Document alpinecountyca_gov_doc_f2ee51b28e

BOARD OF SUPERVISORS COUNTY OF ALPINE, STATE OF CALIFORNIA AGENDA REGULAR MEETING TUESDAY, JULY 20, 2021 09:00 AM OPEN SESSION – 09:00 AM January Riddle District 1 Board Chambers Ron Hames District 2 County Administration Building Irvin Jim District 3 99 Water Street Terry Woodrow District 4 – Chair Markleeville, CA – 96120 David Griffith District 5 – Vice Chair Nichole Williamson Margaret Long Teola L. Tremayne County Administrative Officer County Counsel County Clerk and [PHONE REDACTED] [PHONE REDACTED] Ex-officio Clerk to the Board [PHONE REDACTED] IMPORTANT NOTICE REGARDING ALPINE COUNTY BOARD OF SUPERVISORS MEETING TELECONFERENCE INFORMATION As authorized by Governor Newsom’s Executive Order, N-29-20, dated March 17, 2020, the meeting will be held via teleconferencing with members of the Board attending from separate remote locations. This altered format is in observance of recommendations by local officials that precautions be taken, including social distancing, to address the threat of COVID-19. Important Notice to the Public Regarding COVID-19 Based on guidance from the California Department of Public Health and the California Governor’s Officer, in order to minimize the spread of the COVID-19 virus, please note the following: 1. There will be limited public access to the physical location of the meeting open to the public. You may participate in the Zoom Webinar, including listening to the meeting and providing public comment, by following the instructions below. To join the meeting by computer: Visit Or visit click on "Join A Meeting" and use the Zoom Meeting ID 930 3615 3372. To join the meeting by telephone: Dial (253) 215-8782 or (346) 248-7799 or (669) 900-9128, then enter Webinar ID: 930 3615 3372. To provide public comment (at appropriate times) during the meeting, press *9 to raise your hand. 2. If you are unable to join the Zoom Webinar of the Board meeting you may still view the live stream of the meeting by visiting http://alpinecountyca.iqm2.com/citizens/default.aspx Submission of Public Comments for the record: For those wishing to make public comments at the Board meeting, please submit your comments ---PAGE BREAK--- Board of Supervisors Agenda for Tuesday July 20, 2021 Page 2 DRAFT for Agenda Review electronically for the record. Comments will not be read aloud at the meeting. Email comments must be submitted to the County Clerk at [EMAIL REDACTED]. Comments may also be submitted though the Alpine County website form http://alpinecountyca.gov/FormCenter/County-Clerk-5/Public- Comment-Form-42. All documents submitted during the meeting are available in the County Clerk’s Office. Reading of Public Comments: The County Clerk will not read electronic comments. The public has the opportunity to participate and comment through the Zoom meeting information above. The email comments submitted shall become part of the record of the Board meeting. 1. CALL TO ORDER REGULAR MEETING 2. OPEN SESSION - PLEDGE OF ALLEGIANCE 3. ORAL COMMUNICATION - GENERAL PUBLIC COMMENT This portion of the meeting is an opportunity for members of the public to address the Board of Supervisors on subjects relating to county business. No action can be taken on matters not listed on the agenda. Each member of the public who wishes to address the Board shall be allotted three minutes and no more than three individuals shall address the same subject. Time permitting, at the discretion of the Chair, time allotted may be increased or decreased depending on the number of speakers and available time. 4. DEPARTMENT ANNOUNCEMENTS 5. ADMINISTRATIVE ANNOUNCEMENTS 6. BOARD MEMBER'S ANNOUNCEMENTS OR REPORTS 7. CONSENT AGENDA These matters are expected to be routine and non-controversial and are usually approved by a single majority vote without discussion. Items can be removed from the consent agenda to be discussed and considered separately. Prior to approval of the consent agenda the chair will announce that comments or questions will be taken from members of the public, staff or the Board on consent agenda items when the comment does not necessitate the item being removed for separate action. 7.1. Request approval of regular meeting minutes of 07/06/2021 - County Clerk 7.2. Request approval of County Claims. - County Clerk 7.3. Request approval of amended Alpine County Salary Schedule as required by California Code of Regulations (CCR) section 570.5. - Deputy CAO to Personnel and Risk Management 7.4. Request approval of 2021-2022 Victim Witness Grant application to the California Office of Emergency Services. - District Attorney 7.5. ADDENDUM: Request reappointment of Virginia Craik representing District 2 and Stacey James representing District 3 to the Library Commission for the terms July 1, 2021 to June 30, 2025. - County Clerk ---PAGE BREAK--- Board of Supervisors Agenda for Tuesday July 20, 2021 Page 3 DRAFT for Agenda Review 7.6. ADDENDUM: Request re-appointment of Nick Hartzell representing District 1 and Tom Sweeney representing District 2 to the Planning Commission for the terms July 1, 2021 to June 30, 2025. - County Clerk 7.7. ADDENDUM: Request appointment of JT Chevallier representing the non-elected appointee position on the Central Sierra Economic Development District Governing Board. - County Clerk 8. PUBLIC HEARINGS None 9. REGULAR AGENDA - UNFINISHED BUSINESS 9.1. CONTINUED: Request approval of the revised Alpine County COVID-19 Prevention Plan per the Occupational Safety and Health Standards Board Emergency Temporary Regulation. - Deputy CAO to Personnel and Risk Management 9.2. CONTINUED: Request approval of the 2020 Child Welfare Services (CWS) System Improvement Plan (SIP) annual update report. - CAO/HHS Director 10. REGULAR AGENDA - NEW BUSINESS 10.1. (9:30 AM) Presentation by Nobel Grand Humbug of the Snowshoe Thompson Chapter 1827 of E. Clampus Vitus Jordan Smith regarding a request to place historical plaques in Heritage Park for Jedediah Smith and Peter Ranne. - Deputy CAO to Personnel and Risk Management 10.2. (10:00 AM) ADDENDUM: Presentation and discussion of Alpine County COVID-19 Response Report by Public Health Officer Dr. Richard Johnson. - CAO/HHS Director 10.3. ADDENDUM: Request the Senior Building Maintenance Worker position on the allocation list be funded and direct Finance to make the appropriate modifications. - Community Development Director 10.4. Resolution to approve appointment of Nichole Williamson as acting Behavioral Health Services Director effective 7/8/2021 as the formal signing agent for Behavioral Health Services until further notice. - Behavioral Health Director 10.5. Request approval to dispense with public bidding procedures for the development of the Commercially Sexually Exploited Children protocol and procedures, and the provision of Trauma Informed Training in the amount of $48,500 for the term of July 1, 2021 through June 30, 2022. - CAO/HHS Director 10.6. Request approval of contract with Kings View Corporation for Electronic Health Records System, Health Analytics and All Pay Sources Billing Services in the amount of $371,341 for the term 07/01/2021-06/30/2024. - Behavioral Health Director 11. ADJOURN TO ANY OF THE FOLLOWING AGENCIES FOR WHICH THE BOARD OF SUPERVISORS SITS AS OFFICERS: BOARD OF EQUALIZATION, LOCAL TRANSPORTATION COMMISSION, WATER AGENCY ---PAGE BREAK--- Board of Supervisors Agenda for Tuesday July 20, 2021 Page 4 DRAFT for Agenda Review A. The Board of Supervisors will adjourn to the Local Transportation Commission meeting at 11:00 am and reconvene to the Board of Supervisor meeting, if necessary. 12. CLOSED SESSION 12.1. Closed Session: Conference With Labor Negotiator - (GC§ § 54954.5 And 54957.6) Agency Designated Representatives: Margaret Long. Employee Organization: Alpine County Deputy Sheriff's Association (DSA), UDW Homecare Providers Union (IHSS) - Deputy CAO to Personnel and Risk Management 13. ADJOURNMENT The Board will adjourn to the next regular meeting of Tuesday, August 3, 2021 at 9:00 AM at Alpine County Government Center, 99 Water Street, Markleeville, California. Teola L. Tremayne, County Clerk and ex officio Clerk to the Board of Supervisors By: Patricia Griffin, Assistant County Clerk ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Teola Tremayne, County Clerk DATE OF MEETING: July 20, 2021 PREPARED BY: PJ Griffin, Assistant County Clerk TITLE: Request approval of regular meeting minutes of 07/06/2021 SUMMARY: RECOMMENDED ACTION: Approve minutes of 07/06/2021. ISSUE STATEMENT AND DISCUSSION: FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $0.00 $0.00 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: INSTRUCTIONS TO CLERK: 7.1 Packet Pg. 5 ---PAGE BREAK--- Board of Supervisors ALPINE COUNTY Board Chambers County Administration Building Markleeville, CA 96120 Telephone (530) 694-2281 MINUTES JULY 6, 2021 1. CALL TO ORDER REGULAR MEETING Chair Terry Woodrow called the Regular Meeting to order at 9:00 AM with Supervisors January Riddle, Ron Hames, Irvin Jim, Terry Woodrow, and David Griffith present. 2. OPEN SESSION - PLEDGE OF ALLEGIANCE 3. ORAL COMMUNICATION - GENERAL PUBLIC COMMENT Sierra Nevada Conservancy (SNC) representative Andy Fristensky provided clarifying information regarding SNC Grant opportunity requirements and how applications are evaluated and scored in relation to public and privately owned lands. Fristensky explained that the SNC evaluated projects based on their landscape resilience and maximum public benefit as opposed to projects that procure private owners defensible space. Fristensky explained that SNC has and would work on private lands, even within defensible space areas so long as it is part of a larger project that had a great amount of public benefit. Alpine Fire Safe Council representative Kris Hartnett gave a presentation regarding the Council’s upcoming grant application submission at the request of Board Members. Alpine Watershed Group (AWG) Program Manager Mo Loden provided information on upcoming AWG meeting on Tuesday, July 13, 2021 at 1:30pm at the Markleeville Library Park and Markleeville Creek Day scheduled for September 18, 2021. 4. DEPARTMENT ANNOUNCEMENTS Librarian/Archivist Rita Lovell reported that the Library was recruiting for several positions for the libraries in both Markleeville and Bear Valley. Lovell announced that the library was open for appointments and was able to accommodate several drop-ins as space allowed. Assessor/Recorder Donald O’Connor reported that the 21-22 Tax property tax roll was rolled out with an increase in real property tax and a slight decrease in personal property tax. Undersheriff Tom Minder provided an update regarding incidents that took place over the previous weekend including several area fires. Community Development Director Debbie Burkett announced the hiring of new Building and Grounds Supervisor, Clayton Kelley. 7.1.a Packet Pg. 6 Attachment: BOS Unapproved Minutes 07.06.2021 (BOS minutes 07/06/2021) ---PAGE BREAK--- Board of Supervisors Minutes for Tuesday July 6, 2021 Page 2 In response to Supervisor Griffith’s question regarding Planning Commission Vacancies, Assistant County Clerk, Pj Griffin stated that there were currently two vacancies following the expiration of terms that the notice had to be posted for a 10-day period before appointments to the Commission could be made. Griffin stated that applications had been received by the Clerk’s Office and the appointments would be brought to the next Board meeting. County Counsel Margaret Long reported that County Counsel would be sending out a calendar regarding County Counsel office hours in the upcoming week. First 5 Alpine Executive Director Amy Broadhurst announced an upcoming summer pop-up playgroup event scheduled for July 20, 2021 at the Markleeville Library Park and a second one August 25, 2021 at the Hung-A-Lel-Ti gym. Broadhurst stated that the Commission was working on getting dates set for Bear Valley. Mental Health Services Act Coordinator Dawn Riddle reported that yoga would be offered in person in Bear Valley at the ball field on Monday’s from 5:00 – 6:00 pm and at the Markleeville Library Park Tuesday’s and Thursday’s from 5:30 – 6:30 pm. Interim Director of Finance Craig Goodman provided an update regarding the FY19/20 audit, 2021 year end process, next fiscal year’s budget process, and the property tax roll out status. 5. ADMINISTRATIVE ANNOUNCEMENTS CAO/HHS Director Nichole Williamson provided a report on behalf of Eastern Alpine Fire Administrator Chief Terry Hughes regarding on-going area wildfires. Chief Hughes passes on his appreciation to Stacey Saucito, incident commander for the Carson Ranger District on her excellent work. 6. BOARD MEMBER'S ANNOUNCEMENTS OR REPORTS Due to time constraints, Board Members Riddle, Jim and Chair Woodrow opted to provide their reports at the next meeting. Supervisor District 2 Ron Hames – discussed possible shooting restrictions in the Humbolt- Toyabie National Forest. Supervisor District 5 David Griffith – reported that there were 18 applications received for the Resource Advisory Council. 7. CONSENT AGENDA Matters that are routine and non-controversial and are usually approved by a single majority vote without discussion. Items can be removed from the consent agenda to be discussed and considered separately. MOTION Hames / SECOND Griffith approving the Consent Agenda as follows: AYES: Riddle, Hames, Jim, Woodrow, Griffith; MOTION CARRIED. 7.1. Approval of regular meeting minutes of 06/15/2021 - County Clerk 7.2. Approval of County Claims. - County Clerk 7.1.a Packet Pg. 7 Attachment: BOS Unapproved Minutes 07.06.2021 (BOS minutes 07/06/2021) ---PAGE BREAK--- Board of Supervisors Minutes for Tuesday July 6, 2021 Page 3 7.3. This item was pulled. 7.4. Approval to replace the position of Deputy Auditor on the Finance Department's position allocation with a Chief Deputy Auditor position effective 8/3/2021. - Deputy CAO to Personnel and Risk Management 7.5. This item was pulled. 7.6. Approval of a contract between Mountain Valley Emergency Medical Services Agency and Alpine County in the amount of $499.40 for emergency medical services from July 1, 2021 to June 30, 2022. - Deputy CAO to Personnel and Risk Management 7.7. Approval of Contract No. CC2021-amendment #5 to contract CC2018-24 with California Association of Environmental Health Administrators (CAEHA) for Environmental Health Services to increase compensation for D. Lampson's services to $106.09 per hour and the annual amount to $148,526. - CAO/HHS Director 7.8. Approval of an increase in appropriations by $83,491 to 149-1449-321350 Fire/Rescue Reimbursement and 149-149-501800 Overtime-Mutual Aid for the Mutual Aid payout. - Requires 4/5th vote - Sheriff 7.9. This item was pulled. 7.10. Appointment of Kate Harvey to the Mental Health Board representing Consumer Member for the term expiring May 30, 2023 and re-appointment of Jane Sweeney representing Public Interest Representative for the term expiring May 30, 2024. - County Clerk 7.11. Appointment of Stacey James to the Alpine County Advisory Redistricting Commission representing District 3. - County Clerk ITEMS PULLED FOR SEPARATE ACTION 7.3. Request approval of Library/Museum/Archives Director job description ; direct Finance Department to add the position to the position allocation list at Unrepresented Exempt Classification Range $6251-$6899 per month and remove the position of County Librarian; make budget appropriations and reclassify Rita Lovell to the position of Library/Museum/Archives Director Step 2 $6407/Month effective 7/1/2021. - Deputy CAO to Personnel and Risk Management Supervisor Griffith reported that there were concerns from the Historical Society regarding the position change and suggested that the Board hear them before making a decision. CAO/HHS Director Nichole Williamson stated that the Museum Curator hired just a week before had already resigned. Markleeville Resident Karen Dustman stated that the Historical Society had concerns that the Memorandum of Understanding (MOU) between the Historical Society and Alpine County was not followed, that they had questions regarding the changes the new position would make regarding the Historical Society and their close involvement with the museum and its curator. 7.1.a Packet Pg. 8 Attachment: BOS Unapproved Minutes 07.06.2021 (BOS minutes 07/06/2021) ---PAGE BREAK--- Board of Supervisors Minutes for Tuesday July 6, 2021 Page 4 Woodfords resident and Historical Society member Jim Holdridge reported that the Historical Society had worked closely with the Curators in the past and was concerned as to why there was no communication between the Historical Society and the County regarding the position change. Holdridge strongly recommended that the Board continue the item to the next meeting and arrange to meet and discuss the issue with the historical society in the meantime. MOTION Hames / SECOND Riddle approving of Library/Museum/Archives Director job description ; directing Finance Department to add the position to the position allocation list at Unrepresented Exempt Classification Range $6251-$6899 per month and remove the position of County Librarian; make budget appropriations and reclassify Rita Lovell to the position of Library/Museum/Archives Director Step 2 $6407/Month effective 7/1/2021 with the understanding that staff would meet with the Historical Society to answer questions. AYES: Riddle, Hames, Woodrow, NOES: Jim, Griffith; MOTION CARRIED. 7.5. Request approval of the revised Alpine County COVID-19 Prevention Plan per the Occupational Safety and Health Standards Board Emergency Temporary Regulation. - Deputy CAO to Personnel and Risk Management Supervisor Griffith stated that he had several questions that were unable to be answered due to the holiday weekend and asked that the item be continued. This item was continued. 7.9. Request approval of Memorandum of Understanding (MOU) with the Golden State Financing Authority (GSFA) in support of GSFA’s application for a grant from the Economic Development Administration (EDA) to develop a broadband strategy for Alpine County with a County match not to exceed $25,000. Requires 4/5 vote - Supervisor District 5 Supervisor Griffith asked that the Clerk’s Instructions be changed to request that two originals be mailed to Golden State Financing Authority (GSFA). MOTION Griffith / SECOND Hames approving Memorandum of Understanding (MOU) with the Golden State Financing Authority (GSFA) in support of GSFA’s application for a grant from the Economic Development Administration (EDA) to develop a broadband strategy for Alpine County with a County match not to exceed $25,000 and changing the Clerk’s Instructions as discussed. AYES: Riddle, Hames, Jim, Woodrow, Griffith; MOTION CARRIED. 8. PUBLIC HEARINGS None. 9. REGULAR AGENDA - UNFINISHED BUSINESS 7.1.a Packet Pg. 9 Attachment: BOS Unapproved Minutes 07.06.2021 (BOS minutes 07/06/2021) ---PAGE BREAK--- Board of Supervisors Minutes for Tuesday July 6, 2021 Page 5 9.1. Request approval of Contract for a professional services agreement between the County of Alpine and MGT of America Consulting, LLC ($29,829) for the provision of Cost Allocation Plan preparation services for five fiscal years retroactive to July 1, 2020, due to Finance oversight, and ending June 30, 2025, with County's option for June 30, 2024 and June 30, 2025 and authorize Board Chair to sign. - Interim Director of Finance Interim Director of Finance Craig Goodman explained the necessity for the contract. MOTION Griffith / SECOND Hames approving Contract No. CC2021-13 for a professional services agreement between the County of Alpine and MGT of America Consulting, LLC ($29,829) for the provision of Cost Allocation Plan preparation services for five fiscal years retroactive to July 1, 2020, due to Finance oversight, and ending June 30, 2025, with County's option for June 30, 2024 and June 30, 2025 and authorizing the Board Chair to sign. AYES: Riddle, Hames, Jim, Woodrow, Griffith; MOTION CARRIED. 9.2. Request approval of obligating funds for Secure Rural Schools and Community Self- Determination Act of 2000, Title III and approval of proposed plan. The 45 day comment period ends on August 20, 2021. - CAO/HHS Director CAO/HHS Director Nichole Williamson reported that funding was redistributed from the Alpine County Sheriff’s Office and Alpine Fire Safe Council to Community Development for clean up of the biomass pile. MOTION Griffith / SECOND Riddle to Adopt Action Item DOC-2021-66: CONTINUED: Request approval of obligating funds for Secure Rural Schools and Community Self- Determination Act of 2000, Title III and approval of proposed plan. The 45 day comment period ends on August 20, 2021. AYES: Riddle, Hames, Jim, Woodrow, Griffith; MOTION CARRIED. 9.3. CONTINUED: Discussion and possible direction to staff to provide necessary information to identify property owners within the wildfire risk mitigation tier 1 area to the Alpine Biomass Collaborative (ABC) in order for ABC to meet with and educate these homeowners on potential fuel reduction projects with Alpine Biomass Collaborative on the east slope. - Supervisor District 5 Supervisor Griffith stated that he was able to get the needed information and asked to pull the item. This item was pulled. 10. REGULAR AGENDA - NEW BUSINESS 10.1. Presentation by CalRecycle representative regarding SB 1383 (Senate Bill 1383, Short-lived Climate Pollutants: Organic Waste Reduction) - Community Development Director 7.1.a Packet Pg. 10 Attachment: BOS Unapproved Minutes 07.06.2021 (BOS minutes 07/06/2021) ---PAGE BREAK--- Board of Supervisors Minutes for Tuesday July 6, 2021 Page 6 Cal Recycle representative Robert Carlson gave a presentation regarding SB 1383. In response to Supervisor Riddle’s question regarding funding for the bill, Carlson stated that the bill did not include any funding, that Alpine County would qualify for many of the waivers, and that there were one or two pending legislative bills to provide funding for the programs discussed. 10.2. Request adoption of a resolution to rescind and replace Resolution No. R2021-24 adopting an expenditure plan for Fiscal Year 2021/2022 Funded By SB1: The Road Repair and Accountability Act of 2017, to include the useful life of the project of 7-10 years - Community Development Director Community Development Directory Debbie Burkett provided a brief explanation regarding the need for the minor change to the resolution. MOTION Hames / SECOND Griffith adopting Resolution No. R2021-39 to rescind and replace Resolution No. R2021-24 adopting an expenditure plan for Fiscal Year 2021/2022 Funded By SB1: The Road Repair and Accountability Act of 2017, to include the useful life of the project of 7-10 years. AYES: Riddle, Hames, Jim, Woodrow, Griffith; MOTION CARRIED. 10.3. Discussion and possible direction to staff on whether to apply for the California Fire Safe Council 2021 County Coordinator Grant Program. - Community Development Director 10.4. Request approval of Amendment # 6 to Contract 2010-73 with Quincy Engineering for the Hot Springs Road Bridge Replacement project. Contract amendment amount not to exceed $96,000. - Community Development Director MOTION Hames / SECOND Griffith approving Contract No. CC2021-23 amendment # 6 to Contract 2010-73 with Quincy Engineering for the Hot Springs Road Bridge Replacement project. Contract amendment amount not to exceed $96,000. AYES: Riddle, Hames, Jim, Woodrow, Griffith; MOTION CARRIED. 10.5. Request approval of the 2020 Child Welfare Services (CWS) System Improvement Plan (SIP) annual update report. - CAO/HHS Director Supervisor Griffith requested that the report be editing to spell out acronyms for better understanding. CAO/HHS Director Nichole Williamson stated that the department would make the changes and bring it to the next meeting. This item was continued. 10.6. Request adoption of sole source resolution, and approval of contract with Alpine County Unified School District for Positive Behavioral Interventions and Supports services in the amount of $75,734 for the term 07/01/2021-06/30/2023. (Requires 4/5 vote). - Behavioral Health Director 7.1.a Packet Pg. 11 Attachment: BOS Unapproved Minutes 07.06.2021 (BOS minutes 07/06/2021) ---PAGE BREAK--- Board of Supervisors Minutes for Tuesday July 6, 2021 Page 7 Behavioral Services Director Gail St. James provided background information and read the Resolution. MOTION Riddle / SECOND Hames adopting Resolution No. R2021-38 sole source resolution, and approving Contract No. CC2021-22 with Alpine County Unified School District for Positive Behavioral Interventions and Supports services in the amount of $75,734 for the term 07/01/2021-06/30/2023. (Requires 4/5 vote). AYES: Riddle, Hames, Jim, Woodrow, Griffith; MOTION CARRIED. 11. ADJOURN TO ANY OF THE FOLLOWING AGENCIES FOR WHICH THE BOARD OF SUPERVISORS SITS AS OFFICERS: BOARD OF EQUALIZATION, LOCAL TRANSPORTATION COMMISSION, WATER AGENCY The Board adjourned to the Local Transportation Commission Meeting at 11:21AM, and to the Board of Equalization at 11:39AM and reconvened as the Board of Supervisors. 12. CLOSED SESSION 12.1. Closed Session: Conference With Labor Negotiator - (GC§ § 54954.5 And 54957.6) Agency Designated Representatives: Margaret Long. Employee Organization: Alpine County Deputy Sheriff's Association (DSA), UDW Homecare Providers Union (IHSS) - Deputy CAO to Personnel and Risk Management Information and direction was given. 12.2. Conference with Legal Counsel Pursuant to Gov. Code § 54956.9 – Existing Litigation. (1 case) Alpine County V. STPUD Case# 2:20-cv-01514-WBS-CKD - Deputy CAO to Personnel and Risk Management Information and direction was given. 12.3. Closed Session-PUBLIC EMPLOYEE PERFORMANCE EVALUATION: CAO/HHS Director (GC § 54956.9 and 54957) - Deputy CAO to Personnel and Risk Management Information was given. The Board directed the CAO/HHS Director Nichole Williamson to re-open the County for business on Monday, July 12, 2021. 13. ADJOURNMENT The Board adjourned to the next regular meeting of Tuesday, July 20, 2021 at 9:00am at the County Administrative Office Building, Markleeville, California. Terry Woodrow, Chair, Board of Supervisors County of Alpine, State of California ATTEST: Teola L. Tremayne, County Clerk & ex officio Clerk of the Board of Supervisors 7.1.a Packet Pg. 12 Attachment: BOS Unapproved Minutes 07.06.2021 (BOS minutes 07/06/2021) ---PAGE BREAK--- Board of Supervisors Minutes for Tuesday July 6, 2021 Page 8 By: Patricia Griffin, Assistant County Clerk *A complete audio recording of this meeting is available on the County website* www.alpinecountyca.gov 7.1.a Packet Pg. 13 Attachment: BOS Unapproved Minutes 07.06.2021 (BOS minutes 07/06/2021) ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Teola Tremayne, County Clerk DATE OF MEETING: July 20, 2021 PREPARED BY: PJ Griffin, Assistant County Clerk TITLE: Request approval of County Claims. SUMMARY: RECOMMENDED ACTION: Approve County Claims ISSUE STATEMENT AND DISCUSSION: FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $0.00 $0.00 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: INSTRUCTIONS TO CLERK: 7.2 Packet Pg. 14 ---PAGE BREAK--- 7.2.a Packet Pg. 15 Attachment: Check Register 7.9.21 (County Claims) ---PAGE BREAK--- 7.2.a Packet Pg. 16 Attachment: Check Register 7.9.21 (County Claims) ---PAGE BREAK--- 7.2.a Packet Pg. 17 Attachment: Check Register 7.9.21 (County Claims) ---PAGE BREAK--- 7.2.a Packet Pg. 18 Attachment: Check Register 7.9.21 (County Claims) ---PAGE BREAK--- 7.2.a Packet Pg. 19 Attachment: Check Register 7.9.21 (County Claims) ---PAGE BREAK--- 7.2.b Packet Pg. 20 Attachment: Check Register Property Tax Refunds FY 20.21 (County Claims) ---PAGE BREAK--- 7.2.b Packet Pg. 21 Attachment: Check Register Property Tax Refunds FY 20.21 (County Claims) ---PAGE BREAK--- 7.2.b Packet Pg. 22 Attachment: Check Register Property Tax Refunds FY 20.21 (County Claims) ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Sarah Simis, Deputy CAO to Personnel and Risk Management DATE OF MEETING: July 20, 2021 PREPARED BY: Michelle Beckwith, Administrative Assistant TITLE: Request approval of amended Alpine County Salary Schedule as required by California Code of Regulations (CCR) section 570.5. SUMMARY: CalPERS requires public members pursuant to CCR section 570.5 to determine employee compensation by reference to an approved and adopted salary schedule that identifies the position title for every employee position and shows the pay rate for each identified position. Changes to the Salary Schedule are to remove County Librarian and add Library-Museum-Archives Director, which was approved on July 6, 2021. RECOMMENDED ACTION: Approve amended salary schedule. ISSUE STATEMENT AND DISCUSSION: FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $ 00.00 $ 00.00 $ 00.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: INSTRUCTIONS TO CLERK: Finance Personnel 7.3 Packet Pg. 23 ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Michael Atwell, District Attorney DATE OF MEETING: July 20, 2021 PREPARED BY: Debbie Diamond, Admin Assistant TITLE: Request approval of 2021-2022 Victim Witness Grant application to the California Office of Emergency Services. SUMMARY: The Victim Witness Grant provides assistance to victims and witnesses of crime in Alpine County. The Victim-Witness Grant Application will be requesting a grant of $186,697 (based on the 2021-22 Grant Award) from California Office of Emergency Services’ Victim Witness Assistance Program for the fiscal year 2021-2022. This Grant will finance the Victim Witness Assistance Program in Alpine County for the coming fiscal year beginning October 1, 2021. The Grant includes out of state travel for the Victim Witness Coordinator for Annual Victim Witness Conferences. RECOMMENDED ACTION: Approve grant application. ISSUE STATEMENT AND DISCUSSION: The Grant sub-award has been submitted to California Office of Emergency Services in draft form. A signature by the Board of Supervisors is needed to put our grant into award and finalize our application. There may be minor changes made to the Grant Application, but not to the amount awarded to Alpine County. FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $186,697 $0.00 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: California Office of Emergency Services, VOCA and VWAO Funds. INSTRUCTIONS TO CLERK: Copy of signed Application to District Attorney’s Office. 7.4 Packet Pg. 24 ---PAGE BREAK--- 7.4.a Packet Pg. 25 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 26 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 27 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 28 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 29 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 30 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 31 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 32 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 33 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 34 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 35 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 36 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 37 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 38 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 39 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 40 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 41 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 42 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 43 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 44 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 45 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 46 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 47 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 48 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 49 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 50 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 51 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 52 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 53 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 54 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 55 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 56 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 57 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 58 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 59 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 60 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 61 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 62 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 63 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- 7.4.a Packet Pg. 64 Attachment: Victim Witness Grant App. Signed (Request Approval of 2021-2022 Victim Witness Grant) ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Teola Tremayne, County Clerk DATE OF MEETING: July 20, 2021 PREPARED BY: PJ Griffin, Assistant County Clerk TITLE: ADDENDUM: Request reappointment of Virginia Craik representing District 2 and Stacey James representing District 3 to the Library Commission for the terms July 1, 2021 to June 30, 2025. SUMMARY: The purpose of the Library Commission is to advise and make recommendations to the Board of Supervisors concerning policies and procedures for the operation of the county free library system, working in cooperation with the Alpine County Library. Letters were sent to commissioners with upcoming term expirations on June 3, 2021. A Notice of Vacancy was posted on July 1, 2021 for the three expiring positions representing Districts two three and five James’ application was received on June 22, 2021, Craik’s application was received on June 24, 2021. RECOMMENDED ACTION: Approve Re-appointments ISSUE STATEMENT AND DISCUSSION: FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $0.00 $0.00 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: N/A INSTRUCTIONS TO CLERK: Letter to applicant and BOS file 7.5 Packet Pg. 65 ---PAGE BREAK--- 7.5.a Packet Pg. 66 Attachment: LC Application - James (Library Commission Appointment) ---PAGE BREAK--- 7.5.b Packet Pg. 67 Attachment: LC Application - Craik (Library Commission Appointment) ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Teola Tremayne, County Clerk DATE OF MEETING: July 20, 2021 PREPARED BY: PJ Griffin, Assistant County Clerk TITLE: ADDENDUM: Request re-appointment of Nick Hartzell representing District 1 and Tom Sweeney representing District 2 to the Planning Commission for the terms July 1, 2021 to June 30, 2025. SUMMARY: The representative terms for Hartzell and Sweeney expired on May 31, 2021 A notice of vacancy was posted on June 3, 2021. Sweeney’s Application was received on June 1, 2021 and Hartzell’s application was received on June 9, 2021. The Planning Commission bylaws 2.68.020 Creation-Membership states that: “The board of supervisors shall strive to select one member from each of the board of supervisor districts to serve on the commission. However, there shall be no requirement to have a commission member from each board of supervisor district. RECOMMENDED ACTION: Appoint one applicant to the Planning Commission ISSUE STATEMENT AND DISCUSSION: A Notice of Vacancy was posted at the Administration Building, Markleeville Post Office; mailed for posting to Bear Valley Post Office, Kirkwood Post Office, Woodfords Station, Woodfords Community Council and Woodfords Indian Education Center. The Notice was distributed for posting at Alpine County Unified School District, District Attorney’s Office, Alpine County Superior Court, Markleeville Library, Community Development, Health and Human Services, Probation Department and Sheriff’s Office; commission/committee vacancy list on the County’s website. FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $0.00 $0.00 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: INSTRUCTIONS TO CLERK: Letter to applicant, Community Development and BOS file. 7.6 Packet Pg. 68 ---PAGE BREAK--- 7.6.a Packet Pg. 69 Attachment: T.Sweeney PC Application (Planning Commission Appointment) ---PAGE BREAK--- 7.6.b Packet Pg. 70 Attachment: PC Application - Hartzell (Planning Commission Appointment) ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Teola Tremayne, County Clerk DATE OF MEETING: July 20, 2021 PREPARED BY: PJ Griffin, Assistant County Clerk TITLE: ADDENDUM: Request appointment of JT Chevallier representing the non-elected appointee position on the Central Sierra Economic Development District Governing Board. SUMMARY: The economic development district was created by a joint exercise of powers agreement adopted August 1976 between Alpine County, Amador County, Calaveras County and Tuolumne County; Amador City, City of Angels, City of Ione, City of Jackson, City of Plymouth, City of Sonora and the City of Sutter Creek to provide economic development planning and to participate in federal programs relating to economic development. RECOMMENDED ACTION: Appoint JT Chevallier representing the non-elected appointee position on the Central Sierra Economic Development District Governing Board. ISSUE STATEMENT AND DISCUSSION: A Notice of Vacancy was posted on June 3, 2021. Chevallier’s application was received on July 12, 2021. FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $0.00 $0.00 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: INSTRUCTIONS TO CLERK: Letter to applicant, Central Sierra Economic Development District Governing Board and BOS file. 7.7 Packet Pg. 71 ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Sarah Simis, Deputy CAO to Personnel and Risk Management DATE OF MEETING: July 20, 2021 PREPARED BY: PJ Griffin, Assistant County Clerk TITLE: CONTINUED: Request approval of the revised Alpine County COVID-19 Prevention Plan per the Occupational Safety and Health Standards Board Emergency Temporary Regulation. SUMMARY: On November 19, 2020 the Occupational Safety and Health Standards Board (OSHSB) adopted an emergency temporary regulation requiring that employers adopt and implement a COVID- 19 Prevention Program (CPP). (See 8 C.C.R. 3205.) On 6/17/2021 the Occupational Safety and Health Standards Board amended the Emergency Temporary Standards. This CPP complies with the regulatory requirements provided in Title 8 Section 3205 of the California Code of Regulations as amended on 6/17/2021. The CPP is drafted as a standalone document that can be adopted and implemented independent of the employer’s Injury and Illness Prevention Program (IIPP). RECOMMENDED ACTION: Approve plan ISSUE STATEMENT AND DISCUSSION: The following is a list of brief summary of the major changes:  Most physical distancing requirements are eliminated  Most fully vaccinated workers no longer need to wear face coverings unless there is a workplace outbreak (Requires documentation that an employee is vaccinated)  Employers must ensure that unvaccinated workers wear face coverings indoors and in shared vehicles with some exceptions.  Definition of face coverings specifically excludes scarfs, ski masks, balaclava, bandanas, turtlenecks, collars, or single layers of fabric.  Employers must provide respirators (N95 mask or similar) to unvaccinated employees who work indoors or in shared vehicles if the employees request them.  The notice and other responses to workplace COVID cases, returning to work after exposures and outbreaks are revised somewhat. The regulations do not provide for a non-enforcement period. As a result, the Division of Occupational Safety and Health (Cal/OSHA) may enforce the regulations immediately. Cal/OSHA possesses authority to issue citations, special orders and orders to take special action after investigation of hazards in a workplace. (Labor Code 6305, 6308, and 6317.) FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current (Not Applicable) $0.00 SOURCE Unanticipated Revenue From $0.00 $0.00 9.1 Packet Pg. 72 ---PAGE BREAK--- Year 3) Total Anticipated Cost Annual Year $0.00 $0.00 Contingency Other: $0.00 FUNDING SOURCE: N/A INSTRUCTIONS TO CLERK: Personnel/Risk Management 9.1 Packet Pg. 73 ---PAGE BREAK--- Revised 6/17/2021 ALPINE COUNTY COVID-19 Prevention Program (CPP) 9.1.a Packet Pg. 74 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 1 I. PURPOSE: The purpose of the Alpine County’s COVID-19 Prevention Program (“CPP”) is to provide employees a healthy and safe workplace as required under the California Occupational Safety and Health Act (Lab. Code 6300, et seq.) and associated regulations (8 C.C.R. § 3205). Nothing in this CPP precludes the County from complying with federal, state, or local laws or public health order or guidance that may recommend or require measures that are more prescriptive and/or restrictive than those that are provided herein. II. SCOPE Unless one of the exceptions provided below applies, this CPP shall apply to all Alpine County employees (hereinafter referred to as “employees”), including those who are “fully vaccinated”. The following employees are exempt from coverage under the CPP: Employees who are teleworking from home or a location of the employee’s choice that is not under the control of the County; Employees who are working in or at a work location and do not have contact with any other individuals; and Employees that because of their tasks, activities or work location have with occupational exposure as defined by the Aerosol Transmissible Diseases (“ATD”) regulation 8 C.C.R. § 5199). III. DEFINITIONS: For the purposes of the CPP, the following definitions shall apply: “Close contact COVID-19 exposure” means being within six feet of a COVID-19 case for a cumulative total of 15 minutes or greater in any 24-hour period within or overlapping with the “high-risk exposure period” as defined here. This definition applies regardless of the use of face coverings. Employees who were wearing a respirator as required by the County and who used such respirator in compliance with Title 8 Section 5144 during contact with a COVID- 19 case will be deemed not to have had close contact COVID-19 exposure. “COVID-19” means coronavirus disease, an infectious disease caused by the severe acute respiratory coronavirus 2 (SARS-CoV-2). “COVID-19 case” means a person who either: Has a positive COVID-19 test as defined in this section; Is subject to COVID-19-related order to isolate issued by a local or state health official; Has a positive COVID-19 diagnosis from a licensed health care provider; or Has died due to COVID-19, in the determination of a local health department or per inclusion in the COVID-19 statistics of a county. “COVID-19 hazard” means potentially infectious material that may contain SARS-CoV-2, the virus that causes COVID-19. Potentially infectious materials include airborne droplets, small particle aerosols, and airborne droplet nuclei, which most commonly result from a person or persons exhaling, talking or vocalizing, coughing, or sneezing, or from procedures performed on persons 9.1.a Packet Pg. 75 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 2 which may aerosolize saliva or respiratory tract fluids. This also includes objects or surfaces that may be contaminated with SARS-CoV-2. “COVID-19 means one of the following: fever of 100.4 degrees Fahrenheit or higher or chills; cough; shortness of breath or difficulty breathing; fatigue; muscle or body aches; headache; new loss of taste or smell; sore throat; congestion or runny nose; (10) nausea or vomiting; or (11) diarrhea, unless a licensed health care professional determines the person’s were caused by a known condition other than COVID-19. “COVID-19 test” means a viral test for SARS-CoV-2 that is both: Approved by the United States Food and Drug Administration (“FDA”) or has an Emergency Use Authorization (“EUA”) from the FDA to diagnose current infection with the SARS-CoV-2 virus; and Administered in accordance with the FDA approval or the FDA EUA as applicable. “Exposed group” means all employees at a work location, working area, or a common area at work, where a COVID-19 case was present at any time during the high-risk exposure period. However, if the COVID-19 case visited a work location, working area, or a common area at work for less than 15 minutes during the high-risk exposure period, and all employees were wearing face coverings at the time the COVID-19 case was present, other people at the work location, working area, or common area would not constitute part of the exposed group. Common areas at work includes bathrooms, walkways, hallways, aisles, break or eating areas, and waiting areas. However, places where employees momentarily pass through while everyone is wearing face coverings, without congregating, is not a work location, working area, or a common area at work. “Face covering” means a surgical mask, a medical procedure mask, a respirator worn voluntarily, or a woven fabric or non-woven material of at least two layers. A face covering has no visible holes or openings, and must cover the nose and mouth. A face covering does not include a scarf, ski mask, balaclava, bandana, turtleneck, collar, or single layer of fabric. “Fully vaccinated” means the County has documented that the person received, at least 14 days prior, either the second dose in a two-dose COVID-19 vaccine series or a single-dose COVID-19 vaccine. Vaccines must be FDA approved; have an emergency use authorization from the FDA; or, for persons fully vaccinated outside the United States, be listed for emergency use by the World Health Organization (WHO). “High-risk exposure period” means the following: For COVID-19 cases who develop COVID-19 from two days before they first develop until each of the following are true: it has been ten (10) days since first appeared; 24 hours have passed with no fever, without the use of fever-reducing medications; and have improved; or For COVID-19 cases who never develop COVID-19 from two days before until ten (10) days after the specimen for their first positive test for COVID- 19 was collected. 9.1.a Packet Pg. 76 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 3 “Respirator” means a respiratory protection device approved by the National Institute for Occupational Safety and Health (“NIOSH”) to protect the wearer from particulate matter, such as an N95 filtering face piece respirator. “Worksite,” for the limited purposes of COVID-19 prevention regulations only, means the building, store, facility, agricultural field, or other location where a COVID-19 case was present during the high-risk exposure period. It does not apply to buildings, floors, or other locations of the County that a COVID-19 case did not enter. IV. PROGRAM A. SYSTEM FOR COMMUNICATING WITH EMPLOYEES 1. Reporting COVID-19 Possible COVID-19 Close Contact Exposures, and Possible COVID-19 Hazards at Alpine County Worksites and Facilities The County requires that employees immediately report to their manager or supervisor or to Human Resources any of the following: the employee’s presentation of COVID- 19 the employee’s possible COVID-19 close contact exposures; possible COVID-19 hazards at County worksites or facilities. The County has not and will not discriminate or retaliate against any employee who makes such a report. 2. Accommodations Process for Employees with Medical or Other Conditions that Put them at Increased Risk of Severe COVID-19 Illness The County provides for an accommodation process for employees who have a medical or other condition identified by the Centers for Disease Control and Prevention (“CDC”) or the employees’ health care provider as placing or potentially placing the employees at increased risk of severe COVID-19 illness. For all employees who request such an accommodation, including fully vaccinated employees, the County will require that the employee provide information from the employee’s health care provider explaining why the employee requires an accommodation. The CDC identifies the following medical conditions and other conditions as placing or potentially placing individuals at an increased risk of severe COVID-19 illness The CDC guidance provides that adults of any age with the following conditions are at increased risk of severe illness from the virus that causes COVID-19: 1. Cancer 2. Chronic kidney disease 3. COPD (chronic obstructive pulmonary disease) 9.1.a Packet Pg. 77 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 4 4. Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies 5. Immunocompromised state (weakened immune system) from solid organ transplant 6. Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2) 7. Severe Obesity (BMI ≥ 40 kg/m2) 8. Pregnancy 9. Sickle cell disease 10. Smoking 11. Type 2 diabetes mellitus The CDC guidance also provides that adults of any age with the following conditions might be at an increased risk for severe illness from the virus that causes COVID-19: 1. Asthma (moderate-to-severe) 2. Cerebrovascular disease (affects blood vessels and blood supply to the brain) 3. Cystic fibrosis 4. Hypertension or high blood pressure 5. Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines 6. Neurologic conditions, such as dementia 7. Liver disease 8. Overweight (BMI > 25 kg/m2, but < 30 kg/m2) 9. Pulmonary fibrosis (having damaged or scarred lung tissues) 10. Thalassemia (a type of blood disorder) 11. Type 1 diabetes mellitus The County periodically reviews the following web address in order to account for any additional medical conditions and other conditions that the CDC has identified as placing or potentially placing individuals at an increased risk of severe COVID-19: medical-conditions.html (Last updated on May 13, 2021). Employees are encouraged to review the list of medical conditions and other condition provided above in order to determine whether they have such a condition. 9.1.a Packet Pg. 78 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 5 To request an accommodation, employees may make a request with their manager or supervisor or Human Resources. 3. COVID-19 Testing The County possesses authority to require that employees who report to work at County worksites or facilities be tested for COVID-19. Where the County requires testing, the County has adopted policies and procedures that ensure the confidentiality of employees’ medical information and comply with the Confidentiality of Medical Information Act (“CMIA”). Specifically, the County will keep confidential all personal identifying information of COVID-19 cases or persons with COVID-19 unless expressly authorized by the employee to disclose such information or as other permitted or required under the law. 4. COVID-19 Hazards The County will notify employees and subcontracted employees of any potential COVID-19 exposure at a County worksite or facility where a COVID-19 case and employees were present on the same day. The County will notify employees of such potential exposures within one business day, in a way that does not reveal any personal identifying information of the COVID-19 case. The County will also notify employees of cleaning and disinfecting measures the County is undertaking in order to ensure the health and safety of the County worksite or facility where the potential exposure occurred. B. IDENTIFICATION AND EVALUATION OF COVID-19 HAZARDS AT ALPINE COUNTY WORKSITES AND FACILITIES 1. Screening Employees for COVID-19 The County possesses authority to screen employees and require that employee self- screen for COVID-19 The County provides that employees will self-screen for COVID-19 prior to reporting to any Alpine County worksite or facility and will complete the health questionnaire when employees log on to their computers. 2. Responding to Employees with COVID-19 Should an employee present COVID-19 during a self-screen, the employee must remain at or return to their home or place of residence and not report to work until such time as the employee satisfies the minimum criteria in order to return to work (as discussed in Section IV.J. of this CPP). The County will advise employees of any leaves to which they may be entitled during this self-quarantine period, including, but not limited to COVID-19 Supplemental Paid Sick Leave (“SPSL”). Further, the County has adopted policies and procedures that will ensure the confidentiality of employees and comply with the CMIA, and the County will not disclose to other employees the fact that the employees presented COVID-19 9.1.a Packet Pg. 79 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 6 3. Alpine County’s Response to COVID-19 Cases In the event that an employee tests positive for COVID-19 or is diagnosed with COVID- 19 by a health care provider, the County will instruct the employee to remain at or return to their home or place of residence and not report to work until such time as they satisfy the minimum criteria to return to work (as discussed in Section IV.J. of this CPP). The County will advise employees of any leaves to which they may be entitled during this self-isolation period, including, but not limited to SPSL. The County complies fully and faithfully with all reporting and recording obligations as required under the law, including, but not limited to, reporting the COVID-19 case to the following individuals and entities as required based on the individual circumstances: The local health department; Cal/OSHA; Employees who were present at a County worksite or facility when a COVID-19 case was present; Employee organizations that represent employees at the County worksite or facility; Employers of any subcontracted employees who were present at the County worksite or facility; and The County’s workers’ compensation plan administrator. If possible, the County will interview the COVID-19 case(s) in order to ascertain the nature and circumstances of any contact that the employee(s) had or may have had with other employees during the high-risk exposure period. If the County determines that there were any close contact COVID-19 exposures, the County will instruct those employees to remain at their home or place of residence and not report to work until such time as the employees satisfy the minimum criteria to return to work (as discussed in Section IV.J. of this CPP). The County has adopted policies and procedures that will ensure the confidentiality of employees and comply with the CMIA. Specifically, the County will not disclose to other employees, except for those who need to know, the fact that the employee(s) tested positive for or were diagnosed with COVID-19. Further, the County will keep confidential all personal identifying information of COVID-19 cases or persons, unless expressly authorized by the employees to disclose such information or as other permitted or required under the law. 4. Workplace-Specific Identification of COVID-19 Hazards The Alpine County will periodically conduct workplace-specific assessments of all interactions, areas, activities, processes, equipment, and materials that could potentially expose employees to COVID-19 hazards. As part of this process, the County identified places (work locations, work areas, and common areas) and times when employees and individuals congregate or come in contact with one another, regardless of whether employees are performing an assigned work task or not, including, for example, during meetings or trainings, in and around entrances, bathrooms, hallways, aisles, walkways, elevators, break or eating areas, cool-down areas, and waiting areas. The County will provide notice of any such potential workplace exposure to all persons at County worksites and facilities, including employees, employees of other entities, 9.1.a Packet Pg. 80 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 7 members of the public, customers or clients, and independent contractors. The County considered how employees and other persons enter, leave, and travel through County worksites and facilities, in addition to addressing employees’ stationary workspaces or workstations. Further, the County will treat all persons, regardless of the presentation of COVID-19 or COVID-19 status, as potentially infectious. 5. Maximization of Outdoor Air and Air Filtration For indoor County worksites and facilities, the County evaluates how to maximize the ventilation of outdoor air; provide the highest level of filtration efficiency compatible with the worksites and facilities’ existing ventilation systems; and whether the use of portable or mounted High Efficiency Particulate Air (“HEPA”) filtration units, or other air cleaning systems, would reduce the risk of COVID-19 transmission. 6. Alpine County Compliance with Applicable State and Local Health Orders The County monitors applicable public health orders and guidance from the State of California and the local health department related to COVID-19 hazards and prevention. The County fully and faithfully complies with all applicable orders and guidance from the State of California and the local health department. 7. Evaluation of Existing COVID-19 Prevention Controls and Adoption of Additional Controls Periodically, the County evaluates existing COVID-19 prevention controls at the workplace and assess whether different and/or additional controls may be needed. This includes evaluation of controls related to the correction of COVID-19 hazards, physical distancing, face coverings, engineering controls, administrative controls, and personal protective equipment (PPE) (as discussed at Section VI, subsections D, and F- H of this CPP). 8. Periodic Inspections The County conducts periodic inspections of County worksites and facilities as needed to identify unhealthy conditions, work practices, and work procedures related to COVID- 19 and to ensure compliance with the County’s COVID-19 policies and procedures, including, but not limited to this CPP. C. INVESTIGATING AND RESPONDING TO COVID-19 CASES IN ALPINE COUNTY WORKSITES AND FACILITIES 1. Procedure to Investigate COVID-19 Cases The County developed a procedure for investigating COVID-19 cases in the workplace, which provides for the following: requesting information from employees regarding COVID-19 cases; contact tracing of employees who may have had a close contact COVID-19 exposure; requesting COVID-19 test results from employees who may 9.1.a Packet Pg. 81 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 8 have had a close contact COVID-19 exposure; requesting information from employees regarding the presentation of COVID-19 and identifying and recording all COVID-19 cases. 2. Response to COVID-19 Cases As provided above at Section IV.B.3., in the event that an employee tests positive for COVID-19 or is diagnosed with COVID-19 by a health care provider, the County will instruct the employee to remain at or return to their home or place of residence and not report to an County worksite or facility until such time as the employees satisfy the minimum criteria to return to work (as discussed in Section IV.J. of this CPP). a. Contact Tracing If possible, the County will interview the COVID-19 case(s) in order to ascertain the following information: the date on which the employee(s) tested positive, if or the date on which the employee(s) first presented COVID-19 if the COVID-19 case(s) recent work history, including the day and time they were last present at a County worksite or facility; and the nature and circumstances of the COVID-19 case(s)’ contact with other employees during the high-risk exposure period, including whether any such contact qualifies as a close contact COVID-19 exposure. If the County determines that there was or were any close contact COVID-19 exposures, the County will instruct those employees to remain at their home or place of residence and not report to work until such time as the employees satisfy the minimum criteria to return to work (as discussed in Section IV.J. of this CPP). Further, the County will instruct those employees to be tested for COVID-19, and that the County will provide for such testing during paid time, as discussed in subsection c. below. b. Reporting the Potential Exposure to Other Employees The County fully and faithfully complies with all reporting and recording obligations as required under the law, including, but not limited to, reporting the COVID-19 case to the individuals and entities described below. Within one business day of the time the County knew or should have known of a COVID-19 case, the County will give written notice of a potential workplace exposure to the following individuals: All employees at the worksite or facility during the COVID- 19 case’s high-risk exposure period; Independent contractors at the worksite or facility during the COVID-19 case’s high-risk exposure period; and Other employers at the worksite or facility during the COVID-19 case’s high-risk exposure period. The County will provide notice by either personal service, email, or text message. The County’s notice(s) will not reveal any personal identifying information of the COVID- 19 case. The notice will include information about the County’s disinfection plan. Within one business day of the time the County knew or should have known of the COVID-19 case, the County will also provide the notice of the potential workplace 9.1.a Packet Pg. 82 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 9 exposure to the authorized representative of any employee at the worksite or facility during the COVID-19 case’s high-risk exposure period. c. Offer of Free COVID-19 Testing Following a Close Contact COVID-19 Exposure The County makes COVID-19 testing available at no cost to employees to all employees who had a close contact COVID-19 exposure at a County worksite or facility. The County will offer employees COVID-19 testing during paid time, whether during the employee’s regular work schedule or otherwise, and will provide compensation for the time that the employee spends waiting for and being tested. The County will not provide free COVID-19 testing to the following two classes of employees: Employees who were fully vaccinated before the close contact COVID- 19 exposure and who do not have COVID-19 and COVID-19 cases who returned to work pursuant to the criteria set forth in Section K of this CPP and have remained free of COVID-19 for 90 days after the initial onset of COVID-19 or, for COVID-19 cases who never developed for 90 days after the first positive test. d. Leave and Compensation Benefits for Close Contact Exposures The County provides employees that had a close contact COVID-19 exposure with information regarding COVID-19-related benefits to which the employees may be entitled under applicable federal, state, or local law, the County’s own leave policies, and leave guaranteed by contract. These benefits include, but are not limited to, SPSL. The County will continue and maintain these employees’ earnings, seniority, and all other employee rights and benefits, including the employees’ right to their former job status, as if the employees had not been removed from their jobs. The County may require that these employees use County provided employee sick leave benefits for this purpose and consider benefit payments from public sources in determining how to maintain earnings, rights and benefits, where permitted by law and when not covered by workers’ compensation. e. Investigation to Determine Whether Workplace Conditions Contributed to COVID-19 Exposure The County will conduct an investigation in order to determine whether any workplace conditions could have contributed to the risk of COVID-19 exposure and what may be done to reduce exposure to such COVID-19 hazards, if any. 3. Confidential Medical Information The County will protect the confidentiality of the COVID-19 cases, and will not disclose to other employees the fact that the employees tested positive for or were diagnosed with COVID-19. 9.1.a Packet Pg. 83 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 10 The County will keep confidential all personal identifying information of COVID-19 cases unless expressly authorized by the employees to disclose such information or as other permitted or required under the law. D. CORRECTION OF COVID-19 HAZARDS AT ALPINE COUNTY WORKSITES AND FACILITIES The County will implement effective policies and/or procedures for correcting unsafe or unhealthy conditions, work practices, policies and procedures in a timely manner based on the severity of the hazard. This includes, but is not limited to, implementing controls and/or policies and procedures in response to the evaluations conducted related to the identification and evaluation of COVID-19 hazards and investigating and responding to COVID-19 cases in the workplace. This also includes implementing controls related to physical distancing, face coverings, engineering controls, administrative controls, and personal protective equipment E. TRAINING AND INSTRUCTION OF EMPLOYEES The County will educate all staff by continuing to update and distribute the Alpine County Protocols for Maintaining a Safe and Health Workplace), provide public health briefs, CDC and CDPH guidance as needed, and offer online trainings regarding COVID as necessary. 1. COVID-19 The County provides employees training and instruction on COVID-19 including advising employees of COVID-19 which include the following: fever of 100.4 degrees Fahrenheit or higher or chills; cough; shortness of breath or difficulty breathing; fatigue; muscle or body aches; headache; new loss of taste or smell; sore throat; congestion or runny nose; (10) nausea or vomiting; or (11) diarrhea, unless a licensed health care professional determines the person’s were caused by a known condition other than COVID-19. The County monitors and adheres to guidance issued by the CDC concerning COVID- 19 including guidance provided at the following web address: The County will advise employees in the event that the CDC revises the that its associates with COVID-19. In addition to providing training and instruction on COVID-19 the County provides information and instruction on the importance of employees not coming to work if they have any COVID-19 As discussed below, the County provides information on paid leaves to which employees may be entitled if they are experiencing a COVID-19 and would like to be tested for COVID-19. 2. COVID-19 Vaccinations The County provides employees information and instruction on the fact that COVID-19 vaccines are effective at both preventing the transmission of the virus that causes 9.1.a Packet Pg. 84 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 11 COVID-19 and preventing serious illness or death, and how employees may receive paid leave for reasons related to COVID-19 vaccinations. As discussed below, the County provides information on paid leaves to which employees may be entitled in order for them to be vaccinated and in the event that they experience any illness or adverse effects as a result of such vaccination. 3. Alpine County’s COVID-19 Policies and Procedures The County provides regular updates to employees on the County’s policies and procedures adopted in order to prevent COVID-19 hazards at County worksites and facilities, how such policies and procedures are intended to protect the health and safety of employees and County worksites and facilities, and how employees may participate in the identification and evaluation of COVID-19 hazards in order to make such worksites and facilities healthier and safer for themselves and others. 4. COVID-19 Related Benefits The County advises and provides updates to employees on the leaves to which employees may be entitled under applicable federal, state, or local laws as well as the County’s own leave policies. Paid leave benefits include, but are not limited to, SPSL. Further, when employees require leave in order to receive a COVID-19 test or to be vaccinated or are directed not to report to work by the County for reasons related to the presentation of COVID-19 a COVID-19 case, close contact COVID-19 exposure, the County will advise the employees of the leaves to which the employees may be entitled for that specific reason. 5. Spread and Transmission of the Virus that Causes COVID-19 The County advises and provides updates to employees about the known spread and transmission of COVID-19. The County specifically advises employees of the following: that COVID-19 is an infectious respiratory disease; that the virus that causes COVID-19 can be spread through the air when an infectious person talks or vocalizes, sneezes, coughs, or exhales; that particles containing the virus can travel more than six feet, especially indoors, so physical distancing must be combined with other controls, including face coverings and hand hygiene, including hand washing, in order to be effective; that COVID-19 may be transmitted when a person touches a contaminated object and then touches their eyes, nose, or mouth, although that is less common; and that an infectious person may have present no COVID-19 or be 6. Hand Hygiene, and Face Coverings and Respirators The County advises employees of the importance of physical distancing, face coverings, and hand hygiene, including hand washing, and instructs employees that the combination of physical distancing, face coverings, increased ventilation indoors, and respiratory protection make such preventative measures most effective. With respect to hand hygiene, the County provides employees information regarding the importance of frequent hand washing, that hand washing is most effective when soap 9.1.a Packet Pg. 85 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 12 and water are used and the employees washes for at least 20 seconds. The County instructs employees to use hand sanitizer when employees do not have immediate access to a hand washing facility a sink) and that hand sanitizer will not be effective if the employee’s hands are soiled. With respect to face coverings and respirators, the County provides employees information on the benefits of face coverings, both to themselves and to others. The County also provides employees instructions on the proper use of face coverings and the differences between face coverings and respirators. The County will provide certain employees respirators for their use in certain circumstances, including to individuals who are not fully vaccinated, who are working indoors or in a vehicle with more than one person, and who request the devices for their use at work. At such time as the County provides respirators to employees for their use, it will provide such employees training on the proper use of such respirators, including, but not limited to, the method by which employees may check the seal of such respirator in conformance with the manufacturer’s instructions. The County will provide training on the conditions under which face coverings must be worn at the workplace and that face coverings are additionally recommended outdoors for people who are not fully vaccinated if six feet of distance between people cannot be maintained. Employees can request face coverings from the County at no cost to the employee and can wear them at work, regardless of vaccination status, without fear of retaliation. F. FACE COVERINGS 1. General Face Covering Requirements The County provides face coverings to all employees who are not fully vaccinated and requires that such face coverings are worn by employees when indoors or in vehicles, unless certain conditions are satisfied, as explained below. The County adheres to the most restrictive or prescriptive public health order provided by the CDC, CDPH or the local health department applicable to the County, and will provide face coverings and ensure they are worn by employees when required by orders from the CDPH. The County requires that employees face coverings be clean and undamaged. The County allows employees to use face shields to supplement, not supplant, face coverings. 2. Limited Exceptions Alpine County provides for the following exceptions to the face coverings requirement: 1. When an employee is alone in a room alone in an office or another space with walls that extend from the floor to the ceiling and a door that may be closed in order to close the space to others) or vehicle; 9.1.a Packet Pg. 86 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 13 2. While eating and drinking at the workplace, provided employees are at least six feet apart and outside air supply to the area, if indoors, has been maximized to the extent feasible. 3. Employees wearing respirators required by the County and being used in compliance with the regulatory requirements for the use of such respirators. 4. Employees who cannot wear face coverings due to a medical or mental health condition or disability, or who are hearing-impaired or communicating with a hearing-impaired person. 5. Specific tasks which cannot feasibly be performed with a face covering. This exception is limited to the time period in which such tasks are actually being performed 3. Required Use of Effective Non-Restrictive Alternative for Employees Exempted from Face Covering Requirement The County requires that its employees who are exempted from wearing face coverings due to a medical condition, mental health condition, or disability wear an effective non- restrictive alternative, such as a face shield with a drape on the bottom, if their condition or disability permits it. 4. Physical Distancing Required If Employee Is Not Wearing Face Covering or Non-Restrictive Alternative The County requires that any employees not wearing a face covering due to either exception number 5, identified in Subsection 2 above, and not wearing a face shield with a drape or other effective alternative as described in Subsection 3 above, shall remain at least six feet apart from all other persons unless the unmasked employees are tested at least weekly for COVID-19 during paid time and at no cost to the employee or are fully vaccinated. In situations where a face covering is otherwise required, face coverings must be worn, and the exceptions to face coverings contained in this section no longer apply. However, the County does not use COVID-19 testing as an alternative to face coverings when face coverings are otherwise required by this section. 5. Prohibition on Preventing Employees from Wearing Face Covering The County does not prevent any employee from wearing a face covering when wearing a face covering is not required by this section, unless not wearing a face covering would create a safety hazard, such as interfering with the safe operation of equipment. 6. Communication to Non-Employees Regarding Face Covering Requirement 9.1.a Packet Pg. 87 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 14 The County posts signage to inform non-employees of the County’s requirements concerning the use of face coverings at Alpine County worksites and facilities. G. OTHER ENGINEERING CONTROLS, ADMINISTRATIVE CONTROLS AND PERSONAL PROTECTIVE EQUIPMENT (PPE) 1. Maximization of Outdoor Air As provided above at Section IV.B.5., for indoor Alpine County worksites and facilities, the County evaluated how to maximize the quantity of outdoor air. Further, for County worksites and facilities with mechanical or natural ventilation, or both, the County maximizes the quantity of outside air provided to the extent feasible, except when the Environmental Protection Agency (“EPA”) Air Quality Index (“AQI”) is greater than 100 for any pollutant or if opening windows or letting in outdoor air by other means would cause a hazard to employees, for instance from excessive heat or cold. 2. Cleaning Procedures The County undertakes the following cleaning measures: 1. Identify and regularly clean frequently touched surfaces and objects, such as doorknobs, elevator buttons, equipment, tools, handrails, handles, controls, phone, headsets, bathroom surfaces, and steering wheels; 2. Inform employees and authorized employee representatives of the County’s cleaning and disinfection protocols, including the planned frequency and scope of cleaning and disinfection; and 3. Clean areas, material, and equipment used by a COVID-19 case during the high-risk exposure period and disinfection if the area, material, or equipment is indoors and will be used by another employee within 24 hours of the COVID-19 case. Further, the County requires that cleaning must be done in a manner that does not create a hazard to employees or subcontracted employees who do the cleaning and disinfecting. 3. Evaluation of Handwashing Facilities In order to protect employees, the County evaluates its handwashing facilities in order to determine the need for additional facilities, encourage and allow time for employee handwashing, and provide employees with an effective hand sanitizer. The County encourages employees to wash their hands with soap and water for at least 20 seconds each time. The County does not provide hand sanitizers with methyl alcohol. 4. Personal Protective Equipment (“PPE”) a. Evaluation of the Need for PPE 9.1.a Packet Pg. 88 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 15 The County evaluates the need for PPE in order to prevent employees from being exposed to COVID-19 hazards. b. Provision of PPE When Necessary The County provides PPE, including, but not limited to, face coverings, respirators, gloves, goggles, and face shields, to and for employees who require such equipment in order to perform their job duties in a healthy and safe manner, including where employees are exposed to procedures that may aerosolize potentially infectious material such as saliva or respiratory tract fluids. Upon request, the County shall provide respirators to employees for voluntary use to all employees who are not fully vaccinated and who are working indoors or in vehicles with more than one person. Whenever the County makes respirators available for voluntary use, the County will ensure that employees receive a respirator of the correct size and will provide such employees training on the proper use of such respirators, including, but not limited, the method by which employees may check the seal of such respirator in conformance with the manufacturer’s instructions, as discussed in Section IV.E.6. 5. Testing of Employees Who Are Not Fully Vaccinated The County makes COVID-19 testing available at no cost to employees with COVID-19 who are not fully vaccinated. This testing will be made available during the employees’ paid time. H. REPORTING, RECORDKEEPING AND ACCESS 1. Reporting COVID-19 Cases to the Local Health Department The County reports COVID-19 cases and COVID-19 outbreaks at Alpine County worksites and facilities to the local health department. Further, the County provides any related information requested by the local health department. 2. Maintenance of Records Related to the Adoption of the CPP The County maintains records of the steps it has taken to implement these provisions described in this CPP. 3. Availability of the CPP for Inspection The County makes this written CPP available to employees and employee organizations at County worksites or facilities. Further, the County makes this written CPP available to Cal/OSHA representatives immediately upon request. 4. Records Related to COVID-19 Cases The County keeps a record of and tracks all COVID-19 cases with the following information: employee’s name; contact information; occupation; location where the employee worked: the date of the last day at the workplace; and the date of a positive COVID-19 test. 9.1.a Packet Pg. 89 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 16 Alpine County keeps employees’ medical information confidential. I. EXCLUSION OF COVID-19 CASES AND EMPLOYEES WHO HAD A CLOSE CONTACT COVID-19 EXPOSURE 1. Exclusion of COVID-19 Cases from Alpine County Worksites and Facilities The County ensures that COVID-19 cases are excluded from Alpine County worksites and facilities until the employee satisfies the minimum return to work criteria, as provided in Section IV.J. 2. Exclusion of Employees with Close Contact COVID-19 Exposures from Alpine County Worksites and Facilities The County ensures that employees who had a close contact COVID-19 exposure are excluded from County worksites and facilities until the employee satisfies the minimum return to work criteria, as provided in Section IV.J. The County may allow the following employees to continue to report to County worksites and facilities: Employees who were fully vaccinated before the close contact COVID-19 exposure and who have not developed COVID-19 since such exposure; and COVID-19 cases who returned to work pursuant to the return to work criteria, as provided in Section IV.J. and have remained free of COVID-19 for 90 days after the initial onset of COVID-19 or, for COVID-19 cases who never developed COVID-19 for 90 days after the first positive COVID-19 test. 3. Provision of Benefits to Employees Excluded from Work as a Result of a Positive COVID-19 Test or Diagnosis or a Close Contact COVID-19 Exposure a. Employees Who Are Able to Telework During Isolation or Quarantine Period The County allows employees who are able to telework to telework during the isolation or quarantine period. The County will provide these employees their normal compensation for the work that they perform for the County during the isolation or quarantine period. The County continues and maintains such an employee's earnings, wages, seniority, and all other employee rights and benefits, including the employee's right to their former job status, as if the employee had not been removed from their job. b. Employees Who Are Unable to Telework During Isolation or Quarantine Period The following employees are not entitled to the benefits described below: Employees for whom the County can demonstrate that the close contact COVID-19 exposure was not work-related; and Employees who received disability payments or were covered by workers’ compensation and received temporary disability. Such employees may still 9.1.a Packet Pg. 90 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 17 use paid sick leave for the purpose of receiving compensation during the isolation or quarantine period if they elect to do so. For other employees, the County requires that employees who are unable to telework, but are otherwise able and available to work, the County may use paid sick leave available to the employee, including but not limited to SPSL, for the purpose of continuing and maintaining the employee’s earnings during the isolation or quarantine period. If the employee has exhausted their SPSL entitlement, the County may use the employee’s paid sick leave in order to continue and maintain the employee’s earnings during the isolation or quarantine period. Employees retain their entitlement to elect not to use other earned or accrued paid leave during this time. The County may provide such employees who are unable to telework, but who do not have any paid sick leave available, paid administrative leave in order to receive compensation during the isolation or quarantine period. For all employees who are subject to an isolation or quarantine because of a COVID-19 case or a close contact COVID-19 exposure, the County will maintain the employees’ seniority and all other employee rights and benefits, including the employees’ right to their former job status, during the isolation or quarantine period. 4. Adherence with Laws, Policies, and/or Agreements Providing Excluded Employees Greater Protections The obligations set forth in this section do not limit any other applicable law, Alpine County policy, or collective bargaining agreement that provides employees with greater protections or benefits. 5. Provision of Information Concerning Benefits to Excluded Employees At the time of exclusion, the County provides the excluded employees the information on paid leave benefits to which the employees may be entitled under applicable federal, state, or local laws. This includes, but is not limited to, COVID-19 Supplemental Paid Sick Leave (“SPSL”) (under Labor Code section 248.2), any paid leave benefits available under workers’ compensation law, Labor Code sections 3212.86 through 3212.88, the County’s own leave policies, and leave guaranteed by contract. J. RETURN TO WORK CRITERIA 1. Minimum Criteria to Return to Work for COVID-19 Cases The County requires that a COVID-19 case with one or more COVID-19 remain at their home or place of residence and not report to any County worksite or facility until they satisfy each of the following conditions: At least 24 hours have passed since a fever of 100.4 degrees Fahrenheit or higher has resolved without the use of fever-reducing medications; COVID-19 have improved; and At least 10 days have passed since COVID-19 first appeared. 9.1.a Packet Pg. 91 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 18 2. Minimum Criteria to Return to Work for COVID- 19 Cases The County requires that COVID-19 cases who tested positive but never developed COVID-19 not report to any County worksite or facility until a minimum of 10 days have passed since the date of specimen collection of their first positive COVID-19 test. 3. COVID-19 Testing Not Required in Order to Return to Work In accordance with CDC guidance concerning strategies for the discontinuation of isolation, once an employee has satisfied the criteria to return to work, as provided in this Section, the County will not require that the employee submit to a COVID-19 test or produce a negative COVID-19 test result, in order to return to County worksites or facilities. 4. Minimum Criteria to Return to Work for Close Contacts a. Employees An employee who had a close contact COVID-19 exposure, but never developed COVID-19 may return to County worksites or facilities 10 days following the last known close contact COVID-19 exposure. b. Employees An employee who had a close contact COVID-19 exposure and developed one or more COVID-19 may not return to County worksites or facilities until they satisfy each of the following conditions: At least 24 hours have passed since a fever of 100.4 degrees Fahrenheit or higher has resolved without the use of fever-reducing medications; COVID-19 have improved; and At least 10 days have passed since COVID-19 first appeared. An employees who had a close contact COVID-19 exposure and developed one or more COVID-19 may return earlier if they meet each of the following conditions: The employee tested negative for COVID-19 using a polymerase chain reaction (“PCR”) COVID-19 test with specimen taken after the onset of At least 10 days have passed since the last known close contact COVID-19 exposure; and The employee has been for at least 24 hours, without using fever reducing medications. c. Critical Staffing Shortages During critical staffing shortages, when there is an insufficient number of health care workers, emergency response workers or social workers whose jobs duties require face to face contact with clients in child welfare or assisted living, workers in such job classifications may return to County worksites or facilities seven days following the last known close contact COVID-19 exposure if they have received a negative PCR 9.1.a Packet Pg. 92 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 19 COVID-19 test result from a specimen collected five days after the 5 close contact COVID-19 exposure 5. Minimum Criteria to Return to Work for Employees Directed to Self-Quarantine or Isolate by a State or Local Health Official If employees are subject to an isolation or quarantine order issued by a state or local health official, the County requires that the employees not report to any County worksite or facility until the period of isolation or quarantine is completed or the order is lifted. If the relevant order did not specify a definite isolation or quarantine period, then the County will require that employees isolate or quarantine according to the applicable periods and criteria provided for in this Section or as otherwise instructed by the County. 6. Allowance by Cal/OSHA for an Employee to Return to Work If no violations of state or local health officer orders related to the employee’s isolation, quarantine, or exclusion would result, the Alpine County may request that Cal/OSHA waive the quarantine or isolation requirement for essential employees and allow such employees to return to work on the basis that the removal of employees would create undue risk to a community’s health and safety. Where the absence of an essential employee from the County worksite would cause a staffing shortage that would have an adverse on a community’s health and safety and pose an undue risk to the community’s health and safety as a result, Cal/OSHA may grant such waiver. In order to request a waiver under such circumstances, the Alpine County will submit the written request to [EMAIL REDACTED]. In the event of an emergency, the Alpine County may request a provisional waiver by contacting the local Cal/OSHA office while the Alpine County prepares the written waiver request. The written waiver request must provide for the following information: 1. Employer name and business or service; 2. Employer point-of-contact name, address, email and phone number; 3. Statement that there are no local or state health officer orders for isolation or quarantine of the excluded employees; 4. Statement describing the way(s) in which excluding the exposed or COVID-19 positive employees from the workplace impacts the employer’s operation in a way that creates an undue risk to the community’s health and safety; 5. Number of employees required to be quarantined under the Cal/OSHA regulation, and whether each was exposed to COVID-19 or tested positive for COVID-19; and 9.1.a Packet Pg. 93 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- 20 6. The employer’s control measures to prevent transmission of COVID-19 in the workplace if the employee(s) return or continue to work in the workplace, including the prevention of further exposures. These measures may include, but are not limited to, preventative steps such as isolating the returned employee(s) at the workplace and requiring that other employees use respirators in the workplace. In addition to submitting a request for a Cal/OSHA waiver, the County will develop, implement, and maintain effective control measures to prevent transmission in the workplace including providing isolation for the employees at the County worksite or facility and, if isolation is not feasible, the use of respirators in the workplace. 9.1.a Packet Pg. 94 Attachment: Revised COVID-19 Prevention Program 6.2021 (CPP- REVISED 061721) ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Nichole Williamson, CAO/HHS Director DATE OF MEETING: July 20, 2021 PREPARED BY: PJ Griffin, Assistant County Clerk TITLE: CONTINUED: Request approval of the 2020 Child Welfare Services (CWS) System Improvement Plan (SIP) annual update report. SUMMARY: The SIP is Alpine County Social Services’ 5-year plan with the California Department of Social Services (CDSS) for CWS. The 5-year plan was approved by the Board of Supervisors on September 19, 2019 and annual updates have been submitted to CDSS as required. However, the 2020 report requires Board of Supervisors additional approval due to the elimination of Strategy 3: Implementation of Promoting Safe & Stable Families (PSSF) Funded Activities. RECOMMENDED ACTION: Approve the CWS SIP 2020 annual report. ISSUE STATEMENT AND DISCUSSION: Strategy 3: Implementation of PSSF Funded Activities is being removed from Alpine County’s SIP, as Alpine County no longer receives an annual allocation of $10,000 from CDSS for the PSSF. The County has historically not been able to expend PSSF funds due to state categorical requirements related to adoption services. The County has not had an adoption case in the last ten years. Additionally, CDSS has multiple mandated activities required of Child Welfare during this SIP period that are not included in the SIP and is requiring a significant amount of staff time, resulting in the need to reduce the number of SIP strategies. FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year X (Not Applicable) $0.00 $0.00 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: N/A INSTRUCTIONS TO CLERK: Minute order of approval of plan to HHS Director 9.2 Packet Pg. 95 ---PAGE BREAK--- California - Child and Family Services Review Annual SIP Progress Report April 2019 to April 2024 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES Rev. 12/2017 9.2.a Packet Pg. 96 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 1 California – Child and Family Services Review Signature Sheet For submittal of: CSA SIP Progress Report X County Alpine SIP Period Dates April 2019- April 2024 Outcome Data Period Q3 2020 County Child Welfare Agency Director Name Nichole Williamson Signature* Phone Number [PHONE REDACTED] 75-A Diamond Valley Rd. Markleeville, CA 96120 County Chief Probation Officer Name Tami DiSalvo Signature* Phone Number [PHONE REDACTED] 14777 State Route 89 Mailing Address PO Box 458 Markleeville, CA 96120 Public Agency Designated to Administer CAPIT and CBCAP Name Alpine County Health and Human Services Signature* Phone Number [PHONE REDACTED] 75-A Diamond Valley Rd. Mailing Address BOS Approval Date Name Signature* Markleeville, CA 96120 Board of Supervisors (BOS) Signature Children and Family Services Division Outcomes and Accountability Section Mail the original Signature Sheet to: California Department of Social Services 744 P Street, MS 8-12-91 *Signatures must be in blue ink Sacramento, CA 95814 Mailing Address 9.2.a Packet Pg. 97 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 2 Contact Information Child Welfare Agency Name Nichole Williamson Agency Alpine County Health and Human Services Phone & E-mail [PHONE REDACTED] / [EMAIL REDACTED] Mailing Address 75-A Diamond Valley Rd. Markleeville, CA 96120 Probation Agency Name Tami DiSalvo Agency Alpine County Probation Phone & E-mail [PHONE REDACTED] / [EMAIL REDACTED] Mailing Address 14777 State Route 89 PO Box 458 Markleeville, CA 96120 Public Agency Administering CAPIT and CBCAP (if other than Child Welfare) Name Agency Phone & E-mail Mailing Address CAPIT Liaison Name Janel Morales Agency Alpine County Health and Human Services Phone & E-mail [PHONE REDACTED]/ [EMAIL REDACTED] Mailing Address 75-A Diamond Valley Rd. Markleeville, CA 96120 CBCAP Liaison Name Janel Morales Agency Alpine County Health and Human Services Phone & E-mail [PHONE REDACTED]/ [EMAIL REDACTED] Mailing Address 75-A Diamond Valley Rd. Markleeville, CA 96120 PSSF Liaison Name Janel Morales Agency Alpine County Health and Human Services Phone & E-mail [PHONE REDACTED]/ [EMAIL REDACTED] Mailing Address 75-A Diamond Valley Rd. Markleeville, CA 96120 9.2.a Packet Pg. 98 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 3 SIP PROGRESS REPORT SIGNATURE 1 INTRODUCTION………………………………………………………………PAGE 4 SIP PROGRESS REPORT NARRATIVE PAGE 6 SIP PAGE 21 Table of Contents 9.2.a Packet Pg. 99 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 4 Alpine County Health and Human Services Department (ACHHS) is the designated agency to facilitate the development of Alpine County's Child and Family Services Review (C-CFSR), the County Self- Assessment (CSA, 2018) and System Improvement Plan (SIP), and all progress reports related to the plans. ACHHS conducted its CSA and developed the five-year SIP in close collaboration with the California Department of Social Services (CDSS), Alpine County Child Abuse Prevention Council, (which serves as the C-CFSR Team), and the CSA/SIP Stakeholder's Group comprised of representatives of the Washoe Tribe, parents/consumers, community leaders, and virtually all responders and service providers from both public and private agencies who play a role in the prevention and intervention of child maltreatment in the County. This report provides a detailed summary of the progress made to date within each of the seven strategies identified by these groups during the development of the 2019-2024 System Improvement Plan.1 These strategies are designed to help Alpine County meet its primary goals: preventing or limiting the entry of youth into the child welfare system and limiting the level of government intervention into the lives of the youth, families, and adults residing in Alpine County. There are several important contextual pieces of information needed to understand both Alpine County's SIP and the information presented in this Progress Report. These are the County's extremely small population size of approximately 1,200 residents, its commensurately small and statistically insignificant number of annual child welfare cases, and the impact of the COVID-19 pandemic on staff availability. Alpine's small population size means that statistically significant demographic and service outcome changes are slow to emerge and virtually impossible to demonstrate except over a period of many years. Alpine County typically has less than one child welfare case opening per year and less than 35 referrals per year, and in many years, the County has no youth with Juvenile Probation status and/or no youth receiving services through the Probation Department. For these reasons, the 2019-2024 SIP focused on system improvements that fall within one of three federal systematic factors, rather than on making improvements tied directly to outcome data measures. The period this Progress Report covers (April 2020-April 2021) also coincides with the onset and escalation of the COVID-19 pandemic in the United States. Alpine’s small population size and additional State mandate implementation requirements, such as AB 2083 and the Family Urgent Response 1 Note that Strategy Implementation of PSSF identified activities in Alpine County through contracted providers and ACCHS, originally included in the SIP will be removed upon approval of this progress report. A reference to this strategy will be retained for posterity in future SIP Progress Reports, with a note indicating that it was removed during the April 2021 Progress Report submission. Introduction 9.2.a Packet Pg. 100 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 5 System (FURS), already serve as limiting factors on the number of service providers and staff available to assist with system improvement efforts, and staff capacity was only reduced after April 2020 as many team members took on additional responsibilities related to the pandemic. Recognizing their limited capacity, the Alpine team expanded the scope of the existing contract in place with Social Entrepreneurs, Inc. (SEI) to include targeted implementation support. The expanded scope of work now includes targeted SIP strategy implementation support for Strategies and This includes assisting ACHHS with identifying and vetting vendors for trauma-informed training, working with the Tribal Law and Policy Institute (TLPI) to assess the county’s response to CSEC cases, and tracking training needs related to utilizing the CWS/CMS and other data management systems. Evaluation of all SIP strategies remains in SEI’s contract in addition to the implementation support described above. In addition to providing this targeted implementation assistance, SEI continues to monitor and evaluate progress on the SIP strategies. In June 2020, SEI submitted the 2020-2021 System Improvement Evaluation Plan to ACHHS. This plan, which covers the period July 1, 2020-June 30, 2021 and was approved by ACHHS in August 2020, outlines the inputs, outputs, and activities identified as necessary to meet project objectives and anticipated outcomes during this timeframe for each of the strategies. SEI also created separate evaluation plans for each of the CAPIT/CBCAP-funded programs in summer 2020; funded program-specific evaluation plans also cover the July 1, 2020- June 30, 2021 period. Relevant outcomes are included in the Evaluation and Monitoring subsection for each strategy within the Status of Strategies section below. 9.2.a Packet Pg. 101 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 6 STAKEHOLDERS PARTICIPATION Alpine County Health and Human Services staff, the First 5 Alpine Executive Director, and staff from SEI form the Core Evaluation Team overseeing evaluation and monitoring activities during the 2019-2024 SIP Period. This team met during the period April 2020-April 2021 to review progress and identify next steps to meet the action step timelines outlined for each strategy in the SIP chart beginning on page 21. Throughout Year 2, many community stakeholders and partner agencies have also participated in SIP activities. These include:  Alpine County Behavioral Health  Alpine County Probation  Alpine County Sherriff’s Department  Alpine County Board of Supervisors  Child Welfare Services Social Workers  Washoe Tribal Social Services  Funded program representatives, including Alpine County Office of Education/Alpine County Unified School District, Busy Bears Playschool, Child Abuse Prevention Council, and Live Violence Free; and  Consultants from UC Davis and the Tribal Law and Policy Institute. CURRENT PERFORMANCE TOWARDS SIP IMPROVEMENT GOALS The primary goal of the SIP within Alpine County is to prevent or limit the entry of youth into the child welfare system and to limit the level of government intervention into the lives of the youth, families, and adults residing in Alpine County. However, due to the small population size in Alpine County (approximately 200 children in the County per the most recent Census data), trends in child welfare outcome data over time are difficult to analyze and few outcomes show trends. Therefore, for the 2019-2024 SIP, Alpine County has opted to focus on improvements within three Federal systemic factors, rather than on CWS Outcomes Performance Measures: Staff, Caregiver, and Provider Training; Service Array Agency Collaboration; and Quality Assurance System. Progress within each systemic factor has been achieved during Year 2 of the current SIP reporting period. Detailed information is provided within the Status of Strategies section and is summarized below. Staff, Caregiver, and Provider Training and Service Array Agency Collaboration: As an agency with few staff, partnerships with outside agencies, tribes, and surrounding counties are critical to the success of SIP Progress Narrative 9.2.a Packet Pg. 102 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 7 ACHHS’ child welfare activities. Increasing both internal and external capacity through training and collaboration go hand-in-hand, and therefore strategies toward improving these two systemic factors are intertwined. Key progress toward the improvement of both during this reporting period included:  Identification of an outside organization to assist ACHHS in implementing comprehensive trauma-informed practices and systems within Alpine County;  Holding regular SOP coaching sessions and applying SOP within child welfare services;  Obtaining CANS certification for ACHHS staff; and  Development of a report by a contracted vendor that will inform CSEC training topics and guide the development of a culturally competent outreach program. Quality Assurance System: Ongoing, iterative evaluation, reliable data, and documented processes are critical elements to continuous quality improvement. Key progress toward the improvement of the Alpine Quality Assurance System during this reporting period included:  Development of the System Improvement Evaluation Plan and funded program-specific evaluation plans, including defining initial outcome and performance measures for SIP strategies and funded programs; and  Receiving help desk and data clean up assistance from El Dorado County to address CWS/CMS data issues and increase data reliability, and provisioning training for ACHHS staff related to CWN/CMS and CARES data entry and management. STATUS OF STRATEGIES Strategies selected for inclusion within the 2019-2024 SIP are focused on system improvements and are not tied specifically to CWS Outcomes Data. The majority are new initiatives for ACHHS, and baseline data is not available from prior years. Additionally, this Progress Report is being created during a process evaluation, wherein documenting inputs and activities is important to evaluating success. Therefore, the sections for each strategy summarize the strategy and work to date, and when possible, note if the strategy has been effective at improving the designated program/outcome area. Strategy Trauma Informed Practice (TIP) will be implemented within ACHHS and as a model for other County partner agencies Analysis: ACHHS is committed to transforming its department into a trauma-informed organization, and ultimately serving as a model for other departments and organizations with the County. This will be achieved through organization-wide training and the adoption of practice models that will support staff in this process. Work toward achieving this strategy began prior to the current SIP Period, with initial conversations with potential outside agencies that could provide TIP training and guidance taking place in May of 9.2.a Packet Pg. 103 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 8 2019. During Year 1, an outside consultant was identified as being well-suited to guiding ACHHS through this transition into a trauma informed organization. Meetings between this consultant and ACHHS staff were scheduled for March 2020 but were postponed due to COVID-19 and the need for ACHHS staff to prioritize other activities and meetings. During summer 2020, ACHHS requested assistance from SEI in conducting outreach to this consultant and other organizations that could offer comprehensive TIP training plans. After confirming that the previously identified consultant was no longer an ideal fit, SEI then contacted five additional organizations to gauge their interest and availability in developing a comprehensive training program for this strategy. Two of these organizations responded and indicated that they would be interested in submitting a scope of work. ACHHS reviewed the options and requested a scope of work from TLPI, due to their familiarity with the County and extensive experience working with and within tribal communities. The latter is deemed particularly important as approximately one-third of Alpine County residents identify as American Indian or Alaska Native, according to the most recent Census data. TLPI, as the consultant selected, will provide training in the next fiscal year. Training topics will include the impact of trauma, trauma responses, trauma effects on the provision of services, and the six core values of trauma-informed care. It is anticipated that training will occur both virtually and in-person and will also include supervision coaching. In order to further define and document elements of its trauma-informed system, ACHHS established an Interagency Leadership Team (ILT) comprised of ACHHS, including Child Protective Services, Behavioral Health and Probation, the Alpine County Office of Education, the Alta Regional Center, and the Washoe Tribe of Nevada and California to develop each section of the AB 2083 Memorandum of Understanding (MOU) required by CDSS. The purpose of the MOU is to ensure that children and youth in foster care receive coordinated, timely, and trauma-informed services. It outlines the roles and responsibilities of ILT agencies and describes ways in which services can be coordinated. The MOU is expected to be completed by April 2021. Action Step Status: Strategy 1 comprises three action steps. Action Step A has been partially completed through the identification of TLPI as the organization best suited to assist ACHHS in the development of a comprehensive program to implement TIP within Alpine County. Development of outcome measures to identify and monitor program effectiveness will begin after a contract between ACHHS and TLPI is executed (anticipated for spring/summer 2021). Action Steps B and C are anticipated to be completed as scheduled. Evaluation and Monitoring: Determining outcome measures to identify and monitor program effectiveness, as outlined in Action Step C, and identification, development, and utilization of evaluation tools will commence after the scope of work is finalized and continue as scheduled through April 2024. The focus of the evaluation and monitoring of this strategy will depend on the focus area selected by ACCHS and may incorporate training evaluations and organizational assessments. Specific 9.2.a Packet Pg. 104 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 9 tools will be determined by ACHHS in conjunction with TLPI and SEI once training commences in the summer of 2021. However, SEI and ACHHS have defined initial, anticipated outcomes associated with this strategy in the System Improvement Plan Evaluation Plan that covers the period July 2020-June 2021. These include:  Increased staff confidence and comfort utilizing a trauma-informed approach;  Increased understanding of the importance of a trauma-informed approach and its value to Alpine County families and staff; and  Inclusion of a trauma-informed approach is supported and prioritized by ACHHS staff and identified partner organizations. These outcomes will be monitored through April 2024 per the SIP Table for this strategy. Strategy The CSEC Program and Protocol will be implemented within ACHSS in partnership with County Probation, the Washoe Tribe, and Tribal Law and Policy Institute Analysis: ACHHS, during creation of the 2019-2024 SIP, identified the opportunity to work in collaboration with the Washoe Tribe and County stakeholders to implement a comprehensive Commercially Sexually Exploited Children (CSEC) program that focuses on prevention and intervention practices and programs to address CSEC and human trafficking in local communities. On November 1, 2019, the Multi-Jurisdictional Protocol to Serve Commercially Sexually Exploited Children (CSEC) in Alpine County was signed by the District Attorney, County Administrative Officer/Health and Human Services Director, Alpine County Sherriff, Chief Probation Officer for the County, and the County Behavioral Health Services Director. The Washoe Tribe’s participation within the CSEC protocol is facilitated by the Jurisdictional MOU between Alpine Child Welfare Services (CWS) and the Tribe that was executed within the last SIP period (2014-2019). The CSEC Protocol establishes a Steering Committee and a Multidisciplinary Team (MDT) to ensure a coordinated, effective response to CSEC in Alpine County and to lead implementation of guiding principles and policies established within the Protocol. The Washoe Tribe is a standing member of the Steering Committee. Additional county partners include Alpine Superior Court, the County Public Defender, County Counsel, Public Health, Alpine County Unified School District, and community service providers. The purpose of the Steering Committee is to provide ongoing oversight and leadership to ensure that County agencies and partners effectively collaborate to better identify and serve victims of CSEC or children at risk of becoming exploited. Members of the Steering Committee are responsible for implementing the Protocol; collecting and analyzing aggregate data, as available; performing reviews of case data to identify trends, gaps in services, or issues that can be resolved by the MDT; assessing sufficiency of CSEC-specific resources in the County; and identifying necessary training and ensuring training occurs on a continuing basis. The MDT has the purpose and function outlined in California Welfare and Institutions Code Sections 18960-18964 and will address CSEC issues as necessary. 9.2.a Packet Pg. 105 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 10 In order to assess the county’s response to trafficking and develop a culturally appropriate training and community outreach program, during Year 2 contractors with TLPI and SEI conducted key informant interviews with eight county stakeholders. Stakeholders, including Child Welfare Services Social Workers, law enforcement, service providers, and the Tribal Social Services Director were interviewed between June and August 2020. Interviews examined program structure and operations, workforce, community partnerships and providers, and needs of families, and data. Themes and findings from these interviews were summarized in a report developed by TLPI. The CSEC Steering Committee then met on February 17, 2021 to provide input on how to prioritize training. At that meeting, the CSEC Steering Committee decided that the first next step would be to review screening tools and select the one most suited to Alpine County. A screening tool will be selected by June 2021. Foundational training as well as training on the tool will be planned following the selection of a screening tool. TLPI will coordinate the provision of training in accordance with their contract with ACHHS. Additional potential training topics identified through development of the TLPI report included:  Red flags for CSEC;  Services that best serve children and families who have been victimized by CSEC;  Law enforcement training to be provided by law enforcement;  CSEC in Indian Country;  Protective factors and risk factors, including risk factors associated with small, rural communities. Findings from the TLPI report were also presented to the Alpine County Board of Supervisors on January 5, 2021. At that same meeting, the Board of Supervisors agreed to a resolution acknowledging January as Human Trafficking Prevention Month. As this was the first year the Board of Supervisors made this acknowledgement, it served to raise awareness and interest from County and Tribal leadership. Future Human Trafficking Month activities may be determined by the CSEC Steering Committee. In addition, the TLPI report was shared with Jeannette McNeill, Analyst, Child Welfare Program and Policy Development Bureau, Child Trafficking Response Unit at CDSS on January 21, 2021. ACHHS has also committed to participating in the California Preventing and Addressing Child and Trafficking Project (PACT) to learn from subject matter experts and the experiences of other counties. Participation is expected to help the county collaborate and coordinate services across county lines, which is critical given Alpine County’s proximity to main thoroughfares through the state. The activities described above have been effective in achieving progress on identifying training needs related to preventing and responding to commercial sexual exploitation. Through development of the TLPI report and presentation of its findings to the Board of Supervisors and the CSEC Steering Committee, awareness of the issue has grown, and the foundation has been laid for further training in 9.2.a Packet Pg. 106 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 11 accordance with the Action Steps identified as part of this strategy. Action Step Status: Strategy 2 comprises four action steps. Action Steps A and B, both scheduled to be implemented between July 2019 and June 2020, were completed via the execution of the CSEC Protocol and the activities described in the prior SIP Progress Report. Step C has begun, as evidenced by the assessment conducted by TLPI and SEI to identify components of a culturally competent outreach program. Both Steps C and D are anticipated to be completed as scheduled. Evaluation and Monitoring: Determining outcome measures to identify and monitor program effectiveness and development and utilization of evaluation tools are in process and will take place as scheduled, from April 2022 through April 2024. However, baseline information on the system and programs in place to support victims of trafficking were gathered as part of the development of the TLPI report and can be used in future years to gauge progress on this strategy. SEI and ACHHS have also defined initial, anticipated outcomes associated with this strategy in the System Improvement Plan Evaluation Plan that covers the period July 2020-June 2021. These include:  Increased staff and stakeholder knowledge of CSEC, specific to areas identified by CSEC Steering Committee, which will be determined when training commences;  Identification of services needed to support victims of commercial sexual exploitation;  Identified barriers to implementation and plan for resolution; and  Increased community awareness of issues related to human trafficking. These outcomes will be monitored through April 2024 per the SIP Table for this strategy. Strategy Implementation of PSSF identified activities in Alpine County through contracted providers and ACCHS Analysis: During Year 2, ACHHS examined the feasibility and necessity of contracting with an outside agency for reunification, family support, guardianship, and post-adoptive services (PSSF-aligned activities). During this analysis, it was determined that a contract for standing services with an outside vendor is not necessary. These services are available through Lake Tahoe Community College (LTCC) and are available to Alpine County residents. Alpine County Child Welfare would cover mileage or other costs associated with use of these LTCC-provided services as needed. In the case that PSSF- aligned services, other than those provided at LTCC are necessary, Alpine would engage an external vendor at that time. Additionally, per the County Fiscal Letter No.20/21-39 dated November 6, 2020, Alpine County was awarded $0 in PSSF funds for the 2020-21 fiscal year. Due to the lack of need for a contract in order to provide these services on an as-needed basis described above and the lack of available funding, ACHHS is proposing that this strategy be removed from the SIP. 9.2.a Packet Pg. 107 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 12 Action Step Status: Strategy 3 currently comprises four action steps. As detailed in the 2020 SIP Progress Report, implementation for Action Step A was postponed to allow ACHHS to determine how to engage in PSSF-aligned activities without PSSF funding. The outcome of that investigation is the proposed removal of this strategy from the SIP. Evaluation and Monitoring: No anticipated outcomes are provided, as this strategy is proposed for removal. Strategy Full implementation of Safety Organized Practice (SOP) in ACHHS CWS and CSW activities with providers and families engaged in child welfare services Analysis: Safety Organized Practice is a solution-focused family engagement model designed to provide skills, techniques, and an overarching practice methodology for child welfare social workers. Implementation of SOP was a prior SIP objective (2014-2019) but was not fully realized or implemented during the last SIP period due to the state mandate to implement Continuum of Care Reform. However, during the previous and current reporting periods SOP has been a strong focus for ACHHS and the agency has been able to make progress on understanding SOP and how to incorporate it into child welfare practice. The development of a comprehensive SOP framework over the SIP period will align ACHHS with the Core Practice Model (CPM) being implemented by CDSS as a component of Continuum of Care Reform. In the last reporting period, ACHHS received coaching on integrating SOP tools and concepts into Since that time, the county has established a facilitation model with the Social Services Program Manager/Deputy Public Guardian overseeing Adult Protective Services leading the facilitation and the family, case-carrying social worker, and other service providers participating with families. During Year 2, key informant interviews were conducted to better understand social workers’ perspectives on SOP tools and strategies and their ability to apply those tools in practice. The County’s two social workers were interviewed in July and August of 2020 by SEI staff members. Key discoveries and practice changes identified in interviews included:  Social worker knowledge of SOP ranges from “beginning to learn about SOP” to being “able to implement/utilize some SOP strategies/techniques”.  Social workers have a working knowledge of SOP tools. This includes developing behaviorally- based case plans, genograms, and harm and danger statements and using tools like the Safety House with children. However, opportunities to integrate these tools into practice are not frequent given the low number of cases in the County.  Social workers feel that the initial implementation of SOP in Alpine County has improved the engagement of families and the development of family-centered case plans.  Social workers are interested in learning more about the overall SOP framework and its alignment with structured decision making.  ACHHS will use the SOP framework within Multi-Disciplinary Team meetings (MDTs) to drive 9.2.a Packet Pg. 108 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 13 accountability and focus on preventing cases from coming into the child welfare system or helping plan for a transition, as such MDTs are scheduled to discuss specific cases or systemic issues. MDT participants will be asked to come to meetings prepared to discuss cases within the SOP dialog structure. ACHHS’ skill acquisition is currently in the “emergent practice” growth stage according to criteria in the Practice Profiles for Safety Organized Practice: Handbook developed by the UC Davis Northern California Training Academy. “Emergent Practice” is the first of three broad stages (emergent, accomplished, and distinguished). This means ACHHS has “built infrastructure” and individual social workers have “taken action to integrate the practice into their work at a basic level” (pg. Achieving the next state, Accomplished Practice, requires being able to consistently apply these approaches. However, over the course of the current reporting period (Year CWS social workers have had limited opportunities to put learning into practice due to the small number of cases handled by the department and needing to modify approaches due to COVID-19 restrictions, such as holding a CFTM virtually. It is anticipated that the low number of annual child welfare cases will continue to impact staff ability to regularly apply SOP approaches through the end of the current SIP period. Additionally, CWS staff was registered to participate in a Safety Organized Practice for Supervisors online course on February 10, 2021 but due to low enrollment UC Davis postponed this until May 2021. Alpine County participated in a CANS implementation pilot in the prior SIP period and in Year 2 have prioritized training related to the CANS as part of its efforts to implement California’s Integrated Core Practice Model (ICPM) and the Safety Organized Practice framework. A CANS training was held in December 2020 that included Alpine County Social Workers and a staff member from neighboring Mono County. ACHHS CWS staff were asked to complete a survey to assess how participation in the training would impact their practice. Following the training, staff reported that they understand how to use the CANS within and to monitor outcomes. Staff also agreed that the training would help them tailor services and supports to address the unique circumstances of youth and families living in Alpine County. The CANS is intended to help social workers identify the needs and of children and/or youth and their families. It provides a framework for understanding presenting issues and their impact and aids in the development of a case plan that is collaborative and targeted to the specific needs of the child and family. The County is now using the Safe Measures system, to support implementation of Structured Decision Making (SDM) and enhance case management. ACHHS Social workers have been using the Safe Measures SDM tool on paper and received access to the online system in November 2020. The system will help drive decision-making that is aligned with ACHHS’s goal to prevent or limit the entry of youth into the child welfare system. The following summarizes the main activities that have taken place around the “Training” element of this systemic factor since April 2020 (Action Step 9.2.a Packet Pg. 109 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 14  Through ACHHS’s contract with the Northern California Training Academy at the University of California, Davis ACHHS CWS staff have received targeted coaching on harm and danger statements, integrating SOP into MDTs, and collaborative case staffing.  As described above, on December 7 and 8, 2020 CWS social workers and staff from Mono County participated in a two-day training, The CANS: Overview, Case Planning and Preparation for Certification. The Social Services Program Manager/Deputy Public Guardian was certified in administering the CANS on February 8, 2021. Though implementation is expected to continue throughout the SIP period, this strategy has nonetheless been effective for improving two of the three systemic factors around which the SIP strategies are focused: Staff, Caregiver, and Provider Training; and Agency Collaboration. Tools reported in the prior Progress Report are being integrated into practice, including using the CANS to ensure that case plan objectives leverage family and focus on priority needs identified. Action Step Status: Strategy 4 comprises three action steps. Action Step A, scheduled to be implemented between July 2019 and April 2024, was partially completed in 2019 as UC Davis was identified as the program that would be used to train ACHHS staff in SOP. Peggi Cooney, UC Davis Extension Instructor, has been retained to serve as a coach for ACCHS staff, which was determined to be a more effective approach than having ACHHS staff enroll in courses at UC Davis directly. In addition, ACHHS has introduced the SOP model to the County’s MDT and will begin integrating SOP’s focus on family and networks of support to prevent out-of-home placement and address case issues in a cross-system teaming environment. SOP training and coaching is expected to be ongoing, with Action Step A not being fully completed until the end of the SIP period. Progress has been made on Step B, evidenced by the development of a facilitation protocol for along with CWS staff obtaining certification in the CANS. Action Step C is underway with the development of the July 2020-July 2021 SIP Evaluation Plan approved by ACHHS. The SIP evaluation plan includes measuring if and how families are engaged in the SOP process to find solutions that ensure safety, permanency, and well-being. To that end, a survey was developed by SEI and approved by ACHHS for distribution to families that participate in Surveys will be collected by ACHHS staff and mailed to SEI for analysis. Survey data is not available at this time as no have taken place since survey development but is expected following the next in-person CFTM. All Action Steps are expected to occur as scheduled. Evaluation and Monitoring: Determining outcome measures to identify and monitor program effectiveness, development and utilization of evaluation tools, and monitoring of SOP programs and services has begun and will take place as scheduled through the end of the SIP period. SEI and ACHHS have defined initial, anticipated outcomes associated with this strategy in the System Improvement 9.2.a Packet Pg. 110 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 15 Plan Evaluation Plan that covers the period July 2020-June 2021. These include:  Increased use of SOP strategies and tools when working with families and within MDTs;  Families are engaged in the process to find solutions to ensure safety, permanency, and well- being; and  Barriers to implementation are identified and a plan for resolution is developed. These outcomes will be monitored through April 2024 per the SIP Table for this strategy. Strategy Develop an evaluation plan with an outside consultant to measure the effectiveness of contracted child abuse prevention funded services Analysis: Through development of the 2019-2024 System Improvement Plan, ACHHS identified the need for a comprehensive evaluation that could measure the effectiveness of CAPIT/PSSF2/CBCAP funded programs. SEI was contracted in October 2019 to develop and implement said evaluation plans. A copy of SEI’s proposal to conduct this work, including the framework and approach, was submitted to the State in the fall of 2019. Evaluation plans were established in Year 2 for all funded programs, covering the period July 1, 2020- June 30, 2021. These plans will be updated/revised annually each spring. Evaluation activities that align with these plans have been successfully executed to align with the SIP and the Office of Child Abuse Prevention (OCAP) annual reporting activities. These evaluation activities are intended to provide ACHHS and stakeholders with the feedback needed to further understand and address outcomes and continuous quality improvement within the CWS program. Related technical assistance to support both ACHHS’ and provider capacity for evaluation was also provided during Year 2 and will be ongoing through the end of the current SIP period. Since the previous reporting period, ACHHS has  Approved evaluation plans developed by SEI for each of the CAPIT/CBCAP-funded programs to measure progress toward achievement of intended program outcomes. As part of the development of the evaluation plans, program-specific evaluation surveys and other data collection tools have been implemented to support a more complete understanding of funded programs achievement of desired outcomes; and  Continued to engage the Community of Practice established in Year 1 to review and collectively explore the Family StrengtheningTM Framework, share resources and opportunities to collaborate in support of child abuse prevention, and further develop an understanding of evaluation efforts. As a result of the COVID-19 pandemic, the Community of Practice has also 2 Note that with the change to Strategy 3, evaluation activities around PSSF-funded programs will be focused on PSSF-aligned programs. 9.2.a Packet Pg. 111 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 16 been a tool for programs to consider adaptations and responses to families’ changing needs. Action Step Status: Strategy 5 comprises three action steps. As noted in the previous progress report, Action Step A, scheduled to be implemented between July 2019 and April 2020, was partially completed in October 2019 with the execution of the contract between ACHHS and SEI. The second part of Action Step A, described as “define outcome measures to monitor evaluation program effectiveness across CWS,” was addressed through development of the funded program-specific evaluation plans in summer 2020. Activities related to Action Step A will be ongoing throughout the entire SIP period, as evaluation plans, and data collection tools and approaches, will be reviewed and revised annually as necessary to account for programmatic changes within CAPIT and CBCAP programs. Action Steps B and C are in progress, although Step C was not scheduled to begin until April 2022. All CAPIT and CBCAP funded programs (Alpine County Child Abuse Prevention Council, Alpine Early Learning Center, Alpine Expanded Learning Program, Busy Bears Playschool, and Live Violence Free) began collecting data per their individualized evaluation plans in July 2020. Semi-annual progress reports were due on January 31st and this data has been reviewed. Feedback forms were sent to programs responding to data discrepancies, asking questions regarding any potential improvements, and noting progress towards milestones. An evaluation brief will be produced for each program in summer 2021, providing an understanding of progress towards achieving outcomes, relevant information gathered from qualitative data collection, and recommendations and considerations for both programs and ACHHS, as applicable. The latter will be used to support continuous quality improvement within CWS programming as outlined in Action Step C. Evaluation and Monitoring: Implementation of evaluation plans for each of the funded programs described in the paragraph above began in July 2020. Collection and analysis of data for the July 2020 to June 2021 period will take place as outlined in the aforementioned evaluation plans and be included in the 2021 OCAP Report for this period. As part of Action Step A, outcome and performance measures have been established at a programmatic level for each funded program. Those data collected and reported during the 2020-2021 contract period will be reviewed to refine evaluation efforts and potentially revise measures as necessary. It should be noted that due to the circumstances of the pandemic, service delivery has been significantly impacted in the County. Evaluation efforts and data collection have been adjusted to respond to new service delivery modalities, but it is expected that the results of this year’s evaluation efforts will likely be an anomaly in terms of the planned approach to future evaluation. Additional qualitative data will be gathered to provide context about programmatic responsiveness to family needs. Program-level outcomes will be monitored through April 2024 per the SIP Table for this strategy. Strategy Update the ACCHS Child Welfare Services Policies & Procedures Manual 9.2.a Packet Pg. 112 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 17 Analysis: ACHHS has identified the need for the CWS policy manual currently in use by Child Protective Services to be updated to reflect the new CWS policy as mandated by state and federal legislation. This will be a contracted project, with the intent to engage a vendor to develop a new Policy and Procedures Manual that can subsequently be updated during each SIP period. A potential vendor was identified in 2019 to provide these services; however, that vendor was later determined not to be an appropriate fit for this project. Implementation of this strategy was thus postponed to Year 2 of the current SIP period via the April 2020 SIP Progress Report. During Year 2, key informant interviews were conducted with ACHHS staff by SEI. During those interviews, some staff provided suggestions for manual improvements, such as simplifying the manual and making it more succinct, utilizing bullet points, adding page numbers, indexing it by case type, and creating an electronic version such as a PDF that could be pinned to their desktops and easily searched. These recommendations will be shared with the identified vendor once one is selected. ACHHS staff did identify another possible vendor in 2020, but due to limited staff capacity caused by increased COVID- 19 responsibilities and the need to address additional State-mandates (e.g. AB 2083 and FURS), it is not expected that a contract will be executed during Year 2 as planned. Action Step Status: Strategy 6 comprises four action steps. Given the difficulty in identifying an appropriate vendor to facilitate strategy implementation, all four action steps were revised as noted in the relevant Strategy Table in the April 2020 SIP Progress Report. It is anticipated that Action Steps A-C will each need to be pushed back another year, with the manual update to be started in spring of 2022 pending the resolution of COVID-19 in the county. This update is reflected in the amended SIP 5-Year Chart. Evaluation and Monitoring: Evaluation activities around implementation of this strategy will begin in April 2022, or upon execution of a contract with a vendor to begin work on updating the Policy and Procedures Manual. Strategy Contract with another California county for help desk and data clean up assistance in CWS/CMS Analysis: During development of the 2019-2024 SIP, ACHHS identified the need for data cleanup and related data management activities within the CWS/CMS program in order to support the accurate and timely delivery of CWS utilization and permit an easier transition to the new CWS-CARES system. ACHHS does not have the existing personnel to maintain a CWS/CMS help desk, so the department determined that contracting with another California county to serve as the Alpine Help Desk was the best option for the provision of these needed services. During Year 1, ACHHS contracted with El Dorado County to provide these services. Data cleanup and help-desk activities began in April 2020 and have been provided by El Dorado County Child Protective Services IT Department Coordinator Karen Anda. Support provided by Ms. Anda during Year 2 includes 9.2.a Packet Pg. 113 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 18 data clean-up and deduplication activities within CWS/CMS, providing help desk services such as facilitating password resets and authorizing system access to new users, and offering trainings for key ACHHS staff. The first training is anticipated to be held in March 2021 and will focus on providing a CWS/CMS overview for new users, instruction on how to enter CANS assessments into the CARES System for recently CANS-certified ACHHS staff, and best practices for documenting CSEC and Child and Family Team Meetings within CWS/CMS. As a result of data clean-up activities, as of February 3, 2021 Alpine County has zero duplicate clients and zero duplicate Substitute Care Providers within the system. Action Step Status: Strategy 7 comprises four action steps. Action Step A was completed on February 20, 2020 through an MOU executed between ACHHS and El Dorado County Health and Human Services Agency. Step B began as scheduled, and no revisions to the timeline included in the approved SIP are anticipated for this strategy. Evaluation and Monitoring: Outcome and performance measures to monitor data cleanup and help desk efforts were scheduled to be defined in April 2021. However, with execution of the contract with El Dorado being completed in February 2020, SEI was able to define outcomes associated with this strategy in the System Improvement Plan Evaluation Plan that covers the period July 2020-2021. These comprise:  Data within the CWS/CMS is deduplicated, reliable, and validated  ACHHS staff feel prepared and equipped to enter CWS data into applicable systems  All applicable data is regularly entered into appropriate CWS/CMS systems These outcomes will be monitored through April 2024 per the SIP Table for this strategy. OBSTACLES AND BARRIERS TO FUTURE IMPLEMENTATION As described in the previous SIP Progress Report, several external factors have the potential to affect ACHHS’s progress in SIP implementation. During winter months, sections of Alpine County can become isolated due to unsafe travel conditions, which has and continues to be a challenge for in-person trainings and coaching. In order to support clients, funded programs are strategically located in the County to allow for accessibility by the majority of County residents. ACHHS staff also utilize remote and teleconferencing technology to connect with clients, but internet access and connectivity is limited in some parts of the county. Therefore, clients are supported throughout the winter months by social workers who travel for face- to-face visits within and outside the county whenever necessary and possible. Social workers also collaborate with other child welfare agencies to ensure clients who are placed out of county receive support and services. For example, ACHHS has an MOU with Calaveras County to provide Emergency Response services to clients on the west side of the Sierras. The onset and escalation of the COVID-19 pandemic and associated social distancing and stay-at-home 9.2.a Packet Pg. 114 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 19 orders have changed the reality in which ACHHS executes its mission. The agency has adjusted the way it conducts work and implements training by limiting in-person interactions and utilizing virtual technologies as the primary mode for conducting these activities. As described in an All County Letter 20-25 from March 21, 2020 case workers are making child- and family-specific decisions to determine if face-to-face visits are necessary while the state has restrictions in place; ACHHS staff continues to perform in-person visits within the framework provided in the All County Letter. ACHHS staff have also taken on additional, COVID-related responsibilities, such as providing basic services and assistance to residents of Alpine County impacted by the pandemic and organizing, supporting, and staffing COVID testing and vaccination activities. Implementation of additional State-mandates, such as AB 2083 and FURS, have further limited staff capacity to engage in system improvement activities. While it is anticipated that some capacity issues will resolve as more of the county becomes vaccinated, the long-term impacts of the pandemic on Alpine families will continue to affect ACHHS staff priorities and availability past the official end of the pandemic. Staff capacity will additionally continue to be impacted as new State-mandates are released. PROMISING PRACTICES/ OTHER SUCCESSES Several promising practices contributing positively to SIP strategies have been achieved in the past year and are summarized below.  In summer 2020, ACHHS expanded its contract with SEI, the evaluation and monitoring consultant, to include providing targeted assistance around several key strategies, specifically 1, 2, and 7. During this same time, SEI and ACHHS in collaboration created the System Improvement Evaluation Plan, covering the period July 1, 2020, through June 30, 2021. This plan, to be updated annually, describes the SIP goals and strategies; outlines evaluation questions; and identifies inputs, outputs, and activities needed to achieve short- and long-term outcomes for each strategy.  In December 2020, ACHHS began working on the AB 2083 MOU to create a trauma-informed system of care for children and youth. such as this require diverting staff time and other resources from primary SIP strategies, The System of Care MOU is an added requirement of the state that is aligned with SIP Strategies 1 and 4. Mandated activities however, ACHHS is committed to creating a trauma-informed and integrated system of care and sees the completion of the MOU as an additional strategy toward that goal. ACHHS established an Interagency Leadership Team (ILT) to develop each section of the MOU, which is expected to be completed by April 2021.  In January 2021, the Social Worker IV was promoted to Social Services Program Manager/Deputy Public Guardian and the county expects to add an additional social worker to its staff in the coming months. This additional capacity will help the county provide services to families in need, particularly as the county recovers from the COVID-19 pandemic. 9.2.a Packet Pg. 115 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 20  As of February 2021, the Social Services Program Manager/Deputy Public Guardian now certified to administer the CANS. CWS staff continue to receive coaching on implementing the SOP framework. Over the next reporting period, ACHHS will begin integrating the CANS into to ensure case plans address the priority needs identified in the CANS. OUTCOME MEASURES NOT MEETING STATE/NATIONAL STANDARDS A review of Q3 2020 data, provided by Outcomes and Accountability Bureau Social Services Consultant Henry Franklin on February 3, 2020, was conducted to identify any measures for which ACCHS was not meeting National or Compliance Standards. One measure, 3-S2, did not meet National or Compliance Standards for the period 10/1/18-9/30/19.  3-S2 (Recurrence of maltreatment) I Most recent performance: 33.3%, N/CS: 9.1% The 33% noted above represents one case of maltreatment recurrence. Alpine County cannot provide additional information on this case in a public-facing document such as the SIP Progress Report, as the small sample size could lead to identification of impacted or associated individuals. Trends over time are not discussed due to a scarcity of child welfare cases and the resulting inability to draw meaningful conclusions. However, it is worth noting that, as described in the previous year’s SIP Progress Report, two measures were noted as failing to meet National or Compliance standards. Both measures, 2B-10 Day Timely Response and Visits Out of Home, now meet or exceed the National or Compliance standard. WELFARE/PROBATION PLACEMENT INITIATIVES On January 28, 2020 ACHHS, Child Protection Services and Alpine County Probation Department signed a Memorandum of Understanding (MOU) under Welfare and Institutions Code Section 241.1. The MOU describes the collaborative response the agencies will take when dual status youth are identified. In implementing this collaborative response, the agencies strive to achieve the following common goals:  Serve dual status youth more effectively and efficiently by early identification and providing coordinated services in the least restrictive manner and before further penetration into either system.  Outline specific tasks of each agency relative to dual status youth.  Provide increased access to targeted, evidence-based services for dual status youth that will address their individualized needs, including those that address trauma. The agencies will hold case staffings to discuss the needs of the youth and their family and determine the appropriate course for the case, including diverting the case from formal adjudication in the delinquency court. Alpine County has had a very low number of dual status cases over the past decade, but will implement strategies outlined in the MOU as cases arise. 9.2.a Packet Pg. 116 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 21 In addition, the Probation Department engaged an external organization to complete an evaluation of the department’s staffing needs. This report will be used to inform future staffing decisions within the Department. 9.2.a Packet Pg. 117 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 22 Priority Outcome Measure or Systemic Factor: Staff, Caregiver, and Provider Training - Implementation of identified strategies to support staff and providers in intervention and prevention activities to address the circumstances leading to youth and families entering child welfare services (CSA, pg. 38). National Standard: N/A CSA Baseline Performance: N/A Target Improvement Goal: Year 1 (April 15, 2019 -April 12, 2020): Contract with the Northern Regional Training Academy to provide Safety Organized Practice (SOP) training for CWS staff and begin defining outcome measures to monitor program effectiveness. Identify and contract with an outside organization to implement trauma informed practice. Define initial outcome measures to identify and monitor program effectiveness for select strategies. Year 2 (April 15, 2020 -April 14, 2021): Implement SOP and partner with UC Davis (or similar organization) to develop SOP protocols. Begin implementation of trauma informed practices and systems. Year 3 (April 15, 2021-April 14, 2022): Full implementation of Safety Organized Practice (SOP) and Structured Decision Making (SDM) within CPS and Probation, and continue to monitor program effectiveness. Continue implementation of trauma informed practices and systems. Year 4 (April 15, 2022 -April 14, 2023): Continue to meet timelines related to CWS policy and procedure updates. Continue to meet timelines related to CWS policy and procedure updates. Begin evaluation of trauma informed practice program effectiveness. Continue to monitor program effectiveness of SOP. Year 5 (April 15, 2023 -April 14, 2024): Evaluate and monitor SOP programs and services through a contract for evaluation services, and continue to meet timelines related to CWS policy and procedure updates. Continue evaluation of trauma informed practice program effectiveness. Continue to monitor program effectiveness of SOP. 3 The 5-year SIP Chart was updated in 2020 to summarize all information from the Strategy Tables as the version submitted with the original SIP excluded some strategies. This was corrected via the April 6, 2020 Progress Report. Note that goals associated with strategies were listed under only one systemic factor, although progress toward goal achievement may be applicable to more than one systemic factor. The following Strategy Tables indicate all systemic factors addressed by each strategy. All changes made during the 2020 Progress Report were indicated with strikethroughs (deletion) and underlines/italics (additions). That same formatting is applied in this 2021 Progress Report but is specific to proposed changes that occurred after approval of the 2020 Progress Report; changes made in the 2020 Progress Report are incorporated into this report with no formatting. 5-Year SIP Chart2 9.2.a Packet Pg. 118 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 23 Priority Outcome Measure or Systemic Factor: Service Array Agency Collaboration – Implementation of identified strategies to support agency collaboration with County Probation, other County agencies, Tribal service partners and local provider agencies in intervention and prevention activities to address the circumstances leading to youth and families entering child welfare services (CSA, pg. 38). National Standard: N/ A CSA Baseline Performance: N/ A Target Improvement Goal: Year 1 (April 15, 2019 -April 12, 2020): Contract with the Tribal Law and Policy Institute (TLPI) to collaboratively develop a comprehensive CSEC policy, protocol, and training program with the Washoe Tribe and Alpine County. Develop an operational protocol and a memorandum of understanding between specified agencies operating as a multi-disciplinary team. Year 2 (April 15, 2020-April 14, 2021): In partnership with the Washoe Tribe and TLPI identify and implement a culturally appropriate community outreach program. Determine feasibility of contract with Lilliput Families for guardianship and post-adoptive services, and implement family support, family preservation, time-limited family reunification services, and guardianship and post- adoptive services in Alpine County. Begin defining outcome measures to identify and monitor program effectiveness for PSSF-aligned activities. Year 3 (April 15, 2021-April 14, 2022): Continue implementation of family support, family preservation, time-limited family reunification services, and guardianship and post- adoptive services in Alpine County. Continue defining outcome measures to identify and monitor program effectiveness for PSSF- aligned activities. Year 4 (April 15, 2022 -April 14, 2023): In partnership with the Washoe Tribe, TLPI, and an outside evaluation consultant develop outcome measures to identify and monitor program effectiveness. Continue defining outcome measures to identify and monitor program effectiveness for PSSF-aligned activities and evaluate and monitor programs and services. Year 5 (April 15, 2023 -April 14, 2024): Continue to evaluate and monitor CSEC programs and services through a contract for evaluation services. Continue defining outcome measures to identify and monitor program effectiveness for PSSF-aligned activities and evaluate and monitor programs and services. 9.2.a Packet Pg. 119 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 24 Priority Outcome Measure or Systemic Factor: Quality Assurance System – Implementation of a contracted evaluation plan with an outside consultant to measure the effectiveness of contracted child abuse prevention fund services (CSA, pg. 39). National Standard: N/A CSA Baseline Performance: N/A Target Improvement Goal: Year 1 (April 15, 2019 -April 12, 2020): Identify a vendor to develop a comprehensive evaluation program for child welfare services and CAPIT/CBCAP/PSSF-aligned programs. Define initial outcome and performance measures. Identify a County to contract with to assist with or develop a comprehensive plan to address data issues within CWS/CMS to support CWS program and migration to CWS-CARES. Year 2 (July 1, 2020 -April 14, 2021): Implement the evaluation program to be incorporated into CWS program reporting to include the annual SIP update and OCAP report. Identify and contract with a vendor to update the existing child welfare services manual of policies and procedures, to include a mechanism for at least annual updates. Implement the data-cleanup project and CWS/CMS help-desk activities to ensure fidelity within CWS program. Year 3 (April 15, 2021-April 14, 2022): Define outcome and performance measures to monitor evaluation program effectiveness across CWS programs. Continue to implement the evaluation program to be incorporated into CWS program reporting to include the annual SIP update and OCAP report. Identify and contract with a vendor to update the existing child welfare services manual of policies and procedures, to include a mechanism for at least annual updates. Implement the process to update the existing child welfare services manual of policies and procedures, and evaluate and monitor program effectiveness by working with the contracted vendor to ensure implementation deadlines are met. Continue to implement the data- cleanup project and CWS/CMS help-desk activities to ensure fidelity within CWS program, and define outcome measures to monitor data clean-up efforts. Year 4 (April 15, 2022 -April 14, 2023): Evaluate and monitor program effectiveness by working with the contracted vendor to implement change processes to support continuous quality assurance/improvement (QA/QI) within the CWS program. Implement the process to update the existing child welfare services manual of policies and procedures, and evaluate and monitor program effectiveness by working with the contracted vendor to ensure implementation deadlines are met. Define timelines for the completion of updates to the child welfare services manual of policies and procedures and monitor progress and continue to evaluate and monitor program effectiveness by working with the contracted vendor to ensure implementation deadlines are met. Continue to define outcome measures to monitor data clean-up effort and evaluate and monitor program effectiveness. Year 5 (April 15, 2023 -April 14, 2024): Continue to evaluate and monitor QA/QI program and outcomes to ensure fidelity of the implemented evaluation model. Define timelines for the completion of updates to the child welfare services manual of policies and procedures and monitor progress and continue to 9.2.a Packet Pg. 120 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 25 evaluate and monitor program effectiveness by working with the contracted vendor to ensure implementation deadlines are met. Monitor CWS manual update by working with the contracted vendor to ensure implementation deadlines are met. Continue to define outcome measures to monitor data clean-up effort and evaluate and monitor program effectiveness. 9.2.a Packet Pg. 121 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 26 Strategy 1: Trauma Informed Practice will be implemented within ACHHS and as a model for other County partner agencies CAPIT Applicable Outcome Measure(s) and/or Systemic Factor(s): Staff, Caregiver, and Provider Training & Service Array Agency Collaboration CBCAP PSSF N/A Title IV-E Child Welfare Waiver Demonstration Capped Allocation Project Action Steps: Implementation Date: Completion Date: Person Responsible: A. Identify and contract with an outside organization to assist ACHHS in the development of a comprehensive program to implement trauma informed practices and systems within Alpine County. Define outcome measures to identify and monitor program effectiveness through a contract for evaluation services. July 2019 April 2024 CWS Director and Deputy Director B. Implement Trauma informed practices and systems within ACHHS to increase provider knowledge of trauma informed care, to decrease staff issues related to vicarious trauma and integrate trauma informed processes into child welfare services. July 2020 April 2022 CWS Director, Deputy Director and Staff C. Evaluate ACHHS trauma informed practices program effectiveness and engage County, Tribal, and Community Partners to explore a countywide, Trauma Informed system and systems of care through a contract for ` including pre and post knowledge tests, staff surveys and increased use of trauma informed practice in child welfare services. July 2022 April 2024 CWS Director and Deputy Director 9.2.a Packet Pg. 122 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 27 Strategy 2: The CSEC Program and Protocol will be implemented within ACHSS in partnership with County Probation, the Washoe Tribe and Tribal Law and Policy Institute. CAPIT Applicable Outcome Measure(s) and/or Systemic Factor(s): Staff, Caregiver, and Provider Training & Service Array Agency Collaboration CBCAP PSSF N/A Title IV-E Child Welfare Waiver Demonstration Capped Allocation Project Action Steps: Implementation Date: Completion Date: Person Responsible: A. Expand contract with the Tribal Law and Policy Institute (TLPI) to collaboratively develop a comprehensive CSEC policy, protocol, and training program with the Washoe Tribe and Alpine County. July 2019 June 2020 CWS Director, Deputy Director and Staff B. Develop an operational protocol and a memorandum of understanding between specified agencies operating as a multi- disciplinary team for the provision of services for CSEC victims. July 2019 June 2020 CWS Director and Deputy Director C. In partnership with the Washoe Tribe and TLPI identify and implement a culturally appropriate community outreach program. This collaborative effort will support efforts to address CSEC and Human Trafficking within Alpine County. April 2020 June 2021 CWS Director, Deputy Director and Staff D. In partnership with the Washoe Tribe, TLPI, and an outside evaluation consultant develop outcome measures to identify and monitor program effectiveness, such as pre and posttest of community and staff knowledge of CSEC issues; and community and staff satisfaction surveys related to trainings. April 2022 April 2024 CWS Director and Deputy Director 9.2.a Packet Pg. 123 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 28 Strategy 3: Implementation of PSSF Identified Aligned Activities in Alpine County through contracted providers and ACHHS. CAPIT Applicable Outcome Measure(s) and/or Systemic Factor(s): Staff, Caregiver, and Provider Training & Service Array Agency Collaboration CBCAP PSSF N/A Title IV-E Child Welfare Waiver Demonstration Capped Allocation Project Action Steps: Implementation Date: Completion Date: Person Responsible: A. Determine feasibility of contract with Lilliput Families an outside organization for guardianship and post- adoptive services. April 2020 April 2021 CWS Director, Deputy Director and Staff B. Implement family support, family preservation, time-limited family reunification services, and guardianship and post- adoptive services in Alpine County. These activities will include services for reunification, family support, family preservation and permanency. April 2020 April 2022 CWS Deputy Director and Staff C. Define outcome measures to identify and monitor program effectiveness. April 2020 April 2024 CWS Deputy Director and Staff D. Evaluate and monitor programs and services through a contract for evaluation services, including pre and post knowledge tests, and staff and community based surveys. April 2022 April 2024 CWS Director and Deputy Director 9.2.a Packet Pg. 124 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 29 Strategy 4: Full implementation of Safety Organized Practice (SOP) in ACHHS CWS and CSW activities with providers and families engaged in child welfare services. CAPIT Applicable Outcome Measure(s) and/or Systemic Factor(s): Staff, Caregiver and Provider Training & Service Array Agency Collaboration CBCAP PSSF N/A Title IV-E Child Welfare Waiver Demonstration Capped Allocation Project Action Steps: Implementation Date: Completion Date: Person Responsible: A. Identify programs to train ACHHS staff in SOP and begin full implementation within Alpine County. Safety Organized Practice (SOP) will be part of the County MDT that meets to address youth and families at risk for CPS interventions within Alpine County. July 2019 April 2024 CWS Deputy Director and Staff B. Implement SOP and partner with UC Davis (or similar organization) to develop SOP protocols. April 2020 April 2022 CWS Deputy Director and Staff C. Define outcome measures to identify and monitor program effectiveness. Evaluate and monitor SOP programs and services through a contract for evaluation services, including pre and post knowledge tests, and staff and community based surveys. April 2019 April 2024 CWS Director and Deputy Director 9.2.a Packet Pg. 125 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 30 Strategy 5: Develop an evaluation plan with an outside consultant to measure the effectiveness of contracted child abuse prevention funded services. CAPIT Applicable Outcome Measure(s) and/or Systemic Factor(s): Quality Assurance System CBCAP PSSF N/A Title IV-E Child Welfare Waiver Demonstration Capped Allocation Project Action Steps: Implementation Date: Completion Date: Person Responsible: A. Identify and contract with a vendor to develop a comprehensive evaluation program for child welfare services and CAPIT /CBCAP /PSSF-aligned programs. Define outcome and performance measures to monitor evaluation program effectiveness across CWS programs. July 2019 April 2024 CWS Director, Deputy Director and Staff B. Implement the evaluation program to be incorporated into CWS program reporting to include the annual SIP update and OCAP report. July 2020 April 2022 CWS Deputy Director and Staff C. Evaluate and monitor program effectiveness by working with the contracted vendor to implement change processes to support continuous quality improvement within the CWS program. April 2022 April 2024 CWS Director and Deputy Director 9.2.a Packet Pg. 126 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 31 Strategy 6: Update Child Welfare Services Policies & Procedures Manual CAPIT Applicable Outcome Measure(s) and/or Systemic Factor(s): Quality Assurance System CBCAP PSSF N/A Title IV-E Child Welfare Waiver Demonstration Capped Allocation Project Action Steps: Implementation Date: Completion Date: Person Responsible: A. Identify and contract with a vendor to update the existing child welfare services manual of policies and procedures, to include a mechanism for at least annual updates. July 2020 April 2021 April 2022 CWS Director, Deputy Director and Staff B. Implement the process to update the existing child welfare services manual of policies and procedures April 2021 April 2022 April 2022 April 2023 CWS Deputy Director and Staff C. Define timelines for the completion of updates to the child welfare services manual of policies and procedures and monitor progress. April 2022 April 2023 April 2023 April 2024 CWS Deputy Director and Staff D. Evaluate and monitor program effectiveness by working with the contracted vendor to ensure implementation deadlines are met. April 2021 April 2022 April 2024 CWS Director and Deputy Director 9.2.a Packet Pg. 127 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- Page I 32 Strategy 7: Contract with another California County for help desk and data clean up assistance in CWS/CMS CAPIT Applicable Outcome Measure(s) and/or Systemic Factor(s): Quality Assurance System CBCAP PSSF N/A Title IV-E Child Welfare Waiver Demonstration Capped Allocation Project Action Steps: Implementation Date: Completion Date: Person Responsible: A. Identify a County to contract with to assist with or develop a comprehensive plan to address data issues within CWS/CMS to support CWS program and migration to CWS-CARES. July 2019 April 2020 CWS Director, Deputy Director, and Staff B. Implement the data- cleanup project and CWS/CMS help-desk activities to ensure fidelity within CWS program. April 2020 April 2022 CWS Deputy Director and Staff C. Define outcome and performance measures to monitor data cleanup efforts and CWS/CMS activities. April 2021 April 2024 CWS Deputy Director and Staff D. Evaluate and monitor program effectiveness by working with the contracted QA/QI vendor to ensure data integrity within CWS/CMS and CWS program. April 2022 April 2024 CWS Director and Deputy Director 9.2.a Packet Pg. 128 Attachment: Alpine County SIP PR - Final 6.17.21 (Request approval of the 2020 System Improvement Plan annual update report.) ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Sarah Simis, Deputy CAO to Personnel and Risk Management DATE OF MEETING: July 20, 2021 PREPARED BY: Sarah Simis, Deputy CAO to Personnel and Risk Management TITLE: Presentation by Nobel Grand Humbug of the Snowshoe Thompson Chapter 1827 of E. Clampus Vitus Jordan Smith regarding a request to place historical plaques in Heritage Park for Jedediah Smith and Peter Ranne. SUMMARY: Snowshoe Thompson Chapter #1827 of The Ancient and Honorable Order of E Clampus Vitus has requested approval to place historical plaques in the Markleeville Heritage Park. E. Clampus Vitus will be responsible for any ongoing maintenance needed for the plaques. RECOMMENDED ACTION: Approve placement of the plaques. ISSUE STATEMENT AND DISCUSSION: The proposed language on both plaques is attached to this agenda item. FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $0.00 $0.00 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: N/A INSTRUCTIONS TO CLERK: 10.1 Packet Pg. 129 ---PAGE BREAK--- Snowshoe Thompson #1827 Chapter of E. Clampus Vitus. Is requesting permission to erect two monuments, one for Jedediah smith and one for Peter Ranne in Heritage Park or a possible alternate location of Alpine County’s choosing. Below is a suggested location in the park. There is currently a plaque for Jacob Marklee on the south end of the marked area near Hwy 4 that we put up a couple years ago. We have been informed that there may be a good deal of construction occurring in this area in the next year or so. If there is an alternate location to permanently or temporarily place the plaques until the construction is complete, we are open to suggestions. Monument type. We have two different mounting options for the plaques. We can mount them to a large stone like the one that was provided for us that the Jacob Marklee Plaque is mounted to. Alternatively, we can pour in place a concrete monument with the plaques embedded in it (see photo below). 10.1.a Packet Pg. 130 Attachment: Markleeville Plaque proposal_ (9:30 AM E Clampus Vitus re monuments in Heritage Park) ---PAGE BREAK--- Below are proofs of the plaques from the Casting company. 10.1.a Packet Pg. 131 Attachment: Markleeville Plaque proposal_ (9:30 AM E Clampus Vitus re monuments in Heritage Park) ---PAGE BREAK--- JEDEDIAH SMITH JEDEDIAH SMITH WAS BORN ON JANUARY 6, 1799 IN JERICHO, NEW YORK. AS A BOY, SMITH HAD A LOVE FOR THE OUTDOORS AND HUNTING. HE AL- SO ENJOYED READING ABOUT GREAT MOUNTAIN MEN SUCH AS KIT CAR- SON, DANIEL BOONE, JIM BRIDGER, AND LEWIS AND CLARK. IN 1822, AT THE AGE OF 23, SMITH WOULD FOLLOW IN THE FOOTSTEPS OF HIS BOY- HOOD HEROES AND BEGIN A NINE-YEAR ADVENTURE OF EXPLORING AND TRAPPING IN THE NEW AMERICAN WEST. IN 1827, SMITH LEAD A GROUP OF MEN, CONTRACTED BY THE ROCKY MOUNTAIN FUR COMPANY, FROM THE GREAT SALT LAKE INTO THE SOUTHERN PARTS OF CALIFORNIA. IN MAY OF THAT YEAR, SMITH NEEDED TO LEAVE THE GROUP AND HEAD BACK TO THE SALT LAKE AREA TO REACH A RENDEZVOUS BY JULY 1. SMITH WOULD BE FORCED TO MAKE HIS WAY OVER THE SNOWY SIERRA NEVADA RANGE, ON A ROUTE THAT MOST LIKELY PASSED THROUGH THE CURRENT AREA OF ALPINE COUNTY. SMITH’S JOURNAL ENTRIES ARE OPEN FOR INTERPRETATION, AND THE EXACT COURSE THAT WAS TRAVELED IS UNKNOWN. MANY HISTORIANS BELIEVE THAT SMITH TRAVELED UP A PROMINENT MOUNTAIN RIVER SYSTEM TO EBBETTS PASS, AND THEN MADE HIS WAY DOWN THE EAST- ERN SLOPE ON A ROUTE THAT TOOK HIM JUST SOUTH OF WALKER LAKE. THE TRIP WOULD ADD ANOTHER DISTINCTION TO SMITH’S REMARKABLE ACCOMPLISHMENTS BY MAKING HIM THE FIRST NON-NATIVE TO CROSS THE SIERRA NEVADA RANGE. ON MAY 27, 1831, SMITH WAS AMBUSHED AND KILLED BY A PARTY OF 20 MEN. LEGEND HOLDS THAT SMITH FOUGHT WITH SUCH BRAVERY THAT HIS ATTACKERS TREATED HIS BODY WITH GREAT HONOR AND RESPECT. DEDICATED JULY 24, 2021 (2026) BY THE SNOWSHOE THOMPSON CHAPTER 1827 THE ANCIENT AND HONORABLE ORDER OF E CLAMPUS VITUS® 10.1.b Packet Pg. 132 Attachment: Jedediah Smith FINAL FINAL (9:30 AM E Clampus Vitus re monuments in Heritage Park) ---PAGE BREAK--- PETER RANNE IN 1826, PETER RANNE WOULD JOIN THE COMPANY OF FOURTEEN OTHER MEN CONTRACTED BY THE ROCKY MOUNTAIN FUR COMPANY AND BEGIN A SOUTHWEST EXPLORATION FROM THE GREAT SALT LAKE IN SEARCH OF ABUNDANT BEAVER TRAPPING AREAS. THE GROUP CROSSED THE BORDERS OF THE CURRENT STATE OF NEVADA NEAR THE PRESENT LOCATION OF MESQUITE AS THEY MADE THEIR WAY TOWARDS THE COAST. UPON ENTERING CALIFORNIA, THE GROUP EXPLORED NORTH- WARD INTO THE SAN JOAQUIN VALLEY WHERE THEY WOULD SPEND SEV- ERAL MONTHS TRAPPING. EVENTUALLY THE GROUP MADE THEIR WAY NORTH INTO OREGON. IT WAS THERE THAT RANNE AND FOURTEEN OTH- ER MEN WOULD BE KILLED IN AN AMBUSH. LITTLE IS KNOWN ABOUT RANNE, AND HE MAY HAVE BEEN LOST TO HISTORY IF NOT FOR THE JOURNAL ENTRIES OF FELLOW EXPLORER HARRISON G. ROGERS, AND THE ROCKY MOUNTAIN FUR COMPANY REC- ORDS. THESE RECORDS INDICATED THAT RANNE WAS A “MAN OF COLOR,” AND THAT HE RECEIVED PAY EQUAL TO THAT OF THE OTHER MEMBERS OF THE PARTY. RANNE AND THE OTHER MEN WERE NOT EMPLOYEES OF THE ROCKY MOUNTAIN FUR COMPANY, BUT WERE FREE MOUNTAIN MEN, WHO SOLD THEIR FURS TO THE FIRM FOR A PRICE OF $3 PER POUND. RANNE WOULD BE THE FIRST MAN OF AFRICAN DESCENT TO BOTH ENTER THE BOUNDARIES OF THE MODERN STATE OF NEVADA AND TO REACH CALIFORNIA BY LAND. HE WOULD SUCCESSFULLY TRAVEL ACROSS THE SOON-TO-BE STATE OF CALIFORNIA FROM ITS SOUTHERN TERRITORIES TO ITS NORTHERN BORDER. LIKE MANY MOUNTAIN MEN DURING THE 1800s, RANNE WOULD SURVIVE GREAT HARDSHIPS AND DIE YOUNG, YET HE WOULD ALSO LIVE LIFE AS A FREE MAN IN THE MOUNTAINS OF THE AMERICAN WEST. DEDICATED JULY 24, 2021 (6026) BY THE SNOWSHOE THOMPSON CHAPTER 1827 THE ANCIENT AND HONORABLE ORDER OF E CLAMPUS VITUS® 10.1.c Packet Pg. 133 Attachment: Peter Ranne FINAL FINAL (9:30 AM E Clampus Vitus re monuments in Heritage Park) ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Nichole Williamson, CAO/HHS Director DATE OF MEETING: July 20, 2021 PREPARED BY: Nichole Williamson, CAO/HHS Director TITLE: ADDENDUM: Presentation and discussion of Alpine County COVID-19 Response Report by Public Health Officer Dr. Richard Johnson. SUMMARY: The Health Department has drafted report for the Board of Supervisors regarding our response to the COVID-19 pandemic. RECOMMENDED ACTION: None, presentation and discussion. ISSUE STATEMENT AND DISCUSSION: Public Health Officer Dr. Richard Johnson will present the Alpine County COVID-19 Response Report to the Board of Supervisors. FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $0.00 $0.00 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: None INSTRUCTIONS TO CLERK: 10.2 Packet Pg. 134 ---PAGE BREAK--- Alpine County: Response to the COVID-19 Pandemic January 2020 – June 2021 10.2.a Packet Pg. 135 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 2 This page is intentionally left blank. 10.2.a Packet Pg. 136 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 3 Table of Contents 5 – Executive Summary 9 – Goals and Objectives 11 – Best Practices, Issues and Recommendations: EOC/DOC Management, Information Sharing, Public Information and Warning 15 – Best Practices, Issues and Recommendations Testing and Clinical Evaluation 17 – Best Practices, Issues and Recommendations Epidemiology, Surveillance and Investigation, Case Investigation/Contact Tracing 19 – Best Practices, Issues and Recommendations Vaccines Appendices: 23 - Indicators 27 – Timeline 33 – Coronavirus Daily Tracker 35 – Supporting Documents: EOC/DOC Management, Information Sharing, Public Information and Warning 39 – Supporting Documents Testing and Clinical Evaluation 41 – Supporting Documents Epidemiology, Surveillance and Investigation, Case Investigation/Contact Tracing 47 – Supporting Documents Vaccines 69 - Looking Ahead – What’s Next? 71 - Acronyms 10.2.a Packet Pg. 137 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 4 This page is intentionally left blank. 10.2.a Packet Pg. 138 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 5 Executive Summary Not since the 1918 influenza pandemic has the United States and the world faced a public health emergency of the magnitude of this current COVID-19 pandemic. This is the first pandemic in the history of mankind where vaccines are playing a key role in bringing a pandemic to its knees. Much has been learned, but as time goes on, the more we know, the more we know we don’t know! We have included a brief commentary on “Looking Ahead – What’s Next”? (page 69) Our focus includes four areas, highlighting Best Practices, Issues and Recommendations for each. Supporting documents are included in the appendices. EOC/DOC Management, Information Sharing, and Public Information and Warning (See page 11 and 35) Our awareness began on January 6, 2020. As we developed situational awareness of the seriousness and implications, we quickly opened a Public Health Department Operations Center (DOC) followed by an Alpine County Emergency Operations Center (EOC). This combined DOC/EOC dealt with a myriad of issues (see Appendix, page 35). Our first COVID-19 case was in March 2020 in a resident who had traveled out the area. A Local Emergency and a Local Health Emergency were declared and ratified by the Board of Supervisors on March 17, 2020. Public Health Briefs (PHB) addressed to healthcare workers and all first responders (EMS, fire, law) and the public outlined recommendations and orders for non-pharmaceutical interventions (NPI’s). There were >175 PHBs delivered via e-mail distribution lists to >500 e-mail addresses over the 18-month response. A Warm Line was established which received >300 calls per week at its peak. Messages were responded to by the Health Officer or Public Health Program Manager within 24 hours. Testing and Clinical Evaluation (See page 15 and 39) Persons with possibly due to COVID-19 were evaluated at the Public Health Clinic in Woodfords. Various testing options including both antigen and the gold standard PCR tests were available. In addition, the California Department of Public Health had contracted with Verily to provide surveillance testing in 3 locations in Alpine County: Bear Valley, Kirkwood, and Woodfords. Between June 2020 and February 2021, a total of 4,052 swabs were performed, 2,012 of those in Alpine County residents. 95 tests were positive, including 15 of those in Alpine County residents, for a positivity rate of 0.75% in Alpine County residents. 10.2.a Packet Pg. 139 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 6 Epi, Surveillance and Investigation Case Investigation/Contact Tracing (See page 17 and 41) Five of our Public Health staff received certified training in Case Investigation and Contact Tracing which was adequate for our needs. We received a score of 100% from CDPH on Contact Tracing Performance Measures. We experienced a total of 91 cases, with a peak in November 2020. 63.7% of our cases were in the Hung-A-Lel-Ti Community. There were no deaths directly attributed to COVID-19, although there were 2 deaths where COVID-19 was most likely a contributing factor in persons with preexisting underlying medical conditions. In California’s Blueprint for A Safer Economy, Alpine County remained in the least restrictive YELLOW tier 63.6% of the time, longer than any other county in California. Vaccines (See page 19 and 47) Alpine County developed a Vaccination Plan which is a modification of the CDPH plan and was based on local needs and priorities. Our first priority was essential workers and their households, followed by seniors. We began vaccinations on December 23, 2020, and by February 24, 2021, opened vaccine availability to all full and part-time residents and persons who work in Alpine County and their households over the age of 17. This was almost 2 months prior to the state opening to all on April 15th. CDPH reports that Alpine County has vaccinated 87.2% of its eligible resident population with a first dose, and reports that 71.3% of the eligible population has been fully vaccinated. This is above federal and state goals and is included in the 5 highest levels of vaccination among counties in the state of California (others are all Bay Area counties – Marin, San Mateo, Santa Clara, San Francisco). Gratitude None of this could have been accomplished without the sustained and incredible hard work performed by our COVID-19 Response Team. Their names follow alphabetically. They carried out their many tasks with some risk to their own health and well-being in the name of protecting the residents and workers of Alpine County. We are eternally grateful! There are other individuals and agencies not mentioned that supported our efforts in protecting our community. Specifically, we would like to call out East Fork Fire Protection District and the Washoe Tribal Health Center and their personnel for providing services to our community during this pandemic. 10.2.a Packet Pg. 140 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 7 We are also grateful to the Alpine County Board of Supervisors for their many questions, concerns, and perspectives that helped to shape our response. Their support and encouragement was valuable during this crisis. In addition, we thank the residents and workers of Alpine County for working with us in protecting our community. Without your willingness to cooperate with us, our goals would not have been accomplished. Alpine County’s COVID-19 Response Team Jessica Bennett Tim Bottomley Dr. Bill Bowie Amy Broadhurst Debbie Burkett Clint Celio Misty Dee Ron Dobyns Cameron Dopke Erica Forzley Deb Goerlich PJ Griffin Sgt. Chris Harootunian Kate Harvey Dr. Richard Harvey Hunter Haase Mark Haase Chief Terry Hughes Laura Jensen Riley Jill Jessen-Smith Linda Johnson Dr. Rick Johnson Hillary Jolly Michelle Kaner Jema Kimmel Sharon King Dennis Lampson Margaret Long Rita Lovell Jake McCormick Undersheriff Tom Minder Brian Peters Chris Seal Sarah Simis 10.2.a Packet Pg. 141 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 8 Kathy Snyder Sheriff Rick Stephens Tim Streeper Teola Tremayne Patience Wenck, NP Nichole Williamson Zach Wood Terry Woodrow 10.2.a Packet Pg. 142 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 9 Goals - To prevent deaths from the COVID-19 pandemic - To delay the onset of local cases/outbreaks - To protect the integrity of our local and regional healthcare system - To minimize serious illness from COVID-19 especially in persons at high risk for serious outcomes - to minimize the disruptive effect of the COVID-19 pandemic on the Alpine County community Objectives Objective 1: to monitor and interpret international, national, state, and regional information about the pandemic, including the geographic extent, numbers of cases, who is at risk, and professional guidance. Objective 2: to have an active local enhanced surveillance system in place to monitor and respond on a daily basis to any evidence of potential COVID-19 activity in the local community, with testing, case investigation, and contact tracing Objective 3: to protect our local and regional healthcare system by providing guidance on diagnosis and prevention of infection while protecting our healthcare workforce with guidance and adequate PPE Objective 4: to issue guidance to all partners (employers, businesses) and the public on non- pharmaceutical interventions as appropriate for each phase of the pandemic based on state and CDC recommendations and tailored to our local situation Objective 5: administer vaccine according to recommended phases and tiers by the CDC and CDPH, following the Alpine County COVID-19 Vaccination Plan 10.2.a Packet Pg. 143 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 10 This page is intentionally left blank. 10.2.a Packet Pg. 144 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 11 EOC/DOC Management Information Sharing Public Information and Warning Best Practices DOC/EOC • We followed the principles of ICS, SEMS, and NIMS by establishing a combined Public Health DOC/jurisdictional EOC. The Incident Manager was the Public Health Officer in a Unified Command with Emergency Management (Office of Emergency Services). • All of the Command and General functions were performed. Participating included county administration (CAO, HR), HHS (Public Health, Environmental Health, Social Services), Community Development, fire, EMS, law (Office of Emergency Services). • Technology was in place and utilized to transition to coordinated operation in a virtual environment. • Whenever public information involved elements of restrictions and issues of enforcement, we discussed possible effects, challenges, and unintended consequences with partners at DOC/EOC meetings to develop consensus and clear delineation of roles and responsibilities. In general, our attitude as a jurisdiction was to provide clear, consistent, and repetitive messaging from trusted voices over mandates and enforcement actions. • As the Incident Manager, the Health Officer provided updates to elected officials and the public at the Board of Supervisors meetings on a regular basis. • A Local Health Emergency and a Local Emergency were declared and ratified by the BOS in order to maximize utilization of funding, resources, and authorities to accomplish goals during each phase of the response. Regional epi approach • A decision was made early on in the DOC/EOC to adopt a regional approach to situational awareness. Several factors made this useful: o Many of our workers in Alpine County live in neighboring counties, including Douglas County (NV), El Dorado, Amador, and Calaveras. o Our ALS services are provided from outside of the county. o Since we do not have a hospital, persons needing evaluation and care above that which could be provided by the Public Health Clinic needed to seek care in neighboring jurisdictions. 10.2.a Packet Pg. 145 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 12 Situational Awareness • The Incident Manager also functioned as the Planning Section Chief. This section includes situational awareness and forecasting. Resources accessed multiple times 7 days per week through virtual meetings, phone calls, and e-mail during the 18 months of the response included among others: o CDPH o HOAC o CCLHO o Region 4 o Quad Counties (Douglas, Carson, Lyon, Storey) in Nevada o Washoe County o California county alerts (Amador) o Sierra-Sacramento Association of Health Officers o Media outlets o CDC o WHO o CIDRAP o Johns Hopkins o IHME • Information was evaluated and used to produce information sharing for DOC/EOC personnel, first responders (EMS, fire, law), healthcare personnel, and public information and warning through Public Health Briefs. • Monitoring of the capacity and availability of hospital beds in the region and state was performed daily. • It became obvious that if a need arose for alternate care sites when hospitals did not have any further staffed beds, local hospitals would not be able to staff or provide these services. Plans were then implemented with CDPH and EMSA for a regional approach using the Sleep Train Arena outside of Sacramento. Public Health Briefs • We proactively developed over 175 Public Health Briefs which were distributed to over 500 e-mail addresses, including evolving guidance, Public Health Orders, testing and vaccine information, and addressing misinformation, rumors, and These were then sent to additional distribution lists and posted at places of business and employment. • We sought to be transparent about what we knew and did not know, and tailor guidance received from the state or federal government to our local/regional epidemiology. • All Public Health Briefs were posted on the Alpine County web site, and can be found at COVID-19 I Alpine County, CA - Official Website (alpinecountyca.gov) 10.2.a Packet Pg. 146 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 13 • Incorporating guidance from the above sources, guidance was produced to be utilized by the first responder community to protect these essential and limited staff. Staffing • In order to perform necessary functions in each stage of the pandemic response, public health staff were re-directed into response functions after receiving appropriate training and necessary PPE if required. • A number of county employees were utilized as Disaster Service Workers (DSW) to perform various roles as required by the response phase. • Disaster Healthcare Volunteers (DHVs) were recruited, registered, trained, and utilized to fulfill a number of critical and essential roles during response. • All staff were made aware and had access to mental health resources (mental health days, EAP, etc.). • Staff demonstrated resilience, flexibility, and cohesiveness in their coordinated response during each phase of the pandemic. Issues and Recommendations Guidance • Two factors caused frustration and confusion among public health personnel and the public regarding guidance: the evolving nature of science and our understanding of COVID-19; and the politicization of the process of producing guidance documents. There was a lack of cohesive, aggressive, science-based leadership at both state and federal levels. One of the consequences early on was a lost opportunity to contain the virus, forcing movement into mitigation strategies. • Public health and subject matter experts should be the lead agency and voices in a response to any infectious disease emergency with a strong unity of command at the federal and state levels. • Ensure a single official federal and state voice for pandemic guidance. • Timely, accurate, useful, consistent, and clear broad guidance should be provided to local governments that can be implemented flexibly based on their local/regional epidemiology (one size does not fit all). Supply Chain • Supply chain shortages and lack of a coordinated and sustained procurement strategy were ongoing issues throughout the response. • Re-evaluate the anticipated need for all components of response, e.g., swabs and viral transport media for testing large numbers of persons. 10.2.a Packet Pg. 147 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 14 • Utilize existing resource acquisition processes rather than creating new processes which bypass trusted and proven EOM processes through the MHOAC and Business continuity • Evaluate business closure decisions and develop a decision-making process that is tailored to the local epidemiological situation and not to regional, state, or federal restrictions that do not apply to the local pandemic status. • Continue to foster relationships with businesses throughout the jurisdiction to maximize voluntary cooperation and adoption of requested restrictions (masking, social distancing, limitations on groups, closures, etc.) • Continue to explore administrative and legal authorities and options to implement and provide enforcement in the event of non-compliance with recommendations or public health orders. 10.2.a Packet Pg. 148 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 15 Testing and Clinical Evaluation Best Practices • Testing (both surveillance testing for persons, and testing for those who might be mildly was offered weekly or bi-weekly at 3 sites in Woodfords, Kirkwood, and Bear Valley through Verily and staffed by Advanced Clinical. • Superb logistical support and coordination was provided by Team Rubicon. • Having these resources lessened the need for county staff time and allowed for a much greater volume of surveillance testing. • Support in the registration process was provided by county staff including Public Health and DSWs. All staff, from Advanced Clinical, Verily, Team Rubicon, Public Health and county DSWs worked seamlessly as a well-oiled machine. • Testing was available through the Washoe Tribal Health Center, both for persons and for surveillance, by appointment, whether or not persons were tribal members. • CDPH working with the San Joaquin Public Health Laboratory provided us with 150 Abbott IDNow antigen testing kits. • CDPH provided us with 1,200 Binax antigen testing kits. • PCR testing with improved turn-around time was available through Barton Hospital. Swabs were obtained in Woodfords and delivered to the hospital by our staff. • Our staff provided evaluation and swabbing at the Public Health Clinic in Woodfords (in the office or in the parking lot in a vehicle) and at home when necessary. Swabbing was performed by our Public Health Nurse, our Nurse Practitioner (NP), and our NP student. • All staff having contact with the public and persons being tested or evaluated were trained and provided with appropriate PPE. • We purchased 1,000 Let’s Get Checked home PCR kits to distribute to the public for testing at home and sending to the laboratory via UPS pick-up. • We purchased a new combined COVID-19 and influenza antigen rapid lateral flow test to be used at the Public Health Clinic. • The availability of testing and contact with public health staff increased the visibility of the Public Health Clinic to the community and awareness of the services provided at this facility. 10.2.a Packet Pg. 149 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 16 Issues and Recommendations • Advanced Clinical was not able to predictably sustain staffing of scheduled testing events, resulting in public angst when they showed up for appointments, but no one was present to perform testing. We therefore opted out of continuing this relationship shortly after the first of the year 2021. Vendors contracted by CDPH need to be able to provide predictable and adequate staffing. • Because of this experience, even when CDPH offered continued testing through OptumServe, once we determined that these sites would be staffed by Advanced Clinical, we declined. • Supply chain issues were common especially early on, with limited access to swabs and viral transport media. The SNS and other caches need to be evaluated and adequate to meet the anticipated need for the next infectious disease crisis. • Turn around time for testing results was frequently delayed, due to logistical issues, shipping, and volume. This included Barton (Nevada State lab), LabCorp, Quest, Valencia lab, UCSF, and the San Joaquin Public Health Laboratory. This diminished the value of testing, as results would often come back after the actionable time for quarantine or isolation had passed. Lab capacity needs to be adequate to handle the anticipated surge of volume. • Early on in the spring of 2020, testing processes were totally inadequate. CDC provision of kits was delayed, requirements to establish a candidate as a PUI were unrealistic and caused delays, supply chain was woefully inadequate, turn around time was too long, and there was not national or state cohesive policy or process to allow testing to be performed with volume and timeliness to enable containment of the virus. An aggressive federal and state plan needs to be in place and tested in advance of the next pandemic. • Abbott offered us a contract for Abbott IDNow antigen testing kits. However, they promised more than they could deliver, and were never able to fulfill our order. • Although we did not suffer any wildfires in our jurisdiction during summer of 2020, a number of testing events were cancelled due to poor air quality from smoke. Communication plans need to account for last minute changes forced on us by events external to the pandemic. • Early on in the midst of the pandemic response, our Nurse Practitioner was called up to Active Duty leaving us without a healthcare provider in the only healthcare clinic in our jurisdiction. She was serving our country for 5 months and returned to work with us in November 2020. Our staff facilitated appropriate referrals and prescription needs during this time. However, our ability to provide clinical services was impaired. 10.2.a Packet Pg. 150 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 17 Epi, Surveillance and Investigation Case Investigation/Contact Tracing Best Practices • Five of our staff (Health Officer, Public Health Nurse, NP student, PH Program Manager, and PH Program Coordinator) participated in on-line training for contact investigation/contact tracing (CI/CT) offered through ASTHO and Johns Hopkins. This is the training utilized by the New York Department of Health and Mental Hygiene. Staff were very adaptable in dropping their day-to-day program work and tackling this new assignment. • All of our CI/CT activities were carried out by these staff persons. We did not have a surge large enough requiring us to request personnel from CDPH. • Data shows that our Alpine County staff scored 100% on Performance Measures as compiled by CDPH. • We were able to utilize existing quarantine and isolation guidance documents and orders and modify them for use in Alpine County. We benefited from having an informed close-knit community with a desire to comply with recommendations protecting the health of their household and community. This information was delivered in person, via phone, or via e-mail. As a result, we experienced little household or community spread during the 18 months of response. • Systems were put into place to provide food and lodging for persons in quarantine or isolation. Food bags were available, several rooms available at the Woodfords Inn, and food available through Mad Dog. • In the Hung-A-Lel-Ti Community, groceries and cleaning supplies were available for those in quarantine or isolation who did not leave their homes. Issues and Recommendations • Public had difficulty understanding the differences between quarantine and isolation. Repeated verbal and written instructions continue to be necessary. • There is no “hammer” to orders for quarantine or isolation. Compliance is voluntary, non-compliance to Health Officer Orders is a misdemeanor, without ability to change behavior of anyone resistant to compliance. • A number of community members persistently “squealed” on individuals that they believed were not complying with public health recommendations or orders. Investigations and educational efforts to correct observed deficiencies were staff and time consuming. 10.2.a Packet Pg. 151 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 18 • The CI/CT training offered by CDPH was extremely long and “fluffy”. The Health Officer accessed more appropriate training which was used by our staff who received certification upon completion of the training. • As expected, there were persons who did not answer their phones, or were less than forthcoming in providing requested information regarding movement and possible contacts. Staff needed to continue to be gently persistent, but at some point, discontinue attempts to elicit information that was not readily available. • Reporting of positive results from the WTHC was often delayed. The WTHC is in Douglas County NV and therefore reports to Douglas and the state of NV. Results would often come to us days later after CDPH had received the result from the State of NV. A smoother and timely process of reporting based on the county of residence needs to be developed. • CI/CT staff soon learned that the majority of American Indian persons living in the Hung-A-Lel-Ti Community didn’t wish to be identified, traced, quarantined, isolated, or monitored. o When offered food, water, or alternate living arrangements, they chose to stay in what was often multi-generational housing. o Attempts to influence behavior and freedom of movement with knowledge and recommendations regarding quarantine or isolation were ignored, as attitudes about advice from government officials were already deeply imbedded. o County officials did not have the authority to enforce any recommendations or orders due to sovereign nation status. o Traditionally epidemiologists define sources of infection by travel, workplace, community, family, and household. We gradually came to appreciate that these concepts do not apply to this community. Family ties are strong and cross into multiple households, movement between households is common, and caregiving for those who are sick within the community is part of the culture. Kin did what kin do – they took care of each other. We all have something to learn! However, this caused us to regard the Hung-A-Lel-Ti Community of approximately 200 persons as a single family, household, and community. As a result, “household” transmission speeded up. We were not able to influence the spread of COVID-19 infections within this community. o Further dialogue with key members and leaders in the community needs to occur to explore strategies that may be used in the future to prevent and improve the health of community members. 10.2.a Packet Pg. 152 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 19 Vaccines Best Practices • Procedures were developed or in place to receive allocations of the Moderna vaccine as pre-determined by CDPH. • A 3-stage process was developed to administer vaccine: screening, administration, followed by a 15-30 minute observation period, each staffed independently. Screening was performed utilizing a standard form by a clinical person, or if a non-clinical person, with ready access to clinical staff to answer any questions. Vaccine administration was by an RN, and post-vaccine observation was by an MD. • Staffing was achieved utilizing existing public health staff redirected to this task, supplemented by county DSWs and DHVs. All teams functioned seamlessly and scheduling of staff was very efficient. • Transportation to vaccine sites was provided by Alpine County Dial-A-Ride. • Flyers announcing vaccine availability were delivered door-to-door in the Hung- A-Lel-Ti Community and Sierra Pines. • Vaccine was administered in a home when logistics prevented a person from coming to a vaccine site. • Vaccine sites were primarily the Public Health Clinic in Woodfords, the Perry Walther Building in Bear Valley, and supplemented by use of Station 91, Kirkwood Fire Station, Diamond Valley Elementary School and Turtle Rock Park (TRP) Community Center. • A vaccination team was created in Bear Valley utilizing the Perry Walther Building, county staff including a hire of a new RN, a Public Safety RN, a member of the Board of Supervisors, and a physician as a DHV. • When the volume of appointments made use of the Public Health Clinic inefficient, staff developed a plan to vaccinate up to 300 persons per day using the facility at TRP. This worked exceedingly well on multiple occasions, and included scheduling and feeding of staff, and use of DSWs and DHVs. • Vaccines were started on December 23, 2020, utilizing the Alpine County Vaccination Plan, which was a local modification of the priorities as established by CDPH. The focus initially was on essential workers in the fields of healthcare, emergency services (EMS, fire, law), and education. • The most significant modification was the inclusion of all household members of essential workers. We realized that our workforce in Alpine County is not deep, with few replacements if someone is incapacitated. Therefore, since household spread is a significant risk, we intentionally included all household members 18 years of age and up. 10.2.a Packet Pg. 153 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 20 • Once this was accomplished, we were rapidly able to open up to seniors, and by February 24, 2021, we opened up to anyone 18 years of age and older. This was almost 2 months prior to the state opening up to all on April 15th. • We included full-time residents, and the many workers who travel into Alpine County every day to work but live in neighboring jurisdictions (Calaveras, Amador, El Dorado, and Douglas Counties). We also included part-time residents who own properties in Alpine County. Many have come to stay for longer periods of time during COVID-19 and may travel back and forth from areas with a higher risk of disease and transmission. • We utilized a local home-grown system for screening and making appointments. This was our Warm Line, answered by the Health Officer or PH Program Manager within 24 hours. We received up to 300 calls per week at the peak in February and March of 2021. • We made a decision not to go with the TPA or MyTurn systems provided by the state. We were receiving adequate allocations of vaccine to meet the demand without using the TPA. Our population responded well with gratitude to the Warm Line, in contrast to the use of the MyTurn system requiring Internet access or a stranger on the phone. Many counties reported on-going frustrations with both systems, and we have no regrets about our decision to use a process appropriate for our small county. • Over 1,200 persons were contacted by phone >2 weeks after the second dose, questioned about their experience and side effects, given the chance to ask any questions, and offered to be added to the distribution list for Public Health Briefs. • Throughout the vaccination experience, staff rarely experienced any unhappiness from the public. The majority were very grateful for the opportunity to receive vaccine and complimented the local process which was efficient and low-tech and home grown. Issues and Recommendations • Supply chain issues were persistent. Issues included needle length, syringe size, and dead space in syringes. • Although we stated on the Warm Line that we would ask for documentation of property ownership, we rarely did so, and trusted the integrity of persons who claimed to be part-time residents. Perhaps there was a small risk of dishonesty, but we do not believe it was substantial. However, in the future, we may want to reconsider. • In the beginning of the vaccine campaign, we believed security was an issue. However, as time went on, our perception was more relaxed. However, this needs to be kept in mind in the future. • Since we did not enroll with the TPA, our supply of vaccine was terminated at some point. We did arrange a re-distribution with Calaveras County, and 10.2.a Packet Pg. 154 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 21 obtained 300 additional doses of Moderna vaccine. In the future, processes need to be in place to ensure adequate supply to meet the anticipated need in Alpine County. • Once the Pfizer vaccine was authorized under an EUA for use in those 12 years of age and older, we made verbal arrangements to obtain small quantities from El Dorado or Mono Counties. However, even though we put out Public Health Briefs, the demand has not justified obtaining any Pfizer vaccine so far. Anyone inquiring is referred to pharmacies in neighboring jurisdictions. A plan will need to be developed once any of the vaccines are approved for use in persons 6 months of age and older. 10.2.a Packet Pg. 155 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 22 This page is intentionally left blank. 10.2.a Packet Pg. 156 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 23 Appendices Indicators May 5, 2020 Alpine County Roadmap to Modify State Stay-at-Home Orders California, the nation, and the world are currently experiencing a once-in-a-hundred-year pandemic caused by the COVID-19 virus. Early social distancing measures have been credited with “flattening the curve” in many areas. On April 14th, the Governor issued a “Roadmap to Modify the Stay-at-Home Order” of March 19th, with 6 indicators that will be used to modify the order through 4 phases. We are currently in the first phase, with a reflective assessment of the status of the indicators required before moving on to a next phase. At the Noon Press Conference today, the Governor plans to announce the “soft opening” of Phase 2 on Friday, May 8th for the entire state, with an accelerated opening allowed for counties in which the Health Officer submits an attestation document that meet certain requirements (details not yet available). The stated goals are: - Ensure our ability to care for the sick within our hospitals - Prevent infection in people who are at high risk for severe disease - Build the capacity to protect the health and well-being of the public - Reduce social, emotional and economic disruptions We recognize that the current efforts to minimize the impact of the pandemic (although somewhat successful) are impossible to sustain for the long haul ahead of us. Therefore, the team at the Alpine County Emergency Operations Center has examined the 6 indicators as they apply to Alpine County. Indicator The ability to monitor and protect our communities through testing, contact tracing, isolating, and supporting those who are positive or exposed. We have the capacity 10.2.a Packet Pg. 157 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 24 and are prepared to test everyone who is Specimens are collected at our Health Department and sent to one of several laboratories – LabCorp, UNR through Barton, or San Joaquin Public Health Laboratory. We have tested everyone who has met screening criteria. 16 persons have been tested, with 2 positives (one a non-resident), and no test results pending. The only resident who tested positive (more than a month ago) has recovered with no community transmission. The infection was acquired out of state (not Nevada). All residents – or – will have the ability to obtain testing at an OptumServe site in South Lake Tahoe beginning this week. We have the ability to identify contacts of those who are positive to reduce further transmission. This is in coordination with the Health Officer and utilizing other HHS staff or other county staff as Disaster Service Workers with Just-in-Time training from a CDPH Academy or other training resources. Indicator The ability to prevent infection in people who are at risk for more severe COVID-19. We have systems in place to support older residents and the medically vulnerable living in their own homes so that they can continue appropriate physical distancing. This includes provisions of food through a variety of means, transportation, and in-home support. We do not have any congregate living facilities in the county. Persons with co-morbidities are connected to a healthcare provider who is prepared to screen for of COVID-19 or epidemiological connections to confirmed or probable cases. Indicators The ability of the hospital and health systems to handle surges. We do not have a hospital in Alpine County. However, we receive daily bed counts on the 2 closest hospitals across the border in Nevada, and on all California hospitals from the Region 4 and CalOES. None are experiencing surges on utilization of acute beds, ICU beds, or ventilators. Our Alpine County Public Health Clinic has not seen any increase in illness consistent with suspected COVID-19. Appropriate screening procedures are in place for EMS and clinic so that these front-line personnel are protected as much as possible from exposure to COVID-19. Training has been completed, and PPE stock is adequate to meet anticipated burn rate. Our healthcare system can adequately address COVID-19 and other critical healthcare needs through our networking and relationships with neighboring EMS, clinic, and hospital providers. Indicator The ability to develop therapeutics to meet the demand. We monitor available medical literature to identify potential therapeutics that have shown promise. Our focus is on the outpatient world since we do not have a hospital. We do not have a coalition of private, public, and academic partners to accelerate the development of therapeutics. Indicator The ability of businesses, schools, and child-care facilities to support physical distancing. We are working with businesses to support physical distancing practices and 10.2.a Packet Pg. 158 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 25 have already introduced guidelines to provide health checks when employees or the public enter the workplace to keep employees and customers safe. For facilities to be open, the workforce must be confident that everything is being done to protect their own health, and the consumer or client must be confident that the owner/management is doing everything possible to protect them during any interaction. Schools and child-care facilities are currently closed and are working closely with the Health Department and the California Department of Education on guidelines for opening that will protect staff and students. Indicator The ability to determine when to reinstitute certain measures, such as stay-at-home orders, if necessary. The Alpine County Public Health Department Operations Center (DOC) has been open and meeting weekly since March 2, 2020 and has been combined with the County Emergency Operations Center (EOC). A Local Emergency and a Local Health Emergency were declared and ratified by the Board of Supervisors on March 17, 2020. Both are still in effect. The Health Officer monitors and tracks all available data from local, regional, state, and national sources to provide an early warning system for possible reinstitution of stay-at-home orders. We can quickly communicate the need to reinstitute orders to the public through multiple communication portals which are used on a regular basis. Alpine County and the surrounding rural jurisdictions have been spared from outbreaks and the predicted surge to the healthcare system experienced in urban areas. Therefore, we have determined that moving to a next phase in our pandemic response is a rational response with an acceptable increased level of risk. In another time of national crisis, at the depth of the Great Depression in the spring of 1932, then candidate Franklin D. Roosevelt described the country’s situation in words that resonate in our own situation: “The country needs, and unless I mistake its temper, the country demands bold, persistent experimentation. It is common sense to take a method and try it. If it fails, admit it frankly and try another. But above all, try something.” We are moving forward with eyes and minds and hearts wide open. We will see what works and what doesn’t and respond accordingly. The reality is that individuals in Alpine and the surrounding rural counties have begun to take matters into their own hands to preserve their own physical, emotional and economic health. Our goal as county government is to align ourselves with the current situation and behavior and maintain our credibility. In this way individuals will enjoy their outdoor activities and business will begin to open in a way that maximizes adherence to guidelines issued by public health. Ours is a risk-based perspective, focusing on those modifications that will maximize impact at low risk. 10.2.a Packet Pg. 159 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 26 This page is intentionally left blank. 10.2.a Packet Pg. 160 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 27 Timeline January 6, 2020 – internal e-mail 10.2.a Packet Pg. 161 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 28 To view all Public Health Briefs (PHB) – go to: COVID-19 I Alpine County, CA - Official Website (alpinecountyca.gov) January 19, 2020: first case in the US, a traveler from Wuhan to Seattle January 21, 2020: PHB – “Should You Be Concerned”? January 27, 2020 - 5 cases in the US - one in Orange County, one in Los Angeles County - Public Health Brief – “Are You Worried?” February 6, 2020: first death from COVID in California (San Jose) February 25, 2020: PHB – “Get Used to the Word – Pandemic” February 26, 2020: PHB – “First Case of Community Transmission in California” March 12, 2020: PHB – “Time to Hunker Down” March 17, 2020: PHB – “The Talk” March 17, 2020 – Alpine County Declaration of Local Health Emergency and Local Emergency March 19, 2020: Stay-at-Home Order from the State of California, closing all non- essential business and restaurants March 30, 2020: PHB – Alpine County reports its first case in a resident, source of infection out of state (not Nevada), no community transmission. March 31, 2020: California has reported >7,000 cases April 2, 2020: PHB – “Hope Amidst the COVID Crisis – How to Get There” April 14, 2020: California’s Pandemic Roadmap – a 4 stage plan April 17, 2020: PHB – “How Do We Keep A Lid On?” April 23, 2020: PHB – “Wanted Dead or Alive” April 30, 2020: California reports approx. 40,000 cases and >1,000 deaths May 7, 2020: state moving to Stage 2 as new cases and deaths fall, Alpine allowed accelerated option, beginning to re-open by 6/5 and 6/12 May 21, 2020: PHB – “It’s Up to You - Time, Distance, and Shielding” July 13, 2020: California closes bars and indoor dining due to a second surge July 16, 2020: PHB – Alpine County reports a second case in a resident, source of infection out of the area, no community transmission. July 2020: peak of new cases in California, with >400,000 cases and >7,000 deaths 10.2.a Packet Pg. 162 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 29 August 31, 2020: Alpine County lands in Tier 4 in the state “Blueprint for a Safer Economy”, the least restrictive Tier, California now reports >700,000 cases September, 2020: California reports infection rates lower resulting in loosening of restrictions, but still almost 800,000 cases and >15,000 deaths. October 3, 2020: PHB – Alpine County (AC) reports a third case in a resident, source of infection out of the area, possibly resulting in community spread. TOTALS US cases CA cases AC cases US deaths CA deaths Alpine deaths Jan 2020 1 0 Feb 2020 16 2 2 0 Mar 2020 223,600 8,155 1 5,300 171 0 Apr 2020 1,000,000 50,442 1 54,700 2,073 0 May 2020 1,790,000 113,006 1 100,000 4,251 0 Oct 2020 7,260,000 926,534 8 200,000 17,667 0 Nov 2020 51 Dec 2020 64 Jan 2021 76 Jun 28, 2021 33,500,000 3,714,813 91 601,506 62,999 0 October 26, 2020: PHB – “Table Manners Matter” October 29, 2020 – Alpine County surges to a total of 8 cases November 2, 2020: - PHB – “Sit Down” - Alpine County surges with 13 cases in 7 days for a total of 16 cases - California reports a total of >1 million cases and >18,000 deaths Nov/Dec 2020 – Alpine County surge continues: - 11/11 – total of 26 cases - 11/13 – total of 30 cases - 11/30 – 51 cases - 12/14 – 64 cases November 19, 2020: PHB – “We Hold Our Future in Our Hands” November 22, 2020: PHB – “The Game is Not Over” November, 2020: Blueprint: - 11/24 – Alpine County moved to Orange Tier - 11/28 – Alpine County moved to Red Tier 10.2.a Packet Pg. 163 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 30 December 10, 2020: new California Regional Stay-at-Home Order, Alpine County in “Red” December 19, 2020: PHB – “Don’t Let This Be You” December 23, 2020: Alpine County begins first vaccines with the Moderna mRNA vaccine: - Open to Phase 1a and parts of Phase 1b, healthcare workers, emergency services, education, county staff with contact with the public, and their households December 31, 2020: California 3rd surge exceeds capacity of the health care system, resulting in use of alternate care sites, including tents and large arenas. January 3, 2021: PHB – “Let’s Stick It to COVID” January 8, 2021: PHB – “Musings” January 12, 2021: Alpine County released from Regional Stay-at-Home Order into the Red Tier as California cases begin to fall January 19, 2021 – Moderna vaccine available in Alpine County to all >74 years of age, plus those >64 years of age with chronic underlying medical conditions (parts of Phase 1b) January 27, 2021 – Moderna vaccine available in Alpine County to all >64 years of age, plus food workers and other essential services (parts of Phase 1c) January 2021: Governor Newsom contracts with Blue Shield as the Third Party Administrator (TPA) for the COVID vaccine program January 31, 2021: Alpine County reports a total of 76 cases February 2, 2021: Alpine County graduates into the Orange Tier February 19, 2021 – Moderna vaccine available in Alpine County to all >17 years of age with underlying chronic medical conditions (part of Phase 1c) February 24, 2021 – Moderna vaccine available in Alpine County to all >17 years of age (Phase 2) February 2021: - California reports >50,000 deaths, US >500,000 deaths - Alpine County reports a total of 86 cases March 15, 2021: PHB – “Our Choices” March 17, 2021: - Alpine County graduates into the Yellow Tier, the first county to do so 10.2.a Packet Pg. 164 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 31 March 30, 2021: PHB – “The Great Race” March 31, 2021: PHB – “Good – Bad – Ugly” March 2021: - roll-out of the vaccine program plagued with spot shortages and the public attempting to violate eligibility rules - new cases in California plummet April 15, 2021: - California reports the lowest average COVID-19 cases per capita in the USA - Limited reopening permitted - All persons eligible for vaccine 16 years of age and older in California May 12, 2021: Pfizer vaccine approved under Emergency Use Authorization for all 12 years of age and older. May 13, 2021: PHB – “Free and Responsible – If You Are Fully Vaccinated” May 18, 2021: PHB – “Herd Immunity – Only Two Counties Are Even Close” June 15, 2021: - California moves into “Beyond the Blueprint” and removes most restrictions. See COVID19.CA.GOV - Alpine County reports a total of 91 cases. - CDPH Releases New State Public Health Officer Order CDPH released a new state public health officer order that goes into effect on June 15. To help prevent the transmission of COVID-19, the new order requires all Californians to follow the state's current guidance for masking, mega events, K-12 schools, child-care programs and providers, and the portions of current K- 12 schools guidance that have been made explicitly applicable to day camps and other supervised youth activities. The order replaces four previous state public health officer orders issued throughout the pandemic that are in effect through June 14. They include: - • Order of the State Public Health Officer 8/28/2020 - • Order of the State Public Health Officer 7/13/2020 - • Order of the State Public Health Officer 5/7/2020 - • Order of the State Public Health Officer 3/19/2020 June 2021: - COVID-19 deaths in the USA <300 per day for the first time since March 2020 - After being the third leading cause of death in 2020, more people are now dying from accidents, chronic pulmonary disease, strokes or Alzheimer’s disease than from COVID-19. 10.2.a Packet Pg. 165 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 32 - 150,000,000 Americans are fully vaccinated. - Newer variants are displacing older ones, with surging pockets of infection, hospitalization, and deaths occurring in counties with lower vaccination rates. - So far, the mRNA vaccines are still >80% effective against the new variants. - It appears that a delta variant which is more contagious and perhaps more serious threatens to create another surge in the coming months even as we re- open. 10.2.a Packet Pg. 166 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 33 10.2.a Packet Pg. 167 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 34 This page is intentionally left blank. 10.2.a Packet Pg. 168 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 35 EOC/DOC Management Information Sharing Public Information and Warning Informal discussions amongst staff in Public Health (PH) during January and February graduated into the formation of a joint Public Health Department Operations Center (DOC), and subsequently an Alpine County Emergency Operations Center (EOC). The first PH DOC meeting was held on March 2, 2020, and then weekly. Key agenda items for the first meeting included: - Operational Period – one week, with weekly meetings - Membership – 5 persons (HHS Director/CAO, HHS Assistant Director, PH Program Manager, Public Health Nurse, Health Officer) - Process for communication with the Board of Supervisors established - Trigger for declaration of a Health Emergency discussed - Sources of situation awareness and communication - Refinement of isolation and quarantine orders with County Counsel - Lists of organizations and events potentially affected (50’s Plus, congregate meals, MHSA list, etc.) - Public information using Public Health Briefs, to include Chamber of Commerce, county staff, schools, Kirkwood (Safety and Human Resources staff), etc. - Regional epi concept to include El Dorado (South Lake Tahoe) and Douglas Counties (Minden/Gardnerville) - Triggers for instituting and removing non-pharmaceutical interventions (NPIs) such as closing schools, events, gatherings, businesses - Lab testing issues - Protection of all first responders (EMS, fire, law) - Signage and messaging - Inventory and assessment of PPE needs The first DOC/EOC meeting was held on April 8, 2020. At that time, Alpine County had 1 case, Amador – 3, Calaveras – 5, El Dorado – 25 with 10 in South Lake Tahoe, Douglas – 7, Carson -11, and California 16,349, including 20% of LAPD, >200 healthcare workers, and 388 deaths, including 2 Deputies in Riverside in <24 hours. Agenda items included bed status of hospitals in our epi region, community reactions, HIPAA, 911 calls, protecting first responders, inventory (PPE), 3D printers, testing (labs, supplies, rapid tests), event cancellations, closures, surge planning (clinic, hospitals, home, ACS), public information (healthcare and first responders, public), media, Warm Line, community complaints 10.2.a Packet Pg. 169 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 36 During the spring surge, meetings were held weekly, and then on a PRN basis based on local surveillance and needs for input on decisions regarding cancellations, closures, restrictions, signage, enforcement, etc. Membership included: Sheriff Undersheriff Sergeant Fire Chief Deputy Fire Chief CAO/HHS Director Human Resources PH Program Manager/PH Emergency Response Coordinator Health Officer Environmental Health Director Community Development Department Head Although we did not formally assign persons to Command Staff and General Staff, the functions and roles were performed according to SEMS principles: - Unified Command, Planning Section Chief and Safety Officer – Health Officer, and Sheriff’s Office (as the Alpine County Office of Emergency Services) - Operations, Logistics, and Finance Section Chief – PH Program Manager, with the able assistance of appropriate personnel The Health Officer functioned as the Subject Matter Expert, and decision making was by consensus after discussion, with responsibility for action items delegated to appropriate parties. Surveillance and situational awareness (Planning Section functions, including modeling and forecasting) was performed by the Health Officer. Sources included (not exclusively): - CDPH (CAHAN, CalREDIE) - CDC (HAN) - WHO - CalOES - CalOSHA - Region IV - Greater Sierra Sacramento Health Officers Association - Epi-X - ProMED - Quad County HCC (Nevada) - HCC (El Dorado, Amador, Alpine) - CCLHO/HOAC - CHEAC 10.2.a Packet Pg. 170 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 37 - CIDRAP - NYC DHMH - Johns Hopkins Center for Health Security - Numerous professional journals/literature (JAMA, NEJM, Lancet, BMJ, Pediatrics, Health Security, AIM) - Professional associations (AAP, National Pediatric Disaster Association, Public Health Communications Collaborative, DisasterDoc, ASTHO, NACCHO, National Public Health Information Coalition) - Various media outlets (California Healthline, CalMatters) The Health Officer compiled and distributed almost 200 Public Health Briefs (PHB) during the18 month response. To view all Public Health Briefs (PHB) – go to: COVID-19 I Alpine County, CA - Official Website (alpinecountyca.gov) These are distributed via current distribution lists to over 500 addresses, and then in turn, are redistributed to an unknown number of additional recipients by at least several dedicated residents to their private distribution lists. The Health Officer lists are targeted both to HHS (healthcare) and first responders, and to the public. The PHBs are often posted by employers in workplaces. Questions and responses are frequent and welcomed and receive a response from the Health Officer usually within 24 hours if not immediately. A Warm Line is in place to receive recorded messages from anyone regarding COVID- 19. Responses are by the Health Officer or the PH Program Manager within 24 hours. Volume is typically low, with at most several calls per day. However, during the opening of our vaccine program to all on February 24, 2021, we received and responded within 24 hours to over 300 calls per week for several weeks. 10.2.a Packet Pg. 171 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 38 This page is intentionally left blank. 10.2.a Packet Pg. 172 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 39 Testing Verily surveillance testing Site: BV Kirk Wood Number of tests by site 4,[PHONE REDACTED] 1634 By Alpine County address 2,012 [PHONE REDACTED] Positive tests 95 Positive by customer address: - Alpine County 2 3 10 - Douglas 19 - El Dorado 19 - Amador 4 - Calaveras 7 2.3% positive overall 0.75% positive tests in Alpine County residents by Verily 0 200 400 [PHONE REDACTED] 1200 <18 18-24 25-34 35-44 45-54 55-64 65-74 >74 No. Verily tests by age group 10.2.a Packet Pg. 173 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 40 2010 Census: Woodfords Community: Hung-A-Lel-Ti 214 Mesa Vista 200 Alpine Village 114 Markleeville 210 Kirkwood 158 Bear Valley 121 10.2.a Packet Pg. 174 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 41 Epi, Surveillance and Investigation Case Investigation/Contact Tracing 10.2.a Packet Pg. 175 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 42 10.2.a Packet Pg. 176 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 43 Alpine County did not have any deaths where COVID-19 was the primary cause of death, but there were 2 deaths in the weeks and months following infection in 2 residents. Both had been hospitalized and were in rehab and recovery stages. One resident was 63 years of age with multiple chronic underlying medical conditions including chronic renal disease with dialysis, diabetes Type 2, and hypertension. The other was 72 years of age, with diabetes Type 2 and dementia. Data from CDC data suggests that 50% of deaths will occur between days 4-31 post illness onset. A study of over 14,000 hospitalized patients found that death generally occurred between 1-41 days post admission to the hospital. A recent study published in Nature (Vol 594, June 20, 2021) studied outcomes in 13,654 hospitalized patients and 73,435 non-hospitalized patients. It showed that people with COVID-19 who survive the acute phase of COVID-19 exhibit a higher risk of death with a risk gradient that increases according to the severity of the acute COVID- 19 infection (not hospitalized, hospitalized, admitted to intensive care). 10.2.a Packet Pg. 177 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 44 10.2.a Packet Pg. 178 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 45 8/31/20 9/7/20 9/14/20 9/21/20 9/28/20 10/5/20 10/12/20 10/19/20 10/26/20 11/2/20 11/9/20 11/15/20 11/23/20 11/27/20 11/30/20 12/7/20 12/14/20 12/21/20 12/28/20 1/4/21 1/11/21 1/18/21 1/25/21 2/1/21 2/8/21 2/15/21 2/22/21 3/1/21 3/8/21 3/12/21 3/15/21 3/22/21 3/29/21 4/5/21 4/12/21 4/19/21 4/26/21 5/3/21 5/10/21 5/17/21 5/24/21 5/31/21 6/7/21 6/14/21 % Weeks in Purple % Weeks in Red % Weeks in Orange % Weeks in Yellow Alpine 2.3% 22.7% (10) 11.4% 63.6% (28) Amador 34.1% (15) 34.1% (15) 20.5% 11.4% Calaveras 34.1% (15) 27.3% (12) 31.8% (14) 6.8% Colusa 52.3% (23) 15.9% 31.8% (14) 0.0% Del Norte 27.3% (12) 45.5% (20) 27.3% (12) 0.0% Glenn 65.9% (29) 15.9% 15.9% 2.3% Inyo 45.5% (20) 20.5% 25.0% (11) 9.1% Lake 38.6% (17) 40.9% (18) 20.5% 0.0% Lassen 34.1% (15) 15.9% 27.3% (12) 22.7% (10) Mariposa 0.0% 34.1% (15) 36.4% (16) 29.5% (13) Mendocino 59.1% (26) 15.9% 6.8% 18.2% Modoc 31.8% (14) 13.6% 31.8% (14) 22.7% (10) Mono 34.1% (15) 20.5% 31.8% (14) 13.6% Nevada 45.5% (20) 29.5% (13) 25.0% (11) 0.0% Plumas 27.3% (12) 11.4% 52.3% (23) 9.1% San Benito 54.5% (24) 20.5% 18.2% 6.8% Sierra 0.0% 6.8% 50.0% (22) 43.2% (19) Siskiyou 40.9% (18) 9.1% 38.6% (17) 11.4% Sutter 56.8% (25) 25.0% (11) 18.2% 0.0% Tehama 61.4% (27) 27.3% (12) 11.4% 0.0% Trinity 20.5% 18.2% 34.1% (15) 27.3% (12) Tuolumne 40.9% (18) 6.8% 52.3% (23) 0.0% Yuba 59.1% (26) 40.9% (18) 0.0% 0.0% Small Counties (Pop. < 106K) 10.2.a Packet Pg. 179 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 46 0 1 2 3 4 5 6 7 8 26-Oct 2-Nov 9-Nov 16-Nov 23-Nov 30-Nov 7-Dec 14-Dec 21-Dec 28-Dec 4-Jan 11-Jan 18-Jan 25-Jan 1-Feb 8-Feb 15-Feb 22-Feb 1-Mar 8-Mar 15-Mar 22-Mar Alpine County cases by date from 10/26 - Mar 22 0 5 10 15 20 25 30 35 40 45 50 Mar Jul Oct Nov Dec Jan Feb Mar Apr May No. Alpine County cases by date and exposure source travel community household Hung-A-Lel-Ti 10.2.a Packet Pg. 180 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 47 Vaccine 0 5 10 15 20 25 30 35 40 45 50 # of shots Week Bear Valley Vaccinations 1st Dose 2nd Dose 0 50 100 150 200 250 300 350 26-Dec 2-Jan 9-Jan 16-Jan 23-Jan 30-Jan 6-Feb 13-Feb 20-Feb 27-Feb 6-Mar 13-Mar 20-Mar 27-Mar 3-Apr 10-Apr 17-Apr 24-Apr 1-May 8-May 15-May 22-May 29-May 5-Jun # of Shots Week Woodfords Vaccinations 1st Dose 2nd Dose 10.2.a Packet Pg. 181 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 48 10.2.a Packet Pg. 182 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 49 10.2.a Packet Pg. 183 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 50 10.2.a Packet Pg. 184 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 51 10.2.a Packet Pg. 185 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 52 10.2.a Packet Pg. 186 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 53 10.2.a Packet Pg. 187 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 54 10.2.a Packet Pg. 188 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 55 10.2.a Packet Pg. 189 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 56 CDPH Phases Jan 2, 2021: Phase 1a: Tier 1, 2, and 3: HHS, first responders, testing and vaccination teams, medical transportation, IHSS workers Phase 1b: all >74, emergency services, food services, education, 65-74 with underlying chronic medical conditions, USPS, essential government workers with public contact, industrial Phase 1c: all 65-74, 18-64 with underlying chronic medical conditions, essential government workers without public contact, all other essential workers, lodging, ski patrol Justification for prioritizing the elderly (California numbers): (as of June 9, 2021) Age # cases % cases # deaths % deaths % CA pop 65-69 131,741 3.6 6,649 10.6 5.0 70-74 91,311 2.5 7,292 11.7 4.1 75-79 60,766 1.6 7,465 11.9 2.7 80+ 106,704 2.9 24,513 39.2 3.9 Total 3,693,362 62,538 10.2.a Packet Pg. 190 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 57 0 20 40 60 80 100 65-74 75-84 >85 CA hospitalizations compared to age 5-17 years 0 2000 4000 6000 8000 10000 65-74 75-84 >85 CA deaths compared to age 5-17 year olds 10.2.a Packet Pg. 191 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 58 CDPH data: Alpine County - 1494 doses administered to Alpine County residents - 87.2% of Alpine County residents have received a first dose. • 15.9% of Alpine County residents have received only a first dose. - 724 (71.3%) Alpine County residents have been fully vaccinated with 2 doses • 57.3% of California residents have been fully vaccinated. • Our % is in the top 5 with San Francisco, San Mateo, Santa Clara, Marin • 45.3% of US residents have been fully vaccinated. Please note that these numbers do not account for anyone who has been vaccinated out of the county, including at the WTHC and pharmacies in other counties or states. Adverse Events: We had 2 persons who received the Moderna vaccine from ACPH with adverse events for which we filed reports to the VAERS (Vaccine Adverse Event Reporting System). Both instances were following the second doses in the series of 2 doses. One is a 55- year-old female with subdural hematoma requiring surgery, the other is an 18-year-old male with pericarditis that completely resolved after a short hospital stay. We also had an 82-year-old who expired in March 2021 of natural causes, having received the Moderna COVID-19 vaccine series in the previous weeks. 10.2.a Packet Pg. 192 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 59 Washoe Tribal Health Center Serving the Hung-A-Lel-Ti Community, Southern Band of the Washoe Tribe of California and Nevada - Has vaccinated 80 residents - 43 have had 2 doses - 15 are >65 years of age - 11 are <18 years of age 10.2.a Packet Pg. 193 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 60 0 500 1000 1500 2000 2500 3000 BV Woodfords Total WTHC ACPH first and second doses by site state re-distrib first dose second dose 0 200 400 [PHONE REDACTED] 1200 1400 Total population White American Indian Hispanic multi Asian black Population and ACPH second dose by ethnicity second dose 2021 CA DOF 10.2.a Packet Pg. 194 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 61 0 50 100 150 200 250 300 350 400 >75 65-74 50-74 18-49 0-17 ACPH population and second doses by age Population full-time % part-time other 10.2.a Packet Pg. 195 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 62 10.2.a Packet Pg. 196 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 63 10.2.a Packet Pg. 197 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 64 Alpine County Health Department COVID-19 Vaccine (Moderna) 1st Dose Given 2nd Dose Due (28-42 days) 2nd Dose Given Inventory – all shipments are for 100 doses Date Site # Date Site # Ordere d Rec’d On-hand Given 12/11 100 12/23 HHS 10 1/20 90 12/26 190 12/30 HHS 20 1/27 – 2/10 170 12/30 Sta 91 10 1/27 – 2/10 160 12/31 BV 10 1/28 – 2/11 150 1/4 HHS 20 2/1 – 2/15 1/1 230 1/5 DVES 30 2/2 – 2/16 200 1/6 HHS 40 2/3 – 2/17 160 1/7 BV 21 2/4 – 2/18 140 1/7 Kirk 9 2/4 – 2/18 130 1/8 230 1/11 HHS 50 2/8 – 2/22 180 1/13 HHS 40 2/10 – 2/24 140 1/14 BV 30 2/11 – 2/25 1/14 110 1/15 210 1/19 1/20 HHS 30 2/17 – 3/3 1/20 HHS 10 1/20 1/20 270 1/21 BV 44 2/18 – 3/4 230 1/22 HHS 40 2/19 – 3/5 1/22 290 1/25 HHS 21 2/22 – 3/8 1/25 HHS 1 1/25 270 1/26 370 1/28 BV 21 2/25 – 3/11 1/28 BV 9 1/28 340 2/1 HHS 13 3/1 – 3/15 2/1 HHS 27 300 505 2/2 400 2/3 HHS 20 3/3 – 3/17 2/3 HHS 26 2/3 2/3 Sta 91 17 340 569 2/4 DVES 7 3/4 – 3/18 2/4 DVES 24 2/4 BV 9 3/4 – 3/18 2/4 BV 22 280 631 2/5 HHS 18 3/5 – 3/19 2/5 HHS 26 2/5 340 675 2/8 HHS 2 3/8 – 3/22 2/8 HHS 42 2/8 300 719 10.2.a Packet Pg. 198 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 65 2/9 400 2/10 HHS 44 2/10 360 763 2/11 BV 8 3/11 – 3/25 2/11 BV 33 320 804 523/281 2/12 2/17 HHS 4 3/17 – 3/31 2/17 HHS 28 2/17 290 836 527/309 2/18 BV 42 250 878 527/351 2/19 HHS 2 3/19 – 4/2 2/19 HHS 41 210 921 529/392 2/22 HHS 19 3/22 – 4/5 2/22 HHS 24 2/22 170 964 548/416 2/23 470 2/25 BV 7 3/25 – 4/8 2/25 BV 24 2/25 540 2/26 HHS 43 3/26 – 4/9 2/26 HHS 1 500 1039 598/441 2/28 3/1 HHS 39 3/29 – 4/12 3/1 HHS 16 450 1094 637/457 3/2 550 3/3 HHS 30 3/31 – 4/14 3/3 HHS 24 3/3 3/3 600 1148 667/481 3/4 BV 24 4/1 – 4/15 3/4 BV 9 570 1181 691/490 3/5 HHS 41 4/2 – 4/16 3/5 HHS 14 3/5 620 1236 732/504 3/8 HHS 55 4/5 – 4/19 3/8 HHS 5 570 3/10 HHS 205 4/7 – 4/21 370 3/11 BV 35 4/8 – 4/22 3/11 BV 8 3/11 (200) 330 3/12 HHS 27 4/9 – 4/23 3/12 HHS 4 300 1575 1054/521 533 needed for 2nd doses 3/15 HHS 39 4/12 – 4/26 3/15 HHS 1 3/14 260 1615 1093/522 571 needed 3/17 HHS 47 4/14 – 4/28 3/17 HHS 4 210 3/18 BV 43 4/15 – 4/29 3/18 BV 1 3/18 3/18 [PHONE REDACTED] 1183/527 10.2.a Packet Pg. 199 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 66 656 needed 3/22 HHS 34 4/19 – 5/2 3/22 HHS 18 3/22 - M 3/22 520 1762 1217/545 672 needed 73/24 HHS 17 4/21 – 5/4 3/24 HHS 17 3/24 590 1796 1234/562 672 needed 3/25 BV 36 4/22 – 5/5 3/25 BV 7 3/25 550 1839 1270/569 701 needed 3/29 HHS 2 4/26 – 5/9 3/29 HHS 29 3/29 3/29 620 3/31 3/31 720 4/1 BV 11 4/29 – 5/12 4/1 BV 22 690 4/2 TRP 59 4/30 – 5/13 4/2 TRP 106 4/2 640 2068 1342/726 616 needed 4/5 4/6 290 4/7 TRP 35 5/5 – 5/19 4/7 TRP 258 4/7 4/8 BV 16 5/6 – 5/20 4/8 BV 36 690 2413 1393/1020 373 needed 4/10 – Washoe Tribal Health Center – 78 Hung-A-Lel-Ti residents 4/14 TRP 29 5/12 – 5/26 4/14 TRP 75 4/15 BV 11 5/13 – 5/27 4/15 BV 40 540 2568 1433/1135 298 needed 4/18 – WTHC – 80 Hung-A-Lel-Ti residents, total of 926 vaccines given 4/21 TRP 17 5/19 – 6/2 4/21 TRP 47 470 4/22 BV 29 440 2661 1450/1211 239 needed 4/28 TRP 8 5/26 – 6/9 4/28 TRP 55 4/29 BV 10 370 2734 1458/1276 182 needed for second doses 10.2.a Packet Pg. 200 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 67 5/5 TRP 8 6/2-16 5/5 TRP 24 5/6 BV 11 330 2,777 1,466/1,311 155 need 2nd dose 5/19 TRP 30 300 2,807 1,466/1,341 125 need 2nd dose 6/2 HHS 18 280 2,825 1,466/1,359 107 need 2nd dose Vaccine hesitancy by zip code – good news for Alpine County: COVID-19 Vaccine Hesitancy (healthdata.org) 10.2.a Packet Pg. 201 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 68 This page is intentionally left blank. 10.2.a Packet Pg. 202 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 69 Looking Ahead – What’s Next? Everyone of course wants to know when this will be over. Is it over now? NO. Will it be over soon? We do not know. Models and predictions are based largely on previous experience with influenza pandemics, which usually last 18-24 months, consisting of 3-4 waves/surges. Using that model, we are getting closer to the end. But we do not know if a coronavirus pandemic will behave in the same way. Pandemics always end, but the viruses don’t go away. The door to contain the virus and make it disappear has long been closed. Herd immunity is not going to happen. Viruses often become “endemic” in the community, which means they will still be with us, although typically causing less frequent and less severe disease. Think of the COVID- 19 virus becoming one of several coronaviruses causing the common cold, typically in the colder winter months when we spend more time indoors. You will have efficient spread among younger folks who are out and about, and more serious complications in seniors and those with chronic underlying medical conditions. It is also possible that a mutation may significantly affect younger people as has occasionally happened with influenza outbreaks. It has been said that vaccines are the ticket out of this crisis. Partially true, but only if you live, work, and travel in an area with a high degree of vaccination uptake, and the vaccines stay effective against any as yet unknown variants. Unfortunately, as we look around the US, and around the world, there are states and counties (“state of Jefferson”) with low acceptance of vaccine, and large areas of the world with little if any vaccine (Haiti has 0% of its population vaccinated, Africa as a continent maybe Expect “dense” outbreaks in those areas. The implication is that there is opportunity for the virus to continue its “sloppy” process of replication resulting in many new variants, some of which have the potential to cause more efficient spread, more serious disease, and higher number of deaths. The world is truly a village, and with the huge amount of travel, we are 24 hours or less away from someone bringing the gift with them that no one wants. Will we be asked to endure new restrictions again, such as social distancing, masking, and travel limitations? Possibly. As of yesterday (6/29/21), Los Angeles has reinstated recommendations for all people – vaccinated or not – to wear masks while indoors in public places due to the emergence and surge of the delta variant. The CDC, state of California, and Alpine County are not recommending this so far, but CA is contemplating this in the days to come. Will we be asked to get boosters? We do not know yet. Two things to keep in mind. So far, the mRNA vaccines (Moderna and Pfizer) are holding up well with good effectiveness against the known variants, including the newer delta variants. Secondly, 10.2.a Packet Pg. 203 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 70 we do not have long-term data yet on how long protection will last from the series of 2 doses. The good news is that evidence is mounting that it may be much longer than originally thought. Stay tuned! There is discussion regarding whether a second dose is necessary following a person having been infected. So far, the answer is yes, and even that the protection from two doses following infection is much greater than in persons who never had an infection. Answers to these questions show how science works. Recommendations are based on evidence as it accumulates and are not fixed in time. What about “long-haul” This may be our next public health and healthcare crisis, as what appears to be a significant % of persons with not only severe disease but also milder disease showing up with an extensive variety of that may last for a long time if not a lifetime. What’s next? We may never know where this COVID-19 originated. What we do know is that over the last 50 years, many new infections, termed “zoonoses” since they originate at the animal-human interface, have impacted the human population around the world. With a growing population, with climate change, and with movement of people through recreational travel and forced migration, this is bound to continue. We must stay alert and be prepared to respond to whatever threat is seen coming down the pike headed our way. Our job is to keep abreast of any early warning signs and inform you of any recommended actions to protect your health and that of your family, your household, and your community. Expect the unexpected! 10.2.a Packet Pg. 204 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 71 Acronyms AAP American Academy of Pediatrics AC Alpine County ACIP Advisory Committee on Immunization Practices ACS Alternate Care Site AIM Annals of Internal Medicine ALS Advanced Life Support APS Adult Protective Services ASTHO Association of State and Territorial Health Officials BMJ British Medical Journal BOS Board of Supervisors CA California CAHAN California Health Alert Network CAIR California Immunization Registry CalOES California Office of Emergency Services CalOSHA California Occupational Safety and Health Administration CAO Chief Administrative Officer CBO Community-Based Organization CCLHO California Conference of Local Health Officers CDC Centers for Disease Control and Prevention CDPH California Department of Public Health CHEAC County Health Executives Association of California CPS Child Protective Services CI/CT Case Investigation/Contact Tracing CIDRAP Center for Infectious Disease Research and Policy DHV Disaster Healthcare Volunteers DOC Department Operations Center DSW Disaster Service Worker EAP Employee Assistance Program EMS Emergency Medical Services EMSA Emergency Medical Services Authority EMT Emergency Medical Technician EOC Emergency Operations Center EOM California Public Health and Medical Emergency Operations Manual EUA Emergency Use Authorization GACH General Acute Care Hospital HAN Health Alert Network HCC Health Care Coalition 10.2.a Packet Pg. 205 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- 72 HHS Health and Human Services HIPPA Health Insurance Portability and Accountability Act HOAC Health Officers Association of California HR Human Resources HVAC heating ventilation and air conditioning ICS Incident Command System IHME Institute for Health Metrics and Evaluation IHSS In-Home Support Services JAMA Journal of the American Medical Association LTC Long-Term Care MD Medical Doctor MHSA Mental Health Services Act MHOAC Medical Health Operational Area Coordinator NACCHO National Association of City and County Health Officials NEJM New England Journal of Medicine NIMS National Incident Management System NP Nurse Practitioner NPI Non-Pharmaceutical Interventions NV Nevada NYC DHMH New York City Department of Health and Mental Hygiene PCR Polymerase Chain Reaction PH Public Health PHB Public Health Brief PHN Public Health Nurse POD Point of Dispensing PPE Personal Protective Equipment PUI Person Under Investigation Regional Disaster Medical Health Specialist RN Registered Nurse SEMS Standardized Emergency Management System SNS Strategic National Stockpile TPA Third Party Administrator TRP Turtle Rock Park UCSF University of California San Francisco UNR University of Nevada Reno UPS United Parcel Service US United States USPS United States Postal Service VAERS Vaccine Adverse Event Reporting System WHO World Health Organization WTHC Washoe Tribal Health Center 10.2.a Packet Pg. 206 Attachment: AC Response to COVID 7.1.21 (COVID Response Report - Please time this item for 1 hour) ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Debbie Burkett, Community Development Director DATE OF MEETING: July 20, 2021 PREPARED BY: Candace Stowell, Community Development Deputy Director TITLE: ADDENDUM: Request the Senior Building Maintenance Worker position on the allocation list be funded and direct Finance to make the appropriate modifications. SUMMARY: The current position allocation list has a Senior Building Maintenance position that is currently not funded. In order to retain the current employee and to provide opportunity for advancement, we are requesting the following: 1) Funding the position of Senior Building Maintenance Worker, Range 41A, at Step 3 ($4,008 per month), 2) Eliminating the Building Maintenance Worker position, and 3) Moving Julio Haro into the position of Senior Building Maintenance Worker. RECOMMENDED ACTION: Approve changes to the Community Development Department position allocation and authorize Finance to make the adjustments. ISSUE STATEMENT AND DISCUSSION: The proposed change will provide an increase in salary from $3,257 to $4,008 per month. FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $0.00 $0.00 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: 10.3 Packet Pg. 207 ---PAGE BREAK--- INSTRUCTIONS TO CLERK: 10.3 Packet Pg. 208 ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Gail St.James, Behavioral Health Director DATE OF MEETING: July 20, 2021 PREPARED BY: Nani Ellis, Fiscal and Administration Supervisor TITLE: Resolution to approve appointment of Nichole Williamson as acting Behavioral Health Services Director effective 7/8/2021 as the formal signing agent for Behavioral Health Services until further notice. SUMMARY: Per Nichole Williamson, CAO/HHS Director, as of July 8, 2021 Behavioral Health Services (BHS) is in need of an authorized signer and acting director. RECOMMENDED ACTION: Resolution to approve appointment of Nichole Williamson as acting Behavioral Health Services Director effective 7/8/2021 as the formal signing agent for Behavioral Health Services until further notice. ISSUE STATEMENT AND DISCUSSION: FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $0.00 $0.00 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: N/A INSTRUCTIONS TO CLERK: N/A ID 4160 10.4 Packet Pg. 209 ---PAGE BREAK--- RESOLUTION NO. RESOLUTION OF THE BOARD OF SUPERVISORS, COUNTY OF ALPINE, STATE OF CALIFORNIA APPROVAL OF INTERIM APPOINTMENT OF BEHAVIORAL HEALTH DIRECTOR WHEREAS, as of July 8, 2021 Behavioral Health Services requires an acting Director with signature authority; and WHEREAS, the County Administrative Officer is available to perform these tasks as needed; NOW, THEREFORE, BE IT RESOLVED, BY THE Board of Supervisors of the County of Alpine, State of California, do hereby approve appointment of Nichole Williamson as acting Behavioral Health Services Director effective 7/8/2021 as the formal signing agent for Behavioral Health Services until further notice. Terry Woodrow, Chair Board of Supervisors, County of Alpine, State of California ATTEST: APPROVED AS TO FORM: Teola L. Tremayne, County Clerk Margaret Long, County Counsel & Ex Officio Clerk to the Board of Supervisors By: Patricia Griffin, Assistant County Clerk 10.4 Packet Pg. 210 ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Nichole Williamson, CAO/HHS Director DATE OF MEETING: July 20, 2021 PREPARED BY: Janel Morales, Fiscal and Administration Supervisor TITLE: Request approval to dispense with public bidding procedures for the development of the Commercially Sexually Exploited Children protocol and procedures, and the provision of Trauma Informed Training in the amount of $48,500 for the term of July 1, 2021 through June 30, 2022. SUMMARY: Alpine County Health & Human Services (ACHHS) wishes to enter into contract with Tribal Law and Policy Institute (TLPI) to provide continued Commercially Sexually Exploited Children (CSEC) training and support and Trauma Informed Training and services as outlined in the Alpine County 2019- 2024 Child Welfare System Improvement Plan (SIP). RECOMMENDED ACTION: Approve resolution dispensing with Public Bidding for the contract with Tribal Law and Policy Institute in the amount of $48,500 for the term of July 1, 2021 through June 30, 2022. ISSUE STATEMENT AND DISCUSSION: Alpine County Health & Human Services entered into contract with Tribal Law and Policy (TLPI) to provide services for the Commercially Sexually Exploited Children (CSEC) program on May 9, 2018 on contract # HHS 2018-08. TLPI has developed the CSEC protocol as required in Alpine County’s System Improvement Plan (SIP) for the 2019-2024 period. The SIP also outlines Trauma Informed Services to be provided and references that the Native American population has disproportionately experienced historical traumas. The Tribal Law and Policy Institute is a Native American operated non-profit and the Trauma Informed Training they can provide will be through a Native American focused lens. ACHHS has contacted multiple Trauma Informed Training organizations and either we received no response, were not able to meet a small county’s needs, or the entity was not able to provide Native American specific trainings. Additionally, TLPI has partnerships with Native American trainers who have worked extensively with the Washoe Tribe. FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $25,000 $48,500 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: CDSS program allocations INSTRUCTIONS TO CLERK: Please scan fully executed contract to HHS 10.5 Packet Pg. 211 ---PAGE BREAK--- RESOLUTION NO. RESOLUTION OF THE BOARD OF SUPERVISORS, COUNTY OF ALPINE, STATE OF CALIFORNIA APPROVAL TO DISPENSE WITH PUBLIC BIDDING PROCEDURES WHEREAS, Alpine County is a small, rural and remote county where services, supplies, or equipment are difficult and costly to obtain; and WHEREAS, contracts for services, supplies, and equipment to the County must generally be awarded to the lowest bidder pursuant to Alpine County Code 2.32.050 and/or Public Contract Code 20120 et seq; and WHEREAS, the County’s Child Welfare System Improvement Plan requires Alpine County to implement trauma informed practices during the 2019-2024 plan “with the eventual goal of implementing trauma informed practice county-wide, to include partner agencies and local providers”; and WHEREAS, Alpine County’s Child Welfare System Improvement Plan (SIP) was approved by the Alpine County Board of Supervisors on September 19, 2019; and WHEREAS, Native Americans have disproportionately experienced historical trauma; and WHEREAS, Alpine County’s population is twenty-five percent Native Americans; and WHEREAS, Tribal Law and Policy Institute (TLPI) is a Native American operated non-profit organization which is currently providing services to Alpine County for the delivery of the Commercially Sexually Exploited Children (CSEC) protocol as required in the SIP; and WHEREAS, TLPI can provide Trauma Informed Training to Alpine County staff, Alpine County Partner agencies and the Washoe Tribal members as required in the SIP; NOW, THEREFORE, BE IT RESOLVED, BY THE Board of Supervisors of the County of Alpine, State of California, do hereby dispense with public bidding for the provision of Trauma Informed Training. Terry Woodrow, Chair Board of Supervisors, County of Alpine, State of California 10.5.a Packet Pg. 212 Attachment: TLPI RESOLUTION (Request approval to dispense with public bidding procedures for the development of the Commercially) ---PAGE BREAK--- ATTEST: APPROVED AS TO FORM: Teola L. Tremayne, County Clerk Margaret Long, County Counsel & Ex Officio Clerk to the Board of Supervisors By: Patricia Griffin, Assistant County Clerk 10.5.a Packet Pg. 213 Attachment: TLPI RESOLUTION (Request approval to dispense with public bidding procedures for the development of the Commercially) ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 1 STANDARD FORM PERSONAL SERVICES CONTRACT COUNTY OF ALPINE AND TRIBAL LAW & POLICY INSTITUTE THIS AGREEMENT is made and entered into this 1st day of July 2021, by and between the COUNTY OF ALPINE, hereinafter referred to as "County," and TRIBAL LAW AND POLICY INSTITUTE hereinafter referred to as "Contractor". RECITALS: WHEREAS, County desires to retain a person or firm to provide the following services: TRAUMA INFORMED TRAINING; and ongoing work related to COMMERCIALLY SEXUALLY EXPLOITED CHILDREN. WHEREAS, Contractor warrants that it is qualified and agreeable to render the aforesaid services. NOW, THEREFORE, for and in consideration of the agreement made, and the payments to be made by County, the parties agree to the following: I. SCOPE OF SERVICES: Contractor agrees to provide all of the services described in Exhibit attached hereto and by this reference made a part hereof. II. ADDITIONAL SERVICES: The County may desire services to be performed which are relevant to this contract or services but have not been included in the scope of the services listed in Paragraph I above and Contractor agrees to perform said services upon the written request of County. These additional services could include, but are not limited to, any of the following: A. Serving as an expert witness for the County in any litigation or other proceedings involving the project or services. B. Services of the same nature as provided herein which are required as a result of events unforeseen on the date of this contract. III. COUNTY FURNISHED SERVICES: The County agrees to: A. Facilitate access to and make provisions for the Contractor to enter upon public and private lands as required to perform their work. B. Make available to Contractor those services, supplies, equipment and staff that are normally provided for the services required by the type of services rendered by Contractor and as set forth in Exhibit C. Make available all pertinent data and records for review. 10.5.b Packet Pg. 214 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 2 IV. FEES: The fees for furnishing services under this Contract shall be based on the rate schedule which is included on Exhibit and by this reference incorporated herein. Said fees shall remain in effect for the entire term of this contract. V. MAXIMUM COST TO COUNTY: Notwithstanding any other provision of this contract, in no event will the cost to County for the services to be provided herein exceed the maximum sum of $48,500 (FOURTY EIGHT THOUSAND FIVE HUNDRED DOLLARS) including direct non-salary expenses. VI. PAYMENT: The fees for services under this Contract shall be due within 60 calendar days after receipt by County of an invoice covering the service(s) rendered to date. For any services involving a public works or construction project the County shall retain 10 percent of each progress payment, which shall be due upon completion and acceptance by County of the work or termination of this Contract. With respect to any additional services provided under this Contract as specified in paragraph II hereof, Contractor shall not be paid unless Contractor has received written authorization from County for the additional services prior to incurring the costs associated therewith. Said additional services shall be charged at the rates set forth on Exhibit Invoices or applications for payment to the County shall be detailed and shall contain full documentation of all work performed and all reimbursable expenses incurred. Where the scope of work on the contract is divided into various tasks, invoices shall detail the related expenditures accordingly. Labor expenditures need documentation to support time, subsistence, travel and field expenses. No expense will be reimbursed without adequate documentation. This documentation will include, but not be limited to, receipts for material purchases, rental equipment and subcontractor work. Notwithstanding any other provision herein, payment may be delayed, without penalty for any period in which the State or Federal Government has delayed distribution of funds that are intended to be used by the County for funding payment to contractor. VII. CONTRACT PERFORMANCE TIME: All the work required by this contract shall be completed and ready for acceptance no later than June 30, 2022. Time is of the essence with respect to this Contract. VIII. INSURANCE: Contractor shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder and the results of that work by the Contractor, his agents, representatives, employees or subcontractors. 10.5.b Packet Pg. 215 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 3 Minimum Scope and Limit of Insurance A. The Contractor shall maintain a commercial general liability (CGL) insurance policy [Insurance Services Office Form CG 00 01] covering CGL on an occurrence basis, including products and completed operations, property damage bodily injury and personal & advertising injury with limits in the amount of $ 2,000,000, and a general aggregate limit of $4,000,000. The County, its officers, officials, employees, and volunteers are to be covered as additional insureds on the General Liability policy with respect to liability arising out of work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connection with such work or operations. Additional insured should read as follows: Alpine County PO Box 158 Markleeville, CA 96120 B. Contractor shall also provide comprehensive business or commercial automobile liability coverage including non-owned and hired automobile liability in the amount of $1,000,000 per accident for bodily injury and property damage. Coverage shall be at least as broad as ISO Form CA0001 (Code or if Contractor has no owned autos, hired, (Code 8) and non-owned autos (Code The County, its officers, officials, employees, and volunteers are to be covered as additional insureds on the Automobile Liability policy with respect to liability arising out of work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connection with such work or operations. Additional insured should read as follows: Alpine County PO Box 158 Markleeville, CA 96120 C. The Contractor shall be required to carry Professional Errors & Omissions coverage in the amount of $1,000,000 per occurrence or claim, $2,000,000 aggregate. 10.5.b Packet Pg. 216 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 4 The insurer shall supply a Certificate of Insurance and endorsements signed by the insurer evidencing such insurance to County prior to commencement of work. However, failure to obtain the required documents prior to the work beginning shall not waive the Contractor’s obligation to provide them. The County reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the Entity. Insurance is to be placed with insurers with a current A.M. Best’s rating of no less than A:VII, unless otherwise acceptable to the Entity. Any deductibles or self-insured retentions must be declared to and approved by the County. The County may require the Contractor to purchase coverage with a lower deductible or retention or provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. For any claims related to this contract, the Contractor’s insurance coverage shall be primary coverage at least as broad as ISO CG 20 01 04 13 as respects the County, its officers, officials, employees, and volunteers. Any insurance or self- insurance maintained by the County, its officers, officials, employees, or volunteers shall be excess of the Contractor’s insurance and shall not contribute with it. Contractor hereby grants to County a waiver of any right to subrogation which any insurer of said Contractor may acquire against the County by virtue of the payment of any loss under such insurance. Contractor agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the County has received a waiver of subrogation endorsement from the insurer. IX. WORKER'S COMPENSATION: The Contractor acknowledges that it is aware of the provisions of the Labor Code of the State of California which requires every employer to be insured against liability for workers’ compensation or to undertake self-insurance in accordance with the provisions of that Code and it certifies that it will comply with such provisions before commencing the performance of the work of this Contract. A copy of the certificates evidencing such insurance with policy limits of at least $1,000,000 per accident for bodily injury or disease, shall be provided to County prior to commencement of work, or a signed County Workers’ Compensation Exemption form. X. NONDISCRIMINATORY EMPLOYMENT: In connection with the execution of this Contract, the Contractor shall not discriminate against any employee or applicant for employment because of race, color, religion, age, sex, national origin, political affiliation, ancestry, marital status or disability. This policy does not require the employment of unqualified persons. 10.5.b Packet Pg. 217 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 5 XI. INTEREST OF PUBLIC OFFICIALS: No officer, agent or employee of the County during their tenure or for one year thereafter shall have any interest, direct or indirect, in this Contract or the proceeds thereof. XII. SUBCONTRACTING AND ASSIGNMENT: The rights, responsibilities and duties under this Contract are personal to the Contractor and may not be subcontracted, transferred or assigned without the express prior written consent of the County. XIII. LICENSING AND PERMITS: The Contractor shall maintain the appropriate licenses throughout the life of this Contract. Contractor shall also obtain any and all permits which might be required by the work to be performed herein. XIV. BOOKS OF RECORD AND AUDIT PROVISION: Contractor shall maintain on a current basis complete books and records relating to this contract. Such records shall include, but not be limited to, documents supporting all bids and all expenditures for which any reimbursement is sought. The books and records shall be original entry books. In addition, Contractor shall maintain detailed payroll records including all subsistence, travel and field expenses, and canceled checks, receipts and invoices for all items for which any reimbursement is sought. These documents and records shall be retained for at least five years from the completion of this contract. Contractor will permit County to audit all books, accounts or records relating to this contract or all books, accounts or records of any business entities controlled by Contractor who participated in this contract in any way. Any audit may be conducted on Contractor's premises or, at County's option, Contractor shall provide all books and records within a maximum of 15 days upon receipt of written notice from County. Contractor shall refund any moneys erroneously charged. If County ascertains that it has been billed erroneously by Contractor for an amount equaling 5% or more of the original bid, Contractor shall be liable for the costs of the audit in addition to any other penalty to be imposed. This paragraph applies to any contract which provides for reimbursement of expenses. XV. TERM OF AGREEMENT: This Agreement shall commence on July 1, 2021 and shall terminate on June 30, 2022. XVI. CONFIDENTIALITY: All information and records obtained in the course of providing services under this agreement shall be confidential and shall not be open to examination for any purpose not directly connected to the administration of this program. Both parties shall comply with State and Federal requirements regarding confidential information. 10.5.b Packet Pg. 218 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 6 XVII. TITLE: It is understood that any and all documents, information, computer disk, and reports concerning this project prepared by and/or submitted to the Contractor, shall be the property of the County. The Contractor may retain reproducible copies of drawings and copies of other documents. In the event of the termination of this Contract, for any reason whatever, Contractor shall turn over all information, writing, computer disk, and documents to County without exception or reservation. Contractor shall transfer from computer hard drive to disk any information or documents stored on hard drive and provide County with said disk. XVIII. TERMINATION: A. If the Contractor fails to provide in any manner the services required under this Contract or otherwise fails to comply with the terms of this Contract or violates any ordinance, regulation or other law which applies to its performance herein, the County may terminate this Contract by giving five calendar days written notice to the party involved. B. The Contractor shall be excused for failure to perform services herein if such services are prevented by acts of God, strikes, labor disputes or other forces over which the Contractor has no control. C. Either party hereto may terminate this Contract for any reason by giving thirty (30) calendar days written notice to the other parties. Notice of Termination shall be by written notice to the other parties and be sent by registered mail. D. In the event of termination not the fault of the Contractor, the Contractor shall be paid for services performed to the date of termination in accordance with the terms of this Contract. XIX. RELATIONSHIP BETWEEN THE PARTIES: It is expressly understood that in the performances of the services herein, the Contractor, and the agents and employees thereof, shall act in an independent capacity and as an independent contractor and not as officers, employees or agents of the County. XX. AMENDMENT: This Contract may be amended or modified only by written agreement of all parties. XXI. ASSIGNMENT OF PERSONNEL: The Contractor shall not substitute any personnel for those specifically named in its proposal unless personnel with 10.5.b Packet Pg. 219 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 7 substantially equal or better qualifications and experience are provided, acceptable to County, as evidenced in writing. XXII. JURISDICTION AND VENUE: This Contract shall be construed in accordance with the laws of the State of California and the parties hereto agree that venue shall be in ALPINE County, California. XXIII. INDEMNIFICATION: Contractor agrees to indemnify, defend at its own expense, and hold County harmless from any and all liabilities, claims, losses, damages, or expenses, including reasonable attorney’s fees, arising from all acts or omissions to act of Contractor or its officers, agents, or employees in rendering services under this contract; excluding, however, such liabilities, claims, losses, damages, or expenses arising from County’s sole negligence or willful acts. XXIV. COMPLIANCE WITH APPLICABLE LAWS: The Contractor shall comply with any and all federal, state and local laws affecting the services covered by this Contract, including the Health Insurance Portability and Accountability Act. XXV. ATTORNEY’S FEES: If any party hereto employs an attorney for the purpose of enforcing or construing this Agreement, or any judgment based on this Agreement, in any legal proceeding whatsoever, including insolvency, bankruptcy, arbitration, declaratory relief or other litigation, including appeals or rehearing, the prevailing party shall be entitled to receive from the other party or parties thereto reimbursement for all attorneys’ fees and all costs, including but not limited to service of process, filing fees, court and court reporter costs, investigative costs, expert witness fees, and the cost of any bonds, whether taxable or not. If any judgment or final order be issued in that proceeding, said reimbursement shall be specified therein. XXVI. NOTICES: Notices to terminate, change or otherwise provide notice as provided in the contract shall be given to County at the following location: County of Alpine 99 Water Street Markleeville, CA 96120 Attn: County Clerk Notices shall be given to Contractor at the following address: Tribal Law & Policy Institute 8235 Santa Monica Blvd; Suite 211 West Hollywood, CA 90046 10.5.b Packet Pg. 220 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 8 XXVII. PUBLIC WORKS PROJECTS: No contractor or subcontractor may be listed on a bid proposal for a Public Works project unless registered with the Department of Industrial Relations pursuant to Labor Code section 1725.2 [with limited exceptions from this requirement for bid purposes only under Labor Code section 1771.1(a)]. No contractor or subcontractor may be awarded a Public Works project unless registered with the Department of Industrial Relations pursuant to Labor Code section 1725.2. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. IN WITNESS WHEREOF, the parties hereunto have executed this Contract on the date written below. COUNTY OF ALPINE: TRIBAL LAW & POLICY INSTITUTE: By By Nichole Williamson Name: Jerry Gardner County Administrative Officer Title.: Executive Director Date: Date: Approved as to form: Margaret E Long County Counsel 10.5.b Packet Pg. 221 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 9 EXHIBIT SERVICES TO BE PROVIDED BY CONTRACTOR Statements of Work follow this page 10.5.b Packet Pg. 222 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- Page 1 of 3 Statement of Work Alpine County CSEC Response and Training (FY 2021 - 2022) The following tasks and corresponding deliverables will be implemented by the Tribal Law and Policy Institute: Overall Task: Increase the capacity of Alpine County staff and their partners to prevent and respond to the commercial sexual exploitation of children, ensure compliance with state requirements for the program, and maintain positive relationships with the state entities overseeing the program. In collaboration with Alpine County Department of Health and Human Services, the Tribal Law and Policy Institute (TLPI) will continue to build the county’s ability to prevent and respond to the commercial exploitation of children by facilitating in the development of tools and protocols, cross-training county staff and their regional partners, and developing awareness materials. TLPI will work with the Alpine County DHHS to identify priority areas, facilitate conversations, and work with the parties to identify and meet needs. Delivery Method: TLPI staff will identify materials and trainings available through the state and other entities and fill in gaps as they are identified. In addition, TLPI staff will attend meetings facilitated by the California Child Welfare Council’s Commercially Sexually Exploited Children (CSEC) Action Team, by the Child Trafficking Response Unit of California’s Child Welfare Program & Policy Development Bureau in order to ensure that Alpine County can take advantage of resources and information available to it and to ensure that proposed protocols meet the needs of Alpine County’s families. TLPI staff will utilize virtual meeting technology and in-person meetings throughout the year (see project timelines). Objectives 1. TLPI will assist in meeting training needs designed to: a) engage the community in the project and raise their awareness about CSEC; b) cross-train staff; and c) familiarize staff and partners with the CSEC protocols. 2. TLPI will attend meetings facilitated by state and other entities, report back to DHHS staff and get their input in order to ensure that state requirements are being met and that suggested protocols and programs meet the needs of Alpine County families. 3. TLPI will facilitate discussions between Alpine County DHHS and Washoe Tribal staff to identify additional priority areas for protocol development. 10.5.b Packet Pg. 223 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- Page 2 of 3 CSEC Prevention and Response Project Snapshot of 12 Month Timeline Tasks Dates Objective TLPI will assist in meeting training needs by providing training designed to: a) Avoid duplication with what is offered by state and other entities; b) Engage the community in the project and raise their awareness about CSEC and how it can be prevented; and c) Cross-train staff and partners to ensure smooth operationalization of protocols. TLPI staff will consistently monitor which trainings are available from the state and other entities, attend select trainings, and forward information on which trainings it believes will be useful to Alpine County staff and their partners. In addition, TLPI staff will work with Alpine County DHHS to identify trainings to fill the gaps in what is already available and to ensure smooth operationalization of protocols and an effective response to CSEC. Finally, TLPI staff provide onsite training to engage the community in the project and raise their awareness about CSEC and how it can be prevented. Given the ongoing pandemic, TLPI does not give a timeline for the on-site training, but will work with DHHS and the Washoe Tribe to identify when the on-site visit can be held safely. Months: Ongoing (July 2021 – July 2022) Objective TLPI will attend meetings facilitated by state and other entities, report back to DHHS staff and get their input in how to respond in order to ensure that state requirements are being met, that any suggested protocols and programs meet the needs of Alpine County families, and the Alpine County understands response protocols enacted by local partners such as the state of Nevada and neighboring counties. California agencies and state contractors hold meetings about CSEC and its prevention on a regular basis. Some of these meetings are quarterly, some and some are on an as-needed basis. TLPI staff will attend those meetings and report back in order to ensure that the needs of Alpine County families are being met, to ensure compliance with state requirements, and to advocate for supports and assistance that will improve Alpine County’s ability to serve families impacted by the commercial sexual exploitation of children. In addition, TLPI staff will familiarize itself with response protocols enacted by neighboring states and counties so that Alpine County’s response is, as much as possible, part of a regional approach to preventing and responding to CSEC. Months: Ongoing (July 2021 – July 2022) Objective TLPI will facilitate discussions between Alpine County DHHS and Washoe Tribal staff to identify additional priority areas for protocol development. At this time, no additional priority areas have been identified, but given the shifting nature of state and federal law and compliance expectations, TLPI proposes that this objective be kept in this scope of work. Months: Ongoing (July 2021 – July 2022) 10.5.b Packet Pg. 224 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- Page 3 of 3 Commercially Sexually Exploited Children Budget Proposed Compensation: $100.00 per hour, with a total of 250 hours = $25,000. Arrangements for additional compensation to cover potential travel or other identified needs may occur. Budget: Task Hours Rate Total General Project Management 155 $100 $15,500 Training Development & Delivery 70 $100 $7,000 Follow-up Calls 25 $100 $2,500 Grand Total: $25,000 10.5.b Packet Pg. 225 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- Page 1 of 1 Statement of Work Trauma Informed Training – Alpine County and Washoe Tribe The following tasks and corresponding deliverables will be completed by the Tribal Law and Policy Institute from July 1, 2021 – December 31, 2021: Overall Task: Building the county’s capacity to deliver and sustain trauma informed practices and programming (in accordance with the county’s systems improvement plan) through training and technical assistance. In collaboration with Alpine County Department of Health and Human Services, the Tribal Law and Policy Institute (TLPI) will offer 4, 90-minute trauma informed training sessions for a core group of county staff with a follow-up, hour-long phone call to continue practical work with the group. After the training sessions and follow up calls are complete, TLPI will discuss next steps with the Alpine County Department of Health and Human Services which may include further training for the core group or other identified parties, additional skill development such as motivational interviewing, and coaching. Delivery Method: TLPI staff and a TLPI consultant with subject matter expertise will develop and deliver the trainings. TLPI staff will utilize videoconferencing, teleconferencing, and in-person meetings as appropriate. Objectives 1. TLPI will collaborate with Alpine County to plan the details regarding the core group participants and other training logistics. 2. TLPI will train the identified core group of staff on trauma informed care and practices over 4, 90-minute sessions. 3. TLPI will host follow-up calls with the core group to assist with implementation of trauma informed shifts in practice. Tasks Dates Objective Collaborate with Alpine County on logistics for each training, including identifying the core group, timing, messaging, and recording sessions. 6 months (July - December) Objective Train staff on trauma informed care and practice. 2.1 – Training 1 – Introductions and Broad Project Overview, The impacts of trauma, Trauma responses, Trauma effects on the provision of services 2.2 – Training 2 – Effects of trauma on staff, trauma informed services, importance of internal trauma informed practice/healing for staff 2.3 – Training 3 – Core values of trauma informed care 6 months (August – September) (September - October) (October - November) Objective Host 4 follow-up calls with the core group to assist with implementation of trauma informed shifts in practice. 6 months (August - December) TLPI Staff: Suzanne Garcia, Child Welfare Legal Specialist; Art Martinez, Senior Program Specialist; Jeremy Braithwaite, Tribal Research Specialist; TLPI Consultant with additional subject matter expertise Proposed Compensation: $100.00 per hour, with a total of 235 hours = $23,500. Arrangements for additional compensation to cover potential travel or other identified needs may occur. Budget: Task Hours Rate Total General Project Management 67 $100 $6,700 Training Development & Delivery 144 $100 $14,400 (36 hours x 4 trainings) Follow-up Calls 24 $100 $2,400 (2 hours x 3 staff x 4 calls) Grand Total: $23,500 10.5.b Packet Pg. 226 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 10 EXHIBIT COMPENSATION OR FEES TO BE PAID TO CONTRACTOR Trauma Informed Training Proposed Compensation: $100.00 per hour, with a total of 235 hours = $23,500. Arrangements for additional compensation to cover potential travel or other identified needs may occur. Budget: Task Hours Rate Total General Project Management 67 $100 $6,700 Training Development & Delivery 144 $100 $14,400 (36 hours x 4 trainings) Follow-up Calls 24 $100 $2,400 (2 hours x 3 staff x 4 calls) Grand Total: $23,500 Commercially Sexually Exploited Children Proposed Compensation: $100.00 per hour, with a total of 250 hours = $25,000. Arrangements for additional compensation to cover potential travel or other identified needs may occur. Budget: Task Hours Rate Total General Project Management 155 $100 $15,500 Training Development & Delivery 70 $100 $7,000 Follow-up Calls 25 $100 $2,500 Grand Total: $25,000 10.5.b Packet Pg. 227 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 11 EXHIBIT HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT SUPPLEMENT Definitions: Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in the Privacy Rule. a. Business Associate. "Business Associate" shall mean the Contractor named in the first paragraph of this agreement. b. Covered Entity. "Covered Entity" shall mean the County of ALPINE. c. Designated Record Set. “Designated Record Set” shall mean: A group of records maintained by or for a covered entity that is: a. The medical records and billing records about individuals maintained by or for a covered health care provider; b. The enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or c. Used, in whole or in part, by or for the covered entity to make decisions about individuals. For purposes of this paragraph, the term record means any item, collection, or grouping of information that includes protected health information and is maintained, collected, used, or disseminated by or for a covered entity. d. Individual. "Individual" shall have the same meaning as the term "individual" in 45 CFR § 164.501 and shall include a person who qualifies as a personal representative in accordance with 45 CFR § 164.502(g). e. Privacy Rule. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR Part 160 and Part 164, Subparts A and E. f. Protected Health Information. "Protected Health Information" shall have the same meaning as the term "protected health information" in 45 CFR § 164.501, limited to the information created or received by Business Associate from or on behalf of Covered Entity. g. Required By Law. "Required By Law" shall have the same meaning as the term "required by law" in 45 CFR § 164.501. h. Secretary. "Secretary" shall mean the Secretary of the Department of Health and Human Services or his designee. i. Electronic Protected Health Information. “Electronic Protected Health Information” (“EPHI”) means individually identifiable health information that is transmitted or maintained in electronic media, limited to the information created, received, maintained or transmitted by Business Associate from or on behalf of Covered Entity. j. Security Incident. “Security Incident” shall mean the attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with systems operations in an information system, but does not include minor incidents that occur on a daily basis, such as scans, “pings”, or unsuccessful random attempts to penetrate computer networks or servers maintained by Business Associate. k. Security Rule. “Security Rule” shall mean the Standards for the Protection of Electronic Protected Health Information at 45 CFR Part 160 and Part 164, 10.5.b Packet Pg. 228 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 12 Subparts A and C. Obligations of Business Associate Business Associate shall: a. Not use or disclose Protected Health Information other than as permitted or required by the Agreement or as Required By Law. b. Use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Agreement. c. Mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of Protected Health Information by Business Associate in violation of the requirements of this Agreement d. Report to Covered Entity any use or disclosure of the Protected Health Information in violation of the requirements of this Agreement of which it becomes aware. e. Ensure that any agent, including a subcontractor, to whom it provides or receives Protected Health Information agrees to the same restrictions and conditions that apply through this Agreement to Business Associate with respect to such information. f. Document disclosures of Protected Health Information and information related to such disclosures as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR § 164.528. g. Provide to Covered Entity or an Individual, in time and manner agreed to between the parties, information collected pursuant to this Agreement, to permit Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR § 164.528. h. Provide access, at the request of Covered Entity, and in the time and manner agreed to by the parties, to Protected Health Information in a Designated Record Set, to Covered Entity or, as directed by Covered Entity, to an Individual in order to meet the requirements under 45 CFR §164.524. i. Make any amendment(s) to Protected Health Information in a Designated Record set that the Covered Entity directs or agrees to pursuant to 45 CFR §164.526 at the request of Covered Entity or an Individual, and in the time and manner agreed to between the parties. j. Business Associate shall implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of EPHI that Business Associate creates, receives, maintains, or transmits on behalf of Covered Entity. k. Business Associate shall conform to generally accepted system security principles and the requirements of the final HIPAA rule pertaining to the security of health information. l. Business Associate shall ensure that any agent to whom it provides EPHI, including a subcontractor, agrees to implement reasonable and appropriate safeguards to protect such EPHI. m. Business Associate shall report to Covered Entity any Security Incident within 5 business days of becoming aware of such incident. 10.5.b Packet Pg. 229 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 13 n. Business Associate shall make its policies, procedures, and documentation relating to the security and privacy of protected health information, including EPHI, available to the Secretary of the U.S. Department of Health and Human Services and, at Covered Entity’s request, to the Covered Entity for purposes of the Secretary determining Covered Entity’s compliance with the HIPAA privacy and security regulations. Permitted Uses and Disclosures by Business Associate Except as otherwise limited in this Agreement, Business Associate may use or disclose Protected Health Information to perform functions, activities, or services for, or on behalf of, Covered Entity as specified in this Services Agreement, provided that such use or disclosure would not violate the Privacy Rule if done by Covered Entity or the minimum necessary policies and procedures of the Covered Entity. Obligations of Covered Entity Covered Entity shall notify Business Associate of any: a. Limitation(s) in its notice of privacy practices of Covered Entity in accordance with 45 CFR § 164.520, to the extent that such limitation may affect Business Associate's use or disclosure of Protected Health Information. b. Changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, to the extent that such changes may affect Business Associate's use or disclosure of Protected Health Information. c. Restriction to the use or disclosure of Protected Health Information that Covered Entity has agreed to in accordance with 45 CFR § 164.522, to the extent that such restriction may affect Business Associate's use or disclosure of Protected Health Information. Permissible Requests by Covered Entity Covered Entity shall not request Business Associate to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy Rule if done by Covered Entity. Term and Termination a. Term. The Term of these provisions shall be concurrent with the term of the Services Agreement, and shall terminate when all of the Protected Health Information provided by Covered Entity to Business Associate, or created or received by Business Associate on behalf of Covered Entity, is destroyed or returned to Covered Entity, or, if it is infeasible to return or destroy Protected Health Information, protections are extended to such information, in accordance with the termination provisions in this Section. b. Termination for Cause. Upon Covered Entity's knowledge of a material breach by Business Associate, Covered Entity shall either: a. Provide an opportunity for Business Associate to cure the breach or end the violation and terminate this Agreement if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity; b. Immediately terminate this Agreement if Business Associate has breached a material term of this Agreement and cure is not possible; or 10.5.b Packet Pg. 230 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 14 c. If neither termination nor cure are feasible, Covered Entity shall report the violation to the Secretary. c. Effect of Termination. a. Except as provided in paragraph of this section, upon termination of this Agreement, for any reason, Business Associate shall return or destroy all Protected Health Information received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of the Protected Health Information. b. In the event that Business Associate determines that returning or destroying the Protected Health Information is infeasible, Business Associate shall provide to Covered Entity notification of the conditions that make return or destruction infeasible. Upon determination that return or destruction of Protected Health Information is infeasible, Business Associate shall extend the protections of this Agreement to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such Protected Health Information. Reservation of Right to Monitor Activities. Covered Entity reserves the right to monitor the security policies and procedures of Business Associate. Specific Provisions for Use and Disclosures by Business Associate of PHI Subject to 42 CFR Part 2. Covered Entity operates a program for treatment of alcohol or drug abuse, receives federal financial assistance in the operation of that program, and is required to comply with 42 CFR Part 2 pertaining to use and disclosure of patient information and patient records. Business Associate is a “Qualified Service Organization” as that term is defined at 42 CFR 2.11. Business Associate acknowledges that it will have access to records that are covered by 42 CFR Part 2. Business Associate agrees that it is fully bound by the provisions of 42 CFR Part 2, and will only use and disclose protected health information as permitted by those regulations. Business Associate will, if necessary, resist in judicial proceedings any effort to obtain access to patient records not permitted by 42 CFR Part 2. Miscellaneous a. Regulatory References. A reference in this Agreement to a section in the Privacy Rule means the section as in effect or as amended. b. Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for Covered Entity to comply with the requirements of the Privacy Rule and the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191. 10.5.b Packet Pg. 231 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- TRIBAL LAW & POLICY JUNE 2021 15 c. Interpretation. Any ambiguity in this Agreement shall be resolved to permit Covered Entity to comply with the Privacy Rule. 10.5.b Packet Pg. 232 Attachment: TLPI 21-22 Contract CSEC and Trauma 6.28.21 (Request approval to dispense with public bidding procedures for the development ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Gail St.James, Behavioral Health Director DATE OF MEETING: July 20, 2021 PREPARED BY: Nani Ellis, Fiscal and Administration Supervisor TITLE: Request approval of contract with Kings View Corporation for Electronic Health Records System, Health Analytics and All Pay Sources Billing Services in the amount of $371,341 for the term 07/01/2021-06/30/2024. SUMMARY: Behavioral Health Services (BHS) requests approval of a contract between Alpine County and Kings View Corporation for the management of the department’s electronic health record system (EHRS), Health Information Analytics (HIA), and All Pay Sources Billing Services. On 5/15/2012, Alpine County Board of Supervisors adopted a resolution dispensing with public bidding and a contract with Kings View was executed for electronic health record and all pay billing services on 7/3/2012. BHS executed a separate contract with Kings View for HIA on 7/1/2018. This renewal contract merges these two contract and addresses a planned transition to a new EHR system. RECOMMENDED ACTION: Approval of a contract between Alpine County and Kings View Corporation for EHRS-HIA services in the amount of $371,341 for the 3-year term of 7/1/2021-6/30/2024. ISSUE STATEMENT AND DISCUSSION: The Kings View contract approved on 6/1/2021 is for services only and is an added portion of the Kings View service for a rural county without an employed This Electronic Health Record System (EHRS) and Health Information Analytics (HIA), as well as all support and billing by Kings View is the principal agreement utilized by BHS. See attached Exhibit D for further details regarding annual expenditure. FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $0.00 $0.00 $112,729.25 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: 203; 204; 377 INSTRUCTIONS TO CLERK: Copy to BHS 10.6 Packet Pg. 233 ---PAGE BREAK--- 10.6.a Packet Pg. 234 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 235 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 236 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 237 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 238 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 239 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 240 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 241 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 242 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 243 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 244 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 245 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 246 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 247 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 248 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 249 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 250 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 251 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 252 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 253 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 254 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 255 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 256 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 257 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 258 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 259 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 260 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 261 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 262 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 263 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 264 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 265 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- 10.6.a Packet Pg. 266 Attachment: Kings View signature 7-1-21 thru 6-30-24 EHRS-HIA Contract (Kingsview EHRS-HIA Contract 7/1/21-6/30/24) ---PAGE BREAK--- AGENDA TRANSMITTAL TO: Board of Supervisors FROM: Sarah Simis, Deputy CAO to Personnel and Risk Management DATE OF MEETING: July 20, 2021 PREPARED BY: Sarah Simis, Deputy CAO to Personnel and Risk Management TITLE: Closed Session: Conference With Labor Negotiator - (GC§ § 54954.5 And 54957.6) Agency Designated Representatives: Margaret Long. Employee Organization: Alpine County Deputy Sheriff's Association (DSA), UDW Homecare Providers Union (IHSS) SUMMARY: RECOMMENDED ACTION: ISSUE STATEMENT AND DISCUSSION: FISCAL IMPACT: 1) Budgeted Current Fiscal Year 2) Total Anticipated Cost Current Year 3) Total Anticipated Cost Annual Year (Not Applicable) $0.00 $0.00 $0.00 SOURCE Unanticipated Revenue From Contingency Other: $0.00 $0.00 $0.00 FUNDING SOURCE: INSTRUCTIONS TO CLERK: Personnel 12.1 Packet Pg. 267