San Luis Obispo County Grand Jury
2017-2018
From the annual report
The consolidated year-end volume. The individual investigations it contains are listed separately below.
📑 Year-End Report
The full consolidated volume; individual reports are listed below.
Individual reports (11)
Findings & Recommendations
10 findings
F1:
SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency
F2:
SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency
F3:
SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency
F4:
SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency
F5:
SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency
F6:
SLO County Health Agency Agreed
F7:
SLO County Health Agency’s Drug and Alcohol Services Partially-agreed by Health Agency
F8:
SLO County Health Agency’s Drug and Alcohol Services Agreed
F9:
SLO County Sheriff’s Department Agreed
F10:
SLO County Health Agency’s Drug and Alcohol Services Disagreed Of the 10 recommendations made by the Grand Jury in the Residential Detox report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response
Additional Recommendations
10
Not linked to specific findings.
R1:
SLO County Health Agency Implemented
R2:
SLO County Board of Supervisors Will be implemented
R3:
SLO County Health Agency Requires further analysis 2017-2018 San Luis Obispo County Grand Jury Final Report 28
R4:
SLO County Sheriff’s Department Agrees and implements when and where possible
R5:
SLO County Sheriff’s Department Requires further analysis
R6:
SLO County Health Agency Will be implemented
R7:
SLO County Health Agency Requires further analysis
R8:
SLO County Board of Supervisors Will be implemented
R9:
San Luis Obispo City Council No response
R10:
SLO County Health Agency Implemented Of the five findings listed for the County Jail Inmate Health and Safety report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response
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Findings & Recommendations
12 findings
F1:
The current number of Mental Health Evaluation Teams is inadequate to serve the County with reasonable response times and effective intervention.
F2:
The “best practice” for patients in crisis is daily contact from peer counselors and mental health professionals. 2017-2018 San Luis Obispo County Grand Jury Final Report 50 A LOOK AT COUNTY BEHAVIORAL HEALTH SERVICES: THE TIME FOR IMPROVEMENTS IS NOW
F3:
There is a wide disparity in compensation between the State of California psychiatrists, locum tenens psychiatrists, and San Luis Obispo County psychiatrists.
F4:
The current organizational structure of the County Health Agency and, specifically, Behavioral Health appears convoluted based upon the maze of funding streams and regulatory requirements.
F5:
The consumer satisfaction/perception survey imposed by the State is not relevant to assessing service needs.
F6:
Expansion of supportive and community housing programs would reduce the number of crisis situations.
F7:
The new CSU is expected to take pressure off of the PHF.
F8:
Current efforts to reduce stigma are not having the magnitude of impact within our community.
F9:
Expansion of the system navigator and case manager roles will result in improved comprehensive care.
F10:
A limited number of law enforcement personnel have taken the full 40-hour Crisis Intervention Training (CIT), which is more effective than a shorter course in de- escalating crisis situations involving the mentally ill.
F11:
The full-service partnership programs are very effective and use the current “best practices” for treatment.
F12:
The closure of Vista Del Mar in Ventura County, due to the Thomas Fire, has had a negative impact due to the lack of nearby facilities to treat crisis patients who need longer term care.
Additional Recommendations
7
Not linked to specific findings.
R1:
Increase financial support to Behavioral Health from the County General Fund to accomplish the following within the next fiscal year. (Note: Some of this expense is reimbursable by Medi-Cal.): a. Reduce the wait time to enter the Full-Service Partnership program from months to weeks. 2017-2018 San Luis Obispo County Grand Jury Final Report 51 A LOOK AT COUNTY BEHAVIORAL HEALTH SERVICES: THE TIME FOR IMPROVEMENTS IS NOW b. Add clinicians and case managers to the mental health clinics thereby reducing wait time below the 10-day requirement and reducing the time between maintenance appointments. c. Add full time system navigators to all mental health clinics and encourage Cen-Cal (the local Medi-Cal affiliate) to add them at medical clinics. d. Add two additional Mental Health Evaluation Teams, one in North County and one in South County.
R2:
Increase funding and support for the community and supportive housing programs.
R3:
Improve efforts to reduce stigma through County sponsored educational programs and public service announcements.
R4:
Combine drug and alcohol treatment with mental health treatment, having all clinicians cross-trained to manage dual-diagnosis patients.
R5:
Reorganize the agency to concentrate on the complete behavioral health treatment process.
R6:
Use innovation and incentives, such as County backed bonds or tax breaks to support the building of private psychiatric and substance abuse facilities within the County.
R7:
Adopt more aggressive and innovative recruitment strategies for key positions such as Psychiatrists, Nurses, and Nurse Practitioners.
Findings & Recommendations
9 findings
F1:
The District does not have an effective system to follow-up with the public, schools, medical clinics, hospitals, or those who sign up to receive AirAware Alerts and Better Breather Alerts.
Related Recommendations (1)
R1:
The 2017-2018 Grand Jury recommends the San Luis Obispo County APCD prior to September 30, 2018 should: a. Contact senior centers, hospitals and clinics, child-care facilities, and local residents who may be unaware of the District air quality alert notification and alert forecast program and encourage them to sign up to receive AirAware Alerts. b. Perform follow-ups with residents and groups who previously signed up for District alert notification programs and confirm whether these residents and groups are receiving alerts and forecasts. c. Coordinate directly with the Lucia Mar Unified School District (LMUSD) and other schools on the Nipomo Mesa and nearby communities to facilitate sending them AirAware Alerts and warnings.
F2:
The LMUSD does not use the APCD AirAware Alerts system or routinely use the CARB AQMIS system.
Related Recommendations (1)
R2:
The 2017-2018 Grand Jury recommends the LMUSD should prior to the start of the next school year: a. Enroll in the APCD AirAware Alert notification program so that it can obtain current air quality alert conditions or alert forecasts. b. Use the APCD’s online Air Quality Management Information System (AQMIS) to obtain first-hand knowledge of the days when high particulate levels are forecast.
F3:
CARB computer modeling performed in 2017 confirmed that emissions of PM and PM 2.5 10 predominately originate from riding areas in La Grande Tract of the ODSVRA.
F4:
State Parks Deputy Director and the District APCO have worked together cooperatively to create a mitigation plan that was accepted by the APCD Hearing Board.
F5:
When PM concentrations were recorded in the hazardous range, the Nipomo Mesa 10 experienced some of the worst air quality conditions in the United States.
F6:
A collective total of 605 individual exceedances of the State PM air quality standard were 10 recorded on 363 days between 2012 and 2017 at three monitoring stations on the Nipomo Mesa.
F7:
San Luis Obispo County is the owner of most of the land in the La Grande Tract, and the Board of Supervisors has the authority to terminate vehicular riding activity on the La Grande Tract.
Related Recommendations (1)
R3:
The 2017-2018 Grand Jury recommends to the Board of Supervisors that if the Particulate Matter Reduction Plan (PMRP) fails to achieve its required goal of eliminating exceedances of state and federal PM air quality standards within the four-year time-frame 10 specified in the PMRP, the Board of Supervisors should within 30 days perform the following: a. Rescind State Parks current month-to-month, informal agreement under which State Parks has operated and managed off-highway vehicular activities on the La Grande Tract, and under Board of Supervisors authority, do the following: • Give written notice to State Parks that all off-highway vehicular activity on the La Grande Tract shall cease after a period of no longer than six months. • Support State Parks’ planned transition of off-highway vehicular activity on the La Grande Tract to State owned areas in the southern portion of the ODSVRA located near Oso Flaco Lake within six months. b. Choose one of the following two options: • Negotiate a lease with State Parks and include in the lease agreement the stipulation the La Grande Tract shall only be used for non-vehicular camping or conventional recreational activity and that it not be used for any type of vehicular-recreational activity. • Sell the La Grande Tract to State Parks and include in the sales agreement the stipulation that the La Grande Tract shall only be used for non-vehicular camping or conventional recreational activity, and it not be used for any type of vehicular-recreational activity.
F8:
The APCD Hearing Board has the authority to require vehicular riding activity on the La Grande Tract be terminated.
Related Recommendations (1)
R4:
The 2017-2018 Grand Jury recommends to the APCD Hearing Board if the Particulate Matter Reduction Plan (PMRP) fails to achieve its required goal of eliminating exceedances of State and Federal PM air quality standards within the specified four-year 10 time-frame of the PMRP, the Hearing Board immediately restrict vehicular riding activity on the La Grande Tract.
F9:
There is a health risk to the residents on the Nipomo Mesa and nearby communities caused by high levels of PM and PM particulate matter in the ambient air. 2.5 10
Findings & Recommendations
4 findings
F1:
The CALPIA factories in the East facility areas have significant deficiencies in fire and safety standards due to their age and the codes at the time they were built.
F2:
The dog training in the West facility is enthusiastically supported by both staff and inmates.
F3:
There is adequate incentive for prisoners to participate in programming classes and sessions.
F4:
There is sufficient time for the programs to be effective prior to prisoner eligibility for release.
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Findings & Recommendations
20 findings
F1:
EHD acted properly with respect to the complaint regarding the case of Legionnaires’ disease thought to have originated at a hotel in San Luis Obispo County.
F2:
San Luis Obispo County’s Public Health testing laboratory does not have the capability to test for Legionella and must send samples to an out-of-county laboratory.
F3:
There has been an outbreak of Hepatitis A in several California counties. Hepatitis A can cause death in some cases, especially those with compromised immune systems.
F4:
Mosquitoes carrying Zika virus are in adjacent counties and will soon be in this County.
F5:
There is currently no mosquito abatement (Vector Control) program in San Luis Obispo County. The BoS occasionally reviews that situation but has not authorized funding for an abatement program.
F6:
The 2017-2018 Grand Jury reviewed the San Luis Obispo County Public Health Department’s website early in the course of its investigation and found the most recent health statistics available were from 2012. However, the website has since been updated to reflect data from 2016. The Grand Jury also found other county health departments update their websites quarterly.
F7:
The turnover in JSO positions leads to younger officers and may improve rapport with the detainees.
F8:
The staffing is based upon the 65-detainee capacity, not the average daily population which is approximately 30. Therefore, the facility does not have the staff shortage problems that plague other facilities.
F9:
The facility has significant excess capacity. San Luis Obispo County Jail
F10:
The entire jail complex appears to have been built piecemeal with no master plan.
F11:
The parking for jail visitors is inadequate.
F12:
Scheduling visitation appointments is difficult for people without access to a computer or without computer skills.
F13:
The lack of a metal detector or other screening at the lobby presents an unnecessary risk to visitors.
F14:
The lack of a closed-circuit TV system between the jail and the courthouse results in trips to the courthouse for hearings where the direct presence of the inmate is not mandatory.
F15:
The jail has a strong need for a psychiatric hospital facility on-site for both felon and misdemeanant PC 1370 inmates as well as inmate WIC 5150 cases.
F16:
The addition of behavioral health staff would reduce the wait time for non-crisis service and could provide 24-hour capabilities.
F17:
Addition of correctional deputies, beyond filling the nine current vacancies, would decrease the impact of transporting prisoners within the jail for medical, behavioral 2017-2018 San Luis Obispo County Grand Jury Final Report 63 INSPECTION REPORT FOR SAN LUIS OBISPO COUNTY DETENTION FACILITIES health, or programming reasons as well as reduce the burden of mandatory overtime now placed on all of the correctional staff. County Coroner’s Facility
F18:
The lack of on-site back-up electrical power presents an unnecessary risk.
F19:
The use of an administrative assistant as a medical transcriptionist places an uncompensated burden on the employee.
F20:
The lack of a foot control for the audio recording system causes unnecessary delays during autopsies.
Additional Recommendations
10
Not linked to specific findings.
R1:
The San Luis Obispo County Department of Public Health should require that customers at commercial hot tub and spa establishments be informed there is a risk of Legionnaires’ disease inherent in that environment.
R2:
The San Luis Obispo County Department of Public Health should use only ELITE Program Laboratories to test for the presence of Legionella when there is a known case of disease potentially associated with the samples.
R3:
The San Luis Obispo County Department of Public Health should conduct a vaccination and sanitation outreach program among the homeless population to prevent an outbreak of Hepatitis A in the County. Funding to support the program should be allocated by the San Luis Obispo County Board of Supervisors.
R4:
The cost of starting and operating a comprehensive mosquito abatement program (Vector Control) is known. Funding commensurate with that cost should be set aside each year by the San Luis Obispo County Board of Supervisors and County Administration, so that when it becomes necessary, the money will be immediately available.
R5:
The San Luis Obispo County Department of Public Health has a program to educate the public about mosquitoes, how to avoid acting as their host, and how to minimize the risk of becoming infected with the diseases they carry. Before mosquitoes carrying the Zika Virus arrive in this County, additional funding should be allocated by the San Luis Obispo County Board of Supervisors to support expansion of EHD’s public education efforts.
R6:
The San Luis Obispo County Department of Public Health website’s statistics should be updated at least quarterly.
R7:
The Sheriff should construct a psychiatric hospital (jail bed competency treatment facility) on the jail campus or elsewhere within the County.
R8:
The Sheriff should increase the staffing for the jail mental health workers to reduce the wait time for appointments from five days to one day or less.
R9:
The Sheriff should increase the staff in excess of the nine positions currently unfilled. County Coroner’s Facility
R10:
The County should procure and install a back-up generator (fixed or portable) on site to provide back-up power in case of an outage.
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Findings & Recommendations
20 findings
F1:
The use of a closed-circuit video system would cut the transportation cost to the County and State (ASH) while relieving overcrowding within the facility.
Related Recommendations (1)
R1:
The Sheriff should petition the court for the addition of a closed-circuit AV system between the courthouse and the jail (potentially ASH can tie into the system) to reduce transportation cost and resolve overcrowding at the holding facility. If the court approves the use of a closed-circuit AV system between the jail and the court, for hearings, additions or modifications in R2 are no longer recommended.
F2:
The facility does not provide enough segregated cells to deal with the number of ASH inmates requiring court appearances and the changing jail population.
Related Recommendations (1)
R2:
The facility needs an expansion to house the current inmate traffic. The expansion should add segregation cells (for ASH patients or mental health jail inmates), employee restrooms, and a regular holding cell. This would improve the safety of both inmates and staff. In light of the increase in mental health jail inmates coming to the courthouse, this expansion is needed immediately.
F3:
The lack of internal restroom facilities for the employees can cause an unnecessary temporary shortage of staff.
Related Recommendations (1)
R2:
The facility needs an expansion to house the current inmate traffic. The expansion should add segregation cells (for ASH patients or mental health jail inmates), employee restrooms, and a regular holding cell. This would improve the safety of both inmates and staff. In light of the increase in mental health jail inmates coming to the courthouse, this expansion is needed immediately.
F4:
The facility often exceeds the 77-inmate capacity and should be expanded if another way to reduce the number of inmates is not implemented. County Juvenile Hall
Related Recommendations (1)
R2:
The facility needs an expansion to house the current inmate traffic. The expansion should add segregation cells (for ASH patients or mental health jail inmates), employee restrooms, and a regular holding cell. This would improve the safety of both inmates and staff. In light of the increase in mental health jail inmates coming to the courthouse, this expansion is needed immediately.
F5:
The CVA provides an effective alternative to normal incarceration.
F6:
The greater focus on programming and education leads to a less contentious and more stable relationship between officers and detainees.
F7:
The turnover in JSO positions leads to younger officers and may improve rapport with the detainees.
F8:
The staffing is based upon the 65-detainee capacity, not the average daily population which is approximately 30. Therefore, the facility does not have the staff shortage problems that plague other facilities.
F9:
The facility has significant excess capacity. San Luis Obispo County Jail
F10:
The entire jail complex appears to have been built piecemeal with no master plan.
Related Recommendations (1)
R5:
The Sheriff should formulate a long-term plan to deal with the problems associated with the condition and layout of the main jail. This plan should include the replacement of the current main jail facility.
F11:
The parking for jail visitors is inadequate.
Related Recommendations (1)
R6:
The jail administration should improve the visitor process including adding more parking, the ability to register for visits over the phone or on-site, and screening of visitors as they enter the facility.
F12:
Scheduling visitation appointments is difficult for people without access to a computer or without computer skills.
Related Recommendations (1)
R6:
The jail administration should improve the visitor process including adding more parking, the ability to register for visits over the phone or on-site, and screening of visitors as they enter the facility.
F13:
The lack of a metal detector or other screening at the lobby presents an unnecessary risk to visitors.
Related Recommendations (2)
R3:
In addition to either of the first two alternatives, the Grand Jury also recommends that cameras be added in the stairwells leading to the courtrooms and to the fenced area outside the sally port. County Juvenile Hall
R6:
The jail administration should improve the visitor process including adding more parking, the ability to register for visits over the phone or on-site, and screening of visitors as they enter the facility.
F14:
The lack of a closed-circuit TV system between the jail and the courthouse results in trips to the courthouse for hearings where the direct presence of the inmate is not mandatory.
Related Recommendations (1)
R1:
The Sheriff should petition the court for the addition of a closed-circuit AV system between the courthouse and the jail (potentially ASH can tie into the system) to reduce transportation cost and resolve overcrowding at the holding facility. If the court approves the use of a closed-circuit AV system between the jail and the court, for hearings, additions or modifications in R2 are no longer recommended.
F15:
The jail has a strong need for a psychiatric hospital facility on-site for both felon and misdemeanant PC 1370 inmates as well as inmate WIC 5150 cases.
Related Recommendations (2)
R4:
The Grand Jury recommends the Board of Supervisors commission a study to investigate repurposing the juvenile hall wing currently being used as a recreational/storage/training area as a juvenile and transitional aged youth PHF with separate exterior access. This could be a better use of the facility and fill an urgent County need. For better outside access, the study should consider using the current CVA space and moving the CVA to the unused area. County Jail
R7:
The Sheriff should construct a psychiatric hospital (jail bed competency treatment facility) on the jail campus or elsewhere within the County.
F16:
The addition of behavioral health staff would reduce the wait time for non-crisis service and could provide 24-hour capabilities.
Related Recommendations (1)
R8:
The Sheriff should increase the staffing for the jail mental health workers to reduce the wait time for appointments from five days to one day or less.
F17:
Addition of correctional deputies, beyond filling the nine current vacancies, would decrease the impact of transporting prisoners within the jail for medical, behavioral health, or programming reasons as well as reduce the burden of mandatory overtime now placed on all of the correctional staff. County Coroner’s Facility
Related Recommendations (1)
R9:
The Sheriff should increase the staff in excess of the nine positions currently unfilled. County Coroner’s Facility
F18:
The lack of on-site back-up electrical power presents an unnecessary risk.
Related Recommendations (1)
R10:
The County should procure and install a back-up generator (fixed or portable) on site to provide back-up power in case of an outage.
F19:
The use of an administrative assistant as a medical transcriptionist places an uncompensated burden on the employee.
F20:
The lack of a foot control for the audio recording system causes unnecessary delays during autopsies.
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Findings & Recommendations
8 findings
F1:
The PHF is staffed with dedicated professionals whose attitude toward their patients is in keeping with the goal of recovery.
Related Recommendations (1)
R1:
Even though the PHF second and third shifts meet minimum State standards, staffing levels should be increased for staff, patient, and community safety reasons.
F2:
The PHF facility is woefully inadequate for a psychiatric hospital.
Related Recommendations (1)
R2:
The San Luis Obispo County Jail should have its own dedicated psychiatric hospital facility, serving only inmates. This would limit the number of inmates admitted as patients in the PHF. When inmates are admitted to the new PHF, a correctional deputy should be assigned.
F3:
There is not enough room for the programs and therapies required towards a goal of recovery; a separate and dedicated area is lacking for both treatment rooms and physical exercise.
Related Recommendations (1)
R3:
The County should find or build a new psychiatric hospital facility, with sufficient room for patient treatment and recovery. Funding could come from reserves sources (County and/or MHSA) or pursuing a state grant. Recognizing that R2 and R3 may take a considerable amount of time to be implemented, the following short-term recommendations are made to address some of the more immediate problems:
F4:
The facility lacks adequate natural lighting and is excessively dreary when compared to a modern psychiatric hospital.
Related Recommendations (1)
R4:
The current lighting should be replaced with natural spectrum lights (preferably LEDs). The facility interior should be painted and the ceiling tiles replaced/repaired to provide an improved therapeutic environment.
F5:
In the event of an emergency requiring evacuation during the night or evening, the required staffing is insufficient for the safety of the patients, staff, and community. In an area-wide emergency, law enforcement may not be able to respond.
Related Recommendations (1)
R5:
Upgrade video surveillance capabilities.
F6:
Inmates in the patient population impact other patients and may require full time supervision within the facility.
Related Recommendations (1)
R6:
The facility should annex additional area from the adjacent County facilities, adding the treatment and therapy environments to improve effectiveness and safety.
F7:
The outdoor area is inadequate for the number of patients served and doesn’t provide space for exercise.
F8:
If an inmate patient commits a violent act toward staff or another patient, there is no peace officer present to intervene. The staff member or patient may report the act in the same way a private citizen would by calling the San Luis Obispo City Police.
Findings & Recommendations
10 findings
F1:
SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency
Related Recommendations (1)
R1:
SLO County Health Agency Implemented
F2:
SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency
Related Recommendations (1)
R2:
SLO County Board of Supervisors Will be implemented
F3:
SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency
Related Recommendations (1)
R3:
SLO County Health Agency Requires further analysis
F4:
SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency
Related Recommendations (1)
R4:
SLO County Sheriff’s Department Agrees and implements when and where possible
F5:
SLO County Health Agency’s Drug and Alcohol Services Agreed by Health Agency
Related Recommendations (1)
R5:
SLO County Sheriff’s Department Requires further analysis
F6:
SLO County Health Agency Agreed
Related Recommendations (1)
R6:
SLO County Health Agency Will be implemented
F7:
SLO County Health Agency’s Drug and Alcohol Services Partially-agreed by Health Agency Submitted May 4, 2018 28 GRAND JURY REPORTS: DOOMED TO REPEAT?
Related Recommendations (1)
R7:
SLO County Health Agency Requires further analysis
F8:
SLO County Health Agency’s Drug and Alcohol Services Agreed
Related Recommendations (1)
R8:
SLO County Board of Supervisors Will be implemented
F9:
SLO County Sheriff’s Department Agreed
Related Recommendations (1)
R9:
San Luis Obispo City Council No response
F10:
SLO County Health Agency’s Drug and Alcohol Services Disagreed Of the 10 recommendations made by the Grand Jury in the Residential Detox report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response
Related Recommendations (1)
R10:
SLO County Health Agency Implemented Of the five findings listed for the County Jail Inmate Health and Safety report: (Ctrl + Click to see response) (Click on Return to return) # Respondent Response
Findings & Recommendations
12 findings
F1:
The current number of Mental Health Evaluation Teams is inadequate to serve the County with reasonable response times and effective intervention. 9
F2:
The “best practice” for patients in crisis is daily contact from peer counselors and mental health professionals.
F3:
There is a wide disparity in compensation between the State of California psychiatrists, locum tenens psychiatrists, and San Luis Obispo County psychiatrists.
Related Recommendations (1)
R7:
Adopt more aggressive and innovative recruitment strategies for key positions such as Psychiatrists, Nurses, and Nurse Practitioners.
F4:
The current organizational structure of the County Health Agency and, specifically, Behavioral Health appears convoluted based upon the maze of funding streams and regulatory requirements.
Related Recommendations (1)
R5:
Reorganize the agency to concentrate on the complete behavioral health treatment process.
F5:
The consumer satisfaction/perception survey imposed by the State is not relevant to assessing service needs.
F6:
Expansion of supportive and community housing programs would reduce the number of crisis situations.
Related Recommendations (2)
R2:
Increase funding and support for the community and supportive housing programs.
R6:
Use innovation and incentives, such as County backed bonds or tax breaks to support the building of private psychiatric and substance abuse facilities within the County.
F7:
The new CSU is expected to take pressure off of the PHF.
F8:
Current efforts to reduce stigma are not having the magnitude of impact within our community.
Related Recommendations (1)
R3:
Improve efforts to reduce stigma through County sponsored educational programs and public service announcements.
F9:
Expansion of the system navigator and case manager roles will result in improved comprehensive care.
Related Recommendations (1)
R1:
Increase financial support to Behavioral Health from the County General Fund to accomplish the following within the next fiscal year. (Note: Some of this expense is reimbursable by Medi-Cal.): 10 a. Reduce the wait time to enter the Full-Service Partnership program from months to weeks. b. Add clinicians and case managers to the mental health clinics thereby reducing wait time below the 10-day requirement and reducing the time between maintenance appointments. c. Add full time system navigators to all mental health clinics and encourage Cen-Cal (the local Medi-Cal affiliate) to add them at medical clinics. d. Add two additional Mental Health Evaluation Teams, one in North County and one in South County.
F10:
A limited number of law enforcement personnel have taken the full 40-hour Crisis Intervention Training (CIT), which is more effective than a shorter course in de- escalating crisis situations involving the mentally ill.
F11:
The full-service partnership programs are very effective and use the current “best practices” for treatment.
Related Recommendations (1)
R4:
Combine drug and alcohol treatment with mental health treatment, having all clinicians cross-trained to manage dual-diagnosis patients.
F12:
The closure of Vista Del Mar in Ventura County, due to the Thomas Fire, has had a negative impact due to the lack of nearby facilities to treat crisis patients who need longer term care.
Findings & Recommendations
10 findings
F1:
Available and affordable residential detox services are necessary for delivering comprehensive substance abuse treatment in San Luis Obispo County.
Related Recommendations (1)
R1:
The County Health Agency’s Drug and Alcohol Services should resume its concentrated efforts to develop a residential detox service in the County to serve its Medi-Cal and less financially able citizens.
F2:
The opening of the Haven provides needed detox services for County residents who are privately insured or can afford the high costs.
Related Recommendations (1)
R2:
The Board of Supervisors should direct the Sheriff and the Health Agency to evaluate the feasibility of and approach to repurposing vacated buildings within the County Jail’s honor farm as a residential detox service. A final report on the feasibility and if indicated the specific steps 17 required to convert this housing to a substance-abuse residential and/or treatment facility should be completed by June 2018.
F3:
There are no residential detox services available in the County for those with limited financial resources or insurance through Medi-Cal or Medicare.
Related Recommendations (1)
R3:
The County Health Agency’s Drug and Alcohol Services should expand its County Jail programs, including individual and group counseling, to cover inmates who go through withdrawal protocols regardless of AB 109 status.
F4:
The County Jail provides physical detox to newly admitted inmates but fails to provide the additional psychological and social treatments and supportive environment essential for the first phase of addiction treatment: detox-stabilization. 16
Related Recommendations (1)
R4:
The County Jail should revise inmate classification and cell assignment to take into account the inmate’s substance abuse treatment needs and interest in such when determining cell placement.
F5:
There are some arrestees currently booked in the County Jail who would be more effectively served by a diversion program, like Law Enforcement Assisted Diversion, and/or receiving treatment in a residential substance-abuse facility.
Related Recommendations (1)
R5:
The County Jail should house inmates interested and/or involved in drug and alcohol services in such a way as to create groups of addiction-treatment participants (e.g., units or pods) that allow for efficient delivery of treatment services; this includes separation from other inmates who interfere or disrupt treatment participation.
F6:
There is a lack of integration in how medical and drug/alcohol services are provided at the County Jail.
Related Recommendations (1)
R6:
The County Health Agency and Sheriff should integrate the functions of the jail’s medical and drug and alcohol service providers by locating their offices in close proximity and requiring coordinated care for inmates with substance use disorders.
F7:
The use of medication-assisted approaches for detox and addiction treatment at the County Jail is limited while other jurisdictions have been able to provide such treatments.
Related Recommendations (1)
R7:
The County Health Agency should pilot the usage of medication-assisted treatments, i.e., Buprenorphine and Naltrexone, with a select population of opioid and alcohol addicts at the County Jail.
F8:
Logistical and environmental challenges at the County Jail make delivery of drug and alcohol treatment services difficult and inefficient due to placement of inmates with substance use disorders.
Related Recommendations (1)
R8:
The Board of Supervisors should evaluate the Law Enforcement Assisted Diversion program or a similar pre-booking substance abuse diversion for County implementation as a means of motivating and engaging young adult arrestees who are assessed to be primarily substance abusers and not criminally oriented. A written evaluation by the County Administrative Officer should be reviewed at a meeting of Board of Supervisors by June 2018. 18
F9:
With the opening of the women’s jail, there is unused space in the honor farm which presents an opportunity for alternative program development.
Related Recommendations (1)
R9:
The San Luis Obispo City Council should evaluate the Law Enforcement Assisted Diversion program or a similar pre-booking substance abuse diversion for City implementation as a means of motivating and engaging young adult arrestees who are assessed to be primarily substance abusers and not criminally oriented. A written evaluation by the City Manager should be reviewed at a meeting of the San Luis Obispo City Council, by June 2018.
F10:
The homeless shelter has no clear plan as to how it will provide its long-anticipated detox beds/service.
Related Recommendations (1)
R10:
The County Health Agency should direct its Drug and Alcohol Services to work with the board of the homeless shelter to develop a plan for operationalizing two detox beds in the yet-to- be-built Homeless Services Center, which could entail the DAS providing onsite outpatient detox services if other treatment options are not viable. This plan is to be developed prior to the opening of the center or by June 2018.
Findings & Recommendations
9 findings
F1:
The District does not have an effective system to follow-up with the public, schools, medical clinics, hospitals, or those who sign up to receive AirAware Alerts and Better Breather Alerts.
F2:
The LMUSD does not use the APCD AirAware Alerts system or routinely use the CARB AQMIS system.
F3:
CARB computer modeling performed in 2017 confirmed that emissions of PM2.5 and PM10 predominately originate from riding areas in La Grande Tract of the ODSVRA.
F4:
State Parks Deputy Director and the District APCO have worked together cooperatively to create a mitigation plan that was accepted by the APCD Hearing Board.
F5:
When PM10 concentrations were recorded in the hazardous range, the Nipomo Mesa experienced some of the worst air quality conditions in the United States.
F6:
A collective total of 605 individual exceedances of the State PM10 air quality standard were recorded on 363 days between 2012 and 2017 at three monitoring stations on the Nipomo Mesa.
F7:
San Luis Obispo County is the owner of most of the land in the La Grande Tract, and the Board of Supervisors has the authority to terminate vehicular riding activity on the La Grande Tract.
F8:
The APCD Hearing Board has the authority to require vehicular riding activity on the La Grande Tract be terminated.
F9:
There is a health risk to the residents on the Nipomo Mesa and nearby communities caused by high levels of PM2.5 and PM10 particulate matter in the ambient air. 2017-2018 San Luis Obispo County Grand Jury Final Report 126 IS THERE A HEALTH RISK FROM THE DUNES? “THE ANSWER, MY FRIEND, IS BLOWING IN THE WIND”
Additional Recommendations
4
Not linked to specific findings.
R1:
The 2017-2018 Grand Jury recommends the San Luis Obispo County APCD prior to September 30, 2018 should: a. Contact senior centers, hospitals and clinics, child-care facilities, and local residents who may be unaware of the District air quality alert notification and alert forecast program and encourage them to sign up to receive AirAware Alerts. b. Perform follow-ups with residents and groups who previously signed up for District alert notification programs and confirm whether these residents and groups are receiving alerts and forecasts. c. Coordinate directly with the Lucia Mar Unified School District (LMUSD) and other schools on the Nipomo Mesa and nearby communities to facilitate sending them AirAware Alerts and warnings.
R2:
The 2017-2018 Grand Jury recommends the LMUSD should prior to the start of the next school year: a. Enroll in the APCD AirAware Alert notification program so that it can obtain current air quality alert conditions or alert forecasts. b. Use the APCD’s online Air Quality Management Information System (AQMIS) to obtain first-hand knowledge of the days when high particulate levels are forecast.
R3:
The 2017-2018 Grand Jury recommends to the Board of Supervisors that if the Particulate Matter Reduction Plan (PMRP) fails to achieve its required goal of eliminating exceedances of state and federal PM10 air quality standards within the four-year time-frame specified in the PMRP, the Board of Supervisors should within 30 days perform the following: a. Rescind State Parks current month-to-month, informal agreement under which State Parks has operated and managed off-highway vehicular activities on the La Grande Tract, and under Board of Supervisors authority, do the following: • Give written notice to State Parks that all off-highway vehicular activity on the La Grande Tract shall cease after a period of no longer than six months. 2017-2018 San Luis Obispo County Grand Jury Final Report 127 IS THERE A HEALTH RISK FROM THE DUNES? “THE ANSWER, MY FRIEND, IS BLOWING IN THE WIND” • Support State Parks’ planned transition of off-highway vehicular activity on the La Grande Tract to State owned areas in the southern portion of the ODSVRA located near Oso Flaco Lake within six months. b. Choose one of the following two options: • Negotiate a lease with State Parks and include in the lease agreement the stipulation the La Grande Tract shall only be used for non-vehicular camping or conventional recreational activity and that it not be used for any type of vehicular-recreational activity. • Sell the La Grande Tract to State Parks and include in the sales agreement the stipulation that the La Grande Tract shall only be used for non-vehicular camping or conventional recreational activity, and it not be used for any type of vehicular-recreational activity.
R4:
The 2017-2018 Grand Jury recommends to the APCD Hearing Board if the Particulate Matter Reduction Plan (PMRP) fails to achieve its required goal of eliminating exceedances of State and Federal PM10 air quality standards within the specified four-year time-frame of the PMRP, the Hearing Board immediately restrict vehicular riding activity on the La Grande Tract.