FINAL REPORT

CASE #0501 SAN JOAQUIN COUNTY ADULT PROTECTIVE SERVICES

REASON FOR INVESTIGATION:

The San Joaquin County 2001-2002 Civil Grand Jury (SJCCGJ) received a formal complaint from the San Joaquin County Criminal Grand Jury requesting that SJCCGJ initiate an investigation into the practices and power of:

BACKGROUND:

The San Joaquin County Criminal Grand Jury alleged that HSA has lacked in oversight and training of those paid to take care of the elderly. Upon completion of the investigation, criminal charges were filed against the primary care giver as a result of the premature death of a dependent adult. The Department of Aging has direct oversight of Adult Services provided by Human Service Agency (HSA). This includes the divisions of APS, IHSS and the current contract with ACI. In-Home Support Services pays care givers to tend to the needs of qualified recipients, including the elderly.

The IHSS caseload averages 4,100 clients each month. ACI provides in-home services for approximately 625 individuals who do not have an independent care giver available. The costs of these services annually are approximately $18.7 million for independent care givers and $2.3 million for services provided by ACI care givers. ACI=s contract is for approximately 280,000 billable hours per year.

APS is a division of HSA that investigates allegations of abuse or neglect of elderly in this county.

METHOD OF INVESTIGATION:

INTERVIEWS CONDUCTED:

MATERIAL REVIEWED:

FINDINGS:

Under Welfare and Institution Code Section '15630, the caregivers are mandated reporters. Per the ACI contract all caregivers are required to be trained on how to identify possible neglect and abuse as well as the protocol for reporting.

Per the Programmatic Monitoring Report provided by HSA, ACI was provided with corrective actions on 12 issues, which included:

ACI has provided a Notice of Intent to terminate their contract with San Joaquin County, effective June 30, 2002. HSA will be presenting the Board of Supervisors with a request to enter into negotiations with the second, and only other qualified bidder from the Invitation for Bid to assume services for the remainder of the contract period July 2, 2002 through September 30, 2002.

Based on reports by St. Joseph=s Hospital medical staff for the deceased, APS submitted a referral to the San Joaquin County Public Conservator/Guardian Office on 12/29/99 to appoint a public conservator.

San Joaquin County Public Conservator/Guardian responded to SJCCGJ with a letter from the Public Conservator, based on the recollection of the Deputy Public Guardian stating that the deceased was of sound mind, although all medical records reviewed by the committee indicated that the deceased had dementia.

There is no written policy or protocol in place between San Joaquin County Public Conservator/Guardian and APS regarding elder abuse cases where the possible need for conservatorship has been identified.

The APS & IHSS workers manually track the follow up of clients, which in all probability may leave room for cases to fall through the cracks. As a result of the unfortunate death of one of their clients, the Department of Aging has entered into a joint effort with APS, IHSS and ACI to meet weekly to discuss and identify Ared flag cases.@ These are cases of potential problems such as needs and/or abuse.

Prior to her death this case was referred to the Multi Disciplinary Task Force (MDT). This task force is comprised of the Public Conservators Office, Mental Health Older Adult Services, and the Mental Health Mobile Evaluation Team. The task force meets to discuss potential abuse cases and the assignment or referral to the agency or group best able to resolve the issues of the Ared flag cases.@ No additional documentation was found as to the result of this referral.

RECOMMENDATIONS:

  1. The San Joaquin County Board of Supervisors change the future bidding process to a Request for Proposal as opposed to the current Invitation for Bid. This will allow for the contract to be awarded on quality service rather than Alowest cost.
  2. HSA provide specific elements for mandatory training to the contracted agency for the care givers including but not limited to:
  3. HSA conduct quarterly monitoring of the contracted agency to ensure that both the programmatic as well as fiscal elements of the contract met compliance.
  4. APS develop and implement a formal process for requesting conservatorship in cases of abuse and neglect.
  5. San Joaquin County Public Conservator/Guardian develop and implement a formal procedure for referrals from APS when requesting conservatorship.
  6. San Joaquin County Public Conservator/Guardian maintain a log of all referrals with documentation via a computer database.
  7. San Joaquin County Public Conservator/Guardian and APS develop a memorandum of understanding governing the procedure for referrals between the two agencies, which includes an appeal process in relationship to the handling of elder abuse cases where the possible need for conservatorship has been identified.

RESPONSE REQUIRED:

Pursuant to Section 933.05 of the Penal Code:

The Human Services Agency, Department of Aging and the San Joaquin County Public Conservator/Guardian shall report to the Presiding Judge of the San Joaquin Superior Court, in writing and within 90 days of publication of this report, the response indicates one of the following.

As to each finding in the report a response indicating one of the following:

  1. The respondent agrees with the finding.
  2. The respondent disagrees with the finding, with an explanation of the reasonstherefore.

As to each recommendation, a response indicating one of the following:

  1. The recommendation has been implemented, with a summary of the action taken.
  2. The recommendation has not yet been implemented, but will be with a time frame for implementation.
  3. The recommendation requires further analysis, with an explanation of the scope of the analysis and a time frame not to exceed (6) six months.
  4. The recommendation will not be implemented, with an explanation therefore.