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Minutes 022602
Approved March 12,2002 MINUTES i918 1976 \ CADS ATASCADERO CITY COUNCIL MEETING TUESDAY, FEBRUARY 26, 2002 7:00 P.M. REDEVELOPMENT AGENCY: 6:30 P.M. CLOSED SESSION: 1 . PUBLIC COMMENT - CLOSED SESSION 2. Call to Order a.) Conference with legal counsel - Pending litigation (Govt. Code Sec.54956.9) Diamond v City of Atascadero 3. Adjourn 4. CLOSED SESSION REPORT City Attorney Roy Hanley announced there was no reportable action taken. REGULAR SESSION, 7:00 P.M.: Mayor Arrambide called the meeting to order at 7:22 p.m. and Council Member Johnson led the Pledge of Allegiance. ROLL CALL: Present: Council Members Clay, Johnson, Luna, Scalise and Mayor Arrambide Others Present: City Clerk Marcia McClure Torgerson and City Treasurer David Graham CC 02/26/02 Page 1 Staff Present: City Manager Wade McKinney, Community Development Director Warren Frace, Administrative Services Director Rachelle Rickard, Public Works Director Steve Kahn, Public Works Technician Valerie Humphrey, Associate Civil Engineer Jeff van den Eikhof, Police Chief Dennis Hegwood, Fire Chief Kurt Stone and City Attorney Roy Hanley. APPROVAL OF AGENDA: MOTION: By Council Member Luna and seconded by Council Member Johnson to approve the agenda. Motion passed 5:0 by a roll-call vote. PRESENTATIONS: 1. Proclamation - Proclaiming March 2002, "Grand Jury Awareness Month." Mayor Arrambide read the proclamation and presented it to Leon Korba. Mr. Korba thanked the Council for acknowledging the importance of the Grand Jury in our community. COMMUNITY FORUM: Ann Ketcherside, P.O. Box 941 , Atascadero, expressed her concerns with previous actions of the Council by reading scriptures from the Bible. Eric Greening, 7365 Valle, informed Council that the County Planning Commission would consider the expansion of the Rocky Canyon quarry at their meeting on Thursday. Mr. Greening urged City representation at the hearing. Austa Haman, San Gabriel Road, representing the El Camino Homeless Organization (ECHO), gave the Council a summary of their services and a few success stories. David Broadwater, 6604 Portola Road, employee of Atascadero State Hospital, shared with the Council his concerns regarding the operations at the Hospital and distributed a packet to the Council explaining those concerns in detail. (Attachment A) Council Member Luna asked the Council to agree to place this issue on a future agenda as a public hearing and invite Hospital management to address the hearing. CC 02/26/02 Page 2 PUBLIC COMMENT Mary Maloney, Carmelita Avenue, asked the Council to support a yes vote on Measure A. Maryanne Cates, 5800 Cascabel Road, urged the Council to vote yes on Measure A. Eric Greening, 7365 Valle, stated he is going to vote no on Measure A and asked the Council to oppose the measure. Tom Hale, 8375 Los Osos Road, thanked the Council for letting him speak again on this issue. He spoke in favor of Measure A. Pearl Munak, 3770 North River Road, Paso Robles, stated that AARP has endorsed a yes vote on Measure A. Charlotte Bryne, Tranquilla Avenue, speaking as Chair of the Commission on Children and Youth for the County, stated they are against Measure A. Mayor Arrambide closed the Public Comment period. MOTION: By Council Member Clay to support a negative on Measure A. Motion failed for lack of a second. Mayor Arrambide stated that Council would close this matter with the idea that this is a very important issue and the community needs to get out and vote their conscience. A. CONSENT CALENDAR: 1 . City Council Minutes — February 12, 2002 ■ City Clerk recommendation: City Council approve the City Council minutes of February 12, 2002. [City Clerk] 2. 22 Passenger Accessible Bus - Authorization to purchase through State Department of General Services ■ Fiscal Impact: $48,000 funded through a Section 5311 Grant, $12,000 funded through TDA funds ■ Staff recommendation: Council approve: 1. The draft Resolution authorizing the City Manager to execute contracts with the State of California for Transit grant monies and amending the Transit budget to reflect the purchase of an additional Transit vehicle; and, 2. The draft Resolution authorizing the Department of General Services of the State of California to purchase vehicles on behalf of the City of Atascadero. [Public Works] CC 02/26/02 Page 4 MOTION: By Council Member Johnson and seconded by Mayor Pro Tem Scalise to: 1. Adopt the draft Resolution certifying the proposed Negative Declaration 2001-0053; and, 2. Introduce the draft Ordinance for first reading by title only, to approve Zone Change 2001-0019; and, 3. Adopt the draft Resolution approving Conditional Use Permit 2001-0050 for the Master Plan of Development subject to findings and conditions of approval; and, 4. Adopt the draft Resolution approving Road Abandonment 2001-0007, a request to abandon a portion of the Musselman Avenue colony right-of-way, based on the appropriate findings and subject to the conditions of approval; and, 5. Adopt the draft Resolution approving Tentative Tract Map 2001-0008, subject to findings and conditions of approval. Motion passed 4:1 by a roll-call vote. (Luna opposed) (item #1. Resolution No. 2002-005, #3. Resolution No. 2002- 006, #4. Resolution No. 2002-007, and #5. Resolution No. 2002-008) C. MANAGEMENT REPORTS: 1 . 2001 Audit Report ■ Fiscal Impact: None ■ Staff recommendation: Council review and accept the audit report for the fiscal year ended June 30, 2001. [Administrative Services] Administrative Services Director Rachelle Rickard gave the staff report and answered questions of Council. PUBLIC COMMENT - None MOTION: By Council Member Luna and seconded by Council Member Johnson to receive and file the audit report for the fiscal year ended June 30, 2001. Motion passed 5.0 by a voice vote. 2. 2002 Community Development Block Grant Funds ■ Fiscal Impact: $242,266 in 2002 Community Development Block Grant Funds ■ Staff recommendation: Council forward to the County Board of Supervisors allocation recommendations for the 2002 Community Development Block Grant (CDBG) funds as recommended by staff. [Public Works] CC 02/26/02 Page 7 Public Works Technician Valerie Humphrey gave the staff report and answered questions of Council. PUBLIC COMMENT Barbara Newsom, Atajo Avenue, EOC Health Services, thanked Staff for recommending funding of their services, and asked Council to concur with the recommendations. J.D. Main, 9340 Madrilla Lane, Homeless Housing Project (HHP), asked the Council to re-consider their request for funding for the Motel Voucher Program. Eileen Allan, North County Women's Resource Center, thanked Staff for their recommendation. Frank Furtschneider, Atascadero Loaves and Fishes, thanked Staff for their recommendation. Pearl Munak, HHP, explained their services, how ECHO and other organizations make referrals to HHP, and their current financial situation. She asked Council to consider these factors when making grant recommendations. Dwayne Homan, San Gabriel Road, representing ECHO, thanked the Staff for their recommendations. Gail Gresham, Big Brothers Big Sisters (BBBS), asked the Council to consider their application and referred to her handout. (Attachment B) Jerry Kanamoto, Board Member of BBBS, asked the Council to support their application for funding for the mentoring program at Atascadero High School. Bernadette Bernardi, Executive Director Literacy Council, thanked staff for their recommendation and asked Council to concur. Barbara Newsom, discussed the importance of mentors in their program. David Rile, Cuesta College Small Business Development Center Program, thanked staff for their recommendation. Mayor Arrambide closed the Public Comment period. MOTION: By Council Member Johnson and seconded by Mayor Pro Tem Scalise to approve the CDBG funds as allocated with the exception of taking the $3,000 excess funds in the EOC and moving them over to the Big Brothers Big Sisters Program. Motion passed 5:0 b y a roll-call vote. CC 02/26/02 Page 8 Attachment : A Atascadero City Council Mtg . to: Atascadero City Council 2/26/02 2-26-02 re: Community Hazard presented by current operations at Atascadero State Hospital (ASH) Under-staffing, Over-crowding, Escape Potential Abuse & Neglect of Weakest & Most Dangerous SLO County Residents for: Inquiry into ASH operations. The most disturbed and dangerous mentally ill criminals in California are housed at ASH, except for those incarcerated in Pelican Bay. ASH has a higher rate of escape than any other institution in SLO County. Conditions inside ASH perpetuate the potential for continued escapes. Those most in need of ASH's services are denied them. Internal bureaucratic inertia militates against reform. Governmental agencies must investigate and intervene to improve conditions, care and community security. In 1990, the U.S. Department of Justice's Civil Rights Division concluded its eight-year "investigation of alleged unconstitutional conditions of confinement at Atascadero State Hospital" by notifying ASH of its "continuing criticism of inadequate staffing". The CRD cited three specific "deficiencies at ASH that were uncovered by our investigation" and "minimum measures needed to correct those deficiencies". The CRD explained how understaffing leaves LOC (Level Of Care) employees over-burdened and patients under-served & under-supervised, creating an unnecessarily dangerous environment. Among the CRD's "minimum measures" were adding: (1) one staff person per shift to compensate for staff dispensing medications, and (2) one person per shift to compensate for staff performing any individual (1-to-1) patient observation. This means that a day or afternoon shift on a ward with 40 patients and a "1-to-1" should be staffed with seven employees, and that the night shift should have four on duty. ASH's refusal to comply with these "minimum measures" (staffing the day &afternoon shifts with only five, and the night shift with only three) leaves this typical ward with staff at 71% & 75% the level recommended by the federal government. The third area of deficiency involves the way minimum staffing levels are calculated and the inclusion of"a host of unlicensed staff categories" in those minimums. ASH continues to use these methods to cheat staff and patients of adequate assistance, competent care and sufficient supervision. ASH's practice of over-crowding wards with populations exceeding their capacity exacerbates the problems created by understaffing, by jamming too many people into a confined space, and eliminating places of refuge from the ambient cacophony and the availability of seclusion rooms for those reacting violently to their environment. ASH refuses to adopt a policy prohibiting the use of "quiet rooms" and seclusion rooms as patient residence areas. This creates a situation in which neither staff nor their clients have effective means to cope with environmental contingencies or stressors. Supervision and vigilance are compromised under these circumstances, as well. The ward from which the serial rapist escaped in September was overcrowded, and it & those where the riots occurred were subjected to this condition after those events. Under these conditions, it is impossible for LOC staff to adequately observe and intervene in activities that pose threats to the safety of those working and living inside ASH, or to prevent exposure of the community to these threats. Patients intent on escaping are provided with an environment in which it is relatively easy to engage in clandestine activities undetected. Under these conditions, it is impossible for LOC staff to provide services to those clients ASH is designed to help. The current level of SVP commitments exacerbates these impediments, but they precede and will persist beyond this anomaly. Attempts at reform from within have proven futile. As it now functions, ASH presents a clear& present danger to the safety of the community at large. It's clear that only pressure from neighbors and investigation by their representatives will provide the impetus for improved worker, patient and community security. Local governmental bodies and agencies must take the initiative to protect ASH's residents, workers and neighbors from the hazards it presents to them. Too many escapes and riots and too few corrective actions have occurred, indicating that internal bureaucratic adjustments, by themselves, will be impotent. Please initiate an evidentiary / exploratory inquiry soon to examine this situation - before it's too late. David E. Broa ate_ Psychiatric Technician, ASH since 1972, DMH since 1969 013 Le • >, ^' _ Y E N C .v1 Y V R= •� �C _— C. Y A, '� J N TS O 3•C '• C - 3u " 3R.cauT LL. Ems-= RC __ k = � � W � — = mum E o 'J �N :< .' ,C GG C C y��' C R 3= R E C N J _f" 7�.�Oj �S //,, i ' _ - ^7, C'T 7 N.•"C ° y �._ ° R E 3 £ a u E au �� 0 0 0. �`o'• Y2 c= E > n•O e � o aL ,y °J v _'^= cc � � u .. :•3 Y n E £Toui Tc c . _.. _ £ e�= E e E c !JL u c o ° o-k°= gxs Y! 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R :Z N t °N-°o YY a t' C� °' c u E �+ L� -r =0 cC :.:�.: ��; '• :�,...::.:'• a � o EYaEu uRu ° aooc ` uRR-5 �= CS Cc°, uu �> Ci :.:j =^' :._;:• ,:: mW ueot°ou �=�°s�� -5 �° ae � uS .�S 'ER�aE .'S Y •O O o0�+e0 C T, Y Y ACY `uRueL ` 3 N io pp'n� p,•p6 L^ 6%_>i o4�• F"ov�� C =cE >•� G V � C._ C C•fl C V1 Y E >`O tS C•_ 7 > HoE•a,> �d�• �NLNQ a�YC�� �.��,�� �yYYEGX• �R R-ica'�.. E < E W- n R 5 � 5 u S. Z • v o -.-Rua;p 4 b _ 014 ASH Brief 11-2-01: n Threats to Staff& Community Safety sl + Overcrowding of Wards/Units • Understaffing of Wards/Units • Lack of Control over Patient Behavior ASH Administration's overcrowding and understaffing of the facility's units, and its subversion of staff authority over patients are dangerous to employees and the community. These conditions increase the potential for violence and escape. ASH Administration has repeatedly refused to correct these conditions despite admonitions to do so by the federal government, ASH advisory committees, employee unions & individual staff. OVERCROWDING Before, during& after the most recent escape& two recent riots, numerous units are housing patients at levels from 5 to 15 above capacity, despite an ASH vacancy rate ranging from 71 to 93. Overcrowding causes: • Increased tension among the patient population & potential for incidents of violence& injury. • Elimination of Quiet Rooms (for patient relaxation) & Seclusion Rooms (for violent patient containment). • Decreased safety& security- reduced staff ability to: observe physical conditions on units, observe patient behavior, & a intervene in dangerous patient behavior. a' • Increased potential for escape (ability to secrete materials & act covertly). ti UNDERSTAFFING • Staffing Ratio requirements repeatedly violated. (8-8-16 mandated AM, PM, NOC shift minimums) • Acuity System used to cheat units of adequate staff. (rounded-off fractions reduce staffing) • U.S. DOJ/CRD 1990 recommendations ignored. (Medication & Individual Observation staff used in staffing ratios) ASH is required to staff units using 2 methods: according to patient population, & according to patient needs. The ratio of staff-to-patients during the AM & PM shifts must be at least 1-to-8 & during the NOC shift at least 1-to-16. Individual patient needs in various areas of care (acuity-ratings) are used to estimate the number of staff required on each shift. ASH includes staff dispensing medications and performing individual patient observations in both methods of staff-allocation. ASH also includes un- licensed staff in its staffing ratios. Understaffing causes: • Decreased patient services & structure. • Increased patient anxiety& drug-usage. • Increased patient violence& usage of seclusion & restraint. • Reduced staff ability to: observe physical conditions on units, observe & intervene in dangerous patient behavior, & P1 document & communicate patient behavior. .� Increased potential for escape (reduced supervision of environment&behavior). 015 ASH Overcrowding/ Overpopulation ASH Daily Census Sheet Wd/Ca 9 /40 15 /3120/3421 135 19 /47 7 /33 10 /302 /33 22 / 3423 /3530 /43.29 /43�yT+ �'ac lei—9-11 /+ 1 1 1 1 1 1 l 1 8 87 9-12 /+ 1 1 j 1 1 I I I l l 1 I 1 I I p 7 N 89 i 9-13 /+ 1 1 1 1 j 1 1 1 1 1 1 1 1 7u 75 9-14/+ I-T 1 I 1 6 75t 9-15 /+ 1 1 1 1 i 1 1 i j i 6 N 75 9-16/+ 1 1 1 1 1 I j 6 76 9-17 /+ 1 1 1 1 1 1 I 6 1 73 9-18 /+ 1 1 1 1 j 1 : r 74 i 9-19/+ 1 1 1 1 1 i 5 ' 77 9-20/+ 1 1 1 1 11 j 5 77� 9-21 /+ 1 M11 1 1 j 5 76 9-22 /+ 1 1 1 1 ' 6 77 9-23/+ 11 1 1 5 N 76 9-24/+ 9-25 /+ 1 1 1 1 1 8 79 9-26/+ 2 1 1 1 8 82 9-27/+ 9-28 /+ 3 1 1 1 10 75 9-29/+ 3 1 1 1 10 75 9-30 /+ 3 3 1 1 1 1 10 76 10-1 /+ 3 3 1 1 1 1 1 101 77 10-2 /+ 3 3 1 1 1 1 10 80 —10-,) / + 3 3 1 1 1 1 10 84 10-4 /+ 3 4 1 1 1 1 1 12 78 10-5 / + 3 4 1 1 1 1 1 12 76 10-6/+ 3 4 j 1 1 1 1 1 12 76 10-7/+ 3 4 1 1 1 1 1 12 77 10-8 /+ 3 4 ; 1 I ( 1 1 1 12 77 10-9 / + 10-10 /+ 3 4 1 1 1 1 1 12 72 10-11 / + 3 3 1 1 1 1 1 12 76 10-12 /+ 3 4 1 2 1 1 1 13 73 -10-13 /+ 3 4 1 2 l 1 1 13 73 10-14/+ 3 4 1 2 I 1 1 13 73 10-15 /+ 10-16/+ 2 1 4 1 2 1 l 3 14 71 10-17/+ 2 4 1 2 1 2 1 13 76 10-18/+ 2 4 1 2 1 3 1 14 83 10-19/ + 2 4 1 3 1 2 1 1 15 82 10-20/+ 3 1 4 1 3 1 2 1 1 15 83 10-21 /+ 3 4 1 3 1 2 1 15 84 10-22 /+ 3 4 1 3 1 3 1411 83 10-23 /+ 1 3 1 3 81 93 Wd/Cap=Ward(unit)#&Capacity(population maximum) Date/+=date&census amount Over CapacitN T+=Total ASH census over capacity Vac=total ASH Vacancies 017 U.S. Department of Justice / Civil Rights Division, 1990 "On July 1, 1982 the U.S. Department of Justice started an investigation of alleged unconstitutional conditions of confinement at Atascadero State Hospital, pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA). ... "The investigation is now closed despite continuing criticism of inadequate staffing, ...." [a] "... we issued a findings letter on May 1, 1984, which advised you of deficiencies at ASH that were uncovered by our investigation. Our findings letter also outlined minimum measures needed to correct those deficiencies." [b] "Our most recent on-site visit was conducted in early February 1989, with the assistance of our consultant, Jeffrey Geller, M.D., M.P.H. ... In our view, although some problems remain at ASH,...." [b] "Whereas Dr. Geller found that direct care personnel strength, during the day and evening shifts, gave an appearance of being reasonable, he stated that actual staffing levels did not allow patients to take full advantage of available services." [b] "Dr. Geller suggests that ASH's one-to-sixteen staffing ratio during the night shift be enhanced to permit ASH to deal more effectively with emergencies." [b] "Notwithstanding,this closure decision, I trust that ASH, with full support from the state, will continue to improve conditions and address those matters identified by Dr. Geller in his report and summarized in this Fetter." [b] "FINDINGS ... LOC Staff: ... It is the manner that these minimums are calculated that is problematic. The LOC staff included in the calculations of the minimums are not only psych techs and registered nurses, but also a host of unlicensed staff categories which include... psychiatric technician apprentices, ... psychiatric technician students, psychiatric technician trainees, psychiatric technician candidates,and prelicensed psychiatric technicians. Moreover, all LOC Staff, excluding unit supervisors, are included in the calculation of the ratio. Thus, staff doing close observations or one-to-one staffing are included, as is the medication nurse. Finally, the staffing does not actually represent a 1-8, 1-8, 1- 16 minimum, since the requisite number of staff people does not increase by one staff until one is halfway through any interval. In other words, the requirement to meet the ratio of one to eight for thirty-two patients is obviously four. However, by Atascadero's calculation, the number of staff required to meet a ratio of one to eight for thirty-three patients, thirty-four patients, and thirty-five patients, is also one to four." [c. pg 4] "Calculating the minimums in this fashion does create problems for line staff. Generally, the person passing medication takes anywhere from three quarters to the entire shift in his or her task. ... On some wards in fact, it takes 1.5 persons to pass medication. ... Because the medication person(s) counts in the ratio and because each staff member gets one hour for a lunch break, the actual number of staff at any given point available to patients is considerably lower than the stated minimum." [c. pg 4-5] "For example.... ...an evening when there was nobody on a one-to-one, or close observation. Had there been such, no one would have been able to leave the ward." [c. pg 5] "It was clear... that the current determination of minimums negatively impinged on the ability of patients to go to programs off wards.-... Less programming often leads to more medication usage and more seclusion and restraint since patients are left on wards without structure." [c. pg 5] "Given all of the above, the ratios of 1-8, 1-8 are certainly reasonable. The ratio of 1-16 is of questionable adequacy and allows little room for emergencies. The ratios should be calculated excluding the medication person and excluding any staff on the ward who are required to do one-to- one staffing of any description." [c. pg 5] "FINDINGS ... Medical Record: The medical record,... (CRDS), continues to be a burdensome, cumbersome, and time consuming for all disciplines of clinical personnel at the facility. The medical records system and its requirements place an increased burden on LOC Staff. [c. pg 5] "The record requires personnel to simply fill it up with verbiage, which is noncontributory to good patient care since it neither directs treatment nor reflects outcomes. [c. pg 7] Gis "The problematic nature of the medical records is perhaps best exemplified by those treatment teams that seem to be sincerely trying to produce good to excellent records. ... Even a team who 'follows all the rules' and completes the paper work as it should, ends up with reams of duplicative paper work which do nothing useful to assist the team in the care and treatment of its patients." [c. pg 7] "SUMMARY OF MAJOR FINDINGS - Those issues which still come under the purview of requisite scrutiny and improvement are as follows: ... 3. LOC staff needs to be in attendance in sufficient numbers such that ratios are maintained without counting into the ratio the medication person and those LOC staff providing one-to-one coverage. ...; the ratio of one to sixteen for the night shift needs to be seriously reviewed. Shortfalls of LOC staff are generally compensated for by excessive sedation of patients through overmedication." [c. pg 21] "4. The medical record system needs to be reviewed and overhauled such that it facilitates rather than interferes with patient care and treatment." [c. pg 21] ASH Memorandum announcing closure of 8-year investigation, including: a. Memorandum "To: All Medical Staff Members" re: "U.S. Department of Justice Investigation", A. W. Mertz, M.D., Chief of Staff. 4-19-90. b. U.S. AG/DOJ/CRD letter to Calif. Governor"Re: CRIPA Investigation of ASH". J. P. Turner, Acting Assistant Attorney General. 3-30-90. (CRIPA = Civil Rights of Institutionalized Persons Act). cc: Calif. Attorney General, DMH Acting Director, ASH E.D., U.S. Attorney - Central Dist. Calif. c. Enclosure to b.: U. of Mass. Medical Center, Department of Psychiatry letter to Special Litigation Section, Civil Rights Div., U.S. DOJ, Jeffrey Geller M.D. M.P.H. 3-3-89. 019 .Mate "California Memorandum All Medical Staff Members Date April 19, 1990 File No.: Subject: U. S. Department of Justice Investigation From Atascaclera State Hospital (805) 461-2000 ATSS 690-0111 On July 1, 1982 the U.S. Department of Justice s r _d an investiga- tion of al e�'g d unconsti 'onal conditions of confinement at Atascadero State pital, pursuant to the ivil Rights of Institu- tionalized Persons Act (CRIPA) . Four evaluators came in 1983-84 and six problem areas were identi- fied. A consent decree was reached-1-n 198_6_ for improvements in patient care: -The i`nvesf-i�af ._ �i-'�� �._�_. Q �s nor wc.lose despite continuing. criticism of inade uate s affing, overuse o restraint and sec'Iusion an excessive use and too frequent dosing of medications. Attached is thereportof Jeffrey Giller, M.b. from his (third) visit to Atascadero State Hospital on February 2-3 , 1989 . Please note any comments about your patients and make a response to me. Also be prepared to discuss these notations at the Medical Staff Forum on Polypharmacy scheduled for Tuesday-,-Bay-2 7. Audrey W. Mertz, M.D. Com' Chief of Staff AWM•vw Attachme:lt 020 Civil Rights Division r,Q�• fir. L T) I 'Ulf Office of Me Alttttan t Attorney Genera f►'crhrnfron,D.C. 20330 U, Honorable George Deukmejian 3 ��30 Governor of California State Capitol Building R E E I V K D Sacz•amento, California 95x'.4 OR 9 1990 Re : CRIPA Investigation of IMdesl Sun OnKe Atascadero State NosAital "'a""dr'O sou Wed Dear Governor Deukmej ., I am writing to inforr: you that the Civil Rights Division v of the United States Department of Justice has losed i=icxation of conditions of confinement at Atasca`DDiiv dero State Hospital (ASH) , Atascadero, California. As you are aware, we began our investi ation at ASH in 1982 , pursuant to the Civil Rights o Inst- utiona ize Persons Act (CRIPA) , 42 U.S . C. § 1997 et sea. Since 1983 , our attornevs and consultants visited ASH on several occasions to assess conditions ; here. As a resu t, we issue a in inas letter on which advised you of deficiencies at ASH that were unge vt`'` s b ' our investigation. Our findings letter also outlined minimum measures needed to correct those deficiencies. The Department retoured ASH through the years with various experts to determine whet er the suggested measures were being undertaken and implemented. Our L conducted in early February 1989 ,mwith rthe nassistancet on-site voflourwas consultant, Jeffrey Ge11Er, 2:, D. , M. P.H. In his tour report, which is attached hereto, Dr- Geller observed that ASH continued to make commendable improvements. Based on his rei�ort and other available information indicating significant improvements, we have ecidedo to e our investi ation. In our view, although some robletr,s rain at ASH, they are not of the magnitude Congress intended us to a 3ress pursuant to CRIPA. Dr. Geller made several critical observations with respect to care -it ASH, however, which we believe would be constru - tine to share with you now. Regarding the issue of staffincLl Dr.Dr. Geller concluded that ASH should increase its efforts to — hire. t:cre professional and direct care personnel . He noted a ` need :or additiona psychiatrists to resolve a shortfall which ASH haslaackr'o6wledged. Whereas Dr. Geller found that direct-- care 021 2 personnel strength, during the day and eve:.ing shifts , gave an appearance of being reasonLble, he stated that actual staffing levels did not allow patients to take full advantT:ge of available servi ear. Geller suggests that ASH'srone-to-six-een staLf'f rami Burin the night shift be enhance�to permt ASH to ideal more e . ectively with emergencies. Dr. Geller praised ASH for continued gains in its practice of psychopharmacology. His commendation was tempered , however, by concerns that ASH still needs to step up monitoring efforts with respect to a number of dreg and other p::actices identified in his report attached hereto. We would also call your attention to the need to closely monitor use of restraint and seclusion at ASH-. Though fewer patients are being placed in restraint and seclusion, statistics recently provided by ASH otherwise show a disturbing growth in the total hours of restraint and seclusion used since 1987 . Notwithstanding this closure decision, I trust that ASH, with full support from the State, will continue to improve conditions and address those matters identified by Dr. Geller in his report and summarized in this letter. In closing, I wish to thank State officials and ASF? staff for their cooperation in this matter. Sincerelx, James P. Turner Acting Assistant Attorney General Civil Rights Division Enclosure cc: Honorable John K. van de Kamp Attorney General State of California Mr. Douglas Arnold Acting Director Department of Mental Health Mr. Sidney F. Herndon Executive Director Atascadero State Hospital Robert L. Brosio, Esquire United States Attorney Central District of California 022 University of Y,:,ssachusetts Medical Center A . ,: Department of Psychiatry '. 55 Lcke Auenue, No,-:Ii Worcester, MA 016:.5 (SOS) 856-6580 March 3 , 1989 \ � Robert Stern, Edward Stutman f Special Litigation Section Civil Rights Division United States Department of Justice 320 First Avenue N.W. Washington, DC 20530 Dear Mr. Stern & Mr. Stutman: On February 2 and February 3 , 1989 , I made a site visit to Atascadero State Hospital upon the behest of the United States Department of Justice , Civil Rights Division. My report follows . DATA BASE DOCUME?;TS: Prior to touring Atascadero State Hospital (ASH) , I reviewed the reports that I had written on my two prior visits to that institution . I had visited Atascadero State Hospital at the request of the United States Department of Justice on August 26 , 27 , and 28_1._198.6 and on February 4 and 5 , 1961 . During or subsequent to my visit to Atascadero State Hospital , I reviewed the following materials : ASH Tables of Organization; Daily Census - February 2 , 1989 ; Level of Care (LOC) Staff - February 2 , 1989 ; LOC Guide for Minimum Staffing; ASH Staff Psychiatrist and Physician Surgeon Positions'- February 3 , '1989 ; List of Program Directors and their disciplines ; Monthly Statistics on Admission and Discharge ; Correspondence between ASH and HCFA - 1988 ; Correspondence between ASH and JCAHO - 1508 ; DMH Speci;:l Order No. DSH 117 - (Psychotropic Medication) - July 1; 1987 ; DMH Special Order No. DSH (Psychotropic Medication-) - draft, July 111 , 1988; D1-5i Special Order No. DSH ; 13 - (Psychotropic Medication) - September 1 , 1988 ; ASH Administrative Directive No. 518 (Restraint and Seclusion) January 3 , 1989 ; DMH Special ' Order No. DSH 127 (Movement Disorder) - March 1 , 1988 ; ASH Administrative Directive No. 516 . 2 (Movement Disorder ) 023 2 April 19 , 1988 ; ASH Administrative Directive No. 503 (Infection Control ) - January 5 , 1988 ; ASH Administrative Directivc.. No. 503 . 1 (AIDS) - draft; ASH Quality Assurance Program; Restraint and Seclusion quarterly reports 1988; Restraint and Seclusion annual reports 1987 , 1988 ; Special Incidents Reports 1988 Contracts with California Uni -rersities for Extended Medical Education; Handbook of Rights of Mental Health Patients (D2ui) ; ASH - Patient Privileging .Systen; ASH Trial Competency Program; Psychotropic Medication P.eview Committee 1988; Mortality P.eview* Committee : Juan Crespin 034367 - Death by suicidal hancing 5/88 , Michael Zelonis 33490 - Death 20 pul edema and recent episode of neuroleptic malignant syndrome - 2/88 ; Ilidia Medeiros 36879 - Death by suicidal hanging - 3/88., Thomas Crecz 35458 - 20 metastatic abdominal cancer - 1/88 ; Medical Staff Bylaws ; Medical Staff Rules and Regulations; Medical Staff Committee Assignments - 1988 . INTERVIEWS - During my tour of Atascadero State Hospital , I interviewed and/or had conversations with the following individuals : Gordon W. Gritter, M. D. , Medical Director William J. Sunmers , Clinical Administrator Nicolas R. Burgeson, Director of Information Resources Norman Black, Legal Office, DMH Ben McLain, Standard Compliance Co-ordinator Harold Carmel , M. D. , Assistant Medical Director Pat O'Rourke , Unit Supervisor, Program I, Ward 2 Duane Moench, Unit Supervisor, Medical Services Mitchell Brimmage , Shift Lead, Ward 1 Wanda Anderson, Unit Supervisor, Program II , Ward 10 Elyse Beem, Medical Nurse, Ward 10 Jack Pierce , Nursing Supervisor, Program VII John Beaton , Unit Supervisor, Program VII , Ward 27 Debra Freeman , Unit Supervisor, Program IV, Ward 25 Adelle Border, , Nur.-e , Ward 25 Bill Varges , Shift Lead , Program V, hard 12 Melissa Shemick, Psych Tech, Ward 12 Fred Messing, Unit Supervisor, 'rograr. IX, Ward 17 Sylvia DeMcrales , Nursing Co-ordinator, Program III Earen Sheppard, Psychologist/Project Co-ordinator, Ward 16 Paul Catham, Psych Tech, Ward 16 Peggy Thomas , Training Co-ordinator, Sex Offenders' Program Greg-Wright, Shift Lead, Program IV, Ward 15 Stephanie Garner, Psych Tech, Ward 15 TOUR SITES - All programs were visited at least once . For every program no less than one ward was visited. 024 3 RECORDS REVIEWED - On each ward visited, the medication record for all patients on that ward was reviewed. Individual patient records were also reviewed on each ward. On no ward were less than two records reviewed in detail . For a list of patient records reviewed, see Table 1 . FIT7-- D— T_NG� HOSPITAL ORGANIUXIj Z - The Atascadero State Hospital should be complimented for the relation-hip between its Administrative Staff and its Clinical Staff . As I had observed one year ago, the rapport is excellent and the.morale is good. Subspecialty areas , such as quality assurance and the pharmacy, are laudable . The tables of organization shoo some inconsistencies and at least • warrant a review. Noteworthy are the fact that psychiatrists are shown to be responsible in a line authority fashion to Program Directors in some of the tables of organization, in other tables of organization, they are shown to be directly responsible to the Clinical and Medical Director. Further, the tables of organization show that all nursing staff are directly answerable in a line authority fashion to the Clinical and Medical Director, yet the coordinator of nursing_ services is directly answerable to the Executive Director. Finally, in the table of organi-ation, individuals of significantly less training have line authority over individuals with considerably more clinical training. Basic to the hospital organizational structure is the issue of whether or not each program ought to be allowed to develop its own organizational structure or whether the hospital should be functioning as a single entity with a consistent organizational structure in every program. PHYFICAL VT, The Atasce ero State Hospital continues to move forward with its renovations ; the air conditioning project has gone a considerable distance from its status one year ago; the planned additional office space and program space were under * active construction. taff� Psychiatrists directly involved in ward based patient care number 26 . 6 (see Table 2 ) . Based on a hospital census of 917 , this number yields a ratio of one psychiatrist for every thirty-five patients . The ratio of psYchiatrists to patient; ranges from one to ten on the Acute Ward to one to sixty-three on ward 11 . The current number of direct care staff _psychiatrists is inadequate for the task of - pat'ient evaluation , care arid 'treatment at A�ascadero State Hospital , a finding which Dr. Carnell ag eed with . He indicated the current level of �taf z.n.g was inadequate and that the -- - - - - --- - - - 025 4 l facility was attempting t_o—activel.y__recruit to fill vacancies . - PsvchologistsL The current number of psychologists directly involved in ward assignments is 28 . 1 , rendering a ratio of psychologists to patients of one to thirty-three (see Table 2 ) . The ratio, however, is substan is y high_r than that on some wards . Based on current standards of practice, there ought to be a sufficient number of psychologists such that there can be one psychologist for every twenty to third patients dependent upon how their functions are defined on any given ward. Social Wgrk : The number of social workers is 57 . 5 . This leaves an average ratio of one social worker for every sixteen patients . If ward 8 , with its ten social workers is excluded , the ratio is one social worker for every nineteen patients . This ratio of one to nineteen appears"Madequ to given the fact that placement into the community is not an Issue for a substantial percentage of the population at Atascadero State Hospital. (See Table 2) LOC Staff : The numbers of LOC staff employed at Atascadero State Hospital were apparently sufficient for the hospital to meet staffing ratio of 1-8 , 1-8 , and 1-16 on February 2 , 1989 . They were in fact, able to do this without having to hire any overtime and without pulling staff from the registry with the exception of two staff people who were unnecessary to meet the minimums , but who were employed because of specific needs of the patient population at that time. It is the manner that these mi ' mums are calculat d that is problematic. The LOC staff included in the calculations of the minimums are not only psych techs and registered nurses , but also -.L- a host of unlicensed staff categories which include student as'sisf-ance, gra uate studer►�-assistance, hospital workers , psychiatric technician apprentices , social service assistants , psychiatric technician students , psychiatric technician trainees , psychiatric technician candidates , and prelicensea psychiatric technicians . Moreover, all LOC staff , excluding unit supervisors are inciud �n the`calcuZa'ion ofthe ratio. Thus , staff doing clos observations or one-to- no e_ staffi� ng e included, as is'tt?e 'r- medication nurse�Finally,�the sta��ing does"not'�actually represent_ a 1-8 , 1-8 , 1-16 minimum, since tie reauiste"'number of staff people does not increase by one stc�f -1 f'w�ay"'- t-H-eoucF,a terval..^ n-bt.het %'brds,- the reauirem ent-to neet' t e ratio of one to eiatz for thirty-two patients is obviously four. However , by Atascadero's calculation, the number of staff required to meet a ratio of one to eight for thirty-three patients , thirty-four patients , and thirty-five patients, is also one to four. Calculating the minimums in this fashion does create problems for --�-- _line_ staf.f.. Generally, 46-.he person passing medication to}:hs any.:here from three quarters to the entire shift in his o: h_r . - 026 5 task. This is by report of the line staff. On some wards in fact , it takes 1 . 5 pe:- :ns to pass medication. On Program 4 , Ward 25 , medication is passed by a medication person who take:: his or her entire eight hour shift and the medicatioi, assistant who takes approximately four hours of his o:- her shift. Because the medication person(s) counts in the ratio enc: because each staff member gets one hour for a lunch break, the actual number' o_,_Staff_at a civen -Poi.n.� a.v_a,il,abl.e.to_pati.erit:��_ s�c.Qnslderably- = low��t_ba�the s,ta�e3 mini^un.. For example: On Program 5 , Y,'ard 12 , there were thirty-'tor'patients with one registered nurse and three psych techs . The one registered nurse took nearly her entire shift to pass medication: ' Given that each of the three staff had an hour lunch break, there were in fact, four staff available to the thirty-two patients zero hours of the eight hour shift, three staff available five hours of the eight hour shift, and two staff available three hours of the eight hour shift. There was a evening activity on this second shift. There was a requirement that o:.e staff go with six patients. That evening it meant that no more than six patients could go to the evening ' activity because the staff could not afford to send more than one staff person off the ward. It is noteworthy that this occurrence was on an evening when there was nobody on a one-to-one or close observ._atior�. Had there been such, no one wou d have been a e o leave the ward. It was clear from discussions with LOC staff on several wards that the current dote:-urination of mins negatively impinged on the ability of pat e o go to programs off war s. This held truer for the second shift than for the ffTst-FR1f, and was obviously truer in those situations where patients had lessor privileges than in those situations where patients had greater privileges . Less programming often leads to more medication u^s_a_ga and more seclusion and restraint since patien s are eft on wards without structure . -'- Given all of the above , the ratios of 1-8 , 1-8 are certainly reasonable . The ratio of _1 .6_-�s ,of—que-stionab.le.-adequacy and allows little room emergencies . The ratios should be calbulated excludinq_the�medication personan exc. uding a ny ` . st=f on the ward who are reauiredo tdo 'one-to-one t saffing -of r- 'ariy�2escri.p io�i,_..._____ _ _.. Medical Officer o the Day: The Atascadero State Hospital has a psychiatrist and. a primary care physician on duty nights and weekends . This is in acccrd with good practice. MEDIC rCOP : The medical record , which uses a Clinical Records Documentation System (CRDs) , continues to be a burdensome , cumbersome , and time _consuming �`or-all disciplines of personnel atthe facility. The r+edical records Ts ter and its requirements place an ias_ed._bur.den on_..LOC staff . It was not uncormcn to see staff mer.bers_ 027 G nursing stations___at_almost anytime. For example, on Program 4 , `War2 d -5--at`4 : 00 p.m. , there were six. IAC staff for a census of forty-eight. Three of them were in the nursing station writing in records. On the Sex Offenders Program, there were five IAC + staff for thirty-seven patients. At 2 :00 p.m. , four of them were in the nursing station charting. There is so much paper work generated by these records that the support staff caTTr'f" e e p up witt�t.�e typ=ng. Records often have ,! iriTi'et-T"day reatment p arming conference reports which remain "';' untyped. In fact, some parts of the permanent medical recc-d for these ninety day treatment conferences are hand written on lined white paper and/or on lined yellow paper. Statements on the treatment planning conferences are often of a boiler plat- nature. See for example, patient 137690 . In other charts , data is missing . For example , on patient 135705 , the ' sections for summary of psychiatric medications , psychiatric progress notes , abnormal movements and summary of physical anj medical status are all blank. k'hile records are often up to date, this is not always the case. See for example patient 136810, who had no team conference report in his record since the seven day team conference on July 19 , 1988 . When I asked staff , they were able to locate in someone's office, a treatment team conference report from January 12 , 1989 ; no one could find the one which should have been done in October. On the other hand, this same patient had a discharge summary done on October 12 , 1988 . This was quite an informative document,' but as I have indicated in prior reports , it is problematic to have discharge summaries done so far in advance . It was further noteworthy that this patient also had discharge summaries done on January 20, 1988 , an addendum on March 20, 1988 , and a further addendum on May 25, 1988 . The psychiatrists are generally writing notes when they should. One place where this seems to fall down is in the writing of off- and on-service notes . For example , on patient 37246 , the departing psychiatrist wrote no off-service note on January 3 , 1909 . The psychiatrist who took over this patient's care wrote no subsequent on service note. Psychiatrists are generally writing notes when they change medication. These notes do not always show a good rationale for the pharmacologic intervention, and the medical records are so complicated that the psychiatrists apparently lose track of their ow-r. notes and so don't follow their own plans . For example , patient 37611 was being treated with thioridazine and haloperidol . The patient was ;hanged to thioridazine and chlorpromazine on December 12 , 1982 . There is a note written which do...s not justify the use of the two neuroleptics , but does at least indicate a plan. . However, the psychia .rist then does not follow-urs on his own plan . He indicates that he was going to change the chlorpromazine to prn 028 7 dosing after one week. The use of two neuroleptics , however, is never discussed in the progress note section again by the psychiatrist; this patient remains on the two neuroleptics in February. The record reQuirA.c_ personnel to simply fill-it UD with verb; Age , w1iidF—is noncont it butory to good patient c—are since it neither directs terra'e`ri nom reflects outcomes. For example , patient record 36376 . For problem 114 , depressed mood, on the specific o:=jective form the objective is stated as follows ; "To further s'..a0=ilize and enhance his nondepressed mood 'is evidenced by his self report that his depressed mood as five or less on a scale of zero to ten. " For this same patient, on problem 163 (substance abuse) , for which there is no specific objective form completed , there is on form plan two, the following: "The clinical focus for the patient is to clarify the active role he plays in creating and maintaining the below problem and to support him in identifying and acting upon choices which better promote his self interests and well being. " One of the most striking places where the medical record is problematic is in its requirements for the documentation of seclusion and restraint. The documentation of seclusion and restraint requires personnel to enter data in sir. places in the medical record: I . The treatment objectives and plan and criteria for release; 2. The MD order; 3 . The ID?t notes every two hours; 4 . The HD progress notes 5. The fifteen minute sheet checks ; and 6 . The pink sheet. Tais has to be done in addition to completing a special incident report. If a reviewer, a covering physician, or even the treating physician the following morning wants to understand the whys and wherefores of the preceding days of seclusion and restraint, he/she virtually has to conduct a treasure hunt through the medical record. The problematic nature of the medical records is perhaps best exemplified by those treatment teams that seem to be sincerely trying to produce good to excellent records . To this end , one * can examine the medical records onward 17 completed by Dr. Moss and his team. Even a team who "followsall the . rules.'_ and completes the paper work as 'it-should ~end_a- . p---;. thseaz�s_af„� dupl .G ,ive _paper ,work which do nothing useful to the team -.... _ in the care and _tr_eztment""of its`pa-ti'ents:-'�'"""�� Finally, the usefulness of the medical record in patients with AIDS is compromised by the current interpretation of confidentiality requirements . There is a draft section for t: Operating Manual concerning AIDS. Attention needs to be paid co how to treat patients respectfully and sensitively, but not to negatively impact upon treatment by adherence to standards of that-' do tha ' do not make sense . For example : Patient No . 35705 is being treated far AIDS wi '_h AZT. The diagnosis is not listed , however. All treatment r � planning ignores this 029 21 Patient No. 365:1 On January 30 , 1989 , the patient 'was put i: -.a wrist restraints ; there was an order for the wrist restraints , but no physician note in tI.e progress notes , no IDN describing interventions short of restraints. SU► YkRY OF KLJOR EINDTNGS Once again I- find that Atascedero State Hospital continues to make commendable improvements . Those issues which sti*),.cAme ., under..the purview of._ requisite.,scrutiny an improvement4 are as follows : 1 . While the table of organization is basically sound , there are a few points that need to be addressed. These are the role and location in the table of organization of the nursing coordinator, the structure of the program organization, and the supervision. of considerably more highly trained nursing personnel by those of considerable less training. 2 . Inadequate numbers of professional staff. Recruitment must be active, particularly for psychiatrists. 3 . LOC staff needs to be in attendance in sufficient numbers such that ratios are maintain.ed without,rcountipg.into�theratios .the , ' medication•„person and those,LOC staff._.p:ovidin one-to-one coverage. The ei istent s of f ing ratios are equate--for�'the day ani pm shift; the ratio_o.f_one_to__ sixteen fo_r the nightshift •; ' needs to be seriously�eviewed. Shortfalls of LOC staff�are generally compensated for by excessive sedation of patients through overmedication. 4 . The medical record system needs to be reviewed and overhauled such that i 1 ates rather than interferes with patient care and treatment. 5 . Psychopha:-macologic policies and procedures are excellent . In practice, physicians are not always following the institution's own policies and procedures . More resources are needed to support further psychopharmacologic consultation. More resources are needed for the pharmacy to be able to accomplish reviews and audits of practices , and to provide feedback to the prescribing psychiatrists . 6 . Seclusion and restraint policies are sound. The current utilization cannot be ascertained because of a change in the record keeping system. The practice of allo ing a physician to write an initial order for seclusion and reztraint that lasts twenty-four hours needs to be addressed . The ability to m2intain somebody' in locked room sc .lusion over night without outside review needs to b-2 addressed . These practices alloy: for 030 22 unmonitored or undermonitored seclusion and restraint and therefore, open up the practice to abuse. 7. The referring sof psychiatrists, responsibilities to LJC staff through the ubiquitous util rectified. must of prn dosing be These recommendations—.do,not •"differ_".significantly_ from those that lI made i L—EY-Uport ane..year a o. If I were to prioritize that - ~' is -g—;., would start with the medical record if for no other reason then a resource issue. That is , one does not have to put additional funds into a facility to correct this medical records 'system. � 'in. -a-n- way, the m_edic records system is a resource issue because it is draining existent t resources of he facility. It right be the case that if therecord system facilitated rather than interfered with atient care personnel_could be freer t_o addres _ patients in their apy needs , in'the r AbL,*needs, anci as "persons . The facilit right operate more effectively than it does even without y additional personnel . ADDENDUM I would like to compliment Dr. Harold Carmel for his gracious, sensitive, and inforrative hostA hosting of our visit to tascaderQ' State Hospital . It is a pity that xtascadero State Hospital cannot clone him. Sincerely rs � J e f 11 � -- M. D. , x.?.H. JG:vab - 031 Atascadero State Hospital OPERATING MANUAL SECTION- PERSONNEL --� ADMINISTRATIVE DIRECTIVE NO. 902 Effective Date: July 8, 1999 SUBJECT: NURSING STAFF ALLOCATION: MINIMUM ON-DUTY COVERAGE Cancellation: This directive cancels Administrative Directive No. 902 dated September 18, 1997, same subject. I. POLICY The Department of Mental Health has established that each unit will provide an on-duty nursing staff to patient ratio of at least 1:8 for AM shift, and 1:8 for PM shift, and 1:16 for NOC shift. Because the needs of the patients may vary from unit to unit or change with time, each hospital shall develop a system that will identify those differences and, within existing resources, establish and provide for the staffing necessary to meet those needs. It is the intent of this directive to provide procedures for implementation of this policy. II. ALLOCATION OF NURSING STAFF A. Each Program will be allocated sufficient nursing positions to provide on-duty coverage seven(7) days per week at a ratio of 1:8 AM shift, 1:8 PM shift, and 1:16 NOC shift. Registered nurse coverage will be balanced evenly based on the concept of one per AM and PM shift delivered on acute units and scheduled on all others. NOC shift minimum will be one R.N. delivered per program and one R.N. delivered on Unit 1. Additionally, Program VII requires a minimum of two (2)R.N.s on the NOC shift. Programs will strive to maximize registered nurse coverage within available resources, in that when it is necessary to adjust staff,the nursing and clinical needs of the patients will be the most important factor in the decision making process. An evaluation of the level of functioning and acuity needs of the patients in the Program will be done by the off-going shifts, through use of the established procedures,to determine the level of nursing care required by the on-coming shifts. Based on this evaluation, RN coverage will be provided as necessary. Anytime a patient's level of illness significantly changes, a nurse will complete an assessment and the coverage of that unit will be adjusted to provide necessary care. B. The Clinical Administrator,with input from the Program Directors, Coordinator of Nursing Services,and approval from the Executive Director, will allocate nursing positions on each program. The allocation will be based on the needs of the patient, safety considerations, and total program patient population and the resources available. Program Directors will document any changes in the needs of the patients and forward that information and recommendations to the Clinical Administrator. _ 1 _ A.D. No. 902 032 Nqw III. ON-DUTY STAFF r A. The Program Director is responsible for ensuring that each unit provides on-duty nursing staff equal to the staff ratio established for each unit, including required registered nurse coverage. The Program Director or designee will review unit staffing monthly and adjust coverage as needed. B. The minimum number of licensed nursing staff(RN,PT)to be on duty on all units, each shift, is two(2). The balance of staff required to make up the on-duty requirements may be comprised of unlicensed staff who are under the supervision of the Unit Supervisor or designee. NOTE: Units 3, 8, 9, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 (all dormitory units and units with a second nursing station) require a minimum of three(3) nursing staff on the NOC shift. C. Each program will post on each unit in a place visible to level-of-care staff the minimum staffing requirements for each shift. D. Each program will prepare a Daily Staffing Report that will show actual staffing by unit and shift for the previous twenty-four hours. This report will document the number of staff required, the number of staff assigned and number of staff delivered. Staff delivered will be reported by licensed or unlicensed status. This report will be forwarded to the office of Coordinator of Nursing Services daily. The Coordinator of Nursing Services will aggregate the results of these reports monthly and forward the report to the Clinical Administrator. E. The Program Director or designee will prepare a Nursing Staff Position Report on the first (1 st) of each month. This report will include the total allocation,the number of positions filled by each category of licensed staff and the number of positions filled by unlicensed staff. The report will also include the number of vacancies and the number of staff off- duty for extended lengths of time(i.e. - compensation,NDI, and LOA). This report will be forwarded to the Coordinator of Nursing Services. F. Contingencies: The following situations may impinge on the ability of the program to provide the necessary coverage. The Program Director is authorized to take the following actions: 1. Unanticipated Staff Absences: ➢ Temporary reassignment of employees to other units within the program. ➢ When available staff is insufficient to meet the minimum needs of the patients, the program will request available excess staff from the "sister program." ➢ Request staff from the Registry. All of the above options must be exhausted prior to the use of overtime. 2. Unfilled Vacancies: Vacant positions(i.e., no funds encumbered) may be utilized when necessary to fund coverage. - 2 - A.D.No. 902 033 3. Worker's Co.m ens tion and Non Industrial Disability Leave: The Program Director will attempt to establish parallel positions with the approval of the Clinical Administrator when necessary to meet minimum coverage requirements. 4. If the use of overtime,Registry staff, scheduling changes, or parallel positions are not sufficient to provide minimum coverage, the Program Director may request the Executive Director to temporarily transfer an employee from another program. JON DeMORALES Executive Director updated—no changes Cross Reference( : Human Resources PMT Nursing Procedure Manual - 3 - A.D. No. 902 034 Attachment : B Atascadero City Council Mtg 2/26/02 • ' BIG BROTHERS BIG SISTERS OF SAN LUIS OBISPO COUNTY a non-profit corporation " Making a BIG Difference, One Child at a Time, in San Luis Obispo County Board of Directors P.O. Box 12644 San Luis Obispo, CA 93406(805)466-3570 or 781-3226 Chair FAX. 781-3029 E-Mail:bbbsoffice@fix.net Web Page: www.slobigs.org ^captain-JohnKospf January 23, 2002 Harbor commissioner of Port San Luis Vice chair Valerie Humphries Jed Nicholson,Attorney • Adimski Moroski City of Atascadero Secretary Staff & City Council Bryan Gingg Investor/Community Advocate 6500 Palma Ave. Treasurer Atascadero, CA. 93422 Brett Holman,CPA Barbich.Longuier, Hooper&King Rafael Alvarez Dear Atascadero City Council Members and Staff, Rata Ties d DocuTeam Katherine el lli Home�Ranch Realtors Thank you for offering Big Brothers Big Sisters the opportunity of reconsideration for CDBG c Luclan Dos Santos funds. This is a request to allocate $3,500 towards the support of the Freshman Mentor Former Little Sister MaryAnn Douglas Project at Atascadero High School as an asset builder for at-risk adolescents. Big Sister Rob Garcia First Union Securities We realize that you have a limited number of dollars to share among the "Public Services" Pete Gannon computer Stuff applications. Our original request was for funding of our traditional community based one-to- Jeanne Henninger one mentor relationships in Atascadero. The cost to support a community-bosed match is Sales Assistant P Bili Henry $1500 a year,school based mentoring costs only $500 per match for a school year. The Morro Group Carol McColley The Sign Outlet This "substitute" proposal is to provide funding for school based matches at Atascadero High Marilyn Stein Dept. Of Social Services School, the Freshman Mentor Project. This valuable program is funded only through June Child HalS ProtectiveServices2002. At-risk freshman enteringAtascadero High School are identified prior to graduating Hal Sweasey 9 P 9 9 Patterson Realty f rom Middle School, and are given the opportunity to have a high school leadership student as Jerry Tanlmoto Atascadero High School a Big Brother or a Big Sister mentor. These mentors serve as primary "asset builders„and Jul1e •Schumann SLOGO Data give the at-risk adolescents the role modeling they need to make productive and healthy SLOC Claire Vollmer choices at their new school and in the community. South County Realty Staff Gail Gresham Funds to sustain the Freshman Mentor Project for the 2002-2003 school year are needed. PresidenUCEO Michelle Shoresman,M.P.A. Atascadero High School has labeled the program a success, but does not have the funding in Administrative Director their budget to continue their part of the financial partnership. Big Brothers Big Sisters of Joanne Smith,MA. Clinical Program Director San Luis Obispo County has secured partial funding for the next school year,and students at ofJennifer Jocrultm Lynch,ntlRes B.S. Atascadero High School are participating in this spring's Bowl For Kids' Sake Campaign to Volunteer RecnrilmertilReatwrce Development Specialist raise funds for this program. The cost of the program to provide professional case A.Sylvan Lwin,B.A. Sr.ease Manager management, training and support is $25,000 a year for 100 adolescents to be paired in 50 Case Managers matches at Atascadero High School. Matt Saracen,B.S. Susie Arnold,BA. + istant Case Managers I have attached a copy of the original contract with Atascadero High School, as well as Nicole Hughes Amy Babb interim outcome studies of the Atascadero High School students benefiting from this ministrative Assistants Susan Coronado program. Interna ReJull+aAMiller 4Res, ful bmitte by, Ben Martinez Volunteer Trainer 3 Cadet Activitiessham, President/CEO and resident of Atascadero Youth Orientation and Empower Workshops • 16 youth and their parent/guardian were oriented in lune. We are currently scheduling into October. Outcomes—School Based Mentoring—Spring 2001 Of the 14 freshman matched 3 or more months in the Freshman Mentor Program at Atascadero High School during the spring of 2001, improvements as measured by the mentor,-school counselor/ teacher and parent were reported in the following areas: Mentor Counselor Parent Self-confidence 83% 64% 81% N=13 N=11 N=14 Ability to express feelings 76% 45% 1000/0 N= 13 N=11 N=14 Sense of future 41% 41% 85% N=8 N=9 N=13 Academic performance 73% 38% 50% N=11 N=13 N=14 Attitude towards school 43% 92% 64% N=14 N=12 N=14 Shows trust towards you 1000/0 27% 88% N=13 N= 11 N=9 Relationship towards peers 77% 880/0 --- N=9 N=9 Report submi ed by: Joaa Smith,M.A. Date Clinfcal Program Director Atascadero High School/Big Brothers Big Sisters Freshman Mentor Project Memorandum of Understanding Between Big Brothers Big Sisters of San Luis Obispo County and Atascadero High School, a partnership for the purpose of providing a School-Based Mentor Program at Atascadero High School for Freshmen Students This agreement between Big Brothers Big Sisters of San Luis Obispo County and Atascadero High School specifies the expectations of the partnership. This partnership is a pilot program. The partnership is in effect from February 2001 to June 2002 and is called the Atascadero High School/B&Brothers Big Sisters Freshman Mentor Proiect. Both parties agree to maintain confidentiality of student and family records, as well as circumstances. Partnership Goals: 1. Identify up to 50 freshmen students in need of a positive role model and to provide mentors to assist them in successful assimilation at Atascadero High School. 2. Provide both student mentors and mentees a positive and rewarding experience. 3. Assist Freshmen students at-risk of dropping out, academic and/or social failure: a. To improve academically b. To improve socially c. To improve attendance and avoid truancy d. To avoid the use of illegal substances e. To avoid contacts with the juvenile justice system f. To make healthy life choices and set positive goals g. To make plans for the future Roles and Responsibilities: Big Brothers Big Sisters of San Luis Obispo County agrees: To provide the services of a Professional Case Manager and administrative services for this program at Atascadero High School To train, "match", organize and supervise the Atascadero High Schoollft Brothers Big Sisters Freshman Mentor Proi t. To train,"match"and supervise up to 50 qualified Sophomore,Junior and Senior Atascadero High'School students as mentors for freshmen students in need of a positive role model. To use mentors, as a tool, to provide freshmen students assistance in successful assimilation at Atascadero High School. Alascadero High School agrees: To identify,recruit and select qualified Sophomore, Junior and Senior Atascadero High School students as Big Brother Big Sister mentors for freshmen students To identify, recruit and select freshmen students in need of a positive role model mentor at Atascadero High School. To provide a place on campus,and use of a telephone, for the purpose of screening, training and matching mentors and mentees To provide a scheduled time and place on campus for mentor/mentee activities Finances: Big Brothers Big Sisters of San Luis Obispo County and Atascadero High School agree to each provide$15,000 to support this project. Atascadero High School agrees to pay Big Brothers Big Sister of San Luis Obispo County$10,000 in March 2001 and $ 5,000 in October 2001. Big Brothers Big Sisters agrees to match these funds. Community Service: Atascadero High School students who mentor freshmen will receive community service credits. Atascadero High School students will also be encouraged to participate in Bowl For Kids' Sake 2001 and 2002 to raise additional funding for this project. Students who participate in Bowl for Kids' Sake can receive community service credits. Evaluation: Big Brothers Big Sisters of San Luis Obispo County agrees to: Use an evaluation tool to measure the success of the students and the program at the mid point and end of the school year. Atascadero High School agrees to: Provide Big Brothers Big Sisters with access to necessary school records in order to evaluate the success of each student, and the success of the program. Counselors and/or teachers agree to complete their portions of the evaluation tool. Communication: Big Brothers Big Sisters of San Luis Obispo County and Atascadero High School commit to open and regular communications: Joanne Smith, Clinical Program Director and Deborah Bridenstine,Professional Case Manager will be primarily responsible for the ongoing communications on behalf of BBBBS/SLO. Art Bugg, Director of Guidance and Counseling and Amik Metzger,Counselor Manager will be primarily responsible for the ongoing communications on behalf of Atascadero High School. Gail Gresham, President/CEO Date Kim Spinks, Principal Date Big Brothers Big Sisters Atascadero High School of San Luis Obispo County BIG BROTHERS BIG SISTERS OF SAN LUIS OBISPO COUNTY • a non-profit corporation Making a BIG Difference, One Child at a Time, in San Luis Obispo County Board of Directors P.O. Box 12644 San Luis Obispo, CA 93406(805)466.3570 or 781-3226 Chair JED Nicholson,Attorney FAX: 781.3029 E-Mail;bbbsof cce c@fix.net Web Page:www slobigs.orgr Adamski Moroskl LLP Vice Chair FACT SWE 'T Bill Henry Morro Group —r—...�� Secretary Bryan Gingg aOur mission is.to invest in children, investor, Advocate b providing: tiv t»�*hro 0 Brett Holman,CPA Karoo &King mekhq,a BIG diffe nce 'ons .hi7.d at�:tune,;. Hooper S King Members n faelAlvarsz in Ssn=Lu�S flbispa awn !. , Rare nea - Ra .. ,. Cathy tmunI Mission Commun)ty Bank Where Does the Money Go? LuclanForme L�fttle Siste ❑ It stays at home to provide mentors for children in San Luis Obispo County B�istD` las ❑ Ongoing, professional case management of all "matches Rob Garcia First Union Securities ❑ Free monthly educational and recreational special activities for "matched" Computers children and those still waiting to be matched Jeanne Henninger ❑ "One-to-One" recruitment of qualified volunteers 5alenAohnKo ❑ Extensive background screening of all staff and mentor volunteers to protect 'Captain'John Kcepf g � Harbor SanLsichildren in the program of PortdSan Luiss Carol outiigt ❑ Home assessments of Big Brothers, Big Sisters and "Littles" MarilynBuddtein ❑ Training of volunteers Marin Stein Dept.of Social Services Child Protective Services ❑ Personal safety training of all "Littles" with their guardians Hal Ra� Patterson ty ❑ Development of new programs to serve an increased number of youth Jerry Tanimoto Atascadero High School Steve Thayer California Mentor Foundation Statistics First Union Securities Julie Tiaano•Schumenn Demonstrate that Mentoring Works! SLOCO Data South County Big Brothers Big Sisters of San Luis Obispo County is a sound long-term Staff investment as reflected in studies such as the one conducted by the California Pr@s1d Mentor Foundation. That stud showed that of 57 000 ours Y young people in mentor Joanne Smith,M.A. programs in 1999: Program Director 1. A.Sytm Levin,S.A. © 98: $ta��d''In'S01�OOI Senior Case Manager Susie Arnold,Cast Manager A {{�i�?r�i>• dl"�,* d lig$` Jennifer Johnson-ynch.B.S. Volunteer Recruitment& :'0 7 9%did nd. be+�rsime a teen.:paf�a t Case Managament Matt saraCase ceno�eer 9$ 2%'did nd1<`°jblifl a gang Nicole Hughes at" Manager Big Brothers Big Sisters of San Luis Obispo County made their first "match" in Assistant Can Manager April 1995. Since opening, over 540 children have been "matched" and AdministmiteAssiwnta received the valuable benefits of quality one-to-one mentoring from a carefully Julie uA'' 'ori sc selected, trained, supervised and guided Big Brother or Big Sister. Versa Holguln,intern Rebecca Miller,Intern Angels Vttug,Intern ,� � w� � °A�7 � F�` / t .i h f:&'S,� y,yA' Ben MartinezAc � Trakter ti Cadet Activities ,: trt i S {, -d°�,j; ,^ j , + x t ;r�..w�va:F.dt c�• .'�?. �. � ..+.}a..•,>.tr.z.t<.. r3, ..... .: ..'�+�i�t �rf'r�►+Y/r��':if9'lyti':ss�..�..a��1�.• .,:Yf.:h...5ftt.2.a4,..�t''. .a.n,.,.....,:t ..... • BIG BROTHERS BIG SISTERS OF SAN LUIS OBISPO COUNTY a non-profit corporation Making a BIG Difference, One Child at a Time in San Luis Obispo County P.O.Box 12644 San Luis Obispo,CA 93406 (805)781-3226466.3570 Fax:(8'05)781-3029 Email bbbsoffice@fix.net 2002 BOWL FOR KIDS' ,SAKE' As onsoraba,p Loved$: ❑ PRESENTING MAJOR SPONSOR: V0.000 minimum Event spokesperson and presenter of event in media campaign, i.e., broadcast and print media in addition to all of the benefits listed for a Corporate Sponsor, ❑ MAJOIR SPONSOR, $5,000 minimum Busmess.name included in TV advertising in addition to all of the benefits listed for a Corporate Sponsor ❑ CORPORATE SPONSOR (UNDERWRITER)- $1,500 minimum Business size advertisement for 1 year in newsletter Logo on T-shirt Logo/name used in all promotional material Media Coverage in Public Service Announcements Company banner at the event Receive an event sweatshirt ❑ EVENT SPONSOR: S500 minimum Name on T-shirt Name listed in promotional material Media coverage at event Company banner at the event Receive an event T-shirt ❑ DONOR (MERCHANDISE, PRIZE OR SERVICES DONATI-ON):(Minimum retail value $500) Name listed in our newsletter Name in promotional materials Exposure at the event ❑ TEAM SPONSOR: 5375 minimum Team of 5 bowlers. Event T-shirt for each bowler Your signage at the event Name in promotional materials Thank you award Q LAW SPONSOR: S100 minimum Your signage at the event Names listed in event program 'Allows a Big/Little match to bowl at the event Pease chgrikappm priate box co tete s ansor information below adtd return form to Big Brothers Bi sisters fan. ui Obis o Co nt .W'th r el our event will be a success. A;:BIGTHANKS TO YOUI ! Best Time to Call: Business Name: rint Name: Business Address: ignature: Business Fax:_ Business Phone#: Email: Website: