wonderful businesseshere. >> >> the san francisco health commission.wonderful to see the laguna honda team here in force in person and the roll. >> yes. commissioner green, present. [roll call] >> commissioner christian will read land acknowment.you. >> the san francisco health

commission acknowledges that we are on the unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants oe indigenous stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as guests, we recognize be homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> ank secretary morewitz now has an announcement to make. >> hi, everyone. the health commispublic comment by members of the public effective at the next full commission meeting schedujanuary 16, 2024. accommodation for remote public comment will continue to be made available to individuals with disabilities so they ticipate in our meetings. individuals requesting accommodation for disability will need to submit their request via e-mail or oth commission meetings. today's meeting will be the last for remote public comment

by the general public. anyone without disability accommodation wishing to address the commission on items or other matters not callanered need to be present and in person. those unable to attend commission meetings in person may still submit lí read and review. future agenda and website postings include these changes topublic comment procedures and clear instructions how to submit request for accommodation for disability. additionally, access to view health commission meeting to be made available. the health commission hearing concerns and input from all community members. >> thank you. we already do receive and do read them, so we'll try this out and hopefully it will work with anyone and again, anyone with disability is welcome to continue with remote public comment so thank you. i believe the next item agenda is laguna honda ho recognition awards and

commissioner guillermo, who chairs the jcclhh will proceed. >> thank you all. i'm so glad to see your them more often. i'm pleased to open this recognition. thyear we recognize all laguna honda hospital staff for this role in securing the future ofat team was a national model for covid-19 response and saved countless lives during the pandemic. catch a breath, staff was faced with greatest challenge in the 150 year history. a multi-year cms recertification process. for the last several years have been extremely challenging, we know we can count on staff. all the laguna honda staff continue to make rapid s top performing skilled nursing facility. most importantly, each staff members day in and day out for

our residents and prioritizing their care and wellbeing. also there for each other. there is no place like laguna honda, no city and county commitment to publicly funded long-term care. as we near thend of our path to dñ recertification, we will always remember all employees have the team that save laguna honda. we want to also acknowledge contributions of the dph leaders who and transferred to assist laguna honda through the recertification process. lifesafers. we are grateful for patience and support through the process. we are thankful for every contributed towards recertification effort and mission of laguna honda. we hope each staff member can end this year proud ole in san francisco. so, without being overly dramatic, i like to stand and give you all a hand. a standing ovation.

[clapping] >> thank you so much and we all are so proud of what you've done. is there public comment on this item? >> is there public comment in the room on this item? folks online, if you like to comment we are on item press * 3. i see no hands, commissioners. >> any commissioner comments? >> i said a lot already. i'm just hoping again that 2024 really opens the door to this new vision that we had for laguna honda and more then just being a model for overcoming this process and all the what the future is supposed to look like and really be the kind of facility people aspire whether a resident or staff or

er part of the new year's resolution we can be part of, i'm happy to be there with you. congratulating you on theered hawork hard work and thank you for the hard work and tireless t it. recognizing that fact and t it was on all levels, because how much you care as well as are human and only have so much capacity for pain and no sleep. thank you. know that we definitely have seen your work and understand as much as we can prom a distance, some of but thank you on behalf of the families and the city and all the people who will come h doors of laguna honda in the future as a result of your good work and your dedication, so thank you. >> commissioner chow. i think you are on mute. 6l

>> fellow commissioners, to all at laguna honda. i think this was very appropriate to not single out duals, because every individual was so important. fallowed lagunar years i have been on the commission. in fact, was involved in laguna honda prior to the commission. my first é#introduction to city [indiscernible] and that was the blue ribbon committee and the committee that many years ago said [indiscernible] that laguna was a important part of san francisco and we made a number of recommendations at that time. to watch laguna go through this last crisis and change so that [indiscernible] so today we are on the brink of being at the apex of a world class organization and delivery

care. that turn-about from thinking we were in an appendage to an acute care system to now work on behalf of the residents as world class skilled nursing long-term care facility is another tribute to the city's dedication seeing that those in greatest need will have an nest care we can deliver. again, i would just echo what everybody has said. e the answer. all those who have worked hard and they were tireless charge and asking the staff to actually [indiscernible] new standards,ering obably say the staff has done that, so thank you very much and i look forward to the continue [indiscernible] service to city.

>> i of course want to associate myself with all the comments. as i thought about it as a member of the what has been most remarkable to me is the way you are able to morale. some requests in human or impossible to never acted resentful. i think onlies have done so well and the residents is the way you have come through this with your with your commitment and your dignity and that is so unusual in medicine today where so many people feel it is you to my mind elevated this profession beyond imagining and wonderful to i see dr. lam in the audience and welcome and it is just a wonderful to see you all together and to be to recognize thsásuper human work

you have done over these past way too many months so very encouraged about the future and we are so confident that you'll continue to shine in every way, so .th i know director colfax wants to say a few words as well. >> thank you. thank you president green and really appreciate the comments from the other commissioners and just to extend on behalf of myself and the rest d proud we are of laguna honda and what everybody has done. we are the city of saint quote attributed to saint francis particularly apt to what you have all done in the last year and a half which is first do what is necessary, then do what is possible and see you are doing the impossible and i think that is apt for the done and the leadership you have shown in terms of shifting a culture of the institution in so many ways through a very challenging bureaucratic system.

one thing that never changed and think your north star ohealth and welfare of the residents and their families were central so grateful for everything you have done and everything you will continue &)toyou so much and thank you for being such wonderful care-takers of god's hotel. , we have any--okay. >> next item. >> next we go to the report, right? >> the recertification update. >> okay. the next item on the agenda is the recertification update and present to us. >> good afternoon commissioners. roland pickens.to be here in person with you today and joined by sandra simon, our new ceo nursing home administrator members of the

laguna honda executive staff and members of command are also present and joining us virtually. i stand here today on behalf of all of them to present you with the very brief .abut hopefully comprehensive update on the cms recertification journey of honda. as you imagine, staff work tirelessly towards recertifyation. we welcome surveys for the cms medicare certification that survey consisted of two components. the first was h inspection portion, which took place between november 27 and december 1 and the second portion, the fire, life safety nd emergency preparedness portion which december 4 through december 7. you will recall after the recertification

back in august, we achieved our goal of becoming recertified in as you know, more then 95 percent of laguna honda residents medicaid as primary funding source for their care. this most recent survey is for the recertification the medicare program. you will hear more about that throughout today's presentation, but wanted to shar÷?wiaddition to the medicare survey we just completed, when state and they also did a very rigorous job with all most 30 surveyors on site to review at had been on the books for laguna for the last several years. there were 39 unopened unresolved cases, 7 unresolved compla32 self-reported.

the surveyors were able to resolve 34 of the 39 cases with preliminary resolutions showing 0 deficiencies so hats off to the staff at doing all the work that resulted in there being no negative findings thus far from those cases.ún so, there is and has been much to celebrate. surveyors were at laguna over the past few weeks, they noted that they saw great improvement and it is clear laguna honda isn't the same organization decertified back in april of 2022. while we are excited and grateful for these words of encouragement and recognition from the surveys, still not complete. we are still awaiting to receive what's called the officialstatement of

deficiency with findings from that survey. as always, we expect findings, especially for facility the size of laguna honda, and our goal is insure the findings er and isolated as possible. staff since the ending of the survey in the exit conference ájve been hard at work preparing for the 2567 statement of deficiencies and working along with our expert, the health service advisory group. we again want to thank each and every laguna honda staff person as we know rveys are very stressful and it is hard to imagine a series of surveys more high stake the most recent one for the medicare recertification. the next step in the medicare recertification process is receive that 2567 statement of deficiencies, which we expect to receive any day now, and

then 10 day turn-around period in order to provide our plan of correction and submit that public health and cms for their review and .hopefully follow approval. it is important to note that the plan of correction does not have with it as we talked about this in theest pa. for the medirqcare recertification n7process there was initial certification in august when we received our medicaid recertification and the most recent second survey had a period about 180 days so we met the requirement for the so when we submit the 2567 there will be no further delay in terms of period of so, we are-we are not quite there, we are nearing the finish line for recertification.

we have much more to do will continue to share our status and updates with you as time goes by. as we surveys for 2024, we anticipate the acute care license survey for 11 acute care beds at laguna honda. that part of the organization has not been surveyed post covid-expect that survey to come at any time and we are prepared and ready to hopefully do well on that finally, we know the status of readmission to laguna is top of mind for we said currently we are laser focus ed on recertification, but we do look forward coming back to the joint conference committee at laguna and health commission to share with you both our plans for ongoing sustainability of improvements made and to share with you our path towards returning to more normal

operations at laguna honda course, admissions is part of the update we'll be bringing to you. so, it is my pleasure and you will more from on to hcintroducyou the newest member of the laguna honda executive staff and that is medical director and chief medical albert lam and invite him to come up to >> good evening everybody. very excited to join this team and i have been im i met people in the janitorial and environmental service staff all the way up and very impressed with the people i have had a chance with. everyone seems dead dicated providing the mission of care and excited to help us get at the top. i look forward to getting to know all the commissioners here future and hopefully

we'll be able to celebrate a lot of our success. thank you. >> thank you. we are veryvery you and welcome. >> dr. lam is very modest. he didn't go into but we were able to recruit him after more then one year long search process. there were over 400 inquiries in terms of potential applicants for this job and dr. lam is the person that rose and was very clear he was head and shoulders above the rest.him. of northern california's top performing post acute care departments at the tthealth palo alto medical foundation and served as the chair geratric department and senior post consultant. dr. lam will be taken over the helm for dr. [indiscernible] wthat position on interim basis for all most now, and we want to extend our thanks to her for all her

work and effort and she will continue to be like many on site to continue with the transition to this new leadership team. next slide. that concludes my recertification update and as you know, there is a h annual report that will come subsequent in the days, but i'm happy to take any questions at the appropriate time. ther any >>public comment on this particular item, which is recertification update? >> yes. i seen one hand and maybe in the audience. statement. for each item, members of the public have a opportunity to make comment for up to three minutes. the public comment process is ne input and feed 37 back, however does not allow questions to be answered or members to in with the commissioners. a commissioners consider comments from members of the public discussing a item and making dph. each individual is allowed one opportunity to speak per item. individuals may not return more

then once to read statements from m2o written public comment may be sent to the health commission, health.commission.dph@sfdph.org. city policy along with federal, state and local law prohibit nst city employees and others and will not be tolerated. we'll take public comment from those in person and then remote public comment from who receive accommodation for disability. i have given one person accommodation for the meeting. i have given each individual a code to prevent others speaking during this time. finally, we'll hear from others who are remote. there will be limit of 20 minutes of comment from each item who have not anyone in the room who would like to comment on item 3, the laguna honda recertification update? i dowe'll go to the two folks that have hands up for remote public comment. please unmute the first caller.

>> it is shaw code aa. can you hear me okay? >> yes, you are loud and clear. you have three minutes mr. shaw. >> thank morewitz. please commissioners, stop calling laguna 's hotel". it isn't a hotel. it is a skilled nursing t2 previously [indiscernible] testified to san francisco board of [difficulty hearing speaker due to audio quality] 90 day reasonable assurance waiting period between the two inspections. ection, mr.

pickens just referred to was technically a "90 day monitoring survey", required by the [indiscernible] required under medicare rules. cms approvchange to its standard rules applicable for ifall facilities? anonymous complaints are a concern because lndgetting a inordinant number of anonymous ints.

[indiscernible] what's the status of 120 bed waver request you [indiscernible] wave submitted. thank you. >> thank you. janette, please unmute the next callervm. hi. this is-can you hear me? >> yes, you have three minutes. >> hi. dr. palmer. i thought we were going to hear the timeline to the readmissions was and given some timeframe and i'm a little i i did not hear that and would like to hear it, and also, what the timeline for submitting a waver to keep 120 beds in, i would like reassurance that there is still a full intention to fight to

i would also like reassurance that the new laguna leaders will be completely supported in turning down inappropio laguna honda cannot safely care for from san francisco general very much. >> that's the last public comment. >> any commissioner questions or commissioner guillermo. >> thank you. i know you can't give assurance pickens, but do you have might end of the year? >> yes, i do. last friday would have been the period that cms by their own rules should have returned this 2567 to us, so they are a few day overdue so why we are expecting it any day now so one would hope they will resolve those issues and get it to us as quickly as possible and we do our due diligence to contact them and

ask them for a update, which we have done already and awaiting for a answer. . chow. >> yes. thank you mr. pickens for the report. wonder if you have some--well, i am curious about understanding more of 90 day gap and the recertification process that then you are saying because we had the medi-cal-we sent the medi-cal survey which an serve did i understand that correctly, we still are waitk you dr. chow for th question. you did understand correctly. the reasonable assurance period is a period 120 days, so that august survey, which gave us back certification in medicaid has s to be our first of two medicare

e requirement onable assurance period. that is over and done and we are beyond that. >> good. according to your previous statements, the issue of tgoing to be pending the recertification completion for dicare, so it would be good to hear that we are still intending to do that. >> very much so. we maintain all along that ce of those 120 beds, not only to laguna, but the entire san francisco bay area, and so we intention upon applying for the requisite waver when we feel we and have that verecei fully approved. that is still our plan and the most appropriate time we will be that forward, but again that is after we achieve medicare recertification. >> great. once again, i we have

received the medicare survey at this point, and that we'll the corrective action plan and seeing we recele] thank you again to your entire staff for the hard work you have done during this survey process. we have been following it day by day as you have been giving us update and it's clear of work. when you have 30 surveyors site, you all most need people to keep with them. having been a surveyor before, i know the stress on both sides, so again, our rd work and we are hoping for success. thank you. >> thank you. >i question. if you do get the 2567 before the end of the year, what kind of flexibility do you guys have see so you don't have the week between christmas and

new years when half of san francisco county is enjoying families and holidays? >>be prepared so we started working immediately after that exit conference on the plan of correction, so we actually have our preliminary correction already done, and as long as we don't anticipate surprises, if there are not any we will be able around. >> thank you. perfect. alright. thank you so much and we are about to go to our tem, which is the annual report and again, mr. pickens will be presenting. >> i am >> wonderful. >> director simon. >> hello. good afternoon. welcome to the laguna hospital annual 2022-2023 annual report presentation. my name is sandra simon, serve a g home administrator and chief executive officer. as you know, i joined the teas the fiscal year was coming to a end so i'm

accompanied by colleagues to help with this presentation. i will say, it has been such a honor to serve alongside the staff of this challenging time and very challenging year and am so grateful and so proud of this team and the staff dedication, their perseverance, their excellence and just rely the pride they have in their work. it really was a honor during the survey to see the staff and how they interacted and proud of the work they have they have really carried the changes through. it is also been such a honor to serve the not only have i received such a warm warm welcome from them, the patience and support throrecertification process has been outstanding and we all know it is their care, their wellbeing, thei really drives and lifts this work. just after the close of fiscal

year, laguna back the recertification into the medicaid program. that is the funding source that serves and supports about perct of our population. our path to full recertification continues. i do want to acknowledge and just again celebrate as heard that it is a major accomplishment. next > who we are. as we have all said tonight and as we know, there is no place quite like na hospital. we are one of the largest skilled nursing facilities in the country [indiscernible] and also adults with abilities. the uniqueness of [indiscernible] why cms recertification has been top io the city. next slide, please. our mission d about laguna

honda, provides a welcoming, therapeutic healing environment that pports and wellbeing. resident centered care. our vision is to build a healthier lives of leader in post acute nursing and carry out the mission with resident centered care, values of compassion, professionalism, competency, teamwork collaboration integrity and communication. next slide. who do we serve? we have a diverse population and here's a few oú"residents with complex medical needs. we are often low and very low income and we serve a broad community in terms of both care demographics and really proud of the fact laguna honda does serve residents that may not be able to be served well nursing homes, so we are very proud of that fact also. next slide, please.

you can see the demographics here. one of the thingz that makez laguna honda special is diversity resident population. as we said, we are public l the resident care comes from medi-cal and medicare program. home to residents with very needs and really just would not have other places where they could find care. ralanguages spoken and the facility and also have two specialty units, dicated spanish language unit and chinese language unit. next slide, please. just a couple highlights. especially in this really we did serve even with reduction, we were able to serve 849 people over

[indiscernible] these two numbers really represent our effort not only supporting our residents through all the changes and provided resident centered care through about the financial, i want to invite lily up now, the cfo from laguna honda. >> thank you. hello commissioners. lily, cfo. i'll be reviewing ouañr financial report. if you can go to the next great. so, i'll start with revenue. year over year we saw revenue spite having lower overall census. this was primarily due to increase in the distinct and prior year settlement of $8 million. increase to the reimburse ment rates with the primarily driver nsus and that result in a surplus in

total operating revenue for the year of $5.4 million. on the side, total expenditures increase year over year due to recertification and registry cost primarily. recertify cost include consulting service with health service advisory group, health management associates and [indiscernible] in we had increase security and communication service costs for the year. on the registry sie, due to recertification specific registry, covid continued need for es and to cover just general increase need of registry [indiscernible] we saw over the year at increase to non personnel cost covered by labor savings and the laguna honda operating budget and also yja $24 million fund transfer from neral dph network wide savings. this reallocation of funds

contributed to higher year over year general fund subsidy the slide there. next slide, please. th sources for the year, and we continue to rely primarily on medicare as payer source and historically we don't see much of the shift year over year in our payer mix. we did see a slight shift last year from outpatient visit from medi-cal to medicare due increased outpatient clinic volume and primary covered by medicare part payer sources remained largely consistent year over year and we expect to see a similar payer mix for fiscal 24. we'll wait to do questions until the end. >> thank lily. so, our 3path towards recertification could not have

happened without the support of the laguna honda recertification incident command structure and i want to coincident commanders in the audience, troy williams and baljet. they really helped to drive have done. also want to acknowledge dr. [indiscernible] who as transitions out of being interim cmo will be the interim chief medical officer for san francisco health network and continue to support laguna that position and also maggie--joined remotely who is part of cidentoverall hospital administration and [indiscernible] who has been the executive sponsor for nursing en the chief nursing officer over veral months. so, incident command, it is one of the beauties of being part of the department of public

heafocuses on all hands approach, particularly to emergencies and critical incidents, so we are de truly utilized the hospital incident command structure to take on this overwhelming task of recertification and us well and again thank you to all parts of dph that supplied staff to help support because that structure was really beneficial to support the staff at laguna as we wards as we shared, we've met all of the maerent milestones and metrics put forward towards for on, and again cht to say thank you to incident command structure for supporting that and making it i'll turn it over to naz. >> good afternoon commissioners.

naz, quality officer for laguna honda hospital. as part of the annual report today i want to share work we all did over the last fiscal year in particular response to first monitoring plan done in 2022. laguna honda partnered with qie to develop our first action plan in response to that survey whof 500 milestones. the facility was able to successfully complete that action plan and submit it with supporting evncof may 2023. those milestones covered areas such as medication gement, more and the facility continues to do more action plans throughout the year to insure we continue this great work ide, please. >> good afternoon. name is jennifer, [indiscernible] and you imagine with all the milestones comes a great e past year we were very

successful in having two major facility wide educatiwe called ed them. we were able to educate over people including [indiscernible] reaching up to 97 and 98 percent compliance each time. this was really exciting event for us to be able to put in the sense that it was really important to support our recertification efforts, and we will continue to participate as have to see what the future brings. next slide. another thing we have done this past year increased our executive rounding. we go to the different units, all the executives have assigned units 4/anenvironment of care, but talk with residents, talk with families, talk with staff. we make sure that people's questionsthe

higher visibility really has garnered a different relationship quite frankly with bu staff, which i think is appreciated as we going through these very challenging times. nede i'll pass it off to dr.-- >> hi. interim chief medical officer. i'm going to come about the restraint free journey. this is a huge success of the recertification effort and moving the organization towards the the use of restraints, which are not only about safety, but also about ge"ndignity and dependence and took partnership across multiple disciplines, helping to make sure we approach this in a resident centered trauma informed way and at this point we are well within the goals we set ourselves in this line of standards across the country. next slide. turn it back er. mathank you doctor.

as i shared with you before, one of the key initiatives we undertook this year istent care at the bedside initiative. professionally known as ccbm initiatirecall back in june and july of this year, we were little over a year into recertification journey and we despite tremendous progress there were still areas that needed more detailed and higher level of expertise. in essence, the ccbm initiative was born out of that need, where our quality improvement expert to bring on-board senior nurse leaders who directors of nursing at skilled nursing facilities and assign one to each of our 13 units order to again, bring more direct

supervision and coaching and expertise to the nursing unit level. so far that program has been very i think by virtue of the most recent surveys, we feel that this program particularly in allowing us to proactively identify areas of barriers and correct those before they were being found by surveyors. the ccbm initiative was key we are planning to continue to operationalize that at least through our first year recertification as part sustainability program. next slide. let's go one more slide and then come back to this one. you recall february, mayor breed hosted u.s. secretary of health and "khuman

service javier [indiscernible] it was a great opportunity for the secretary himself to all the work at laguna was a great visit for him to really put names and faces with what he had only seen in writing and verbal reports. you recall i previously reported at the conclusion of that visit the secretary said that he was so glad he was grave him a perfective of laguna honda and i see that as part of a turning point in ndthis whole recertification effort, so again, that's why we wanted to highlight that visit as part of this report. let's go back to slide, . at this point, i want to reintroduce our new nursing home administrator and chief exec the opportunity to further introduce the new members of the laguna honda leadership team. >> hi. extremely honored to introduce this team. so inspired by

this team and coming together to really help lead the path to and these professionals and passionate long-term care professionals and guides and leaders, it is a thrill so i want to introduce you to them and maybe you can stand up. jennifer--you probabl already. assistant nursing home administrator for south tower. righthe assistant nursing home administrator and he is over the north tower and they all still hatheir respective areas of services all under [indiscernible] greg is not able to be here today. don't know if he is online, but greg chase is executive director of facilities. engineering, fire life safety and capital michael collins is here, one of our directors of urs nursing and over thclic oversee the south

tower. and then tracey brown, who is ill today. she is not able to with us, she-tracey and michael joined on the same day, started together and she oversees the north tower some other initiatives, care initiatives and dr. albert lam comes to us here as chi([efofficer week two. third week already. anyway, just an amazing team and to-we never get a chance to all-very unique opportunity for executsame time with a goal in mind and to just mesh and do this work together, exciting opportunity. with that, i think jen has a few--[indiscernible] >> next slide. maybe not. imagine with all the work we are doing we like to

give back to staff as much as we can, so we are able to ha which was fun and exciting. our staff love food trucks so try to get them as frequently as possible. t like a food truck? we did part with the union at the event which was really special and i think that the partnership we have developed e past year i would like to see that grow and continue to help benefit our continued next slide, please. this next event i want to say fortune of attending the opening just across the street for the art summer exhibition that featured some of the laguna honda residents. it was very special. it was one first outings, official outings post pandemic and it was a real lovely celebration of life.

when you live in a facility, sometimeshumanity isn't seen anymore, because you live in a facility. partnership with art with elders for the past 30 years they have best by showcasing and showing that humanity and that beauty that comes and might have at laguna honda, so really beautiful. i hope you got a chance to see it. not we have a bunch of art featured at laguna honda. special too because the mayor was able to join us and spend timit was really beautiful. thank you. so, as we talk about numbers, compliance, work, operations, we never want to lose sight of why we our mission is to support our residents through this time of their life. here for our residents and so want to highlight two of our residents

and share a few stories with you and both of these residents participated in our eir work is displayed i believe still at city hall. the program that jen spoke about. felipe comes from a small town and you can see that his 1977 father bought a ice cream factly and his family made ice cream, sandwichprodu that inspired him to embark upon a path of business school and started working in coca cola at the accounting then in 1998 he became a american resident and that is how he came here.' in la and worked at various facilities and in 2003 moved to san francisco. thenin2006 he had a stroke and became handicapped and moved to laguna honda and he has been there 15 years ;2that he has enjoyed and participated in art with elders for the last 5

years . ida was born in san francisco in 1940 and had a stroke that paralized her right 2 years old, but ida will declare she doesn't feel-inspite of the stroke, never missed out on anytwere immigrants from northern italy and she grew up in north beach and she just cherished memories with her family and children and telegraph hill and strolls at fisherman's union art and enjoyed coloring throughout her life and you see her in the studio doing artwork and she can y long. she always wanted to do it for extended periods of time. never had the chance and now has the chart with elder program. i hope you enjoy hearing about ida and felipe. next slide, please. so, we look w year and you hear how optimistic this team is and excited and we look forward to the

to a close and we are looking forward to new beginning and what beginning of a new chapter and what i like to call new laguna honda hospital. this new organization that is as we talked about providing z leaders and exemplary care in the skilled nursing field and being a model for other said. on behalf of honda leadership team, again, i just want to take a moment to thank the dedicated staff. so proud of emjx. their dedication and they met this challenge with such grace and such strength and fortitude. thank you staff of laguna honda. we would not be here today if not for your work. finally, a big thank you to the for your guidance, support through this process and happy holidays nñeveryone. >> thank you. public comment on this item? >> anyone in the room who would like to comment on this

this item? don't see any hands. anyone on line who would like to comment on this item? we are on item 4, honda annual report. i see no hands, commissioners. >> any commissioner comments or estions? commissioner guillermo. report. i really enjoy always every year hearing about really what is going at laguna honda and aside from all the going's on on recertification and covid prior to that and the other that, it really is about the residents and the staff and this report really does bring that home and though only couple stories about the residents, those two stories give a flavor of the kind of quality care and the comprehensiveness i are think of services and care that comes toresidents at laguna honda. felipe who has been there 15 years, for as a

resident that he can enjoy art and he can really be a vibrant human being in a institutionalized setting means he doesn't feel institutionalized, right? so, i think that is really really important for us and the public to understand and hear it is not all about rules and regulations and pod facility report incidents. those things are obviously important, but to the end, it is about the people always enjoy getting the report, particularly since we don't-especially with covid, we az min the facility and be witness that energy and the vibe that goes honda, so i thank you for putting the time and effort into putting t together and to giving us a glimpse into laguna honda. i did have a question abou when the readmission occur, i

don't know how much a sense of who will be coming back and might be coming in, but is going to change significantly the demographic or diversity mix in strive to keep that stratifyed in terms of both nder, identify and all the things that show up here as soon as wearle to reinvite folks to come in? >> thank you for the question. i'll start and theno has been coleading the group looking at preparing for readmissions. in essence, we to our charge to serve all of san francisco meaning all san francisco in terms of the diversity in every respect. with a focus on under served, those who cannot get care anywhere else and so that remained constant in all our

planning. overseen the work with medical staff in terms of admission criteria. we have a very robust process that we are started about a month and a half ago and continue over the next few mont aspect of what's needed to begin to safely resume admissions and make sure we have all the and programs in place to care for residents. >> thank i think i would just say that i think we are all very excited to begin the process of opening the doors again and i to making sure the quality of care improvement work we have done translates to admissions so i the for feedback and help getting mission policy we feel comfortable with and evto the core principals and criteria you helped us develop and as part of the process this week had great conversations with folks at the san francisco health plsan francisco consortium clinics

across primary care so i we are transparent about all the work we have done and we can carry that through to the process of the readmissions and again, san incisco is diverse community with a lot of needs and you [indiscernible] i think we-there are a lot of k will be perfect fits to come into laguna honda hospital from san francisco and so i think that will the diversity of san francisco as part of this process and i think bringing that trauma informed equity lens to the procthiswill be cras well. any particular questions on that that i can address? >> no, that was--just good to hear that the robustness i guess of the process for readmission and really making sure that the population of laguna honda continues to be as diverse and reflective of the diversity have seen. >> i think it is tribute to the leadership of the organization, both the folks who have been

there and the new folks who have come i think we can meld that experience from the past with the standardization and quality that our leadersh zation, so very confident we can do that and again, one of the best are part of brouder san francisco helt network so everyone has a place to receive care that is right for them and j.lot is figuring where is that place to find a right fit that meets needs where they are. >> great. i did húother question around, i think for lily around the financial's. given that we these readmissions and recertification there is hopefully increased revenue that from medicaid and medicare, so will we be needing the general fund subsidy to the extent that have had in the past given the budget cuts required in this year and the future so how

might that effect the operational and economic health of laguna honda if you take the budget cuts along with increase in revenue is going to be? >> yeah, i think in the upcoming fiscal year, i don't will be ramped up enough to make a significant increase to revenue to off-set the budget cuts, but those are things we are modeling now to see based what we know and what we think may happen in the next year we can anticipate additional revenue, dn't be back to our pre-recertification processa higher census. probably second year out ve that higher revenue picture again. >> so, we should anticipate ere will be a [indiscernible] >> i think it is just a ramped up increase that wouldn't be going frhere to here and in a short period of time. >> just concerned we are able to continue to fund the stability

and sustainability efforts that have come to date so something that we will be watchful for and very concerned about. >> yeah, and i think we uld continue to benefit from the higher reimbursement rates we experienced last year and that ntinue into this year, so the revenue picture isn't as dire as it would be had we not seen that that to increase. >> great. thank you. commissioner chow. >> yes, thank you. a exciting annual report. it was when fiheard the decertification a downer and it is hard now looking back over so much has been done and then i think this year in particular in the annual report reflects, we are moving out just a stabilization, first of all, bailing out the order from a

ship having tractually pivoting to a brand new day for laguna, like sandra said. a new think it shows in this document. new ways of doing things, resident centered, looking for the best we under these new regs that cms has been promulgating in order to see that residents are properly cared for and respected, so i want to again congratulate everybody - to me we turned a corner, we have a new way of doing things, we have a brand new team that looks exciting and [indiscernible] i think in a different ball park here. thank you all very hard year and i think the work is showing and you're really turning not just turning ner er, but moving forward getting that world class care

that roland had talearlier. thank you. >> commissioner christian. >> thank you. as commissioner chow said, this is really excithink probably always probably not unique in this way, but really impacts me is what we learned about the people who are working in the space and the people who 8hare being served in the space, and thank you for the two resident a' st about the residents going forward. fe ipe and ida because it helps everyone and someone like myself who is new to laguna honda as somebody when i came on to the health commission and still learning a great deal about it, and knowing that we have sister

citizens there, but really not having a sense of who they ayou for this and the importance of the woin seeing the faces and stories and hearing the stories of the people and thank you for caring for them. and, on note, i wanted to tell you that i am impressed and thank you for the idea of this increased executive rounding that you are bringing to us today. i know someone who works in a organization and not at the of the food chain, it is always incredibly useful and inspiring and helpful for the people the decisions at the executive level to interact with the people who are doing the day to day woanwill definitely insure a greater positivity and have a huge impact on the staff. believe me, i know from personal experience one way so very

impressive and glad to hear you intend regularly going forward. and, in the same vain of finally i think i will say, moving to restraint free--it has been impressive to see the level of performance and care has been lifted in the last year, and one thimore about is, how you will be incorporating bringing this critical eye to not only meeting al regulations, but continuing to exceed them and to be continuing to step into a leadership space going forward in the country around providing care for people and what is right and what is you can tell me how that will look going forward once the doors are fully open again and people are coming in and what will it look like next year? >> thank you for the question. i'll start and most people on the team can help answer briefly in

the presentation that we will be coming to the jcc and what our best thinking in terms of a long-term sustainability and stabilizationwill lay out what were the things that we put in place doing recertification that need to so those day to day operations so we can build forward and towards our becoming the premier exemplary skilled nursing fa we brought in best practices that have been incorporated into operations. when she came on board introduced the idea of [indiscernible] she meets with the leaders from all the nursing units. that is best practice that had not previously existed so that will continue. we'll continue to have key

performa publish so there is transparency to all in terms of operati incorporating ongoing external skilled nursing t expertise over the long-haul, so as commissioner guillermo was saying we e progress, we are building ongoing external review and validation to make sure that we are sustaining th [ii was asking the question, can we do better and how can we do that? >> absolutely. >> thank you for this report and incredible work and i'm really looking forward to seeing the future. >> yes are, th beautiful and we hear so much about the regulatory and bureaucratic aspects of laguna h isis the human istic part of laguna and as the other commissioner says, so wonderful to hear about the e few i interacted with are

such incredible people and overcome major disabilities with such strength and chthere are a lot of individuals that have other struggles, but this is so uplifting to read and we are really grateful and i think speak on behalf of all the commissioners that we are very grateful to those who deployed to lu laguna and want to acknowledge [indiscernible] she was critical supporting your team. she was often a liaison ission leadership helping really help us understand a lot of complexities of the step by step you were going through, appreciative of the role you played and delighted with the ne it seems each of you has ing unique skills you are bringing to the organization. i cannot imagine there is another skilled nursing facility inhas a team like this one so we look forward to 2024 and thank you for all you have done and this beautiful report.

director colfax. >> thank you president green and the commission for your comments and i want to acknowledge the incredible work that has been done by this team and across laguna honda and reinforce the connection of th report with humanity of laguna honda and also the fact i think with the transformational year the team has prove changed. having a resident centered human istic approach intertwined with also continually improving your work. those are now intertwined at laguna honda and you can walk the laguna honda hallways and pass by the art studio, which is incredibly inspiring, the getting care there and go to the neighborhoods, you see the environment now when people receive meals, tabgo into the nursing rooms and you actually see the indicators. you see celebration about staff

and what they have done and also see post it notes staff estions for improvement. all this is transformational and changed and it is under a very focused environment how continue to improve and just an example i don't think has been spoken today. there are 6 thousand observations a guna honda for quality improvement. 6 thousand a day. to your point about the galaxy, country there isn't another nursing home that continues to drive that and thank roland pickens for leader ship and insure the top leaders for laguna honda were selected and also thank the commission for your support and leadership throug a really challenging time both for supporting the team and making sure that they felt like they were getting what they needed and also for tment and the considerable amount of financial resources that it took and will continue to take to make sure na direction and just to assure

the commission, laguna honda remains a priority for the department going forward. thank you. >> thank you. approval of the minutes of the health commission meeting of december 5, 2023. you mind-can we do one more round of applause for all the laguna honda d colleague, you don't have to stay beyond your items. feel free to do whatever is comfortable for you. >> you dont want to hear about the minutes? >> they have so much work to do. >> alright. having commissioners seen the minutes, any additions or corrections to the minutes? hearing none, is there a motion to approve the minutes? nd. >> is there any public comment on the item? >> any public comment in the room on the minutes? how about folks on i don't see hands, but that is item 5. >> alright. then we'll take a >> commissioner chow, yes.

everyoneen the room, how do you vote? >> yes. >> thank you so much. miapproved. >> now go to general public comment. >> folks, read a statement and then look at the room and online. ie atthis time members may address the commission on items of interest to the public within the subject matter jurisdiction of the commission but not on this meeting each member of the public may address the commission up to three minutes. the brown act forbids the commission taking action or discussing item not appearing ng those raised during public comment. please note each individual is allowed one opportunity to speak per item. may not return more th to read statements from other individuals. written public comment sent to the health mmission at health .commission.dph@sfdph.org and everybody else i read y folks in the room who like to make general public comment? if you would i guess get in line and ch will have three

minutes. note when i say time is up, please finish your statement like the sentence because your time is literally up. thank you. by the way, the microphone, just speak and it will pick up >> my name is [indiscernible] license clinical social worker in intensive care units at san francisco general hospital. i'm a so at the level because i know first hand what the effect of genocide displacement and generational trauma look like and work 1( day to mitigate the effect on my patients. i'm lebanese armenian. each generation of my family the generations were refugees. my personal and profession experience brought scuss the [indiscernible] genocide is a public health issue. in gaza not only do we see the murder of innocent civilians by way of bombing, we see disease and setting of 2 million displayed viduals with little to no

shelter or medication, lack of hospital and clinics, lack of supplies like ventilators and lack of food, water due to bombing and blockade. the [indiscernible] the death toll surged over to 19 thousand people. over 40 percent killed are children. saturday a tank ran over 20 and injured people. this was deliberate assault of those seeking care in northern gaza. we all the premature babies die because bombed [indiscernible] cut off electricity and killed the healthcare workers. sunday israel bombed the muturnty ward. these are well documented human rights violations and a on avalanche of human rights violation we have seen in palestine since october 7. these attacks on hospital entire generations of families, blake odd of aid in are preventable and stand in stark contrast with entire ethical

framework of public health. genocide isn't acceptable and leaders in public health and hope you the same. your silence with regard to the crisis in gaza is deafening.tatives of dph your [indiscernible] not only in san francisco but globally. there is no situation no political landscape ies genocide of the people of palestine. call for cease fire is call > next. thank you.

>> is elizabeth a therapist at primary care clinic for queer and tran youth here today because i'm vax)by the occupation and genocide of palestinians and the rapidly escalating health crisis in gaza. called for protection of healthcare workers and patients november 20, i'm alarmed by department has not done more to speak out atrocities we witness every day in gaza. i'm proud to work for a department declared antiblack raca isis and denounce violence against the api community. i can't understand why we are not decrying the massive of life, injuries and wide spread disease and hungers the violence of the israeli occupation isn't new. when i visited palestine in 2014 i went to camp in west bank established 70

years ago after [indiscernible] near entrance of the camp is a large statue made from crap of ambulances blown up in 2002 during the [indiscernible] decades ago healthcare infrastructure targeted just as it has been the last two months in gaza. the occupation has been a public health crisis for decades and it is time for this department to name as such. the occupation and genocide of palestinians is within the jurisdiction commission as it is directly impacting the people of san francisco. palestinian patients and colleagues have lost loved ones and gr their people. our muslim patience and colleagues experience heightened islamophobeia and fear of rebeen reeling from watching the genocide unfold reminded of another that impacted their home country. all of us are aware of the silence of our department. silence is not a neutral position. silence perpchtion and genocide are permissible. this harm to health of san

franciscans which is the opposite of many of my clients, all young people told the ways they take action in their community to raise awareness and stand in solidarity with the stine. how is it a 17 year old has more courage then one of the largest and most progressive public health departments in the state or v i urge the health commission to declare that occupation and genocide of palestinians is a public health crisis and huuse your privilege and your voice to support the cease fire resolution supervisor preston introduced to the board thank you for your time. >> is there anyone else in the room who would like to make comment? >> good evening san francisco health commissioners. dr. alth service

clinic based at san francisco general hospital. in response to the humanitarian circulated a letter among dph employees to issue a statement in support of cease fire. we have all most 200 sig torry. we took to various leaders and to date have not received acknowledgment request. despite national and international calls for cease fire including from the ciation and the world health organization our leaders remain silent. i like to share a jordan, she wrote the poem after 40 years ago after learning a [indiscernible] in lebanon. her words are as urgent now as moving towards home. i do not wish to speak about the bulldozer and red dirt not

covering all the arms and legs. nor do i wish to ñjspc:about the night long screams ethat reach the observation post where soldiers lounged about. nor do i wish to speak about the woman when shoved her baby in the stranger hands as lead away. nor the army that [indiscernible] so others see the backs of lined agaimznst the wall. nor do i wish to speak about the piled up bodies and stinch that will not float. i do the bulldozer and not covering all the arms and legs because i do not wish to speak about events that follow dare to perify a people those who re to exterminate a people and mop up to tighten the nuse and step up the military pressure to ring around civilian streets with tanks. those are the oneswords of our beginning because i need to speak about home i need to speak about living room where land is not bulbeaten into a [indiscernible] take place in my language.

i need to speak about living room whe my without horror. i need to speak about living room where the men of my family between the age of 6 and 65 are not marched a i need to speak about living room where i sit without grief and wailing allowed for loved . where is [indiscernible] because he will be there besides me. i need to talk about living room because i need to talk about home. i was born a black woman a palestinian. there less and less living room and where are my loved ones? it is time to make our way home. thank you. >> thank you. anyone else in the om wh would like to speak? >> good evening. thank you commissioners for the opportunity to speak. [indiscernible] workingrtinez urgent care. to ask each and every one of you commissioner and dr.

colfax to the mission to preserve momoat promote and protect the lives of all san franciscans. i read your bioes and see have histories serving marginalized communities. you clearly value health safety and wellbeinl.mmunity and beyond, so i'm asking you to take a stand against a genocide committed upon the palestinian people in gaza. the clinic i work is only a few blocks away. at one point located in this building. as a new social bring clients here for tb [indiscernible] the wait was long clients were treated kindly with dignity and respect. safe and cared for, seen no matter how ciotic the world outside may be. cut wrenching to see places of refuge bombed relentless [indiscernible] first at. patients and healthcare workers [indiscernible] murdered in

healthcare facilities. imagine that in your place of work? imagine your place of work and yourself targeted doing what you love doing? as a mental health clinician i had the honor working withe palestinian in san francisco. our health system serves the palestinian community and our health system is incredibly [indiscernible] our silence rdth colleagues and patients faced and actively surviving trauma informed care. how can we tell any patients or cogull if we cannot say we do not condone the genocide and want the violence and killing and brew utstop immediately and permanently. this especially so when the [indiscernible] funded by our money, our tax dollars. as our healthcare system [indiscernible] budget cuts and program cuts. we are at the same time watchs hospitals in gaza bombed wi we why is there no funding to solve our healthcare crisis

when there is always money for weapon snz you the health commission have the power to make a difference to say enough is enough to save lives. i'm asking power and voice to pass cease fire resolution put forth by supervisor preston without amendment. asking you declare occupation and genocide a human rights and public health crisis and call for cease fire as a first step to alleviate the >>yotime. >> thank you. >> thank you. anyone else in the room that woulmake comment? alright. there is one remote public comment person.unmute the person. >> my name is jude, a registered nurse at san francisco general hospital. i have 15 of these years at san francisco general hospital. calling to lend my voice to my collin different disciplines but connected by the work as are all you on this board.

you have so much power as icink then the board of supervisors or local officials because you are specific to health and helt care, specifically crisis and umhooen rights abuses and if we just think to the beginnmeeting i the land acknowledgment that often happens in the world these days speaking to indigenous population genocide said in our country and don't can say those words and have land acknowledgment without lending the voices to the genocide happening before us. e icimplak out. as healthcare workers we are met with ihave lns by all leaders which is have a word for it. why we are compelled to be with you today. so much if we look at the healthcare infrastructure as someone on a med surge floor turned into covid unit wherg deeply especially in the mission, i think back how days went by and didn't have enough ppe to enter the rooms idea

what risks we are taking. these workers risk their lives day in and out working 72 hour shifts. these are we are connected all of us and shared work and the work you all do as well. we need your support and helping pass the cervise r preston put forward. your voices have power and we need them to be spoken loudly right now and join with the chorus we all saying healthcare workers--300 signed the petition that are falling on deaf ears with senator padilla an[indiscernible] elected officials around the country in similar ways and i we hope you support us in speaking loudly and clearly and calling for a cease fire in gaza. thank you. >> thank you. that is the last public comment commissioners. >> thank you all for being here and really giving such eloquent voice to concern. we really appreciate that you come to us.

be the 4th quarter financial report from jen louie. / >> good evening. jen louie, chief financial officer from department public health. can i have the first slide, please? eaforward the year-end 4th quarter financial report to the commission and pleased to report that after what was a are ending the year positively with overall balance there are adjustments that i'll talk about as there is [indiscernible] part of the budget, but overall ce we net those out it is $50 million above budget revenues and $20

million of surplus not spent. year end for total of $70.1 mito make additional deposit to the reserve and final balance that would be returned to the city, next slide, please. in terms of the major highlights, the $50 million revennews we received towards between the third and 4th quarter report and about $20.1 million of of the $20.1 million, $15 million related to personnel savings. we had in 22-23 we did add significant number of new positions, all most 400 and think we had aggressive assumption in terms many we can fill and in terms of workforce retention. one thing we are seeing, we were filling them in the front door, on the back door so in terms of the projections and year end we didn't end up with one time vings.

noting, as we prepare first quarter financials for current fiscal year we are moving the on permanent vacancies. it is still a bit of challenge, but there is improvement compared to what we have seen in the prior year and something we'll continue to watch closely over the current fiscal year. as mentioned before, we are [indiscernible] assumed as part of the process and so, the first one is $21.2 million one time revenue we thought would come after in just before june 30 and so as a matter of practice we had to recognize that surplus when the venureceived it, but if we did then we would-create a hole in the current year, so therefore we are netting it out taking a momentary ride in the management reserve from 4th quarter to the first quarter where we release to really ; recognize thwhere we originally expected it to avoid short-fall weez might have. in addition there is $10.8

million of primarily to our april proposal to leverage interest income related to healthcare income and offset administration fees. the savings was expected and mechanics was uxto year end so we don't want to count that fund balance assumptions used to balance the upcoming budget for u+milar reasonof the gmu revenue so those two are netted out which is why it brings wn to do so. and then i also note our actuals following year end by the controller office, we did $33.5 million transfers to [indiscernible] inflationary cost and increased reand census at the hospital and $24.1 million to support the recertification efforts and registry efforts you have earlier this evening. next slide please. our report overall just talks about budget rsus actuals. i

want to comment on comparison of third to 4th quarter, which is bit we had significant amount of improvement primarily in the form of revenue, $68 million increase. some changes in information we received that allowed us to recognize revenue. i will refer to notes to make sure i get this right. $20.2 million zuckerberg francisco general. 4.7 related to the [indiscernible] revenues related to transition of a portithe health network patients for fee for service. $6.7 million in improvement in the quality improvement the state provided additional reporting options that enabled to meet 100 percent of the thresholds. $7.2 million as we-they favorly adjudicated a lawsuit unsatisfactory

immigration status and we are able to recognize patients we did not expect to be previously and about $9.6 million sprinkled in other areas of the deerment partment. laguna honda improved by $27.8 llion. 21-22 cost report was settled may this year. it enabled us to recognize additional one time rechb and also enabled us to create an assumption around there 22-23 peeshave, which bumped up some portion of the current year rates we had for net improvement of 27.8. and then behavioral health also achieved $14.8 million of additional prior year we were able to recognize. as i mentioned earlier, about $9 million in expenditure

savings we did anticipate. i note while these are improvements compared to third quarter, in some areas we remained negajtive and such as gpp so it is sort of less negative in some areas and some areas more positive so just clarification moving forward as we shift back to looking at budget versus actuals. next please. and so getting into it san francisco general revenues million favorable chblt net patient was about 90.5 related to primary fee for service conversion we implemented mid-year and after the budget developed, so there was above budget revenue there.we were short on both the glaibl payment program, about $30 million and made assumption million prior year settlement we were expecting to get and budget and did not achieve.

we ll be coming in and we were able to recognize that as part of our mid-year savings to meet some of instructions that we have and there is potential for that remaining $60 million to come in by the end of this current fiscal year. we received $7 million supplemental revenue as well as additional revenue related to the gme program as well as increased matching rate for the public health emergency. we also had all most rate increase for capitation we assume in the current year budget and >e340 pharmacy program short $8.3 million. overall with transfers made there is $1.9 million of primarily in areas of salary and fringe as well as miner savings in non

personnel and servicess you see the service of other de have work orders and year end they close out th as well and you see this as a theme throughout all the divisions. next slide, please. again there is-5.4 million favorable after the $27 milliowent over expenditures but salary and fringe assumptions materials and supplies and rk orders savings as we have seen for san francisco general. next in terms health, we received while we were expecting to be short we had improvement related one time dollars, so [indiscernible] had a shortfall and eawethere was improvement in the medi-cal program we had. miner short fall in behavioral health quality improvement. we didn't meet all mile stones

and $16 million of realignment and 6.6 in prior savings and agsalaries and benefits savings due to salary savings due to vacant positions as weas $1.4 million of contractual services as well as materials and supplies. next slide, please. primary care, we are showing $4.6 million short fall in patient revenue made up of a few things but 1.2 ofis really more recognition of cal aim revenues we are recognizing under the health network under the care program. it was originally budgeted here because we were not sure how the revenues would hit to allocate the revenues where they were accrued so it shows as negative but there will be a positive down the road to offset it. in addition, 1.9 as we completed an audit. some know, the hc, the healthcare system we are on prospective payment and

so we get interim payments we recognize based nuon a perspective expectation of what they think they may receive, compare that with a audit year end. we win some, we lose some, in this case we lost some, somewhat routine. and then small uptick capitation revenue similar to the [indiscernible] and again we are seeing in department. next slide, please. jail he surplus overall. fringe and personnel. supplies. next slide. within the health network overall the revenues ended up being pretty much on budget but there is a lot going on so there is minusment we improved of patient revenues, we were short on billing activities related

to avativities. had a shortfall in healthy san francisco [indiscernible] capitation for health home and shortfalls on [indiscernible] this is where we recognized interesainitiative from prior year, so it shows as balance and we net that out of the total, but it is recognized jthis here. next slide, please. and then with pop ulation health, revenues million unfavorable. we have seen a consistent shift with lower billing and (hadult and travel [indiscernible] in addition with environmental health and lab fees with shift to epic understand we reenroll billing.has been submitted, but we are waiting and it will 6 months for that to be approved but we are hopeful

that will go through. overall the pandemic probably had a really big impact on overall of service and are adult travel and immunization clinic as travel patterns change and businesses change if focus more on staying home and remote work as well. in terms expenditure savings, $3.2 million in salary fringe benefits. we did make a significant investment in the population health infrastructurdid receive significant portion of the new positions for fiscal year 22-23 so not achieve additional savings, but again we are seeing movement in terms of closing the gap in the vacancies and miner contracts and as well as interdepartmental services. next slide, please. in terms of public health variances on the revenue, but close to budget. savings in terms of salary and fringe and miner ntracts and then

we did have a it project close out which was assumed as part the budget savings with the budget frauss process the prior year. finished out the covid response budget, the controller's office did make adjustments. this is a city multiyear city wide project that was stood up initially in 2020 in response covid project. after all the balancing with the controller office we recognize $6.9 millio in prior years, 4.4 of that recognizes technical inventory for ppa purchased prior years and recognize and utilize and in a [indiscernible] in the current year million of additional savings to get to 6.9. sabeings in contracts and testing $11 million closed out and i could be not

more pleased to say that hopefully this will be the last on as the controller's office will be closing this out for us and all city departments and balancing and then as you know dget for any continuing cost we believe necessary for infrastructure we allocated to our operating budgets and so, not be reporting on this in subsequent fiscal years. and then for the--next slide, please. i'll note to report in the next slide after that--advance one more slide, please. i at we did not provide the updated slide. this is from the third quarter, that instead of withdraw we expected in shortfall in the third quarter we will make a 'tsiour budgeted revenues in the upcoming fiscal

year to fully fund our management reserve at $130 in addition, we will put that $21.2 million of revenue budgeted in the current year to recognize ending balance of $50 million, but note in q1 that balance will disappear and we just recognize for those revenues. that completes my report but happy to answer any questions from yxcommmay have. >> thank you for that extensive work. any public comment on this item? >> person on the line, if you like to comment we press star 3 to do so. i don't see a hand. >> then any commissiqu the presentation? commissioner guillermo. >> just a lot to take in i guess in terms of some of the movement in each of . glad to know at least for this

year that we are able to and in fact have a contribution to the reserve, so i don't anticipate that's going to probably be in the years to come. i guess my concern is i guess looking forwa be very difficult, so-but i want to complement you on-jenny managing what is such a difficult budget and in and out that occur that in many ways are not under our control because we get funding from so many different sources and have distribute that out in just some ways very convoluted ways to use the budget, so nt to again thank you for all of the work and know you will need a lot of support and you ask your staff will need a lo support coming forward in the months to come as we look at the coming budget and the

impl >> commissioner christian. commissioner chow, any questions or comments? ess i just had one and not sure because this is after all q4. do you have a sense-it looks many categories revenues improve. we heard from laguna as well. can you make projections how that helps with and the budget cuts and the other question is, can you refresh how and what trigger use of the sure. i'm pleased to see that we ended the year positively. some of the positive revenue we were expecting anhave already budgeted in the current year. we implemented the fee for service conversion and expect to be about $55 million growth inthe upcoming budget so some has been captured and there is additional rate kkprovements we know we have more data points me and finance team will be taking some of that information

over and then trying to put that in n to make projections for the upcoming year and again, we have the management reserve.really to buffer against the fluctuations and assumptions we see and as you recall, what we have led to make more aggressive assumptions just recognizing that similar to the case of the fqhc audit we win some and lose some. it is matter of course and this is public health fmes there is a policy--yes. 10 years is--i'm still-that $38 million of prior yearsure we indicated from california association of public hospital that would be finally judeicated for years. 10, 11, 11, 12 and 13, 14. skipped a year, whice would be closed just before the end of the

fiscal year, fiscal year and possible they may close them out, but it is real ly hard to predict ffered revenue so the idea behind the management reserve is project negative revenue because e uncertainty associated with all the different programs. it isn't just medi-cal. [indiscernible] different milestones, formulas, percentages, state wide county balancing that happens with at creates a lot of uncertainty for us. who wh we have negative revenues as we have enin previous quarters where we project a short fall as a result of the lower census at laguna honda, instead of having to get the budget balanced we make the assumption short fall would be covered by the management to take the corrective action opposed when you look at the q1 book and say we have to drop

everything and have big fire drill to try to get things back into balance. it gives us a lot of buffer and gave us and what payments also might come in and then any updates we have anservice. even though it is reserve related to revenues, we can't use it. it isn't expenditur authority can't use for short fall on the expenditure side but it can help us buffer the ebbs and flows of healthcare in you. i know there is cal aim and so forth, are there any indication about medi-cal fee think medicare is cutting clinicians by 3 percent in 2024. is there anything good or bad about msement to hospitals or to the clinics that would impact our revenues? >> i think there is nothing i can quite forecast right the state has given the health plans their rates and we are working closely with the san

francisco health plan. wait to finalize and see what they end up with. i don't expect it to be negative or adverse in any way and so usually there is adjustments primarily related more towards cpi and inflationary issues opposed to a big bump up and i know there is of advocacy around just considering public hospital safety net hospitals the role we served and importance and looking overall rates and again, as you saw with the financial's, the rates come different times of the year depending on the program. cayear so we get information throughout the year on this and as soon as we get that we'll take that and try to use that oject out our budget for the next year. >> thank you. i see a commissioner chow hand. >> yes. this is more a follow-up about in terms of medi-cal reimbursement. i wonder on a primary care--for the primary care cls and all, because we have a large number of medi-cal it issan

francisco health plan, hopefully san franci plan will also be getting the increase of rates that the practitioners are medi-cal this year. i dont know how that translaets into amounts that are then capitated for the health plans,oing to be continuing to look at that, but definitely presumably the has increase medi-cal fee for service reimbuow how specifically that will translate, but there is more to come as we prepare first quarter financials for the alright. obviously as commissioner guillermo said, this is complicated work and we are grateful for you to be willing toof this complexity and the challenges of the year to come, so thank you so much. >> thank you president >> next item is director's report. director colfax.

>> good evening president green and commsioner we have a robust director's report here for you to review. i'll just go over highlights with regard to the budget upda, you see our mid-year budget reductions accepted by the mayor and lúemphasize going forward, on december 13, the mayor issued her instructions to departments for two fiscal years. the fiscal landscape is challenging. th property taxes. as a result, department requested to l to meet 10 percent reduction each year of the proposed budget and 5 percent contingency target if the situation worsens. for gph that translate to reduction target of 98.3 million and contingency target

is $46.9 million. the instructions also ask the departadd new positions, so our team is working hard on this. we are with our cbo stakeholders including one tomorrow and we will return to the commission in january with greater details on full budget proposal. next item is dph awards sist reducing overdose death dispirties. awarded 2.2 million dlr network of commitment to reducing racial disparities in overdose deaths to revention nt this funding which year over 5 years will help expand capacity of e homeless children network, community based organization to prevent harmful outcomes with rough innovative tailored approaches. next item is san francisco

begins wastewate fentanyl [indiscernible] and high risk substance s. the health department with assistance of the san francisco public begun wastewater testing for substances, including fentanyl to track trends and inform response activities. san francisco is one of unities across the united states participate in the first national institute on drug abuse to gauge and measure the ciated with adverse health consequence including overdose through wastewater testing. earlier this month requested the public utility commission sent wastewater samples two treatment plants to a contract from nida, wastewater surveillance program testing the water. dph is exkjreceive initial results january and every 2 weeks going forward. san francisco participation is no cost to the city. current contract program the program is scheduled to end late august 2024.item, happy to report to the commission that primary

care team hosted awards this week. all 500 members were invid. including eligibility worker, medical assistance, [indiscernible] nurses and providers [indiscernible] tadeal of great team to provide primary care across our system and just to note é erof the covid-19 pandemic, the primary care team logged more then 250 thousand visits this year up 23 percent since 2020. next item is zuckerbering san health emergency response team received equity award. the team received the equity quality leader award from the california hospital and health system. response team is behavioral health rapid response initiative that began in 2018

and pivotal addressing force on patients at zuckerberg san francisco [indiscernible] implementation of a trauma informed approach to care insuring safety for staff and patients in the workplace de-escalating difficult situations before they become violent. also at zuckerbering san ciit was-the hospital recognized for reducing disparities in cardio vascular disease. was recognized in american team expanded implemented a heart failure care pathway integrated into epic and tailored to needs by targeting social determinant of health. this lead to more then 10 percent drop in 30 day readmission rates.n in mortality rate and decrease in racial disparity and readmissions. is happy to report

that the environmental health branches reach out tobacco program appld the department of justice for tobacco enforcement grant and awarded nearly $2.9 million for enforcing tobacco laws and regulations, and just to note that these lines environmental health retail tobacco program surveyed hundreds of onlie ils120 online businesses did not block the sale of flavored tobacco in san francisco. the environmental health branch formation to the city attorney office and based on their work on december 5 the city attorney announced a lawsuits pagainst retailers for unlawfully selling flavored tobacco products and electronic cigarettes to consumers in our health department health officer susan phillip stated "flavored tobacco products from [indiscernible] and yoin

communities of color. i want to thank ehp for their hard work in this very important covid-19 update, as of 12-14, san day rolling average of test positive is 4.9 percent. of hospitalized patients across the city. 24 percent of san francisco residents are fully up to date onr covid vaccinations and you have the item there of dph in the news which you can click on and happy to answer any of the commissioners with regard to other areas in this report or more details in the items that i reviewed. thank you. you for highlighting the well deserved awards for so many teams within the department. this was a particularly impressive one, diverse departments and individuals getting recognition, which is always wonderful. is there any public comment? >> no public comment.line. >> what about commissioner questions or comments? commissioner christian. >> thank you for the report. good to see you.

about the homeless children network and this grant to reduce overdose death disparities? what age range of person is generally served or targeted by this work? >> i'll loop back with behavioral health team and get you the information. if you have more specific questions, i'm happy to get them and get back to the team. >> >> commissioner chow. >> yes. dr. colfax, wond ú< wastewater analysis, how would the department actually use this? is it just to-i understand when we were doing wastewater on would be watching pandemic, but these are substances which are used in it is [indiscernible] how would we take a fentanyl level and to know from it, since there are no

specific, no neighborhoods >> i appreciate the question. as part of this pilot project, those are some things we are going to be testing and learning and as part of our alth update or sooner happy to get the information from the behavioral team. it is a area of trying to link learned from covid and wastewater testing to see if we can be more specific and targeted in our response to the ÷ and i think that's part of-your specific question is one thing the pilot is going to seek to answer to see thbe an effective tool, but to get you more specifics i can get behavioral team to report back and they can provide an up on this project in the next update to the commission. >> that would be fine. thank you very much. other comments or questions, thank you. the next item commissioner christian will give us a community public healk you.this afternoon

commissioner gerardo and i were able to get a update on two matters. first, we reviewed the draft dph annual report for year 22-23. as you know, the report summarize and highlight dph data and services. we were generally very with the report and the only thing i think primarily we were encouraging them to do highlight more of the successes of--and g#increase in service providing and through the communities, particularly given what we have been and focusing on in the last year around healthcare provision and also substance people with treatment and the stark difference between the tments in this past fiscal year versus

previously. i think itis very important for the department to highlight that information so people can see and the media can see in the annual report the good work and change also the really excellent work and increase in service providing and our public health sites and so, basically just moplhas been and the data and the numbers and so we can focus on those accomplishments and them. so, the final report is scheduled to come to full commission in february. second item was update child and adolescent section. it was an amazing report given by arlean armstrong, the director of

section. incredibly impressed with the spectrum of work they are doing and the partnerships in the community. both commissioner gerardo and i were interested in additional data to follow-up with the narrative contained in the slides. some of the request included information on parent goes into substance use habilitation service, what cascade of happen when a person gives birth and perhaps the child is found to be testing positive enthe legal system and other systems come in, but it ]] was very impressive support that comes into play for the person and the child when something like that does a occur. definitely director armstrong is doing work and

her presentation was very good and we asked for her to come back soon with a little more you to go through the presentation if you have a few minutes things like using a non invasive bio marker on children to what level of nutrients are in the system to measure and see if they are getting enough of the food theyvegetables. that is incredible and great. just the breath the of the impact is really impressive and we are looking to be able to support that inways we can going forward. i think that's what i got. >> thank you. >> no public comment. >> any comments or questions from commissioners? thank you so much ly look at that

hand-out. that sounds fantastic. the next item i believe will be the joint conference committee report from zuckerbering $kuzuckerberg san francisco general. commissioner chow will present. >> green. at the december 12 meeting, the committee reviewed and recommended that the full commiss environment of care report, which is as you know on today's consent calendar. which report provides important informationabmany logistics and operational systems that enable to be such functioning institution. the work that they ing. many of which were aspirational

goals, but well earlier reports looked at were regulatory [indiscernible] and the december ceo report. human resources report. in the report of the ceo [indiscernible] our chief medical officer at the hospital was leaving to go to ucsf health, gnificantly important position. he had been our ceo at the hospital since 2018 and lead staff and the hospital through the epic update and the response to the pandemic along with continuing to work and we found him very responsive to dr. [indiscernible] announced that the

[interference in mxe background] was going to a very high level position at sutter health. once again, itour work here then continues to allow others to benefit from all the-i suppose learning and the experience that they are getting fraul from us so that is wonderful dph continues to inform so many other organizations. we also were informedthat the-and accepted dr. [indiscernible] been the administration and staff and ucsf as chief of pediatrics and jcc accepted that recommendation. furthermore, under the medical report, we then reviewed all e policies and procedures that you see listed at the other portion of the consent

calendar and the commission approve all of these. in [indiscernible] that ends my report. >> thank you for the report. is there any public >> no one in the room or online. >> questions or comments from commissioners? ndar and is there any public comment on-- >> no public comment. first to approve the items on consent calendar. >>second. >> i will do roll call. chow, yes. commissioners in the room, how do you yes. the consent calendar is approved. thank you. >> the next item is other business. any other business? ]&>> no public comment on this item. >> okay. then the next item is motion to move into closed session.

>> first we'll take public comment one is closed session and one is to attorney client privilege so start with closed session into closed session? >> so moved. >> second. >> commissioner chow, yes. u yes. thank you. how about motion for to assert eye for this discussion? >> so moved. >> second. >> roll call. chow, yes. commisíyou vote? yes. folks who are watching please give us 30 seconds. you will not-give us ab minutes. you will not hear or see while we are in closed session and folks in the room, please give me 30 seconds to take to closed session. sfgovtv i'll >> is there a motion to or not disclose? >> i move we not disclose closed session.

>> second. >> commissioners in the room. yes. thank you so much. now is time to consider motion >> so moved. se >> commissioner chow, yes. commissioners in the room, yes. thank you all so much. happy hodays. >> happy new year. [meeting adjourned] >> i went through a lot of

struggles in my life and ies this. i am familiar with what people are going through to relate and and compassion to their struggle so they can see i came out of the struggle it gives them hope to come up and do something positive. ♪ ♪ am a community ambassador. we work a lot with homeless of people

in the area. >> what i like doing is posting at hotspots to let people see visibility. they ask you questions, ask you directions they might have a services are available. checking in you guys. >> wellness check. we walk by to see anydual, you know may be sitting on the sidewalk, we make sure they are okay, alive you never know. somebody might walk by and they are laying there for hours. you never know if they are alive. we let them know we a area and we are here to promote safety and if they have somebody that is, you knowi around that they don't want to call the police on, they don't have to call the police. they can call. we can direct them to the

services they might need. >> we do the three one one to keep the citys clean. there are people dumping waste on the ground and needles on the ground. it isns for children and adults to commute through the streets. when we see them we take a picture dispatch to 311. theys tracking number and they come later on to pick it up. we take pride. when we come back later in the day and we see loose trash or debris is picked up it makes you feel good about what you are doing. >> it makes you feel aboutrting kids a them feel safe walking to the play area and back. the stuff we do as ambassadors makes us feel proud to help keep the city clean helping táhe residents. >> you can see the community ambassadors. i used to be on the streets. i didn't think i could become a

community ambassador. it was too far out there for me to doing this job makes me feel good. because i came from where a lot of them arend on the street, i feel like i can give them hope because i was once there. i am not afraid to tell them i i used to be le this, you know. i have compassion for people that are on the streets like the are caught up with their addiction because now, i feel like i can give them hope. reminds you every day of where i used to be and where i am at now. >> hello and welcome. >> recording in progress. ]hello examine welcome to the

tuesday december 19, 2023 entertainment meeting of the commission.m president, we will start with announcements. >> we would like to start the meeting with the land acknowledgment. we francisco entertainment commission recognizes that we're on the homeland ofam as