San Bernardino County Grand Jury 2022 Final Report

FINAL
REPORT
SAN BERNARDINO COUNTY

CIVIL GRAND JURY
2022
INSERT GRAND JURY LOGO HERE
December 16, 2022 INSERT GRAND JURY LOGO HERE
December 16, 2022
Honorable R. Glenn Yabuno, Presiding Judge
Superior
HonorableCourt of California,
R. Glenn Yabuno, County of Judge
Presiding San Bernardino
247 West Third Street, 11th Floor
Superior Court of California, County of San Bernardino
San
247 Bernardino, CA 92415-0302
West Third Street, 11th Floor
San Bernardino, CA 92415-0302
Dear Judge Yabuno,

Dear Judge Yabuno,
It has been my honor to represent this year’s 2022 Civil Grand Jury. This Jury, which consist of 19 civic minded
individuals,
It has been my dedicated
honor to their time and
represent efforts
this year’sthis
2022past year
Civil to identify
Grand areas
Jury. This Jury,of which
improvement
consist ofwithin theminded
19 civic County
for the benefit
individuals, of its residents
dedicated their timeand andgovernmental
efforts this pastorganizations. The results
year to identify areas of of improvement
their dedication, knowledge,
within the County and
experiences are evident in this year’s 2022 Civil Grand Jury report, which I am pleased
for the benefit of its residents and governmental organizations. The results of their dedication, knowledge, and to present to you and the
Board of Supervisors,
experiences are evident andinthe
thiscitizens of SanCivil
year’s 2022 Bernardino
Grand Jury County.
report, which I am pleased to present to you and the
Board of Supervisors, and the citizens of San Bernardino County.
This report is the result of countless hours of research, investigations, interviews, as well as numerous site visits.
This process
report isistheonly possible
result with thehours
of countless positive interface investigations,
of research, with many of the county’s as
interviews, agencies
well asand personnel.
numerous We
site visits.
would like toisthank
This process the San Bernardino
only possible Countyinterface
with the positive Counselwithand the
many SanofBernardino
the county’s County
agenciesSheriff’s Department
and personnel. Wefor
their valuable assistance. We would also thank the Innovation and Technology
would like to thank the San Bernardino County Counsel and the San Bernardino County Sheriff’s Department for Department for their tireless
support of theassistance.
their valuable Civil GrandWe Jurywould
throughout the year.
also thank This reportand
the Innovation wouldn’t be complete
Technology without
Department for the
theirvaluable
tireless
interaction
support of the withCivil
those
Grandprivate
Jurycitizens
throughout and organizations
the year. This who reportgive their time
wouldn’t and information.
be complete without the valuable
interaction with those private citizens and organizations who give their time and information.
The Civil Grand Jury would like to add a special thank you to the San Bernardino County Sheriff’s Training
Academy, who kindly
The Civil Grand invited
Jury would and
like to hosted the members
add a special thank you of this
to theJury
SantoBernardino
a walk through CountyandSheriff’s
demonstration
Trainingof their
facilities
Academy,and who their training
kindly invitedprograms.
and hosted the members of this Jury to a walk through and demonstration of their
facilities and their training programs.
The Civil Grand Jury was also able to fulfill its PC §919b obligation as well as PC §925a by visiting the California
Institution
The Civil Grandfor MenJuryandwasCalifornia
also able Institution
to fulfill its for
PC Women and several
§919b obligation county
as well as PCand§925a
municipal jails. These
by visiting the California
observations can be reviewed in the last section of this report.
Institution for Men and California Institution for Women and several county and municipal jails. These
observations can be reviewed in the last section of this report.
This Grand Jury experienced a few unexpected events this year. First off in early June we were displaced from
our Grand
This GrandJury Juryroom due to aa structure
experienced fire. And
few unexpected thanks
events to year.
this a fewFirst
dedicated individuals
off in early June we wewere
only displaced
experienced froma
briefGrand
our delay Jury
in our process.
room due to The second event
a structure was thanks
fire. And much more devastating.
to a few dedicatedInindividuals
Novemberwe weonly
suffered the loss aof
experienced
two
briefJurors.
delay in Theourfirst was Daniel
process. Lowry.event
The second Danielwas wasmuch
the youngest juror and was
more devastating. very excited
In November we about
suffered serving
the lossin his
of
first Civil Grand Jury, and his eagerness was obvious from the start. The second one
two Jurors. The first was Daniel Lowry. Daniel was the youngest juror and was very excited about serving in his we lost was David Hutson.
DavidCivil
first wasGrand
a veteran
Jury, ofandsixhis
Civil Grand Juries,
eagerness and his from
was obvious contributions
the start.and Theguidance
second one were wevaluable
lost wasasDavid
well Hutson.
as timely.
Both
Davidthese
was agentlemen’s
veteran of six commitment
Civil Grand to serveand
Juries, their
hiscommunity
contributions is evident within were
and guidance thesevaluable
pages ofas this report.
well At
as timely.
this time, I would like to officially thank Daniel and David for their service.
Both these gentlemen’s commitment to serve their community is evident within these pages of this report. At
this time, I would like to officially thank Daniel and David for their service.
In conclusion I along with the rest of the 2022 Civil Grand Jury would like to extend a special recognition to you
Judge Yabuno,I along
In conclusion for yourwithguidance
the restand support
of the 2022 throughout the year.
Civil Grand Jury wouldTolikeKristie Armstead,
to extend for her
a special support and
recognition to you
leadership.
Judge Yabuno, A very
for special thank you
your guidance andtosupport
our Grand Jury Coordinator
throughout the year. Valerie
To Kristie Silvas and former
Armstead, Legal
for her Advisor
support and
Michael
leadership. Dauber
A very who worked
special thankwithyouthetoGrand Jury every
our Grand day sharingValerie
Jury Coordinator their knowledge, leadership,
Silvas and former Legalcompassion,
Advisor
professionalism, as well a true commitment to helping us create the best report
Michael Dauber who worked with the Grand Jury every day sharing their knowledge, leadership, compassion, we can.
professionalism, as well a true commitment to helping us create the best report we can.
Sincerely,
Sincerely,
Bruce McGuire
2022
BruceSan Bernardino County Civil Grand Jury Foreperson
McGuire
2022 San Bernardino County Civil Grand Jury Foreperson
THE 2022 SAN BERNARDINO COUNTY CIVIL GRAND JURY’S
FINAL REPORT IS
DEDICATED TO THE MEMORY OF
DAVID HUTSON DANIEL LOWRY
November 23, 1982 –

June 10, 1941 –
November 18, 2022 November 02, 2022
“Do not stand at my grave and weep;

I am not there. I do not sleep.
I am a thousand winds that blow.
I am the diamond glints on snow.
I am the sunlight on ripened grain.
I am the gentle autumn rain.
When you awaken in the morning's hush
I am the swift uplifting rush
Of quiet birds in circled flight.
I am the soft stars that shine at night.
Do not stand at my grave and cry;
I am not there.
I did not die.”
-Mary Elizabeth Frye

SAN BERNARDINO
SANSAN
BERNARDINO COUNTY
COUNTY
BERNARDINO COUNTY
2022 CIVIL
20222022
CIVIL GRAND
GRAND
CIVIL JURY
JURY
GRAND JURY
OFFICERS:
OFFICERS:
OFFICERS:
OFFICERS:
BRUCE
BRUCEMCGUIRE
BRUCE MCGUIRE
MCGUIRE
BRUCE MCGUIRE *** * FOREMAN
FOREMAN
FOREMANFOREMAN
BRUCE
BRUCE MINER
MINER MINER
BRUCE MINER
BRUCE *** * FOREMAN
FOREMAN
FOREMAN PRO
PROTEM
PRO TEM
TEM
FOREMAN PRO TEM
MARGARET
MARGARET
MARGARET BREWSTER
BREWSTER
BREWSTER
MARGARET BREWSTER *** * SECRETARY
SECRETARY
SECRETARY
SECRETARY
JOANNA
JOANNA HAMILTON
HAMILTON
JOANNAJOANNA
HAMILTON
HAMILTON *** * SECRETARY
SECRETARY
SECRETARY
SECRETARY
DONNA
DONNAJORDAN
DONNA JORDAN
JORDAN
DONNA JORDAN *** * SECRETARY
SECRETARY
SECRETARY
SECRETARY
JESSE
JESSEWEBSTER
JESSE WEBSTER
WEBSTER
JESSE WEBSTER *** * SERGEANT-AT-ARMS
SERGEANT-AT-ARMS
SERGEANT-AT-ARMS
SERGEANT-AT-ARMS
MEMBERS:
MEMBERS:
MEMBERS:
MEMBERS:
RICHARD
RICHARD
RICHARD BANASIAK
BANASIAK
BANASIAK
RICHARD BANASIAK *** * NONIE
NONIEKLEINHANS
NONIE KLEINHANS
KLEINHANS
NONIE KLEINHANS
DAVID
DAVIDCEBALLOS
CEBALLOS
DAVID CEBALLOS
DAVID CEBALLOS *** * LIZA
LIZALOPEZ
LOPEZ
LIZA LOPEZ
LIZA LOPEZ
WILLIAM
WILLIAM
WILLIAM CHAPMAN
CHAPMAN
CHAPMAN
WILLIAM CHAPMAN *** * DANIEL
DANIEL LOWRY
DANIELDANIEL
LOWRYLOWRY
LOWRY
REGINALD
REGINALD
REGINALD CLARK
CLARK CLARK
CLARK
REGINALD *** * VICTORIA
VICTORIA
VICTORIA MEDLOCK
MEDLOCK
MEDLOCK
VICTORIA MEDLOCK
DAVID
DAVIDHUTSON
DAVID HUTSON
HUTSON
DAVID HUTSON *** * NANCY
NANCYTEEGARDEN
NANCY TEEGARDEN
TEEGARDEN
NANCY TEEGARDEN
EDWARD
EDWARD
EDWARD JABO
JABO JABO
JABO
EDWARD *** * KAREN
KARENZAGORSKY
KAREN ZAGORSKY
ZAGORSKY
KAREN ZAGORSKY
DONNA
DONNA KENNEY-CASH
KENNEY-CASH
DONNA KENNEY-CASH
DONNA KENNEY-CASH *** *
ADMINISTRATION:
ADMINISTRATION:
ADMINISTRATION:
ADMINISTRATION:
PRESIDING
PRESIDING
PRESIDING JUDGE
JUDGE JUDGE
JUDGE
PRESIDING *** * R.
R.GLENN
R. GLENNR.YABUNO
GLENN YABUNO
YABUNO
GLENN YABUNO
GRAND
GRANDJURY
GRAND JURYCOORDINATOR
JURY
GRAND COORDINATOR
COORDINATOR
JURY COORDINATOR*** * VALERIE
VALERIE
VALERIE SILVAS
SILVAS SILVAS
SILVAS
VALERIE
AUTOMATED
AUTOMATED
AUTOMATED SYSTEMS
SYSTEMS
SYSTEMS
AUTOMATED ANALYST
ANALYST
ANALYST
SYSTEMS ***
ANALYST * GREG
GREGHENRY
GREG HENRY
HENRY
GREG HENRY
GRAPHIC
GRAPHIC
GRAPHIC DESIGNER
DESIGNER
DESIGNER
GRAPHIC DESIGNER *** * OSCAR
OSCAR AGUIRRE
OSCAR AGUIRRE
AGUIRRE
OSCAR AGUIRRE
2022 CIVIL GRAND JURY
Back Row (left to right): Liza Lopez, William Chapman, Bruce McGuire, Joanna Hamilton, David Hutson,
Daniel Lowry, David Ceballos, Reginald Clark, Bruce Miner
Front Row (left to right): Edward Jabo, Donna Jordan, Karen Zagorsky, Donna Kenney-Cash,
Nancy Teegarden, Victoria Medlock, Jesse Webster, Richard Banasiak
Not Pictured: Margaret Brewster, Nonie Kleinhans
Honorable
R. Glenn Yabuno
TABLE OF CONTENTS
2022
SAN BERNARDINO COUNTY CIVIL GRAND JURY
FINAL REPORT
RESPONSE ACCOUNTABILITY
Introduction ............................................................................................................. 1
San Bernardino County Sheriff and Department of Behavioral Health ................... 3
Redlands Unified School District ............................................................................ 10
San Bernardino County Food Permits .................................................................... 33
San Bernardino County Lakes ................................................................................ 44
San Bernardino County Public Guardian.……….………………………….……….....51
COMPLAINTS
Introduction ............................................................................................................. 55
REPORTS
Grand Jury Reports
Redlands Animal Shelter ........................................................................................ 57
San Bernardino County Children and Family Services ........................................... 105
Informative Reports
San Bernardino County Jails...…………………….………………………….………...137
San Bernardino County Municipal Jails...…………………….……………………......145

This Page Left Intentionally Blank
N
CA EV
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FO A
Trona RN
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DEATH VALLEY
127 Las Vegas
Pinnacles Excelsor
NNL Mine Rd
FORT IRWIN
M o j a v e N AT I O N A L D e s e r t
TRAINING CENTER
Cima
Johannesburg 15 Dome
Red Mountain Goldstone Cinder
Baker Cones Cima
Fort Irwin
Cooper NNL MOJAVE
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City Rd Fort Irwin Ke
lb a ke NATIONAL
Rd Zzyzx r Rd PRESERVE
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95
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Harper
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Lake r
Calico Ghost ive
Town RP veR Mitchell Mtns SRA
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Mo
Hinkley Caverns Needles
Barstow
395 Yermo
National
Trails Hwy Daggett
Newberry Essex
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Ludlow 40
AR
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Southern 15 Tr a il
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IZ
247
California io n 95
Na t
ON
Int’l Airport
Amboy
A
Oro Grande
Old
Established April 26, 1853 Adelanto

Victorville
Apple Valley
TWENTYNINE
PA L M S U S M C
Amboy
Crater
Route 66
18 Bristol
Devil’s Punchbowl
Mountain High
Lucerne Valley Emerson Lake
Named in 1810 by Francisco Dumetz Natural Area
Phelan
Resort
Hesperia
18 247
Lake
Cadiz Parker
Dam
Lake Darby
Silverwood Lake Lake Vidal
20,105 Square Miles

Junction
Big Bear Lake Landers Earp
Big Bear
Lake Arrowhead
Running Pioneertown Twentynine Amboy Rd M o j a v e
North Etiwanda r
Springs Rive Yucca Vidal Big
Preserve 330 Ana Palms
Muscoy Santa 38 Valley
62 95
River
2020 Population was 2,181,654 Rancho

Cucamonga
Citizens
Bank Arena Fontana
Highland
San Bernardino
San Bernardino National Forest
62 Joshua Tree
Park
Int’l Airport Morongo Valley Blvd
Ontario 10 Redlands Yucaipa Big Morongo
Colton
24 Cities
Canyon Preserve JOSHUA TREE
60 Auto Club
Speedway Snow Summit
Chino San Bernardino Wildwood
Victoria Gardens Mountain Resort
Canyon
Cultural Center
Chino Hills State Park
5 Native American Reservations

Ontario
State Park
Mills
Pa
Prado Regional Park Planes of Fame
cif
Air Museum
ic
7 National Forests And Parks
Cr
es
tT
rai
l
35 Official Wildness Areas
8684 Acres of County Regional Parks
12 Airports (2 International) 1 2 3 4
12 Colleges and Universities
President Lyndon B Home of the first The Rolling Stones first US The City of Colton’s first
33 School Districts Johnson at the age of McDonald’s restaurant in concert tour started in San Marshall (1887-1889)
50 Public Libraries 17 (1925) worked as an 1940 at 1398 North E Street Bernardino on June 5, 1964 was Virgil Earp, the older
elevator operator in the at The Swing Auditorium brother of Wyatt and
34 Museums San Bernardino’s Plat Morgan Earp
Building
2500 miles of roads and 300 bridges
RESPONSE ACCOUNTABILITY
RESPONSE
ACCOUNTABILITY

CIVIL GRAND JURY
2022
RESPONSE AND ACCOUNTABILITY
Review of Grand Jury Recommendations from report of 2021
Methodology
The 2022 San Bernardino County Civil Grand Jury was tasked with verifying
the 2021 Grand Jury report recommendations directed toward several
agencies. The verification was done by in-field visits, reviewing documents,
along with analyzing the responses provided to the Grand Jury. The topics
included: San Bernardino Department County Sherriff and Department Of
Behavior Health Connection: Is The Bridge Strong Enough? Predatory
Behaviors And Ignorance Within Redlands Unified School District: Has The
School District Learned Its Lesson? , Doing Business With The City Of San
Bernardino, A Guardian For The Public Guardians, Food Permits and San
Bernardino County Lakes.
Background: Response and Accountability Committee

The Civil Grand Jury’s primary role, as supported by the evidence, is to
evaluate the performance of local government agencies and officials and to
publish recommendations in its final report. The responsibility of the
Response and Accountability (R&A) Committee is to follow-up on the
previous year's recommendations of the Grand Jury Final Reports to
evaluate the responses that are received for each listed recommendation.
California State Penal Code Section §933.05, government entities identified
by any Grand Jury investigation are required to respond to each
recommendation made in the Grand Jury Final Report.
The area of focus for the 2022 Grand Jury R&A Committee is on the
recommendations and how the response (s) complies to the (Penal Code)
PC § 933.05(b) as noted below:
(1) The recommendation has been implemented, with a summary regarding

the implemented action.
(2) The recommendation has not yet been implemented, but will be
implemented in the future, with a timeframe for implementation.
San Bernardino County Grand Jury Final Report 1

(3) The recommendation requires further analysis, with an explanation and
the scope and parameters of an analysis or study, and a timeframe for the
matter to be prepared for discussion by the officer or head of the agency or
department being investigated or reviewed, including the governing body of
the public agency when applicable. This timeframe shall not exceed six
months from the date of publication of the grand jury report.
(4) The recommendation will not be implemented because it is not warranted

or is not reasonable, with an explanation therefor.
SUMMARY
The 2020 San Bernardino County Civil Grand Jury reviewed the five Final
Reports in 2021 San Bernardino County Civil Grand Jury which included the
following:
The 2022 San Bernardino County Civil Grand Jury reviewed the following:
FY2021 Grand Jury Final Report: San Bernardino Department County
Sherriff and Department Of Behavior Health Connection: Is The Bridge
Strong Enough? Predatory Behaviors And Ignorance Within Redlands
Unified School District: Has The School District Learned Its Lesson? Doing
Business With The City Of San Bernardino, A Guardian For The Public
Guardians, Food Permits and San Bernardino County Lakes.
2 San Bernardino County Grand Jury Final Report

San Bernardino Department County Sherriff and Department Of
Behavior Health Connection: Is The Bridge Strong Enough?
Please find below, in every recommendation, the original recommendations

given, the responses by San Bernardino Department County Sherriff and the
Department Of Behavior Health, and the status review.
RECOMMENDATION R21-1:
Sheriff’s Department to CIT train all deputies hired prior to 2013 who have
not received the 40-hour CIT training. To be implemented by June 2022.
RESPONSE:
The Sheriff’s Department DISAGREES in part with this recommendation, The
Sheriff’s Department will coordinate with the Department of Behavioral
Health (DBH) to add additional 40-hour CIT classes to the Department
training calendar for the next three years.
Both DBH and the Sheriff’s Department will make efforts to train deputies
who have not received CIT training, particularly those who are in
assignments where the training will be beneficial. Additional 40-hour CIT
classes will be open to all safety members regardless of assignment and to
certain professional staff members. Commanders will be encouraged to send
personnel to this training, when possible, given station staffing levels and the
availability of backfill funding.
Not every deputy hired prior to 2013 is assigned to a position that would
benefit from a 40-hour CIT class. Deputies are required to attend mandatory
training on a variety of topics on an ongoing basis. Training all deputies hired
prior to 2013 in CIT by June 2022 would severely impact the Sheriff’s
Department’s mandatory training schedule and ability to provide Law
Enforcement services.
In June of 2025, the Sheriff’s Department will evaluate the progress of its
efforts to train deputies who have not yet received CIT training.
The response complies with PC § 933.05 (b)(2).

Sheriff’s Department to CIT train all deputies hired prior to 2013 who have
not received the 40-hour CIT classes to the Department training calendar for
the next three years.
RESPONSE:
The Sheriff’s Department and DBH DISAGREE in part and have concluded
that this recommendation requires further analysis
If the analysis reveals that a refresher course is warranted the Sheriff’s
Department and DBH will need to develop curriculum, analyze the
appropriate course length, and appropriate method of delivery. After
conducting additional analysis, the Sheriff’s Department and DBH will make a
recommendation as to whether, and under what circumstances, refresher
courses may be needed and the method of presentation and length of any
needed refresher course. The Sheriff’s Department and DBH will complete
the analysis no later than June 2022.
SBCSD and DBH develop virtual mental health/resource updates for
deputies leaving the jail and entering patrol assignment to be implemented
by June 2022.
RESPONSE:
The Sheriff’s Department and DBH AGREE and have proactively
implemented the following measures:
DBH has developed and released virtual/on-line resources and updated.
DBH’s CIT Community Recourses Guide is currently available to all Sheriff’s
Department members, including patrol deputies who can access the guide on
the Mobile Data Consoles (MDC) In their patrol vehicles. The guide us is
updated annually at a minimum,

DBH will continue to collaborate with and support the Sheriff’s Department by
updating the resource material available to deputies in the field and
conducting regularly scheduled CIT trainings.
SBCSD to unify all CIT personnel under the same division for the continuity
of CIT chain-of-command. To be implemented by June 2022.
RESPONSE:
The Sheriff’s Department AGREES and has created the Community Service
and Reentry Division (CSRD).
The Captain and Lieutenant of the CSRD serve on the CIT Committee and
are heavily involved in all aspects of the CIT program. The CSRD command
team is in constant contact with DBH on various levels and will be integral to
the continuity and continued success of the CIT program.
The Sheriff’s Department and DBH will assess whether it would be

appropriate to modify the existing MOU to place the CIT deputy under direct
supervision of CSRD.
The response complies with PC § 933.05(b)(1).
SBCSD to assign a minimum of two CIT Station Coordinators per patrol
station. To be implemented immediately.
RESPONSE:
The Sheriff's Department AGREES and has implemented a policy requiring a
CIT Coordinator (Sergeant) and an alternate (Corporal or higher) at each
station. The creation of the CSRD will allow for a coordinated effort between
CSRD and CIT Coordinators to ensure that implementation of the policy is
consistent across all patrol stations.
RECOMMENDATION R21- 6:
SBCSD to develop an accessible and continually updated CIT trained sheriff
personnel roster. To be implemented by June 2022.
RESPONSE:
The Sheriff's Department AGREES and will implement a tracking system to
accurately track attendance.
The Sheriffs Training Center will immediately begin tracking attendance in all
future CIT courses. The Training Center will also contact each
station/division to create a roster of deputies who have already attended the
training.
SBCSD and DBH to revise and simplify the CIT form to be more deputy user-
friendly to facilitate completion by law enforcement in the field. To be
implemented by June 2022.
RESPONSE:
The Sheriff department and DBH AGREE and have proactively been working
to review and revise the CIT form template.
The CIT Committee will continue to work diligently to simplify the and
reorganize the CIT form to create a more user-friendly form. The new form
will be available to deputies immediately upon completion, projected
completion date of June 2022.

The
The response
response complies
complies with
with PC
PC §
§ 933.05
933.05 (b)(1).
(b)(1).
RECOMMENDATION
RECOMMENDATION R21-8: R21-8:
SBCSD
SBCSD and and DBH
DBH to to make
make thethe CIT
CIT form
form a a duplicate
duplicate tear-off
tear-off form
form with
with the
the
tear-off portion given to the TEST staff at patrol station for immediate
tear-off portion given to the TEST staff at patrol station for immediate follow- follow-
up.
up. This
This alerts
alerts and
and allows
allows immediate
immediate notification
notification to
to the
the station
station TEST
TEST
personnel
personnel of clients without interrupting original CIT form processing to DBH.
of clients without interrupting original CIT form processing to DBH.
In the case of electronic transmission (email) provide a copy to
In the case of electronic transmission (email) provide a copy to TEST stationTEST station
person
person immediately.
immediately. To To be
be implemented
implemented immediately.
immediately.
RESPONSE:
RESPONSE:
The
The Sheriff
Sheriff Department
Department DISAGREES
DISAGREES and and has
has decided
decided not
not to
to implement
implement this
this
recommendation for reasons outlined below:
recommendation for reasons outlined below:
The
The Sheriff’s
Sheriff’s Department
Department utilizes
utilizes an an automated
automated report
report writing
writing program.
program.
Reverting
Reverting to a paper form would create unnecessary work for deputies in
to a paper form would create unnecessary work for deputies in the
the
field. The Department has a policy requiring Station CIT Coordinator
field. The Department has a policy requiring Station CIT Coordinator to email to email
the
the automated
automated one-page
one-page CITCIT form
form toto DBH
DBH within
within 48
48 hours.
hours. During
During business
business
hours
hours while TEST personnel are in the office, notifications are often made
while TEST personnel are in the office, notifications are often made in in
person. TEST personnel attend patrol briefings, receiving
person. TEST personnel attend patrol briefings, receiving case informationcase information
and
and updates
updates directly
directly from
from station
station staff.
staff. Most
Most TEST
TEST personnel
personnel areare issued
issued
radios information and monitor radio traffic, responding to calls as
radios information and monitor radio traffic, responding to calls as necessary. necessary.
The
The Department
Department will
will remind
remind Station
Station Coordinator/
Coordinator/ Alternates
Alternates of of existing
existing policy
policy
and work to enforce reporting timeline.
and work to enforce reporting timeline.
The
The response
response complies
complies with
with PC
PC §
§ 933.05
933.05 (b)(4).
(b)(4).
RECOMMENDATION
RECOMMENDATION R21-10: R21-10:
DBH
DBH to
to provide
provide more
more vehicles
vehicles for
for TEST
TEST personnel
personnel (preferably
(preferably one
one per
per TEST
TEST
person) at each patrol station. To be implemented by October 2022.
person) at each patrol station. To be implemented by October 2022.
RESPONSE:
RESPONSE:
DBH
DBH will
will make
make efforts
efforts toward
toward implementing
implementing this
this recommendation.
recommendation. DBH's
DBH's goal
goal
is to fully equip programs, including TEST, with adequate vehicle availability,
is to fully equip programs, including TEST, with adequate vehicle availability,
as
as funding
funding permits.
permits. Each
Each law
law enforcement
enforcement agency
agency (LEA)
(LEA) has
has an
an assigned
assigned
vehicle for TEST use - either a DBH vehicle or a vehicle provided by the host
LEA per the agency's formal agreement with DBH. DBH is preparing a
department-wide vehicle utilization analysis to ensure all programs are
effectively and efficiently equipped with appropriate transportation resources.
The response complies with PC 933.05(b)(2).
SBCSD and DBH to develop a formal and accessible system to track
recidivism of the mentally ill. To be implemented by June 2022.
RESPONSE:
This recommendation will be implemented. DBH will collaborate with the
Sheriff's Department to identify and/or develop a system to track recidivism
and clinical management of persons with behavioral health concerns and
frequent law enforcement contact.
DBH to develop a collaboration among stakeholders for high desert
accessible mentally ill hospital and/or procurement of land for a facility. To be
implemented by October 2022.
RESPONSE:
This recommendation is in practice. DBH continues to seek and pursue
opportunities to partner with agencies/organizations interested in developing
and/or providing acute psychiatric inpatient services for all ages in this region
of San Bernardino County.

CONCLUSION:
The San Bernardino County 2022 Civil Grand Jury concluded that the San
Bernardino Department County Sherriff and the Department Of Behavior
Health, responses 21-1 thru 21-12 comply with PC § 933.05.

Predatory Behaviors And Ignorance Within Redlands Unified School
District: Has The School District Learned Its Lesson?
During an employee’s performance evaluation, District supervisors are to
verify each employee's understanding of “reasonable suspicion”, mandated
reporting laws, predatory behaviors, grooming behaviors, and complaint
processes. This information can be obtained via a written question and
answer sheet, signed by the employee declaring their comprehension of the
legal obligation. This recommendation is to be implemented no later than
August 2022.
RESPONSE:
Each year, every employee undergoes mandated reporter training and is
required to take a quiz confirming their understanding of reasonable
suspicion, predatory behaviors, grooming behaviors and mandated reporting
processes. These records, or a review thereof, can hypothetically be
incorporated into the evaluation process. However, evaluation procedures fall
within the scope of mandatory collective bargaining, and therefore the District
cannot unilaterally implement this recommendation. Furthermore, not all
teachers and staff are evaluated on a yearly basis, so this will impede a
consistent application of the recommendation.
The District is willing to approach the subject in collective bargaining with the
goal of implementing this recommendation to the extent possible.
Accordingly, pursuant to Penal Code section 933.05(b), the District responds
that to the extent noted above, this recommendation will be implemented in
the future through the collective bargaining process.
The response complies with PC § 933.05(b)(1), (b)(2).
RECOMMENDATION R21-2(a)-(b):
The District is to create an Administrative Regulation explaining the
procedure for immediate mandatory parental notifications before interviewing
or investigating students regarding possible suspected sexual abuse by staff.
This recommendation is to be implemented no later than June 2022.
Immediate telephonic notification made to the legal guardian followed up by a
written copy of notification to the parent/guardian with a document parent
receipt of the notification. This recommendation is to be implemented
immediately.
RESPONSE:
As noted above, the District must balance this recommendation with its
commitment to cooperate with law enforcement on criminal investigations of
serious sexual misconduct. This requires the District to balance parental
notification with law enforcement directives not to interfere with criminal
investigations. With these limitations in mind, the parental notification
procedure regarding sexual harassment or abuse investigations can be
found in the newly adopted Administrative Regulation 5145.71.
Accordingly, pursuant to Penal Code section 933.05(b), the District responds
to the extent noted above, this recommendation will be implemented in the
future.
The response complies with PC § 933.05(b)(2), (b)(3).
Each school is to conduct training in conjunction with staff meetings
throughout the school year, including but not limited to role-play scenarios.
This will begin with the District Superintendent training school administrators,
on a quarterly basis. This recommendation is to be implemented no later
than August 2022.
RESPONSE:
This will be accomplished with the micro-trainings noted above, due to begin
in the 2022-23 school year. The District is in the process of obtaining and
assembling suitable materials. These micro-trainings will occur quarterly
moving forward. Accordingly, pursuant to Penal Code section 933.05(b), the
District responds that this recommendation will be implemented according to
the recommended timetable.

Provide school assemblies at least twice a year in these areas and invite
teachers, staff students, school volunteers, and parents/guardians.
Videotape these assemblies and make them available on the RUSD website
for those unable to attend in person. Show the recordings in the students'
homerooms twice a semester as student reminders. This recommendation is
to be implemented no later than October 2022.
RESPONSE:
The District responds that the implementation of this recommendation will
take further analysis related to issues of parental consent, determination of
appropriate content for TK-12 students. This recommendation infringes on
student instructional time as well as staff duty time, which is subject to
mandatory collective bargaining.
While we recognize the Grand Jury's emphasis on parent and student
training, we are not clear that the Grand Jury has contemplated the
impediments to creating a training program appropriate to all these groups in
a manner that respects other stakeholder rights and the educational program
in the classrooms. RUSD agrees to explore the feasibility of implementing
such a program, or something similar. Accordingly, pursuant to Penal Code
section 933.05(b), the District responds that this recommendation will not be
implemented at this time because it is not warranted and is not reasonable
for the reasons stated above.
The response complies with PC § 933.05 (b)(3),(b)(4).
In addition to the Parent-Student Handbook, develop easy-to-read and user-
friendly reference sources, with information explaining prohibited behaviors,
reasonable suspicion of sexual abuse and grooming, mandated reporting,
and the complaint process. This information can be incorporated into smaller
pamphlets that are available in the District and school offices, and online. It is

also recommended that the English and Spanish versions be separate. This
recommendation is to be implemented no later than November 2022.
RESPONSE:
The District has developed some related materials and will focus on
developing informational pamphlets as described above. Accordingly,
pursuant to Penal Code section 933.05(b), the District responds that this
recommendation will be implemented in the future according to the
recommended timeline.
Revise the "Working Smart" tips to read, "Prohibited Behaviors, " and "Red
Flags" to read, "Boundary Violations. " These listed "red flags " simply
identify the past behaviors of staff that permitted the sexual abuse of
students to thrive. Therefore, these behaviors should not be "red-flagged" but
expressly prohibited, to protect the students. These recommendations are to
be implemented immediately.
RESPONSE:
This document will be eliminated as this information now exists in a Board
Policy on Professional Adult/Student Boundaries. Accordingly, pursuant to
Penal Code section 933.05(b), the District responds that to the extent noted
above, this recommendation has been implemented.
RECOMMENDATION: R21-7:
Ensure that all students receive hall passes from office staff, not the teacher.
This recommendation is to be implemented immediately.
RESPONSE:

As discussed above in response to Finding No. 7, the District's approach will
focus on the difference between a student request for a bathroom pass, for
example, and teacher requests for an individual student to leave another
classroom. The district has implemented a protocol whereby any teacher or
staff member calling a student out of another classroom requires
administrator knowledge and consent. In some cases, a "third wheel"
approach would be applied as suggested by the Grand Jury. Accordingly,
pursuant to Penal Code section 933.05(b), the district responds that to the
extent noted above, this recommendation has been implemented.
Ensure that "quadrant monitoring" is being completed daily and documented
by school administrators throughout the school year, via a sign-in clipboard in
each school's front office for completion verification. This recommendation is
to be implemented immediately.
RESPONSE:
As discussed above in response to Finding No. 8, "quadrant monitoring" is
not a Districtwide standard and instead was the method adopted at one
school site in response to the district's mandate for a physical monitoring
system. In response to this recommendation, RUSD will implement a daily
logging system for each school's monitoring program. In addition, at the
secondary level, campus safety officers may assist with this function. Further,
the District is exploring verification of site monitoring using electronic
software. Accordingly, pursuant to Penal Code section 933.05(b), the district
responds that to the extent noted above, this recommendation is intended to
be implemented by the start of the 2022-23 school year.
The response complies with PC § 933.05(b)(2),(b)(3).
A "Third Wheel" rule to be instituted whereby an adult third party is always
present when a student meets with staff and/or included in any electronic
communication. This "Third Wheel" rule ensures the safety of students and
staff against misconduct and/or allegations of misconduct due to a witness
always being present and/or included. This recommendation is to be
RESPONSE:
Certain educational functions necessitate being one-on-one with a student
(example, psychologist testing a student or confidential counseling), but
every space should have at least one window and administration will be
informed in advance of such activities.
Subject to the above understanding, BP 4019.1 already outlines rules
consistent with this recommendation. Accordingly, pursuant to Penal Code
section 933.05(b), the district responds that to the extent noted above, this
recommendation has been implemented, and the district will continue to
identify any necessary one-on-one circumstances to ensure third person
knowledge and visibility.
The Superintendent is to perform short virtual training updates concerning
staff sexual misconduct, mandated reporting, grooming, reasonable
suspicion, the complaint process, etc., on a quarterly basis to all
administrators and school personnel. These trainings are to be available on
the RUSD website and available for check-out in all school libraries. This
recommendation is to be implemented no later than October 2022.
RESPONSE:
As discussed above, the District is implementing a schedule of micro-
trainings to adopt this recommendation. Whether it is feasible to arrange to
record the trainings for inclusion on the website and for check out in the
libraries is subject to further study, and the District reserves on this part of
the recommendation. However, pursuant to Penal Code section 933.05(b),
the District responds that to the extent noted above, this recommendation will
be implemented according to the recommended timetable.

Electronic and hard-copy complaints and/or allegations of staff sexual abuse,
grooming, etc. retained for a minimum of 10 years. Files of staff sexual
misconduct complaints retained in the Superintendent's office, the Assistant
Superintendent of Human Resources office, and the Assistant
Superintendent of Education Services office at the District Office, both
electronically and in hard copy for consistency, accountability, and
transparency. This recommendation is to be implemented immediately.
RESPONSE:
This recommendation is not clearly stated. The District keeps complaints,
which would include allegations of staff sexual abuse/grooming/etc. as
permanent records. However, it is not reasonable to expect "files of staff
sexual misconduct complaints" to be held in multiple locations and offices.
This would have the effect of reducing consistency and transparency,
compared to an appropriate central location for all such materials. and
personnel files hard copy in the Human Resources division as it is
confidential.
Personnel files are kept in one central location as required by law and are
kept in physical format to allow for inspection as required. It is not reasonable
or appropriate to expect duplication in electronic format of these files, which
would include discipline files. Complaint records are not required in a
particular format (paper vs. electronic) to avoid limiting or impeding the
submission of complaints — we want students, parents, and staff to have
multiple avenues for bringing complaints. Moving forward, the District will
make all complaint files electronic as well as keeping them hard copy. The
Superintendent, Title IX Coordinator and Assistant Superintendents of
Human Resources and Educational Services, will have access to all such
physical or electronic files.
As we understand this recommendation, RUSD believes its practices are in
compliance. Accordingly, pursuant to Penal Code section 933.05(b), the
District responds that to the extent noted above, this recommendation has
been implemented on a move-forward basis. To any further extent, this
recommendation will not be implemented because it is not warranted and is
not reasonable.
Develop and implement a visual flowchart of the complaint procedures and
process, from receipt of complaint to conclusion. Flowchart to be distributed
to every school front office in hard copies, put on the RUSD website and
"Aeries, " in one of the handbook pamphlets, and placed in staff rooms,
classrooms, assembly areas, etc. This recommendation is to be implemented
no later than June 2022.
RESPONSE:
In combination with the above responses, a flowchart as suggested will be
included in the easy-to-read pamphlet that is being developed. The District
disagrees that the confidential Aeries student database is an appropriate or
useful location for this information but will include it on the District's website
for full community access. Accordingly, pursuant to Penal Code section
933.05(b), the District responds that this recommendation will be
implemented according to the recommended timeline.
ACT Now Initiative rolled out again by the Superintendent to the District and
the communities it serves by April 2022. To be presented to staff meetings,
churches, school assemblies, teachers of English classes in Middle and High
schools, elementary classrooms, Parent Teachers Association (PTA) or other
parent meetings, and other community meetings. This implementation to be
done annually and remain continuously.
RESPONSE:
The Superintendent will reprise ACT Now in the District and will also continue
presenting in the community, when invited. The district will seek such
opportunities. Accordingly, pursuant to Penal Code section 933.05(b), the

district responds that this recommendation will be implemented according to
district responds that this recommendation will be implemented according to
the recommended timeline.
the recommended timeline.

Conduct an annual review of all board policies and administrative policies in
Conduct an annual review of all board policies and administrative policies in
these areas, preferably done by a taskforce headed by the Superintendent,
these areas, preferably done by a taskforce headed by the Superintendent,
and including, but not limited to, students, parents, staff, school volunteers,
and including, but not limited to, students, parents, staff, school volunteers,
and community members. This recommendation is to be implemented no
and community members. This recommendation is to be implemented no
later than October 2022.
later than October 2022.
RESPONSE:
RESPONSE:
The district will explore forming a committee and working in conjunction with
The district will explore forming a committee and working in conjunction with
legal counsel on annual policy review on these subjects, separate from the
legal counsel on annual policy review on these subjects, separate from the
ongoing universal policy review that is already in place otherwise. The district
ongoing universal policy review that is already in place otherwise. The district
reserves on the reasonableness of this recommendation, depending on the
reserves on the reasonableness of this recommendation, depending on the
ability to achieve community interest and involvement, and the
ability to achieve community interest and involvement, and the
appropriateness or the extent to which students may be included. This further
appropriateness or the extent to which students may be included. This further
analysis will occur within the timeline stated above. Accordingly, pursuant to
analysis will occur within the timeline stated above. Accordingly, pursuant to
Penal Code section 933.05(b), the district responds that this
Penal Code section 933.05(b), the district responds that this
recommended timeframe.
recommended timeframe.

Working cameras to be installed in all locations where teacher sand student
Working cameras to be installed in all locations where teacher sand student
meet, installations beginning in all classrooms. This recommendation is to be
meet, installations beginning in all classrooms. This recommendation is to be
RESPONSE:
RESPONSE:
As discussed above, while this recommendation is certainly well- meaning,
As discussed above, while this recommendation is certainly well- meaning,
the Grand Jury is not fully cognizant of the statutory limitations on installing
the Grand Jury is not fully cognizant of the statutory limitations on installing
recording devices in classrooms and has not considered the pupil privacy
recording devices in classrooms and has not considered the pupil privacy
laws and collective bargaining requirements that are implicated here.
Contrary to the Grand Jury's comment, the desire to do the right thing does
not override legal requirements covering these subjects. Instead, these
sometimes, conflicting interests must be harmonized, and the other
protections already in place in RUSD, combined with the additional
recommendations of the Grand Jury, provide sufficient preventative
measures that would obviate the need for disregarding privacy laws and
related rules.
Further, the Grand Jury has not considered the extreme cost of a wall- to-
wall camera surveillance program as suggested in the report. Accordingly, for
these reasons, pursuant to Penal Code section 933.05(b), the district
responds that this recommendation will not be implemented because it is not
warranted and is not reasonable. The district remains open to other
suggestions that will enhance student safety that take these considerations
into account.
The San Bernardino County Civil Grand Jury finds that many of the
Responses by Redlands Unified School District are within the parameters of
PC933.05(b), but that the District is clearly putting the safety and welfare of
their students on the back burner. The District states, in many of its
Responses, that these Recommendations of the Grand Jury, meant to keep
children safe from sexual assault by staff, are simply too expensive or too
difficult to implement. For example, the District asserts that cameras
everywhere are too costly. Yet the District has paid out over 40 million in
settlements to its victims over the years. Cameras in all areas of campuses
would be much less expensive. Furthermore, the District says it is bound by
collective bargaining (aka The Redlands Teachers Association) issues.
However, it is possible that most teachers and parents would trade privacy
issues if it meant that children were safe. Another example is the District’s
assertion that the Student/Parent Handbook is read and understood by all
students and parents and does not need to be revised. This is a false
assertion, since parents/guardians MUST sign that they read and understood
the handbook before their children are assigned to classes.
The 2022 San Bernardino Civil Grand Jury encourages the Redlands Unified
School District to do the hard work needed to keep students safe from

predatory staff. Hopefully, in the future, the District will roll up its sleeves and
do whatever it takes to keep our most precious resource, our children, safe.
CONCLUSION:
The San Bernardino County 2022 Civil Grand Jury concluded that Redlands
Unified School District Responses 21-1 thru 21-15 comply with PC § 933.05.
The Grand Jury tasked the Redlands Unified School District to provide
verification of Recommendation 2 (A) & (B), Recommendation 5 and
Recommendation 6. Although lengthy, documentation was provided on each,
an implementation date was not given. The 2022 Grand Jury will forward the
data to the 2023 Grand Jury to insure said policies are implemented
The Grand Jury received an e-mail with the below pamphlet attached to
further exemplify the current commitment of RUSD to educate the parents
and students on defining professional adult / student boundaries.

Presented by the Redlands
Unified School District
DEFINING PROFESSIONAL
ADULT / STUDENT
BOUNDARIES
20 W. Lugonia Ave.
Redlands, CA 92374
www.redlandsusd.net
(909) 307-5300

Purpose of Pamphlet
The purpose of this pamphlet is
to provide all staff, students,
volunteers and community
members with information to
increase their awareness of their
role in protecting children from
inappropriate conduct and
failure to maintain appropriate
boundaries by adults. All adults
are expected to maintain
professional, moral and ethical
relationships with students that
are conducive to an effective,
safe learning environment.
Topics to Cover ... It addresses a range of behaviors

that include not only obvious
Prohibited Interactions
unlawful or improper
Boundary Violations
interactions with students, but
Actions Create Trust
also boundary-blurring and
(ACT) Now
grooming behaviors that
Call to Action
undermine the professional
Title IX
adult/student relationship and
Duty to Report
can lead to misconduct or the
Uniform Complaint
appearance of impropriety.
Procedure (UCP)
District Personnel
Complaint Procedure
Page 2

Prohibited Interactions
Employees are prohibited
from engaging in social and
other interactions with
students which abuse the
student/staff professional
relationship.
Prohibited social and other

interactions involving
students include, but are not
limited to:
Sending or accompanying students on personal errands

1. unrelated to any legitimate educational purpose;
Furnishing alcohol, drugs or tobacco to a student, or being

2. present where any student is consuming these substances;
Disclosing personal, sexual, family, employment concerns or

3. other private matters to one or more students;
4. Sharing personal secrets with a student;
5. Unnecessarily invading a student's privacy;
Taking a student out of class without a legitimate

6. educational purpose;
Giving a student a ride alone in a personal vehicle in a non-

7. emergency situation without prior notification to and/or
approval from the school principal.
Page 3

Prohibited Boundary
Violations
Examples of prohibited employee conduct that
violate professional adult/student boundaries
include, but are not limited to, the following:
Singling out a particular student for personal

attention and friendship beyond the
professional staff-student relationship.
Encouraging students to confide their

personal or family problems and/or
relationships.
Maintaining personal contact with a student

outside of school (by phone, e-mail, instant
messenger, or Internet chat rooms, social
networking websites, such as Facebook , or
letters beyond homework or other legitimate
school business) without including the
parent/guardian.
This prohibition specifically includes

"friending" or "following" students on social
media. This also specifically includes the
posting of student images or other personally
identifiable information of students on an
adult's personal website.
Page 4

Prohibited Boundary
Violations
Exchanging personal gifts, cards or letters
with an individual student for which it is
suggested that a student is to say or do
something in return.
Touching students or initiating inappropriate

physical contact without a legitimate
educational purpose (i.e., assisting with an
injury/coaching).
Socializing or spending time with students

outside of school-sponsored events, except as
participants in organized community
activities or with the approval of and in the
presence of parents/guardians.
Being alone with a student without a

legitimate educational purpose.
Addressing students with personalized terms

of endearment, pet names or otherwise in an
overly familiar manner.
Page 5

Actions Create Trust
(ACT) Now
When an employee observes conduct or has knowledge of
another employee violating this policy that creates a
reasonable suspicion of child abuse (including sexual abuse), or
when an employee has reasonable suspicion of an adult
harming or endangering a child, the employee shall report the
conduct to San Bernardino County Children and Family
Services (CFS) and law enforcement in accordance with State
law and District Board Policy and Administrative Regulation
5141.4-Child Abuse Prevention and Reporting.
Whenever the District receives a

report concerning a possible
boundary violation, the site
supervisor and the assigned Human
Resources Administrator will
conduct a prompt investigation
utilizing the procedures for
investigations of allegations of
serious misconduct. Immediate
intervention shall be considered and
implemented when necessary to
protect student safety and/or the
integrity of the investigation. Any
incident of suspected child abuse
will be reported immediately to law
enforcement in accordance with
State law.
Page 6

Call to Action
Page 7

Title IX
What is Title IX?
Title IX of the Education
Amendments of 1972 prohibits
discrimination based on sex in
programs and activities of federally
funded institutions.
Title IX Sexual
Harassment
Complaint Form
This form can be used for allegations of
discrimination on the basis of sex
occurring in the district's education
program or activity, when a student is
subjected to sexual harassment.
Contact
Information
District Title IX Coordinator:
Assistant Superintendent,
Educational Services
Redlands Unified School District
20 West Lugonia Avenue
Redlands, CA 92373
Page 8
(909) 307-5300 ext. 6761

Duty to Report
Page 9

Uniform Complaint
Procedures (UCP)
UCP is a written and signed statement alleging a violation of
federal or state laws governing certain educational programs.
UCP Form
The form is to be used for allegations of
unlawful discrimination targeting a student,
including discriminatory harassment,
intimidation, or bullying based on the
protected groups/characteristics listed
below. For bullying and other complaints
not based on the protected
groups/characteristics listed below, contact
your site administrator, counselor, or the
District’s Student Services Director:
Age Immigration Status
Ancestry Marital Status
Association with a person or Mental / Physical Disability
group with one or more of the National Origin
actual or perceived Nationality
characteristics listed Parental Status
Color Pregnancy / Pregnancy
Ethnic Group Association Status
Gender Race or Ethnicity
Gender Expression Religion
Gender Identity Sex
Genetic Information Sexual Orientation
Page 10

District Personnel
Complaint Procedure
Complaint Form Concerning
District Personnel
Complaints concerning district personnel
should be made directly to the employee
against whom the complaint is lodged.
Complaints not resolved with the employee
shall be directed to the employee's
administrative supervisor. If the complaint,
after review by the administrative supervisor,
remains unresolved, the complainant may use
the form, together with the administrative
supervisor's report/decision, to submit to the
Superintendent or designee.
Links to All District

Complaint Procedures
Uniform Complaint Procedures Form
Complain Form Concerning District Personnel
Title IX Sexual Harassment Complaint Form

(For any other forms of sexual harassment not listed above,
please use the UCP Procedures form)
Page 11

The purpose of this pamphlet is to provide all
staff, students, volunteers and community
members with information to increase their
awareness of their role in protecting children
from inappropriate conduct and failure to
maintain appropriate boundaries by adults.
All adults are expected to maintain
professional, moral and ethical relationships
with students that are conducive to an
effective, safe learning environment.
@RedlandsUSD
#ThisisRUSD

Food Permits
EHS to develop an online program to help Street and Sidewalk vendors learn
how to obtain licenses, permits and certifications. This service would help to
prevent future violations. The online program would ensure their success
along with increasing the safety of food served to the general public. To be
implemented by July 7, 2022.
RESPONSE:
The County’s goal is to implement this recommendation by December 31,
2022. EHS and county Code Enforcement currently provide education to
street and sidewalk vendors in the field, in County offices, and via the County
website. EHS is committed to the long-term success of street and sidewalk
vendors as well as ensuring that food served to the public is safe. It is
anticipated that there will be little to no additional cost to develop and
implement this specific aspect to the County’s online training program as
doing so would be withing the scope of an existing contract EHS has with a
vendor. The addition of a food safety training for sidewalk vending will require
EHS to provide the vendor with a scope of work, design, review, and
implementation
EHS /County Code Enforcement Department to develop a joint program to
identify Street and Sidewalk vendors. This shall include a task force patrolling
the county to identify and track Street and Sidewalk vendors through the
creation of a central database. To be implemented by July 7, 2022.
RESPONSE:
This recommendation is in practice. EHS and County Code Enforcement has
developed and implemented a tracking mechanism that utilizes mobile phone
and GIS applications to not only identify hot spots for street and sidewalk
vendors, but also to record information during field observations on vendors,
repeat violations, and the intervention provided. This information is currently
uploaded to a shareable dashboard that EHS and County Code Enforcement
use to develop applicable educational materials and tailor additional
interventions.
EHS to provide Street and Sidewalk vendors with resource materials
(bulletins, flyers, websites) regarding mandated requirements. To be
implemented by July 1, 2022.
RESPONSE:
This recommendation is in practice. Currently, Sidewalk Vending resource
materials are available online at https:// wp.sbcounty.gov/dph/programs/ ehs/
food-facilities/ . EHS will update the website and materials to be more user-
friendly and accessible.
CONCLUSION:
The San Bernardino County 2022 Civil Grand Jury concluded that EHS
Responses 21-1 thru 21-3 comply with PC § 933.05.

Doing Business With The City Of San Bernardino
Routine City permits should be handled in-house for efficiency and
timeliness. To be implemented by January 31, 2023.
RESPONSE:
In Fiscal Year 2021-2022 the City moved its plan review & permit services in-
house for improved customer service, including efficiency and timeliness
(also $930,000 in annual savings).
The City is also working to procure and implement an Enterprise Resource
Planning System (ERP), an integrated software system that integrates
financial and document resources across all departments. Current systems
do not communicate, causing delays, requiring duplicative record keeping,
and opportunities for errors. Replacing these systems will be costly and take
approximately 24 months but will enable the City to improve lead times for
permitting and licensing, allow online tracking of permits and projects, and
will save thousands of hours of staff time annually.
After the current Commercial Cannabis licensing process is complete, a
lottery-type system should be utilized by the City to ensure transparency and
fairness. To be implemented by April 30, 2022.
A lottery-type process should be considered in the City whenever a limited
number of opportunities would be available as part of an application/permit
process.
RESPONSE:
The City’s application process for commercial cannabis permits is set forth in
Chapter 5.10 of the City’s Municipal Code, which was adopted by the City’s
voters. The voter-approved process anticipates detailed objective review
criteria, followed by the scoring and ranking of applications. The Mayor and
City Council are required to adopt a resolution governing the application
process, consistent with the voter-approved laws. To the extent permissible,
the Mayor and Council may in the future choose to exercise their legislative
discretion to assess the merits of incorporating a lottery component in the
process. Ultimately, this is a policy matter and will be decided by the Mayor
and Council consistent with the voter-approved laws.
The City should develop strategies to increase operational knowledge and
understanding for elected officials through training. To be implemented
immediately.
RESPONSE:
In the past year, the City of San Bernardino has held thirteen public budget,
funding allocation, and strategic planning workshops and discussion
sessions to provide updates, in depth training and information to the Mayor,
Council and members of the public with the intent of educating and informing
prior to decisions being made. Further, the City manager has instituted
regular meetings with each council member to discuss, educate, and update
them on city issues, as well as answer questions.
As mentioned in the Findings section of this response, Council members are
provided extensive training when they take office. The city contracts with the
law firm Best, Best, and Krieger to provide the following training sessions: 1)
Local Government Survival Guide for Newly Elected Leaders (6 hours); 2)
Sexual Harassment Avoidance Training for Supervisors (2 hours); 3) The
Brown Act “Open Meetings Law” (1.5 hours); 4) Ethics Training for Public
Agencies (2 hours).
In addition, all Council members are provided a City Council Handbook
during a separate training session with the City Manager, Assistant City
Manager, City Clerk, and City Attorney. This handbook has two sections that
cover the annual budget, the process, and the role of the City Council
members. The section “How City Government Works” includes subsections
on: The City Charter, San Bernardino Municipal Code, California Codes,
Annual Budget, Capital Improvement Plan and General Plan. The section
“Financial Management and Budget Process includes subsections on: City
Revenue Projections, Budget Process, Mid-year/Year End Budget Review,
Budget Control, Funds, Audits, and Additional Information Regarding City
Finances.
The City should reconstruct its website to be user-friendly with current and
regularly updated information. To be implemented by June 30, 2022.
RESPONSE:
The City’s website is currently under redevelopment with plans to deploy a
new website by June 2022. The new design, in addition to being more user-
friendly in general, will include an improved transparency portal with budget
information with real-time data so that the City’s financial information and
performance may be easily accessed. The data can be viewed in tabular or
graphic form, and users will be able to manipulate it to analyze the City as a
whole, or drill down to a more granular level to evaluate the performance of a
department, division or specific program or project.

The City should apply the current Commercial Cannabis Integrity Standards
to all City application processes for the sake of integrity and transparency.
The Integrity Standards should be posted in public view in all City facilities
and on the City website. To be implemented by March 31, 2022.
RESPONSE:
There was no response to Recommendation R21-5.

RECOMMENDATION R21-5a:
Amend Integrity Standards so they apply to elected City officials as well as
the applicants. To be implemented by March 31, 2022.
RESPONSE:
In June 2021, the Mayor and City Council adopted Ordinance No. MC1558,
which established local campaign finance regulations. These regulations
include restrictions on elected officials, candidates, and applicants. In
addition, the City contracted with the Fair Political Practices Commission to
assist with enforcement of the new regulations. To our knowledge, no other
city in the County has such far reaching rules and utilizes an outside agency
for enforcement purposes.
The Purchasing Department should complete the current update to the
Purchasing Manual to ensure staff adheres to clearly defined policies for all
procurement activities. To be implemented by March 31, 2022.
RESPONSE:
An update to the City’s Purchasing Policy and Manual is underway. The
update is extensive and requires updates to the Municipal Code, particularly
Chapter 3.04, and is anticipated to be fully implemented by summer 2022.
The City is in the process of expanding the Purchasing Department from one
to four employees. A Purchasing Manager was hired in May 2021. Prior to
the hiring of the Manager, the City had only an Assistant Buyer to support
purchasing activities city-wide. The City Council authorized the hiring of a
Contract Specialist in December 2021. The City is adding a Disadvantaged
Business Enterprise (DBE) Specialist to the team in the summer of 2022.
This will bring the total staffing for the Division to four. This increased
staffing, with each individual responsible for specific types of procurement,
will work with departments and the City Attorney to ensure that procurement

activities are transparent, consistent, and comply with policy and state and
federal laws and regulations.
RECOMMENDATION R21-6a:
The Purchasing Department should continue to review and update the
Purchasing Manual periodically (with most current revision date noted).
RESPONSE:
An update to the City’s Purchasing Policy and Manual is underway. The
update is extensive and will require updates to the Municipal Code. It is
anticipated to be fully implemented by summer 2022.
The City should require a Development Review Committee meeting for all
commercial development projects in which all involved departments
participate with written acknowledgement of all project requirements. To be
RESPONSE:
Contrary to the Grand Jury report, the City of San Bernardino has a
Development Environmental Review Committee (DERC), which meets twice
a month on the 2nd and 4th Wednesdays. The DERC includes members
from Community and Economic Development, Building & Safety, Land
Development, Public Works, Fire, Water, and Engineering. DERC agendas,
meeting minutes, and audio recordings dating back to 2014 are available
online. A review of the functions and scope of the City’s existing
Development Environmental Review Committee (DERC), which is
established under Title 19 of the City’s Municipal Code, will occur in
connection with the City’s current General Plan Update and review of the
City’s Development Code. The city is currently in the process of filling the
positions of Community and Economic Development Director and Deputy.
The City should establish a public method of risk assessment that protects
the City from undue liability but does not unfairly overcharge or burden
businesses or citizens with inappropriate bonding requirements. To be
implemented by June 30, 2022.
RESPONSE:
Public contract bonding requirements are set by state law for many types of
contracts. In other cases, bonds may be required by the City to protect the
City from liability. The assessment of when bonds are appropriate will be
made by the appropriate department in coordination with the Risk Division
and the City Attorney’s Office. The City has upgraded the position of Risk
Manager to a Deputy Director level position and will be recruiting for the
position in May 2022. The Risk Manager oversees, manages, monitors, and
coordinates the City’s Risk Division and assists in implementing policies and
procedures that minimize City risk while increasing service and effectiveness.
The City is also currently undertaking a comprehensive fee study that will
evaluate fees city-wide to determine the appropriate fees for services. This
study will enable to City to recover costs where appropriate and will ensure
that fees are reasonable in consideration of the service and the community. It
is expected Director/City Planner. The Community and Economic
Development Director is responsible for directing, managing, and integrating
the functions, programs, and activities of the Plan. The City is also currently
undertaking a comprehensive fee study that will evaluate fees city-wide to
determine the appropriate fees for services. This study will enable to City to
recover costs where appropriate and will ensure that fees are reasonable in
consideration of the service and the community. It is expected that the study
and subsequent adoption by the council will be completed in fall 2022.
The response complies with PC § 933.05(b)(1), (b)(2), (b)(3), (b)(4).

The City should develop a process for collecting required taxes from all
unlicensed businesses. To be implemented by September 30, 2022.
RESPONSE:
The City contracts with a consulting firm to ensure that cannabis companies
that are properly licensed to do business within the City of San Bernardino
are remitting the proper tax to the City. In recent months, the City has been
able to collect all back taxes due from cannabis businesses operating legally
within the City.
The City cannot collect tax from unlicensed, illegally operated businesses,
whether these businesses are related to cannabis or other businesses.
These are identified by the City’s contractor or by Code Enforcement or

Business Registration personnel, and depending on the circumstances may
be ticketed, fined and/or shut down by law enforcement.
In Spring of 2022, the City Council approved expanding the Code
Enforcement Division to 20 officers. It is anticipated that this action, when
fully staffed in summer 2022, will enhance the identification of unlicensed and
illegal businesses in San Bernardino, along with either shutting the
businesses down or bringing them into compliance with applicable codes,
permits, fees, and if applicable, taxes.
The City should develop policies and procedures for all departments and
continue to review and update periodically with revision dates noted. To be
implemented by June 30, 2022.
RESPONSE:
The City is working to update all policies and procedures. Below are
examples of policies and procedures that have been updated since the city
was visited by the Grand Jury (this is not a complete list of updated policies
was visited by the Grand Jury (this is not a complete list of updated policies
and procedures):
and procedures):
• Investment Policy (Reso. 2021-117)

• Investment Policy (Reso. 2021-117)
• Cash Handling and Revenue Control Policy (Reso. 2021-246)
• Cash Handling and Revenue Control Policy (Reso. 2021-246)
• Travel Authority and Expense Policy (Reso. 2021-164)
• Travel Authority and Expense Policy (Reso. 2021-164)
• Reimbursement Policy (Reso. 2021-202)
• Reimbursement Policy (Reso. 2021-202)
• Procedure for Elected Officials to Place Items on the City Council
• Procedure for Elected Officials to Place Items on the City Council
Agenda (Reso. 2021-68)
Agenda (Reso. 2021-68)
• Elected Officials Interaction with City Staff and Involvement in
• Elected Officials Interaction with City Staff and Involvement in
Administrative Affairs (Reso. 2021-69)
Administrative Affairs (Reso. 2021-69)
• Hometown Heroes Military Banner Program Policy (Reso. 2021- 114)
• Hometown Heroes Military Banner Program Policy (Reso. 2021- 114)
• Administrative Policy Regarding Municipal Volunteer
• Administrative Policy Regarding Municipal Volunteer
• Program (Reso. 2021-114)
• Program (Reso. 2021-114)
• Administrative Policy Regarding Use of City Equipment and `
• Administrative Policy Regarding Use of City Equipment and `
Resources (Reso. 2021-162)
Resources (Reso. 2021-162)

CONCLUSION:
CONCLUSION:
GRAND JURY RESPONSE:
The San Bernardino County Civil Grand Jury finds that regarding the
The San Bernardino County Civil Grand Jury finds that regarding the
response of Recommendation R21-2 from the city that states that the permit
response of Recommendation R21-2 from the city that states that the permit
process in Chapter 5.10 of the City’s municipal code adopted by the city’s
process in Chapter 5.10 of the City’s municipal code adopted by the city’s
voters did not work. Municipal code states that there is a detailed objective
voters did not work. Municipal code states that there is a detailed objective
review criteria followed by scoring and ranking of applications. There was no
review criteria followed by scoring and ranking of applications. There was no
transparencies or fairness hence the Civil Grand Jury’s recommendation for
transparencies or fairness hence the Civil Grand Jury’s recommendation for
the lottery type process.
the lottery type process.
The 2022 San Bernardino Civil Grand Jury had serious concerns on how the
The 2022 San Bernardino Civil Grand Jury had serious concerns on how the
responses were received by from the 2021 Grand Jury Recommendations.
responses were received by from the 2021 Grand Jury Recommendations.
With the “Doing Business With The City Of San Bernardino”. A response was
With the “Doing Business With The City Of San Bernardino”. A response was
to be received by the Grand Jury office by March 17,2022, as noted in the
final report. Nothing was received by the Grand Jury until inquiries were
made by the 2022 Grand Jury in April 2022. The Grand Jury finally received
the response to the recommendations on May 12, 2022.
The San Bernardino County Civil Grand Jury finds that many of the
Responses of the City of San Bernardino are within the parameters of PC §
933-05 (b) and commends The City for those responses.

San Bernardino County Lakes
The Grand Jury recommends that San Bernardino County establish a bi-
annual testing program to test the fish for mercury contamination that are
available in the lakes at the County Regional Parks that have public fishing
lakes. The results of these tests should be posted to the San Bernardino
County Regional Parks website. These test results should also be handed
out at the Regional Parks when the fishing fee is paid. To be implemented by
May 2022.
RESPONSE:
Will not implement the recommendation as implementation is not necessary.
There is no legal requirement for the testing of fish for mercury. The County's
fish vendor conducts health checks of the fish prior to delivery and monitor
the fish daily and weekly, conducting more-intense health checks of their fish,
internally and externally.
The Grand Jury recommends that San Bernardino County post the following
fish consumption advisory, in a prominent location, on the San Bernardino
County Regional Parks website (https://parks.sbcounty.gov/activity/fishing)
and on webpages where San Bernardino County Regional Parks lake fishing
information is obtained. The fish consumption advisories to be posted are
"Statewide Health Advisory and Guidelines for Eating Fish from California's
Lakes and Reservoirs without Site-Specific Advice" and the "Statewide
Health Advisory and Guidelines for Eating Fish from Lake Gregory (San
Bernardino County)" published by the California Office of Environmental
Health Hazard Assessment. To be implemented immediately.
RESPONSE:
This recommendation has been implemented.

The Grand Jury visited Yucaipa regional park. There was no signage in any
of the parking lots but one. That sign was located way beyond the tiny
parking lot that maybe had 6 spaces to park near lake #3. The Grand Jurors
could not see this sign from the parking lot. The Grand Jurors had to go very
close to the sign and bend down to see what it was. It was a very tiny, printed
sign and the sign was located at knee level. There was no signage at any of
the parking lots but the one referenced.
There was no sign at the entry to the park as the GJ requested. In our
recommendations.
After our perusal of the grounds, the Grand Jury asked a park employee
about the signage. The Grand Jury was informed that there were 3 signs
placed near each lake. One of the signs was down completely, and one sign
was near one of the lakes that we could not see. All the signs were placed at
knee level.
After an informative conversation, the Grand Jury was assured that the park
would order new, bigger signs, put them at eye level and put in at least 2
signs per lake so that they were visible to everyone
The Grand Jury also inquired about the flyers that were supposed to be
handed out to anyone coming into the park for fishing regarding the
consumption of the fish caught there. It was indicated that the park had
handed out flyers in the beginning, but when the flyers were all used up the
park did not print anymore. The Park will resume handing out flyers.
The Grand Jury recommends that San Bernardino County post, on every
informational board at each of the County Regional Parks' Lakes that provide
recreational fishing, the - "A GUIDE TO EATING FISH from CALIFORNIA
LAKES AND RESERVOIRS" poster, published by the California Office of
Environmental Health Hazard Assessment. To be implemented immediately.

RESPONSE:
The grand Jury recommends that San Bernardino County post on every
informational board at Lake Gregory the -” A GUIDE TO EATING FISH from
LAKE GREGORY (SAN BERNARDINO COUNTY)” poster, published by the
California Office of Environmental Health Hazard Assessment. To be
RESPONSE:

The Grand Jury visited Lake Gregory Regional Park on June 27, 2022. There
were two (2) signs posted on two of the lakes that were not in plain view.
There were no signs at the entrance of the Park and there were no signs
along where people were fishing. The signs that were posted were about
11x14 in size and the signs were posted at knee level. The Grand Jury
observed a person reading the sign in which the patron had to bend over to
read it. The water looked disgusting. (exhibit1 & 2).
The Grand Jury recommends that San Bernardino County test the water in
the lakes of the Regional Parks on a monthly basis, during the months of
May through October, for harmful algae bloom. To be implemented by May
2022.

RESPONSE:
The County will not implement this recommendation as implementation is not
necessary. In addition to testing the water before Memorial Day, the Fourth
of July, and Labor Day, Regional Parks also tests the water in our lakes for
algae when there are algae blooms or discoloration observed by staff. After
the initial testing, Regional Parks tests the lakes every 10 to 14 days until the
results are within an acceptable range. Regional Parks also works in
partnership with the local Water Board to implement our testing program.
CONCLUSION:
The San Bernardino County 2022 Civil Grand Jury concluded that the San
Bernardino Lakes Responses 21-1 thru 21-5 comply with PC § 933.05.
Exhibit 1
Lake Gregory Signage Guide to Eating Fish at Lake Gregory and Healthy Guide to Eating
Fish from California Lakes and Reservoirs. The signage is posted at knee level, and this is
one of the entrances to go down to the lake for fishing. There is only one signage and
there is different ways to go down fishing, there are no signage where you actually fish.

Exhibit 2
A Guide to Eating Fish from Lake Gregory signage and Healthy Guide to Eating Fish from
California Lakes and Reservoir signage only posted at one entrance at Lake Gregory.

Exhibit 3
Guide to Eating Fish from California Lakes and Reservoirs Signage at Yucaipa Regional
Park. The sign is at adult knee level and is very difficult to read from the Lake parking lot.
There is only one sign at this lake, and it is not where people fishing access the lake.

Exhibit 4
The same sign shown above, only seen close-up. This sign was one of only two signs
seen at Yucaipa Regional Park.

A Guardian For The Public Guardians
The Human Services Department, specifically the Administrative Services
Division shall audit the entire Public Guardian Organization (OPG) with
specific focus on Conservatees post-death accounting. To be completed by
June 30, 2022.
RESPONSE:
This recommendation will not be implemented. The Administrative Services
Division does not have the legal background and training to audit OPG
accounting. The accounting process is a multi-step process, which includes
comprehensive legal review by multiple agencies, including, but not limited to
sworn officers of the court, County Counsel, and the Superior Court. OPG
has seen sweeping improvements in processing all court accounting,
including post-death, with the implementation of the recently established
Terminated/Deceased Unit and the Accounting Unit.
The Human Services Department, specifically the Administrative Services
Division, shall oversee the restricting of the Public Guardian to a Functional
model of case management. To begin by April 1, 2022.
RESPONSE:
This recommendation is in practice. As a result of Human Resources
classification studies, conducted in 2019/2020, the Board of Supervisors
approved twenty-one (21) positions across multiple classifications, including
several new classifications. In 2021, OPG created several new units,
including the Terminated/Deceased Unit, Accounting Unit and Clerical
Support Unit, which facilitated the transition to and implementation of a
“functional” model of case management.
If a backlog of any function, accounting or visitation occurs beyond a
deficiency of 5% under the Functional model of case management,
temporary additional manpower needs to be requested from the Human
Services Department (specifically the Administrative Services Division), to
resolve the issue. To be implemented immediately upon occurrence.
RESPONSE:
This recommendation will not be implemented. Human Services
Administration Services Division personnel cannot be utilized to perform
OPG tasks because OPG is a General Fund-supported function. Reduction
of reported backlog is currently underway through the increased staffing
levels recently approved by the Board of Supervisors to implement the
“functional” model of case management.
The response complies with 933.05 (b)(4).
The Public Guardian shall begin tracking the California Association of Public
Administrator, Public Guardians, and Public Conservators (CAPAPGPC)
Association training and continuing education units acquired. To be
implemented by April 1, 2022 and continue on a quarterly basis.
RESPONSE:
This recommendation is in practice. As a result of recent CA PA/PG/PC
statewide computer system upgrades, OPG Executive Leadership obtains
individual training/certification data on a monthly basis, which is provided to
OPG Leadership for monitoring and reporting in employee WPEs.

The Public Guardian shall provide training specifically on accounting duties.
Training to begin by April 1, 2022.
RESPONSE:
This recommendation is in practice. OPG provided multiple in-house
accounting trainings prior to and following its interaction with the Grand Jury.
This practice will continue as part of the training of new employees and as
refresher training when deemed necessary for existing staff. Additionally, CA
PA|PG|PC has and continues to provide court accounting training.
The Public Guardian shall hire additional Deputy Public Guardians and other
budgeted support staff. To be fulfilled by June 30, 2022.
RESPONSE:
This recommendation is in practice. OPG is actively recruiting and
interviewing eligible candidates for the nine (9) vacant positions across all
classifications.
The Public Guardian is directed to implement a Public Guardian specific
Ombudsman program to provide advocacy services to Conservatees. The
Ombudsman shall maintain records of Conservatees complaints and
resolutions. This program to be implemented immediately.

RESPONSE:
The County disagrees with this finding. OPG staff are provided regular
weekly training opportunities, including CA PAIPGIPC and County training,
which includes core competencies and proficiencies. Efficacy of training is
determined through one-on-one discussions, staff surveys, participation in
case study sessions, supervisory review, and feedback, as well as on the-job
observation, which demonstrates core competencies and proficiencies.
CONCLUSION:
The San Bernardino County 2022 Civil Grand Jury concluded that Public
Guardian responses 21-1 thru 21-7 comply with PC § 933.05.

COMPLAINTS
COMPLAINTS
CIVIL GRAND JURY
2022
COMPLAINTS
The San Bernardino County Civil Grand Jury receives numerous citizen complaints
throughout the year. The 2022 Grand Jury received a total of 45 complaints. Every
complaint is carefully reviewed by the Grand Jury for issues regarding appropriate
jurisdiction and importance of the complaint topic.
After completion of the initial review of a citizen complaint, the Grand Jury may approve
the complaint and assign it to an appropriate committee. The committee will conduct an
investigation with appropriate oversight by the full Grand Jury. A written report of the
committee’s findings and recommendations regarding a specific complaint may or may
not be included in the year-end Grand Jury’s Final Report.
The process of submitting a citizen complaint is to obtain a Confidential Citizen

Complaint form from either the Grand Jury’s website or by calling the Grand Jury’s
office at (909) 387-9120. The website is http://wp.sbcounty.gov/grandjury/file-a-
complaint/. Once the complaint form has been completed and signed, it can be
returned to the Grand Jury’s office for processing. Although the Grand Jury usually
does not investigate anonymous complaints, it may conduct an investigation depending
on the issue.


REPORTS

CIVIL GRAND JURY REPORTS
2022
WORKING TOGETHER
FOR THE ANIMALS
REDLANDS ANIMAL SHELTER

SUMMARY
It has been said that a society can be judged by how it treats its most
vulnerable. If that is true, the City of Redlands (the City/Redlands) can be
judged harshly for its treatment of the animals at the Redlands Animal
Shelter.
Since 1985, the City of Redlands Police Department (RPD) had maintained
control over the Redlands Animal Shelter (RAS/the Shelter). The 2022 San
Bernardino County Civil Grand Jury (GJ/the Grand Jury) became concerned
as to what extent the City of Redlands and the Redlands Animal Shelter were
caring for the animals.
As the investigation unfolded, the Grand Jury’s evidence revealed severe
issues regarding the Redlands Animal Shelter. The following issues for the
Shelter were established by the evidence:
• No full-time Permanent Shelter Manager
• Facility Deterioration and Substandard Care of the Animals
• Organizational Dysfunction
o Failure to Inventory Expired Medications
o No Volunteer Program
o Staffing Problems
• Lack of Training/Continuing Education
o Training for Sexual Harassment and Adverse Working
Conditions
• Lack of Standards for Foster Care of Animals
• No Outreach to Rescue Groups
• Refusing offers from Rescue Groups
• Lack of Adoption/Meet-and-Greet Events
• Budgetary Problems
• Lack of Oversight for the Shelter
o Problems with Euthanasia Reporting
• Lack of Transparency/Accountability

SUMMARY
It has been said that a society can be judged by how it treats its most
vulnerable. If that is true, the City of Redlands (the City/Redlands) can be
judged harshly for its treatment of the animals at the Redlands Animal
Shelter.
Since 1985, the City of Redlands Police Department (RPD) had maintained
control over the Redlands Animal Shelter (RAS/the Shelter). The 2022 San
Bernardino County Civil Grand Jury (GJ/the Grand Jury) became concerned
as to what extent the City of Redlands and the Redlands Animal Shelter were
caring for the animals.
As the investigation unfolded, the Grand Jury’s evidence revealed severe
issues regarding the Redlands Animal Shelter. The following issues for the
Shelter were established by the evidence:
• No full-time Permanent Shelter Manager
• Facility Deterioration and Substandard Care of the Animals
• Organizational Dysfunction
o Failure to Inventory Expired Medications
o No Volunteer Program
o Staffing Problems
• Lack of Training/Continuing Education
o Training for Sexual Harassment and Adverse Working
Conditions
• Lack of Standards for Foster Care of Animals
• No Outreach to Rescue Groups
• Refusing offers from Rescue Groups
• Lack of Adoption/Meet-and-Greet Events
• Budgetary Problems
• Lack of Oversight for the Shelter
o Problems with Euthanasia Reporting
• Lack of Transparency/Accountability

Volunteers were no longer welcome; the facility needed numerous repairs or
possibly even a new building; there was little attempt to reunite lost animals
with their owners. Adoptions were handled by appointment only during hours
that many adults were working. The Redlands City budget sets aside money
designated to the Shelter every year for salaries, operating expenses, and
continuing education. However, there is little to no education for employees,
no training manuals, no Policy and Procedures Manual and no incentives for
employees to seek out training opportunities. Additionally, there is no
preparation on how to work with other adults in creating and maintaining a
work environment that is positive for the employees. The Shelter has no idea
what the best practices for animal shelters are. If the City of Redlands was a
family, and truly worked for the good of the animals, the Animal Shelter would
not be forgotten.
BACKGROUND
After multiple complaints were received by the 2022 San Bernardino County
Civil Grand Jury, the Grand Jury decided to investigate the operations of the
Redlands Animal Shelter.
During a Grand Jury visit to the Shelter on July 1, 2022, the Grand Jury
experienced the Shelter’s still closed-to-the-public COVID-19 policy while
other City offices were open. The Jurors also found that the Shelter building
was old. The kennels were made of chain link, were outside, and had no
shade. The cages in the cat room were small, overcrowded, and unclean.
The Grand Jury discovered that the Redlands Animal Shelter was built in
1985, with three office renovations since then. The rest of the Shelter was in
a sad and embarrassing state of disrepair.
For decades, the Redlands Animal Shelter had been under the direction of
the Redlands Police Department. However, in July 2022, that was changed.
It is now the Department of Facilities and Community Services (F&CS) of
Redlands that oversees all Shelter operations.
As the investigation continued, evidence revealed that volunteers had
always been welcomed at the Shelter, until recently. Even though the Shelter

was closed in March 2020, due to COVID-19, no volunteers were allowed
into the facility even with protective equipment. At least one volunteer was
escorted off the premises by the Redlands Police Department. Paid staff,
needed to care for the animals, was at a bare minimum. Partnerships with
local rescue groups and other shelters had ceased to exist. Even the number
of families willing to foster animals had declined.
While people used to be able to walk into the Shelter and look for their lost
pet, now they needed to make an appointment and have internet access to
email a picture of their lost animal to the Shelter, or to even check for their
lost pet online. The website used to provide information about Shelter
animals is 24PetConnect.com. Evidence demonstrated that this website was
complicated to use. It was very difficult to obtain information regarding the
lost animal because the only easy search on the website was done by
searching for the Animal Control number of the lost animal (which the pet
owner would have no way of knowing). Beyond that, no one at the closed
Shelter could assist them.
Instead of properly storing donated food so that it would not spoil or expire,
the food sat uncovered in the hot summer sunshine, quickly spoiling, with
the cardboard boxes fading in the 90+ degree heat. Thus, the donated food
for the animals had to be thrown out. A less wasteful option would have been
to offer it to either another shelter or a rescue. Knowledgeable staff, who
among other things would have known where to store the food, were no
longer employed by the Shelter, like the much-needed volunteers.

There were also concerns about where budgeted and donated monies were
being spent. It was noted that donated money was not being spent on the
Shelter or the animals.
The citizens of Redlands have donated thousands of dollars to the Shelter
over the years. The Grand Jury was shocked to find out that not all that
money has been used for the animals or the repair of the facility. Shelter
staff, instead of the City Maintenance Department, had been tasked to make
temporary repairs.
As of the Grand Jury’s more recent visit on August 12, 2022, much had
changed. Under the new management of the Shelter by F&CS, the City has
put out a request on their job openings page for volunteers. They are also
trying to hire Kennel Attendants (KAs) and Animal Control Officers (ACOs).
There are new temporary front office personnel. The employees seem
happy. The courtyard now has shade sails, and the dangerous, uneven
asphalt has been replaced with new concrete. The temporary dog kennels
are gone. The Grand Jury saw new cat cages, and a misting system for the
dogs was working and was positioned so that it cooled the kennels. There is
a new larger meet-and-greet area out front. Under the new department,
adoption rates are rising again at the Redlands Animal Shelter. The
Department of Facilities and Community Services is to be commended for
these swift and positive changes.
Although these recent changes were necessary, these changes are not
enough. And why did it take the City of Redlands so long for their animals to
receive a better level of care?

METHODOLOGY
The 2022 San Bernardino County Civil Grand Jury reviewed documents,
receipts, contracts, budgetary records and forms regarding the City of
Redlands Animal Shelter. The Grand Jury also read the Veterinary
Standards report which is referred to as the Guidelines for Standards of Care
in Animal Shelters (Guidelines).
The investigative research included reading the websites of many national
animal groups including those of Best Friends Animal Society, the University
of California at Davis, and Cal Animals.
The Grand Jury interviewed some complainants, multiple witnesses
including former and current employees of the City of Redlands, employees
of the Redlands Police Department, and staff at the Shelter, along with staff
of other shelters in the Southern California area. The Grand Jury also
questioned former RAS volunteers and many rescue group members. Some
Redlands citizens were interviewed. The Jurors talked to interviewees about
modern, humane and effective ways of managing animal shelters. The
Grand Jury found many helpful viewpoints and ideas of how a modern shelter
should be run.
The Grand Jury visited multiple shelters in the area for different perspectives
on managing an effective and humane animal shelter. Best practices were
researched for current ideas of modern sheltering of animals. Finally, the
Grand Jury observed the City of Redlands Animal Shelter facility and
reviewed the Redlands City website for more information.
DISCUSSION
Hayden’s Act and Standards of Care
Hayden’s Act (SB 1785) was enacted in 1998 to codify how shelter animals
in California are treated, adopted out and returned to owners. It includes an
explicit provision that shelters, including public shelters, are depositories of

living animals (Civil Code § 1815, 1816) responsible for treating those
animals kindly (Civil Code § 1834). Hayden’s Act also has a requirement that
California Animal Shelters release animals to Internal Revenue Code §
501(c)(3) animal rescue and adoption groups that have requested an animal
prior to his/her euthanasia. (Food and Agricultural Code § 31108, 31752,
31752.5, 31753, 31754). Hayden’s Act requires that shelters use all
reasonable means of checking for owner-identification (Penal Code § 597.1).
Modern Concepts of Standards of Care in Animal Shelters
The Guidelines for Standards of Care in Animal Shelters (Guidelines) are

intended as a positive tool for shelters and communities to:
• review animal care
• identify areas that need improvement
• allocate resources and implement solutions so welfare is optimized,
euthanasia is minimized, and suffering is prevented
The Association of Shelter Veterinarians (ASV) wrote the Guidelines. ASV is
an international organization whose mission is to improve the health and
well-being of animals in shelters. The Guidelines were written by experts
from many countries to provide information that will help any animal welfare
entity meet the physical, mental and behavioral needs of animals in their
care. The Guidelines were developed to identify minimum standards of care,
as well as best and unacceptable practices.
The Five Freedoms and Animal Welfare
The American Veterinarian Medical Association (AVMA) has brief guidelines

called AVMA Animal Welfare Principles (The Principles) for companion
animals including some recommendations for humane societies. This
organization wrote its report as an American model for the treatment of
animals, using the international Guidelines referenced above. The AVMA
stated in The Principles that animals should be treated with respect and
dignity throughout their lives. These welfare principles are known as The Five

Freedoms (originally written by the Farm Animals Welfare Council). These
principles provide a model that is applicable across species and situations
including animal shelters. The Five Freedoms are broadly accepted as
guidelines for welfare of all animals in the United States. The Five Freedoms
are as follows:
1. Freedom from hunger and thirst. Have ready access to fresh water and
a diet to maintain full health and vigor.
2. Freedom from discomfort. Provide an appropriate environment
including shelter and a comfortable resting area.
3. Freedom from pain, injury and disease. Provide prevention of disease,
or rapid diagnosis and treatment.
4. Freedom to express normal behavior. Provide sufficient space, proper
facilities and company of the animal’s own kind.
5. Freedom from fear and distress. Ensure conditions and treatment
which avoid mental suffering.
The Guidelines for Standards of Care in Animal Shelters has been written
using the Five Freedoms for Animal Welfare as the basis for all sections in
the document.
The 2022 San Bernardino Civil Grand Jury reviewed the Guidelines, the Five
Freedoms, as well as California’s Hayden’s Act for this report. Standards of
care referenced in the following discussion are based on the principles
published in all three publications.
Under the Police Department
Historically, the Redlands Animal Shelter has been under the direction of the
Redlands Police Department (RPD) which has reported to the Redlands City
Council. Evidence established that under the RPD umbrella the Redlands
Animal Shelter has been understaffed and that facilities had deteriorated.
This is understandable in some ways, because the Police Department is
charged with reducing crime, reinforcing the law in the City, serving the public
and keeping everyone safe. Consequently, the needs of the Shelter had
been ignored.

Before 1984, many animal shelters were considered more like a “pound” as
depicted in old cartoons. Animals were caught and put in a jail-like setting.
During the Redlands Police Department’s tenure, the Shelter was not fully
staffed with people who were knowledgeable and highly trained in sheltering
and managing shelter animals.
No Permanent Shelter Manager
For years, managing the shelter was rotated among different police officers
in management. The Grand Jury was shocked to discover there has never
been a permanent and full-time Shelter Manager. The Supervising Animal
Control Officer (Supervising ACO) was also required to oversee ACOs
(including sometimes going out on field calls), Kennel Attendants (KAs) and
Customer Service Representatives (CSRs). The Supervising ACO was also
in charge of managing medications, reaching out to rescue groups for help
and planning community events.
A permanent, full-time Shelter Manager would be at the Shelter daily, making

sure that all tasks are done, repairs are completed, and animals are properly
cared for and comfortable. The duty of the Shelter Manager is to be educated
and trained in all areas of animal care, shelter management and leadership.
The Grand Jury strongly recommends a full-time Shelter Manager be hired

whose ONLY job is overseeing the Shelter operations. A permanent Shelter
Manager could track expired medications, oversee cleaning of animal cages
and educate himself/herself and the Shelter staff in current standards of care.
In more recently constructed shelters in the local area toured by the Grand
Jury, animals are now being housed in comfortable, inside kennels and
cages that are air conditioned. The pets are exercised and socialized daily,
cleaned, fed and watered constantly. Long term stays are discouraged.
Shelters are fully staffed, and the employees are trained in animal care.
Management, employees, rescue groups, foster families, community animal

Volunteers were no longer welcome; the facility needed numerous repairs or
possibly even a new building; there was little attempt to reunite lost animals
with their owners. Adoptions were handled by appointment only during hours
that many adults were working. The Redlands City budget sets aside money
designated to the Shelter every year for salaries, operating expenses, and
continuing education. However, there is little to no education for employees,
no training manuals, no Policy and Procedures Manual and no incentives for
employees to seek out training opportunities. Additionally, there is no
preparation on how to work with other adults in creating and maintaining a
work environment that is positive for the employees. The Shelter has no idea
what the best practices for animal shelters are. If the City of Redlands was a
family, and truly worked for the good of the animals, the Animal Shelter would
not be forgotten.
BACKGROUND
After multiple complaints were received by the 2022 San Bernardino County
Civil Grand Jury, the Grand Jury decided to investigate the operations of the
During a Grand Jury visit to the Shelter on July 1, 2022, the Grand Jury
experienced the Shelter’s still closed-to-the-public COVID-19 policy while
other City offices were open. The Jurors also found that the Shelter building
was old. The kennels were made of chain link, were outside, and had no
shade. The cages in the cat room were small, overcrowded, and unclean.
The Grand Jury discovered that the Redlands Animal Shelter was built in
1985, with three office renovations since then. The rest of the Shelter was in
a sad and embarrassing state of disrepair.
For decades, the Redlands Animal Shelter had been under the direction of
the Redlands Police Department. However, in July 2022, that was changed.
It is now the Department of Facilities and Community Services (F&CS) of
Redlands that oversees all Shelter operations.
As the investigation continued, evidence revealed that volunteers had
always been welcomed at the Shelter, until recently. Even though the Shelter

was closed in March 2020, due to COVID-19, no volunteers were allowed
into the facility even with protective equipment. At least one volunteer was
escorted off the premises by the Redlands Police Department. Paid staff,
needed to care for the animals, was at a bare minimum. Partnerships with
local rescue groups and other shelters had ceased to exist. Even the number
of families willing to foster animals had declined.
While people used to be able to walk into the Shelter and look for their lost
pet, now they needed to make an appointment and have internet access to
email a picture of their lost animal to the Shelter, or to even check for their
lost pet online. The website used to provide information about Shelter
animals is 24PetConnect.com. Evidence demonstrated that this website was
complicated to use. It was very difficult to obtain information regarding the
lost animal because the only easy search on the website was done by
searching for the Animal Control number of the lost animal (which the pet
owner would have no way of knowing). Beyond that, no one at the closed
Shelter could assist them.
Instead of properly storing donated food so that it would not spoil or expire,
the food sat uncovered in the hot summer sunshine, quickly spoiling, with
the cardboard boxes fading in the 90+ degree heat. Thus, the donated food
for the animals had to be thrown out. A less wasteful option would have been
to offer it to either another shelter or a rescue. Knowledgeable staff, who
among other things would have known where to store the food, were no
longer employed by the Shelter, like the much-needed volunteers.

There were also concerns about where budgeted and donated monies were
being spent. It was noted that donated money was not being spent on the
Shelter or the animals.
The citizens of Redlands have donated thousands of dollars to the Shelter
over the years. The Grand Jury was shocked to find out that not all that
money has been used for the animals or the repair of the facility. Shelter
staff, instead of the City Maintenance Department, had been tasked to make
temporary repairs.
As of the Grand Jury’s more recent visit on August 12, 2022, much had
changed. Under the new management of the Shelter by F&CS, the City has
put out a request on their job openings page for volunteers. They are also
trying to hire Kennel Attendants (KAs) and Animal Control Officers (ACOs).
There are new temporary front office personnel. The employees seem
happy. The courtyard now has shade sails, and the dangerous, uneven
asphalt has been replaced with new concrete. The temporary dog kennels
are gone. The Grand Jury saw new cat cages, and a misting system for the
dogs was working and was positioned so that it cooled the kennels. There is
a new larger meet-and-greet area out front. Under the new department,
adoption rates are rising again at the Redlands Animal Shelter. The
Department of Facilities and Community Services is to be commended for
these swift and positive changes.
Although these recent changes were necessary, these changes are not
enough. And why did it take the City of Redlands so long for their animals to
receive a better level of care?

METHODOLOGY
The 2022 San Bernardino County Civil Grand Jury reviewed documents,
receipts, contracts, budgetary records and forms regarding the City of
Redlands Animal Shelter. The Grand Jury also read the Veterinary
Standards report which is referred to as the Guidelines for Standards of Care
in Animal Shelters (Guidelines).
The investigative research included reading the websites of many national
animal groups including those of Best Friends Animal Society, the University
of California at Davis, and Cal Animals.
The Grand Jury interviewed some complainants, multiple witnesses
including former and current employees of the City of Redlands, employees
of the Redlands Police Department, and staff at the Shelter, along with staff
of other shelters in the Southern California area. The Grand Jury also
questioned former RAS volunteers and many rescue group members. Some
Redlands citizens were interviewed. The Jurors talked to interviewees about
modern, humane and effective ways of managing animal shelters. The
Grand Jury found many helpful viewpoints and ideas of how a modern shelter
should be run.
The Grand Jury visited multiple shelters in the area for different perspectives
on managing an effective and humane animal shelter. Best practices were
researched for current ideas of modern sheltering of animals. Finally, the
Grand Jury observed the City of Redlands Animal Shelter facility and
reviewed the Redlands City website for more information.
DISCUSSION
Hayden’s Act and Standards of Care
Hayden’s Act (SB 1785) was enacted in 1998 to codify how shelter animals
in California are treated, adopted out and returned to owners. It includes an
explicit provision that shelters, including public shelters, are depositories of

living animals (Civil Code § 1815, 1816) responsible for treating those
animals kindly (Civil Code § 1834). Hayden’s Act also has a requirement that
California Animal Shelters release animals to Internal Revenue Code §
501(c)(3) animal rescue and adoption groups that have requested an animal
prior to his/her euthanasia. (Food and Agricultural Code § 31108, 31752,
31752.5, 31753, 31754). Hayden’s Act requires that shelters use all
reasonable means of checking for owner-identification (Penal Code § 597.1).
Modern Concepts of Standards of Care in Animal Shelters
The Guidelines for Standards of Care in Animal Shelters (Guidelines) are

intended as a positive tool for shelters and communities to:
• review animal care
• identify areas that need improvement
• allocate resources and implement solutions so welfare is optimized,
euthanasia is minimized, and suffering is prevented
The Association of Shelter Veterinarians (ASV) wrote the Guidelines. ASV is
an international organization whose mission is to improve the health and
well-being of animals in shelters. The Guidelines were written by experts
from many countries to provide information that will help any animal welfare
entity meet the physical, mental and behavioral needs of animals in their
care. The Guidelines were developed to identify minimum standards of care,
as well as best and unacceptable practices.
The Five Freedoms and Animal Welfare
The American Veterinarian Medical Association (AVMA) has brief guidelines

called AVMA Animal Welfare Principles (The Principles) for companion
animals including some recommendations for humane societies. This
organization wrote its report as an American model for the treatment of
animals, using the international Guidelines referenced above. The AVMA
stated in The Principles that animals should be treated with respect and
dignity throughout their lives. These welfare principles are known as The Five

Freedoms (originally written by the Farm Animals Welfare Council). These
principles provide a model that is applicable across species and situations
including animal shelters. The Five Freedoms are broadly accepted as
guidelines for welfare of all animals in the United States. The Five Freedoms
are as follows:
1. Freedom from hunger and thirst. Have ready access to fresh water and
a diet to maintain full health and vigor.
2. Freedom from discomfort. Provide an appropriate environment
including shelter and a comfortable resting area.
3. Freedom from pain, injury and disease. Provide prevention of disease,
or rapid diagnosis and treatment.
4. Freedom to express normal behavior. Provide sufficient space, proper
facilities and company of the animal’s own kind.
5. Freedom from fear and distress. Ensure conditions and treatment
which avoid mental suffering.
The Guidelines for Standards of Care in Animal Shelters has been written
using the Five Freedoms for Animal Welfare as the basis for all sections in
the document.
The 2022 San Bernardino Civil Grand Jury reviewed the Guidelines, the Five
Freedoms, as well as California’s Hayden’s Act for this report. Standards of
care referenced in the following discussion are based on the principles
published in all three publications.
Under the Police Department
Historically, the Redlands Animal Shelter has been under the direction of the
Redlands Police Department (RPD) which has reported to the Redlands City
Council. Evidence established that under the RPD umbrella the Redlands
Animal Shelter has been understaffed and that facilities had deteriorated.
This is understandable in some ways, because the Police Department is
charged with reducing crime, reinforcing the law in the City, serving the public
and keeping everyone safe. Consequently, the needs of the Shelter had
been ignored.

Before 1984, many animal shelters were considered more like a “pound” as
depicted in old cartoons. Animals were caught and put in a jail-like setting.
During the Redlands Police Department’s tenure, the Shelter was not fully
staffed with people who were knowledgeable and highly trained in sheltering
and managing shelter animals.
No Permanent Shelter Manager
For years, managing the shelter was rotated among different police officers
in management. The Grand Jury was shocked to discover there has never
been a permanent and full-time Shelter Manager. The Supervising Animal
Control Officer (Supervising ACO) was also required to oversee ACOs
(including sometimes going out on field calls), Kennel Attendants (KAs) and
Customer Service Representatives (CSRs). The Supervising ACO was also
in charge of managing medications, reaching out to rescue groups for help
and planning community events.
A permanent, full-time Shelter Manager would be at the Shelter daily, making

sure that all tasks are done, repairs are completed, and animals are properly
cared for and comfortable. The duty of the Shelter Manager is to be educated
and trained in all areas of animal care, shelter management and leadership.
The Grand Jury strongly recommends a full-time Shelter Manager be hired

whose ONLY job is overseeing the Shelter operations. A permanent Shelter
Manager could track expired medications, oversee cleaning of animal cages
and educate himself/herself and the Shelter staff in current standards of care.
In more recently constructed shelters in the local area toured by the Grand
Jury, animals are now being housed in comfortable, inside kennels and
cages that are air conditioned. The pets are exercised and socialized daily,
cleaned, fed and watered constantly. Long term stays are discouraged.
Shelters are fully staffed, and the employees are trained in animal care.
Management, employees, rescue groups, foster families, community animal

societies, non-profit groups, volunteers and the general public all work
together to make sure the animal’s stay is as comfortable and as short as
possible. A permanent Shelter Manager, working full-time and not splitting
the time with other responsibilities, would ensure all these actions occur.
According to evidence reviewed during the investigation, this is the most
important change needed immediately for the Redlands Animal Shelter.
Finally, as the Grand Jury discovered during its investigation, the Redlands
Police Department had tried to operate the Redlands Animal Shelter as a
for-profit business. An animal shelter is a community service designed to
serve the public and the animals of the area. It must be run as such, and a
permanent Shelter Manager must understand this. In other words,
conducting a shelter like a business is incompatible with public service.
Facility Problems
Deterioration of the Facility of Redlands Animal Shelter
The Redlands Animal Shelter was built in the mid-eighties. Thirty-seven

years later, the facility is in desperate need of renovations. Evidence
revealed the only renovations done at the Shelter were to replace the front
lobby floor (once) and renovate the Supervising ACO offices (twice!). The
animals’ quarters were not redone. The issues observed by the Grand Jury
on its visit of 7.1.22 are as follows:
• Plugged drains
• Inoperable doors (guillotine-style) separating the two sides of the dog
kennels
• A lack of shade for the dogs
• Hot outdoor kennels made of chain link
• Temperatures were above 94 degrees in the kennels in the late
morning

• No air conditioning provided for the dogs when they are in the back half
of their kennel
• Some of the misters for the dogs not working properly

• Some of the mister valves over the dog kennels were pointed away
from the dog kennels and not providing cooling for the dogs
• The indoor cattery had small cat cages with multiple cats and kittens
creating crowding
• In the cattery, air conditioning did not work at least two times per week
• Cat feces observed in food, and cat food very close to cat litter
• Litter boxes not emptied

• Empty water and food bowls, some bowls dirty, and some bowls
knocked over by dogs spreading the food over the kennel floor
• Dogs and cats ungroomed and some dirty and matted
• Dangerous opening in chain link dog kennel; potential injury to a dog
• Freezer for animal remains close enough to the front lobby for the odor
to spread to the front office
Both dog and cat kennels need to be replaced. The cattery also needs to be
replaced. The City of Redlands’ multiple yearly budgets show goals for
improvements to the Shelter and monies allocated for those improvements.
Therefore, the City has recognized the problems with the Shelter. Evidence
established to the contrary and the Grand Jury’s observations of the
Redlands Animal Shelter demonstrated that these improvements had not
been completed prior to July 2022.
Finally in August 2022, some improvements were implemented at the

Shelter, including the addition of shade sails, replacing asphalt with concrete,
resetting misters and employing ServPro. Although there is still much to be
accomplished, the Grand Jury recognizes and appreciates the work of the
City of Redlands Facilities and Community Services Department for what
they have done thus far.

However, there is still no air conditioning in the interior section of the dog
kennels. This is Southern California where temperatures can reach well over
100 degrees. The interior section of the dog kennels does have a heater,
which only works intermittently, for cold weather, according to multiple
witnesses. Staff make necessary repairs to broken guillotine door ropes so
the dogs can go from inside to outside without assistance. According to the
Guidelines, inside/inside or inside/outside kennels are now the standard of
care for sheltered animals. Redlands Animal Shelter is encouraged to build
new facilities that conform to modern standards.
Recently, the Facilities and Community Services Department of Redlands

finally contracted with ServPro to assist in cleaning kennels. This will
continue, according to the management, until there are enough staff and
volunteers to keep the Shelter clean. The Grand Jury notes, that as of August
12, 2022, there have been positive changes at the Redlands Animal Shelter.
Substandard Level of Care for the Animals
On more than one occasion, the evidence showed that dogs and cats who
were confined without daily play, exercise or enrichment could be in various
stages of distress. When dealing with the confinement or sheltering of
animals for varying periods of time, the following concepts, paraphrased from
the Guidelines, should be considered:
1. The concept of enrichment refers to a process for improving the

environment and behavioral care of sheltered or confined animals to
meet their emotional and psychological needs. This means to bring the
cats and dogs out of their cages in order to interact with people and
other animals. Enrichment reduces stress and will improve well-being
by providing physical and mental stimulation. Shelters that have
scheduled periods for enrichment are successful in helping to prevent
the development of abnormal behavior in sheltered animals.
Enrichment is as important as nutrition and veterinary care.

2. Even a short-term stay in a shelter can compromise the health of an
animal by causing stress. When confined for days and weeks at a time,
without being allowed out of their kennels to exercise, the animals can
suffer from chronic anxiety, isolation, lack of mental stimulation and
lack of physical exercise. Stress can lead to the development of
abnormal behaviors. The behavior problems compromise the health
and well-being of the animals and lessen the potential for adoption.
Animals kept in shelter situations must be provided with exercise and
enrichment daily to help reduce stress.
Lack of Documentation/Incomplete Identification
Animals housed at the Redlands Animal Shelter have no clear records on

the outside of their cages to let the public know how long they have been
housed at the Shelter. Some kennels/cages do not have any information
posted about the animal. Information such as:
• Gender
• Breed (most of the dogs are a mixed breed)
• Age
• Date the animal entered the Shelter
It is unclear if the Chameleon Computer System used by the RAS has correct
information on every animal in the Shelter, and how long each animal has
been there. The Grand Jury requested “Outcome” (an indication of what
happened to each animal) pages printed out from the computer system at
the Shelter, but never received them. For example, during the Shelter visit of
8.12.22, one cat was not listed in the computer system used by Redlands
Animal Shelter to track animals. The cat was deemed to be too old to be
adopted and so had never been put into the system. The Grand Jury strongly
recommends that every animal at the Shelter be entered into the system,
and that every animal cage have information posted on the outside for the
public to see.

Expired Medication
During the third visit to RAS the evidence showed there were several bottles
of expired medications stored in the care room of the facility. The expiration
dates of these medications ranged from three months out-of-date to three
years out-of-date. Most of the medications were antibiotics. Also, several
vials of prescription medication had expired. Expired medication can be
hazardous to the health of the animals and should be disposed of properly.
Because of the potentially critical nature of this problem, the situation was
brought to the attention of the head of F&CS via a letter from the Grand Jury.
The Grand Jury is very pleased to note that within two weeks of receipt of
the letter, the F&CS Department responded and assured the Grand Jury that
the expired medications were removed from the facility. The F&CS
Department is to be commended for their prompt response.

No Volunteer Program
Redlands Animal Shelter has had positive support from community

volunteers and other local rescue groups. Redlands’ citizens have been very
generous to the Shelter, both monetarily, and with donations of food,
blankets, cat litter and volunteer hours.
The Shelter was closed to the public from March 2020 to July 2022. The
reason for the closure initially was the Covid Pandemic, but as time went on,
City leadership decided the Shelter must remain closed after other Redlands
City offices had reopened.
As of August 12, 2022, the volunteer program was still not up and running at
the Redlands Animal Shelter. Lack of volunteers has caused multiple
problems at the RAS: animals are not socialized/exercised, and staff are not
freed up to do their assigned daily tasks. Volunteers had been cleaning
cages/kennels, checking food and water, washing bowls and doing laundry,
freeing up the staff to complete their daily routines. Volunteers are an
essential part of the Redlands Animal Shelter.
The Department of Facilities and Community Services is commended by the

Grand Jury for the recent postings for volunteer positions at RAS. The
community, the Shelter, and the animals deserve a robust volunteer
program. But the GJ was flabbergasted to find out that the new department
is looking at hiring only 10 volunteers, and no Shelter Volunteer Coordinator.
What? The evidence revealed that approximately 24 people had applied for
a volunteer position as of August. The F&CS Department is strongly
encouraged to hire as many volunteers as possible, as well as a paid
Volunteer Coordinator specific to the Shelter to organize and train the
volunteers.

Staffing Problems
Staffing problems are not unique to the last four years at the RAS. Evidence
revealed that keeping staffing at a level where the animals could be
adequately cared for has been a problem at the Shelter during most of its
history. A fully staffed Redlands Animal Shelter would include:
• Three full-time Kennel Assistants
• Three full-time Animal Control Officers
• Two full-time Customer Service Representatives
• One full-time Shelter Supervisor
Being fully staffed would also include as many volunteers as possible and a
paid Volunteer Coordinator specific to the Shelter.
However, in the last few years, the RAS has had a low level of staffing. In
2018, the Shelter endured months when there was no ACO Supervisor at
the Shelter. Management from the Police Department stepped in to fill the
gap for almost a year. At that time, volunteers were used to clean, feed,
water, exercise and socialize the animals and organize events, since the staff
level was low.
During the closure, the Shelter was trying to operate with a skeleton crew
and no volunteers, which meant the cleaning tasks at the RAS were difficult
to complete daily. Two Kennel Assistants were laid off at the beginning of
the Pandemic and a Customer Service Representative was exchanged for
an Animal Control Officer. ACOs were told to take over the duties of the
Kennel Assistants, who were laid off. The staff became too small to get
everything done (especially without volunteers) and the Redlands Police
Department did not fill the empty positions nor allow volunteers back.
Volunteers could have reentered the Shelter with masks and vaccine
requirements and/or negative Covid test results in place. However, evidence
showed the Shelter remained closed while other Redlands’ offices reopened.

Training highly experienced individuals and then offering them competitive
wages and continuing training opportunities will help solve the staffing
problems of the Shelter in the years to come. The Facilities and Community
Services Department is encouraged to keep the Shelter always fully staffed.
Lack of Training/Continuing Education
The GJ found there is no Shelter or job-specific training programs, such as

animal handling, zoonotic diseases, etc., for the employees at the Redlands
Animal Shelter. The RAS also has no training manual nor a Policy and
Procedures Manual. There are no volunteer training handbooks, training
manuals and/or guidelines. All of these are essential to proper and effective
staff operations. See below an example of a volunteer training program from
Best Friends, online:
Sample volunteer training taken from network.bestfriends.org:

Level 1: Level 2: Level 3:
Trained in cleaning Level 1 training plus a Levels 1 & 2 training
and sanitation of all script for talking to the plus training on
areas of the shelter: public and answering hygiene for all the
lobby, offices, outside, questions with in- animals, paperwork for
kennels, cattery, person visitors. fostering animals and
play/exercise area. Correctly answering adoptions.
Have a clear telephones and taking Putting together meet-
understanding of the messages. Washing and-greet events with
animal shelter’s and drying dishes, the shelter and
mission and duties of towels, bedding. potential adopters.
all volunteer positions. Feeding and watering Setting up and running
of all animals. Taking fundraising events for
animals out from the Shelter in public
kennels and cattery to areas around the city.
meet potential
adopters at the shelter.

Recommended 40-45 Recommended 40-45 Recommended 40-60
hours. hours. hours.
However, volunteers and Kennel Assistants at the Redlands Animal Shelter

receive very little training. Many Animal Control Officers are not trained
adequately. Their only training consists of two days to two months as a ride-
along with another ACO out in the field. Most ACOs at the Redlands Shelter
are not certified to perform euthanasia, even though euthanasia is a part of
their job. There is no training at all for Customer Service Representatives.
Initial and continuing education offered to all leadership and staff will help
train employees in areas such as updated laws, leadership, infectious
diseases, animal behavior, how to inspect animals upon intake, cleaning
techniques, and working with the public. The Department of Facilities and
Community Services is encouraged by the Grand Jury to thoroughly train all
employees and managers.
Training for Sexual Harassment and Adverse Working Conditions
Redlands Animal Shelter staff and management need additional and more
effective training in the area of adverse working conditions. The employees
would benefit from learning how to recognize and report sexual harassment.
The Human Resources Department currently handles sexual harassment
training for the City of Redlands. Evidence showed the Shelter needs more
specific training in this area. Site-specific role-play scenarios and extensive
training of all employees at the RAS will help clarify this issue. Those in
leadership positions and staff alike will learn in-depth the meaning of sexual
harassment and adverse working conditions. The Grand Jury recommends
any staff member reporting harassment and/or adverse working conditions
to report anonymously (if desired) and directly to the City Attorney, the
Director of the F&CS, and Human Resources. The City needs to implement
and inform the RAS personnel how they may report.

Foster Care of Shelter Animals
Fostering shelter animals is a method for the Shelter to provide care in a

home environment. Foster families take shelter animals into their homes.
The Shelter had no standardized procedure for foster care of the pets as of
8.12.22. There is no Policies and Procedures Manual for the RAS. When one
is written, it is essential that it includes a section on the procedures used
upon intake of animals, and how to find fostering situations for the pets.
Well-run foster care programs can increase the capacity of the Shelter and
their ability to intake more animals, as foster animals can reside in homes
rather than in the Shelter. A shelter can be a very stressful place for pets,
and that stress can weaken immune systems and increase vulnerability to
illnesses. Providing a less stressful housing option can often speed recovery,
minimize behavioral deterioration, and increase chances for adoption.
The Department of Facilities and Community Services is to be commended

for reinstating the Foster Care program at the Redlands Animal Shelter as of
September 2022, according to the City’s website.
No Reaching out to, and Refusal of Help from, Rescue Groups
Evidence showed during the last four years few or no non-profit/rescue

organizations have been contacted for help at the RAS. Even more
concerning, when organizations like The Redlands Humane Society,
REDfosa and other non-profit rescue groups asked to help animals at the
Shelter, the answer was that the animals and staff were fine and didn’t need
help.
The Grand Jury found that in prior years the Shelter had worked with dozens
of local rescues. But in the last four years, the Shelter was working with a
limited number of rescues, even going so far as to refuse offers from local

rescues. The Redlands Animal Shelter, as of August 2022, has a list of seven
rescue groups to contact. The evidence revealed that other shelters in the
area keep a list of, and contact with, over 100 of these groups for help in
placing the shelter animals.
Reestablishing ties with REDfosa, the Redlands Humane Society, and as

many local rescue non-profit organizations as possible will help the animals
receive the medical care and rehabilitation needed to be adoptable. The
F&CS Department is encouraged to strengthen these relationships, keep
lists of all rescue groups in the area, and reach out to them at least monthly
beginning immediately.
Lack of Adoption/Meet-and-Greet Events
Because the volunteer program at the Redlands Shelter was abruptly halted
in March 2020, and three experienced employees were furloughed, the
Shelter lost most of its ability to do Adoption/Meet-and-Greet events in the
City. The experienced furloughed staff and volunteers had conducted a
majority of these events.
The volunteer program has recently been reinstated as of September 2022,

per the City of Redlands website. Hopefully, the Facilities and Community
Services Department will hire as many volunteers as possible and a
Volunteer Coordinator to organize them. These volunteers, along with
management and staff, could begin to reinstate Adoption/Meet-and-Greet
events.
Meet-and-Greet and Adoption events benefit both the animals and the public
who would like to adopt animals. The Grand Jury finds that having at least
six of these events per year would help animals find forever homes.

Following the Money/Budget Concerns
Donations to the Shelter
One of the functions of the Chameleon Computer system serves is to allow

the Shelter to handle cash donations made by visitors at the Shelter. The
donation amount received is entered into the computer program and the
program generates a receipt for the donor. Evidence shows that, while a
receipt is supposed to be generated for each donation (and a copy given to
the donor), this does not always happen.
The City Treasurer also has access to Chameleon and can verify that the
Shelter turns in all donations received to the treasurer. This is done on a
weekly basis. However, evidence has shown that individual donations are
rarely entered into the City’s books. Weekly donations are shown as a total
amount of donations received from the Shelter and are entered as one entry
into the City’s accounting software. Rarely is there a donation with its
intended purpose entered into the system, ensuring that the donation is used
as requested by the donor.
Thus, the Grand Jury finds that there is an inability for the public to verify
how donations to the Shelter are used, indicating that there is a lack of
transparency and accountability for donation money spent.
The Shelter also receives non-cash donations. Not all the donations received
are used by the Shelter. Multiple interviews established that the Shelter
received non-cash donations for which they had no use. These items
included blankets or animal toys. Rather than refuse the donation or offer it
to another shelter or rescue, the Shelter simply threw the items away.
Additionally, according to various yearly budgets, the Shelter has received

multiple large donations of pet food. A tour of the Shelter on 7.1.22 by the

Grand Jury found palettes of canned cat and dog food that had been sitting
in the sun rather than in a protected location. At the subsequent visit on
8.12.22, the cans had been removed.
It Is unclear to City residents as to whether all monies and supplies donated

to the Shelter are used for the intended purposes.
Volunteers Spending Their Own Money
Evidence has established that some volunteers used their own money to buy
supplies that were needed by the Shelter as the supplies were not always
available when the volunteers came to work. Some of the items they
purchased included tarps for shade, bleach and other cleaning supplies.
Supplies should have been ordered and available at the Shelter, or the Petty
Cash fund should have been used for these purchases. It is offensive to the
Grand Jury that, in addition to donating their time and talent to the Shelter,
the volunteers also ended up purchasing supplies with their own hard-earned
money when they were told that no Petty Cash was available.
Bids for Veterinary Services
The City has a long-term contract with a veterinarian that exceeds the
predetermined standard term between the City and its vendors. The current
contract between the City and a veterinary service was agreed to when the
Shelter was part of the Police Department. The contract was for three years,
with an effective date of July 2018 through June 2021. It provided for a yearly
renewal option for the two subsequent years (July 2021 through June 2022
and July 2022 through June 2023). The contract was renewed for both years.
This exceeds the length of time for which the City normally signs contracts.
Evidence revealed that City contracts are normally yearly and the longest
term that most departments enter into is a contract for three years. This is a
concern for multiple reasons including potential higher prices because of

favoritism or lack of competitive bids. Yearly bids for this contract need to be
made, as is the standard, for other City departments.
Fundraising Events
Fundraising events are used to raise money for a shelter. Parades, parties
and 5-K walk/run events are a few examples. Evidence has shown there
have been no fundraising events coordinated by the Redlands Animal
Shelter since 2018. Volunteers had previously helped with offsite fundraising
events. The volunteers who had helped plan, coordinate and hold community
fundraising events were no longer there. The Department of Facilities and
Community Services is strongly encouraged to begin holding fundraising
events for the Shelter.
Lack of Grant Writing Success
The City has been unsuccessful in obtaining grants for the Redlands Animal
Shelter from any governmental or private entity, or from nonprofit
organizations. The Grand Jury recommends the permanent full-time Shelter
Manager be trained in grant writing. This would give the RAS an opportunity
to obtain more money for the Shelter. Other shelters in the area have been
able to obtain grants for help with extra staff, medicinal care, educational
opportunities and other purposes.
Lack of Oversight/Accountability of the Redlands Animal Shelter
The City of Redlands Animal Shelter has no independent Animal

Commission overseeing the operations of the Shelter, unlike many other
agencies in the City. The Redlands City Council has appointed multiple ad
hoc committees to watchdog different agencies in Redlands. For example:
the Street Tree Committee, the Citrus Preservation Commission and the
Traffic and Parking Commission, just to name a few.

There is an urgent need for an independent group (no one employed by the
City of Redlands) to oversee the operation of the Animal Shelter. An Animal
Oversight Committee appointed by and reporting to the City Council and the
people of Redlands will inform the City and the public about
problems/improvements within the Shelter.
An independent Animal Commission will observe the operations at the

Shelter, and then report its findings to the City Council every quarter. The
commission will make suggestions to the City Council about improving the
facility, the staff training and the care of the animals, along with budgetary
ideas. This commission would consist of local citizens, local veterinarians,
national and local animal experts, animal rescue group members, a
Redlands Humane Society member and others interested in helping the
animals.
This ad hoc committee will set up a formal written system for answering
complaints/concerns from the public. The system would include a method of
receiving complaints, copying them, logging them, and answering them.
Then the Animal Commission will present these to the City Council quarterly.
Citizens will have more transparency about concerns regarding the RAS and
the solutions proposed to address them.
Budgetary and donation concerns will also be addressed by this committee.

The City website will be updated to reflect the new formal and written
complaint procedure and system, along with the resolutions. The website will
also explain the system that records and uses the donations given to the
Shelter. The citizens and government of Redlands will have more
transparency.
In addition, according to the City of Redlands webpage, the treasurer has

the responsibility to report monthly to the City Clerk all revenue received and

money spent. There was nothing reported about the Shelter by the City Clerk
to the City Council, per the minutes of the June and July 2022 meetings. The
City has multiple Commissions and Boards, some of which provide financial
information during City Council meetings. If this information was provided at
Council meetings or on the website monthly, it would help with accountability,
openness and trust.
Reporting of Euthanasia
The Redlands Police Department reports to the City Council concerning

euthanasia have been brief and misleading. Instead of reporting out the
“Asilomar Live Release Rate” of animals when reporting euthanasia, RPD
reported the numbers of animals euthanized each year. (The “Asilomar Live
Release Rate” is the percentage of animals that leave a shelter alive).
The raw numbers of animals euthanized has been dropping but the City
Council and the public do not see the true picture and have no transparent
facts if the Asilomar Live Release Rate is not reported. This is because the
live release rate reflects the percentage of animals that leave the shelter alive
verses just reporting several animals that were euthanized. The Department
of Facilities and Community Services is encouraged to use the Asilomar Live
Release Rate when reporting euthanasia to the City Council. Euthanasia
facts including the live release rate at the Redlands Animal Shelter will be
posted online as well, so the community has a better understanding of the
facts.
The Shelter was keeping animals for many months at a time. Therefore,
reporting just the number of euthanasia did not provide an accurate picture
of Shelter outcomes. Some pets at the Shelter have lived in their cages for
several months. No animal should be kept in a shelter for months or years
waiting for adoption or fostering, according to the Guidelines. More effort
needs to be made to make sure the pets’ stays in the Redlands Animal
Shelter are short. The Grand Jury recommends that the Shelter keep and
use extensive lists of foster families and rescue groups. These groups are to
be contacted monthly to take animals who have been in the Redlands Animal
Shelter. Digital and hard copy records of these contacts need to be kept and
reported out.

Accountability
The new department in charge of the Shelter (F&CS) will help the oversight
of the Redlands Animal Shelter in the future by:
• Updating the City of Redlands’ website to include a dedicated
Redlands Animal Shelter site with informational pages which include
quarterly explanations about the City’s budget for the Shelter as well
as reports about quarterly revenue and expenditures for the Shelter.
• On this Shelter website, including a detailed quarterly account of RAS
donations and where the donation monies were applied. These would
be reported to the City Council quarterly as well.
• Requiring employees at the RAS to advise donors how to identify
Shelter donations that are for a specific purpose when writing checks.
• Placing a formal complaint form on this RAS website will direct the
public on how to lodge an official complaint. Include a Redlands Animal
Shelter complaint form. (Complaints need to be kept in digital and hard
copy which would be reported to the City Council quarterly).
• Keeping digital and hard copies of fostering and adoptee applications
and reporting these to City Council quarterly.
• Keeping digital and hard copies of euthanasia records and Asilomar
Live Release rate of the Shelter and reporting these to the City Council
quarterly.
• Keeping digital and hard copies of the total months each animal has
spent at the Redlands Animal Shelter, along with digital and hard copy
written accounts of each animal being offered to non-profit groups,
which would be reported out to the City and local newspaper(s)
monthly.
The citizens of Redlands, who have donated tens of thousands of dollars

and countless hours to the Shelter through the years, deserve no less. It is
time to answer the community concerns in an open and transparent way.
The Grand Jury is hopeful the F&CS Department and the Redlands City
Council will do so.

COMMENDATIONS
The Grand Jury notes that the new department overseeing the Redlands
Animal Shelter, Facilities and Community Services, has been eager to help
the Grand Jury in its investigation. They are to be commended, as we are all
interested in the health and well-being of animals.
Hope for the Future of the Redlands Animal Shelter
There is hope for the future of the animal shelter in Redlands and the pets
who live there. The move from the Police Department to the Facilities and
Community Services Department is a positive one. The Grand Jury has seen
more improvements in the months of July and August 2022 than the Shelter
has experienced the last four years.
Two new temporary front-desk workers and one new ACO have been hired.
ServPro is on contract to clean and sanitize the kennels five days per week.
There are plans to fix the drain in the feral cat area and expanding and adding
new cages to the cattery, which will be larger and more modern. To make
the Animal Control Officers and their vehicles look more friendly to the public,
changes are being made. New uniforms are on order that consist of polo
shirts and there will be new logos on the trucks. The building will get a new
look to make it look less like “the pound” and more animal friendly. There are
plans for an exercise area and new indoor kennels. The foster care program
has also been restarted, per the City website. And, finally, the volunteer
program is about to be up and running again since the city now has 20 plus
applications for volunteer positions. All of this is good news for the animals.
The Grand Jury sincerely hopes these changes continue to come about, and
that even more are on the way. This report contains multiple suggestions
that will help the F&CS Department with some great new ideas for the budget
and the Shelter. The citizens and animals of Redlands deserve it.

CONCLUSION
The Grand Jury came to several conclusions about the Redlands Animal
Shelter. The Shelter has no full-time permanent Shelter Manager at the site
daily. The facility needs to be replaced. The standard of care for the animals
in Redlands Animal Shelter has been extremely low. Hard-working
volunteers had kept the Shelter animals safe in the past by freeing up the
employees to do their jobs. Stopping the volunteer program left the staff
without enough hours to do their jobs, and the animals suffered.
The Shelter has also shown much organizational dysfunction through the
years under the Redlands Police Department. However, the Grand Jury does
see hope for the future. In the middle of the Grand Jury’s investigation, the
Shelter was moved to the Facilities and Community Services Department as
of July of 2022. The Grand Jury has seen many improvements since this
change. The Grand Jury hopes the Redlands Animal Shelter, the City
Council and the Redlands citizens will go forward and work together for the
animals.
FINDINGS
F 1: There have been no upgrades to the dog and cat cages at the Redlands
Animal Shelter since 1985.
F 2: The kennels are outside and the guillotine doors (which let the dogs go
into the shaded inner part of the kennel) are not working. Dog kennels do not
have adequate drainage. The kennels are hosed down once per day, and
the drains clog and feces cannot go down the drain as of 7.1.22.
F 3: The cats and kittens at the Redlands Animal Shelter are living in hot,
crowded spaces and the food and water are placed next to the litter boxes.

F 4: On the visit of 8.12.22 evidence of controlled drugs being stored and
locked up could not be located upon request.
F 5: There were expired medications at the Redlands Animal Shelter.
F 6: As of 7.1.22, the animals were lacking exercise, enrichment, and

socialization with other animals and people. Also lacking at the Redlands
Animal Shelter was shade for the animals. The animals were fed once a day
and fresh water was not always available.
F 7: Redlands Animal Shelter is not using the Asilomar Live Release Rate to
report to the City Council regarding euthanasia.
F 8: The Redlands Animal Shelter has not been reaching out to, and has
been refusing offers of help from, local rescue groups such as REDfosa and
the Redlands Humane Society.
F 9: As of August 2022, Redlands Animal Shelter had a list of seven rescue

groups with which to work. Before 2018, the Redlands Animal Shelter had
kept a list of forty-three rescue groups.
F 10: Redlands Animal Shelter has no permanent full-time Shelter Manager.
F 11: For months at a time, the Shelter had no on-site supervisor.
F 12: Staff level as of 8.12.22 was: two Kennel Assistants, two Animal
Control Officers and two temporary Customer Service Representatives.
F 13: Redlands Animal Shelter had no volunteers as of 8.12.22.

F 14: There have been multiple reports of sexual harassment at the
Redlands Animal Shelter. Lack of supervision and monitoring has provided
an atmosphere where sexual harassment opportunities can occur.
F 15: Redlands Animal Shelter has had one Community Adoption and/or
Meet-and-Greet event since 2018.
F 16: Redlands Animal Shelter does not have training manuals for volunteers
and staff. The Shelter has no Policies and Procedures Manual.
F 17: The Redlands Animal Shelter currently has no training for staff nor
Shelter Management in the basic operations of an animal shelter. For
example, courses such as:
• leadership training
• record-keeping
• animal population management
• medical and behavioral health of animals
• euthanasia
• animal transport
• preventing infectious diseases
• zoonotic disease control
• sanitation practices
• animal behavior management
• identifying contagious diseases
• animal handling
• customer service techniques
F 18: As of 8.12.22, only one Animal Control Officer at Redlands Animal

Shelter is certified by the State of California.
F 19: There is no tracking of specific individual donations that are made for
a specific purpose.

F 20: The City of Redlands website does not inform the public if the money
allocated for improvements at the Shelter is specifically spent on
improvements for the Shelter.
F 21: Redlands Animal Shelter volunteers have spent their own money on
shelter cleaning and other supplies.
F 22: Request for bids for veterinary services are not put out for competitive
bids annually.
F 23: Redlands Animal Shelter has not been holding fundraising events for
the Shelter to help fund medical care, adoption programs and improvements
for the Shelter.
F 24: Redlands Animal Shelter has not successfully acquired grants and has
no dedicated shelter grant writer and/or a Shelter Manager trained in writing
grants.
F 25: There has not been an objective operational audit (evaluation) done by
a qualified third party/agency regarding how to improve the operations at the
F 26: The Redlands City Council has no independent Animal Commission to

oversee the Redlands Animal Shelter and report the Shelter’s operations to
the City Council.
F 27: The City of Redlands has not implemented a formal written complaint
process for the public specific to the Animal Shelter.

RECOMMENDATIONS
R 1: The Grand Jury recommends that the City of Redlands plan a new
building that will house the animals under their care. Dogs to be housed in
double kennels in an indoor/outdoor or indoor/indoor configuration, with the
indoor component being heated and air-conditioned. Cats and kittens to be
housed in cages large enough to have fifteen-inch spaces between the litter
boxes and the food and water; with an area in which to rest. Cats and kittens
to be put in a large, continuously air-conditioned cattery room, feral room,
and isolation room. Creation of a written action plan to be done by August
2023.
R 2: The Redlands Animal Shelter to keep a formal written and digital copy
of all medications stored at the Shelter, and expired medications to be
disposed of according to legal requirements. To be implemented by March
2023.
R 3: The Grand Jury recommends a checklist be attached to each animal’s

cage. Water and food bowls filled to be documented/recorded daily on the
checklist. Exercise, enrichment activities, socialization with other animals
and cage/kennel cleanings to be documented on the checklists. The
checklists to be kept for three years. To be implemented by March 2023.
R 4: The Grand Jury recommends that cat litter boxes be cleaned at least
three times per day. Dog kennels to be hosed down at least three times per
day. Recorded by checklist on every animal’s cage. Checklists to be kept
three years. To implemented by March 2023.
R 5: Within 24 hours of intake, all animals to be bathed, groomed, and

examined for issues such as external parasites, injuries, infection and
zoonotic diseases. To be recorded on a digital and hard copy log. Designate
an area within the Redlands Animal Shelter to bathe, groom and inspect
animals. To be implemented by March 2023.

R 6: The Grand Jury recommends all euthanasia be reported as the Asilomar
Live Release Rate to the City Council quarterly beginning March 2023.
R 7: Initiate/reestablish partnerships with all available rescue groups. Keep

a current list of them in the Redlands Animal Shelter Chameleon computer
system. RAS to call or email every month to let rescue groups know about
newly available animals. Log these calls and e-mails and report them to
Redlands City Council quarterly. To be implemented by March 2023.
R 8: The Grand Jury recommends that the Redlands Animal Shelter

relinquishes an animal to a non-profit group for adoption if requested by that
rescue group. To be implemented by March 2023.
R 9: Hire and train a qualified and permanent full-time Shelter Manager by

August 2023, who is to make bi-monthly Shelter status reports concerning
Shelter operations to the local newspaper(s), the City website and the
Redlands City Council beginning August 2023.
R 10: The Grand Jury recommends that the Redlands Animal Shelter keep
at least three full-time Animal Control Officers, three full-time Kennel
Assistants, two permanent full-time front desk Customer Service
Representatives, one Volunteer Coordinator and one full-time Shelter
Manager continuously. To be implemented by August 2023.
R 11: Utilize twenty-five or more volunteers at the Redlands Animal Shelter.

To be implemented by March 2023.
R 12: Redlands Animal Shelter to provide site-specific sexual harassment

and adverse working conditions training using in-person role play scenarios
to all staff at the Shelter on an annual basis. To be implemented by June
2023.

R 13: City of Redlands to set up anonymous (if desired) reporting of sexual
harassment allegations at Redlands Animal Shelter. The report to go to the
Director of Facilities and Community Services, the City Attorney and the
Human Resources Department with a resolution required within two weeks.
R 14: Cameras, with audio recordings, to be placed in all Animal Control

Officers’ City-owned trucks, operational and continuously activated. To be
reviewed by Shelter Management weekly. To be implemented by August
2023.
R 15: Redlands Animal Shelter to conduct at least six community, Adoption

and/or Meet-and-Greet events per year. Advertise and report these events
to Redlands City Council and Redlands local newspaper(s) quarterly. To be
implemented by March 2023.
R 16: City of Redlands, Facilities and Community Services Department,

Shelter Manager, staff and volunteers to collaborate to develop formal,
written and digital volunteer manuals, training manuals and policy and
procedures manual for the Shelter. To be reviewed and updated annually.
To be implemented by August 2023.
R 17: Every ACO to complete the Certified Animal Control Officer Program
which includes 60 hours of training in Animal Care and State Laws. The
program is administered by CalAnimals.org. State Certification to be
completed within 90 days of hire date and paid for by the City of Redlands.
R 18: Require all Shelter staff and Management to obtain continuing

education through online sites such as CalAnimals.org. City of Redlands to
pay for the training. Staff and Management required to complete at least four
courses per year, as verified by certificates of completion given to Facilities
and Community Services Department. To be implemented by March 2023.

R 19: The City Council and the Facilities and Community Services
Department to post on the Redlands Animal Shelter website exactly what
happens to donations and budget allocations and how the budget process
works. To be implemented by March 2023.
R 20: Redlands Animal Shelter to make it mandatory for Shelter personnel

to print out donation receipts, give a copy to the donor and keep the duplicate
and provide it to the City Treasurer. A thank you form letter to be used when
donation is above a predetermined dollar amount. A blank space to be left
and used to explain donation usage (if usage was designated by the donor).
Provide a copy of the letter to the City Treasurer to match with the donation
receipt. To be implemented by March 2023.
R 21: Donation subaccounts to be set up for donations where the purpose is

clearly designated. It is to be set apart in the yearly budget for the citizens’
information and reported to the City Council and on the Redlands Animal
Shelter website quarterly. To be implemented by July 2023.
R 22: The Shelter Manager to keep a written inventory of supplies and

conduct a physical inventory of these items every month, informing the City
when items need to be purchased. In cases of emergency the Shelter staff
to use the Petty Cash fund. To be implemented by March 2023.
R 23: Request for quotes on veterinary service to be done, as part of the

City’s competitive bid process, annually for contracted veterinary service,
with no automatic extensions included in the contract. To be implemented by
June 2023 and/or end of current contract.
R 24: Use rescue groups and volunteers to help with fundraising activities
(at least one every month). Ensure money is accounted for by Shelter staff
and input into Chameleon. To be implemented by March 2023.

R 25: Permanent Shelter Manager to complete a grant writing class. Shelter
Manager to apply for at least four grants per year and keep a documented
account of those applications in digital and hard copy. Report applications
for grants to the City Council quarterly. To be implemented by August 2023.
R 26: Redlands Animal Shelter to appoint an independent third party agency,

such as Best Friends Animal Society, to conduct an operational audit of the
Redlands Animal Shelter. Items evaluated by the third party will include such
areas as management style; facilities; expired medications; records of drugs;
improvements needed; adoptions and other outcomes, etc. The Shelter to
report the results of the audit at the public portion of the City Council meeting.
To be implemented by June 2023.
R 27: City of Redlands City Council to form an independent (not city

employees) oversight group/commission/ ad hoc committee to oversee the
Redlands Animal Shelter. This Animal Commission to include, but not be
limited to, local citizens; members from local animal rescue organizations;
veterinarians and animal shelter consultants/professionals. The group to
meet a minimum of four times per year and report to the City Council
quarterly. Committee to be formed by June 2023.
R 28: The Facilities and Community Services Department (F&CS) to create

a process by which all complaints concerning the Redlands Animal Shelter
are received, logged in, reviewed and answered in writing. The Grand Jury
recommends creating a three-person panel (not City employees) to review
and respond to all complaints within two weeks. Complaints and resolutions
to be kept indefinitely by F&CS Department, and reported to the City Council,
local newspapers and on the City website quarterly. The panel and process
to be created by June 2023.
REQUIRED RESPONSES
Redlands City Council (All Findings and Recommendations)

Chris Boatman, Head of Facilities and Community Services Department (All
Findings and Recommendations)
PERMITTED RESPONSES
Redlands Police Department
GLOSSARY
• ACO: Animal Control Officer: responsible for going out into the field,
educating lost animals’ owners etc.
• Adoption event: an event put on by a shelter or rescue group that

encourages a high volume of pet adoptions. It involves a gathering of
adoptable pets in one location.
• Asilomar Live Release Rate: this is a calculation. The calculation

reveals the percentage of animals that leave the shelter alive. The
calculation is arrived at by the following means: divide the number of
animals that left the shelter alive by the total number of animals that
entered the shelter, minus the owner requested euthanasia.
• ASPCApro.org: provides training, research, and resources to help

animal welfare professionals.
• Best Friends Animal Society: largest animal sanctuary in the US. Its
primary purpose is to advocate for the prevention of senseless killing
of shelter animals. It has developed into a national network of like-
minded partners with various educational components.

• CA Civil Code § 1834.4a: it is the policy of California that no adoptable
animal should be euthanized if it can be adopted into a suitable home.
• CAL Animals: California Animal Welfare Association. this is the

agency that administers the certification of Animal Control Officers in
California.
• Cattery: a building that contains numerous cages/kennels to house

cats in a climate controlled, sanitary, private and secure manner.
• Chameleon Computer System: Provides Technology solutions for

Animal Control, Humane Societies, SPCA’s and other animal rescue
organizations. Helps with activities such as: licensing, shelter
management, field ops, inventory, donations and veterinary record
keeping.
• Community Outreach event: refers to efforts that connect an

organization’s ideas or practices to the public. It helps the organization
connect with the local community.
• The Crystal Project: this rescue adopts “unadoptable” animals from

shelters, rehabilitates them, or pays for their medical conditions,
readies them for adoption, and then adopts them out to forever homes.
• Financial audit: an examination and inspection of an entity’s financial

statements for verification purposes.
• Fostering: shelter animals are given the opportunity to temporarily

spend time in a safe and loving home environment while they wait for
adoption.

• Fundraising: a process of collecting money as donations, for a cause,
from individuals and businesses.
• F&CS: Department of Facilities and Community Services.
• GJ: 2022 San Bernardino County Civil Grand Jury.
• Guillotine Door: a barrier that keeps a pet from entering or exiting

through a dog kennel door opening. It slides up and down, to open and
close the opening, with the help of a cable system.
• Highland Village Pet Hospital: veterinarian who has a current

contract to provide services to the Redlands Animal Shelter.
• Kennel Attendant: KA responsible for cleaning kennels and cages

and keeping water and food supplied at an Animal Shelter, etc.
• Infectious diseases: diseases that is caused by an organism such as

a bacteria, virus, fungi, or parasite.
• Inside/inside: the configuration of a kennel whereby both sections of

an individual kennel are located in an air conditioned and climate-
controlled building.
• Inside/outside: the configuration of a kennel whereby only the inside

portion of the kennel is located in an air conditioned and climate-
controlled building. The outside portion of the kennel allows the dog to
be outside.

• Maddie’s Fund: (Maddie’s University) Champions for Animal Welfare
(www.maddiesfund.org) This fund offers the pet/animal industry a
national voice. If also provides important funding opportunities,
learning resources and access to other networks to share ideas.
• Meet-and-Greet: a process of introducing an adoptable animal to your

family and/or current pets.
• Operational audit: a review of an entity’s operations including policies,

procedures, etc. to identify areas of weakness and to make
recommendations to improve upon these weaknesses.
• Outcome: How an animal that enters the shelter, finally leaves the
shelter. For example: return to owner, adopted by private party,
adopted by rescue, euthanasia.
• RAS: Redlands City Animal Shelter
• RCC: Redlands City Council
• REDfosa: Redlands Friends of Shelter Animals Rescue Group
• RHS: Redlands Humane Society
• RPD: Redlands Police Department
• San Diego Humane Society: (Humane Law Academy)

www.sdhumane.org Humane Law Enforcement Training Academy
(San Diego Humane Society)

• SB 1785: Hayden’s Act. This California law provides the guidelines for
animal shelters’ treatment of animals in California.
• VSBP Document: Veterinarian Standards and Best Practice

Document. A report by the Association of Shelter Veterinarians that
outlines best practices for animal shelters in the United States.
• Zoonotic: a disease that passes from an animal or insect to human.
BIBLIOGRAPHY
ASPCA: American Society for the Prevention of Cruelty to Animals

www.ASPCApro.org/training/grants/research
CAL FOR ALL ANIMALS

Animal Shelter Assistance Act
https://leginfo.legislature.ca.gov/faces/codesdisplayText.xhtml?
The initiative is administered by the Koret Shelter Medicine Program at the
UC Davis Center for Companion Animal Health. This state funded initiative
funds $50 million in grant money to shelters.
For more information about grants: grants@californiaforallanimals.com
California Animal Welfare Association (CalAnimals)

http://www.calanimals.org
Certified Animal Control Officer Program
Animal Care Conferences
Online education

Education and Training Resources
Guidelines for Standards of Care in Animal Shelters

The Association of Shelter Veterinarians: 2010
Newbury, Blinn, Bushby et al
Keeping Controlled Drugs Under Control

Atlantic Coast Veterinary Conference 2001
Philip J. Seiber, Jt. CVT
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Maddie’s Institute, 223 Santa Clara Ave, Suite B, Alameda, CA

94501
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May 2013
UC Davis Koret Shelter Medicine Program

Facility design, Shelter Animal Housing and Shelter
Population Management
Last updated: 2019-03-07
Information sheet
Species: Canine, Feline

University of Florida, College of Veterinary Medicine
Maddie’s Shelter Medicine Program
Design of Animal Housing
Information Sheet
Heather E. Lewis, AIA, NCARB
Http://www.sheltermedicine.vetmed.ufl.edu
University of Wisconsin-Madison, School of Veterinary Medicine

Facility Design, Shelter Animal Housing and Shelter
Population Management
Date: March 2019
Information sheet
Species: Canine, Feline


SUMMARY
When is something too broken to fix? That is the question asked by the
2022 San Bernardino County Civil Grand Jury (GJ), during its investigation
into the San Bernardino County Children and Family Services (CFS). The
CFS has been investigated multiple times by the San Bernardino County
Civil Grand Jury in the last decade. However, the 2022 GJ found that even
with changes forced by California State Law since 2018, the foster children
of San Bernardino County CFS continue to be abused in Resource Family
Homes (RFHs: formerly known as Foster or County Homes).
The Civil Grand Jury began its investigation by reading many articles and
researching professional papers and books concerning the Foster Care
system and CFS. The GJ also received citizen complaints and interviewed
some of those complainants. The Grand Jury interviewed multiple
witnesses in CFS. After many months delay, data was received from the
County concerning the number of abuse cases substantiated in the years
2019, 2020, 2021 and 2022, all of which occurred while the foster children
were in the care of CFS.
Sadly, substantiated foster children abuse cases have increased every
year from 2019 through 2021. The GJ was looking for changes made since
2018 and determining if those changes have been effective. For example:
less substantiated cases of foster children being sexually and physically
abused while in county Resource Family Homes and other foster settings.
Significantly, the GJ has found during its investigation that the
substantiated abuse cases continue. The revelation that there are
significant amounts of substantiated sexual abuse and physical abuse
cases is eye-opening. Additionally, the GJ learned that there are no
temporary shelter facilities in San Bernardino County where already
traumatized children could go to have a place to feel safe, instead of the
offices of CFS where they are currently housed during the search for
placement.
During multiple interviews, the GJ found some positive changes have come
about since 2018 in San Bernardino County CFS. The GJ is aware the staff
of CFS does not go to work with the attitude of allowing continual abuse of
foster children. There are now numerous reactive measures, for example,
the creation of the Open Case Investigations Unit (OCI), Risk Assessment

Meetings (RAMs), and social workers (SWs) no longer investigating their
own cases. These measures help children AFTER the abuse has occurred.
However, the GJ found no proactive measures to keep foster children from
entering abusive RFHs to begin with, and very little proactive efficient
monitoring of these homes once the placement has been made. Foster
children are put in danger in SB County. The data received from CFS
demonstrates this. Some changes initiated since 2018 have been positive,
but they are not enough! Children are still being abused in county Resource
Family Homes and other foster settings.
However, the GJ also found the bureaucracy that permeates the San
Bernardino County CFS is so extensive, complicated, secretive, and
inefficient that the GJ strongly recommends CFS be abolished, and a new
system be created to help raise and parent foster children in the county.
The CFS is too broken to fix.
BACKGROUND
The 2022 San Bernardino County Civil Grand Jury decided to investigate
the San Bernardino County Children and Family Services (SBC CFS).
Complainants were interviewed, and research was performed. The
investigation revealed to the GJ that foster children in SB County were still
being abused in foster settings in alarming numbers. The Jurors pored over
documents and noted new laws and changes made since 2018. The GJ
questioned whether these changes were enough to keep foster children
safe.
The GJ began interviewing employees, directors, and Social Workers in

CFS. From the interviews, and from reading the CFS’ Policy and
Procedures Manual, it became apparent that all the measures and positive
policies initiated since 2018 were REACTIVE, NOT PROACTIVE. It
appeared it was more of a rebranding of the former Child Protection
Services (CPS) to the new CFS had occurred. Many new policies and
agencies had been put in place, but they were all addressing the abuse
AFTER it happened.
There was no evidence of measures taken to ensure foster children were

never put into abusive RFHs to begin with. There was no evidence of
effective and ongoing checks or monitoring that abuse didn’t start or

continue. There was no evidence of effective proactive measures that
would prevent a foster child from being placed into an abusive RFH after
being pulled out of one setting and placed into another foster setting.
Finally, after receiving data of substantiated abuse cases from the years
2019-2022, the GJ found the numbers show the problem is ongoing. Most
significantly, substantiated abuse cases have increased every year from
2019 through 2021. The GJ concluded the problem has not been solved,
and the reactive measures instituted since 2018 have been ineffective.
Most importantly, no proactive measures have been put in place. The
conclusion reached, after talking to experts in the field, is the San
Bernardino County Children Family Services is too broken to fix and needs
to be rebuilt from the ground up.
METHODOLOGY
The 2022 San Bernardino County Civil Grand Jury began its investigation
by researching foster care in articles, documents, and professional papers
and books. The GJ reviewed the laws concerning foster care in California.
The GJ reviewed manuals provided by the CFS. Finally, after many
requests were made for data of substantiated abuse cases of foster
children for the years 2019 through 2022, the GJ was able to finally review
that data. The GJ interviewed CFS social workers and administrators. The
GJ questioned citizen complainants, medical personnel, Foster Family
Agency (FFA) employees, experts on foster care systems, and a former
foster care child who is now an adult. The GJ also visited sites where foster
children are forensically interviewed, the Children’s Assessment Center
(CAC), CFS offices, group settings, and an out-of-county temporary care
facility for foster children. Finally, the GJ summarized the data received and
prepared a report. During the various interviews the GJ observed that some
interviewees were reluctant to, and refused to, answer or claimed they had
no knowledge in specific divisions even though they had been working in
these particular areas for years.

DISCUSSION
Data
During the 2022 San Bernardino County Civil Grand Jury’s investigation,
the GJ sought and obtained information from the San Bernardino County
Children and Family Services that included the total number of
substantiated cases. These cases involved sexual abuse, physical abuse,
and deaths that occurred against foster children under the San Bernardino
County CFS’s care, defined by the California Welfare and Institutions Code,
for the years of 2019-2021.
CFS also provided substantiated abuse cases for the year of 2022 that
included cases up to the end of May 2022. Since the GJ’s request involved
confidential information, the GJ obtained a court order from the court that
authorized the release of the requested information, with the appropriated
legally redactions annotated.
Every one of the foster child abuse cases were investigated and
substantiated by the CFS OCI unit responsible for these types of
investigations. Substantiated, in these cases, means that there was
sufficient evidence to support and prove the allegations occurred. In almost
all the cases, they were cross-reported to the appropriate law enforcement
agency with jurisdiction in the cases. The following graphs depict what the
GJ received and what it extrapolated from the cases provided.
Graphs

Based on the review of the substantiated foster child abuse cases above,
the GJ determined that there are significant and alarming number of cases
involving already traumatized children that come into the care of the CFS
who have been further physically or sexually abused by a system that was
created to protect them. There were 307 foster child victims of
substantiated physical or sexual abuses during the period of 1/1/2019
through 5/31/2022.
Of these numbers, 204 were physically abused foster children and 103
were sexually abused foster children. The abuses committed occurred to
134 foster children males, 160 foster children females, and 13 were
unknown gender foster children. The data demonstrates that the abuses

crossed the range of the various age groups, but specifically they are listed
as: 0-4 years old: 67 abused children, 5-9 years old: 100 abused children,
10-14 years old: 75 abused children, 15-18 years old: 46 abused children,
and unknown age: 19 abused children.
Of special note, the review of the data provided by CFS included one
physical abuse case resulting in the death of a child that was investigated
in 2022. Additionally, the 2022 data only covers a portion of the year. It
creates an imbalance in the ability to compare like data. Without a
complete years' worth of results, the GJ recognizes that the 2022 data
could indicate a decrease. However, no one is able to predict what will
happen in future months.
Preventative Measures
Children and Family Services has assumed the role of parenting

traumatized children who have been removed from their biological families. 
As such, the GJ found that CFS has made attempts at providing for the
safety of those they have been entrusted to protect.  However, the CFS of
San Bernardino County does not have significant preventative measures to
stop the abuse or minimize it within their care.  Children are still at
significant and unacceptable risk for continued abuse while under the care
of CFS.   
The following are some preventative examples CFS does practice:

• CFS conducts Live Scans (a fingerprint check for criminal history) on
prospective resource foster parents
• completes a DMV check once per year
• conducts physical inspections of prospective settings
• carries out interviews 
 
However, these preventative measures are not enough!  The Live Scans,
DMV checks, home inspections and interviews only reveal the history of the
Resource Parent(s).  The measures are not extended to visitors to the
foster home, such as unknown family members, boyfriends/girlfriends and
other residents not known to CFS.  The GJ investigation revealed that
these risk factors noted above have contributed to many of the
substantiated sexual and physical abuse cases.  

Reactive Measures 
  
Open Case Investigation Unit (OCI) 
The OCI unit was created in 2018 to investigate abuse cases.  This CFS
internal unit investigates ‘open cases’ of alleged abuse from the hotline,
social workers, teachers, other adults, children, law enforcement, medical
personnel, and others.  An open case means that the foster child victim is
already within the CFS system.  As a result, the social worker no longer
does his/her own investigation.   Now there is a higher level of assessment
and effectiveness than before.  The OCI allows for more eyes on the
alleged abuses. However, this is a reactive measure, and takes place only
after there is an alleged abuse.  It is not preventative. 
Risk Assessment Meeting (RAM)
Another positive reactive change is the Risk Assessment Meeting (RAM). 

These meetings involve reviewing cases with multiple attendees, including
two supervisors, one social worker, law enforcement (sometimes), upper
manager at CFS, and the foster child, if appropriate.  They discuss what
went wrong, how things could have been done better, possible solutions,
and a possible plan for going forward.  But, again, this is a purely reactive
measure, and is not preventative. 
Foster Family Agency (FFA) 
An FFA is a private non-profit agency that provides foster care services to

the community, which contracts with CFS.  The GJ learned that the FFA
related services are another positive factor in the services provided for
foster children.  The FFAs have more services; smaller caseload ratios;
perform more visits, announced and unannounced; demand more training
and ongoing training to resource homes.  They are able to spend more
quality time with their foster children and they utilize more community-
based resources. However, once again, these are not preventive measures
within the CFS.

The Children’s Assessment Center (CAC) 
The CAC has been operating in SBC since 1980.  CAC is a private and
public agency where many community-based resources partner. The CAC
task force consists of representatives from CFS, County Medical Center,
Public Health, Behavioral Health, District Attorney's office, Sheriff's Office,
Juvenile Court, Family Law Court, County Counsel, Children's Network,
Children's Fund and Loma Linda University Children's Hospital. 
 
The children are referred to them by law enforcement and/or Children and
Family Services. CAC does forensic interviews and/or forensic physical
examinations of the children of alleged child abuse. CAC also has Victims
of Crimes Advocates and Mental Health personnel. In an effort to minimize
that trauma, CAC provides forensic interviews and evidentiary medical
exams in one child-friendly location for sexually abused children in San
Bernardino County. This is a very positive one-stop shop where a
traumatized foster child can be professionally interviewed.  However, this is
also a reactive measure, not a proactive one.   
The Capture, Tracking, and Monitoring of Data  
Whether the sexual or physical abuse allegation is criminal or not, CFS

usually cross reports to law enforcement as well as provide other CFS sub-
investigation units with the same database.  However, this communication
is not integrated, interoperable, or interconnected in a virtual environment
for all participating partners.  In an interoperable and interconnected
environment, data collection systems kept by CFS and law enforcement
would be updated to reflect and statistically track every foster child abuse
allegation and investigation. Those allegations and investigations from
Foster Family Agencies and other California counties should be looked at
more closely, so that foster children are less likely to be placed in abusive
settings.   
 
Law enforcement in San Bernardino County does not separately identify or
differentiate foster children abuse cases from other types of child abuse
cases.  Further, law enforcement cannot determine how many instances of
actual abuse (physical and/or sexual) of foster children have occurred in
SBC because the San Bernardino County Sheriff‘s Department does not

statistically track or classify it that way. According to the evidence, law
enforcement would have to read every single investigation to determine
which children have been abused while in foster settings.  The GJ found
that this is a critical function that law enforcement should perform as a
separate measure of providing a resource for determining these foster
children abuse cases. 
 
Law enforcement needs to classify reports indicating that these reports are
part of the foster children care system so they can be tracked and
evaluated.  Children and Family Services and law enforcement need to
meet quarterly and review their alleged and substantiated foster child
abuse cases together.   
NO Oversight Group/Foster Children Commission to Oversee the

CFS 
Critical to the democratic process in San Bernardino County is the need for
an independent ‘checks and balances’ system in the form of an
independent oversight commission to monitor all foster children.  Currently,
there is no separate oversight group that oversees the Children and Family
Services lack of accountability. The GJ found a need for a
committee/commission who is authorized and empowered to ensure that
foster children are provided the level of care expected by the people of San
Bernardino County.   
 
Presently, CFS has no local accountability, which allows them to operate
behind an air of confidentiality.  An oversight committee/commission would
ensure a set of independent eyes to monitor the CFS’s focus on protecting
the foster children.  With CFS operating under confidentiality, any
accountability for their actions is extremely difficult.  This watchdog
committee/commission will operate under the same level of confidentiality
as CFS. 
 
The GJ recommends that this new oversight committee/commission
includes, at the very least, former foster children, educational professionals,
medical professionals and legal professionals.  This new oversight group
would monitor, investigate, and recommend actions to the Board of
Supervisors, at least on a quarterly basis.  The GJ finds that this new group
would contribute to the prevention and minimizing of factors relating to
abuses that occur in foster child settings.     

VULNERABILITIES OF FOSTER CHILDREN
  
 CFS Reactive not Proactive
The evidence established that foster children in San Bernardino County are
vulnerable to significant risks that in an alarming number of instances have
led to abuses and further traumatization.  These vulnerabilities have been
shown in the graphs above, the interviews completed, and the documents
reviewed by the GJ.  The GJ found that most measures taken were reactive
not proactive. Children are still vulnerable to abuse.  The vulnerabilities
confirmed by the GJ include: 
Before Initial Placement
Vulnerabilities after Placement in CFS
• Lack of sufficient law enforcement involvement  

• Lack of thorough home inspection procedures including opening all
doors and inspecting the yards and outer buildings 
• Lack of oversight during unsupervised visits with biological family
members 
• Lack of communications between interdepartmental units within CFS 
• Lack of local and community oversight accountability 
• Inadequate medical and mental health services 
• Overloaded social worker caseloads (70-90 each) which deter the
SWs from proper monitoring of the foster children and Resource
Family Homes and other foster settings
• Insufficient staffing levels to provide quality services 
• Lack of transparent record-keeping by CFS; not reported to the public
because of confidentiality rules, which inhibits openness and trust 
• No standard number of times infants to four-year-olds are seen by
social workers/nurses per week 
• Delay in Medical cards and behavioral information passed to other
foster placements, especially FFAs 
• Lack of Social Worker visits that are unannounced at Resource
Family Homes 
• Social Workers becoming overly familiar with the Resource Family
Homes and Resource Parents

• Lack of sufficient training of SWs 
• Lack of training of foster children 
• Inadequate training of resource parents 
Additional Vulnerability Factors
• Overly regulated by California State guidelines (Big brother controls) 

• Insufficient number of community-based resources and services 
• Bureaucracy and rebranding.  For example, the name, “Child
Protective Services” to "Children and Family Services” did not change
the approach to foster care as it has been business as usual 
• Lack of funding sources/grants not tied to governmental regulations
and controls  
Help for the Biological Families 
The Grand Jury found that for true proactive measures to occur, there
needs to be resources and services for biological families who could use
help but don’t necessarily need involvement with any governmental agency
like a foster care system.  There is an urgent need for assistance to be
provided to these families without governmental regulation and oversight as
they only require a nudge or temporary help.   
 
The evidence established that in one community, the foster care system
actually interacted with almost 20% of the population in some form or
another.  The number of those that became part of the system was reduced
to about 5%-7% of those needing long-term assistance.  
 
The evidence suggested that if assistance was given to the biological
family before the child was removed, the potential for coming into the foster
care system would be reduced tremendously. The GJ recommends that
community-based one-stop shops be set up to help biological parents who
only need some temporary help, not governmental oversight and
regulation.  
The Grand Jury recommends that the new foster care system develop a
proactive services division where they have community-based services
available. The GJ believes that just as much money should be spent on
proactive measures as on foster care services.

Lack of Temporary Sheltering Facilities
Currently, most foster children who are initially removed from their
biological family and/or who are transitioning from one foster care setting to
another are temporarily housed at a local CFS office. These office settings
lack the basic needs of the traumatized children. The foster children could
remain in these office settings up to 72 hours or more while permanent
placement is sought.  During their stay, they sleep on the floor, cots, and
other locations.  Their food comes from different providers, including fast
food restaurants.  There are limited bathroom facilities.  Any special needs
such as medications (which are currently administered by non-medical
personnel) are non-existent. Likewise, safety and security efforts are
minimized.  There are security issues for the social workers and their work
environments while these children are roaming the office. It is not
uncommon for foster children to go through Social Workers’ and others’
desks where there is confidential material.  Even thefts and assaults have
taken place! It is an unsafe, unsanitary, and unacceptable environment for
all involved.  
 
CFS should create community-based temporary sheltering centers for
foster children transitioning between their biological home and/or Resource
Family Home, other foster settings, or Foster Family Agency. This is
another traumatic event for the children who have already been removed.
Sometimes the foster children sleep in the SW’s office for days, weeks or
even months at a time.  This is just adding to the trauma they are
experiencing. These children are placed with other unknown children who
could possibly have behavioral issues or medical issues, thereby bringing
more trauma.  With the creation of regional community-based temporary
sheltering centers, this would reduce some of the trauma these children
have to experience.   
 
These community-based temporary sheltering centers, to include additional
regional centers, would resemble a home environment, and contain all the
needs of the foster child. For example: 
• a bed 
• a shower 
• bathroom facilities for all genders 
• kitchen and dining room 

• a dayroom 
• an exercise/playground area,  
• work areas that include computers, Wi-Fi, and other
• technologies for homework, school related activities, and
• educational and life-skill needs  
• rooms for visitation by foster care social service, families,
and other similar and related partners 
• medical and infirmary services  
These centers should also have ample supplies to provide for, at the very
least, the basic needs of all foster children and their various ages and
developments. These centers could also be joint ventures between foster
care social services and other community-based service partners. The GJ
recommends that these centers be managed by non-governmental
providers such as those created under IRS Code 501(c)(3), non-profit
and/or non-government organizations.  Potential funding sources:
major/minor foundations, grants, colleges/universities, and contributions
from government, private, and other community-based partners.  
Ongoing Vetting (Monitoring) of Resource Parents and Homes
CFS has no comprehensive and complete background check/vetting

system for Resource Parents and foster care settings. (Definition of vetting:
to examine, investigate, or evaluate in a thorough or expert way).
Background checks of resource homes often miss unknown or undisclosed
boyfriends or relatives who visit the home.  Lack of complete and
comprehensive vetting of resource parents and foster situations subject
foster children to abusive settings.  
  
This monitoring of Resource Families and their Resource Family Homes
should occur often, as much as 4 times a month.  During interviews, the GJ
found that San Bernardino County Children and Family Services have not
been conducting sufficient and consistent monitoring efforts, which has led
to substantiated sexual and physical abuses to foster children.  
  
Under the auspices of CFS, all foster children are supposed to be visited
once a month when placed in Resource Family Homes or foster home
settings. (This same visit occurs weekly under the care of FFA homes).
SWs are not consistently making unannounced visits and are not doing a

thorough home inspections on monthly visits.  Unannounced visits will help
the SW identify regular visitors and changes to the home, which could
indicate someone has moved into the home or is frequently visiting, who
has not gone through a background check.  The GJ evidence revealed that
SWs prefer to announce the monthly visits because they can be sure that
there will be someone home when they arrive. 
However, this leads to the possibility that all adults, including unknown and
unvetted visitors, could be missed by the SW.  Moreover, SWs do not
always check all rooms of RFH. If the door is closed to a room or closet,
the SW does not always open all doors.  Evidence showed that some SWs
visit less than monthly and announce their visit ahead of time, allowing
possible abusers to hide abuse problems.  
Social Worker Interviews
The evidence showed the social workers’ interviews with foster children
and their resource families are not being conducted in an effective way.  
The SW does not always interview the child alone without the foster
parents present.  The SW does not spend enough time with the child.  Also,
there is no standardized written interview form for the SW to use while
talking to the child. Sometimes, according to evidence, the SWs even do a
“fly-by” visit.  That means that SWs walk into the house and say hello to the
foster family and do not interview the child or look into rooms or closets. 
They don’t open closed doors or go out into the backyard. The evidence
revealed that these brief interviews have led to substantiated abuse cases.
At least one visit per month should be unannounced. The social worker
would then see the home in its natural state, not in a prearranged manner. 
That way, the SW may find adults in the home who are not supposed to be
there, children put in closets, boyfriends/girlfriends visiting or living there
without CFS approval or background checks, and other questionable
practices.  Evidence established the SW becomes too familiar with the
resource family and assumes that everything is being done correctly,
without checking to verify.  The GJ recommends that SWs treat every
monthly interview as an initial interview and investigate the resource family
thoroughly during every visit. 
There is currently no standard written report required after each interview of

a foster child.  A standard form would produce accountability for SWs and

provide baselines for the condition of the child.  It would eliminate “fly-by”
visits because certain questions would then have to be asked.  It would
take away the practice of forgoing interviews when the Social Worker is
assuming that everything in a familiar home is okay.  It would standardize
all the reports turned in by SWs.  The GJ recommends that a standardized
written interview form be filled out for every foster setting visit.  This would
be turned in monthly. 
 
Sometimes the SWs interview the foster child in a school setting. This
creates a more friendly environment for the children without adults present.
This can be appropriate and effective at times, but the SW should make
sure they do a full home inspection also, at least once per month. 
Supervised and out-of-county home visits are very time consuming. 
Reducing the caseloads to no more than 40 would help the SW.  Also, the
SWs could use training specifically geared to time management and case
management. 
No Routine Medical and Mental Health Evaluation
Children are not medically and behaviorally examined before every

placement in a Resource Family Home, Foster Family Agency Home, or
any other foster setting. Newly placed children are only medically and
behaviorally assessed when the SW determines that this is necessary.
There might be bruises or injuries that a SW might not see. If examined
every time before placement, a baseline would be established of the
physical, emotional and behavioral condition of the children when they go
into a new or different foster setting.   
Caseloads too High to Manage
The average caseload for Social Workers in San Bernardino County,

according to evidence, is 70 to 90 cases. There are only 20 working days
per month.  SWs are assigned at least 2 days per month, where they are
on desk duty. Additionally, SWs must complete routine court reports.  The
SWs therefore only have about 15 working days per month to complete
their required remaining duties which also include their monthly foster
home visits. When the out-of-county interviews are factored in, some
requiring hours of travel time, evidence established that monitoring 70 to 90
foster children and their resource families in 15 working days per month is

impossible.  Evidence shows each SW’s caseload should not exceed a
total of 40 for each month. 
 
However, the private Foster Family Agencies (FFAs) succeed in monitoring
the foster children entrusted to their care.  This is accomplished by a lower
caseload of their SWs, (average caseload of twenty), and more resources
at their disposal.  The FFAs visit their resource families weekly while the
San Bernardino County CFS settings are only visited monthly.   The GJ
determined that the San Bernardino County Social Workers should visit
resource homes and other foster settings at least four times per month, two
unannounced, interview the foster children, and thoroughly inspect those
homes on each visit. 
Not enough visits per month for ages Birth to Four 
 After a review of SBC CFS’s Policies and Procedures Manual, the Grand
Jury was surprised to find that there are no separate requirements
specifically for visiting foster children ages birth to four years old.  Babies
and toddlers are the most vulnerable population because they are either
non-verbal or have difficulty expressing themselves. Therefore, their safety
is completely in the hands of the SWs assigned to them. SWs, however,
are only required to visit these children once per month!  Physical/sexual
abuse could be easily missed, which is completely unacceptable!  The GJ
recommends that babies and toddlers be visited at least four times per
week for the first thirty days, and then two times per week until they are
four years old.  Every visit to these vulnerable children should also have a
nurse attending, so that these young ones can be examined thoroughly. 
Training of Foster Children
Foster children are not significantly trained in recognizing grooming

behaviors, predatory behaviors and child abuse reporting. Examples of
grooming behaviors include inappropriate comments and sharing
pornography. They are given a copy of Foster Children Rights, and a list of
numbers to call, but not specifically trained on how to spot abuse and
report on it.  Child abuse of foster children may not always be reported by
victims and their siblings due to foster children’s lack of training.  This
training could give the foster child knowledge of how to address abuse
before it starts as well as how and when to report it. The GJ recognizes that

in-person training using role-play scenarios would be the most effective.
The GJ also recognizes that this does not limit the use of other various
types of training and teaching tools.
Lack of Services
  
Mental Health Services 
The Grand Jury has learned the current level of mental health services for
foster children is severely lacking.  Foster children are traumatized by their
removal from their biological homes as well as throughout every step in the
foster care system.  The GJ recognizes the health and well-being of all
foster children needs to be understood as a critical part of their
development and success.    
 
Currently, the CFS does not have sufficient nor effective mental health
services and resources for foster children.  There is a lack of evaluation
tools, assessment guidelines, therapy services and experienced mental
health professionals.  CFS lacks sufficient community-based mental health
resources.  
The CFS system does not have enough mental health professionals called
Child Life Specialists working with the county’s foster children. These
mental health professionals specialize in helping traumatized foster
children. 
Foster children who are new to the system do not have their own Child Life
Specialists.  Children separated from their homes are already extremely
traumatized.  They all need the services of these Child Life Specialists. 
Currently, there are an insufficient amount of these in the County of San
Bernardino.  The SW on the case decides if a foster child who just entered
the CFS system needs a mental health assessment.  The GJ strongly
recommends that EVERY foster child receive the services of a Child Life
Specialist. The children all need to be assessed by a mental health
professional. The SW should not be the only evaluator of the emotional
health of these vulnerable children.   
  
The Grand Jury realizes that CFS might lack the funding and other
resources needed to obtain and provide significant mental health services
for foster children. The GJ understands there are a number of options to

assist in resolving this.  The writing of grants to hire more of these
specialists may help the problem, especially obtaining more funds for the
Child Life Specialists and other therapists.   The evidence has revealed that
there are other sources of funding and resources that CFS could utilize. 
These include partnering with community-based service providers that
either already have these services and/or are willing to partner with CFS to
provide these services.  There are also foundations, universities and
colleges, and non-profit groups that could join with CFS to accomplish
these goals.   Another example of mental and medical services partnering
could be a Memorandum of Understanding (MOU) with the Resilience
Institute for Childhood Abuse (RICA). The evidence shows CFS has not
committed, for years, to partnering with RICA as CFS has blocked efforts to
agree with the MOU.
The CFS system does not have enough mental health professionals called
Child Life Specialists working with the county’s foster children. These
mental health professionals specialize in helping traumatized foster
children. 
Foster children who are new to the system do not have their own Child Life
Specialists.  Children separated from their homes are already extremely
traumatized.  They all need the services of these Child Life Specialists. 
Currently, there are an insufficient amount of these in the County of San
Bernardino.  The SW on the case decides if a foster child who just entered
the CFS system needs a mental health assessment.  The GJ strongly
recommends that EVERY foster child receive the services of a Child Life
Specialist. The children all need to be assessed by a mental health
professional. The SW should not be the only evaluator of the emotional
health of these vulnerable children.   
  
The Grand Jury realizes that CFS might lack the funding and other
resources needed to obtain and provide significant mental health services
for foster children. The GJ understands there are a number of options to
assist in resolving this.  The writing of grants to hire more of these
specialists may help the problem, especially obtaining more funds for the
Child Life Specialists and other therapists.   The evidence has revealed that
there are other sources of funding and resources that CFS could utilize. 
These include partnering with community-based service providers that
either already have these services and/or are willing to partner with CFS to
provide these services.  There are also foundations, universities and

colleges, and non-profit groups that could join with CFS to accomplish
these goals.   Another example of mental and medical services partnering
could be a Memorandum of Understanding (MOU) with the Resilience
Institute for Childhood Abuse (RICA). The evidence shows CFS has not
committed, for years, to partnering with RICA as CFS has blocked efforts to
agree with the MOU.
Delay of Medi-Cal Cards and Information between Placements 
San Bernardino County Children and Family Services does not share
critical information, in a timely manner, for other foster settings or FFAs
when a child is placed in a new location.  There is currently a 30-day
timeline for passing along Medi-Cal Cards and medical and behavioral
issues to the new location. Evidence revealed that the timeline is rarely
met.  The new resource family home setting waits long past 30 days to
receive Medi-Cal cards and other information for the child.  Meanwhile, the
new Resource Family Home or other foster setting cannot schedule
medical and dental visits and has no idea about any behavioral/emotional
issues of the foster child they are receiving!  It is inexcusable. 
THE SOLUTION 
The Case for Dismantling the Current CFS system 
 It Takes a Local Community 
It is time to realize that the current San Bernardino County Children and
Family Services is too broken to fix.  We, as the parents for all our children,
demand that a new approach in parenting and raising foster children be
created.  Raising a child takes all our efforts and should not be left to the
responsibility of a governmental agency or department.  If we truly mean
“one child, one family,” then it’s time to prove that these traumatized
children are worth the effort, time, energy and money.  We, as the San
Bernardino County community, must prove and demonstrate the love that
our foster children need so they can grow up with the best possible chance
of a happy and successful life. 
  
There needs to be a multiplayer approach to raising a foster child. 
Community homes, facilities, mentors, caregivers, families, and community-
based service providers need to unify to meet this significant challenge.  Do

we keep doing the same thing by using different labels, or do we commit to
designing, developing, and implementing an interactive, integrated, and
interconnected local community-based innovation that commits to treating
and loving foster children the same way we should be treating all our
children? These children are our future!  
A new children and family services concept will be where partnership

coalitions with community-based organizations and service providers are
created.  This concept will be the standard that reflects the culture and
diversity of the communities they serve and where trust is earned and
fostered.  The bureaucracy of governmental agencies inhibits local
community diversities and needs by administering them with regulations
and conditions placed on it by state and federal controls.  The care and one
raising of our children must be a community effort, and if government must
be a part of that effort, then it will be only a participating partner.  
 
The current children and family services system resembles what it has
always been for decades.  The rebranding of the Child Protection Services
into the Children and Family Services resulted in more controls, mandates,
and regulations from the top all the way down to the county level.  These
controls have been so significant and stifling that they have suppressed the
local community identity and culture.  The San Bernardino County
Community is responsible for its own children, including its foster children,
no matter who they are. 
ONE-STOP SHOP RECOMMENDATION
One-stop shop local community centers where foster children and their
families can go to get everything the child needs done in one place are
crucial to a new and reimagined way of running CFS in the future.  These
centers would be placed in local communities, easily within driving distance
of Resource Family Homes and other foster settings. 
 
Each one-stop shop local community center would provide all the services
needed.  These services include:
• medical and mental screening

• evaluations and treatment
• social worker/family office visits

• food, clothing, supplies and toys
• educational, after-school, and extracurricular programs
• other services and programs to be developed for foster children,
resource parents, and social workers, as well as the other
community-based partnerships
These centers would be a joint venture between foster care services and
local communities, schools, churches, and other local resources.  They
would be managed by non-governmental community-based service
providers such as those created under IRS Code 501(c)(3), non-profit and
or non-government organizations.  Potential funding sources include private
foundations, grants, schools, colleges, universities, and contributions from
government, private, and other community-based partners.   
 
Social Workers from CFS would work out of these local community-based
offices instead of huge regional offices for the entire county.  This would
reduce travel time for the Social Workers, as well as the Resource Parents
(RP).  This way, instead of the initial or relocation being handled by many
agencies, the RP would take the foster child to the center to be
“processed”. In other words, have a complete medical and mental exam, be
signed up for therapy, and meet and be interviewed by their new Social
Worker.  Records would be kept at these community centers.  Resource
Parents would be given information about services in the community which
provide help.  There would be workers who provide much-needed respite
care and/or babysitting for the foster children.  There would be daycare,
and even educational tutoring.  Volunteers from the local community would
help in these ways. 
 
Community-based regional one-stop centers would give the power back to
the local communities.  The current CFS bureaucracy, so huge and
ineffective, would be divided into many small and manageable parts.  The
GJ finds that these community centers are the solution to the broken CFS
system in San Bernardino County. 
CONCLUSION
In the beginning, the Grand Jury asked, “When is something too broken to
fix?” The follow-up question asked, “When do you stop doing the same
thing with the same results, even if you rebrand the organization?” These
are the questions that have resonated with the 2022 San Bernardino

County Civil Grand Jury during its investigation into the San Bernardino
County Children and Family Services.  These are valid questions since
CFS has already been investigated multiple times by the San Bernardino
County Civil Grand Jury in the last few years.   
Evidence revealed, even with changes forced by California State Law, the
foster children of San Bernardino County continue to be abused in alarming
and unacceptable numbers. All of these occurred while under the care of
the Children and Family Services.   Sadly, based on the 2022 San
Bernardino County Civil Grand Jury’s review of the substantiated abuse
cases, it determined that there was a steady increase every year from 2019
through 2021.  
The 2022 San Bernardino County Civil Grand Jury’s investigation analyzed
the changes made since 2018 to determine if those changes have been
effective in minimizing the abuses committed against foster children while
in the care of the Children and Family Services.  Regrettably, the Grand
Jury determined in its investigation that the substantiated foster children
abuse cases have continued. The revelation that there are significant
numbers of substantiated sexual and physical abuse cases is eye
opening.  
  
Additionally, the Grand Jury learned there are no temporary sheltering
facilities in San Bernardino County.  These already traumatized children
need to have a place to feel safe after removal and during the search for
placement. 
There is hope for the future for the foster children in San Bernardino
County. The Grand Jury found that this hope lies in small community-based
one-stop shop centers where all services can be provided.  The Grand Jury
strongly recommends CFS be abolished, and a new system be created that
is community-based to help raise and parent our foster children in the
county. San Bernardino County Children and Family Services is too broken
to fix. Let’s all work together “For the Children”.

FINDINGS
 
F1: San Bernardino County Children and Family Services has no proactive
outreach unit with strategies or services to assist those families in need, so
that they do not become part of Children and Family Services in the future. 
  
F2: There is no independent watchdog group which oversees the San
Bernardino County Children and Family Services. 
F3: There are no proactive/preventive measures for effectively vetting and

background checking San Bernardino County Children and Family
Services Resource Family Homes and foster settings.    
  
F4: There is no data interfacing between Children and Family Services and
law enforcement which would capture, track, and maintain data on all foster
child abuse allegations and investigations.  
F5: Children and Family Services does not share information with a Foster
Family Agency in a timely manner. This causes delays in foster children
being evaluated by medical/behavioral health providers, and the 30-day
requirement to see a primary care physician is delayed.  
  
F6: Social workers do not visit all children monthly or make frequent
unannounced visits and there are insufficient and inadequate home
inspections during visits.   
  
F7: There is insufficient, inconsistent, and a lack of continuous education
and training for social workers, resource families, and foster children within
the San Bernardino County Children and Family Services.  
  
F8: There are insufficient mental health services and resources for the
foster children.   
  
F9: Children placed in any Resource Family Home or foster setting are not
routinely evaluated mentally and physically before going into another foster
setting.  A baseline is not established for the new foster setting.  
  
F10: The younger foster children, aged birth - four, have very limited
access for reporting abuse.

F11: The requirement for how many times babies and toddlers, ages
birth to four, are seen by their SWs is unclear and babies and toddlers are
seriously at risk for abuse and neglect in Resource Family Homes or other
foster settings.   
    
F12: Children removed from a biological or foster setting do not have a
Temporary Sheltering Center in which to stay while placement is
determined. The children must sleep on a cot in the Social Worker’s office
or an area in the Children and Family Services building for days or weeks
at a time.
RECOMMENDATIONS
R1: Disband the current San Bernardino County Children and Family
Services organizational system and create, build, and implement
community-based one-stop shop centers where all services are centralized,
integrated, and interconnected for all foster care services. To be
implemented by July 2023.    
R2: Children and Family Services to create a community outreach

proactive services unit to provide services and resources to those in-need
families without any governmental intervention or regulation. Services
provided to include food, babysitting services, clothes, respite care,
parenting classes, child development classes, medical referrals, etc...,
without documentation. To be implemented by July 2023. 
 
R3: San Bernardino County Board of Supervisors to form an independent
watchdog group/children commission to oversee Children and Family
Services social workers in San Bernardino County.  Members of this group
would be authorized by the court and have full access to all confidential
documentation. The commission would report to the County Board of
Supervisors quarterly. To be implemented by July 2023.  
 
R4: Before the initial placement of any child into the foster care system, or
subsequent placement, there will be a mental and medical examination.  
To be implemented by June 2023. 
  
R5: Law enforcement to classify reports indicating that they are part of the
foster care system so they can be referenced. Children and Family

Services and law enforcement to capture, track and maintain data on all
foster child abuse allegations and investigations.  To be implemented by
July 2023.
R6: Children and Family Services Social Worker to visit the Resource
Family Home or foster setting four times a month, two announced and two
unannounced, perform a complete home inspection, and interview foster
children alone every visit. No field visit to be accomplished by any form of
virtual technology. To be implemented by July 2023. 
  
R7:All Resource Parents to have monthly mandatory training online. 
Children and Family Services to require resource parents to complete
continuing education in the fields of child abuse, foster childcare and
resource services at least two hours per month.  To be implemented by
July 2023.  
  
R8: Children and Family Services to write, implement and maintain a
checklist of mandatory attendees at all Children’s Assessment Center child
abuse interviews. Checklist to be maintained in the foster child’s case file.
To be implemented by July 2023. 
  
R9: Children and Family Services to hire two additional mental health
specialists per region, called “Child Life Specialists”, for the foster children. 
To be implemented by July 2023.
  
R10: Every initial foster child to see a Child Life Specialist during the first
30 days of placement in a Resource Family Home or foster setting, two
unannounced and two announced. To be implemented by July 2023.
R11: Children and Family Services and law enforcement to meet quarterly
and review their child abuse allegations and investigations in order to easily
identify and track all foster children abuse allegation cases, as a form of
checks and balances. To be implemented by June 2023. 
R12: Reduce the Children and Family Services Social Worker’s caseload to
no more than forty per month.  For example, utilize one-stop shop to
eliminate excess travel, hire support staff for Social Workers to reduce their
collateral duties and hire more Social Workers. To be implemented by
June 2023.
  

R13 Create a protocol and guidelines to ensure every child receives the
same written review from their Social Worker during their monthly
interviews, which should be included in the child's case file. Questions
should focus on any potential child abuse indicators. For example, has
anyone new visited or moved into the home, how have you been
disciplined and how was your visit with your family. To be implemented by
June 2023.
  
R14: Babies and toddlers to be seen four times a week for the first 30 days,
after that twice a week while in foster care until the child is four years old. A
nurse is required to attend every visit. To be implemented by July 2023.
  
R15: Create, build, and implement new innovative community-based
temporary sheltering centers where all removed foster children can go and
be housed during the transition time until suitable placement is located,
vetted, and determined by foster care services.  To be implemented by July
2023.  
R16: Children and Family Services to train foster children in identifying

grooming behaviors, predatory practices, child abuse, and how to report to
officials. Training to include in-person role-play scenarios. Also, provide a
list with all contact information to the child/children for their use when they
need to call for help or support.  To be implemented by June 2023.
  
R17: Implement a 20-day requirement to pass along medical cards and
behavioral issues to the Foster Family Agencies, regarding foster children
assigned to their care. To be implemented by July 2023. 
.
R18: Children and Family Services to complete initial vetting process of any
and all foster and visitation settings. Include in-person interviews of all
extended adult family and friends, all potential adults who would come into
contact with the foster child, and all adults who live or will reside in the
Resource Family Home or foster setting. To be implemented by July
2023.

REQUIRED RESPONSES
1.San Bernardino County Children and Family Services
R1, R2, R4, R5, R6, R7, R8, R9, R10, R11, R12, R13,
R14, R15, R16, R17, R18
2.San Bernardino County Board of Supervisors
R1, R3, R11, R12
3.San Bernardino County Sheriff’s Department

R5
GLOSSARY
CAAHL: Children and Adult abuse Hotline (the hotline)
CARF: Commission on Accreditation of Rehabilitation Facilities
CCL: Community Care licensing  
CFS: Children Family Services  
CHILD ABUSE/NEGLECT: Includes sexual abuse, sexual exploitation, and
other physical or emotional abuse, severe or general neglect of the child’s
needs (food, clothing, shelter, medical care, and willful cruelty or
unjustifiable punishment of a child).
CHILD LIFE SPECIALIST: They reduce the negative impact of stressful or
traumatic life events and situations that affect the development, health and
well-being of infants, children, youth, and families.  
CLETS: California law enforcement telecommunication system 
CMS: Case management system 
CPS: Child Protective Services 
CPU: Central Placement Unit 
CSAR: California Sex and arson registry  
CWS: Child welfare services 

DOJ: Department of Justice 
FFA: Foster family agency 
FFH: Foster family home/Resource Home 
GH: Group Home 
NREFM: nonrelative extended family member 
OCI: open case investigation 
PRD: placement resource division 
RAM: Risk assessment meeting
RAPBACK: An additional vetting tool that allows for the monitoring of any
new arrests and or judicial information involve a Foster Parent.  
RF: Resource Family/Foster Parent 
RFA: Resource family approval 
RFA SW: resource family approval social worker 
RFH: Resource family home/Foster Home/County Home 
SBC: San Bernardino County 
SBCSD: San Bernardino County Sheriff Department  
SBC CFS: San Bernardino County Children and Family Services 
SDM Tool: Structured Decision-Making Tool  
SIR: CFS Incident Report Form  
STRTP: short-term residual therapeutic program 
SSP: Social Service Practitioner  
SUBSTANTIATED: Abuse Allegation Proven 
SW: Social Worker/Carrier worker/ Case Manager
VETTING: to examine, investigate, or evaluate in a thorough or expert
way. 

WRAPAROUND SERVICES: provides a comprehensive, holistic, youth
and family-driven way of responding when children or youth experience
serious mental health or behavioral challenges.
BIBLIOGRAPHY
D. Roberts, Torn Apart, Basic Books, New York, 2022
APPENDIX
DISCLAIMER   This report was issued by the San Bernardino County Civil
Grand Jury with the exception of one member of the jury who has a family
member that works for Children and Family Services in San Bernardino
County. This juror was excluded from all parts of the investigation, including
interviews, deliberations, and the making and acceptance of the report.  


1
CONDITIONS WITHIN SAN BERNARDINO COUNTY JAILS (PC § 925)

and
CONDITIONS WITHIN SAN BERNARDINO COUNTY MUNICIPAL JAILS
(PC § 925a)

2
CONDITIONS WITHIN SAN BERNARDINO COUNTY JAILS (PC § 925)
SUMMARY
Per California Penal Code § 925: The 2022 San Bernardino County Civil
Grand Jury shall investigate and report on the operations, accounts, and
records of the officers, departments, or functions of the county including
those operations, accounts, and records of any special legislative district or
other districts in the county created pursuant to state law for which the
officers of the county are serving in their ex officio capacity as officers of
the districts.
METHODOLOGY
Using assessment categories from the Jail Inspection Observation Form
provided by the California Board of State and Community and Community
Corrections, as noted on the California Grand Jury Association website,
www.cgja.org. San Bernardino County Civil Grand Jurors (GJ) obtained
information from personal observations made by the Grand Jury and from
jail administrative staff about the housing, grounds and functioning at two
County jail facilities’ premises. The administrative staff’s responses to
questions on the Jail Inspection Observation Form, and our personal
observations, are listed below in bullet form and complete sentences. The
information next to each bullet point is taken directly from the Jail
Inspection Observation Form that was completed during the tours of two (2)
jail facilities:
PC § 925 Glen Helen Rehabilitation Center (GHRC)

PC § 925 West Valley Detention Center (WVDC)
The statements below in Attachment 1 and Attachment 2 reflect what the

GJ observed on the days of the visits to GHRC and WVDC facilities. The
GJ believed it was important to inform the public of our point-in-time
observations. The information about the inspection reports carried out at
the facilities can be obtained from the Board of State and Community
Corrections (BSCC) website,
https://bscc.ca.gov/s_fsolocaldetentionfacilityinspectionreports/

3
The Grand Jury did not discuss other issues the GJ were told about by staff
but did not observe. The GJ believes some of the issues touched on in this
report may warrant further inquiry.
CONCLUSION
The 2022 San Bernardino County Civil Grand Jury greatly appreciated the
staff at both locations’ willingness to lead the GJ on an inspection of their
facilities both inside and out. An assortment of administrative staff
members and Sheriffs made themselves available for questions before the
inspection, during the walkthrough, and at the end of the walkthrough. The
2022 San Bernardino County Civil Grand Jury would like to thank the
Facility Administrators for their cooperation, professionalism, and
hospitality.

4
ATTACHMENT 1
GLEN HELEN REHABILITATION CENTER

DATE OF GRAND JURY VISITATION: JULY 19, 2022
GENERAL INFORMATION
On July 19, 2022, the 2022 San Bernardino County Civil Grand Jury
conducted a walkthrough at the Glen Helen Rehabilitation Center, in the
City of San Bernardino, to observe the conditions at the County jail facility.
INDIVIDUAL CELLS/ROOMS
• The general population (GP) of inmates are housed in separate units
or sections based on their individual classifications when they are
booked. The inmate classification system is based on the level of
inmate security risk. Classification of an inmate is done before the
inmate is assigned to a living area. Inmates with major medical or
mental health issues are not housed at Glen Helen. Those inmates
are sent to West Valley Detention Center to ensure they receive a
higher level of care, and they have their own classification.
• Clean walls were observed in the facility and cells.
• The female section had two bunks to a cell, with one 4 bunk cell.
• The General Population cells for men had multiple bunk beds in each
section.
• On the day of the visit, hallways were clear and cell doors were
closed.
• Inmates have access to drinking water and toilets in each cell.
• Beds are metal bunk beds or singular beds.
• It was observed in the female housing section that inmates have

access to mops and brooms to clean their cells.

5
LOCAL INSPECTIONS
• A fire inspection was conducted on 11/16/2021.
• A medical/mental health inspection was conducted on 2/23/2022.
• The Environmental Health Department inspection was conducted on

2/23/2022.
• The Nutritional Health Department inspection was conducted on

2/23/2022.
• The Corrections Standards Authority inspection was conducted on

4/15/2022.
STAFFING
• The staff and inmates displayed a good rapport. The Grand Jury
witnessed several inmates all greeting a deputy who walked into the
building.
CONDITION OF GROUNDS
• Lawns, recreation area, and asphalt are clean and well-kept.
EXTERIOR OF BUILDING
• There were no visible signs of housing in ill repair in the areas
observed.
INTERIOR OF BUILDING
• A podular (pod) jail design has a master control area in the center
with cells and program areas surrounding the perimeter in a circular
or pie-shaped layout. This design eliminates staff’s need to run down
long corridors to see what's going on because there are clear
sightlines for observation of inmates and activities at all times.

6
• When the Grand Jurors were on the premises for the inspection, the
temperature was set at 75 degrees, the airflow was good, and the
lighting was bright.
ORIENTATION OF INMATES
• The Grand Jury was given a demonstration by an inmate on how to
use a computer kiosk to file commissary orders, grievances, and
medical requests.
PERSONAL APPEARANCE OF INMATES

• Inmates observed looked clean and kept.
• The jail has a laundry facility that keeps clean clothing available to
inmates.
• The Grand Jury observed inmates wearing color-coded clothing

according to their housing classifications.
PROGRAMS FOR PERSONAL GROWTH

• Recreational activities and equipment were observed. Basketballs
and volleyballs were being used by inmates. Other inmates were
jogging or walking.
• There are inmate work programs at the jail, such as jobs in the
kitchen.
GRIEVANCES
• Kiosks are used by inmates to file grievances.

7
ATTACHMENT 2
WEST VALLEY DETENTION CENTER

DATE OF GRAND JURY VISITATION: AUGUST 17, 2022
GENERAL INFORMATION
On August 17, 2022, the 2022 San Bernardino County Civil Grand Jury
conducted a walkthrough at the West Valley Detention Center (WVDC) in
the City of Rancho Cucamonga, California to observe the conditions at the
County jail facility.
INDIVIDUAL CELLS/ROOMS
• There are individual cells and dormitory units at the facility.
• Clean walls were observed in the facility and cells.
• Inmates have access to drinking water and toilets in the pods and
cells.
• Cells have metal bunk beds or individual beds.
• Mops, brooms, and cleaning supplies for cell upkeep were observed.
LOCAL INSPECTIONS
• A fire inspection was conducted in February 2022.
• A medical/mental health inspection was conducted in February 2022.
• The Environmental Health Department inspection was conducted in

February 2022.
• The Nutritional Health Department inspection was conducted in

February 2022.
• The Corrections Standards Authority inspection was conducted in

February 2022.

8
STAFFING
• Professional attitudes were observed during staff interactions with
inmates.
• Lawns, recreation area, and asphalt were clean, well-kept, and no
defects or areas of concern were observed.
EXTERIOR OF BUILDING
• There were no visible signs of housing in ill repair in the areas
observed.
• A podular (pod) jail design has a master control area in the center
with cells and program areas surrounding the perimeter in a circular
or pie-shaped layout. This design eliminates staff’s need to run down
long corridors to see what's going on because there are always clear
sightlines for observation of inmates and activities.
• When the Grand Jurors were on the premises for the inspection, the
temperature was set at a comfortable level, the airflow was good, and
the lighting was bright.
ORIENTATION OF INMATES
• The Grand Jury observed a computer kiosk that inmates use to file
commissary orders, grievances, and medical requests.
PERSONAL APPEARANCE OF INMATES

• Inmates looked clean and kept during the visit.
• The Grand Jury observed a laundry facility and keeps clean clothing
available to inmates.
• The Grand Jury observed inmates wearing color-coded clothing

according to their housing classifications.

9
PROGRAMS FOR PERSONAL GROWTH

• No recreational equipment was observed during the visit.
• There are inmate work programs at the jail, such as jobs in the
kitchen and laundry.
• The Grand Jury observed a classroom where inmates receive training

in Culinary Arts and Food Handling.
GRIEVANCES
• Kiosks are used by inmates to file grievances.
EDUCATIONAL PROGRAMS
• The GJ observed a presentation in a classroom from a vocational
instructor regarding Culinary Arts and Bakery Certification activities at
the facility.
• The classroom was clean and orderly and had desks and books.
CONCLUSION
The 2022 San Bernardino County Civil Grand Jury greatly appreciated the
staffs at Glen Helen Rehabilitation Center and West Valley Detention
Centers’ willingness to lead us on an inspection of their facility both inside
and out. An assortment of San Bernardino County Sheriff’s Department
administrative staff members made themselves available for questions
before, during and after the walkthrough. The 2022 San Bernardino County
Civil Grand Jury would like to thank the Facility Administrators for their
cooperation, professionalism, and hospitality.

10
CONDITIONS WITHIN SAN BERNARDINO COUNTY MUNICIPAL JAILS

(PC § 925a)
SUMMARY
Per California Penal Code § 925a: The Grand Jury may at any time
examine the books and records of any incorporated city or joint powers
agency located in the county. In addition to any other investigatory powers
granted by this chapter, the Grand Jury may investigate and report upon
the operations, accounts, and records of the officers, departments,
functions, and the method or system of performing the duties of any such
city or joint powers agency and make such recommendations as it may
deem proper and fit.
The Grand Jury may investigate and report upon the needs of all joint
powers agencies in the county, including the abolition or creation of
agencies and the equipment form or the method or system of performing
the duties of the several agencies. It shall cause a copy of any such report
to be transmitted to the governing body of any affected agency.
METHODOLOGY
The 2022 San Bernardino County Civil Grand Jury performed visitations to
(3) jails within San Bernardino County using the Jail Inspection Handbook
for the Grand Jurors provided by the California Board of State and
Community and Community Corrections as noted in the California Grand
Jury Association Web site: www.cgja.org. The 2022 San Bernardino
County Civil Grand Jury was led on a tour of three jail facilities. The tours
were led by administrative staff at the three jails. Grand Jury members
notated the administrator’s responses to the questions, and the GJ made
their own observations. The information notated during the walkthroughs
was listed on the Jail Inspection Observation Form, and is provided below
on Attachments 3, 4 and 5 in bullet form and in complete sentences. The
information on the attachments below reflects only what the Grand Jurors
observed on the days of the visits. The GJ believed it was important to
inform the public of the point-in-time observations. The only information in

11
these reports that was not observed is information about the inspection
reports carried out at the facilities. This information can be obtained from
the Board of State and Community Corrections (BSCC) website,
https://bscc.ca.gov/s_fsolocaldetentionfacilityinspectionreports/ .
The Grand Jury did not discuss other issues the GJ were told about by staff
but did not observe. The GJ believes some of the issues touched on in this
report may warrant further inquiry. The three (3) municipal jail facilities are:
PC § 925a Fontana City Jail (visited on June 21, 2022)

PC § 925a Ontario City Jail (visited on August 31, 2022)
PC § 925a Upland City Jail (visited on August 1, 2022)
CONCLUSION
The 2022 San Bernardino County Civil Grand Jury identified a few minor
maintenance and upkeep issues, but no major issues during the visits to
the three municipal city jails. The Grand Jury appreciated the organization,
teamwork, and professionalism exhibited by the staff during the site visits.
The Civil Grand Jury would like to thank the facility administrators for their
cooperation.

12
ATTACHMENT 3
FONTANA CITY JAIL

DATE OF GRAND JURY VISITATION: JUNE 21, 2022
GENERAL INFORMATION
On June 21, 2022, the 2022 San Bernardino County Civil Grand Jury
conducted a walkthrough inspection of the Fontana City Jail in Fontana,
California.
STAFFING AT FACILITY
• The Grand Jury met three sworn officers and the civilian jail
manager.
• The jail is in the basement of the Fontana Police station. The grounds
observed were well-kept and clean.
EXTERIOR OF BUILDING(S)
• The building is made of concrete.
• The exterior of the police department looked well-maintained during

the visit.
INTERIOR OF BUILDING(S)
• The walls in the jail cells contained some graffiti and the paint was
peeling in at least one of the cells. The windows were in good
condition with no visible cracks. The air vents and plumbing in the
cells were in excellent working order on the day of the visit.
• The Grand Jury observed that cleaning fluids and chemicals were
placed in two holding cells and locked.
• The entrance from the sally port has several lockers available for
officers to use prior to their entry into the jail. The sally port is a
secured area situated between an outside area and an area inside a
jail or prison. A sally port allows officers to make a 2-step controlled

13
entry to a jail or prison to deter, defend, and delay against unwanted

entry (or exit).
• The hallways were clear during the visit.
• Holding areas (cells) have access to drinking water and a toilet. Each
cell has a faucet and a toilet. The faucet has a hot and cold dial. The
water shoots up from the faucet like a fountain and can be used for
drinking water. The toilets were in good working order.
• There were fifteen individual cells. Nine cells are available for use.
The rest were used for storage. The holding cells can hold up to two
detainees if necessary.
• Beds are metal single off the floor. Mattresses were seen in a
separate cell, and could be provided when needed.
LOCAL INSPECTIONS
• The Board of State and Community Corrections (BSCC) indicated
that Type 1 facilities such as municipal jails undergo annual and
biennial inspections to ensure safety from fire, environmental and
structural problems. The Board of State and Community Corrections
(BSCC) conducts a biennial inspection of the facilities pursuant to
Penal Code § 6031 and WIC § 209 to determine compliance with the
minimum standards for local detention facilities.
ORIENTATION OF DETAINEES
• The Grand Jury observed a list of rules for detainees posted on a wall
about phone use.
• Fontana police provided the Grand Jury with a form showing that
when they perform medical screenings of detainees, there are a
series of 15 questions that include their health history, prescribed
medications (including psychiatric), and current state of being.

14
USE OF CELLS/ROOMS FOR DETAINEES

• The Fontana jail accommodates adult detainees.
• One cell is available for adult handicapped detainees.
• There were no detainees in the cells when visited.
DETAINEE TELEPHONE USE

• Each holding cell had a telephone available for use.
• Local calls are free and long-distance calls can be made “collect.”
CONDITIONS OF SECURE DETENTION

• Staff supervises detainees with audio-equipped closed-circuit
cameras for monitoring.
• There is a cuffing rail in the intake area and the cell area. A cuffing
rail is a long wooden or steel pole cemented into a wall that an
detainee can be handcuffed to for safe and secure controlled
movement.

15
ATTACHMENT 4
ONTARIO CITY JAIL

GENERAL INFORMATION
conducted a walkthrough at the Ontario City Jail in Ontario, California.
STAFFING AT FACILITY
• There was one male and one female staff member in the holding cell
area.
• In the detainee holding area, the walls were dirty and needed
cleaning. The floors were clean. The toilet and sink in the cells were
checked and were in working condition. However, one toilet needed a
thorough cleaning.
• Grand Jurors observed cleaning fluids and chemicals labeled and

stored in a separate room away from detainees.
• No detainees were being held in the three holding cells and lavatory,
so the doors were open for free and convenient examination of the
cells.
• Detainees have access to drinking water and a toilet.
LOCAL INSPECTIONS

16
• Detainees are booked when they are brought to the jail.
about phone use.

• The Ontario jail accommodates adult detainees, as well as juveniles
(ages 12-17).
• The facility has the capacity to hold up to 44 detainees.
• The jail has six (6) holding cells that can accommodate a capacity of
up to 26 detainees. A sobering cell can hold up to eight (8) detainees.
Another cell was designated to hold up to six (6) female detainees.
One cell is available for adult handicapped detainees. The other three
cells can each hold up to three detainees.
• The jail has a separate section of cells for juveniles. Those cells have
the capacity to accommodate up to 16 juveniles.

• There is a phone in the hallway outside of the cells.

• Staff supervises detainees at the jail with a closed-circuit camera
system with audio recording for monitoring.
rail is a long wooden or steel pole cemented into a wall that a
movement.

17
• Lockers were observed where officers store their weapons before

they enter the sally port area of the jail. The sally port is a secured
area situated between an outside area and an area inside a jail or
prison. A sally port allows officers to make a 2-step controlled entry
to a jail or prison to deter, defend, and delay unwanted entry (or exit).

18
ATTACHMENT 5
UPLAND CITY JAIL

GENERAL INFORMATION
conducted a walkthrough at the Upland City Jail in Upland, California.
• Walls were in excellent condition without any visible marks. They
appeared to have been recently painted. The floors were clean.
• The toilet and sink in the lavatory holding cell area were checked and
were in working condition.
• Each holding cell was designed to hold an individual detainee.
• Hallways were clear. No detainees were present during the

walkthrough. Therefore, the doors were open for free and convenient
examination of the cells.
• Each cell had a toilet, sink and drinking water. One toilet needed
cleaning as there was a dark brown ring around the toilet at the water
level and the seat was dirty.
• Detainees’ beds had a plastic unit-construction built-in bench along

the back side of the cell.
• Bedding and blankets were observed in a storage room.
LOCAL INSPECTIONS

19
• The Grand Jury was provided a copy of the screening form they use
to classify new detainees when they are brought to the jail. The
screening assesses their health and mobility, arrest history, violence
history, escape history, gang association or involvement, and
victimization and abusiveness history.
about phone use.

• The facility can hold up to 12 detainees at a time, four in each of the
three cells they have.
• The jail accommodates adult detainees (age 18 and older).
• One cell is available for adult handicapped detainees.
• The holding cells had a combined toilet, sink, and fountain.

• A phone is in the hallway outside of the detainee’s cell.

• Staff supervises detainees at the jail with a closed-circuit camera
system with audio recording for monitoring.
• A bank of weapon lockers is located outside of the holding cell area.

20
rail is a long wooden or steel pole cemented into a wall that a
movement.


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FINAL

SAN BERNARDINO COUNTY

Dear Judge Yabuno,

DAVID HUTSON DANIEL LOWRY

November 23, 1982 –

“Do not stand at my grave and weep;

-Mary Elizabeth Frye

San Bernardino County Sheriff and Department of Behavioral Health ................... 3

Redlands Unified School District ............................................................................ 10

San Bernardino County Food Permits .................................................................... 33

San Bernardino County Lakes ................................................................................ 44

San Bernardino County Public Guardian.……….………………………….……….....51

Grand Jury Reports

Redlands Animal Shelter ........................................................................................ 57

San Bernardino County Children and Family Services ........................................... 105

San Bernardino County Jails...…………………….………………………….………...137

San Bernardino County Municipal Jails...…………………….……………………......145

Established April 26, 1853 Adelanto

20,105 Square Miles

2020 Population was 2,181,654 Rancho

5 Native American Reservations

SAN BERNARDINO COUNTY

Background: Response and Accountability Committee

(1) The recommendation has been implemented, with a summary regarding

San Bernardino County Grand Jury Final Report 1

(4) The recommendation will not be implemented because it is not warranted

2 San Bernardino County Grand Jury Final Report

Please find below, in every recommendation, the original recommendations

San Bernardino County Grand Jury Final Report 3

The response complies with PC § 933.05 (b)(3).

4 San Bernardino County Grand Jury Final Report

The response complies with PC § 933.05 (b)(1).

The Sheriff’s Department and DBH will assess whether it would be

The response complies with PC § 933.05(b)(1).

The response complies with PC § 933.05(b)(1).

The response complies with PC § 933.05(b)(2).

6 San Bernardino County Grand Jury Final Report

The response complies with PC 933.05(b)(2).

The response complies with PC 933.05(b)(1).

The response complies with PC 933.05(b)(1).

8 San Bernardino County Grand Jury Final Report

San Bernardino County Grand Jury Final Report 9

The response complies with PC § 933.05(b)(1), (b)(2).

The response complies with PC § 933.05(b)(2), (b)(3).

San Bernardino County Grand Jury Final Report 11

The response complies with PC § 933.05 (b)(3),(b)(4).

12 San Bernardino County Grand Jury Final Report

The response complies with PC § 933.05(b)(2).

The response complies with PC § 933.05(b)(1).

San Bernardino County Grand Jury Final Report 13

The response complies with PC § 933.05(b)(1).

The response complies with PC § 933.05(b)(2),(b)(3).

The response complies with PC § 933.05(b)(4).

San Bernardino County Grand Jury Final Report 15

The response complies with PC § 933.05(b)(2).

San Bernardino County Grand Jury Final Report 17

The response complies with PC § 933.05(b)(2).

The response complies with PC § 933.05(b)(3).

The response complies with PC § 933.05(b)(4).

San Bernardino County Grand Jury Final Report 19