BOARD OF SUPERVISORS

STATEMENT OF PROCEEDINGS COUNTY OF SAN DIEGO BOARD OF SUPERVISORS REGULAR MEETING TUESDAY, AUGUST 27, 2024, 9:00 AM COUNTY ADMINISTRATION CENTER, ROOM 310 1600 PACIFIC HIGHWAY, SAN DIEGO, CALIFORNIA Order Of Business A. REGULAR SESSION: Meeting was called to order at 9:04 a.m. PRESENT: Supervisors Nora Vargas, Chair; Terra Lawson-Remer, Vice-Chair; Joel Anderson; Monica Montgomery Steppe; Jim Desmond; also, Andrew Potter, Clerk of the Board of Supervisors B. Statement (just cause) and/or Consideration of a Request to Participate Remotely (emergency circumstances) by a Supervisor, if applicable. C. Invocation was led by Reverend Marcus Lohrmann. D. Pledge of Allegiance was led by Jasmin Taylor. E. Presentations or Announcement of Proclamations and Awards: Chairwoman Nora Vargas and Supervisor Monica Montgomery Steppe presented a proclamation declaring August 27, 2024, to be San Diego County Black Chamber of Commerce Day throughout the County of San Diego. Supervisor Joel Anderson presented a proclamation declaring August 27, 2024, to be Jacumba Hot Springs Hotel and We Are Humankind Day throughout the County of San Diego. Supervisor Jim Desmond presented a proclamation declaring August 27, 2024, to be The Kawanis Club of Escondido-Hidden Valley Day throughout the County of San Diego. Chairwoman Nora Vargas presented a proclamation declaring August 27, 2024, to be Commission on the Status of Women and Girls Appreciation Day throughout the County of San Diego. Vice-Chair Terra Lawson-Remer presented a proclamation declaring August 27, 2024, to be Librarians and Library Staff Day throughout the County of San Diego. Vice-Chair Terra Lawson-Remer and Supervisor Monica Montgomery Steppe presented a proclamation declaring the month of August 2024, to be California Schools Voluntary Employees Benefits Association (VEBA) National Wellness Month throughout the County of San Diego. F. Non-Agenda Public Communication: Opportunity for members of the public to speak to the Board on any subject matter within the Board’s jurisdiction but not an item on today’s agenda. 1TUESDAY, AUGUST 27, 2024

G. Approval of the Statement of Proceedings/Minutes for the meeting of July 16, 2024. ACTION: ON MOTION of Supervisor Desmond, seconded by Supervisor Anderson, the Board of Supervisors approved the Statement of Proceedings/Minutes for the Regular meeting of July 16, 2024. Vargas, Anderson, Lawson-Remer, Montgomery Steppe, DesmondAYES: H. Consent Calendar I. Discussion Items J. Board Member Committee Updates. This is an opportunity for Members of the Board to provide informational updates on their committee assignments. No action may be taken. NOTICE: THE BOARD OF SUPERVISORS MAY TAKE ANY ACTION WITH RESPECT TO THE ITEMS INCLUDED ON THIS AGENDA. RECOMMENDATIONS MADE BY COUNTY STAFF DO NOT LIMIT ACTIONS THAT THE BOARD OF SUPERVISORS MAY TAKE. MEMBERS OF THE PUBLIC SHOULD NOT RELY UPON THE RECOMMENDATIONS IN THE BOARD LETTER AS DETERMINATIVE OF THE ACTION THE BOARD OF SUPERVISORS MAY TAKE ON A PARTICULAR MATTER. Board of Supervisors' Agenda Items Category # Subject Public Safety 1. SHERIFF - REQUEST FOR SINGLE SOURCE PROCUREMENTS OF TOXICOLOGY AND CONTROLLED SUBSTANCE TECHNOLOGY FROM GERSTEL AND AGILENT TECHNOLOGIES 2. SHERIFF - REQUEST FOR AGREEMENTS WITH THE CITIES OF CARLSBAD, EL CAJON, ESCONDIDO, AND SAN DIEGO FOR CALIFORNIA IDENTIFICATION SYSTEM SUPPORT Health and Human Services 3. AUTHORIZE ACCEPTANCE OF HIV SERVICES GRANT FUNDING AND APPLICATIONS FOR FUTURE FUNDING OPPORTUNITIES 4. AUTHORIZE COMPETITIVE SOLICITATION AND AN INTERIM CONTRACT WITH TRADITIONS BEHAVIORAL HEALTH FOR MEDICAL SERVICES GROUP SERVICES Financial and General Government 5. SUPPORT FOR PROPOSITION 36: THE HOMELESSNESS, DRUG ADDICTION, AND THEFT REDUCTION ACT 6. AFFIRMATIVE LITIGATION AGAINST SOCIAL MEDIA COMPANIES FOR THEIR ROLE IN THE YOUTH MENTAL HEALTH CRISIS 7. INCLUDING THE IMPACT OF COST-OF-LIVING DIFFERENTIALS IN SAN DIEGO COUNTY AS A PART OF COMPENSATION ANALYSIS FOR COUNTY EMPLOYEES 2TUESDAY, AUGUST 27, 2024

8. GENERAL SERVICES - APPROVAL OF THIRD AMENDMENT TO LEASE AGREEMENT FOR HEALTH AND HUMAN SERVICES AGENCY, 3609 OCEAN RANCH BOULEVARD, OCEANSIDE, AND NOTICE OF EXEMPTION 9. ORDINANCES AMENDING THE COMPENSATION ORDINANCE AND ESTABLISHING COMPENSATION AND AMENDING VARIOUS SECTIONS OF THE ADMINISTRATIVE CODE (8/27/24 - First Reading; 9/10/24 - Second Reading, unless the ordinance is modified on second reading) 10. RESPONSE TO 2023-2024 GRAND JURY REPORTS Appointments 11. APPOINTMENTS: VARIOUS Communications Received 12. COMMUNICATIONS RECEIVED Public Safety 13. RECEIVE REPORTS DETAILING A COMPREHENSIVE EVALUATION OF THE COUNTY’S BASE STATION HOSPITALS AND TRAUMA CENTER CATCHMENT AREA DESIGNATIONS, AND AUTHORIZE STAFF TO COORDINATE WITH LOCAL STAKEHOLDERS TO JOINTLY DEVELOP AND PILOT CHANGES FROM THE REPORTS Financial and General Government 14. RECEIVE THE COUNTY OF SAN DIEGO HOUSING BLUEPRINT AND NOTICE OF EXEMPTION 15. ESTABLISHING AN UNSAFE CAMPING ORDINANCE TO PREVENT WILDFIRE HAZARDS AND ENSURE PUBLIC SAFETY IN OUR COMMUNITIES 16. REASSESSING ACTIONS RELATED TO THE COMPASSIONATE EMERGENCY SOLUTIONS AND PATHWAYS TO HOUSING FOR PEOPLE EXPERIENCING HOMLESSNESS IN EAST COUNTY IN LIGHT OF FORTHCOMING ENTERPRISE-WIDE ASSESSMENT OF COUNTY PROGRAMS ON HOMELESSNESS Health and Human Services 17. DEVELOPMENT OF A HOMELESSNESS OUTREACH AND SERVICES PILOT PROGRAM IN THE CITY OF LEMON GROVE Land Use and Environment 18. PROTECT THE FREEDOM OF SAN DIEGO COUNTY RESIDENTS TO READ “CHALLENGED & BANNED BOOKS” AT THEIR LOCAL COUNTY LIBRARIES Financial and General Government 19. AN ORDINANCE TO ADD CHAPTER 27 TO DIVISION 1 BUSINESS REGULATIONS, OF TITLE 2 LICENSES, BUSINESS REGULATIONS, AND BUSINESS TAXES OF THE COUNTY CODE OF REGULATORY ORDINANCES RELATING TO PRIVATE EMPLOYERS’ USE OF CRIMINAL HISTORY IN EMPLOYMENT DECISIONS (8/27/24 - First Reading; 9/10/24- Second Reading unless ordinance is modified on second reading) 3TUESDAY, AUGUST 27, 2024

20. NOTICED PUBLIC HEARING (TEFRA): ISSUANCE OF REVENUE OBLIGATIONS BY THE CALIFORNIA ENTERPRISE DEVELOPMENT AUTHORITY FOR THE BENEFIT OF NEIGHBORHOOD HEALTHCARE AND/OR A SUCCESSOR ENTITY IN AN AGGREGATE MAXIMUM STATED PRINCIPAL AMOUNT NOT TO EXCEED $8,000,000 21. A RESOLUTION OF THE BOARD OF SUPERVISORS OF THE COUNTY OF SAN DIEGO TO SUPPORT THE CALIFORNIA LEGISLATIVE BLACK CAUCUS’ 2024 REPARATIONS LEGISLATIVE PACKAGE 22. ENHANCING EQUITY AND COMMUNITY STRENGTH THROUGH PROCUREMENT AND TECHNICAL ASSISTANCE PROGRAMS 23. SUPPORTING SAN DIEGO’S SCHOOLS WITH SOLUTIONS TO THE YOUTH MENTAL HEALTH CRISIS AND SMARTPHONE ACCESS DURING SCHOOL HOURS Closed Session 24. CLOSED SESSION Public Communication 25. NON-AGENDA PUBLIC COMMUNICATION 4TUESDAY, AUGUST 27, 2024

1. SHERIFF - REQUEST FOR SINGLE SOURCE PROCUREMENTS OF TOXICOLOGY AND CONTROLLED SUBSTANCE TECHNOLOGY FROM GERSTEL AND AGILENT TECHNOLOGIES (DISTRICTS: ALL) SUBJECT: OVERVIEW The ability for the San Diego County Sheriff’s Department Regional Crime Laboratory (Crime Lab) to perform toxicology analysis is vital to the County of San Diego. Much of the equipment procured by the Crime Lab to perform toxicology analysis is solely manufactured by Agilent. The items the Crime Lab is seeking to procure for toxicology will be procured from GERSTEL and manufactured by both GERSTEL and Agilent Technologies. This procurement package containing an Agilent Gas Chromatograph 8890 (GC-MS) and a GERSTEL Multi-Purpose Sampler (MPS) robotic sampler is a collaboration between the two companies, GERSTEL and Agilent Technologies, and is only available through GERSTEL. GERSTEL is the only vendor that can configure and deliver such a system encompassing the necessary analytical sample preparation and introduction capabilities with complete software control of the GERSTEL and Agilent components. The Agilent GC-MS with Gerstel MPS robotic sampler will allow the Crime Lab’s Forensic Toxicology Section to advance their testing for volatile compounds to ensure accurate and specific chemical identification. These systems will also allow the Crime Lab to expand volatile testing to commonly used inhalant drugs as recommended by the National Safety Council, rather than send samples that need inhalant testing to a third-party laboratory at an additional cost. This will be the first ever GERSTEL system for the Crime Lab. The Crime Lab is also seeking to purchase another Agilent 8890 Gas Chromatography System from Agilent Technologies, which is an analytical instrument that combines features of gas-chromatography and mass-spectrometry to identify various substances within a certain test sample. The Crime Lab’s Controlled Substances Unit currently has three Agilent Gas Chromatography-Mass Spectrometry (GC-MS) instruments used to identify various drugs within a given sample. However, two of the three instruments are no longer supported under the manufacturer’s maintenance contracts, as they are from the early 2000’s and have since been replaced with newer models. These instruments will also no longer work with the upgraded network technology currently being implemented in the Crime Lab, such as the Laboratory Information Management System (LIMS). To ensure that the Controlled Substances Section is still able to process more than 5,000 items a year, one additional GC-MS is needed, for a total of two. Today’s actions request the Board of Supervisors to approve two single source procurements based on standardization where the procurement of goods from these particular vendors are beneficial for reasons including maintenance, repair, training, and interoperability. The Crime Lab currently has GC-MS instruments from Agilent Technologies, therefore, continuing with both GERSTEL and Agilent Technologies ensures absolute compatibility with existing instruments and software. RECOMMENDATIONS SHERIFF 1. In accordance with Board Policy A-87, Competitive Procurement, approve and authorize the Director, Department of Purchasing and Contracting to enter into negotiations with 1TUESDAY, AUGUST 27, 2024

GERSTEL and subject to successful negotiations and determination of a fair and reasonable price, award contracts for toxicology analysis technology for up to one year and four one-year option periods and an additional six months, if needed, and to amend the contracts as needed to reflect changes to requirements and funding, subject to the approval of the Sheriff. 2. In accordance with Board Policy A-87, Competitive Procurement, approve and authorize the Director, Department of Purchasing and Contracting to enter into negotiations with Agilent Technologies, and subject to successful negotiations and determination of a fair and reasonable price, award contracts for controlled substances analysis technology for up to one year and four one-year option periods and an additional six months, if needed, and to amend the contracts as needed to reflect changes to requirements and funding, subject to the approval of the Sheriff. EQUITY IMPACT STATEMENT Identification of people convicted of crimes is crucial in the criminal justice process to deliver accountability and bring justice and healing to victims. Standardization of tools and analysis is critical for over 30 law enforcement and criminal justice agencies to ensure a fair and equitable justice system in both the defense and prosecution of crimes. Due to the uniqueness of sample preparation and delivery of analysis, standardizing equipment at the Crime Lab ensures consistency and that the highest quality service is provided to the County and other criminal justice agencies. SUSTAINABILITY IMPACT STATEMENT Today’s actions to single source with GERSTEL and Agilent Technologies supports the County of San Diego’s Sustainability Goal of providing just and equitable access for victims of crimes and those who may have been wrongfully accused of a crime. Considering the regional support the Regional Crime Laboratory’s forensic science services provide to law enforcement and criminal justice agencies in San Diego County, it is necessary to obtain equipment that ensures a standardized and validated process. FISCAL IMPACT Funds for this request are included in the Fiscal Year 2024-25 Operational Plan for the Sheriff’s Department. If approved, this request will result in estimated one-time costs of $552,359 to GERSTEL and approximately $153,414 to Agilent Technologies. The funding sources are the 2023-25 CHP Toxicology Grant ($550,773) and Asset Forfeiture Fund ($155,000). There will be no change in net General Fund cost and no additional staff years. BUSINESS IMPACT STATEMENT N/A ACTION: ON MOTION of Supervisor Montgomery Steppe, seconded by Supervisor Vargas, the Board of Supervisors took action as recommended, on Consent. Vargas, Anderson, Lawson-Remer, Montgomery Steppe, DesmondAYES: 2TUESDAY, AUGUST 27, 2024

2. SHERIFF - REQUEST FOR AGREEMENTS WITH THE CITIES OF CARLSBAD, EL CAJON, ESCONDIDO, AND SAN DIEGO FOR CALIFORNIA IDENTIFICATION SYSTEM SUPPORT (DISTRICTS: ALL) SUBJECT: OVERVIEW The California Identification System/Remote Access Network (Cal-ID/RAN) is a statewide system that provides local law enforcement agencies with direct access to local, state, and federal automated fingerprint, palm print, photo systems and databases. This statewide system allows for the rapid identification of persons booked into detention facilities and latent prints lifted from crime scenes. Since 2007, the San Diego County Cal-ID/RAN Board has served as a regional policy and advisory board responsible for making recommendations for a program to employ staff and purchase equipment for crime laboratories across the region to support the identification of suspects. The Sheriff’s Department serves as San Diego County’s Cal-ID/RAN administrator. The County of San Diego’s current agreements for Cal-ID support positions with the cities of El Cajon, Escondido, and San Diego will expire on June 30, 2025. To ensure the continued success of the program, there is a need to continue to provide funding for staff at the El Cajon, Escondido, and San Diego Police Departments as well as equipment and other Cal-ID/RAN Board approved items at the Carlsbad Police Department. Today’s actions request the Board of Supervisors (Board) to authorize agreements between the County of San Diego by and through the Sheriff’s Department and the cities of Carlsbad, El Cajon, Escondido, and San Diego to provide annual funding from the Sheriff Fingerprint ID Trust Fund to the four cities for Cal-ID support positions and equipment. This funding comes from the collection of a $2 fee for every vehicle registered in San Diego County by the Department of Motor Vehicles. The term of the agreement for equipment is from October 1, 2024 through June 30, 2025 with optional annual renewals up to a maximum of four additional years through June 30, 2029. The term of the agreements for positions is from July 1, 2025 through June 30, 2026, with optional annual renewals up to a maximum of four additional years through June 30, 2030. RECOMMENDATIONS SHERIFF 1. Authorize the Sheriff's Department (Sheriff) to execute a Memorandum of Agreement (MOA) with the City of Carlsbad to provide funding for Cal-ID/RAN Board approved equipment, training, and certification based on revenue from the Sheriff Fingerprint ID Trust Fund for the period of October 1, 2024 to June 30, 2025 with optional annual renewals, with the option to renew being at the Sheriff's discretion, up to a maximum of four additional years through June 30, 2029, and to amend the MOA as needed to reflect changes to requirements and funding. The estimated funding for the initial term is $22,025 to include $17,025 for a fingerprint development chamber and $5,000 for training. Funding for option years will be based on requests for equipment, training, and certification to enhance the City of Carlsbad’s capacity to provide fingerprint identification. 2. Authorize the Sheriff to execute a MOA with the City of El Cajon to provide an estimated $131,721 in annual funding for one full-time Forensic Latent Print Examiner 3TUESDAY, AUGUST 27, 2024

position based on revenue from the Sheriff Fingerprint ID Trust Fund for the period of July 1, 2025 through June 30, 2026, with optional annual renewals, with the option to renew being at the Sheriff's discretion, up to a maximum of four additional years through June 30, 2030, and to amend the MOA as needed to reflect changes to requirements and funding. 3. Authorize the Sheriff to execute a MOA with the City of Escondido to provide an estimated $275,032 ($137,516 per position) in annual funding for two full-time Latent Print Specialist positions based on revenue from the Sheriff Fingerprint ID Trust Fund for the period of July 1, 2025 through June 30, 2026, with optional annual renewals, with the option to renew being at the Sheriff's discretion, up to a maximum of four additional years through June 30, 2030, and to amend the MOA as needed to reflect changes to requirements and funding. 4. Authorize the Sheriff to execute a MOA with the City of San Diego to provide an estimated $256,000 ($128,000 per position) in annual funding for two full-time Latent Print Examiner Aide positions based on revenue from the Sheriff Fingerprint ID Trust Fund for the period of July 1, 2025 through June 30, 2026, with optional annual renewals, with the option to renew being at the Sheriff's discretion, up to a maximum of four additional years through June 30, 2030, and to amend the MOA as needed to reflect changes to requirements and funding. EQUITY IMPACT STATEMENT Offender identification is crucial in the criminal justice process to deliver offender accountability and bring justice and healing to victims. Qualified Latent Print Examiners/Specialists demonstrate an in-depth knowledge and understanding of friction ridge physiology and morphology, terminology, detection, recovery, photography, preservation, enhancement, analysis, comparison, documentation and reporting of latent print evidence. This level of expertise in conjunction with the necessary equipment is critical in supporting the San Diego County California Identification System program. Fingerprint identification and forensic evidence handling are key components to identifying individuals involved in crimes and exonerating the innocent. The positions for El Cajon, Escondido, and San Diego ensure that these critical components of criminal investigations are completed. SUSTAINABILITY IMPACT STATEMENT Today’s actions to authorize agreements with the cities of Carlsbad, El Cajon, Escondido, and San Diego support the County of San Diego’s Sustainability Goal of providing just and equitable access for victims of crimes and those that may have wrongfully been accused in a crime. The California Identification System program requires both Latent Print Examiners/Specialists and equipment to ensure that accurate identification is conducted, a critical component of serving justice and holding the responsible parties accountable for their actions. FISCAL IMPACT If approved, the equipment agreement with the City of Carlsbad will result in Fiscal Year 2024-25 estimated costs and revenue of $22,025 for fingerprint development chamber ($17,025) and training ($5,000). Costs and revenue for four optional annual renewals will be determined and approved by California Identification System/Remote Access Network (Cal-ID/RAN) Board and included in future Operational Plans for the Sheriff’s Department. The funding source is the 4TUESDAY, AUGUST 27, 2024

Sheriff Fingerprint ID Trust Fund. There will be no change in net General Fund costs and no additional staff years. If approved, costs and revenue estimated at $662,753 for agreements to fund positions supporting the cities of El Cajon, Escondido, and San Diego will be included in the Fiscal Year 2025-26 Operational Plan for the Sheriff’s Department. As needed annual increases for up to four additional years, through June 30, 2030, will be included in future Operational Plans for the Sheriff’s Department. The funding source is the Sheriff Fingerprint ID Trust Fund. There will be no change in net General Fund costs and no additional staff years. BUSINESS IMPACT STATEMENT N/A ACTION: ON MOTION of Supervisor Montgomery Steppe, seconded by Supervisor Vargas, the Board of Supervisors took action as recommended, on Consent. Vargas, Anderson, Lawson-Remer, Montgomery Steppe, DesmondAYES: 3. AUTHORIZE ACCEPTANCE OF HIV SERVICES GRANT FUNDING AND APPLICATIONS FOR FUTURE FUNDING OPPORTUNITIES (DISTRICTS: ALL) SUBJECT: OVERVIEW The San Diego County Board of Supervisors (Board) has authorized grants and agreements with the United States Health Resources and Services Administration (HRSA) to provide care and treatment services to persons living with HIV for over three decades. These funding sources include the Ryan White HIV/AIDS Treatment Extension Act of 2009 (RWTEA) Part A, the RWTEA Part A Minority AIDS Initiative, and the Ending the HIV Epidemic: A plan for America- Ryan White HIV/ AIDS Program Parts A and B. Ryan White HIV/ AIDS Treatment Extension Act (RWTEA) Part A and RWTEA Part A Minority AIDS Initiative Funding Awarded annually, the RWTEA Part A and the RWTEA Part A Minority AIDS Initiative comprise the single largest federal funding source for HIV services received by the County of San Diego (County). The County received notice of a grant award on May 15, 2024, by HRSA. The RWTEA Part A funding is $11,313,642 and the RWTEA Part A Minority AIDS Initiative funding is $784,859, for a total of $12,098,501 for the period of March 1, 2024, through February 28, 2025. This funding will continue to support medical treatment, mental health treatment, substance use disorder treatment, temporary housing assistance, and other critical services for persons living with HIV. Ending the HIV Epidemic Funding In 2020, HRSA created a new funding source, Ending the HIV Epidemic: A Plan for America - Ryan White HIV/AIDS Program Parts A and B, in response to the introduction of the federal Ending the HIV Epidemic initiative. Initial Board action, April 7, 2020 (6), authorized the acceptance of $5,000,000 in grant funds and subsequent Board action, November 15, 2022 (7), authorized the acceptance of an additional $1,667,400 in grant funds. Both initial and subsequent 5TUESDAY, AUGUST 27, 2024

Board action authorized funding through February 28, 2025. On May 14, 2024, the County received notice from HRSA that an additional $2,559,215 was awarded for the period of March 1, 2024 through February 28, 2025 and the County has exceeded the amount authorized in prior Board Actions. This funding supports and is utilized for programs and services related to community engagement and leadership development for persons living with HIV, linkage and retention in HIV care, low barrier medical care, and housing supports. Today’s action requests the Board to approve and authorize acceptance of $11,313,642, $784,859, and $2,559,215, respectively in RWTEA Part A, RWTEA Part A Minority AIDS Initiative, and Ending the HIV Epidemic funding to support HIV care and treatment activities. This item supports the County vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished through education, prevention, and intervention to interrupt transmission of disease in the region. This item also supports the County Getting to Zero initiative by planning and allocating resources dedicated to services for residents who are vulnerable to or living with HIV. RECOMMENDATION(S) CHIEF ADMINISTRATIVE OFFICER 1. Waive Board Policy B-29, Fees, Grant, Revenue Contracts - Department Responsibility for Cost Recovery, which requires prior approval of grant applications and full-cost recovery of grants. 2. Authorize the acceptance of $11,313,642 and $784,859 in grant funds from the United States Health Resources and Services Administration for the period of March 1, 2024 through February 28, 2025 for Ryan White Part A and Ryan White Part A Minority AIDS Initiative respectively, and authorize the Agency Director, Health and Human Services Agency or designee, to execute all required grant documents, upon receipt, including any annual extensions, amendments and/or revisions thereto that do not materially impact or alter the services or funding level. 3. Authorize the acceptance of an additional $2,559,215 in grant funds from the United States Health Resources and Services Administration for the period of March 1, 2024 through February 28, 2025 for Ending the HIV Epidemic, and authorize the Agency Director Health and Human Services Agency or designee, to execute all required grant documents, upon receipt, including any annual extensions, amendments and/or revisions thereto that do not materially impact or alter the services or funding level. 4. Authorize the Agency Director, Health and Human Services Agency, or designee, to apply for any additional funding opportunity announcements, if available, to address the prevention, testing, care and treatment needs of those impacted by HIV. EQUITY IMPACT STATEMENT In San Diego County in 2023, gay, bisexual, and other men who have sex with men comprise 48% of recent HIV diagnoses and 70% of persons living with HIV. HIV has disproportionately impacted some of San Diego County’s most vulnerable residents, who include Black and Hispanic communities, gay, bisexual, and other men who have sex with men. Local surveillance data from 2023 demonstrated that Blacks comprise less than 6% of the county population but comprise 13% of recent HIV diagnoses. Hispanics comprise 35% of the county population yet 6TUESDAY, AUGUST 27, 2024

comprise 53% of recent HIV diagnoses. Because of the disproportionate impacts of HIV among communities of color, community engagement efforts have been utilized to plan and provide services that address issues such as stigma, medical mistrust and access to care. The County of San Diego Health and Human Services Agency, Public Health Services works in partnership with the HIV Planning Group, an official advisory board to the San Diego County Board of Supervisors to address the needs of persons living with HIV, particularly those with disproportionate impact, as described above. The HIV Planning Group is comprised of people living with HIV, service providers, subject matter experts, HHSA designees, community members and designees from each supervisorial district. The HIV Planning Group conducts needs assessments of system capacity and capabilities every three years. This includes engaging with different impacted communities through focus groups. These engagement efforts play an impactful role in informing decisions and ensuring resources are effectively and equitably distributed to serve the needs of those most impacted by HIV in San Diego County. The last needs assessment was conducted in 2021 and the results led to service changes as a result of COVID-19, including temporary housing, transportation and food services. The next needs assessment is currently being conducted. SUSTAINABILITY IMPACT STATEMENT By increasing capacity and services aimed to prevent, identify, and treat HIV, the proposed action aligns with the County of San Diego (County) Sustainability Goal #2 to provide just and equitable access to County services and resources, and Sustainability Goal #4 to protect the health and well-being of San Diego residents. Testing and identification of those unaware of their HIV status, and treatment of HIV will improve the overall health of communities and reduce the demand of associated care services, while increasing effectiveness of care providers and lowering operating costs. FISCAL IMPACT Recommendation #2: Authorize acceptance of Ryan White Treatment Extension Act (RWTEA) Part A and RWTEA Part A Minority AIDS Initiative funding Funds for this request are included in the Fiscal Year (FY) 2024-26 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs of $12,268,293 and revenue of $12,098,501 in FY 2024-25. The funding source for this grant is the United States Health Resources and Services Administration. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated to be $169,792. The funding source for these costs will be existing Realignment. The public benefit for providing these services far outweighs the costs. There will be no change in net General Fund cost and no additional staff years. Recommendation #3: Authorize acceptance of Ending the HIV Epidemic funding Funds for this request are partially included in the Fiscal Year (FY) 2024-26 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs of $2,650,793 and revenue of $2,559,215. The funding source for this grant is the United States Health Resources and Services Administration. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated to be $91,578. The funding source for these costs will be existing Realignment. The public benefit for providing these services far outweighs the costs. There will be no change in net General Fund cost and no additional staff years. 7TUESDAY, AUGUST 27, 2024

BUSINESS IMPACT STATEMENT N/A ACTION: ON MOTION of Supervisor Montgomery Steppe, seconded by Supervisor Vargas, the Board of Supervisors took action as recommended, on Consent. Vargas, Anderson, Lawson-Remer, Montgomery Steppe, DesmondAYES: 4. AUTHORIZE COMPETITIVE SOLICITATION AND AN INTERIM CONTRACT WITH TRADITIONS BEHAVIORAL HEALTH FOR MEDICAL SERVICES GROUP SERVICES (DISTRICTS: ALL) SUBJECT: OVERVIEW The San Diego County Board of Supervisors (Board) has demonstrated an ongoing commitment to ensuring a robust continuum of services to meet the needs of individuals with behavioral health conditions in San Diego County. The San Diego County Psychiatric Hospital (SDCPH) is a critical setting within the local behavioral health continuum of care, providing services for some of the region’s most vulnerable residents. Care and support for operations at SDCPH is largely provided by County of San Diego (County) staff, including nursing, social work, environmental services, recreational therapy, quality assurance, and other staffing categories. Certain services at the hospital, such as physician staffing and other temporary staffing, are provided via contracted providers. Today’s action requests the Board authorize a competitive solicitation for comprehensive physician staffing services via a medical services group and to authorize an interim contract with Traditions Behavioral Health. Through this interim contract, the medical services group would provide physician staffing, including coverage of clinical and administrative physician functions, during the procurement period. Other categories of staffing would not be impacted. This item supports the County vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished by ensuring the critical behavioral health workforce that supports the provision of quality care for underrepresented communities. RECOMMENDATION(S) CHIEF ADMINISTRATIVE OFFICER 1. In accordance with Board Policy A-87, Competitive Procurement, and Section 401, Article XXIII of the County Administrative Code, approve and authorize the Director, Department of Purchasing and Contracting, to issue a competitive solicitation for physician staffing services via a medical services group and upon successful negotiations and determination of a fair and reasonable price, award contracts for an Initial Term of up to one year, with four 1-year Options, and up to an additional six months, if needed; and to amend the contracts to reflect changes in program, funding or service requirements, subject to the availability of funds and the approval of the Agency Director, Health and 8TUESDAY, AUGUST 27, 2024

Human Services Agency. 2. Waive Board Policy A-87, Competitive Procurement, and in accordance with Administrative Code Section 401, authorize the Director, Department of Purchasing and Contracting, subject to successful negotiations and a determination of a fair and reasonable price, to award a contract to Traditions Behavioral Health for medical services group services, for an initial term of up to one year, with one 1-year option, and up to an additional six months if needed, subject to the availability of funds; and amend the contract as required in order to reflect changes to services and funding allocations, subject to the approval of the Agency Director, Health and Human Services Agency. EQUITY IMPACT STATEMENT The vision of the County of San Diego (County) Health and Human Services Agency, Behavioral Health Services is to build a behavioral health services delivery system in which mental health and substance use services are regionally distributed and accessible to all individuals and families who are in need, particularly those vulnerable and traditionally underserved populations. To accomplish this, the County needs a robust and skilled behavioral health workforce. However, there is currently a nationwide, statewide, and local behavioral health worker shortage. According to the 2022 San Diego Workforce Partnership workforce report, there are approximately 17,000 behavioral health professionals working in San Diego County - 8,000 less than the number needed to meet current and future needs. To meet the behavioral health workforce needs in San Diego County, it is crucial that the County prioritizes actions that both maintain and grow the local behavioral health workforce. Utilizing a medical services group for physician staffing services will ensure the San Diego County Psychiatric Hospital can continue the provision of behavioral health care to the most vulnerable adults with behavioral health needs across San Diego County, including individuals who are at risk of or experiencing homelessness, to reduce local health disparities. SUSTAINABILITY IMPACT STATEMENT Today’s proposed action supports the County of San Diego (County) Sustainability Goal #2 to provide just and equitable access to County services and appropriate resource allocation with investments focused on chronically underserved communities and Sustainability Goal #4 to protect the health and well-being of everyone in the region. This will be accomplished by ensuring the San Diego County Psychiatric Hospital can continue providing critical behavioral health care to individuals with chronic behavioral health conditions, who are historically underserved, and ensure the psychological health and well-being of clients. FISCAL IMPACT Funds for this request are included in the Fiscal Year (FY) 2024-26 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs of and revenue of $10.5 million in FY 2024-25 and $10.9 million in FY 2025-26. The funding source will be existing Realignment and Federal Financial Participation. It is anticipated that reduced utilization of other contracts for staffing services will provide sufficient revenue to cover the costs of this new contract. If further appropriations are determined to be necessary in order to cover projected costs, staff would return to the Board as needed. There will be no change in net General Fund cost and no additional staff years. BUSINESS IMPACT STATEMENT 9TUESDAY, AUGUST 27, 2024

N/A ACTION: ON MOTION of Supervisor Montgomery Steppe, seconded by Supervisor Vargas, the Board of Supervisors took action as recommended, on Consent. Vargas, Anderson, Lawson-Remer, Montgomery Steppe, DesmondAYES: 5. SUBJECT: OVERVIEW Whether it’s rampant retail theft causing neighborhood store closures and higher prices for working families, or the growing epidemic of fentanyl overdoses, Californians must address these pressing public health and public safety issues. Retail theft not only affects the livelihood of business owners but also disrupts community stability, leading to workplace violence, store closures and increased prices that disproportionately impact low-income families. At the same time, the fentanyl crisis continues to ravage communities, with overdose deaths reaching unprecedented levels and straining our healthcare and emergency response systems. The need for balanced reform is clear: it’s on our streets, in our stores, and affecting our communities and families. Passed in 2014, Proposition 47, the Criminal Sentences, Misdemeanor Penalties, Initiative Statute, expressed the intention to make California’s criminal justice system more equitable by expanding opportunities for offenders to be treated at the misdemeanor level. Unfortunately, it also led to a decade of unintended consequences: Repeat, habitual and organized offenders who steal amounts under $950 and, or repeatedly possess hard drugs such as fentanyl and methamphetamine go without any increased accountability, or incentive to engage in addiction or mental treatment since the consequence is always a citation or misdemeanor. Sadly, there is no dispute that a substantial segment of persons experiencing homelessness suffer from untreated addiction resulting in the staggering data point from our Medical Examiner that this vulnerable population of unhoused individuals has a 117 times higher rate of overdose death, adding to the barriers to prevent and end homelessness. Supported by over 900,000 signatures, Proposition 36 seeks to provide a balanced reform that preserves options for individuals who want to pursue rehabilitation and diversion, while also providing public safety with tools to hold repeat offenders accountable and incentivize treatment. It also provides accountability for fentanyl dealers by bringing it into the same fold as methamphetamine. Proposition 36 is not a three strikes law nor is it a mandatory state prison law. It maintains judicial discretion needed to allow probation and to order treatment. It’s time for meaningful reforms to our justice system, that ensure our communities are safe. This includes responsible and balanced changes to Proposition 47. Proposition 36: The Homelessness, Drug Addiction, and Theft Reduction Act will address homelessness, drug addiction, and theft by: · Classifying repeat theft as a felony for individuals who steal less than $950 if they have two or more prior theft related convictions with the option to reduce to a misdemeanor 10TUESDAY, AUGUST 27, 2024

even on the third theft while the fourth conviction remains a felony. · Allowing stolen property values from multiple thefts to be combined so repeat offenders can be charged with a felony if the total exceeds $950. · Authorizing judges to impose an enhanced penalty when an offender steals, damages, or destroys property by participating in organized theft with two or more offenders or by causing losses of $50,000 or more. · Adding fentanyl to the list of hard drugs. · Enabling stricter penalties for dealers whose drug trafficking causes death or serious injury and warns traffickers of potential murder charges if continued drug trafficking results in fatalities similar to the warnings that are given in DUI cases. · Enacting a new class of crime called a “treatment-mandated felony” where offenders with two prior hard drug possession convictions would be given the option of participating in drug and mental health treatment in lieu of incarceration. · Allowing offenders who successfully complete drug and mental health treatment to avoid jail time and have the charge fully expunged. Therefore, we recommend that the Board adopt a resolution in support of Proposition 36: The Homelessness, Drug Addiction and Theft Reduction Act which will be included on the November 5, 2024, statewide ballot. RECOMMENDATION SUPERVISOR JIM DESMOND, SUPERVISOR JOEL ANDERSON AND DISTRICT ATTORNEY SUMMER STEPHAN Adopt the Resolution titled: RESOLUTION OF THE BOARD OF SUPERVISORS OF THE COUNTY OF SAN DIEGO FORMALLY EXPRESSING THE COUNTY’S SUPPORT FOR PROPOSITION 36, THE HOMELESSNESS, DRUG ADDICTION AND THEFT REDUCTION ACT ON THE NOVEMBER 5, 2024 STATEWIDE BALLOT. EQUITY IMPACT STATEMENT The Homelessness, Drug Addiction, and Theft Reduction Act seeks to enhance community safety and address critical issues of retail theft, drug addiction, and homelessness, impacting all Californians, particularly marginalized communities. By classifying repeat thefts and organized retail crime as felonies, the measure aims to protect small businesses and working families from economic harm and neighborhood disinvestment. Including fentanyl in the list of hard drugs and imposing stricter penalties on traffickers addresses the overdose crisis, while offering pathways to treatment over incarceration. These reforms balance justice with compassion; ensuring that repeat offenders face appropriate consequences while maintaining the original intent of reducing incarceration for non-violent offenses will help address disparities in the criminal justice system and enhance community safety for all residents. 11TUESDAY, AUGUST 27, 2024

SUSTAINABILITY IMPACT STATEMENT This proposed action contributes to the County of San Diego’s Sustainability Goal of protecting the health and well-being of all San Diego residents. By supporting the proposed reforms to Proposition 47, the County can promote sustainable public safety policies that protect communities while providing opportunities for rehabilitation and reducing recidivism. This balanced approach is essential for creating safer and more resilient neighborhoods throughout San Diego County. Enhancing public safety is of paramount priority for the County. FISCAL IMPACT There is no fiscal impact associated with this recommendation. There will be no change in net General Fund cost and no additional staff years. BUSINESS IMPACT STATEMENT The approval and subsequent enactment of The Homelessness, Drug Addiction and Theft Reduction Act ballot measure will help to restore historical protections that have been in place for our business community. By restoring confidence for retailers and others that thefts will be addressed through arrests and prosecutions, regardless of any thresholds, we can protect the business community and may prevent the closure of stores and help stem the exodus of businesses to other states. ACTION: A motion was made by Supervisor Desmond, seconded by Supervisor Anderson, for the Board of Supervisors to take action as recommended. (A substitute motion was introduced.) ON MOTION of Supervisor Vargas, seconded by Supervisor Lawson-Remer, the Board of Supervisors directed the Chief Administrative Officer to work with relevant groups and departments to provide an analysis of how the changes to Proposition 47, through the potential passage of Proposition 36, may impact funding for County services, with a specific focus on behavioral health services, housing and development services, and homelessness-related programs, and return to the Board on October 8, 2024, with a multiple-scenario analysis so the Board can consider taking a position on Proposition 36. Vargas, Lawson-Remer, Montgomery SteppeAYES: Anderson, DesmondNOES: 6. AFFIRMATIVE LITIGATION AGAINST SOCIAL MEDIA COMPANIES FOR THEIR ROLE IN THE YOUTH MENTAL HEALTH CRISIS (DISTRICTS: ALL) SUBJECT: OVERVIEW On July 16, 2024 (16), the Board of Supervisors considered this item. The motion to adopt the recommendations failed due to a tie vote, and the Board did not continue the item. Pursuant to Rule 2(g) of the Board of Supervisors Rules of Procedure, the item was placed on the agenda for the next regular meeting. In May 2023, the U.S. Surgeon General issued an advisory 12TUESDAY, AUGUST 27, 2024

<https://www.hhs.gov/about/news/2023/05/23/surgeon-general-issues-new-advisory-about-effect s-social-media-use-has-youth-mental-health.html> warning that social media is contributing to our nation’s youth mental health crisis. The American Psychological Association (APA) has since also issued a health advisory <https://www.apa.org/topics/social-media-internet/health-advisory-adolescent-social-media-use> examining the connections between social media use and reduced well-being and rising mood disorders, chiefly depression, and anxiety among youth ages 10 to 25 years old. According to the Pew Research Center, <https://www.pewresearch.org/internet/2023/12/11/teens-social-media-and-technology-2023/> in 2010, when smartphones were becoming mainstream, only about half of teens reported using social media. Today, social media usage is ubiquitous with 95% of teens reporting they use some social media and about a third reporting they use it constantly. The APA reports <https://www.apa.org/monitor/2024/04/teen-social-use-mental-health> that U.S. teens spend an average of five hours every day using the seven most popular social media apps, with Instagram, TikTok, and YouTube accounting for 87% of their social media time. Since 2010, nearly every indicator <https://www.npr.org/sections/health-shots/2023/04/25/1171773181/social-media-teens-mental- health> of mental health and psychological well-being among teens and young adults has deteriorated. ’San Diego Countys Health and Human Services Health Equity Report (2022) <https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/CHS/Health%20Equity%20Re port%20Series_Age_2022.pdf> confirms this alarming trend with youth ages 15 to 24 years of age having the highest burden of depression compared with all other age groups in the County. These youth are also utilizing inpatient treatment services and visiting emergency rooms at a rate two times higher than any other age group for depression and anxiety. It is in response to these developments that mental health experts are warning habitual social media use is nearing addiction levels and contributing to the youth mental health crisis. To date, there have been few meaningful changes by the industry and no adoption of federal or state policies curbing the industry’s harm to developing minds. As of June 2024, 475 social media lawsuits are pending in multidistrict litigation in the Northern District of California. And, as many as 41 U.S. states, including California’s Attorney General Office, have taken direct legal action against one specific company, Meta Platforms, Inc., to hold them accountable for their negligence in ensuring its platforms are safe for minors. With today’s item, the County of San Diego would add its voice to underscore the urgent need to enact new, responsible safety standards on all social media platforms in order to mitigate harm to youth and their mental health. Today’s item directs County legal counsel to explore legal actions that would hold social media companies, including but not limited to, Facebook, Instagram, X, TikTok, and YouTube, accountable for their failure to protect youth mental health and for their purposeful creation of an unreasonably dangerous product that incentivizes addictive behaviors among vulnerable youth. Just as San Diego County has joined other cities and counties in California to successfully hold opioid painkiller manufacturers and distributors accountable for deceptive marketing and for creating an epidemic of opioid abuse and addiction that killed thousands in San Diego alone, the 13TUESDAY, AUGUST 27, 2024

County should hold social media platforms accountable for their failure to protect vulnerable youth. RECOMMENDATION(S) SUPERVISOR TERRA LAWSON-REMER 1. Direct the County Counsel, in consultation with the Chief Administrative Officer, to explore options for initiating, pursuing, and/or joining litigation against social media platforms, including but not limited to Facebook, Instagram, X, TikTok, Snapchat, and YouTube for their failure to protect youth mental health and regularly report back to the Board in an appropriate manner until litigation is filed and, thereafter as necessary. 2. Adopt a resolution entitled: A RESOLUTION OF THE BOARD OF SUPERVISORS OF THE COUNTY OF SAN DIEGO RELATING TO THE SURGEON GENERAL’S CALL FOR WARNING LABELS ON SOCIAL MEDIA PLATFORMS. EQUITY IMPACT STATEMENT Studies show that certain subpopulations of youth, including females, LGBTQ+, Black and Latinx young people, are more likely to use social media platforms to combat loneliness and/or as a tool to locate mental health or well-being resources. Some of these same groups are experiencing disproportionate rates of poor mental health and suicidal thoughts and behaviors. Today’s actions will ensure that the operators of social media platforms are further directed to take action to minimize the harmful aspects of their platforms and to preserve the well-being of young, vulnerable users. SUSTAINABILITY IMPACT STATEMENT Today’s actions to hold social media platforms accountable helps to further the County of San Diego’s Sustainability Goals through its leadership and advocacy to remediate the current online environment in support of youth mental health. It is imperative that the County of San Diego be a pro-active partner in pushing for social media platforms to take seriously the deleterious impacts the current design of their products are having on the mental health of County residents ages 10 to 25 years of age. FISCAL IMPACT Funds for the actions requested in Recommendation 1 are included in the Fiscal Year 2024-25 Operational Plan based on existing staff time in County Counsel funded by General Purpose Revenue. There will be no change in net General Fund cost and no additional staff years. There may be fiscal impacts associated with future related recommendations which staff would return to the Board for consideration and approval. There is no fiscal impact associated with Recommendation 2. There will be no change in net General Fund cost and no additional staff years. BUSINESS IMPACT STATEMENT N/A 14TUESDAY, AUGUST 27, 2024

ACTION: ON MOTION of Supervisor Montgomery Steppe, seconded by Supervisor Vargas, the Board of Supervisors took action as recommended, on Consent, and adopted Resolution No. 24-107, entitled: A RESOLUTION OF THE BOARD OF SUPERVISORS OF THE COUNTY OF SAN DIEGO RELATING TO THE SURGEON GENERAL’S CALL FOR WARNING LABELS ON SOCIAL MEDIA PLATFORMS. Vargas, Lawson-Remer, Montgomery SteppeAYES: Anderson, DesmondNOES: 7. INCLUDING THE IMPACT OF COST-OF-LIVING DIFFERENTIALS IN SAN DIEGO COUNTY AS A PART OF COMPENSATION ANALYSIS FOR COUNTY EMPLOYEES (DISTRICTS: ALL) SUBJECT: OVERVIEW As one of the region’s largest employers, the County of San Diego is recognized as a leader in fostering a dynamic and inclusive work environment and setting a high standard for public sector employment. In recent years, the County has made strong commitments towards implementing forward-thinking policies that advance equity and employee well-being, and that recognize our workforce as the cornerstone to delivering the high-quality services and programs that our communities and residents rely upon. As part of this approach, in 2021, the County collaborated with employee groups to utilize compensation studies to compare the wages of employee classifications for 25 represented bargaining units and non-represented employees with those in 13 other counties across the state. This compensation analysis was conducted by Koff and Associates and aimed to provide data that could inform discussions and decisions around compensation levels. Compensation studies are crucial for public sector management for ensuring salaries and benefits are set at levels that allow recruitment and retention of talent while promoting transparency and responsible resource management. To address the impact of regional differences in wages, the 2021 compensation studies used a “cost-of-labor” methodology that focuses on what other employers are paying for similar jobs within the region. According to the UC Berkeley Labor Center, the cost-of-labor methodology has several weaknesses: (1) public sector work is complex with a diversity of occupations and responsibilities that are not easily compared with private sector benchmarks, (2) unlike the private sector, public sector compensation is not based on the market alone, but reflects budget constraints, revenue availability, and labor negotiations, and (3) there is a well-documented lag in public sector compensation based on educational level, compared to counterparts in the private sector, suggesting that cost of labor may not accurately capture public sector salary realities, and (4) the cost-of labor methodology fails to adequately account for the vast differences in cost-of-living between these regions. The 13 comparator agencies included counties like: Fresno, Kern, and San Bernardino, which are a far cry from the cost of living in San Diego County. According to Zillow, the median rent in Fresno is $1,345 per month compared to $3,095 in San Diego - a 230% difference. In fact, San Diego recently took the No. 1 spot on the U.S. News & World Report's list of the Most Expensive Places to Live in the United States, given soaring housing prices, as well as high food, transportation, childcare, and utilities costs across our region. An emerging practice in compensation studies is to account for these regional differences using a cost-of-living methodology. The cost-of-living accounts for the actual expenses that employees 15TUESDAY, AUGUST 27, 2024

incur, including housing, transportation, healthcare, childcare, broadband, and other necessities. It can also allow for consideration of the differences in cost-of-living faced by different family structures, including but not limited to single-parent households, households with multiple children under five, households supporting people with disabilities, and more. Choosing cost-of-living rather than cost-of-labor as the comparator in a compensation study is crucial for ensuring equitable and realistic compensation for employees across different regions and supports the County’s recruitment and retention goals. MIT created a Living Wage Calculator as a robust and highly popular tool that has widespread adoption across public, private, and nonprofit sectors. The tool features geographically-specific data for housing, food, childcare, health care, housing, transportation, other basic needs - like clothing, personal care items, and broadband, among others - and taxes at the county, metro, and state levels for 12 different family types. This tool provides a data-driven tool to compare cost-of-living differences across 3,143 counties in the United States. Today’s action directs the Chief Administrative Office (CAO) to include the MIT Living Wage Calculator as a cost-of-living comparator in the 2024 compensation studies. The scope of this item is limited to the methodological approach to the compensation studies to ensure relevant data is available and does not constrain the County’s full range of options as part of any future compensation negotiations with employee groups. RECOMMENDATION(S) VICE CHAIR TERRA LAWSON-REMER AND SUPERVISOR MONICA MONTGOMERY STEPPE 1. Direct the Chief Administrative Officer to include the MIT Living Wage Calculator as a comparator to analyze regional differences for the 2024 compensation studies. 2. Direct the Chief Administrative Officer to discuss with the employee groups the application of the various indicators in the MIT living wage calculator to determine the final indicators to be used. EQUITY IMPACT STATEMENT Implementing a cost-of-living analysis for determining county compensation would increase equity by ensuring that all employees are compensated based on the actual expenses they incur in their specific regions. This approach addresses regional disparities in living costs, helping to create a more balanced and just compensation structure that reflects the true economic realities faced by workers. SUSTAINABILITY IMPACT STATEMENT The proposed actions ordinance aligns with the County of San Diego’s Sustainability Goals by promoting sustainable economic growth for our community. The proposed actions included in this letter provide just and equitable wages. FISCAL IMPACT There is no fiscal impact associated with today’s actions. There will be no change in net General Fund cost and no additional staff years. There may be fiscal impacts associated with future related recommendations which staff would return to the Board for consideration and approval. BUSINESS IMPACT STATEMENT 16TUESDAY, AUGUST 27, 2024

N/A ACTION: ON MOTION of Supervisor Montgomery Steppe, seconded by Supervisor Vargas, the Board of Supervisors took action as recommended, on Consent. Vargas, Anderson, Lawson-Remer, Montgomery Steppe, DesmondAYES: 8. GENERAL SERVICES - APPROVAL OF THIRD AMENDMENT TO LEASE AGREEMENT FOR HEALTH AND HUMAN SERVICES AGENCY, 3609 OCEAN RANCH BOULEVARD, OCEANSIDE, AND NOTICE OF EXEMPTION (DISTRICT: 5) SUBJECT: OVERVIEW On November 15, 2016 (11), the San Diego County Board of Supervisors (Board) approved a lease for space located at 3609 Ocean Ranch Boulevard in Oceanside for use by the Health and Human Services Agency (HHSA). HHSA is currently utilizing this space as the North Coastal Public Health Center. This public health center provides access to preventive health services such as immunizations and education with an emphasis on communicable disease control and maternal child health for families and individuals in North Coastal communities. The lease has been extended through a series of Board approved amendments. The lease expires on August 31, 2024, and there are no options to extend the term. HHSA has a need to continue operating from this site. Staff from the Department of General Services have negotiated a lease amendment that will extend the term one (1) year and provide three (3) one-year options to further extend the term. Today’s request is for Board approval of the amendment. RECOMMENDATION(S) CHIEF ADMINISTRATIVE OFFICER 1. Find that the proposed lease amendment is exempt from the California Environmental Quality Act (CEQA) pursuant to State CEQA Guidelines section 15301. 2. Approve and authorize the Director, Department of General Services, to execute the proposed lease amendment for the premises located at 3609 Ocean Ranch Boulevard, Oceanside. EQUITY IMPACT STATEMENT It is anticipated that the proposed lease amendment for the Health and Human Services Agency will have a positive impact on the community by ensuring access for all through a fully optimized health and social service delivery system. SUSTAINABILITY IMPACT STATEMENT Implementing effective sustainability objectives is crucial to ensuring safe and healthy communities and contributing to the overall success of the region. The approval of the lease amendment is appropriate as it supports the County’s Strategic Initiative of Sustainability to ensure the capability to respond to immediate needs for individuals, families, and the region. 17TUESDAY, AUGUST 27, 2024

FISCAL IMPACT Funds for this request are included in the Fiscal Year (FY) 2024-2026 Operational Plan for the Health and Human Services Agency (HHSA). If approved, this request will result in estimated costs and revenue of $267,440 in FY 2024-2025 based on an amendment commencement date of September 1, 2024. The funding sources are existing Realignment and existing General Purpose Revenue. There will be no change in net General Fund cost and no additional staff year