📋
Extracted from Consolidated Report

This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.

Santa Cruz County Grand Jury • 2007-2008

The Road to Compliance

Published: March 29, 2007 36 pages
View PDF View Full Original

Findings 30 findings

F1 Page 39
Conclusions 2. Since the most pressing concern today is from where the money will come to maintain Medicare and Medicaid services for those who qualify under today’s system, extending it to include low-income families is not being discussed. 3. Santa Cruz County public, non-profit, and for-profit medical resources have worked together to make health care more accessible to low-income families. Commendation 1. The Human Services Department and the Health Services Agency are to be commended for ongoing focus on the delivery of adequate health care services to Santa Cruz County residents. Health Insurance Coverage 2000-2001 Grand Jury Recommendation 3: The Healthy Families Program should include parents in its coverage. Premiums should be set at more affordable levels in order to accelerate enrollment of families without insurance. Coverage should be maintained during short periods of seasonal unemployment. The Central Coast Alliance for Health should approach local employers to continue premium payments for families during short periods of seasonal unemployment to keep insurance coverage from lapsing. It should continue to expand the participation of specialists in its programs. County Response: This recommendation has been implemented. 2007-2008 Grand Jury Findings 12. The Healthy Families Program does not include parents in its coverage. Healthy Families insurance premiums vary depending on the health plan selected. Families receive a discounted premium if they select the local Community Provider Plan, which is the Central Coast Alliance for Health (the Alliance) in Santa Cruz County. The Alliance’s maximum monthly premium for a family with three or more children is $36 (or $108 per quarter). 13. Recent local funding contributions to the Healthy Kids program, which came primarily from Sutter Santa Cruz and Dominican Hospital, will allow the Alliance to move 295 children off the waiting list and into enrollment. 14. Seasonal unemployment only affects the eligibility of adults in a family receiving Medi-Cal. The Alliance reports that their Medi-Cal membership fluctuates by about five percent each year according to the growing season and migration of Medi-Cal recipients out of the area. Typically, a seasonal employee becomes eligible for Medi- Cal when the work season ends or slows down because the worker’s income A Promise Kept 29 2007–2008 Santa Cruz County Grand Jury Final Report decreases. When an individual’s work hours increase again, Medi-Cal eligibility could be lost due to the corresponding increase in income. Thus, an individual may qualify during periods of little work or unemployment but no longer qualify for Medi- Cal when working full-time. 15. Medi-Cal has no provision for continued eligibility if an adult no longer meets the criteria. However, children can maintain Medi-Cal eligibility for 12 months even if the adults in the family are terminated due to an increase in income or assets. 16. Although families pay no premiums for the Medi-Cal program, there are premiums associated with the Healthy Families and Healthy Kids programs. However, regardless of changes in family income, once a child is deemed eligible for Healthy Families or Healthy Kids, that child remains eligible for 12 months unless he or she becomes eligible for no-cost Medi-Cal, is covered by other health insurance, or turns 19. Children also lose Healthy Kids eligibility and coverage when they move out of Santa Cruz County. 17. In 2000, the Santa Cruz County population was 255,602. In 2007, the population increased slightly to an estimated 264,125 (3.3 percent). But the supply of health care specialists for Alliance programs has increased by almost 30 percent since that year. In 2000, the Alliance had an average of 499 specialists available to serve Santa Cruz County residents. As of March 2008, 697 specialists are available. 18. The Alliance collaborates with over 60 community coalitions and organizations to promote its programs, including the Santa Cruz County Human Services Department. It also promotes health care resources to the public at events, such as farmers’ markets, health fairs, community block parties, and other festivals. In addition, the Alliance publishes a provider bulletin in which providers are urged to encourage their Healthy Families and Healthy Kids patients to stay enrolled and thereby continue their health care coverage. 19. In March 2008, at California’s annual Medi-Cal Quality Conference, Central Coast Alliance for Health tied for first place with Health Plan of San Francisco, winning the Gold Award for the highest rate of preventive care services among all 39 Medi-Cal health plans in California. The Alliance also won a second place Silver Award for member satisfaction. Conclusions 4. Because Healthy Families is a state and federally funded health plan, Santa Cruz County cannot change the eligibility requirements for the program. 5. The 2000-2001 report recommended, “Coverage should be maintained during short periods of seasonal unemployment.” But, in fact, qualifying seasonal workers are covered while unemployed. They risk losing coverage when employed because their income may exceed guidelines. That issue has not been addressed by Medi-Cal or any county agency. 6. A public/private partnership exists in the county to provide affordable access to health care for low-income individuals and families. A Promise Kept 2007–2008 Santa Cruz County Grand Jury Final Report
F2 Page 13
County code violations do not always result in enforcement action. • The Planning Department documents some violations but does not enforce them, for example, violations of residential property fence height limits. Response from the County: PARTIALLY AGREES. In certain, limited situations such as side or rear yard fences that are slightly over the maximum height, no enforcement action is taken due to workload/caseload issues. Enforcement action for other minor violations may be limited to the issuance of a Notice of Violation (Red-tag) and recordation of the Notice of Violation on the property title. The Notice of Violation must be addressed when the property is sold or refinanced or when a permit is required for something else. • Some enforcement decisions are based upon Board of Supervisors’ policy, such as the 2002 board policy specifying that structures built pre-1980 without permit will not be subject to enforcement. Response from the County: PARTIALLY AGREES. This policy directive is followed, but pertains solely to non-habitable structures. • “No enforcement” is one complaint classification category in HANSEN®. Between March 29, 2007, and February 7, 2008, 11 percent of “no enforcement” decisions were based on policy adopted by the board; the remaining 89 percent were decided within the Planning Department without clear policy guidelines. Response from the County: DISAGREES. A portion of these “no enforcement” designations were open Service Requests (complaints) that had not yet been resolved. The Code Compliance staff initially selected “no enforcement” in the Hansen system for complaints that did not immediately result in the issuance of a Notice of Violation. It is common for a Code Compliance Investigator to conduct a site inspection and need to perform additional review of office records before determining whether, in fact, a violation exists. The remainder of the Service Requests referred to were actually resolved, with no further action, using the “no enforcement” designation. During the deliberations that ultimately led to adoption of the policy regarding structures built without permits prior to 1980, the Planning Department informed the Board that there is a category of violations that are so minor that no enforcement action on the part of the County is warranted. Planning Department management staff is involved in the decision-making process for each of the Service Requests that result in resolution using the “no enforcement action” coding. Examples of these determinations include side or rear yard fences that are a few inches over height, or a minor setback encroachment of a deck that would not otherwise require a Building Permit. Code Compliance Enforcement 3 2007–2008 Santa Cruz County Grand Jury Final Report
F3 Page 14
There is no formal policy requiring county building inspectors or code compliance investigators to report code violations they might chance upon. • The City of Watsonville requires home maintenance compliance, and its inspectors report violations they happen to see. • The City of Santa Cruz expects its staff to report obvious violations it encounters as a matter of policy. Response from the County: DISAGREES. The Planning Department Procedures Manual contains a Section related to the reporting of code violations by staff. That procedure, established in 2006, requires that certain types of violations be reported to the Code Compliance Section if encountered by any departmental employee during the course of their work. These include obvious and serious health and/or safety violations, significant environmental violations, and construction in-progress. The procedure contains specific definitions to provide further guidance to staff related to filing a code compliance complaint.
F4 Page 14
After a party files a complaint and receives an initial acknowledgement letter, the complainant is responsible for future contact with the Planning Department to determine the status of the violation.
F5 Page 14
It appears to be technically feasible to access the public information contained in the code violation database and there is a plan to implement public online INCOMING COMPLAINTS (by type) access before the end of 2009. 50.0% Currently, members of the public wishing to learn the status of a code violation must telephone or visit the 40.0% Planning Department. Response from the County: AGREES. 30.0%
F6
The code compliance staff fields roughly 750 incoming complaints 20.0% annually. About 300 of the complaints require continuing 10.0% extensive investigation and action. These represent approximately 40 percent of the total; the other 60 0.0% BUILDING ZONING VIOLATIONS ENVIRONMENTAL REFERRALS percent are either found to be invalid VIOLATIONS VIOLATIONS or are referred to another agency for appropriate action.
F7 Page 14
Each of the four full-time and one half-time code compliance investigators averages 66 new complaint investigations per year (not including those classified as “no violation,” “no enforcement action,” or “referred to other agency”), or fewer than two each week.
F8 Page 14
The code compliance group has positions for one typist/clerk, one planning technician, five code compliance investigators, and a principal planner. Additional assistance may also be provided by county financial and legal staff. Code Compliance Enforcement 2007–2008 Santa Cruz County Grand Jury Final Report
F9 Page 15
Earlier this year one investigator worked half time assisting the Planning Department’s understaffed fiscal section.
F10 Page 15
One additional investigator position has been funded but will not be filled during 2008; funding for this position for 2009 is not guaranteed.
F11 Page 15
Staff responsible for data entry works part time performing Planning Department receptionist duties.
F12 Page 15
To help reduce the overall workload, follow-up with complainants is generally limited to a single written acknowledgment that the complaint has been received. Also the Planning Department does not take any enforcement action against some low-priority violations or investigate anonymous complaints. Response from the County: PARTIALLY AGREES. In addition to the written acknowledgment of the complaint, code enforcement staff frequently answer questions from complainants about the status of a case throughout the enforcement process. In addition, our Compliance-by-Mail Program requires the original complainant to verify that a violation has been in fact been resolved following receipt of a declaration from the property owner stating that the violation has been corrected. Planning staff makes contact with the complainant to verify resolution. Staff is also investigating whether it will be possible, within the Hansen system, to allow complainants to access the status of their code complaints on-line.
F13 Page 15
Compliance-by-mail form letters are sent to violators asking for voluntary cooperation in correcting some low-priority violations. Violators comply by returning a signed Declaration and Affidavit of Correction. Investigators may subsequently perform an inspection to confirm compliance. Violations currently handled this way include illegally inhabited mobile homes or campers, or people keeping too many cats or dogs. Compliance-by-mail was used in two percent of the complaints reviewed by the Grand Jury.
F14 Page 15
Despite two requests, the Grand Jury was not provided with precise data describing the size of the backlog of unresolved code compliance complaints or the rate at which this backlog is growing. One estimate provided was that for every 100 complaints entering the system 80 were being resolved, leaving 20 to accrue to the existing backlog. Based on this estimate and the annual number of complaints, the backlog of unresolved complaints would grow by about 150 a year. Response from the County: DISAGREES. We believe that the Department has now provided all information requested by the Grand Jury related to their investigation. There was an initial misunderstanding as to whether such a request was related to code compliance cases that reside in the older, ALUS system or in Hansen. Information on this topic of the backlog does exist for both systems and has since been provided to the Grand Jury. There has been a dramatic reduction in the number of unresolved cases since the beginning of 2008 due, in large part, to the audit of the department’s records related to the transition to the Hansen system. In addition, the department has implemented a systematic strategy for addressing the backlog and is confident that further reductions will occur. Code Compliance Enforcement 5 2007–2008 Santa Cruz County Grand Jury Final Report
F15 Page 16
There are many rules built into the current code violation resolution system that allow violators to delay complying with code requirements. Examples: • It may take six weeks or more to get on the calendar for a protest hearing. • Once the hearing is scheduled, the violator has the right to delay the hearing once. • During the hearing, a violator may request a continuance, which the judge will usually grant.
F16 Page 16
In 2003, the Planning Department committed to the Board of Supervisors to develop written procedures for using the HANSEN® system. The code compliance group has established process mileposts and created a detailed flow chart, but there is no employee procedures manual for handling complaints. Response from the County: DISAGREES. The Grand Jury was provided with a high level summary page that represents the milestone flow within the Code Violation case type. This summary page was excerpted from a detailed user’s manual that guides users through each milestone of a code case, from intake to completion. This manual, over 120 pages in length, was developed in July of 2007 and was distributed to each of the Code Compliance staff to assist them in their transition to using the Hansen system.
F17 Page 16
Except for a single summary report, the HANSEN® system was not generating data management reports as of March 1, 2008.
F18 Page 16
The Planning Department has requested at least 12 data management reports. As of April 11, 2008, only six of the reports originally requested the previous December were completed. Response from the County: PARTIALLY AGREES. Initially, the development of management and other system reports was a joint undertaking by the Planning Department and the County Information Services Department. However, after several months, it became clear that the development of these reports required a stronger technical background, and the Information Services Department took the lead in getting these reports into production. This resulted in some delays, but that has since changed. The Planning Department has been working closely with the Information Services Department on the development of numerous reports utilizing the information contained within the Hansen system. These reports fall into three categories: letters and forms generated by the system, information related to Service Requests, and information related to Cases. To date, seventeen of these reports have been developed and are in use. Of these, nine fall into the category of “data management reports.” The remaining reports will be completed by Fall of 2008. In addition to these programmed reports, a great deal of management information can be generated on- demand using Hansen’s search and reporting function that are built into the software.
F19 Page 16
The Planning Department has not asked for a routinely-generated report listing unresolved cases chronologically, with the oldest first. Code Compliance Enforcement 2007–2008 Santa Cruz County Grand Jury Final Report Response from the County: DISAGREES. It is true that the department does not get a listing of unresolved cases by the age of the case, because that is not how the caseload is managed: the oldest cases are not necessarily the most important. The department does track cases to ensure that appropriate actions are taken at the various stages of the enforcement process. The Planning Department receives reports for various milestones within the Hansen system to ensure that cases are moving forward according to their established business practices. The department receives reports listing unresolved Service Requests to ensure that new complaints do not remain open ended. The department has requested a report listing cases where a red tag has been issued and the Notice of Violation has not been recorded on the property title within 35 days of the mailing of that Notice. Similarly, the department has requested a notification report when 60 days have elapsed since recordation of the Notice of Violation and that, if the violation has not been corrected, a stipulation must be developed and sent to the property owner specifying required compliance periods and penalties. Finally, the department has requested a report indicating the current milestone of all cases and number of days spent in that milestone. The report will be able to be sorted in any number of ways, including chronologically.
F20 Page 17
The Grand Jury reviewed 100 consecutively numbered complaints (spanning entry dates between August 10 and September 27, 2007) and found the following: • Almost 30 percent of them were incorrectly coded. • Nearly 18 percent of the complaints had activity dates earlier than the entry date. These differences mean that work was performed on the complaints before their entry into the HANSEN® system. The largest discrepancy between entry date and the activity date was more than two months. • The Planning Department received more code violations than it resolved. After six months, unresolved complaints outnumbered resolved complaints by 50 percent.
F21 Page 17
In April and May of 2008, the Planning Department presented several code change proposals to the Board of Supervisors. Some were approved and others were tabled for further study and discussion. While major focus of the changes was on rules for building second units, among the approved changes were several that are intended to reduce the burden on code enforcement by eliminating requirements judged unnecessary. For example, the County now intends to • exclude most demolition from requiring Coastal Commission approval. • allow installation of solar energy systems in the coastal zone without a discretionary permit. Conclusions
F22
Although with careful scrutiny the whistleblower program link can eventually be located, many people have difficulty finding it on the county’s website. Typing “whistleblower hotline” into the search box results in “no matches.”
F23 Page 42
The budget for fiscal year was $403,000. First 5 funded $300,000, and the Coalition hopes to receive the additional $103,000 from Medi-Cal Administrative Activities.
F24 Page 42
The County works as a middleman for both sources of Coalition funding. Medi-Cal Administrative Activities
F25 Page 42
During the month of September, the Coalition completes a “time survey” to establish the annual cost of outreach activities in excess of what First 5 already pays. The federal government agency Medi-Cal Administrative Activities is billed that excess cost. The turnaround for payment is generally about three years.
F26 Page 42
The County supports various organizations associated with the Coalition throughout the year and receives the money from Medi-Cal Administrative Activities. Many 32 A Promise Kept 2007–2008 Santa Cruz County Grand Jury Final Report variables determine what work is being done and how it is being claimed. On average, the Coalition received approximately 75 percent of what they predicted in their budget from Medi-Cal Administrative Activities. The County then funds the remaining budget. First 5 California
F27 Page 43
The State of California retains 20 percent of the money First 5 receives, and 80 percent is distributed to the 58 counties throughout California based on the number of children born in the county. Santa Cruz receives approximately $2,700,000 annually.
F28 Page 43
First 5 has three established goals: healthy children, children learning and ready for school, and healthy families. Allowing for local decision-making, the First 5 Santa Cruz County Commission determines how to distribute funds based on a three-year strategic plan and annual contracts. Money provided to the Coalition by First Five has been designated as outreach funds.
F29 Page 43
First 5 reimburses the County for payments made to community agencies for contracted services.
F30 Page 43
In the fall of 2008, First 5 will create a new three-year strategic plan. This may or may not result in continued funds for the Coalition for Health Care Outreach. Conclusion

Recommendations 23