LOS ANGELES (AP) — The city of Los Angeles is violating the county health code in its Skid Row area by allowing the nation's densest population of homeless people to live on streets infested with rats, human excrement and used hypodermic needles, the Los Angeles County Department of Public Health has found.

An extensive agency inspection of the downtown district found nearly 90 rats' nests, mostly around street planters, people living in about 60 tents on sidewalks — some with animals — and 90 piles of human waste. The inspection last month focused on eight blocks of the 10-block district. On one block alone, close to 30 piles of excrement were noted.

The department ordered the city to clean up the area by this week and will start making routine inspections, roughly every week, to ensure hygiene is maintained, said Jonathan Fielding, county director of public health.

"There are clear health risks," he said. "Conditions seem to have been exacerbated there. There are more people, more material of different kinds on the sidewalks."

Some 800 people bed down on Skid Row sidewalks nightly, and 3,000 others cram into its shelters and special housing. During the day, they teem into the streets. Most are mentally ill or substance abusers.

The May 21 Health Department report underscores the precarious conditions that homeless advocates have long decried.

Inspectors found 13 hypodermic needles strewn on the ground and disposable rubber gloves tucked under tree roots. They also found people were disposing of human waste — including vomit, feces and buckets of urine — in storm drains.

The crowded, unsanitary conditions make the area a high risk for communicable disease. Four cases of meningococcal disease cropped up in March 2011, and outbreaks of staph infection were reported in 2005, inspectors said.

The report recommended the city install more trash cans and public toilets, provide soap, water and hand basins, and step up waste collection.

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The city must implement a vermin-control program in the area and monitor for hypodermic needle litter, the report said.

Inspectors also noted the desperate condition of many of Skid Row's residents, including one man observed crawling across the street on his hands and knees, another eating out of a trash can and many unkempt people living amid garbage and debris. They recommended increasing efforts to get more social services to people.

Sanitation workers have been intensely cleaning the neighborhood to remedy the violations, and are developing a maintenance plan, said Jane Usher, special assistant city attorney.

Public health officials have conducted inspections of Skid Row in the past in response to specific complaints, but this was the first comprehensive look at the neighborhood's overall sanitation, Fielding said.

The inspection last month was requested by the city attorney's office as it gathers evidence in a bid to overturn a federal judge's order last year prohibiting the seizure of homeless people's property from sidewalks without notice.

The city says the order is making it difficult to clean up the area as sanitation workers are not sure what is personal property and what is trash. Meanwhile, nearby businesses and residents have complained about the proliferation of furniture and shopping carts and people living in tents as police have stopped removing tents due to the order.

"The deposits on sidewalks have reached a crisis point," Usher said. "Conditions have deteriorated."

Fielding said the county Health Department will continue to press the city on the problems.

"The city has demonstrated a willingness to address the concerns, but ultimately, it is our responsibility," he said.

For homeless advocates, who have long criticized the city's neglect of Skid Row, the violations are a black eye for the city.

Attorney Carol Sobel, who sued the city over the destruction of homeless people's property, said providing toilets, trash bins and soap to people has nothing to do with confiscating people's belongings, including important papers and medications, without warning.

"This really is a condemnation of the city," she said. "The county is saying, 'Come out and clean it.'"

Residents said they hoped the cleanups would be ongoing.

"I've been trying to get the county Public Health Department out here for years," said community activist Jeff Page, who goes by General Jeff. "It's not like Skid Row suddenly got dirty and infected. It's always been like this. But at least it's something."

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