DATE: June 20, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Salary Resolution Amendment
RECOMMENDED ACTION(S):
TITLE
Approve Amendment to the Salary Resolution adding one Medical Assistant position, one Environmental Health Aide position, one Senior Staff Analyst position, one Program Technician I/II position, one Epidemiologist position, and one Accountant I/II position and deleting two Office Assistant I/II positions, one Supervising Office Assistant position, one Public Health Nurse I/II position, one Staff Nurse I/II/III position, and one Account Clerk I/II position to the Public Health Org 5620, effective June 26, 2023, as reflected in Appendix D.
REPORT
There is no additional Net County Cost associated with the recommended action. Approval of the recommended action would add six positions and delete six positions to ensure optimal staffing levels in alignment with the Department of Public Health (Department) goals with no increase to the total number of positions for the Department.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended action, the Department would continue to try to fill the Office Assistant vacancies; however, Environmental Health, Public Health Nursing and Health Policy and Wellness would not have the appropriate positions available to fill in order to complete the scope of work for the lead, home visitation and oral health grants.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. Realignment cost savings realized by the deletion of the Office Assistant I/II position vacant since March of 2022, will fund the Medical Assistant (MA) position. Both positions currently have a matching maximum salary of $44,694 per year. The Environmental Health Aide position will be funded through revenue from the State of California Childhood Lead Poisoning Prevention (CLPP) Grant, a three-year grant with enough funding through June 30, 2026. The Senior Staff Analyst and Program Technician (PT) I/II positions will be funded through revenue from the California Home Visitation Program (CHVP) State General Fund (SGF) Expansion Year 1 grant, a one-year grant with enough funds through June 30, 2023. The CHVP SGF Expansion grant will be renewed annually through June 30, 2028. The Epidemiologist position will be funded through multiple sources: CalFresh Healthy Living provides $100,000 (+/-) annually from October 1, 2023, through September 30, 2026; Health Disparities provides an allocation of $125,000 through May 31, 2024 and; Oral Health has allocated $75,674 for a five-year period. Future of Public Health (FoPH) will be the main funding source for the Accountant I/II position. FoPH funds are considered ongoing funds and part of the ongoing baseline state budget.
DISCUSSION:
The requested staffing changes will support Departmental goals around improving local health access to disadvantaged communities, surveillance and detection of communicable diseases, and overall population health through evaluation of policies and systems in place.
The Department’s Community Health Division is in need of a Medical Assistant (MA) position in the Immunization Clinic. The Immunization Clinic has had a vacant Office Assistant (OA) position since March 30, 2022. The nature of this position includes staffing the reception desk, which entails answering multi-line phones, screening patients for eligibility for services, checking patients in and out for appointments, verifying insurance eligibility, and maintaining health records. Multiple rounds of OA candidate interviews were conducted; however, due to the candidates either taking other positions, waiving job offers, and siting low pay, the position has remained open. The Department is now requesting that the OA position be deleted and replaced with a MA position. The nature of the position will maintain the tasks noted above, with the addition of the MA’s scope which can include health screening, TB skin test placements/reading, and taking vital signs with provider oversight.
The Department’s Environmental Health Division has the need for an Environmental Health Aide to assist the Divisions Childhood Lead Poisoning Prevention Program. The Environmental Health Aide will assist with Childhood Lead Poisoning Prevention case investigations supporting Registered Environmental Health Specialists that conduct the Environmental Investigations when a child with elevated blood lead levels is identified. The amount of lead poisoning cases is anticipated to increase as of July 1, 2023, since the State of California Childhood Prevention Grant definition of a lead-poisoned child will be lowered from 5.0 mg/dl blood lead level to 3.5 mg/dl blood lead level. The Department would like to delete a vacant Office Assistant position in order to add the proper classification for the tasks associated with the CLPP grant.
A Senior Staff Analyst and Program Technician are needed within the Public Health Nursing Division. These positions will gather, analyze, and research evidence-based models (EBM) of local community-based organizations and determine the EBM for the division’s California Home Visitation Program (CHVP) program. The Department would delete a vacant Supervising Office Assistant and a vacant Public Health Nurse position to accommodate the addition of these positions.
The Department’s Health, Policy and Wellness Division is in need of an Epidemiologist position to provide primary support and assist with the evaluation needs of their Local Oral Health, CalFresh Healthy Living, and Health Disparities programs. The Department would delete a Staff Nurse position that has been vacant since 2019 in order to accomplish this.
The Epidemiologist will lead evaluation efforts to increase/improve data collection and reporting for each of the HPW programs. These functions include identifying and planning the needs assessment strategies based on available resources; developing needs assessment tools to meet the needs of both the programs and Fresno County residents; ensuring training is provided to data collectors on how to integrate and use the tool; integration of the tool responses into the common data systems for access by necessary staff and community partners; analyze data and prepare summary analysis. The Epidemiologist will also develop a satisfaction survey for Oral Health Action Committee (OHAC) membership to determine OHAC progress, recommendations, and future direction of the LOHP and strategies to address challenges. They will lead evaluation of Department and Nutrition Education Obesity Prevention (NEOP) efforts to improve the nutritional status and prevent obesity among Fresno County residents living in the following six neighborhoods/areas (and their corresponding approved census tracts): Kerman, Lowell, Parlier, Sanger, and West Fresno. Finally, they will work to increase/improve data collection and reporting for populations experiencing a disproportionate burden of COVID-19 infection, severe illness, and death to guide the response to the COVID-19 pandemic.
The Department’s Business Office is requesting to add one Accountant Position to better support the goals of the Department. This position will provide oversight, management, and program support. The proposed addition will relieve the current workload of the existing Accountants. It will also allow the Supervising Accountant to focus on performing leadership duties over the Business Office. This position will also serve in aspects of support, planning, directing, and evaluating of the current processes and future additions as the Department continues to expand. The Business Office has two Senior Accountants and one Supervising Accountant that support the management of 65 awarded grants department wide as well as supporting other funding sources. Support provided for each grant can consist of many accountant duties such as; running queries, tracking labor cost, providing expenditure reports, transferring cost, tracking revenue, depositing checks, completing journal entries, filling out invoices, providing required State or Federal reports, drawing down revenue funds, setting up Special Revenue Funds or new cost centers, year-end reporting, creating and tracking accruals, providing fiscal information to outside auditors, and other duties as needed. The three Accountants are at their maximum capacity to support this workload and provide the best quality output. The Business Office is requesting to delete a vacant Account Clerk position to add an Accountant position because the work duties needed are better suited for an Accountant.
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Appendix D
CAO ANALYST:
Ron Alexander