Completed Summarized Recommendations

The following 43 (54%) Summarized Recommendations have been completed by the Sheriff’s Office, Facilities and Fleet, and Custody Health Services.  For additional information regarding each one, please select the appropriate box below:  ​

    Steps Taken: With regard to facilities, Main Jail North men’s booking area counters are 100% complete, and designs for women’s booking area are approved and construction was completed in Spring 2017. M-1 construction was completed in October 2017, and BSCC has requested modifications to areas outside scope of the project and are under evaluation by County staff.
    For CHS, programming has been increased for inmates in 8A. A tracking method for outside medical records exists through VMC Health Information Management (HIM).

    This Summarized Recommendation is completed to the extent the CHS concurs with the recommendations, and the FAF component is complete.

    Budget Status: On March 1, 2016, the Board approved $250,000 for the Main Jail North Reconfiguration project to address reasonable privacy issues during screenings and assessments at the intake booking area.

    Currently, staff is ensuring that assessments are conducted in a reasonably private location.

    As part of the FY 2016 Adopted Budget, the Board approved $3 million in funding for M-1 Renovations to open the unit and increase the number of medical beds. On March 22, 2016, the Board approved an additional $1.4 million to complete funding for this project.

    The Board approved the following staff to assist in creating a therapeutic and programming environment:

    • December 2015: 59 positions in Custody Health Services to provide multi-disciplinary healthcare staff and support staff ($16.6 million) for mentally ill inmates in need of behavioral health services during incarceration and re- integration into the community.
    • FY 2017 Adopted Budget: 10 Sheriff’s Correctional Deputy positions and 1 Sheriff’s Correctional Sergeant position ($1.6 million) were added as Multi Support Deputies to support behavioral health teams.
    • FY 2018 Adopted Budget: Added new Psychiatrist position to provide on-site clinical oversight of behavioral health services, and Hospital Services Assistant position, 2 Clinical Nurse III positions, and one Staff Developer position to support jail reform efforts ($1.4 million).
    •  January 23, 2018: Added new Director, Custody Behavioral Services Positions, in Custody Health Services to provide oversight of all Custody Health behavioral health staff and services.

    County Administration and the departments are evaluating to determine if additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan, Blue Ribbon Commission on Improving Custody Operations, Healthcare Gap Analysis – Wilcox

    Responsible Department(s): Custody Health Services, Facilities and Fleet

    Master List Nos.: 100, 104, 422, 423, 424, 573, 576, 581, 582

    Review Date: FGOC reviewed on January 26, 2017.

    Steps Taken: The Sheriff's Office agrees and is evaluating policies of IA investigators from other jurisdictions in addition to existing Sheriff’s Office policies. The Sheriff’s Office has also been working with the Employee Services Agency (ESA) for a year and a half to establish a special investigator classification that could help to expedite Internal Affairs investigations. Currently, the Special Investigator duties have been fulfilled by eight (8) Contractors, whose contracts are due to expire in March, 2017. The Sheriff’s Office is awaiting additional information from ESA on the Special Investigator classification.

    The Sheriff’s Office continues to review and prioritize serious allegations submitted to the Internal Affairs Unit.  The IA Lieutenant is responsible for monitoring caseloads and assigning cases in avoidance of any conflicts of interest. 

    This Summarized Recommendation has been completed.

    Budget Status: The Board approved the following:

    • February 2016: 1 Sheriff’s Sergeant for the Internal Affairs Unit ($229,610).
    • FY 2017 Adopted Budget: 2 Sheriff’s Sergeant positions and 1 Management Analyst position to the Internal Affairs Unit ($591,854).
    • FY 2017 Adopted Budget: 1 Sheriff’s Correctional Lieutenant position and 2 Management Analyst positions ($502,408) to track, investigate, and respond to grievances.
    • FY 2018 Adopted Budget: 2 Senior Management Analyst positions ($338,062) to conduct audits, provide quality assurance of grievance responses, identify trends, and produce training materials regarding grievances.

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Zisser

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 508, 512, 513

    Review Date: FGOC reviewed on December 19, 2016​

    Steps Taken: Facilities and Fleet Department has completed designs for the surveillance systems at Main Jail North and Elmwood complexes. The Board approved the construction contract and funding for the project in February 2017.  Construction started April 2017 and installation was substantially done by January 2018. This action includes the Anticipated Impact Report and Use Policy which outline the procedures for reviewing and storing records.  The Sheriff’s Office has also drafted policies and procedures for Body Worn Cameras, which were approved by the Board in January 2017.

    The Facilities and Fleet Department completed the permanent surveillance systems project as of April 2018. Both the Main Jail North and Elmwood facilities had a total of 1,393 surveillance cameras installed. 845 cameras were installed at Elmwood and 548 cameras were installed at Main Jail North.  Additionally, for the Elmwood facility, the perimeter fence alarm system enhancement has been incorporated with the video surveillance system and some minor fine tuning is being completed.

    This summarized recommendation has been completed to the extent the Sheriff’s Office is able to, while complying with the Surveillance Use Policies.

    Budget Status: The Board approved the following:

    • February 9, 2016: Board approved $820,000 in funding to design the video surveillance system for Main Jail North and Elmwood.
    • FY 2017 Adopted Budget, the Board approved $715,000 to purchase body-worn cameras for the Custody Bureau.
    • FY 2017 Adopted Budget: Board approved $10 million in funding for jail video surveillance systems for Main Jail North and Elmwood.
    • December 6, 2016: the Board approved $300,000 in funding for a video surveillance system for Main Jail South.
    • On January 24, 2017, the Board approved an agreement with Taser International relating to providing body-worn cameras not-to-exceed $3,980,684. Additionally, the Board approved one-time funding related to body-worn cameras in the amount of $1,136,002 for equipment costs ($414,510), one-time overtime costs related to training ($422,000), and salary costs ($299,492). The salary costs for the addition of 1 Deputy Sheriff and 2 Senior Training & Staff Development Specialist positions, and 1 Sheriff's Correctional Deputy position with an ongoing cost of $730,367.
    • February 7, 2017: The Board approved a transfer of $9.2 million from a reserve established for jail surveillance cameras as part of the FY 2017 Adopted Budget, and transferred the funds into the capital project for the Main Jail North and Elmwood video surveillance systems.
    • June 20, 2017: The Board approved a transfer of $800,000 from a reserve established for jail surveillance cameras as part of the FY 2017 Adopted Budget, and transferred the funds into the capital project for the Main Jail North and Elmwood video surveillance systems. This additional funding will allow the existing contractor to integrate the proposed Elmwood perimeter fence detection systems and lighting upgrades work.
    • On May 8, 2018: The Board approved a transfer of $71,610 from the General Fund Contingency Reserve to the Office of the Sheriff's budget to purchase additional body-worn cameras.
    • FY 2019 Adopted Budget: The Board approved one-time funding in the amount of $47,680 and ongoing funding in the amount of $288,710 to add 270 body worn cameras for Sheriff Deputies and Correctional Officers.
    • FY 2019 Adopted Budget: Added 1 Electronic Repair Technician position to address electronic maintenance and security ($117,509).

    Source Report(s): Sheriff’s Jail Reform Plan, Human Relations Commission, Blue Ribbon Commission on Improving Custody Operations

    Responsible Department(s): Sheriff’s Office, Facilities and Fleet

    Master List Nos.: 160-161, 323-324, 364

    Review Date: FGOC reviewed on January 26, 2017.​

    Steps Taken: On March 1, 2016, the Board approved $250,000 for the Main Jail North Reconfiguration project to address reasonable privacy issues during screenings and assessments at the intake booking area.
    There are currently 3 separate capital projects related to privacy in the booking area. The first is men’s intake counter, which was completed in February 2017. The second is the women’s intake counter, which was completed Spring 2017.
    The third is the intake partitions and room configurations, which was completed in January 2018. Currently, staff are ensuring that assessments are conducted in a reasonably private location.

    This Summarized Recommendation has been completed.

    Budget Status: This summarized recommendation was budgeted for design and construction in the various capital projects described above in the amount of $250,000.

    Source Report(s): Suicide Prevention Gap Analysis – Hayes

    Responsible Department(s): Facilities and Fleet

    Master List Nos.: 300-301

    Review Date: FGOC reviewed on August 26, 2016 and December 19, 2016

    Steps Taken: The new Suicide Risk Assessment tool (SRA) was implemented on October 24, 2016. The recommendations by the suicide prevention expert, along with the screening questions, are done in booking in as private of a setting that is available in the Jail booking area while the facility improvements related to privacy are in process. The SRA is built on a two tier system. The first tier assesses medical and mental health emergent conditions, then the second tier is used if needed for an extensive assessment.

    This Summarized Recommendation has been completed.

    Budget Status: No additional resources are needed.

    Source Report(s): Suicide Prevention Gap Analysis – Hayes

    Responsible Department(s): Sheriff’s Office, Custody Health Services, Facilities and Fleet

    Master List Nos.: 220, 221, 223, 224, 226, 238 - 240

    Review Date: FGOC reviewed on December 19, 2016.

    Steps Taken: The Sheriff’s Office has a protocol in place for initiating suicide precautions. For CHS, all of the above recommendations started as of October 24, 2016. This includes the start of data collection for the quality assessment/quality monitoring. The CHS policies have been updated.

    This Summarized Recommendation has been completed.

    Budget Status: No additional resources are needed.

    Source Report(s): Suicide Prevention Gap Analysis – Hayes

    Responsible Department(s): Sheriff’s Office, Custody Health Services

    Master List Nos.: 132, 222, 225, 228 - 233, 235, 237, 244, 245, 396

    Review Date: FGOC reviewed on December 19, 2016.

    Steps Taken: The CHS Triage System provides guidelines to clinicians and nurses concerning estimation of the time-sensitivity of an evaluation by an appropriate provider in an appropriate setting, according to a patient’s mental health conditions. The goal of triage is to rapidly assess and identify life threatening emergencies and to activate emergency responses in a timely fashion.
    Triage is a system for assigning prioritization to groups of patients according to the time-sensitivity of their health needs and the expected response. Patients with health needs may present to CHS staff through intake, self-referrals (e.g., white cards), and staff referrals. Triage is an iterative process since some health needs improve or worsen over time.
    Timeframes for current practice of clinician response:

     

    • Emergent mental health (MH) conditions: patient requires a MH clinician to respond within 15 minutes and intervene within an hour.
    • Urgent mental health (MH) condition: patient requires a MH clinician to assess and to intervene within 2 hours.
    • Routine mental health (MH) condition: patient requires a MH clinician to assess and to intervene within 24 hours.

    The Suicide Risk Assessment tool (SRA) is built on a two tier system. The first tier assesses medical and mental health emergent conditions, then the second tier is used if needed for an extensive assessment. The Tier 2 assessment for mental health includes the questionnaire associated with the tool used at the California Department of Corrections and Rehabilitation, and SRA will be conducted by mental health professionals. Suicide precautions will be noted in the medical record. For the current system, CHS will continue to document on current paper and electronic medical record systems. All of the above recommendations are being incorporated and built into the triage system.

    This Summarized Recommendation has been completed.

    Budget Status: No additional resources are needed.

    Source Report(s): Suicide Prevention Gap Analysis – Hayes

    Responsible Department(s): Custody Health Services

    Master List Nos.: 227, 234, 236, 241, 242

    Review Date: FGOC reviewed on December 19, 2016.

    Steps Taken: Training for existing Custody Health staff on the new Suicide Risk Assessment tool is complete. New CHS employees will be trained as part of orientation, and refresher training will be provided to all staff.

    All Sheriff’s Office employees are offered the Emergency Assistance Program (EAP) following a critical incident. The Sheriff’s Office is expanding its peer support program so employees have a resource in addition to EAP. The Sheriff’s Office also monitors CPR/AED training and has maintained a high level of compliance.

    This Summarized Recommendation has been completed.

    Budget Status: No additional resources are needed.

    Source Report(s): Suicide Prevention Gap Analysis – Hayes

    Responsible Department(s): Sheriff’s Office, Custody Health Services

    Master List Nos.: 246, 249, 252, 304 – 309

    Review Date: FGOC reviewed on December 19, 2016.

    Steps Taken: The Sheriff’s Office and CHS have a quality committee to review suicide attempts and deaths that was implemented prior to August of 2016.

    This Summarized Recommendation has been completed.

    Budget Status: No additional resources are needed.

    Source Report(s): Suicide Prevention Gap Analysis – Hayes

    Responsible Department(s): Sheriff’s Office, Custody Health Services

    Master List Nos.: 217 - 219, 247, 248, 250, 251

    Review Date: FGOC reviewed on December 19, 2016.

    Steps Taken: The Sheriff’s Office has finalized a revised Use of Force Policy which has been published on the Sheriff’s website and will take effect on January 1, 2018 after all Custody Bureau staff have received training on the new policy. The Use of Force Review Committee (UFRC) is outlined beginning on page 9.01-31 of the revised policy. The composition and review standards are outlined in the policy. The UFRC will be established when the policy takes effect.

    The Sheriff’s Office has experienced difficulty extracting data from the Early Warning System to begin the UFRC.  Early review of reports has also highlighted the need for additional training on the caliber of report writing needed to comply with the revised Policy.  Currently, supervisors are completing extensive training which lengths the amount of time for Use of Force reports to be completed. The Use of Force Review Committee (UFRC) has been meeting monthly since August 2018 and has reviewed incidents from January 2018 through September 2018.

    This Summarized Recommendation has been completed.

    Budget Status: No additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 472-473, 475-477

    Review Date: FGOC reviewed on August 26, 2016.

    Steps Taken: The train-the-trainer for the UOF policy was completed in July 2017. As a result of this course, the expert has suggested revisions to the policy and that the initial training will be extended to a ten- hour block. Training will commence on September 5, 2017 to ensure comprehension of the revised policy and to complete force- options training scenarios. and will be completed by December 21, 2017. Sergeants and Jail Training Officers will be trained first, followed by staff assigned to housing units within the jails. After the initial eight hours of training, Custody Bureau staff will be required to complete a two hour refresher training every other year.

    10 hours of training on the revised Policy Training of all Custody Bureau badge personnel was completed in December 2017.  

    This Summarized Recommendation has been completed.

    Budget Status: County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan, Department of Justice

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 195,466

    Review Date: FGOC reviewed on August 26, 2016.

    Steps Taken: The Sheriff’s Office has been working with experts for months on revising the policy.

    All but one of these recommendations have been incorporated into the new Use of Force Policy, which is now available on the Sheriff’s website. De-escalation training is being provided to all staff, not just a specialized team as recommended and the Sheriff’s Office will continue to utilize special units such as the Emergency Response Team.

    This Summarized Recommendation has been completed.

    Budget Status: No additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 467-469, 474, 481-484, 487

    Review Date: FGOC reviewed on August 26, 2016. 

    Steps Taken: The Sheriff’s Office implemented a new tracking system in May 2016.

    This Summarized Recommendation has been completed.

    Budget Status: No additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 478,479

    Review Date: FGOC reviewed on August 26, 2016. 

    Steps Taken: Within the Sheriff’s Office, the Jail Crimes Unit has been reviewing significant UOF incidents for the past several months.

    This Summarized Recommendation has been completed.

    Budget Status: The Board approved the following:

    • FY 2015 Recommended Budget: 3 Deputy Sheriff positions to create a Jail Investigative Unit ($427,080).
    • January 2015: Re-organization of jail Sergeant positions and moved 4 Sheriff’s Sergeant positions into the Jail Investigative Unit, bringing the staffing up to 3 Deputy Positions and 4 Sheriff’s Sergeant positions.
    • FY 2016 Recommended Budget: 2 more Deputy Sheriff positions ($323,256), which filled the Jail Investigative Unit and allows for 24/7 coverage of the jails.

    No additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 470,471,480

    Review Date: FGOC reviewed on August 26, 2016.

    Steps Taken: The Sheriff’s Office has been working closely with the consultant for many months to learn the various aspects of the NIC tool and methods for applying it within the jail system. Now that the consultant’s final report is public, the Office of the County Executive will be working with the Sheriff’s Office Custody Bureau to understand the staffing needs and other implications if the Board approves these recommendations.

    On December 12, 2016 the Sheriff’s Office began using the tool designed by JFA Institute on females being booked into custody. Initial re-classification assessments were conducting in February. The tool was implemented with the male population beginning on March 9, 2017. In May 2017, use of the reclassification tool will begin. The JFA Institute will also conduct an on-site visit to complete reliability testing of the new tool. The Sheriff’s Office is on track for a 6-month evaluation report with JFA Institute at the end of July 2017.

    This Summarized Recommendation has been completed.

    Budget Status: Board added $30,000 in onetime funding in FY 2016 to implement a new classification system.

    Board added $25,000 in onetime funding in FY 2017 to assist with the implementation of the jail classification system.

    No additional resources are needed.

    Source Report(s): Blue Ribbon Commission on Improving Custody Operations, Department of Justice, Human Relations Commission, Sheriff’s Jail Reform Plan, JFA Institute Classification Study

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 130-132, 184, 310-311, 347-348, 637-639, 641-642

    Review Date: FGOC reviewed on August 26, 2016.

    Steps Taken: ​

    The Sheriff’s Office is reviewing all of the specific recommendations related to this item for operational impact and feasibility. Inmate files contain confidential safety information such as witness information and current or prior gang affiliation which would prevent some information from being shared with the inmate.

    As of March 8, 2017, the Sheriff’s Office has been classifying all inmates with the new initial classification form. Within the first eight hours of arriving at the jail, inmates are assessed and housed.  The reclassification interviews happen every 60 days via a face to face interview where the inmate also gains information on their file.

    The Sheriff’s Office is utilizing the 60-day review process in lieu of an appeal process and inmates are not allowed access to their files, but complete face to face interviews with Classification deputies as part of the 60-day review process where they discuss their behavior and documented incidents.

    Inmates that entered custody prior to implementation of the new tool cannot currently be entered into the tool’s program for 60-day reviews. Therefore, deputies assigned to Classification manually monitor compliance and complete review documents, including providing inmates with an advisement form outlining the 60-day review process and a copy of their custody score. The Sheriff’s IT staff is working to identify a temporary solution and ensuring that JMS will have the ability to manually enter assessments.

    This Summarized Recommendation is completed to the extent the Sheriff’s Office concurs with the recommendations.

    Budget Status:  No additional resources are needed.

    Source Report(s): Blue Ribbon Commission on Improving Custody Operations, Emblidge Report, Sheriff’s Jail Reform Plan

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 134-135, 349, 352-356

    Review Date: FGOC reviewed on August 26, 2016.​

    Steps Taken: This recommendation will be considered in the context of the consultant’s report, which says there is no need to create a separate instrument for the female inmates as the proposed system uses objective factors that apply equally to male and female inmates. The Sheriff’s Office continues to work with the Commission on the Status of Women, the Office of Women’s Policy, and the Office of LGBTQ Affairs to develop gender responsive policies in the jails.

    The Sheriff’s Office has also included proposed changes from the Commission on the Status of Women in the 60 day reclassification tool.

    This Summarized Recommendation has been completed.

    On International Women’s Day, March 8, 2018 the Sheriff’s Office also began a pilot at the women’s facility that involves providing a classification of low, medium, or high security for female inmates.

    Budget Status: Onetime funding in the amount of $30,000 was provided in FY 2016 to implement a new classification system, although the department is working with impacted stakeholders to discuss and respond to this summarized recommendation.

    Board added $25,000 in onetime funding in FY 2017 to assist with the implementation of the jail classification system.

    Source Report(s): Commission on the Status of Women

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 181, 544

    Review Date: FGOC reviewed on August 26, 2016.​

    Steps Taken: Implementation of these recommendations is dependent on facility modifications, and will be considered as part of the new classification system implementation. The Sheriff’s Office has closed every maximum security tier at Main Jail South (MJS) and half of the remaining MJS facility. Since August of 2016, the Sheriff’s Office has downclassed approximately 600 inmates who were previously maximum security. By downclassing, they are rehoused in areas where they can come out of their cells in groups, thus increasing unstructured out-of-cell time, and given increased access to structured programming.  Inmates with mobility issues can be housed in any facility other than MJS. However, beds of all security levels are available for inmates with mobility issues in all other facilities.

    This Summarized Recommendation has been completed. The Sheriff’s Office will continue to house inmates according to their classification that is based on their behaviors and allows for the greatest amount of out of cell time and access to programs.

    Budget Status: No additional resources are needed.

    Source Report(s): Department of Justice, Emblidge Report, Sheriff’s Jail Reform Plan

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 183, 351, 357

    Review Date: FGOC reviewed on August 26, 2016.​

    Steps Taken: The Sheriff’s Office has implemented two comprehensive management software systems into their business processes. The Sheriff’s Office has been analyzing issues and compiling resource need requests for FY 2018 related to this Summarized

    Recommendation, which will focus on conducting research as well as tracking, monitoring, and implementing jail reforms. They will also evaluate external best practices to ensure the Sheriff’s Office Custody and Enforcement Bureaus are remaining up to date and are consistent in both Bureaus. They will be tasked with developing management reports and recommendations to Executive Staff for areas of improvement. This will allow Office of Operational Standards and Inspection Unit within the Sheriff’s Office Custody Bureau to focus on audits and policy compliance. They will also evaluate commissary options and establish the Vocational Training Program.

    This Summarized Recommendation has been completed.

    Budget Status: The Board approved the following:

    • FY 2016 Adopted Budget: 1 Sheriff’s Correctional Sergeant position and 1 Sheriff’s Correctional Deputy position ($314,500) were added for the Professional Compliance unit.
    • November 2015: Also for the Professional Compliance Unit, 1 Sheriff’s Correctional Lieutenant, 1 Sheriff’s Correctional Sergeant, and 2 Sheriff’s Correctional Deputy positions were added ($741,000)
    • FY 2017 Adopted Budget: 5 Sheriff’s Correctional Deputy positions and 1 Clerk position ($827,539) were added to the Office of Operational Standards and Inspection Unit to support policy and compliance work.

    No additional resources are needed.

    Source Report(s): Civil Grand Jury

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 530

    Review Date: FGOC reviewed on August 26, 2016.​

    Steps Taken: The Sheriff’s Office has published the results of PREA audits and other inspections on their Jail Reforms webpage. They have also started convening Inmate Advisory Councils at Elmwood and will soon at Main Jail in order to provide another opportunity for inmate input.

    This Summarized Recommendation has been completed.

    Budget Status: The Board approved the following:

    • FY 2017 Adopted Budget: $2.5 million reserve for jail reform and oversight.

    No additional resources are needed.

    Source Report(s): Blue Ribbon Commission, Zisser

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 1, 6, 517, 524, 526, 528

    Review Date: FGOC reviewed on September 30, 2016.​

    Steps Taken: The Sheriff’s Office has been analyzing issues and compiling resource need requests related to this Summarized Recommendation, which will help to conduct research and policy development for both Custody and Enforcement.  The primary function of these positions will be to track, monitor and implement jail reforms.  They will also evaluate external best practices to ensure the Sheriff’s Office Custody and Enforcement Bureaus are remaining up to date and are consistent in both Bureaus.  They will be tasked with developing management reports to recommendations to Executive Staff for areas of improvement.  This will allow Office of Operational Standards and Inspection Unit within the Sheriff’s Office Custody Bureau to focus on audits and policy compliance.  They will evaluate commissary options and establish the Vocational Training Program.

    The Director of Custody Health Services (CHS) regularly meets with the Jail Reform Workgroup and is responsible for providing project management and prioritizing recommendations to ensure the implementation of various jail reform efforts. 

    CHS has two full-time Quality Improvement Managers who continually conduct audits and studies; review critical incidents; provide recommendations; and monitor compliance with and consistent application of Custody Health policies and procedures.

    With the implementation of HealthLink, productivity and other relevant information are tracked and measured to develop a clearer picture of CHS operations, pinpoint areas that may require service or staffing level adjustments, and identify areas of need. 

    The CHS component of this Summarized Recommendation has been completed.  However, CHS will continue to monitor services to adapt to the evolving needs of inmates.

    The Sheriff’s Office has contracted with Gary Raney to conduct a culture assessment that can be used to develop an employee and inmate survey to track ongoing progress.  His initial report of findings will be presented to the Board of Supervisors on April 3, 2018.

    On July 18, 2018 GAR, Inc. presented the results of the first inmate survey. The results have been posted on the Sheriff’s Jail Reforms website. The Sheriff’s Office plans to continue inmate surveys annually as recommended by GAR, Inc. once tablets have been introduced to the inmates at the facilities.

    The Sheriff’s Office is continuing to develop data reports to guide operations. The new Grievance monthly dashboard is the first publicly available report and it is posted on the Sheriff’s Jail Reforms website.

    The Sheriff’s Office has completed this recommendation to the extent possible with the existing technology infrastructure. In the future, the new Jail Management System will assist with conducting audits and creating management reports.

    Budget Status: The Board approved the following:

    • FY 2017 Adopted Budget: $2.5 million reserve for jail reform and oversight.
    • June 5, 2018, the Board approved an amendment with Sabot Consulting relating to assistance with monitoring and reporting on jail reform efforts, compliance, and policy review in the amount of $35,000.

    Source Report(s): Sheriff’s Reform Plan, Blue Ribbon Commission, Civil Grand Jury, Dental Gap Analysis - Shulman, Healthcare Gap Analysis - Wilcox, Zisser

    Responsible Department(s): Sheriff’s Office, Custody Health Services

    Master List Nos.: 5, 404, 516, 521, 527, 534, 536, 561, 602-604, 606

    Review Date: FGOC reviewed on September 30, 2016.​

    Steps Taken: The Sheriff’s Office has incorporated a cognitive evaluation in the initial screening process. CHS staff provides recommendations on housing to Custody staff, which is taken into consideration for placement.

    This Summarized Recommendation has been completed.​

    Budget Status: County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 350

    Review Date: FGOC reviewed on September 30, 2016.

    Steps Taken: The Sheriff’s Office has purchased and configured ADA tracking software and is in the process of training end users. The County Executive’s Office has a contract with Sabot Consulting to monitor compliance for ADA mandates and facility modifications and to ensure timely implementation.

    This Summarized Recommendation has been completed.

    Budget Status: No additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 417, 418

    Review Date: FGOC reviewed on September 30, 2016.

    Steps Taken: Comprehensive ADA training has been provided for all Custody and Custody Health staff by Sabot Consulting. When the updated policies are complete, Sabot Consulting will provide refresher training, and Riley Consulting will be providing training on the ADA tracking system.

    This Summarized Recommendation has been completed.

    Budget Status: No additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan

    Responsible Department(s): Sheriff’s Office, Custody Health Services

    Master List Nos.: 450, 451, 452, 456

    Review Date: FGOC reviewed on September 30, 2016.​

    Steps Taken: A Grievance Unit has been established by the Sheriff’s Office.

    The Sheriff’s new Grievance Policy has been finalized and posted on the Sheriff’s website. Revised forms are also now being used in all facilities. Custody staff was trained on how to use the new system and the Grievance Unit will conduct follow-up at squad meetings. Inmates also received information and instructions on the new grievance process and forms via an informational video that was played on loop in the housing units and intake areas as part of the Inmate Information Bulletin.

    This Summarized Recommendation has been completed.

    Budget Status: The Board approved the following:

    • FY 2017 Adopted Budget: 1 Sheriff’s Correctional Lieutenant position and 2 Management Analyst positions ($502,408) to track, investigate, and respond to grievances.
    • FY 2018 Adopted Budget: 2 Senior Management Analyst positions ($338,062) to conduct audits, provide quality assurance of grievance responses, identify trends, and produce training materials regarding grievances.

    Source Report(s): Human Relations Commission, Blue Ribbon Commission on Improving Custody Operations

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 23, 25, 27, 29, 33, 40, 41, 43, 327, 328, 488, 489, 495, 497

    Review Date: FGOC reviewed on November 10, 2016.​

    Steps Taken: The Sheriff’s Office is configuring an automated tracking system for grievances. Collection boxes were installed and the collection process was revised. Forms are being revised and the tablet RFP will include a requirement for inmates to submit grievances electronically also, via the tablet or a kiosk.

    This Summarized Recommendation has been completed.

    Budget Status: The Board approved the following:

    • FY 2017 Adopted Budget: 1 Sheriff’s Correctional Lieutenant position and 2 Management Analyst positions ($502,408) to track, investigate, and respond to grievances.
    • FY 2018 Adopted Budget: 2 Senior Management Analyst positions ($338,062) to conduct audits, provide quality assurance of grievance responses, identify trends, and produce training materials regarding grievances.

    Source Report(s): Sheriff’s Jail Reform Plan, Blue Ribbon Commission on Improving Custody Operations, Zisser

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 28, 32, 34 - 39, 379 - 381, 383, 384, 496, 498, 511, 514

    Review Date: FGOC reviewed on November 10, 2016.

    Steps Taken: Last year, PREA information was added to the end of the Inmate Orientation Video inmates view prior to housing. Both the Inmate Rule Book and the Orientation Video are being updated.  The PREA video continuously plays in the following areas: Men's and Women's Intake/Booking, Main Jail Classification, and Elmwood Processing. Inmates have access to the important information relayed through this video.

    This Summarized Recommendation is complete to the extent the Sheriff’s Office concurs with the recommendations.

    Budget Status: The Board approved the following:

    • FY 2016 Adopted Budget: 1 Sheriff’s Correctional Sergeant position and 1 Sheriff’s Correctional Deputy position ($314,500) were added for the Professional Compliance unit.
    • November 2015: Also for the Professional Compliance Unit, 1 Sheriff’s Correctional Lieutenant, 1 Sheriff’s Correctional Sergeant, and 2 Sheriff’s Correctional Deputy positions were added ($741,000)
    • FY 2017 Adopted Budget: 5 Sheriff’s Correctional Deputy positions and 1 Clerk position ($827,539) were added to the Office of Operational Standards and Inspection Unit to support policy and compliance work.

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Zisser

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 493- 494

    Review Date: FGOC reviewed on November 10, 2016.​

    GRV 4: For accountability and investigatory purposes, assign all complaints to Internal Affairs for investigation. Investigations of grievances should be completed in a timely manner. Hold staff accountable for timely and appropriate responses. If there is an oversight body created, their role should include grievance oversight.

    Steps Taken: All complaints are now funneled through the Internal Affairs Unit for review to determine what the best course of investigative action will be. Likewise, all grievances will be forwarded to the Grievance Unit for the same review.

    This Summarized Recommendation has been completed.

    Budget Status: The Board approved the following:

    • February 2016: 1 Sheriff’s Sergeant for the Internal Affairs Unit ($229,610).
    • FY 2017 Adopted Budget: 2 Sheriff’s Sergeant positions and 1 Management Analyst position to the Internal Affairs Unit ($591,854).
    • FY 2017 Adopted Budget: 1 Sheriff’s Correctional Lieutenant position and 2 Management Analyst positions ($502,408) to track, investigate, and respond to grievances.
    • FY 2018 Adopted Budget: 2 Senior Management Analyst positions ($338,062) to conduct audits, provide quality assurance of grievance responses, identify trends, and produce training materials regarding grievances.

    Source Report(s): Sheriff’s Jail Reform Plan, Blue Ribbon Commission on Improving Custody Operations, Zisser

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 24, 490, 499 – 501

    Review Date: FGOC reviewed on November 10, 2016.​

    Steps Taken: The Sheriff’s Office is working on this analysis, and will provide more information on the number and location of telephones.

    The Sheriff’s Office brought an action to the Board on February 28, 2017 relating to the Inmate Welfare Fund and inmate services. As part of that action, the Board approved the following objectives for the RFP for telephone services previously approved by the Board’s Finance and Government Operations Committee:

    1. The best value to the County in the form of an inmate telephone security system and security support, including call monitoring, call recording and storage, and call recording management and retrieval system.
    2. The lowest possible per-minute inmate telephone call cost.
    3. No IWF commission.
    4. The lowest possible called party costs.
    5. Full cost recovery only.
    6. No County subsidy.

    The Sheriff’s Office has also added phones to the 6th and 7th floors at Main Jail North and will continue to add phones until the overall number of phones at Main Jail North has doubled.

    The Sheriff’s Office is presenting a 1 year extension of the contract with the current telephone vendor at the August 2017 Jail Reforms Study Session.

    This Summarized Recommendation has been completed.​

    Budget Status: The Board approved the following:

    • FY 2017 Adopted Budget: Reduced reimbursements from the Inmate Welfare Fund ($1.3 million) so that the Inmate Welfare Fund positions and services would not get cut.
    • February 28, 2017: The Board approved changes to the Inmate Welfare Fund, which will have an impact of $484,202 during FY 2017, and approximately $2.3 million of impacts to the General Fund.
    • The Board approved a one-year extension of the contract with the current telephone vendor at the August 15, 2017 Jail Reforms Study Session.

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Human Relations Commission, Blue Ribbon Commission on Improving Custody Operations

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 99, 163, 164, 335

    Review Date: FGOC reviewed on December 19, 2016.​

    Steps Taken: The IWFC convened a subcommittee to evaluate the recommendations from the Blue Ribbon Commission.

    The Sheriff’s Office brought an action to the Board on February 28, 2017 relating to the Inmate Welfare Fund and inmate services. As part of that action, the Board voted to end commissary commissions, which was an overall price reduction of 52.5% effective March 1, 2017. Since the current contract with Aramark Commissary Network will expire on June 30, 2017, staff will vigorously renegotiate the contract to lower prices even further beginning July 1, 2017. Staff will also draft a two-year extension with Aramark to lock in the reduced prices while studying alternative models and preparing an RFP for commissary services.

    The Sheriff’s Office provided an off-agenda report to the Board of Supervisors on January 23, 2018 with an analysis of in-house commissary options.

    This Summarized Recommendation has been completed.

    Budget Status: The Board approved the following

    • FY 2017 Adopted Budget: Reduced reimbursements from the Inmate Welfare Fund ($1.3 million) so that the Inmate Welfare Fund positions and services would not get cut.
    • February 28, 2017: The Board approved changes to the Inmate Welfare Fund, which will have an impact of $484,202 during FY 2017, and approximately $2.3 million of impacts to the General Fund.

    County Administration and the department are evaluating to determine if additional resources are needed.

    The Sheriff’s Office has been analyzing issues and compiling resource need requests for FY 2018 related to this Summarized Recommendation, which will help to assist with evaluating commissary models.

    Source Report(s): Blue Ribbon Commission on Improving Custody Operations

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 72 - 74, 84 - 88, 174

    Review Date: FGOC reviewed on December 19, 2016.​

    Steps Taken: The Sheriff’s Office has established Inmate Advisory Councils to assist with communication between inmates and jail administration. The Sheriff’s Office has held two Inmate Advisory Council (IAC) meetings at Elmwood and one at Main Jail.  The next meetings will be in July 2017.  The Sheriff’s Office has also begun regular meetings with advocacy groups to discuss operational changes so that they can help to communicate information to inmates and their families.

    In March, the Sheriff’s Office began utilizing Monthly Inmate Information Bulletins in the facilities. Updates are broadcasted on the televisions in the housing units to assist with disseminating information to inmates.

    Quarterly Inmate Advisory Council (IAC) meetings were scheduled for January, April, July and October 2017.

    Q1) January 9, 2017

    Q2) April 24, 2017 

    Q3) July 17, 2017 

    Q4) October 16, 2017

    Prior to each meeting, IAC participation rules of conduct are reviewed, and administration and participants discuss all agenda items submitted by inmates.  Meeting minutes are shared with inmates (inmate video loop) and a copy is sent to the Jail Observer Program.

    Inmate Information Bulletins and the Inmate Advisory Council continue.  The Sheriff’s Office has contracted with Gary Raney to conduct a culture assessment that can be used to develop an employee and inmate survey to track ongoing progress.  His initial report of findings will be presented to the Board of Supervisors on April 3, 2018.

    On July 18, 2018 GAR, Inc. presented the results of the first inmate survey.  The results have been posted on the Sheriff’s Jail Reforms website.  The Sheriff’s Office plans to continue inmate surveys annually as recommended by GAR, Inc. once tablets have been introduced to the facilities.

    This summarized recommendation has been completed and efforts to expand programs are ongoing.

    Budget Status: The Board approved the following:

    • FY 2017 Adopted Budget: Reduced reimbursements from the Inmate Welfare Fund ($1.3 million) so that the Inmate Welfare Fund positions and services would not get cut.
    • February 28, 2017: The Board approved changes to the Inmate Welfare Fund, which will have an impact of $484,202 during FY 2017, and approximately $2.3 million of impacts to the General Fund.

    Source Report(s): Sheriff’s Jail Reform Plan, Blue Ribbon Commission on Improving Custody Operations, Department of Justice, Civil Grand Jury, Zisser

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 62-65, 110, 165, 171, 175, 191, 197, 406, 523, 535

    Review Date: FGOC reviewed on December 19, 2016.​

    Steps Taken: Custody Health Services has re-designed the assessment and re-assessment protocols to increase the intensity and depth of assessments for all inmates booked into the Santa Clara County jail facilities.  As in the past, nurses continue to be patient advocates and receive ongoing training to apply best practices related to patient care.

    The CHS component of this Summarized Recommendation has been completed.  However, CHS will continue to monitor and update/apply best practices as necessary.   

    The Sheriff’s Office agrees with these recommendations and has sent staff to the Department of Justice, National Association of Civilian Oversight of Law Enforcement, and American Correctional Association seminars. The Sheriff’s Office also regularly utilizes the California State Sheriff’s Association resources to connect with other agencies and to exchange information regarding best practices. The Sheriff’s Training and Compliance Unit has revised the Jail Training Officer program and will begin training for the new program in January 2017. Estimated completion is December 2017 to train all Jail Training Officers.

    Per the Sheriff’s Office, they have fostered a culture based on sharing information and best-practices with other law enforcement agencies. They will continue to actively participate in information sharing activities and site visits with other agencies to learn from other agencies.

    This Summarized Recommendation has been completed.

    Budget Status: County Administration and the departments are evaluating to determine if additional resources are needed.

    Source Report(s): Department of Justice, Healthcare Gap Analysis – Wilcox, Human Relations Commission

    Responsible Department(s): Sheriff’s Office, Custody Health Services

    Master List Nos.: 201, 205, 206, 342, 592, 600

    Review Date: FGOC reviewed on December 19, 2016.​

    Steps Taken: For Custody Health Services, training curriculum in the listed areas of focus has been developed and is ongoing with clinical medical staff, custody staff (MSDs), mental health staff (MFTs & LCSWs). This includes RNs, Psychologists, Nurse Practitioners and Psychiatrists. It is offered in all the available and various formats to allow for comprehensive global training of all staff.

    Suicide prevention and assessment training was provided to Custody Health staff in October of 2016, with video refreshers for new and existing staff. Full-day Annual Review Day (ARD) training is offered to nursing and clinical staff annually. This year, topics included: Workplace Safety, Gangs in Our Jails, as well as Mental Health and Suicide Prevention.

    The CHS component of this Summarized Recommendation is complete.

    The Sheriff’s Office agrees with these recommendations and continually evaluates training to ensure inmate and staff safety. A timeline and update on training is provided to the Finance, Government and Operations Committee and the Public Safety and Justice Committee quarterly. Many of these trainings are already being implemented, while others are pending policy revisions.

    The Sheriff’s Office has been able to make significant progress on training.  Four hours of PREA training is provided in the academy, and custody bureau staff complete 2 hours of biannual refresher training.  All Custody Bureau staff has completed 16 hour Behavioral Health and De-Escalation training.  All Sheriff’s Office staff will complete Crisis Intervention Training by December 2019.  Implicit Bias training is on-going. The Sheriff’s Office has completed overview training on the new LGBTQI policy and will conduct more in-depth training beginning in July.   The Sheriff’s Office partnered with the Probation Department to adapt their training curriculum on Gender Responsiveness to a custody setting and began training in February.  The Office is also completing Mindfulness Training this quarter and will continue to provide quarterly reports on training to the Public Safety and Justice Committee on all training topics.
    This Summarized Recommendation has been completed.

    Budget Status: The Board approved the following:

    • FY 2017 Adopted Budget: $215,000 to support staff attendance at training for Implicit Bias Training, Crisis Intervention Team (CIT) training, and Americans with Disabilities Act training.
    • May 2016: Agreement with Sabot Consulting to provide ADA training and use of force training to DOC and Custody Health Services staff.

    County Administration and the departments are evaluating to determine if additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan, Human Relations Commission, Commission on the Status of Women, Civil Grand Jury, Zisser, Department of Justice, Blue Ribbon Commission on Improving Custody Operations

    Responsible Department(s): Sheriff’s Office, Custody Health Services

    Master List Nos.: 109, 133, 136 – 145, 179, 203, 204, 343-346, 453 – 455, 457- 465, 503, 507, 538 - 542

    Review Date: FGOC reviewed on December 19, 2016.​

    Steps Taken:

    • Both mental health and medical staff are available at Intake Booking twenty-four (24) hours a day, seven (7) days per week.  Staff includes registered nurses, mental health clinicians, and psychiatrists.  The registered nurses and mental health clinicians are available 24/7, while the psychiatrists are available sixteen (16) hours a day, seven (7) days per week.
    • CHS has implemented a two-tier triage screening at Intake Booking.  The initial screening is conducted by a registered nurse who takes individuals through a series of standardized intake admission and screening questions while obtaining baseline vital signs.  Those assessed with a severe medical condition are sent to the hospital.  Those assessed to have an increased risk for medical or behavioral needs are referred to a medical or mental health physician or a mental health clinician for further evaluation.  Following the evaluation, a treatment plan and discharge planning are initiated based on standardized protocols.
    • A second Dentist has been added to expand hours and days of availability.
    • CHS offers a comprehensive range of mental health services and provides both acute and outpatient mental health services to the jail facilities.  Mental health crisis clinicians are available at the jail facilities 24 hours a day, 7 days a week. 
    • There are currently ten (10) Behavioral Health Teams (BHT) in operation.  Each BHT is comprised of a psychiatrist, psychologist, and a mental health clinician.  They provide care coordination in special management units that house patients with intellectual disabilities, serious mental illness, and/or substance use issues.  Services include psycho social assessments, individual/group therapy, and discharge planning.  The BHTs are supported by Multi-Support Deputies who assist with custody-related issues.
    • Through a contract with Family & Children’s Services, a team of 10 substance use counselors, a clinical supervisor, and a program director work collaboratively with the Behavioral Health Teams at the Main Jail, Elmwood, and CCW for substance use screening, treatment engagement, and linkages to community services.
    • CHS utilizes a model of care that integrates Clinical Staff across cost centers for more robust and efficient services across facilities.
    • A Special Populations RN case manager who works in cooperation with Mental Health Social Workers and outside agencies has been added to assist with ensuring that the continuity of care needs of CHS clients are met, both in and out of the jail system. Continuity of care includes identifying special housing needs and providing assistance with missing benefits or legal status, as necessary, to ensure that clients receive the most appropriate assistance as possible.


    This Summarized Recommendation has been completed.  However, CHS will continue to monitor staffing levels to meet the evolving needs of inmates.

    Budget Status: The Board approved the following:

    • FY 2017 Adopted Budget: 1 Dentist position and 1 Dental Assistant position ($326,928)
    • FY 2017 Adopted Budget: 1 Psychiatric Social Worker II position ($185,697) for night shift mental health staffing.
    • December 2015: 59 positions in Custody Health Services to provide multi-disciplinary healthcare staff and support staff ($16.6 million) for mentally ill inmates for behavioral health services during incarceration and re-integration into the community.
    • FY 2017 Adopted Budget: 10 Sheriff’s Correctional Deputy positions and 1 Sheriff’s Correctional Sergeant position ($1.6 million) were added as Multi Support Deputies to support behavioral health teams.
    • FY 2018 Adopted Budget: Added new Psychiatrist position to provide on-site clinical oversight of behavioral health services, and Hospital Services Assistant position, 2 Clinical Nurse III positions, and one Staff Developer position to support jail reform efforts ($1.4 million).
    • January 23, 2018: Added new Director, Custody Behavioral Services Positions, in Custody Health Services to provide oversight of all Custody Health behavioral health staff and services.

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Blue Ribbon Commission on Improving Custody Operations, Dental Gap Analysis – Shulman, Healthcare Gap Analysis-Wilcox, Civil Grand Jury

    Responsible Department(s): Custody Health Services

    Master List Nos.: 108, 113, 533, 552, 580, 585, 586, 593, 594, 605

    Review Date: FGOC reviewed on December 19, 2016.​

    Steps Taken: The Sheriff’s Office has implemented a policy by which all complaints are reviewed by the Internal Affairs Unit (IAU) first for investigation, before determining which matters can be sent back to the division of origin for investigation if the matter is operational in nature. IAU investigates all moderate and major complaint matters. IAU has increased staffing to process and investigate complaints in a timelier manner.

    The Sheriff’s Office continues to ensure all grievances are routed to the Grievance Unit and all complaints are routed to the Internal Affairs Unit.  The Office is also monitoring caseloads to ensure timely processing and responses to complaints.


    This Summarized Recommendation has been completed.

    Budget Status: The Board approved the following:

    • February 2016: 1 Sheriff’s Sergeant for the Internal Affairs Unit ($229,610).
    • FY 2017 Adopted Budget: 2 Sheriff’s Sergeant positions and 1 Management Analyst position to the Internal Affairs Unit ($591,854).
    • FY 2017 Adopted Budget: 1 Sheriff’s Correctional Lieutenant position and 2 Management Analyst positions ($502,408) to track, investigate, and respond to grievances.
    • FY 2018 Adopted Budget: 2 Senior Management Analyst positions ($338,062) to conduct audits, provide quality assurance of grievance responses, identify trends, and produce training materials regarding grievances.

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan, Zisser

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 370, 371, 502, 504, 505

    Review Date: FGOC reviewed on December 19, 2016.​

    Steps Taken: The Sheriff’s Office has implemented an Early Warning System that identifies trends and produces reports for management to address conduct, training or policy issues proactively.

    This Summarized Recommendation has been completed.

    Budget Status

    The Board approved the following:

    • February 2016: 1 Sheriff’s Sergeant for the Internal Affairs Unit ($229,610).
    • FY 2017 Adopted Budget: 2 Sheriff’s Sergeant positions and 1 Management Analyst position to the Internal Affairs Unit ($591,854).
    • FY 2017 Adopted Budget: 1 Sheriff’s Correctional Lieutenant position and 2 Management Analyst positions ($502,408) to track, investigate, and respond to grievances.
    • FY 2018 Adopted Budget: 2 Senior Management Analyst positions ($338,062) to conduct audits, provide quality assurance of grievance responses, identify trends, and produce training materials regarding grievances.

    No additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan, Blue Ribbon Commission on Improving Custody Operations

    Responsible Department(s): Sheriff’s Office

    Master List Nos.: 11-13, 365, 366, 375

    Review Date: FGOC reviewed on December 19, 2016.​

    Steps Taken: The addition of a new dentist has given the Custody Dentistry Director more flexibility in increasing dental hours at Main Jail and Elmwood, as necessary.  Wait times are also constantly monitored so that the dentists’ schedules can be adjusted to minimize wait times. 
    FAF is currently in the process of designing the new dental office at Main Jail.  The new dental office would accommodate an additional dental chair and have an area for lab work.
    With the implementation of HealthLink, Custody Health Services (CHS) now has a single, integrated record system that allows caregivers to securely and efficiently document and view relevant patient information from all episodes of care to promote consistent patient care.  CHS also monitors various reports from HealthLink to track and measure productivity and pinpoint areas of need.

    This Summarized Recommendation has been completed.

    Budget Status: The Board approved the following:

    • FY 2017 Adopted Budget: 1 Dentist position and 1 Dental Assistant position to support Dental Services in the Jail ($326,928).

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Dental Gap Analysis - Shulman

    Responsible Department(s): Custody Health Services

    Master List Nos.: 559, 562, 570

    Review Date: FGOC reviewed on December 19, 2016.

    Re-institute squad meetings before each shift.

    Steps Taken: For the Sheriff’s Office, Custody squad meetings were re-instituted in February 2016. The Office of Standards and Inspection Unit (OSIU) is in the process of developing a training plan that include a variety of learning paths for long term development. Staff assigned to the Elmwood Women's facility receives gender-sensitivity training. A department-wide protocol will be developed after further input from stakeholders such as the Commission on the Status of Women and the Office of LGBTQ Affairs.

    Custody Health (CHS) staff has reviewed all policies for gender responsiveness and appropriate changes were implemented. A two-tiered mental and physical health screening system was developed and implemented in Intake Booking. All policies have been distributed to staff, reviewed, trained to, and implemented.
    CHS conducts annual eight hour “8A Officer Training,” which provides an overview of mental illness, developmental disabilities, psychotropic medications, legal issues/patients’ rights, suicide prevention, and de-escalation strategies. 
    The Sheriff’s Office has been able to make significant progress on training.  Four hours of PREA training is provided in the academy, and custody bureau staff complete 2 hours of biannual refresher training.  All Custody Bureau staff has completed 16 hour Behavioral Health and De-Escalation training.  All Sheriff’s Office staff will complete Crisis Intervention Training by December 2019.  Implicit Bias training is on-going. The Sheriff’s Office has completed overview training on the new LGBTQI policy and will conduct more in-depth training beginning in July.   The Sheriff’s Office partnered with the Probation Department to adapt their training curriculum on Gender Responsiveness to a custody setting and began training in February.  The Office is also completing Mindfulness Training this quarter and will continue to provide quarterly reports on training to the Public Safety and Justice Committee on all training topics.

    This Summarized Recommendation has been completed.

    Budget Status: The Board approved the following:

    • FY 2016 Adopted Budget: 1 Sheriff’s Correctional Sergeant position and 1 Sheriff’s Correctional Deputy position ($314,500) were added for the Professional Compliance unit, now known as the Operational Standards and Inspection Unit (OSIU).
    • November 2015: Also for the Professional Compliance Unit, now known as the Operational Standards and Inspection Unit (OSIU),1 Sheriff’s Correctional Lieutenant, 1 Sheriff’s Correctional Sergeant, and 2 Sheriff’s Correctional Deputy positions were added ($741,000)
    • FY 2017 Adopted Budget: 5 Sheriff’s Correctional Deputy positions and 1 Clerk position ($827,539) were added to the Operational Standards and Inspection Unit to support policy and compliance work.

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Blue Ribbon Commission on Improving Custody Operations, Human Relations Commission, Commission on the Status of Women, Civil Grand Jury

    Responsible Department(s): Sheriff’s Office, Custody Health Services

    Master List Nos.: 16-21, 178, 326, 537

    Review Date: FGOC reviewed on December 19, 2016​

    Steps Taken: With the implementation of HealthLink, staff can identify medical and behavioral health issues during the booking process, provide appropriate intervention throughout an inmate’s incarceration period and when necessary, provide assistance upon an inmate’s release.

    Medication administration has always included identification checks and mouth checks.  Staff will ensure continuous adherence to this policy.

    Inmates receive a discharge summary (HealthLink report) that includes their care needs and medication(s).

    Medications for medical and behavioral health are monitored using lab testing as appropriate to determine levels as per the recommendation of the manufacturer and medical decision making.
    Voluntary versus involuntary medication use is reviewed on a case by cases basis and is dependent on review by a physician or psychiatrist.
    The list of medications has been completed and staff has been trained on the policies regarding Keep on Person medications.

    This Summarized Recommendation has been completed.

    Budget Status: The Board allocated $2.5 million as part of the FY 2016 Adopted Budget and $2.0 Million as part of the FY 2017 Adopted Budget for HealthLink to be implemented in Custody Health.

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Blue Ribbon Commission on Improving Custody Operations, Healthcare Gap Analysis – Wilcox, Mental Health Gap Analysis – Gage

    Responsible Department(s): Custody Health Services

    Master List Nos.: 46, 608, 610, 611, 619, 624, 625

    Review Date: FGOC reviewed on January 26, 2017.​

    Steps Taken: The services described in this Summarized Recommendation are available. 

    HealthLink tracks the number of appointments per dentist and the average number of dental clinic appointments by clinic and provider.  The information will be used to identify areas of need to minimize wait times.

    This Summarized Recommendation has been completed. 
    However, Custody Health will consider providing additional services when construction of the new Main Jail dental office is completed.  Construction is anticipated to begin in November 2018, with an anticipated completion date of September 2019. 

    Budget Status: The Board approved the following:

    • FY 2017 Adopted Budget: 1 Dentist position and 1 Dental Assistant position to support Dental Services in the Jail ($326,928).

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Blue Ribbon Commission on Improving Custody Operations, Dental Gap Analysis – Shulman

    Responsible Department(s): Custody Health Services

    Master List Nos.: 55, 548, 549, 550, 551, 553, 554, 556, 557, 560, 568

    Review Date: FGOC reviewed on January 26, 2017.

    Steps Taken: CHS has implemented a two tier triage screening for booking. The initial screening (Tier 1) takes the client through a series of medical and behavioral health screening questions while obtaining baseline vital signs. Depending on the answers to the Tier 1 screening, clients that show an increased risk for medical or behavioral needs are then sent for further evaluation. This further evaluation is performed by a medical physician or mental health clinician. A triage set of criteria has been developed and implemented to determine acuity levels and appropriate next steps for both emergent, urgent and routine care. CHS staff completes all intake parameters.

    All nurses assigned to Intake Booking are given a one-week on-the-job training for Intake screenings and are paired with two experienced nurses. 

    This Summarized Recommendation is complete to the extent that Custody Health Services concurs with the recommendations.  CHS will continue to review the screening and assessment process on an ongoing basis to ensure that it reflects best practices.

    Budget Status: County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Healthcare Gap Analysis – Wilcox

    Responsible Department(s): Custody Health Services

    Master List Nos.: 574-575, 577-579

    Review Date: FGOC reviewed on January 26, 2017.​

    Steps Taken: The restraint policies have been reviewed, refined and implemented. The protocol for medical or behavioral restraints in the jail follow the same policy and procedures as VMC policy on physical and chemical restraints.

    This Summarized Recommendation has been completed.

    Budget Status: No additional resources are needed.

    Source Report(s): Mental Health Gap Analysis – Gage

    Responsible Department(s): Custody Health Services

    Master List Nos.: 627, 628, 629, 630

    Review Date: FGOC reviewed on January 26, 2017.​

    Steps Taken: The electronic medical record HealthLink system went live in May 2017. HealthLink is an integrated system that has the ability to update an administrative dashboard. Patients’ records on dental, medical and mental health are available in HealthLink. 

    With the implementation of HealthLink, caregivers are now able to securely and effectively view relevant patient information from all episodes of care to promote consistent patient care.  It also decreased paper documentation and replaced manual data tracking of information.

    Programming to capture metrics continue to be refined to accurately measure the effectiveness of healthcare delivery.

    A full time Quality Improvement (QI) manager for psychiatric/Mental Health services has been hired as of October, 2016 to be in charge of the quality management program of psychiatric and mental health for Adult Custody Health Services.

    Custody Health works closely with the Department of Correction to review critical incidents to determine if there were systematic issues that need to be addressed and, if necessary, make recommendations to reduce or eliminate the likelihood of future adverse events. 

    This Summarized Recommendation has been completed.

    Budget Status: The Board allocated $2.5 million as part of the FY 2016 Adopted Budget and $2.0 Million as part of the FY 2017 Adopted Budget for HealthLink to be implemented in Custody Health.

    County Administration and the department are evaluating to determine if additional resources are needed.

    Source Report(s): Sheriff’s Jail Reform Plan, Blue Ribbon Commission on Improving Custody Operations, Mental Health Gap Analysis – Gage, Healthcare Gap Analysis – Wilcox

    Responsible Department(s): Custody Health Services

    Master List Nos.: 54, 56, 111, 571, 572, 591, 391, 392, 617, 622, 631, 635, 636

    Review Date: FGOC reviewed on January 26, 2017.​

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