‘COUNTY OF Los ANGELES: Public Health coupe stn. JONATHAN E. FREEDMAN fea ‘hit Depa Drea tn ANGELO J. BELLOMO, REHS FevSncneey Decrement Heath Som TERRI S. WILLIAMS, REHS thot 0 Atroh ‘esa Get of enone ean PEARL JACQUELINE E, TAYLOR, REHS, MPA Dies, ue of abet Suvalianen an Enorarent Rogen 060 commerce Dine ‘TEL G26) 480-5200 FAK 25) 8104034 mm publcheabh acount gov May 21, 2012 City of Los Angeles Office of the City Attomey City Hall East 200 N, Main Street, Rm 800 Los Angeles, CA 80012 Attention: William W. Carter, Chief Deputy Dear Attorney Carter: SUBJECT: REPORT OF FINDINGS - REQUEST FROM CITY OF LOS ANGELES TO ADDRESS PUBLIC HEALTH ISSUES IN THE SKID ROW AREA OF DOWNTOWN LOS ANGELES This report is in response to a request by the City of Los Angeles(City) to the Los Angeles County Department of Public Health (DPH) to provide assistance in assessing and addressing public health issues in the Skid Row area of downtown Los Angeles. On March 28, 2012 representatives from the City and DPH, Environmental Health Division (EH) met to discuss the City's concems and to conduct an initial site assessment of the target area. On April 26, 2012, a second meeting was held with William Carter, Chief Deputy Los Angeles City Attorney, several other City Attorneys, and representatives from DPH, EH and DPH Community Health Services to discuss the March 28, 2012 observations and determine a course of action to address the public health conditions. At the conclusion of the April meeting, DPH determined that an in-depth environmental survey of the impacted area was necessary and agreed to provide a report of findings to the City by May 21, 2012Skid Row Findings May 21, 2012 Page 2 On May 2, five multi-disciplinary EH teams conducted a survey of the target area, a 10 block area bounded by Sth Street to the North, 7th Street to the South, Gladys Street to the East, and San Julian Street to the West (see Attachment |). EH was joined in the survey by Dr. Sheree Poitier, Medical Director, DPH Community Health Services, Dr. Elizabeth Norris, DPH Homeless Coordinator, and officers from the City Police Department. ‘The EH teams were instructed to note health code violations, paying particular attention. to the presence of feces, urine and discarded hypodermic needles on the ground, the depositing of liquid or solid waste in the storm drain system, the sanitation/condition of City maintained public toilets, and potential vermin harborage. The medical director evaluated the risk of disease transmission from the perspective of Community Health Services. On May 18, 2012, a follow-up survey was conducted by EH focusing attention on the presence of vermin in the area, The survey findings have been divided into six categories, Immediate Threat to Public Health, Safety Hazards, Vermin Control, Solid Waste Disposal, Communicable Disease Risk, and Non-Public Health Observations, Each category lists the Findings, Corrective Actions required to abate the violations, and Recommendations as to how the violations can be prevented in the future. The Official Notice of Violation (NOV) lists each violation observed and stipulates the respective compliance date (see Attachment Il). A description of the violations and the specific location where the violations were observed is found on Attachment Ill, Attachment Ill also documents other “non-public heaith issues" observed during the survey, such as the number of personal items, tarps, and shopping cars. A tally summarizing the occurrence of each observation is found on Attachment IV, while Attachment V contains photos of the violations that fel into the category of “immediate threst to public health" and Attachment VI is a copy of the referral sent to LA County Department of Mental Health. Note a re-inspection will be conducted by EH on June 5, 2012 to ensure compliance with the attached NOV. Immediate Threat to Public Health Findings: Survey teams observed small piles of feces and/or urine on the sidewalks and grass areas of the majority of the streets surveyed (Le. 8 of the 10 blocks surveyed). Additionally, teams observed an accumulation of feces/urine in two storm drains, no soap in one of the City maintained automatic public toilets, and trash and debris in another public toilet. Corrective Action: Compliance with No. 1 listed on the NOV dated May 21, 2012 “at once.” Recommendations: Provide additional automatic public toilets particularly on San Julian, San Pedro, and Crocker Streets. Provide barrier type screening and/or repairireplace damaged screen covers at storm drain inlets.‘Skid Row Findings May 21, 2012 Page 3 In response to the question, “should City workers in the area wear bio-hazard suits," itis. recommended that the City seek guidance from its Human Resources Department, specifically the ‘Workplace Safety & Health Program’ or a private company. A worker safety specialist can assess the potential environmental hazards/exposures on sidewalks, streets, and gutters and identify any control requirements (i.e. engineering, administrative, or personal protective equipment) that may be necessary to protect City ‘employees involved in enforcement or clean-up activities in the area Safety Hazards Finding: Survey teams observed approximately 13 discarded, improperly disposed hypodermic needles/syringes. Corrective Action: Compliance with No. 2 listed on the NOV dated May 21, 2012, “at once." Recommendation: [Monitor area to ensure discarded hypodermic needles, syringes, and sharps are properly disposed of. Vermin Control Finding: Survey teams observed an active rodent infestation in the area, as evidenced by approximately 88 active burrows. Corrective Action: Compliance with No, 4 listed on the NOV dated May 21, 2012, by June 4, 2012. Recommendation: Contract with DPH to provide a vermin monitoring/rodent abatement program Solid Waste Disposal Finding: Survey teams observed solid waste improperly disposed of on the ground, sidewalks, and gutters in the form of trash, garbage, and debris, Corrective Action: Compliance with No. 3 on the NOV dated May 21, 2012, by May 29, 2012. Recommendation: Provide adequate number of trash bins with frequent, as needed disposal to prevent the accumulation of trash and debris on the sidewalk. Communicable Disease Risk Findings: The tisk of communicable disease transmission is generally associated with the size, health status and living conditions of the population present. Crowding, inadequate water and sanitation, and poor access to health services, increase the risk of communicable disease transmission (WHO 2006). There have been reports of