San Luis Obispo County Grand Jury • 2016-2017

Inal Eport San Luis Obispo County Grand Jury P.o. Box 4910 San Luis Obispo, California 93403

Published: August 08, 2017 120 pages Consolidated Report

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⚠️ Aviso de traducción: Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.

⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.

Findings 10 findings

Available and affordable residential detox services are necessary for delivering comprehensive substance abuse treatment in San Luis Obispo County.

The opening of the Haven provides needed detox services for County residents who are privately insured or can afford the high costs. 2 016-2017 San Luis Obispo County Grand Jury Final Report 16 Residential Detox

There are no residential detox services available in the County for those with limited financial resources or insurance through Medi-Cal or Medicare.

The County Jail provides physical detox to newly admitted inmates but fails to provide the additional psychological and social treatments and supportive environment essential for the first phase of addiction treatment: detox-stabilization.

There are some arrestees currently booked in the County Jail who would be more effectively served by a diversion program, like Law Enforcement Assisted Diversion, and/or receiving treatment in a residential substance-abuse facility.

There is a lack of integration in how medical and drug/alcohol services are provided at the County Jail.

The use of medication-assisted approaches for detox and addiction treatment at the County Jail is limited while other jurisdictions have been able to provide such treatments.

Logistical and environmental challenges at the County Jail make delivery of drug and alcohol treatment services difficult and inefficient due to placement of inmates with substance use disorders.

With the opening of the women’s jail, there is unused space in the honor farm which presents an opportunity for alternative program development.

F10

The homeless shelter has no clear plan as to how it will provide its long-anticipated detox beds/service. 2 016-2017 San Luis Obispo County Grand Jury Final Report 17 Residential Detox

Recommendations 10

R1

The County Health Agency’s Drug and Alcohol Services should resume its concentrated efforts to develop a residential detox service in the County to serve its Medi-Cal and less financially able citizens.
R2

The Board of Supervisors should direct the Sheriff and the Health Agency to evaluate the feasibility of and approach to repurposing vacated buildings within the County Jail’s honor farm as a residential detox service. A final report on the feasibility and if indicated the specific steps required to convert this housing to a substance-abuse residential and/or treatment facility should be completed by June 2018.
R3

The County Health Agency’s Drug and Alcohol Services should expand its County Jail programs, including individual and group counseling, to cover inmates who go through withdrawal protocols regardless of AB 109 status.
R4

The County Jail should revise inmate classification and cell assignment to take into account the inmate’s substance abuse treatment needs and interest in such when determining cell placement.
R5

The County Jail should house inmates interested and/or involved in drug and alcohol services in such a way as to create groups of addiction-treatment participants (e.g., units or pods) that allow for efficient delivery of treatment services; this includes separation from other inmates who interfere or disrupt treatment participation.
R6

The County Health Agency and Sheriff should integrate the functions of the jail’s medical and drug and alcohol service providers by locating their offices in close proximity and requiring coordinated care for inmates with substance use disorders. 2 016-2017 San Luis Obispo County Grand Jury Final Report 18 Residential Detox
R7

The County Health Agency should pilot the usage of medication-assisted treatments, i.e., Buprenorphine and Naltrexone, with a select population of opioid and alcohol addicts at the County Jail.
R8

The Board of Supervisors should evaluate the Law Enforcement Assisted Diversion program or a similar pre-booking substance abuse diversion for County implementation as a means of motivating and engaging young adult arrestees who are assessed to be primarily substance abusers and not criminally oriented. A written evaluation by the County Administrative Officer should be reviewed at a meeting of Board of Supervisors by June 2018.
R9

The San Luis Obispo City Council should evaluate the Law Enforcement Assisted Diversion program or a similar pre-booking substance abuse diversion for City implementation as a means of motivating and engaging young adult arrestees who are assessed to be primarily substance abusers and not criminally oriented. A written evaluation by the City Manager should be reviewed at a meeting of the San Luis Obispo City Council, by June 2018.
R10

The County Health Agency should direct its Drug and Alcohol Services to work with the board of the homeless shelter to develop a plan for operationalizing two detox beds in the yet-to- be-built Homeless Services Center, which could entail the DAS providing onsite outpatient detox services if other treatment options are not viable. This plan is to be developed prior to the opening of the center or by June 2018.

Conclusions 5

CL1

The Grand Jury completed an extensive investigation into the history, need, and future plans for residential detox services in San Luis Obispo County. This need has been apparent since 1982 when the detox unit at General Hospital closed its doors. The addition of the Haven last year reduces the need for those who can afford or have private insurance to cover the high costs. For those less fortunate, the county jail remains as a de facto detox facility and it is not an option for most residents in need. Addicts admitted to the jail experience services that are less than optimal. Jail staff and service providers have identified areas for improvement. Though medicines are used for short-term withdrawal management, the standard medication assisted treatments for opioid addiction are rarely employed at the jail. And, some substance-abusing inmates are considered as simply misplaced in the jail setting. As an alternative, a police-led, pre-booking diversion program (LEAD) was identified as a way to better serve some lower-level drug and alcohol offenders, including residential treatment when needed. Coincidentally, space for alternative programs or repurposing has become available on the grounds of the jail with the relocation of female honor- farm participants to the new women’s jail. For the County’s homeless whose addiction rates run very high, the long-planned detox beds at the soon-to-be-completed Homeless Services Center remain possible but appear to lack a clear plan. And lastly, the Grand Jury notes the likely positive impact that the County’s DMC-ODC Implementation Plan will have on detoxification services, if that plan comes to fruition.
CL2

The fire risk remains high. While significant work has been done to lower the danger, continuous improvement requires that all involved parties see it as the highest priority. The primary parties include CCSD and its fire department, with the support of CAL FIRE, the Fire Safe Council, the Cambria Fire Safe Focus group and, importantly, the citizens of Cambria.
CL3

The expanded Hall has 65 beds, although the Hall’s average daily population 15 was 23 during the fiscal year before the expansion opened. In hindsight, the Hall was likely overbuilt, although excess space allows Probation the opportunity to open an in-custody treatment program within the hall to treat high-needs youthful offenders. Probation is repurposing one of the Hall’s old units to run this treatment program but the program’s net zero impact to the County’s general fund has yet to be seen. Even with this repurposing, the Hall’s underuse could be significant and prolonged, although the Hall’s reported average daily population could mask underuse if Probation does not separate out statistics for the treatment side versus the detention side of the Hall. Underuse has cost implications for County taxpayers. Alternative uses may provide solutions.
CL4

CALPIA at CMC appears to meet requirements imposed for workplace noise exposure levels as required by the Hearing Conservation Program and CAL/OSHA regulations. However, some questions did arise regarding the availability and easy access of audiometric testing data, and how such data is being used. The Grand Jury noted the following areas of interest that future grand juries may wish to examine:  Records of inmate worker hearing tests to determine if hearing loss has occurred  Observation of inmate worker use of hearing protection devices when required to do so and interviews of randomly selected workers in the CALPIA factories to determine if they feel adequately protected  Consistent implementation of the Hearing Conservation Program  Appropriate use of audiometric testing results in the Hearing Conservation Program by local CALPIA staff
CL5

A summary of the comments and responses to the 2015-2016 bail report indicates general agreement and that the agencies were already largely implementing the bail enhancement policies. Recommendations in the 2015-2016 MUP report were largely rejected. The Board consistently agreed with the reasons for rejection as prepared by the Department. Overall, agencies have followed through on their committed responses to the 2014-2015 reports.

Commendations 2

CM1

The Grand Jury commends the Probation Department, the District Attorney’s office, the Juvenile Court, the Department of Social Services, the County Office of Education, the Juvenile Justice Commission and the Juvenile Delinquency Prevention Commission for their compassionate and caring attitude toward the County’s youth and the determined efforts they make in their ongoing mission to keep youth out of the juvenile justice system and help those who do offend rehabilitate and mature into responsible adults. 2 016-2017 San Luis Obispo County Grand Jury Final Report 58 Juvenile Hall The Grand Jury also commends Probation for posting comprehensive annual statistical reports on its website for use by researchers and members of the public interested in knowing more about the offenders Probation supervises.
CM2

The Grand Jury commends the County on its efforts to take advantage of the new opportunity to add the Design-Build approach to its toolbox for managing the delivery of County capital projects. 2 016-2017 San Luis Obispo County Grand Jury Final Report 82 Challenges in County Capital Projects In particular, the Grand Jury agrees with and applauds its decision to take this step carefully, with due consideration and the use of two pilot projects as a means of gaining experience to evaluate the use of the Design-Build delivery method in the future, before making commitments to a permanent change from prior practices.