San Mateo County Grand Jury
2004-2005
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 (23)
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Findings & Recommendations
1 findings
F2:
Each school district should: 2.1
Additional Recommendations
1
Not linked to specific findings.
R2:
Train and encourage school district employees to use the recommended confidential hot line to report, to the extent permitted by law, any student who exhibits “at risk” behavior. The District would need to receive more information regarding a “confidential hot line” to determine if its use would be appropriate for the Burlingame School District. Currently, counselors are available at Burlingame Intermediate School to help counsel students, while principals are available at each of the elementary schools. “At risk behavior” is brought to the counselor’s attention (at the Intermediate School) and to the principal’s attention (at the elementary schools). Once a report on behavioral issues has been brought to the attention of the appropriate individual, the situation is investigated and appropriate disciplinary action is taken. Counselors, administrators, parents, and the police, if necessary, are involved in the process.
Findings & Recommendations
4 findings
F1:
The Board of Supervisors should immediately begin the search for better facilities for the long-term care of the patients at the Burlingame Long-Term Care Center. This facility, or its replacement facility, should have safe and efficient ingress and egress for non-ambulatory or disabled patients in both emergency and routine situations. Response: Disagree. The San Mateo Medical Center agrees that a better facility would be desirable; however, the feasibility of locating such a large facility (the largest in the County) is prohibitively expensive under current Medi-Cal reimbursement rates and is effectively not possible. The County’s 20-year lease for the current facility is the only practical way these patients can be housed in San Mateo County. This recommendation will not be implemented. Improving Water Quality Flowing to the Ocean and Bay Findings:
Related Recommendations (1)
R1:
C/CAG should, by September 1, 2005, develop and implement a plan to increase the awareness of residents and businesses of the repercussions of dumping pollutants into storm drains.
F2:
Improvement of Storm Water Quality Staff agrees with the finding. The quality of storm water can be improved by frequent street sweeping, using storm drains that dissipate the energy of the water flow to decrease erosion, designing slow water flow in new developments, preventing construction site debris from reaching streams, and providing a means for the public to properly dispose of household hazardous wastes. Environmental Health will continue to offer a means for proper disposal of household hazardous waste through collection events located throughout the County.
Related Recommendations (1)
R2:
The Board of Supervisors should provide funding for the Environmental Health Services Division for a staff person whose function is to determine pollution sources and to monitor ranches for compliance.
F3:
Watershed Assessment and Monitoring Staff agrees with the finding. Environmental Health samples various recreational beach areas and has had success in identifying and remediating sources of contaminants. Beach monitoring will be continued and, within existing resources, investigations will be conducted into possible sources of contamination.
Related Recommendations (1)
R3:
The Board of Supervisors should direct the Environmental Health Services Division to expand the focus of manure management plans to include an emphasis on decreasing creek pollution.
F4:
The Board of Supervisors should support a request from the Environmental Health Services Division to provide sufficient funding to inspect each septic system every three years. Response: This recommendation requires further analysis. The re-inspection of septic systems has been in place for five years. The inspection program is an important component of the Land Use Program since the only other means for managing septic systems after installation is complaint-based. There are over 5,000 septic systems in the county. Currently, inspections are conducted on a periodic basis at a rate of approximately 700 per year; this roughly equates to an inspection every seven years. The Environmental Health Advisory Committee has prioritized the septic inspection system based on situations where potential failure could cause contamination; i.e., for septic systems where there is a well on the property. Environmental Health will evaluate the staffing required to inspect each septic system every three years. Environmental Health staff will report back to the Board of Supervisors on the results of their findings in a future quarterly update. COUNTY OF SAN MATEO Inter-Departmental Correspondence County Manager’s Office DATE: August 3, 2005 BOARD MEETING DATE: August 16, 2005 SPECIAL NOTICE: None VOTE REQUIRED: None TO: Honorable Board of Supervisors FROM: John L. Maltbie, County Manager SUBJECT: 2004-05 Grand Jury Response
Related Recommendations (1)
R4:
The Board of Supervisors should support a request from the Environmental Health Services Division to provide sufficient funding to inspect each septic system every three years. IMPROVING WATER QUALITY FLOWING TO THE OCEAN AND BAY Issue What are city and County agencies doing to improve the quality of water flowing into the ocean and the bay?
Additional Recommendations
3
Not linked to specific findings.
R1:
The District Attorney determined that the individuals in question were at no time employees of the City of San Carlos.
R2:
The District Attorney determined that the accusation was groundless and without merit.
R3:
The District Attorney forwarded these findings to the Civil Grand Jury two (2) months prior to the issuance of the Civil Grand Jury’s letter in June. The Civil Grand Jury concludes with a comment that the city should “stop awarding multiple contracts, of any dollar amount, to persons of close working relationships with city administration without first establishing a fair, open and appropriately advertised contracting process.” Here the City offer two comments in this area:
Findings & Recommendations
6 findings
F1:
Transfer two or more social workers who are dedicated to youth in the ILSP, ILP Aftercare Services, THPP, and WIA Youth Education and Employment Services, into Adolescent Services from Children and Family Services. Response: Disagree. Adolescent Services is part of Children and Family Services (CFS). Currently, there are three Social Workers assigned to cover the Permanency Planning (PP) cases in the unit. Caseloads in this unit, as in all CFS units, are determined by a workload standard that is uniform across all CFS units. The unit currently justifies three Social Workers based on the caseload size. In addition to these three workers, Independent Skills Living Program and Employment Services staffs team with the Social Workers to provide expanded services to these youth. As caseloads grow in this unit, additional Social Workers will be assigned as needed.
Related Recommendations (1)
R1:
Transfer two or more social workers who are dedicated to youth in the ILSP, ILP Aftercare Services, THPP, and WIA Youth Education and Employment Services, into Adolescent Services from Children and Family Services.
F2:
Increase housing options for current and emancipated foster youth. Response: Agree. The Board of Supervisors (BOS) authorized $750,000 to support the development of a transitional housing unit for these youth at the June budget hearings. The BOS also authorized $180,000 in stipends to assist emancipated youth with housing, school, training, and employment. This program will be implemented over the next several months. HSA will be analyzing the service needs of emancipated youth and reporting back to the BOS in December 2005.
Related Recommendations (1)
R2:
Increase housing options for current and emancipated foster youth.
F3:
Reclassify the Workforce Investment Act staff to permanent status. Response: Agree. Two Extra Help positions will be converted to permanent ESS positions in the September budget revisions, to be covered by a combination of Workforce Investment Act (WIA) and Children and Family Services funding.
Related Recommendations (1)
R3:
Reclassify the Workforce Investment Act staff to permanent status.
F4:
Complete the planned Adolescent Services survey of all program participants to gauge the effectiveness of the programs and find areas where improvements could be made and provide a base for follow-up. Response: Agree. Adolescent Services completed a survey with ILP youth towards the end of the program term, with general questions on what they thought about the program. Several youth focus groups were also held to gauge the effectiveness of these programs. The results of these surveys were used to improve the curriculum for 2005-2006 ILP training. Assessment of survey information will continue, with changes to be made as necessary.
Related Recommendations (1)
R4:
Complete the planned Adolescent Services survey of all program participants to gauge the effectiveness of the programs and find areas where improvements could be made and provide a base for follow-up.
F5:
Provide improved transportation options to Independent Living Skills Program participants. Response: Agree. Current transportation systems will be reviewed to develop plans for better utilization of existing resources. Expanding the use of bus passes and offering mileage to foster parents could increase the options available to older youth to help them become more independent and experienced in using the public transportation system. Payment of mileage expenses to foster parents for transporting youth to the evening Independent Living classes will also be explored.
Related Recommendations (1)
R5:
Provide improved transportation options to Independent Living Skills Program participants.
F6:
Develop better outreach programs to inform and involve eligible participants not currently participating in Adolescent Services programs. Response: Agree. As the Grand Jury report notes, there has been an increase in the number of youth participating in Adolescent Services Programs. Participants in the ILP have gone from 25 to 50 in the last two years. This year, a new contract with College of San Mateo was completed to further expand the ILP program. Another opportunity for growth is the Transitional Housing Program; brochures and information notices will be developed and sent to emancipated youth and youth currently in active Adolescent Services cases.
Related Recommendations (1)
R6:
Develop better outreach programs to inform and involve eligible participants not currently participating in Adolescent Services programs. COUNTY OF SAN MATEO Inter-Departmental Correspondence County Manager’s Office DATE: September 2, 2005 BOARD MEETING DATE: September 13, 2005 SPECIAL NOTICE: None VOTE REQUIRED: None TO: Honorable Board of Supervisors FROM: John L. Maltbie, County Manager SUBJECT: 2004-05 Grand Jury Response Recommendation Accept this report containing the County’s responses to the following 2004-05 Grand Jury reports: Proposition 36, Children and Family Services, and Integrating Emancipated Foster Youth into Society. VISION ALIGNMENT: Commitment: Responsive, effective and collaborative government. Goal 20: Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain. This activity contributes to the goal by ensuring that all Grand Jury findings and recommendations are thoroughly reviewed by the appropriate County departments and that, when appropriate, process improvements are made to improve the quality and efficiency of services provided to the public and other agencies.
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Additional Recommendations
1
Not linked to specific findings.
R1:
0 THE COUNTY BOARD OF EDUCATION AND COUNTY SUPERINTENDENT OF SCHOOLS SHOULD: 1.1 PUBLICIZE, THROUGH EXISTING MEDIA, SERVICE ORGANIZATIONS, AND PUBLIC AND PRIVATE SOCIAL AGENCIES, THE NEED FOR EARLY IDENTIFICATION (0-3) AND EARLY CHILDHOOD EDUCATION FOR CHILDREN WITH AUTISM SPECTRUM DISORDER. Each year, the San Mateo County Special Education Local Plan Area (SELPA), representing the 23 school districts and 3 charter schools, publishes a “Child Find” notice in the local newspapers. This “Child Find” notice is also posted on the SELPA website. The notice informs the public of services and resources in San Mateo County for children with special needs. 1.2 EVALUATE PROGRAMS USED IN ORANGE COUNTY AND DESCRIBED IN THE RESEARCH LITERATURE TO DETERMINE HOW TO INTEGRATE THEIR PRE-SCHOOL AND SCHOOL PROGRAMS IN SAN MATEO COUNTY. Representatives from the San Mateo County Office of Education Special Education Office and SELPA have visited and reviewed the programs offered by the Orange County Office of Education. We have worked closely with representatives from the Golden Gate Regional Center to implement an infant program so that students can transition easily from the infant program, to the pre-school program and to the school-age program for autism. 1.3 DEVELOP A STRONG LIAISON WITH PUBLIC AND PRIVATE SOCIAL AGENCIES AND SCHOOLS IN THE COUNTY TO INCREASE KNOWLEDGE OF EFFECTIVE TECHNIQUES FOR SPECIAL EDUCATION TEACHERS WORKING WITH AUTISTIC YOUTH. A County-wide Autism committee was established in Spring 2005. The focus of this committee will be to bring agencies together to provide seamless services to students and families. 1.4 EXPLORE SHARING OF COSTS OF EDUCATING AUTISTIC CHILDREN WITH OTHER SOCIAL, MENTAL HEALTH, MEDICAL, AND EDUCATIONAL AGENCIES. CONSIDER THE USE OF LOW OR NO-COST ASSISTANCE, SUCH AS SPECIAL EDUCATION INTERNS WORKING TOWARDS CERTIFICATION REQUIREMENTS; PRO BONO LEGAL AID; RETIRED EDUCATORS, ETC. Currently services for students on the Autism spectrum are provided by a variety of public and private agencies. Each agency funds its individual programs, including Mental Health, Health and Human Services Agency, but works collaboratively with education. Each agency actively recruits qualified and trained volunteers to support the delivery of quality services. 1.5 EXPAND HIGH SCHOOL PROGRAMS TO FOCUS ON OLDER STUDENTS REQUIRING MENTAL HEALTH THERAPY, LIFE SKILLS TRAINING, INDEPENDENT LIVING, OR VOCATIONAL TRAINING, CONNECTING WITH SMALL BUSINESSES FOR PART-TIME WORK TO FOSTER INDEPENDENCE. All students at age 16 have transition planning as an integral part of the IEP. Students participate in the Workability Program which provides career planning and on the job training. The programs currently offered by the San Mateo County Office of Education and districts to high school students with special needs include life skills, independent living skills and vocational training. 1.6 WORK WITH SCHOOL DISTRICT ADMINISTRATORS AND SPECIAL EDUCATION DIRECTORS TO IMPLEMENT WAYS TO REDUCE THE POTENTIAL COSTS OF LITIGATION FOR DISTRICTS AND PARENTS BY USING MEDIATION AND/OR PARENT TRAINING (E.G. INFORMATIVE MEETINGS PRIOR TO AN IEP MEETING). The San Mateo County SELPA Alternative Dispute Resolution process is in place. ADR is an informal process for resolving conflicts. It is a process that respects the dignity of individuals while using communication, collaboration, negotiation and mediation to meet the interests of the parties involved. San Mateo County SELPA has the following ADR Options: EXPANDED IEP: Parties come back together to an IEP with additional information to discuss issues that remain unresolved. A SELPA representative may be invited to attend. FACILITATED IEP: A trained, neutral third party, usually a SELPA staff member, works with disputing parties to structure the IEP and also facilitates the meeting. CONFERENCE-STYLE MEDIATION: The local mediation consists of two trained facilitators/mediators, the concerned parent and an administrative representative from the child’s district. Mediators assist the parties in reaching a mutually acceptable agreement. 1.7 SET UP COUNTYWIDE TEAMS TO COLLABORATE IN PROGRAM PLANNING AND EXPANSION OF PROGRAMS THAT WORK, SUCH AS THE SAN BRUNO PALOS VERDES SCHOOL PROGRAM AND HIRE A COE PROGRAM COORDINATOR TO HELP DISTRICTS IMPLEMENT THE MODEL. The Countywide Autism Committee will review and evaluate programs currently being implemented throughout the State. The Autism Team Program currently being implemented at Palos Verdes School completed a successful “pilot” year and the concept of developing highly trained classroom teams is being replicated on integrated school sites. A program specialist with an expertise in successful programs to meet the needs of students with autism is being hired to support these teams. 1.8 ESTABLISH A BLUE RIBBON COMMITTEE, SUCH AS THOSE USED EFFECTIVELY TO SOLVE OTHER EDUCATION FUNDING PROBLEMS, TO ADDRESS THE RAPIDLY EXPANDING COSTS OF SPECIAL EDUCATION. The concept of a Blue Ribbon Panel will be discussed and evaluated by the Countywide Autism Committee.
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Findings & Recommendations
1 findings
F1:
Direct the Redevelopment Agency to develop written guidelines for its staff on proper treatment of citizens, and conduct training sessions to acquaint the staff with the contents of these guidelines (staff should be made aware of California Government Code Section 7260.5(b) concerning treatment of the public).
Related Recommendations (1)
R1:
Direct the Redevelopment Agency to develop written guidelines for its staff on proper treatment of citizens, and conduct training sessions to acquaint the staff with the contents of these guidelines (staff should be made aware of California Government Code Section 7260.5(b) concerning treatment of the public).
Additional Recommendations
1
Not linked to specific findings.
R2:
Set up a mechanism for dealing with citizen complaints concerning the Redevelopment Agency, such as: a) Appoint a RDA Ombudsman familiar with the statutory duties and rights of the property owners who will actively seek out persons affected by RDA actions to insure that they are being fairly treated. The RDA Ombudsman would report periodically to the City Council; or alternatively, b) Designate a member of the City Council as the point person for complaints concerning the RDA. This member, familiar with the statutory duties and rights of the property owners, would seek appropriate remedies and report back to the City Council concerning required actions. 5
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Findings & Recommendations
17 findings
F1:
Issue a request for proposal (RFP), within 90 days, to review public health care services provided by the county with particular emphasis on indigent care. Qualified proposals should demonstrate a high level of experience and active involvement with indigent care in California. The RFP should include but not be limited to a study of: (cid:131) Advantages and disadvantages of the payer model as compared to San Mateo County’s provider health care system and should include the fiscal, medical, and social effects of each. (cid:131) The effectiveness of the provider model currently employed. (cid:131) The sale or lease to a third party, (e.g. Stanford Medical Center, University of California San Francisco Medical Center), of the San Mateo Medical Center and clinics with the agreement it remain a provider of medical care to the indigent. Response: Disagree. It is premature to issue a request for proposal (RFP) until the County has the information needed to make decisions related to employing a payer vs. provider model. The County acknowledges that it needs to determine the best approach to providing and funding indigent healthcare to meet its obligation under Section 17000 of the California Welfare and Institutions Code. It has recently developed separate financial assistance policies for the medically indigent, charity care, and self-pay, and has begun a pilot process to conduct full screening and verification of uninsured persons applying for health care coverage. The data gathered during the pilot (October 2005 through March 2006) will be used to better define the medically indigent population and the County’s financial responsibility under Section 17000. It will also provide more information about the charity care population being served at SMMC. This type of information is needed by County staff or outside consultants to analyze the advantages and disadvantages of a payer vs. provider model. It should be noted that a similar proposal to examine a payer model was considered in 1993 when the construction funding for SMMC was being discussed. At that time, there was little interest on the part of the private community hospitals to assume responsibility for SMMC’s population, particularly the psychiatric and long-term care components, which comprise over half of SMMC’s current bed capacity. There is also limited capacity in the private sector for absorbing the large volume of SMMC outpatient clinic visits. The current SMMC leadership has more recently attempted to create affiliations with Sutter, Kaiser, CHW, UCSF, Stanford and Palo Alto Medical Foundation, with limited success. II. Revenue Enhancement and Cost Reduction San Mateo Medical Center The Board of Supervisors should authorize the County Manager to direct the Director of the San Mateo Medical Center to: General Operations
F2:
Require enrollees of the WELL program to pay the annual fee within three months of enrollment or commit to a more suitable payment plan. Response: Agree. Currently patients are asked for payment prior to or on the same day of the visit. Patients should expect to pay off the full amount of the annual fee in a timely manner. SMMC will explore shortening the timeframe in which a patient must pay the annual fee and what the penalty should be for non-compliance. This will be accomplished by the end of the fiscal year.
F3:
Triage WELL and other uninsured patients requesting emergency room services. Those determined not to be in need of immediate care should be directed to clinics for follow-up care. Although triage may slightly increase the medical liability and add initially to the administrative burden of emergency personnel, it would dissuade patients from using emergency services for non-emergency needs. Response: Agree in principle but find it difficult to implement due to recently enacted federal legislation called the Emergency Medical Treatment and Labor Act (EMTALA). This act requires all patients to be medically stabilized in the emergency room by a physician prior to discharge. In addition, all patients seeking emergency room care must be seen and treated by a physician regardless of ability to pay or type of insurance coverage. It is doubtful that this type of change would ultimately lower the Medical Center’s costs since the patient, if referred later to a clinic, would be treated twice by a physician. However, Emergency Room management and Ambulatory Care management are currently looking at ways to reduce the number of patients being seen in the emergency room for non-urgent care. This includes educating patients on the alternatives for receiving non-urgent care outside of the emergency room.
F4:
Instruct screeners to verbally verify patient eligibility with each hospital visit and annually confirm and document patient continued eligibility. Response: Agree. SMMC does annually confirm and document continued WELL eligibility and verify patient eligibility with each hospital visit. In the outpatient clinics, registrars verbally verify demographic and insurance information with each visit.
F5:
Develop a formal indigent care policy that specifies the qualifications required to receive medical care. This policy should be posted and published, where appropriate and any individual seeking medical services should be required to formally acknowledge the qualifications established. Response: Agree. The Health Department, Human Services Agency, the County Manager’s Office and SMMC have recently developed four financial assistance policies, including a formal indigent care policy. They will be posted and published in conjunction with the expanded WELL eligibility pilot program. Patients will be required to acknowledge the qualifications established to be eligible to receive financial assistance.
F6:
Transfer all accounts over 90 days past due and not eligible for the WELL program to the Revenue Services Collection Unit. Response: Agree. Currently any self-pay account greater than 30 days is assigned to the Revenue Services Collection Unit. As part of the new WELL Eligibility pilot program, this timeframe will be extended to any account greater than 90 days delinquent because SMMC will be forming an in-house self-pay team to collect on accounts that did not qualify for WELL or other coverage, including additional self-pay accounts that receive the new Health Care Discount option (charity care discount).
F7:
Suspend the 50% cash discount option that is available to uninsured patients with resources. Initiate a study that establishes the profitability of offering this option. Response: Agree that a study should be established to review the profitability of offering this option, but do not concur on suspending the cash discount option for uninsured patients with resources. The compelling reasons for offering discounts to self-pay patients are threefold, 1) self-pay patients represent the only payer group that has no option but to pay full charges, while all other payers receive some sort of discount. It is difficult to justify not offering a discount without the appearance of exploitation and it has become a community standard among hospitals to offer a discount, 2) this discount still allows the Medical Center to recover its costs, and 3) offering a discount allows the Medical Center to resolve its outstanding bills sooner, which lowers days in accounts receivable and reduces bad debt write-offs. A study will be performed by the end of the fiscal year.
F8:
Require non-critical patients to provide identification prior to receiving initial treatment and inform them that a subsequent visit will require a documentation and verification process. Response: Agree with the implementation of the new WELL Eligibility pilot program. All patients that present without insurance coverage will be screened for financial assistance through a formal documentation and verification process. Screening Operations
F9:
Investigate the cost, advisability, and timeliness of outsourcing the entire screening process as it relates to indigent care across all programs. Response: Agree. Community Health Advocates from the SMMC and the Health Department, as well as community-based organizations, will be performing the screening function during the pilot process to conduct full screening and verification of uninsured applicants. The Human Services Agency will also be reviewing a portion of applications that are determined eligible for the WELL and Discounted Health Care (charity care) programs. Outsourcing of the screening process will be explored after the pilot has been completed and results evaluated at the end of the current fiscal year.
F10:
Upgrade the enrollment process to identify those individuals who do not qualify for medical care programs because of residency, income, or asset criteria by making verification of qualifying criteria mandatory in all cases and creating a prescribed script for screeners to determine that all relevant issues are covered. Response: Agree. The County has initiated a pilot process to conduct full screening and verification of uninsured persons applying for health care coverage. Data collection will take place from October 2005 through March 2006 using a web-based screening tool called One-e-App. It is estimated that this effort will cost $950,000. This includes modifications to One-e-App, extra help staffing and increases to community-based provider contracts, equipment and supplies.
F11:
Create or integrate a countywide, inter-departmental database to facilitate monitoring of program participants. Response: Agree. As part of its information technology strategic plan, SMMC, along with the County’s Information Services Department and other applicable departments has begun work on an unduplicated client database that will track health and social services provided to individuals by County departments including SMMC, the Health Department and Human Services Agency. The unduplicated client database will use a common client database across these three departments so that program data about common clients can facilitate better services for clients and for analytical and statistical reporting purposes. This is referred to as the “Applicable Client Record Store (ACRS) and this technology approach lays important groundwork for other County operations. ACRS allows County departments who share clients to identify client records in the same way. This process will allow better Countywide reporting to measure the effectiveness of services provided by the County and to determine unmet needs. Cost estimates are not available at this time, but there will be costs incurred by the County for these efforts.
F12:
Combine all screening processes under one department to enhance operational control and consistent application of qualifying criteria. Response: Agree. Alternatives to performing the screening process will be explored after the screening and verification pilot process has been completed and evaluated at the end of the fiscal year. There will be consistent application of qualifying criteria during the pilot, given the features offered by the One-e-App screening tool, including eligibility calculation logics for all programs and the validation of all required data fields and verification documents.
F13:
Redesign the WELL Program’s self-declarative form to impress upon applicants the seriousness of the process and that providing false or inaccurate information may have legal ramifications. Response: Agree. The WELL self-declaration process has been eliminated as part of the screening and verification pilot that is estimated to cost $950,000. The financial assistance policies, application forms, and brochures have been modified in order to emphasize the consequences of providing false or inaccurate information, including denial or dis-enrollment, and criminal charges for perjury. Private Pay Patients The San Mateo Board of Supervisors should require that San Mateo Medical Center:
F14:
Build a for-fee parking structure and offer valet parking providing convenient facility access for those unable or unwilling to negotiate parking lot distances. Response: A study is currently underway to evaluate additional parking. We anticipate recommendations by the end of October. However, it is doubtful that the majority of patients and visitors to SMMC would be able to pay for parking.
F15:
Initiate a publicity campaign describing hospital capabilities and desirability as a provider of health care services. Response: Agree. We agree that SMMC is more than a "County hospital" and that its new hospital, in addition to its clinics and its many key programs, offer County residents quality services that anyone should be proud to use. Unfortunately, because many people have not seen or heard from the Medical Center, public perception may not match this reality. As the Grand Jury report states, to date we have signed agreements that enable us to accommodate private-pay patients yet the hard work of attracting them remains. We will be working on this effort through targeted outreach and publicity campaigns that focus on service lines where we have capacity. It is important to note than most of the clinics are filled to capacity and some have waits as long as three months for non-urgent visits so we can therefore only market certain services unless we open additional capacity. As much of the Grand Jury report focuses on cost, it is also important to note that publicity campaigns will require an investment in order to generate goodwill and eventual growth in volume. For example, we are developing an outreach campaign for the Ron Robinson Senior Care Center, in order to tell the community about its services and most important, about the benefits that this Center offers to seniors and caregivers. We will be preparing a similar campaign for the new Keller Women and Children's Center, scheduled to open in 2006.
F16:
Affiliate with other medical groups capable of referring doctors and patients. Response: Numerous conversations with private physicians and medical groups were unsuccessful in generating significant additional private patients. Most physicians are affiliated with a hospital and are not interested in the additional drive time to SMMC. We are considering opening a private primary care office near SMMC to increase capacity and access for private pay patients and increase ancillary and hospital volume. Indigent Care and Charity Care Cost Sharing
F17:
The Board of Supervisors should research and explore methods to encourage the other non-profit hospitals to substantially increase their charity care. Response: Agree. Charity care is defined as free or discounted health and health-related services provided to persons who are uninsured and cannot afford to pay or who are not eligible for public programs. SMMC provides 95% of indigent in the county and a majority of the Medi-Cal or underinsured care. The County General Fund will contribute over $54 million in FY 2005-06 toward these costs. It is anticipated that these costs will rise given continued increases in costs related to providing healthcare. While most private hospitals have maintained their non-profit status by contributing to the community for the community’s benefit and or by providing care to the underinsured, they have not significantly contributed to costs directly related to indigent care. There have been efforts to highlight the need for other hospitals to contribute to costs incurred by SMMC for indigent patients. One of the recommendations from the Southern San Mateo County Task Force on New Hospital Construction in its June 2004 report was for the County to “create a vehicle that includes all hospitals in order to dialogue as a group and see how the charity care issue can be resolved.” The Hospital Consortium of San Mateo County, which includes SMMC, Mills-Peninsula Health Services, Sequoia Hospital and Seton Medical Center/Seton Coastside, has recently attempted to quantify each organization’s contribution to indigent/charity care and benefits provided to the community. The County is developing separate policies for medically indigent care, for which the County is financially responsible under its Section 17000 mandate, and charity care, in an attempt to further quantify costs incurred for charity care patients. The charity care policy was developed based on income and asset standards used by other community hospitals. The policies will be implemented during the eligibility screening and verification pilot that will start in late October. The results of the pilot will be used to further define the County’s obligation under Section 17000, which will not include charity care. Estimated costs for charity care will then be developed so that the Board can make decisions on how these costs should be funded by the County and other hospitals in the community. The County has also reviewed San Francisco’s charity care ordinance that requires annual publication and dissemination of charity care statistics for all hospitals in the City, and will explore recommending a similar ordinance after completion of the pilot at the end of the fiscal year.
Additional Recommendations
17
Not linked to specific findings.
R1:
Issue a request for proposal (RFP), within 90 days, to review public health care services provided by the county with particular emphasis on indigent care. Qualified 1 proposals should demonstrate a high level of experience and active involvement with indigent care in California. The RFP should include but not be limited to a study of • Advantages and disadvantages of the payer model as compared to San Mateo County’s provider health care system and should include the fiscal, medical, and social effects of each. • The effectiveness of the provider model currently employed. • The sale or lease to a third party, (e.g. Stanford University Medical Center, University of California San Francisco Medical Center), of the San Mateo Medical Center and clinics with the agreement it remain a provider of medical care to the indigent. II. Revenue Enhancement and Cost Reduction San Mateo Medical Center The Board of Supervisors should authorize the County Manager to direct the Director of the San Mateo Medical Center to: General Operations:
R2:
Require enrollees of the WELL program to pay the annual fee within three months of enrollment or commit to a more suitable payment plan.
R3:
Triage WELL and other uninsured patients requesting emergency room services. Those determined not to be in need of immediate care should be directed to clinics for follow-up care. Although triage may slightly increase the possibility of medical liability and add initially to the administrative burden of emergency room personnel, it would dissuade patients from using emergency room services for non-emergency needs.
R4:
Instruct screeners to verbally verify patient eligibility with each hospital visit and annually confirm and document patient continued eligibility.
R5:
Develop a formal indigent care policy that specifies the qualifications required to receive medical care. This policy should be posted and published, where appropriate, and any individual seeking medical services should be required to formally acknowledge the qualifications established.
R6:
Transfer all accounts over 90 days past due and not eligible for the WELL program to the Revenue Services Collection Unit.
R7:
Suspend the 50% cash discount option that is available to uninsured patients with resources. Initiate a study that establishes the profitability of offering this option. 2
R8:
Require non-critical patients to provide identification prior to receiving initial treatment and inform them that a subsequent visit will require a documentation and verification process. Screening Operations:
R9:
Investigate the cost, advisability, and timeliness of outsourcing the entire screening process as it relates to indigent care across all programs.
R10:
Upgrade the enrollment process to identify those individuals who do not qualify for medical care programs because of residency, income, or asset criteria by making verification of qualifying criteria mandatory in all cases and creating a prescribed script for screeners to determine that all relevant issues are covered.
R11:
Create or integrate a county wide, inter-departmental database to facilitate monitoring of program participants.
R12:
Combine all the screening processes under one department to enhance operational control and consistent application of qualifying criteria.
R13:
Redesign the WELL Program’s self-declarative form to impress upon applicants the seriousness of the process and that providing false or inaccurate information may have legal ramifications. Private Pay Patients The San Mateo Board of Supervisors should require that San Mateo Medical Center:
R14:
Build a for-fee parking structure and offer valet parking providing convenient facility access for those unable or unwilling to negotiate parking lot distances.
R15:
Initiate a publicity campaign describing hospital capabilities and desirability as a provider of health care services.
R16:
Affiliate with other medical groups capable of referring doctors and patients. Indigent Care and Charity Care Cost Sharing
R17:
The Board of Supervisors should research and explore methods to encourage the other non-profit hospitals to substantially increase their charity care. San Mateo County Indigent Health Care Issue What can San Mateo County do to reduce the annual appropriation for indigent health care?
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Findings & Recommendations
5 findings
F1:
Create an express line in the Planning and Building lobby for simple permits. Response: Concur. The Planning and Building Department will create an express line so that representatives from various customer groups such as architects, contractors, and homeowners can help define which projects should be considered “express.” Customers will be included in the discussion and implementation of an express line to address and respond to actual customer need and the concern that some customers may be helped more quickly than others. Defining express projects should be carefully considered so that a customer does not have a negative experience when the “express project” customer receives service before the “non- express project” customer—when the “non-express project” customer came to the counter first. The express line is scheduled to be implemented by the end of June 2007.
Related Recommendations (1)
R1:
Create an express line in the Planning and Building lobby for simple permits (Recommendation 2);
F2:
Raise awareness of fax-in and mail-in options as well as the on-line status through the website, brochures, and signage. Response: Concur. Signs have been posted in the Planning and Building lobby about the fax and mail-in option for applicable permits. The Department will update its website and brochures by June 2007 so that fax and mail-in options for applicable permits are emphasized. To meet this deadline, stickers will be added to pertinent brochures emphasizing the fax and mail-in options. As brochures are updated and reprinted, the stickers will be replaced with text integrated into the description of the permit process.
Related Recommendations (1)
R2:
Raise awareness of fax-in and mail-in options as well as the on-line permit status through the website, brochures and signage (Recommendation 4);
F3:
Improve accessibility to the website by creating better links from the County’s homepage. These links should reflect the Planning and Building Department function in the planning and permit process. Response: Concur. The County of San Mateo homepage has recently been updated as part of the Countywide reorganization and links to the Planning and Building Department have been improved. The Department is now directly accessed from the County homepage by its department name rather than through the name of a larger Agency. The link to the Planning and Building Department directly links to the “Permit Plan” tracking system and permitting processes. The Department’s “Permit Plan” tracking system includes information fields for in- house and third party agencies, such as special districts, that are responsible for reviewing and commenting on permit applications. Anyone can access this information on-line through the application number, site address, or assessor’s parcel number. Department staff is responsible for filling in all project status fields. The Department will coordinate with Accela, the service provider for “Permit Plan,” to upgrade the tracking system so that comments and documents received from third party agencies can be directly attached to the tracking system and applicants and interested parties thereby have access to more complete information. The Department also understands that it can improve its customer service by facilitating communication between applicants and third party agencies. To achieve this goal, the Department has hired a Permit Coordinator who is responsible for serving as liaison between an applicant and a third party agency. The Permit Coordinator informs third party agencies of timelines for comments and will assist in communicating the comments received from third party agencies to applicants. Although this is not an on-line solution, it does provide a County liaison between applicants and agencies so that communication during the permit process is enhanced.
Related Recommendations (1)
R3:
Improve accessibility to the website by creating better links from the County’s homepage. These links should reflect the Planning and Building Department’s function in the planning and permit process (Recommendation 5); and
F4:
Design and implement an in-depth survey to solicit recommendations from architects, contractors and homeowners for improving the permit process. Response: Concur. The Department will convene a focus group of selected customer representatives—architects, contractors and homeowners—to design and implement an in-depth survey that will be used to solicit specific recommendations for improving the permit process. This survey will include solicitation on how to design and implement an “Express Line” in the lobby as well as other ways to streamline the permit process. The Department will develop a workplan and budget, based on the focus group recommendations, by the end of June 2007.
Related Recommendations (1)
R4:
Design and implement an in-depth survey to solicit recommendations from architects, contractors and homeowners for improving the permit process (Recommendation 6). The Grand Jury also recommends that the Board of Supervisors direct the Planning and Building Department to improve the information content available on-line to create a single access point for building permit applicants to review the status of their permit applications. If third party agency approvals are required for permit issuance, links should be created to the websites of the third party agencies or, if links are not available, information from the third party agencies received by the Planning and Building Department should be scanned and uploaded. COUNTY OF SAN MATEO Inter-Departmental Correspondence County Manager’s Office DATE: February 12, 2007 BOARD MEETING DATE: February 27, 2007 SPECIAL NOTICE: None VOTE REQUIRED: None TO: Honorable Board of Supervisors FROM: John L. Maltbie, County Manager SUBJECT: 2006-07 Grand Jury Response Recommendation Accept this report containing the County’s responses to the following 2006-07 Grand Jury report: Unfinished Business at San Mateo County Planning and Building Division Report. VISION ALIGNMENT: Commitment: Responsive, effective and collaborative government. Goal 20: Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain. This activity contributes to the goal by ensuring that all Grand Jury findings and recommendations are thoroughly reviewed by the appropriate County departments and that, when appropriate, process improvements are made to improve the quality and efficiency of services provided to the public and other agencies.
F2007:
2. Raise awareness of fax-in and mail-in options as well as the on-line status through the website, brochures, and signage. Response: Concur. Signs have been posted in the Planning and Building lobby about the fax and mail-in option for applicable permits. The Department will update its website and brochures by June 2007 so that fax and mail-in options for applicable permits are emphasized. To meet this deadline, stickers will be added to pertinent brochures emphasizing the fax and mail-in options. As brochures are updated and reprinted, the stickers will be replaced with text integrated into the description of the permit process.
Additional Recommendations
2
Not linked to specific findings.
R5:
Improve accessibility to the website by creating better links from the County’s homepage. • Links between the County’s homepage and Current Planning are not intuitive. A word search for “building permits” on the homepage will not link directly to Planning and Building or Current Planning. 2004-2005
R6:
Immediately solicit written feedback from architects, contractors and homeowners on recommendations for improving the application process. • Planning and Building makes the generic “San Mateo County Cares” customer satisfaction survey available to applicants via the Internet and in printed form. The Grand Jury did not review the results of the surveys. • Planning and Building has not implemented a program to solicit recommendations from architects, contractors and homeowners for improving the permit process. Conclusions The County is reconfiguring and remodeling the physical premises of the DRC. It is creating a new Planning and Building Department as part of its government reorganization. The application process for building permits should be improved to make it as user friendly as possible. Planning and Building has responded to the need for better educated employees by implementing an ongoing formal training program. The Grand Jury commends this change and anticipates that a better trained staff will deliver more accurate and efficient services to permit applicants. Planning and Building does not maximize use of information technology and electronic communication. The planning process remains very paper intensive. The 2004-2005 Grand Jury concluded that Planning and Building had not taken full advantage of available technologies to improve operating efficiencies and communications with applicants. The Grand Jury has observed improvement in this Department’s use of facsimiles and electronically accessed databases, but the progress appears to be disjointed and not a priority. There is no single electronic database which can be accessed in real time by both the applicant and County employees to determine the conditions for issuance of a permit or the status of a permit application which includes third party correspondence and processes bearing on the permit approval. The Grand Jury commends the use of customer satisfaction surveys as recommended by the 2004-2005 Grand Jury. However, it appears that Planning and Building has not conducted a focused and in-depth survey of homeowners and building professionals to solicit ideas to improve the permit process. Recommendations The Grand Jury recommends that the Board of Supervisors direct the newly created Planning and Building Department to implement each of the following recommendations of the 2004-2005 Grand Jury previously accepted by the Board: 1. Create an express line in the Planning and Building lobby for simple permits (
Findings & Recommendations
4 findings
F1:
The Board of Supervisors should take steps to relieve the burden, which Proposition 36 has placed on the Probation Department and the Court. Response: Agree. A significant number of Proposition 36 participants fail to report to Probation let alone attend treatment. It was reported at the June 2005 Workgroup meeting that there were 62 first time violations filed in Redwood City Court and that 42 of those were for not reporting to Probation. To address this situation, the Board of Supervisors recently allocated funding for an additional Probation Officer and a Human Service’s Assessor. The Assessor will meet with participants immediately following their sentencing hearings to explain treatment and the assessment process, instill in them the importance of treatment, clarify program procedures, and reinforce the Court’s expectations. The additional Probation Officer increases the program’s ability to respond more rapidly to Court violations and failures to enroll in programs. Additionally, the Probation Department has recently developed new computer software to streamline documents to the Court. The new software allows Probation Officers to complete approximately seven to ten violations per hour versus two to four violations per hour under the old system. The increased staffing and the software upgrade should allow Probation Officers to spend more time with program participants, resulting in better outcomes.
Related Recommendations (1)
R1:
The Board of Supervisors should take steps to relieve the burden which Proposition 36 has placed on the Probation Department and the Court. In August of this year, the Board of Supervisors approved an additional position for a Probation Officer for one fiscal year. We are very appreciative of this additional position. While this will certainly be of assistance, it is not a solution to the workload problems inherent in the Proposition 36 program. The sheer volume of work does not allow the Department to provide effective interventions, and coupled with the problems in the design of the law, it is questionable whether we will have better outcomes with the additional position, due to continuing workload issues involving extraordinarily high caseloads (400+/officer). Our Proposition 36 caseload has increased to approximately 1800 cases on active supervision. Our violation rates remain high, averaging 90 to 100 violations a month. We also continue to have only approximately 30% to 35% of our cases successfully complete the program. The Proposition 36 caseloads are by far the most time consuming, active caseloads within the Department. The Probation Department has taken steps to enhance our computer programs to increase the efficiency in processing the high volume of violations and bench Grand Jury Response ______________________________________________________________________ warrants. However, even with our new technology, we are still unable to process all of our violations and bench warrants. Until new Proposition 36 legislation is passed, (Senate Bill 803) the Probation Department will continue to have excessively high caseloads, and we will most likely be unable to respond to all of the violations and warrants. Additionally, we will be unable take appropriate action on positive drug tests, and we will be unable to provide effective drug treatment interventions.
F2:
The Board of Supervisors should request the State legislature to amend Proposition 36 in accordance with Senate Bill 803. Response: Agree. While Senate Bill 803 will likely not pass through the Legislature in 2005, it has the opportunity to address some key elements regarding the effective treatment should it pass next year. The most significant component of SB 803 – appropriation of at least $120,000,000 annually – must remain in this bill or any bill that addresses SACPA. While language stating the intent of the Legislature is helpful, it does not assure the annual appropriation of funds needed to sustain SACPA mandates.
Related Recommendations (1)
R2:
The Board of Supervisors should request the State legislature to amend Proposition 36 in accordance with Senate Bill 803. We concur.
F3:
The Board of Supervisors should continue to urge the Legislature to formulate new legislation should Senate Bill 803 fail, which will reconfigure Proposition 36, and also allow funds to be used for programs proved to be more effective. Response: Agree. The Proposition 36 Workgroup will monitor all legislation related to Proposition 36 and continue to work with the County’s legislative advocates and statewide groups to correct some of the inherent problems with the legislation, most notably funding, the allocation formula and enforcement options.
Related Recommendations (1)
R3:
The Board of Supervisors should continue to urge the Legislature to formulate new legislation should Senate Bill 803 fail, which will reconfigure Proposition 36, and also allow funds to be used for programs proved to be more effective. We concur.
F4:
The Sheriff and Probation Department should develop a standardized protocol in cooperation with cities for drug testing that includes random basis testing and frequency of testing. Response: Disagree. The Probation Department is required by the Court to randomly drug test probationers. In the past calendar year, Probation has administered over 25,000 drug tests in the Adult Division. With the additional Probation Officer and efficiencies achieved with the new software, Probation should be able to complete this task without the help of the Sheriff’s Department or other police departments in the County. June 17, 2005 Honorable Norman J. Gatzert Judge of the Superior Court Hall of Justice and Records 400 County Center, 2nd Floor Redwood City, CA 94063-1655 Re: Grand Jury Report : PROPOSITION 36 Dear Judge Gatzert: Summary Proposition 36 was passed by the voters to save dollars by diverting drug users from incarceration into drug treatment. Anyone charged with a nonviolent drug arrest is potentially eligible to enter a treatment program. The Proposition has two major faults. One: there is no incentive such as short term incarceration to participate in the program. Two: a positive drug test cannot be considered a violation of probation. Steps should be taken to relieve the burden placed on the Probation Department and the Court to allow funding to be used for programs which have proved to be more effective in the County. Response Concur with these observations;
Related Recommendations (1)
R4:
The Sheriff and Probation Department should develop a standardized protocol in cooperation with cities for drug testing that includes random basis testing and frequency of testing. By far, the most reliable means of assessing drug usage is by drug testing. Self reports or other subjective assessments are notoriously unreliable and inaccurate. In our judgment, the most effective means of assessing the most basic element of a drug treatment program, i.e., whether or not participants continue to use drugs, would be by using such a testing protocol. The Probation Department would be very pleased to work with all of the Proposition 36 treatment providers who are doing drug testing to jointly develop a randomized, uniform drug testing protocol. We believe this process would be the most effective, rather than working with the Sheriff’s Office and cities, neither of which are responsible for administering criminal justice drug tests. Respectfully submitted, Loren Buddress Chief Probation Officer CC: Board of Supervisors County Manager’s Office
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Findings & Recommendations
2 findings
F1:
If one or more hospitals can be built in the District without SHD assistance, the SHD should initiate a public dialogue on the its own future.
F2:
Sequoia Healthcare District should explore more options to further develop the workforce. The first action is the concern that the rebuild of Sequoia Hospital will result in redundant facilities within the South County. The Palo Alto Medical Foundation is planning to build a new facility in San Carlos; Kaiser is seeking a new location in Redwood City; and Stanford has expressed interest in locating a specialty center there as well. As there is no definitive answer to the number of beds or facilities that will be needed in San Mateo County, especially since each seems to be following the model of providing more clinic and outpatient services rather than increasing acute care facilities, hospital count is too narrow a measure to determine the future medical needs of either the District or the County. The second action urges the SHD to develop housing, training, and opportunities for hospital staffing. This is a suggestion consistent with its sponsorship of a regional nurses training program. The SHD offers the following: 4 • In 1996, voters approved the reorganization and the SHD continues to represent the public with its five-member oversight board. • The SHD’s original responsibility is to support community health and is not limited to hospital operations. • The practice of medicine has become more specialized and geographically dispersed with some facilities located beyond the SHD borders. The hospital could no longer serve as the sole source of all community health needs. • The SHD supports many county-wide initiatives for the benefit of SHD and county residents including: a ten-year nurses education program in cooperation with local colleges and universities; a $1 million plus per year contribution to the Children’s Health Initiative that offers previously unaffordable health care; funds for school nurses in the budget-limited Redwood City School District; support for Samaritan House, a free clinic using the skills of retired medical professionals in offering primary and preventive care to workers making too much money for Medi-Cal and not enough for insurance. • Sequoia Hospital, under the direction of CHW, provides free lab and x-ray services in support of Samaritan House. • Continued funding of hospital improvements. While the District’s detractors would like to see its dissolution, there are two positions that argue against that outcome. The first was offered by the San Mateo County Counsel who indicated that the District's collection of taxes is legal and that the District's board members should decide the best use of its resources. The second was offered by LAFCO (Local Agency Formation Commission) that notes taxpayers would see no drop in taxes even if the SHD Board initiated dissolution with voter approval. Proposition 13 set property tax assessment in California at 1% of the assessed value. All properties in the county are assessed at 1% and an increment of that 1% is distributed to Sequoia Healthcare District. That increment is approximately $72.00 for a home in the SHD assessed at $500,000. If the District is dissolved, the property tax would remain at 1% and SHD's share would be redistributed based on a formula reflecting the remaining agencies' sharing in the affected tax rate areas. The taxes would not be returned as a discretionary resource for the County. Board Member and CEO Compensation SHD board members receive a fringe benefit of health insurance. It is common practice for special districts to provide board members with insurance and their program is consistent with other districts the Grand Jury has reviewed. Members do not receive other fees for services even though such fees are within the special district legislation. The CEO’s earnings are well within the bounds of a chief administrator’s expected income for a special district. Governance Failure to file state-required reports could be an indicator of lax management. While the time stamp on the 2003 State Controller Annual Report was after the filing date, thus exposing the SHD to penalties and interest, the source of the delay was the Controller’s office. No penalties or interest were levied. The District employs a professional investment management company. The investment strategy pursued has resulted in a prudent rate of return consistent with conservative, governmental investing. Reporting, particularly the balance sheet item, "Accrued Liability – Escheat," deserves immediate attention. Escheat is an arcane part of the law used in reference to unclaimed property. Such property as lost or uncashed checks and unclaimed refunds or insurance payouts, over time, become the property of the state. The State Controller can impose penalties and interest for failure to file or for late filing of unclaimed property. The SHD has stated that as a result of the hospital divestiture in 1996, the liability resides on their balance sheet, as a governmental body cannot lawfully assign liabilities to a succeeding, non-governmental entity. It was agreed that Sequoia Health Services would be responsible for paying these claims. While special districts are exempted from submitting these types of funds to the State Controller, it still leaves the question of why these 1996 claims were not transferred to the state by Sequoia Health Services, which has five SHD board members, and the liability removed from the SHD’s balance sheet. There is almost universal concern regarding the SHD’s management of its large financial reserves. The SHD indicated that it would soon begin the process of developing a 10- year plan for the expenditure of the reserves of approximately $68 million plus surplus property. Twenty-five million dollars of this surplus has already been committed and is payable over a five-year period primarily for the seismic rebuild of the hospital. The estimated total cost for the hospital is $130 million, and is not the responsibility of the SHD. Current community funding commitments are: Children’s Health Initiative ($1.35 million over 5 years), SFSU Nursing Program ($1million per year for 10 years), Samaritan House Free Clinic ($500,000 per year), Sequoia Hospital Foundation ($1million per year), and Redwood City School District Nursing Support ($291,000 over 3 years). For 2004, annual tax revenues were $5.5 million of which approximately $4 million is allocated to the first four programs mentioned with the remainder set aside as board-designated strategic reserves and for administrative costs. Conclusions The Sequoia Healthcare District continues to represent and serve the health care interests of the District. The divestiture of direct responsibility for owning and operating Sequoia Hospital has not diminished the value provided. In fact, separation has allowed for the redirection of resources to additional and complementary services that are not provided by the hospital. The Supervisors’ Task Force questioned whether the rebuild of Sequoia Hospital was necessary and whether the Sequoia Healthcare District has any viability in light of other 6 planned new hospital construction. A hospital count ignores the fact that some of these facilities will be for medical specialties and that some are modeled in support of outpatient and clinic services rather than acute care beds. As of this writing, there is neither an accurate way of predicting the future hospital needs of the county nor where these facilities should be sited. Additionally, the dissolution of the SHD would not provide tax relief as there would be a redistribution of the revenue to other agencies that may have a mission other than health care, resulting in a net loss in health care resources. The Task Force urged Sequoia Healthcare District to explore options to develop the work force. The nurses training program is an important recruitment tool and needs to be partnered with concepts of staff retention. One of these is low-cost housing, an idea guaranteed to be on any task force agenda. If subsidized housing is not a reality, then retention must include the needs of young professionals. Professionals with young children need an affordable and readily available source of child day care. Without it, experienced professionals seek employment closer to home or request shorter work schedules, and may be replaced with less experienced professionals. The key to engendering district-wide support is to provide a long-range investment strategy that ably demonstrates a thoughtful use of its large financial reserves. As a step in that direction, the SHD board is meeting to plan for future community investing of financial reserves as well as budgeting. The Grand Jury endorses the suggestions heard in County Supervisors’ meetings and other forums exploring the possibility of joining Sequoia Healthcare District with Peninsula Hospital District into a single agency addressing the needs of all County residents and not just those fortunate enough to reside in a district. There are obvious differences between the two districts, such as the best way to divest responsibility for a hospital as well as the size of funding reserves. However, philosophically they both profess the same health care goals. The districts are already providing de facto funding of non-district taxpayers through direct grants as well as paying for the enrollment of district residents in non-district programs. In combination, the two districts can offer greater resources for these and other programs and perhaps gain some economies of scale. This combination would cause no increase in property taxes. All homeowners pay the same 1% General Tax no matter where they live in the county. Currently, residents in both districts have an advantage over other county residents as a portion of the 1% is returned specifically for funding district programs. The district tax receipts drawn from the 1% county property tax theoretically deprive non-district residents of funds that could be used for additional services. As Prop. 13 rewards the homeowners for length of residence by paying less tax and still getting the same services as their recently arrived neighbor, district owners are rewarded based solely on location. The County is facing dramatically increasing health care costs for the indigent, working poor, elderly, and others unable to pay. Dissolving the SHD would redirect health care dollars to other agencies within the SHD to be used for non-health care purposes. Merging the two districts, through a joint powers agreement or merger structured to serve the entire county, amplifies the effect of both and levels the playing field for all county residents.
Additional Recommendations
7
Not linked to specific findings.
R1:
The Sequoia Healthcare District Board should: 1.1 immediately explore with the Peninsula Healthcare District the merging of the two agencies via a joint powers agreement or reorganization structured to serve the health care needs of the combined districts, and explore the expansion of the districts to include all San Mateo County residents. 1.2 implement a working investment plan for use of strategic reserves by June 30,
R2:
The Peninsula Healthcare District Board should: 2.1 immediately explore with the Sequoia Healthcare District the merging of the two agencies via a joint powers agreement or reorganization structured to serve the health care needs of the combined districts, and explore the expansion of the districts to include all San Mateo County residents. July 28, 2005 Hon. Norman J. Gatzert Judge of the Superior Court Hall of Justice 400 County Center, 2cd Floor Redwood City, CA 94063 RE: Civil Grand Jury Report of May 11, 2005 / Peninsula Health Care District Dear Judge Gatzert, The Peninsula Health Care District hereby submits this response to the Civil Grand Jury’s (“CGJ”) May 11, 2005, Report on its review of issues principally addressing the Sequoia Healthcare District, with comments concerning the Peninsula Health Care District. The District thanks the members of the 2004-2005 Civil Grand Jury for their work and appreciates their recommendations. The District has paraphrased the CGJ’s suggestions (in bold) and has responded only to the CGJ’s Conclusions and Recommendations directed toward the Peninsula Health Care District. Civil Grand Jury Conclusions and Recommendations The Grand Jury endorses the suggestion that the Sequoia and Peninsula Health Care Districts explore joining with each other to serve the needs of a combined district and to the creation of a single combined agency serving all County residents. The Peninsula Health Care District does not oppose the concept of exploration of cooperative activities or merger with the Sequoia District. The District believes, however, that there are two prohibitive obstacles to pursuit of the suggestion at this time:
R3:
Regarding communicating with District residents to dispel the notion that District residents are being taxed above the 1% parcel tax rate for Sequoia Healthcare District services. The District has been actively communicating with residents in a variety of ways. As of the summer of 2004, we initiated a comprehensive information program utilizing community newsletters, presentations to community and civic and governmental groups, along with regular updates to our Web site. The information conveyed includes correct information regarding how the District is funded.
R4:
Regarding the recommendation to support and retain health care professionals by creating day care facilities close to medical/health providers. This is an interesting suggestion and would be worth exploring to see if day care facilities are a viable strategy for the recruitment and retention of health care professionals and if constructing or funding child care facilities is within the legal scope of services that the District may use tax funds to support. The District is committed to supporting the needs of young people and families through programs such as the Children’s Health Initiative (CHI) and related projects. There are many groups in the community working towards increasing the availability of child care to make our District a more economically sustainable place to raise a family, such as the Child Care Coordinating Council (4C's), etc.
R5:
Regarding pursuing a joint powers agreement or other arrangement with the Peninsula Healthcare District. At its May 26, 2005 meeting, the Peninsula Healthcare District rejected the idea of merging its district with ours. However, our healthcare district is currently exploring ways in which we can be more efficient by leveraging funding for the benefit of community health across the board, such as what we currently do with the Children’s Health Initiative (CHI).
R6:
Regarding the recommendation that the nurse training program should be partnered with staff retention programs. This concept is built into the nurse training program through (i.) Sequoia Hospital’s offer of forgivable loans for students enrolled in the nurses training program at Cañada College in exchange for their commitment to work at Sequoia Hospital upon graduation and (ii.) the development of a relationship with Sequoia Hospital based on the fact that they are doing their clinic training there. Furthermore, as registered nurses with a Bachelor of Science degree, these students will have a career that provides a living wage enabling them to stay and work in this area.
R7:
Regarding the Escheat liability issue. The Grand Jury is correct in that health care districts are exempt from the law that requires this liability to be paid to the State. Legal counsel has determined that under California Government Code Sections 50050 et seq., we can publish notice and set up a claim procedure that will allow persons to file claims for funds in the Escheat Liability fund that the claimants believe belong to them. Funds that remain unclaimed after the close of the claim filing period can then be transferred to the Sequoia Healthcare District general fund and the Escheat Liability item can be removed from the balance sheet. At its June 1, 2005, meeting, the Sequoia Healthcare District board authorized staff and legal counsel to proceed with this process, and staff is currently setting up the statutory notice and claim program.
Findings & Recommendations
2 findings
F1:
The Grand Jury recommends that the Board of Supervisors direct the Director of Health Services to: 1.1 identify the office of Public Guardian in its building and in directories to improve citizen awareness and access. 1.2 give proposed conservatees an explanation in person and in writing of their rights at the time of filing a petition to curtail or remove their personal and/or property rights. 1.3 issue specific written policies instructing the deputy Public Guardians about AAS priorities, including maintaining the conservatees in their own home if possible, locating and consulting with all family, friends, and neighbors (against whom there is no evidence of abusive actions), and providing all needed assistance without delay. 1.4 install a plan for regular agency oversight and consultation with the deputy Public Guardians. 1.5 eliminate any lag time between the time that all bank accounts are frozen and the time when provision is made for the proposed conservatee’s bills to be paid and supplies and services made available. 1.6 document the oversight and upgrade the training of in-home service caregivers. 1.7 establish written policies for requests for proposals or contracts for in-home caregiver organizations, financial managers, real estate brokers, et al. 1.8 visit conservatees living independently once a month at a minimum. 7 1.9 perform an annual audit of investment accounts of conservatees held by the Financial Manager to assure they are appropriately invested to meet the account goals and to clearly show the annual rate of return and commissions on transactions. 1.10 establish additional procedures that set rigorous “best practices” standards for calculation of fees and consider requiring that any billing method used not include cash or money market accounts as part of the total investment account, and determine whether there is additional compensation, such as commissions or partial commissions paid the Financial Manager as a result of his affiliation with the broker.
Related Recommendations (1)
R1:
The Grand Jury recommends that the Board of Supervisors direct the Director of Health Services to: 1.1 identify the office of Public Guardian in its building and in directories to improve citizen awareness and access. 1.2 give proposed conservatees an explanation in person and in writing of their rights at the time of filing a petition to curtail or remove their personal and/or property rights. 1.3 issue specific written policies instructing the deputy Public Guardians about AAS priorities, including maintaining the conservatees in their own home if possible, locating and consulting with all family, friends, and neighbors (against whom there is no evidence of abusive actions), and providing all needed assistance without delay. 1.4 install a plan for regular agency oversight and consultation with the deputy Public Guardians. 1.5 eliminate any lag time between the time that all bank accounts are frozen and the time when provision is made for the proposed conservatee’s bills to be paid and supplies and services made available. 1.6 document the oversight and upgrade the training of in-home service caregivers. 1.7 establish written policies for requests for proposals or contracts for in-home caregiver organizations, financial managers, real estate brokers, et al. 1.8 visit conservatees living independently once a month at a minimum. 7 1.9 perform an annual audit of investment accounts of conservatees held by the Financial Manager to assure they are appropriately invested to meet the account goals and to clearly show the annual rate of return and commissions on transactions. 1.10 establish additional procedures that set rigorous “best practices” standards for calculation of fees and consider requiring that any billing method used not include cash or money market accounts as part of the total investment account, and determine whether there is additional compensation, such as commissions or partial commissions paid the Financial Manager as a result of his affiliation with the broker.
F2:
The Grand Jury recommends that the Board of Supervisors fund Aging and Adult Services for additional transportation services for conservatees’ appointments for personal or medical care, or court appearances. Response: Disagree. AAS has one Transportation Officer who provides transportation for Public Guardian clients to Court, medical appointments, and for shopping. When Deputy Public Guardians transport conservatees to medical appointments, this time spent allows for conferring with medical treatment care providers and for individual visiting time with the conservatees. This is valuable and necessary time spent developing relationships and assuring that necessary services are appropriately provided. AAS will review current staff resources and allocations of funding for this function. Staff will convene a committee comprised of the Paratransit Council, Mental Health Services, and other community providers to address the overall transportation gaps and client needs, and will report back to the Board in January during the FY 2005-06 mid-year budget review.
Related Recommendations (1)
R2:
The Grand Jury recommends that the Board of Supervisors fund Adult and Aging Services for additional transportation services for conservatees’ appointments for personal or medical care, or court appearances. 8
Findings & Recommendations
6 findings
F1:
The results of the Grand Jury survey indicate that: • ISD is perceived by virtually all departments as performing well in providing telephone, data, and connectivity infrastructure services and support; • A disconnect in perception exists between ISD and several major information technology users on application evaluation, implementation, and cost of services rendered. In some instances, ISD is viewed as thwarting timely, cost-effective upgrades and implementation of applications.
Related Recommendations (2)
R1:
complete, by June 30, 2005, the organization of the Information Technology Management Structure and its shift from independent, departmental systems development to a collaborative model directing the resources available within ISD and the departments.
R3:
Create a customer satisfaction survey and circulate it annually to assist in the evaluation of performance on a non-project specific basis. COUNTY OF SAN MATEO Inter-Departmental Correspondence County Manager’s Office DATE: July 13, 2005 BOARD MEETING DATE: July 26, 2005 SPECIAL NOTICE: None VOTE REQUIRED: None TO: Honorable Board of Supervisors FROM: John L. Maltbie, County Manager SUBJECT: 2004-05 Grand Jury Response Recommendation Accept this report containing the County’s response to the 2004-05 Grand Jury report: County Information Services Department Focuses on Change. VISION ALIGNMENT: Commitment: Responsive, effective and collaborative government. Goal 20: Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain. This activity contributes to the goal by ensuring that all Grand Jury findings and recommendations are thoroughly reviewed by the appropriate County departments and that, when appropriate, process improvements are made to improve the quality and efficiency of services provided to the public and other agencies.
F2:
The County’s use of and reliance on information technology has grown as a result of perceived departmental operational needs with only limited guidance from ISD. Most departments have created an internal IT function to address unique day-to-day operational data recovery and reporting needs.
Related Recommendations (1)
R1:
complete, by June 30, 2005, the organization of the Information Technology Management Structure and its shift from independent, departmental systems development to a collaborative model directing the resources available within ISD and the departments.
F3:
– ISD has initiated a Relationship Management program in which every ISD customer department is assigned a Relationship Manager who is responsible for working with department staff to understand the business needs of the department. Overall, the CIO and ISD are focused on maintaining and improving customer service throughout this department. At the same time, all ISD staff is encouraged to focus on the benefits of approaching IT with a Countywide view.
F4:
ISD has acknowledged its limitations and, as indicated in Item 3 of the Findings, is taking steps to address the issues while maintaining its overall responsibility for system and data integrity.
Related Recommendations (1)
R2:
Continue implementation of the Mainframe Elimination Plan and accelerate it to the extent possible.
F5:
There is evidence that the relatively new ISD senior management team is successfully refocusing the department to a customer-based orientation. (See Rate Relief Plan above). Conclusions ISD is just starting its transition to a customer-focused, collaborative management orientation. It is premature to evaluate whether the transition will be accomplished successfully, although the progress made to date is reassuring. ISD is knowledgeable about and conversant with many of the shortcomings of the current interdepartmental environment, and is attempting to address them. Given the scope and nature of the needed changes, it is unrealistic to expect immediate quantifiable results. ISD is meeting its basic mandate of providing service but in several cases how that is done leaves the other departments uneasy. ISD is identifying and implementing interim strategies that may become the foundation for the new collaborative Management Structure of Information Technology, once it is organized. 5
F6:
ISD should discontinue application development support Disagreed: they felt that ISD has the knowledge and technical skills necessary to develop and maintain programs and systems operating on most computing platforms. ISD and the CIO (Chief Information Officer) will continue to demonstrate the value of ISD while concurrently supporting department-based staff. The focus of the previous investigation appears to have been a “top-down” review, i.e., a study of the management structure needed for effective application of information technology. The resulting analysis referred to a “governance model” implemented in Nevada County, California, and many of the Grand Jury’s recommendations were based on this analysis. As an alternative evaluation, the 2004-2005 Grand Jury used a “bottom-up” approach in which a questionnaire was sent to all County departments to focus on user concerns and perceptions. Investigation The Grand Jury: 1. Created, distributed, summarized, and reviewed a satisfaction and utilization survey of county department heads. The response rate was 93.3%.
Findings & Recommendations
1 findings
F2004:
Members, representing relevant city and county agencies and districts, met monthly. The Panel examined a comprehensive review of educational and budgetary approaches to serve these at-risk youth. Members of the Panel attended meetings of statewide associations, such as the Community Day School Network, to encourage the sharing of ideas and solutions to common problems. Along with providing the appropriate education, the members’ major concern was the projected annual $500,000 budget deficit. The Blue Ribbon Panel determined that the optimal financial and operational model for Community Schools would be to combine the district-run with the County-run schools. Independent studies demonstrate that a substantial economic benefit exists in educating these at-risk youth. Three recent studies by the Rand Corporation, the University of 4 California at Los Angeles Graduate School of Management and Research, and the National Opinion Research Center at the University of Chicago concurred in their findings that the cost of incarceration far exceeds the cost of education. The San Mateo Probation Department estimates that every dollar spent in prevention (i.e., education, counseling, etc.) saves $7 in future costs to taxpayers. Conclusions The Community Schools are functioning adequately given the economic constraints under which they operate. These constraints, however, result in the almost constant search for money to provide services. Despite the bare-bones budgets, students are making progress, as shown by increases in test scores from 2003 to 2004 in language and math, and by completion rates, such as numbers receiving diplomas or GED certificates. The relatively low rates for students dropping out of the Community Schools due to attendance or behavior problems underscores the need to continue supporting these schools with stable funding and easily accessible locations. Staff at the schools are dedicated to the education and success of these at-risk youth. Experienced teachers and counselors work to help the students learn life skills, including goal setting, dependability, and assuming responsibility for one’s actions. The Grand Jury observed the need not only to maintain a viable Community Schools program, but also to expand academic offerings to a growing number of adolescents. Current thinking by state and local educators anticipates increased placements of troubled youth in local communities rather than incarceration in state-run facilities. It is essential that these at-risk youth obtain as much education and socialization as possible to enable them to be contributing members of their families and of the community.
Additional Recommendations
9
Not linked to specific findings.
R1:
IMPLEMENT THE RECOMMENDATIONS OF THE BLUE RIBBON PANEL, INCLUDING COMBINING THE DISTRICT-RUN DAY SCHOOLS WITH THE COUNTY-RUN COMMUNITY SCHOOLS. MOUs have been completed with Sequoia and San Mateo Union High School District to combine district Community Day Schools with County Community Schools. The combined programs will be located at the Fair Oaks Center in Redwood City and at the Pen-Crest site in San Bruno.
R2:
CONVENE A SMALLER SUBSET OF THE PANEL TO HOLD REGULARLY SCHEDULED MEETINGS TO EXAMINE EMERGING ISSUES RELATED TO PROGRAMS, FACILITIES, FUNDING AND FUTURE GROWTH AND TO DEVELOP STRATEGIES TO ADDRESS THEM. Monthly meetings are scheduled including representatives from Probation, High School Districts and County Office of Education managers and staff.
R3:
CONVENE A TASK FORCE OF FISCAL OFFICERS FROM THE COUNTY OFFICE OF EDUCATION PARTICIPATING DISTRICTS, PROBATION DEPARTMENT AND OTHER MEMBERS OF ORGANIZATIONS OF THE BLUE RIBBON PANEL TO DETERMINE HOW BEST TO SHARE THE COSTS OF THESE SCHOOLS. A preliminary meeting including the Assistant Chief of Probation, San Mateo County Office of Education Associate Superintendent, and Community School managers is scheduled for May 16. The fiscal task force will be discussed.
R4:
CONTINUE TO EVALUATE THE PROGRESS MADE AND THE BENEFITS RESULTING FROM COMBINING COMMUNITY AND COMMUNITY DAY SCHOOLS. THE EVALUATION SHOULD RECOGNIZE ANY LONG-TERM IMPLICATIONS OF COMBINING SCHOOLS, INCLUDING BUDGETARY ISSUES AND PROGRAM EFFECTIVENESS. Ongoing program review will take place and evaluation reports will be provided to the San Mateo County Office of Education Board of Trustees.
R5:
REQUIRE AND SUPPORT PARENT/GUARDIAN OR ANY OTHER CONCERNED ADULT INVOLVEMENT. Parent involvement is encouraged. Parents participate in an intake interview where expectations are delineated and parent input is sought. Parent meetings may be planned three times per year.
R6:
WORK TO RETURN YOUTHS TO THEIR HOME SCHOOL DISTRICTS OR TO LOCAL COMMUNITY COLLEGE PROGRAMS BY IDENTIFYING AND CO- OPERATING WITH AVAILABLE ACADEMIC AND VOCATIONAL PROGRAMS. Student transitions are discussed at the monthly Community School Task Force meetings. The Regional Occupational Program (ROP) currently makes presentations to students regarding opportunities for vocational training and it is hoped that ROP may extend classes to community school sites. Career education will be provided as a component of the after school activities planned by the East Palo Alto Boys and Girls Club.
R7:
CONSIDER PARTNERSHIPS WITH EDUCATIONAL ORGANIZATIONS AND AGENCIES TO SEEK ADDITIONAL FUNDING SOURCES, SUCH AS STRATEGIC FUNDING AND OTHER NONGOVERNMENTAL ORGANIZATIONS TO IDENTIFY AND PROCURE FUNDS. Funding issues are a regular item on the Task Force agendas. Grant opportunities are being researched. The San Mateo County Office of Education Associate Superintendent for Student Services Division is the Co-Chair of the Adolescent Collaborative Action Team comprised of 45 county agencies and community based organizations. Opportunities for revenue enhancement and/or resources for services are sought through this group.
R8:
CONTINUE TO PARTICIPATE IN ORGANIZATIONS SUCH AS THE COMMUNITY DAY SCHOOL NETWORK TO BUILD ON THE EXPERIENCES AND RESEARCH OF OTHER SIMILAR SYSTEMS. San Mateo County Office of Education program managers are members of the Community Day School Network (CDN) and the Juvenile Court, Community and Alternative School Administrators Association (JCCASAC). The Associate Superintendent of Student Services Division is a member of the Student Programs and Services Steering Committee (SPSSC) of the California County Superintendents’ Education Services Association (CCSESA). This group meets six times per year to discuss alternative education issues and advocate for legislation and California Department of Education policy that support alternative education students and programs.
R9:
CONTINUE TO WORK TO FIND MORE COST EFFECTIVE LOCATIONS INCLUDING, BUT NOT LIMITED TO, SURPLUS COUNTY OR DISTRICT SCHOOL SITES CLOSER TO REQUIRED ANCILLARY SERVICE SUCH AS PUBLIC TRANSPORTATION. For the 05-06 school year, all community school classrooms, with the exception of the Daly City site, will be in rent-free sites. The sites are located in East Palo Alto, Redwood City, San Bruno, San Mateo and Daly City. These sites are selected to be accessible to students. The sites in East Palo Alto, Redwood City, San Bruno and Daly City are co- located in facilities with community-based organizations that can provide resources and opportunities for extended learning for the students.
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Additional Recommendations
5
Not linked to specific findings.
R1:
“The Board of Directors of the San Mateo County Transit District should actively seek out opportunities for development along the right of way.” Response: We agree and are doing so. SamTrans currently is reviewing proposals from well-established development firms for the design and construction of a transit-oriented development in San Carlos on right of way property. The project is intended to provide housing and retail integrated with the Caltrain station and bus service and to serve as a community gathering place for the residents of San Carlos and adjacent cities. It is our intention that this project also serve as a model for development projects along the right of way. Our formal, long-range planning calls for several similar projects on right of way properties over the next several years.
R2:
“The Board of Directors of the San Mateo County Transit District should reopen negotiations with San Francisco and Santa Clara Counties to seek repayment of the contribution, plus accrued interest, no later than November 1, 2005.” Response: The issue of repayment has been the subject of continuing discussions with our partner agencies as we work together to find a means by which those funds can be generated. Specifically, we are engaged in the renewal of the Joint Powers Authority Agreement under which our partnership is governed and the issue of repayment and efforts to generate funds sufficient for repayment are key Hon. Norman J. Gatzert June 27, 2005 elements of those discussions. Further, we expect to continue to raise this issue with our partner agencies and with their support seek the means by which to obtain repayment.
R3:
“The Board of Directors of the San Mateo County Transit District should work with San Francisco and Santa Clara Counties and their elected representatives to investigate sources of grants and state and federal monies that could be used for projects that would lead to repayment of the contribution.” Response: We concur with this recommendation.
R4:
Board of Directors of the San Mateo County Transit District should report annually by November 1 to the Grand Jury on the status of activities and efforts to collect repayment of the contribution, plus accrued interest.” Response: SamTrans will comply with this recommendation.
R5:
“The Board of Directors of the San Mateo County Transit District should insure that any future projects that SamTrans undertakes that include advances, contributions, or loans should be sufficiently secured to assure repayment, and should include specific terms of repayment at competitive interest rates, and should be an unrestricted obligation of the borrower.” Response: As noted above in the Response to Findings, it has been and will continue to be the policy of SamTrans to secure any and all investments with binding guarantees that provide security against the failure of a partner entity to make repayment, either by secured real estate, waiver of comparable financial obligations accruing to SamTrans or by an enforceable repayment schedule. We will be happy to respond to additional questions from the Grand Jury and, again, appreciate the efforts of the Grand Jury to understand the issues facing SamTrans and its relationship with the Peninsula Corridor Joint Powers Board. Sincerely, Michael J. Scanlon General Manager/CEO Cc: SamTrans Board of Directors David Miller
Findings & Recommendations
6 findings
F1:
Follow through with the formal training program for new Current Planning employees and allow ample time to learn regulations before handling customer inquiries. Response: Concur. The Planning and Building Division is committed to training new employees. The Current Planning Section is recruiting to fill three vacancies in the near future. With this recruitment, the Current Planning Section will have the opportunity to initiate and complete the Division’s training program with each of the new employees. The program will include instruction provided by senior staff in their areas of expertise and other relevant planning topics. The training program will also include assigning senior staff to mentor new employees. We believe that ample time is required to fully understand complex Planning regulations. Before a new employee is assigned counter or phone duty, an assessment by senior staff will be completed to insure new employees exceed a minimum level of competence for those responsibilities.
Related Recommendations (1)
R1:
follow through with the formal training program for new Current Planning employees and allow ample time to learn regulations before handling customer inquiries.
F2:
Immediately set up an express line for picking up and processing simple permits in the Planning and Building lobby. Response: Concur. The Planning and Building staff are taking the necessary steps to develop a work plan for implementing this recommendation. Through feedback provided in customer surveys, the Planning and Building Division identified the need for an express line service for picking up permits and simple permits. This
Related Recommendations (1)
R2:
immediately set up an express line for picking up and processing simple permits in the Planning and Building lobby.
F3:
Immediately raise awareness of the fax-in and mail-in options as well as the on-line permit status through the website, brochures, automated phone messages and personal contact with the applicants. Response: Concur. The Planning and Building Division staff is currently in the process of implementing this recommendation. Staff is developing a new brochure that identifies the different methods for the public to contact the Division, submit applications and review application status on-line. In addition, as part of the Division’s community outreach and information program, phone messages will be updated to reflect options for submitting permits.
Related Recommendations (1)
R3:
immediately raise awareness of the fax-in and mail-in options as well as the on-line permit status through the website, brochures, automated phone messages and personal contact with the applicants.
F4:
Expand the use of fax and e-mail in the Planning and Building Division to facilitate and expedite the processing of permits and responses to customer inquiries. Response: Concur. The Planning and Building Division staff is currently in the process of implementing this recommendation. Staff will notify customers of the option of providing a fax number in order to expedite plan check review comments and/or responses to customer inquiries.
Related Recommendations (1)
R4:
expand the use of fax and e-mail in the Planning and Building Division to facilitate and expedite the processing of permits and responses to customer inquiries.
F5:
Improve accessibility to the web site by creating better links from the County’s home page. Response: Concur. The Planning and Building Division management staff is currently developing a work program and budget with the Information Services Department (ISD) to improve the Planning and Building Division’s web site links, and will work with the County Manager’s Office (CMO) and ISD to make necessary improvements to comply with established guidelines for the County’s homepage.
Related Recommendations (1)
R5:
improve accessibility to the web site by creating better links from the County’s home page.
F6:
Immediately solicit written feedback from architects, contractors, and homeowners on recommendation for improving the application process. Response: Planning and Building management staff is currently developing a work program and assigning responsibilities to develop a survey form and method for soliciting comments and suggestions from the public to improve the application process. The status of these responses will be reported to the Board in a future Grand Jury update.
Related Recommendations (1)
R6:
immediately solicit written feedback from architects, contractors, and homeowners on recommendations for improving the application process. COUNTY OF SAN MATEO Inter-Departmental Correspondence County Manager’s Office DATE: May 26, 2005 BOARD MEETING DATE: June 7, 2005 SPECIAL NOTICE: None VOTE REQUIRED: None TO: Honorable Board of Supervisors FROM: John L. Maltbie, County Manager SUBJECT: 2004-05 Grand Jury Response Recommendation Accept this report containing the County’s response to the 2004-05 Grand Jury report on the San Mateo County Planning and Building Division. VISION ALIGNMENT: Commitment: Responsive, effective and collaborative government. Goal 20: Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain. This activity contributes to the goal by ensuring that all Grand Jury findings and recommendations are thoroughly reviewed by the appropriate County departments and that, when appropriate, process improvements are made to improve the quality and efficiency of services provided to the public and other agencies.
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Findings & Recommendations
8 findings
F1:
Agriculture performs vital services of education, inspection, and quarantine to prevent pests and diseases from infecting both imported and exported plants in a thorough and efficient manner.
F2:
Agriculture ensured that 95 % of agricultural and pest control businesses in the County in 2003 were in compliance with all pesticide regulatory requirements.
F3:
Agriculture, in collaboration with the California Department of Food and Agriculture, developed a unique certification program that now allows for the export of plants to Canada from Sudden Oak Death-infected counties including San Mateo County. Plant shipments to Canada from infected counties had been prohibited since November 2001. 3
F4:
Weights and Measures monitors the calibration and accuracy of various weighing scales and measuring devices for over 2000 businesses in the County in a timely and efficient manner.
F5:
Weights and Measures exhibited leadership with the creation of the price scanner program to the benefit of the consumers of San Mateo County.
F6:
Weights and Measures has cross-trained employees to be more flexible in the face of personnel cutbacks and has managed the budget challenges of the past few years in a responsible manner.
F7:
Weights and Measures maintains a high level of customer satisfaction (95% to 98%) for services rated as “Good” or “Better”. The recent San Mateo County Cares survey indicated a high approval rating for Weights and Measures’ courteous and responsible services. Conclusion The Grand Jury finds that the Agriculture Commissioner/ Sealer of Weights and Measures Division is well managed and commends the Division for the quality of service provided. COUNTY OF SAN MATEO Inter-Departmental Correspondence County Manager’s Office DATE: March 14, 2005 BOARD MEETING DATE: March 29, 2005 SPECIAL NOTICE/HEARING: None VOTE REQUIRED: Majority TO: Honorable Board of Supervisors FROM: John L. Maltbie, County Manager SUBJECT: County Responses to Grand Jury Reports and Recommendations
F33:
The San Mateo County 1999 Grand Jury recommends that the County Board of Supervisors direct the Director of Public Works to prepare a comprehensive time-phased plan for completion of the seismic retrofit and lead/asbestos abatement of the County Hall of Justice. Urgency should be placed on the development and implementation of the plan, including a detailed time-phased series of actions and the designation of personnel responsible for each action and associated deadlines. The plan should include details on office and employee relocation. The County Board of Supervisors should give high priority to implementation and funding of this program. Response: Concur. The Director of Public Works will work with the Court on developing a tentative phasing plan that allows for the work to go forward on the 7th and 8th floors. A similar approach will be undertaken with the Probation Department for the 5th Floor. However, a key aspect of this plan will be to identify additional funding sources. An additional $2.2 million will be required to complete the project. To date, the County has spent approximately $1.6 million in the design of the seismic retrofit plan, the remediation work that was done immediately after the Loma Prieta Earthquake, and for the work completed or under construction on the 4th and 6th floors. Public Works estimates that it will take approximately two years to complete the work once funding is identified and agreement with the Court and Probation is obtained. Abatement work is generally done in conjunction with other work on the structure, as encapsulated lead and asbestos in the building will remain in place and does not present a threat to either the citizens visiting the Hall of Justice or employees. Status: Final Phase - Installation of Seismic Dampers and Roof Panels Retrofit On June 8, 2004, the Board of Supervisor, under Resolution No. 66710, adopted plans and specifications, determining prevailing wage scales and calling for sealed bid proposals. On July 6, 2004, bids were accepted for this project and were subsequently referred to the Department of Public Works for checking and
Additional Recommendations
5
Not linked to specific findings.
R1:
The Board of Supervisors and the Sheriff should develop and implement plans for reducing the populations or expanding capacity at the Maguire Correctional Facility and the Women’s Correctional Center. Response: Disagree in part. Such a plan can only occur with the active involvement and support of the Courts. The Board has established a Task Force on Jail Overcrowding composed of representatives from the Court, Sheriff’s Office, District Attorney’s Office, Probation Department, and Private Defender Program. One component of the Task Force charge is to examine the need for a new Women’s Correctional Center.
R4:
The Board of Supervisors and the Sheriff should immediately develop a plan to replace the existing Women’s Correctional Center with a new facility with adequate space to meet the California Board of Corrections standards and incorporating room for multiple classes, more opportunities for work inside the facility, and childcare in an expanded visiting area. Response: Disagree. There are currently insufficient resources available for such an undertaking. However, the Jail Overcrowding Task Force will be examining the need for replacement of the Women’s Correctional Center and should such need be identified steps will be taken to begin planning for the replacement.
R5:
The Board of Supervisors and the Sheriff should create a program to allow women inmates to pursue work opportunities outside the facility. Response: Concur. The Board supports the commercial baking program the Sheriff has put in place to help female inmates prepare for and pursue work opportunities outside the facility. The Board-established Jail Overcrowding Task Force will evaluate both the physical space needs and Court support for a work furlough program for female inmates as part of its study.
R6:
The Board of Supervisors and the Sheriff should develop a plan for a minimum security facility for women. Response: Concur. Agree to study. Status: A task force to review the issues of jail overcrowding and the Women’s Correctional Center was formed September 2004, following the FY 2004-05 Recommended Budget hearings. The task force includes representatives from the Board, the Sheriff’s Office, Probation Department, District Attorney’s Office, Private Defender Program, the Court and the public. An update on the task force’s progress is being prepared for the Board of Supervisor’s April 12, 2005 meeting and will include plans to pilot a Work Furlough Program and provide quarterly updates on jail population trends to task force members. The data elements to be tracked will include average daily population, average length of stay, pre-sentenced vs. sentenced populations, number of bookings, and number of criminal filings by types of crime.
R33:
The San Mateo County 1999 Grand Jury recommends that the County Board of Supervisors direct the Director of Public Works to prepare a comprehensive time-phased plan for completion of the seismic retrofit and lead/asbestos abatement of the County Hall of Justice. Urgency should be placed on the development and implementation of the plan, including a detailed time-phased series of actions and the designation of personnel responsible for each action and associated deadlines. The plan should include details on office and employee relocation. The County Board of Supervisors should give high priority to implementation and funding of this program. Response: Concur. The Director of Public Works will work with the Court on developing a tentative phasing plan that allows for the work to go forward on the 7th and 8th floors. A similar approach will be undertaken with the Probation Department for the 5th Floor. However, a key aspect of this plan will be to identify additional funding sources. An additional $2.2 million will be required to complete the project. To date, the County has spent approximately $1.6 million in the design of the seismic retrofit plan, the remediation work that was done immediately after the Loma Prieta Earthquake, and for the work completed or under construction on the 4th and 6th floors. Public Works estimates that it will take approximately two years to complete the work once funding is identified and agreement with the Court and Probation is obtained. Abatement work is generally done in conjunction with other work on the structure, as encapsulated lead and asbestos in the building will remain in place and does not present a threat to either the citizens visiting the Hall of Justice or employees. Status: Final Phase - Installation of Seismic Dampers and Roof Panels Retrofit On June 8, 2004, the Board of Supervisor, under Resolution No. 66710, adopted plans and specifications, determining prevailing wage scales and calling for sealed bid proposals. On July 6, 2004, bids were accepted for this project and were subsequently referred to the Department of Public Works for checking and recommendation. The bids have been checked and the base bid of Gonsalves and Stronck Construction Company, Inc. was the lowest base bid received. On August 31, 2004, the Board of Supervisor, under Resolution No.66898, awarded the contract to Gonsalves and Stronck Construction Company for the contract amount of $2,599,251. On September 20, 2004, Department of Public Works issued a notice to proceed, authorizing the start of construction. The Contractor has mobilized and submitted shop drawings. The prototypes of the damper assembly are at UC Berkeley - PEER Center for testing. Further testing is required due to the unexpected splitting of the visco-elastic material. At the same time the contractor is working on the roof panel connections upgrade and the 3rd floor installation of seismic bracing supports. The construction operations are taking place between the hours of 6:00 pm - 3:00 am, Monday through Friday. The seismic retrofit work has been coordinated with the departments that occupy the space in the Hall of Justice and Records. The offices and courts in the building will remain occupied while the work is being accomplished. The target completion date of this final phase is November 2005. Grand Jury Whistleblower Recommendation
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Findings & Recommendations
5 findings
F1:
San Mateo Medical Center (Medical Center) staff is correctly using the Medication Administration Check (MAK) system, and there appears to be no identified abuse or inappropriate use of the system.
Related Recommendations (1)
R1:
Improve data used to measure the Medication Administration Check (MAK) system performance by creating bench marks and a baseline to assess the safety and efficiencies when dispensing medication to patients at the Medical Center.
F2:
The Medical Center’s goal is to improve the accuracy of patient identification, ensure the effectiveness of communication among caregivers, ensure the safety of administering medications, and encourage the patients’ active involvement in their own health care.
Related Recommendations (1)
R2:
Utilize MAK data to make decisions and suggestions for improvement of the current MAK module, and development of future software modules.
F3:
Clinicians contributed to the success of the MAK implementation by being involved in the pre-implementation planning, developing, and training, and by demonstrating their competency prior to using the MAK system. Operational Findings:
Related Recommendations (1)
R3:
Submit regular reports that evaluate the overall effectiveness and efficiency of the MAK system and recommend areas for system improvement to the Medical Center Board of Directors.
F4:
The clinician can stop the medication administration process if there is an error in the prescription, dosage, or bar code reconciliation. They then verify, reconcile, and/or override the system, and report the incident manually.
Related Recommendations (1)
R4:
Contact other hospitals who use MAK and share ideas contributing to successful data gathering and reporting processes.
F5:
Patients are informed by staff about the checks and balances performed before their medication is administered. Assessment and Evaluation Findings:
Related Recommendations (1)
R5:
Evaluate the purchase of a Computerized Provider Order Entry (CPOE) module which allows physicians to coordinate with the MAK software module. San Mateo Medical Center’s Medication Administration Check System
Findings & Recommendations
5 findings
F1:
The Board of Supervisors should continue with the sub-committee on Jail Overcrowding and the Jail Overcrowding Task Force to determine the most feasible solutions to the problem and implement those solutions. Response: Concur. The Jail Overcrowding Task Force will convene to review a final report that recommends on-going monitoring of jail population trends by a position added to Maguire Administration during the FY 2005-06 budget process. Task Force members will be provided with regular updates on jail population trends and recommended solutions as needed. Task Force members will reconvene on a semi- annual or as-needed basis as long as overcrowding issues continue at the jail.
Related Recommendations (1)
R1:
The Board of Supervisors should continue with the sub-committee on Jail Overcrowding and the Jail Overcrowding Task Force to determine the most feasible solutions to the problem and implement those solutions.
F2:
The Board of Supervisors and the Sheriff should immediately develop a plan to replace the existing Women’s Correctional Center with a new facility that meets the California Board of Corrections current standards. This new facility should include room for multiple classes, child care, an honor camp, and more opportunities for work inside the facility. Response: Concur. In June 2005, the Board of Supervisors adopted the FY 2005-06 Recommended Budget, which includes funds to hire a consultant to conduct a needs and site assessment for a new Women’s Correctional Center.
Related Recommendations (1)
R2:
The Board of Supervisors and the Sheriff should immediately develop a plan to replace the existing Women’s Correctional Center with a new facility that meets the California Board of Corrections current standards. This new facility should include room for multiple classes, child care, an honor camp, and more opportunities for work inside the facility.
F3:
The Board of Supervisors and the Sheriff should complete installation of security cameras in the Women’s Correctional Center immediately. Response: Concur. Installation of security cameras at the Women’s Correctional Center is nearly complete.
Related Recommendations (1)
R3:
The Board of Supervisors and the Sheriff should complete installation of the security cameras in the Women’s Correctional Center immediately.
F4:
The Board of Supervisors and the Sheriff should make expanding the Choices Program a priority in both the men’s and the women’s jails. Response: Concur. The Maguire Correctional Facility will work with Correctional Health Services, the Service League, and the Classification Unit to review solutions for expanding the Choices Programs and other identified programs throughout the facility to provide accessible services to the inmate population. The existing Women’s Correctional Center does not have the physical capacity to expand the Choices Program; however, the County remains committed to the program and will consider its expansion as a part of the Women’s correctional programming and facility needs assessment scheduled to begin in the fall. Jail Administration is also reviewing the possibility of establishing inmate computer workstations with Microsoft Office and limited Internet Access for inmates located in the pod’s multi-purpose rooms and will review other optional program enhancements.
Related Recommendations (1)
R4:
The Board of Supervisors and the Sheriff should make expanding the Choices program a priority in both the men’s and the women’s jails.
F5:
The Board of Supervisors and the Sheriff should add one additional staff person to the Women’s Correctional Center. Response: Concur in part. Given the sustained increase in inmate population at the Women’s Correctional Center, the availability of resources to fund one additional staff member per team in FY 2005-06 will be considered at the September Budget Hearings. June 17, 2005 Honorable Norman J. Gatzert Judge of the Superior Court Hall of Justice and Records 400 County Center, 2nd Floor Redwood City, CA 94063-1655 Re: Grand Jury Report : SAN MATEO COUNTY JAILS Dear Judge Gatzert: In response to the San Mateo Grand Jury’s report concerning county jails, we are in agreement with their findings and offer the below clarifications to update and reflect changes since their inspections: Summary Maguire Correctional Facilities (Detention Division) The Maguire Correctional Facility (Maguire) and the Women’s Correctional Center (WCC), both located in Redwood City, are well run but have overcrowded facilities. The professionalism and quality of the staff at both locations are noteworthy, especially given the demands placed on everyone by a high inmate/staff ratio. Response Concur with these findings; The Maguire Correctional Facility is the largest housing facility and the only receiving correctional facility for adult offenders in San Mateo County. The Detention Division has been working to develop alternatives to incarceration with the Custody Division, Probation and the Courts to manage the growing inmate population. We are very proud of our well trained and professional staff. We will continue to train our staff in regards to inmate management and progressive discipline steps for establishing positive inmate behavior. Implementation of our New Facility Training Program tracking and reporting database system will assist in accomplishing that goal.
Related Recommendations (1)
R5:
The Board of Supervisors and the Sheriff should add one additional staff person to the Women’s Correctional Center. 12
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Findings & Recommendations
12 findings
F1:
Intimate knowledge of the community as well as those persons involved in criminal activity. This knowledge is best obtained by working closely with the community daily. As part of our community policing plan, patrol officers are assigned to one of four beats in the City. They are expected to become experts of their beats and interact with block groups, community-based organizations, faith-based organizations, businesses and schools, to develop contacts and information crucial in criminal investigations.
F2:
The willingness of the community to provide information to the police. The community and police must have a relationship based on trust and confidence before the crime occurs, not after. Otherwise, a detective, especially one from another department and outside the community, asking questions about who did what is often perceived as a stranger not to be trusted.
F3:
The Department's internal capacity to conduct thorough preliminary investigations and control and protect crime-scenes and evidence. The quality of preliminary investigations contributes greatly to the clearance rates. East Palo Alto police officers have been primarily assigned to field duties with little exposure to criminal investigations. This not only stifles their development, it limits their understanding of criminal investigations and
F4:
what role preliminary investigations play in solving crime. We must invest in our staff so that we build internal capacity and increase our competency, not invest our scarce resources to develop outside staff who will take their knowledge and experiences away from the Department once they transfer out of the City.
F5:
Coordination between patrol officers and detectives. The Sheriff’s Office and the Police Department enjoy a good relationship, however, the level of interaction is limited because of logistics. Homicide investigators are based in Redwood City. This disconnect contributes to slow communication and even the failure to share valuable information.
F6:
Increased Accountability. The Sheriff deputies are not city employees; therefore, as the police chief, I do not have the authority to select or remove detectives assigned to the investigations unit; change their work hours or days off if needed, or administer discipline if warranted. Such actions must be approved by the Sheriff. Localizing the investigation function offers other benefits to the Department and City, such as:
F7:
Single point of accountability. Residents will no longer have to figure out whom to contact -- the police department or the sheriff's office -- to follow-up on an investigation.
F8:
Reduced costs. It will be less expensive for the Department to operate an investigation function rather than contract with the Sheriff. Currently, the City leaves vacant six police officer positions to pay for the Sheriff’s contract. Even at the subsidized rate, the costs of Sheriff deputies have exceeded the funds generated from the vacant positions. The City has increased the Department’s budget in 2005 – 06 to make up the difference, however the subsidy is scheduled to end in two years, which means the cost of the contract will increase even more – about 40%.
Related Recommendations (2)
R1:
The East Palo Alto City Council should implement fully recommendation 5.12 of the 2003-2004 Grand Jury to ensure that adequate funding is provided to the Police Department. This includes providing for temporary filling of the patrol police officer shortage. CITY OF EAST PALO ALTO OFFICE OF THE CITY MANAGER September 23, 2005 Honorable Norman J. Gatzert Judge of the Superior Court Hall of Justice 400 County Center, 2nd Floor Redwood City, CA 94063-1655 Dear Judge Gatzert: Attached is the City of East Palo Alto’s response to the 2004-2005 Grand Jury dated June 23, 2005, which contained one finding and recommendation regarding the East Palo Alto Police Department. In accordance with the instructions of that report, the Chief of Police has completed his response and it is being transmitted together with this letter for your consideration. If I may be of further assistance, please do not hesitate to let me know. Respectfully submitted, Alvin D. James City Manager C E P A ITY OF AST ALO LTO OFFICE OF THE CHIEF OF POLICE Ronald L. Davis, Chief of Police RESPONSE TO THE GRAND JURY RECOMMENDATIONS TO THE CITY OF EAST PALO ALTO AND THE EAST PALO ALTO POLICE DEPARTMENT
R5:
12 states: The City Council should ensure that adequate financial services and staff are allocated to enable the East Palo Alto Police Department to fully implement the recommendations of the organizational assessment provided by PSComm, LLC/Joseph Brann and Associates, LLC. Response The East Palo Alto City Council has made public safety its top priority. The Police Department’s amended budget in 2004 -05 was $6.1 million, which represented approximately 44% of the City’s general fund budget. The City Council increased the Police Department’s budget in 2005 - 06 to $8.6 million, an increase of approximately $2.5 million representing 61% of the City’s general fund. Additionally, the City Council approved Measure K to be placed on the November ballot. Measure K is a public safety measure that asks the electorate to impose a parcel tax to increase police and social services and enhance public safety. If passed, Measure K will generate approximately $1.3 to 1.7 million of which 50% of the funds are designated for the Police Department. The Police Department has been authorized the fill the existing four police officer vacancies, in addition to the crime analyst and police captain positions. The City has initiated the hiring process for police officers and to date processed over 130 applicants and conducted oral boards for lateral and academy graduate applicants. An eligibility list has been created and certified by the City Manager. This list is currently under review by the Chief of Police. Candidates approved by the Chief will proceed to the background investigation phase. The Chief of Police has started recruitment to fill the Captain’s vacancy and expects this position to be filled by December. The Crime Analyst position has not yet been filled, however, the City has received assistance from the California Department of Justice to conduct a five year analysis of violence in East Palo Alto. The Police Department is also working closely with the Community Development Institute (CDI) to conduct crime analysis and mapping. The Palo Alto Police Department has agreed to allow the Police Department use of one of its crime analyst for the next few months to work with the Department and CDI, and assist the Police Department to build its internal capacity. Over the past three months, the Department has dramatically enhanced its ability to track and analyze crime, and now uses this information as a key part of the Department’s crime reduction strategy. The City chose not to purchase $700,000 in additional services as proposed by the Sheriff’s Department. Instead, the Department added two additional police officers to the Regional Investigations Bureau (RIB) and two additional officers to the newly formed Metro unit, which was formed to address increasing violence in the City. In July, two officers on extended leave returned to the Police Department and the two School Resource Officers became available during the summer break. This allowed the Police Department to reassign two officers to RIB and two to the Metro Unit. The Police Department also obtained assistance from the Drug Enforcement Agency (DEA), the San Mateo County Sheriff’s Office and the California Highway Patrol (CHP). In August, the DEA task force arrested 44 persons for various narcotics and weapons offenses – the largest narcotics operations in East Palo Alto in over 15 years. Since June, the newly formed Metro team has made over 170 felony arrests and conducted over 400 probation and parole searches. In August, the CHP has assigned one sergeant and six officers to work in the City through October – they have since conducted over 100 stops and made over 25 arrests. Additionally, the Police Department has received assistance from the United States Marshal to capture East Palo Alto’s Most Wanted and will be working with the Federal Bureau of Investigations to enhance our enforcement efforts. The assistance from the aforementioned agencies has greatly assisted the Police Department, especially during the summer months, and it did not increase the City’s cost or require the purchase of additional services. Moreover, the temporary purchase of additional staff from the Sheriff fails to advance the Department, build internal capacity, and address long-term staff development issues identified in the Joseph Brann organizational assessment and the Grand Jury Report. By assigning two additional police officers to the RIB, the Department has developed two officers and increased their level of training and expertise – expertise that increases the Departments internal capacity and can be used to develop additional staff. As part of the Police Department’s community policing plan, the Department will assume responsibility for criminal investigations in January 2006. This transition is also critical to the Department’s reform efforts and will serve to develop staff, increase opportunities within the Department, increase recruitment and retention, and increase the Police Department’s accountability to the community (see Attachment #1). On September 20, 2005, the Police Department outlined its Community Policing and Violence Reduction Plan to the East Palo Alto City Council (see Attachment #2). The plan focuses on three components: Education, Prevention and Enforcement, and adopts community policing principals and problem-solving practices. We are confident that our short and long-term efforts will have a dramatic effect on violence in the City and an equal affect on the Department’s reform efforts. CITY OF EAST PALO ALTO OFFICE OF THE CHIEF OF POLICE To: Honorable Mayor and Members of the City Council From: Ronald L. Davis, Chief of Police Via: Alvin James, City Manager Date: September 20, 2005 Re: Community Policing and Violence Reduction Plan RECOMMENDATION Accept this as an informational report only. No policy action is requested at this time.
F9:
Professional Development. The department has lacked much opportunity for professional advancement for its patrol officers or incentives to attract new recruits. Now an ambitious officer can look forward to trying to become a detective. Detectives transferring out of the East Palo Alto investigations unit remain in the Department and share their knowledge and experience to less experienced officers. This will create a more experienced core of officers and prepare the future leadership of the Department.
F10:
Increased Officer Recruitment and Retention. As we compete with other agencies to recruit qualified police officer candidates, we are limited by the growth and development we offer police officers. Without opportunities to learn and advance within the organization, many candidates look elsewhere. The newly formed investigations unit will provide lateral movement within the organization.
F11:
Increased grant opportunities. Because the City has not conducted criminal investigations over the past ten years, many grants designated to reduce crime and violence and increase clearance rates have not been available to the City. The Department will now seek grant opportunities and funding alternatives.
F12:
Increased pride and morale. An important part of reform is creating an environment conducive to high morale and pride. Officers must take pride in their Department and their community. Contracting with the Sheriff for investigations has diminished organizational pride, albeit not intentional, as it suggests that EPA officers are not good enough to conduct a basic function in policing. This serves as a source of tension for officers and has created what I can only describe as low organizational-esteem. If you set low standards and expectations, people will aim low. If you set high standards and expectations, people strive to those heights. This change has already created a level of excitement and synergy within the Department and increased organizational pride. We face many challenges ahead and face even more skeptics. I am confident that working together we can and will form a Department that is effective and one we can and will be proud of. Respectfully, Chief Ronald Davis
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Findings & Recommendations
4 findings
F1:
The Board of Supervisors should immediately begin the search for better facilities for the long-term care of the patients at the Burlingame Long-Term Care Center. This facility, or its replacement facility, should have safe and efficient ingress and egress for non-ambulatory or disabled patients in both emergency and routine situations. Response: Disagree. The San Mateo Medical Center agrees that a better facility would be desirable; however, the feasibility of locating such a large facility (the largest in the County) is prohibitively expensive under current Medi-Cal reimbursement rates and is effectively not possible. The County’s 20-year lease for the current facility is the only practical way these patients can be housed in San Mateo County. This recommendation will not be implemented. Improving Water Quality Flowing to the Ocean and Bay Findings:
Related Recommendations (1)
R1:
The Board of Supervisors should immediately begin the search for better facilities for the long-term care of the patients at the Burlingame Long-Term Care Center. This facility, or its replacement facility, should have safe and efficient ingress and egress for non-ambulatory or disabled patients in both emergency and routine situations. COUNTY OF SAN MATEO Inter-Departmental Correspondence County Manager’s Office DATE: June 7, 2005 BOARD MEETING DATE: June 21, 2005 SPECIAL NOTICE: None VOTE REQUIRED: None TO: Honorable Board of Supervisors FROM: John L. Maltbie, County Manager SUBJECT: 2004-05 Grand Jury Response Recommendation Accept this report containing the County’s responses to the following 2004-05 Grand Jury reports: Improving Water Quality Flowing to the Ocean and Bay, and the Burlingame Long-Term Care Center. VISION ALIGNMENT: Commitment: Responsive, effective and collaborative government. Goal 20: Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain. This activity contributes to the goal by ensuring that all Grand Jury findings and recommendations are thoroughly reviewed by the appropriate County departments and that, when appropriate, process improvements are made to improve the quality and efficiency of services provided to the public and other agencies.
F2:
Improvement of Storm Water Quality Staff agrees with the finding. The quality of storm water can be improved by frequent street sweeping, using storm drains that dissipate the energy of the water flow to decrease erosion, designing slow water flow in new developments, preventing construction site debris from reaching streams, and providing a means for the public to properly dispose of household hazardous wastes. Environmental Health will continue to offer a means for proper disposal of household hazardous waste through collection events located throughout the County.
Related Recommendations (1)
R2:
Improvement of Storm Water Quality Staff agrees with the finding. The quality of storm water can be improved by frequent street sweeping, using storm drains that dissipate the energy of the water flow to decrease erosion, designing slow water flow in new developments, preventing construction site debris from reaching streams, and providing a means for the public to properly dispose of household hazardous wastes. Environmental Health will continue to offer a means for proper disposal of household hazardous waste through collection events located throughout the County.
F3:
Watershed Assessment and Monitoring Staff agrees with the finding. Environmental Health samples various recreational beach areas and has had success in identifying and remediating sources of contaminants. Beach monitoring will be continued and, within existing resources, investigations will be conducted into possible sources of contamination.
Related Recommendations (1)
R3:
Watershed Assessment and Monitoring Staff agrees with the finding. Environmental Health samples various recreational beach areas and has had success in identifying and remediating sources of contaminants. Beach monitoring will be continued and, within existing resources, investigations will be conducted into possible sources of contamination. Recommendations:
F4:
The Board of Supervisors should support a request from the Environmental Health Services Division to provide sufficient funding to inspect each septic system every three years. Response: This recommendation requires further analysis. The re-inspection of septic systems has been in place for five years. The inspection program is an important component of the Land Use Program since the only other means for managing septic systems after installation is complaint-based. There are over 5,000 septic systems in the county. Currently, inspections are conducted on a periodic basis at a rate of approximately 700 per year; this roughly equates to an inspection every seven years. The Environmental Health Advisory Committee has prioritized the septic inspection system based on situations where potential failure could cause contamination; i.e., for septic systems where there is a well on the property. Environmental Health will evaluate the staffing required to inspect each septic system every three years. Environmental Health staff will report back to the Board of Supervisors on the results of their findings in a future quarterly update.
Related Recommendations (1)
R4:
The Board of Supervisors should support a request from the Environmental Health Services Division to provide sufficient funding to inspect each septic system every three years. Response: This recommendation requires further analysis. The re-inspection of septic systems has been in place for five years. The inspection program is an important component of the Land Use Program since the only other means for managing septic systems after installation is complaint-based. There are over 5,000 septic systems in the county. Currently, inspections are conducted on a periodic basis at a rate of approximately 700 per year; this roughly equates to an inspection every seven years. The Environmental Health Advisory Committee has prioritized the septic inspection system based on situations where potential failure could cause contamination; i.e., for septic systems where there is a well on the property. Environmental Health will evaluate the staffing required to inspect each septic system every three years. Environmental Health staff will report back to the Board of Supervisors on the results of their findings in a future quarterly update.
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Findings & Recommendations
4 findings
F1:
equipment approved by the Office of Domestic Preparedness
F2:
training exercises, approved consultants, and trainers
F3:
grants “in progress” currently being used for Weapons of Mass Destruction (WMD), First Responders Awareness Training, training for specials teams such as SWAT, HAZ MAT (Hazardous Materials), and safety, rescue, and detection equipment
F4:
overtime costs to send city personnel for training, reducing city budget costs The County benefits from three other sources of money directed at Homeland Security issues. Two of the three grants are health related.
Additional Recommendations
4
Not linked to specific findings.
R1:
acquire and implement the proper technologies to further improve communications between San Mateo County first responder agencies as well as with neighboring jurisdictions.
R2:
provide additional hiring and training for all personnel in the Sheriff’s Area Office of Emergency Services in the prevention of terrorist attacks.
R3:
draw down funds before the October 2005 deadline directly from the Federal government to take advantage of the unique waiver granted by Congress. These funds can be used to service, use, and maintain all equipment required for first responders, and to purchase needed equipment sooner rather than later.
R4:
negotiate with other Bay Area offices of emergency services within the Coastside Regional Offices of Emergency Services to improve interaction, sharing of resources, training, and cost savings. 8