Annual Report: a Summary of Activities and Status of Recommendations

districts which annually spend billions of "local assistance" dollars. Our Commission found that although State funding for schools has increased drastically since the enactment of Proposition 13, necessary oversight has not increased commensurately to ensure program accountability. Recommendations • In order for the Superintendent of Public Instruction to effectively discharge his responsibility to promote the fiscal and performance accountability of schools, the Department should systematically develop, monitor, and publicly disclose measures of school district admin i strat ive and program costs, staffi ng, fac i lit ies uti 1 i zati on and maintenance, and student achievement to identify exceptional districts. • The Superintendent should use performance and financial inforTnation as a basis for initiating such technical assistance, fact-finding, and management audits as he may deem appropriate. • California Assessment Program testing should be expanded to evaluate student achievement at additional grade levels. • The State Board of Education should establish basic standards for academic achievement. • The Legislature should consider the merits of caps on local admin› istrative expenditures and incentives to reward particularly effective and efficient school districts. Action to Date and Benefits Consistent with our recanmendations in this area, S8 813 implemented the following measures: • As previously indicated, • implementation of a system to monitor the efficiency of local facility utilization. • Expanded California Assessment Program testing to evaluate student achievement at additional grade levels. • Administrative caps which require that at least 85 percent cif specified categorical funds be spent on direct services for students. • Established a program to award financial bonuses to high schools that demonstrate improved student performance on basic skills achievement tests (initial funding in 1984-85) • • Requires uniform statewide graduation standards in English, mathe- matics, science, social studies, fine arts and foreign languages by 1986 .. 87. Further Action Needed The independent annual audits of school districts should be expanded and more thoroughly utilized to improve district management practices and reduce the incidence o~ insolvency. At our request, Assemblywoman Hughes has introduced AS 3755 which would require that these annual audits be expanded to provide an early warning when districts run the risk of fiscal insolvency in the following year. In the next owalve months, Commission staff will determine whether the Department is making optimal use of financial and performance information to ensure the efficiency and effectiveness of school district programs. Additionally, the Superintendent of Public Instruction has acknowledged the need for a comprehensive approach to improved oversight of school districts. To this end, he has proposed the formation of a "School Financial Management Advisory Committee" to assist him in the implementation of our recommenda- tions in this area. -12- Finally, our Commission believes that the State must develop practicable intervention strategies which may be applied on an exception basis to correct serious deficiencies in district financial management and program performance. In December 1982, then Superintendent-elect Honig stated that in certain extreme cases of district mismanagement the State might need to place d i stri cts in trusteeshi p or apply f inane i a 1 sanctions. We cont i n.ue to urge the Super i ntendentto give high p r i or; ty to th i s fundaments 1 po 1.i cy ques t i on concurrent with the development by his School Financial Management Advisory Committee of necessary measures of district efficiency. Sanctions Findings and Recommendations The effectiveness of Commission recommendations to improve the State's administrative oversight of school districts is contingent in part on the availability of sanctions which we have recommended as sometimes necessary to enforce sound management practices. Our Commission has recommended that sanctions including suspension or revocation should be imposed against the administrative credentials of school officials who incompetently manage educat i on resources or knowi ng ly report fa 1 se information concern i ng the costs, staffing, or results of any program. Action to Date and Benefits Assembly Bill 415 (Floyd, enacted as Chapter 854, 1983) partially implemented this recommendation by requiring the Commission on Teacher Credentialing to revoke the credential of any person who knowingly and wi llfully reports false fiscal expenditure data relative to the conduct of any educational program. -13- .. Further Action Needed The Legislature could further strengthen the fiscal accountability of California's K-12 school system by authorizing the Superintendent to initiate hearings before the Commission on Teacher Credentialing to suspend or revoke local superintendents' administrative credentials when school districts cannot be certified by local CPA's as "going concerns" using national professional association standards for audits. These hearings would be based upon the rebutab1e presumption of administrative incompetency in cases of impending district insolvency . -14- HORSE RACING IN CALIFORNIA: REVENUE & REGULATION In July 1982, our Commission reported its findings and recommendations concerning State revenues fran horse racing and the adequacy of in~ustry regulation exercised by the California Horse Racing Board. Pari-mutuel wagering which totalled $2.1 billion in each of the 1981 and 1982 racing years averaged about $120 per capita for every Californian over 17 years of age. Since the horse racing industry is a licensed and taxed monopoly in California, it is essential that tax provisions strike an equitable balance between the industryls need for profitability and the Statels need for derivitive revenues. Additionally, the State and the wagering public must be assured that the Board effectively regulates the industry according to its delegated responsibil ity and sound managerial practices. Findings and Recommendations Our re1)Ort concluded that available information did not corroborate the industryls need for statutory changes in the distribution of hOr"Se racing revenues which became effective in 1981 and had the net effect of reducing the Statels s~are of revenues from $.70 to $.47 for every dollar • paid to racing .associations (tracks) and horsemen. These change5 cost the State an estimated $32 million in potential revenues in each of the 1981 and 1982 racing years. Our report therefore r::ecommended legislative action to amend the horse racing law and restore a more equitable share of racing revenues to· the State. We also reported that the Board did not deposit State license fees on a timely basis, resulting in a loss of earnings, and did not administer uniform penalty guidelines to assure the equity of penalties assessed for racing infractions. -15- Subsequent to this report, a study prepared by Commission staff indicated that the State could moderately increase revenues from wagering not returned to bettors without causing an adverse reduction in the level of revenue-generating wagering activity. Action to Date and Benefits -These Commi ss ion stud i es prov i ded the cata 1 ys t for recomnendat ions by the Governor's Efficiency Teams (GET) and three bills which contained provisions to increase State revenues from horse racing license fees. Assembly Bitt 1428 (Brown) incorporated the GET proposal for statutory changes which would have increased State racing revenues by about $25 million annually. Assembly Bill 2058 (Wyman) would have increased State revenues by $31 mi 11 i on at the then current 1 eve 1 of wager i ng. A-I though the re 1 evant horse racing provision was ultimately deleted from the "tax loopholell bill (AI 1428), a similar provision was incorporated in the budget trailer bill (A8 223) which was approved as Chapter 323, Statutes of 1983. No legislative action was taken on AB 2058. Chapter 323 increases State revenue from exotic pari-mutuel wagering (daily doub-le, exacta, and pick six) by an estimated $9.1 mi 11 ion between August 1, 1983 and July 1, 1984. As a result of recommendations made by our Commission, the Board states that it has improved the timeliness of its collections of State license fees from racing associations and has issued uniform penalty guide- lines for the use of its stewards. Although the Board has not adopted the Monday collection day recommended in our report, its issuance and strict enforcement of a directive requiring Wednesday payments may have resulted in increased, indeterminate State interest earnings of up to $50,000 annually. Additionally, the Board's recently adopted penalty guidelines -16- .. .. will improve the fairness and deterrent value of civil penalties assessed for specific types of horse racing infractions. Further Action Needed We were not able to identify any administrative actions by the Board to monitor or improve the dispersal of charity racing revenues "as soon as pract i cab 1 e" af ter the i r co 11 ect i on as requ i red by the Bus i ness and Professions Code (Section 19555, Chapter 4, Division 8). Although many racing associations make timely donations of their net profits from some race meets to charities in accordance with the State Racing Law, our July 1982 report (page 25) identified vagueness in the statutory language which permitted racing associations to inappropriately earn interest income on the tardy .d i spersel of char i ty mon i es. We reported that $676,000 chari ty race revenues collected by one Southern Thoroughbred Racing Association earn~d approximately $50,000 in interest over a nine~th period. There- fore, we recommended that the Soard ensure the prompt payment of charity monies pending legislative clarification of existing statutory language. Since the Soard has failed to act in this area, the Legislature should consider an appropriate clarification of this ambiguous statutory provision. Further, if the Legislature chooses to indefinitely extend the provi- sion of Chapter 323 which increases State revenue from exotic pari-mutuel wagering, additional revenue of approximately $10 million or more will recur annually. -17- OFFICE OF SPECIAL HEALTH CARE NEGOTIATIONS Through the years, the continuing rise of health care costs in California has been a major concern of this Commission and has been the subject of several reports. Our leadership in making the State a prudent purchaser of hospital services under Medi-Cal \'las acknowledged by the former director of the Department of Health Services, Beverlee Myers, who stated that this Commission was the lIearliest and most continuous supporter" of proposals for selective hospital contracting.!1 Therefore, our Commission welcomed the Selective Provider Contracting Program and related reforms which were initiated by the provisions of AS 799 (Chapter 328, 1982) and S8 20l2(Chapter 1594, 1982). The fi rst negoti ated contracts for inpatient Medi-Cal services were effective on February 1, 1982. Estimated month of payment savings as a result of competitive hospital contracting are about $14 million in fiscal year 1982-83, $180 million in 1983-84, and $236 million in 1984-85.21 Findings As a result of its analysis of relevant issues and two meetings with former Special Negotiator William Guy, our Commission issued a letter report in March 1983 concerning potential problems in the negotiation and imple- mentation of contracts for the inpatient care of Medi-Cal beneficiaries. Our Commission found that the requirement that all terms and conditions of v"i rtua l1y all hospi ta I contracts must rema In confidenti a 1 created administrative problems and appeared to circumvent necessary public over- sight. Under the innovative system of hospital contracting, fiscal incentives encourage providers to reduce the cost of care or to find lower cost 47 Public meeting of commission, August 26, 1982. 5/ Re ort to the Le istature on the 0 erations of Calffornia - Assistance Commission, January 19 ,and oommunicat on from CHAC staff. -18- alternatives to high-cost procedures. While these incentives are expected to lead to hospital-initiated management controls, our Commission and the State Department of Health Services have observed that in extreme cases they could also lead to such abuses as skimming and dumping of patients with heavy care needs and underutilization of appropriate services. Reccnrnenda t i on Our report recommended that the enabling statutes should be amended to require that all of the contracts become part of the public record after all negotiations in an area have been completed. Additionally, we recommended thorough monitoring to ensure adequate client access to appropriate hospital services. Action to Date and Benefits Assembly Bill 1167 (Connelly) effectively implemented our recommenda- tion concern i ng pub 1 i c di sclosure by requ i ring that all contracts or amend- ments thereto entered into on or after January 1, 1984, for inpatient Medi-Cal services shall be open to inspection one year after they are executed. Additionally, if the California Medical Assistance Commission enters into contracts with health care providers for other than inpatient hospital services, these contracts are also required to be open to inspec- t ion one year after' they are executed. The Department has responded to identified potential abuses by expand- ing and augmenting its contract monitoring systems to assure hospital compliance with contract terms. Besides increasing its oversight of hospital compliance through expansion of the activities of its Audits and Investiga- tion Division and the Licensing and Certification Divis-ion, the Department has added two special "Contract Officer's Medical Oversight Teams" to quickly -19- evaluate potential problems and has developed an "Incident Reporting System" to identify perceived problems relating to hospital contracting. The Department's system of lIincident" review and resolution is initiated by reports which can be filed by an individual (beneficiary, relative, nursing personnel, Medi-Cal field office staff, onsite reviewers, etc.) who observes a situation involving a contract hospital that seems inappropriate. Additionally, incident reports are completed by staff within the Department who receive complaints from beneficiaries and providers concerning contract hospitals. Although the Incident Reporting System was only recently implemented and is still undergoing modifications, the Department has already found the system to be instrumental in providing its staff with accurate indications . of how contract hosp ita 15 are cornp ly i ng wi th the requ i rements and condi ti ons of their contracts and where areas of abuse or difficulty may exist. As of November 1, 1983, 393 incident reports were filed. While many of these reports were undergoing analysis or had been resolved as allowable "non- incidents,1I 13 reports were detennined to indicate contract violations. In these instances, the Department sent warning letters which required correc- tive behavior of the affected contract facilities. Further Action Needed Our Canrnission considers the Department's incident reporting system to be a necessary and useful means to monitor problems which may develop unde; the State's Selective Provider Contracting Program. Therefore, we intend to periodically review infonna·tion from this system in connection with any future Commission studies of health care services provided under the Medi- Ca 1- program. -20- 'REVIEW OF COST SAVINGS ASSOCIATED WITH CONVERSION OF GUADALUP~ COLLEGE INfo A WOMEN'S PRISON During the past few years, California has enacted several new laws which have increased the number of people sentenced to prison and extended .the length of time they remain incarcerated. However, these changes in the Statels sentencing laws have not been accompanied by an equal expansion of the number of State correctional institutions. As a result, California today faces a significant problem of overcrowding in our prisons. Recent Department of Corrections I reports indicate that our institutions are currently at about 130 percent of their capacity. Furthennore, the criminal population is continuing to grow at a net increase of 400-500 inmates per month. In response to this overcrowded condition in State prisons, the citizens of California approved Proposition 1 authorizing the sale of $495 million in bonds for new prison faci 1 ities. In addition to planning for the con- struction o.f new facilities, the Department of Corrections periodically investigates opportunities for the State to purchase existing facilities which are adaptable for use as correctional institutions. In response to a legislative request, our Commission evaluated infor- mation on the feasibility and cost-benefits of the State purchasing Guadalupe College and converting it into a minimum security women1s correctional institution. As part of our study, we also reviewed the Guadalupe College for other potential uses which could be beneficial to the State. Findings and Recommendations • The college is in excellent condition and is adaptable for use as a minimum security women1s prison. -21- • If the purchase and conversion of the college were authorized in lieu of a planned facility in Stockton, the State could save an estimated $9.8 million in prison bond funds. • The college could possibly be converted for use sooner than the Stockton facility could be built. • The college appears adaptable for other potential State use such as an instructional institution. • Since it is not the role of this Commission to decide what properties the State should purchase, our issue and cost analysis was intended only to provide direction should the Legislature choose to authorize this purchase. Action to Date and Benefits Subsequent to our March 1983 report on the subject, Assemblyman Art Agnes introduced a bill authorizing the Department of Corrections to purchase Guadalupe College for use as a minimum security women's prison. This bill was later withdrawn by the author. Further Action Needed None required. -22- • " REVIEW OF THE DEPARTMENT OF TRANSPORTATION'S HIGHWAY PLANN ING AND DEVELOPMENT PROCESS In June 1983, our ~ommission released its report on the State Depart- ment of Transportation's highway planning and development process. This study was undertaken because of concern expressed by legislators, local government officials, and others that the Department has historically been unable to produce expected projects as originally conceived and scheduled. These delays have also affected local transportation needs that depend on State highway projects. Our study examined State highway financing, the planning of improve- ments, and the scheduling and budgeting of projects through the Department's State Transportation Improvement Program. Attention was also given to highway maintenance which protects the public's multi-billion dollar invest- ment in the 15,200-mile State highway system which carrys about 87 billion vehicle miles annually. The most significant findings from this study and the status of corresponding recommendations are summarized below. Ten-Year H.ighway· Systems PI an Findings and Recommendations Our report observed that the lack of a State highway systems plan results in undue emphasis on individual projects rather than the priority needs of the whole system. We recommended that the Department, in coopera- tion with other appropriate agencies, should develop a IO-year highway systems plan. Action to Date and Benefits The Department has established a new unit within its Division of Transportation Planning to develop a systemwide identification and -23- pr io'r it izat ion of projects. I f the Department comp letes th i s plan by December 1984 as it intends J the plan wi 11 play a cen tra 1 ro 1 e in 1 eg i s 1 at i ve consideration of highway revenue measures and investment decisions in 1985. To ensure that there is legislative input to this process, Assemblyman William Lancaster recently introduced Assembly Concurrent Resolution 110. This measure would request the Department of Transportation to submit a status report to the Legislature by August 31, 1984, on its highway system planning process and to submit a final draft report on October 15, 1984, in order for the Legislature to have sufficient opportunity to review and comment on the highway system planning effort while work is in progress. Further Action Needed None required. Stand2X Projects Findings and Recommendations We found that the Department does not have an inventory of approved "shelf" projects that would be ready to go to bid when there are major delays in projects underway, or changes in policies or revenues. We there- fore recommended the development of a proposal to determine the requirements, co:s ts, and i mpac ts of c rea t i ng th i 5 comp rehens i ve i nven tory. Action to Date and Benefits Although both the Department and the California Transportation Commission have reservations about implementing this recommendation on a high priority basis, the Department has taken an initial step by recently retaining the firm of Arthur Young and Company to assist in the improvement of its project development process. This study would begin to address issues including the need for an inventory of standby projects. -24- • • Further Action Needed None required. Li fe Cyc I e Cos ts Findings and Recommendations Our study found that the Department does not systematically consider estimates of life eyc]e costs when it decides to undertake new highway projects or improvements to existing highways. We recommended that the Department examine the feasibility of introducing these estimates to make informed investment decisions and to develop adequate information concerning the long-range maintenance and reconstruction needs of our highway system. Action to Date and Benefits The Department currently engages in limited trade-off cost analyses but agrees that full life cycle costs are very important and informed US that it will be expanding its "efforts" in this area. Due to a lack of specificity in the Department's response, we are not currently able to assess the extent to which it will implement this recommendation. Further Action Needed Our Comnission wi 11 continue to monitor the Department·s implementa- tion of this recommendation . Maintenance Priorities Findings and Recommendations We recommended that the Department should review its criteria for prioritizing pavement rehabilitation projects because it assigned more than $300 million worth of major structural repair needs to a lower priori ty than ~hat ass igned to improve structurally sound pavements wi th an 'Iunacceptab Ie ri de. II -25- Action to Date and Benefits No action. Further Action Needed Although the Department is reluctant to re-examine its established method for prioritization, in part because it believes that increased funding for this program will virtually eliminate the current backlog of repairs in five years, we would urge the Department to avail itself of the Cal Iforni a Transportation Comniss ion I s expressed offer to- work wi th the Department in reviewing and improving its prioritization system. Environmental Review Process Findin2s and Recommendations In order to speed up highway project development while at the same time assuring adequate consideration of the environment, our study recommended that the Legislature and the Administration should seek Federal legislation that would sanction the State environmental process as acceptable in lieu of the Federal process. Action to Date and Benefits Since no provision exists for delegating environmental approvals to the State, the Department is attempting to implement the intent of this recom- mendation by the alternative approach of soliciting Federal legislation to expand Certification Acceptance under Title 23 of the Federal Highway Administration Code so that it applies to the National Environmental Quality Act (NEPA). Acceptance of a certificate by the Secretary of Transportation permits a state to discharge those responsibilities otherwise assigned to the Secretary under Title 23. Thus, the addition of NEPA to those responsi- bilities already covered by the Certificate Acceptance process would enable the Department to approve NEPA environmental documents. -26- " " • Further Action Needed Assembly Joint Resolution Number 64, introduced by Assemblyman Lancaster on June IS, 1983, would memorialize the President and Congress to enact this legislation. If AJR 64 clears both houses of the California Legislature by March 1984, Congress will have an opportunity to consider it early in the upcoming session which commenced January 23, 1984. User-Beneficiary Participation in Financins Findinss and Recommendations Our Commission reported that California needs a broader user-based highway financing mechanism in order to meet priority needs despite fluctuating highway construction costs, gallonage tax revenues which are not conmensurate with increases in highway travel, and restrictive criteria for Federal funding. Among user-related sources of revenue that are worthy of examination, we suggested weight-distance fees for commercial trucks and contributions from local sources for improvements to State highways which are of benefit to specific communities. Action to Date and Benefits The Cal ifonnia Transportation Commission has devoted considerable time in the last six months to analyzing this issue. It reports that it has recently adopted a policy for private sector and local government participa- tion in the financing of guideway development and is working towards achieve- ing a consensus with the Department and regional agencies early this year. Additionally, Assemblywoman Gwen Moore has introduced Assembly Concurrent Resolution Number 109 which requests the Department of Transportation to conduct a highway cost allocation study and to report to the Legislature by January 1, 1985, its findings concerning the respective cost responsibilities -27- of automobiles, buses, and the various classes of trucks which use State highways. The Department would also be requested to report to the Legislature by April 1, 1985, its findings with respect to an evaluation of alternative taxes to meet the C09t responsibilities of the classes of motor vehicles. Further Action Needed Legislation to implement the final version of the California Transporta- tion Commission's pol icy on this matter subject to amendment after April 1985 if ACR 109 study recommendations so warrant. Allocation Formula Findings and Recommendations Our report recommended that the Legislature, the Department, and the California Transportation Commission should find an alternative to the "county minimum" requirement in order to better allocate highway revenues to projects which are most critical to the achievement of systerrwide transporta- tic:m objectives. Cal ifornia's county minimum requirement mandates that at least 70 percent of the funds in each county group must be distributed according to a formula based on population and highway miles. The r~maining 30 percent of the funds may be allocated at the discretion of the Transportation Commission. Action to Date and Benefits Both the Transportation Commission and the Department agree with our recommendation for reform of the current allocation formula. The Transporta- tion Commission has informed our Commission that any reform could include either a reduction in the total number of individual guarantees (from the 58 county minimum to a lesser number of multi-county minimums), a reduction in the percentage of total expenditures subject to the county minimum formula -28- " .. • (from the current 70 percent to a lesser percentage), or the identification of circumstances of statewide significance under which these requirements could be suspended. Further Action Needed Currently, there are no pending bills to implement this reform • -29- II THE BUREAUCRACY OF CARE - CONTINUING POLICY ISSUES FOR NURSiNG ROME SERVIEES AND REGULATION The Little Hoover Commission has had a long-standing interest in nursing home issues. Since 1976, we have conducted several public hearings on conditions in these facilities. In October 1982, the Commission again conducted a public hearing which documented that many nursing home residents were being subjected to substandard conditions, neglect, and physical and sexual abuse. The Commission concluded that the system for licensing nursing homes and monitoring conditions in these facilities lacked the strength necessary to eliminate the most severe problems. In response to these continuing problems, the Commission appointed a Blue Ribbon Advisory Committee chaired by Lieutenant Governor Leo T. McCa'rthy and represented by the Assemb ly and Senate po Ii cy commi ttee cha i rs responsible for aging issues, the State Department of Health Services, the legal profession, consumer groups, the State Ombudsman, academia, the Calt'fornia Nurses Association, and the nursing home industry itself. This Advisory Committee invested hundreds of hours assisting the Commission's expert consultants in collecting extensive infonmation and contacting scores of individuals, analyzing eighteen different nursing home policy issues, and developing over 80 detailed recommendations for the Legislature and the Administratipn to implement. Findings and Recommendations The Commission's report, entitled liThe Bureaucracy of Care," was released in August 1983 and concluded that more needs to be done to protect the 105,000 frail and elderly individuals living in California's 1,170' nursing homes. The report details findings and recommendations in the fo 11 owl ng areas: -30- • Changes in inspection procedures. • Greater statutory rights for complainants. • Increased fines for violations. • Criminal penalties for abuse or neglect. • An information service for consumers. • Ease restraints on the supply of available beds, • Prohibit discrimination against Medi-Cal recipients, and • Study the need for a ceiling on profits realized by care providers. Action to Date and Benefits Although it would be premature to anticipate the specific benefits of this recent study, it is already evident that it will have extensive impact on the licensing and certification of nursing nomes. The State Department of Health Services either supports or is neutral on 75 of this reportls 83 recommendations. Moreover, virtually all of the 35 recommendations which require legislative action were introduced this January in a bipartisan reform package (Senate Bills 1340 through 1347 and Assembly Bills 2257 through 2265). Assemblyman Wyman and Senator Carpenter each have also introduced legislative packages the provisions of which incorporate certain Commission recommendations. Among other things, the legislation currently proposed includes: • Increasing fines for violations, • Varying inspection periods and make them less predictable, • • Prohibiting discrimination against patients on Medi-Cal, • Expanding the State1s IIOmbudsmanll program that hears complaints of nursing home conditions, • Prohibrting retaliation by nursing homes against patients who complain or have relatives who complain about treatment, and -31- • Allowing patients or relatives to file cases in municipal or small claims courts. Further Action Needed The Commission intends to continue monitoring implementation of the recommendations. -32- • CONTRACTING OUT OF GOVERNMENTAL SERVICES At the request of Assemblyman Mike Roos, Majority Floor Leader, our Commission conducted a review of Los Angeles County's program for contract- ing out governmental services. We analyzed and updated information originally prepared by the Los Angeles County Grand Jury, clarified issues, and made recommendations concerning contracting activities specifically authorized by the County's Proposition A in 1978. County contracting programs which shift governmental services to the private sector should be carefully studied to ensure that participating State funds are being well spent and also to make observations which would be relevant if the State itself were to consider contracting out certain services in the future. As part of our review process, we conducted a hearing in Los Angeles in conjunction with the Assembly Committee on Governmental Organization. The hearing received testimony from the project manager of the Grand Jury study, representatives of labor unions, and executive staff of the Los Angeles County Chief Administrative Office. Findings Our Commission, in conjunction with the Assembly Committee on Government Organization, reported that contracting out of services could reduce governmental operating costs but should be approached with caution because anticipated savings might be achieved only at 'considerable cost to the public work force. Specifically, we found that: • Estimated cost savings were historically overstated because the County included savings from non-Proposition A contracts and committed various methodological errors. -33- .. • determine the effectiveness of County affirmative action programs to encourage minority contractors' participation in the contracting out program; • evaluate the effects on minority public employees; and • evaluate contractor performance trends. Action to Date and Benefits Too soon to evaluate • Further Action Needed Continue to monitor program and review any subsequent evaluation. -35- COMMUN ITY RES I DENT IAL CARE I N C~L I FORN IA - COMMUNITY CAR£AS A LONG tERM CARE SERVICE California has 22,000 community care facilities which are State- or coun ty- 1 i cen sed to p rov I de I i v i ng a rrangemen ts for app rox i rna te I y 150,000 individuals who are subject to some condition that makes independent living imposs i b le or un'des i rab le. These homes prov i de supervi sed she 1 ter, mea 1 5 including special diets, personal care as needed, housekeeping services, and bedside care during periods of minor illnesses. Although some residents are not ambulatory, they do not require such high levels of medical super- vision as residents of intermediate care or skilled nursing facilities. In addition to conducting public hearings and making unannounced visits to facilities, our Commission sponsored three all-day workshops in which we brought government officials, facility operators, residents and familY'~embers, local enforcement officials, and consumer advocates together to work with our commissioners, staff and project consultant to develop recommendations to solve identified problems. Our study and workshops focused on the adequacy of services, protection and funding for the elderly, developmentally disabled, and mentally disabled residents of community care facilities. Findings The Commi ss i on I s December 1983 report, ent it led IIConmun i ty Res i dent i a I Care in CaJifornia,ll documented numerous instances of abuse and neglect of facility residents. Other findings included the following: • The number of unlicensed conwnunity care facil ities appears to be increasing, thereby posing a danger for unsuspecting clients . • In the existing community care system, facilities are licensed but certification of administrators is not mandated by State law. -36- Additionally, the system for screening individuals applying for facility licenses is inadequate. • Information systems do not adequately monitor facilities and residents or assist consumers. • Edlerly residents are particularly subject to abuse because they are rarely monitored by outsiders. • Current investigative resources are inadequate in number, expertise, and geographic allocation. Recommendations (Not a complete listing) • Clarify the definition of unlicensed facilities and create a citation system, similar to traffic tickets, to assist in taking action against them. • Increase fines for licensing violations and triple the fines for repeat offenders.\ • Establish an automated licensee information system. • Establish an Ombudsman Foundation to recruit and train volunteers to monitor residents. • Implement a case management system for the elderly and mentally disabled client groups. • Implement a pilot project for cluster administration of small facilities. • Encourage private action against abusive facilities by allowing recovery of legal fees through attachment of administrators' property. -37- : , Action to Date and Benefits The State Department of Social Services, Licensing and Certification Division, has acknowledged the validity and anticipated usefulness of the major recommendations in this report. Eleven bills have been Introduced in the Legislature that implement certain recommendations. Additionally, the Chair of the Senate Subcommittee on Aging and the Assenbly Committee on Human Services have each pledged to conduct hearings on the report's recommenda- tions. Further Action Needed Monitor implementation of recommendations. -38- A STUDY OF THE ORGANIZATION AND COORDINATION OF ELECTRIC ENERGY PLANNING & ELECTRICUTrLlTY REGULATION' IN CALIFORNIA In 1974, the State created the Cal ifornia Energy Commission to address such energy issues as conservation, development of alternative energy sources, assessments of energy needs, and the siting of new power plants. At the same time, the California Public Utilities Commission (PUC) has continued to fulfill its responsibilities in regulating utilities. Critics have charged that the Energy Commission and the PUC have failed to coordinate effectively, resulting in inefficiencies and diseconomies for both organizations, the public, and the regulated utilities. Although the electrical energy planning and regulatory activities of these Commissions are not supported by general fund money, their work affects literally billions of dollars paid annually by electrical energy ratepayers including the State of California. Findings and Recommendations Our study determined that there is virtually no linkage between the development of State electrical energy policy, as conducted by the Energy Commission, and the implementation of policy through the PUC's rate-setting process. Recommendations include the following: • Communication and coordination between the highest levels of the Energy Commission and the PUC must be improved by establishing formal structures and procedures for mutual participation. • Duplication between the two Commissions in the areas of bad manage- ment, forecasting, and research and development should be eli m i na ted. • The PUC should determine and express in advance a policy construct for each of the major cases it considers. "39- • The Energy Commission's Biennial Report must be improved to be more responsive to PUC needs. Additionally, the report should outline recommendations that are sufficiently specific to facilitate their implementation and evaluation. • The number of PUC Commissioners should be increased from five to seven to permit greater personal involvement in all phases of PUC business. Action to Date and Benefits On February 8, our report was the ,subject of a joint legislative hearing conducted by the Assembly Utilities and Commerce and the Senate Energy and Pub 1 i cUt i lit i es commi ttees. Th is hea ring 'prov i ded ass i stance in establishing legislative priorities for the implementation of specific reconwnenda t ions. Legislative and administrative adoption of specific recommendations presented in this report will streamline certain government operations and reduce operating costs, create a more coherent approach to energy issues, reduce the cost to util ities which must respond to State regulatory agencies, and help ensure that future electrical energy rate increases are mil"timized; Further Action Needed Monitor implementation of recommendations. -40- -• STATE OF CAL.IFORNIA GEORGE OEUKMEJIAN • • ""'01' COMMISSION ON CAl.I FORNIA STATE GOVERNMENT ORGANIZATION AND ECONOMY 11th. L aUILDING.SUITE 510, (1181 "5-2125 SACR"MENTO 95814 @ Page 1 BIBLIOGRAPHY OF REPORTS Title Date Cost - - 1. Findings' RecOl1lnendatlons Concerning Reorganlzatfon of the Executive Branch of CalIfornia State Govern- ment 2. Findings and Recommendations Concerning OrganizatIon for Central Staff Services 3. FIndings and Recommendations Concerning Automotive Fleet Management 4. Proposals Relating to Inheritance Tax AdminIstratIon (lETTER) 5. Need for Revenue Unification (LETTER) 6. Management Man1X)Wer Requl raments 7. Engineering Costs In the Dlv.lsion of HIghways (LETTER) 8. The Use of Boards and COftI'I1fsslons In the Resources Agency 9. Program Budgeting (lETTER) 10. Statement of the Commlsslon1s 1967 legislatIve Interests, (placing top prlodty on unIfication of tax collection activItIes, procedural changes that wIll result in direct economies I~ the operation of December 31, 1962 Nle March 11, 1963 NIC June 24, 1963 NIC December 28, 1%4 Nle Dec_er 28, 1964 NIC February 23, 1965 Nle Apri 1 7, 1965 NIC AprIl 9, 1965 Nle February 28, 1966 Nle the state government, etc.) (lmER) . December 12, 1966 Nle II. The Cal ffomia State Highway ConInlsslon and Its ReI atlonsh I p to the State Transportation Agency, the Department of Public Works, and Division of HIghways (lETTER) 12. An Examination of the Department of Professional and VocatIonal Standards 13. Report on CalifornIa Statutory Salaries of ExecutIve Branch of 'Government , 14. A Study of the Department of IndustrIal Relations 15. A Study of the Need fora Matedals Management System December 28, 1966 September 15, 1967 December 11, 1968 December 4, 1969 May 14, 1970 As indicated~ thelte is a ehaltge ~ postage inc Z.uded~ fer z-eporls weI' 2S pp in 14ngth. pubZuhed aftez- 1981. Make (iheeks payabZe to "Ccmrrislrion on Ozoga7ri.za'tion & Ec01ftJfJTY" and foZ"rlJa%'d to the abwe adtJ:ztBSS indiaati.?f(J a...iI'ed daaument. -41- Nle Nle NIC Nle Nle STATt OF CALIFORNIA GEORGE DEUKMEJIAN, GoIMmor COMMISSION ON CALIFORNIA STATE GOVERNMENT ORGANIZATION AND ECONOMY 11t". L BUILDING, SUITt 510, Un61 "5-2125 SACfllAMINTO 151'4 BIBLIOGRAPHY OF REPORTS Page 2 ~ ~ TItle Date Cost 16. A Pilot Study of Cal ifornla State Employee Workmenls Compensation, and other Work-Related DIsabIlity Senefl ts 17. Report onloeal Ca1tfornla FaIrs Receiving State Ftnancial Support 18. Study of Salaries of Executive and Adm'nistr~tive Positions in CalIfornIa State Government 19. Preliminary FIndings of SubCommittee on California Division of Highways Excess Right of way 20. A Study of the School BuIlding-Aid Program 21. The Internal AudIting Program in the ExecutIve Branch of California State Government 22. Administration of the HUD-7ot Comprehens Ive Planning Assistance Grant Program by tne State of CalifOrnia 23. A Study of the California State Public UtIlItIes Comml 55 Ion 24. A ,Review of Callfornials Vehicle EmIssion Control Program 25. A Study of the AdministratIon of State Health Programs .. 26. Supplemental Report on licensing and Certification, Department of Health 27. Supplemental Report on State HospItals, Department of Health 28. Should Social Security Coverage Be Continued for CalIfornIa State Employees? 29. A Study of the CalIfornia Department of Transportat Ion , 30. A Study of the CalifornIa Department of Motor VehIcles Hay 15, 1970 May 1, 1971 January 10, 1972 January 12, 1972 June 4, 1973 March 21, 1974 August 5, 1974 December 13, 1974 January 15, 1975 . January 14, 1976 March 1977 AprIl 1977 AprIl 1977 Hay 1977 Hay 1977 As indicated, there is a chtz.toge, postage incZuded, for repons (]f)er 2S pp in Zength pubUshed after 1981. Make checks payabZe to "COIfI1fission on Organization & Economy" and f~ to the above address indicating desired doaument. -42- Nle Nle "; Nle_ N/C N/C Nle NIC Nle Nle Nle Nle -. .. Nle :; Nle Nle Nle , STATE OF CALIFORNIA GEORGE OEUKMEJIAN. G4wemor COMMISSlON ON CALIFORNIA STATE GOVERNMENT ORGANIZATION AND ECONOMY 11th. L BUIIJ)ING. SUITE 550, (8161445-2125 SACRAMENTO 9581. BIBLIOGRAPHY OF REPORTS Page 3 TItle 31. Supplemental Report on Medl-Cal Program, Department of Health 32. Supplemental Report on Developmental Dlsabllttles Pr.ogram, Department of Health 33. A Study of the Ut tl I zat ion· of Pub 1 I c Schoo I Faclt Itles (K through 12) 34. An Analysis of Community HospItal Medi-Cal Audits 35. Comments and Recommendations Regarding Professional and ·Bus i ness L i cens I ng 36. The Status of Health PlannIng In California - A Supplementary Report 37. Administration of the Medi-Cal Program -- Second Supplementary Report Date - September 1977 DecenOer 1977 July 1978 July 1978 January 1979 February 1979 February t979 Cost - N/C N/C N/C NIC N/C N/C Nle 38. The rax Appeals System In CalifornIa May 1979 N/C 39. AdmInistration of the Mental Health & Developmental Dlsabtl itles Programs August 1979 N/C 40. Pe~sonnel Management in the State ServIce August 1979 N/C 41. Medi-Cal Reform Letter September 1979 N/C 42. 1979 Summary of Activities . March 1980 N/C 43. Health Care Del Ivery System Reform Letter May 1980 N/C 44. AdditIonal Funding for the Los Angeles Unlfted School District (LETTER) November 1980 N/C 45. A Report on the Los Angeles Unified School District 46 •. Century Freeway Letter 47. Report on· the San Juan Unified School District 48. A Report on the Role of Education in Cal ifornials System ,. the State Department of K-12 Public Education June 1981 August 1981 Jan ua ry 1 982 June 1982 N/C N/C $ 1. 80 $.2.70 As i~icated# there is a <!harge # postage inc'Luded, for reports over 2S pp in 'Length puliL1,shsd attn" 1981. Make <!he<!ks payabZe to "CoImrission on Ozog'aniaaticn & Economy" and fo'1"bJa:1td to the abOT1e address indicating dellizted document. STATE OF CALIFORNIA GEORGE DEUKMEJIAN, GowInor COMMISSION ON CALIFORNIA STATE GOVERNMENT ORGANIZATION AND ECONOMY 11th. L BUILDING, SUITE 110, (11""5-2125 SACRAMENTO "'4 BIBLIOGRAPHY OF REPORTS Titl e 49. Horse Racing in Cal ifornia: Revenue and Regulation 50. Century Freeway Letter 51. Office of Special Health Care Negotiations (Letter) 52. Review of Cost Savings Associated with Conversion of Guadalupe College into a Women's Prison 53. Review of the Department of Transportation's Highway Planning and Development Process 54. Cal ifornia's K-12 Education Funding (Letter Report) 55. THE BUREAUCRACY OF CARE • Continuing Policy Issues for Nursing Home Services and Regulation 55-a EXECUTIVE SUMf'lARY OF liTHE BUREAUCRACY OF CARE" 56. Los Angeles County Contracting Out (Letter Report) 57. Community Residential Ca're in Cal ifornia - Community Care as a Long Term Care Service 58. State Employee Air Travel (Letter Report) 59. A Study of the Organization and ~oordination of Electric Energy Planning and Electric Utility Regu- lation in California , Page 4 Date - July 1982 December 21, 1982 /'larch 15, 1983 /'larch 25, 1983 June 1983 June 20, 1983 August 1983 August 1983 November 1983 December 1983 February 1984 February 1984 Cost - $ 3.60 NIC NIC ~. Nle r.: $ 2.70 NIC $14.40 $ 1.80 NIC $ 5.80 Nle $ 2.70 ., As indicated» there is a oharge» postage incZuded» for reports 0'tJe1' 25 pp in Zength pubUshed after 1981. Make oheoks payabZe to "Cotmrission on Organiaation & Ec01"fC1l'rY" and f01'!lX1.1'd to the above address indicating desired doawnent. -44·