By Jason Henry
Los Angeles Daily News
LOS ANGELES — Staff inside Los Angeles County’s jails performed safety checks to an “exemplary” standard while their supervisors were watching, but those standards plummeted when their bosses weren’t around, according to a report by the Los Angeles County Office of Inspector General.
Amid concerns that negligence may have played a part in the deaths of more than 100 people in custody, the OIG visited Men’s Central Jail and Twin Towers Correctional Facility in December and January — alongside each facility’s leadership — to observe how sheriff’s deputies handled routine checks on inmates.
The inspector general has flagged “the quality and/or timeliness of safety checks” in approximately 40% of the 253 in-custody deaths from Jan. 1, 2020, to Dec. 31, 2025, according to the report.
Safety checks, required by law every 15 to 60 minutes depending on the type of housing, are meant to verify “signs of life” in the cells.
While observed, the staff at Twin Towers “took several seconds to look into each cell and utilized their flashlights to elicit a response from people in custody when performing safety checks.” But when the OIG watched CCTV footage of the checks before and after the visit with the department’s top brass, the deputies no longer broke their stride and completed checks in less than a minute on average.
At Men’s Central Jail , they skipped whole sections of the required route.
Lack of serious discipline
The OIG questioned safety checks in seven of the 10 deaths on the same floor of MCJ since 2020. Deputies rarely faced more than a slap on the wrist, if they were investigated at all.
“In several administrative death reviews, facility leadership have been reticent to impose discipline on custody staff who have conducted untimely and/or poor quality safety checks,” the report states. “Instead, the Department often opened supervisor inquiries (which ultimately concluded that safety checks were timely or of sufficient quality) and/or opted to conduct additional briefings or re-train staff on how to properly conduct safety checks.”
An administrative investigation into an October 2022 death found safety checks were nearly two hours late. Three deputies received a written reprimand.
In 2023, a man was attacked in the showers and then dragged to a bunk, but he was not discovered until nearly four hours later. In between, his wristband was cleared in a headcount, though he was “bloody, bruised and swelling,” the report states. One officer was reprimanded.
Twenty deputies received reprimands for 19 hours of “poor quality” safety checks in July 2024 in which they failed to notice a man who had been dead for so long that he had turned purple and stiffened from rigor mortis.
In another instance, the department determined safety checks were compliant with department policy, though a man was on the floor of a MCJ dorm “in different positions and seemingly unable to rise for approximately 22 hours.”
“The video additionally showed that during a safety check, people in custody appeared to wave their arms to get assistance from the custody staff members conducting the check, who walked to the individual and appeared to speak to him briefly before leaving,” the report states. “Custody staff did not transport the person to TTCF for a higher level of mental health care until after he had defecated on himself.”
Deputies received training, counseling or performance log entries — a note used in performance reviews — following other deaths with seemingly deficient safety checks, including instances in which deputies failed to remove obstructions preventing them from looking into cells where someone later died.
The fact that safety checks were “exemplary” when conducted in the presence of OIG staff and jail leadership suggests “custody staff are aware of the legal, policy and facility expectations for conducting safety checks” and do not require additional training to understand their responsibilities, the report states.
In a statement, the sheriff’s Custody Services Division said it takes seriously its duty to conduct timely and meaningful safety checks.
“The Department has strengthened training, electronic monitoring, supervisory review and accountability surrounding inmate safety checks,” the statement reads. “Safety checks are electronically documented and monitored through a web-based system, supervisors conduct audits, and dedicated safety check sergeants monitor compliance and address identified deficiencies.”
While the OIG has raised concerns about the quality and timeliness of safety checks in certain in-custody death reviews, that should “not be interpreted as a determination that safety check deficiency caused or contributed to those deaths,” the department said.
“Each in-custody death is reviewed based on its individual circumstances, and any potential policy violation identified during that process is evaluated separately,” the statement reads.
The department stated it opened 31 administrative investigations and imposed discipline on 81 staff members related to safety checks since 2022. It declined to provide data about the severity of the disciplinary actions.
Did action plans matter?
The OIG, in its review, attempted to evaluate whether corrective action plans instituted at MCJ and Twin Towers in response to deaths had made a difference. It found that checks at MCJ, in particular, remained poor. Of the 171 safety checks in MCJ’s 5500 dorm from Oct. 18 to Oct. 31 , only 2% were “quality.”
The review used CCTV footage and a “conservative” analysis that dinged custody staff for not properly checking a cell only if they were observed “not moving their head or looking away from a cell” altogether.
While checks in MCJ were timely, none was staggered, meaning inmates could easily predict when the next check would occur. On about 93% of the checks, staff did not enter the bathroom as required, though a man had received fatal injuries from an attack in the showers in that same dorm just two years earlier.
The average duration of each safety check was just 39 seconds. That means staff spent an “average of half a second” observing each of the 82 people housed there, the report noted.
Reviews of safety checks in two pods of Twin Towers during the same period had much better results. Approximately 91% and 90% of the checks performed were deemed quality. However, staff still “often walked quickly and rarely broke stride when conducting safety checks.”
The average check took just 38 seconds in one pod and 39 seconds in the other.
Oversight lacking
The OIG’s review found that while the Sheriff’s Department requires sergeants to audit safety checks daily, it does not have a standardized criteria, resulting in “inconsistent findings.”
“Specifically, sergeants who audited safety checks at MCJ dorm 5500 determined that checks were quality checks when staff did not walk the required pathway and sergeants who audited safety checks at TTCF module 242 determined that checkswere quality checks when staff did not look into every cell,” the report states.
The report recommended the department standardize such audits, hold staff who fail to conduct compliant checks accountable, install additional safety-check scanner barcodes to force deputies to complete the full route, stagger safety checks, require officers to break their stride to look into cells, monitor CCTV in real-time and reduce the jail’s population.
In its response, the Sheriff’s Department said it has “reviewed the OIG’s recommendations and has already implemented or reinforced several mitigating measures addressing training, auditing, supervision and accountability.”
The OIG has continued to flag concerns about safety checks in its quarterly reports throughout this year. The watchdog listed the timeliness and/or quality of safety checks as an element warranting further investigation in nine of the 22 in-custody deaths from January to June.
So far this year, 27 people have died in-custody, according to the Sheriff’s Department. That’s compared to about 46 total last year when the jail population was much higher.
‘Horrifically tragic’
Haley Broder, chair of the Sybil Brand Commission, which routinely conducts jail inspections, said she continues to see poor safety checks during every visit. The commission described the lack of adequate safety checks as a “longstanding failure” in a March report to the Board of Supervisors.
“That is horrifically tragic and also accurate to what I observe,” Broder said of the OIG’s report.
She often sees tenting — a sheet or a towel or another obstruction — that makes it impossible for deputies to see inside and little effort to remove it.
“Sometimes, you can’t even look into the cells and see what is going on,” she said. “We watch the officers going past, conducting their Title 15 safety checks and scanning (the barcodes), and there is no possible way they looked inside because of tenting.”
Despite department claims that there are not enough staff in the jails, Broder said, deputies often were seen watching TV or movies during their shifts. Meanwhile, those in custody are not receiving basic human rights, she said.
“Every single inspection lately has us saying ‘there are five deputies crowded around watching a TV,’ ” she said.
In May 2024, commissioners observed a deputy walk past a noose hanging in a partially obscured cell, and when they went to report it, they found eight deputies gathered around a monitor watching pornography. A stack of about eight videos was sitting next to the screen.
To this day, Broder said she still does not know if anyone was disciplined in that case.
Board pushes reforms
Earlier this year, the Los Angeles County Board of Supervisors approved a motion, authored by Supervisor Janice Hahn , that aimed to reduce jail deaths through several reforms, including increased screenings for contraband, improved and randomized safety checks and increased monitoring of surveillance systems.
The motion asked the Sheriff’s Department to report back on the work it is doing to improve safety checks specifically. The department has yet to do so, however, and that report is now expected sometime this month.
In a statement, Hahn called safety checks “critically important.”
“If they are done poorly, people can die,” she said. “I am awaiting a report from our sheriff about how his department is working to improve these safety checks and I hope these efforts will go a long way toward preventing deaths in our jails.”
In the meantime, Broder and other members of the commission continue to see deputies walking to barcode scanners without so much as glancing into cells, she said.
More urgency is desperately needed, she said. A missed safety check could mean someone will not get the medical care they need to save their life.
“We are in a crisis where we should be doing everything we can to address this, instead of pretending everything is fine,” Broder said.
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