Health & Human Services
The Health and Human Services Committee toured facilities, investigated complaints, and gathered information on policies and procedures from various health and human service agencies serving Sacramento County. These county agencies included:
· Bureau of Family Support
The tours provided the Sacramento County Grand Jury with the opportunity to ask questions of key staff and directly observe program operation. In two instances (Coroner's Office and Susie Gaines Mitchell Building), the Grand Jury was able to tour these new facilities and gain an appreciation of the significance of modern design and equipment. In contrast, the Grand Jury toured the Children's Receiving Home, which is showing its age relative to growing demands for space, modern design, and upgraded infrastructure.
The committee also reviewed responses from agencies relating to the 1996/97 Grand Jury Final Report to verify implementation of the responses.
On October 6, 1997, the Sacramento County Grand Jury toured the Children's Receiving Home (CRH), located on Auburn Boulevard in Sacramento.
Founded in 1944, CRH relocated to its current six-acre site in 1965. In 1974, the County committed federal revenue-sharing money to enlarge the facility to its current 70-bed capacity. The annual budget is approximately $2 million.
California law requires Sacramento County to provide short-term residential care for children who are temporarily deprived of parental care. Sacramento County contracts with CRH for this service. CRH is a nonprofit agency governed by a board of directors. It is the only agency in Sacramento established to provide this type of shelter to children between the ages of two and seventeen. CRH is open 24 hours a day, seven days a week. It provides for the educational, recreational, and medical needs of children who are dependent or neglected, or deprived of home supervision due to emergencies.
CRH is licensed by the California Department of Social Services. The children are placed in CRH by the County's Department of Health and Human Services or by court order. Approximately three-quarters of the children are brought to CRH by Sacramento County law enforcement agencies; the rest are referred by social service agencies.
Generally coming from traumatic situations, many of these children have acute emotional and physical needs. For most, it is the first time they have been removed from their homes. A child's stay may range from a few days to several months, depending on the circumstances. The average length of stay is 35 days. Children are usually discharged to extended family instead of their immediate families. Or, if the situation warrants, children are released to foster care or a long-term group home such as the Sacramento Children's Home located on Sutterville Road.
CRH's executive director oversees the daily operations and programs. Most of CRH's 70 employees are childcare workers, who work in three shifts to provide continuous care. Psychologists and social workers prepare the children for court appearances and provide age-appropriate counseling. The staff also includes three licensed vocational nurses, an activity and recreational therapist, and a pediatrician. The pediatrician is on site weekly and on call 24 hours a day. A psychologist provides weekly counseling services. Every staff person is required to be fingerprinted.
For the past 20 years, the San Juan Unified School District has provided kindergarten through 12th grade classes on site. CRH has its own principal / teacher, plus several other dedicated teachers and aides. There are four classrooms to meet the challenges of the children's educational needs. Curriculum may vary daily as the school's population fluctuates. Translators are provided for non-English speaking children.
CRH runs an in-house volunteer program. This program provides support to the staff and coordinates the volunteer activities. Volunteers include individuals as well as persons affiliated with church and service organizations. Last year, corporate volunteers spent a day painting and cleaning. They also donated furniture and computer equipment to the facility. CRH accepts community contributions such as clothes and toys.
The Grand Jury was impressed with the efforts made by the staff at CRH given the limited resources.
Findings & Recommendations
Finding: According to the Children's Receiving Home's executive director, there is on-going discussion regarding needed repairs and expansion of the facility. The plans include increasing bed space to accommodate 100 children. The exterior fencing and landscaping need to be upgraded and security improvements made to provide more protection to the children. It was reported there are insufficient funds to finance the needed repairs.
Recommendation: The Children's Receiving Home's Board of Directors and the Sacramento County Board of Supervisors should make the much needed facility improvements. In order to fully fund these improvements and provide the security for the facility, the Sacramento County Grand Jury recommends that the Board of Directors explore all options such as seeking funding from the County as well as private resources.
Finding: The Children's Receiving Home's lobby is inadequate because of intense multiple usage in limited space. This area is shared by children waiting to be placed in CRH, by Children's Protective Services (CPS) as a temporary holding area for children requiring placement decisions, for police officers bringing in children needing temporary shelter, and for visitation of children or release of the children to their families. The limited lobby space is being used for temporary care of CPS children, who often wait hours before placement.
Recommendation: Children's Receiving Home's Board of Directors needs to work with CPS to establish a more appropriate work / waiting area for CPS' clients and case workers. This area needs to be away from the front lobby, which should be used exclusively for CRH needs. As an interim measure, CRH / CPS should consider the use of a portable building to house custodial children en route to temporary or permanent placements. Since the wait for placement could take hours, this building should have a play area for the children.
Finding: The present laundry facility is inadequate to handle the daily sorting, washing, and folding of the laundry. The laundry and kitchen are located in close proximity. There is a leaking walk-in freezer between the two rooms.
Recommendation: The laundry facility needs to be expanded to meet the requirements of the washing activities necessary to provide clean clothing for the children. The walk-in freezer needs to be replaced.
Finding: The storage room for donated items, primarily clothing and toys, is too small and inadequate.
Recommendation: Children's Receiving Home needs adequate storage to receive, sort, and store donated items until needed.
Finding: Safety issues were raised when the Grand Jury observed a plugged in hair dryer and curling iron left on sinks in the older girls' dormitory. These items, if accidentally in contact with water, could prove deadly.
Recommendation: These items need to be safely stored when not in use. If not done so already, all bathroom, laundry, and kitchen areas should have ground-fault interrupters installed.
Finding: The Grand Jury observed there was inadequate exterior lighting around the building. The play area's hardtop was uneven, several pieces of play equipment were not age appropriate, and other playground equipment needed modernizing.
Recommendation: Increase the exterior lighting by installing motion sensor lights. Bring the play yards and equipment up-to-date with today's standards for playground equipment and safety.
Special Recommendation to the Residents of Sacramento County
The Children's Receiving Home is urgently in need of more residential space. The plans are ready, the ground is available. Missing is the community's commitment to provide the resources necessary to make it happen. The children here are victims, most removed from their homes through no fault of their own. As residents, we should all work together to create an environment to welcome and care for these children. Our report identified some needs; however, call the Children's Receiving Home at (916) 482-2370 to find out how you can help.
On March 25, 1998, the Sacramento County Grand Jury toured the newly constructed Department of Human Assistance (DHA) facility located at 2450 Florin Road. This 55,000 square foot facility, known as the Susie Gaines-Mitchell Building, is open Monday through Friday from 7:30 a.m. to 9:00 p.m. The extended hours allow staff to share workspace and serve more clients. Public assistance services include CalWorks (welfare-to-work program), food stamps, general assistance, MediCal, and Temporary Aid to Needy Families (TANF), formally known as Aid to Families with Dependent Children.
The Bowling Green Office, another DHA facility, is located at 4333 Florin Road, within a few miles of the Susie Gaines-Mitchell Building. The service demands of the client population requires two offices in the same area. The Susie Gaines-Mitchell facility serves zip codes areas 95820, 95822, 95824, and 95831. The Bowling Green facility serves zip code areas 95823, 95828, and 95832.
The location of social service offices often involves a great deal of controversy. There are community concerns regarding concentration of facilities, traffic, loitering, litter, unemployment, and crime. According to DHA staff, they took those concerns into consideration during ten years of planning, designing, and searching for a suitable location. Financing this facility resulted from a combination of federal, state, and local funds.
According to DHA staff, to support small business development in the area, landscaping is maintained by contract with a local maintenance firm. An outdoor waiting area with tables and benches is located next to the designated covered parking space for a canteen truck. Locally owned and operated canteen truck vendors, approved by DHA, are allowed to park in the designated area.
The waiting area can accommodate 124 clients who can access information from television monitors, electronic bulletin boards at both ends of the room, and the public information desk. The building's design includes skylights to supplement artificial light and counters to fill out applications. Several smaller rooms are specifically designed and equipped for private interviews. Larger areas may be used for workshops, staff meetings, and job search activities. A specifically designed play area allows clients to place their children temporarily in a supervised setting.
The arrangement of cubicles in work-related modules facilitates easy access to client files. The use of cubicles also reduces construction costs and allows maximum flexibility to reconfigure workstations as programs and services change. Wiring for electricity, telephones, and computers is aesthetically hidden to allow easy access for maintenance and repair. and maximize opportunities when areas are reconfigured.
The County Board of Supervisors formally adopted a Good Neighbor Policy for the new facility. The policy enables DHA and the community to proactively solve problems, which helps maintain good will among businesses and neighbors in the area. DHA representatives, neighborhood groups, and business associations meet quarterly to discuss issues and resolve any concerns related to the operation and maintenance of this facility.
The Grand Jury was impressed with the newly constructed facility. The County and DHA have done an excellent job focusing on improvements in customer service and mitigating impact on the neighborhood.
On September 15, 1997, the Sacramento County Grand Jury toured the Sacramento County Coroner's facility, which opened July 1996.
The Coroner's Office investigates sudden and unexpected deaths in the County, certifies cause of death, and releases the bodies for final disposition. The staff consists of 20 permanent positions and 25 full-time equivalent contract personnel who handle investigations, forensic pathology, and administrative functions. The Coroner's Office is staffed 24 hours per day, 7 days a week. In fiscal year 1997/98, the budget was $4.3 million, with approximately $1.4 million bid by contract. The Coroner is appointed by the Board of Supervisors. This position does not require a medical background.
Observations & Recommendations
The Coroner's Office performs between 500 - 600 autopsies per year. An autopsy is usually performed in situations with any of the following criteria: homicide, suspected child abuse, suspected elder abuse, fire scenes, multiple vehicle accident with trauma to body, sudden or unexplained death in children 12 years old or younger (an autopsy is mandated by law for sudden infant death), any undetermined death, any unidentified body, apparent natural death without supporting medical history, death while in custody, and peace-officer-involved deaths. The Coroner's Office may exercise discretion in performing an autopsy if death occurs under other criteria not listed above. A resident requesting an autopsy bears the cost if the Coroner's Office determines the autopsy is not necessary. The cost of an autopsy is approximately $1,000.
Recommendations: From January 1993 to June 1997, the average number of days to complete a case was reduced from 79.6 to 34.2 as a result (in part) of new procedures, technology upgrades and a new facility. The Sacramento County Grand Jury encourages the Coroner to continue to implement efficiencies associated with the time to complete cases.
The Coroner's Office has the potential to increase revenue for the County by marketing its facility and services. Revenue is generated from the leasing of morgue space and contracting out forensic pathology services. The Sacramento County Grand Jury encourages the Coroner to continue to develop revenue generating opportunities, such as providing morgue services to hospitals and adjacent counties. Also, the Grand Jury encourages the Coroner to explore the costs and benefits of utilizing outside providers when it is determined to be cost effective.
No Response Required
The following is a list of complaints received and investigated by the Health and Human Services Committee.
Children's Protective Services (CPS) is a division of the County's Department of Health and Human Services. CPS administers programs to prevent child abuse and neglect by assisting families of children considered at risk and removes children from families where the risk is imminent.
Three well-publicized cases of child abuse were brought to the Sacramento County Grand Jury's attention. These cases were all similar in that a young child was seriously injured or died at home as a result of abuse. Based on the Grand Jury's investigation, it was determined CPS was aware of these children's domestic situations. Those events led the Grand Jury to initiate a proactive complaint to question whether the problems in the system were due to CPS' guidelines regarding the removal of children from a potentially dangerous environment (drugs, alcohol, history of abuse) or due to how cases were handled. The Grand Jury also questioned whether the philosophy of keeping the family together (Family Maintenance Program) was taking priority over protecting the children's welfare.
The Grand Jury interviewed detectives from the Sheriff's Child Abuse Bureau. Also interviewed were the agency administrator for Health and Human Services, a court investigator for CPS, staff from the District Attorney's Office, and child homicide investigators.
Findings & Recommendations
The Grand Jury's investigation concluded that problems in the system were due both to CPS' guidelines regarding the removal of children from a potentially dangerous environment and the day-to-day handling of the cases. Both aspects are being addressed by CPS, particularly in response to the Critical Case Investigation Committee. According to the District Attorney's Office, the rate of child homicides is decreasing. An effort is under way to reduce social workers' caseloads.
Finding: CPS recognizes that substance abuse in the home is an important factor in deciding whether a child should be removed from or returned to his or her home.
Recommendation: The Grand Jury encourages Children's Protective Services to continue to emphasize its policy which places the welfare of the child above family preservation.
Finding: CPS personnel are inconsistent in their interactions with personnel from other agencies such as the Sheriff's Child Abuse Bureau and the District Attorney's office. Communication with CPS, although improving, remains problematic as do some procedures. Based on the Grand Jury's investigation, it would appear CPS procedures are inconsistent and seem to depend on the individual executing them. Agency reports, which can be shared, are not shared. Other agencies report that CPS files are often hard to find and are inaccessible. Furthermore, some agencies allege that CPS does not prioritize medical reports of suspected child abuse.
Recommendation: CPS should improve its filing system so that files can be found more readily. They should develop, implement, train, and monitor personnel on communication procedures. CPS should provide suspected child abuse reports received from medical personnel to appropriate agencies.
Finding: The Sheriff's Department has a Child Abuse Bureau (CAB) and Homicide Unit. The Homicide Unit investigates child homicides.
Recommendation: CAB and homicide detectives should be cross-trained in each other's disciplines. Alternatively, CAB and Homicide detectives should team on cases of child homicide.
Finding: According to multi-agency teams, two recent joint child protective operations were effective in removing at-risk children from high-risk situations.
Recommendation: There should be ongoing joint child protective operations to put the community on notice that the County is serious about removing children from homes where they are at risk.
In-Home Support Services (IHSS) is a unit within the Senior and Adult Services Division of the Department of Health and Human Services. IHSS family service workers assist homebound seniors and disabled adults with daily needs such as meals, bathing, shopping, cleaning, medication, and social service referrals. The Sacramento County Grand Jury received a complaint alleging that an IHSS supervisor was harassing a subordinate.
Finding & Recommendations
Finding: Based upon the Grand Jury's findings, civil service procedures were not followed to resolve complaints and grievances.
Recommendation: The Department of Health and Human Services should conduct ongoing in-service training for staff and management regarding conflict resolution, personnel evaluations, and county policies and procedures for addressing complaints and grievances. In addition, IHSS should investigate and resolve individual complaints of harassment.
Finding: Management and human resources personnel appear to differ over their roles and responsibilities regarding the handling of adverse actions not related to sexual harassment or discrimination.
Recommendation: The Department of Health and Human Services should define roles and responsibilities of management and human resources, and ensure their implementation by providing adequate training and evaluation.
The Bureau of Family Support (BFS) is responsible for the accounting and collection of court-ordered child support payments and spousal reimbursement of Aid to Families with Dependent Children (AFDC). BFS also prosecutes individuals delinquent in child support. The Investigations Division looks into welfare fraud complaints.
The Sacramento County Grand Jury investigated a complaint concerning BFS and the Investigations Division. The custodial parent alleged his ex-wife was fraudulently receiving AFDC. Consequently, BFS inappropriately requested that he pay child support. Although the complainant resolved the issue during the initial stages of the Grand Jury's investigation, the Grand Jury felt it was important to complete the investigation to determine the cause of the problems. The difficulties encountered by the complainant were exacerbated by each agency referring the complainant back to the other agency for assistance.
Findings & Recommendations
Finding: Based upon interviews conducted by the Grand Jury, it appears communication between the Bureau of Family Support and the Investigations Division is poor, as it relates to the collaboration on individual cases.
Recommendation: The Bureau of Family Support and the Investigations Division should improve communication between their agencies regarding case investigations with joint responsibility. Both BFS and Investigations Division should continue with technological upgrades to facilitate information sharing between the agencies.
Finding: The Grand Jury noted neither the Bureau of Family Support nor the Investigations Division adequately inform clients and the public about their procedures.
Recommendation: Both agencies should make basic information regarding commonly asked questions and confidentiality of information visible and available in their respective lobby areas. In addition, the Bureau of Family Support and Investigations Division should develop partnerships with other agencies to assist clients and the public with questions about the administrative and legal procedures associated with their respective agencies.
Finding: During discussions with personnel from the Bureau of Family Support, procedures were unclear regarding the acceptance and processing of case information.
Recommendation: The Bureau of Family Support and the Investigations Division should conduct in-service training involving staff at both agencies.