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Analysis of the 2006-07 Budget BillLegislative Analyst's Office
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The Department of Mental Health (DMH) operates five mental health hospitals and two correctional facility mental health programs. The five mental health hospitals have capacity of over 6,300 beds and approximately 6.4 million square feet of space. Four of the mental health hospitals were constructed more than 50 years ago. In 2005, DMH opened the Coalinga Mental Hospital with 1,500 beds for sexually violent predators.
We recommend the Legislature fund only preliminary plans for new main kitchens at Napa State Hospital and Patton State Hospital, requiring a funding shift from lease-revenue bonds to the General Fund. We withhold recommendation on the amount ($947,000) requested for preliminary plans to renovate satellite kitchens at the two hospitals pending review of the federal Civil Rights of Institutionalized Persons Act remediation agreement and in order to allow the department to submit a revised proposal.
Proposal for Napa State Hospital New Kitchen. The Governor’s budget proposes $20.7 million in lease-revenue bonds to prepare preliminary plans and working drawings, and to construct a new main kitchen at Napa State Hospital. The purpose of the project is to implement a cook-chill method of food preparation and to replace the deteriorated main kitchen. The Governor’s budget further proposes to fund preliminary plans for the renovation of 13 satellite kitchens at Napa. The proposed satellite kitchens each include food reheating capability and a dining room area. The satellite kitchen preliminary plans would be funded from the General Fund at $598,000. The future costs for working drawings and construction of the Napa satellite kitchens would be $11.3 million (General Fund).
Proposal for Patton State Hospital New Kitchen. The Governor’s budget also proposes $21 million in lease-revenue bonds to prepare preliminary plans and working drawings, and to construct a new main kitchen at Patton State Hospital. The purpose of the project is to implement a cook-chill method of food preparation and to replace the deteriorated main kitchen. The Governor’s budget further requests $349,000 from the General Fund for preliminary plans for the renovation of seven satellite kitchens at Patton. The future costs for working drawings and construction of the Patton satellite kitchens would be $6.5 million.
Cook-Chill Method Efficient for Large Institutions. Our review indicates that the new main kitchen projects for both hospitals are justified. The projects will enable both hospitals to address the failing equipment and inefficient workspace layout of the kitchen facilities. The current main kitchens were built in the 1950s and do not meet current health and safety codes in many areas. In addition, the projects will allow shifting the food preparation and delivery to the cook-chill method, which provides better food safety control.
The cook-chill method also could result in staff savings as multiple meals are cooked at one time so that fewer staff would be needed at every mealtime to prepare food. For instance, the state correctional facilities, which already use the cook-chill method, realized staff savings at implementation.
Preliminary Plans Provide Detailed Project Scope. Preliminary plans include a detailed project scope description (exactly what will be built and why), a site plan, architectural floor plans, building elevations, outline specifications, and a detailed cost estimate. The completion of preliminary plans is important because they provide the initial design documents used to prepare the construction documents. Without completed preliminary plans, any project cost estimate is merely a “best guess” estimate concerning the final scope and cost of the project.
Complete Preliminary Plans Prior to Funding Construction. The proposed new main kitchen and satellite kitchen renovation projects are complex and will take several years to complete. If lease-revenue bonds are used to fund these projects, as requested by the department, the Legislature would have to authorize funding for all three phases-preliminary plans, working drawings, and construction-at one time. This is because lease-revenue bonds cannot be used without the assurance that a project will be constructed. Thus, lease-revenue bond funds cannot be used to fund only preliminary plans. However, authorizing a project’s full funding before the project scope is defined reduces the Legislature’s oversight of the project’s development. To ensure that oversight, we recommend that the Legislature wait to fund the working drawings and construction phases of the projects until after it has had an opportunity to review the plans. Funding only preliminary plans for these projects would necessitate the use of General Fund money. Accordingly, we recommend funding the Napa new main kitchen preliminary plans from the General Fund at a cost of $1,026,000, and the Patton new main kitchen preliminary plans from the General Fund at a cost of $904,000. Once the detailed cost estimates from the preliminary plans are complete, the Legislature can consider funding for working drawings and construction of the main kitchen projects from lease-revenue bonds.
Federal CRIPA Dispute. The department is currently involved in negotiations with the federal government over alleged violations of the federal Civil Rights of Institutionalized Persons Act (CRIPA). The final agreement between the state and the federal government on addressing CRIPA issues at DMH hospitals is anticipated in spring 2006. The remediation agreement could result in changes in programs and treatment models. Because these changes could have an impact on how the hospitals serve meals, they should be evaluated prior to the implementation of the satellite kitchen projects. For example, the federal government might require DMH to provide patients more time away from housing units-an action that might necessitate a differently configured dining-hall system.
Department Should Examine Alternatives. Our review also indicates that the department did not examine alternatives to renovating numerous satellite kitchens at two hospitals. For instance, the department did not consider consolidating some service kitchens. The satellite kitchen proposals include two service kitchens in some buildings, so patients would not have to walk between floors. Depending on the CRIPA agreement, there may be opportunities for the department to consolidate some of the service kitchens.
Wait for Revised Satellite Kitchen Proposal. We think that the department should await the federal CRIPA remediation agreement before it determines how the satellite kitchens of both Napa and Patton hospitals should be configured. Furthermore, the department should examine the cost and benefits of other alternatives, including consolidation of some satellite kitchens. After the CRIPA remediation agreement is released during spring 2006, DMH should submit a revised satellite kitchen proposal for legislative consideration. We withhold recommendation on the satellite kitchen proposal pending receipt of this information.