To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Andrea Dos Santos, 565-6624
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
COVID-19 Emergency Response Alternate Care Site and Non-Congregate Sheltering Sites Appropriations and Delegated Authority
End
Recommended Action:
Recommended action
A) Authorize the Interim Director of Health Services, or designee, to execute the continued COVID-19 Response Plan hereby described, to execute agreements, and to obtain necessary resources, services, supplies, equipment, and such other properties to be lacking or needed for the protection of life and property, and to bind the County for the fair value thereof not to exceed the appropriations authorized by the Board in this item.
B) Adopt a budget resolution authorizing adjustments to the Department of Health Services Fiscal Year 2021-2022 final budget to increase revenues and expenditures by $9,122,900 to support continued COVID-19 response efforts.
(4/5 vote required)
end
Executive Summary:
To support ongoing COVID-19 response efforts, the Department of Health Services requires additional authority to execute agreements and to obtain necessary resources, services, supplies, equipment, and such other properties found to be lacking or needed for the protection of life and property. This authority will allow for continued support of the Alternate Care Site (ACS) and Non-Congregate Sheltering (NCS) sites COVID-19 response programs through December 31, 2021. These programs have been in place since April 2020.
This item includes a request for approval of a budget adjustment to appropriate $9,122,900 to support services and facilities costs associated with ACS and NCS operations through December 31, 2021. The total estimated cost of the ACS and NCS programs from July 1, 2021 through December 31, 2021 is $18,370,498. The ACS and NCS operational costs for occupied rooms are a Federal Emergency Management Agency (FEMA) eligible expenses, reimbursable at 100% through December 31, 2021. Operational costs for unoccupied rooms are not FEMA reimbursable and will be funded from the State of California’s Project Roomkey.
Given full reimbursement for costs to date for the FEMA Eligible COVID Response activities is not expected to materialize in the current Fiscal Year, expanded COVID response ACS and NCS services expected expenses will be financed with FEMA Public Assistance reimbursements expected this Fiscal Year from prior year COVID-19 expenses and other FEMA reimbursements from prior disasters (2019 Kincade, 2020 LNU Fire, 2020 Glass Fire, etc.). During the upcoming fall Board fiscal update, Auditor-Controller-Treasurer-Tax Collector and CAO staff will include estimated FEMA reimbursement timeline between disasters in order to show your Board where the County currently stands on FEMA eligible project cost recovery, expected reimbursement date, and funds financing the projects. Subsequently, Health Department staff may return to the Board with additional budget authority request, if there is a need to extend ACS/NCS operations based on the conditions of the pandemic at that time.
Discussion:
On June 15, 2021, the State of California reopened the economy and retired the Blueprint tier structure. However, due to the rapid spread of the Delta variant and increased spread among pockets of unvaccinated individuals, the County is once again experiencing a surge of COVID-19 cases. A critical resource throughout the pandemic has been the County’s ACS and NCS programs which have been operational since April of 2020.
The County established NCS sites early in its response to serve vulnerable populations without the ability to safely shelter in place and observe Health Orders aimed at reducing the spread of the virus. Sites were established across the County at the Astro Motel in Santa Rosa, the Sonoma County Fairgrounds, the trailer site at D-Lot Fairgrounds, the trailer site at Ballfield Fairgrounds, the Windsor Holiday Inn, and at Alliance Redwoods in Occidental (the NCS at Alliance was closed in May 2021 and residents were moved to the Windsor location).
Over the course of the pandemic, 414 people were sheltered at six Non-Congregate Sheltering sites across the County. Of those, the vast majority had most previously been in emergency shelters (35%) or in places not meant for human habitation (streets, car, etc.).
The County established Alternate Care Sites (ACS) at Sonoma State University in Rohnert Park and subsequently at the Dry Creek Inn/Best Western in Healdsburg to provide a safe place for individuals to quarantine and isolate. The ACS has served 889 clients to-date, providing them with shelter, food, and medical monitoring.
This item requests additional authority to execute agreements and to obtain necessary resources, services, supplies, equipment, and such other properties found to be lacking or needed for the protection of life and property. This authority will allow for continued support of the ACS and NCS COVID-19 response programs through December 31, 2021.
Alternate Care Site at Best Western, Dry Creek Inn. In August 2020, the ACS relocated to the Best Western, Dry Creek Inn in Healdsburg with a capacity of 49 rooms for COVID-19 positive or COVID-19 pending result patients. The cost estimate model assumes that 25%-50% capacity will remain the same through December 31, 2021 with the costs for the vacant and occupied rooms being covered for that time. Targeted populations include those who are COVID-19 positive that do not require hospitalization, but still require some level of monitoring by medical staff such as Registered Nurses and Medical Assisted Personnel; and those who are pending COVID-19 tests who are unable to isolate at home. The estimated cost for the ACS includes non-congregate space rental, set-up services, meals, security, medical staff, emergency transportation, portable toilets and hand washing stations, portable showers for medical staff, medical supplies and equipment, PPE, custodial services, and biohazard waste disposal. Closure and demobilization of the ACS site at the Dry Creek Inn/Best Western in Healdsburg is expected around December 2021 and the Department does not anticipate the need to transfer individuals from the ACS to another site at that time.
Motels/Hotels - Non-Congregate Sheltering (NCS) sites are comprised of the Astro Motel which has a capacity of 33 rooms and the Holiday Inn, Windsor which has a capacity of 101 rooms. The cost estimate assumes 80% capacity through December 31, 2021. The County will use Project Roomkey funding for the costs associated with any vacant rooms at these sites. Targeted populations include FEMA eligible at-risk of homelessness and homeless vulnerable individuals over 65 or with certain underlying health conditions (respiratory, compromised immunities, chronic disease). The estimated cost includes room rental, special room cleaning, meals, security, laundry services, and service provider. Planning is under way for housing solutions for individuals residing at the NCS sites that will be exiting the NCS sites around December 2021. Housing Navigators will continue their ongoing efforts to find temporary and permanent housing options for the individuals currently located at those sites. Additionally, the Department will continue to work with city partners to evaluate options to place individuals currently located at the NCS sites in temporary and permanent housing such as indoor/outdoor shelters and eventually Homekey sites as more information on how to access funding becomes available from the State.
Sonoma County Fairgrounds Non-Congregate Sheltering (NCS) site is comprised of 30 FEMA trailers (13 trailers at D-Lot and 17 trailers at the Ballfield) with an average occupancy of up to 60 individuals. Targeted populations include FEMA eligible at-risk of homelessness and homeless who are COVID-19 vulnerable individuals over 65 or with certain underlying health conditions (respiratory, compromised immunities, chronic disease.) The estimated cost includes site rental, sewer and trash services, clinic in a can service (onsite medical clinic), meals, security, janitorial and laundry services, household supplies, and service provider. Individuals at the Sonoma County Fairgrounds NCS will continue to be housed at the site and receive wrap-around services with additional funding resources such as Emergency Solutions Grant (ESG), Community Development Block Grant (CDBG), Homeless Housing, Assistance and Prevention (HHAP), or other funding sources as they become available. The trailers were donated by the State at no cost to the County and the services and other ancillary costs as detailed above will be funded by grants beyond December 2021 as long as funding remains available.
Prior Board Actions:
On September 21, 2021 the Board received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination.
On August 17, 2021 the Board received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination.
On July 27, 2021 the Board A) received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination and B) received an update on the COVID-19 Response Point-In-Time Feedback Report.
On July 13, 2021 the Board received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination.
On June 8, 2021 the Board received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination.
On May 25, 2021 the Board A) received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination, B) approved the Environmental Health COVID pandemic offset to permit fees and administration costs, totaling $2,780,969 for fiscal year 2020-2021, C) adopted a resolution amending the fiscal year 2020-2021 Department of Health Services and County Administrator’s budget in the amount of $2,780,969; financed from the county’s General Fund Infrastructure Sinking balance, and D) adopted a resolution implementing local aid strategies to provide additional financial relief to local restaurants, body art, and recreational health establishments that suffered financial hardship during the pandemic.
On May 11, 2021 the Board received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination.
On April 20, 2021 the Board received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination.
On April 6, 2021 the Board A) received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination and B) adopted a personnel resolution amending the County Administrator’s allocation list to extend the term of 2.0 full-time equivalent time-limited positions through December 31, 2021, and the Department of Health Services allocation list to extend the term of 3.0 full-time equivalent time-limited positions through June 30, 2022, and convert a 1.0 full-time equivalent time-limited position to a permanent position, as detailed in the attached resolution.
On March 16, 2021 the Board received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination.
On March 2, 2021 the Board received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination.
On February 23, 2021 the Board received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination.
On February 2, 2021 the Board A) authorized the Director of Health Services, or designee, to execute the COVID-19 Vaccination Response Plan hereby described, to execute contracts and to obtain necessary resources, services, supplies, equipment, and such other properties to be lacking or needed for the protection of life and property, and to bind the county for the fair value thereof not to exceed the cumulative appropriations already authorized by the Board for COVID-19 Response activities from July 1, 2020 through June 30, 2021; B) authorized the Director of Health Services and County Administrator’s Office to work with the Human Resources Department to hire extra-help personnel, temporary agency personnel, independent contractors, and/or other appropriate options to expeditiously hire needed staff to effectively continue the emergency pandemic response, for the Vaccination Unit of the temporary COVID-19 Section in the Public Health Division and associated departments; and C) received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination.
On January 5, 2021 the Board received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts and vaccination coordination.
On January 5, 2021 the Board A) received a report on H.R. 133 - Consolidated Appropriations Act, 2021 and the current protections provided with the Federal, State, local Eviction and Sick Leave policies; B) authorized the Director of Health Services, or designee to execute the continued COVID-19 Response Plan hereby described, to execute agreements, and to obtain necessary resources, services, supplies, equipment, and such other properties to be lacking or needed for the protection of life and property, and to bind the county for the fair value thereof not to exceed the cumulative appropriations authorized including those in this item.; C) directed staff to return with additional budgetary adjustments necessary to expand Department of Health COVID-19 Response Plan through 6/30/2021, which may include up $5 million from county discretionary resources; D) provided direction to staff regarding the Local Aid Strategies and direct staff to return to the Board for further action, or, alternatively authorize additional appropriations to support Local Aid strategies and authorize the Director of Health Services, Community Development Commission, Department of Emergency Management, Office of Equity, County Counsel, and/or Economic Development Board, or designee, to execute the Local Aid Strategies approved by the Board, to execute agreements, disperse funding, and to obtain necessary resources, services, supplies, equipment, and such other properties and to bind the county for the fair value thereof not to exceed the appropriations authorized.
On December 15, 2020 the Board approved the following actions: A) Authorize the Director of Health Services, or designee to execute the continued COVID-19 Response Plan hereby described, to execute agreements, and to obtain necessary resources, services, supplies, equipment, and such other properties to be lacking or needed for the protection of life and property, and to bind the county for the fair value thereof not to exceed the cumulative appropriations authorized including those in this item.; B) Authorize the Director of Health Services, Human Resources, County Counsel, Auditor-Controller-Treasurer-Tax-Collector, and County Administrator, or designee to continue to hire extra-help personnel, temporary agency personnel, and/or independent contractors, whichever is the most expeditious method to effectively continue the emergency pandemic response, for the temporary COVID-19 Section in the Public Health Division and associated departments. Staffing costs are not to exceed the cumulative appropriations authorized including those in this item.; and C) Adopt a resolution to execute all budget appropriations increases and adjustments up to $22,666,105 (federal/state $8,608,298 and county funds $14,057,807 for the period of December 31, 2020 to March 31, 2021 to continue the COVID-19 Response Plan per the Board’s direction.
On December 8, 2020 the Board received a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts.
On October 20, 2020, the Board of Supervisors authorized the Director of Health Services, or designee, to execute the Enhanced COVID-19 Response Strategies and to execute agreements, and to obtain necessary resources, services, supplies, equipment, and such other properties to be lacking or needed for the protection of life and property, and to bind the county for the fair value thereof not to exceed the appropriations authorized by the Board in this item. The Board of Supervisors also approved redirecting within fiscal year 2020-2021 $4 million Coronavirus Aid, Relief, and Economic Security (CARES) Act assigned to COVID-19 response activities led by the Department of Health Services to finance the initial phase of Enhanced COVID-19 Response Strategies.
On September 1, 2020, the Board of Supervisors approved the Department of Health Services COVID-19 Emergency Plan allowing for the continuation of the COVID-19 Response plan and authorizing the Director of Health Services to obtain necessary resources, services, supplies, equipment and for the temporary COVID-19 Unit to be established.
On July 27, 2020, during Budget Workshops, the Board approved a plan to allow for a sustainable COVID-19 response through June 30, 2021 to continue the County’s COVID-19 Response efforts.
Fiscal Summary
|
Expenditures |
FY 21-22 Adopted |
FY 22-23 Projected |
FY 23-24 Projected |
|
Budgeted Expenses |
9,247,599 |
|
|
|
Additional Appropriation Requested |
9,122,900 |
|
|
|
Total Expenditures |
18,370,499 |
0 |
0 |
|
Funding Sources |
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|
General Fund/WA GF |
|
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|
|
State/Federal |
18,370,499 |
|
|
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Fees/Other |
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Use of Fund Balance |
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|
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Contingencies |
|
|
|
|
Total Sources |
18,370,499 |
0 |
0 |
Narrative Explanation of Fiscal Impacts:
Revenues and expenditures appropriations of $9,247,599 for the Alternate Care Site (ACS) and Non-Congregate Sheltering (NCS) sites services and operations for the July 1, 2021 - September 30, 2021 period were included in the FY 21-22 adopted budget.
This item is requesting additional revenues and expenditures appropriations of $9,122,900 to deliver ACS/NCS services through the extended FEMA eligible period through December 31, 2021.
The Federal Emergency Management Agency (FEMA) funds 100% of occupied rooms estimated to be at $8,656,368; however, it may not be received in FY 21-22. Therefore, the increased expenditure authority will be funded with prior fiscal years’ disasters’ reimbursements estimated to be received in this fiscal year and have not yet been programmed. The unoccupied rooms estimated to total $466,532 will be funded with Project Roomkey. The Emergency Solutions Grant-COVID would be an alternate funding source if the actual vacancy rates at the ACS and NCS were to be higher than anticipated.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Budget Resolution
Attachment 2 - COVID-19 Response Budget
Attachment 3 - Alternate Care & Non-Congregate Care Sites Cost Estimate Detail
Related Items “On File” with the Clerk of the Board:
None