Good morning everyone. I'm going to call this meeting to order. This is Alameda County's Board of Supervisors Public Protection Committee meeting for Thursday November 21st. Can we please start with the roll call followed by the instructions to participate in person and remotely. Supervisor Miley, excused. Supervisor Marquez present in person participation. The meeting site is open to the public. Please adhere to all safety protocols while in the building. If you'd like to speak on an item, please fill up a speaker's card in the front of the room and hand it to the clerk or remote participation. Follow the teleconferencing guidelines posted at www.acgov.org. If you'd like to speak on an item remotely, use the raise your hand function at the appropriate time. Thank you very much, Tisa. I want to welcome everyone. We do have three items on our agenda today. We're going to hear each item and then in the conclusion of that presentation, we will take public comment and proceed to the next presentation The first item on today's agenda these are all informational items the first item is Alameda County Public Health Department's annual centurated jail Title 15 inspection report for 2024 the presenters are Dr. Nicholas Moss with County Health Officer and Ronald Browder, Director of Environmental Health Department with Elmita County Health. So welcome and when you get started I want to just do an audio check to make sure that our members participating remotely can hear you clearly. So Dr. Moss, I believe, you're in person. Welcome. And we have a presentation correct? You have the size. Yeah. Okay. There are there copies in the back of the room for members of the public in front. Perfect. Thank you. If we could just test your audio and the presentation of someone online, can give us a thumbs up. Testing testing. Thank you. Perfect. Thank you so much. Great. Good morning, Supervisor Marquez. I'm Dr. Nicholas Moss, Alameda County Health Officer here with my colleague, Ron Browder, Director of the County Environmental Health Department for the Title 15 Inspection Report for Sanery to Jail for 2024. Next slide please. The purpose of this presentation is to summarize the annual Title 15 Medical Mental Health Nutrition and Environmental Health Inspection of San Arida Jail. The Health Officer and Environmental Health Director present these inspection results every fall for informational purposes. Next slide please. This is an overview of what we'll cover. First of all, the regulations regarding correctional facility inspections, then the team and approach, and our findings and recommendations in the areas of medical and mental health, nutrition, and environmental health and hygiene. Next slide, please. Beginning with the regulations. Next slide. Annual local inspections of C&RBJL are required by state law and the California Code of Regulations. As shown on this slide, the California Board of State and Community Corrections, or BSC, establishes the minimum standards for local detention facilities. The BSC performs its own inspections every two years. Next slide, please. The work of the Title 15 inspection is divided between the Public Health Department and the Environmental Health Department according to the nature of the specific standards, with healthcare and nutrition matters covered by the Public Health Department and Environmental Health and hygiene matters covered by the Environmental Health Department. The slide shows specific articles and the minimum standards covered by each department. Next slide please. This slide shows the areas covered in the minimum standards for medical and mental health services in the Title 15 regulations. It will not read them all in the interest of time. Next slide. These are the areas covered in nutrition standards. Next slide. And these are the areas covered by the Environmental Health and Hygiene Standard. Next slide please. It will now review the inspection team and approach. Next slide. This slide shows the makeup of the team that performed the 2024 Title 15 inspection of Santerita Jail. For the Public Health Department, I attended along with our registered nurse certified legal nurse consultant, two registered dietitians, our Jail Inspection Program Coordinator and two Jail Inspe inspection program coordinator trainees, as well as our director of public health nursing. And also not listed here. Kimmy Watkins-Tart, director of public health for Alameda County, joined the inspection. From the Environmental Health Department, we were joined by a registered Environmental Health Specialist. Next slide, please. This slide summarizes the approach to the inspection. The inspection team reviews facility policies and procedures that are required in the Title 15 minimum standards and performs a visual inspection of the facility, focusing on areas covered by the various standards. For example, the team inspects clinical areas, first aid kits, sick call processes, and pharmacy procedures, as well as the intake process, food storage, and preparation areas, health record systems, and the selection of housing units. The nutrition staff also performs a chart review focusing on special medical diets. The team typically samples several meals as part of the inspection. Next slide. The team uses an inspection tool published by the Board of State and Community Corrections. This is an example image taken from the Medical Mental Health Evaluation tool. The facility categories you see listed at the top refer to the type of correctional or detention facility in question. Finery the Jail is a type two facility as it is holding people pending a reigningment, awaiting and during trial and upon sentence of commitment. Next slide. Moving on to findings. Next slide. Moving on to findings. Next slide. On July 11, 2024, Alameda County Public Health and Environmental Health staff conducted the annual required Title 15 inspection of San而ida Jail. The following slides briefly summarize the findings and recommendations of that inspection. The top line finding for medical and mental health was that compliance was met with all articles and sections. The inspector made recommendations for improvement, however. Next slide. The slide shows the recommendations for improvement based on inspector observations by section of Title 15. These are based on observations that did not rise to the level of noncompliance with the Title 15 minimum standards. They all carry over from the prior year's inspection. I want to highlight Section 1202, which requires that the facility have processes for health care quality assurance and continuous quality improvement, QA and CQI. There has been overall improvement in these efforts in recent years, but there remains a recommendation to ensure CQI meetings occur regularly and incorporate corrective action plans and follow-up. For additional background, the county hired a consultant for this Mazaar's starting in 2020 to review health care and related QA and CQI efforts at the facility. That process is ongoing, but our inspection recognized it as part of an effort to improve health services at the facility. Also, under the leadership of our Agency Medical Director, Dr. Kathleen Klanin, Alameda County, Alameda County Health Clinical Leaders, including me, I've been invited to observe this process as a continuation of the work of the former adult inmate medical services panel or AIMS panel, which had been charged with reviewing the quality of healthcare at Santa Rita in the past. The other medical and mental health recommendations from this inspection are as follows. In Resection 1216, pharmaceutical management, to improve the process for documenting and tracking syringe use, and under Section 1220 for state kits to review all kit medications for appropriateness of first aid use in the housing units. Next slide, please. This slide shows the recommendations from the 2023 inspection. You can see that the 2024 recommendations were carried forward from, excuse me, three of the 2024 recommendations were carried forward from the 2023 inspection. For Prowl-Vo2, again, the continuous quality improvement efforts were noted to be improving, but you heard that there continues to be a recommendation there. Under 12-16 pharmaceutical management, there's been no change in our recommendation from the prior year, having to do with the syringe labeling and tracking procedures. And similarly, regarding the first eight-kit medications, there's been no change to our recommendation from 2023, the recommendation to review the appropriateness of the medication stands. An additional recommendation from 2023, regarding documentation of the nursing assessment of a restrained person, resolved in the 2024 inspection. Additional details of the inspection and all recommendations are included in the full inspection report. Next slide, please. I will now comment on deaths in custody. Desson custody remains a serious issue and all efforts must be made to prevent them. Atel 15, Section 1046 addresses deaths in custody and requires the facility to have death review process. The Title 15 inspection team verifies that death reviews happen for any incustody deaths that have occurred since the prior inspection. The inspection team does not participate in those reviews, nor do I. There were two incustody deaths during the period covered. Details of these deaths and the review process are briefly summarized here and in the period covered. Details of these deaths and the review process are briefly summarized here and in the written report. They offer my condolences to the loved ones of those who died. This is always a sensitive issue for many stakeholders, but particularly so at this very moment, and I must also acknowledge that other lives are being impacted. For our part, the Public Health Department and Alameda County Health of a long history of partnering with the Sheriff's Office and responding to health concerns in Arida. The Title 15 inspection process is not sufficient to address in custody deaths and it does not come with authority to require or implement changes. However, the reconstituted aims panel I referred to gives Alameda County Health a new and better platform to work with the Sheriff's Office on identifying and addressing healthcare gaps that could contribute to future deaths. We offer our support in this and all efforts to addressing custody deaths. Next slide, please. I'm just gonna take a breath here before changing back to more day-to-day aspects of the inspection. Every year, our inspection team notes areas of strength, and I have included some here. This is not an exhaustive list. As in years past, the women's clinic continues to impress the inspection team. In addition, the new reception center is an improvement in terms of facilitating intake procedures in an environment most conducive to the health and appropriate assessment of incoming incarcerated persons on our review. In addition, the Cell Check Reminder System is an improvement over the past approach to Cell Checks. And also, as in past years, we were impressed by programs for incarcerated persons. And I wanted to highlight the Laborers Union of North America or Launa training. We actually happened to have our inspection on a day when there was a training class in progress. We got to see some of that class. And we also got to take a tour of the facility that they have at San而ida jail for construction trade training. And I have to say it was quite impressive. And seemed to offer real promising reentry pathway for participants in the training program. And then again, as in years past, the facility, we wanted to recognize the facility's strong pharmacy management system. Next slide, please. I also wanted to share some observations from the inspection team about recent changes in the behavioral health program. The highlights are listed here with some additions in the full report. First of all, we noted expanded staffing and behavioral health with all of the new management positions already filled. We and I, Sheriff's Office can correct me if I have this wrong, but we understand there to be now six therapeutic housing units. All safety cells have been closed. A pilot program for those found incompetent to stand trial and involving treatment planning and incentives is underway, and I'm understanding with the goal to restore competency. And the services to support reentry have been expanded in order and essentially begin at the start of incarceration in order to better support people with behavioral health diagnoses as they transition back out of the facility. Next slide please. Now I will cover the 2024 nutritional health findings. There were several findings of noncompliance with the Title 15 minimum standards on inspection, as in years past. And the inspectors provided several other recommendations for improvement. Before going into details, I wanted to highlight the summary quote from our Nutrition Inspectors report. Considering the facility size and operational and financial constraints that impact food served, there is an ongoing challenge to meet the recommended dietary guidelines while offering appealing, nutritious meals to incarcerated persons. I note over the decade or so I have participated in our jail inspection program, and nutrition services have steadily improved. Next slide please. Here are the findings from this year's nutritional health inspection. Servings of whole grains have improved, but additional servings are still needed in order to meet the requirements of the standards. Also, sodium levels in the menu actually increase slightly from last year, despite a standing recommendation from our team, to move to lower sodium menu items in order to meet US dietary guidelines. Lastly, menu substitutions are still not all documented as required. The recommendations are listed on the right in this table. Add a third whole grain to the menu on days identified in the report to reach the minimum title 15 requirement of three whole grains each day. Continue to strive for less ultra-process foods and lower sodium options in the weekly menus to better align with 2020 to 2025 US dietary guidelines for Americans. And ensure daily documentation of substitutions as required. Next slide please. The nutrition team made several additional recommendations, first to provide an annual reminder of training about meal procedures, the importance of special diets and snacks and proper times of delivery to be incarcerated persons. Second, to offer other fruits aside from oranges. Third, to provide alternative food substitutes for baked goods when needed. My understanding is there's a heavy reliance on pre-packaged cookies in this case. Fourth, to list all medical conditions. Under medical issues during intake, these do end up in the chart, on the chart review performed by our team, but not always at the time of intake. Fifth, timely physician approval signature is required for all medical diets. And lastly, the system is needed to flag diets or physician approval. More details may be found in the full report, and I'll note that timely doctors approval of medical diets was noted as an issue in 2023 as well. Next slide. But this time I'll turn the presentation over to Director Braver. Thank you, Dr. Moss. Welcome. Good morning, everyone. Good morning, Zulu Hazem, Marquez. Ronald Brown is my name. I'm Director for the Department of Environment and Health within the Alameda County Health. And I will summarize the inspection as Dr. Mals has indicated earlier Here a next slide, please So article 12 is about the kitchen facilities the sanitation complete sanitation of the facility and the food service and There are several articles and sections that need to be complied with and the facility has done a good job. Food is prepared at the facility. Food hallers have to be trained, medically fit to actually work in the kitchen. And there are waiting procedures for education and ongoing monitoring and cleanliness of these workers and accordance with the standards set for within the half of safety code. The California Read to a Food Code. Or as we call it, Cal Code, next slide. There shall be a food service plan. This is section 1243. Facilities will have a written full service plan that complies with CalCode. The manager is trained and certified and should be able to prepare a full service plan if necessary. It will include menu planning, purchasing, storage, and inventory control. If there is a situation where preparation and handling is found to be out of compliance, or if there is contamination, expired foods, or foods that show obvious signs of spoilage, or otherwise not fit for human consumption, that food will be eliminated from the kitchen. Food serving is important as well. We have to take consideration, potential for cross contamination and food temperatures, and transportation of the food is important as well because of the potential for contamination. Next slide, please. Section 1245, the kitchen facilities were in pretty good shape. There were a couple of minor leaks, employment issues that were observed, but most of those minor issues were corrected either during the inspection or soon thereafter. There was a refrigeration unit, a walk-in refrigerator freezer that had condensate lines that were creating ice formations and on the 25th of June that was taken care of and all the repairs were necessary repairs were made. In facilities where incarcerated people prepare meals for self-consumption of where frozen meals and prepare food from other permitted facilities. We won't have to have that. But in this case, breakfast and dinners are reheated incarcerated food workers, load the food that you're re-thermalizing units in each of the housing units. And the housing unit deputies verify reheating internal food temperature of minimum 165 degrees and they require their measurements. Recording those measurements are important and critical. All the equipment used in the facility is commercial and approved by Environmental Health. There are diswashing units that use high temperature for sanitizing. These units have to make sure that the utensils themselves, the surface of the utensils, it reaches 160, 165 degrees. And we'll make sure they're working on our bacteria. Next slide. Okay, Article 13, clothing and personal hygiene. Standard 1260 is about institutional clothing. Abung entry into the facility, incarcerated persons are provided clean, outer garments and undergarments. For males we have shorts and undershirts for females, brie and two pairs of panties. The person's personal undergarments and footwear may be substituted for the personal undergarments and footwear may be substituted for the institutional undergarments and footwear specified in this regulation. But the facility has a primary responsibility to provide personal undergarments and footwear. Our issued and exchanged clothing shall be clean, free of holes and tears, reasonably fitted, durable, easily londered and repaired. Undergarments shall be clean, free of holes and tears, substantially fitted, durable, easily laundered and repaired. On the garment, we shall be clean for your holes of tears, substantially for your stains. And the visuals will be able to select garmentized, more compatible with their gender identity and gender expression. And all of these requirements are reflected in the sheriff's office policies and procedures. Next slide, please. Article 13, T and personal hygiene, continue section 1264, control of vermin and personal clothing. There are written policies and procedures developed by the facility and administrator to control the contamination or the spread of vermin in incarcerated people's personal clothing. If there are infested clothing, they're clean, disinfected and stored in their clothes container. So as to eradicate or stop the spray of vermin, section 1265, the issuance of personal care items, there are policies and procedures developed by the facility administrator for the issuance of personal hygiene items. Administiding persons are provided sanitary napkins, liners, tampons, as requested with no maximum allowance. These persons held over 24 hours to supply with a two-brush, then to frisk, soapcom, saving implements within the first 12 hours of the housing assignment. Cross-arrated persons will not share disposable razors. Next slide please. Okay, section 1266 showering. There are policies and procedures developed by the facility administrator for showering and bathing. incarcerated persons permitted to shower or bathe upon assignment to a housing unit and at least every other day or more often if possible. If shower and is prohibited must be approved by the facility manager or a designated need and the reason for that prohibition document. Section 1267 haircut services. Acre services are available through Swan Agency member upon request and several those who may not say for reasons of identification in court. Carcerated persons may say daily and receive their hair care services at least once a month. All the equipment is disinfected after each use. The facility administrator may suspend these services in relation to people who are considered to be a danger to themselves of us. Next slide please. Section 1270, an article 14, Bed and Litting. Standard Bed and Litting issue. Plain suitable bedding and linen for each incarcerated person, entering a housing area to remain overnight, include one server of mattress, one mattress cover or one sheet, one tile, one blanket or more depending on climate conditions. Two blankets or a sleeping bag maybe you should replace a one mattress cover or one sheet at the request other incarcerated person. Section 1271, bed in and linen exchange. Again, written policies and procedures are developed. For the scheduled exchange of laundry and our sanitized bedding and linen, issued to each person's house. Washable items, let your sheets and your mattress covers and your towels, which change at least once a week. Blankets or slidman bags are under the drivetling at least once a month. Next slide slide please. Continue on on with the mattress. Matches are enclosed in the easily clean, non-assorbate ticking and conform to the size of the bunk. The mattresses ought to be free of hose and terrors. If they lack sufficient padding, they are replaced. So then it needs requirements. All mattresses must meet, excuse me, meet requirements of the state farm marshal and the brule of home furnishing test and the Filipino mattress at the time of purchase, fire proofing and so on. Two mattresses with tears were immediately replaced during inspection. Article 15, Facility Cemetery the government's budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the budget for the housekeeping tasks and inspections to identify and correct unsanitary or unsafe conditions, all work practices that are discovered. Medical care housing is clean and sanitized according to policies and procedures. The staff is about to have authority. And at the time of the inspection, there was one water fountain in housing unit to West that had low pressure, work order was submitted, and repairs were completed in a couple of weeks. So at this junction, I just like to say that all of the issues that were out of compliance have to thank the facility administration and the shared department for getting those things right away and taking care of them. That's a big help. Next slide, please. So the main kitchen is self. There were no food, hell and violations observed during the inspection of food prep areas. Main kitchen has always been well-maintained and operated. There are a few things that needed to be addressed. The floor sink at the Walgreens refrigerator number five was slow draining and maintenance to carry that right away. The food prep sink faucet was loose and leaking, that us, excuse me, leaking and that was repaired by maintenance. Drain pipe lease at the co-prep sink and the scullery two compartment sink were repaired. Parts for the hand wash sink near the kettle was on order, so operationally staff were to use other light, other U-Las, other sinks until that particular sink is repaired. The peeling wall behind the scullery area, scullery is a diswashing area, was repaired in August with a two-party epoxy-to-water proofed wall. Constant hot water splash on the wall needs to be made waterproof and that epoxy would take care of it. Work orders for warm door gaskets and missing cold base towels and walking refrigerated number five were submitted and the replacements have been completed. Our refrigeration units were whole and full temperatures properly. We're talking about internal full temperatures minimum 41 degrees for cold foods. The high-timp dishwasher machines were tested, and they sanitized utensils properly at 165 degrees minimum. There were water samples taken from various sinks in the kitchen, but vectorological analysis, and the results were negative for all of those samples, for total coliform and for E. coli. Next slide, please. So the bakery in the laundry again well maintained and operated. There was a door sweep for a door 440 that was not secure that was taken care of a couple of weeks later. Walking refrigerated number one was out of order at the time of the inspection. So that particular unit was not used. They brought in a temporary unit once number one was repaired, temporary unit was taken away. The drinking water sample taken from the bakery also tested negative for total conformity colliet. And as I said earlier, the learner was well-maintained and there are no issues in this area of the facility. Next slide please. So the housing units, only a subset of the housing units were inspected. Units 21, 31 and 34 were closed either for renovations or because of low population. The facilities housing units were noted to be well maintained and operated. Potable drinking water is available in all of the housing units were noted to be well maintained and operated Potable drinking water is available in all of the housing units drinking water samples were taken from hand sinks located in unit 24 East and unit nine well west for bacterial analysis both were negative Hot hole in temperature records were maintained there were no temperature violations as far as food is concerned during inspection, there were no violations noted in the shower or the toilet areas either. Next slide. The garbage area was well maintained as well because of SB 1383 implementation. We have to make sure that we separate our waste streams and everything is disposed or recycled properly Organic waste or being collected from composting Doing a really good job as far as S concern next slide These are the knives miss and I think Dr. Moss will be doing those for us Thank you Thank you. Thank you, Director Browder. I appreciate you both. Just going to quickly read the acknowledgments. If that's OK, supervisor Marquez. So our thanks to Valerie Tennyson, Angela Ball, Gene Herndon, Netlavardy, Norrie Grossman, Vina Coda, Alicidavia, and Agnée Erby for their work on the inspection program. It's not just this facility, it's all correctional and detention facilities around the county, including, for example, at City Department. It's a lot of work. And then also our thanks to the Sheriff's Office, GSA, the behavioral health department, and well-path for their cooperation and service. Thank you. I do have a couple questions. Is this audit an unannounced visit or does a facility know that date that you're coming? It's scheduled. It's not an unannounced visit. Okay. And do you recall when the visit took place last year? Is it roughly around the same time? It was around the same time. Yeah, I don't have the exact date. Okay, and then the time under review, because section 1046 mentions two in custody deaths. Can you please remind me the time under review? The start date and end date that was under review. So it is from the date of the last inspection which I don't have in front of me but it was a believe in June of 2023. Okay. So approximately a 12 month. 12 month. Okay. Okay. So it's not calendar year. It's just based off the last inspection. Okay. And the two in custody deaths that's verified with administration of the sheriff's department. We received that information. Okay. From the sheriff's. Okay. And then can you speak to the issues with the nutritional needs? There was mention of still having issues with high sodium, the Clark intake, what could we be doing differently to address this issue by the next review? Yeah, I mean, generally we, it is the role of the facility management to manage the menu and the diet. I think they use, I believe, the contractor's Aaron Mark who a meal services at the facility. So our job is to characterize what we see as deficiencies in that program and share them. Certainly, we, over many years now, our nutrition inspection program has been very thorough in terms of characterizing issues of noncompliance with the standards. And that is our tool and approach to try to move the meal service in the direction that we believe is most appropriate for health of the incarcerated persons. And also, as I noted in my presentation, I think that has been happening, but we don't actually control that contract. The review of the first aid kits is it a requirement to have one first aid kit per housing unit? So the first aid kit, I don't have the exact statutory language in front of me, so I don't know if it's housing unit is the way it's framed in the regulations, but but first aid kits must be available. The issue is not with first aid kit availability, but rather that some of the medications that are in those first aid kits are actually like injectable medications, they're not really first aid, so to speak. They're things that may be more appropriate when somebody is moved to the trauma facility or with the first, you know, if it's a first responder type of emergency where paramedics are in the space, they'll use more than first aid. But first aid, really you want very simple medications that can be quickly administered. You're not drawing up, you know, and exact those things like that. And so the issue is that it's actually probably more than is appropriate. They have more tools in that toolkit than are really appropriate to be called first aid. Understood. And then who's reviewing if they're they haven't expired? Whose responsibility is that? So the inspection looks at the logs for the kits and reviews the medications to determine whether they're expired or not. But there is a process in place to manage the kits that's ongoing at the facility. Okay. And then during your presentation when you were talking about nutritional health, additional recommendations, I believe I heard you said there's a high concentration on pre-packaged cookies. Yeah. So my understanding was that, so there is, the baked goods are part of the menu, but my understanding is that they have at times, so sometimes they're not able to supply the baked goods that's in the planned menu, and when that happens, a substitution is made, and are upon review of the logs, what our inspector's note was that it's frequently pre-packaged cookies. So the recommendation was to have a more very set of potential substitutions in that case, and also to try to avoid the substitutions in the first place. Okay, and what's the current requirement for calorie intake per day? I don't know that off the top of my head. Sorry. Okay. But it's, there is a standard and the nutritional means should be median those. That's correct. It's something, I think it's 2700 or something like that, but I don't quote me on that. Okay. Those are all my questions for now. Dr. Moss, I'm not sure how many public comments we're gonna have. Do you have an email that you could provide if individuals wanna reach out to you directly? Yeah, absolutely. So my email is like the other county emails, firstname.lastname at acgov.org. Nicholas and ICH, O-L-A-S, as in SAM, dot, Moss, M-O-S-S, as in SAM, at ACG-O-V.ORG. Thank you so much. And, Dr. Browder, I just have a couple questions for you. Thank you. Thank you. On slide 32, there's a second bullet point under 1270 standard vetting and linen issue. It says two blankets are sleeping bag may be issued in place of one mattress. So can you describe to me why someone wouldn't be given a mattress? The two mattresses that were replaced were damaged in some way. I don't know exactly how they were damaged. Maybe they had taros or stains or something like that, but it was a replacement. That's all it was a replacement. But everyone in custody is entitled to a mattress. No, everyone is a mattress, yes. Okay. And let's see. In terms of the use of razors, how is that managed just for safety? According to the policies and procedures they're designed by the facility administrator. And obviously, you know, that part of it when it comes to the use of it, if it is a razor that could be used for, you know, as a weapon, I'm sure there's somebody who's looking over that situation as well. But it's, we don't, we don't, we don't govern that. Okay. And then then I'm director of Browder. Do you have an email you could provide just in case members of the public have follow yes one old dot Browder our ONA LD dot V R O W D E R at AC g o V dot org thank you director Browder. Tissa how many speakers do we have on this presentation right now we have many speakers do we have on this presentation? Right now we have two speakers. Okay, we'll give them two minutes each. Thank you. Jane Kramer. If you could please state your name in the city you residing. I've got a couple of thoughts. Can you state your name in the city you reside in please? Pardon me. Can you state your name in the city you reside in? Pardon me. The city you reside in. Pardon me? The city you reside in. Elemeted. OK. A couple of thoughts. Having worked in a maximum security person for men is a instructor. You can give a person all the opportunities for treatment. And the person receiving the treatment will apparently comply. Doesn't really buy into it, but they comply. Okay. Second thought is you've got individuals, housing, and prisons who medical problem, or psychiatric problem, will not inform to conventional medical treatment. For instance, an autoimmune system that doesn't work. You can't give them drugs because it can't deal with the drugs. You have, they have special dietary needs because the system, just because the system works that way, will not accept foods. So it means you need a medical specialist who is going to intervene with alternative medical interventions. And that may cause social problems and it may be made because it means special privileges. Thank you for your comments. Collar, you're on the line. You have two minutes, Bob. Thank you. My name is Bob Britton. I'm with the Interfaith Coalition for Justice and Our Jail. I live in Supervisor Miley's District Unincorporated Castile Valley. I wanted to draw attention to Dr. Moss's remarks regarding Article 11 of Title 15, the Medical and Mental Health Services, his chart and his comments about the measures reports show only that conditions that measures are measuring are improving. It doesn't state which areas are out of compliance and which are not. I sent our group, Interfaith Coalition, sent a report to your office supervisor, Marquez, about the measure reports several months ago. The latest report I have access to was from March of last year, and that showed measures reporting that well path was out of compliance in 73% of the categories measured. So, it would be helpful if the report from Dr. Moss showed what the present compliance rate is or made those reports available to the public. I've had a California Public Records Act request pending with the Sheriff's Office since July 9th of this year and I have not received the one I Oda of information in response from them. The person I'm dealing with is very cordial and reporting to me that she's working on it and gives me a deadline that then passes without any information and then a new deadline that passes without a new information. So my bottom line is I think that these measures reports should be made public. Thank you. Richard Speedlemann. Good morning. Thank you for this event. I'm Richard Speeglemann. I live in Oakland and I'm with the Interfaith Coalition for Justice in our jails. I wanted to raise two things that may be appropriate to discuss in this context or maybe elsewhere, and if elsewhere, I would appreciate that they got discussed. One is concerning the death reviews. I'd like to hear from the appropriate people, whether it's Dr. Moss or someone else, what the county has learned from those reviews and what it's doing differently to protect the lives of people incarcerated at Santa Rita. And then secondly, Dr. Moss made reference to some of the nutritional problems to the fact that it's unclear who's involved or responsible for contract compliance with the supplier of the food. I'd be interested to know what's being done to enforce that contract in a way that there are no more problems with food across the years. I think those problems have come up many times. And finally, I'd like to say that in general, I feel like these reports have been getting better across time and I want to extend my appreciation to whoever is responsible. Thank you. Collar, you're on the line. You have two minutes. Mickey. Hi, good morning. Thank you for this opportunity. I want to underline what Mr. Britain said about the Mesa as reports. I think they should be made public to all of the supervisors. They're very complex to understand, but I'm sure there'll be staff that can help decipher the meaning of them. And as he said, many aspects of them are not in very low compliance and have not shown much approval. So our big question on with the Interfaith Coalition for Justice in our Jails also is who is monitoring the Mays, RS reports and who is trying to specifically respond to each measure and make sure that changes because when we look at it over a year and a half of the reports that we've had, it's not evident in many areas that there are significant changes. In fact, some have had lower compliance. So I think this calls into question an issue about well path and their provision of services and the kind of coordination that happens or might not happen sometimes between well path and the Sheriff's Department and or Alameda County behavioral health care forensic health care. We are particularly concerned that some of those issues in the May's ours reports directly affect people's outcomes in terms of mental health, especially if there's not observed. We know from the horrific case of Maurice monk that he laid in his cell for several days without anybody really taking it seriously that he was prone and extreme and horrific example but those extreme and horrific examples exist because something didn't work and we want to know not this minute but what's being done to make sure that nothing like that ever happens again. Thank you. No additional speakers for this item. Thank you. We'll now move on to item number two. This is also an informational item. This is Elimita County Sheriff's Office update on Santa Rita Joe programs and contract vendor update. Presenter today, along with others, I think Captain Oscar Perez is going to kick us off. So welcome. Good morning Supervisor Monkies. Thank you for this opportunity for us to talk about our services and programs and some of the new concepts that we have at our jail. And we have a few of our contracted providers with us here as well, who are gonna speak on some of the new information that we're doing and some of the procedures that we have in place Want to recognize also our chain of command who's here as well Assisting shift any we know and share of Sanchez and a lot of our staff. That's what this here today as well I'll start with our chain of command at Santa Rita jail On our commander Jimmy McGrell and captain Justin McGell Unfortunately, they both cannot be with us here today. And we have Captain Ray Kelly, who's with us here today. And I am Captain Oscar Perez. My area of responsibility at the jail is administration and our services and programs. Next slide, please. We're starting with our population that San Rita jail as you can see over the past three years. There's been a steady decline That's right. Okay, sorry about that. Yes, there's been a steady decline in the population since 2022 we've had a 21,993 in 2022, and I'm currently we're at the average of 1,588. And in regard to gender over the past three years as well, a 92.9% of the individuals in our custody are males and 7.1% are females. That's an daily average of about 109 females in our custody. In regards to our population, again, over the past three years, it has gone down significantly. As you can see on this slide right here, the ages between 30 to 49 years old are the majority of individuals that are in our custody. And we believe that is due to the cycles of recidivism, due to systematic challenges, like rehabilitation opportunities, difficulties, reintegrating into society, and barriers to employment after prior incarceration. That's something that we'll address later on in this slide. Next, please. Yes, that's fine. Alrighty, well, we're going to talk about the book into release process here at Sanery the Jail. As you can see, once an individual comes in or is pressing their book, they are medically screened. It goes to our reception center. Then they go to their mainline housing or the housing unit that they're classified in. We provide them with reentry outreach and then release and reentry. As you can see in this slide right here, this is our intake transfer and release area. This is when an individual comes into custody. This is where the booking process starts, on which you can't see in this photo right here is we actually have a well-path nurse who pre-screens an individual prior to coming into booking to see if they are fit for incarceration. Once the world path nurse decides they are fit for incarceration, they proceed to this booking area right here. As you can see in this photo, the individual right there is being searched. The paperwork is being done. Their property is being handled at this area right here and in that gray area to the right. I don't know if you can see that, but that's where they take their booking photo. Once that is complete, they go into or custody, which are the holding cells to the left. Right there, those black boxes attached to those holding cells are amnesty boxes. The amnesty boxes right there is a chance for an individual. If they have contraband prior to coming into that jail, which they shouldn't have, they can place it in that amnesty box right there and there won't be any charges placed on them. Next slide, please. Our medical screening, once an individual is classified, they go through a comprehensive health assessment to determine their level of care. For each individual, it's important for us and our partners at World Path to provide them the necessary treatment and medications for those that require them. And we try to do that as soon as possible to ensure their care while it's at Rita's jail. Our reception center, and we're very proud of this concept. We discovered throughout the years that many individuals in our custody were unaware of resources available to them that could prevent them from future incarceration. I'm often the learn about these opportunities after multiple arrests or extended stays in custody. So to address this, we aim to educate individuals within the first 24 hours of incarceration and connect them with service providers whenever possible. 66% of our individuals in custody come through the Reception Center. Those that require a higher level of care are booked directly into our therapeutic housing units or our partners at AFBH provide reentry services. Our females as well are booked directly into their respective housing units and are provided with the reentry services by our female deputies. This is our reception center snapshot. As you can see, 14,710 individuals have come into our custody through the reception center and the breakdown between mainline minimum, mainline medium and mainline max. What's important here to highlight is that the mainline minimum 7,895 individuals that came into our custody. A lot of those individuals previously wouldn't receive reentry resources because the average length of the state was 28 days. Now these individuals are receiving resources within the first 24 hours that they're coming into custody. This is a reentry assessment. Each individual that comes into our reception center receives an assessment and we ask these questions. So with 38.6 have requested reentry resources which can be housing employment, case management, family re-neification, and a variety of other opportunities. 55.7% have received their high school diploma. We get asked why do we ask that question? We ask that question because we want individuals to continue their education through our partnership with five Ks and our MOU with Shabok College. 35.2% are on probation. We asked that question again as well because we have a deputy probation officer who is on on site five days a week and can provide resources to the probation department. 11.3% requested substance abuse treatment. With the information, it goes out to our community based organizations and to our partners at WELPATH. 32.6% state that they want to take some of the classes that were offered, whether it's our educational classes or our new vocational program. And 39.6% state that they need Medi-Cal enrollment. With that information, we provide that to well-path, who provide to their discharge planners and works with social services to begin the Medi-Cal enrollment process. After an individual leaves the housing unit, or excuse me, the reception center, surveys are provided to our transition center deputies. The deputies coordinate with our community based organizations to provide these reentry resources. This is a time where our community based organizations can work with these individuals throughout their stay at San Rita Jail, so that at the end there can be a warm handoff. We also offer reentry resources 90 days prior to being released because we understand that an individual's needs may have changed while they're in custody. These are some of our community-based organizations that we are working with. A lot of these are in partnership with the Alameda County probation department that provides services through AB 109 eligible population. All right, during this past fiscal year, our transition, our transition center team, I'm connected with 6,262 incarcerated individuals. That is with our community-based organizations and with the Sheriff's Office Behavioral Health Unit Operation My Home Town. Operation My Home Town is the Sheriff's Office Behavioral Health Unit. It's a reentry program at CentriageAail that provides case management by our licensed behavioral professionals. There's a variety of different resources, housing, employment, clinical case management, risk assessment, and they provide individual reentry plans requested through our messaging system and through our tablets. It's focused using evidence-based practices and risk needs responsiveness principles to reduce recidivism and promote self-sufficiency. With our behavioral health unit, we are very proud of the work that they are doing. They not only work with individuals in custody, but they also follow them outside of custody. As you can see during this past fiscal year, our OMHT team served 254 individuals. So on September 10th of this past year, representatives from 46 different agencies met with the 351 incarcerated individuals. This was our first reentry exposition that we did, which we were able to see five different housing units that came. And this is the first expo, like I said, that we did since since COVID. A release in reentry. This is this is our goal when an individual is released is to connect these individuals with with the probation apartment through our deputy probation officer and through our community partners to ensure coordination of care and provide transportation assistance. the budget. We have the routes transportation. I will talk about that later. They provide reentry services and they have the shuttle bus that gives individuals rides to the bar station. It may well fare fine. The majority on the left, the majority of our revenue is coming from our Commissary and our telecommunications contract. But that has been over the past years, has been reduced due to the percentages that we are receiving. And to the right, as you can see, the total cost of employment and the education are the primary expenses. And over this past year, we had a net deficit of $2.2 million. And to talk about our new partners, our commissary, our AeroMark, and to talk about the food that's being provided at San Luis Joe. I'll bring up our partners from airmark. I'm Ivan. Excuse me, Shirley in Australia and Renee Garcia. Thank you Captain Press I'm going to go through a few things. He does have all the information up there. Our menu was we worked on with the client and the Santa Rita jail to go over to make sure. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. up there. Our menu was we worked on with the client and the Santa Rita jail to go over to make sure. I'm sorry. To make sure we went through the menu with a Santa Rita jail team to make sure we were in compliance with their food that they would like us to present to the inmates at Santa Rita Jail. I'd also like to go over some of the things that we've implemented since we've come on at the beginning of September. We brought in a scanner handheld that we use when we deliver our I care in our commissary. What that does is it gives us a digital reading right away as to when the IP as we see their package and it also takes their signature on. So there's no question and we identify those folks that are receiving the packages Our packages are actually laid out in a way they're in clear bags So the IPs can see what's inside the bag along with the invoice that's in the bag as well So we've implemented that as well. We do have an onsite manager that is there five days a week To make sure those deliveries go smoothly and to deal with any questions that the staff might have. Also along with our partnership with Santa Rita Jail, we participated in the Rantry Programfare and I hope to do more of that with them. And along with that we would be working on partnering with them on setting up our Rise Up program which is to train IPs in warehousing and they would be certified through that program. Since it's such a new program at this point we don't have a whole lot to report out on but those are the key things at this point that we are doing. I'd like to hand it over to Renee Garcia who can speak more about the food program that we also run there. Thank you. Good morning. Good morning. What do I want to tell you? Over the years, I've been working with the air market at Santa Rita facility for approximately eight years. And I just wanted to update everyone that we have been working really hard to increase the quality of the meals that we've been serving to the incarcerated people. We have within the last couple of years removed the soy based products, replaced them with ground turkey. We provide whole muscle meats and is opposed to just having a bunch of minced meat patties available. We've added in whole grain English muffins to their breakfast, whole grain bagels. And we are, we're in compliance compliance with our nutritionists reviews our menus and signs off on them annually. And I don't know what else do we do? We also partner with the Sheriff's Office and we've made some charitable contributions recently to the community. We've been a chair of the community. We've been a chair of the community. We've been a chair of the community. We've been a chair of the community. We've been a chair of the community. We've been a chair of the community. We've been a chair of the students in the Alameda County area. So thank you. All righty our educational provider five Ks and we have our principal Melanie Fuka Hara here that's what to talk about our program. Welcome. Good morning. Good morning. Five keys has been in partnership with ACSO since 2016. Over the past eight years, our program has experienced significant growth and success. We've provided system-impacted individuals at San Areta with valuable educational opportunities aimed at enriching their lives and reducing the likelihood of future incarceration. Our programs are carefully designed to help students achieve both their educational and personal goals. In addition to offering the chance to earn their high school diploma or GED, we provide a range of certification programs to further enhance our students' qualifications. Our courses address common barriers of our critical opportunities for personal development and equip students with skills and tools necessary to succeed upon release. Currently we have 100 classes running a week and the courses included are Angular Management, Computers, Gardening, High School Diploment, GED, ESL, Job Readiness, OSHA 10 and First aid CPR certification, parenting and substance abuse. Next slide please. Last week we had the privilege of celebrating our students with our first graduation since the pandemic. The ceremony was a heartfelt occasion honoring our dedication, the dedication and hard work and achievements of our students over the past few years. It was truly a special event which highlighted their perseverance and commitment to reaching their educational goals. Over the past year we've had 265 students graduate with Certificates and their diplomas. Thank you. Thank you And it regards our via path by tablets. I like to be got the vice vice president of operations. I'm Ken If you could please just introduce yourself, your name and title please. Say again. If you could please introduce yourself, your name and title. Okay, my name is- And you could adjust the mic. Okay. My name is Ken McNeil. I'm the regional vice president for ViPath in the West Region. And I have been supporting Alameda County for quite some time here. So here for the first time, I will appreciate the time and being able to speak here. So to slide, we have here about four bullets that we're actually, and I'll talk to each of these, but I'm going to go ahead and just acknowledge in the network upgrade, just site route or firewall that kind of combines into one. The AirMark Commissary, AirMark just spoke, we're interfacing with them through our tablets. And then the Adobe, which is an online educational offering that we do on our tablets as well. So I'm gonna take the first bullet of the network upgrade. So recently we've taken, because we've grown, evolved into a lot of different products that we offer on our tablets, and not just the phone company, from that perspective. So recently we've actually gone through and primarily what we've done is we've done up a full boom remediation. We, I guess an analogy that would be kind of layman's term would be we took the highway and added multiple lanes so we could increase our flow because of all the different offerings we have at this point. So what we have done is we've actually replaced every piece of network equipment at the facility. We've also replaced our servers that interface with our tablets. And we've also taken and did remediation on our Wi-Fi networking so that we have better signal strength to our tablets. As far as the results from this, feedback that we've gotten from the county, from meet with county this feedback that we've gotten from the county, from meeting with the county, the feedback we've gotten from the incarcerated personnel is that there's a decrease in the complaints about the buffering the content that we have on the tablets. There's a decrease from our side, specifically about network averages, things like that. So we've seen that that's stabilized. And then also with the streaming services that we offer on our tablets, that has been a better, again, feedback from the incarcerated personnel, which is the actual customer of the stream, is actually saying that it's much better. So no further complaints regarding that. This actually puts us in a situation right now as far as the state of our infrastructure. We now have upgraded our infrastructure, our equipment. We've also done our security side of it, so right now we're prepared for the future. We're scalable for anything that comes out as from additional services that we might potentially obtain from County Valorita. So this third bullet on Aremark, this recently was added to our tablets. Previously, the commissary was done over our phones where they incarcerated personnel would actually go to a phone, pick up the phone, order their commissary, now they get the experience of being able to do it on the tablet. They actually can connect to the Aremark store. They can do it from a table. They can do it from location versus being at a fixed location or a wall from doing the commissary. We worked directly with air mark to get that put in place. And from that perspective, you know, that everything went into play. No problems that were being experienced. We worked directly with our mark in our project team and have also had some follow-up with them since the deployment of AirMark. The next one is Adovo. This is our partner that we're doing on online education. This was recently rolled out as well. This is a partnership, as I said. The curriculum that is involved with this is built for the correction environment. It allows incarcerated population to find and chart their own personal growth through their training and their success. Courses that they take, they they earn certificates they earn transcripts these can be utilized with other programs that they that they are involved with the content is again built for corrections it's aligned with the county their initiatives and their goals there's 25,000 hours of content that's available to the incarcerated personnel there's resources like religious devotions, recovery addiction type training, anger management, others, vote tech, plumbing, electrical, electrician, that types of though. They also can do college courses, business, physics, political science. And they also have reentry success type programs as well. So it's just another avenue of additional recidicism and reentry into the private world. Other than that, our closing out here, you know, we're a firm believer in all these communications and educational type offerings that we have. It empowers the facility staff to help they incarcerated individuals make a change for better. We provide them and their families with the means of communication, support, accountability and encouragement. And because of the incarceration, it isn't just serving time, it's about making the best of the time that they serve. Thank you And next light here is in regards to our pre-apprenticeship program that we just started this past March and To talk about this is gonna be I'm sergeant Dan Murphy Good morning my name is sergeant Dan Murphy. I'm with the Green Transport Services Unit. I want to highlight this program. So when Sheriff Sanchez took office, we did a survey of the incarcerated population. And we found that majority of them need help with housing and employment. And we began to look at what we could do to help benefit that population. And we found that the Laborers Union, our unions, the Laborers unions are the way to go. For every 100 individuals that are retiring right now, only ones coming into the trades. And we need so many buildings and things like that to help keep the infrastructure of the country going. So we reached out to the Laborers Union and who referred us to Laborers Training Center in Santa Ramon, which is the Northern California Training Center. And we began discussing on what this could look like and building this partnership. As part of it, we decided to try this program. Right now, it's a 12 week program. They earn up to 20 certificates, ranging from blueprint reading, basic instruction, all the way up to skid steer certification in CISO-LIFT. Why this is all important is that we basically took the entire four years of coursework. They would receive on the outside if they were going through the program not in custody and condensed it down to 12 weeks. So once they get released they won't have to go back to the schoolhouse per se in four years. As long as they do their hours they'll continue getting raised and building and developing. One thing that makes this program amazing is that one it's a living wage when they get out, but they get medical, dental, vision, and they're a part of that team that is the union. So if they needed to get out of the environment that got them in the custody, they could transfer these services to any other area or state to be successful with a guaranteed job built in. I do want to highlight that currently we are on our fourth cohort. We have eight individuals currently working in the union right now with four more pending release in the next coming weeks. As part of this program, we pay their initiation fees and their first three months of dues. Again, breaking down that barrier that would cause them not to begin into the field. We also give them their initial, I call it kit, but basically their boots, their pants, their shirt, a tool belt. Again, helping relieve that financial burden that hinders so many coming into society and reenering. We've been featured on KTVU. We've been featured on other local media stations. We've actually had 13 people go to the courts and ask to stay in custody longer to complete this program. This program is life changing. As you've been out there supervisor and others, it's unbelievable. And I do want to highlight that this program aligns with the visions of 2026 and govern new sums realignment of the prison system by getting them out there with the living wage, building Alameda County and the state itself. We partner with local through the form, which is the Alameda County local, so these gentlemen and participants, excuse me, will actually be building Alameda County wants to get released. On average, it takes about a week from release to being on the job site, which is much faster than many other programs out there. We are working with off-the-street ministries in Oakland to help with transitional housing, as housing is one of the key things that people need when they get released. This is just the beginning. This is the future of reentry at Santa Rita Jail. This is one of many programs we have, but this is one where the participants still contact us. They'll still reach out to us. It's great. One thing we learn reentry is you don't always know how the person ends up once a year released. They will only contact us and they'll send us a picture of like the job they just did. They just did an asphalt or they did concrete. It's amazing what these skills and opportunities that they're having and they'll tell us they stay in contact with us all the time. Thank you very much. Thank you, Sergeant Murphy. As you can see, there's a lot of passion that goes into what that's happening at San Rizio. In regards to our consent degree, I'll bring in our's the 20? Sheriff. Mr. Sheriff. All right. In February 2022, the Sheriff's Office entered into the consent decree per Babu V. Alameda County. Since then, we have achieved 27.4% substantial compliance and also 62.9% partial compliance. The difference between those two percentages and 100% are some of the provisions aren't currently monitored due to a need to add additional staff and other pieces that need to come into effect before they begin to be monitored. Next tab please. Out of the 113 policies that are consent-degree related, we have completed and published 77 of them. The majority of those remaining policies that have not been published yet are due to the need for specific information systems, infrastructure such as cameras, also hiring at the jail. So some of those policies are dependent on systems and services being implemented that we can't do yet until those other milestones are achieved. Next tab. Staffing and behavioral health access as everyone in the county knows it is difficult hiring additional personnel right now, both deputies and civilian staffing. We are working diligently to increase the staffing. We have larger numbers in our academies, and we're currently raising those numbers as we speak. We've also dedicated eight full-time deputies to our behavioral health access team. The behavioral health access team is a group of deputies that receive additional training. They are our primary liaisons with the behavioral health team at Santa Rita Jail. These deputies have an amazing ability to be able to build relationships with our incarcerated population. They're often who we lean on to bring in for de-escalation with our behavioral health clients and also to establish that effective communication. We are still working on improving out of cell time and adequately documenting that out of cell time. Right now, some of the issues that are hamstringing us are the speed of construction. Currently building the outdoor recreation areas that the consent decree required. Once those are completed, we'll begin the quasi yard updates as well. We've greatly reduced the amount of time in ITR, just as Captain Perez spoke of. We have established the reception center, which helps to bring services to our incarcerated population within 24 hours of them coming into our custody, but also it has alleviated the pressure on ITR by being able to move the majority of our population out to an area where they're able to decompress, make phone calls, contact their loved ones and attorneys. It is allowed the remaining people who are in ITR to be processed more quickly as well. All right, in a line with our consent degree, there's a lot of projects in construction that's happening right now at San Rida Jail and our projects, Lieutenant Misty Kerosu, who's going to talk about all of the work that's being done on the infrastructure at San Rida Jail. Welcome. Thank you. Good afternoon. Perfect timing. Welcome. Thank you. Good afternoon. Perfect timing. There's three major constructions going on at Santa Rita Gell. The first one will be the ADA upgrades. You can go to the next slide. These are photos so everybody can see the construction work is actually happening. ADA began a few years ago. The purpose is to accommodate incarcerated individuals, identified ADA needs. The housing it sells were expanded, tables and chairs were replaced, and showers were also remodeled. Each housing unit takes about six months to complete. We have four left or four remaining, and the scheduled time of completion will be 2026 or early 2027. The NIU is the network infrastructure upgrades. It began earlier this year. The purpose was to replace and install over 800 cameras within the facility and provide live stream and data storage for areas where inmates are going to be housed and intake and release in other areas such as the kitchen and the hallways for safety purposes. The estimated time of completion is 2026. Outdoor recreation, this is one of my favorite projects. This was started because of the consent degree. If you began earlier this year, the purpose is to provide incarcerated individuals the opportunity for more recreation time. The hours will be from seven o'clock till 10 o'clock at night and it gives non-mainline population the opportunity to go outside. The outdoor recreation was identified in several areas of the jail so these spaces will have half-court basketball hoops, they'll have seating areas running water, hot and cold, and restroom facilities. Some are really excited about that. The estimated time of completion for that should be summer of 2025, so they should have some outdoor rec time for the summer time next year. Thank you. Can you just clarify is it's 7 a.m. or 7 p.m.? Okay, thank you. And our strategic response team, this is a new team as well that came this year and we have Lieutenant Great Port, who is our lieutenant of training and compliance. Good afternoon. So under the watchful eye of Captain Justin McGill, we created the Strategic Response Team in April of this year. This involved a vigorous selection process, including a physical training exercise, scenario-based challenges, interviews, which allowed us to assess the staff's ability to perform under stress and work collaboratively in high-stakes environments. The staff has made up of a mixture of age, experience, knowledge, skill sets, and backgrounds. SRT staff received and continued to receive additional training and critical thinking, de-escalation, effective communication, and have all been certified in critical intervention training or CIT. SRT continues to maintain contacts with multiple outside agencies or guidance regarding best practices, tactics, methods, and tools employed. Within the first several months, SRT successfully utilized their skillsets with assistance with our partner to AFPH to gain compliance of multiple and start incarcerated persons without injury to persons or staff. Since then, SRT has effectively assisted 10 other high risk incidents with very minor force or no force used with zero injuries to any staff or any of the incarcerated persons. Additionally, SRT has received training in search and rescue and crowd management and have assisted with mutual aid and mutual counties for recent fires and crowd management issues based on outside law enforcementforstment requests. Thank you. And last we have our reception center murals that are going around all over our housing units all over the base at Santa Rita Jail. When Sheriff Sanchez was a commander at the Jail, we often talked about all the blank walls at Santa Rita Jail when Sheriff Sanchez was a commander at the Jail. We often talked about all the blank walls at Santa Rita. And we know that we have a lot of our population there who are a tremendous artist. And we decided to let them put their art to work. So this is in our reception center. This art is this is all drawn, I guess, on of that proper word. But the on-carcer population, there are the ones that actually come up This is all drawn, I guess, some of us proper word, but on a car surrepellation, there are the ones that actually come up with these ideas, and these are placed now in about four of our different housing units. Next slide. This is our woman's therapeutic housing unit, and we are getting input from our partners at AFPH as well about some of the the art that's being put up here. This is our men's therapeutic housing unit. And lastly, this is the last one. This is our OBGYN clinic murals. They're very, very happy with the art that's going up. And the OBGYN is for our pregnant female population. And our nurses, again, are extremely happy with the art that is in their offices. And now I'll pass it off to our partners at WOPAT. Welcome. Good afternoon. My name is Kim Saddam, the Health Services Administrator with WALPAT, here in Santa Rita, jail, and that's my honor to present in front of you. So just a quick overview. We're going to review some of the services provided and we're going to review staffing and highlights for the year 2024 and then we're going to talk about future direction, namely coordination of care, building, community connections. Just to set a proper context as this data is from November 2023, throughout October 2024. So first thing I want to highlight are primary provider services that includes our physicians, our physicians, assistants and nursing practitioners. In the span of that year, we had 22, 421 problem-based primary care visits and we've had chronic health conditions with initial visits, 1,742 with 1,446 follow-up visits and these numbers are significant because as you have, as you guys know, majority of our patients don't have an established or consistent healthcare outside. So when they come in, we try to make sure that they do have a good healthcare in jail. Next I want to highlight some specialty provider encounters. As I already mentioned by Captain Perez, one of the main things, one of the things that we like to talk about is our Women's Health OBGYN team. We've had 1,683 encounters. We also provide orthopedic services in the jail, 490 encounters in that 12-month period. We also have an HIV hepatitis C transgender specialist that service our patients and they've had 733 encounters. We have a very robust dental clinic that's seen to 2,000-499 patients. About the year, we just wanted to highlight annual cleanings, amounting to 469 and approximately 80% of them are deep cleanings, which I think is very significant, especially in incarcerated setting. And then we also provide optometry services once a week. And in the past year, we've had 753 encounters with that. We also provide physical therapy with 937. And last but certainly not least, off-site specialty referrals, 644. And that includes community partnerships with hospitals and other healthcare services outside into community. Next, the nursing team and pointed care encounters. So in the past year we've had 17,533 intake screenings all being done by registered nurses. We've had 20,985 nursing sick calls responding to medical requests, 4,540 emergency responses with 1,312 of them ending up being emergency offside referrals. And we also wanted to highlight 43 patients were given an arcane during emergency response. That seems like a very municipal number, but in a grand scheme of things, especially with a current climate and acute increase in substance use disorder in our community, and in the jails, these narcans are our lifesavers. And also we provide withdrawal monitoring for CO or CO, being alcohol use disorder and in cows for opioid use disorder. As we monitor withdrawals, we do symptom management and all of that. And that amounts to 36,824. Also, we provide SCI screenings with HIV tests, 1,810 with four new positives discovered. Epititis C test, 2,605 with a total of 31 new positives. And we also provide syphilis and gonorrhea with syphilis RPR tests, amounting to 1,709. 115 of those are new positives that work caught in jail in gonorrhea, or GCCT, 2,244 with a total of 27 new positives identified. Next is our MAT or a medication assisted treatment program, also known as an opioid treatment program outside in the community. We provide that along with our opioid treatment program counseling and discharge planning. So with our MAT program, we've had 3,073 encounters. And we provide all three of these medications, methadone, sublicate, and suboxone. And he sees the numbers there. And then the OTP counselor encounters are 3159. And for, we have a specialized discharge planner, specifically for MAT OTP, and they've had 5888 encounters. And then for our, oh I'm sorry, let me correct that. For our discharge planer team they've had 5,888 encounters and part of that are our medical enrollments with medical eligibility verification 776 completed and then 167 successfully enrolled and And just recently we started this enhanced care management referrals in collaboration primarily with Alameda Alliance. And we've had 595 referrals submitted with 238 found eligible. I wanna highlight some of our staffing just to give you a brief snapshot of what the medical staff or medical team looks like. We have four in site leadership who have 140 full-time positions, four in-site leadership, three physicians, five physicians assistants or nurse practitioners, 11 specialty roles, or our and supervisors, 69 registered nurses, 25 LVNs or license vocational nurses, and eight medical assistants, seven medical records, and four administrative support staff. I also want to highlight that currently we are 96% hired to roll when we started 2024 at 97. Currently our staffing in physicians is 94%, meaning with that 96%, we have people currently onboarding or on L away. And 230 total staff, 134 full time and 190 part time with two on leave of absence. It's not on this slide, but I also want to highlight that by the last quarter of 2023, we were at 94% retention rate. And as we started 2024, even though I don't have complete data yet, I want to venture that we're still in the high mid 90s for our retention rate for staffing. Some 2024 highlights. Recently, we expanded our MAT program or our medication system treatment program from 350 licensed capacity to 500 patients licensed capacity, just to give you an idea how much we prioritize this program, how much we believe in the services that we offer through this program. And currently we offer three types of substance use, this order treatments, methadone, suboxone, and suboxone we have pills, we have sublingual films. And most recently we have long acting injectables, namely sublocate, and that's in collaboration with Alameda County Sheriff's Office and Alameda County behavioral health so we're very thankful for them and partnership with us and we also provide an altruxone and pill form and long acting injectable a name, Vivitrol. We also doubled our Average counseling sessions over the past year and then we currently We renewed our NCCHC certification in our department of health care services certification for MAT program and This year we've actually added or expanded our CQI program. We have a QA coordinator. And so far they've had 18 core aspect studies, four site specific studies, and monthly review studies, namely right now the talks of draw and emergency response. And this team is actually what we're leaning on when it comes to the response with four vismasars and collaboration base CSO and four v msr's as we try to assess and address areas of deficiency and non compliance. It is our goal. It is our our aim to improve in every way we can starting now and beyond. We also in collaboration with HEPAC, we place a NARCAN distribution box in the lobby where incarcerated folks get released. And it's accessible to everyone. And it's basically free and they just grab and go. And each box, each Narcan box, we see that as a potential life saved outside of the community. So we think that's a big deal. We've also expanded clinical affiliations, which is basically partnerships with programs, schools, hospitals, where PAs and P's, physicians, they rotate into Santa Rita jail so they can have an idea and know that there is good medical care inside the jail and that this is something they can do in their career. Namely, we've entered into this agreement with Highland Emergency Clinic. We added clinical affiliations for lifelong. We're also working with Stanford and other organizations. And we have open source. We have an open agreement with UCSF, OBGYN, so they have some staff from that department coming through to the jail. And like I mentioned, Stanford Physician Assistant Program. I want to highlight some, a couple things with the Women's Health Clinic, our Director Women's Health along with one of our OBGYNs, where they were selected to present at the NCCHC conference. Bless you with NCCHC conference earlier this year in October and they were chosen to present on how a women's health clinic should look like in a jail and a correctional setting and we're very proud of that. They presented best model practice to discuss disparity in women's health and offered historical perspective of correctional women's health care. And one great thing this year that we all can be proud of in a collaboration with ACSO. We had an in custody delivery of a baby and we corded our women's health team coordinated that with the sheriff's team and there was a safe delivery in the hospital. Thankfully they didn't happen to jail so we were able to connect them with the sheriff's team and there was a safe delivery in the hospital. Thankfully, they didn't happen in the jail, so we were able to connect them with the proper people. And then we successfully coordinated the pickup of the baby, the patient's mother had to come from out of state and drive in and pick up the baby. And as far as we know, the patient is recovering and the baby is safe and she's healthy. So we're very proud of that collaboration. Also, another big win is again in collaboration with Alameda County Sheriff's Office. We work with the reentry support services to provide the more appropriate soap for feminine hygiene. As we know, females have a more sensitive skin. And so we, with our guide and colleges, recommendations and women's health director, did a whole case study to support their case and essentially help get the right tools or the right soap for our women, for our women patients. And then also, as Captain Perez mentioned, there's a mural project and as they highlighted, there's a beautiful mural in the women's clinic. Sorry. Yes, so I just want to highlight again future trends, building and maintaining community connections. We have an ongoing partnership with Highland Bridge Clinic where it's like a reentry discharge coordination from our MAT team to Highland Bridge Clinic so that when they leave, when they get released, our patients can have continuity of care out into community. And we've completed a total 118 pre-release telehealth visits here, just this year. we continue to focus on reentry and like I mentioned earlier enhanced care management has been a big part of our discharge team looking into cowlames and all the other things that are required from us and I guess you just want to highlight again a continued partnership with ACSO and Alameda Forensic Behavioral Health, meeting Cali measures for just as involved individuals and meetings with AFBHACSO and probation to develop strong pathways to assist reentry and reduce recidivism as we know. Reentry and reducing recidivism is a multif, reentry and reducing recidivism as a multifactorial endeavor. And it's not just medical, it's not just mental, it's not just custody, it's everyone working together and we're very happy and proud to present to you that that's what's happening currently. And we continue to focus on strong recruitment or retention. Just wanna highlight that we have, I don't wanna say a lot, but we have a handful of employees that have been with us. They started as a medical assistant. Got their RNs. Now they're working with us as an RN or LVN. Got their RN or an RN becoming a nurse practitioner. Working with us and that's just very good to know that they resonate with what we believe in and we'd like to keep quality team members. And that's it. Thank you. Thank you, Mr. Sidiya. Is there a contact email for someone within Well Path if members of the public have follow up questions? Of course. So my email is ksadD at wellpath.us. Great, thank you so much. Captain Perez, back. Yes, thank you. And I'll provide my email as well. It's opares at acgov.org. Let's Perez with the Z. Okay, that concludes the presentation. Thank you very much. Do have a couple questions, and then we're gonna take a five minute recess before we open public comment. So my first question for Captain Perez, appreciate the updates really impressed with all the work that's been taking place that's on a read of jail. I think I've tou toward there maybe two or three times by now. So just excited to hear these updates, but I'm just wondering with respect to the educational programs, the CVOs, are they ever surveyed to ask them directly, are there any barriers are we ever seeking their input to find out how we could increase utilization of their services. That's actually one of the challenges that we're having because of a lot of the community-based organizations are talking to the individuals once they're released. So, after the release, sometimes that connection is a little difficult to get that data to find out how many individuals they actually saw that were in custody that they're now seeing out of custody and just collecting collecting that data has been a challenge. But I'm right now primarily concerned about the service providers that are housed within Sanerita jail that are on site. Are you ever reaching out to those providers to ask them is there additional support? What could we be doing differently to increase participation? Is that ever asked of the service providers? I can ask, answer that. Yes, absolutely. So not only are we doing outreach to the current providers in the jail, but we're doing outreach to those who want to bring services into the jail. That's something that we continue to touch on as far as gaps. We know what the gaps are. It's housing, right? And making sure that we have transportation that connects people even after hours. Roots isn't there 24-7, so if we can fill those gaps, that's something that we're looking for. We have these conversations with probation as well because they are also onboarding CBOs that provide services in the jail. But it is a constant circle back. And at this point, we still haven't closed all those gaps. Thank you for tracking that though. There is mention of CalAIM. So I just want to be clear, is it well-patched that's enrolling individuals in Tameda-Cal? So we do a lot of the outreach to CalAims. Yes, it is our partners at well-path, who with their discharge planners, who are working with social services to enroll individuals into CalAims. Okay, and can someone start the process while they're in custody and then finish it when they're released? Yes. We take a proactive approach with that. We have several flyers, we have information on our tablets, individuals that want to roll into medical, we provide them with that information. Okay. And then are we tracking data with respect? I remember one of the comments made when I visited Senator Rachel was that the reception center has reduced like fights and critical incidents are we tracking that data? Oh yes yes we are and the reason that it's reduced reduced fights is we moved from an intake transfer and release area which was a small compact area those individuals now were going to our reception center. And it's a more humane way of treating individuals. It's a lot bigger. They have access to showers, they have access to TV. There's free phone calls in the reception center, and they can start accessing their tablets in there as well. Okay. Really impressed with all the programming of that singing place for the males. Just wanted to know what is the response and what type of programming is being offered to the female population. Well, we offer education programs to our female and a lot of recreation as well to our female population. We are working as far as our vocational program to find a way to fit our females that want to go into those vocational programs as well. Okay, and I'm just being clear, they could not participate in the program with the labors because we can't combine the populations as that accurate. Yes, we're not mixing males with females at this point. Okay. And then what's the status of Epic? I know we've been talking about Epic for a while, but what's the status of pursuing that opportunity? I know it's a funny mask, but where are we at with that? Yeah, we've been in discussion about Epic and with our partners in healthcare services. It's a lot of money, and so really it's about how we can best move forward in partnership in that respect, because I know that the information is not only important for those that we're serving but it's for those who are utilizing that data platform as well. But really the money is a big issue right now and we're trying to work through how that will be possible. Director Chalice, standing up. Welcome. Thank you. Supervisor Marquez, Colleen, Chavla, Director of Alameda County Health. Alameda County Health is looking at Epic for different parts of our system and we've incorporated the Epic review for the jail as well as part of our review. We're looking at three different ways to get Epic. Epic directly going to the Epic and purchasing a product directly from EPIC. Also using a community connect product either through OCHIN, which is the EPIC that the community clinics use or through Alameda Health System. So we're looking at comparing what we get, what the pros and cons of each of those are including the cost as the sheriff. Indicated. Thank you. I appreciate that update and certainly something I'm very much interested in not only for a San Rita jail, but for St. Rose Hospital has been recently affiliated with element house system. Those are all my questions. We're going to take a five minute recess and then open public comment. Tisa, can you tell me how many speakers we have for this presentation? Five okay we'll give them two minutes but let's take a five minute break I'll come back at 12 30 or 12 31 thanks. Okay. you you you you you you you you you you you you you you you you you you you you you you Okay everyone please take a seat. Okay, I'm going to call this meeting back to order. If the clerk can please conduct the roll call. Please take a seat. Supervisor Miley excused. Supervisor Marquez. Present. Thank you so much. We are now going to open up public comment. And this is specific to item number two. Alameda County Sheriff's Office update on Santa Rita Jail programs and contract vendor update. We will give the callers two minutes. Car here on the line for item two Bob. Thank you. This is Bob written again from the interfaith coalition for Justice and Regels. I'm calling to offer my gratitude and congratulations. Thank you very much for the Sheriff's staff, particularly the leadership of Sheriff Sanchez, in instituting some of these programs for the booking to release process. Particularly the free apprentice program. It seems to be wonderful and should bring great returns. So thank you very much. Car, you're on the line, Michelle. Good afternoon, Michelle Taylor. I think I'm a five keys teacher. I had a couple questions for Captain Perez. The first question is what is the policy and procedure for resolving conflicts that arise in the jail between ACSO and its contracted providers. My other question is what is a policy and procedure when you're a provider such as five keys and well-path? Our name does defendants in New or recurring lawsuits with the county. I also have a comment for five-keys principle Melanie Fukuhara. I just wanted to say it's not too late to start speaking truthfully and kudos to all of the individuals who painted those all the leadership in the jail that made many of these programs possible. It's seeing the murals was just completely inspiring and it shows that people that have been marginalized and sent to the edges of our society have incredible beauty and power and creativity in them and then that you allow the space for that to occur in the jail is a very powerful statement and we don't like to see more of it. I have a question about the labor contract and that I understand why women might not be involved in that but it seems there are not adequate programs for women at the jail to have similar even though they might be gender based training programs. I want to stress that I understand that the jail can't solve all of our society's problems and nor is that its intentions but nevertheless we are not of our society's problems and nor is that its intentions. But nevertheless, we are not solving our society's problems. You have a captive population that you can impact on change in a way that so many other places can. I just strongly encourage when Captain Perez said this is just the beginning of the kind of programs you want there, that you want this to truly be rehabilitative and healing place where people can get the help they need, not just wider and jail, but afterwards. So I'm stressed, I want to stress the need for the county and the Board of Supervisors to consider more programs that evaluate and follow people six months a year down the road once they're in these training programs to see how have they done, what have they needed, how can the community come forward more to make these people successful? Thank you very much and thank you for your work to transform the jail summit. Or you're on the line for item two, Gene. Hi, my name is Gene Moses. I am in District 3 and I also want to thank Captain Perez and the other presenters very much for your super informative presentations. I hope that at some point we have a town hall where there can be more feedback on this information. I know that happens occasionally and that would be a really good opportunity for this annual report. I have several questions. One category of them is to ask for more data on the relative success of your programs. For example, during intake, you identified 44% of the individuals don't have a high school diploma. How successful are you at providing a means for these folks to get at a diploma in jail or in the community? And this touches with what Mickey just said, which is that there needs to be as much continuity of concern as possible between the jail and the community. And 40% of the intake people have no medical. For data purposes, I would love to know what percent do have medical when they leave the jail. Similarly, five keys offers great selection of opportunities. Can we measure the number of people who want to participate compared to the number of people who get in and compared to the number of people who complete the program? Can we measure some success and not just throw out a bunch of numbers? differently topic is the welfare fund 43% of the expenses are administrative costs that was very concerning and also on the income side 30% of the sales in the commissary are commission and that seems like an exorbitant profit margin so I think the inmate welfare fund needs to be managed a little bit more tightly. Another question I have for five keys and others is what portion, what portion of the staff are people with lived experience and are we leveraging that experience in the way that's most effective? Collar, you're on the line for item two, Allison. Hello. We can hear you. Allison Monroe here from FASME Families with Serious Mental Illness. Many FASME members have had family members with serious mental illness in the jail. Some 20 to 30 percent, it's hard to tell exactly of people in Santerita have serious mental illness. But illness that prevents people from understanding the extent of their illness and they are not in Santerita through any fault of their own. Ideally they would not be considered offenders. They would be considered people with a disease that can be treated. Our family members are not well represented here. I'd like to represent the interests of my late daughter and of my friends and family members. But we know that when you go to provide services to the utterly powerless, and those people who are getting the services have no role and nobody to represent them, the services are gonna fall short. That's our experience after years of dealing with systems through the powerless. And I'd like to see this system transferred, the system for the seriously mental meal out of jail and into hospitals and very supportive residential facilities. And to do that, we're going to have to start moving on that. We're going to have to quit hiring deputies under Babu. They don't seem to be signing up. We can't meet our targets and start hiring psychiatrists and social workers outside jail. And we're going to have to quit constructing at the jail and start constructing hospitals and very supportive living facilities for the seriously mental ill. And so I'm glad people have done so much to improve conditions for people in the jail. But we know that when family members aren't involved, our family members suffer. And there's no way for us to be involved in this process that's if I see things go wrong. Thank you very much. I have more speakers for this item. Thank you so much. We're going to move on to informational item number three. I have one more speakers for this item. Thank you so much. We're going to move on to informational item number three. This is Elimitie County Behavior Health Department, adult forensic behavioral health update. Presenters are Juan Thyson and welcome. Thank you, supervisor Marquez. Good afternoon. My name is Juan Teisson. I'm the Director of the Forensic Diversion and Reentry System of Care with Alameda County Behavioral Health. I am joined today by some of our contracted providers. I believe we have Deatrice Simpson from Telecare and Shanice Smith or Dr. Noha Abalada from Roots may still be on. They may have had to jump off. I think they jumped off. I'm also joined, I just wanna acknowledge our assistant director, Svetlana Lasova, who's here, and she manages the Adult Forensic Behavioral Health Program at San Maria Jail, so I acknowledge her presence as well. Okay, so today I want to provide updates on the adult forensic behavioral health program, some of our progress that we've made in the consent decree as well as other projects that we have initiated this year. As a reminder, AFBH, it has been the mental health provider at Santerida Jail for several years. We have been the primary mental health provider for individuals who are incarcerated at Santerida jail. But I want to acknowledge that in the last two years, we have grown tremendously and made some really incredible progress in the model that we operate at San Arida Jail. A lot of it in alignment with consent decree, with the consent decree. A lot of it in alignment with CalA mandates that are coming down, but also additional projects that our staff and our program has taken on. I'm happy to say that the Adult Forensic Behavioral Health program has really shifted from a crisis and triage model to a true treatment model with a therapeutic foundation. So, you can see here the number of services that we have provided that we now provide has grown incredibly. We conduct mental health assessments for every individual who is booked in that tenorated jail that averages around 1,600 assessments a month that our staff are completing. We conduct individual mental health as services so that it's inclusive of therapy, counseling, one-on-one services with clients, our psychiatric services, both medication evaluation and prescriptions. We have increased our mental health and substance use counseling support groups that we offer both through county staff as well as through our contractor providers. I'm really focused in our therapeutic housing unit, which I'll speak about. We've increased our care coordination for clients with significant mental health needs and that's done in partnership with our collaboration with our partners in the Sheriff's Office as well as Well Path. We have dedicated clinical teams on several specialized units. So we now operate in at least six housing units across Santerida, jail. Half of those are designated as therapeutic housing units with a very specific model that I'll speak about. We continue our crisis intervention and support, which is available 24-7. We have overnight on-site intervention and on-call crisis consultation through our clinicians and clinical supervisors, and really proud around the work that we've done around reentry and expanding our reentry team. You can see for the last fiscal year, AFB H-STURR, just over 6,600 individuals, and this number to give context is this number. As I mentioned, we do about 1,600 intakes a month. Not every one of those individuals are opened, become open clients to adult forensic behavioral health. This number represents individuals who are officially opened and receiving ongoing services. You can see that the race and ethnic breakdown of our clients somewhat reflects the jail population. African American and black clients are the highest percentage. We are still working on increasing engagement with Asian and Hispanic Latino population as well. In terms of the breakdown, I fail to mention that the vast majority of our clients are males. Again, reflecting the population at San Maria Jail. And then the majority of our clients are under the age of 39 years old. So you'll see about 65% of our clients are under 39 years old and then about half of those fall within a younger adult ages. But pretty significant tape population, which is important for us when we talk about reentry and the continuity of care for our clients. There's some highlights I discussed kind of the incredible growth that we have had with an AFBH. Since last year we presented, we had 57 FTE and that has increased this year to 69 FTE. But in the last two years we have had over 30 new staff join AFPH. So that is a pretty significant increase in staff. Our retention staff retention has significantly improved. As of this calendar year, we have had, out of all of the new hires we have had and the existing staff, we have had no staff who have resigned or left the program. So retention has increased significantly. A lot of this is related to the new jail classifications that the board approved, as well as the hiring and retention bonuses that the board approved. So both of those have really helped us attract new staff. An important point, all of our clinical managers and supervisor positions are currently filled. And that's important because that really helps support the staff for doing the work on the ground. Especially newer staff who are coming into the field or into the forensic field, really making sure that they're supported. In addition to county staff, we've also hired two clinical consultants who really have helped us improve the work. The clinical consultants have been key to meeting both consent decree and cally mandates. One clinical consultant has done an extensive training for our staff around forensic mental health services, a lot of work around treatment planning and treatment behavioral health incentives towards treatment planning. And then we have another consultant who has done a lot of work in supporting clients who have developmental disabilities or intellectual disabilities. So a lot of work there. We've also continued to expand our intake team. So we have a dedicated clinical team and an intake that operates 24-7, that's both county staff as well as our telecare contractor who works overnight shifts and weekends. As I mentioned, we are in six housing units. Three of those are therapeutic housing units. And just to pause for a minute, the concept around the therapeutic housing units, all of these six housing units have dedicated clinical teams. So a clinician who has a physical presence, we have a psychiatrist who come and provide services. We are conducting daily huddles and daily rounds on those units so that we're bringing together our partners from the medical team well path as well as the deputies who work on the units. So identify any needs that clients may have, anything that may have occurred overnight that our team needs to address. And then the daily rounds are for those individuals who are higher level need and just need more engagement, more eyes. And then as I mentioned, we have our reentry team that I'll talk about a little bit later as well. In terms of our clinical practices, I went over a few of them already around the services that we provide in the therapeutic housing units. I also just want to mention the multidisciplinary team meetings that were involved in both with the Sheriff's Office and with well-path. We have weekly meetings around our therapeutic housing units when we're discussing client progress, which clients may be able to move to least less restrictive housing in terms of more feel of general population which Which clients we may be able to step down in terms of the level of care because they're progressing well and then we also partner with the sheriff and well path in other Multitrust monitoring team meetings around reentry or clients who need just more one-on-one engagement. We are moving towards a milieu focus, so the idea and that our therapeutic housing and it's more not just their providing services, one-on-one services, but we are simultaneously providing psychiatric services, multiple groups happening at one time, social groups and supports for our clients who are on those units, and make it feel more therapeutic and less like a typical housing unit. Lastly, I want to just mention the progress we've made on our treatment plans. We have been working very closely with our consultant and with the Sheriff's team, both the Housing Unit deputies as well as classification team to implement treatment plans for some of our more difficult to engage clients. We've historically made that engaged in a treatment planning with our team. The progress that we have made has really been tremendous and just being able to offer incentives to these clients, getting them out of their cells, more playing cards with them, engaging them in sports, offering them food incentives, if need be. And I just want to share, we've had really great success and You know clients who have not been engaging will not program well with other clients Now being able to come out of their cell engage with other clients engage in activities with other clients Another highlight is we had a Transition age youth who was with us Did a lot of work to support that youth and actually divert them out of jail and into treatment. And it really is because of the effort of our team and our staff engaging in these treatment plans and working in partnership with the sheriff and with our levels of care and levels of care is a specific mandate of the consent decree. I'm happy to now report that we have fully implemented levels of care across the base. So everyone who was currently incarcerated at San Maria Jail has a level of care and levels of care are determined at intake and they are reassessed every time a client is engaged by an AFPH staff person. And essentially we're looking at the individual's functioning as it relates to their mental health and ensuring that they have the appropriate level and that level then drives the services that they receive while they're incarcerated. You can see here this is a snapshot of our level of care report. This was our most recent report. And again, you'll see that every incarcerated individual has a current level of care on the left hand side. It gives you a brief breakdown of what our levels mean in terms of mental health and need. The majority of individuals who are incarcerated are what we would consider LOC-1 or LOC-X, meaning that they are clinically determined to not need mental health services and they have not requested services. So we've conducted our clinical assessment. They have not met the need for services and they have not requested services so we can give them a clinically appropriate level of LLCX or clients who are LLC one and that's the 33% and these clients have mild functional impairment related to their mental health clinically stable, usually typically stable on medication and are able to safely be housed in general population. And then the other percentages, LLCs 2 to 4, are clients that we would have clinically assessed to require housing and therapeutic housing units. So they are held in a house in one of those housing units that our clinical teams represent. Our caseload averages about 850 to 880 clients at any given time, and that is, again, LLC 1 to 4, with about 40% of our clients, LLCs 2 to 4 requiring placement in a therapeutic housing unit. Another program that I want to highlight that we successfully lifted up this year is our EES program or early access to stabilization services program. This is a program that was designed by the Department of State Hospitals and AFBH and HCSO have been in a conversation and negotiation with the Department of State Hospital to lift up this program. I'm happy to report that in August we successfully implemented this program. It is a DSH design program. So only individuals who have been found incompetent to stand trial by the courts and who are facing felonies and who have been ordered by the court to be placed at a state hospital can be a part of this program. The goal of this program is to get to this clients as quickly as possible, conduct a medication evaluation from a psychiatrist, and then provide them with intensive services. So you can see that they are seen by a psychiatrist weekly and they're seen by a license behavioral health clinician twice a week. The objective of the EES program is to help move clients through the waiting list for the department of state hospitals as quickly as possible so that they're not languishing in jail and then they get the treatment services they need outside of jail. As I mentioned, it's only, individuals who are eligible only if they're referred to us directly from the state hospital. So it's not open to the general population or the general AFBH client list. I am happy report that we have currently to date served 23 clients in the EES program, eight of whom we were able to successfully divert to community-based level of care. So that means in a, that is inclusive of inpatient restoration program, community-based restoration program, but it's not a jail setting. The other clients have been successfully transferred to a state hospital. This program, while diversion currently focuses on the community-based restoration or inpatient restoration, we will eventually expand diversion to include our departmental state hospital diversion program, which seeks to treat individuals in our sub-acute facilities and then step them down to a full service partnership. So over the next year we will be looking to connect ease with our Department of State Hospital Diversion Program and ensure that clients can be treated in the community. It does not include our other programs, our behavioral court program, or our assisted outpatient treatment program. So it doesn't involve our other court programs. Additionally, this year we have been working towards our CalAIM mandates and specifically the behavioral health linkages mandate as it relates to Allen and to county behavioral health department. I do want to say that we are actually ahead of other jurisdictions in terms of our cally planning because of a lot of the changes that we've made. A lot of the required changes for the consent decree have really set us in a good and good shape to meet a lot of the CalA mandates. So right now we really focused on updating a lot of our clinical templates, updating our clinical processes to align both consent decree mandates with CalA mandates, which at the end of the day I'm happy to say we'll better serve our clients and our community members. So some of the work that's involved in that has been updating our initial intake assessment. The intake assessment, as I mentioned, is a standard part of the intake process. Everyone is assessed for mental health need. They're assessed for their level of care, for suicide risk. We are now updating that to also increase how we're assessing individuals for substance use needs, which will move us closer to being able to identify clients who are needing both mental health services as well as substance use treatment. And then our hope is within the next year, we'll actually have some data on clients who are a dual diagnosis and require both services. We are also increasing in developing our process for secondary assessments. So this will speed up the timeline for individuals who are assessed, receive a more comprehensive mental health and substance use assessment. We have developed and implemented a new reentry care plan that is very comprehensive and that really seeks to identify the clients needs and serves as a true tool for us to help as it relates to continuity of care when individuals are leaving The community and we connect them to our reentry treatment teams Some of our SMI or my ultimatart programs, as well as our full service partnership. So a lot of work has gone into our reentry plan and piloting reentry. We are now moving into piloting the behavioral health linkages component of that, which means which is inclusive of some one-on-one engagement with our community-based providers, either in-person or via telehealth, whatever is easier for the providers to be able to access. We've also hired a post release clinician and the role that post release clinician is to follow clients who have higher levels of needs, make phone calls, see if they were connected to services, see if they need updated referrals, help with transportation if needed, but really connecting them to services after they leave so that they don't fall through the cracks. I mentioned we have one of our mental health contractors on line who will be able to speak to some of the work, but I want to just quickly highlight our providers when we are working with telecare. Telecare has been a critical partner for us in really helping to staff up the intake area and make sure that we have coverage 24-7. They've also been providing groups, seven days a week. So they provide five counseling groups, seven days a week around seeking safety, as well as some co-occurring, which is mental health and substance use support groups. We have lifelong who recently restarted their group services and I'll highlight some of their programs. And then Roots Community Health is a partner in operating the Safe Landing Program and is a critical part of reentry as they engage individuals when they are leaving the jail. I want to turn it over now to Deattra, who will speak on telecare. Thank you, Director Taisan. Welcome, Deattra. Thank you. You could raise your hand. My name is Deattra Simpson. I am the administrator for the Telecare Corporation Santa Maria Gile Adult Forensic Behavioral Health Program and partnership with Alameda County Adult Forensic Behavioral Program. For our mental health services, they include screening for anyone who can use the Gile crisis support to the jail crisis support. To the housing units as well as counseling services, to provide groups. I was the behavioral health. The after seven days a week, which as one stated, yes. Can you just us load down a little bit? Can you hear me? We can hear you now, but it was a little bit choppy before it was breaking up the audio. Go ahead though. Okay, would you like me to start over? No, just maybe like the last 30 seconds, we heard you clearly in the beginning. Okay. In 2022, telecare facilitated 69 groups for 1,851 participants. In 2023, telecare facilitated 1,160 groups for 3,350 participants. And today in 2024, telecare has facilitated 955 groups for 2,392 participants. Thank you. Thank you. Thank you, Diatra. As I mentioned, lifelong medical care has been a partner with AFPH and working in Santa Rita for some years. The COVID pandemic threw things off a bit, but happy to report that lifelong as of July 11th restarted their group services group counseling, primarily focused on our therapeutic housing units. They are running five groups a week and it's really around substance use. So you can see the group format here, they do a little bit of guided meditation, some check-ins, and then I focus really on psychoeducation and coping skills. To date, the group has served 81 group sessions for a total 44 participants. That number is duplicative. We have individuals who attend the multiple sessions and enjoy the groups. And then six clients have participated in individual counseling with lifelong. I just want to acknowledge the sheriff's office and the bad deputies have been really critical in us expanding our groups, both through telecare and lifelong, as well as for AFBH. We've started our own staff run groups. We now I'm happy to report have a schedule, a group schedule that we are offering in our therapeutic housing units. And it really has been the expansion of the bad deputies that has allowed us to expand our group services and run multiple groups while providing our ongoing individual treatment. We are looking to expand lifelong groups to the female clients, hopefully, if not this year, early next year, as well as our staff run groups, we also will be expanding those to the female units as well. I mentioned safe landing and roots community health has been a long partner with AFPH and ACBHD. Some data here, again, as a reminder, the safe landing model individuals when they are released from San Rita Jail can stop at safe landing. They provided some immediate support, water snacks, hygiene kits. There's a lot of masks that were provided and gloves during COVID, and they continue to provide some of these critical services. They also help with transportation, either providing transportation vouchers, or using the route shuttle to take clients to VART or to their facility in Oakland. And then secondarily, they provide, for those clients who were willing to stay with roots and engage, they're able to complete an intake assessment, identify any needs, benefits needs that the client may have, and then sign them up for CalFresh, MediCal, get them connected to housing services and other linkages as needed. Director Kaison, can I pause you? A lot of people are leaving. I just wanted to make sure that I give my sincere appreciation to all of the presenters. It's really remarkable to see the progress and I should have made that comment earlier, but just want you all to know that myself as well as the public really appreciate these updates. So I know this meeting has ran really long, which I appreciate that just mean we're doing good work. So I think next year we're definitely gonna have to schedule this maybe 10, 30 or 11, but time stamp the presentations, take a break just so the public could kind of anticipate the schedule, but really appreciate everyone's participation. And sorry to interrupt, you could continue. Thank you. No worries, thank you. I'm almost done. So just in terms of client-served routes, since its inception has served just shy of 11,000 individuals who have been released from San Rita Jail. I may have lost control here. There you go. So in terms of next steps, AFDH, we continuously focus on aggressive recruitment. We have grown incredibly again, just a number of staff that we have, the services that we're able to offer. Our clinical footprint across San Rita Jail has increased incredibly, and we know we need more staff. So we continue to do aggressive recruitment. Our leaders have been attending conferences, tabling at conferences, trying to attract nationwide, trying to attract clinicians from other areas. We've been in contact with colleges and universities and done some outreach there to really build that pipeline. We know that without the additional staff we're not going to be able to meet a lot of the consent to Cree mandates. So we are aggressive about our recruitment efforts. We will also continue our CalAIM behavioral health linkages, planning and implementation. Again, a lot of that will be working with our contracted providers, our reentry treatment teams, our full service partnerships, to making sure that we're developing those linkages and doing warm handoffs with our clients, working closely with ACSO and with well-path to make sure that our clients are leaving with comprehensive care plans as they re-enter the community. I'm also happy to report that our team has made some strong partnerships with the managed care plans, Alameda Alliance and Kaiser and referring individuals to their services when appropriate and we're currently working on identifying transportation benefits with Alameda Alliance so that individuals when individuals leave and they need transportation to their appointments that's a benefit that they're able to tap into through the managed care plants so we're getting access to that. The last piece around CalAIM and kind of consent decree we are working with our housing partners to really develop a tighter pipeline. We know that the majority of our clients with severe mental health needs are unhoused and so working with our housing partners and AC health to make sure that they get connected to housing and housing resources as soon as possible ideally prior to release. We continue to work with ACSOM GSA around the physical appearance of our therapeutic housing units. I want to lift up the murals. Those have been great. We want to see those kind of grow and expand in the therapeutic housing units and make the therapeutic housing units feel more like a therapeutic unit as much as possible. So we continue to plan with ACSOM GSA on that. And then lastly, we meet with our federally appointed monitor and a mental expert twice a month just to continue to plan and implement new consent to pre-mandate. So a lot of work goes into that through our leadership team. And with that, also thank you. Thank you so much for the great work you're doing. Would you be able to provide an email away if the public has follow up questions? Yes, so I think if there are questions about AFPH, the best email is AFPH-M-G-R-S at acgov.org. Do my repeating it one more time. Yep. AFPHMGRS at acgov.org. And then my email is my first name and last name at acgov.org. Great. Thank you. A couple questions for you. With respect to individuals that have intellectual or developmental disabilities, how are they being screened? Yeah, so that's actually right now we are transitioning that. Well Path has traditionally screened those individuals at intake and we continue to gather information from them. As we roll out a new process, AFBH will have a larger role in identifying those. We screen in our brief initial assessment as well, and we will play a larger role in those secondary assessments. So when someone has been flagged as possibly being ID or DD, then AFBH will go and administer the actual test to confirm if they need those adaptive supports or any kind of supports because of their IDODD and then we work closely with the Sheriff's ADA unit to make sure that that knowledge is shared across all partners. Okay. And if I understood correctly, the level care assessment is done at intake? Correct. It's done at intake and then every time a clinician sees a client that level of care is reassessed to make sure it doesn't change. So what happens if someone's status changes if they decompensate? How is that? Yeah, great question. So our clinicians or psychiatric providers will update a, what's called a classification form. So, in our system, they will provide the updated level, they'll provide the clinical justification for that update level. If someone's decompensated, they may go from a level 2 to a level 3, which means then their next appointment needs to be bumped up. They need to be seen by a psychiatric provider or a clinician more quickly and then we inform ACSO classifications so that they are aware that this person's level of care has changed and that information lives in our system as well as in the sheriff's database system as well. So that information gets shared across all partners. Okay, great. Those are all my questions. Before we open public comment I do have one question for a well path that I meant to ask earlier. So Mr. Cindy, if you don't mind coming back up, please. With respect to individuals benefiting from substance abuse treatment, are you aware of best practices and other facilities like what we're doing differently to increase the level of participation of those programs. Yes, so WELPATH has a pretty big presence all around the nation. We have regional support from our MET directors, regional MET directors, so we have data from other facilities all across the nation. We work with health management, associate HMA, I don't know if you're familiar with that. They also have connections with other jails and other prisons. And we've had meetings with them where they would connect us with their MAT program and look at their best practice, how they do, like a housing unit or like a separate clinic or how they would apply certain policies depending on their population and stuff like that. I know that's a pretty broad answer, I just don't have anything for me. No, that's fine. And then individuals that are under the jurisdiction of probation could some of them be court order to participate? I'm sorry, what can you say? If they're under probation, of them be court ordered to participate? I'm sorry. Can you if they're under probation, can they be court ordered to participate in those services? I don't know off the top of my items. Okay. I'll check with probation. Okay. Thank you. Thank you. We're going to open up public comment. Tisa, how many speakers do we have? Perfect. Two minutes please. Jane Kramer. Collar you're on the line for item three. Merna. Yeah I there. Murnish warts with interfaith coalition for justice and our jails and care first community coalition. I want to thank Stratize on for this really informative and encouraging presentation for all the work that Dean and his team have been doing in the jails. It's truly impressive. My comment concerns the level of care analysis in slide seven. It's definitely positive news that everyone booked into the jail is now promptly assigned a level of care classification. I'd like to see this board committee along with forensic behavioral health and the sheriff's department help the public to track numerical trends in, especially LOCs 2, 3, and 4, along with the staff and costs associated with keeping these high needs individuals safe. In passing the care first jail session resolution three years ago, your board committed to dramatically reducing the number of individuals with serious mental illness incarcerated in jail. As one measure of progress, I hope we'll soon see daily LLC counts posted on both the sheriff's and behavioral health websites. As these numbers come down, as we all hope and expect, there should be measurable savings and staffing costs. These two should be regularly and transparently reported. Additionally, I hope we'll have regular updates to this committee on progress in diverting these high needs individual from jail to community-based care through the IST diversion and collaborative ports. With the unfortunate passage of Prop 36, it's more critical than ever to keep the spotlight on these LOCs 23 and 4. I'd also like to just ask about the East Program, the really need of exploration of that, and including the use of involuntary meds. Thank you. Collar, you're on the line for item 3, Gene. Hi, this is Gene Moses, District 3, and also a member of the Interfaith Coalition for Justice and Our Jails. I'd like to second the motion of everything that Meredith said, and also more information on the EES program was one of my top questions, so I would love to learn more about how people are put into that, whether it's from the courts and how many people who are in that program are already on meds and how many people are involuntarily put on medication. My second question, which perhaps you could answer today, what the hours are for the roots safe landing trailer and has that safe landing service been expanded into the jail because I think I heard not too long ago that there was discussion of having a police inside the building where people could stop and get services from routes. Thank you very much for all your work. Collar, you're on the line for item two, Brian. I thank Mrs. Brian Bloom. I live in Berkeley. I'm the Chair of the Mental Health Advisory Board. Nice to see everybody and hear these comments. Great presentation from Mr. Tyzon. I really appreciate the information, wanted to also to state publicly that he's been a very collaborative partner with the Mental Health Advisory Board. I always open answer questions, providing information, and that's much appreciated. As Mirna said, I like to focus on slide seven of his presentation. We actually do have some good information. The level of caring numbers, two, three, and four, that is the people that are the sickest and the most mentally ill in jail. When you total those up on his slide, it's 372. That number regrett, has stayed just about the same since the Board of Supervisors passed the care first resolution. So despite a lot of good energy, a lot of good talking, a lot of recommendations, and a lot of people putting another's and that's a good proxy for the number of menlial people in jail has hovered between 3,000, 3,400 for the last 18 months. So the proof will be in the pudding. Clearly from Mr. Tyzon's presentation, silos are being broken down, unmet needs are being identified, people are getting treatment. But it's only going to matter if over time we see that number decrease. Because as the jail population decreases, as the sheriff pointed out in one of the earlier slides of the sheriff's presentation, we know that the percentage of mental ill people in jail has actually increased. Because as the general population goes down, mentally ill people are not being diverted into community treatment as much as they could be. So I hope and urge us to keep the focus on that. Track that number so that over time we hopefully if our efforts bear fruit that number will decrease. Thanks. I have a number of speakers on the side. Thank you, Tisa. Thank you all members of the public that called in. Again, I want to sincerely appreciate the work that's been done. This was an impressive update. They're obviously still room firm proven. I know that we're all committed to doing that work. So I look forward to the presentation next year and thank you everyone for sharing your email contact information for individuals that have follow up questions and to hurts some good advice in terms of maybe a town hall betraying these topics so there could be more engagement. The committee meeting doesn't it's not really designed for that it's really just to receive this information in period public comments but the level of engagement is limited in this space. So thank you all for your patience I know this has been a very long meeting. I do have one quick question for the sheriff. Thank you for being here. I've had many inquiries from the public with respect to the incoming administration. Next year concerns about their well-being, safety with regard to nasty portation. Is there any information you could share with the public in terms of what is your policy with interacting with ICE? So our policy is pretty restrictive with communications to immigration. And what I will say is in our community, we for several years have been trying to build strong relationships with all of our community residents, regardless of where their documented status is. And quite frankly, I'll be damned if we go backwards on those relationships and the strides that we've made. So if there's any concern from the community as far as the sheriff's office being utilized as an arm of immigration enforcement that is not going to happen. I'm also going to be meeting with our chiefs across the county next week. And this will be something that I will share with them as well. Thank you, Sheriff. I really appreciate you sharing that with the public. We are now going to move to item number four, which is general public comment for items under the purview of this committee. So if you call and start talking about things under this better not, put into this committee, I will ask the clerk to mute you. So do we have any members from the public that would like to speak on items under the purview of public protection committee, but we're not on today's agenda. I have no speakers for public comment. Thank you. Our next meeting will be on Thursday, December 19th at 10 a.m. This meeting is adjourned. Thank you everyone. Thank you.