submitted that. after speaking with supervisor campos, he asked us to identify what, if any, sides had received cultural competency training. of the total staff in the single system, approximately 100 staff received it. delores street, working with people in the mission. hospitality house. larkin. msc south. supervisor campos: if you could clarify that -- how many received and the percentage? >> i cannot have a percentage. we have asked hsa to follow up and give us the number of staff employed at each shelter. but if you turn to page 5, you will see the cultural competency

component. the letter after this indicates they used the curriculum in the training manual. 11 staff a tendon that training. i am not 100% sure, but i believe that is reflective of all the staff at the lawrence street. there are 85 clients at that street. -- dolores street. at the top of the page, this encompasses the two large shelters next door and sanctuary. approximately 534 clients at that site. 26 people received training in cultural competency. if you go up a couple of pages, the second line on page six, ucf, nine clients -- staff

providing services to 534 clients received transgender cultural sensitivity training. if you go down to hospitality house, within the text of the report -- the number of of really high -- hospitality house encompasses three programs besides the shelter in itself. basically, they have 30 people on staff, 30 people received cultural competency training. above that, they also have trading on the elimination of transgender workplace bias. supervisor campos: if i may, one thing that i was wondering as i was reading the report -- we talked about this a little bit. is there a way to know what percentage of staff that works in the shelter is actually

getting the training that is needed? >> the committee requested information from the human services agency. the human services agency spent a lot of time putting together employee lists, but some of that information was not provided because it was not asked. we followed up with an information request this morning, asking that we have the number of all staff at each site. what the committee is hoping for in the 2010-2011 fiscal year is that 80% of all staff will meet the training requirements, although the legislation requires 100%. supervisor campos: where do you think we are right now? >> probably below 15%. supervisor campos: 15%? >> yes, for every training category. supervisor campos: you mentioned

there is a shelter training manual. is that something -- how is that embedded in the operations of a shelter? people know about it, are trained on it? >> in a single adult system, they are supposed to be trained on it. perhaps the human services agency can speak to this. i believe it is part of their contract that they have to trade within the first three months of coming on. there are certain chapters that you have to cover. there are additional chapters. supervisor campos: i know they are supposed to, but are they doing it? >> unfortunately, without the data, i cannot tell you. only one side responded that they used the training manual in the information collected. in the follow-up information request, what we have asked hsa, is whether or not they are

utilizing those training manuals. supervisor campos: out of how many? >> one site out of 13 -- no, that is wrong. 9 shelters and resource centers for single adults. when i spoke with you, committee staff had been going to all the sites during training about standards of care, changes in our methodology. in those interactions, we know for a fact that other sites have utilized the shelter training manual. unfortunately, that information was not captured in the data we received. that is why we are asking for more information from hsa. supervisor campos: i have a number of questions, but i will turn it over to supervisor mar.

supervisor mar: under supervisor ammiano's leadership, shelter had become one of the major reform issues. several months ago, the board had a fall of shelter reform process that was supposed to create greater access for reservations, create better training for disability training, and also, move to safer and cleaner sites. after the passage of that, had that change anything? >> the training component is offered by the city and county of san francisco. as far as i know, the city and county has not offered that yet. that is done in cooperation with the mayor's office on disability. i have not received any information from either of those departments stating that they have coordinated training. when supervisor campos asked me

what i would rate the percentage of compliance -- 15% -- in the data that you have, no site received ada training. as far as the access issue, we will be tracking that this quarter when we do a turn away report that is part of the new legislation. that will provide overall analysis. then we usually interview 30 to 40 clients. supervisor campos: i have a couple of sets of questions. some are to the specifics of the report. then another set of general, structural questions. going back to training, as i see the issue of training, i believe it is critical to have proper training provided to staff.

the idea behind training is it will ensure that each person who is at a shelter is being treated with respect, dignity, so that safety is also injured. so is troubling -- ensured. so it is troubling to me when you show these low levels of compliance, when you have legislation requiring 100 percent staff being trained on these items, and the number you are talking about -- i know it is not an exact number because the data is lacking -- even if it was double 15, 30% would be troubling. how do we know, as a city, that the fact that the kinds of

things that training is supposed to avoid an prevent from happening, are in fact, not happening? >> part of the methodology the community uses when we do a site -- committee uses when we do a site inspection, when we do follow-up investigations on complaints, we interview clients so that we are able to capture from a client perspective how they were treated. that is not the most perfect way, but that is one way we gather data. the other way we gather data is when we go to the site, we talked to staff. we ask them what type of training they recently received, so that we can have an ongoing understanding of which side is getting what type of training. i think the reason this is a policy suggestion of the committee is to really be able to hold a site accountable, tools need to be provided.

these tools are sometimes costly. right now, there does not seem to be within the city and county a standard of care training module going out to training sites. it is unclear what agency is tracking that. is that the fault of the committee, tracking providers, dph -- so what the committee is looking for, looking to you, our resources are allotted. sites can have an opportunity to send some staff to training. that information can be brought back and they can train the trainer. we are looking to see if training manuals are being used, which staff has had what type of training, so we know what is lacking. right now, the data that we have

is inconclusive as far as which sites have had an opportunity to sit down and go through every chapter in the manual. supervisor campos: on case management, you are having 11th -- talking about having 11 case managers for close to 1134 adults. you noted some of those case managers, sometimes the number is actually smaller because some are assigned to specific sites. what are we talking about in terms of the specific case load of these case managers? >> unfortunately, i do not have that data. the information we got from the roving team, you are looking at one to 54 or 136, depending on the services they are providing. delors street has 85 clients.

they have two case managers. that ratio is below below. hospitality house has 1430. -- 1 for 30 clients. the two case managers in the south are there to refer clients on to other services within the city. next door on sanctuary, they make up a huge percentage of. over 60% of them, and there is no case manager at the site. the other challenge is the city has not clearly defined case management, and i feel that is an important component in holding people accountable to what kind of services they are

providing. last week, and warren did testimony -- a woman gave testimony about how she was unable to access services for the first 90 days she was enrolled. supervisor campos: if you just look at the numbers, you are talking about 100 cases on average, but eat you take away some of the -- if you take away some of the case managers assigned to individual sites, you are talking about an even greater number. i'm just trying to understand. >> for example, we're talking about the three largest shelters -- msc sells and sanctuary next door. that is 77% of the shelter. there is no case manager on- site. supervisor campos: what?

>> there is no case manager on- site at any of those locations. the information we got stated that there are two. again, public testimony last month was that they connect people to services. the roving team of case managers goes to each of those sites and provides services. that is the case management model. again, going back to the 2008 ford, it was not only looking at lower numbers, the one to 50. it was also looking at a tool for staff to have the component there and help provide better services and may be involved in that into the training component. >> what happens to those 800- plus individuals with there is no case manager? >> a percentage of those are on care not cash. they receive housing services.

sari the county assistance program -- sorry. the county assistance program provides housing, housing case management and help people get on to a special case services like food stamps, etc., but the case management as the committee has started to define it is looking for employment, housing, mental health services, and also looking to a shelter staff in working with clients who may not necessarily seek out those services. to have a case manager within the shelter to perhaps utilize something similar, but that

happens in the shelter so that clients they may think of as lead people who need services but are not self-referring, but there is something on site or to take them to larger sites with the case management can work with those clients. supervisor campos: you talked about the number of tokens that are provided. in your report, the executive summaries say that the agency allots about 1250 tokens a month. what is the actual monthly would be any in terms of tokens that the shelter systems have? >> again, i do not have that data. anecdotally, i can tell you that in the committee goes out and conduct site inspections, particularly at locations that also do reservations, one of the first questions they ask is if you have tokens, and if the majority of the time, the answer is no.

i know that at providence, which at certain times of the year also acts as a family shelter, they have a certain amount of tokens, and they give some to the family members so the family can come back into downtown and go back out. in 2010 and 2011, the hsa put out 1000 tokens, and they have increased that in october to 1250. >> -- supervisor campos: you said that was enough to give one -- >> approximately. there is 1134, and a percentage of those people are on a program where they might get a fast pass, but just to give you an overall sense, that is what to do distribution would look like. supervisor campos: i have more

specific questions, but i do not want to belabor the point. how does the shelter monitoring committee work with regard to hsa? i'm trying to understand the relationship between this committee that is supposed to provide essentially some oversight about the shelter system and what is the committee's relationship to hsa structurally? >> the shelter monitoring committee was created and made changes to the administrative charter. it is an independent body. it has two main purposes through the four different pieces of legislation that have changed since it was started. one is to conduct site inspections, a minimum of four a year of each side, and provide that information to the board of supervisors, the mayor's office, and any other individual that requests it, and the second

is an implementation of a standard of care that the committee not only takes from plants, but in the changes that were made this past summer, that when they are now conducting investigations, they can initiate a complaint at that time, where before, the process was always a client-driven. hsa has a seat on the committee. they hold the majority of the contracts for the shelter for writers. their relationship is the -- that we provide information about the concerns and the data we have collected to all agencies. some of the information the committee has provided around access issues have been part of the change in policies around reservations days and changes locations as part of another

process, so hsa has the information from the shelter monitoring committee, the service providers themselves, and my understanding is they use that information in making some of their decisions. supervisor campos: is the shelter monitoring committee under hsa? >> no, it is not. as far as i understand, it is under the legislative branch. it is under the board of supervisors that created the administrative code. the staff is a department of public health staff, but the shelter monitoring committee is not under the department of public health. supervisor campos: the committee staff its staff of hsa? >> of dph. i am employed by the department of public health, but i work for

the shelter monitoring committee. supervisor campos: in terms of a report like this, let's say you outline the problems you have outlined in this report -- what happens to that report? >> the information is provided to the board of supervisors and to the mayor's office. the human services agency and department of public health respond to any questions we have through the information request. at times when recommendations are made, hsa will respond to them. they are not required to. as far as the complaints, that is information we continually try. we provide it on a quarterly and annual basis through these reports, and we also provide follow-up information to all the sites. supervisor campos: who insures that the problems identified by the shelter monitoring committee

are unjust? >> through the center of care complaint process, it would be the department of public health because the standard of care process is a complaint process in which a complaint is filed by a client, the site response. the site says the client is not satisfied with their response, we do a follow-up investigation and submit our findings to dph and the site. supervisor campos: 1 the report says there's no verification that -- when the report says there's no verification that staff are being trained along the lines of the organs the code requires, when there are issues around transportation, dph is the one -- >> i'm sorry, i misspoke. supervisor campos: who makes sure that the concerns you have

identified our address? >> i do not know. the key the data to the supervisors. it is our understanding that the data gets shared with the hsa as the contract holder, and they make changes as they see fit with the data we have provided. this did care component is the component -- the standard of care component is the component overseen, by the department of public health. the data in the standard of care reports themselves provide a system overview and system recommendations, so it would fall within hsa. supervisor campos: 90. supervisor mar: -- thank you. supervisor mar: thank you for the quarterly report, but it is becoming clear there is no accountability in how the system works. if i were sitting here, i would

be fuming about this. i'm starting to understand why they called it the runaround. i guess i just have a basic question, more from a human level -- how far have become towards a more people-centered process that supervisors amiano, campos, and others have been advocating for along with myself >> that is a challenging question to answer. you have to look at some of the individual sites to see some of the improvements. i will say that will world, you are seeing some of the same challenges that were reported in 2006. where i think you have seen improvement that has been documented, part of the work of supervisor amiano was about making basic health improvements within the standard of care, and

you are seeing more access to personal hygiene products. i feel that is a big improvement. early on in 2006 and 2007, you started to relators put into every single shelter, and every single staff person at that point proceeded with very thorough training. not every site now has a defibrillator. the staff that i interviewed, most people have not have first- aid training. supervisor campos: thank you very much. why don't we provide this opportunity to hear from the department if they want to add anything or respond to what has been said. good afternoon. thank you for being here. >> there were a lot of this characterization's -- this

characterization -- mis characterizations made today. i would like the site manager or the program manager for both of the shelters to respond because i cannot talk on the everyday, grass roots level, but she is here, she is taking notes, and she can respond to some of the things. i do want to say that's quarterly reports are prepared, and we do take into consideration through community meetings with all our shelter providers the recommendations made from the shelter monitoring committee, and i do have a staff person that sits on the committee. yesterday, this report that you have in front of you was addressed, and i did not get the full report until yesterday

evening to respond to some of the things that were there, but this has been -- what has happened throughout the entire shelter monitoring committee process is that even though i was a member of that committee from the very beginning, the it takes up until the 24th power to actually approve the report. the substance is there, but if you are working from a draft the day before, and i do not get it until towards the evening time, it is really hard to respond to some of the issues. supervisor campos: i think you raise a very important point. is there a reason why we could not have a process where the report is presented, and then there is an opportunity for hsa to respond and have at least more of engage process where it

is both sides talking about what the report says and actually being able to talk about some of the specifics. >> exactly, and when you came on board, that was the process, that it was a report presented to you. if you for any of your fellow committee members had issues with the report, then we could come back and address them, but what i want to say before cathie gets up to speak is the enhancements to the shelter monitoring committee where it was monetary issues has never been fully funded. supervisor campos: let me ask you this -- in terms of process, do you think this is very substantive stuff that has a lot of facts, a lot of details in the. i'm trying to understand if in terms of process, would it be better for us, having heard the presentation from the shelter

monitoring committee, to then give you an opportunity to look at this report and maybe come back to us? >> i would love to respond, but a lot of things that bernese said today is not in this report. that is some of the issue that i have. she talked about the defibrillators. one shelter did not have a defibrillator. when we put them in, we put them in all of the shelters, the single and the family, and most of the conversation here is about singles, although the family schulz's to come under the shelter monitoring committee legislation. it would really help me because i think some of the issues i have is if i'm presented with a report and when the report is given verbally, if it goes of what is written, then i have to write down some of the things