OHIO DEPARTMENT OF HEALTH 246 North High Street 61 4/466-3 543 Columbus, Ohio 432-15 John R. Kasich Governor Theodore E. MD. 1? Director of Health September 6, 2013 Karen K. Butler, Director Cleveland Department of Public Health 75 Erieview Plaza 3rd Floor Cleveland, OH 44114 Dear Director Butler: Thank you for the cooperation and assistance given to the Ohio Department of Health?s (ODH) Ohio Healthy Homes and Lead Poisoning Prevention Program staff during our recent site visit. Enclosed is the site visit report prepared by Angela Evans, Healthy Homes Consultant, with input from other ODH staff involved in the program review. Four recommendations have been provided at the end of the report. Recommendations are given as suggestions to enhance the performance of your roleas a Delegated Authority of ODH for Public Health Lead Investigations. Please respond to these recommendations within 45 days of receiving this report. Contact Ms. Evans, at (614) 644-7799 if you should have comments or concerns about the site visit or if you have any questions about the program. We look forward to working with you. Sincerely, Pam Blais, Environmental Supervisor Ohio Department of Health Healthy Homes and Lead Poisoning and Prevention Program Enclosures cc: Angela Evans, Healthy Homes Consultant, Ohio Healthy Homes and Lead Poisoning Prevention Program Pamela Cross, Health Commissioner, Cleveland Department of Public Health Brian Kimball, Cleveland Department of Public Health Kimalon Meriweather, Cleveland Department of Public Health Delegated Authority File HEA 6413 22'1?; An Equal Opportunity EmployerIProvider OHIO DEPARTMENT OF HEALTH Ohio Healthy Homes and Lead Poisoning Prevention Program Delegated Authority for Public Health Lead Investigations Site Visit Report The Ohio Department of Health?s Ohio Healthy Homes and Lead Poisoning Prevention Program conducted a site visit of Cleveland Department of Public Health on August 22, 2013. was represented by Angela Evans. Cleveland Department of Public Health was represented by Pamela Cross, Brian Kimball and Kimalon Meriweather. Below is an assessment of the local health department?s ability to conduct public health lead investigations and public health lead risk assessments. Delegation of Authority: Cleveland Department of Public Health is capable of conducting public health lead investigations and public health lead risk assessments, but is challenged because of existing ?nancial restraints. However, there are discussions with the senior leadership of the Department to seek additional funding from the City of Cleveland. Cleveland Department of Public Health has written policies and/or procedures which cover the investigation process, record retention and enforcement protocol. To date, a public health lead investigation or public health lead risk assessment has not been conducted for a majority of referrals which ODH has sent to the local health department. Because of the large number of referrals Cleveland receives, Cleveland now prioritizes the referrals based on the EBL level and the age of the child. Cleveland Department of Public Health provides excellent educational outreach to the families with case management follow-up and explanations from the licensed lead risk assessor. Cleveland Department of Public Health conducts periodic meetings to discuss all elevated blood level cases.- A referral process with the city?s Community Development Department will provide, at least, ?fty homeowners grant funding to control lead hazards in their properties with active lead hazard control orders. Cleveland reported that twelve grants have been approved to date. Equipment and Supplies: Cleveland Department of Public Health maintains all equipment and supplies in a secure manner. The XRF is stored in a locked room. The risk assessor observes safety regulations when handling the XRF and during its transport. Calibrations are conducted appropriately to ensure proper operation of the XRF equipment. The XRF is resourced at appropriate intervals as recommended by the manufacturer. Cleveland Department of Public Health has received the XRF manufacturer?s training on the operation of the XRF. Records and Reports: Cleveland Department of Public Health maintains case referrals in a locked mental ?ling cabinet. This includes the case manager?s ?les, which include individual level child data. Unfortunately, there exists a backlog of case referrals at Cleveland Department of Public Health, because Cleveland currently does not have the capacity to conduct a public health lead investigation for each referral they receive. Cleveland Department of Public Health has not routinely submitted records and documentation to ODH after completed public health lead investigations. In addition, written reports from public health lead risk assessment are not being sent in accordance with Ohio Administrative Code Chapter 3701?30-08 (D). Cleveland is encouraged to comply with the regulation and mail the reports within fourteen calendar days of receipt of laboratory test results. A review of completed risk assessments in the ?le cabinet indicates that Cleveland Department of Public Health is not using current ODH templates. A web address where electronic copies of all public health lead documents can be downloaded was provided. Cleveland Department of Public Health has a Records Retention Schedule for determining when records can be removed and destroyed. Public Health Lead Investigations: Cleveland Department of Public Health employs one employee who is a licensed lead risk assessor. The case manager provides educational literature and other resources to homeowners and renters. Cleveland indicated it would like to participate in HEPA vacuum loaner program. The risk assessor is very knowledgeable about the investigation process. Upon arrival to the home, the licensed public health lead investigator provides an explanation about the investigation and equipment. Currently, Cleveland Department of Public Health has only one licensed lead risk assessors and she conducts a minimum of one hundred and twenty public health lead investigations and public health lead risk assessments annually. The licensed lead risk assessor uses her professional judgment to determine to test interior and exterior components. When the investigation is complete, a brief summary of the ?ndings and recommendations are shared with the parent. Cleveland Department of Public Health conducts investigations throughout the city jurisdiction. Properties are monitored to ensure that lead abatement work is initiated and completed. RECOMNIENDATIONS: 1. Invite the Cuyahoga County Job and Family Services Coordinator to accompany you on public health lead investigations, when verifying Medicaid eligibility. 2. Ensure that the most current templates are used for investigation documentation and case report creation. 3. Develop a monitoring and tracking tool to ensure that all ODH referrals are investigated in a timely manner. 4. ODH strongly encourages the employment of additional licensed lead risk assessors to increase the capacity of the department. SUNIMARY: Cleveland Department of Public-Health is not the responsibilities as a Delegated Authority of the Ohio Department of Health for Public Health Lead Investigations. Currently, there is a large referral backlog. The referrals have not been investigated and documentation has not been returned to ODH. ODH is hopeful that the discussions with senior leadership to seek additional funding from the city will provide additional staff to assist the department.