LAFCO
Cambria Community Healthcare District
Read the report at Local Agency Formation Commissions ↗
Cambria Community Healthcare District
Municipal Service Review
and Sphere of Influence Study
Prepared by
the San Luis Obispo Local Agency Formation Commission
Adopted May 16, 2024
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Acknowledgments
San Luis Obispo LAFCO gratefully acknowledges the time and effort of staff with the Cambria
Community Services District in assisting in the preparation of this report and includes – but not limited
to – the following:
Linda Hendy, Cambria Community Healthcare District, Administrator
Michael Bryant, Cambria Community Healthcare District, Paramedic Supervisor
Cecilia Montalvo, Cambria Community Healthcare District, Board President
Iggy Fedoroff, Cambria Community Healthcare District, Board Member
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TABLE OF CONTENTS
About LAFCO _________________________________________________________ 5
Authority and Objectives ___________________________________________________________ 5
Regulatory Responsibilities _________________________________________________________ 5
Planning Responsibilities ___________________________________________________________ 6
LAFCO Decision-Making ____________________________________________________________ 7
SLO LAFCO ______________________________________________________________________ 8
District MSR & Sphere Study ____________________________________________ 10
Overview ____________________________________________________________________ 10
At A Glance __________________________________________________________________ 12
Boundary Map ________________________________________________________________ 13
Sphere of Influence ____________________________________________________________ 14
Accountability ________________________________________________________________ 14
Population Profile _____________________________________________________________ 15
Present and Planned Land Use ___________________________________________________ 19
Services & Capacity ____________________________________________________________ 20
Finance ______________________________________________________________________ 24
Other Matters Related to Efficient Service Delivery ___________________________________ 32
Determinations ______________________________________________________ 34
Service Review Determinations per Government Code Section 56430 ______________________ 34
Sphere of Influence Determinations per Government Code Section 56425 __________________ 38
Appendix ___________________________________________________________ 40
Sources ________________________________________________________________________ 40
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List of Figures
Figure 1: CCHD Boundary Map ............................................................................................................... 13
Figure 2: San Simeon Disadvantaged Unincorporated Community Area #1 Boundary Map ................ 18
Figure 3: Cambria Disadvantaged Unincorporated Community Area #1 Boundary Map ...................... 19
Figure 4: Actual Revenues vs. Actual Expenditures (FY 2018-19 to FY 2022-23) ................................... 27
Figure 5: Operating Ratio (FY 2018-19 to FY 2022-23) ........................................................................... 27
Figure 6 Liquidity Ratio (FY 2018-19 to FY 2022-23) .............................................................................. 31
List of Tables
Table 1: District Profile ........................................................................................................................... 12
Table 2: CCHD Board of Directors ........................................................................................................... 14
Table 3: Population Projections .............................................................................................................. 16
Table 4: Summary of Service Calls .......................................................................................................... 22
Table 5: Audited Assets and Deferred Outflow ...................................................................................... 29
Table 6: Audited Liabilities and Deferred Inflow .................................................................................... 30
Table 7: Audited Net Position ................................................................................................................. 32
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ABOUT LAFCO
Authority and Objectives
Local Agency Formation Commissions (LAFCOs) were established in 1963 and are considered regional
subdivisions of the State of California responsible for providing regional growth management services
in all 58 counties. LAFCOs’ authority is currently codified under the Cortese-Knox-Hertzberg Local
Government Reorganization Act of 2000 (CKH) with principal oversight provided by the Assembly
Committee on Local Government. LAFCOs are comprised of locally elected and appointed officials with
regulatory and planning powers delegated by the Legislature to coordinate and oversee the
establishment, expansion, and organization of cities, towns, and special districts as well as their
municipal service areas.
Regulatory Responsibilities
LAFCOs’ principal regulatory responsibility involves approving or disapproving all jurisdictional changes
involving the establishment, expansion, and reorganization of cities, towns, and most special districts
in California. CKH defines “special district” to mean any agency of the State formed pursuant to general
law or special act for the local performance of governmental or proprietary functions within limited
boundaries. All special districts in California are subject to LAFCO oversight with the following
exceptions: school districts; community college districts; assessment districts; improvement districts;
community facilities districts; and air pollution control districts. LAFCOs are also tasked with overseeing
the approval process for cities, towns, and special districts to provide new or extended services beyond
their jurisdictional boundaries by contracts or agreements or annexation. LAFCOs also oversee special
district actions to either activate new service functions and service classes or divest existing services.
LAFCOs generally exercise their regulatory authority in response to applications submitted by affected
agencies, landowners, or registered voters. Recent amendments to CKH also authorize and encourage
LAFCOs to initiate jurisdictional changes to form, consolidate, and dissolve special districts consistent
with community needs.
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Planning Responsibilities
LAFCOs inform their regulatory actions, in part, through two central planning responsibilities: (a)
making sphere of influence determinations and (b) preparing municipal service reviews. With these
and other relevant information in the record, LAFCO makes decisions on a variety of matters, including
but not limited to annexations to cities and special districts, city incorporations, activation of powers
for special districts, dissolutions of special districts, etc.
Sphere of Influence (SOI)
A SOI is defined by G.C. 56425 as “…a plan for the probable physical boundary and service area of a
local agency or municipality…”. A SOI is generally considered a 20-year, long-range planning tool.
LAFCOs establish, amend, and update spheres for all applicable jurisdictions in California every five
years, or as necessary. When updating the SOI, LAFCOs are required to consider and prepare a written
statement of its determinations with respect to each of the following 5 factors:
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.
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, that
occurs pursuant to subdivision (g) on or after July 1, 2012, the present and probable need for
those public facilities and services of any disadvantaged unincorporated communities within
the existing sphere of influence.
SOI determinations have been a core planning function of LAFCOs since 1971. The intent in preparing
the written statements is to orient LAFCOs in addressing the core principles underlying the sensible
development of local agencies consistent with the anticipated needs of the affected communities.
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Municipal Service Reviews (MSR)
MSRs in contrast, are intended to inform, among other activities, SOI determinations. LAFCOs also
prepare MSRs regardless of making any specific sphere determinations in order to obtain and furnish
information to contribute to the overall orderly development of local communities. When updating a
MSR, LAFCOs are required to consider and prepare written statements of its determinations with
respect to each of the following 7 factors:
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.
7) Any other matter related to effective or efficient service delivery, as required by commission
policy.
LAFCO Decision-Making
LAFCO decisions are legislative in nature and therefore are not subject to an outside appeal process;
only courts can overturn LAFCO decisions. LAFCOs also have broad powers with respect to conditioning
regulatory and planning approvals so long as not establishing any terms that directly affects land use
density or intensity, property development, or subdivision requirements.
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LAFCOs are generally governed by a board comprising of county supervisors, city council members,
independent special district members, representatives of the general public, and an alternate member
for each category. SLO LAFCO is governed by a 7-member board comprising of two county supervisors,
two city council members, two independent special district members, one representative of the
general public, and an alternate member for each category. All members serve four-year terms and
must exercise their independent judgment on behalf of the interests of residents, landowners, and the
public as a whole. LAFCO members are subject to standard disclosure requirements and must file
annual statements of economic interests. LAFCOs are independent of local government with their own
staff. All LAFCOs, nevertheless, must appoint their own Executive Officers to manage agency activities
and provide written recommendations on all regulatory and planning actions before the Commission.
In addition, all LAFCOs must also appoint their own legal counsel.
SLO LAFCO
Regular Commissioners
Chair Marshall Ochylski Special District Member
Vice Chair Steve Gregory City Member
Jimmy Paulding County Member
Debbie Arnold County Member
Robert Enns Special District Member
Ed Waage City Member
Heather Jensen Public Member
Alternate Commissioners
Carla Wixom City Member
Dawn Ortiz-Legg County Member
Ed Eby Special District Member
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David Watson Public Member
Staff
Rob Fitzroy Executive Officer
Imelda Marquez-Vawter Analyst
Morgan Bing Clerk Analyst
Brian Pierik Legal Counsel
Contact Information
San Luis Obispo LAFCO’s office is located at 1042 Pacific St Suite A in the City of San Luis Obispo. The
LAFCO office is open by appointment to discuss proposals or other matters and can be scheduled by
calling 805-781-5795. Additional information is also available online by visiting slo.lafco.ca.gov.
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DISTRICT MSR & SPHERE STUDY
Overview
Hospital districts in California began forming in the mid-1940’s in order to fund the construction and
operation of hospital facilities in rural and urbanizing areas during a period of rapid population growth
and comparatively undeveloped capital markets that now provide private financing for healthcare
facilities of all types. The use of the property tax for this purpose required an organization with a
boundary and service area – a special district.
This report represents San Luis Obispo LAFCO’s scheduled municipal service review for the Cambria
Community Healthcare District (CCHCD or District) which provides Advanced Life Support ambulance
service and community health education, located in the northwestern coastal region of San Luis Obispo
County and serves the communities of Cambria, San Simeon, and the surrounding North Coast of San
Luis Obispo County. CCHD also provides ambulance services outside of its boundaries as allowed under
the CA Health and Safety Code Section 32121 (l). The areas receiving service outside of CCHD’s service
area boundary, pursuant to Health and Safety Code Section 32121 (l), are the Coastal Zone in Monterey
County which is the southern portions of the County bordering SLO County and at times numerous
areas within SLO County through the San Luis Ambulance move up and cover system as it is discussed
further later in the report.
The report has been prepared by staff consistent with the requirements of the CKH Act. The purpose
of this report is to produce an independent assessment of municipal services in this area over the next
five years or as necessary, relative to the Commission’s regional growth management duties and
responsibilities as established by the State Legislature. This includes evaluating the current and future
relationship between the availability, demand, and adequacy of municipal services within the service
areas of the CCHD subject to the Commission’s oversight. The information generated as part of the
report will be used by the Commission in (a) guiding subsequent sphere of influence updates, (b)
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informing future boundary changes, and – if merited – (c) initiating government reorganizations, such
as special district formations, consolidations, and/or dissolutions.
The period for collecting data to inform the Commission’s analysis and related projections on
population growth and service demands has been set to cover any major updates and changes since
the last time the MSR was updated in 2014. The financial analysis has been set to cover the last five-
year audited fiscal year period. The timeframe for the report has been generally oriented to cover the
next five to seven-year period with the former (ten years) serving as the analysis anchor as
contemplated under State law.
The document outline serves to inform all the state-mandated requirements outlined in government
code sections 56430 and 56425. Written determinations have been included as the concluding chapter
of this document.
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At A Glance
Table 1: District Profile1
Agency Name Cambria Community Healthcare District
Formation 1947
Legal Authority California Health and Safety Code §32000-32003
Office Location 2535 Main Street Cambria, CA 93428
Website www.cambria-healthcare.org
Administrator2 Linda Hendy
Employees 15 Full-time Employees, 15 Reserve/Contracted employees
Public Meetings The Cambria Community Healthcare District (CCHD) Board of Directors
holds its regular meetings on the fourth Tuesday of the month at 9:00
a.m. Special meetings may be scheduled on an as-needed basis.
Board of Directors Five members elected to four-year terms
Powers The District operates an Advanced Life Support ambulance service and
provides community health education.
District Service Area Approx. 310 square miles not including the 500 square miles within
Monterey County
Population Estimate 6,5203 residents and over 1 million annual visitors
Revenues $2,359,8074
1 As of submission of MSR-SOI Request for Information Questionnaire, December 2023
2 Health and Safety Code Sections 32121 – 32140 outlines a Healthcare District’s Powers, wherein the district is allowed to
enter into a written employment agreement with a hospital administrator or employ any officers and employees the board
of directors deems necessary to carry on properly the business of the district.
3 Cambria CDP 2020 US Census Data, San Simeon CDP 2020 US Census Data and San Luis Obispo Council of Governments
2050 Regional Growth Forecast (Figure 118)
4 Cambria Community Healthcare District Audited Financial Statements June 30, 2023
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Boundary Map
Figure 1: CCHD Boundary Map
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Sphere of Influence
Existing & Proposed SOI
In 1984 LAFCO adopted a Sphere of Influence for the CCHD that was coterminous with the District
service boundary. In 2007 and 2014 LAFCO reaffirmed the coterminous SOI for the District. CCHD’s
existing SOI remains coterminous to the District’s service area boundary. The CCHD does not wish to
make any SOI adjustments at this time; therefore, no areas specifically requested by the District are
being studied for possible inclusion into the District.
Accountability
CCHD is an independent special district governed by a five-member Board of Directors who are elected
to four-year terms. In 2022, the CCHD moved from at-large to by-district elections to eliminate the risk
of any potential litigation against the District. Directors do not receive per diem or compensation for
attending board meetings or board committee meetings. The Board holds regular meetings on the
fourth Tuesday of the month at 9:00 AM at Old Cambria Grammar School, 1350 Main Street Cambria,
CA 93428. Currently, the board room is open to the public who wish to attend meetings in person;
however, meetings are also available by teleconference. Agendas and board packets are officially
posted on the CCHD website and bulletin boards at the meeting location and are made available a
minimum of 72 hours prior to the meeting in accordance with the Brown Act. Every agenda for a regular
meeting provides an opportunity for members of the public to directly address the Board.
Table 2: CCHD Board of Directors
Board Member Title Term Expiration
Cecilia Montalvo President December 2024
Laurie Mileur Vice President December 2026
Dawn Kulesa Board Member December 2026
Bruce Mumper Board Member December 2024
Igor Fedoroff Board Member December 2024
CCHD has several sub-committees that help shape the District’s needs and guide District operations.
There are a total of 8 sub-committees (Executive Committee (Ad Hoc); Finance Committee; Property
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and Facility Committee (Standing); Development Committee (Standing); Healthcare Advocacy and
Outreach Committee (Standing); Strategic Planning Committee (Ad Hoc); Facility Project Committee
(Ad Hoc); and Trust Committee (Ad Hoc)). The CCHD website posts each committee’s purpose and the
members involved.
CCHD currently employs 15 full-time and 15 reserve or contracted employees including the
Administrator/Finance, Director of Operations and Supervisor of Paramedics. Current staffing levels
are considered adequate to provide services within the District’s service area. CCHD recently
implemented new supervisor positions to provide 24/7 coverage and additional cross-training.
CCHD maintains an up-to-date website in compliance with Senate Bill 929 which contains contact
information for the District, the current agenda, financial transaction reports, compensation reports,
and an SB 272 Enterprise System catalog. Audio/visual recordings are also made available for public
access on the website. CCHD reports that all Form 700 financial disclosures are current. The District
maintains active memberships with several supportive associations including the California Special
Districts Association and Special District Risk Management Authority.
Population Profile
CCHD is located in the north coast area of the County which includes the following communities and
areas: 1)Cambria, 2)Harmony, 3)San Simeon, and 4)Rural areas on the North Coast up to the Monterey
County line. CCHD predominantly follows the North Coast Planning Area boundary although the
District’s boundaries do not overlap exactly and some areas on the eastern side extend beyond the
planning area discussed. While there are no specific population growth forecasts for CCHD boundaries
due to data limitations, Table 3 shows projections for the North Coast Planning Area boundary. During
the summer months, the population increases dramatically with the influx of tourists to the area.
Tourist population numbers are not shown in the table below but are estimated at over 1 million5
annual visitors.
5 As of submission of MSR-SOI Request for Information Questionnaire, December 2023
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Table 3: Population Projections6
Population Forecast 2010 2020 2050 Growth Rate
Forecasted population served by CCHD and within the North Coast Area Plan Boundary
Cambria 6,025 5,678 6,217 3.2%
San Simeon 450 445 463 2.9%
Rural Areas 385 397 415 7.8%
Total 6,860 6,520 7,095 3.4%
Disadvantaged Unincorporated Communities
In 2011, SB 244 (Chapter 513, Statutes of 2011) made changes to the CKH Act related to Disadvantaged
Unincorporated Communities (DUCs), including the addition of SOI determination number five, which
states:
“(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, that occurs pursuant to subdivision (g) on or after July 1, 2012, the present and
probable need for those public facilities and services of any disadvantaged unincorporated
communities within the existing sphere of influence.”
DUCs are defined in government code section 56033.5 as inhabited territories (containing 12 or more
registered voters) where the annual median household income (MHI) is less than 80 percent of the
statewide annual median household income. LAFCOs are required to make written determinations
regarding DUCs within a city or special district’s SOI in Municipal Services Reviews. In addition,
Government Code Section 56375 (a)(8)(A) prohibits LAFCO from approving a city annexation of more
than 10 acres if a DUC is contiguous to the annexation territory but not included in the proposal unless
an application to annex the DUC has been filed with LAFCO. The legislative intent is to prohibit selective
6 Cambria CDP 2020 US Census Data, San Simeon CDP 2020 US Census Data and San Luis Obispo Council of Governments
2050 Regional Growth Forecast (Figure 118)
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annexations by cities of tax-generating land uses while leaving out under-served, inhabited areas with
infrastructure deficiencies and lack of access to reliable potable water and wastewater services.
As previously mentioned, one of the qualifications for a DUC is a community with an annual MHI that
is less than 80 percent of the statewide annual MHI. California’s MHI is $84,097; therefore, the
threshold for a DUC (80% of the state’s MHI) is an MHI less than $67,277. To identify the MHI for
locations within the unincorporated areas of SLO County, and to identify those that meet the DUC MHI
threshold, LAFCO used U.S. Census American Community Survey (ACS) five-year reports for Census
Block Groups and Census Designated Places data. Once a Census Block Group (CBG)7 or a Census
Designated Place (CDP)8 meets the DUC MHI threshold, LAFCO must then verify that those areas are
inhabited as specified in government code section 56033.5. For the purpose of identifying whether a
location is inhabited, LAFCO staff used Registered Voter data from the SLO County Clerk-Recorder to
verify that any CBG and CDP area that was flagged is also inhabited (containing 12 or more registered
voters).
Two communities within CCHD’s boundaries meet this definition: the unincorporated communities of
San Simeon and a portion of the community of Cambria. LAFCO identified the DUCs at the Census Block
Group level, as seen in Figure 2 on the following page. The first is San Simeon DUC Area #1 with an
estimated MHI of $50,486 and approximately 200 registered voters. The second is Cambria DUC Area
#1 with an estimated MHI of $51,875 and approximately 529 registered voters. It should be noted that
the identified DUCs include some open space, recreation, public facilities, and agriculture-zoned areas
with no registered voters, and determinations made are for the inhabited areas only, per State law.
7 Block groups are a group of blocks within a census tract with populations of 600 to 3,000 people.
8 CDPs are a statistical geography representing closely settled, unincorporated communities that are locally recognized
and identified by name.
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Figure 2: San Simeon Disadvantaged Unincorporated Community Area #1 Boundary Map
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Figure 3: Cambria Disadvantaged Unincorporated Community Area #1 Boundary Map
Social or Economic Communities of Interest in the Area
There are no District relevant social or economic communities of interest in the proposed SOI area.
Present and Planned Land Use
The CCHD’s service area consists primarily of rural, unincorporated territory, and is generally located
within the unincorporated North Coast Area Plan including Cambria, San Simeon, and surrounding rural
areas. Although the CCHD and North Coast Area Plan boundaries do not exactly align, some areas on
the eastern side of the CCHD boundary are within the North County Planning Area. Land uses within
the unincorporated territory are governed by the County of San Luis Obispo General Plan land use
designations and zoning.
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Services & Capacity
Authorized Services
California Health & Safety Code Section 32121, identifies a range of services that a Healthcare District
may provide. A complete listing of the powers afforded to Healthcare Districts is located in Health and
Safety Code Sections 32121 – 32137. Some Healthcare Districts in California operate hospitals and
community-based medical clinics; others focus on wellness and prevention programs. Authorized
healthcare services granted to Healthcare Districts under current law include, but are not limited to:
• Operating healthcare facilities such as hospitals, clinics, skilled nursing facilities, adult day
health centers, nurses’ training schools, and child care facilities.
• Operating ambulance services within and outside of the district.
• Operating programs that provide chemical dependency services, health education, wellness
and prevention, rehabilitation, and aftercare.
• Carrying out activities through corporations, joint ventures, or partnerships.
• Establishing or participating in managed care.
• Contracting with and making grants to provider groups and clinics in the community.
• Other activities that are necessary for the maintenance of good physical and mental health in
communities served by the district.
Healthcare Districts have generally evolved to meet the changing healthcare market demands.
Divestitures of local Healthcare District facilities and services have raised significant governance
questions by public and private groups as to the necessity of retaining the public Healthcare District
model supported by local property tax revenues in such a competitive, for-profit market environment.
The MSR and Sphere of Influence Study provides discussions on present and long-term service
demands and resource capabilities of the local agency. LAFCO reviews and evaluates 1) the resources
and services that are currently available, and 2) the ability of the CCHD to expand such resources and
services in line with increasing demands. An adequate ability to provide service should be documented
to support areas in the sphere envisioned for eventual annexation and service by a jurisdiction. If
warranted, different governance options may be reviewed for the local Healthcare District, including
potential jurisdictional changes such as consolidation, reorganization, and dissolution. As was
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previously mentioned, CCHD does not wish to make any SOI adjustments at this time; therefore, no
areas are being studied for possible inclusion into the District.
CCHD provides emergency 911 ambulance transportation for the community of Cambria, San Simeon,
and the surrounding area of the North Coast of San Luis Obispo County. CCHD also provides ambulance
services outside of its boundaries as allowed under the CA Health and Safety Code Section 32121 (l).
CCHD provides services north of the San Luis Obispo County line in the southern portions of the
Monterey County coastal zone; which includes a coastal area extending up to the community of Pacific
Valley. Service is provided in Monterey County through an American Medical Response (AMR) contract
with the County of Monterey and the CCHD is a subcontractor. As stated in the AMR contract, services
are provided in and around the "South Valley Zone". The boundaries of the South Valley Zone are
defined as HWY l north from the San Luis Obispo and Monterey County line to Plaskett Ridge Road
intersection, or further north on HWY 1 in cases of road closure due to landslides or other causes if
available. The contract was initiated on January 30, 2010, and is reviewed and updated when a fee
increase is initiated by the District; the last increase was approved on May 1, 2023. CCHD also
participates in a county-wide move-up and cover system for San Luis Ambulance, which means that
when other ambulance response zones are busy, CCHD ambulance crews may be called to help cover
their area. San Luis Obispo Emergency Medical Services Agency (EMSA) move-up and cover system
calls were reported at a total of 729 calls in 2023 and 747 calls in 2022, please note that these numbers
are not included in Table 4.
The CCHD operates an Advanced Life Support (ALS) ambulance service and provides community health
education. The District does not currently, nor has it at any time in the past, operated a hospital facility.
In 2023, the District responded to 1,069 911 calls for service, for an average of 89 calls per month. The
District is capable of providing emergency response on most incidents encountered within the CCHD.
Additional apparatus, equipment, and staffing are available through Automatic or Mutual Aid
agreements with SLO County EMSA (which in part includes County Fire/Cal Fire, San Luis Ambulance,
and Cambria Community Services District Fire Department). This coverage allows an average 10-minute
emergency response time by CCHD to any location within the District service area and ensures that the
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needs of area residents are addressed most efficiently. Cambria Community Services District Fire
Department and CCHD work collaboratively as parties to the EMSA Mutual Aid Agreement and as
agencies whose service areas overlap with one another. Cambria Community Services District Fire
Department’s EMSA response requirements differ from the healthcare district’s requirements,
therefore resulting in a lower response time of 5-minutes. CCHD Board reviews monthly Operations
Reports with a goal of providing response to 100% of calls. CCHD currently reports an average response
of 93% to 100%. Table 4 below summarizes CCHD’s 911 calls within the last two years.
Table 4: Summary of Service Calls9
Description 2022 2023
Total number of responses 1161 1069
Number of emergency responses 1114 1043
Number of non-emergency responses 47 26
Total number of transports 673 609
Number of emergency transports 88 81
Number of non-emergency transports 585 533
Total of responses outside jurisdictional boundaries10 37 15
Staffing & Personnel
CCHD employs a highly trained team of Emergency Medical Technicians (EMT)/Paramedics and staff
dedicated to providing the highest level of pre-hospital care. The District consists of 1 Administrator, 1
Office Manager, 6 Full-Time Paramedics, 6 Full-Time EMT’s, 8 Paramedics Reserve, and 7 EMT’s
Reserve. CCHD recently implemented three new supervisor positions to provide 24-7 coverage and
cross-training. The District indicated that existing staffing levels are adequate to provide service to its
service area.
Service Delivery & Performance
9 Five Year Emergency Medical Service Plan, May 2023 and CCHD Staff, Feb 2024
10 Responses within Monterey County
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The CCHD offers 24-hour emergency medical services, ambulance transport, and community health
education. CCHD has a total of four ambulances. Two ambulance units are available 24/7, each staffed
with one Paramedic and one EMT. The other two ambulance units are stationed as a backup unit,
placed into service when a unit is out of service for repairs or used for additional EMS coverage. The
District participates in a county-wide cover system, which means that when other ambulance response
zones are busy, the District ambulance crew may be called to help cover the area within San Luis Obispo
County. The District also maintains a contract to provide services in the south coastal zone of Monterey
County.
Capital Facilities & Equipment
The CCHD facilities include two larger buildings and several small, relatively temporary outbuildings.
The main building contains the CCHD administrative offices and crew quarters. The other larger
building (the ambulance building) is no longer in use, has been red-tagged by the County, and is
intended to be demolished. According to the CCHD Facility Condition Assessment that was done in
January 2022, it was determined that the main facility is in very poor condition, primarily related to its
age. Most building systems are either original or well beyond their normal useful life expectancy. The
District identified the need to replace the current facility that houses their crews, administration staff,
and fleet of ambulances. CCHD placed a Bond Measure G-22 on the November 2022 ballot which would
have funded the replacement of the facility. The Measure did not receive the required 2/3 voter
majority approval and as a result, the District is currently seeking other funding sources in order to
move forward with temporary repairs or replacement of the current facility. A plan to rebuild the
facility has been developed and the CCHD is seeking state and federal grant funding and bond financing
to replace the aging facility. In March 2024 CCHD was awarded a one-million-dollar Community Project
Funding Grant for a new ambulance station. Federal support was secured through the FY2024
appropriations process sponsored by Congressman Jimmy Panetta. Anticipated completion of the new
facility is reliant upon a bond measure passing, which is scheduled to be placed on the November 2024
ballot. CCHD utilizes (1) 2019 Demers Ford Ambulance, (1) 2016 Chevrolet Ambulance, (1) 2005 Ford
F350 Ambulance Type I, (1) 2023 Ford E350 Ambulance CCL 150 Type III, and associated medical
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equipment and communications systems (radios). The District indicated that existing vehicles and
medical /communications equipment are adequate.
Shared Services and Facilities
There are opportunities for continued shared relationships between agencies for services within the
CCHD boundary. At present, the distinction between the CCHD and neighboring agencies in the area is
clear. Opportunities for coordination may include:
• Continued coordination between CCHD and San Luis Obispo County EMSA
• Continued coordination between CCHD and Cambria Community Service District Fire Dept
• Continued coordination between CCHD and Monterey County
• Continued coordination between CCHD and San Luis Ambulance
Finance
LAFCO is required to make a determination regarding the financial ability of the CCHD to provide public
services. This section provides a general overview of financial health and provides a context for the
financial determinations. LAFCO uses three financial indicators to help evaluate the District’s general
health; those are an assessment of Revenues & Expenditures (Operating Ratio), Assets and Liabilities
(Liquidity Ratio), and Net Position. The audited Financial Statement Reports from the District for the
fiscal years (FY) 2018-2019 through FY 2022-2023 are the primary source of information for this section.
Budget and Financial Statements
CCHD is a public, tax and fee supported special district. An annual budget is prepared prior to the
beginning of each fiscal year, which includes estimates for the District's principal income sources to be
received during the fiscal year, as well as estimated expenses and cash reserves needed for operations.
The District maintains a financial reserve that equates to 5% of its general fund. The District posts its
current budget on its website. CCHD staff conduct monthly financial statements that provide their
board with frequent reporting on their financial performance; these documents are also available on
the District’s website.
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Audited Financial Statements
CCHD hires an outside accounting firm to perform an annual audit in accordance with established
governmental accounting standards. This includes auditing CCHD’s financial statements with respect
to verifying overall assets, liabilities, and net position. These audited statements provide quantitative
measurements in assessing CCHD’s short and long-term fiscal health with a specific focus on delivering
its active service functions. LAFCO used the five most recent audited financial statements to conduct
its evaluation of the District’s Financial Health; separated into four categories (Revenues and
Expenditures, Agency Assets, Agency Liabilities, and Agency Net Position).
Revenues and Expenditures
One way to measure the District’s financial health is by comparing its revenues against its expenses.
CCHD revenues are primarily comprised of general and special tax, insurance and patient billings,
federal grants, community grants, and receipts from a Charitable Trust that help fund budgeted
expenditures. In December 2022, the District approved a 2023 Ambulance Service Rate Schedule Fee
Increase to cover the District’s reasonable cost for services. Annual increases to the Special Tax
Assessment are based on each parcel. The County of San Luis Obispo determines the general tax rate
increases using a CPI that averages 3% per year for the District’s Assessment charges. CCHD expenses
are primarily comprised of payroll, operational costs associated with the ambulance service activities,
and also include management, administrative, and depreciation expenses. While revenue is sufficient
to cover operation costs, the District must seek outside funding for facility repairs and fleet
replacements.
CCHD’s revenue during the latest audited FY 2022-2023 was $2.359 million. CCHD is primarily funded
through property tax/assessment and charges for services. CCHD’s expense during the last audited FY
2022-2023 was $2.173 million.
When analyzing the previous five-year audited period, it was found that expenses exceeded their
revenues between FY 2018-2019 through FY 2020-2021. In 2018, a newly elected Board of Directors
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began cost-saving efforts to reduce expenses by fully implementing a strategic deployment plan to
maximize the potential for emergency response based on the highest probability for 911 requests for
service, and at the same time, reduce unnecessary payroll expenses. Medical billing for ambulance
transports was brought in-house, legal fees were reduced, and the 24-hour unit was reinstated
resulting in additional billable transports increasing revenue and reducing overtime by full-time staff.
During the fiscal year ending on June 30, 2021, the District continued to recognize their recorded
operating expenses in excess of operating revenues, property tax, and special assessment revenues
which resulted in a net deficit for the year, similar to the previous years. Throughout the 2021 year,
the CCHD Board took corrective action to address prior year auditor findings, as a result operating
expenses such as professional services and contract accounting services increased along with the
reconciliation of bad debt expense for the fiscal year ending on June 30, 2021. In 2022, the District
proceeded with a reorganization of the management structure for operations and as a result, promoted
the Director of Operations to the Administrator position and hired a Director of Finance. The new hire
of the Director of Finance has provided a full-time accounting professional in-house employee to
regularly reconcile all accounts and decrease the need for outside contractor services which will
continue to generate cost savings for the District. The 2018 strategic deployment plan effort to, in part,
reduce payroll expenses was realized in 2022 and the District continues to experience positive cash
flow. Consequently, in FY 2021-2022 and FY 2022-2023, the District’s revenues exceeded expenditures,
as depicted in Figure 4.
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Figure 4: Actual Revenues vs. Actual Expenditures (FY 2018-19 to FY 2022-23)11
$2,500,000 $2,338,547 $2,359,807
$2,000,000 $1,842,821 $1,895,721
$1,732,339
$1,500,000
$1,000,000 $1,967,748 $2,117,392 $2,174,352 $2,095,854 $2,173,689
$500,000
$0
FY 18-19 FY 19-20 FY 20-21 FY 21-22 FY 22-23
Total Revenues Total Expenditures
Figure 5 shows CCHD’s operating ratio which measures the ratio of annual operating revenues to
annual operating expenses. A ratio of 1.0 means the agency is breaking even, a ratio of less than 1.0
indicates insufficient operating revenue to cover operating expenses, and a ratio greater than 1.0
means an agency can pay all its operating expenses and has revenue left over to spend on other items.
Figure 5: Operating Ratio (FY 2018-19 to FY 2022-23)
Operating Ratio
FY 22-23 1.09
FY 21-22 1.12
FY 20-21 0.87
FY 19-20 0.82
FY 18-19 0.94
0.00 0.20 0.40 0.60 0.80 1.00 1.20
11 CCHD Financial Statements between FY 2018-19 to FY 2022-23
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Agency Assets
An agency’s assets provide current, future, or potential economic benefit for the entity. An agency
asset is therefore something that is owned by the agency or something that is owed to the agency. In
this section agency assets will be reviewed in two separate categories as defined below:
1) Current Assets: cash and other assets that are expected to be converted to cash within a year.
2) Non-Current Assets: long-term investments that are not expected to become cash within an
accounting year.
CCHD’s audited assets at the end of FY 2022-2023 totaled $1.133 million and are 26% higher than the
average year-end amount of $0.897 million documented during the previous five-year audited period.
Assets classified as current, with the expectation they could be liquidated within a year, represented
60% of the total amount, or $0.680 million, and are primarily tied to cash and investments. Assets
classified as non-current make up the remainder of the total, $0.452 million, and are primarily
attributed to property, plant, and equipment capital. Overall, all assets for CCHD have increased by
45% over the corresponding 5-year audited period.
In addition to assets, the District’s net position also considers deferred outflows of resources. A
deferred outflow of resources is defined as a consumption of net position by the government that is
applicable to a future reporting period. The District has two items that qualify for reporting in this
category; those are 1) Deferred Pensions and 2) Deferred Other Post-employment Benefits (OPEB). A
total of $1.685 million was reported in FY 2022-2023 as deferred outflows of resources and will be
recognized as a reduction of the net pension liability in a future reporting period.
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Table 5: Audited Assets and Deferred Outflow
5-yr % 5-yr
Category FY 18-19 FY 19-20 FY 20-21 FY 21-22 FY 22-23
Change Average
Current Assets 604,050 569,012 505,740 675,901 680,892 13% 607,119
Non-Current Assets 177,646 226,996 327,072 268,270 452,958 155% 290,588
Total Assets 781,696 796,008 832,812 944,171 1,133,850 45% 897,707
Deferred Pensions 357,871 287,194 258,042 477,064 956,493 167% 467,333
Deferred OPEB 57,264 82,547 348,893 933,240 729,247 1173% 430,238
Total Deferred
Outflow of 415,135 369,741 606,935 1,410,304 1,685,740 306% 897,571
Resources
Agency Liabilities
An agency’s liability is something the agency owes, usually a sum of money. Liabilities are settled over
time through the transfer of economic benefits including money, goods, or services. In this section
agency liabilities will be reviewed in two separate categories as defined below:
1) Current Liabilities: an agency's short-term financial obligations due to be paid within a year
2) Other Non-Current Liabilities: an agency’s long-term financial obligations that are due more
than a year away
CCHD’s audited liabilities at the end of FY 2022-2023 totaled $5.738 million and were 10% higher than
the average year-end amount of $5.207 million documented during the previous five-year audited
period. Liabilities classified as current and representing obligations owed in the near term account for
2.9%, or $0.165 million, of the total. Non-current liabilities represent the remaining total, or $5.572
million, and are largely tied to payments on liabilities due after one year. Most of the non-current
liabilities are composed of net pension liabilities, at $2,094,778, and OPEB liabilities, at $3,218,908,
during FY 2022-2023. Relating to pension liabilities, as of June 30, 2023, the District had no amount
outstanding for contributions to the pension plan required for the fiscal year ended June 30, 2023.
Relating to OPEB liabilities, the District currently finances benefits on a pay-as-you-go basis and does
not have any assets in a trust. District Staff have indicated that they do not currently have an additional
plan to pay down the OPEB liabilities and will continue to contribute required contributions and look
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toward possibilities of instituting a Trust Fund in the future. CCHD also participates in loan agreements
for ambulance acquisition and agreements to lease certain equipment that have led to increased
liabilities. Overall, all liabilities have increased by 14% over the corresponding 5-year audited period.
In addition to liabilities, the District’s net position also considers deferred inflows of resources. A
deferred inflow of resources is defined as an acquisition of net position by the District that is applicable
to a future reporting period. The District has two items that qualify for reporting in this category; those
are 1) Deferred Pensions and 2) Deferred OPEB. A total of $1.556 million was reported as deferred
inflows of resources in FY 2022-2023 and will be recognized as an acquisition of the net position in a
future reporting period.
Table 6: Audited Liabilities and Deferred Inflow
5-yr % 5-yr
Category FY 18-19 FY 19-20 FY 20-21 FY 21-22 FY 22-23
Change Average
Current liabilities 55,734 70,980 98,840 117,069 165,831 198% 101,691
Non-Current
4,974,000 4,484,727 5,222,187 5,276,206 5,572,551 12% 5,105,934
Liabilities
Total Liabilities 5,029,734 4,555,707 5,321,027 5,393,275 5,738,382 14% 5,207,625
Deferred Pensions 139,979 239,935 262,876 938,596 244,726 75% 365,222
Deferred OPEB 997076 761444 683,799 1,311,559 388% 804,582
269,034
Total Deferred
Inflow of 409,013 1,237,011 1,024,320 1,622,395 1,556,285 280% 1,169,805
Resources
Figure 6 shows the District’s liquidity ratio which measures current assets against current/near-term
obligations. The liquidity ratio is another way to measure the District’s financial health. A ratio of less
than 1.0 indicates insufficient short-term resources to cover short-term liabilities and anything over 1.0
indicates good financial health (the higher the number, the greater the degree of liquidity).
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Figure 6 Liquidity Ratio (FY 2018-19 to FY 2022-23)
Liquidity Ratio
FY 22-23 4.1
FY 21-22 5.8
FY 20-21 5.1
FY 19-20 8.0
FY 18-19 10.8
0.0 2.0 4.0 6.0 8.0 10.0 12.0
Agency Net Position
The agency’s net position is the difference between an entity’s (1) assets plus deferred outflows of
resources and (2) liabilities plus deferred inflows of resources. Net position should be displayed in three
categories which focus on the accessibility of the underlying assets:
• Net investment in capital assets: consists of capital assets, net of accumulated depreciation,
and reduced by the outstanding principal of related debt
• Restricted Net Position: is the portion of net position that has external constraints placed on it
by creditors, grantors, contributors, laws, or regulations of other governments, or through
constitutional provisions or enabling legislation
• Unrestricted Net Position: consists of net position that does not meet the definition of net
investment in capital assets or restricted net position
CCHD operated with a net deficit over the last five-year audited period, ending with a deficit of $4.475
million at the end of FY 2022-2023 which represents the difference between the District’s total assets
and total liabilities along with adjusting for deferred resources (i.e., pension & OPEB outflows and
inflows). The most recent year-end deficit amount is 2% lower than the average year-end deficit of
$4.582 million documented during the previous 5-year audited period. The ending net investment in
capital assets is 4% of the net position, or $0.188 million, with the remainder categorized as
unrestricted, at $4.663 million. According to the FY 2022-2023 audit, it was determined the significant
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expenses of the District are payroll and benefit-related expenses. The primary increase in expenses and
resulting increase in the net deficit is the recognition of net pension liability and OPEB liability and
recognition of their related expenses as required by the Governmental Accounting Standards Board. It
should be noted that the District lacks capital assets, which typically helps an agency offset its liabilities
(Including OPEB and Pension Liabilities). The District pays their annual contributions to Pension and
OPEB liabilities. Overall, the net deficit for CCHD has increased by 10% through the corresponding 5-
year audited period.
Table 7: Audited Net Position
5-yr % 5-yr
Category FY 18-19 FY 19-20 FY 20-21 FY 21-22 FY 22-23
Change Average
Net
Investment in 79,518 77,411 132,476 139,679 188,226 137% 123,462
Capital Assets
Restricted 0 0 0 0 0 - -
Unrestricted -4,321,434 -4,704,380 -5,038,076 -4,800,874 -4,663,303 8% -4,705,613
Total Net
-4,241,916 -4,626,969 -4,905,600 -4,661,195 -4,475,077 10% -4,582,151
Position
Other Matters Related to Efficient Service Delivery
Government Structure Options
In 2014, the Commission adopted the last version of the CCHD SOI and MSR Study; this report included
a discussion about a proposed shared service structure between the Cambria Community Services
District (CCSD) and the CCHD. At the time, both Districts were considering a Joint Powers Agreement
(JPA) or special legislation that would allow for shared services between the two agencies. The agencies
anticipated and identified challenges they’d face in pursuing this effort; where the Health and Safety
Law allows healthcare district personnel to provide Transportation and Paramedic service and not
firefighting duties that are required of the CCSD. Additional issues that were identified in 2014, were
the need to address unity of command, shared facilities, and long-term qualification of personnel
duties for efficient services. Since 2014, no progress has been made in pursuing the effort of shared
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facilities through a JPA between CCHD and CCSD. It is LAFCO’s understanding that neither the CCHD
nor the CCSD are interested in shared services or facilities at this time.
Other governmental structure options are available to Healthcare Districts, such as jurisdictional
changes consisting of reorganizations that may involve consolidation or dissolution if warranted. Any
proposed changes of organization or reorganization for a Healthcare District may be initiated by
petition of local voters or landowners within the proposal area; a resolution of subject/affected
agencies; or by LAFCO action. There are different initiation threshold requirements for the various
proposal types; as well as corresponding protest provisions following LAFCO approval, with specified
minimum protest thresholds to require subsequent voter approval or termination of the proposal with
a sufficient majority protest. A key issue to be determined when considering any potential
governmental structure option for Healthcare Districts involves the identification of a successor agency
that is authorized, capable, and willing to sustain the provision and level of healthcare services provided
by the dissolved Healthcare District. A proposed reorganization involving dissolution/annexation, or a
consolidation/merger, would transfer the extinguished Healthcare District’s assets and facilities to the
successor agency, along with responsibilities for any Healthcare District bonded indebtedness. A plan
for service is also required to be submitted to LAFCO by the annexing agency/successor agency with
these types of jurisdictional changes. Neither LAFCO nor CCHD see the need to pursue a jurisdictional
change. The current coterminous sphere of influence for CCHD should be reaffirmed.
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DETERMINATIONS
Service Review Determinations per Government Code Section 56430
As set forth in Section 56430(a) of the CKH Act—In order to prepare and update the SOI 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 a service review the county, the region, the sub-region, 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
a. While there are no specific population growth forecasts for the CCHD boundaries due
to data limitations, projections for the North Coast Planning Area boundary provide an
approximation; this encompasses most of the CCHD service area. The estimated
population served by the CCHD and within the North Coast Area Plan was 6,520 in 2020
and over 1 million annual visitors according to CCHD. With an estimated build-out
population of 7,095 by 2050, the North Coast Area Plan region is currently
approximately 92% built out.
2. The location and characteristics of any disadvantaged unincorporated communities within or
contiguous to the sphere of influence
a. LAFCO staff have identified two DUCs within CCHD’s SOI and service area boundary. The
locations identified as DUCs display characteristics of a DUC pursuant to the CKH Act.
b. The threshold for a DUC (80% of CA’s MHI) is an MHI less than $67,277. Once a Census
Block Group (CBG) or a Census Designated Place (CDP), meets the DUC MHI threshold,
LAFCO then verifies that those areas are inhabited as specified in government code
section 56033.5. Two CBGs within the CCHD boundary met the threshold for a DUC. The
first is San Simeon DUC Area #1 with an estimated MHI of $50,486; the area was also
determined to be inhabited with approximately 200 registered voters. The second is
Cambria DUC Area #1 with an estimated MHI of $51,875; the area was also determined
to be inhabited with approximately 529 registered voters. Therefore LAFCO, identified
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these two DUCs at the Census Block Group level, within the CCHD boundaries as seen in
Figures 2 and 3 within the “Population Profile” Section of this report.
3. Present and planned capacity of public facilities and adequacy of public services, including
infrastructure needs or deficiencies
a. CCHD is authorized to provide a range of services as described in the California Health
& Safety Code Section 32121 - 32137. However, the District only provides Advanced Life
Support ambulance (ALS) service and community health education services. In 2023, the
District responded to 1,069 911 calls for service, for an average of 89 calls per month.
The District is capable of providing emergency response on most incidents encountered
within the CCHD. Additional apparatus, equipment, and staffing are available through
Automatic or Mutual Aid agreements with SLO County Emergency Medical Services
Authority (EMSA) which in part includes Cal Fire/County Fire, and the Cambria
Community Services District Fire Department. This coverage allows for an average 10-
minute emergency response time by CCHD to any location within the District’s service
area. CCHD Board reviews monthly Operations Reports with a goal of providing response
to 100% of calls. CCHD currently reports an average response of 93% to 100%. CCHD
indicated that existing staffing levels are adequate to provide service to its service area.
According to the CCHD Facility Condition Assessment, it was determined that the main
facility is in very poor condition, primarily related to its age. The District identified the
need to replace the current facility that houses their crews, administration staff, and
fleet of ambulances. A plan to rebuild the facility has been developed and the District is
seeking state and federal grant funding and bond financing to replace the aging facility.
In March 2024 the CCHD was awarded one-million-dollars in grant funding for the new
facility. Anticipated completion is reliant upon a bond measure passing, which is
scheduled to be placed on the November 2024 ballot. LAFCO determines that CCHD has
capability and capacity to provide services where service is provided in the best manner
possible within available funding.
4. Financial ability of agencies to provide services
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a. District revenues and expenditures are considered to assess the overall health of the
District. The District’s overall revenues and expenditures have fluctuated over the last
five-year audited period. CCHD’s expenses exceeded their revenues between FY 2018-
2019 through FY 2020-2021 and in FY 2021-2022 and FY 2022-2023 revenues exceeded
expenditures; ending with a revenue of $2.359 million and expenditures of $2.173 in FY
2022-2023. As a result, the District’s operating ratio12 was 1.09 in FY 2022-2023.
b. LAFCO also considers District assets and liabilities to help determine the District’s health.
CCHD’s assets have increased by 45% over the last 5-year audited period ending with
$1.133 million in FY 2022-2023. CCHD’s liabilities have increased by 14% over the last 5-
year audited period ending with $5.738 million in FY 2022-2023. As a result, the CCHD’s
liquidity ratio13 was 4.1 in FY 2022-2023.
c. Increases or decreases in an agency’s net position is another indicator of whether its
financial health is improving or deteriorating. In the case of CCHD, assets and deferred
outflows were exceeded by liabilities and deferred inflows over the last five-year
audited period. As a result, the District has been operating with a net deficit. CCHD’s net
deficit has increased by 10% over the last 5-year audited period ending with a deficit of
$4.475 million in FY 2022-2023. According to the FY 2022-2023 audit, it was determined
that the most significant expenses of the District are payroll and benefit-related
expenses. The primary increase in expenses and the resulting increase in the net deficit
is the recognition of net pension liability, at $2.094 million, and recognition of OPEB
liability, at $3.218 million during FY 2022-2023. However, the District pays their annual
contributions to Pension and OPEB liabilities to the State. District Staff have indicated
that they will continue to contribute the required contributions and look toward
possibilities of instituting a Trust Fund in the future to help lower the District’s Liabilities.
12 The operating ratio measures the ratio of annual operating revenues to annual operating expenses. A ratio greater than
1.0 means an agency is able to pay all its operating expenses and has revenue left over to spend on other items. A ratio of
less than 1.0 indicates insufficient operating revenue to cover operating expenses.
13 The liquidity ratio indicates the necessary cash the agency has (current assets) to fund its current liabilities; the higher
the number, the greater the degree of liquidity. A ratio of less than 1.0 indicates insufficient short-term resources to cover
short-term liabilities.
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d. LAFCO determines that out of the three financial indicators used to determine the
District’s health, CCHD scored well on two of the three. CCHD’s operating ratio and
liquidity ratio exceeded the minimum of 1.0 for the latest FY 2022-2023. Regarding the
District’s net position, the CCHD operated with a net deficit over the last five-year
audited period; primarily related to pension liability and OPEB liability. However, as
noted, the District pays their annual contributions to Pension and OPEB liabilities to the
State. The District is encouraged to continue its efforts towards pursuing a plan to offset
the District’s liabilities such as a Trust Fund.
5. Status of and, opportunities for, shared facilities
a. At present, the distinction between the CCHD and neighboring agency services in the
area is clear.
b. Additional apparatus, equipment, and staffing are available to CCHD through Automatic
or Mutual Aid agreements with SLO County Emergency Medical Services Authority
(EMSA) (which includes County Fire/Cal Fire, San Luis Ambulance, Cambria Community
Services District Fire Department, and others).
c. Opportunities and continued coordination for shared facilities may include:
i. Continued coordination between CCHD and San Luis Obispo County EMSA
ii. Continued coordination between CCHD and Cambria Community Service District
Fire Department
iii. Continued coordination between CCHD and Monterey County
iv. Continued coordination between CCHD and San Luis Ambulance
6. Accountability for community service needs, including governmental structure and
operational efficiencies
a. CCHD is governed by a five-member Board of Directors who are elected to four-year
terms. Regularly scheduled monthly Board meetings are held on the fourth Tuesday of
the month and all meetings are open to the public and are publicly posted a minimum
of 72 hours prior to the meeting in accordance with the Brown Act.
b. CCHD maintains an up-to-date website that contains District information, documents,
and updates.
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c. CCHD has demonstrated accountability and transparency in its disclosure of information
and cooperation during the process of this MSR. The District responded to the
questionnaires and cooperated with document requests.
d. LAFCO determines that CCHD is accountable and transparent.
7. Any other matter related to effective or efficient service delivery
a. No changes are recommended at this time.
Sphere of Influence Determinations per Government Code Section 56425
In order to carry out its purposes and responsibilities for planning and shaping the logical and orderly
development of local governmental agencies to advantageously provide for the present and future
needs of the county and its communities, the commission shall develop and determine the sphere of
influence of each local agency, as defined by G.C. Section 56036, and enact policies designed to
promote the logical and orderly development of areas within the sphere. 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 the following:
1. Present and planned land uses in the area, including agricultural and open-space lands.
a. The CCHD SOI is coterminous with the District’s service area boundary.
b. The SOI is expected to remain unchanged, with no expansions or reductions.
c. Land uses within CCHD's existing boundary consist of rural, unincorporated territory,
and is generally located within the unincorporated North Coast Area Plan including
Cambria, San Simeon, and surrounding rural areas. Some areas on the eastern side of
the CCHD boundary are within the North County Planning Area.
d. Land uses within the unincorporated territory are governed by the County of San Luis
Obispo General Plan land use designations and zoning.
2. Present and probable need for public facilities and services in the area.
a. The CCHD SOI is coterminous with the District’s service area boundary.
b. The SOI is expected to remain unchanged, with no expansions or reductions.
c. There is an existing need for service within the existing SOI boundary which is
coterminous to the service area boundary.
San Luis Obispo LAFCO | Adopted 5/16/24
Cambria Community Healthcare District
39
MSR & Sphere Study
3. Present capacity of public facilities and adequacy of public services that the agency provides
or is authorized to provide.
a. The CCHD SOI is coterminous with the District’s service area boundary.
b. The SOI is expected to remain unchanged, with no expansions or reductions.
c. CCHD has capability and capacity to adequately meet existing and future service
demand within the existing SOI area which remains coterminous to the District’s service
area boundary.
4. Existence of any social or economic communities of interest in the area if the commission
determines that they are relevant to the agency.
a. The CCHD SOI is coterminous with the District’s service area boundary.
b. The SOI is expected to remain unchanged, with no expansions or reductions.
c. There are no District relevant social or economic communities of interest in the existing
SOI area.
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.
a. The CCHD SOI is coterminous with the District’s service area boundary.
b. The SOI is expected to remain unchanged, with no expansions or reductions.
c. LAFCO staff has identified two DUCs, within part of CCHD’s service area and SOI, as seen
in Figures 2 and 3 within the “Population Profile” Section of this report. The locations
identified as a DUC displays characteristics of a DUC pursuant to the CKH Act of 2000.
d. CCHD does not provide public facilities or services related to water, wastewater, or fire
protection, therefore this SOI factor does not apply.
San Luis Obispo LAFCO | Adopted 5/16/24
Cambria Community Healthcare District
40
MSR & Sphere Study
APPENDIX
Sources
General
1. Sphere of Influence Update and Municipal Service Review for Coastal Community Services
Districts and Cambria Healthcare District (Avila Beach Community Services District, Cambria
Community Services District, Los Osos Community Services District, San Simeon Community
Services District, and Cambria Healthcare District), 2014
2. CCHD Response to LAFCO MSR-SOI Request for Information Questionnaire, December 2023
3. CCHD Website, Cambria Community Healthcare District (cambria-healthcare.org)
Accountability
1. CCHD Response to LAFCO MSR-SOI Request for Information Questionnaire, December 2023
2. CCHD Website, District Transparency - Cambria Community Healthcare District (cambria-
healthcare.org)
3. CCHD District Bylaws, August 2022
Population Profile
1. CCHD Response to LAFCO Follow-Up Questionnaire, February 2024
2. SLO County North Coast Area Plan, 2007, Revised April 2022
3. San Luis Obispo Council of Governments 2050 Regional Growth Forecast
4. US Census, 2020 Cambria Census Designated Place Data
5. US Census, 2020 San Simeon Census Designated Place Data
6. U.S. Census Bureau, American Community Survey data from 2016-2020 in 2021
inflation/adjusted dollars
Services
1. California Health & Safety Code Section 32121
2. CCHD Ambulance Station/Administrative Offices Pre-Design Services, January 2022
3. CCHD Response to LAFCO MSR-SOI Request for Information Questionnaire, December 2023
4. CCHD Response to LAFCO Follow-Up Questionnaire, February 2024
5. CCHD Strategic Planning Presentation, July 2023
San Luis Obispo LAFCO | Adopted 5/16/24
Cambria Community Healthcare District
41
MSR & Sphere Study
6. Five Year Emergency Medical Service Plan, May 2023
Finance
1. CCHD Approved Fiscal Year 23-24 Operating Budget
2. CCHD Approved Fiscal Year 22-23 Operating Budget
3. CCHD Audited Financial Statements June 30, 2023
4. CCHD Audited Financial Statements June 30, 2022
5. CCHD Audited Financial Statements June 30, 2021
6. CCHD Audited Financial Statements June 30, 2020
7. CCHD Audited Financial Statements June 30, 2019
8. CCHD Response to LAFCO MSR-SOI Request for Information Questionnaire, December 2023
9. CCHD Response to LAFCO Follow-Up Questionnaire, February 2024
San Luis Obispo LAFCO | Adopted 5/16/24
IN THE LOCAL AGENCY FORMATION COMMISSION
COUNTY OF SAN LUIS OBISPO, STATE OF CALIFORNIA
Thursday, May 16, 2024
RESOLUTION NO. 2024-04
RESOLUTION APPROVING THE CAMBRIA COMMUNITY HEALTHCARE DISTRICT MUNICIPAL
SERVICE REVIEW AND SPHERE OF INFLUENCE STUDY
The following Resolu�on is now offered and read:
RECITALS
WHEREAS, the San Luis Obispo Local Agency Forma�on Commission, hereina�er referred
to as the “Commission”, is authorized to conduct municipal service reviews and establish, amend,
and update spheres of influence for local government agencies whose jurisdic�ons are within San
Luis Obispo County; and
WHEREAS, the Commission conducted a municipal service review to evaluate availability
and performance of governmental services provided by Cambria Community Healthcare District,
hereina�er referred to as the “District”, pursuant to California Government Code § 56430, hereby
incorporated by reference as contained in LAFCO File No. 5-S-23 Cambria Community Healthcare
District Municipal Service Review and Sphere of Influence Study included as Atachment B of the
May 16, 2024, LAFCO Staff Report; and
WHEREAS, the Commission conducted a sphere of influence study for the District
pursuant to California Government Code § 56425, hereby incorporated by reference as contained
in LAFCO File No. 5-S-23 Cambria Community Healthcare District Municipal Service Review and
Sphere of Influence Study included as Atachment B of the May 16, 2024, LAFCO Staff Report; and
WHEREAS, Government Code §56425(i) requires that when adop�ng, amending, or
upda�ng a sphere of influence for a special district, the Commission shall establish the nature,
loca�on, and extent of any func�ons or classes of services provided by those districts; and
WHEREAS, Government Code § 56050.5 provides that once the Commission establishes
the func�ons or services being provided by a district pursuant to Government Code § 56425(i),
all services, facili�es, func�ons, or powers authorized by the principal act under which the district
is formed, but that are not being exercised, are deemed to be latent services or powers; and
WHEREAS, no change in regula�on, land use, or development will occur as a result of
Resolu�on No. 2024-04
Page 2
the adop�on of a sphere of influence for the district; and
WHEREAS, the Execu�ve Officer gave sufficient no�ce of a public hearing to be conducted
by the Commission in the form and manner provided by law; and
WHEREAS, the staff report and recommenda�ons on the municipal service review and
sphere of influence study were presented to the Commission in the form and manner prescribed
by law; and
WHEREAS, the Commission heard and fully considered all the evidence presented at a
public hearing held on the municipal service review and sphere of influence study on May 16,
2024; and
WHEREAS, the Commission considered all of the municipal service review and sphere of
influence factors required under California Government Code § 56430 (a) and 56425 (e) and
adopts as its writen statements of determina�ons therein, the determina�ons set in the Public
Review Dra� of the municipal service review and sphere study �tled “Municipal Service Review
and Sphere of Influence Study for Cambria Community Healthcare District”, with said
determina�ons being included in Exhibit B of this resolu�on; and
WHEREAS, the No�ce of Exemp�on, prepared pursuant to § 15062 is adequate as the
documenta�on to comply with the California Environmental Quality Act (CEQA) under the
General Rule Exemp�on § 15061(b)(3) and Categorical Exemp�on § 15306, for the municipal
service review and sphere of influence study for the District; and
NOW, THEREFORE, BE IT RESOLVED AND ORDERED by the Local Agency Forma�on Commission
of the County of San Luis Obispo, State of California, as follows:
1. That the recitals set forth hereinabove are true, correct, and valid and are hereby
incorporated by reference.
2. The municipal service review and sphere of influence study �tled “Municipal Service
Review and Sphere of Influence Study for Cambria Community Healthcare District”,
includes the related statements of determina�on, and is determined to be exempt from
CEQA pursuant to § 15061(b)(3) and § 15306 of the CEQA Guidelines.
3. That the No�ce of Exemp�on prepared for this proposal is complete and adequate, having
been prepared in accordance with the provisions of the CEQA and is hereby determined
to be sufficient for the Commission’s ac�ons and is incorporated by reference as Exhibit A
of this resolu�on.
4. That the Execu�ve Officer of this Commission is authorized and directed to mail copies of
this resolu�on in the manner provided by law.
5. Pursuant to Government Code § 56430(a), the Commission makes the writen statement
of determina�ons for municipal service reviews, included in Exhibit B of this resolu�on.
Resolu�on No. 2024-04
Page 3
6. Pursuant to Government Code § 56425(e), the Commission makes the writen statement
of determina�ons for the sphere of influence, included in Exhibit B of this resolu�on.
7. That the sphere of influence for the district be adopted pursuant to the map in Exhibit C
of this resolu�on.
8. In adop�ng this sphere of influence for the district, pursuant to Government Code
§56425(i), the Commission establishes that the District exercises a number of general
powers when opera�ng the healthcare district as allowed in Health and Safety Code §
32121 - § 32140; the primary func�on or service provided within its jurisdic�onal
boundaries is Advanced Life Support ambulance services and health and wellness
educa�on.
9. Advanced Life Support ambulance services and health and wellness educa�on are
considered general terms used to iden�fy the primary authorized powers being exercised
by the district and that the powers are further described in Health and Safety Code §
32121.
Upon a mo�on of Commissioner Waage, seconded by Vice Chair Gregory and on the following
roll call vote:
AYES: COMMISSIONER ED WAAGE, VICE CHAIR STEVE GREGORY, COMMISSIONERS
DEBBIE ARNOLD, ED EBY, JIMMY PAULDING, DAVID WATSON, AND
CHAIRPERSON MARSHALL OCHYLSKI
NAYS: NONE
ABSENT: COMMISSIONERS ROBERT ENNS
ABSTAIN: NONE
The foregoing resolu�on is hereby adopted.
05/24/2024
Marshall Ochylski Date
LAFCO Chairperson
Resolu�on No. 2024-04
Page 4
ATTEST:
5/28/24
Rob Fitzroy Date
LAFCO Execu�ve Officer
APPROVED AS TO FORM AND LEGAL EFFECT:
5/20/2024
Brian Pierik Date
LAFCO Legal Counsel
Notice of Exemption
To: □ Office of Planning and Research From: San Luis Obispo LAFCO
PO Box 3044, 1400 Tenth Street, Room 222 Rob Fitzroy, Executive Officer
Sacramento, CA 95812-3044 1042 Pacific St. Suite A
San Luis Obispo, CA 93401
(805) 781 – 5795
□ County Clerk rfitzroy@slo.lafco.ca.gov
County of San Luis Obispo
County Government Center
San Luis Obispo, CA 93408
Project Title: LAFCO File No. 5-S-23 |Cambria Community Healthcare District Municipal Service Review and Sphere
of Influence Study
Project Location: Cambria Community Healthcare District (CCHD) is located in the northwestern portion San Luis
Obispo County.
Description of Nature, Purpose, & Beneficiaries of Project: The Local Agency Formation Commission (LAFCO) has
prepared a Sphere of Influence (SOI) Study and Municipal Service Review (MSR) for the Cambria Community
Healthcare District pursuant to Government Code § 56425 and § 56430. The SOI is a 20-year growth boundary that
includes areas that may be served by the District in the future. State law requires the MSR to be completed either
prior to or concurrent with, the SOI study. The MSR evaluates the public services provided by the District and is
used as the basis for any changes to the SOI. The Commission took action to reaffirm the district’s SOI to remain
coterminous to the service area boundary as depicted in Attachment A, Exhibit C of the LAFCO May 16, 2024, staff
report found on the LAFCO website at https://slo.lafco.ca.gov/. The Commission also established that the District
exercises a number of general powers when operating the healthcare district as allowed in Health and Safety Code
§ 32121 - § 32140; the primary function or service provided is Advanced Life Support ambulance services and
health and wellness education.
Name of Public Agency Approving Project: The San Luis Obispo County LAFCO conducted a noticed public hearing
on May 16, 2024, at 9:00 a.m. in the Board of Supervisors Chambers in San Luis Obispo at the County Government
Center. Additional information is available on the LAFCO website at https://slo.lafco.ca.gov/.
Exemption Status: (check one)
Ministerial (Sec. 21080(b)(1); 15268); Categorical Exemption: State type and section number
Declared Emergency (Sec. 21080(b)(3); 15269(a)); Statutory Exemptions: State code number
Emergency Project (Sec. 21080(b)(4); 15269 (b)(c)); Other: The activity is not a project subject to CEQA.
Reasons Why Project is Exempt: It has been determined with certainty that the MSR is categorically exempt under
Class 6, Section 15306 and the MSR & SOI qualifies for a general rule exemption under Section 15061(b)(3). There
is no possibility that this MSR and SOI update may have a significant effect on the environment because there are
no land use changes associated with the documents; therefore, the CCHD MSR & SOI Study is found to be exempt
from CEQA pursuant to section 15061(b)(3) and section 15306 of the State Guidelines. LAFCO will file this Notice
of Exemption upon approval of the MSR and SOI Study.
Rob Fitzroy, Executive Officer Date
Exhibit B | Resolution No. 2024 - 04
Page 1 of 6
Service Review Determinations per Government Code Section 56430
for the Cambria Community Healthcare District
1. Growth and population projections for the affected area
a. While there are no specific population growth forecasts for the CCHD boundaries
due to data limitations, projections for the North Coast Planning Area boundary
provide an approximation; this encompasses most of the CCHD service area. The
estimated population served by the CCHD and within the North Coast Area Plan
was 6,520 in 2020 and over 1 million annual visitors according to CCHD. With an
estimated build-out population of 7,095 by 2050, the North Coast Area Plan region
is currently approximately 92% built out.
2. The location and characteristics of any disadvantaged unincorporated communities
within or contiguous to the sphere of influence
a. LAFCO staff have identified two DUCs within CCHD’s SOI and service area
boundary. The locations identified as DUCs display characteristics of a DUC
pursuant to the CKH Act.
b. The threshold for a DUC (80% of CA’s MHI) is an MHI less than $67,277. Once a
Census Block Group (CBG) or a Census Designated Place (CDP), meets the DUC
MHI threshold, LAFCO then verifies that those areas are inhabited as specified in
government code section 56033.5. Two CBGs within the CCHD boundary met the
threshold for a DUC. The first is San Simeon DUC Area #1 with an estimated MHI
of $50,486; the area was also determined to be inhabited with approximately 200
registered voters. The second is Cambria DUC Area #1 with an estimated MHI of
$51,875; the area was also determined to be inhabited with approximately 529
registered voters. Therefore LAFCO, identified these two DUCs at the Census Block
Group level, within the CCHD boundaries as seen in Figures 2 and 3 within the
“Population Profile” Section of the Cambria Community Healthcare District
Municipal Service Review and Sphere of Influence Study, LAFCO File No. 5-S-23.
Exhibit B | Resolution No. 2024 - 04
Page 2 of 6
3. Present and planned capacity of public facilities and adequacy of public services,
including infrastructure needs or deficiencies
a. CCHD is authorized to provide a range of services as described in the California
Health & Safety Code Section 32121 - 32137. However, the District only provides
Advanced Life Support ambulance (ALS) service and community health education
services. In 2023, the District responded to 1,069 911 calls for service, for an
average of 89 calls per month. The District is capable of providing emergency
response on most incidents encountered within the CCHD. Additional apparatus,
equipment, and staffing are available through Automatic or Mutual Aid
agreements with SLO County Emergency Medical Services Authority (EMSA) which
in part includes Cal Fire/County Fire, and the Cambria Community Services District
Fire Department. This coverage allows for an average 10-minute emergency
response time by CCHD to any location within the District’s service area. CCHD
Board reviews monthly Operations Reports with a goal of providing response to
100% of calls. CCHD currently reports an average response of 93% to 100%. CCHD
indicated that existing staffing levels are adequate to provide service to its service
area. According to the CCHD Facility Condition Assessment, it was determined that
the main facility is in very poor condition, primarily related to its age. The District
identified the need to replace the current facility that houses their crews,
administration staff, and fleet of ambulances. A plan to rebuild the facility has
been developed and the District is seeking state and federal grant funding and
bond financing to replace the aging facility. In March 2024 the CCHD was awarded
one-million-dollars in grant funding for the new facility. Anticipated completion is
reliant upon a bond measure passing, which is scheduled to be placed on the
November 2024 ballot. LAFCO determines that CCHD has capability and capacity
to provide services where service is provided in the best manner possible within
available funding.
4. Financial ability of agencies to provide services
Exhibit B | Resolution No. 2024 - 04
Page 3 of 6
a. District revenues and expenditures are considered to assess the overall health of
the District. The District’s overall revenues and expenditures have fluctuated over
the last five-year audited period. CCHD’s expenses exceeded their revenues
between FY 2018-2019 through FY 2020-2021 and in FY 2021-2022 and FY 2022-
2023 revenues exceeded expenditures; ending with a revenue of $2.359 million
and expenditures of $2.173 in FY 2022-2023. As a result, the District’s operating
ratio was 1.09 in FY 2022-2023.
b. LAFCO also considers District assets and liabilities to help determine the District’s
health. CCHD’s assets have increased by 45% over the last 5-year audited period
ending with $1.133 million in FY 2022-2023. CCHD’s liabilities have increased by
14% over the last 5-year audited period ending with $5.738 million in FY 2022-
2023. As a result, the CCHD’s liquidity ratio was 4.1 in FY 2022-2023.
c. Increases or decreases in an agency’s net position is another indicator of whether
its financial health is improving or deteriorating. In the case of CCHD, assets and
deferred outflows were exceeded by liabilities and deferred inflows over the last
five-year audited period. As a result, the District has been operating with a net
deficit. CCHD’s net deficit has increased by 10% over the last 5-year audited period
ending with a deficit of $4.475 million in FY 2022-2023. According to the FY 2022-
2023 audit, it was determined that the most significant expenses of the District
are payroll and benefit-related expenses. The primary increase in expenses and
the resulting increase in the net deficit is the recognition of net pension liability,
at $2.094 million, and recognition of OPEB liability, at $3.218 million during FY
2022-2023. However, the District pays their annual contributions to Pension and
OPEB liabilities to the State. District Staff have indicated that they will continue to
contribute the required contributions and look toward possibilities of instituting a
Trust Fund in the future to help lower the District’s Liabilities.
d. LAFCO determines that out of the three financial indicators used to determine the
District’s health, CCHD scored well on two of the three. CCHD’s operating ratio
and liquidity ratio exceeded the minimum of 1.0 for the latest FY 2022-2023.
Exhibit B | Resolution No. 2024 - 04
Page 4 of 6
Regarding the District’s net position, the CCHD operated with a net deficit over
the last five-year audited period; primarily related to pension liability and OPEB
liability. However, as noted, the District pays their annual contributions to Pension
and OPEB liabilities to the State. The District is encouraged to continue its efforts
towards pursuing a plan to offset the District’s liabilities such as a Trust Fund.
5. Status of and, opportunities for, shared facilities
a. At present, the distinction between the CCHD and neighboring agency services in
the area is clear.
b. Additional apparatus, equipment, and staffing are available to CCHD through
Automatic or Mutual Aid agreements with SLO County Emergency Medical
Services Authority (EMSA) (which includes County Fire/Cal Fire, San Luis
Ambulance, Cambria Community Services District Fire Department, and others).
c. Opportunities for shared facilities may include:
i. Continued coordination between CCHD and San Luis Obispo County EMSA
ii. Continued coordination between CCHD and Cambria Community Service
District Fire Department
iii. Continued coordination between CCHD and Monterey County
iv. Continued coordination between CCHD and San Luis Ambulance
6. Accountability for community service needs, including governmental structure and
operational efficiencies
a. CCHD is governed by a five-member Board of Directors who are elected to four-
year terms. Regularly scheduled monthly Board meetings are held on the fourth
Tuesday of the month and all meetings are open to the public and are publicly
posted a minimum of 72 hours prior to the meeting in accordance with the Brown
Act.
b. CCHD maintains an up-to-date website that contains District information,
documents, and updates.
Exhibit B | Resolution No. 2024 - 04
Page 5 of 6
c. CCHD has demonstrated accountability and transparency in its disclosure of
information and cooperation during the process of this MSR. The District
responded to the questionnaires and cooperated with document requests.
d. LAFCO determines that CCHD is accountable and transparent.
7. Any other matter related to effective or efficient service delivery
a. No changes are recommended at this time.
Sphere of Influence Determinations per Government Code Section
56425 for the Cambria Community Healthcare District
1. Present and planned land uses in the area, including agricultural and open-space lands.
a. The CCHD SOI is coterminous with the District’s service area boundary.
b. The SOI is expected to remain unchanged, with no expansions or reductions.
c. Land uses within CCHD's existing boundary consist of rural, unincorporated
territory, and is generally located within the unincorporated North Coast Area Plan
including Cambria, San Simeon, and surrounding rural areas. Some areas on the
eastern side of the CCHD boundary are within the North County Planning Area.
d. Land uses within the unincorporated territory are governed by the County of San
Luis Obispo General Plan land use designations and zoning.
2. Present and probable need for public facilities and services in the area.
a. The CCHD SOI is coterminous with the District’s service area boundary.
b. The SOI is expected to remain unchanged, with no expansions or reductions.
c. There is an existing need for service within the existing SOI boundary which is
coterminous to the service area boundary.
3. Present capacity of public facilities and adequacy of public services that the agency
provides or is authorized to provide.
a. The CCHD SOI is coterminous with the District’s service area boundary.
b. The SOI is expected to remain unchanged, with no expansions or reductions.
Exhibit B | Resolution No. 2024 - 04
Page 6 of 6
c. CCHD has capability and capacity to adequately meet existing and future service
demand within the existing SOI area which remains coterminous to the District’s
service area boundary.
4. Existence of any social or economic communities of interest in the area if the
commission determines that they are relevant to the agency.
a. The CCHD SOI is coterminous with the District’s service area boundary.
b. The SOI is expected to remain unchanged, with no expansions or reductions.
c. There are no District relevant social or economic communities of interest in the
existing SOI area.
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.
a. The CCHD SOI is coterminous with the District’s service area boundary.
b. The SOI is expected to remain unchanged, with no expansions or reductions.
c. LAFCO staff has identified two DUCs, within part of CCHD’s service area and SOI,
as seen in Figures 2 and 3 within the “Population Profile” Section of the Cambria
Community Healthcare District Municipal Service Review and Sphere of Influence
Study, LAFCO File No. 5-S-23.
d. . The locations identified as a DUC displays characteristics of a DUC pursuant to
the CKH Act of 2000.
e. CCHD does not provide public facilities or services related to water, wastewater,
or fire protection, therefore this SOI factor does not apply.