Trinity County Grand Jury
2001-2002
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Findings & Recommendations
3 findings
F1:
Trinity County Sheriff Schmidt and Animal Control Officer Whitcomb provided the Grand Jury with a good overview of this division and were most responsive to questions and issues raised by the members. Although the division is extremely small, Ms. Whitcomb in par- ticular appeared to all present to be very dedicated, hardworking and innovative. Ms. Whitcomb is a professional officer, knowledge- able abort both state and local animal ordinances, and she assisted the BOS and county Counsel in the development of the newly enacted Trinity County animal regulations. As with many county departments, the Animal Control Division is in need of additional resources but appears to be well served under the management of the Sheriffs Department and Ms. Whitcomb. The Grand Jury believes the repeal and re-enactment of the out- dated county animal regulation codes were warranted.
F2:
The tracking of pet licensing, dog bits, impounds, adoptions, etc., within Trinity County is currently conducted manually by the Ani- mal Control Division. The 1991-1992 Grand Jury report recom- mended the purchase of an animal control software program to pro- vide automated tracking of these records. In 1993 the BOS ap- proved the purchase of a software program called PetNet to put in place a tracking program; and the 1992-1993 Grand Jury concluded that revenues between $6,000 and $7,000 would be generated/an- ticipated. In response to the 1993 Grand Jury report, Sheriff Schmidt wrote that the “...PetNet license renewal program has been ordered and should be here by August 1St.” To date, the tracking system is not automated and continues to be done manually.
F3:
The new Trinity County Animal Shelter is an excellent facility, clean and well maintained. However, on the day that members of the Grand Jury toured the facility, it was raining and there were large accumula- tions of water and mud on the ground in the immediate vicinity of the facility. The parking area has numerous potholes that need filling and grading. Ms. Whitcomb advised members of the Grand Jury that there is a need to fence off both the front and rear entrances to the animal shel- ter due to vandalism and individuals throwing rocks and trash at the animals in the outdoor runs when department members are away for short periods. The Grand Jury was advised that the General Ser- vices Division is aware of the drainage issues at the facility and is working toward a resolution of the problem. The jury further ob- served that there is currently fencing already purchased and ready to be installed for this project but was advised by General Services that this effort could not be completed until the drainage issues were re- solved.
Additional Recommendations
3
Not linked to specific findings.
R1:
The Board of Supervisors, County Counsel and Sheriff’s Depart- ment are commended for working together to update the animal control regulations for the county.
R2:
The Grand Jury concurs with the decision of both the 1993 BOS and the previous Grand Jury’s recommendation that animal control soft- ware be obtained to facilitate the licensing of animals within Trin- ity County, the tracking of officer response, and facility manage- ment within the animal Control Division.
R3:
The Grand Jury concurs that the parking area and fencing at the animal shelter need further work. The jury also recognizes that the General Services Division is aware of the issues, is committed to resolving the problems and needs time to obtain the necessary infor- mation and funding to complete the project. The jury recommends that both divisions continue to work together toward a successful and timely resolution of the fencing and drainage projects. RESPONSES REQUIRED: Under Penal Code 933, the following entities are required to re- spond to the listed findings and recommendations within the re- quired time period. ENTITY FINDING RECOMMENDATION DAYS Trinity County Sheriff 1,2,3 2,3 60 Director, Trinity County General Services Division 3 3 60 Trinity County Board of Supervisors 1,2,3 2,3 90 Responses TO: The Honorable John K. Letton Presiding Judge of the Superior Court FROM: Trinity County Board of Supervisors J.C. Erikson, Chairman DATE: September 12, 2002 SUBJECT: 2001-2002 Trinity County Grand Jury Judicial Com mittee Report of the Animal Control Division The Grand Jury Judicial Committee has requested a written response to their Trinity County Animal Control Division Re- port. The response of the Board of Supervisors is as follows:
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Findings & Recommendations
2 findings
F1:
(In pertinent part) “However, what cannot be ascer- tained is the reason for the decline. There are various ways for recipients to be dropped from the Program, i.e., move from the County, non-participation, becoming ineligible, voluntary removal, death, and hopefully by gaining employment. This data is nec- essary to properly measure the success of the CaIWORKs Program.” Response #1:, “The Grand Jury recommends that the CaIWORKs Program and the Health and Human Services Department jointly establish internal records to capture data regarding changes in the number of participants enrolled in the CaIWORKs Program and the reason for those changes.” I agree in part with the Grand Jury’s finding. I note that at the time of the review by the Grand Jury, the Welfare to Work com- puter network had only recently become operational, and staff was not fully trained in all its capabilities.
F2:
The administering of the CalWORKS Program, as with most pro- grams which provide assistance, evokes many emotions on the part of both the providers and the recipients. Stress among caseworkers is always a concern. In such an intense area, the enthusiasm, com- passion and the “can do” attitude of the Director of Health and Human Services and the CalWORKS Supervisor are most com- mendable, gratifying, and should be recognized. Their attitude has a direct bearing on the morale of the employees as well as the level of assistance provided to those in need.
Additional Recommendations
2
Not linked to specific findings.
R1:
The Grand Jury recommends that the CalWORKS Program and the Health and Human Services Department jointly establish internal records to capture data regarding changes in the number of partici- pants enrolled in the CaIWORKS Program and the reason for those changes.
R2:
The Grand Jury recommends that commendations be rendered to the Director of Health and Human Services and the CalWORKS Supervisor as well as all case workers who provide such a needed service to all participants in the Program and ultimately benefit all of Trinity County. RESPONSES REQUIRED: Under Penal Code 933, the following entities are required to re- spond to the listed findings and recommendations within the re- quired time period: ENTITY
Findings & Recommendations
5 findings
F1:
After many interviews and much examination it has become apparent that this is a very complex and highly technical issue. The county wide emergency 911 and GIS mapping and addressing system is unfinished at this time. The county has been mapped showing 10,468 addresses and related information such as driveways and private roads. This information is still incomplete. The Grand Jury finds the primary reason the system is still unfinished is lack of direction from the Planning Department whose responsi- bility it is to hire the personnel and oversee the project to its comple- tion. The delays now seem to be exacerbated with the departure of Mary Arey who was the Project Specialist II.
F2:
The lack of a countywide mapping and address system was expressed as a major concern by the fire departments and interviewees and ex- pressed in letters to the editor of the Trinit Journal by citizens of Trinity County.
F3:
The mapping and addressing system information compiled by the planning department needs to be combined with the telephone company’s Databases. Some special programming will be needed to accomplish this.
F4:
In order to secure a proper sign for private roads connecting to county roads it is the individual property owner’s responsibility to obtain any necessary permit and road sign to comply with County Ordi- nance #1162 which calls out such items as height of sign, distance from the road etc.
F5:
Not all information to correspond with private road names and ad- dress numbers that have been assigned are accurate or seem to corre- spond with some residents perception of what these names or num- bers either are or should be. In addition not all APN’s have been given an address road name and/or house.
Additional Recommendations
3
Not linked to specific findings.
R1:
and 2 may desire to address this issue as well.
R3:
The Grand Jury recommends that the GIS committee appoint a per- son to work with the telephone companies to determine what is needed to accomplish the necessary transfer of data.
R4:
and #5: This recommendation is already part of our procedure. In addition, we will coordinate with the U.S. Post Office, UPS, emergency dis- patch, telephone company (which also has its own verification sys- tem), and local fire districts. Conclusion: The plan for implementing the address system, described in part above, is well established and was in the process of being imple- mented when Mary Arey, who was an Associate Planner gifted with the ability and acquired knowledge to develop and implement the county’s GIS system, left county service for a better paying job as a GIS Coordinator in Reno. I agree that the Board of Supervisors should establish a high prior- ity to hiring a “GIS trained person” to complete the project and that this position needs to have the full support of the Board. Sincerely, John Alan Jelicich, Planning Director TO: The Honorable John K. Letton, Presiding Judge of t he Superior Co FROM: J.C. Erikson, Chairman Trinity County Board of S DATE: July 16, 2002 SUBJECT: 2001-2002 Trinity County Grand Jury Development and Environment Committee Final Report on the Emergency 911 Mapping System. The Grand Jury Development and Environment Committee has requested a written response to their Final Report on the Emer- gency 911 Mapping System. The response of the Board of Supervi- sors is as follows:
Findings & Recommendations
2 findings
F1:
This finding describes the process with time lines for enacting a redistricting ordinance and denotes the dates and events that oc- curred in Trinity County in 2001. July 3, 2001 Board of Supervisors’ Meeting. The BOS Agenda for their regular meeting of July 3, 2001 included an item for the Clerk/Recorder/Elections Officer to inform the BOS about the 2000 census, its impact on current apportionment, and to request the BOS to appoint a citizens committee to assist in a redis- tricting recommendation. The Clerk/Recorder/Elections Officer indicated he had 3 applicants for such a committee and he wanted to have 7 members if possible. All agreed to work on the matter of establishing a committee. The Clerk/Recorder/Elections Officer said he intended to put the Census Bureau information onto the County’s Geographic Infor- mation System (GIS) maps. The BOS concurred. August 7, 2001 Board of Supervisors’ Meeting. The BOS regular meeting agenda of August 7, 2001 introduced the Redistricting Plan. At this time the Clerk/Recorder/Elections Of- ficer reported that the County’s timelines were much shorter than in past years due to the Primary election month changing from June to March. A memo from the California Secretary of State said that the reapportionment had to be completed 45 days prior to the dead- line for filing candidacy for public office in the next election (which is the March 2002 primary). Therefore, the reapportionment ordi- nance would need to be in place by September 28, 2001. The Clerk/ Recorder/Elections Officer stated that the data from the Census would not be available until August 8, 2001. He further outlined that the following schedule must be adhered to: 1. The ordinance must be in effect by September 28, 2001. 2. To be in effect, 30 days must elapse from the time the ordinance is adopted, which means the ordinance must be adopted by August 28, 2001; and the law requires that of such an ordinance must be at a regular (not a special) meeting of the BOS. 3. There must be 5 days between the introduction of the ordinance and its adoption. The decision was made to continue the August 7, 2001 meeting to August 14, 2001 for introducing the ordinance. August 14, 2001 Board of Supervisors’ Meeting. When the ordinance was introduced, the Clerk/Recorder/Elections Officer provided the BOS and everyone attending the meeting, a display of the existing and proposed maps detailing the superviso- rial district boundaries, copies of the legal descriptions of those boundaries, and copies of a written summary, “Trinity County Re- districting Plan.” The written summary, “Trinity County Redistricting Plan” hand- out, and the actual text of the ordinance which consists of the legal descriptions of the boundaries, differed from each other in their description of the boundary locations in the East Weaver Creek area of Weaverville. These differences led to inaccurate reporting in the Trinity Journal and a general misrepresentation of the bound- ary location in the East Weaver Creek area. August 21, 2001, Board of Supervisors’ Meeting. The BOS Agenda for their regular meeting on August 21, 2001 listed the Redistricting Ordinance as an Action Item. The minutes of this meeting record the adoption of the ordinance as described by the legal description of boundaries. The law requires that the BOS can either publish a summary of the ordinance within 15 days of enacting or publish the ordinance in its entirety within 30 days of enactment. The ordinance was published in its entirety within 30 days in the September 5, 2001 issue of the Trinity Journal. A news article in the August 30, 2001 issue of the Trinity Journal, covering this decision, quoted the “Trinity County Redistricting Plan” rather than the legal description, which comprises the ordi- nance as adopted. Not all tapes of the July and August BOS meetings were available to the Committee for viewing. The County Clerk’s office did not know where they were.
F2:
This finding describes the process and timelines for public recourse to an enacted ordinance. Means of recourse are required to be completed within 30 days of the adoption of the ordinance or they are considered invalid. With this redistricting ordinance, the 30-day deadline was September 21, 2001, for either of the following means of recourse: l. Within 30 days of adoption, a citizen can claim that the new boundaries do not reflect real census and they can go to the Supe- rior Court for action which forces the BOS to revisit the ordinance. 2. Within 30 days of adoption, ten percent (10%) of the voters can sign a referendum to the BOS to challenge their decision. This ref- erendum is filed with the County Elections Department.
Additional Recommendations
5
Not linked to specific findings.
R1:
a: The Grand Jury recommends establishing a citizen advisory com- mittee to work with the Clerk/Recorder/Elections Officer and the BOS to recommend any redistricting resulting from the 2010 cen- sus. The Grand Jury further recommends to the Board of Supervi- sors and the County Clerk/Recorder/Elections Officer that there be instituted a realistic and effective means to remind the BOS of the time frames for this process so that it can start in 2010, rather than the last minute in 2011.
R1b:
The Grand Jury recommends to the Board of Supervisors and the County Clerk that video tapes of the meetings of the BOS be filed and stored in such a way that is secure, allows for borrowing, and maintains their availability to the public for a minimum of 10 years. RECOMMENDATION #Ic: It appears that the existing “rulings” on the interpretation of the redistricting codes applies to more densely urban areas. Therefore, the Grand Jury recommends to the Board of Supervisors that they join with other rural counties with low populations to work with their legislators and senators to adapt the interpretation of the ex- isting State Elections Code to allow for use of the other four crite- ria listed in addition to population figures. These considerations are 1) topography; 2) geography; 3) cohesiveness, contiguity, in- tegrity, and compactness of territory; and 4) community of interests of the districts.
R1h:
, The recommendation has been implemented.
R2a:
Since the time frames for recourse by citizens to the current redis- tricting have passed, the Grand Jury recommends that the BOS, on behalf of the citizens, energetically pursue Recommendation #l e above, while the issue is still fresh in the minds of legislators.
R2b:
The Grand Jury recommends that the BOS, on behalf of the citi- zens, educate citizens about the law that allows for recourse through another census or on the basis of population estimates prepared by the State Department of Finance or the county planning depart- ment or planning commission (Elections Code § 21503). RESPONSES REOUIRED: Under Penal Code 933, the following entities are required to re- spond to the listed findings and recommendations within the re- quired time period: ENTITY
Findings & Recommendations
1 findings
F1:
County Counsel advised the Committee that a loan may indeed be closed even though a civil action is pending between the home- owner and the contractor. In these housing rehabilitation projects, the County is acting as a bank. Any dispute on defects after the work is completed is a civil matter and separate from the “banking” relationship.
Related Recommendations (1)
R1:
None. CONCLUSION: It is the Grand Jury’s judgment that the Grants Office was acting in accordance with established policy, and that there is value for Trin- ity County citizens to know the relationship of loan repayment and any civil actions pending on housing rehabilitation projects. RESPONSES REQUIRED Under Penal Code 933, the following entities are required to re- spond to the listed findings and recommendations within the re- quired time period: ENTITY FINDING RECOMMENDATION RESPOND WITHIN Grants Department Administrator #1 n/a 60 days Trinity Co. Board of Supervisors #1 n/a 90 days Responses TO: The Honorable John K. Letton, Presiding Judge of the Superior Court FROM: Patricia Mortensen, Grants Administrator SUBJECT: Response to Recommendations of 2001-2002 Grand Jury Finance andAdministration Committee, Final Report, Citizen Complaint for Trinity County Housing Rehabilitation Department DATE: February 27, 2002 The Grand Jury Finance and Administration Committee has re- quested a written response to their final report on the citizen com- plaint for the Trinity County Housing Rehabilitation Department. In my capacity as Grants Administrator my response is as follows: Finding #1: 1 agree. Recommendation: There is no recommendation by the Grand Jury Finance and Administration Committee. TO: The Honorable John K. Letton, Presiding Judge of the Superior Court FROM: J.C. Erikson, Chairman Trinity County Board of Supervisors DATE: April 8, 2002 The Grand Jury Special Investigation Committee has requested a written response to their Final Report on the Citizen Complaint for the Trinity County Housing Rehabilitation Department. The re- sponse of the Board of Supervisors is as follows: Finding #1: The Trinity County Board of Supervisors agrees with the finding. Recommendation: There is no recommendation by the Grand Jury Finance and Administration Committee.
Findings & Recommendations
3 findings
F1:
Responses to the 2000-2001 Grand Jury reports were notice- ably late from many department heads and especially late from the BOS. Director of General Services 4 reports were due in 60 days. 0 reports were received within 60 days. 4 reports were received over the maximum time (74 & 74 days).
F2:
The BOS procedure for completing responses to Grand Jury re- ports is to assign a report to an individual board member. The board member usually waits for the department head to complete and file the response prior to completing the BOS response. Once drafted the response must be brought before the BOS for adoption as a final recommendation. The process of bringing the response before the BOS for approval is normally done without an item by item discussion or any open meeting discussion of content. The result appears to be that only one board member becomes fully aware of the content of the re- sponse.
F3:
Once the response is approved by the BOS it is signed by the current chairman. If there are items requiring action by individual county employees or departments, it is unclear as to who directs the imple- mentation of the action item. In most cases the actions are com- pleted because the Department Head response mirrors the BOS re- sponse. However, in one case this did not happen. In the 20002001 report titled Trinity County Treasurer/Tax Collector Department and Related County Operations the Grand Jury recommended that the Treasurer/Tax Collector and the Auditor/Controller meet to discuss possible changes in the recently implemented county money han- dling policy. The Treasurer/Tax Collector agreed but the Auditor/ Controller did not agree. The BOS response agreed with the Grand Jury recommendation. As of March 2002 such a meeting has NOT taken place.
Additional Recommendations
10
Not linked to specific findings.
R1:
Upon receipt of a final or interim report as provided in Sec- tion 933 of the Penal Code, the County Clerk will distribute copies to the members of the Board of Supervisors, the County Adminis- trative Officer, and all affected departments. The Clerk shall estab- lish a timetable for response to the report to comply with the 90 day limitation for the Board of Supervisors and the 60 day limitation for Elective Officers and appointed Department Heads.
R1A:
All County department heads and elected officials must adhere to the time frames established in Penal Code 933 in completing their required responses. The BOS should mandate that all County Department Heads pre- pare their responses as per Trinity County Policy Statement #3-90, which will allow the BOS to prepare and approve a response within the required 90 days it is required to respond within.
R1B:
The BOS should mandate that all County Department Heads prepare their responses as per Trinity County Policy Statement #3-90, which will allow the BOS to prepare and approve a response within the required 90 days it is required to respond within. Response: I generally agree with the policy that was set by the Board in 1990.
R2:
The Grand Jury believes that as the reports are likely to affect all supervisors’ districts, and not just the one overseen by the person doing the response, all district supervisors should be knowledge- able about the response. The Grand Jury strongly recommends the full involvement and discussion of the response to the Grand Jury by all members of the BOS. This would require a discussion of the response in an open session of a BOS hearing.
R3:
Comments shall be due from affected department heads within 30 days. Upon receipt, the Clerk shall immediately forward copies to the County Administrative officer, Grand Jury and the Su- perior Court Judge.
R3A:
The Grand Jury recommends that the BOS define a process or method of follow-up to insure implementation of what they agree to in Grand Jury reports.
R3B:
The BOS should direct the Auditor/Controller and Treasurer/Tax Collector to meet to discuss and resolve the Treasurer/Tax Collector’s input regarding recording errors being incurred by the change in the county money handling system as instituted by the Auditor/ Controller. RESPONSES REQUIRED: Under Penal Code 933, the following entities are required to respond to the listed findings and recommendations within the required time period. ENTITY FINDING RECOMMENDATION DAYS Board of Supervisors 1,2,3 1B,2,3A,3B 90 County Clerk/Recorder 1 1A 60 Sheriff 1 1A 60 Superintendent of Schools 1 1A 60 Director of General Services 1 1A 60 County Counsel 1A 60 Trinity County Board of Education 1 1A 60 Salyer CSD 1 1A 60 POLICY STATEMENT NO. 3-90 (P) POLICY STATEMENT RE PROCEDURE FOR COMMENTING TO GRAND JURY REPORTS AND THE MANAGEMENT REPORT OF THE ANNUAL COUNTY AUDIT In order to establish a uniform procedure for the preparation and filing of comments to Grand Jury Reports, and the Management Report of the Annual Audit, it is the policy of the Board of Super- visors that the following steps be followed: Grand Jurv Reports: 1. Upon receipt of a final or interim report as provided in Sec- tion 933 of the Penal Code, the County Clerk will distribute copies to the members of the Board of Supervisors, the County Adminis- trative Officer, and all affected departments. The Clerk shall estab- lish a timetable for response to the report to comply with the 90 day limitation for the Board of Supervisors and the 60 day limitation for Elective Officers and appointed Department Heads. 2. The County Administrator shall be responsible for the prepara- tion of the response to the recommendations and findings of the Grand Jury. 3. Comments shall be due from affected department heads within 30 days. Upon receipt, the Clerk shall immediately forward copies to the County Administrative officer, Grand Jury and the Su- perior Court Judge. 4. The County Administrative Officer will review all depart- mental responses for adequacy and completeness and may comment on the responses but shall not alter them. 5. The County Administrator, in coordination with members of the Board of Supervisors, shall prepare a final draft response which shall be scheduled on the Board agenda for discussion and approval in adequate time to meet the 90 day time frame required by Penal Code Section 933. 6. Upon adoption by the Board, the Clerk will file the original and furnish copies of the response, together with all departmental responses, to the Superior Court Judge, the Grand Jury and others specifically requesting copies. The response shall reflect substantially the following: 1. As to each finding, whether the responding department agrees with or disputes the finding. If the finding is disputed, an explana- tion of the dispute should be provided. 2. To enable each Grand Jury to track its recommendations, the response shall indicate that the recommendations: A. Have been implemented. Provide a summary of significant detail. B. Will be implemented. A time frame for implementation is required. C. Requires further analysis. Detailed outline required show- ing the scope and parameters of the study. D. Is not feasible. Explanation required. 3. Responses shall be brief and to the point. Each finding and recommendation shall be replied to separately. Management Reports, Annual Audit: 1. Upon receipt of the Management Report, the County Clerk will distribute copies to the members of the Board of Supervisors, the County Administrative Officer, the Auditor/Controller, the Fore- men of the Grand Jury and all affected departments. The Clerk shall establish a timetable for response to the report. 2. Comments shall be due from affected department heads within 30 days. Upon receipt, the Clerk shall immediately forward copies to the County Administrative Officer, the Auditor/Control- ler, the Grand Jury and the Board of Supervisors. 3. The Management Report and Responses shall be filed in the Office of the County Clerk. ADOPTED: July 17, 1990 /s/ Howard G. Myrick Howard G. Myrick - Chairman Board of Supervisors, County of Trinity, State of California. Responses June 27, 2002 TO: Honorable John K. Letton Presiding Judge of the Superior Court FROM: John Whitaker, General Services Director SUBJECT: Response to Recommendations of 2001-02 Grand Jury Continuity Committee - County Officials’ Re sponses
R4:
The County Administrative Officer will review all depart- mental responses for adequacy and completeness and may comment on the responses but shall not alter them.
R5:
The County Administrator, in coordination with members of the Board of Supervisors, shall prepare a final draft response which shall be scheduled on the Board agenda for discussion and approval in adequate time to meet the 90 day time frame required by Penal Code Section 933.
R6:
Upon adoption by the Board, the Clerk will file the original and furnish copies of the response, together with all departmental responses, to the Superior Court Judge, the Grand Jury and others specifically requesting copies. The response shall reflect substantially the following:
Findings & Recommendations
2 findings
F1:
At the October 30, 2001, meeting, Mr. Muir basically reiterated the position that his office is aware of the delinquency of the audits from the three special districts in question. However, due to the expenses required to conduct the audits and the limited funds avail- able to the districts, he was giving them as much latitude as pos- sible in the completion of the requirement under the Code. In the case of the Lewiston Community Service District, Mr. Muir con- curred with the 2000-2001 Grand Jury that due to the Lowden Fire, their records had been destroyed and he was allowing them time to reconstruct these records. Mr. Muir assured the committee mem- bers that his office was aware of its responsibilities under the Code regarding audits of special districts and would continue to monitor their progress.
F2:
Responding to a follow-up suggestion from the previous Trinity County Grand Jury, the 2001-2002 Grand Jury decided to update the Handbook for Special Districts originally prepared by the 1996- 1997 Grand Jury. State Law defines a special district as “any agency of the state for the local performance of government or propriety functions within limited boundaries.” In plain language, a special district is a sepa- rate local government that delivers public services. Trinity County has 17 special districts. The 1996-1997 Grand Jury concluded “that there is no reliable, comprehensive source of accurate information that special districts can use for the legislative aspect of district business.” That Grand Jury created a Handbook for Special Dis- tricts to assist the governing bodies of special districts in Trinity County in the performance of their duties. The handbook had not been updated since 1997. The Grand Jury Education/Special Districts Committee reviewed the Handbook for Special Districts, determined what changes were needed and edited and updated the handbook. Changes to the Handbook include but are not limited to: 1) an updated Special Districts Index to include the current names of Board Members, mailing addresses, meeting times and locations; 2) the insertion of a summary of the requirements of the Brown Act (the intent being to have public agencies conduct their business and make their decisions in open public meetings); 3) the insertion of a memorandum dated May 18, 2000, from David Hammer, County Counsel, establishing a procedure for advising newly elected and appointed officials and designated employees of special dis- tricts of certain conflict of interest laws; and 4) an overall consoli- dation and standardized format of the handbook. The handbook will be distributed to all Special Districts in Trinity County and to the County Board of Supervisors.
Additional Recommendations
2
Not linked to specific findings.
R1:
The 2001-2002 Trinity County Grand Jury concurs with the previ- ous year Grand Jury’s conclusion that the Greater Hayfork Valley Park and Recreation District, the Salyer Community Service Dis- trict, and the Lewiston Community Service District are more than 12 months overdue in audits of their respective districts and are not in compliance with government code. The Grand Jury recognizes that at times state regulations impose financial hardships on small county governments, including spe- cial districts. Nevertheless, the County Auditor/Controller needs to work closely with the special districts, assist them in their efforts to comply with the required financial reviews and insure that overdue audits are completed by the end of the 2001-2002 fiscal year.
R2:
None. RESPONSES REQUIRED: Under Penal Code 933, the following entities are required to re- spond to the listed findings and recommendations within the re- quired time period: ENTITY
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Findings & Recommendations
1 findings
F1:
Analysis of the voter rolls by the county Elections Officer produced the following information: six voters in the East Weaver Creek Road area received ballots for District 4 when they should have voted in District 1. Supervisors in both districts were up for reelection. In the Oregon Mountain area, 16 voters received District 4 ballots, even though they are located in District 2. The District 2 supervisor was not up for reelection this year. Of these 16 voters, seven are located on Trinco Road and nine are located on or near Oregon Street. In the two Weaverville precincts, precincts 1 and 2, ten voters in Precinct I and eight voters in Precinct 2 (a total of 18 voters) had addresses that may in fact not be in those precincts - that is, they are incorrectly located on the precinct rosters. In the above situations, only a portion of a precinct and district were redistricted to a new precinct and district. In the Salyer, Burnt Ranch, and Buckhom areas, these precincts were moved, in their entirety to new districts, and the ballots were all correct. The Wildwood area was redistricted in the same manner as the East Weaver, Oregon Mountain, and Weaverville I and 2 areas. However, the Wildwood voters were not voting for a supervisor, so the accuracy of their supervisorial district was not required for this election. These have not yet been analyzed. The County Elections Office is using this relatively slow time (vis a vis elections) to correct each of the identified cases, expecting to complete this work in a month’s time. Much of their success in meeting this time line depends on cooperation from the Planning Department, which is the only department that has the names of private streets and roads (and driveways). Though this investigation began in order to find out how many voters’ ballots were incorrectly located in the supervisorial districts redistricting, it has also uncovered other voters who are not as- signed to the correct district in the first place. As a result of these findings, the department is planning changes to the voter registra- tion and re-registration process that will assist the department place voters in the correct precinct. In most places, a person’s address is sufficient to place them accurately in their districts. However, Trin- ity County does not have an address system. Therefore, the infor- mation that is vital to accuracy is the Assessor’s Parcel Number (APN) where the voter lives. In the case of renters, the owner’s name will assist in locating the APN. The Elections Office workers in the polling places have been a great help in discovering erroneous precinct assignments; and they will continue to be an important link between the Elections Office and registered voters. Errors discovered at the polling places, in conjunction with continued efforts by the Elections Office to accu- rately locate registered voters, will result in a more accurate reflec- tion of voter distribution in Trinity County.
Additional Recommendations
1
Not linked to specific findings.
R1:
The Grand Jury commends the County Elections Office for their continuing efforts to provide the most accurate voter registration rolls possible under less than ideal circumstances. To this end, the Grand Jury recommends to the Board of Supervisors and the County Clerk/Recorder/Elections Officer that this department continue to pursue and gather accurate information on the physical location of all registered voters so that they will receive correct ballots and poll- ing place information for upcoming elections. RESPONSES REOUIRED: Under Penal Code 933, the following entities are required to re- spond to the listed findings and recommendations within the re- quired time period: ENTITY
Findings & Recommendations
8 findings
F1:
TCBHS Advisory Board agrees moral was low in the department at the time of the investigation.
F2:
Under the initial contract, the County paid Kings View an addi- tional $12,000 for training and setup services. Kings View training of County employees has been at best inadequate. At 21/2 years into the contract’s 3-year initial term, no training manuals have been made available. The Grand Jury finds that inadequate train- ing, and the lack of implementation of that training through appli- cable policies and procedures, is an underlying cause of the numer- ous compliance issues.
F3:
The TCBHS staff occupies office space at several locations around Weaverville. The former General Services building at the edge of the airport was recently renovated and accommodates the TCBHS ADDS functions and Adult Services clinicians, along with other County entities. However the walls at this facility are not suffi- ciently soundproofed to provide the necessary audio suppression during confidential client sessions. The same problem also exists at the Hayfork clinic, as was noted in a State On-Site Review in July 2001.
F4:
As noted in item 3 of the General Finding section, the computer- ized information management/accounting system has frequently failed. These malfunctions can, and have caused tardy or incom- plete billing, resulting in reduced State reimbursements. Also, the lack of a reliable email system has hindered communications within the department, as well as with external organizations (other County organizations, Kings View, State, etc.)
F5:
The Grand Jury received allegations that the Kings View informa- tion system failed for a period of four to six months. We also re- ceived allegations that numerous Medi-Cal billings were never sub- mitted, and that the total Medi-Cal reimbursement losses may have exceeded $100,000. Both the Mental Health Director and the Ex- ecutive Director indicated during interviews that some funds may have been lost due to errors or late billing, but the amounts were insignificant in their eyes, and certainly not of this magnitude. Given what the Kings View information management service is to provide contractually (refer to the Background section), and in an attempt to shed some light on these allegations, the Grand Jury initiated a test of the current information system. We requested fi- nancial information for fiscal year (FY) 2000-01 and FY 2001-02 to date, broken down by month, and including total revenue, Medi- Cal billings, and Medi-Cal reimbursements. We also requested, over the same time periods, and by month, the total numbers of clients, and the Medi-Cal client subset. During the same visit, the Grand Jury also requested copies of all State reviews, inspections, and audits involving TCBHS, from January 2001 to date. We also re- quested copies of the current State/County mental health provider contract, including any memorandaof-understanding (MOU), ad- denda, or any other documents that modify the initial contract. The Grand Jury did not obtain this information the day it was re- quested, nor on the following workday when Grand Jury members returned. It was two weeks later before we obtained the bulk of the material requested. The Grand Jury notes that industry standards normally require audit information be made available by the end of the workday on which it is requested. The Grand Jury did eventually receive the monthly Medi-Cal bill- ings and reimbursements for FY 1999-00, 2000-01, and 2001-02 through December. Given the Medicare/Medi-Cal reimbursement rate of 51.25 percent and the amounts billed and received, one can determine the potential “fully compliant” reimbursements, assum- ing no disallowance by the State, and consequently the revenue forfeited by the County for a lack of compliance. The following table illustrates these results, in which the numbers on the top two rows were provided by TCBHS, while those figures on the lower three rows were derived by the Grand Jury. FY 1999-2000 FY 2000-2001 FY 2001- Dec. Amount Billed $600,700. $805,856. $430,620. Amount Received $215,503. $307,384. $184,958. Fully Compliant $307,859. $413,001. $220,693. Reimbursement Forfeited Revenue $92,356. $105,617. $35,735. Reimbursement 70% 74% 84% Achievement Rate Keep in mind that the “forfeited revenue” figures are the difference between the “fully compliant reimbursement” (assuming full com- pliance with Federal and State requirements, resulting in no Medi- care/Medi-Cal disallowance) and the actual “amount received” by the County. The “reimbursement achievement rate” is simply the ratio of actual reimbursements “amounts received”) to the “fully compliant reimbursements”, and illustrates management’s effective- ness. While the Grand Jury realizes that, as a practical matter, achiev- ing 100 percent compliance is highly unlikely, we believe management’s goal should be reimbursement achievement rates of over 95 percent. Although the recent trend is in the right direction, management still has much to rectify. While the loss of potential revenue is staggering and adds credence to the original allegations, it does not constitute proof as to the remaining allegations. For example, it does not address the asser- tion that a significant number of billings were not submitted that would add significantly to reimbursement to the County. Because the Grand Jury could not either validate or dismiss all of the allega- tions, and because the Grand Jury lacks the resources necessary to conduct thorough financial and management audits, the Grand Jury finds that such audits should be performed to identify and correct any related problems. When the Grand Jury reviewed the State/County contract, we noted under Exhibit B - Payments Provisions, section 4 - Amounts Pay- able, that the State was to pay TCBHS an allocation amount of $126,096 for FY 2001-02. We had not received any documentation that modified this allotment, nor assigned it to another source. Since we had not been provided this figure during our interviews with the directors, we asked the Executive Director to explain this omis- sion. Initially, he was unable to explain it, and wanted a copy (in effect, a copy of a copy originally obtained from TCBHS). Several days later the Executive Director stated he believed this funding was a portion of the realignment funds listed in the County budget associated with Medi-Cal managed care reconciliation. The Grand Jury queried the State contract representative from the Department of Mental Health, and he informed us the allocation was direct fund- ing for the contract. Consequently the Grand Jury is still uncertain as to the real funding source and any restrictions associated with this revenue, and just where it resides in the funding explanations provided to us for the Background section. Examples such as these tend to erode the Grand Jury’s confidence in the Department’s man- agement. In summary, the Grand Jury finds that the Kings View information management system, as implemented at TCBHS, does not measure up to industry accounting standards. The Grand Jury believes that the type of fiscal information we requested should already have been available as printed monthly reports, but at the very least, should have been readily available from the computerized infor- mation system. The Grand Jury also finds that any prudent depart- ment manager should have had accounting reports provided monthly (as noted above) in order to verify and oversee the client informa- tion and costs being reported to the State, and for comparison with the reimbursements returned from the State. Any disallowance should have been a flag to management indicating a problem that required inquiry and solution, in order to maximize revenue return. A management information system can be a superb tool for manag- ers to properly execute their managerial duties and responsibilities, but only if properly utilized. As stated in the opening paragraph of this Finding #5, both the Mental Health Director and the Executive Director indicated dur- ing interviews that some funds might have been lost due to errors or late billing, but the amounts were insignificant in their eyes. This Grand Jury finds that the funds lost due to management negli- gence are not insignificant in our eyes, and believes that further investigations are warranted.
F6:
Given the numerous problems that have arisen in the Department during the transition to contract services with Kings View, and managed care medical delivery service in general, including the compliance issues identified during the State audits, the Grand Jury finds that the leadership and oversight has not been commensurate with the task. We recognize that the Mental Health Director is also the County Auditor and the interim CAO, in addition to other du- ties that he has been assigned. Overall, he can only devote about 30 percent of his time overseeing the TCBHS Department operations.
Related Recommendations (1)
R00-01:
(kv) Total Units 49,168 532,284 25,425 22,070 628,947 Paid Units 44,145 320,381 11,012 15,305 390,843 32.98% Rate/Unit - Published 1.33 1.71 3.18 2.57 Paid M/C Revenue $ 58,713 547;852 35,018 .39,334 680,916 37.03% RECOMMENDATION #5 No opinion. The state periodically audits the Department now. An independent audit may be redundant. FINDING #6 NA RECOMMENDATION #6 NA FINDING #7 r.e. Director The original Kings View contract called for an Executive Di- rector and a management information system. Both Kings View and the County entered into that agreement in good faith. What has been learned over that three year contract is that there are three specific skill sets that are necessary to adequately run a small county managed care mental health and alcohol and drug program: 1. Program and political expertise The ability to work with a di- verse group of staff from front office support staff to psycholo- gists and psychiatrists in a variety of settings. The ability to work collaboratively with other agencies towards common goals such as children’s system of care and CaIWORKS. The ability to work with a local county government structure and be respon- sive to the Board of Supervisors, Advisory Boards, and a variety of local agencies (both public and private) and special interest groups and interface with other counties, the state and federal gov- ernment. The ability to make and communicate decisions as to who can be served and who can’t based upon available resources, man- dates and regulations. 2. Fiscal Administration The ability to manage a budget composed of multiple funding sources, legislative mandates, cost report- ing systems and fiscal oversight bodies including complex systems such as the Medicaid system. 3. Quality Improvement The ability to develop, implement and monitor a medical model quality improvement process that assures the development and oversight of compliance standards and pro- cedures (this is even more important then ever before due to HIPAA requirements), proper documentation, client grievance pro- cedures, treatment authorization procedures, etc Four years ago, the County was not able to recruit a qualified Mental Health Director. Through Kings View, a Director that meets the qualifications of the State has been hired. During the past five years, the County has not been able to recruit or retain quali- fied people in the latter two areas described above. Many of the problems described in the Grand Jury report are directly related to the County’s inability to recruit and retain qualified Fiscal Administrative personnel and Quality Assurance personnel. It is only in the past 6 months - as a result of an amendment to the Kings View contract that shifted all of the above responsibilities to Kings View - that these issues have begun to be resolved. Cur- rently, via the Kings View contract, a highly qualified fiscal ad- ministrator with over 30 years experience (who has already increased revenues by identifying areas that Trinity County has never billed in the past) and a highly qualified Quality Improve- ment Coordinator with a similar level of experience are fulfilling the responsibilities that are bringing the Department into com- pliance, increasing revenues and improving the care of the cli- ents of Trinity County. The fundamental issue is that Trinity County, like every other county in the State agreed to become the managed care provider of mental health services. This decision was made in the mid nine- ties. While most other counties spent the next four or five years learning how to do managed care (including going through similar struggles as has been experienced over the past two years in Trinity County), Trinity County Behavioral Health resisted that responsibility. The County was unable to recruit or retain not only a Director, but, as mentioned above, a qualified fiscal administra- tor or a Quality Improvement Coordinator. Had the County been able to hire its own people in these positions, the Department would still have gone through exactly the same issues as it has recently been going through. RECOMMENDATION #7 A. I strongly disagree for the reasons mentioned above. It would not be in the County, the clients or the State’s best interest to ter- minate the Kings View contract. B. I agree that quality mental health services to our community must remain a top priority. I also agree that organizational changes will result in improved service delivery. Recommendations have been made to accomplish this and are included in the County Salary Study and in the proposed Kings View contract. FINDING #8 r.e. Advisory Board The roles, responsibilities and makeup of the Mental Health Advi- sory Board are clearly set forth in regulation. Besides attending all Advisory Board meetings, the Department management staff meets with the Advisory Board Executive Committee monthly and makes available to the Advisory Board all management staff at the Advisory Board’s request. To the extent that resources are avail- able, all informational requests of the Advisory Board receive a response.
F7:
Throughout most of its history, a single director has headed the County mental health organization. Now, under the Kings View contract, the organization’s management includes a Mental Health Director, an Executive Director, and a Deputy Director, in addition to the section/team leaders. As indicated in the background section and reported findings, both the Mental Health Director and Deputy Director hold other managerial appointments with separate respec- tive duties. The Executive Director, a Kings View employee, re- sides outside of Trinity County. In addition, the team leaders (es- sentially first-line supervision) have reduced some of their clinical duties, thus either impacting client services, or adding to the bur- den of the remaining clinical staff. The Grand Jury has found that the duties and responsibilities of the Mental Health Director and Executive Director are not well delin- eated and are inexorably intertwined. At times they overlap, at times they seem not to cover fully all the Department’s requirements, and, above all, are confusing to both departmental employees and outside observers. The Grand Jury finds that Kings View has not achieved the original contractual goal of clinical efficacy, cost efficiency, nor full com- pliance with State requirements. The Grand Jury finds that the post of Executive Director is extraneous, provided the Board of Super- visors accepts the previous recommendation for a full-time County Mental Health Director.
Related Recommendations (1)
R00-01:
(kv) Total Units 49,168 532,284 25,425 22,070 628,947 Paid Units 44,145 320,381 11,012 15,305 390,843 32.98% Rate/Unit - Published 1.33 1.71 3.18 2.57 Paid M/C Revenue $ 58,713 547;852 35,018 .39,334 680,916 37.03% RECOMMENDATION #5 No opinion. The state periodically audits the Department now. An independent audit may be redundant. FINDING #6 NA RECOMMENDATION #6 NA FINDING #7 r.e. Director The original Kings View contract called for an Executive Di- rector and a management information system. Both Kings View and the County entered into that agreement in good faith. What has been learned over that three year contract is that there are three specific skill sets that are necessary to adequately run a small county managed care mental health and alcohol and drug program: 1. Program and political expertise The ability to work with a di- verse group of staff from front office support staff to psycholo- gists and psychiatrists in a variety of settings. The ability to work collaboratively with other agencies towards common goals such as children’s system of care and CaIWORKS. The ability to work with a local county government structure and be respon- sive to the Board of Supervisors, Advisory Boards, and a variety of local agencies (both public and private) and special interest groups and interface with other counties, the state and federal gov- ernment. The ability to make and communicate decisions as to who can be served and who can’t based upon available resources, man- dates and regulations. 2. Fiscal Administration The ability to manage a budget composed of multiple funding sources, legislative mandates, cost report- ing systems and fiscal oversight bodies including complex systems such as the Medicaid system. 3. Quality Improvement The ability to develop, implement and monitor a medical model quality improvement process that assures the development and oversight of compliance standards and pro- cedures (this is even more important then ever before due to HIPAA requirements), proper documentation, client grievance pro- cedures, treatment authorization procedures, etc Four years ago, the County was not able to recruit a qualified Mental Health Director. Through Kings View, a Director that meets the qualifications of the State has been hired. During the past five years, the County has not been able to recruit or retain quali- fied people in the latter two areas described above. Many of the problems described in the Grand Jury report are directly related to the County’s inability to recruit and retain qualified Fiscal Administrative personnel and Quality Assurance personnel. It is only in the past 6 months - as a result of an amendment to the Kings View contract that shifted all of the above responsibilities to Kings View - that these issues have begun to be resolved. Cur- rently, via the Kings View contract, a highly qualified fiscal ad- ministrator with over 30 years experience (who has already increased revenues by identifying areas that Trinity County has never billed in the past) and a highly qualified Quality Improve- ment Coordinator with a similar level of experience are fulfilling the responsibilities that are bringing the Department into com- pliance, increasing revenues and improving the care of the cli- ents of Trinity County. The fundamental issue is that Trinity County, like every other county in the State agreed to become the managed care provider of mental health services. This decision was made in the mid nine- ties. While most other counties spent the next four or five years learning how to do managed care (including going through similar struggles as has been experienced over the past two years in Trinity County), Trinity County Behavioral Health resisted that responsibility. The County was unable to recruit or retain not only a Director, but, as mentioned above, a qualified fiscal administra- tor or a Quality Improvement Coordinator. Had the County been able to hire its own people in these positions, the Department would still have gone through exactly the same issues as it has recently been going through. RECOMMENDATION #7 A. I strongly disagree for the reasons mentioned above. It would not be in the County, the clients or the State’s best interest to ter- minate the Kings View contract. B. I agree that quality mental health services to our community must remain a top priority. I also agree that organizational changes will result in improved service delivery. Recommendations have been made to accomplish this and are included in the County Salary Study and in the proposed Kings View contract. FINDING #8 r.e. Advisory Board The roles, responsibilities and makeup of the Mental Health Advi- sory Board are clearly set forth in regulation. Besides attending all Advisory Board meetings, the Department management staff meets with the Advisory Board Executive Committee monthly and makes available to the Advisory Board all management staff at the Advisory Board’s request. To the extent that resources are avail- able, all informational requests of the Advisory Board receive a response.
F8:
The number of compliance issues cited during the State Oversight Review in January dumbfounded the TCBHS Advisory Board. Though they meet monthly (some times more frequently) with the Executive Director, they were perplexed by the large number of deficiencies. The Mental Health Director is present at some of these meeting as well. When the Grand Jury interviewed the TCBHS directors (separately), each downplayed any problem or issues we introduced, be they from citizens complaints, or issues we had uncovered during our investigation. The Advisory Board has apparently been satisfied by similar assurances. The contract with Kings View states that the selection of the Ex- ecutive Director shall be subject to the approval of the County. The Grand Jury assumes that the “approval of the County” involves review and advice from the Advisory Board. Yet the Advisory Board was simply informed about Kings View Executive Director appoint- ments after the fact, and was not part of the process.
Related Recommendations (1)
R00-01:
(kv) Total Units 49,168 532,284 25,425 22,070 628,947 Paid Units 44,145 320,381 11,012 15,305 390,843 32.98% Rate/Unit - Published 1.33 1.71 3.18 2.57 Paid M/C Revenue $ 58,713 547;852 35,018 .39,334 680,916 37.03% RECOMMENDATION #5 No opinion. The state periodically audits the Department now. An independent audit may be redundant. FINDING #6 NA RECOMMENDATION #6 NA FINDING #7 r.e. Director The original Kings View contract called for an Executive Di- rector and a management information system. Both Kings View and the County entered into that agreement in good faith. What has been learned over that three year contract is that there are three specific skill sets that are necessary to adequately run a small county managed care mental health and alcohol and drug program: 1. Program and political expertise The ability to work with a di- verse group of staff from front office support staff to psycholo- gists and psychiatrists in a variety of settings. The ability to work collaboratively with other agencies towards common goals such as children’s system of care and CaIWORKS. The ability to work with a local county government structure and be respon- sive to the Board of Supervisors, Advisory Boards, and a variety of local agencies (both public and private) and special interest groups and interface with other counties, the state and federal gov- ernment. The ability to make and communicate decisions as to who can be served and who can’t based upon available resources, man- dates and regulations. 2. Fiscal Administration The ability to manage a budget composed of multiple funding sources, legislative mandates, cost report- ing systems and fiscal oversight bodies including complex systems such as the Medicaid system. 3. Quality Improvement The ability to develop, implement and monitor a medical model quality improvement process that assures the development and oversight of compliance standards and pro- cedures (this is even more important then ever before due to HIPAA requirements), proper documentation, client grievance pro- cedures, treatment authorization procedures, etc Four years ago, the County was not able to recruit a qualified Mental Health Director. Through Kings View, a Director that meets the qualifications of the State has been hired. During the past five years, the County has not been able to recruit or retain quali- fied people in the latter two areas described above. Many of the problems described in the Grand Jury report are directly related to the County’s inability to recruit and retain qualified Fiscal Administrative personnel and Quality Assurance personnel. It is only in the past 6 months - as a result of an amendment to the Kings View contract that shifted all of the above responsibilities to Kings View - that these issues have begun to be resolved. Cur- rently, via the Kings View contract, a highly qualified fiscal ad- ministrator with over 30 years experience (who has already increased revenues by identifying areas that Trinity County has never billed in the past) and a highly qualified Quality Improve- ment Coordinator with a similar level of experience are fulfilling the responsibilities that are bringing the Department into com- pliance, increasing revenues and improving the care of the cli- ents of Trinity County. The fundamental issue is that Trinity County, like every other county in the State agreed to become the managed care provider of mental health services. This decision was made in the mid nine- ties. While most other counties spent the next four or five years learning how to do managed care (including going through similar struggles as has been experienced over the past two years in Trinity County), Trinity County Behavioral Health resisted that responsibility. The County was unable to recruit or retain not only a Director, but, as mentioned above, a qualified fiscal administra- tor or a Quality Improvement Coordinator. Had the County been able to hire its own people in these positions, the Department would still have gone through exactly the same issues as it has recently been going through. RECOMMENDATION #7 A. I strongly disagree for the reasons mentioned above. It would not be in the County, the clients or the State’s best interest to ter- minate the Kings View contract. B. I agree that quality mental health services to our community must remain a top priority. I also agree that organizational changes will result in improved service delivery. Recommendations have been made to accomplish this and are included in the County Salary Study and in the proposed Kings View contract. FINDING #8 r.e. Advisory Board The roles, responsibilities and makeup of the Mental Health Advi- sory Board are clearly set forth in regulation. Besides attending all Advisory Board meetings, the Department management staff meets with the Advisory Board Executive Committee monthly and makes available to the Advisory Board all management staff at the Advisory Board’s request. To the extent that resources are avail- able, all informational requests of the Advisory Board receive a response.
Additional Recommendations
20
Not linked to specific findings.
R1:
A. I concur. It is good business practice to have an action plan. The Department has an extensive action plan that has been approved by the State. It is monitored by the State on a weekly basis. B. I concur in part. The Deputy Director for Quality Improvement/ Administration has been eliminated from the proposed budget. However, the roles and functions of Quality Assurance/Improvement in a Managed Care system are extensive and require a great deal of technical expertise and training. The roles and functions require more than one person to adequately maintain compliance with com- plex Medi Cal regulations. Over the past five years the Department has attempted to add Quality Improvement as an additional assign- ment to an already overloaded staff person. In so doing, we have “burned out” three different people because the task was too large and complex. C. I concur. Over the past five years the county has been unable to fill this position for any length of time due to the highly specialized nature of the position and its role in assuring compliance with Medi Cal Managed Care regulations. The inability to fill that county posi- tion has - to a large degree - contributed to the number of items that the Department was out of compliance at the last state review. Be- ginning in February, 2001, this position was included as a contract amendment in the Kings View contract. Since that time, Kings View has supplied the County with a highly qualified person who has suc- cessfully developed and implemented a Plan of Correction that has been approved by the State. She has also implemented a training pro- gram for clinicians to improve their record keeping skills in accor- dance with state requirements. Given that the County has been un- able to fill this critical need in the past five years, and the current relationship with Kings View is accomplishing what needs to be done, it is to the county’s best interest to continue this position as part of the Kings View contract. This position takes on increased impor- tance in light of the new Federal privacy and security rules (HIPAA). If anything, the Department needs to increase its commitment of resources to “...achieve compliance with State regulations and pro- vide quality medical service to the community.”
R1A:
The recommendation will be partially imple- mented. The Department will continue to promote open communi- cation and team building. However, no formal plan is necessary other than the plan approved by the State.
R1B:
The Advisory Board agrees, please see Attachment A, a letter written to the Board of Supervisors on April 10th, recommending that a quali- fied Director be hired. The Advisory Board agrees that the layers of management and com- mittee structure are cumbersome and “extraneous” for such a small agency serving 206 clients. Under the current structure it appears that the administration levels are not well defined. Behavioral Health has a Director, an Executive Director and a variety of consultants that do specific activities, i.e. BHS contracts with a retired mental health Director to provide for fiscal oversight. In response to the firing of the Deputy Director the TCBHS Advisory Board also notes a lack of support from management in organizing a Quality Improvement Committee although she had the most ac- tual mental health experience and client culture knowledge. To as- sure that the Department is more responsive to the deficiencies and defines who will address issues, the Advisory Board will recom- mend that a job description addressing individual positions, roles and responsibilities of each of the supervisory positions, the man- agement structure and hierarchal reporting are in a written form that can be used to guide employees and the TCBHS Advisory Board. It appears that the amount of in-house committees and meetings that are closely interrelated and contain the same people with the exception of one or two additional persons appear to be cumbersome and inefficient but seem to consume the weekly schedule. The Executive Director has stated that it is not good prac- tice to have the team managers involved in clinical duties but the Board finds that the hands-on experience of this County could be beneficial to employees from other areas especially in as much as this frontier community finds it difficult to employ licensed clinicians.
R2:
A. The Grand Jury recommends that the Mental Health Director require the Executive Director to develop a training plan setting forth the steps he intends to take to ensure that each employee is thoroughly knowledgeable of current statutory requirements as they pertain to their individual duties, as well as a comprehensive orien- tation of the Kings View information management system. He should also require the Executive Director to create an action plan for imple- menting the training. This action plan should be specific and in- clude steps and appropriate time lines for completion. Methods to be used for measuring and evaluating the success of the action plans should be clearly identified. Providing training manuals should be a part of the action plan. B. The Grand Jury recommends that the County Mental Health Director review the original contractual obligations with regards to Kings View training performance.
R2A:
The recommendation will be partially imple- mented. The Executive Director will plan for appropriate training on the Kings View MIS system as well as statutory requirements.
R3:
The Grand Jury believes that client confidentiality must remain a high priority within TCBHS, and recommends that the County Mental Health Director provide appropriate facilities. Either the airport facility needs to be upgraded to meet the soundproofing standards, or the TCBHS staff should be relocated to a facility that is in accordance with established standards. The same holds true at all remote facilities or clinics. The Grand Jury is aware of the recent Airport Road facility modifi- cations by the General Services Department to correct the defi- ciency, and though improved, the soundproofing is still inadequate. The situation at the Hayfork clinic will require active leadership, coordination, and cooperation among several County departments, as well as several Hayfork entities, to reconcile the interrelated is- sues necessary to correct this compliance problem. Since this is a TCBHS problem, the Grand Jury recommends that the County Mental Health Director take the active lead role in initiating the process, insuring the process is proceeding in a timely manner, and that the results rectify the problem.
R4:
A. The Grand Jury recommends that the Mental Health Director require the Executive Director insure that the computerized system Kings View implemented meets or exceeds industry standards for downtime. In addition, the Mental Health Director should require the Executive Director to develop a backup procedure or system to insure that billing information and data are transferred within the State-mandated schedules to avoid any further loss of revenue to the County. B. The Mental Health Director should communicate with other counties that have service contracts with Kings View to ascertain their experience regarding system failures and if their system fail- ures correlate with those at TCBHS. When persistent problems such as these occur, and in order to provide proper oversight, the Mental Health Director should seek substantiation as to the underlying cause and corrective actions taken.
R4A:
This recommendation has been imple- mented. The Kings View management information system meets or exceeds industry standards for downtime and a backup system to access client and accounting information already exits.
R4B:
This recommendation has been imple- mented. Other Kings View counties have not experienced an ab- normally high system failure rate. The Mental Health Director will continue to evaluate causes and corrective actions regarding per- sistent system problems.
R5:
The Grand Jury strongly recommends that the Board of Supervi- sors initiate independent fiscal and management audits of the TCBHS for FY 2000-01 and 2001-02. Given that the County Audi- tor is also the Mental Health Director, and to avoid any appearance of impropriety, the prudent course of action would be for an out- side entity such as the State or a professional auditing firm to con- duct these audits.
R6:
The Grand Jury strongly recommends that a full-time, fully accred- ited Mental Health Director be hired to provide the vital leadership and oversight this Department requires.
R7:
A. The Grand fury strongly recommends that the Board of Supervi- sors terminate the service contract with the Kings View Corpora- tion at the earliest contractual opportunity. B. The Grand Jury has also found a bureaucracy growing within the department, while concurrently, the quality of clinical services are deteriorating. Quality medical service to our community must remain a top priority. Consequently, the Grand Jury recommends that the TCBHS organizational structure be streamlined to maxi- mize client services.
R7A:
Implementation of the recommendation is up to the Board of Supervisors, but I recommend renewing the Kings View contract.
R8:
A. The Grand Jury recommends that the Board of Supervisors en- act policies and procedures to ensure that the TCBHS Advisory Board can investigate and evaluate problems or issues within the TCBHS, in order to fulfill the Advisory Board’s obligations to re- port and advise. B.State statutes and regulations not only require that the County Board of Supervisors establish a mental health board, but consult with it on any County agreements involving mental health services, including service or consulting contracts, and director appointments. The Grand Jury recommends that the Board of Supervisors and County Mental Health Director abide by these requirements in the future. The Grand Jury also recommends that out of courtesy the County consult with the TCBHS Advisory Board about any profes- sional appointments within the TCBHS Department. C. The Grand Jury recommends the Board of Supervisors give equal if not more credence to the TCBHS Advisory Board’s advice than that of the Mental Health Director. The Advisory Board represents the community’s opinion, and the members are serving unselfishly to obtain the best mental health care for the benefit of the County’s citizenry. D. The Grand Jury recommends that the County Mental Health Director attend all of the TCBHS Advisory Board meetings. CONCLUSIONS: After review of documents and assimilation of numerous interviews, it is the Grand Jury’s conclusion that the TCBHS Department is experiencing significant morale problems, especially between man- agement and rank and file employees. It is clear from the inter- views with both management and rank and file employees that the transition from a smaller, less bureaucratic department to a larger, more bureaucratic managed care organization has been rocky and difficult for most of the employees. An atmosphere of distrust and fear has replaced the family atmosphere that existed before the tran- sition, resulting in communication breakdowns and very low mo- rale. It is also the conclusion of the Grand Jury that the lack of leader- ship from management has exacerbated the situation, is totally un- acceptable, and in the end, is manifestly detrimental to the entire Department. This has resulted in further erosion of trust and team- work, and has made the transition to a managed care institution even more difficult and stressful than otherwise would have been the case. Part of the problem can be attributed to not having a full time director physically in and interacting daily with the depart- ment. Such a person is necessary to rapidly address developing issues, as well as employee concerns, smooth the transition, and furnish the leadership required during times of stressful change. The Grand Jury concludes that management deficiencies have also contributed to many other unresolved problems; excessively long client waiting periods, compromised confidentiality during client sessions, continuing compliance issues, inadequate staff training, ineffective computer-based information systems, high disallowance rates of the Medi-Cal billings resulting in reduced reimbursements, to name just a few. The Grand Jury concludes that a comprehensive audit is required to fully identify and correct the management and fiscal problems within the TCBHS Department. The Grand Jury concludes that the Board of Supervisors should hire a full-time, fully accredited Mental Health Director. With an accredited Mental Health Director, the Executive Director’s posi- tion becomes unnecessary and should be eliminated. Also, given the numerous compliance issues, and the demonstrated ineffective- ness of the currently implemented information management sys- tem, the Grand Jury sees no benefit in continuing the Kings View service contract, and the contract should be terminated forthwith. The Grand Jury also concludes that the TCBHS Advisory Board should involve themselves more actively in exploring complaints and operations within the department, rather than relying primarily on the information provided by the Department director. That also includes any services provided by the Kings View Corporation, should they be retained. In regards to mental health services, this Advisory Board should be the real watchdog for the community. And as the watchdog, the Board of Supervisors should ensure that the TCBHS Advisory Board has sufficient “teeth” to fully accom- plish their obligations to the State and the County Board of Super- visors. RESPONSES REQUIRED: Under Penal Code 933 the following entities are required to re- spond to the listed findings and recommendations within the re- quired time period: ENTITY
R8A:
There is no need to implement this recom- mendation. The Advisory Board can access any record not involv- ing Confidential patient information, and they have the ability to interview any member of the Department’s staff.
R8B:
The recommendation has been partially implemented. The County will continue to involve the Advisory Board Chairman in director appointments. The Grand Jury’s state- ment that State regulations require that the Advisory Board be consulted on any agreements involving mental health services is incorrect. Welfare and Institutions Code Section 5604.2(a)(2) provides that the Advisory Board reviews only the annual perfor- mance contract with the State Department of Mental Health. Al- though the Advisory Board will not be involved in the contracting process for other contracts, all completed contracts are available for their review
R8C:
Implementation of the recommendation is up to the Board of Supervisors.
R8D:
The recommendation will not be imple- mented. I agree that it is important for the Director of Behavioral Health Services to attend Advisory Board meetings. However, in a small county, where we all wear many hats, other important County business, which conflicts with scheduled Advisory Board meet- ings, is a common occurrence. RESPONSE TO THE GRAND JURY REPORT Dated April 30, 2002 By Ted Klemm, Executive Director Trinity County Behavioral Health
R98-99:
Total Units 105,035 289,643 23,782 12,009 430,469 Paid Units 54,532 213,822 15,470 10,089 293,913 Rate/Unit - Published 1.03 1.71 3.18 2.57 Paid M/C Revenue $ 56,168 365,636 49,195 25,929 496,927
R99-00:
(kv) Total Units 82,767 452,985 19,741 11,646 567,139 Paid Units 64,075 258,170 11,625 8,921 342,791 16.63% Rate/Unit - Published 1.33 1.71 3.18 2.57 Revenue’ Paid M/C $ 85,220 441,471 36,968 22 927 586,585 18.04%
Findings & Recommendations
2 findings
F1:
Trinity County Jail The Trinity County Jail is in compliance with the requirements of the California State Department of Corrections. Although there were several issues of concern raised with jail officials during the two inspections conducted by the Committee, all of these problems were either corrected or are currently being addressed by the Sheriffs Department. Several members of the Jury commented on the need for improved maintenance in the waiting rooms for both the en- trances to the Jail and the entrance to the Sheriffs Offices. The Sheriff advised the committee members that the maintenance of these ar- eas is the responsibility of the General Services Department. There is an obvious “overcrowding” situation existing at the dis- patch center where booking, oversight of jail operations, and 911 / dispatch communications occur. This problem was also addressed in a previous report issued by the 1998-1999 Grand Jury. The Judi- cial committee was advised by the Sheriff that he was well aware of this problem and that a rear oversight station currently being used for storage was again being considered for the Dispatch/911 center. The utilization of the rear oversight station as a Dispatch/911 cen- ter would also enable jail staff to visually observe the outdoor rec- reation area when prisoners are exercising, another issue of con- cern raised by several Judicial Committee Members. The Sheriff advised the Committee that he felt the outlook was positive that an expansion alleviating the cramped conditions in the dispatch area could occur this year and that the Department was proactively pur- suing this initiative internally. Although the Trinity County Jail is currently staffed with the mini- mum levels as required by the Califomia Board of Corrections and by law, often Deputies on patrol are pulled in to assist in the man- agement of the Jail. These situations occur when jail staff call in sick, are out on job related injury or maternity leave, attending mandatory training, or during other emergencies. When these events occur, Sheriff Schmidt stated that law enforcement coverage in Trin- ity County is negatively affected due to the already minimal staff- ing level of sworn personnel in the Sheriffs Department.
F2:
Trinity County Juvenile Detention Facility The Juvenile Detention Facility is in compliance with the Califor- nia State Board of Corrections standards for Youth Detention Fa- cilities. An additional on-site biannual inspection of the facility by the Board is planned prior to the end of 2001. The Trinity County Juvenile Justice Commission has inspected the facility and identi- fied minor discrepancies that are being addressed by the Trinity County Probation Department. Overall, the Commission concluded that the facility is well run and that a follow-up inspection will be conducted prior to the end of calendar 2001. The JDF is a showcase operation that most impressed the members of the Grand Jury. It was clearly evident that much effort, commit- ment and professional expertise were brought to bear in the con- struction and development of the center. All personnel involved in the development and operation of the center are to be commended for their efforts.
Additional Recommendations
4
Not linked to specific findings.
R1:
a: The Trinity County Grand Jury strongly supports the Sheriff Department’s efforts to alleviate the overcrowding situation in the 911/Dispatch Center by utilizing the rear oversight station located in the jail. The Grand Jury recommends that the county make every effort to identify funding to implement this much needed reloca- tion as soon as possible.
R1a:
The Trinity County Board of Supervisors agrees.
R1b:
The Trinity County Board of Supervisors agrees that it is the Trinity County General Services Department’s responsibility to inspect and determine the “appropriate mainte- nance” needed and to ensure the waiting rooms are clean, safe and presentable, regardless of who performs the work.
R2:
None CONCLUSION: Judicial committee members were impressed with the profession- alism and dedication of the staff at both facilities. Sgt. Robert Angulo and his staff at the Trinity County Jail are doing an excellent job under difficult conditions. Under-Sheriff Charles Downen and Sher- iff Paul Schmidt were most helpful and responsive in the review of issues at the jail. The Trinity County Jail is being staffed with the minimum levels as required by the Board of Corrections and by law. However, there are times when Deputies on patrol are pulled in to assist in the management of the Jail during shortages due to illness, injuries or emergencies. The Sheriff has stated both publicly and to members of the Grand Jury that occasionally there is inadequate law enforce- ment coverage in Trinity County. He has stated that that the root cause is low salaries that create a high turnover among his officers. The Grand Jury concludes that the Board of Supervisors needs to work closely with the Sheriffs Department to provide the necessary funding to insure the continued safety of the citizens of this county. Chief Probation Officer Terry Lee and his staff have done a truly remarkable job of obtaining the necessary funding for and contin- ued oversight of the new Trinity County Juvenile Detention Facil- ity and adjacent Probation Department offices. Professionalism is evident in all aspects of the physical plant and the operation of the program.
Findings & Recommendations
3 findings
F1:
The Independent Auditor’s Report is dated September 13, 2000. That report was not available to the public or the Grand Jury until April 2001. Since audits are normally dated on the last day of field- work done by the independent auditor, the audit was dated Septem- ber 13, 2000. The delay until April was the time taken to write the report. Both the Independent Auditor and the County Auditor/Controller have taken steps to expedite the audit for the year ending June 30, 2001. Language was included in the contract requiring a timely delivery of the audit and the Independent Auditor scheduled field work early in the year. A preliminary draft of the June 30, 2001, audit report (except for the cost report from the medical center) was delivered to the County Auditor/Controller on Dec. 4, 2001. The final audit report (which includes the hospital’s conservative cost estimates) arrived from the Independent Auditor to the Audi- tor/Controller’s office on January 23, 2002.
F2:
The Independent Auditor’s Report for the year ended June 30, 2000 is a qualified report. A qualified report is issued when there are qualifications (exceptions) to the Independent Auditor’s opinion that the financial statements fairly present the financial position and results of operations of the County. The report contains the following statement: “Because of the inadequacy of accounting records for fixed assets, we were unable to form an opinion regarding the amount at which the General Fixed Assets Account Group (stated at $22,944,534), and fixed assets and accumulated depreciation in proprietary fund types (stated at $5,944,728 and $1,938,329, respectively), or the amount of depreciation expense (stated at $382,363) are recorded in the accompanying financial statements as of and for the year ended June 30, 2000.” The Grand Jury has been informed that obtaining an unqualified independent auditor’s report would require an additional auditing cost of $8,000 per year, plus an undetermined amount of labor to improve the accounting records. While the County Auditor/Con- troller and the County Administrative Officer’s responses indicate that the County’s accounting records accurately reflect fixed assets and accumulated depreciation, the Grand Jury has been informed that the accounting records only cover equipment. They do not have detail to back up the financial statements’ balances for land, build- ings and their locations, cost, use, and dates of acquisition. The County Auditor/Controller, County Board of Supervisors, and County Administrative Officer have indicated they felt the benefit of an unqualified audit report was not worth the $8,000 required for including an audit of the fixed assets in the independent auditor’s annual audit of the county’s general purpose financial statements. The 2000-2001 Grand Jury recommended that the fixed assets be included in the audit performed by the independent auditors. The Grand Jury has been informed that the independent auditors have recommended for several years that the fixed assets be included in the audit. While the Grand Jury understands that the County does not desire to expend more than. needed on the audit, the same argument that the cost outweighs the benefit of the audit could be applied to all other areas of the audit. The balance in the fixed assets account group is material to the overall general-purpose financial statements. Auditing the fixed assets will enable the independent auditors to verify that the fixed assets as presented in the general purpose fi- nancial statements of the County, agree with the detailed records of fixed assets; that the fixed assets exist and are owned by the county; that they are not encumbered (or that such encumbrance is reflected in the general purpose financial statements); and that they are be- ing used for the functions for which they were authorized.
F3:
In the County Auditor/Controller’s response to the fourth recom- mendation in the final report of the 2000-2001 Grand Jury, he indi- cated that the “statements are produced by the Independent Auditor and the County cannot control what is in the notes.” However, the audit report states that the County, not the Independent Auditor, is responsible for the financial statements and their notes.
Additional Recommendations
3
Not linked to specific findings.
R1:
The Grand Jury commends and recommends that the Board of Su- pervisors commend the County Auditor/Controller for taking steps to expedite the audit.
R2:
The Grand Jury recommends that the fixed assets be included in the audit for the year ending June 30, 2002, with the goal that there be an unqualified audit opinion from the Independent Auditor.
R3:
The County is responsible for the general-purpose financial state- ments, and for the accompanying notes. The Grand Jury recom- mends the County take whatever steps are necessary to ensure the completeness and accuracy of the financial statements and notes. If, in the opinion of the County, there are amounts that need to be corrected or if further disclosure is required in the explanatory notes, we suggest that the County and its representatives discuss the is- sues with the Independent Auditor until resolved, so that the gen- eral purpose financial statements of the County clearly reflect the financial position of the County. CONCLUSION: The Grand Jury believes that audits are done for the citizens of Trinity County and that the citizens deserve an unqualified audit, which verifies that the financial statements fairly present the finan- cial position and results of operations of the County.