>> nice to see you here and we welcome to june 18, 2024 meeting of the san francisco health commission. secretary morewitz, will you please call the roll? >> commissioner green, present. commissioner guillermo- [roll call] >> thank you. now read the land acknowledgment. >> thank you commissioner green. the san francisco health commission, we acknowledge that we are on the unceded ancestral homeland of the ramaytush ohlone who are the original inhabitants of the san francisco peninsula. as the 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 that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors and relatives of the ramaytush community and by affirming their sovereign rights as first peoples.

>> thank you. the next item on the agenda is proval approval of minutes from june 4, 2024. you have before you the minutes. are there additions or corrections? seeing none, a motion to approve the minutes? >> so move. >> second. >> we'll ask for public comment. >> is there pub lic comment in the room on the minutes? let me quickly check. do we have a hand? yes, we have one person. before i unmute you, i have a script.

in accordance with mayor request the-wrong thing. at this time, members may address the commission on items of interest to the public within subject matter jurisdiction of the commission, but not on the-i apologize. i have the wrong script. members have a tonight to comment up to three minutes. the public comment is designed to provide input and feedback, however does not allow questions to be answered in the meeting or members of the public to engage in back and forth withnitioners. commissioners. the commissioners consider comments from the public. please note each individual is allowed one opportunity to speak per item. individuals may not return more then once to read statements from other individuals unable to attend. written public comment may be sent to health.commission.dph@sfdph.org. if you wish to spell your name for the

minutes you may do so without taking your allotted time. prohibit discriminatory or harassing conduct. city employees and others during public meetings and not tolerated. everyone has three minutes. mr. munet shaw, are you there? >> i am. >> your three minutes begins now. >> this is patrick shaw. [difficulty hearing audio recording] members of the public review the sustainability plans involved. [indiscernible] now

[indiscernible] appears sustainability plan that makes no mention of [indiscernible] 457 to today's agenda. [indiscernible] permanently removed from the sustainability plan going forward because it [indiscernible] local 1021? why was the sustainability plan added today with less then 72 hour notice to the update report in item 5? >> thank you. >> thank you. >> that's all the public comment on this item. >> alright. we have the motion and seconded. all in favor? aye. thank you. the next item on the agenda is

director's report and hear from director colfax. >> before that we have public comment. >> my apologies. i know there are people here for general public comment. i skipped that. let me pull up the presentation. you are good to go. i'll start the clock with three minutes. >> thanks again health commission allowing me to speak. i'm handing out a power point presentation requested about 45 percent complete. before i complete it and present it, the first week of july, i respectfully ask director colfax to present this in a closed door meeting because of the complexity and confidential nature of what we will be talking about. it is very serious. our healthcare is automated and kept confidential in a lot of people and shouldn't be me presenting to the health commission, it should come from a director. i just read the statement at the board. good afternoon board of supervisors, my

name is christopher cline, prior to the meeting i sent each of you a presentation i urge each to read and act on to bring peace. ai isn't new, it has been around over a hundred years. 1963 [indiscernible] 1963, really. may 21, 2024, they replicate. [indiscernible] during supply demand basic instructions we were told widgets were imaginary company to assist with supply and demand. [indiscernible] we cover up ai. ai isn't new and neither is greed. gadgets, widgets are [indiscernible] ibm, at&t, ge are still around and now we have app stores on android and apple and so on and so on. [difficulty hearing speaker] this presentation will present at the health commission first week of july and available to the police

commission and board of supervisors immediately after the presentation. action items for each of you who has authorized access to the system [indiscernible] there is a grand father clause that expires soon. if you are using ai incorrectly or given access to unauthorized individuals cease immediately and we revoke credentials. when i was a kid our ai was at&t t [indiscernible] call for the weather, the time or give your friends phone number if you know the street they or parents live on. nevermind we have a 250 thousand page phone book delivered to each house. [indiscernible] political surveillance, public health and safety surveillance was never intended to be 24/7, 365. it needs to be brief, not long lasting and not impede financial, educational or [indiscernible] this is rule of law under state and federal law under the

constitution. thank you. >> alright. thank you. there is one person remote. received remote accommodation. mr. shaw, you got three minutes. >> i will submit written testimony. thank you. >> okay, great. that's it the end of public comment. >> thank you. again, apology. now we'll go to director's report from director colfax. >> good afternoon commissioners. here with commission report. i will go over some items in detail and some more quickly and happy to answer any questions. first item very delighted the san francisco health commission welcomes karen salgado. june 13, mayor london breed swore in commissioner salgado to

[indiscernible] immigrated to the united states from peru in 1979 and double majored in sociology and criminal justice from san francisco state university in 2000 making the first in her family to earn a college degree. before opening her business, commissioner salgado worked for several san francisco based companies, including wells fargo, the gap and u.s. customs. in 2002 opened her own business on the ucsf campus. commissioner salgado served on a number of advisory committees and boards of directors and she is also established scholarships of san francisco state university in the business literature department to honor [indiscernible] help support students economically and commissioner salgado will be joining the health commission in july. item 2 is funding for critical healthcare infrastructure improvements. mayor london breed and the board of supervisors and the president of the

board of supervisors, president aaron peskin announced they have work to fully fund the needed capital repairs for zuckerberg san francisco hospital and laguna honda hospital to better serve over 10 thousand individuals that receive primary emergency long-term and mental healthcare within san francisco healthcare system. legislative process, the mayor will reprioritize $10 million within the health safety vibrant bond proposal to allocate $66 million towards critical infrastructure repairs of the two hospitals, as well as additional $385.56 million investment in mayor breed's proposed budget submitted on may 31. with these changes, president peskin joined as cosponsor joining ronan, mandelman, stefani, dorsey and engardio. the bond will fund over $104.5

million to insure safety and continuity of services and mitigate infrastructure to maintain licensing certification and regular tore compliance as well as provide safe sufficient and top level care for thousands of individuals. differing repairs escalate cost and lead to failure in the public health infrastructure. in april, mayor breed proposed the helths safety vibrant bond measure that invest $205 million for public health infrastructure renovating and expanding chinatown health clinic, also invest in san francisco city clinic which surged the lgbtq community over a hundred years and providing sexual health services. these are critical

infrastructure and pleased to have the support of the mayor and board of supervisors. item 3 is [indiscernible] recognized dr. susan irlic was recognized during pride month and june 11 the board recognized dr. urlick for leadership , ability to transform [indiscernible] increase helt care to most vulnerable. sponsorered by supervisor mandelman who shared, influences [indiscernible] i'm sure we share that sentiment and pleased she was recognized. sticking with [indiscernible] emergency department accreditation. it achieved the bronze standard level 3 accreditation for gerry atric

care. we are focused on highest standard of care for community older adults. also received the california maternl quality care collaborative. it received the super star award and the quality sustainability award. these two awards are recognized and-these two awards were recognized for hospitals between a thousand and 2500 births and high level of engagement with maternal data center that generate rule time data and performs metric on maternty care. one of 116 hospitals recognized in 2023.

the hospitals continue high performance is due to exceptional skills talent and dedication of labor and delivery team members so congratulations to them. and then i did want to add another item that wasn't in a written part of the report. some of the commissioners may be aware that there is a severe infection that is reported in europe that appears to be sexually transmitted. men who have sex with men. this is similar to ring worm. it a infection known as [indiscernible] genotype 7. we will call it tm7, short. but, we are closely monitoring development a rare form of ring

worm transmitted through skin to skin contact including during sex. there is no reports of tm7 in san francisco, but the ring worm isn't a reportable disease, so it could be circulating and we may not know. we haven't had clinical reports of it. the good news is tm7 infection could be treated using common oral antifungal medications and we are continuing to update the community about tm7, so there have been reports from europe around this and also a case reported in new york city, and several cases in southeast asia. the good news it is a treatable disease with routinely used oral antifungals. happy to answer questions on the report. thank you. >> thank you.

before public comment, i like to say on behalf of all of us, we are so grateful to the mayor for appointing such an exceptional new commissioner to join us and very much looking forward to welcoming here and of course to the board of supervisors for recognizing the amazing susan irlic. she is just a remarkable individual and also for the board as well as the mayor for really acknowledging and supporting the needs of our department in so many ways to better serve the health of san franciscans, so thank you. this is very positive report and very delighted. now we'll ask for public comment. >> is there public comment in the room on this item? seeing none, and there is one person--mr. shaw, you got three minutes. >> thank you mr. morewitz. >> director colfax report hopefully [indiscernible] announced the november 2024 healthy safe vibrant san francisco ballot. fully fund needed capital repairs for

sfgh and [indiscernible] engaging in back flips without [indiscernible] in other words, he's lying. the bond increases funds for sfgh [indiscernible] by $10 million from $56 million to $66 million in this bond will not fully fund facilities capital projects. on may 6, 2024, the capital planning committee itemized fy25 and 26 [indiscernible] $134.7 million for sfgh and $6.85 million for [indiscernible] totaling $203.2 million. the bond $66 millions represents 32.5 percent of full funding. les then 1/3. of additional $38 million for the two hospitals in breed's proposed budget, 9.2 is generic facility maintenance for sfdph facilities not capital repairs.

colfax should have avoided use of the effort. when he claimed repairs have been fully funded. i for one will be voting against the november bond measure because all we have seen in pre-publication marketing materials is bond funds for sfgh and [indiscernible] roof top hvac unit. [difficulty hearing audio] there is no list of the projects will be funded and perhaps none of the projects will receive bond funds. as it is, on may 6, the capital planning committee approved $800 thousand for 2025 [indiscernible] sewage emergency containment project to deal with wastewater holding tanks. how much of $66 million combined in the

bond will go towards funding the $4.8 million needed for lhh wastewater holding system? obviously we are not being told. probably for good reason [indiscernible] we had quite enough colfax semantic back-flips. i'm done with colfax [indiscernible] salad die idt. . do they believe numbers of the public don't know how to read and do basic [indiscernible] we have no idea how much sfdh will come back to the capital planning committee to ask for more funds to additional capital project in the fy27-28. thank you. >> that's the only public comment. >> any commissioner questions or comments on the director's report? >> just a comment. i look forward to director

colfax and both you and jenny louie presenting at the san francisco general hospital foundation and explaining further to the members the wonderful benefits of the bond issue to many parts of dph. >> thank you commissioner. we are delighted that the bond isn't on the ballot yet, so we can discuss it here. the fact that the infrastructure is so important for both of our hospitals, our key clinics, so really looking forward to making sure our infrastructure gets to where it needs to be given climate change and earthquake risk to continue to serve the public and keep our employees safe. thank you. >> i had one question. you an icdotally in the

practice have seen up tick in covid in the last week or so and wondered for the public, some people might want to start masking again or consider remaining indoors and i wonder the best way for the public to see the wastewater data? i know there was a chronicle article you couldn't open if you were not a scriber and it gets complicated when you search online and search so i wonder if there is a simple way to make decisions about habits to look to see where we stand? >> thank you. commissioner, we are obviously want to send a message out people should make sure they are up to date on vaccinations and there are so many iterations around when to get your next shot we ask people to review to make sure they are up to date because it can get confusing and if they have a question to ask their healthcare provider. in terms of uptick in covid

cases, we are seeing uptick. you will see in the report 33 cases across the hospital system, so thankfully we are not seeing a severity of covid that would indicate our hospitals are at risk of being overly filled with covid cases, so in a different dynamic here. i believe dr. [indiscernible] couldn't join us today so i don't know if there is somebody, daisy who is deputy director of ph.d or somebody else who has information around the wastewater site. i don't have that memorized but we can provide that information to you and make sure we put it in our next report back to the commission. >> that would be great. thanks so much. alright. our next item is laguna honda hospital, rehab center medicare recertification update and we welcome roland pickens, the director of the health network and executive sponsor at lhh. >> good afternoon commissioners

and thank you for that welcome. it is my pleasure to present to you today the update on laguna honda hospital. before i present the update, i like to try to clarify some misinformation that continues to permeate and that is the inaccurate assertion that laguna honda presented a sustainability plan at the cms conference a few months ago. that is not true. nothing at the conference was presented that hadn't first come to you, laguna honda jcc or this commission. perhaps mistaking the fact the presentation referenced there would be a forthcoming sustainability plan presented to the health commission so that may be the source of misunderstanding but i wanted to clarify that and assure we would not do anything on a nationally stage

that didn't come first to this group. next slide. >> as we stated the last few meetings, lu guna honda remains focused on medicare recertification, long-term sustainability of corrective actions. surveyor s were on site in december for the final medicare recertification survey in order to validate completion of correction they were on site again in april of 2024 for that survey. as we reported before, there were zero

[indiscernible] returned to laguna honda for one day survey to validate completion of plans of correction related to two facility reported incidents. we are pleased to share the surveyors exited with zero findings on the validation surveys. therefore, laguna honda awaits final determination from the centers for medicare and medicaid service on recertification status. which we believe is imminute. accordingly, we are looking to the future in terms of admissions and operational sustainability. laguna honda and staff are working hard to prepare for new admissions. leaders will meet with staff over the next few weeks to share initial plan s and hear their feedback related

to new admissions and then be coming to the health commission to share that information with you. next slide. this slide shows our statistics for the month of may. there were no admissions because we remain [indiscernible] until fully recertification. it shows the number of discharges, expirations and showed average daily census in may of 2024 of 416 residents at laguna. next slide. next slide. i also like to give you my usual update on the status of laguna honda residents who no longer have needs for

skilled nursing level of care. this is a group we actively work on on a constant basis to try to identify community based sites for these residents to receive the level of care they require. as you might imagine, discharge for these residents, while they still have care needs, do not have the higher level of skill care need, but are not independent enough to return to a independent place in the community. since we began initiating these facility discharges in april of 2023, laguna honda discharged total of 30 individuals who no longer have skilled needs. currently, the residents we have, there are 34 residents at laguna honda still in this category and in need of a community placement. we continue to work with other city agencies, community based

organizations and have expanded to include state department of healthcare and california department of healthcare subs to leave no stone unturned to find appropriate placement for these individuals. next slide. as we give a nod to moving towards recertification and back to regular operations, just wanted to share highlights in term s of the resident experience. the resident council, revamped resident council meets on monthly basis. prior to recertification the average attendance was 7 to 8 and now at 20 to 25 residents who attend on regular basis and also expanded that to include those residents who do not wish to come downstairs to the main meeting, they can join via video from their

individual resident. therapeutic outings ceased during covid and now returned. the activity therapy department has filled all most all the vacant positions and actively taking residents out to the community for the activities you see posted. in addition, we launched a new activity in the arts studio where residents come down and play board games and cards while listening to music in that space. and finally, a more robust calendar of activities for residents has been assembled and disseminateed and of course, it highlights the all time favorite, bingo, the event of the week and the month at lagunaa. just want to share some of those exciting developments with you. next slide. so, this point in today's

update, it is my pleasure to share with you our plan to insure that the significant progress and improvements made at laguna honda over the past 26 months are sustained and embedded in the institutional culture. we must never repeat our recent history of regulatory non compliance and the threat of closure. the laguna honda sustainability and ongoing improvement framework we are about to review, represents our best learning to date, which is tangible, specific, quantifyable, and transparent processes to insure a successful transition from the incident command structure to routine skilled nursing operation. next slide. since decertification in april

2022, staff across the organization have worked tirelessly to make fundamental and structural improvement for operation and delivery of care at laguna. with the support of staff, residents, and families, local leaders, regulatory partners, unions and you, the health commission, we undertook a series of initiatives to enhance resident care, resident safety, regulatory compliance. no stone was left unturned. [indiscernible] extensive and there is much to celebrate, including clear improvements in the quality of care as well as achieving medicaid recertification in august last year. and, now finally being on the brink of being fully recertified in the medicare program. here are highlights that experience.

as reported there were zero deficiencies in the recertification plan of correction validation visit in april 2024. between the first cms monitoring survey, all most two years ago and the final recertification survey, we saw significant reduction of tags of 39cms regulatory tags, which marks 59 percent decrease in overall deficient findings. most notably, cms identified no instances of substandard care and that is so critical because that is the issue which lead to the decertification instances of substandard care, of which there are zero at laguna at this time. to achieve recertification, we address systemic factors through completion of over 1,000 action plan milestones. in the milestones targeted

issues identified in multiple root cause analysis reports over the past 26 months. we achieve 100 percent compliance and completion on all over 1,000 milestones. throughout the process, we prioritize staff education through several major education fairs. and we continuously worked improving care quality, because we know that is how we insure residents receive the highest standard of care and support and comfort they need. next slide. so, laguna honda goal is to become a world class skilled nursing facility. to get there, we are setting a high bar for operational excellence as reflected in the domain shown on this slide. first, we want to insure the

long-term stability of our improvements. it is imperative we maintain the improvements made post recertification to prevent a reoccurrence of previous challenges over the last few years. we established a set of ambishing high level goals to guide our efforts. next, we will have continued emphasis on organizational culture transformation. by nurturing a culture of continuous improve. ment and adherence to best practice, we can meet and exceed regulatory standards consistently. this culture change is also rooted in keeping residents, families and the community voice at the heart of everything we do. this includes increased leadership presence on the units as well as regular engagement with

resident council. and, we will continue to prioritize high quality resident care. our primary focus remains delivering exceptional care which translates to positive health outcomes across various metrics. by prioritizing high quality care, we aim to achieve excellent quality measures, maintain optimal staffing levels, and consistently secure favorable survey outcomes. and finally, we will become a world class skilled nursing facility by creating and sustaining a vision of excellence. these goals will position laguna honda as the exlemper skilled nursing facility:through unwavering dedication to our objectives and commitment to excellence in all asspects of resident care, we aspire to set

benchmark for quality and service in our industry. next slide. to build upon the progress achieved through the efforts, laguna honda and dph collaborated on 8 point plan. we will go into more detail on each of 8 strategies throughout this presentation and here are the key components. strategy number 1, transition to routine skilled nursing facility operations. we will transition the routine skilled nursing facility operations to establish stability in daily practice and procedures. that process started slowsly during the month of december and continued to accelerate over the past several months. this transition will include the standing [indiscernible] incident command structure, which i lead

along with troy, williams and [indiscernible] and we will transition daily operations from incident command fully over to laguna honda current leadership, which includes leaders with extensive skilled nursing facility experience. strategy number 2, sustainability of of operational improvement. sustaining improvements made since 2022 would insure that enhancements are not only achieved but also maintained over time. strategy 3, proactive quality assurance and performance improvement programs. it is at the heart of the cms skilled nursing facility program. we'll continue to prioritize a proactive program fostering culture of ongoing quality improvement. we shared with you in the past one of

the major initiatives was to start neighborhood or nursing unit based quality programs. both continued and continue in the future as part of this expansion. strategy 4, solidifying network collaboration and oversight. collaboration with the san francisco health network is vital and the plan solidifys this partnership. routine laguna honda key performance indicators or kpi will be provided by the san francisco health network leadership, my team. we will provide that to dph leadership, laguna honda joint conference committee and here to the full health commission to insure there is ongoing transparency and accountability. next slide.

next slide. strategy 5, cms regulatory expert quarterly evaluations. we will initiate quarterly cms regulatory expert evaluations very similar to the work we have done the last 26 months with the quality improvement expert, in order to insure that we can sustain the regulatory advances we made the last 26 months. that will mean that at least on a quarterly basis, teams of cms certified quality improvement experts will come to laguna and do very much on-site evaluations, interviews of staff, residents, records review,b and looking at overall regulatory

compliance and report that back to the jcc and health commission. these evaluations will provide valuable insight and guidance, helping take a breath of requirements and best practices, and early identification of any significant regulatory operational gaps. strategy number 6, comprehensive staff support and development strategy. our commitment to staff support and development remains unwavering and was key to our ability to be on the brink of cms medicare recertification. we will continue with all staff trainings, using adult learning techniques as well as coaching at the bedside initiative that was so vital in our path towards recertification. strategy number 7, nurturing relationship with key external

stakeholders. over the last 2 years we learned and recognized the importance of maintaining strong relationships with key external stakeholders. we will continue engagement with organizations such as the california association of health facilities, which is the premier trade association for all skilled nursing and long-term care facilities in california. with the california association of long-term care medicine, and with leading age california to align with best standard and practice at laguna. finally, strategy number 8, we will continue our bidirectional collaboration with regulatory partners via quarterly meetings. collaboration with regulatory partners is essential for success. our fostering bidirectional cooperation with the california department

of public health, centers for medicare and medicaid service we promote transparency, exchange insight and collectsively worked towards shared goal of enhancing resident care and regulatory compliance. through the concerted efforts and partnerships, laguna honda is poised to not only meet but exceed regulatory expectations. insuring the provision of exceptional care and leading in the long-term sector continues. next slide. and now to tell you more about our transition from cms recertification incident command to rue tune operation and management oversight, i invite sandra simon to share these plans with

you. >> good afternoon commission rers. ers. i'm thrilled and want to articulate how excited i am in partnership with the team of new executive leaders and this excellent team of folks i get to have the honor working side by side with on a daily basis. a real skilled nursing facility experts, leaders and i couldn't ask for a better team to help lead this transition to routine operation. feeling very supported and excited about the future of laguna honda. the first step in the transition is to transition away from [indiscernible] and this team was lead by roland pickens, who leadership through the turbulate time has been invaluable and want to thank you roland for

that leadership. the responsibility for the daily operations of laguna honda will be held by my team of two assistant nursing home administrators, [indiscernible] and chief medical officer and two directors of nursing. this team of leaders all have extensive experience in the skilled nursing world in the skilled setting and a long track record of success and had the opportunity to also spend this time working alongside with the [indiscernible] insure seemless transition. this work includes implementing a survey readiness play book to foster daily regulatory compliance that will serve as a comprehensive guide, outlining best practices and are protocols to maintain compliance with regulatory standards on a day to day basis. always being survey ready.

what i am most focused on is insuring a fundamental cultural transformation that prioritizes and focuses on individualized resident centered care. the heart of what we do. our staff are remarkable, and compassionate about their work and we are giving them and tine to give them the tools and knowledge needed to prioritize the needs and preference s of each resident to insure a quality of life and quality of care and overall excellent resident experience. and this also includes just insuring that the voices are heard. voices of our residence, them families and communities we serve and everyone's voice is heard as we all continue on this improvement effort. entrusting daily operation

implementing [indiscernible] fostering culture of compliance and resident centered care, poised to sustain its commitment to excellence and long-term care. next slide, please. so, i want to talk about about the consistent care of the bedside monitor program. played a pivotal role driving improvement efforts. embedding skilled nursing expertise at the unit level, the program facilitated real time identification and resolution of regulatory vulnerabilities. under the ccbm program, expertise integrated into leadership to address regulatory challenges promptly and support the nurses and the unit based nurse managers and staff on

the units with real time coaching and training. this real time coaching and training in the moment activities included, daily clinical reviews, unit management, rounding on skilled nursing and on environment, resident safety, audits from falls and wounds and then also just how we facilitate in the skilled nursing resident care conference and unit base initiatives that roland spoke of, the quality insurance performance improvement at the unit level. we insure the continuity of the activities and develop a comprehensive plan to insure seemless less continuation to nurse manager, directors and two directors of nursing oversight. through the diligent execution of the ccbm program and continuity

care of key activities, laguna honda demonstrated its commitment to investing in our staff, nurturing ongoing learning and it is just-really important to just are in time training and nurturing is invaluable and helps support the nurses through this transition. next slide, please. so, how do we continue to sustain these improve. ment? continued to maintaining momentum and sustain the major gain from the recertification process. this includes fire loif safety and emergency preparedness. recent surveys recognize laguna honda substantial compliance and fire life safety and emergency preparedness. focus remains on insuring ongeeing adherence to standards and

readiness fire emergency situations such as performing fire drills and other drills. second, care plan sustainability program. the care plan sustainability program continues to play a vital role in the training of our staff in auditing and a daily monitoring of care plans for improvements, accuracy and by prioritizing sustainability we insure resident care plans remain accurate, residents centered, most important, and effective over time. [indiscernible] offers kpo support. the lhh propotion office provides a essential support for continuance performance improvement initiatives and we drive efficiency, invasion, quality enhancement across all aspectoffs the operations. four, environment of care rounding and

severe findings report. been a very comprehensive environment of care rounding program and that includes this rounding program severe finding reports sever as early warning protection systems with daily rounding and reviewing weekly helps us detect and facility prompt identification and resolution of any issues that could escalate or rise to something of concern and being able to mitigate in real time. and proactively addressing concerns we maintain a safe and compliant environment day in and day out. five, unit based coaching and just in time training. we'll continue to require unit based coaching and just in time training. coaching and training for clinical staff insure the ongoing skilled development and readiness to address evolving needs. also allows time for folks to ask questions and be comfortable escalating issues and have a trusting

interactive dynamic. these initiatives empower team members to provide high quality care and respond to changing circumstances. through sustained efforts in the critical areas remains steadfast in the commitment to excellence, safety and continuous improvement. next slide, please. i want to show you some of this work in action. some of the examples of what commitment to continuous quality improvement looks like. here, you see the nursing leadership visibility wall. we dedicated spaces and structures for teams to come together and review clinical updates and data and escalate and immediately address concerns including the nurse visibility wall. this includes at this wall,

reviewing weekly sustainability dashboard and allows us to celebrate successes and also alert to any areas that need improvement or attention. it also includes more targeted data review like our dedicated dashboard to review care plan. next slide. we also have neighborhood daily improvement huddles, so this is another example of what happen s at the neighborhood daily unit huddle. here is where the unit staff come together for daily clinical review and escalation. this also includes recognition and celebrations. facility wide data, unit specific data on things like rooms and restraints, response time, falls and weekly area of focus called the weekly huddle speaking points or talking points shared weekly with our staff. this space is vital to engage front line staff and open clear lines of

communication and prioritize key quality metrics. next slide. the lastly, the interdisciplinary team daily stand up. every morning leadership from across the facility come together in person for what we call a stand up meeting. every unit reports on key information at the meetings and if there is need for deeper dive or support, we have what we call, side bars where we can-the staff and leaders can come together to address any issues in a focus session and just have immediate and proactive collaboration to address any issues just in time. there is a constant flow of information between leadership interdisciplinary team and neighborhood huddles. p taken together, these daily meetings insure leaders have a pulse on the organization and front line staff are involved and engaged. i call it the meeting-the place to be for the day. it is a dynamic interactive

meeting. next slide. we talked about quality assurance, so the vital part of the improve is the quality assurance and performance improvement is approach that integrate quality assurance and performance improvement to enhance safety and quality in nursing homes. involves system data driven met udology to insure continuous enhancement of care. also a mandated by cms in the long-term care regulations. during the recertification process, laguna honda greatly expanded the programming, including established unit based to best engage front line staff. i was in a meeting today where a nurse leaders, we were asking about qapi and they were really proud and said when they look back oon the last

year what they are most proud of is unit based quality meetings and the improvement in the care they are able to deliver. it was nice to hear staff say that. implementation of improvement initiative. aims to culture of root cause analysis [indiscernible] across all operational levels allowing us to continually grow and improve, learn, study, act and sustain the unit based meetings focused on high risk area, wounds, weight loss, [indiscernible] infection control and antibiotic stewardship, any falls or physical restraints and also continue to review data related to areas of high risk and just be able to identify improvement opportunities. interdisciplinary meetings are

part of qapi and allow for escalation to resolve verified issues. laguna honda remains committed it upholding the principles of qapi foster a culture of continuous improvement and insuring the highest quality of care is always there for residents at the heart of all we do and also provide a safe engaged staff. with that, i would like to pass it over to cms recertification coincident commander and chief operating [indiscernible] >> good afternoon commissioners. pleased to be here. the next slide will be a slide i'll have a opportunity to walk through and the theme of this slide is solidify net work collaboration and oversight. one thing before i jump into this is step back. the city county of san francisco through department of public health and through this body, governed the san francisco health network.

what you see acrost industry is multiple institutions coming togethers. it is the denotation of stronger together then any individual unit. with that at the back of mind as i walk through the slides when i say the network it is because we want to cat pult off that particular sentiment. the 5 things i want to convey here, as we move towards this plan is, the consistent presence of the network leadership. our network leadership remains embedded on site that facilitate the close collaboration and building and cultivating and communication fl the last couple years. the presence insures the direct plan of communication that enable swift response to operation needs and regulatory compliance requirements. several which are time sensitive doing things in 2 hours, 4 hours, 8 hours so not just being front of

colleague and person to be as clear as possible but do in a particular window of time. the next part is participation in key meetings. leadership will participate about daily operation and all the regulatory compliance elements. this involvement provides additional insight, guidance and contribute to over all success and effectiveness of the up operation. covered the dph kpo support for performance improvement. the network oversight is extended as acrut and outpatient operation and department of education training, quality, nursing and care experience. that important because the broader oversight enable leadership to focus

skilled nursing expertise of a area of scope of oversight that we need, so we can continue that comprehensive management and support across all areas of the operation. finally, the continued governance and oversight. dph leadership, the jcc, health commission and will continue to provide governance and oversight so this is your ongoing involvement to insure accountability, alignment and standards and strategic goals and transparency to the community and stakeholders. advocacy these venues are critical importance and are wouldinate be where we are today if not all the groups coming together. through the efforts and oversight, we are well positioned to meet operational objectives compliance and most important, deliver high centered care to all residents every time. next slide, please. now, for this particular slide, what i want to cover is the goal to

implement frequent routine cms regulatory exprlt evaluations. this is very similar to the work done with our qie to support sustaining regulatory compliance. the qie stands for quality improvement expert. the denotation is meant to explain individual or entity that is especially trained and experts in cms requirements and as we know, the cms requirements are not static and evolve and continue to evolve and evolve for years to come. the other part to highlight how it is related, for anyone who has taken a standardsized exam you take a practest test before the real exam to prepare. another who got a learner permit or driver license you practice in a empty parking lot and then on the road and go for the exam. the idea is be as prepared as possible to be as successful as possible

when the time comes, and so this work that i'm walking through here is analogous to that level of preparation. now, our routine cms regulatory expert evaluation, we recognize the importance of implementing routine cms regulatory expert evaluations to sustainable all the regulatory compliance we made over the last two plus years. these evaluations offer third party assessment of operations, adherence to the regulations, the sustainability of what we put in place and provide additional valuable invite or learnings or opportunities. now, in terms of compounce of the evaluation, these are multi-day on-site assessment and encompass various parts, comprehensively evaluate compliance and performance. we talk about critical element pathways that will be a key component. it involves observation, interviews, and record review across all

the care areas. also includes review of route cause analysis in the previous quarter. in the preceded quarter the entity will come in and really assess the quality of the rca. the rca will be a result of any deficiencies that would have been received to date in that preceding quarter. that will make sure the rca meet and exceed the high standards utilized by the qie to get where we are today. the rca have been a key vehicle to insure we get to the route causes to insure plans of correction actually address what drove us and contribute to the finding. we heard about the program evaluation, so we would have come in and do evaluations that include a key assessment of the program. this insure the initiatives are

robust, effective, and lined with regulatory requirements and best practices. finally, the regulatory quality improvement coaching. our goal is for the regulatory quality improvement coaching to be provided for leaders and our staff. so, that will empower team members with knowledge and skill necessary to maintain compliance and drive those continuous improvements. you heard me say a lot, sustain, maintain, drive. we want to make sure that is part of the dna and culture we are growing the last couple years. by implementing the routine evaluation and leverage expertise of the experts, we and laguna honda reinforce commitment to excellence in regulatory compliance and quality of care delivery. next slide. there we go. now, laguna honda will continue comprehensive staff report and development strategies put in place. this is such a important part

of the planning investing in staff and growth and development will be key for long-term success. we are not able to do that, then we have to have serious conversations, but we have done really well with that to date and our goal is sustain and grow that. the goal is to recognize the importance of staff in resident care. all the staff played a vital role delivering high quality individualized care to residents. their dedication and expertise have been essential insuring wellbeing of those under our care. when i say staff i am talking direct care provider, indirect care provider, 360 of all the staff of the organization that come to work with the residents at the center. we want to sustain staffing gains, that means maintaining strengthening staffing practice, address the aspects of the staffing needs that include managing staffing vacancy, appropriate use of registry, address long-term leave to insure quantnuity in

the care we are providing. a collaborative approach to staffing, we emphasize collaborative partnership between leadership, human resource and iif nance to address all the staffing needs. we know only by working together we can identify the challenges implement solutions and insure the needs of the staffing levels are where they need to be and met to meet our care demands. our commitment to staff training education remains unwavering. it is a component of what we are working to do and focus on adult learning principles, many individuals learn differently. some can watch a presentation and good to go. others need to see something, do something, teach it back. or having one example we shared is for example, hand hygiene.

washing our hands a certain amount of time and certain mechanism and motion. seeing it being done, getting it done, having your hand sprayed with that luminescent and having the uv light shine on it. these are adult learning principles and need to get in the shoes, do it once and see how it feels and if there is something that needs to be worked on, reviewed, coached up. that is our goal to make sure our colleagues are set up for success every time. by incorporating principles we inshurn training programs are effective engaging and meet the needs of it diverse workforce. this approach foster compliance and resident care practice and enhance quality of services. through these efforts, we are dedicated to fostering a supportive and skilled workforce and enhance the quality of life for our resident. that is the center of everything we are doing. now, i would like to pass it on to troy williams to also serve as the

network chief nursing officer and chief quality officer. >> good afternoon commissioners. next slide, please. so, as a part of the recertification process, laguna honda became more connected and engaged with our key association and this is critical. this is something missing historically and focus for laguna honda. we will continue this as a opportunity for continued growth and partnerships and we recognize the importance of maintaining relationships with key associations to uphold best practice and stay informed about care delivery. the partnerships serve as invaluable resources providing access to current information resources and expertise relevant to long-term care sector, and we have been partnering with

these organizations and it has been really helpful over the last few years in different areas. we remain committed fostering relationships with industry experts such as california association of health facilities, leading age california, the california association of long-term care medicine. through collaboration with these organizations gained insight into trends, regulatory update and innovative practice in long-term care and we have the opportunity to share our learning and contribute to field of skilled nursing as we continue to improve, which is very important moving forward. engaging with these key associations, insures alignment with industry standards, enhance knowledge base, and strengthens the position as a leader in the quality care. by maintaining these vital partnerships we remain poised to adapt to

changing landscapes, implement best practice and continuously improve the care and service offered to our residents. next slide. laguna honda will continue bidirectional collaboration with regulatory partners and i have to say, this has been key and critical for us in maintaining these relationships with our regulators. remain committed to foster bidirectional collaboration with our regulatory partners to uphold compliant resident care and maintain regulatory adherence. collaboration initiatives involve key partners such as california department of public health, the center for medicare and medicaid service and these partnerships facilitate open communication, information sharing and joint problem solving to address regulatory challenges effectively. a example is cdph supervisor who helped us a lot in restraint free

journey and other initiatives as we moved forward with our recertification journey. so, they have been very helpful and we want to continue to foster these relationships. once we are restoryed in medicare and medicaid, cdph, cms, dph and laguna honda and network leadership convene ongoing quarterly leadership collaboration meetings with leaders from those areas. these meetings provide a platform for leadership from all parties to engage in meaningful discussion, share updates and collaborate on strategies to enhance resident care and regulatory compliance. these quarterly meetings serve as a opportunity to review performance, discuss regulatory changes or concern and align efforts to address identified areas for improvement. through regular dialogue and collaboration, laguna honda and

regulatory partners insure coordinated approach to achieve and maintain compliance with standards. by fostering culture of collaboration and partnership with our regulatory agencies reaffirm the commitment to delivering high quality compliant care to the residents while maintaining transparency and accountability. and these professional relationships have improved so much over the last couple years and look forward continuing those on. next slide, please. laguna honda aspiration to be a world class skilled nursing facility delivering quality and regulatory compliant care to san franciscans of today and future generations. always working to the industry standard metric of 5 star rating from cms, which symbolize excellence across facility performance. working towards the goal means demonstrating excellence in

every facet of the skilled nursing facility operation including staffing rates, quality measures and survey inspection. we get there through investing in our staff and ust faer a culture of continuous improvement. this involves actively listening to the voices of our residents and staff nurturing a environment of collaboration and empowerment and prioritize regulatory compliance as a foundation of excellence. embracing culture change, actively engaging with steak holders and maintaining compliance poised to achieve the goal of being a world class nursing facility so our residents receive the highest quality of care and support policy. possibly. next slide. on behalf of our team, i thank you for this opportunity for our team to present the laguna honda

sustainability and ongrowing improvement framework. this is a big day. the work represents tremendous arount of work and collaboration. i want to thank laguna honda staff for tireless work for ongoing growth and improve. ment i want to thank the health commission and the joint conference committee for ongoing guidance and could not do it without you. we look to the future of laguna honda with great optimism and at the appropriate time our team is happy to answer questions or take comments. thank you. >> thank you for the excellent presentation, all of you, and listening to what you said, it is really true, this is a collaboration and has been from every individual involved at lagoon ahonda, the staff, the leadership, the residents and your external stakeholders. it is impressive how you engage

them. slide 7 showed where identify were and where you center come. you have made impressive progress and could not have happened without the type of individuals involved, the commitment you show and we are most grateful to all of you. is there any public comment on this item? >> any public comment in the room on this item? there is one hand up remotely. mr. shaw, you got three minutes. >> thank you. >> yesterday at 457 p.m. mark morewitz e-mailed a update to this item report. three minutes before 5 p.m. yesterday violates the sunshine ordinance requiring publication of background materials 72 hours in advance of public meetings. this version seems to short circuit the plan sustainability plan and admission plan report promised to be released to the health commission in july or thereaftermentf it is clear this is strung on the full health

commission without presented to the jcc for consideration and inpt. this 8 point strategy for sustainability is different from the 9.sustainability plan presented to the cms quality conference april 10. contrary to pickens statement, slide 23 presented at the cms conference, lhh strategy to [indiscernible] sustainability plan has been presented at the cms conference. [indiscernible] spin control. [difficulty hearing audio] why was that removed from the 9 point plan presented april 10? is that because the contract was prematurely ended in may and now out of the picture, dropped from the 9

point sustainability plan? pickens new presentation slide 11 states lhh recertification hospital incident command structure has ended and solidify collaboration involve san francisco health network leadership will be or [indiscernible] embedding previously not mentioned until now. leadership will participate in key lhh meetings to keep the pulse of daily operations. in other words, sfhn will take lhh pulse pressing the thumb on the scale. when the san francisco health network was created in 2013 it was set up to manage to pull together neighborhood health center s [indiscernible] has grown and now falsely [indiscernible] embedding network managers is

like embedding foxes in the hen house to deter predators. it is managers themselves or predators and dph and [indiscernible] mismanagement or cause of [indiscernible] this is getting to be hopeless. [indiscernible] decertified again. >> your time is up. >> any other public comment? >> that is the only- >> any commissioner questions or comments? commissioner guillermo. >> i want to echo president green's comments about how lucky we are i guess to be in a place after two

years where we can finally look forward to what appears to be a very comprehensive and thorough sustainability plan that has been anticipated even as we anticipate at any moment the certification notice recertification notice of medicare so we can fully implement the plan, see so i want to congratulate everyone at laguna honda and the department who have been hands on in many ways in putting this plan together and look forward to its full implementation ongoingly. i do have a couple questions. actually several questions, but i'll limit myself to the couple that i think lend itself to today's attention and presentation. there is a lot of mention in the plan about culture change, which i think is probably one of the most key things that we have to consider both

in term of getting where we are today and where we are going aspire to in the future in terms of being world class facility and the facility that serves as a model for those, as well as the uniqueness of a facility like this in the san francisco health network integrated system, which we all know is as mentioned, the way healthcare being provided across the whole spectrum from pre-birth to the end of our time, so really grateful that we have in san francisco the opportunity to be part of something like this, and so, the culture change that was mentioned is something that i think is really important.

the question here is, what aspects-particularly you roland, since you are there--of the sustainability plan in order to be able to keep it going, what aspects of the plan really require the most attention to culture change? ongoing, not just from evaluation standpoint. >> thank you for the question. it is so key where we are now and where we are going. i think cultural change has several components. number one, starting with the initial discovery at the beginning of the process to change from culture to acute care hospital to skilled nursing facility. we made tremendous progress along those lines. we continue to do that. the other change in culture is a culture of accountability. that previously did not exist and we

had to infuse that within operations. we had to infuse more metrics, more outcomes, more reports. reporting that data both internally and externally, so there is transparency for accountability to the health commission. all is change of culture in terms of the ability of staff to welcome new staff members. that has been issue at laguna and we have seen it recent ly with new hires. we are working closely with our dph human resources office of health equity to make sure that we are pulling all the resources of the department to address the issues of interpersonal communication among staff members so they can all support each other and give the best care they can. those are some aspects of culture change that we know we will have to continue to focus on. >> thank you. imagine there will be plenty more as time goes on to pay attention

to, but i think what you mentioned is really important. that switch from an acute care mentality or focus to long-term care i think is very very important. as part that then, and monitoring the need for culture change and sustainability, part that is this sort of evaluating process that happens with a outside expert. could you tell us how that expert will be appointed or selected so that there is a sense of slaberation and partnership and objectivity that will be maintained and along with that, you mentioned in terms of external collaboration or partnerships, the california groups we are going to be maintaining relationship with, are there national groups that also

are important in being able to have a external eye or partnership in the sustainability and ongoing quality improvement for laguna honda? >> yes, yes and yes. so, in terms of the process for selection that cms quality improvement expert, obviously we are obligated to adhere to the procurement processes orcity and county of san francisco, so a request for proposal, rfp was let a few months ago requesting those services. there is a panel that reviews those results and then works with the department of public health contracting office and city attorney to issue an award. that process is well underway and all most complete. >> [indiscernible] >> all most completed with the

selection process, so a vendor will be selected from among those who submitted proposals. >> great. and so we'll hear about that soon? >> yes. >> and then any national groups that- >> yes, there are. i'll let sandra address that. >> so, both the california and leading age california are part of national -each state has a chapter and the association of healthcare facility is the national, so you have access to their national trainings, database and then you have your local district and state groups as well. >> great. so, glad to know that we will be having those cultivating all those relationships is important as it is for the internal monitoring, self-monitoring. the external i think both from those type of groups as well as the public and commission will be really important, so great to hear.

i'll reserve the rest of my questions either in writing or for some other opportunity. allow my colleagues on the commission to ask theirs. >> seeing no other questions or comments from the commission, director colfax. >> thank you. thank you president green. i know we have a lot on the agenda, but i want to express gratitude to the team that presented today and the entire laguna honda staff. this took hundreds of people efforts. we met hundreds of metrics we are required in order to get us where we are today. we do have a substantial journey ahead. i want to make sure that the commission hears that-the positive energy and commitment and investment in making sure we continue on this journey, but we certainly continue to have a way to go to make laguna honda the

world class facility we all want it to be so thank you to the team and thank you to the people who work every day at laguna honda and most of all, thank you to the residents and their families for being on this journey and making sure that laguna honda is here to stay. thanks. >> thank you. >> thanks so much. our next item is the office health equity update and we have tracey who served. thank you the interim chief equity officer and [indiscernible] that is the job of the director of experience and culture from the dph human resources. >> good afternoon. i maim is tracey burris. today i will be presenting the office of health equity update alongside my esteemed colleague, dr. richa

dhanju director of experience and ulture department of human resource. i like to thank you for the opportunity to present today and the community members who connected with the office of health equity in different ways since our last update to the health commission. today we are here to share more about the recent actions focus ed on efforts to advance equity at dph. dph is deeply committed insuring equity is at the forefront of departmental policy and planning and day to day work. we are dedicated to creating and sustaining a departmental culture of accountability, we all take tangible actions towards achieving equity every day. we hold ourselves

accountability for action and impacts by setting goals and being transparent about progress towards health equity. >> [indiscernible] running the presentation and looks like having trouble if we can give her a beat and if not, then i'll figure how to do it on my end. sorry, tracey. there we go. >> thank you. in today's presentation we'll provide update on the future of the office of health equity, explaining more about the hiring timeline and recent office transition. we will review the infrastructure of who is doing the equity work and how we measure our progress. as i mentioned, community has a

big part of our work. we had opportunities to interface with community members throughout different engagements and i'm excited to share more details. lastly, we will review our racial equity action plan to walk through our timeline, priorities, and next steps. next slide, please. for the past 9 months had i had the honor to serve as interim chief health equity officer, overseeing operation, personnel management, financial and driving the mission to focus for dph. our goal has been to have a seemless transition and pass knowledge and

perspective to incoming chief health equity officer. the hr team has been working to create a successful hiring process with recruitment and selection happening this summer with aim to on-board a new director in the fall. this year, as we move through the office transition, we have partnered with be the change consulting, a woman of color owned and operated company who specialize in capacity building and strategic planning. through our work with be the change, we have reviewed prior plans, interviewed office of health equity staff, equity leads, champion and council. using the information from all, be the change will synthesize findings by august 2024 and use them for the foundation for the future.

during the transition, our commitment to advancing equity has not wavered. we continued the work. at the forfront of day to day work. next slide, please. on this slide, we will see the office of health equity organizational chart in the last year. in the last year we worked to fill the positions and we are all most complete. the office of health equity, lead by the interim chief health equity officer and deputy director is made up of four teams. workforce culture, a team dedicated to fostering a work place environment where equity diversity and inclusioniveness are not only embraced but ingrained in policy and practice. data policy and reporting team is responsible for overseeing the

process of both public and internal reporting. our operation team provides business operation and administration support to the office of health equity. community programs, this team plays a critical role integrating a equity perspective into the community initiatives conducted by dph. to the far right of the organizational chart, we have our health disparities team. this team is part of a cdc grant that will end in may 2025. this grant supports the work strengthening partnerships and infrastructure to provide support to san francisco neighborhoods that were identifies as disproportionately effected during covid. the lead for the health disparity team reports directly to the deputy director. at the bottom of the

organizational chart, there are three gray boxes that represent current vacant positions we are working to fill. and we will see how they can support equity work throughout the department. next slide, please. in addition to the office of health equity staff, we have equity leads and champions to support equity at the forefront of departmental policy and planning as well as day to day work. there are 29 equity leads across the division. the equity leads support leadership and advancing equity, the key to those positions is the work must be part of the employee job duties, not in addition to job duties. we also have equity champions in every section of dph. staff who express interest in supporting their divisions

equity goals. champions receive 5 hours a month of protected work time to focus on equity learning and implementation. some examples of equity learning opportunities include, black african american health initiatives equity learning series. these series take place four times a month, they are 90 minutes in duration and facilitated by the office of health equity workforce equity lead. the discussions are centered around articles, pod cast and videos addressing issues of race, racism and other inequities that impact black health. the goals of these learning series are to normalize conversation about race, to help staff see their own role in addressing inequities and to be able to have equity centered convarsations. equity champions also receive equity focused learning trainings from

the world trust educational service. a company who is a contractor with the city. world trust educational services provides virtual learning labs that cover core concepts transformative change strategies and action planning. implementing this work, the equity leads are able to facilitate equity center discussion and trainings with colleagues in their divisions and they are advocates for equity related changes within the organization. some ways that we monitor track and assess our equity progress and the work the equity leads and champions is through the annual self-assessment of equity leads complete. the assessment is a modeled after the government alliance on race and equityism we are in the process

of compiling the 2023 findings and will have the results by the end of the fiscal year. next slide, please. we had opportunities to interface with community members and different agencies since the last health commission presentation. we know through partnership, communication and engagement opportunities, it helps give us a full broader view around health equity. one of the key community engagement where neighborhood engagement session. the goal of each session is strengthen, clinical and leadership knowledge and understanding social determinants of health in priority neighborhood and build relationship with community based organizations. next slide, please. the neighborhood engagement sessions took place in seven priority

areas across the city marked by it gold star. the neighborhood included two sessions in the bayview hunters point, chinatown, excelsior, mission, potrero hill, sunnydale. next slide, please. of the 7 walking session we saw great engagement numbers. 22 community based organizations participated. they often lead the planning and implementation of some sessions. over a hundred leaders and clinicians attendeded and deepened their understanding by learning from the community experiences and using the information to guide their work moving forward. another community engagement opportunities allowed dph to inspire the next generation of public

health and healthcare leaders throughory pathway program. the pathway program was launched by the office of health equity in the summer 2023, with the aim to give bipoc youth access to careers. the office of health equity coordinates with teams across the department, including zucker burg san francisco general, behavioral health, community health equity and promotion as well as maternl health adolescents health to provide opportunities for pathway interns. the interns are assisting medical teams connecting people to benefits and helping address racial disparities and overdose deaths. the program has also partnered with other city and county of san francisco agencies including the san

francisco sheriff office, and san francisco animal care and control. we are proud of the growth of the program. the program began the summer 2023, we had three interns. the next cohort, the number more then doubled to 8 interns in the fall program. and 14 interns in our spring 2024 program. we are excited to see this program flourish and continue to connect the interns to various city resources for career options. even though we connect the pathway interns to resources for career opportunities, we do not track or have data on where they move on after completing the program. that was a lessen learned and moving forward, we will be tracking

that information. next slide, please. now, we will transition into a brief summary of our racial equity action plan. i would like to hand it over to my colleague, dr. to share how dph is holding accountable for demonstrating equitable action and impact by setting goals and being transparent about our progress towards true health equity. >> good afternoon commissioners. the race equity action plan is broadly divided into two phases. phase 1 from 2021 to 2023 focused on workforce equity and i share a summary of efforts shortly. phase 2 focus on community

health equity and begin this year with planning in 2024 and selection of priorities in 2025. for both phases directions and guidelines come from the leadership at the city office of race equity. next slide, please. so, about four years ago in the pandemic the team came together with office of health equity to draft phase one of the race equity action plan focusing on workforce equity. our goal in hr was towards advancing workforce equity meant removing barriers designing and distributed opportunities and resources according to employee needs so that disparities between employee groups can be dismantled and all employees have the same opportunities to thrive at dph. with this goal in mind, hr

identified 80 plus action categories with 160 plus deliverable with 6 large areas including hiring and recruitment, retention and promotion, discipline and organizational culture and more. over time we completed about 75 percent of all deliverable and continuing to meet the rest of the deliverable's. about 10 percent are in progress, and in the current fiscal year, we focused on the three priorities that are highlighted here. hiring [indiscernible] investing in talent pool and employee engagement focus on racial equity and respect. next i would like to share a little about each focus area, but a quick note before that, hr will be coming to the health commission and we will be doing

a thorough year end review with the commission very soon, so i'm providing a quick overview and promise we will be back with lots of details, lots of data and lots of insight. because hr priorities reap deliverable and what we accomplished in the past year, they are all interconnected and overlapping. you will be hearing a lot during the hr presentation that will be extension of what i am just touching upon here today. next slide, please. so, these are our three focus areas. our first focus area is also an hr priority and department priority, hired with focus onficiency and diversity. we implemented 30 plus efficiency to identify redundancy and simplify

process and reduce vacancy rates. we have the highest number of positions filled in the history of dph. the vacancy rate reduced significantly over the last fiscal year and i sure you have heard the vacancy rate is particularly low. [indiscernible] our largest job class, this is significant achievement for us. there has been some increase in workforce diversity for african american, hispanic latino and multicultural employ ooze. over 6 years a 2 [indiscernible] a lot of work ahead of and have to focus not just on diversity overall, but diversity within specific job series and classification. the number two focus here is investing in diverse talent pools and internal career advancement. i will speak more about the 2023 employee engage lt survey, but we heard again and again from employees

that career advancement within dph is a challenge. and taking that feedback very seriously over the past year we expanded the hr workforce and career advancement team from one to five analysts. this team is building the talent pool for academic and union partnership. we have a strong partnership with seiu1021 in career advancement. partnership with city college, the health education department for inshurnships and recruitment, particularly for health worker series and also focus on internal pathway development. two examples in the coming months we are going to see the launch of the first 9910 behavioral health clinician fellowship program and that is going to bring in about 20 clinicians

who recently grad wraited to the system and with focus on diversity of our behavioral health clinicians and are training them up in the next year to be culturally and racially clinicians we apire to have at dph for the community. another example is health worker coordinator program. we see the health workers find it challenging to advance careers, even though there is some clarity that health workers can over time possess the skills and experience and move to health program coordinator series. to address this challenge, hr initiated a program that connects with health workers over across different cohorlts. hort and provides hand on group coaching, workshops, information sessions on how to be a successful candidate for a health program coordinator series and that's

in progress. another example is project [indiscernible] pop stands for promote our people and again, our mission is to insure that our employees that have immense institutional knowledge and networks and commitment to our mission we are able to retain them. if they want to move up, we are here to support them. if they want to move laterally, we are here to support and same if they want a different career option, we want them to stay within dph. what have we din? we provide ongoing workshops and group coaching for employee. over the past 6 months we offered 15 information sessions that have been attended by 360 plus participants. the question is, sure, we have information sessions, what is the outcome? we are closely tracking the progression of the current employees and i hope in the next one or two years i can

come back and report on the progress we are seeing, but this is beginning and we are hopeful. our focus area is related to organizational culture of inclusion and belonging. this is employee engagement. staffing with survey focus on racial equity and respect. coming out of the pandemic, we desperately needed a organizational pulse check. as we know, our workforce experienced a lot, so in 2023, we launched a expansive employee engagement survey, and more about more about the survey findings in a bit. we had one section of the survey dedicated to questions about racial equity and respect, because we truly wanted to understand what is the every day experience of our employees, based on background, identify, not just what they work or job class or

series is:and so once the survey results were out, the hr data team dug deep. we had a deep stratification of survey results not just by division and program and job series, but we stratifyed each question by race ethnicity. and this brings me to a question commissioner guillermo you were asking about culture change. we created a dashboard, that host the data set stratifyed in multiple ways presented it and provided access to our division survey champions, and we within hr reg urally access that data to understand what kind of culture change is needed where and why. they look at race ethnicity metric for questions and one example, we will launch a campaign. we are looking closely at where are we seeing that employee saying they are

not experiencing the [indiscernible] within the job series or division maybe. the stratification of data is helping us take a [indiscernible] culture change and truly understand what our employees need and expectations are. we held a conference in november that focused on stakeholder alignment within dph and specifically on accountability and action. employee engagement surveys happen, but what do we do differently this time given the large complex, how are we going to insure accountability at the level of each division? so, we had a successful conference coming out of which we have a monthly work group on employee engagement that connects with our survey champions from each division, we learned from one another, we break barriers and hold ourselves accountable to action. the next schedule is for march

2025, so we'll know whether or employees approve or if they expect more for us based on their responses. and one point i like to emphasize before moving ahead is the survey helped define our strategic priorities for the workforce, which are now the same as our race equity action priorities, and therefore there is a deep alignment. hr wants to and should be doing for employees and what hr commitments are for the race equity action plan. next slide, please. so, a quick update on employee engagement survey i spoke about and as i mentioned, a lot more coming when hr is back here. we had a 62 percent response rate, 4650 respondents and our strengths were pride in job over 70 percent of

employees take great pride in job. extremely mission driven and communication and teamwork, again over 70 percent response positive. respect as a expectation at dph was at 84 percent. dph employees understand respect towards patient and colleagues is a expectation. moving to areas of improvement, we had about 60 percent negative response to question, my work unit is adequately staffed. we have taken that very seriously and as mentioned earlier, we are going strong on hiring efficiency. between 40 percent to 43 percent responded negatively to three questions around stress, work load and emotional exhaustion and we see a connection with staffing and coming out of the pandemic and other concerns employees may be experiencing.

when asked, what prompt a employee to consider leaving dph, majority noted lack of career advancement as a number one reason. those are areas of improvement and last one here is, respect as reality. as a expectation was 84 percent, respect as reality is 65 percent with a lower positive response from junior front line staff, majority of whom identify as bipoc. going back to data, we were able to understand who among our workforce are not experiencing respect the same way as others may be and that prompted-necessitated us to design and move forward respect that workscome pain in the next fiscal year. on hr action to improve, i

mentioned hiring efficiency, career advancement challenge and respect campaign tracely will briefly mention. next slide, please. this illustration shows dph journey to advance workforce equity over the past 6 years. these are questions that asked year over year, 2019, 2020 and 20 23 survey and data shows we are moving in the right direction and of course we have a lot more work to do. with that, i'll turn the presentation back to tracey and thank you commissioners. >> thank you. next slide, please. as already noted by dr. dhanju action from employee engagement survey

and racial equity action plan are seekless. hindering our [indiscernible] each employee thribes in the next fiscal year we will be focusing on developing supervisors manager and leaders who hold the core responsibility of building a culture of inclusion and respect for all employees and had the strongest impact on employee wellbeing, growth and retention. we will be expanding our learning and development opportunities and accountability measures like embedding the gear equity assessment and performance appraisal process. given our learning from employee engagement survey, not all employees experience respect the same way at dph. we want to close the gap between respect as a expectation and a

reality. in the coming months, hr will lead in partnership with office of health equity to launch a dph wide respect campaign to visualize and normalize respect as a core value to dph. next slide, please. that concludes the presentation, and we are open to and happy to answer any questions which you may have. >> thanks to both of you for this excellent presentation. i have to say, your powerpoint was one of the most elegant well done. i think i have seen since i have been on this commission, and i think it is reflective of the incredible progerize you have made. you are well on way in phase 1 and can't wait to say what you have to say at the hr report and very interested in detail and analytics you are delving

deeply and thoroughly issues of concern. you laid the ground work for phase dwo. 2. this is very encouraging, very positive presentation and we are very grateful. i have to ask for public comment. >> any public comment in the room? i see none online, so commissioners. >> commissioners. commissioner giraudo. >> i want to thank you for the excellent presentation both of you. also, for the questions that i asked that you incorporated into your presentation. i appreciated it and that thank you very much. i look forward to next commissioner green said, phase 2. it is great. thank you. >> thank you. >> commissioner christian. >> thank you president green. thank you so much for the presentation and this work. it is very moving really this work and i think of dr. anna bennett and

how proud she surely is of what is happening here at dph, and i love the collaboration between the presence of both dpr and office of health equity working together as one and as a city employee, i can only hope for the same replication of this throughout the city, throughout the department, so thank you so much for your work. >> thank you commissioner for your comments. >> and for the hope you are giving to the children of our city and they can grow up and stay here and support their families and have meaningful work. >> thank you. >> commissioner guillermo. >> i associate myself with it the previous comments made by colleagues up here and also want to just add my congratulations on where we have gotten so far. i remember a couple years ago

when the phase 1 was introduced and sort of thinking that there was a part of me that thought, can't we go faster to get to where we need-to fix everything internally to show the city and county what is possible. and understanding that it takes time and so this presentation was a indication of how taking time and really doing things thoroughly and thoughtfully and meaningfully make all the difference and so, i really want to appreciate what we heard today and what i'm sure we'll see more of in the future so look forward to that, and really anticipate actually that what we saw today is really going to indicate the kinds of changes that we are all hoping for as the office was

established and really i think modeling for not only the rest of the city and county, but for the region and particularly with dr. bennett moving over to dc, maybe showing that side of the country what is possible with the kinds of dedication in skill and talent that obviously shows up here, so thank you. >> director colfax. >> thank you. i just really want to reflect the commissioner comments and thank the teams for their incredible work, and the progress been made and also just say the work is expanding in other ways too and i wanted to share with the commission, yesterday i had the pleasure of joining director davis and many city leaders and tracey and vincent who lead the effort.

the mayor's focus on bringing interns from historically black colleges and universities, hbcu lead by director davis at hrc, the kick-off was yesterday and dph is sponsoring four interns who i had the pleasure meeting and hoping that as they intern at zuckerberg san francisco hospital that they will continue to play it forward and i want them to come here and work at dph, but just to say that, things are expanding and new exciting directions under the leadership of the mayor, under leadership of hrc and office of health equity team, so just are wanted to share that. additional piece of information i found very inspiring. >> thank you. thank you so much. >> i would to add thank you commissioner and dr. colfax for the kinds words, but i like to add

that dr. bennett set the foundation so she deserves a lot of the credit, most of the credit. but thank you mpts >> thank you. >> next item on the agenda is 2016 public health and safety bond update and we welcome back the dynamic trio here of mark the capital advisory consultant, terry and joe chin from public works program manager. >> good afternoon. >> actually, before you begin i want to say thank you to everyone who presented and are please feel free to continue work elsewhere if you have something else to do. we know you are very busy so don't feel you have to stick to your seats. >> thank you. next slide. terry is here with me and joe

chin. we'll try to be brief. next slide. this really captures a lot of efforts from a lot of different people, including the new cfo, croo, jenny louie, myself, grant and others to close the gap we had in september 2023 from $110 million to 33.5. these are some sources that dr. colfax talked about. we included a section in here that terry will speak to about critical infrastructure that is contained in the new bond, proposed for november 2024 and there is other sorts of things we targeted when we ended up getting more money then we thought we would initially. i will turn this over to terry to talk about some critical projects. >> good afternoon.

mark asked me to talk about critical repairs and the gap funding we hope to receive in november. one biggest thing that support this program is the bond program is completion of the pes relocation critical to the hospitals mental health efforts and right now we are facing a gap with that project and without that funding we have to come up with a plan c to continue with that project. there is also other important projects that have funding, inflation of our clinical lab automation track at zuckerberg to keep the lab up to snuff. this is a project near completion, but running at deficit. and then we have our [indiscernible] which feeds the main buildings on

campus excluding the newest building and that is the-that is in a gap too. beyond the gap funding we expect to see, is critical repairs. let me just say, we have a list of things, all sorts of stuff. bore you if i ran through the list, but to emphasize the needs for repairs, it is something laguna honda and zuckerberg have in common besides great staff and leadership and patience and great mission. they also share very old buildings. they are very old buildings. the ones on the campus are built in 1915 and i think the ones at laguna honda are older then that. with old buildings are old pipes roofs

and windows. do the windows work at ward 86? >> they don't work very well and also burn myself oen the radiator. maintenance for critical repairs, we [indiscernible] and what is on the bond initiative is the short list. there is no way to [indiscernible] this is the short list so looking for ward to tackle these problems should that initiative pass. so, that's my spiel on critical repairs. mark, you want to pick it up? >> next slide. this is a moving target and

there was a amendment over at the board between the mayor and the supervisor peskin was bumped up the numbers and this will continue to probably get revised and we'll keep you posted. the first budget finance committee is on july 10 fallowed by the full board meeting where this gets put on the ballot. i'll turn it over to joe. >> next slide, please. there isn't much update. this is just financial numbers showing status where we are in terms of expenditure and-the next two slides i will provide updates on the progress of the capital projects at building 5. there are 7 active construction projects at building 5 now. partially fully funded by 2016 program. include the seismic upgrade,

relocation to public health lab, it infrastructure, clinical [indiscernible] psychiatric emergency service, expansion and rehab department relocation phase 3. these 7 projects [indiscernible] closest to completion by 72 percent with targeted completion by the end of the summer. location not too far behind, 65 percent. target completion is next summer for the new dialysis. seismic up grade is over 50 percent complete. 52 percent complete. psychiatric emergency service [indiscernible] started officially may 13 of this year. as you might recall, the early demolition project completed towards the end of 2023. public works is expecting to start construction for the family health center phase 1 the end of it summer.

we complete the bidding and award of construction contract. phase 1 is primarily demolition project based on availability of funding for the foundation capital campaign. i won't go through the highlights but key take aways. there are photos highlights different phases of construction. the lab mentioned is most complete. it is all the sheetrock is completed, utilities completed with [indiscernible] dialysis is middle of sheetrock instillation and all areas with painting to start next month. next slide, please. just quickly the focus on the [indiscernible] this is a good representation of the type of flexible pipe connections that will be installed on all floors level 3 to the roof level. in addition to adding a new 24

inch wide seismic separation between building 5 [indiscernible] these are all the pipes being retrofited to allow for movement. [difficulty hearing speaker] once we are able to figure out the new walls and super impose with existing rebar and scans we have done, then the contractor can start the framing. that concludes my portion of the presentation and will turn it back to mark. before mark jumps in, i want to say the 52 percent seismic, that is huge. this is like 207, 211 locations that are tearing the walls apart, adding concrete, cutting, chipping, making

noise:imagine the infection control standard we have to apply. we are at 52 percent of the 211 locations and so i'm very happy that we are at this point. looking ahead, we were at 10 percent, it was a uphill view and then also on the dialysis, that is looking really good and right across the way is rehab unit completed two years ago. it is a beautiful rehab unit t. is amazing to see something that beautiful inside the building and knowing the dialysis unit will look just as good coming out of one och the oldest buildings. it is really a awful place. it is great to see it all most done and coming in, so thank you joe and team efforts. >> next slide. this is the pride hall.

took 10 years to negotiate the ground lease by the way. mostly, hundred percent--there are stragglers in some buildings we are working on to get them out. between now and november-next slide-2024, we are working with staff what happens with the spaces they vacated to reoccupy them. i think-we can open up with questions. >> thank you gentleman for your conciseness. it is all very important information. >> thank you, any public comment. >> sorry, i jumped in before you. there is no public comment. >> any commissioner questions? alright. >> it is great work. you have really worked. you have been presenting to us. you really moved it along, and

congratulations and i look forward to your continued completion of the work, so thank you very much. >> thank you. >> the spaces are clearly beautiful. the ones that are all most complete and you can tell it will be a marvelous facility, so thank you. >> commissioner chung. >> just really happy to see that coming into the building. i remember used to work in the ground floor of the complex, and there were no windows and i kept thinking, what happened if that is a earthquake, so glad to see it is finally getting done. this is in the talk forever. last 20 years at least that i can remember. actually, last 30 years. i forgot how old i am. yeah, so i'm really excited to see all

that happening and cant wait until all the work is finished and the commissioners get to have another tour. >> over state the significance of a beautiful place to work and to heal and help people so thank you so much for your work. >> thank you. >> thank you. >> just to emphasize the gratitude to the team for pushing this forward and the infrastructure that is been improved is remarkable and also the fact that the bond proposal still evolving and not on the ballot just to state that chinatown health center, hasn't been touched since 1965. city clinic had to close down a few weeks this winter because there was no heating, it is old fire station. i think already [indiscernible]

just to say the infrastructure needs to keep going. i also wanted to take a beat. we are close on time, but terry saltz is retiring, and i hope it wasn't a secret, because i just--just to thank him for his incredible work. [indiscernible] he wants to keep changing thing, so thank him for his incredible countsbution and the work he does continues to create a very strong foundation for us to provide the best care and best environment and in the safest environments for people in san francisco, so thank you terry for many years of service. i don't know if you want to share how many years. >> all most 35 years. >> so, congratulations on your retirement and we'll miss you and hope you come back in some other way, like so many of our great people do.

>> thank you. >> coming back two days a week. >> excellent. >> thank you. thanks so much for honoring and bringing that up. indeed. >> you three don't need to stay. please know you can go with your busy lives. as i said to the others. >> thank you. >> alright. the next item is joint conference committee report. first from laguna honda hospital. commissioner guillermo. >> this will be short. at the june 11 laguna honda jcc reviewed what you saw in today's presentation, minus the sustainability plan, really waiting and eagerly for the letter says we are recertified, we understand it goes to billing first before any official word goes. you get a provider number i guess, so that is how the bureaucracy

works but waiting and then we reviewed the human resources and regulatory reports in open session and approved the credentials and minutes report in closed session. >> any public comment? >> yes, mr. shaw is here with us. you got three minutes mr. shaw. >> thank you mr. morewitz. >> this is patrick munet shaw. during commissioner guillermo committee meeting report she didn't mention i asked to display the handout on the overhead projected which shows the discrepancy in number of patients who no longer have skilled nursing level care needs discharged compared to [indiscernible] recent presentations to the lhh jcc made by roland pickens calling into question voracity. pickens reporting buried several reports about these patients.

on may 21, 2024, pickens stated 28 minutes 7 seconds on video tape, in april of 2023, we had all most 90 residents who didn't have skilled nursing level care needs. what happened to the difference of 28 patient between may 21, twen 24 and 64 patients on slide 4 during the june 11 meeting? as well, slide 2 said lhh was waiting for recertification. [indiscernible] how long is recertification going to take since recertified in april 2022? thank you. >> any commissioner questions on this report? okay. hearing none, the next item is

consent calendar, and you have before you a list of the policies and procedures that the lhh jcc recommended for approval by the commission as a whole. we did have some questions answered to our satisfaction as well as a few miner corrections that they have shared with us, so i would entertain a motion to approve. >> i move to approve the consent calendar. >> second. >> any public comment? >> i do not see public comment. >> all in favor approving consent calendar, say aye. thank you. next is update from commissioner giraudo, it sounds like a wonderful meetings. >> it was. good meeting but first i like to thank commissioner chung for her insight and

participation with on our committee and you will be missed. particularly for your like i said, your insight, your comments and giving all of us just great information and advocacy. >> thank you. i will come back and crash the meeting as a non-voting member. >> we welcome you any time. my report will be short. it was on the public health lab and the focus on the emergency response readiness, and the public health networks of the labs are local state and federal. the national emergency response is in three areas, sentinel, which is where

we are, reference, which confirms testing in the top is the national labs which have definitive characteristics of whatever the issue is sent up the chain here. california has 12 catchment areas for emergency lab response. the focus today is on the h5, n1, avian flu, covid and m poxs are the three top. when we were last had the presentation, there were a number of significant vacancies in particularly the micro biologist and there are no vacancies at this time. they have all been filled. the shared lab test that has been developed with 18 other labs

that we are all part of on particularly on m pox 4 plex and it has really been quite an achievement of our lab. the electronic data exchange is essential, particularly if there is a earthquake, fire, any sort of disaster that has been quite well developed. the new lab as you saw in the last presentation will be moving and they are very much looking forward to it with especially when we had a description of a lot of their machines and et cetera that are so sophisticated and state of the art that they will

actually be in moving out to zfgh. when one of the-i asked and commissioner guillermo were asking about the wastewater, they have a machine and once it is moved over there, they will be able to do the wastewater testing, so i thought--it was a very interesting presentation. i don't know if commissioners you have anything more to add. >> i don't. that was a wonderful summary as usual, overview. the only thing i have to add is that, once again, cecilia chung is leading me as the commissioner somewhat. i came on to the hrc when she was just stepping away and she handed me the baton, so i'm really glad to know it is only a small committee and i will see her in the audience with

commentary going forward, but i want to say how much i really enjoyed sitting on the small committee with you community and public health and so glad i get to continue work with you here. >> thank you. just make sure i'm not going anywhere. >> wonderful. any public comment? >> there is no public to make comment. >> any commissioner questions or comments on the wonderful report? always love to see the incredible camaraderie among members of the commission. it is really a special treat to be part of it and to enjoy all your company. i guess we go to other business, right? >> yes. yes. >> any other business? okay. no public- >> no public comment. >> we talked about delaying our closed session and- >> all we do is announce that

and--all you need to do is announce the commission decided to delay the item. >> with everyone commission, we'll delay that item until i guess our next meeting and figure out a time. >> we'll figure a time. >> with that in mind we don't need motion for closed session so we need a motion for adjournment. >> i so move to adjourn our commission meetic. >> second. >> all in favor? >> aye. >> thanks everyone. [meeting adjourned]

[♪♪♪]

>> my family's starts in mexico in a small town. my parents are from a very, very small town. so small, that my dad's brother is married to one of my mom's sisters. it's that small. a lot of folks from that town are here in the city. like most immigrant families, my parents wanted a better life for us. my dad came out here first. i think i was almost two-years-old when he sent for us. my mom and myself came out here. we moved to san francisco early on. in the mission district and moved out to daily city and bounced back to san francisco. we lived across the street from the ups building.

for me, when my earliest memories were the big brown trucks driving up and down the street keeping us awake at night. when i was seven-years-old and i'm in charge of making sure we get on the bus on time to get to school. i have to make sure that we do our homework. it's a lot of responsibility for a kid. the weekends were always for family. we used to get together and whether we used to go watch a movie at the new mission theater and then afterwards going to kentucky fried chicken. that was big for us. we get kentucky fried chicken on sunday. whoa! go crazy! so for me, home is having something where you are all together. whether it's just together for dinner or whether it's together for breakfast or sharing a special moment at the holidays. whether it's thanksgiving or christmas or birthdays. that is home. being so close to berkley and

oakland and san francisco, there's a line. here you don't see a line. even though you see someone that's different from you, they're equal. you've always seen that. a rainbow of colors, a ryan bow of personalities. when you think about it you are supposed to be protecting the kids. they have dreams. they have aspirations. they have goals. and you are take that away from them. right now, the price is a hard fight. they're determined. i mean, these kids, you have to applaud them. their heart is in the right place. there's hope. i mean, out here with the things changing everyday, you just hope the next administration makes a change that makes things right. right now there's a lot of changes on a lot of different levels. the only thing you hope for is for the future of these young kids and young folks that are getting into politics to make the right move and for the folks

who can't speak. >> dy mind motion. >> even though we have a lot of fighters, there's a lot of voice less folks and their voiceless because they're scared. >>