reflects the condition at the time of the inspection. Response: Concur in part. The average restaurant inspection takes 2.31 hours.

The BOS has defined a goal of three routine inspections per year for each restaurant. During the last several years, with only 14 EHSs, the EHD has been achieving about one inspection per year per restaurant. Response: Concur in part. We agree that the BOS has defined a goal of three routine inspections per year for each restaurant. We also agree that EHD has not been fully staffed in recent years and therefore has been unable to meet this goal. EHD has, however, conducted more than one inspection per restaurant per year in 2006, 2007, and 2008. Data regarding the number of routine and follow-up inspections conducted per quarter from October 2005 through May 27, 2009 was requested and provided to the Grand Jury. As reflected in Findings16 and 17, and based on the 1,900 restaurants as stated in Finding F-01, more than one routine inspection was conducted annually and 40% of the restaurants received a follow-up inspection.

The EHD has not determined whether 18 EHSs are sufficient to achieve three routine restaurant inspections per year. The EHD stated that it will re- evaluate its staffing needs after a year of experience with full staff. Response: Concur.

Each EHS has a defined region to cover, typically working a two-week 80- hour schedule, nine out of ten days. Response: Concur. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09

EHSs start their day at the Government Center to complete various office activities prior to picking up their County car and proceeding to their region for inspections. The car is returned at the end of each day. Response: Concur in part. On June 15, 2009, EHD opened and staffed an office space in the East County Courthouse complex in Simi Valley. EHD staff that are assigned to geographic districts in the East part of the County now start their day, and pickup and return their County car at the East County Office.

EHSs are also responsible for enforcement of the California Sherman Act. This law requires menu accuracy and other similar items. The EHD stated that this is a low priority activity and enforcement is usually reactive in response to citizen complaints or a blatant violation. Response: Concur in part. EHD is authorized by the State Department of Public Health to enforce portions of the Health and Safety Code entitled the Sherman Food, Drug and Cosmetics Act that relate to truth in menu, labeling and advertising of food in retail food facilities. However, enforcement is proactive, not "reactive" as suggested in the report. Menus, labels, and advertising are reviewed as part of the inspection and violations are noted on the report. Enforcement activities are generally only undertaken when the violation is not corrected or in conjunction with regional or Statewide action involving corporate chain facilities.

Cal Code requires that food served in public establishments must be obtained from approved sources. Ensuring compliance with this law is also part of the EHS's responsibilities. Response: Concur.

EHSs are also responsible for public swimming pool inspections. Response: Concur.

In 2008, there were 2,551 routine restaurant inspections, 1,354 restaurant re-inspections, and approximately 100 closures. Response: Concur.

Quarterly data on restaurant inspections from the last five years shows a consistent pattern of about 40% re-inspections and 4% closures. Response: Concur.

Inspection frequencies are variable and unannounced. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 Response: Concur.

The County uses a pass/fail system for restaurant inspections and, except for closures, issues a "passed" placard that identifies the date of inspection, and the name of the inspector. The placard also shows the EHD website where inspection results are available and the EHD phone number. (Att-01) Response: Concur in part. The placard also states that a copy of the inspection summary report is available at the facility. The Food Code requires that a notice be posted that informs the consumer that inspection results are available for review at the facility. The placard allows the facility to post one document to meet state law and to provide the public with information. Facilities in counties that post grade cards have to post an additional document to comply with State law.

Placards must be posted in public view within the establishment and inspection results must be made available, if requested. Response: Concur.

The County's re-inspection procedures and protocol are: restaurants subject to closure will be re-inspected as soon as the problem is corrected; most closures last less than two days when there are a number of violations, but not enough to warrant immediate closure, a re-inspection is scheduled with instructions of what must be done to bring the restaurant back into compliance a "passed" placard is issued with no indication that a re-inspection is required if a second re-inspection is still unsatisfactory, a letter is sent strongly delineating what must be done non-compliance after a third re-inspection results in a hearing and possible closure a "passed" placard remains in place throughout this process Response: Concur in part. EHD concurs with the first bullet. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 EHD disagrees with the second bullet. The Grand Jury incorrectly implies that there are a prescribed number of violations that warrant closure of a retail food facility. In fact, closure is determined by the public health threat associated with a specific violation or violations observed during an inspection. We also disagree with the Grand Jury's implication that a prescribed number of violations automatically results in a follow-up inspection by EHD staff. Actually, follow-up inspections are conducted for a variety of reasons including the seriousness of a violation or violations noted during a routine inspection, construction, changing equipment, modifying menus, and consultation requested by the owner/operator. EHD concurs with the third bullet with the following comments: 1. At the conclusion of each passed inspection, a new placard, inspection report, and summary report are issued. Re-inspection information is provided when applicable on the inspection and summary reports available at the food facility. Violations noted on follow-up inspections are posted on the EHD website. Based on the concern brought by the Grand Jury, when a follow-up inspection is warranted, a notation that a re-inspection is required will be posted along with the violations noted on the inspection. 2. It is noted that grading systems such as the Los Angeles County system do not provide reinspection information. EHD does not concur with the fourth bullet. Depending on the nature of the uncorrected violations, EHD staff will either immediately suspend the facility permit to operate, issue a Notice of Violation, take other appropriate enforcement actions such as impounding equipment and embargoing food, schedule a hearing, schedule a re-inspection, or, for very minor violations, review compliance status at the next routine inspection. EHD does not concur with the fifth bullet. See response above. EHD does not concur with the last bullet. As noted, a new placard and summary report is issued at each inspection.

The EHD does not currently assign numeric values (points) to the various elements of the inspection process. Response: Concur.

The EHD uses the Envision System from Decade Software for restaurant inspections. This software will support a point value system. Response: Concur

The EHD is in the process of assigning numeric scores for specific violations. This is planned to be completed by September 2009. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 Response: Disagree. EHD is not in the process nor has any plans of assigning numeric scores for specific violations.

Each EHS uses a laptop computer to input observations during inspections and print out the results on site for review with the owner or manager. This information is later uploaded to the Envision System on the EHD server. Response: Concur.

The EHD plans major Envision System upgrades, estimated by June 2009. This will give EHSs wireless capability to connect to the EHD server from the field. Response: Concur. The Envision upgrades are estimated to be installed by September 2009.

Public complaints regarding a restaurant's sanitary condition result in an immediate investigation by EHD. Response: Concur.

During a Grand Jury inspection observation, it was noted that a number of adjacent restaurants were in different inspection districts. Response: Disagree. Adjacent food facilities are not located in different inspection districts. Food facilities are grouped into geographic districts to ensure equal and efficient workload for inspection staff. Streets, roads, and highways are often used to define the boundaries of inspection districts. Additionally, the cities of Oxnard, Simi Valley, Thousand Oaks, and Ventura have multiple inspection districts due to the number of food facilities located in these cities. Although the district boundaries are carefully drawn to avoid food facilities being on opposite sides of a boundary and thus being in different districts, there are a few examples in the cities with multiple districts where this is the case. We also believe Grand Jury members may have observed inspection placards in adjacent food facilities that were issued by different inspectors and assumed these facilities were in different districts. In fact, the usual reason for this situation is that multiple inspectors are at various times assigned to perform inspections in unstaffed districts, which results in inspection placards being issued by different inspectors until permanent staffing is restored. This was explained to several Grand Jury members during our interviews.

Cal Code requires that each food establishment have one employee or the owner be certified in food handling and sanitation. [Ref-01] McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 Response: Concur.

The County may impose more stringent standards than Cal Code requires; each city in the County may accept or reject the more stringent requirements. Response: Disagree. The State Food Code (Health and Safety Code (HSC) Section 113705) expressly precludes counties and cities from imposing more stringent requirements related to retail food facility health and sanitation standards. It is noted that the Food Code (HSC Section 113709) also authorizes county boards of supervisors and/or city councils to adopt at their discretion evaluation or grading systems for retail food facilities operating in their respective jurisdictions. However, locally adopted requirements associated with such systems cannot alter the health and sanitation standards set forth in the Food Code.

Fifteen cities in Los Angeles County (L.A. County) did not initially adopt the "A B C" grading system when instituted in 1998. Currently, all of these cities have adopted this grading system. Response: Disagree. The cities of Long Beach, Pasadena, and Vernon have Environmental Health departments independent of Los Angeles County and do not post grades in retail food facilities. It is our understanding there are currently eight other cities in Los Angeles County that have not adopted the grading ordinance.

After the initiation of the grading system, the L.A. County Department of Public Health (DPH) reported a 13% decrease in hospital admissions for food- borne illness. State-wide levels remained constant during the same time frame (1993-2000). [Ref-02] Response: Concur in part. An examination of the State Health Department report concerning foodborne hospital admission rates for the time period of 1995-1999 revealed that foodborne illness admission rates for all of California dropped 27% from 4.1 to 3.0 per 100,000 population.

The most common causes of food-borne illness in restaurants are: [Ref-03] poor personal hygiene (hand washing, etc.) improper holding temperature ٠ food from unsafe sources Response: Concur.

Many counties in California and other parts of the country have adopted rating systems using numerical scoring on the basic elements of the inspection requirements. [Ref-03 through Ref-05] Response: Concur in part. In a statewide survey conducted in 2002, only 19 of the 62 (30%) county and city environmental health agencies indicated that they rate, score, or grade food facilities. Of these, only 5 issue letter grades.

While L.A. County's grading system has been used as a model for many jurisdictions, other variations and approaches are used to establish rating or awards of excellence. [Ref-03] Response: Disagree. It is an over-statement to say that "many" counties have adopted grading systems modeled after Los Angeles County's system. Since Los Angeles County's grading system was implemented in 1998, only Kern and San Bernardino Counties have adopted ordinances requiring posting of letter grades. Seven other counties and cities have adopted substantially different posted public notification systems: Ventura, Monterey and Orange Counties post an inspection placard, Sacramento and Merced Counties post color coded placards, and San Francisco and Long Beach post an inspection report/summary.

In the last few years, numerous studies have been conducted about the effect of rating systems on restaurant sanitation. A recent study by the Center of Science in the Public Interest (CSPI) was issued in August 2008. All of these studies concluded that restaurants are cleaner and that there are health benefits to the public attributable to restaurant grading systems. [Ref-02, Ref-05] Response: Disagree. The CSPI study results cited actually found that Las Vegas, one of the two cities included in the study which posts grade cards, to have a greater severity of violations found on inspections (risk factors for foodborne illness) than 12 of the 20 other cities studied. St. Louis, the other city included in the study which posts grade cards, was higher than 4 of the 20 cities. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 Furthermore, the City of Wichita, Kansas did away with a 30-year-old grading system because they felt it gave patrons a false sense of security. The City of Wichita Environmental Services Department, like Ventura County, now provides access on their website to more complete inspection information that is specific to the violation.

In January 2008, the DPH issued a ten-year status review of its grading system to the L.A. County Board of Supervisors. This report concluded that public health had improved, public information on restaurant conditions was improved, and most importantly, restaurants were cleaner. [Ref-02] Response: Concur in part. When Los Angeles County began its restaurant grading system, it also implemented several other program enhancements that may have lead to the noted improvements. The County increased inspection staff, enhanced training for staff, increased the number of inspections performed, created a risk-based approach to inspection priorities, increased public access to inspection results through the County website, and increased industry education relating to safe food handling practices. Each of these actions on its own could lead to improved inspection results. It would be unsupported and likely inaccurate to claim that posting grading placards was the sole cause of the improved inspection results.

The DPH has also noted that, as a result of the grading system, restaurants shifted from a reactive approach to violations to a proactive approach in order to achieve higher grades. [Ref-02] Response: Disagree. As detailed in the referenced report, a major component of the Los Angeles County grading system was working with restaurant and retail market owners to ensure they have the knowledge and capacity to maintain safe and clean facilities. Concurrent with the adoption of letter grading, the Los Angeles County Board approved an action plan requiring restaurant managers and workers to participate in a food safety training program. Starting in 1999, at least one individual who has successfully completed the four-hour Certified Food Handler training program is required by Los Angeles County to be on duty while the establishment is open to the public. Similarly, beginning in January 1999, a new State law required that food facilities throughout California that prepare, handle, or serve non-prepackaged potentially hazardous food have an owner or employee who has passed an approved and accredited food safety certification examination. There is currently legislation that would require that every restaurant employee be certified. Since January 1999, Ventura County EHD staff has verified during inspections that there is a certified individual at each facility where required by State law. In our view, this education component of the food inspection program has contributed more than any other component to improving the proactive nature of food facility owners and operators. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09

Economists Leslie and Jin reported in 2003, in the Quarterly Journal of Economics, that incentives work. Grading systems forced restaurants to improve because lower-graded establishments lost business while the highest-graded places gained customers. Response: Disagree. The referenced report related grading to revenue, not numbers of customers. The findings, based on revenue data covering two years before and one year after the grade cards, were that, restaurants obtaining an A-grade obtained an average of 5.7% higher revenue than before grade cards. For B-grade restaurants, there was a 0.7% increase, and for C-grade restaurants, revenue decreased by 1.0%. It was noted that during the one year that the grade cards were initiated, there was a general trend of increasing revenue for all restaurants. EHD is not aware of any follow-up or current information regarding the long term effects of grading on revenue. A Los Angeles Times article dated September 28, 2005, reported that in the San Gabriel Valley, home to the nation's largest Chinese American community, the letter-grade system is often viewed as little more than a minor intrusion on a proud cuisine - if diners consider it at all. According to this article, restaurants with C-grades are filled with customers.

In San Diego County, EHSs issue a Self-inspection Checklist to each restaurant as part of the routine inspection procedure. (Att-02) Response: Disagree. According to San Diego County staff, the Self-Inspection Checklist attached to the report is part of an Operator Guide that is given to each restaurant when a new permit is issued. The checklist is not handed out at all routine inspections. San Diego County advises the restaurant to use their inspection report as a self-inspection checklist. Ventura County EHD staff also provides this advice.

A random survey conducted by the DPH in 2001 showed that over 91% of the 2,000 respondents liked and used the grading system. A follow up survey of 8,600 respondents in 2005 showed similar results. A national survey in 2007 conducted by the CSPI showed comparable results. [Ref-02, Ref-03] Response: Disagree. The 2001 survey results referenced by the Grand Jury indicated that only 65% of respondents were influenced in their selection of food facilities by letter grades always or most of the time. The national survey in 2007 referenced actually found that 50 percent of consumers said that a letter grade synopsis of the most recent inspection results posted in a restaurant window would be most useful to them in deciding where to dine. This survey also found that 85 percent of respondents said that knowing the results of a restaurant's most recent health inspection would affect their decision of McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 whether to dine at that establishment. Ventura County's posting of the placard, availability of the summary report at the facility and availability of inspection results on line provide the consumer with ready access to the results of a restaurant's most recent inspection. CONCLUSIONS C-01 No system of restaurant inspections is of any value unless it is properly staffed with EHSs who are competent, properly educated, and motivated. The Grand Jury concludes that the Ventura County EHD meets these criteria. Response: Concur. C-02 The ultimate responsibility for restaurant food safety rests with the management of the establishment; they must ensure employees are properly trained and follow the highest food safety standards at all times. Response: Concur. C-03 The first priority of the EHD is to ensure that restaurants and other food providers throughout the County are sanitary and safe for the dining public. Response: Disagree. The first priority of the EHD with respect to retail food facilities is to ensure compliance with applicable sections of the Food Code so that public health is safeguarded and consumers are provided food that is safe, pure, and unadulterated. C-04 The pass/fail system used by the EHD ensures an acceptable level of sanitation is achieved to meet State requirements. Meeting State minimum requirements, by definition, means the restaurant is safe for the dining public. Response: Concur with the following comments. EHD staff's responsibility is to determine if a food facility complies with the requirements of the Food Code. It is unclear what the Grand Jury means by the terms "level of sanitation" and "safe." EHD staff assures a retail food facility complies with the Food Code section 113980, which states: All food shall be manufactured, produced, prepared, compounded, packed, stored, transported, kept for sale, and served so as to be pure and free from adulteration and spoilage; shall have been obtained from approved sources; shall be protected from dirt, vermin, unnecessary handling, droplet contamination, overhead leakage, or other environmental sources of contamination; shall otherwise be fully fit for human consumption; and shall conform to the applicable McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 provisions of the Sherman Food, Drug, and Cosmetic Law (Part 5 (commencing with Section 109875)). When an inspector completes an inspection and determines that the facility operation is substantially in compliance with the Food Code requirements, a placard is issued that indicates the facility passed the inspection on that date. If an imminent health hazard is found during an inspection that can not be immediately corrected, the facility "fails" the inspection, the permit is suspended and the facility is closed until that hazard can be corrected. C-05 Grading systems provide incentives for a restaurant to maintain more than the minimum level of sanitation; the pass/fail system does not. Response: Disagree. We are unsure what the Grand Jury means by "minimal level of sanitation." In our view, Food Code Section 113980 (text included in response to C-04) describes the standards under which food is to be stored, prepared, cooked and otherwise handled. We are unaware of any documentation that grading systems provide incentives for food facilities to exceed Food Code Section 113980. In fact, in the five California counties that currently post grades, food facilities can maintain an "A grade" while violating Section 113980. C-06 The Grand Jury agrees with most professionals in this field, that a cleaner more hygienic environmental benefits the public. Response: Concur. C-07 The Grand Jury concludes that the EHD's second priority should be consumer notification of actual restaurant sanitary conditions. The EHD needs to improve in this area. Response: Disagree. We cannot agree with this conclusion without knowing what the Grand Jury means by "actual restaurant sanitary conditions." Moreover, EHD provides information to consumers about the compliance status of food facilities through issuance of a placard, posting closure and re-opening information on the EHD website, and providing inspection reports that are available for public viewing at each food facility as well as online. C-08 The EHD website does not provide a sufficiently clear, easy, and direct path to restaurant inspection information. Response: Disagree. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 There are two links on the EHD home page that quickly link to restaurant inspection information. The first link is the Restaurant/Food Facility Compliance Status & Closures which is one of eleven clearly listed "buttons" under Environmental Health Updates. The second is on the Quick Links pull down menu under Restaurants and Markets. The link to the Inspection Results has its own icon on the top of the Consumer Food Protection program page. EHD has been informed by numerous individuals that they check on the compliance status regularly: and no one has indicated that they have difficulty finding the information. The link has been published numerous times in the Ventura County Star also. Based on our latest review, approximately 106,000 people have accessed the web site information over the last year. C-09 The placard is the consumer's primary source of information concerning a restaurant's most recent inspection. Response: Disagree. The placard (see enclosure) provides information about the most recent inspection, including the date and name of the inspector, which a letter grade does not provide. The placard primarily provides the consumer with information about the availability of the most recent inspection report at the facility and on-line. C-10 The dining public would be better served if the County had a system that incentivizes restaurants to shift to a proactive stance on sanitation. Response: Disagree. Ventura County's retail food regulatory program provides incentives to owners/operators to maintain a proactive stance regarding Food Code compliance. No owner/operator wants public disclosure that their food facility was closed by EHD. In addition, no owner/operator wishes to have any negative inspection results posted on the EHD website. Additionally, for over ten years, EHD staff has been offering free food handler training emphasizing the proactive approach. This training has been well-received by industry. For example, from January 1, 2009 through July 31, 2009, 276 employees attended this training. C-11 Adding numerical scoring to the EHDs basic inspection procedures for restaurants will provide the department metrics with which it can determine trends and track past performance. The Envision software program used by the EHD fully supports adding numerical scoring. Response: Disagree. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 This statement inappropriately suggests that the EHD does not currently determine trends and track past performance using the current version of Envision. Reports are readily available to identify current and historical trends related to the violations observed during inspections and are used to determine when administrative enforcement is appropriate. These reports are also used to review inspector performance and evaluate consistency in citing violations. Reporting on each violation individually provides more accurate metrics than numerical scoring. C-12 The planned upgrade to a wireless connection of the laptop computer can reduce the number of required visits to the County Government Center. It is inefficient to have all EHSs report daily to the Government Center for their assignments and to pick up their County vehicles. Response: Disagree. We disagree that wireless connections for laptop computers will reduce the number of required "visits" to the County Government Center. Generally, inspectors are required to report to their assigned work site at either the Government Center or East County Courthouse at the beginning and end of each work day. This enables staff to receive training and direction, respond to public inquiries, prepare and file reports, and perform vehicle permit inspections. C-13 A review of the recently redrawn inspection district boundaries may yield additional efficiencies. Response: Disagree. See response to finding F-28. C-14 The dining public will be better served if, prior to entering a restaurant, they could see a placard that gives more definitive information on the sanitary condition as of the last inspection. Response: Disagree. Not all restaurants have entrances that allow for placard posting that is visible from the outside of the facility. Moreover, the placards issued by EHD staff provided definitive information including that the food facility passed the inspection, the date of the inspection, the name of the inspector, and directions for accessing the details of the inspection history of the facility. C-15 The EHD has the tools to develop an incentive/performance/graded rating system. Response: Disagree. McKinns/GrandJury/Comm Svcs Resp to Grand Jury-Grading 10 1 09 It is erroneous to assume EHD has the "tools" to develop an "incentive/performance/graded rating system" simply because EHD uses a software program that can support a point value system (see responses to findings F-23 and