DN Health Care Dist Adopted MSR July 22 2019

Del Norte Healthcare District Municipal Service Review & Sphere of Influence Update Commission Hearing Draft 2019 Del Norte Local Agency Formation Commission Del Norte Local Agency Formation Commission Commissioners Roger Gitlin Chair & County Member Jason Greenough Vice Chair& City Member Blake Inscore City Member Bob Berkowitz County Member Duane (Sparky) Countess Public Member Lori Cowan Alternate County Member Isaiah Wright Alternate City Member Judy Dobbs Alternate Public Member Staff George Williamson, AICP, Executive Officer Vanessa Blodgett, Services Analyst Elizabeth Cable, Legal Counsel Acknowledgements LAFCo staff would like to thank the contributors to this Municipal Service Review. Input instrumental in completing this report was provided by the Del Norte Health Care District’s Executive Secretary, Doris Hendricks. This report would not have been possible without the District’s assistance. TABLE OF CONTENTS Introduction ................................................................................................................................ 1 Agency Profile ............................................................................................................................. 5 Governance ..................................................................................................................... 5 District Boundary ............................................................................................................. 6 Growth and Population .................................................................................................... 6 Existing and Planned Uses ................................................................................................ 7 Services Provided ........................................................................................................................ 7 Other Service Providers.................................................................................................... 9 Financing ................................................................................................................................... 10 Local Accountability ................................................................................................................... 13 Municipal Services Review Determinations ................................................................................ 14 Sphere of Influence Determinations .......................................................................................... 18 References ................................................................................................................................ 18 LIST OF FIGURES Figure 1: District Boundary .......................................................................................................... 6 Figure 2: Wellness Center Site Location ....................................................................................... 7 LIST OF TABLES Table 1: Del Norte Health Care District Contact Information…………………………………………………… ... .4 Table 2: Del Norte Health Care District Board of Directors………………………………………………….. ........ 5 Table 3: Statement of Revenues and Expenditures Summary ..................................................... 10 INTRODUCTION This Municipal Service Review for the Del Norte Healthcare District (DNHCD or District) and its sphere of influence has been prepared by the Del Norte Local Agency Formation Commission (LAFCo) to assess existing and future public service conditions and to evaluate organizational options for accommodating growth and ensuring critical services are provided efficiently. This Municipal Service Review will be available for use by LAFCo, the Del Norte Healthcare District, special districts, and the public to better understand how public services are provided within the district. Review Methods This Municipal Service Review was prepared by Del Norte LAFCo staff during 2018-19. The Executive Secretary, Doris Hendricks, was contacted to obtain information concerning the current status of district operations. LAFCo staff reviewed pertinent resource documents to obtain detailed descriptions of existing infrastructure and services provided by the district. The draft Municipal Service Review was provided to the Del Norte Healthcare District staff for review and clarification. All information gathered for this report is stored in Del Norte LAFCo files for future reference. Statutory Authority The fundamental role of the Local Agency Formation Commission (LAFCo) is to implement the Cortese-Knox-Hertzberg Local Government Reorganization Act of 2000 consistent with local conditions and circumstances. The major goals of LAFCo as established by the Cortese-Knox- Hertzberg Act are to: • Encourage orderly growth and development; • Discourage urban sprawl; • Preserve open-space and prime agricultural lands by guiding minimizing resource loss; • Exercise its authority to ensure that affected populations receive efficient services; • Promote logical formation and boundary modifications that direct the burdens and benefits of additional growth to those local agencies that are best suited to provide services; • Make studies and obtain and furnish information which will contribute to the logical and reasonable development of local agencies to provide for present and future needs; • Establish priorities by assessing and balancing community service needs with financial resources available to secure and provide community services and to encourage government structures that reflect local circumstances, conditions and financial resources; and • Determine whether new or existing agencies can feasibly provide needed services in a more efficient or accountable manner and, are where deemed necessary. 1 Special Districts in Del Norte County A special district is a local governmental agency that delivers public services to a specific area. They are most often established by residents to supply local services in areas not being served by another service provider. In California, there are 58 counties, 481 cities and over 3,361 special districts, exclusive of school districts. Special districts provide critical services such as fire protection and emergency response, are governed by a board of directors and have defined boundaries in which it provides services and facilities. Special districts must have a statutory authority in order to be established. This authority can take the form of a generic statute which applies to all special districts of that type or may be formed by a special act tailored to the unique needs of a specific area. In Del Norte County, there are 20 special districts providing water, wastewater, fire protection, recreation and other services. Healthcare districts are independent public agencies, authorized under the Local Health Care District Law (California Health and Safety Code Section 32000 et seq.). The law was originally established as the Local Hospital District Law, under which the districts provided hospital and related healthcare services. Today these districts provide a range of health-related services and programs that benefit communities and their residents. Service Review Determinations In accordance with California Government Code Section 56430, Del Norte LAFCo conducts service reviews prior to, or in conjunction with, the mandated five-year schedule for updating spheres of influence of the agencies under its jurisdiction. As defined by State law, the service review is a comprehensive overview of public services within a given jurisdiction, addressing the public services provided by agencies subject to LAFCo’s boundary regulation. The service review report must include an analysis of the issues and written determinations for each of the following: 1. Growth and population projections for the affected area; 2. The location and characteristics of any disadvantaged unincorporated communities within or contiguous to the sphere of influence; 3. Present and planned capacity of public facilities, adequacy of public services, and infrastructure needs or deficiencies including needs or deficiencies related to sewers, municipal and industrial water, and structural fire protection in any disadvantaged, unincorporated communities within or contiguous to the sphere of influence; 4. Financial ability of agencies to provide services; 5. Status of, and opportunities for, shared facilities; 6. Accountability for community service needs, including governmental structure and operational efficiencies; and 7. Any other matter related to effective or efficient service delivery, as required by commission policy. 2 State Guidelines and Commission policies encourage stakeholder cooperation in the municipal service review process. It also provides a basis to evaluate, and make changes to Spheres of Influence, if appropriate. Sphere of Influence Determinations A sphere of influence is a plan, adopted by LAFCo, for the probable future boundaries and service area of an agency, such as the DNHCD. State law required LAFCo to periodically review each agency’s sphere of influence and make any amendments LAFCo determines to be advantages. All subsequent boundary change decisions must be consistent with the adopted sphere (i.e., territory cannot be annexed by an agency unless it is within that agency's sphere). When adopting or amending a sphere of influence, the law requires LAFCo to make determinations on a series of topics: 1. The present and planned land uses in the area, including agricultural and open-space lands; 2. The present and probable need for public facilities and services in the area; 3. The present capacity of public facilities and adequacy of public services that the agency provides or is authorized to provide; 4. The existence of any social or economic communities of interest in the area if the commission determines that they are relevant to the agency; and 5. For an update of a sphere of influence of a city or special district that provides public facilities or services related to sewers, municipal and industrial water, or structural fire protection, the present and probable need for those public facilities and services of any disadvantaged unincorporated communities within the existing sphere of influence California Environmental Quality Act The California Environmental Quality Act (CEQA) is contained in Public Resources Code § 21000 et seq. Public agencies are required to evaluate the potential environmental effects of their actions. MSRs are statutorily exempt from CEQA pursuant to § 15262 (feasibility or planning studies) and categorically exempt pursuant to CEQA Guidelines § 15306 (information collection). CEQA requirements are applicable to SOI Updates. The CEQA lead agency for SOI Updates is most often LAFCo, unless an agency has initiated an SOI expansion or update. AGENCY PROFILE The Del Norte Healthcare District (DNHCD) serves all of Del Norte County, California, just south of the Oregon border along the Pacific coast. It serves a sparsely populated rural county with many low-income residents. The DNHCD provides funding and support for healthcare services; however, the district does not directly provide services. 3 The District owned Wellness Center (20,000 ft2) completed in 2007, provides space for the Del Norte Community Health Center (part of Open Door Community Health Centers) and other health related service providers on a 11.9 acre site at Northcrest Drive and Washington Blvd. The Wellness Center site allows for the consolidation of several service providers in one location and is centrally located near the Sutter Coast Hospital and other existing complimentary health facilities and services. The District’s mission, vision and values follow. Mission Statement: To promote a collaborative approach to personal and community health through education, prevention, and health services to the residents of the County. Vision Statement: To be responsive to community needs and ensure that generations of County residents enjoy optimal health through the delivery of wellness services. District Core Values: Leadership, education, personal responsibility, stewardship, and transparency. Table 1 Del Norte Health Care District Contact Information Contact: Doris Hendricks, Executive Secretary 550 E Washington Blvd., Suite 400 Physical Address Crescent City, CA 95531 Del Norte P.O. Box 2034 Healthcare Mailing Address: Crescent City, CA 95531 District Phone Number: (707) 464-9494 Fax Number: (707) 465-6424 E-mail dnhcd@delnortehealth.com Website http://delnortehealthcare.org Governance The Del Norte County Board of Supervisors granted formation for the Del Norte Hospital District and its commission in the 1940’s. In 1994, the District changed its name to the Del Norte Healthcare District to more accurately reflect the range of health-related services and programs the district is involved in. The District is composed of an elected five-member board of directors. The specific powers that the board of directors may exercise are to establish, maintain, and operate, or provide assistance in the operation of, one or more health facilities or services, including but not limited to: • outpatient programs, services and facilities, retirement programs, chemical dependency programs, services and facilities, or other health care programs, services and facilities; • activities at any location inside and outside the district for the benefit of the district and people served by the district; • to acquire, maintain, and operate ambulance, or ambulance services inside and outside the district; and • to establish a nurses’ training school, or a child care facility for the benefit of employees of the hospital or residents of the district (Health and Safety Code 32121). 4 In addition to the powers listed above, Health and Safety Code Section 32121 - 32138 provide the general powers to perform acts necessary to carry out the provision of "The Local Health Care District Law." DNHCD Board meetings are held at the Wellness Center Conference Room, 550 E. Washington Blvd. Crescent City, on the fourth Tuesday of each month, with special meetings scheduled as needed. All meetings are conducted and noticed as required by the Brown Act. The District employs one part-time staff. The District office, located in the Wellness Center, is open Monday through Friday from 8:00 a.m. to 12:00 p.m. Table 2 Del Norte Health Care District Board of Directors Board Member Title Term Expiration Dr. Gregory J. Duncan Chairman 2020 Dr. Kevin J. Caldwell Vice Chair 2020 Dohn Henion, Esq. Director 2024 Elizabeth Austin Board Secretary 2024 Mike Young Director 2024 District Boundary The Del Norte Healthcare District’s service area and sphere of influence are coterminous with the Del Norte County boundary as shown on Figure 1. Growth and Population According to the U.S. Census, the Del Norte County population increased from 27,507 in 2000 to 28,610 in 2010 for a 4.0 percent growth rate over 10 years (2000 and 2010 U.S. Census). The only incorporated city in the county is Crescent City, which grew in population at a similar growth rate over the last decade. More recent California Department of Finance (DOF) projections indicate a slight decrease in County population from 2010-2015 but indicate that slow growth is likely to continue. The DOF projected Del Norte County population was 26,762 at the beginning of 2015 and 26,811 in 2016, a 0.2 percent increase. The County largely contains resource and rural residential land and will likely continue to develop at relatively slow growth rates. Using the DOF 2016 projected population of 26,811 and 0.2 percent annual growth, the County population will be approximately 27,572 in 2030. Existing and Planned Uses The District covers the entire unincorporated area of Del Norte County and the incorporated area of the City of Crescent City. Land uses within the District boundaries are subject to the Del Norte County General Plan and Crescent City General Plan. Del Norte County is comprised of approximately 683,500 acres, of which approximately 192,357 acres (28 percent) are privately owned and 489,697 acres (72 percent) are publicly owned. 5 Figure 1 Del Norte Healthcare District 6 SERVICES PROVIDED Del Norte Community Wellness Center and Garden The District’s main facility is the Del Norte Community Wellness Center which opened in 2007. Building this facility took nearly 10 years of effort by the Del Norte Healthcare District, Open Door Community Health Centers and the openhearted support of the city, county, College of the Redwoods, Area 1 Agency on Aging, First Five and many other social service providers in Del Norte County. The Community Wellness Center’s location, 550 E. Washington Blvd., was selected for its proximity to the Del Norte Senior Center, social services, public health, Sutter Coast Hospital and for its potential for future location of other health and social services. Figure 2 Wellness Center Site Arial View 7 The Wellness Center’s anchor tenant is the Del Norte Community Health Center, which is part of the Open Door Community Health Centers — a nonprofit community clinic providing affordable primary medical, dental, and mental health services. It provides comprehensive primary care services to anyone in the community. Medical and dental services are provided on a sliding scale based on ability to pay. As district leaders began planning for the clinic's expansion, they also opted to explore creation of a more comprehensive facility — one that would include a focus on illness prevention and health promotion. The Del Norte Community Health Center, in collaboration with Community Assistance Network and the Del Norte Healthcare District, established a community garden adjacent to the Wellness Center. Individuals and families can sign up for a garden box and any community member is welcome to volunteer to work in the garden. The garden provides space for patients, staff, and community members to grow their own food. Although the District does not directly provide services, they have provided funding for health related events in unincorporated areas around the County. Bus service is available to people in outlying areas (Smith River, Gasquet, and Klamath) that need to come to Crescent City for health services. In addition, there is a bus stop adjacent to the Wellness Center. Site Utilization In 2010, the DNHCD conducted a site utilization study for the 11.91 acre Wellness Center property owned by the District. The existing site facilities include the 20,000 square foot Wellness Center, 151 parking spaces, and a community garden. The site also contains approximately 175,000 square feet of non-buildable area containing dense trees, steep slopes, a creek and wetlands. The purpose of the study was to determine the highest and best use of the rest of the site to accommodate future needs to carry out the mission and vision of the DNHCD. Some of the uses of the site that were built since their inclusion in the Site Utilization Study include an outdoor garden, a children’s play area, and a walking path with exercise stations (Personal Communication with Doris Hendricks, District Secretary, 10-11-18). The District is also working on a clinic expansion that will provide more dental facilities, more parking and increased access to the mobile MRI machine that currently provides services to Pelican Bay State Prison and will hopefully provide services to local residents a few times per month. 8 Other Service Providers General Governmental Services The County of Del Norte provides general governmental services – which includes social services, emergency services, planning, public works, county roads and parks, etc. – to the unincorporated areas of Del Norte County. The City of Crescent City provides similar general governmental services within city limits. Hospital Services Hospital services within the District are provided by Sutter Coast Hospital, a not-for-profit hospital serving residents of Del Norte County, California and Curry County, Oregon. The main hospital is a 49 bed acute care facility located at 800 East Washington Blvd. in Crescent City. Sutter Coast Hospital offers the following services: • Cardiopulmonary • Maternity Care • Emergency • Pharmacy • Urgent Care Clinic • Radiology • Home Health • Rehabilitation • Intensive Care • Surgical • Laboratory Other Health Care Providers St. Joseph Health, in collaboration with the Del Norte Healthcare District, has opened a medical clinic in Crescent City. Beginning July 18, 2017, Cardiologist Dr. Bryon Dorgan will see patients with cardiac and circulatory conditions, including high blood pressure and all conditions related to the heart. The St. Joseph Health Medical Group (formerly Humboldt Medical Specialists) satellite clinic will be held at Dr. Greg Duncan’s office at 1200 Marshall St. In addition to cardiology, St. Joseph Health Medical Group (SJHMG) provides comprehensive primary and specialty care to patients in the north coast region. SJHMG is currently evaluating resource availability and looks forward to adding additional specialty services to its Crescent City satellite clinic later this year. FINANCING Revenues and Expenditures According to District records, they operate on an annual budget of $ 811,304.36 (FY 2018-19). The majority of revenues come from taxes (secured property tax, unsecured property tax, and timber) and rental income from other tenants at the Wellness Center. Some of the larger Wellness Center expenses including USDA loan repayment, equipment repair, and maintenance; other expenses include special projects, professional fees, wages and insurance. The DNHCD FY2016-17 through FY2018-19 statement of revenues and expenditures summary is below (Table 3). 9 Table 3 Statement of Revenues & Expenditures Summary Revenues Budget 2016-17 Budget 2017-18 Budget 2018-19 Taxes 450,000.00 450,000.00 469,000.00 Investment earnings 12,900.00 17,000.00 64,304.36 Collections on notes receivable 50,213.86 50,005.37 23,400.00 Utility Cost Sharing 48,000.00 50,000 50,000.00 Rents/ Lease 204,600.00 204,600.00 204,600.00 Total Revenues 765,713.56 771,605.37 811,304.36 Expenses Budget 2016-17 Budget 2017-18 Budget 2018-19 Salaries and employee benefits 174,500.00 230,000.00 124,000.00 Services and supplies/Utilities 86,300.00 86,800.00 88,000.00 General Projects 28,000.00 31,000.00 31,000.00 Special Projects/Physician Loan 30,300.00 31,300.00 31,3000.00 Repayment Program General Expense 142,000.00 92,000 230,000.00 Wellness Center 226,571.35 223,345.00 225,873.92 Contingency 76,571.35 77,160.37 81,130.44 Total Expenses 765,713.56 771,605.37 811,304.36 The District prepares and adopts a final budget on or before June 30th of each fiscal year. After the budget is approved, the appropriations can be added to, subtracted from or changed only by Board resolution. All such changes must be within the revenues and reserves estimated as available in the final budget. The Board approves purchase amounts through budget hearings or subsequent budget transfers. The Wellness Center was completed in 2007 and is fully occupied. Space is leased to the Open Door Clinic at $10,000.00/month for a lease term of 20 years and Kathy Wollam for $250.00/month. The USDA $3,000,000 loan that funded much of the Wellness Center was secured on November 1, 2007 and has a 40 year term at 4.125% interest. 10 MUNICIPAL SERVICES REVIEW DETERMINATIONS 56430. (a) In order to prepare and to update spheres of influence in accordance with Section 56425, the commission shall conduct a service review of the municipal services provided in the county or other appropriate area designated by the commission. The commission shall include in the area designated for service review the county, the region, the subregion, or any other geographic area as is appropriate for an analysis of the service or services to be reviewed, and shall prepare a written statement of its determinations with respect to each of the following: 1) Growth and population projections for the affected area. The total population in Del Norte County was 27,540 in July 2016, representing -3.7 percent growth between 2010 and 2016. The District largely contains resource and rural residential land and will likely continue to develop at current county-wide rates of 0.4 percent per year. These are relatively low growth rates compared to much of the rest of the state. Del Norte County’s projected population is 29,967 in 2020 and 31,252 in 2030 (DOF, 2012). The Wellness Center site has the capacity to accommodate this relatively low projected growth. 2) The location and characteristics of any disadvantaged unincorporated communities within or contiguous to the sphere. A disadvantaged unincorporated community is defined as any area with 12 or more registered voters where the annual median household income is less than 80 percent of the statewide annual median household income (pursuant to Government Code Section 56033.5 and Water Code Section 79505.5). Using data from the 2010 Census, the statewide annual median household income is $54,459. Eighty percent of the statewide annual median household income is $43,567. The Del Norte County median household income (2006-2010), as reported by the 2010 Census, is $36,118, which is below the 80 percent threshold referenced above. This prompts the Commission to prepare a written determination on infrastructure needs or deficiencies within or contiguous to the DNHCD’s sphere of influence. The District serves the entire unincorporated area of Del Norte County and the incorporated City of Crescent City. There are a number of small unincorporated communities in the County including Klamath to the south of Crescent City, Gasquet to the east, and Smith River to the north. Del Norte County is largely rural in character comprised of approximately 683,500 acres, of which approximately 192,357 acres (28 percent) are privately owned and 489,697 acres (72 percent) are publicly owned. The District’s mission is to promote a collaborative approach to personal and community health through education, prevention, and health services to the residents of the County. The DNHCD provides funding and support for healthcare services; however, the District does not directly provide services. The Del Norte Community Health Center, located in the Wellness Center, is a nonprofit community clinic providing affordable primary medical, dental, and mental health services to County residents. It provides comprehensive primary care services to anyone in the community. Medical and dental services 11 are provided on a sliding scale based on ability to pay. Bus service is available to people in outlying areas that need to come to Crescent City for health services. In addition, there is a bus stop adjacent to the Wellness Center. There is no evidence to suggest that disadvantaged communities receive less or a lower level of service. 3) Present and planned capacity of public facilities, adequacy of public services, and infrastructure needs or deficiencies including needs or deficiencies related to sewers, municipal and industrial water, and structural fire protection in any disadvantaged, unincorporated communities within or contiguous to the sphere. The DNHCD provides funding and support for healthcare services; however, the District does not directly provide services. The District owned Wellness Center, completed in 2007, provides space for the Del Norte Community Health Center and other health related service providers. The 20,000 square foot building is adequate space for the clinic to meet current demand for its services. The District completed a site utilization study for the 11.9 acre Wellness Center site in 2010. Some of the facilities that have been built on the Wellness Center site that were envisioned in the study include an outdoor garden, a children’s play area and a walking path. The site is currently undergoing a clinic expansion that will provide better dental facilities and a site for the mobile MRI machine that will provide needed services. 4) Financial ability of agencies to provide services. The District appears to have sufficient funding to adequately finance the desired programs. However, the District needs to look for additional funding opportunities to further develop the Wellness Center property and pursue the projects addressed in the site utilization study. The District conducts an annual independent audit of its financial statements. The District received a $3,000,000 USDA loan to help fund construction of the Wellness Center; the rental income covers a majority of the loan payments. 5) Status of, and opportunities for, shared facilities. The DNHCD’s Wellness Center was constructed for the purpose of providing space for the Del Norte Community Health Center and other health related service providers. The Wellness Center site allows for the consolidation of several service providers in one location and is accessible via public transportation. The facility compliments other healthcare services available in the County including Sutter Coast Hospital and specialty services through St. Joseph Health. Future site development will depend on demand for additional healthcare services. Anticipated future site uses include adult day healthcare center, teaching kitchen, community hall, pharmacy, and classrooms for College of the Redwoods and a nurses’ teaching program. 6) Accountability for community service needs, including governmental structure and operational efficiencies. The DNHCD has a board of directors that are elected by registered voters within the District. The board meets regularly, and District board meetings comply with the Brown Act provisions. The 12 District has one part-time employee who provides administrative support for District activities. No potential options were identified with regard to DNHCD’s government structure that would allow for more effective or efficient service provision. The District maintains a website where information is made available to the public. Board meeting agendas and minutes are available on the Del Norte County website. The District makes documents available by request. The District demonstrated full accountability in its disclosure of information and cooperation with LAFCo. The agency responded to LAFCo’s written questionnaires and cooperated with LAFCo inquiries and document requests. 7) Any other matter related to effective or efficient service delivery, as required by commission policy. Additional facilities identified for the Wellness Center site include clinic expansion, adult day healthcare center, café, teaching kitchen, community hall, pharmacy, and classrooms. A site for a mobile MRI machine that currently provides service to Pelican Bay State Prison will allow County residents to access MRI services without traveling out of the county. The future development of these features was identified as the highest and best use of the site and will help maintain effective and efficient service delivery. 13 SPHERE OF INFLUENCE DETERMINATIONS 56425. (e) In determining the sphere of influence of each local agency, the commission shall consider and prepare a written statement of its determinations with respect to each of the following: 1) The present and planned land uses in the area, including agricultural and open- space lands. The DNHCD’s service area and sphere of influence are coterminous with the Del Norte County boundary as shown on Figure 1. The District covers the entire unincorporated area of Del Norte County and the City of Crescent City. Land uses within the District boundaries are subject to the Del Norte County General Plan and Crescent City General Plan. Del Norte County is comprised of approximately 683,500 acres, of which approximately 192,357 acres (28 percent) are privately owned and 489,697 acres (72 percent) are publicly owned. As the DNHCD sphere is coterminous with the District boundary and the Del Norte County boundary, there is no opportunity to expand SOI and therefore no recommended changes. 2) The present and probable need for public facilities and services in the area. The DNHCD has been serving the community since the 1940’s. The District opened the Wellness Center in 2007, which provides space for the Del Norte Community Health Center - a nonprofit community clinic providing affordable primary medical, dental and mental health services. The Wellness Center also has space for other health related service providers. The District completed a site utilization study in 2010 to accommodate future healthcare needs to carry out the District’s mission and vision. The Wellness Center is continuing to expand to offer more services to County residents. 3) The present capacity of public facilities and adequacy of public services that the agency provides or is authorized to provide. The DNHCD has the capacity to establish, maintain, and provide assistance in the operation of health facilities and services. Overall, the District currently functions efficiently. The DNHCD budget demonstrates that the District has sufficient revenues to cover expenses and sustain the District at its current capacity. 4) The existence of any social or economic communities of interest in the area if the commission determines that they are relevant to the agency. The District serves all of Del Norte County including unincorporated communities and the City of Crescent City. The District has not noticed any significant demographic trends. No areas of social or economic interest are known that are not already being served by the District. 5) For an update of a sphere of influence of a city or special district that provides public facilities or services related to sewers, municipal and industrial water, or structural fire protection, the present and probable need for those public facilities 14 and services of any disadvantaged unincorporated communities within the existing sphere. The District SOI has no ability to expand due to already covering the entire County and therefore it is not proposed to be updated. The Municipal Services Review determination made for disadvantaged unincorporated communities applies to this determination as well. REFERENCES California Department of Finance (DOF), 2012. Interim Projections of Population for California. URL: http://www.dof.ca.gov/research/demographic/reports/projections/ interim/view.php Del Norte County Economic Forecast. California Department of Transportation (DOT), 2011. URL: http://www.dot.ca.gov/hq/tpp/offices/eab/socio_economic_files/2011/ Del_Norte.pdf Del Norte Healthcare District, 2011. Independent Auditor’s Report on General Purpose Financial Statements for the Year Ended June 30, 2011. Donald R. Reynolds, CPA. Del Norte Healthcare District, 2010. Site Utilization Study. Vanir. Del Norte LAFCo, 2012 Del Norte Healthcare District Municipal Service Review Personal Communication with Doris Hendricks, District Secretary, 10-11-18, 5-1-19, 6-26-19 15