San Diego County 2003-2004 - California Grand Jury Reports

From the annual report

The consolidated year-end volume. The individual investigations it contains are listed separately below.

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Individual reports (15)

July 06, 2004 — Torrey Hills: a Chapter in the Development of San Diego

6 pages 7 findings

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Findings & Recommendations 7 findings

F1: On November 29, 2001, DSD denied an application for an SCR approval of a development proposal citing numerous deficiencies in the proposal. On January 18, 2002, the proposal was granted SCR approval. There is no record that the deficiencies were remedied. San Diego County Superior Court Case Number GIC 786702 4 San Diego County Superior Court Case Number GIC 793083 5 San Diego County Superior Court Case Number GIC 800306 6 Riverside County Superior Court Case Numbers RIC 390648 and RIC 390673 215

F2: On April 30, 2002 and August 21, 2002, DSD gave SCR approval for development projects that involve biotech work in the vicinity of an elementary school. Findings

F3: When DSD grants SCR approval of a project on a second or later submission, the record should clearly indicate how earlier objections have been satisfied.

F4: Proper environmental considerations should precede any SCR approval.

F5: When DSD grants SCR approval of a project on a second or later submission, the record should clearly indicate how earlier objections have been satisfied.

F6: Proper environmental considerations should precede any SCR approval.

F2001: A request for approval was resubmitted. On January 18, 2002, SCR approval was granted. The Grand Jury asked DSD for documentation showing that the deficiencies 2 In 2001, a Substantial Conformance Review was a process that allowed development to go forward without consideration of the Community Planning Board, the Planning Commission, or the City Council. No administrative appeal could be made to an SCR approval. 214 , 2004) Report 2003/4-16 found in the earlier submission had been remedied. DSD stated that no such documents exist. The project was submitted for SCR approval and was approved with no mention of the rejection two months earlier. The first SCR approval was followed by approval of two additional SCRs involving biotech firms. The first biotech proposal was approved on April 30, 2002 and the second biotech proposal was approved on August 21, 2002. The Torrey Hills community was concerned by these development approvals and raised funds from homeowners to pay for lawsuits against the City for acting improperly. The suit involving the major commercial development was decided June 2, 2003. The Superior Court granted a writ of mandate “on the grounds the City of San Diego’s decision approving Pacific Centre Carmel Hills LLC’s application for development was without any reasonable basis and amounts to an arbitrary and capricious decision mandating an order of reversal”. The court ordered “the City Council to rescind its approval of the Pacific Centre Project”.3 The developer, a party of interest in the suit, has since appealed this decision. The City did not join in the appeal. The result was different for the other two cases. The Court ruled in favor of the City in both cases, the first case4 on June 18, 2003, and in the second case5 on October 7, 2003. In these cases, the court noted that the Petitioner did not provide sufficient documentary evidence to support the contention that DSD acted improperly. The Community has appealed these decisions. Both of the latter cases involved biotech related developments. The proposed facilities were to be built near the local elementary school. The Del Mar School Board has filed two suits6 against the City alleging the SCR approvals place children at unacceptable environmental risk. These suits have been transferred to Riverside County for trial. As of this writing, no decisions have been rendered. FACTS AND FINDINGS Facts • On November 29, 2001, DSD denied an application for an SCR approval of a development proposal citing numerous deficiencies in the proposal. On January 18, 2002, the proposal was granted SCR approval. There is no record that the deficiencies were remedied. San Diego County Superior Court Case Number GIC 786702 4 San Diego County Superior Court Case Number GIC 793083 5 San Diego County Superior Court Case Number GIC 800306 6 Riverside County Superior Court Case Numbers RIC 390648 and RIC 390673 215 , 2004) Report 2003/4-16 • On April 30, 2002 and August 21, 2002, DSD gave SCR approval for development projects that involve biotech work in the vicinity of an elementary school. Findings • When DSD grants SCR approval of a project on a second or later submission, the record should clearly indicate how earlier objections have been satisfied. • Proper environmental considerations should precede any SCR approval.

June 29, 2004 — Help! My Emotionally Disturbed Child is Incarcerated, What Happens Now?

18 pages 2 findings

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Findings & Recommendations 2 findings

F1: To demonstrate strengths and weaknesses in the provision of services that address the mental health needs of youth while they are detained and when they re-enter the community.

F2: To critically examine County practices in building a new Children’s System of Care (CSOC) for emotionally disturbed children. PROCEDURES EMPLOYED Site Visits: • Kearny Mesa Juvenile Detention Facility • East Mesa Juvenile Detention Facility. Interviews: • General Manager, San Diego County Public Safety Group • Director, San Diego County Health & Human Services Agency • Probation Chief, San Diego County • Deputy Chief Probation Officer, Institutional Services, San Diego County • Director, San Diego County Mental Health Services • Supervising Psychiatrist, San Diego County Children’s Mental Health Services • Chief, San Diego County Children’s Mental Health Services • Director, San Diego County Systems of Care 178 , 2004) Report 2003/4-13 Documents: • California Forensic Medical Group Contract with County Health & Human Services Agency • Memorandum of Understanding between HHSA and Probation (02/01/03) • California Code of Regulations, Title 15 (Crime Prevention and Corrections), Division 1, Chapter 1 (Board of Corrections), Subchapter 5 (Minimum Standards for Juvenile Facilities), Article 8 (Health Services, commencing with Section 1400) • California Welfare and Institutions Code Section 5850-5851.5 • Performance Contract No. 03-73157-000, July 01, 2003 through June 30, 2004 By the State of California Department of Mental Health with San Diego County HHSA, for countywide integrated mental health services • Young Hearts & Minds – Making a Commitment to Children’s Mental Health, October 2001, Little Hoover Commission • The Administration of Mental Health Systems in San Diego County by Supervising Psychiatrist, Juvenile Forensic Services, Children’s Mental Health Services, March 30, 2004 • Agenda Item Memo to San Diego County Board of Supervisors, June 10, 2003: Provision Of Physical Health Services at Probation Facilities • California Government Code Section 1090-1098 • San Diego County Juvenile Justice Commission Inspection Reports, Juvenile Hall in Kearny Mesa (2003 and 2002) • San Diego County Children’s Mental Health Service (CMHS), February 2004 Update • San Diego County Network of Care, Mental Health Services website, retrieved 4/1/04 from the World Wide Web http://sandiego.networkofcare.org/mh/resource/wraparound.cfm • National Mental Health Association Fact sheet: Prevalence of Mental Disorders Among Children in the Juvenile Justice System retrieved 3/18/04 from the World Wide Web http://www.nmha.org/children/justjuv/prevalence.cfm. 179 , 2004) Report 2003/4-13 COORDINATION OF ROLES AMONG HHSA, JUVENILE PROBATION AND CFMG DISCUSSION There are 3 entities responsible for providing services for minors who are detained in juvenile institutions: California Forensic Medical Group (CFMG), County Mental Health Services (HHSA), and Juvenile Probation. Monthly operations meetings are held involving staff participation from all of these entities enabling staff to develop the best strategies for resolving problems and achieving quality health care for children who are detained in the juvenile institutions. CFMG CFMG began providing contracted health care services, including nursing, at County Probation facilities on January 21, 1999 as a result of a competitive bidding process. Since then, CFMG has been recognized by the California Medical Association as a quality, cost-efficient healthcare provider. County HHSA – Mental Health Services The County Mental Health Services Department employs licensed mental health clinicians including, psychiatrists, psychologists, and social workers to serve detained minors. The mental health clinicians make up the Juvenile Forensic Services Crisis Team. This team provides mental health training and expert consultation to the Probation Department and Juvenile Court. Their role is to assist with the treatment and disposition of minors exhibiting serious mental illness once they are taken into custody and throughout their detention and institutionalization. Juvenile Forensic Services clinicians ensure the provision of mental health services in accordance with Title 15 regulations as follows: • Screening for mental health problems at intake • Crisis intervention • Stabilization of persons with mental disorders and prevention of psychiatric deterioration • Compliance with time frame requirements for mental health consultation when restraints are used • Medication support services • Provision for timely referral and admission to licensed mental health facilities in the community if psychiatric needs exceed those available at the juvenile detention facility 180 , 2004) Report 2003/4-13 • Mental status assessment provided by a licensed mental health clinician for minors who are displaying significant symptoms of mental health disorder or who are receiving psychotropic medication. Juvenile Probation The Probation Department provides the detention facility and security training for mental health personnel. Probation staff is responsible for the daily supervision of detained minors. The health program at Juvenile Hall has achieved accreditation from the California Medical Association (CMA).1 This is evidence of their ability to provide collaborative health services that exceed minimum standards of care. The accreditation has been a vehicle for maintaining a positive impact on physical and mental health services and relationships among custodial and health care staff. Additional evidence of cooperation is reflected in a Memorandum of Understanding between the San Diego County Health and Human Services Agency and the San Diego County Probation Department, dated April 23, 2003. The purpose of this agreement is to specify the mental health services and staffing levels provided by Children’s Mental Health Services to the Juvenile Detention Facilities. Mental health services are presented in the form of 3 options, dependent on budget and personnel constraints. These options are briefly summarized below: Option 1 – Basic Services: All services mandated by Title 15, 24 hour/ 7 day on-call emergency psychiatric services, prescription and monitoring of medication by a licensed psychiatrist, and provision of Special Education services. Option 2 – Moderate Level of Care: All Option 1 services plus, 8 hours of mental/medical health training for staff every 2 years in accordance with CMA accreditation standards. Option 3 – Complete Service Provision: All Option 1 and Option 2 services plus monitoring and coordination of treatment provided in the County psychiatric hospital, weekly coordination with Probation Department staff, weekly psychotherapy as resources allow, following protocols to minimize suicide risk among youth in detention, and mental health staff involvement in programming on units. The Memorandum of Understanding (MOU) merely reflects a list of “level of care” options or services Children’s Mental Health Services could provide in Juvenile Institutions. It goes on to state that movement up from Option 1 can occur if there are enough funds in the County Mental Health budgets to pay for the more expensive level of service. According to the memo, the decision to move to a different option is 1 Appendix A 181 , 2004) Report 2003/4-13 communicated by the Probation Department to Mental Health Services through their respective representatives. The MOU states, “Arrangements regarding payment, if any, by the Probation Department to the Health and Human Services Agency for services listed herein are addressed in separate fiscal agreements”. When asked for copies of any agreements, staff advised the Grand Jury that a fiscal agreement was not negotiated or entered into. Further investigation has revealed: • There is an apparent conflict between the fiscal emphasis reflected in the MOU and the treatment focus asserted by the Juvenile Forensic Team staff. One glaring example of this conflict is the monitoring of hospitalized minors. The MOU only allows monitoring of hospitalization at the most expensive level. The Juvenile Forensic Crisis Team, which serves the Juvenile Hall, claims they monitor the minor’s progress in the hospital through daily telephone contact. Apparently, clinical staff is providing a more expensive Option 3 service while currently being funded at the Option 1 (lowest) rate. What, then, is the connection between the MOU and actual practice? • The Grand Jury has been informed by HHSA administrators that the Operating Plan (budget) process is done in consultation with Probation, Juvenile Court and the Mental Health Board. While this internal cooperation is commendable, this does not necessarily provide for essential external accountability. County Mental Health Services informed us that the 2003-04 budget allocation to fund mental health positions in facilities is $1,770,653. While this appears to cover more than the minimum staffing required by Title 15, Section 1402 under Scope of Health Care, there was no way for us to verify this. FACTS AND FINDINGS Fact: There are three entities that are responsible for providing services for minors who are detained in juvenile institutions: CFMG – California Forensic Medical Group, County HHSA – Mental Health Services, and Juvenile Probation. Finding: The addition of CFMG health services, along with regular meetings has assisted in maintaining a positive impact on physical and mental health services and relationships among custodial and health care staff. Fact: The health program at Juvenile Hall has achieved accreditation from the California Medical Association (CMA). Finding: The accreditation validates the ability of the mental health program at Juvenile Hall to provide services that exceed minimum standards of care. Fact: A Memorandum of Understanding (MOU) between the San Diego County Health and Human Services Agency and the San Diego County Probation Department specifies 182 , 2004) Report 2003/4-13 the mental health services and staffing levels provided to the Juvenile Detention Facilities. Finding: The Grand Jury has found conflicts between MOU statements and actual practice. In addition, procedures for financial accountability are not stated in the MOU. IDENTIFICATION OF MENTAL HEALTH PROBLEMS DISCUSSION When minors are booked into Juvenile Hall, the Intake Probation Officer (IPO) screens them to determine if they might be unsuitable for placement in Juvenile Hall because of severe mental health symptoms. All Probation Officers in Juvenile Hall have participated in mental health training provided for para-professionals by Juvenile Forensic Services. The screening process involves the use of an Initial Booking and Screening Questionnaire2, which is a perfunctory checklist review. If the Questionnaire reveals mental health symptoms, the IPO requests an “up front” assessment by a licensed mental health clinician from the Juvenile Forensic Crisis Team. The professional assessment evaluates the symptoms exhibited by the youth and includes a mental health diagnosis. The assessment also determines if the treatment should be provided in or outside of Juvenile Hall. If the professional assessment determines that the minor is a danger to him or herself or others, he or she may be sent to the Emergency Screening Unit (ESU) in Chula Vista. At the ESU, an assessment is performed in order to determine if there is a need for hospitalization. Once admitted to Juvenile Hall, a request for referral for an evaluation by the ESU for possible hospitalization can occur at any time. If the IPO does not identify a mental health problem, identification may be made during the next step in the admissions process. This determination could be made when the CFMG clinician performs a physical evaluation of the minor. If the CFMG clinician determines that there is a mental health problem, the minor is referred to the Juvenile Forensics Crisis Team for assessment. This team of Licensed Mental Health Clinicians includes social work, psychological, psychiatric, and nursing staff. It is possible that a mental health problem might not be detected until or unless a minor demonstrates violent or unusual behaviors after completing the admission process. In this case, any Juvenile Hall staff member may refer the minor for a Crisis Team assessment. Youth detained in juvenile facilities who feel that they need mental health support may also request an assessment. Appendix B 183 , 2004) Report 2003/4-13 It is important to note that privacy issues can prevent Juvenile Hall staff from being informed about a child’s mental health treatment history. Notification of the child’s admission to Juvenile Hall to the child’s mental health treatment provider would violate the child’s privacy rights. If an outpatient provider learns of the admission through the minor’s family and wishes to continue to treat the child, the Probation Department and County Mental Health would accommodate the request. With due respect to privacy rights, one of the problems with the current process of identifying a mental health problem, is that this process is reactive rather than proactive. The IPO, as a paraprofessional, lacks the skills to diagnose and recommend specific treatment. These functions need to be performed by a licensed mental health clinician. The assumption indicated by the current perfunctory screening system, is that most minors in the juvenile justice system do not have a mental health problem. This assumption is not consistent with the Juvenile Probation estimates that 80% of the juvenile justice population has dual diagnosis. FACTS AND FINDINGS Fact: Data collected by Juvenile Probation indicates that 80% of the juvenile justice population is dually diagnosed with substance abuse and mental health problems. Finding: It is not clear how frequently existing cases of dual diagnoses are identified by the paraprofessional screening process. Fact: Privacy issues can prevent Juvenile Hall staff from being informed about a child’s mental health treatment history. Finding: It is generally not possible for Juvenile Hall staff to have knowledge of mental health treatment prior to booking. TRANSITION PROCESS FOR MAINTAINING MENTAL HEALTH SERVICES IN THE NEW EAST MESA JUVENILE DETENTION FACILITY DISCUSSION In response to Juvenile Hall overcrowding and the aging of the existing facility in Kearny Mesa (built in 1952), the Chief Probation Officer submitted a grant proposal to the State Board of Corrections. San Diego County was awarded approximately $36 million to build a new East Mesa Juvenile Facility. This facility is scheduled for occupancy in June 2004. The Board of Supervisors authorized an amendment of the California Forensic Medical Group (CFMG) contract in June 2003 to augment physical health services staff to support the new facility. However, the state budget crisis has led to a contingency plan for staffing the new facility. As of April 23, 2004 the Grand Jury was told that the Kearny 184 , 2004) Report 2003/4-13 Mesa Detention Facility may become a “special purpose juvenile hall”. In a special purpose facility, only intake health screening by either health care personnel or trained child supervision staff is required. An interpretation of Title 15, Section 1302, indicates that it is feasible to operate a special purpose juvenile hall at the Kearny Mesa facility with this health-staffing configuration. This would allow for the transfer of current health staff from the old to the new facility, saving the cost of a second fully staffed health program. County Mental Health Services has informed the Grand Jury that comprehensive physical and mental health services will be provided proportional to the number of children detained in each facility. In order to orient staff to the facility and set up the clinic, CFMG is prepared to start shifting staff 30 days prior to the date of opening. Probation staff is in the process of purchasing all equipment. They are working with HHSA on a monthly basis to learn what supplies to order. One year ago, a letter was sent to the State Board of Corrections projecting a daily average population of 500 in Juvenile Hall. At that time, the plan was to send 50% or 250 children to the new East Mesa facility and to transfer staff. The plan called for 40 staff, including mental health and support staff, to serve the needs of 250 children. Most of this staff will be moved from the Kearny Mesa Facility. Support staff such as warehouse workers, cooks, and booking clerks will need to be hired for the new facility. With more severe budget cuts, the Probation Department would only leave 30 beds open at the Kearny Mesa facility and further reduce the total detained population by focusing more on home monitoring and by making more referrals to community programs. This does not seem entirely feasible given the plans to reduce the capacity of some community programs. The intake process, including booking, may remain at Kearny Mesa for the time being. The original plan was to open East Mesa and to start booking operations there after 90 days. Also being considered is utilizing teleconferencing or video conferencing booking. Negotiations between the Probation Department and HHSA have resulted in a commitment to the following mental health staff at East Mesa, if resources allow: • One Psychiatrist • Two Psychologists • One Nurse • One Licensed Mental Health Clinician • One Mental Health Consultant • One Part Time Clerk. 185 , 2004) Report 2003/4-13 FACTS AND FINDINGS Fact: The Kearny Mesa Detention Facility could become a “special purpose juvenile hall” where only intake health screening by either health care personnel or trained child supervision staff is required by Title 15 regulations. Finding: Designating Kearny Mesa as a special purpose facility will allow for the transfer of current health staff from the old to the new facility, saving the cost of a second fully staffed health program. Under this plan, the only fully staffed health clinic will be located at the new East Mesa Juvenile Detention Center. However, comprehensive physical and mental health services will be provided proportional to the number of children detained in each facility. PROVISIONS FOR CONTINUITY OF MENTAL HEALTH TREATMENT AFTER RELEASE DISCUSSION The ability of Juvenile Probation staff to ensure follow-up services for minors with mental health problems depends in great part on whether the minor is released to the community or transferred to another Probation facility. Of all the cases that go to another Probation facility, the staff ensures that the medical files follow the child approximately 85% of the time. In the other 15% of these cases, Probation staff does not always know the release date in advance because the court determines this. When this occurs, the child is sent to a placement with little notice and the Probation staff sends the medical file as soon as possible. If the child is released to the community, that is, if he or she is returned to their family or placed with a foster family, the follow-through is less certain. Approximately 2 years ago, a “red flag” protocol was added at Juvenile Hall. Currently, if a child is on psychotropic medication, this is “red flagged”. When the child is released, the nurse or mental health worker ensures that a responsible person is informed. Prescriptions can be taken to the County pharmacy, or the family is provided with a holdover supply of medication. In order to address post-release health issues of detained minors, County HHSA and Public Health staffs have begun to have joint meetings. Identification of problems has resulted in voluntary access by detained minors to TB screening and testing, HIV testing, and HIV education in Probation institutions. Other services oriented to post-release aftercare include: Wellness Team -- The purpose of this team is to provide education to all detained minors about community resources that assist in abstinence from tobacco products. The team is operated by Children’s Hospital and Health Center -- San Diego and funded by tobacco revenue. 186 , 2004) Report 2003/4-13 Help Outcome Team -- This team is collaboration between The Wellness Team, the Juvenile Hall mental health staff, and the Probation staff to set the child up with Medi- Cal services. This enables the minors to access health care in the community. There are several programs that aim to divert juveniles from incarceration while they are on probation: Breaking Cycles – This program provides links to substance abuse treatment, and youth and family counseling. This is a Probation program funded by the Juvenile Justice Crime Prevention Act (JJCPA) and the County General Fund. There has been a $92,272 reduction of JJCPA funding for FY 2004-05. Reflections Day Treatment -- This is a program that is coordinated under Breaking Cycles. Reflections provides family-based services to adolescents who have been diagnosed with a mental / emotional disturbance and their families. Services include support groups, positive peer selection, violence prevention, and alcohol and drug treatment and education. The program is funded by Medi-Cal, other state funds and a contribution from the County General Fund. Repeat Offender Prevention Program (ROPP) - This Probation program served first offenders and their families. Services included psychological assessment, clinical consultation, intervention, referrals, parenting classes, and drug intervention. As of this writing, the ROPP program has been eliminated. Spectrum – This program serves juveniles who are detained in Juvenile Hall or are on probation. The program is contracted out by County Mental Health Services to a community nonprofit organization, which provides mental health counseling and chemical dependency recovery services. Funding for FY 2004-05 is stable at $650,000 to $675,000. Building Effective Solutions Together (B.E.S.T.) -- This program provides mental health case management for seriously emotionally disturbed dependents, delinquents, and their caregivers. Access to the program is only through referral by Probation or Children’s Services. The program will be merged with Community Intensive Treatment for Youth (CITY) and the Child, Youth and Family Network (CYFN) as part of the recently authorized proposals to integrate services. State funding for this program may be reduced due to budget constraints. Estimates are that 100 fewer families will receive services. The Grand Jury has learned that community-based programs, Juvenile Drug Court, and other prevention efforts are working. This has been revealed by a reduction in the census in the Juvenile Detention Facility. In April 1998, there were 649 youth in the facility. By December 2003, there were only 399. It is reasonable to assume that providing these services to a large number of youth will continue to lighten the burden on our juvenile facilities. This will be essential if state budget cuts are severe enough to reduce the number of available beds at the Kearny Mesa facility. 187 , 2004) Report 2003/4-13 As a response to state budget cuts, the County HHSA is reducing treatment programs. These reductions are occurring even as Probation is planning to refer more children and youth to treatment programs as an alternative to detention. The Grand Jury has observed that HHSA staff sees cutbacks as the only possible response because they are paralyzed by a need to preserve the existing, expensive, bureaucratic system of services. Difficult times call for new ways to provide services. A cost effective mental health system that will be more responsive to the needs of our detained youth, would necessarily include the broad involvement of families. Families who have been denied treatment may bring a wealth of new ideas and energy for the provision of expanded services. This is an untapped resource. Many children and families are denied treatment because the Juvenile Detention Facility staff is limited in its ability to follow through on aftercare for juveniles with mental health problems. Limitations are caused by budget and personnel restrictions, as well as by difficulties in tracking and monitoring juveniles who do not remain in the system. Although the Juvenile Detention Facility has no designated discharge coordinator position, collaborative efforts address basic legal and medical obligations. CFMG nursing staff consults with the Juvenile Forensic Crisis Team and the Probation Department regarding recommendations for continued health treatment for the child and family. The Grand Jury has seen no verification of the provision of follow-up treatment plans by the Juvenile Forensic Crisis Team. Grand Jury interviews revealed other problems for youth who leave Probation’s jurisdiction and programs when they attempt to get continuing treatment from County funded community mental health programs. If a child who was diagnosed with a mental health problem and received treatment while in Probation facilities is not eligible for Medi-Cal reimbursement, there is a low probability that the treatment can continue. We were told that these youth “don’t compete well with kids coming out of hospitals or who have Special Education needs”. This means there are not enough treatment services for mentally ill juvenile offenders. It remains unclear whether the “No Wrong Door”3 policies claimed by County Mental Health would provide interim help. When asked about the effectiveness of “No Wrong Door”, County Mental Health services staff proudly replied that there is a website. The Grand Jury maintains that the mere availability of mental health program information on a website does not provide much help to families who do not understand complicated eligibility requirements or who do not have enough information to know whether a particular program is the right one for their child. A website alone does not meet state-mandated goals which require improved access to community mental health programs. These goals are stated in the following documents: 3 A “No Wrong Door” policy refers to providing assistance at whichever county-funded program contacted for mental health services. 188 , 2004) Report 2003/4-13 • The Children’s Mental Health System of Care Regulations (Welfare and Institutions Code). These regulations require that mental health treatment services be made available in homes and neighborhoods convenient for families. The CSOC further requires that these services focus on individual needs. This means that the program should be tailored to the child’s needs. In the current situation, the child must fit the program or take what is available. • The San Diego County HHSA performance contract with the State Department of Mental Health (2003-04). This contract obligates the County to “…integrate the activities of multiple child-serving agencies and systems to ensure the provision of necessary services to include mental health, substance abuse…and increasingly, juvenile justice services.” According to County Mental Health administrators, juvenile justice services are not increasing due to state budget cuts. The Little Hoover Commission Report on children’s mental health services (2001) noted that in 30 years, attempts to redesign the mental health services system have yielded mixed results. Past attempts have failed to achieve the goal of providing the highest quality, most efficient care possible. This failure can be blamed on an ill-advised approach that involved the creation of a “super agency.” The Grand Jury investigation revealed that the San Diego County Children’s System of Care (CSOC) process is focused more on maintaining the bureaucratic structures to the extent that is possible, and less on the unmet needs of children and families. The state has awarded San Diego County $7 million to develop a system of care that is aligned with the Welfare and Institutions Code regulations. We are concerned about the apparent lack of accountability in the CSOC process. The Grand Jury asked, “How are these dollars being spent to build capacity?” We did not received a clear answer. The task of creating a family-friendly system can be difficult when the family sector has no power. The task becomes impossible when families have no opportunity to participate in decision-making. The Grand Jury has learned that only a few, carefully chosen family members have been invited to monthly meetings with the County staffs and nonprofit service providers. For example, there is an organization called the San Diego County Family Roundtable, which is represented at County meetings. According to their website, the Roundtable is comprised of families who have been able to receive services. Although this sounds like an ideal group of family participants, the membership does not represent the large number of families who have trouble accessing services for their emotionally disturbed children. The very reason the system needs to be reformed is that there are so many families who are not able to find and get the services they need. Further, the president of the board of the San Diego County Family Roundtable is a current nonprofit provider of services. This could easily be construed as a conflict of interest. The Grand Jury is concerned that conflict of interest is inherent in the organizational structure of the Children’s Mental Health Services System of Care Steering Committee. 189 , 2004) Report 2003/4-13 This Committee often recommends the awarding of contracts to specific nonprofits and other groups. Many of these nonprofits and other groups turned out to have officers who are also Committee members. Pursuant to California Government Code Section 1090- 1098, this may be a case of members having a financial interest in a contract. Although there are policies of disclosure and abstention from voting where members have even a remote interest, the potential number of self-interested participants almost certainly includes everyone. The Grand Jury admonishes County Mental Health Services to appoint an independent group to perform the function of advising, recommending, and making decisions on the awarding of contracts. The conflict of interest issue is exacerbated by the failure of the CSOC to include a diverse group of families who truly represent the range of opinions in the community. The Grand Jury believes that County Mental Health leaders must learn the skills needed for effective community development. Knowledge of community development strategies would help these administrators understand how to engage families in a positive reform effort. There are proven methods that work to inspire a better planning process. For example, The Anne E. Casey Foundation has provided funding and expertise to a number of states and localities to help make their public service systems work better for children, families, and communities. An evaluation by this or a similar organization, could lead to a course correction that will achieve a cost effective system of care. Only by paying attention to cost and effectiveness will the County be able to stem the tide of criminal and violent behavior exhibited by our untreated, emotionally disturbed children and youth. It is especially important to maximize our human resources when funds are in short supply. This is a much more positive approach than the current preference for maintaining outdated and awkward structures that limit services. Excluding family members because they might demand more services ignores the benefits that they offer. Family members as partners may well replace the self-limiting “we can’t afford to do more” excuse with a “can do” enthusiasm. Family members are motivated. They want to create opportunities for their children to live productive lives. They also want to contribute creative ideas that tend to minimize costly bureaucratic red tape and will provide services and support. FACTS AND FINDINGS Fact: The CFMG nursing staff coordinates with the Juvenile Forensic Crisis Team and the Probation Department regarding recommendations for continued health treatment for the child and family after release from Juvenile Hall. Finding: The Juvenile Detention Facility staff is limited in their ability to follow through on aftercare for juveniles with mental health problems. These limitations are caused in part by budget and personnel restrictions, as well as by difficulties in tracking and monitoring juveniles who do not remain in the Probation system. 190 , 2004) Report 2003/4-13 Fact: Due to state budget cuts, the County is cutting the capacity of mental health treatment programs in the community that serve juvenile offenders. Budget cuts are also driving plans to drastically reduce the number of available beds in the Kearny Mesa Juvenile Detention Facility. Finding: The County is reducing the capacity of community programs to serve mentally ill juvenile offenders, even as County administrators announce plans to increase the number of referrals to these programs. The stated purpose of increased referrals is to provide an alternative to incarceration in the Juvenile Detention Facility. Fact: The CSOC for seriously emotionally disturbed children and youth represents a state mandated effort to make mental health treatment services available in the home and in the neighborhood, and concentrate those services around the needs of the youth and family, rather than the needs of the bureaucracy. Finding: Many children and youth, who have mental health problems, do not receive treatment services after release from Juvenile Hall. This is the direct result of County policies that maintain costly bureaucratic structures. As a result, this County is limited in its ability to build the capacity of juvenile diversion and treatment programs that have a successful track record. Fact: The San Diego County HHSA performance contract with the State Department of Mental Health Services (2003-04) requires the County to integrate systems that provide necessary mental health and substance abuse services and juvenile justice services. Finding: Families who have been denied services are highly motivated to provide cost- saving ideas and practical assistance for expanding the capacity of community programs to address the dual diagnosis needs of children and youth who are released from Juvenile Hall. This is an untapped resource. Finding: San Diego County is out of compliance with the state mandated concept of facilitating access to services and involving families as partners. The County is pursuing a policy of limiting broad family partnership in the system reform effort (CSOC). The County is supporting Family Roundtable leadership by a service provider, which can easily be construed as a conflict of interest. Fact: The Children’s Mental Health Services System of Care Steering Committee often recommends the awarding of contracts to specific nonprofits and other groups. Finding: According to California Government Code Section 1090-1098, the action of recommending the awarding of contracts to members of the Committee who have financial interests in the contracts constitutes a conflict of interest unless the interests are remote or constitute non-interest. 191 , 2004) Report 2003/4-13 Finding: The County is reluctant to share power with family/consumers, resistant to incorporating new perspectives for cost-effective community participation, and apparently unskilled or unwilling to utilize effective community development strategies.

June 29, 2004 — The Little School District That Does

4 pages 8 findings

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Findings & Recommendations 8 findings

F1: The district has 6 elementary schools, 2 middle schools and 1 charter high school. A second charter grade school is located on the Barona Indian Reservation. The Lakeside District is the sponsoring Local Education Agency but the charter school board does all school administration. One member of the Barona Indian Charter School Board is from the Lakeside School Board.

F2: District enrollment peaked at 5022 for the 2001-02 school year. 175

F3: Enrollment had been flat for the 3 previous school years.

F4: Enrollment has declined in the past 2 years to its present level of 4871.

F5: River Valley Charter High School has an Academic Performance Index (API) rating of 823.

F6: Their API ranking earned River Valley a 10 on both the Similar School Ranking and the Statewide Ranking. Most of Lakeside’s schools have a statewide API rank between 5 and 8. (On a scale of 1-10 with 10 being high)

F7: There are 5 designated Title 1 schools in Lakeside. This determination is for economically disadvantaged pupils. The Federal government provides extra funding for materials and support for these schools.

F8: Advancement Via Individual Determination (AVID) classes are offered at all class levels in the district. This program offers extra educational support for under represented student groups wishing to attend college. To ensure a smooth transition to the high school level there is very good communication between the Lakeside District and the Grossmont District AVID teachers.

June 10, 2004 — Cost Effective Forensic Services in San Diego County

11 pages

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Findings and recommendations not yet extracted.

June 08, 2004 — The Failure of Handicapped Parking Regulation in the City of San Diego

10 pages 3 findings

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Findings & Recommendations 3 findings

F1: At two comparable large home building supply stores in Mission Valley and Mira Mesa, all of the handicapped parking is clustered in a line directly across from one entrance to the store. However, this Grand Jury has determined that there are three entrances to these stores that are generally used by the public: the main entrance; the entrance to the garden supply area; and the entrance to the lumber and building supply area. With three entrances it appears that the handicapped parking should have been distributed among the entrances. Because of the clustered location of the handicapped parking, it was observed that the handicapped parking was seldom used at these locations. However, in the Cities of Santee and El Cajon where the parking spaces are distributed among the entrances, the handicapped parking spaces are almost always in use at similar stores.

F2: At a large retail discount store in Mission Valley, the handicapped parking was lined up against the side of the building in keeping with the preference of avoiding having to cross a lane of traffic to reach an entrance. However, the handicapped parking was lined up on only one side of the building with the last space at a great distance from the entrance. Closer parking was available along the other side of the entrance, yet only two of these parking spots were used for handicapped parking, 3. At a large retail store at College Grove there is no handicapped parking at the entrance. The handicapped parking is two parking lanes away from the entrance, while the parking across from the entrance is used for regular parking. All parking at this location requires crossing a lane of traffic.

F4: At another large discount store in College Grove, parking is lined up on the side of the store, again applying the preference for the handicapped not having to cross a lane of traffic, although there were regular parking places closer to the entrance. However, in this case it was determined that the last space was 279 feet from the entrance or nearly the length of a football field. At this inordinate distance, the distance itself becomes a barrier. The preference not to cross traffic lanes should have been overridden and some of the other parking spaces across from the entrance should have been used. It must be remembered the users of these parking spaces are handicapped. Most have been certified by their physician as having difficulty walking long distances. 4 , 2004) Report 2003/4-10 5. At another location in Mission Valley, an office supply store has the handicapped parking placed as far from the entrance as is physically possible even though parking is available at the front entrance of the store. However, it was determined that the parking lot was recently repaved at which time the handicapped parking was required to be brought into conformance with the Code, but was not brought into conformance. These foregoing apparent errors were found after only a cursory examination of the approved plans and were the motive for further investigation. DEVELOPMENT SERVICES DEPARTMENT The management of the Development Services Department was interviewed and testimony was taken to obtain an overview of the procedure used in the approval of plans. From this testimony, it was determined that when an owner or developer submits plans to the Development Services Department for approval they are given to a Plan Checker who checks the plans for compliance with the Code. This includes checking for compliance with the handicapped parking regulations. After approval by the Development Services Department, the project is then built by the owner or developer and is inspected for compliance with the approved plans for conformity with the Code by building inspectors who issue a certificate of occupancy as final approval. Development Services Department management was furnished with a list of the selected locations to provide members of the department with the locations in question so that when their testimony was taken the witnesses could more easily testify about the specific locations they were to be questioned about. This Grand Jury then ascertained which Plan Checker had approved the plans at each of the locations being investigated and which inspector gave final approval to the project. Each Plan Checker was interviewed separately. The plans were reviewed to determine the appropriateness of the location of the handicapped parking places. The review consisted of determining whether the handicapped parking places were placed on the shortest route to the entrance; whether the locations were distributed among all entrances; and if not, on the shortest route to the entrance or evenly distributed. We also questioned whether there were extenuating circumstances or hardships that made it appropriate to place them farther away. What the Grand Jury learned from this testimony was interesting. In no case were there any extenuating circumstances involved in the location of the parking spaces discussed. Everyone interviewed at the Development Services Department was familiar with the Code requirements regarding the location of handicapped parking spaces. Testimony revealed that in several cases they were approved for that location because the architect must have had a good reason for putting them there. In other cases the testimony was it slipped by me. In one case after the Plan Checker had required a change in the plans to correct the placement of the parking spaces, the architect then submitted a new set of plans with unrelated changes and put the parking places back where they had been 5 , 2004) Report 2003/4-10 originally. The Plan Checker missed the change. The general tenor, which was actually articulated, by some of the Plan Checkers was that the placement of handicapped parking places was not considered a matter of high priority. This attitude was also sensed in later interviews with Development Services Department management. The Grand Jury then interviewed the Field Inspectors regarding the selected locations. The Jury heard the same explanations for the location of the handicapped parking as was heard from the Plan Checkers i.e. It’s a low priority item and The architect must have had a good reason for putting them there. Only one of the Inspectors saw any problem with the location of the handicapped parking spaces. When questioned further it was determined that the training of the Inspectors had not included specific information regarding the proper location of handicapped parking places. Although the low priority given to handicapped parking does not appear to be willful, it has led to neglect in approving construction. In later interviews with the Development Services Department management admitted that training of both Plan Checkers and Inspectors needed more emphasis on priorities of handicapped parking and the location of handicapped parking. NEIGHBORHOOD CODE COMPLIANCE DEPARTMENT The last line of defense provided by the City in enforcement of the Building Code is the Neighborhood Code Compliance Department. The San Diego City Council has described the purpose of the Neighborhood Code Compliance Department to be an important public service, and vital to the protection of the public’s health, safety and quality of life.8 To carry out this purpose the City Council has given the department wide powers of enforcement.9 Management of Neighborhood Code Compliance was interviewed and testimony taken twice. Testimony was also taken from the Accessibility Specialist for the Department. At the first interview, the addresses of the locations were requested. These were provided to the Department to enable more responsive answers to our questions. The testimony of the Accessibility Specialist indicated a well-trained and knowledgeable person who was dedicated to the job. At a few of the locations Neighborhood Code Compliance agreed that the handicapped parking was not in compliance with the Code. However, at the two building supply stores mentioned before, the solution of Neighborhood Code Compliance was to have the entrance sign removed from the building at the building materials entrance. Even with 8 San Diego Municipal Code §12.0101 9 San Diego Municipal Code §12.0102 et.seq. 6 , 2004) Report 2003/4-10 this questionable interpretation of the Code, this solution does not address why there is no handicapped parking at the entrance to the Garden Shop. At another location, the office supply store in Mission Valley, it was determined by Code Compliance that the slope of the parking places in front of the door were in excess of 2 percent, thereby, according to the Code, making them unfit for use as handicapped parking spaces. It was also pointed out by Neighborhood Code Compliance that the parking lot was recently repaved. While the Grand Jury questions whether the existing slope is in excess of 2 percent, the mere fact that the parking lot was repaved creates a need for a new permit that should have required compliance with the Code provisions regarding handicapped parking spaces10. This did not concern Code Compliance; Code Compliance actually used the repaving as the reason that the parking spaces could not be placed at the entrance to the store, and that they were placed as far as physically possible from the entrance while remaining alongside the building. At a third location, the large discount store at College Grove where some handicapped parking was located almost the length of a football field away from the entrance, Neighborhood Code Compliance could not understand why the distance was an issue. It appears that Neighborhood Code Compliance may not fully understand problems the handicapped have walking or wheeling a wheelchair great distances. The managers of Code Compliance vehemently denied that the Department relies on the Development Services Department evaluations regarding the location of handicapped parking. Neighborhood Code Compliance claims they make an independent evaluation of the location of handicapped parking. The testimony of Neighborhood Code Compliance management has led this Grand Jury to believe otherwise. FACTS & FINDINGS Facts Testimony of both the Plan Checkers and Inspectors revealed that the placement of handicapped parking was a low priority item. Testimony revealed that in many of the examined locations both the Plan Checkers and Inspectors gave great weight to the location of the handicapped parking locations chosen by the architects/developers/owners without further inquiry. Testimony revealed that the Neighborhood Code Compliance department would bend over backwards to find a handicapped parking place in compliance, including suggesting the removal of an entrance sign from an entrance commonly used by the public. 10 28 CFR 36 §4.1.6 7 , 2004) Report 2003/4-10 Findings This Grand Jury finds that the Development Services Department has been giving low priority to enforcement of codes regarding the location of accessible parking for the handicapped. The procedures of both Plan Checkers and Inspectors need to be changed to provide them with the tools to do their job. This Jury further finds that training of Plan Checkers and Inspectors by the Development Services Department is inadequate. This Jury further finds that the attitude of the Neighborhood Code Compliance Department management does not well serve the citizens in the City of San Diego. Testimony suggested that management of Neighborhood Code Compliance is more interested in making excuses for the existing handicapped parking locations than in correcting them. This Jury further finds that Neighborhood Code Compliance management needs indoctrination as to the purpose of the Department.

May 27, 2004 — Touch-screen Voting the Future or Failure?

15 pages 35 findings

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Findings & Recommendations 35 findings

F1: The steps required to convert a touch-screen to perform the function of a PCM to create Voter Access Cards.

F2: Procedures should be added to the training to convert touch-screens to be used as a back up of the PCM. This would give one more safeguard against a problem such as the one that occurred in March. Late in the pre-election process, the Secretary of State requested that paper ballots be available for voters not wanting to use the touch-screens. With the complexity and number of versions of ballots6 involved, it was not physically possible to get enough 6 Each voting district has its unique ballot with eleven different options based on party and non-partisan voters. Additionally ballots were available in, English, Spanish, and Tagalog. The total number of different ballots required would have been as high as 25,000-30,000. – 2004 (filed May 27, 2004) 11 ballots printed and distributed to the precincts. The ROV had all versions of the paper ballots available at their office. The Grand Jury believes many of the problems were partially attributable to the extremely short timeframe for the ROV to prepare for the March election. With more time to work with for the November election, the ROV should re-examine all of the processes, procedures, training, and documentation for the new voting systems. They should evaluate what worked and, if possible, improve on those items. They should take a “clean sheet of paper” approach to any part of the implementation that needs to be significantly changed. As a result of our observations, the Grand Jury concluded that San Diego County’s initial use of the touch-screen voting was a qualified success and that the integrity of the election process was maintained. We find no reason that the equipment, with the implementation of the recommendations below, should not be used in future elections. Facts

F3: Many precincts did not open on time because of a problem with the Precinct Control Module.

F4: There were no reported voting irregularities associated with the touch-screen voting equipment.

F5: The hot-line set up by the ROV was overloaded with calls early on Election Day.

F6: The initial tally of 2,821 absentee paper ballots was incorrect and the subsequent vote certification had to be amended.

F7: The decision to purchase the equipment was made in December 2003. The equipment arrived in January 2004, was distributed beginning in February and used for the election on March 2, 2004. Findings

F8: A number of voters were either completely or partially disenfranchised as a result of the late opening of some precincts.

F9: The short time frame from approval-to-receipt-to-distribution-to-implementation of the new voting technology significantly impacted the implementation process.

F10: Outside activities such as lawsuits, media distraction, Secretary of State rulings often diverted attention and effort from the immediate task of implementing the new voting system. 12 – 2004 (filed May 27, 2004)

F11: Recruiting of System Inspectors needs to be enhanced to do a better evaluation of their PC literacy and comfort with technology.

F12: The training and support materials for poll workers, troubleshooters, and troubleshooter supervisors were of generally poor quality.

F13: The classes for poll workers, troubleshooters, and troubleshooter supervisors were of generally poor quality.

F14: The way the ROV implemented the new voting system made it impossible to be “hacked” from the outside. There was no external access to the PCMs or touch- screens.

F15: The current method of insuring the security of the PCMs by sealing the case in which they are stored contributed to the battery discharge issue.

F16: The access security to the supervisor software on the touch-screens is unacceptable as currently implemented by the vendor.

F17: The design of the door securing the ballot memory card on the touch-screen unity requires breaking the door seal to turn on the machine. This means the ballot memory card is not secured by a seal during the Election Day.

F18: The lack of a voter verifiable paper trail makes it difficult to convince the public of the integrity of the new voting technology.

F19: A voter verifiable paper trail would be a significant tool in auditing the results of electronic vote tabulation.

F20: A voter verifiable paper trail could be a valuable tool in a recount of close elections.

F21: The timeframe of the March 2004 Primary Election did not allow for distributing appropriate paper ballots to each precinct.

F22: A number of voters were either completely or partially disenfranchised as a result of the late opening of some precincts.

F23: The short time frame from approval-to-receipt-to-distribution-to-implementation of the new voting technology significantly impacted the implementation process.

F24: Outside activities such as lawsuits, media distraction, Secretary of State rulings often diverted attention and effort from the immediate task of implementing the new voting system. 12 – 2004 (filed May 27, 2004)

F25: Recruiting of System Inspectors needs to be enhanced to do a better evaluation of their PC literacy and comfort with technology.

F26: The training and support materials for poll workers, troubleshooters, and troubleshooter supervisors were of generally poor quality.

F27: The classes for poll workers, troubleshooters, and troubleshooter supervisors were of generally poor quality.

F28: The way the ROV implemented the new voting system made it impossible to be “hacked” from the outside. There was no external access to the PCMs or touch- screens.

F29: The current method of insuring the security of the PCMs by sealing the case in which they are stored contributed to the battery discharge issue.

F30: The access security to the supervisor software on the touch-screens is unacceptable as currently implemented by the vendor.

F31: The design of the door securing the ballot memory card on the touch-screen unity requires breaking the door seal to turn on the machine. This means the ballot memory card is not secured by a seal during the Election Day.

F32: The lack of a voter verifiable paper trail makes it difficult to convince the public of the integrity of the new voting technology.

F33: A voter verifiable paper trail would be a significant tool in auditing the results of electronic vote tabulation.

F34: A voter verifiable paper trail could be a valuable tool in a recount of close elections.

F35: The timeframe of the March 2004 Primary Election did not allow for distributing appropriate paper ballots to each precinct.

May 25, 2004 — San Diego County Emergency Operations Center: Seeking Better Communication

14 pages 2 findings

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Findings & Recommendations 2 findings

F1: All agencies involved should provide a standing representative to the County Emergency Operations Center (EOC) during major wildland fires that affect multiple jurisdictions.

F2: Create a local Multi Agency Coordination (MAC) Group for San Diego County, established by the Office of Emergency Services Fire and Rescue Coordinator. The MAC group would represent all departments and agencies with fires burning within their jurisdictions, Operational plans would establish triggers for activation of MAC based on fire activity. FACTS AND FINDINGS Fact: Emergency, public safety, fire officials and other emergency responders and agencies faced significant problems that resulted from the lack of intelligence and current information regarding the behavior of the firestorm. Finding: The fires defied predictions and had many fronts. Smoke and ash severely reduced visibility and prevented intelligence gathering by air. For these reasons getting current information was very difficult and at times impossible. Fact: In many cases, the “eyes and ears” for the Emergency Operations Center were officials who were “on the ground” fighting the fire and effecting the evacuations. Fact: During an emergency, information from field fire and rescue teams comes into the EOC through a liaison or designated representative. The liaison is elected periodically by representatives from all fire agencies and is called the Fire and Rescue Coordinator Finding: Coincidently, the Fire and Rescue Coordinator was the person in CDF who was heading up the Unified Command for the entire fire so he could not perform EOC function except briefly the second and third days of the fire. Periodically, others filled the seat. Finding: Getting fire intelligence information into the EOC would not have happened instantaneously by having the elected Fire and Rescue Coordinator sitting at the EOC table. Protocols and guidelines for governing working relationships and communications linkages among fire agencies are not established and need to be before this type of situation reoccurs. The 2003 San Diego County Fire Siege Fire Safety Review, California Department of Forestry and Fire Protection and United States Department of Agriculture Forest Service, March 2004; Pg. 41 6 – 2004 (filed May 25, 2004) Report 2003/4-08 Finding: The CDF and USFS San Diego County Fire Siege report contains two recommendations for fire agency representation and preparation that we believe can solve these problems.

May 20, 2004 — Should Hot Teams Be Expanded and for Whom?

8 pages 7 findings

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Findings & Recommendations 7 findings

F1: Transitional shelter 7 San Diego Regional Task Force on the Homeless, 2003, San Diego County’s Homeless Profile, Youth On Their Own.

F2: Substance abuse treatment and recovery

F3: Case management/information and referral

F4: Employment assistance

F5: Permanent supportive housing

F6: Planning/administration and coordination

F7: Food assistance. With all these services being offered by various agencies, it is easy to understand that accessing these or even knowing of their availability would be difficult for anyone. This must certainly be true for the chronically homeless. These people are often isolated from the community’s mainstream. According to the September 2002 Fact Sheet #3 by the National Coalition for Homeless, over 20-25% of the homeless suffer from severe mental illness. The chronically homeless population consumes a disproportionate amount of law enforcement and emergency medical treatment resources. This may be due to the reason for their homelessness not being adequately addressed. Having HOT teams seek out individuals one at a time and addressing their specific needs may lead to better and more appropriate use of limited resources. The Homeless Outreach Teams’ multi-disciplinary make-up allows for comprehensive field assessments. With two or three disciplines (social services, medical, and safety) addressing an individual’s needs it is more likely that a break in the cycle of homelessness will occur. Because of budgetary constraints, the teams now operate with only two professionals on a team in order to make-up more teams and reach more homeless people. With an increase in staff, they would, once again, be able to operate more effectively as they originally did with all three professionals on a team and perhaps expand to serve youth. The Homeless Outreach Teams only cover the downtown and beach areas. The juvenile homeless in our county do not routinely stay within these areas. They tend to be more visible at night and are found in Hillcrest and under freeway ramps along Interstate 5. For the calendar year 2003, the Homeless Outreach Teams contacted over 1,000 chronically homeless people. For the month of January 2004, they contacted over 200 chronically homeless people. Having an outreach team to locate and serve these 1,200 people frees up valuable time and resources from other law enforcement units in our downtown area. Eight shelter beds are designated to Homeless Outreach Team clients. With the number of contacts and placements made by these teams last year, this small amount of shelter space is insufficient to meet their needs. The Homeless Outreach Team program is a successful collaborative effort by the city and county to address the downtown homeless population. There is a need to expand and enhance this outreach to the homeless juveniles of our county. Early intervention and early identification of their reason for being on the street may prevent them from becoming chronically homeless adults.

May 19, 2004 — Public Administrator/public Guardian:

15 pages 1 findings

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Findings & Recommendations 1 findings

F1: As the Public Guardian or conservator of the estate for individuals the Probate Court has determined are no longer able to manage personal and financial affairs and who do not have anyone to assume the role; 2. As the Public Administrator for estates that do not have a private sector individual who can assume the role. As a result of Court action, either “Letters of Conservatorship” or “Letters of Administration” are issued by the Court that authorize the transfer of the assets and liabilities of a person or estate to the Public Administrator/Public Guardian. Individual cases are assigned to Deputy Administrators and Guardians who are responsible for management of assets and payment of financial obligations while ensuring that the person receives the care he/she needs. The case the Grand Jury examined was that of an individual who, at the time of the referral to the Public Administrator/Public Guardian (PA/PG) Office in March 2000, lived alone in his home and required medical care in a skilled nursing facility (SNF). There was no one who would assume responsibility for his medical care and financial affairs. After an investigation, the PA/PG made arrangements for his transfer to a SNF and petitioned the Court to be designated the Guardian/Conservator over the person’s estate. “Letters of Conservatorship” were issued to the PA/PG for this case in March 2000. The Conservatorship continued until his death in October 2002. In October 2002, a Petition for Probate was filed by a private sector administrator in Probate Court, who was officially appointed administrator for the estate in December 2002. In April 2003, the Final Accounting for the Conservatorship was filed by the PA/PG in Probate Court. In August 2003 a hearing was held in Probate Court regarding the final accounting of the estate and the distribution of assets to heirs. Possession of the real property by the heirs, however, could not be taken until October 2003. FOCUS OF THE COMPLAINT While the estate of the case we examined included both financial holdings and real property, the focus of the complaint was only on the PA/PG’s obligations and performance in managing the property that had been occupied by the conservatee until he was transferred to a SNF for medical care. 2 – 2004(filed May 19, 2004) Report 2003/4-06 The complaint was filed by an heir who alleged that the Public Administrator/Public Guardian breached a fiduciary duty and failed to protect the assets of the estate entrusted to them by Probate Court. It described in detail the problems that existed as they attempted to take possession of the north coastal property located in the City of San Diego: • A house that had not been maintained properly and required extensive maintenance in order to make it habitable. • A tenant occupying the property was more than $11,000 in arrears in rent. • There was no longer a $2,000 security deposit to apply towards costs incurred from the tenancy because it was transferred by PA/PG to the Private Administrator in May 2003 with the distribution of assets from the estate and was reported to the Court as rental income. • The need to hire a private attorney to assist them in evicting the tenant. • A prolonged eviction process because the tenant successfully used the fact that the house was uninhabitable or unfit to live in due to prolonged poor maintenance of the house, to relieve the tenant’s obligation to pay rent. In addition to the lost income for the estate during the 3-year tenancy, the complaint stated that the heirs had to make personal expenditures of $40,000 to $50,000 for legal fees and for extensive repairs to the house. These were expenditures that they believed they should not have incurred and would not have incurred had the Public Administrator/Public Guardian’s office properly managed and preserved the assets of the estate. INITIAL ACTION TO PROTECT AND PRESERVE PROPERTY ASSETS When a case comes into the Public Administrator/Public Guardian’s Office, responsibility for the care and management of real and personal property is delegated by the Deputy Administrator or Guardian to the Property Management Division. If the real property is vacant, as in the case the Grand Jury examined, and there are sufficient assets to cover the expenses for the care of the conservatee without selling the property, the property is rented in order to generate income for the estate. Verification and documentation of the physical condition and any problems that existed in the real property when the estate was entrusted to PA/PG, proved to be problematic. The complaint included a list of problems. It was prepared in 2003 by the tenant who had occupied the house for nearly 2½ years. It was used as a defense for relieving her from an obligation to pay rent on the house when the heirs sought to evict her. – 2004 (filed May 19, 2004) 3 Report 2003/4-06 The Grand Jury’s first inquiry asked for either a written professional assessment of the property by Property Management officials when the property first became their responsibility or for a scope of work for the handyman to follow when making improvements to the property so it could be rented. Neither was available. Nor could information about conditions when the tenant moved into the property, be learned from a “tenant entrance checklist.” After reviewing records and interviewing staff, it became clear that when a property goes into management, the division does not develop a written assessment of the needs and conditions for each property and an accompanying plan for responding to those needs. Instead, what was described is an informal process. The Property Manager meets on-site with two contractors, one a rental agent and one a general handyman, to define improvements and repairs. The Grand Jury found only one written document that described the initial conditions and problems at the real property. It was a handwritten list of work the handyman used to invoice payment of $4,000. The 4-page summary did not itemize costs for individual tasks. Other submissions from the handyman were for reimbursement of $2,000 for supplies purchased at a number of stores. These two expenditures and one for $99.99 for carpet repairs and another for $2,137 of new carpeting were the only evidence of problems that staff identified or the repairs that were made to the home between March and August of 2000, when the tenant occupied the property. Because a number of problems noted by the heirs who took possession of the property 2½ years later were related to water damage in the bathrooms and throughout the house and to extensive mold and carpet damage, we paid particular attention to action or inaction surrounding those matters. There are no records or evidence of a request for a professional to assess the condition of the roof. While the handyman’s list of work identified roof and bathroom repairs, there was no way to ascertain if anything was done. The oversight and accountability of the outside contractor when he did this initial work appeared to be minimal. When asked regarding the method used to ensure the adequacy and sufficiency of the contractor’s work performance on-site, we were told by staff that they “took a look at it and it was all right.” When we probed further to determine if the work done was sufficient, given what was described as “deferred maintenance,” we were advised that when Property Management was authorized by case management to rent the house, there was agreement that PA/PG should attempt to set rent at $2,500 a month. A walk-through was done in order for them to identify minimal improvements and repairs that would be necessary so that the rental agent could obtain that level of rent per month. Consistently, we heard the theme that the goal is not to make the property “glorious” but “tenable.” Fact: The Public Administrator/Public Guardian’s Property Management Division did not do a full and complete property assessment or evaluation of the physical condition and problems that existed in the property when the estate was entrusted to them. 4 – 2004(filed May 19, 2004) Report 2003/4-06 Finding: We found that instead of utilizing professional assessments to develop evaluations and the scope of work to be done, the PA/PG Property Manager relied on and utilized informal working relationships with contractors as if they were direct employees. Fact: Expenditures of $8,237 were made from the estate for services and supplies for the handyman and for carpet replacement and repair so the property could be prepared for tenant occupancy. Finding: Because of the informal working relationship between the PA/PG Property Management officials and the contract handyman, we were unable to determine with any specificity either the scope of work or the quality of work that was done at the real property. Finding: Oversight and verification of work performed by the handyman at the property was minimal. This prevented verification of what precise work was done to respond to specific problems that needed repair before tenant occupancy. Finding: The predominant focus of PA/PG Property Management was not on “what needed to be done” but on “what minimum needed to be done” to get the desired rent and to make the property “tenable.” RECOMMENDATION The Grand Jury recommends that the San Diego County Board of Supervisors take action to ensure that the Public Administrator/Public Guardian Office: 04-06-1 Enact and implement policies and procedures that require the procurement and utilization of independent professional assessments and evaluations regarding the condition of real property including roofs, plumbing, structural integrity and overall maintenance whenever possible when initially entrusted to the care of the PA/PG. 04-06-2 Enact and implement policies and procedures that require the development of a clearly defined scope of work to be performed on real property projects over $500, prior to the solicitation of bids from authorized providers. 04-06-3 Enact and implement policies and procedures that require accountability and verification of work performed under service contracts on real property entrusted to the PA/PG. ADEQUACY OF MAINTENANCE DURING TENANT OCCUPANCY After not finding useful documentation regarding the early condition of the real property, the Grand Jury turned its attention to the information that revealed expenditures for maintenance of the property when it was entrusted to the PA/PG Property Management Division. – 2004 (filed May 19, 2004) 5 Report 2003/4-06 Many of the problems identified on the tenant’s list to the heirs were related to water damage – roof leaks in more than 5 areas of the house, mold throughout house, clogged sinks, water damaged carpeting and electrical problems. The expenditures for maintenance by the PA/PG handyman after the initial renovation in preparation for tenancy totaled only $1,955. Between August 2000, when the tenant first occupied the house, and June 2003, two months before distribution of the estate to heirs, there were only 8 visits by the handyman to the house. Seven of the eight visits were to alleviate plumbing problems in the home. Only two of the visits had notations for roof-repairs. In August 2001 a roof repair was one of four tasks that totaled $250. A second roof repair charge was for $95 in June 2003, when the estate was entrusted to the Private Administrator. Fact: In a 34-month period, only $1,955 was paid for service and maintenance at the property; 7 of the 8 visits were to alleviate plumbing problems. Finding: In 2003 the tenant reported problems in the house that revealed extensive water and mold damage throughout the house. Yet only two minor expenditures were made in 2001 and 2003 to repair the roof. OVERSIGHT OF THE RENTAL AGENT’S MANAGEMENT OF PROPERTY The Public Administrator/Public Guardian’s Office uses a rental agent to rent and assist in the management of property that is tenant occupied. Records reveal that the PA/PG has utilized the same rental agent for more than 10 years. For a fee of 10% of collected rents, the agent screens applicants, collects rents, takes calls concerning the properties and makes arrangements for repairs that have been authorized by the PA/PG Property Manager. The Grand Jury’s inquiry concerning the arrangement with the rental agent focused on the following areas. Screening and Selection of Tenants And Collection Of Rents Most of the details concerning the tenancy of the property and the rents collected came from Court records. The tenant occupied the property in August 2000 after entering a rental agreement with the rental agent. In February 2001, only 6 months into the tenancy, the tenant began to fall behind on rent. In March, it was reported that the tenant paid a $35 late rent fee for the February rent. Even though the tenant remained in arrears for the next 27 months, this penalty appeared to be assessed only this one time. This fee was not incorporated into the lost rent calculations. Cumulatively, it represented $945 in lost revenue to the estate. By July 2001, the tenant had been delinquent each month and still had $1,800 owing in back rent. While Court records revealed that notice was served the previous month, it appears no action was taken to demand payment of rent or relinquishment of possession. By December 2001, the tenant was $10,000 in arrears. The deficit showed signs of improvement in 2002. When the private administrator filed the petition to probate in 6 – 2004(filed May 19, 2004) Report 2003/4-06 October of that year, the tenant was $7,000 in arrears. The amount over due increased to $13,000 by the time the heirs took possession when it is taken into consideration that the $2,000 security deposit was improperly applied towards rent. The PA/PG Property Manager reported that the rental agent did screen and do a credit check on the prospective tenant. We were told that even though the credit check was “marginal,” the decision was made to go ahead with the tenancy because the house had been vacant for so long and they expected difficulty in finding another person who would rent the house. Noting that court records revealed that a three-day notice to pay was issued in June 2001, we asked for clarification regarding procedures normally used when tenants are delinquent in rent. We did not receive a direct answer or explanation. We were told it was better to be four months down in rent than to have a vacant home that requires extensive repairs and improvements in order to re-rent it. We were also advised that the decision was made to use labor-intensive strategies to nurse the tenant along. Communication about and Documentation of Problems During the investigation we could not find documentation regarding the condition of the home when the tenant first occupied the property. While the rental agreement with the tenant was found in the PA/PG files, there was not a completed detailed “tenant entrance checklist” attached to the agreement similar to ones used in previous years by the same rental agent. Instead we found one page from what should have been a multi- page checklist. Because there were no procedural requirements, there was no record of any itemization of the problems through tenant reports about required maintenance or the deteriorating condition of the home to the contract property manager. Nor was there documentation reflecting the transmission of that information to PA/PG Property Management. The Grand Jury asked whether the PA/PG Property Manager receives reports from the rental agent concerning tenant reports of problems. We were advised that PA/PG receives calls when problems need to be solved at any of the properties under their care. Monthly written reports for each property are not required. Nor is the rental agent required to conduct periodic on-site inspections for each property so that problems can be identified and reported to PA/PG. Adequacy of Accountability and Oversight of Rental Agent Performance When asked regarding other procedural safeguards that are in place for evaluating and monitoring the performance of the rental agent, the PA/PG Property Manager responded that he receives monthly reports regarding the rents that are collected at each property by the agent. We noted that pursuant to established Department Policy and Procedures, payments are automatically made to the rental agent without PA/PG Property Management staff authorization. – 2004 (filed May 19, 2004) 7 Report 2003/4-06 Fact: Rent was fully paid on time for only 6 of the 34 months of the tenant’s occupancy of the real property. Finding: In addition to what ultimately became $13,000 in lost rental revenue, the contract rental agent and PA/PG Property Management officials did not assess $35 late payment fees for the remaining 27 months that the tenant’s rent was late. Finding: There are no written procedures in place to guide the decision-making and actions by PA/PG staff and especially by their contract rental agent when there is prolonged non-payment of rent. Finding: There appeared to be more concern about the work that would need to be done and the cost if the tenant vacated the property than on the department’s obligation to protect and enhance the largest asset of the estate. Fact: There are no provisions in the contract between PA/PG and the rental agent that require documentation and reporting regarding calls from tenants, reporting of maintenance problems and periodic on site inspections of properties. Finding: The PA/PG has not instituted sufficient safeguards and reporting mechanisms for their monitoring and evaluation of performance of the rental agent. Finding: It does not appear that the PA/PG Property Management Division has a goal to “seek to know and respond to” problems; instead they appeared to do and spend as little as possible on problems.

May 12, 2004 — Senior Volunteer Patrols

6 pages 5 findings

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Findings & Recommendations 5 findings

F1: Depending on the jurisdiction, applicants must be at least 50 to 55 years of age.

F2: Both male and female applicants are accepted.

F3: Applicants agree to abide by all department and program rules.

F4: Applicants must pass a background check, consisting of complete criminal history computer check; Department of Justice fingerprint check; and a check of references.

F5: Applicant must successfully complete the Basic RSVP Academy course. Training To prepare the volunteers for handling these tasks, new volunteers are sent to a two-week academy where they are taught the proper procedures for accomplishing their assigned duties. In addition, monthly meetings are held in which the volunteers are updated on procedures and where problems encountered by the volunteers are addressed. The volunteers commit a minimum of six hours per week to the patrol duties, although many volunteers exceed this time commitment. – 2004 (filed May 12, 2004) 3 Report 2003/4-04 Each of the volunteers is also trained in the non-confrontational policies of the law enforcement agencies as it affects the volunteers. This non-confrontational policy is a vital part of the program’s success. The volunteers are trained to recognize confrontational situations and how to avoid them. This system provides for the safety of the volunteers, their acceptance by the public and helps to avoid potential problems that could arise from the use of “cop wannabees”. Value to the agencies of the services received. Before the senior volunteer programs were adopted, patrol officers performed each of the tasks described in the foregoing section whenever time permitted. If sufficient time were not available to perform the tasks, they would, by necessity, remain undone. With volunteers performing these tasks, the officers are freed to concentrate on duties that require a sworn officer to perform. We have determined, as a result of interviews, that the volunteers in these programs are not only accepted by the sworn officers, but are welcomed by the majority of them. Dollar value of the services performed by volunteers. During fiscal year 2002-2003, 601 volunteers with the San Diego County Sheriff’s Department logged 137,718 man-hours. Approximately 500 volunteers with the San Diego Police Department logged 135,674 hours, and the volunteers at the La Mesa Police Department logged 16,998 hours. The hours volunteered by senior citizens are valued by the departments at $16.54 per hour. The value returned to the community of $4,803,051 is dramatically less than the cost of the sworn officers who had been performing these duties. Cost of maintaining the program. The cost of maintaining the Senior Volunteer Program includes all of the expenses incurred in the operation of the program, such as, uniforms, training, supervision, vehicles and maintenance and supplies. The cost to the Sheriff’s Department was $54,056 using part time supervision; cost to the San Diego Police Department was $125,682; and the cost to the La Mesa Police Department was $81,000. In the La Mesa and the San Diego Police departments, a full time officer is assigned for supervision. FACTS AND FINDINGS Facts This Grand Jury finds that the Senior Volunteer Patrol program provides significant savings to the jurisdictions served. The savings are derived by having volunteers perform valuable services while freeing sworn officers to perform their law enforcement duties. Findings The Senior Volunteer Patrol program provides a real service in the community by performing the routine duties that were formerly performed by sworn officers and deputies, freeing these sworn officers to focus on protecting the citizens of San Diego County. 4 – 2004 (filed May 12, 2004) Report 2003/4-04 The services provided by the volunteers comes at a cost of $260,738 to the jurisdictions examined. That cost, while significant, is outweighed by the benefits derived from the use of the volunteers. The value placed on the hours contributed by the volunteers by the departments examined in this report for fiscal year 2002/2003 is $4,803,051. The net value of these services by the volunteers is $4,542,313 for the year, using the modest value being used of $16.54 per hour. When you also consider the value to the local governments of freeing sworn officers from routine jobs, the value of the volunteers is even more apparent. One issue that has not been evaluated by this Jury is the revenue brought in by the writing of citations for the unauthorized use of handicapped parking. While this revenue is probably quite significant, this revenue has not been considered in determining the value of the Senior Volunteer Patrol program. To determine the true cost and value of the programs, the citation revenues should be included. Even without the revenues, the Senior Volunteer Programs give far more value back to the community than it costs to maintain. COMMENDATION The men and women volunteering their services to the Senior Volunteer Patrols are a dedicated group of citizens who are worthy of commendation by this Grand Jury. They provide a valuable service to the communities they serve by performing the routine duties that otherwise would take sworn officers away from the essential tasks that they perform.

April 27, 2004 — Mental Health Services in the County Jails and Impact of the Connections Program

13 pages 1 findings 37 recommendations

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Findings & Recommendations 1 findings

F1: mental health services upon release. They need case management support and close collaboration with health and human services organizations in order to facilitate patient access to ongoing treatment. TREATMENT PROGRAM RECOMMENDATIONS The Grand Jury recommends that the San Diego County Board of Supervisors and the San Diego County Sheriff's Department: 04-03-1 Build case management services into contracts with all community-based organizations that serve released mentally ill offenders. Ensure that reliable and consistent drug and alcohol counseling services are 04-03-2 included in the Sheriff's mental health programs with a focus on specialized dual diagnosis treatment. 04-03-3 Enhance collaborative efforts with community-based organizations and with the local office of the Social Security Administration to facilitate access to services and benefits for released mentally ill offenders. – 2004 (filed April 27, 2004) Report 2003/4-03 TRAINING TRAINING DISCUSSION All PSU staff members receive training to ensure that they have knowledge and skills regarding the management of inmates with mental health concerns. A multi-disciplinary team jointly developed the training curriculum. The team consisted of a psychiatrist, nurse, social worker, deputy, occupational therapist, and recreational therapist. Deputies may volunteer for the training if they commit to work in the PSU facility for one year. Many deputies have taken advantage of this opportunity. After completion of the one- year commitment, these deputies are able to effectively utilize their skills to recognize and manage mental health problems while on other assignments. Orientation training topics are based on the application of recognized practices that help to reduce the risk of aggression and violence. Topics covered in the training program include: Definition of crisis and crisis resolution. • Essentials of documentation. • Provision of firm, kind support. Definition of drug abuse and addiction. • In addition, nursing staff is trained to: Recognize behaviors related to psychiatric diagnoses. • Become familiar with the medications commonly prescribed to treat symptoms of • mental illness. Understand concepts such as transference and models of violence. • Ongoing training is provided by the psychiatrist during morning treatment team meetings. There is periodic training on special topics such as patient advocacy. TRAINING FACTS AND FINDINGS Mental health cross training is provided for correctional and clinical staff who Fact: will work in the PSU. Finding: As a result of cross training there has been improved understanding of mental health issues by correctional staff, as well as more effective communication between correctional and clinical staff. – 2004 (filed April 27, 2004) Report 2003/4-03 Fact: Correctional staff who have mental health training and experience are taught how to manage behaviors competently and with compassion. Finding: The safety and welfare of patients is enhanced through cross training. TRAINING RECOMMENDATION The Grand Jury recommends that the San Diego County Board of Supervisors, and the San Diego County Sheriff's Department: Expand cross training to develop greater understanding of special needs of 04-03-4 released mentally ill offenders by opening training sessions to probation officers and workers in the public mental health community. BUDGET BUDGET DISCUSSION The Sheriff has allocated $11.4 million in FY 2003-04 for the jail mental health program. According to a Memorandum of Agreement for the Provision of Mental Health Services to Adult Inmates in the Sheriff's Detention Facilities (02/14/00), the San Diego County Health & Human Services Agency "will pay reimbursement to the Sheriff's Department based on actual costs, not to exceed a maximum amount of $4,328,226..." per year. For FY 2003-04, the Health & Human Services Agency withheld $650,000 from the expected allocation due to budget constraints. The San Diego County Public Safety Group is using reserves and has promised to cover this shortage for 2003-04, but there is no commitment for continued support after this year. Based on an assumption that there will be no funding changes or staff raises, there is a projected shortage of $650,000 for FY 2004-05. Attempts have been made to find other revenue sources. For example, if a patient has private insurance, the Sheriff's Department can collect reimbursement for the mental health services provided in jail. Unfortunately, few mentally ill offenders have private insurance. It is not possible to use Supplemental Security Income, Medicare or Medi-Cal reimbursement to defray mental health service costs because patients are not eligible for these payments while incarcerated. The county jail system is the largest mental health provider in the county, and operates a model program that has been recognized throughout the state. New interdepartmental and community partnerships need to be developed in order to ensure continued support. BUDGET FACTS AND FINDINGS County general and state funds, which provide for psychiatric care in jails, are Fact: experiencing cuts due to the State of California budget crisis. – 2004 (filed April 27, 2004) Report 2003/4-03 Finding: Jail staff is working to overcome the budget cuts to maintain quality mental health services in the jails. Fact: State budget constraints are exerting pressure on existing funding agreements between the Health & Human Services Agency and the Sheriff's Department. Finding: Long-term plans are needed for additional funding of mental health services in the jails to maintain the current level of care. BUDGET RECOMMENDATIONS: The Grand Jury recommends that the San Diego County Board of Supervisors and the San Diego County Sheriff's Department: 04-03-5 Work to enhance community understanding of the benefits of effective mental health services in the county jail system in order to generate public and private support. 04-03-6 Develop long term plans to ensure funding for mental health services in the county jail system. Develop and strengthen the working partnerships among Health & Human 04-03-7 Services Resource Development Division, Sheriff's Health Services, and Probation Department. This partnership would work on coordinated grant requests so that mental health services grant revenues can be increased. MEDICATION MEDICATION DISCUSSION The county jail health system uses the San Diego County Health & Human Services Agency (HHSA) as their pharmaceutical provider. HHSA would like to move the purchasing of medications to the Sheriff's Department. To facilitate the transition, HHSA has offered to pass along $3 million to the county jail system. Based on yearly medication expenditure of $3.2 - 3.4 million, this would not fully cover the expense incurred by the county jail system. Expenses include costs of medications dispensed to patients during incarceration, as well as, costs of a 30-day supply of prescribed medications after release. Patients released from the county jail mental health program are provided with a voucher for a 30-day supply of medications. The voucher can be redeemed at a Savon Drug Store. When available, discount coupons from drug manufacturers are attached to the vouchers. These coupons provide some cost savings to the jail system. It is notable that 50% of the total cost of medications for the entire county jail system can be attributed to drugs that help to relieve symptoms of mental illness. As required by law, these medications are used for the patients' benefit, not control. Medications are Report 2003/4-03 administered only after obtaining the informed consent of the mentally ill offender or in an emergency situation with justification documented by a psychiatrist. All use of medications is monitored by a psychiatrist. MEDICATION FACTS & FINDINGS The San Diego County Health & Human Services Agency is the Fact: pharmaceutical provider for the county jail health system. Finding: The county jail health system currently has no other cost effective medication purchasing options. MEDICATION RECOMMENDATION The Grand Jury recommends that the San Diego County Board of Supervisors: 04-03-8 Explore drug purchasing alternatives including those utilized by other states and public agencies to identify potential cost-savings. CONNECTIONS PROGRAM CONNECTIONS PROGRAM DISCUSSION In 1999, the San Diego County Sheriff's Department was awarded a $5 million, four-year grant from the Board of Corrections Mentally Ill Offender Crime Reduction Grant Program. San Diego was one of fifteen Counties in California to receive this funding. Funding was earmarked to provide services to mentally ill individuals who are incarcerated. The funds were exhausted as of December 31, 2003. This program was named Connections Program. San Diego was recognized as having one of the most successful programs in the state. Probation officers teamed with mental health clinicians and others so that Connections Program participants could receive the following services: Pre-release needs assessment, treatment planning and engagement with community service linkages for follow-up treatment and assistance. Intensive case management services for 2 years following release with 24-hour • staff availability 7 days a week. Payee program to assist clients in managing finances. Encourage involvement of families and significant others. • Substance abuse monitoring and intervention. • Report 2003/4-03 San Diego County has demonstrated the best outcomes in the state. Preliminary results from the 105 Connections Program clients who exited the program and the 71 who completed the 6-month follow up interview by June 3, 2003, revealed "...these individuals were less likely to be booked into jail and convicted of a crime in the 6 months following program exit. Other indications are that clients improved their level of functioning in the community and decreased their risk of recidivism over time..." (SANDAG, September 2003). The approximate cost avoidance in reducing the number of jail days for this group of clients is $290,000. Now that the funding is depleted, the Sheriff's staff that enabled this success story has been reassigned to other duties. The remaining services for mentally ill offenders who are exiting jail that are provided include: • Continuing post discharge help for Connections Program clients who have already been engaged in community services. In-jail group-counseling by two community agencies that brief clients on where and how to access services. Without this special assistance, mentally ill offenders who are exiting jails can continue to receive mental health treatment through Public Mental Health Services if: Pre-release arrangements have been made by Sheriff and Mental Health staff for the offender to receive services in a county funded program. The offender is successful in securing eligibility for Medi-Cal or Social Security • Income because of his/her disabling condition. The severity of the offender's illness and condition meets the agency's eligibility • criteria. CONNECTIONS PROGRAM FACTS & FINDINGS Fact: The California Legislature made millions of dollars available through the Mentally Ill Offender Crime Reduction Grant Program so that mentally ill offenders could receive assistance and treatment when they are released from jails. Finding: The San Diego County Sheriff's Department has been recognized by the California Board of Corrections as having one of the most successful transition programs and has demonstrated the best outcomes in the state. Fact: The Connections Program team's pre-release assessments, planning and connections to needed services for offenders not only reduced numbers of re-offenses and bookings but also improved their level of functioning in the communities where they lived. Report 2003/4-03 Finding: Without this type of individualized assistance from trained professionals mentally ill offenders do not consistently or automatically receive treatment or help from County Mental Health Service agencies when they are released from jail. Fact: Through the Connections Program participants received monitoring and intervention services for co-existent substance abuse problems. Finding: When released from jail mentally ill offenders do not necessarily receive assistance, referrals or monitoring for their substance abuse problems. CONNECTIONS PROGRAM RECOMMENDATION The Grand Jury recommends that the San Diego County Board of Supervisors: 04-03-9 Implement a training initiative for probation officers and workers in the public mental health and community agencies in order to enhance their understanding of special needs and concerns of released mentally ill offenders. CONNECTIONS PROGRAM COMMENDATION The San Diego Grand Jury commends the San Diego County Sheriff's Department's Mental Health Program staff for their exemplary work in designing and implementing the Connections Program and congratulates them for being recognized by the state Board of Corrections for demonstrating the best outcomes in the state. MANAGEMENT AND GRANTS The San Diego County Sheriff's Department has an administrative model that differs from that of most other counties in California. Here, jail mental health services are "owned" and operated by the Sheriff's Department, rather than by an outside department such as Health and Human Services. Since 1998, jail health staff has been under the direct supervision of the Sheriff's Department. This has enabled consistency of policies and practices, and prevented confusion caused by the sharing of supervision by two agencies. Other counties have sent representatives to San Diego to learn about this model. The staff prides itself on the quality and depth of its services to its clients. The overall morale is high and there is a strong sense of pride and commitment to members of the community who need advocacy. This attitude starts at the management level and permeates the health staff. Strong management, leadership, and positive professional attitude have enabled the San Diego County Sheriff's Department to obtain one of only 13 funded grants from the Federal Department of Education-Correctional Education Group. There were 125 applicants nationwide. – 2004 (filed April 27, 2004) Report 2003/4-03 REQUIREMENTS AND INSTRUCTIONS The California Penal Code §933 (c) requires any public agency which the Grand Jury has reviewed, and about which it has issued a final report, to comment to the Presiding Judge of the Superior Court on the findings and recommendations pertaining to matters under the control of the agency. Such comment shall be made no later than 90 days after the Grand Jury publishes its report (filed with the Clerk of the Court); except that in the case of a report containing findings and recommendations pertaining to a department or agency headed by an elected County official (e.g. District Attorney, Sheriff, etc.), such comment shall be made within 60 days to the Presiding Judge with an information copy sent to the Board of Supervisors. Furthermore, California Penal Code §933.05(a), (b),(c), details, as follows, the manner in which such comment(s) are to be made: As to each grand jury finding, the responding person or entity shall (a) indicate one of the following: The respondent agrees with the finding. (1) (2) The respondent disagrees wholly or partially with the finding, in which case the response shall specify the portion of the finding that is disputed and shall include an explanation of the reasons therefor. As to each grand jury recommendation, the responding person or entity shall (b) report one of the following actions: The recommendation has been implemented, with a summary (1) regarding the implemented action. The recommendation has not yet been implemented, but will be (2) implemented in the future, with a time frame for implementation. The recommendation requires further analysis, with an (3) explanation and the scope and parameters of an analysis or study, and a time frame for the matter to be prepared for discussion by the officer or head of the agency or department being investigated or reviewed, including the governing body of the public agency when applicable. This time frame shall not exceed six months from the date of publication of the grand jury report. The recommendation will not be implemented because it is not (4) warranted or is not reasonable, with an explanation therefor. If a finding or recommendation of the grand jury addresses budgetary or (c) personnel matters of a county agency or department head and the Board of Supervisors shall respond if requested by the grand jury, but the response of the Board of Supervisors shall address only those budgetary or personnel matters over which it has some decision making authority. The response of the elected agency or department head shall address all aspects of the findings or recommendations affecting his or her agency or department. Report 2003/4-03 Comments to the Presiding Judge of the Superior Court in compliance with the Penal Code §933.05 are required by the date indicated: RESPONDING AGENCY RECOMMENDATIONS DATE San Diego County Board of 04-03-1 through 04-03-9 07/28/04 Supervisors San Diego County Sheriff's Department 04-03-1 through 04-03-7 06/28/04 – 2004 (filed April 27, 2004)

Related Recommendations (1)

R1: Definition of crisis and crisis resolution.

Additional Recommendations 36

Not linked to specific findings.

R2: Essentials of documentation.

R3: Provision of firm, kind support.

R4: Definition of drug abuse and addiction. In addition, nursing staff is trained to:

R5: Recognize behaviors related to psychiatric diagnoses.

R6: Become familiar with the medications commonly prescribed to treat symptoms of mental illness.

R7: Understand concepts such as transference and models of violence. Ongoing training is provided by the psychiatrist during morning treatment team meetings. There is periodic training on special topics such as patient advocacy. TRAINING FACTS AND FINDINGS Fact: Mental health cross training is provided for correctional and clinical staff who will work in the PSU.

R8: The Grand Jury recommends that the San Diego County Board of Supervisors: Pre-release needs assessment, treatment planning and engagement with community service linkages for follow-up treatment and assistance.

R9: The Grand Jury recommends that the San Diego County Board of Supervisors: Intensive case management services for 2 years following release with 24-hour staff availability 7 days a week.

R10: The Grand Jury recommends that the San Diego County Board of Supervisors: Payee program to assist clients in managing finances.

R11: The Grand Jury recommends that the San Diego County Board of Supervisors: Encourage involvement of families and significant others.

R12: The Grand Jury recommends that the San Diego County Board of Supervisors: Substance abuse monitoring and intervention. San Diego County has demonstrated the best outcomes in the state. Preliminary results from the 105 Connections Program clients who exited the program and the 71 who completed the 6-month follow up interview by June 3, 2003, revealed “…these individuals were less likely to be booked into jail and convicted of a crime in the 6 months following program exit. Other indications are that clients improved their level of functioning in the community and decreased their risk of recidivism over time…” (SANDAG, September 2003). The approximate cost avoidance in reducing the number of jail days for this group of clients is $290,000. Now that the funding is depleted, the Sheriff’s staff that enabled this success story has been reassigned to other duties. The remaining services for mentally ill offenders who are exiting jail that are provided include:

R13: The Grand Jury recommends that the San Diego County Board of Supervisors: Continuing post discharge help for Connections Program clients who have already been engaged in community services.

R14: The Grand Jury recommends that the San Diego County Board of Supervisors: In-jail group-counseling by two community agencies that brief clients on where and how to access services. Without this special assistance, mentally ill offenders who are exiting jails can continue to receive mental health treatment through Public Mental Health Services if:

R15: The Grand Jury recommends that the San Diego County Board of Supervisors: Pre-release arrangements have been made by Sheriff and Mental Health staff for the offender to receive services in a county funded program.

R16: The Grand Jury recommends that the San Diego County Board of Supervisors: The offender is successful in securing eligibility for Medi-Cal or Social Security Income because of his/her disabling condition.

R17: The Grand Jury recommends that the San Diego County Board of Supervisors: The severity of the offender’s illness and condition meets the agency’s eligibility criteria. CONNECTIONS PROGRAM FACTS & FINDINGS Fact: The California Legislature made millions of dollars available through the Mentally Ill Offender Crime Reduction Grant Program so that mentally ill offenders could receive assistance and treatment when they are released from jails.

R18: The Grand Jury recommends that the San Diego County Board of Supervisors: Pre-release needs assessment, treatment planning and engagement with community service linkages for follow-up treatment and assistance.

R19: The Grand Jury recommends that the San Diego County Board of Supervisors: Intensive case management services for 2 years following release with 24-hour staff availability 7 days a week.

R20: The Grand Jury recommends that the San Diego County Board of Supervisors: Payee program to assist clients in managing finances.

R21: The Grand Jury recommends that the San Diego County Board of Supervisors: Encourage involvement of families and significant others.

R22: The Grand Jury recommends that the San Diego County Board of Supervisors: Substance abuse monitoring and intervention. San Diego County has demonstrated the best outcomes in the state. Preliminary results from the 105 Connections Program clients who exited the program and the 71 who completed the 6-month follow up interview by June 3, 2003, revealed “…these individuals were less likely to be booked into jail and convicted of a crime in the 6 months following program exit. Other indications are that clients improved their level of functioning in the community and decreased their risk of recidivism over time…” (SANDAG, September 2003). The approximate cost avoidance in reducing the number of jail days for this group of clients is $290,000. Now that the funding is depleted, the Sheriff’s staff that enabled this success story has been reassigned to other duties. The remaining services for mentally ill offenders who are exiting jail that are provided include:

R23: The Grand Jury recommends that the San Diego County Board of Supervisors: Continuing post discharge help for Connections Program clients who have already been engaged in community services.

R24: The Grand Jury recommends that the San Diego County Board of Supervisors: In-jail group-counseling by two community agencies that brief clients on where and how to access services. Without this special assistance, mentally ill offenders who are exiting jails can continue to receive mental health treatment through Public Mental Health Services if:

R25: The Grand Jury recommends that the San Diego County Board of Supervisors: Pre-release arrangements have been made by Sheriff and Mental Health staff for the offender to receive services in a county funded program.

R26: The Grand Jury recommends that the San Diego County Board of Supervisors: The offender is successful in securing eligibility for Medi-Cal or Social Security Income because of his/her disabling condition.

R27: The Grand Jury recommends that the San Diego County Board of Supervisors: The severity of the offender’s illness and condition meets the agency’s eligibility criteria. CONNECTIONS PROGRAM FACTS & FINDINGS Fact: The California Legislature made millions of dollars available through the Mentally Ill Offender Crime Reduction Grant Program so that mentally ill offenders could receive assistance and treatment when they are released from jails.

R28: The Grand Jury recommends that the San Diego County Board of Supervisors: Pre-release needs assessment, treatment planning and engagement with community service linkages for follow-up treatment and assistance.

R29: The Grand Jury recommends that the San Diego County Board of Supervisors: Intensive case management services for 2 years following release with 24-hour staff availability 7 days a week.

R30: The Grand Jury recommends that the San Diego County Board of Supervisors: Payee program to assist clients in managing finances.

R31: The Grand Jury recommends that the San Diego County Board of Supervisors: Encourage involvement of families and significant others.

R32: The Grand Jury recommends that the San Diego County Board of Supervisors: Substance abuse monitoring and intervention. San Diego County has demonstrated the best outcomes in the state. Preliminary results from the 105 Connections Program clients who exited the program and the 71 who completed the 6-month follow up interview by June 3, 2003, revealed “…these individuals were less likely to be booked into jail and convicted of a crime in the 6 months following program exit. Other indications are that clients improved their level of functioning in the community and decreased their risk of recidivism over time…” (SANDAG, September 2003). The approximate cost avoidance in reducing the number of jail days for this group of clients is $290,000. Now that the funding is depleted, the Sheriff’s staff that enabled this success story has been reassigned to other duties. The remaining services for mentally ill offenders who are exiting jail that are provided include:

R33: The Grand Jury recommends that the San Diego County Board of Supervisors: Continuing post discharge help for Connections Program clients who have already been engaged in community services.

R34: The Grand Jury recommends that the San Diego County Board of Supervisors: In-jail group-counseling by two community agencies that brief clients on where and how to access services. Without this special assistance, mentally ill offenders who are exiting jails can continue to receive mental health treatment through Public Mental Health Services if:

R35: The Grand Jury recommends that the San Diego County Board of Supervisors: Pre-release arrangements have been made by Sheriff and Mental Health staff for the offender to receive services in a county funded program.

R36: The Grand Jury recommends that the San Diego County Board of Supervisors: The offender is successful in securing eligibility for Medi-Cal or Social Security Income because of his/her disabling condition.

R37: The Grand Jury recommends that the San Diego County Board of Supervisors: The severity of the offender’s illness and condition meets the agency’s eligibility criteria. CONNECTIONS PROGRAM FACTS & FINDINGS Fact: The California Legislature made millions of dollars available through the Mentally Ill Offender Crime Reduction Grant Program so that mentally ill offenders could receive assistance and treatment when they are released from jails.

March 17, 2004 — Conditions and Management of Detention Facilities in San Diego County

22 pages 2 findings

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Findings & Recommendations 2 findings

F144: The offenders here range in age from 16 to 18 years. No one convicted of arson or sexual offences may be assigned here. Sentences range from 270-547 days with a minimum sentence of 120. Inmates live in dormitories that house up to 40 people. There are also 20 rooms available for staff to use if they choose to stay overnight. Any inmate who has not completed high school or who does not have a GED is required to attend school. They attend classes two weeks out of three and take part in work programs the third week. Students, with very low reading skills, attend Linda Mood Bell literacy classes 3 hours a day. Sworn staff included 4 supervisors, 6 senior Deputy Probation Officers, 48-52 Probation Officers. There were 9 civilian staff plus 5 to 6 teachers. Additionally, there are two nurses who each work three days a week from 6 a.m. until 7 p.m. and trade off coverage on Sundays. Physical health care is provided by California Medical Forensic Group. Nurses dispense medications three times a day and offer daily sick call clinic. A physician visits the camp weekly. Mental health care is provided by the county Health and Human Services —2004 (March 17, 2004) 13 Report 2003/4-02 Agency at Juvenile Hall. Wards are transported to Juvenile Hall monthly for mental health reviews or if they require more intensive medical care. FACTS/FINDINGS • There are forms available for inmates to request services or lodge grievances. It was noted that grievance forms are filed away after they are resolved. However, no control log of these grievances and their disposition is maintained. • Youth being released from Barrett to go home are given a two-week supply of the medications they are currently prescribed. However, no written information is given to the parent explaining what medications are being given or any medical condition the youth is or was being treated for while incarcerated. All the records for the person being released are sent back to Juvenile Hall for storage. • Many of the buildings are showing wear. In many areas electrical wires are exposed. Many extension cords are being used to connect power to permanently installed equipment. • Signs for warning notices and rules are mainly in English. Posters for character education are in both Spanish and English. COMMENDATION Low literacy skill is one of the greatest blocks to educational success faced by a large number of the youth in this facility. The literacy program is to be commended and continued. The Linda Mood Bell program shows growth of four grade levels or more in 8 to 10 weeks time.

F2003: This is a four-part facility for juvenile males aged 12 to 18. It is located in East County near Campo, about one mile from the Mexican border. This is a minimum- security facility located near a large Border Patrol office. Originally this was the location of an army cavalry camp dating back to the early 1900’s. The California Board of Corrections rated capacity is 250. On the day of the visit there were 160 youthful offenders assigned here. There are 76 sworn employees allotted to the ranch with 60-70 actually assigned. Additionally there were 25-30 civilian employees as support staff. The detainees are housed in one of four dorms. Rayo I is for ages 12-16 ½ and focuses on substance abuse and breaking the cycle of addictive thinking and behavior. Rayo II is for ages 16 ½ to 18. Here the focus is on substance abuse, anger management, self- responsibility, and goal setting. The programs at Rayo I and Rayo II include 6 hours of schooling daily, include AA/NA meetings, 12 weeks of drug counseling, and McAlister Institute for Treatment and Education and Aggression replacement therapy. Campo I dorm is for delinquent wards ages 12 to 18 with minor or no history of substance abuse. Juveniles must pass a minimum of a 56-day “Breaking Cycles” program before being considered for release. Campo II is for ages 13-18 focusing on relapses from the “Breaking Cycles” and Drug Court program. Also, they focus on the “STOP Program” of 21-40 days depending upon their behavior and participation. STOP refers to the Short-Term Offenders Program. Along with 6 hours of schooling daily, wards may receive psychological counseling, take part in the Modified Attitude Adjustment Program, and the Thinking for a Change, and or the Criminal Conduct programs. Some detainees take part in the Donovan State Prison Convicts Reaching Out to People program. FACTS/FINDINGS • Two classrooms have been out of use since before last March due to rodent infestation. The rooms are being renovated, however they are still unusable. • Students coming to school here are tested and placed into classes based upon their ability, not their age. This method of placement is something the staff promoted, and it helps the students be more successful. • Additional help in promoting literacy is being addressed with the Linda Mood Bell reading program for some of the students. • Due to various lengths of stay, sometimes as short as a few days, getting school records is sometimes a problem. —2004 (March 17, 2004) 17 Report 2003/4-02 • Due to the high number of special education students, the school has 3 mainstream classes and 3 special education classes. Approximately 50% of the students here are Hispanic, 23% African American and 20% Caucasian. Notices to parents are available in both English and Spanish. However, most posted rules and warning signs on site are in English only. Due to the proximity to the Border Patrol Station, drug dogs are available for searches for contraband. If a detainee goes AWOL, the Border Patrol is notified and has been helpful in returning some detainees to the Ranch Facility. Due to budget cuts, maintenance and upkeep of the facility has been reduced. Although some of the buildings are very new, the older buildings need paint and some siding replaced. The perimeter fence needs repair.

March 10, 2004 — Is There a Need for a Regional Fire Authority and Rescue Helicopters in San Diego County?

11 pages 4 findings

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Findings & Recommendations 4 findings

F1: San Diego Fire - Rescue Department

F2: Task Force on Fire Protection and Emergency Medical Services San Diego County Fire Chiefs' Association Service Authority for Freeway Emergencies (SAFE)

F3: Sycuan Band of the Kumeyaay Nation.

F4: The San Diego County Fire Chiefs' Association recommended to the Board of Supervisors that a professional consultant be utilized to conduct a study to examine the helicopter firefighting requirements in San Diego County. The report should provide

April 22, 2003 — Who Dropped the Berm?

6 pages 19 findings

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Findings & Recommendations 19 findings

F1: The country club had a right and a duty to complete a 27-hole golf course on City owned land before the end of 2008.

F2: The country club had an opportunity to complete the 27-hole golf course under rules and regulations in force in 1983, if the work was completed before December 31, 2003.

F3: A DSD employee acting, as Deputy City Engineer, approved the grading plans prepared by country club for the 9-hole extension on April 22, 2003.

F4: An Engineering Permit was issued the same day. The permit states that the work to be done shall conform to the approved grading plans.

F5: The drawings do not show any indication of a berm along the southern boundary of the course, nor does the Environmental Impact Report for the development evaluate the impact of such a berm.

F6: The grading plans clearly state in the middle of the first page that: “TOTAL GRADING QUANTITY EXCAVATION 380,000 C.Y. EMBANKMENT 380,000 C.Y.” There is no provision for the import of fill.

F7: Work began a week after the plans and permit were signed, and on May 5, 2003 an E&CP inspector first noted that fill was being imported.

F8: Numerous subsequent reports state that approximately 3000 cubic yards, or more, were being imported each day.

F9: There is no evidence that E&CP took any action based on the inspectors’ reports.

F10: There is no evidence that E&CP provided the inspection reports to DSD.

F11: This importation of soil continued until a Stop Work Order was issued on October 29, 2003.

F12: The berm was over 0.8 miles long, and its height was, at least, 5 to 6 feet above the level of the adjacent roadway. 221

F13: The remedy approved by the Deputy City Engineer required country club to grade the upper part of the berm into the valley. There was no request to remove any of the imported fill. Findings

F14: Actions by the E&CP, DSD and NCCD regarding the berm may not have been in the best interests of the City.

F15: The City Engineer who heads E&CP deputized a member of DSD to act as City Engineer for this project, but he did not assure that inspection reports for the project were given to this Deputy City Engineer. The authority to make decisions for the City was delegated, but the responsibility and ability to monitor the project was not.

F16: When a City Department receives a complaint concerning an activity under the oversight of another City Department, it does not generally forward the complaint to that Department or contact the complainant to explain the situation.

F17: Actions by the E&CP, DSD and NCCD regarding the berm may not have been in the best interests of the City.

F18: The City Engineer who heads E&CP deputized a member of DSD to act as City Engineer for this project, but he did not assure that inspection reports for the project were given to this Deputy City Engineer. The authority to make decisions for the City was delegated, but the responsibility and ability to monitor the project was not.

F19: When a City Department receives a complaint concerning an activity under the oversight of another City Department, it does not generally forward the complaint to that Department or contact the complainant to explain the situation.

The Development Services Department Project Tracking System

14 pages 6 findings 8 recommendations

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Findings & Recommendations 6 findings

F1: There is no evidence that the Process 2000/Project Tracking System has reduced permit processing time by 50%.

Related Recommendations (1)

R1: DSD should develop firm deadlines for the final implementation of the remaining modules as well as determining those who are responsible for each module.

F2: Process 2000/Project Tracking System has not been developed and implemented within the time frame initially contemplated. 201

Related Recommendations (1)

R2: DSD should consider outsourcing the completion of the remaining modules so that the current in-house IT development team can focus on modifications and enhancements to the modules already completed. 207

F3: Process 2000/Project Tracking System has not been developed and implemented within the budget originally proposed.

Related Recommendations (1)

R3: DSD should develop an annual budget for PTS expenses including personnel, development, maintenance, software, and hardware expenses.

F4: Information is not available to enable the determination of the actual cost of developing and implementing the Process 2000/Project Tracking System. Findings

Related Recommendations (1)

R4: DSD should set up a job order for DSD staff involved in the development and maintenance of PTS. This job order number could track all labor hours relating to PTS as well as future software and hardware costs.

F5: The Development Services Department has not planned, developed or accounted for the Process 2000/Project Tracking System effort in a proficient manner.

Related Recommendations (1)

R5: DSD should track the cost each individual module of PTS as well as other components of DSD’s IT expense so that management can determine if costs will fall within budget for any given fiscal year. DSD should revise its accounting methods as needed to efficiently and effectively track these expenses and should include salaries, wages, and benefits relating to those expenses.

F6: The Development Services Department has not planned, developed or accounted for the Process 2000/Project Tracking System effort in a proficient manner.

Related Recommendations (1)

R6: In addition to implementing all modules and delivering target dates, as recommended in Finding I, DSD management should use information obtained through Module 10 - Management Reports and Module 11 - Customer Self- Access to improve customer satisfaction by providing customers with data on average time saved using PTS for each project category.

Additional Recommendations 2

Not linked to specific findings.

R7: DSD management should revisit and amend its record retention policies as necessary to ensure that records related to specific projects are retained for a specific period of time after the completion of the project.

R8: DSD management should obtain all relevant information regarding the planning of PTS, research, and due diligence completed relating to decisions to support the development of a software program in-house. COMMENDATION The Office of Audits & Advisory Services commends and sincerely appreciates the courtesies and cooperation extended by the City of San Diego’s Development Services Department for their assistance during this follow-up audit of the risk assessment. AUDIT TEAM Juan R. Perez, Senior Performance Auditor Shane Ellis, Associate Financial Auditor 211 This page left blank intentionally. 212