>> present. >> commissioner christian present and commissioner chung commissioner giraudo read the commissioner giraudo read the land unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory.

ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> thank you. >> the next item on the >> 2. approval of the minutes of the health commission finance and planning committee meeting of june 4, 2024. you have before you the minutes and if are there any additions or corrections? hearing none, a motion to approve. >> second. >> and what about public comment. >> i one person has to participate remotely and i don't see oh, i see a hand there we go. >> three minutes mr. bradshaw. >> okay. give me a second. >> this it meeting minutes are the previous testimony with a component of the subsequent plan for the cms for the quality

conference and the bathroom, was removed from the subsequent plan protected on june 18, 2024, shouldn't pass the minutes because of glag omissions unfortunately, because of the written testimony one hundred and 50 words limit i should mention test number 5 on the testimony presented quarterly evaluation cms refused to remove the safety 2024 a $3.2.6 million no medication of the quarterly reviews or whether they have a - h s a g is one designated in the

innovation and one of the quality experts have designated quality improvement organizations this commission should not be concerned they're involved in the expert contractor if one dies and those minutes are my statements was not a doctorate and stated no one was was presenting this clearly refer to me in my written testimond an official apologize from the health commission and stat the facts in the williams presentation this misinformation is false and nosely o 34i89d the details of the■ twenty-four hou slide 6 subsequent plan presented june 18, 2024, a failure of health commission to summarize anything in the power

point presentation and included the remarks was referring to me and presented this misinformation about the subsequent plan presented on april 10th. thank you. >> that's the only public comment. >> motion and second. >> all in favor, say "aye." aye. and the next general public comment and secretary morewitz will read the statement. >> be afforded when the item is reached in the meeting. each member of the public may address the commission for up to three minutes. the brown act forbids the actions not only those in public comment and please note individuals has one opportunity to speak and individuals may not return. and written

communications maybe sent to the address the word health dot and commission and d e h as dph and if you wish to spell your name not taking time but the policies for the local law prohibits skriemgsz is he checking this is the general public comment anyone in the room like though make general public comment and okay mr. bradshaw i will give you a second to put it it up and no comments for this item. >> in that case the next item the director's report in front

of and 2k4rb9d with the first item the laguna honda recertified into the federal medicare program and laguna honda can support the residents regardless of their financial status and by medi-cal and medicare funding for their care and not relying on that versus for laguna honda has been fully restoreed. >> laguna honda representative by the commitment for the san francisco nursing care and more than representing more than thirty percent of san francisco and laguna honda provides safety net to hundreds of individuals with complex medical and care needs and couple with the successful medicaid completed in

august of last year little league is fully recertified and full completion of two years of recertification for cms and thank you. the leadership team and all the residents laguna honda our union partners and wanted to acknowledge who has been a huge champion for laguna honda in the audience today and formaler city attorney champions of laguna honda. >> the next item moving item two board of supervisors introduced a three hundred and

the bond includes one hundred plus million dollars to have resilient and accessible health infrastructure with $56 million zuckerberg's and laguna honda hospital $40 million to the retrofit a key building and $71 million for renovation of health center and $20 million to relocate and modernize the funding a key department to operate the hospital and modern facility and the improvements areville at&tal to maintain our certification and providing excellent care the 2024 healthy

bond will allow to do that by the infrastructures and in some cases one hundred years old that helps to modernize the health services. i get in other news i want to point out last two weeks ago he mentioned the difficult treatment for infections are detected in rare cases and there's the larger description of that in the director's report here. and need to follow those cases and um, we have notice confirmed cases of the how to treat the infections in san francisco yet but put out a notice to providers with regards for testing and treatment and finally, i wanted to point that

out the received an lieutenant governor healthcare and quality designation for the foundation recognizes have achieved as healthcare quality index so we complete our pride month in june something to point out and additional items not in the director's report but join a contingent over many volunteers and in the pride parade an 1u7bd we had great opportunity to educate san franciscans about the importance of staying healthy and our health and department does have a quote for this first time that is focused on our healthcare facility on the network that was fun and also our savior campaign and

provide provide where to find out more information and the last item to acknowledge we are in the givensz of a heat wave and coordinating with the department of emergency management the lead agrees is in those types of situation to get the information they need and double checking that is where to go more information as f 72.org and continue to monitoring the clinics and our other facilities to make sure that staff and patients stay safe and providing information through dem with the partnering where people go to cool and just to be clear, most of the city right now is is in the minor heat risk and one part of the city in monitor but we'll

go in the next twenty-four hours hours and that completes my director's report. >> i'll be happy to answer any questions you may have. >> and first on record to give the great news about laguna honda thanks any public comment on the item and there is one oh, anyone in the room. okay. we've got one member of the public. >> you have three minutes. >> thank you. secretary morewitz. >> as i testified during the commissions june 18, 2024, the $66 million portion allocated for this and san francisco bond measure proposed for the september ballot dr. colfax mention will fund only 35 pictures of $3 million for the total repair for the facility and publication marketing

material is a backwards - funding projects like the rooftop and the replacement of transfers form and no actual list of had alone funded perhaps no one will receive no funding and unless a list of which projects get the bond money if no list of actual projects they are obligated to repair i'll be using any web site platform to vote against this bond dr. colfax report quote laguna honda proposed projects are tied to regulatey requirements have a direct and maefb enact for the

care we need in san francisco and end quote. one of the wish list of $68. million will be needed repairs is one $.4 million before the parking lot has has nothing to do on the quality of patients care and two, since july 2019 they have received the funding totally $10.9 million and forward and under 2 point one for a total of $13 million for the facilities maintenance are needing capital repairs and they should useless this and it already does and

thank you. >> that's the only public comment for this item. >> any go commissioner comments and questions on the director's report. >> serging next item own the agenda the skilled nursing project update and becoming welcome back and kelly the advisors. >> the light went out temporarily i'm going to turn it back on. >> there we go. >> introduce yourself the light is. thank you. commissioners good afternoon. i'm contingency for the term of july 1, 2024, through june 30, 2027, (3 years).(kimberly voelker, is project director) and die we're going to be presenting the transfer report

and services in san francisco. and last year on the 2022-2023 clarjd year that was the first report that is provide to the health commission for this manual requirement today is preservation will be the 2023 report that has data in much greater detail. next slide, please. the dat report is required by local ordinance it is i want to provide a little bit of 2k3wgd and as many of i are aware the laguna honda hospital transferred in the st. luke's to the campus and the latestau information provided last tuesday for patients and these will be enclosed in when the

last patient leaves and - so san francisco does not have any admitting facilities leaving san franciscans care stone transferred to a different facility so the board of supervisors hesitate an ordinance that reflects indicate if left lane hospitals to have a better need of skilled nursing and care in san francisco and the ordinance requires dph to receive this information and provide a report to the health commission annually about that data it is provide by local hospitals and briefly want to go over the topics nursing care for patients who are medically stable have a need by a licensed professional and the skilled nursing care patient need

ongoing specialized care more complex needs and need management and tube feeding after hospitalization care. next slide, please. so from the language of ordinance you all are familiar reporting the health faculties report on the number of san transferred by the facility to an out of county to receive skilled nursing care and required to report to the residents and non-resident quality and admitted before you not to a skilled nursing faculty the purpose was to understanding the number of patients needing a bed because they're not or in a hospital bed no availability of a skilled nursing facility bed and for

each patient categories hospital will report demographic that is on the slide and that is including general skilled nursing that is in the interest of the nursing care in particular to choose that and report it data prop a and i want to note this is not airlines obtainable to collect and in particular collecting information not for patients that are disarged that a challenge for all facility to estimate and for them to report so for that reason i'm focusing own that population category that data is provided in the report for each hospital and then not required from the ordinance for calendar year 2023 after last year, we requested

that hospital report the number of patients discharged in the cubit and also during that presentation last year um, was from from the health commission around understanding how residents are placed when if we go to a skilled nursing out of the county for this year's report we are requesting a list of out of the county for san franciscans displaced. next slide, please. perfect and so this slide shows the san francisco facilities that are required to report the ordinance applies to the san francisco health facilities that are skilled nursing facilities i want to take a moment on this slide a recognize the work they have put both the report data as i mentioned not easy to get the information but the collaborate

with the department and continue to make improvements in the collection every year the next slide, please. perfect. >> so before we go into the specific data points and finding and the limitations and challenges i want to cover the finding from the report it is really because we require despite the challenges and limitations we face have a greater findings of skilled nursing ever substitute care across the facilities and with the additional exponents are requested for 2023 finding from last year's report. so as you can see own this slide month hospitals are having people transferred in and out of the county. the population of hospital encounters transferred to the nursing in county and out of county and ethically exists

that medi-cal is the highest in the encounters transferred to a skilled nursing facility in and out of the county and also transferred to a skilled nursing facility and finally that most san francisco residents nursing transfers in the health facilities placed in san francisco. and. next slide, please. so, now we covered the finding before we take up the data um, i want to summarize the data collection we utilized for the facilities some have listed on the slide firstting facilities recognition to determine the number of patient transferred to a skilled nursing facility that is discharged is the built in the electronic health record and skilled

nursing is not built into the electronic health record it requires hospitals to come up with a unique ways for medical charts to find the patient 80 transferred to a nursing facility and three of the facilities ucsf and kaiser permanente can be connected to the health records and so that would be capturing those hospital encounters have quality or met the criteria because very had a level of care and utilized by u f g and indicates had a patient is in a medical condition was revolved or admitted without a critical health condition so if what patient is receiving the healthcare an example avenue low level of care patient i would

like to note the methods and accommodation were used is detailed in the report that each year reporting has made improvements and made changes to their own way to request the data they're getting closer to that actual population. and. next slide, please. and great before we jump into the data after the prior reports limitations should be considere illustrate whether a common methodology across all hospitals that data should not be compared to the hospitals or provided so first, i highlighted kind of in the prior slide each facility customized the electronic health records he if available in the

system and second not other facility can differentiate before a transfer versus out of the county. third as mentioned in the prior slide health is defined requiring the methods to find locations and then fourth, clinical presentation and treatment needs change department of education and health facilities reported they don't have the ability to see a patient was not discharged because not a bed available versus a patient not discharged they didn't need the bed. and that lastly one of the most significant challenges for reporting the population my qualify for welfare but not going to that level of care and many of the liemthsdz like i said many of those will continue to be challenges for this

database the data by the hospitals are highly individualized and any changes are outside of what they're able to collect and takes year for staff time to train and can't take the resources. so the next slide will be the actual data in no response with the privacy rules and so the slide here shows the number of transfers to the skilled nursing facilities and in county and out of the county. by residency status and as you can see for china hospital is ucsf for the city of san diego were placed in skilled nursing facilities located in the city and the data combination both out the county and in county discharges because

they're data slides provide demographics and information unfortunately, not have the ability or give the facility information but i'll talk about this later on in the report as part of the facility mapping process dp m pulled a list of out of the county with the discharging designations we identified the ones out of the county and so from that, we found more than 91 percent or about 2 thousand plus of dp mc discharges were facilities in san francisco we don't know the residency status of this population whether they're san franciscans resident or note. >> so the main taky transferred san franciscans were placed in nursing facilities in san francisco and. next slide, please. the slide shows the number of

transfers to skilled nursing care and as evidenced by the methodology i know i said that before the methodologies by the haight facilities varied which is highlighting why we can't compare the data is three hospitals kaiser permanente have acute discharges with electronic health records and the challenges need in the footnote at the bottom they're not used by hospitals for example, ucsf found some encounters with a discharge were transferred to facilitate don't offer the substitute but the discharge status code is likely on over estimate of discharges. and additionally dignity and city of

san diego have the providers list and on the list was a discharging or with that over estimates the number of discharges many of the facilities don't provide the skilled nursing services is he for u sf g has seen in what person has oriented a level of care while in the hospital as you can see all hospitals on ucsf discharged fewer 10 patient to the facilities. next slide, please. and okay the next section of data for 2023 but in response to the feedback we received in the 2021-2022 report um, this year the hospitals were asked to provide a out of

connected for retained to be transferred the address if this information is cloaked by the hospitals and the number of transfers to each facility with that information we went and estimated the distance where san franciscans were placed and one note about the announcements reporting health facilities for the data are aggregate but didn't have the resident address of the individual who respect to the facility for that we used the reporting address and a compost or possible address and then mapped is so the facility and importantly this data does not examine or provide insight why a patient was placed in a particular facility and that shoes out of the county

displacement but because of patient or family if they lived nearby or the other issues. next slide, please. so this slide shows all the hospital nurses transfers by distance range for san franciscans and again, cp mc is responsibility and non-residents in the data and light shaded differently. and then the figure here shows the uncounty and out of the county the blue the first bar and as evidenced by the figure for more of the hospitals either the majority of san franciscans skilled nursing residents in this location in the city and want to noted about kaiser permanente in particular they provided the reason they have a large proportion of our

of the county placements because have a lot of contracted facilities in san francisco which is san mateo and have a limited number of krashlthd skilled new year's providers in the city and preference to place in the locations where is the facility were kaiser permanente. next slide, please. >> all right. so this slide a subset of the same data on the prior slide with it in county discharges and has information for san franciscans you can't see non-residential and resident but out o of san francisco residents 43 percent were placed in a skilled nursing facility within 15 miles and 6 san franciscans were

placed one thirty miles of address and skilled nursing facilities in san mateo county accountability modern 60 pictures of our of the county transfers. and because many facilities we don't have a figure for that and unfortunately, the address information was for more than 4 percent of discharges and next slide. i as i mentioned this distance data i provided is didn't examine why a patient was put in a facility or whether the patient of a family preference of availability by in addition to that conviction other limits to this announcement we just did for the first time but the

hospital records may not be complete for all discharge and some may have an address some have a name or a county or the city the person was placed in and second not augural hospitals will report the addresses so in that case dph staff will attempt to find where that facility items. with respect to agenda items, your opportunity to address the commission will be afforded when the charge records maybe free will text entries it may have chained if they are merged or require different information and fourth many discharging facility are generic names 8 across the state we want identify the person went to and so finally since the announcements didn't include the transfer this is just an estimate. and.

next slide, please. so thank you for the opportunity to present this data i'm going to first again for appreciating our reporting health facilities and then going to visit kelly up thank you, claire and good afternoon commissioners since the last update. um. >> our last update submitted in their applications to cms for the billing and are now waiting for this site. we had anticipated the application will be submitted in january unfortunately, due to details the development the application will no 9 be submitted until april and the laguna honda hospital was waterway an additional $5 million from the

state to support the ongoing renovation for setback for this project that was um, very good ne■. and dph has been focusing on getting those chinese hospital beds so we paused this discussion for san francisco healthcare and hopefully that cms will be 1kre8d their survey to work on the first 23 bed unit and any questions? next slide, please. >> >> thank you (laughter). >> i want to say i believe we have representatives from chinese hospital from - right now and in case questions with

they're specific data or information for their hospitals then any of the other facilities i can try to field the questions or i can follow up on them. >> thank you for the significant amount of data you analyzed and obviously amount o than the last time very instructive and our gratitude for the kwopg of facilities and a heavy lift and granular data. >> any public comment. >> one hand. >> mr. shaw you have three minutes. >> i thought you were going to get my chart. >> oh. >> what we know and want my three minutes please. all right. mr. bradshaw i'll have that up.

>> sorry everyone. >> okay. >> all right. i'm upcoming muting you, mr. bradshaw count to three and the chart will be up mr. bradshaw. >> i'm going to go ahead and start. >> it's up few. >> here we go. >> sdrapd my chart it between

9 thousand san franciscans were discharged across 2021-2022 and 2023 for the level of care excluding care and we're not seeing the dph between in county and out you have district other hospitals using discharges by county. this long overdue data should be used and for the policy for the policies and my sense when supervisor gordon in 2022 the elective it was accurate that are desperately need for the assessments for the breakdown to stop this

franchisee and it is unfortunately, the dph don't have the tables on pages 6 and 9 submitting the data for 2023. that diminishes the maechgness of this report and this health commission must consider one thousand plus out of the unty discharges for the routine and make decisions on using this bed information. and first provides enough beds in the san francisco county and the urgency for the one hundred and 20 beds. today's report should submit the waiver to restore all 120 beds the waiver involves a letter to director of cp h grants those waiver requests and did not need cms approval we can't afford to

lose of 120 beds this report should help with the patient to have traditionally patient and behavorial health power as roll in the monthly bill is considered by the workshop. and if l ah has reduced rockefeller beds and converting 6 hundred plus with three hundred and 25 beds with behavorial health beds will dramatically reduce this in the county that likely disfranchising them and losing 120 beds at la will reduce that but many beds in one swoop must be avoided. >> thank you. >> your time is up. >> that's the only public comment. >> any questions or comments?

>> commissioner giraudo. >> thank you for not only this summary with our report um, with more expensive data it is excellent it really was also helpful in fooufrp or future understanding but brought up an interesting point. on there is no coincide for the substitute 1ki8d nursing in what i got it. this is out of left field suggestion i've been dealing with out of midwest in as they're trying to then on annotate basis code into that system into universally. couldn't someone approach them

about putting in universally a dispute skilled nursing code so that that would be, you know, applicable and apply to all of these might need it they change those things and i'm very much a - they - just a thought that maybe eric or someone would look at making the data collection on your part a lot easier just a thought. >> thank you for the citation i'll take that back. >> i have one can you give us more that context in the number of beds in the city in total? because we're dealing with lower level of care had you look at

the numbers people have successfully discharged with the hospitals and their total alter and kaiser permanente has the system can be give us complexities how we can see challenges of general what, you know, objective people are in beds. >> that's a great question. we're not having it numbers in front of me right now but a couple of things that are for about that data one of the things this data didn't capture what challenges that the hospitals are xeshgs and i mean the discussed that with kaiser permanente but have contact with the providers like the hospitals they operate with you different relationships with nursing facilities out of city so that probably is dictating where different um, san francisco residents are placed but i'm i

don't have, you know, details about that and what they're submitting factors really are um, for the hospitals when they're placing patients. um, but i want to echo that all of them did say that for some patient they need to be closer to families so choose to be out of the county so something we need to consider when we look at the placements as well. >> can you get those numbers to my the total number of beds in san francisco and pass that along to the commission and i'll echo commissioner thompson comments there is is a drop down when people are discharged if 9 hospitals really not a write in opportunity as cms i think their dhr would be so easy to add that

if you're willing to do it and other jurisdictions need this information i'm sure it is a challenge everywhere given the cost and across the country that would be great, you know, bend the ear of this. >> yeah. >> all right. thank you very much. >> so the next item on the agenda we've been looking forward for preparing to resume the admissions and have albert our physician and medical chief medical officer. >> good afternoon commissioners and before we begin our formal presentation i'd like to give you think update on the status of covid for laguna honda as we all know

covid is circulating in the country and unfortunately, we are not unmuseum at laguna honda and seeing the staff it has increased and now have a surge protocol that limits in-person gather and p pe and there victim monitoring and have 6.2 of our units staff are working hard to minimize the transition and laguna honda is a model in terms of managing covid with the nursing facility in the country and beginning of the pandemic and our basin exemptions for control measures community-based beyond those of nursing facilities and want to reassure you that staff are working hard

to um, limit transitioned and protect our residents staff and the community. so accordingly with dr. lamb with the feedback at lightning to implement all the covid surge activities that is why she's not be us here today. so you imaginations a long time in coming before our today's presentation about the missions at laguna honda we're so excited about this opportunity. and um, we'll be hearing more if dr. lamb we know how critical the rolls that laguna honda plays in skilled nursing no if and admitted 1/3rd of utility beds on laguna honda campus. dr. lamb has been

leading the team at laguna honda he working to prepare our processes and policies and our staff towards the date we'll reassume missions. next slide, please. staff has a two-year journey and now fully as dr. colfax recertify in medicare and medicaid and a historic journey and process. we again celebrate everyone that tricked to that resident and families and our partners and elected officials and you are governance board and during that recertification process we made tremendous improvements and the top priorities we begin to prepare for remissions so sustain those

to in order to actually, you more about i'm going to i'm going to turn it over to dr. lamb. >> thank you good afternoon, commissioners. >> um, excited to be here this afternoon and share about our plans a lot of people put a lot of work into this and very grateful for the team and governing work and community partners for getting us here and i'm here to provide an overview of updates to the admissions at laguna honda and like to answer your questions and get our feedback we're excited to resume admissions and caring for the purpose we can't emphasis this is deliberate and gradual our

first goaly certification been waiting on the recertification means admissions have been hard since april ridiculous our next goal is subsequent we know we need to maintain those and i'm confident we have the people and processes in place to make sure that happens. and then our next priority to resume admissions and first we'll begin welcoming the laguna honda resident and other groups based on the policy and next few slides dive into more detail. next slide, please. and all right. >> laguna honda has made significant improvements throughout the recertification process and actually let's go

one anymore slide there we go laguna honda made significant improvement throughout the recertifications process and grateful of positive change and again it is critical those improvements are sustained and know that so that laguna honda can assure regulatory compliant care for every resident and every interaction to help chief this had admissions resume start slowly to conclude check ins for evaluation and only make sure we can care for the revised admissions for the procedures how we provide residents care and remain compliant with all regulations. this is also one of the benefits of being part of san francisco health network we can work with the partners to find the month appropriate fit which may not be laguna honda. so to start we b will begin with

maximum 1 to 5 admissions some weeks only able to welcome one resident because of on the unit or repair or staff to be trained and other weeks able to take up to 5 residents. the pays for each admonition will be in a recycle after every 10 residents or more if directed by the audience will also be admissions within the range. the pds a led by the chief officer and will include the operational component the operational component is a screening tool and the a.d. anything package

checklist and doctor's orders the critical component discharge care deliveries next slide, please. as we prepare for admissions have developed a robust process that was well underway thanks to the disciplinary team we start the 5/mission it is important to note that laguna honda has had many readmissions this year so while not the same as new admissions the readmissions practices and a.d. immunizations planning includes the following improved screening tools to assure appropriateness and laguna honda. recommitting to the process, this for that

allows us to streamline the admonition process adding more uniformist and also for specialized units and at times should the past practice we moved away from reviewing and updating the materials for the last admissions to make sure that skilled nursing and best practices is something we continue to do. we have been developing metrics to sustain the improvements during the recertification those include metrics for admissions that focus on resident care and compliance and plans are the single critical nursing facilities and everything related to excellent care flows through the care plan and laguna honda has used this to recertify

and form the foundations for strong care in the future. next slide, please. just a quick review of our admonition priority group those are proposals 20- zero one. >> resident who are involuntarily transferred from laguna honda and meet the criteria will be given first priority, priority to persons not in the medical facility who are currently receiving skilled nursing or rehabilitation services and have now in need of skilled nursing. our group three folks that san francisco h■1t network needs skilled nursing and or rerehab services people are ready to be discharged for the next level of care and

priority group four folks not in the medical facility that are receiving services for other circumstances and priority 5 patient non-health network facility and requires skilled nursing and/or rehab services. we want to mention that d sf g has their beds is preparing to under community-based undergo the renovation and part of the d f g defense charges for folks we'll be serving under priority 3. and admit care patient in the in support of this renovation project and this is how we work at san francisco health network to insure our residents and in san franciscans

are receiving care in an environment all, all admissions must meet the laguna honda that admissions and not changing that that is an opportunity to provide excellent care not just at one facility but a network and the medium interested of the short stay for 21 days this means that laguna honda will be able to have admissions for patients have short stays and their goals and discharge plans. and once we roll out all priority groups for the applications and make decisions for accepting new resident. next slide, please. so admitting form resident priority one we're overjoyed to meet the staff

interested and eligible to come back and 10 people in this drop off we have already begun the process of reaching out and at any rate, the reviews. for laguna honda resident are considered new admonition and require a full assessment we know how long they've wait and excited to welcome them back home. next slide, please. just the brief overview of what we shared. and conclude with the slide that shows see priority groups starting with priority group one laguna honda resident and then followed by priority group too starting and start priority group three and priority 4 and priority group 5. are planning will make sure the staff and resident and patient

both current and future and making sure the admirations are driving to make sure the success of our organization long term and with that. next slide, please. i like to open up for any questions? >> thank you. >> thank you for the report and again, thank you for everyone who has made much an incredible effort to get us here today. >> new public comment. >> and i put three minutes on the clock. >> thank you very much. members of commissions i'm louise and first want to say thank you, thank you to the staff and all involved in they certification of laguna honda. it is such a worthy effort and a pleasure to be here today and let's celebrate the recertification. i want to make a special point of coming today to urge that we

move forward bringing back the residents who were unfairly in my view transferred and also seriously move forward as fast as we can in bringing new admissions of people that need the care that laguna honda provides. um, one family i happened to know and work with mom born and raised in san francisco she and they are family were born and raised in san francisco and mom is ill right now and all the children have been doing the best they can in care of her reached the point they no longer can and three younger boys in high school and too older ones and mom has to have skilled nursing care, he think she's perfect for

laguna honda but for the possible do something else but stories like that out here in the community. where the need for laguna honda is so clear. so again, i say thank you all involved and anything we can do to bring back people and add those in san francisco who feed did care i urge you you to doing everything we can and if i can help count me in. thank you. >> thank you very much. for your thank you for your comments and an honor to have i hear today. >> we have one remote public comment. >> mr. bradshaw you have three minutes. >> thank you, sir. >> slide 4 preparing to preparation plans to have a maximum of 1 to 5 admissions per week and by 200

and 9 three resident from 2021 to 4 hundred plus takes 59 weeks to return to per week that didn't include the - regrouping and subsequent of the commission might take longer than a single year they have staff positions that have vacancies and with 7, 89 nursing staff should handle more than one admonition per week and as dr. lamb noted and - as stated the one patient from -

for the entire hospital. and l h h h can have is a total of 13 admissions per week and ultimately by the weekly to the neighborhood nursing units a total 665 admissions takes the time to return to seven hundred and 10 resident to restore the residents to the hospital resident for a full year and slide 5 didn't define the four cycles and slide 7 - are interested in priority returned to l h h hard to understand whether 45 of 57 who have not died to return to l h h on 10 of 45 assuming have not died in the

interim represents one quarter of 45 hard to believe and all 45 were successfully contacted? were on the commission resuming full admonition we're mad as hell and not going to take it no where. thank you. >> that's the only comment for the public comment and commissioner questions or comments? >> i guess i have one. we heard in the last presentation about um, this i believe san francisco general one hundred and 15 people were sent out of cubit i'm wondering how do we identify individuals that may have grown up in san francisco and resident until they either had to go to fame in group two maybe or ended

up in instances forces to san francisco medicate had to go to a different county and maybe if you have any number of people that might fit that definition because of involuntarily placement needs is now in county that are not san francisco county yet left san francisco an one time or another. >> that's a great question. we have to get with the dph team and other hospitals to figure out what is the population and do outreach to them just as we're doing to um, former resident for people that fit that criteria and see what is - we'll comment to doing that a might take a team to think about a process and the data you want

and how to determine because i believe that for compensation you're stuck with changing our county had you are placed in an out of county facility. >> that's true the medi-cal and medicaid covers to the county where that skilled nursing is locate so it would require if they're not another county to challenges their medically back. thank you. >> thank you. thank you so much for for this good news and looking forward to repat rotting laguna honda as safely and quickly as possible the next is the cc report at we reviewed the

score cards and got an update throughout the year and reading moving forward at a accelerated pace and did the human resources ceo report and then we also seen to continue to see this improvement how much for the general is an ambulance version they're doing spectacular in areas exchanged in the past and got the medical staff report and recommended the consent calendar the rules and regulations that as a fantastic department at general we're impressed with the report and with the work they do for the community outreach and quality in-person care and approved the report we do in closed session. and any public comment? >> there is a hand.

>> mr. shaw three minutes. >> oh, i meant to lower my hand sorry. >> great. no public comment. >> any commissioners questions or comments all right. hearing none, next item now the committee report infrastructure the financial and planning commissioner chow the finance committee met right before in commission meeting and we reviewed contract reports and several contracts that um, all under the consent calendar for your approval. >> any public comment. >> i see is hand. >> oh, in the hand went away. >> any commissioners comments and questions on the this report very good next is the consent calendar did you have the items

before you that the planning committee recommended for approval entertain motion to approve the consent calendar. >> second and any public comment. >> yes. and i'm here. >> mr. shaw you have a comment phone number for this item. >> i do. what you keep on telling me i'm muted. >> mr. shaw having you have three minutes. >> here i go and it is troubling that the proposed contract 2 $.4 million to help is in critical - for the recertification for a one year and consider why is it not awarded to the second highly

proposal the operational - and designated back up contractors and suggest another contract for the highest proposal is for designation as for a contractor. and just stated in the 2:00 p.m. meeting was chosen for the unit that is completely ludicrous and after that seven hundred and 69 skilled nursing residents and hsh should have been for this contract the statement for the interview for leadership positions and developing a recertification program that work was already completed. (coughing) missing is a quarterly cms regulatory evaluation for this commission that hss and troy

williams presented april 10, 2024. though is one of the 58 organization as the network of contractors at the end to the quality improvement expert and - (coughing) for this commission for the not to be concerned to - why the longtime cms expert quarterly review suddenly vicarious and the long plan for the quarterly reviews were promised to have regulatory compliance. so why are the quarterly reviews apparently not necessary and why where were - and any 34e78 about

they have faded and the commission planning and financed committee that a new contract on august 1.5 quarterly certified quality experts are hard to follow following the recertification the purpose statement mind hsh will develop curriculums and progressives for the leadership provide training and staff to identify and provide recommendations for the serpz with the electronic medical records and provide intervention and your time is up mr. bradshaw a. >> happy the consent calendar a motiono approve and second. >> all in favor, say "aye." >> aye. >> wonderful. >> next is other business? any other business. >> commissioner.

>> thank you. >> good afternoon, everyone so i was um, at the alice pride morning one of the speakers was the person who begun to protest the project and one of the things that she talked about was the um, issue of the effect of social media on kids on youth young adults and while a lot of the - appropriately so focus recently on the negative effects they are significant. but she did bring up the need to be complex about the fact that are also many positive effects that the present and social media has for youth particularly queer youth and other don't fit in the next in this they're lonely and

have healthy support online community but it is social media still clearly a huge, huge issue for mental health for all of us but particularly kids for younger people i think that is an area that the health commission should consider so we can youth do so what the issue in our jurisdiction in san francisco what the exerts work with our youth on a regular basis are finding and what we should be doing here to make sure we are doing everything we can to support and maintain the mental health of kids. and

everything else everybody else. thank you. vice president guillermo i second and third what the commissioner said that is a significant issue there say, i think that is for our behavorial health folks to be able to look at the age spectrum looking at social media from the age 10 to 22. and what the effects are and what mental health is what the effects on mental health and what are we doing what are the services and resources for dph has for kids in not only the school clinics the high school cylinders we partner with but also within our own clinics i think it would be very helpful so have that information and i know that

common sense media and couple of others just published from recent information would be most helpful. for us to um, have some presentation such as that. >> thank you very much. for bringing it up also the surgeon generally identified that i wonder how that fits into the behavorial health division has background and knowledge tous. >> i'll work with the directors office and d hss it is difficul figure that out and i'll be back with you. >> thank you. >> go ahead. >> thank you commissioner and that's all i have to say but

another comment if i may appropriate. >> sure. >> a friend to a friend at the lunch i see a couple of times a year he's a physician with kaiser permanente and let me know he's working on a project on a i and d e i - i want to raise gun i know the issue will be coming back to us but i'm not certain i don't know the full context how the um, the city is looking at a i but definitely want to know as i think we discussed on the agenda the um, the relationship they're looking for things that do relate to the

discrimination within the medical field as well as i'm not sure about the d e i but want to put that own the table but looking at forward to the discussions as they happen. >> i'm aware that the mr. r and his group or working on this and taking their time doing their due diligence and heard i so we'll bring it to you and one more item very simply. with the bond issue. >> that dr. colfax spoke about and jenny louie made an excellent progression to the general hospital foundation and pledged one hundred thousand dollars forces the bond campaign so it was, you know, of co woul

supportive but um, dr. colfax in his discussion persuaded everyone to unanimously approve this. thank you. >> at the for letting us know and thank you, dr. colfax wonderful news anything else thank you for bringing those up i gather we're not doing closed session tonight. >> my understanding i see the member of the public has raised his hand and mr. men shaw did you want to raise your hand for this item. >> i am raising my hand. >> you have three minutes. >> thank you. >> as. the business previously the health commission has two other reports that will be presented one other is la staffing plan with the following subsequent plan presented on june 18, 2024,

today's presentation of la resuming the admonition plan for the stocking plan. the second overdue plan promised months and months ago for the la changes to the yours one for the traditional and the tower for the behavorial health or mental health services. why hadn't that second report and recommendation made for this didn't commission and why not printed before the admissions plan were produced and san franciscans are waited long enough for this promised report to be released to the public and the heartache should direct the give you secretary to report on the commissions forward calendar for presentations soon. and a third future business and other chiropractics this commission will get around to admit all the

120 beds for the 2011 of 2010 the waiver involves writing a simpler for the department of health and grant those waiver requests and don't need federal approval why hadn't that waiver request be submitted and when? whereas is this commission waiting for and for hell to freeze over. thank you. >> okay. thankful that's all so next joined item is >> all in favor, say "aye." >> aye. >> thank you, thank you everyone. >> thank you, everyone. >> !rlocals.

>> (music). >> the work go ahead offered i rec and park friday's local young people between 14 and 17 to be part 6 the

workforce and eastern responsibility and professionalism and gain job skills and assignments in neighborhoods parking and recreation centers and includes art and crafts, sport, cooking, gardening and facility support and so many more. >> (multiple voices). >> i think we're part of the this is the fact we're outdoors and it is really great to be in nature and workreation is great first step to figure out what you would like to do workreation covers real life working skills and expansion can be allowed (unintelligible) it is a really

great program because um, students get placed all the time for what they like. join us in the experience and opportunity and i really like the workreation program it is fun to workout at the summer camp with all the kids each is different and the staff is really nice. >> why? is because i used to go to the local park often when i was a little kid. with my mom i often had to translate for my mom i applied in the hope to provide assistance for other people with first language was for the english. >> i like this job we have fun and working and i feel welcome. >> hi.

>> like how a job actually works like maybe before then i didn't know like all the jobs i don't know any of that now i do. >> it has to be self aware of things and independence of value of this taught me how to be progressiveal but still learning as i go on. >> i learned a lot like a got to adapt and challenges and obstacles come up everyday and . >> i like that we're able to really work with other people and gaining experience like how in the real world hoe how he work with other people. >> if you're looking to develop your live skills as well as cash

and working in the parks, and meeting great people and working with great staff i definitely recommend the corporation. >> it is fun. >> i definitely do the scombrifrm again that the workreation and park and i'll do that again. >> i will

(clapping). >> so nice today. you know, everyone should have the day off today and yeah. >> know i'm joint tenant kidnapping especially the union square ambassadors know not today. um, hi, everyone i'm san francisco mayor london breed and joined today by our union square ambassadors our downtown ambassadors and our union square alliance ceo melissa rodriguez and yerba buena executive director and so many people have a lot to do in the downtown area i want to express my appreciation to all of you for being here but more importantly all of you for building in and