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Audit finds Behavioral Care Center 'very well run' but flags six improvement areas
Summary
The Audit Committee reviewed a report on the 60‑bed Behavioral Care Center that praised operations but identified one high‑risk and five medium‑risk issues, including unclear admittance criteria, handbook readability, security/drill gaps, third‑party documentation gaps, grievance privacy and medication inventory controls.
The county audit office told the Audit Committee that its review of the Behavioral Care Center (BCC) found the 60‑bed facility to be "very well run" but identified six areas needing improvement.
The audit, presented by the audit director, narrowed its scope to the BCC after auditors found the originally broader scope covered distinct processes across several agencies. The audit examined five objectives: intake and equity, training and staffing, clinical response to health events, fiscal controls for sharps and pharmaceuticals, and discharge effectiveness. Auditors said they found "comprehensive intake process, comprehensive discharge process, and dedicated staff that are trained well," but recorded one high‑risk and five medium‑risk observations.
Key recommendations included creating clearer admittance criteria and documenting reasons individuals are denied or decline admission to improve transparency and permit equity analysis; lowering the reading level and improving accessibility of the facility handbook; tightening front‑door security and expanding emergency‑response drills beyond fire drills; ensuring third‑party medical vendor documentation consistently includes timestamps and signatures; improving kiosk privacy and minimum information required for grievance submissions and completing investigations where possible after a person leaves custody; and replacing simple signature checks at medication/ sharps shift changes with numeric inventory counts to reconcile with monthly sheriff's office inventories.
"What we found was overall, this is a very well run facility," the audit director said during the meeting, noting both policy documentation and evidence of routine compliance. The report said auditors reviewed grievance files and third‑party sick‑call logs, and though they saw no evidence of delayed care, the missing timestamps and occasional unsigned entries weaken accountability.
Sheriff Hall, who spoke after the presentation, defended the BCC's intentionally flexible admission approach and described the unit as "my baby," saying officials deliberately avoided overly prescriptive criteria when the program was created so it could adapt. He emphasized that the BCC targets people with treatable mental‑health acuity and that participation is voluntary, noting the program depends on cooperation from the district attorney and public defenders.
On equity, auditors flagged that the BCC's resident demographics differed from booking data, with a larger share of minorities represented among bookings than among BCC admissions; auditors said the difference cannot be explained without better documentation of why individuals decline or are not admitted. Sheriff Hall said some people decline services because of stigma and that booking numbers — not average daily jail census — are the more appropriate comparator when assessing who might be eligible for the BCC.
BCC staff told the committee the handbook has been revamped with more images and clearer layout and that mental‑health staff conduct private one‑on‑one orientations to screen for reading, vision or hearing needs. Staff said they offer a contracted language line and that VitalCore, the contracted medical provider, provides an on‑site Spanish interpreter Monday–Friday.
The audit included a note that monthly sheriff's office inventory counts had found occasional discrepancies not reflected in shift‑change signoffs, prompting the recommendation for numeric inventory reconciliations rather than signatures alone. Auditors categorized the findings as one high‑risk and five medium‑risk observations; the audit team recommended specific documentation and process changes to address each point.
The committee did not take formal action on the audit report at the meeting. Several members asked follow‑up questions about language access, the treatment of domestic‑violence cases, and average census figures. BCC staff said 31 residents were present the day of the meeting, with five additional placements pending and a reported average daily population last year of about 25–26.
The committee will continue to track implementation status and any follow‑up reporting from audit staff.
