Santa Clara County Grand Jury

2006-2007

18 reports

Findings & Recommendations 10 findings
F1: There are no objective, explicit criteria defining each of the complaint classification categories.
Related Recommendations (1)
R1: The IPA and IA should jointly establish definitive and objective criteria for each of the complaint classification categories for their use.
F2: Complaint forms do not: a. require a complainant’s signature, b. clearly define the key classification categories, c. provide a place for the complainant to indicate the classification he/she believes applies, d. consolidate information common to both the IA and IPA on a single complaint form.
Related Recommendations (1)
R2: The IPA and IA should jointly develop a single citizen complaint form that includes: a. complainant’s signature line, b. key complaint classification categories clearly defined and explained, c. complainant’s opinion of the classification category appropriate to his/her complaint.
F3: The complaint forms do not advise complainants of the right to receive copies of their written statements and/or tape-recordings made during their interviews.
Related Recommendations (1)
R3: The IPA and IA include on the citizen complaint form an advisory notification that a copy of the complaint is available, as well as a tape recording of the interview.
F4: Only the IA is authorized to formally classify all citizen complaints.
Related Recommendations (1)
R4: The IPA should be authorized by the City Council to formally classify all citizen complaints.
F5: The Inquiry-type complaint, which represents the largest percentage of complaints, requires no investigations and no officer contact. A pilot program, initiated in April 2007, currently records Inquiry-type complaints and subject officer information.
Related Recommendations (1)
R5: All essential Inquiry complaint information, including that of the subject officer, should be incorporated into the IAPro database and made available to the IPA.
F6: The number of Inquiry-type complaints has continued to increase each year since 2003, going from 113 to 233 complaints in 2006.
F7: In 2005 and 2006, the IPA did a classification analysis of 401 complaints classified by the IA as Inquiries. The IPA disagreed with the classifications on 50 percent of the complaints.
F8: As of April 2007, an off-line data collection pilot program of Inquiries is being maintained and is considered part of the SJPD’s Early Warning System, but it is still not a part of the IAPro database.
Related Recommendations (1)
R8: The off-line pilot program that tracks Inquiry subject officer information should be immediately incorporated into the IAPro database and made available to the IPA.
F9: The IPA is authorized to review closed investigative reports. The IPA is authorized to be a part of the initial investigation into officer-involved shootings and does an in-depth audit of all use-of-force complaints.
Related Recommendations (1)
R9: The City Council should grant the IPA co-investigative authority for cases the IA does not investigate, those questioned by the IPA, and all complaints of officer- involved shootings and use of force.
F10: Neither the IPA nor the IA has undergone a performance audit. 9
Related Recommendations (1)
R10: Performance audits should be conducted of both the IPA and IA. 10
Findings & Recommendations 5 findings
F1: There is no statement of strategic technology objectives for the County.
F2: No one in the County has championed the idea that IT is an area where a long- range vision could provide significant savings and improve service to the public.
Related Recommendations (1)
R2: Mandate the ISSP as the official IT strategic policy of Santa Clara County. The BOS must assume leadership in endorsing this significant change of direction in IT decision making.
F3: The County spent $1.3 million on studies that identified a strategy to make IT more efficient and effective. The County has not adopted this strategy. Specifically, $6.7 million to $8.8 million could be saved over the next five years in server consolidation projects with minimal additional spending. Ongoing savings in this area alone are estimated at $2 million annually.
Related Recommendations (1)
R3: Consolidate email services, directory services, and file-print services as recommended in the two server consolidation studies. Identify $150,000 in infrastructure replacement projects planned in the Fiscal Year 2007-2008 IT budget that can be deferred or included as part of server consolidation as the source of funds needed for the first year of the implementation plan.
F4: Spending on technology projects addresses short-term tactical needs rather than a fundamental change toward a centralized architecture.
Related Recommendations (1)
R4: Revise IT project funding priority criteria to emphasize those projects which help achieve stated strategic objectives.
F5: The authority of the CIO is not understood or recognized throughout County agencies. As a result, departments control 80 percent of General Fund IT spending, allowing them to make choices that solve immediate, local problems, but do not necessarily take into account a collective benefit to the County. 6
Related Recommendations (1)
R5: Formally establish the role of the CIO as having responsibility for all countywide IT functions. As a first step, consolidate control of all IT spending and project management under the CIO. 7
Findings & Recommendations 6 findings
F1: The District has identified areas of vulnerability to terrorism and vandalism at its plants and has developed a long-range Plan to address these vulnerabilities.
F2: The timeline for resolving all of the identified areas of vulnerability is four years.
Related Recommendations (1)
R2: The timeline for implementing the Water Treatment Plants Security Improvement Plan should be shortened to a maximum of two years.
F3: The District’s 2006/2007 Capital Improvement Program priority score for resolving all of the identified areas of vulnerability is a score of 57 out of a maximum priority score of 100, based upon a risk-assessment analysis conducted by the District.
Related Recommendations (1)
R3: The priority score for implementing the Water Treatment Plants Security Improvement Plan should be substantially raised.
F4: The District does not have a rapid response plan for surprise incursions into their plants other than calling 911.
Related Recommendations (1)
R4: The District should coordinate with all local law enforcement agencies to develop a rapid response plan to plant incursions.
F5: There are no written agreements between the District, the San Jose Police Department, and the Los Gatos Police Department for a priority response to a 911 call from any of the District’s plants.
Related Recommendations (1)
R5: The Santa Clara Valley Water District should enter into written agreements with the San Jose Police Department and the Los Gatos Police Department that will provide the highest priority response to a 911 call from any of the District’s water treatment plants.
F6: Security guards are generally on duty during the weekdays for eight hours and are posted in fixed positions. They do not patrol the perimeter of the plants as specified in the District’s procedures. Night and weekend security for the plants is delegated to the control room operators at each plant as a secondary responsibility. 5
Related Recommendations (1)
R6: The District should immediately increase the number of security guards at each plant. The security guards should be present 24 hours per day, 7 days per week at all plants, as specified in the District’s procedures. The guards’ duties should include patrolling the perimeter of the plants, as specified in the District’s procedures. 6
Findings & Recommendations 5 findings
F1: The 0316 Fund and the 0320 Fund are not being administered in a manner that complies with the intent of the BOS, State, and guidelines of the Probation Department.
Related Recommendations (1)
R1: Publish a yearly management report to the BOS which provides details of victim restitution and ward compensation paid over the previous twelve months.
F2: The policy of requiring wards to successfully complete the Aftercare Program before paying restitution penalizes victims of juvenile crime. Only 48 percent of the wards are completing the program.
Related Recommendations (1)
R2: Revise the Probation Department guidelines for restitution from the 0320 Fund to stipulate that victims are to be paid upon the completion of the Ranch Program by the ward.
F3: Other than the six wards who were eligible, no one who has participated in the 0320 Fund program has received payments for their labor.
Related Recommendations (1)
R3: Revise the current Probation Department guidelines to pay for wards’ labor once they have completed the Ranch Program and restitution has been paid.
F4: No payments from the 0316 Fund have been made during the past four years.
Related Recommendations (1)
R4: Pay restitution to victims out of the 0316 Fund and close this fund after it is depleted.
F5: Upon achieving the $100,000 benchmark goal in 2004, there have been minimal restitution and labor payments contrary to Probation Department guidelines.
Related Recommendations (1)
R5: Pay restitution to uncompensated victims and compensate wards who have completed the Ranch Program since 2004. 4
Findings & Recommendations 3 findings
F1: Subscriber information necessary to enforce the ECSS Fee ordinance is not being collected from the telephone providers because the City has not negotiated a mutually acceptable nondisclosure agreement with the telephone companies.
Related Recommendations (1)
R1: The Finance Department and the City Attorney actively negotiate with telephone companies who are subject to the ECSS Fee to conclude an acceptable nondisclosure agreement to allow complete and accurate data collection in support of the fee by December 31, 2007.
F2: The Finance Department has never requested a compliance audit of any telephone company records either to collect the detailed data needed for calculations or to ensure that whatever information has been reported is accurate.
Related Recommendations (1)
R2: The Finance Department perform compliance audits on subject telephone companies to determine reporting accuracy and completeness as directed by the ordinance.
F3: The ordinance authorizing this fee is not being enforced because of inaccurate calculation of allowable revenue. The ECSS Fee is being collected based on an estimated number of exempt and nonexempt telephone lines rather than on actual line counts. 5
Related Recommendations (1)
R3: The San Jose City Auditor conduct a performance audit of the ECC to ensure that procedures for calculation, assessment, collection, and allocation of the ECSS Fee are in compliance with the City ordinance. 6
Findings & Recommendations 4 findings
F1: The evidence, written and oral, provided to the Grand Jury by the Bureau of Fire Prevention demonstrates that, as of May 2007, the Bureau of Fire Prevention has failed to follow many of the recommendations issued by the City Auditor in 2003.
Related Recommendations (1)
R1: Complete all recommendations from the Auditor’s 2003 Report no later than January 2008. A status report on any outstanding audit recommendations should be updated and sent to the San Jose City Council annually.
F2: The Bureau of Fire Prevention lacks a system to prioritize inspections based on risk assessments of the use or occupancy of structures and premises.
Related Recommendations (1)
R2: Establish periodic inspections for other than State-mandated annual inspections, based on a structure’s inspection history and occupancy risk assessment, and implement a self-inspection program for low-risk structures and premises.
F3: There is no approved business plan to provide a focus for the Bureau of Fire Prevention. Thus, the Bureau of Fire Prevention is generally limited in its ability to assess its productivity and increase collectable revenue. Poor record keeping leaves the Bureau of Fire Prevention unaware of: the number of structures in its jurisdiction; changes in occupancy classification; the percentage of structures requiring inspections that are being inspected; the frequency of inspections; the need for re-inspections; the amount of potential revenue relative to the amount of fees collected; and whether code violations are being corrected in a timely manner.
Related Recommendations (1)
R3: Adopt a business plan to ensure that: inspection goals are set and achieved; maximum revenue is collected; inspections are done efficiently and are based on risk evaluations; an accurate and current inspection history is created for all structures and premises; and the Bureau of Fire Prevention’s mandate to eliminate fire hazards in the use or occupancy of structures and premises is followed.
F4: The Bureau of Fire Prevention lacks a data maintenance and retrieval system which renders it unable to show whether Code Enforcement is performing inspections in compliance with State and local laws. 3
Related Recommendations (1)
R4: Maintain a master list of occupancies to be inspected and update it monthly. As new structures or occupancies are constructed or established, add them to the inspection list. 4
Findings & Recommendations 4 findings
F1: Some DOC classification unit staff members are not adequately trained to handle contacts by privileged individuals regarding procedures for adding their phone numbers to the privileged call database.
Related Recommendations (1)
R1: All employees in the classification unit should be fully trained to understand DOC’s procedures regarding the database for privileged individuals.
F2: There are no visible signs in the visitor sign-in area advising individuals on how to add their phone numbers to the privileged call database.
Related Recommendations (1)
R2: A sign should be prominently posted with instructions regarding procedures for including telephone numbers in the privileged call database. This can also be accomplished with a separate sign-in sheet or with appropriate bold lettering on the sign-in sheets.
F3: The privileged call database is not kept up to date. Offices of the District Attorney, Public Defender and Department of Correction:
Related Recommendations (1)
R3: The DOC should use the biannual California Bar Association’s list of new attorneys to update its privileged database to include phone numbers of newly admitted local attorneys. Offices of the District Attorney, Department of Correction, and Public Defender:
F4: Safeguards are lacking to ensure, on a consistent basis, that privileged telephone calls are not released to prosecutors. Also lacking are procedures to ensure that court-ordered production of DOC telephone recordings are complied with promptly. 6
Related Recommendations (1)
R4: The DOC, DA, and PD should coordinate their efforts to establish, and stringently follow, procedures to ensure that privileged telephone calls are consistently not released to prosecutors, and that court-ordered production of DOC telephone recordings are promptly complied with. 7
Findings & Recommendations 6 findings
F1: Emergency Operations Centers of San Jose, Santa Clara, Sunnyvale and the County have personnel availability listings that record where their personnel currently live. The City of Gilroy has records that are not current. • The City of Gilroy has contact information. The information is not current, and callback is through a manual system. They also have a text-paging system that can be used when personnel can be reached by email. • The City of Morgan Hill’s records are current. Callback is a manual system. • The City of Santa Clara has current information, but it is a manual system relying on a phone tree system. • The City of San Jose has printed cards with the information needed to manually call back their personnel. They maintain a list of “the line of succession” for key staff, along with all contact information for these employees. This list is updated on a regular basis. Some departments of the City have automated systems of callback. • The City of Sunnyvale has an automated system that can call a large group of employees simultaneously. The system automatically distinguishes whom to call, based on the type of incident and the size of response required. Personnel are required to update contact information regularly, which they can do on the City’s website. • The County has the necessary records. Their callback system is a manual system.
Related Recommendations (1)
R1: The Emergency Operations Center for the City of Gilroy needs to prepare availability lists showing the employees’ current residence. All emergency operations centers should develop a procedure for keeping their listings current.
F2: The City of Sunnyvale Department of Public Safety and some departments of the City of San Jose have automated means of summoning their workers in the event of an emergency. However, the Emergency Operations Centers for the County and for the Cities of Gilroy, Morgan Hill, San Jose, and Santa Clara do not have automated means. Equipment Availability
Related Recommendations (1)
R2: The Emergency Operations Centers for the Cities of Gilroy, Morgan Hill, San Jose, Santa Clara, and the County should consider developing automated or other rapid means of summoning their employees.
F3: The emergency operations centers of all the jurisdictions surveyed have listings of equipment within their control and are aware of the methods needed to obtain additional emergency equipment. Seismic Security of Communications Equipment
F4: There was no consistency among the jurisdictions surveyed as to the codes to which their communications equipment was installed. In response to questions regarding seismic audits to ensure survivability, most of the jurisdictions identified some code(s) to which their equipment was installed. The Grand Jury cannot determine if the codes cited by the jurisdictions provide the equivalent level of protection for the communications equipment as specified in California Building Code Chapter 16, Section 1632. • The City of Gilroy states that they comply with Section 1605.2 of Chapter 16, California Building Code. In addition, the City refers to Table 16K of the same chapter, which provides data on Occupancy Category/Essential Facilities, and Table 16S, which deals with Near Source Factor/Seismic Source Factor. • The City of San Jose states that the City “does adhere to all State seismic retrofit requirements for buildings at the time of construction” and “newer facilities are designed and constructed to meet or exceed seismic safety standards as public safety facilities…” They did not specify the standards to which they comply. • The City of Santa Clara states that they comply with Section 1632 of the California Building Code for seismic security of equipment. They further state that they use “industry standard” racks and mounting standards that secure the equipment to walls and/or ceilings. Internal audits and safety inspections of communications equipment are regularly conducted. • The City of Sunnyvale states that their facilities conform to the Uniform Building Code, 1991, including the seismic requirements of Section 2312 for Earthquake Zone 4. They also state that they comply with the seismic requirements of SB 239, Chapter 1521. Contracts with their communications equipment suppliers reference the above codes, plus a lengthy list of other building codes, National Fire Protection Administration technical requirements, Occupational and Safety Administration standards, and other standards. • The City of Morgan Hill states that their facility meets the California Building Code standards as an essential facility. They further state that the seismic requirements for essential facilities were incorporated in the facility during reconstruction. • The County states that they know the standards and are in compliance.
Related Recommendations (1)
R4: The County and all of the surveyed cities should assure that they meet California Building Code Chapter 16, especially Section 1632 relating to the physical security of nonstructural equipment.
F5: All of the emergency operations centers surveyed have an Emergency Operations Plan and a designated Emergency Operations Coordinator or equivalent.
F6: Five cities and the County were surveyed. There were ten cities within the County that were not surveyed, and the preparedness levels of these cities as related to the major areas of focus are unknown. 5
Related Recommendations (1)
R6: The ten cities not reviewed in this report should examine their planning for disasters and determine if the above recommendations apply to them. 6
Findings & Recommendations 3 findings
F1: The CommCenter is vulnerable to threats from terrorism, vandalism, and natural disaster. The loss of the CommCenter would lead to serious harm to the public.
Related Recommendations (1)
R1: Approve and implement the security enhancements listed in the Sheriff’s Santa Clara County Communications Threat Assessment Report and the Grand Jury’s Santa Clara County Security Assessment Results, along with the construction of a second access road.
F2: Funding has not been granted to cover all of the security deficiencies listed in the Sheriff’s Santa Clara County Communications Threat Assessment Report and the Grand Jury’s Santa Clara County Security Assessment Results.
Related Recommendations (1)
R2: The BOS should approve funding, on an emergency basis, to correct all the security deficiencies identified in the Sheriff’s Santa Clara County Communications Threat Assessment Report and the Grand Jury’s Santa Clara County Communications Center Security Assessment Results, along with funding to construct a second access road.
F3: Although the CommCenter is not accredited for security by any external agency the threat assessment conducted by the Sheriff’s Special Operations Unit is thorough and sufficient in determining site vulnerabilities.
Related Recommendations (1)
R3: The BOS should request the Sheriff’s Special Operations Section to conduct an annual Sheriff’s Threat Assessment. This annual report should go to the BOS, the Office of the County Executive, and the Communications Director, County Communications Department. 6
Findings & Recommendations 6 findings
F1: Security at the Elmwood Correctional Complex is inadequate and is a public safety threat. The Sheriff’s perimeter patrol at Elmwood was reduced from an eleven- officer staff down to only two because of budgetary choices. Only a single-officer patrol is on duty for a twelve-hour shift. If an exterior patrol had been on duty during the predawn hours of September 3, 2006, the breakout could likely have been prevented. Certainly, the escapees would not have had nine hours and forty minutes to get away. Public safety is of particular concern because there are 683 newly built residences across the street from the jail.
Related Recommendations (1)
R1: Fulfill the Agreement between the County and the Sheriff restoring adequate staffing to the Elmwood perimeter patrol.
F2: There is inadequate staffing in critical areas such as the barracks areas at night, the food preparation building, and the vehicle gate. The minimum camp is sporadically patrolled at night. There is only one officer on duty in the food preparation area to control 200 working inmates. There is usually only one duty officer on the east gate to inspect several hundred vehicles leaving and entering the jail daily.
Related Recommendations (1)
R2: Allocate sufficient DOC officers in critical areas to keep inmates confined and the public safe.
F3: Despite repeated requests for security improvements and updates in the DOC budget submissions to the office of the County Executive, funding has been very slow in coming. Some of these requests go back more than seven years. These requests included vital issues such as a modern control center, surveillance cameras, exterior lighting, and a vehicle sallyport.
Related Recommendations (1)
R3: Prevent critical public safety items, such as an updated control center, surveillance cameras, exterior lighting and secured gates from being passed over during the budget process. The BOS should immediately fund critical security items for County jails. The slow pace of funding these vital elements by the Office of the County Executive disregards the County’s duty to protect the public and secure its jails.
F4: By failing to address any of these public safety concerns in a timely manner, the county places itself under significant public scrutiny should future escapes occur and an individual gets hurt or killed in the process.
Related Recommendations (1)
R4: Remedy the identified security issues to restore and maintain public confidence in the Elmwood Correctional Complex’s public safety mission.
F5: County fire officials recently conducted a comprehensive review of the fire alarm system at Elmwood and found that “most if not all, of the buildings” in the minimum camp, “do not meet minimum fire and building code requirements for detention facilities. They are built of non-rated construction, and most of them lack sprinkler systems, which are just two of the basic minimum requirements for detention facilities.” As the result of this fire code violation, inmates cannot be locked up in their barracks at night.
Related Recommendations (1)
R5: Bring the barracks in the minimum camp up to fire code standards on an urgent basis so that inmates can be locked in their barracks at night to help deter escapes.
F6: Training is inconsistent. Control center officers rely on “word-of-mouth” instructions to perform their jobs. As a result, they failed to know that important alarm system functions were not functioning over a two-year period. Alarm system manuals were not available for reference. 8
Related Recommendations (1)
R6: Review, implement and document training procedures and make operation manuals available for officer review and reference in specialized areas. 9
Findings & Recommendations 6 findings
F1: HHS has not published a formal definition that defines EMR components, deliverables, and costs.
Related Recommendations (1)
R1: Prepare a formal definition of EMR, including its purpose, its components, and specific deliverables. The definition needs to contain a definitive list of all of the components to be included in EMR.
F2: A member of the BOS was unable to convey to the Grand Jury that they understand what the functional components of EMR are that HHS is going to deliver.
Related Recommendations (1)
R2: See Recommendation 1.
F3: Custody Health, which is expected to be a primary user of EMR, has had minimal input and involvement in the definition and planning of this project.
Related Recommendations (1)
R3: Involve Custody Health as an equal partner in the planning and implementation of EMR.
F4: The total cost of EMR has not been determined. The $8 million A-EMR project currently being implemented may represent only a small part of the true cost of a countywide EMR system.
Related Recommendations (1)
R4: Prepare a financial projection of the total implementation and ongoing maintenance cost of EMR broken down by its components.
F5: There is a lack of communication of HHS goals and strategies for EMR to those who will implement and be affected by the system. System features are being developed without consulting with those who will use them.
Related Recommendations (1)
R5: Develop a communication plan that updates project goals and status monthly to all entities and levels of HHS. Plan meetings with staff to discuss plans and status, and to prepare and deliver appropriate training.
F6: Implementation of this system is expected to draw resistance from some potential users. 8
Related Recommendations (1)
R6: Mandate use of EMR. Appendix A: Verbatim email exchange (names excised) between a Grand Juror and a senior management official at HHS. An example of HHS unable to provide a specific, clear definition of an EMR system. Grand Juror: When we first met, [name] asked us for our definition of EMR but we have never gotten a definition from you what HHS uses as a working definition of EMR. I see a lot of projects, applications and diagrams in the Strategic Plan that seem to relate to an EMR system, but can't find a vision statement or goal -- "EMR serves this purpose and consists of these functions and data. When all of that is in place, we will have an EMR system." If there is a definition of EMR in the Strategic Plan, please reference it for me. If you have a definition in another document or taped to the wall somewhere, let me know and I can come pick it up. If you do not have a definition of EMR, let me know that too. HHS response: To clarify, a good starting point may be generally accepted definitions in the industry. The Health Information Management Systems Society (HIMSS) defines EMR and EHR as follows: HIMSS EHR = "The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports." HIMSS EMR = "EMR definition — An EMR is electronically originated and maintained clinical health information, derived from multiple sources, about an individual’s lifetime health status and health care. An EMR is supported by clinical decision systems and replaces the paper medical record as the primary source of patient information." As is evident, there is overlap and the A-EMR emphasizes only the Ambulatory Electronic Medical Record based on the patients [sic] encounter in the ambulatory care setting at this time. This means that the focus of this electronic record differs from a more global perspective. The HER [sic], on the other hand, emphasizes the more “longitudinal” aspects of the patient record and is more broad in its scope of gathering clinical data from multiple systems and contributing to a repository of this data, the Lifetime Clinical Record, which has been discussed and has been demonstrated to the Civil Grand Jury. Appendix B: Function Lists SCVHHS Presentation The Electronic Medical Record: SCVMC’s Road to the Electronic Health Record (May 2006) – (1) Major Systems Investments VMC and Departments: “The missing piece of the puzzle is the A-EMR” • Core Health Information System (Siemens) • Cardiology (Heartlab) • Enterprise Wide Scheduling (GE) • Diagnostic Imaging and PACS (Siemens and Agfa) • Emergency Department (Wellsoft) • Clinical Laboratory and Pathology (Misys and CoPath) • Medical Records (SoftMed) • Nutrition and Food System (CBORD) • Perioperative Services (SIS) • Renal Care (CyberRen) • Physical Medicine & Rehabilitation (MediServe) • Respiratory Care System (MediServe) • Managed Care (Siement/Perot) (2) What Does the Future Hold? • Rules-based Computerized Provider Order Entry (CPOE) • Medication Administration Checking • Automated Vital Signs • Computerized Patient Assessments • Patient Safety Bar Code • Inpatient EMR • Expansion of Wireless, Mobile Computing and Secure Communications 11 Appendix B: Function Lists - continued Kurt Salmon Associates Santa Clara Valley Health & Hospital System Information Technology Strategic Plan (February 2006) – (3) Diagram “The CDR/EMR/EHR Database Continuum” (p II-36) (cid:131) Electronic Health Record • Computerized Patient Record (CPR/EMR) • Clinical Data Repository (CDR) • CPOE • Order Communication • Results Retrieval • Clinical Documentation • Vital Signs & I&Os • MAR • Clinical Decision Support • Critical Care • Ambulatory Electronic Medical Record • Emergency Department • Home Health • Acute Care • Patient’s Personal Data (4) Diagram “The EMR Ambulatory Environment” (p II-37) (cid:131) Clinical Care Processes (EMR) • Workflow Management • Patient Summary • Chart/Results Review • Encounter Documentation • Order Entry • Clinical Decision Support • Medication Management • Health Maintenance • Disease Management • Immunization Record • Digital Imaging • Patient Education • Phone Notes • Clinical Messaging • Remote Access • Personal Health Record • Dictation/Transcription • Document Imaging • Tools for Reporting 12 Appendix B: Function Lists - continued (5) NextGen Functions & Module List – Base functions in NextGen A-EMR system for limited release in Spring 2008 • Patient Registry • Electronic Chart (EMR) • Workflow Management • Electronic Superbill • Image Management • Coding Optimization • Follow Up / Recall Tracking • Lab Module • Fax Capability • Prescription Generation • Graphing • Advance Security • Enterprise Data Sharing • Template Editor • Knowledge Base • Medication Module • Interface Engine • Provider Approval Queue • Allergy Module • Family Unit Module • First Data Drug Database • NextGen EMR RTF Monitor • NextGen OPTIK User License • NextGen Patient Education • NextGen Edits • InfoScan Formulary Database • ACP PIER Content • Diagnosis & Procedure Code Tables • Crystal Reports 13 Appendix C: The EMR Environment Santa Clara Valley Health & Hospital System Information Technology Strategic Plan (February 2006) Kurt Salmon Associates 14 Bibliography Barry, Maryann. Letter to Joyce Wing, Business IP Strategic Planner, Information Services, “Technology Request” (for consultant to perform Business Process Re- Engineering study), January 22, 2001. CTG HealthCare Solutions. Prepared for: Santa Clara Valley Medical Center, Current State Descriptions & Current State Workflows, September 25, 2006 through October 10, 2006. Cutland, Laura. County dismisses indictment of its health record system, June 10, 2005. http://www.bizjournals.com/sanjose/stories/2005/06/13/newscolumn1.html (accessed June 14, 2007) Health Level Seven, Inc. Electronic Health Record-System Functional Model, Release 1, February 2007. Johnson, Sherry. Memorandum to Wendy Mena, Santa Clara County Information Services Department, “Request for access to the warrant information in CJIC”, February 17, 2006. Kurt Salmon Associates. Santa Clara Valley Health & Hospital System Information Technology Strategic Plan, February 2006. Lopez, Kaci R. Memorandum to George W. 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Santa Clara Valley Health & Hospital System, Children’s Shelter & Adult Custody Health Services. JMIMS Project Charter, March 5, 2004. Santa Clara Valley Health & Hospital System, Information Services Department. A-EMR Project Organization—Teams, Rev April 11, 2007. Santa Clara Valley Health & Hospital System, Information Services Department. A-EMR Project Roles & Responsibilities, October 2, 2006. Bibliography - continued Santa Clara Valley Health & Hospital System, Information Services Department. Information Services Annual Report, June 2006. Santa Clara Valley Health & Hospital System, Information Services Department. NextGen Functions & Module List, September 2006. Santa Clara Valley Health & Hospital System, Information Services Department. Santa Clara Valley Medical Center A-EMR Ambulatory Electronic Medical Record, April 2007. Santa Clara Valley Health & Hospital System, Information Services Department. SCVHHS NextGen A-EMR Workplan, March 19, 2007 (Revision Date: May 2, 2007). Interviews September 18, 2006 Santa Clara Valley Health & Hospital System official. November 15, 2006 Santa Clara Valley Health & Hospital System officials. January 19, 2007 Santa Clara Valley Health & Hospital System officials. March 7, 2007 Santa Clara Valley Health & Hospital System officials. March 12, 2007 Santa Clara Valley Health & Hospital System officials. March 26, 2007 Santa Clara Valley Health & Hospital System officials. April 1, 2007 Santa Clara Valley Health & Hospital System Valley Health Clinic staff. April 2, 2007 Santa Clara Valley Health & Hospital System Custody Health officials. April 9, 2007 Santa Clara Valley Health & Hospital System Valley Health Clinic staff. April 11, 2007 Santa Clara Valley Health & Hospital System Custody Health official. April 16, 2007 Santa Clara Valley Health & Hospital System Valley Health Clinic staff. April 24, 2007 Santa Clara Valley Health & Hospital System Custody Health official. April 25, 2007 Santa Clara Valley Health & Hospital System Custody Health official. May 4, 2007 Santa Clara Valley Health & Hospital System official. May 7, 2007 Santa Clara County District Attorney’s Office official. May 23, 2007 Santa Clara Valley Health & Hospital System Custody Health official. Santa Clara Valley Health & Hospital System official. May 31, 2007 Member of Santa Clara County Board of Supervisors. PASSED and ADOPTED by the Santa Clara County Civil Grand Jury on this 19th day of June 2007. Ronald R. Layman Foreperson David M. Burnham Foreperson Pro tem Kathryn C. Philp Secretary 19

Findings and recommendations not yet extracted.

Findings & Recommendations 1 findings
F2006: City of San Jose, Office of the City Auditor. Semi-Annual Recommendation Follow-Up Report on all Outstanding Audit Recommendations for the Six Months Ended June 30, 2006. City of San Jose Ordinance Amending Chapters 4.04 and 4.12, and Repealing Chapters 4.06 and 4.13 of Title 4 of the San Jose Municipal Code to Increase Administrative Contract Authority for Purchase of Supplies, Materials, Equipment to $1,000,000 and Services to $250,000, to Enact a Protest Procedure for Purchases, and to Amend, Reorganize and Consolidate Various Purchasing Procedures, passed February 27, 2007. City of San Jose Policy 5.1.4. Brand Name and Sole Source Procurements, April 3, 2006. City of San Jose Policy 5.1.1. Procurement and Contract Process Integrity and Conflict of Interest – Administrative Procedures, April 18, 2007. City of San Jose Policy. Procurement of Information Technology, adoption pending. City of San Jose Policy. Procurement of Non-Professional Services, adoption pending. City of San Jose Policy. Procurement of Supplies, Material, and Equipment, adoption pending. City of San Jose Policy 5.1.6. Procurements with Grant Funds, September 19,
Page 1
Related Recommendations (1)
R2006: City of San Jose Policy 5.1.3. Source Selection Plan, February 10, 2006. Santa Clara County 2004-2005 Civil Grand Jury Report. City of San Jose Procurement Policies, Procedures, and Practices, June 22, 2005. Interviews August 14, 2006 City of San Jose official February 12, 2007 City of San Jose official May 7, 2007 City of San Jose official PASSED and ADOPTED by the Santa Clara County Civil Grand Jury on this 22nd day of May 2007. Ronald R. Layman Foreperson David M. Burnham Foreperson Pro tem Kathryn C. Philp Secretary 6
Findings & Recommendations 1 findings
F1: The City of Sunnyvale violated California State Elections Code Sections 10262 and 10263. 3
Related Recommendations (1)
R1: Establish a formal procedure that conforms with California State Election Code Section 10263 commencing with the November 6, 2007, election.
Findings & Recommendations 3 findings
F1: PRNS oversight of JTS Northside CC and Fil-Am SODC agreements was inadequate, resulting in the loss of $219,414 in taxpayer money and in the involvement of San Jose City Council to try to correct the problem.
Related Recommendations (1)
R1: PRNS should work with the City Auditor on future RFPs to ensure that adequate financial and management oversight measures are specified in the contract. After a contract has been awarded, PRNS should assign qualified and sufficient staff to ensure that these safeguards are in fact being enforced.
F2: The three RFPs published by PRNS in March, August, and October 2006 for JTS Northside CC operation attracted only one bid for the contract. The lack of bidders for the contract validates the Grand Jury’s concerns that the RFP process is flawed. This is viewed as a severe warning sign of potential failure of the Center’s operation. Specific financial and communication deficiencies in the Community Center Reuse RFP process have been identified to the Mayor and San Jose City Council.
Related Recommendations (1)
R2: PRNS should reevaluate its Community Center Facility Reuse RFP process, improve the economic attractiveness of the RFP, and then rebid the RFP for JTS Northside CC. PRNS should accept the offer to work with SVCN and CFSV to address the perceived deficiencies the two organizations have identified in the Community Center Facility Reuse RFP process, and should communicate more openly with them, since they are representative of the agencies that are potential PRNS bidders.
F3: PRNS has implemented five of the eight recommendations of the San Jose City Council’s December 13, 2005 Memorandum. Two recommendations that concerned working with AACI for interim operation became moot when PRNS assumed control of the Center. The remaining recommendation to select a new operator through a competitive RFP process has not yet been implemented.
Related Recommendations (1)
R3: PRNS should delay recommending a new operator to the City Council for JTS Northside CC until additional bidders have been found through a new RFP. 6
Findings & Recommendations 5 findings
F1: The Plan has stalled because of a lack of cooperation between the various agencies comprising the Leadership Group.
Related Recommendations (1)
R1: Establish the JPA as specified in the Plan.
F2: No time line exists for the implementation of the Immediate Goals.
Related Recommendations (1)
R2: Establish a time line for the implementation of the Immediate Goals.
F3: The Mid-Term and Long-Term Goals are dependent upon the completion of the Immediate Goals and the coordinated allocation of resources.
Related Recommendations (1)
R3: Concurrent with the establishment of the time line for the Immediate Goals, time lines for the Mid-Term and Long-Term Goals should be established.
F4: Only five of the twenty-four Immediate Goals have been accomplished by cooperation of the agencies represented by the Leadership Group.
F5: The City of San Jose, acting independently, accomplished an additional six of the twenty-four Immediate Goals for the citizens of San Jose. 5
Related Recommendations (1)
R5: No recommendation 6 Appendix Leadership Group Membership American Association of Retired People Catholic Charities of Santa Clara County City of Gilroy City of Los Altos City of Milpitas City of Morgan Hill City of Mountain View City of Palo Alto City of San Jose City of San Jose Office of Mayor City of San Jose Office on Aging City of Santa Clara City of Saratoga City of Sunnyvale Congress of California Seniors Council on Aging, Silicon Valley Former City of San Jose Councilmember Ken Yeager Former City of San Jose Councilmember Linda LeZotte Former Santa Clara County Supervisor James Beall Housing Authority of the County of Santa Clara Housing Trust of Santa Clara County John Vasconcellos Legacy Project Metropolitan Transportation Commission National Council on Aging Office of Santa Clara County Supervisor Don Gage Outreach and Escort, Inc. Sacred Heart Community Service Santa Clara County Department of Aging and Adult Services Santa Clara County Executive Santa Clara County Public Guardian Santa Clara County Senior Care Commission Santa Clara County Supervisor Pete McHugh Santa Clara County Valley Health 7 Appendix – continued Leadership Group Membership Santa Clara Valley Transportation Authority State of California Senior Legislature - Senator Robert Jaffee The Health Trust Town of Los Gatos United Way of Silicon Valley Bibliography California Government Code, §§6500 – 6536. MGT of America. 2004. Community For A Lifetime: A Ten-Year Strategic Plan To Advance The Well-Being Of Santa Clara County’s Older Adults. December 2004. Minutes of the Leadership Group, June 22, 2005. Visitations and Interviews August 30, 2006 Official, Santa Clara County Older Adults Program. September 21, 2006 Official, San Jose City Parks, Recreation, and Neighborhood Services Department. October 4, 2006 Member, County BOS. October 25, 2006 Member, San Jose City Council. October 27, 2006 Staff member, San Jose City Office on Aging. Acronyms and Definitions BOS Santa Clara County Board of Supervisors City City of San Jose Council San Jose City Council County County of Santa Clara Faire San Jose Wellness Faire JPA Joint Powers Authority Plan “Community For A Lifetime: A Ten-Year Strategic Plan To Advance The Well- Being Of Santa Clara County’s Older Adults” 9 PASSED and ADOPTED by the Santa Clara County Civil Grand Jury on this 27th day of February 2007. Ronald R. Layman Foreperson David M. Burnham Foreperson Pro tem Kathryn C. Philp Secretary 10
Findings & Recommendations 6 findings
F1: TSJ has failed to meet its contractual obligations to the City.
Related Recommendations (1)
R1: Not renew the contract with TSJ when the contract period expires in June 2009.
F2: The RFP did not include significant information that was necessary for responders to prepare accurate financial proposals.
Related Recommendations (1)
R2: Begin working immediately with the Procurement Department and the Auditor, in accordance with the new City procurement policy, to prepare a new RFP that better reflects the directives of the City Council and that includes necessary and sufficient information to select the most qualified responder.
F3: TSJ, while intending to reduce operating loss, placed undue restrictions on itself regarding salaries and benefits by retaining specific City employees who had been working for CAE. These restrictions have had a negative impact on its ability to control expenses.
Related Recommendations (1)
R3: Validate financial assertions by responders that have economic consequences to the City. Follow new City procurement policy that requires validation of financial projections by the appropriate financial department within the City.
F4: In selecting the operator, proposals were not evaluated equally for all responders. • During negotiations, it was found that TSJ’s projected net loss was inaccurate by more than 100 percent. • Even though marketing was an explicit component of the RFP, marketing costs were left out of the TSJ proposal, thereby allowing it to present a more attractive proforma than other responders. • TSJ was deemed the most qualified of those competing for the contract even though it had no previous experience operating or managing any event facility.
Related Recommendations (1)
R4: Ensure that all responders meet all qualification requirements established in the RFP and that all selection criteria are applied equally to all responders.
F5: The measures used to evaluate TSJ’s contractual performance are inadequate and ineffective.
Related Recommendations (1)
R5: Establish performance measures that accurately reflect the intent and terms of the contract.
F6: Rather than cancel the contract as allowed under the terms of the Management Agreement, the City has chosen to support TSJ at more than double the anticipated subsidy at taxpayers’ expense. 9
Related Recommendations (1)
R6: Enforce contractual agreements to protect taxpayers from supporting failed operations. 10
Findings & Recommendations 6 findings
F1: Prior to March 2005, Finance’s method of estimating supplemental pay was flawed and resulted in under and overpayments to a number of Reservists.
Related Recommendations (1)
R1: Audit the procedures for implementing the Policy within the Human Relations, Employee Relations, Retirement Services, and Finance Departments. Determine how these Departments can coordinate more effectively in serving Reservists’ interests.
F2: Finance has failed to act in a timely and consistent manner to collect documentation from Reservists that is required to complete the reconciliation process. Reservists and their families have been adversely affected by the City’s insistent demand for copies of LESs going as far back as 2002, which are difficult to obtain after one year.
Related Recommendations (1)
R2: Establish procedures that designate the department responsible for obtaining Reservist documentation. The procedure should set a timeline for obtaining missing documents. The responsible department should confirm in writing to the Reservists that their documentation has been received.
F3: Reconciliation of supplemental pay by Finance has been slow due to low prioritization, lack of effective supervision, and an absence of written procedures to guide staff through the complex reconciliation process.
Related Recommendations (1)
R3: Payroll should elevate the reconciliation of supplemental pay to a high priority and provide written procedures for staff. The Policy should stipulate that reconciliation of a Reservist’s account will occur within 30 days of Payroll receiving the required documentation.
F4: Retirement Services, as of November 2006, had a three to four-month backlog of work in calculating Reservists’ retirement contributions and retirement service credits.
Related Recommendations (1)
R4: Retirement Services should assign sufficient staff to calculate the Reservists’ retirement credits and achieve payment of funds into the Reservists’ account within 30 days of receiving reconciliation data from Finance.
F5: The City does not hold senior management accountable for implementing specific directives with regard to the military leave program.
Related Recommendations (1)
R5: The City must proactively monitor the projects they assign staff to ensure projects are accomplished and those responsible are held accountable when such implementation does not occur.
F6: The City’s May 23, 2005, “Statement of Support for the Guard and Reserve” awarded by the United States Department of Defense in recognition of the City’s support of the Reservists, has been tarnished by the prolonged lack of interdepartmental coordination to implement Council’s directives. 5
Related Recommendations (1)
R6: Delegate responsibility for overall Policy administration to a senior level manager who also will act as Military Liaison for the Reservists. 6

Additional documents

Documents found alongside this year's reports — not grand jury reports or responses.