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Health and Human Services Agency recommending the Board adopt and authorize the Chair to sign Resolution 031-2022 to approve the addition of one (1) Full Time Equivalent Public Health Nurse Supervisor allocation in the Health and Human Services Agency.
FUNDING: 100% Enhanced Epidemiology and Laboratory Capacity Funding through the term of the funding to be replaced with ongoing California Department of Public Health sustainability funds. No County match.
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DISCUSSION / BACKGROUND:
The State of California is focusing its attention on reestablishing funding and minimum Public Health staffing requirements of local jurisdictions after years of a patchwork funding structure. For Fiscal Year (FY) 2021-22, the California legislature has set aside significant long-term funding in concert with supplemental funding, designed to sustain a greater foundation of staff to enhance activities in the area of communicable disease identification/mitigation as is mandated by a number of federal and state funding sources. The majority of these public health activities require workers with advanced technical skill sets including but not limited to Public Health Nurses (PHN), Registered Nurses, Disease Investigators, Epidemiologists, Health Educators, etc. The infusion of significant numbers of nursing professionals, both Extra Help and regular allocations, and in response to funding mandates, requires a corresponding ability for practice oversight to meet legal requirements and ensure services quality and best practice implementation.
Oversight of the Communicable Disease/Clinic unit in the Public Health Division is currently lead by one (1) Permanent PHN Supervisor, while being supplemented by one (1) Acting PHN Supervisor that has been extended by six months successively, 3 times. Though this situation was not ideal, the acting PHN Supervisor has been critical, allowing the program to meet additional mandates associated with various, new one-time funding streams. These new mandates were in addition to the requirements associated with our base funding which supports core mandated public health activities.
The acting PHN supervisor was meant as a temporary solution to ensure the division meets the required milestones tied to our ongoing and one-time funding, pending long term funding being identified and secured to justify a permanent PHN Supervisor FTE allocation. In addition, and considering that the Public Health Division has also been operating with an approximate 27% vacancy rate, this temporary fix has proven incredibly useful to support the demand on all levels of the division. While Public Health was operating as though this position may only be temporary, the State recently confirmed in December 2021 that ongoing funding will be allocated to support enhanced staffing within local Health Departments. As such, HHSA is making this recommendation to the board to add a permanent PHN Supervisor allocation.
On June 22, 2021, the Board of Supervisors approved the Fiscal Year (FY) 2021-22 Personnel Allocation Resolution 064-2021, thereafter amended September 28, 2021 by Resolution 124-2021 which reflects HHSA’s personnel allocations for FY 2021-22. This allocation was not included in Personnel Allocation Resolution 064-2021 because counties had not received complete guidance regarding the State's funding decisions or additional mandates at the start of FY 2021-22, only having received this information in December 2021. Therefore, up until recently, there was not enough information available to anticipate a justification for adding to Public Health’s personnel allocation in June or September 2021.
The primary purpose of the PHN supervisor position will be to provide day-to-day planning, organizing, supervising, reviewing, and evaluating the work of professional, technical, and administrative staff who are engaged in enhanced communicable disease surveillance, investigation, assessment and treatment. Included in these activities are the provision of preventive services such as exposure prophylaxis, administration of medications or vaccines, and community-level education. The addition of a permanent PHN supervisor position will provide the necessary infrastructure to meet practice oversight and delegated tasks to paraprofessional workers as prescribed by the California Board of Registered Nursing, California Business and Professions Code, and Title 17. There are currently, fourteen active staff within the Communicable Disease Unit, with five vacancies that Public Health is seeking to fill over the coming months. With 19 staff dedicated to this unit and the likelihood that those will soon be filled, two full-time supervisory positions will be critical to ensuring a proper span of control. In addition, additional leadership within the unit will assist the division in maintaining accreditation status, which requires Public Health to meet a number of nationally set standards.
Working directly with the Human Resources Department, HHSA has developed the attached Personnel Allocation Resolution which was approved by County Counsel on February 2, 2022.
ALTERNATIVES:
The Board could decline to adopt and authorize the Chair to sign the attached Personnel Allocation, thereby retaining the current allocations. If the position is not approved, the HHSA Public Health Division will lack the necessary personnel to effectively manage the span of control needed to ensure service quality, practice competence, efficient planning, and expedient response/mobilization to address communicable disease events in the County.
PRIOR BOARD ACTION:
June 7, 2021, File ID: 21-0922; Agenda No. 1 “CAO Budget Hearing”
June 22, 2021, File ID: 21-0994; Agenda No. 4 “Personnel Allocation”
September 28, 2021, File ID: 21-1519; Agenda No. 2 “CAO Budget Adoption”
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Human Resources, County Counsel
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
The addition of one FTE Public Health Nurse Supervisor allocation has an estimated annual cost increase of $171,253, which includes the additional admin/finance indirect costs. Costs are funded 100% by the ELC grants through the term of the funds with ongoing CDPH sustainability funds to replace thereafter. There is no additional impact to Realignment as a result of adding this position. Due to Salaries and Benefits savings there are sufficient appropriations in the Public Health budget to cover the increased cost for the remainder of the fiscal year.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1) Obtain signature of Chair on attached Resolution XXX-2022.
2) Provide one (1) certified Resolution to HHSA-Contracts at 3057 Briw Rd and one (1) certified Resolution to Heather Andersen in Human Resources at 330 Fair Lane.
STRATEGIC PLAN COMPONENT:
Good Governance
CONTACT
Don Semon, Director, Director, Health and Human Services Agency