manageable number of in terms of interactions being able to do the annual safety checks, the monthly check? does it seem to work out well? is that on par with other similar types of programmes? >> yeah. so, that has been the case with ratio, i would say, from the beginning. and our services are going to be flexible based on the needs of the individual as well. so, you know, we do have a general guideline of being able to meet people in the community on a monthly basis. so there are people who are fairly stable in the community and the service can be every other month or quarterly or a phone call. it is based on need but that case-ratio is generally what it has been and it is fairly manageable. >> ok. i guess -- go ahead. >> just a couple more questions. i noticed that brilliant office vent relatively modest. it's about $2500 a month.

and so rupp in the building or have a long temple lease? >> yeah. so, brilliant corners has been a space at 1390 market, which is right down the street here and those are going to be, you know, current numbers. we are spending now. so yeah. we've been in long-term lease at this location. >> and finally, she is making too much. and no longer qualified for this programme. does that happen with any kind of regularity, is that ok for this programme? >> it has not arised for anybody to make income, to be able to rent within this market currently now. so we do have guidelines and

someone would not be deemed and eligible for this to make it two and a half times the monthly rent. so, with those guidelines, we probably will not foresee that there would be an individual who would -- to be able to take over the lease and assume those rental payments. >> ok. thank you. any other comments of the commission? >> i did have one more question. >> outcome objectives, it talks about programme participants have other housing options, at least 75% of participants who exit housing will secure housing appropriate to their needs, etc., and goes along with your former question as well. so, what happens to the other 25%? generally. >> i mean, of course -- >> go ahead.

>> you know, our services, of course, we want to prevent, like with any type of -- like we have a loss in housing that -- but i think with that 25%, they won't be falling with these type of categories. whether they're moving out of county or they -- they thought they could be in shelters. but at the same rate, we've given the longevity of the programme, we have not come in with that case where -- within those individual exiting the programme. they didn't have an alternative option for them. >> there kind of a landing pad plan in place. if it did arise? >> that would be for us -- like to provide resources in regards to shelter and to make sure that --le like you said, a case management agency involved to help care them through. >> sure. from c.l.f. side? >> yeah. >> any other comments or questions? >> yeah. this programme is a transfer

from the public health department. is that right? how long did you handle -- how long ago was the programme under the public health department? for how many years? >> since 2009. so, last year there was a transition period, so about seven years. sorry, eight years. 2009 to 2017. it was under the department of health. >> so this is the first year for daas so we have to do assessment every year. is that right? sole what are the criteria that daas use to think that they will refund, continue the programme? >> that would be -- they need to continue to meet the criteria for c.l.f. programme, and as i mentioned, it's 18 years of age, being a resident, having 300% of the federal poverty level, income.

so the c.l.f. criteria is what we used. >> commissioner, does that answer your question? i think one of the things we can say about that is that even though department of public health had the contract for many years, d.p.h. and daas work very closely to develop this programme. both the housing side and the community living fund side and we, you know, we essentially looked at it as one programme, even though department of public health was really handling the housing peels of it. and so more recently, departments of public health decided that this is -- we really see this as part of the community living fund programme. we think it should go to daas because of that. we've had a lot of opportunities to work really closely with brilliant corners. certainly fanny and carrie and linda edlestein, etc., have been very, very involved with the creation of this programme. and there is a reason at the beginning that we really wanted to have scattered site housing and not just single room occupancy housing for people

exiting from laguna honda and other skilled nursing facilities or hospitals. and so, you know, we basically noted that people did better if they were in scattered site housing and that they did better with wrap-around services, etc., etc.. so i think obviouslis in a new contract for us to monitor and we need to monitor it as well as department of public health did. but it is easy, i think, in a sense for us because we're already involved with the clientele. >> thank you. >> first of all, i want to thank you, shireen for that explanation. my concern is that we're getting ready to sign off on a $15 million contract for five years and it just raises a lot of flags for me. particularly because it was sole-sourced and i don't have any information before me regarding the monitoring or the assessment from d.p.h. now assuming that all of that

is well, it says, ok, we should probably entertain this. but it gives me great pause when we have such a large amount for one contract going out, under sole source, for five years. and i just need to say that for the record. >> i share commissioner lang's concerns. and of another concern, we'ves been reading a great deal about the ongoing shortage of skilled nursing facilities in san francisco. and we have a five-year contract. and one of the requirement requirements -- requirements for this person to be eligible is they be a resident of san francisco. if they are in a skilled nursing facility outside of the city, would that impair their ability to be eligible for this programme? when they're discharged? if they're down in westlake, daly city, would they still be eligible for this programme? being cared for outside of the

city? >> the referrals to the programme, commissioner, comes through c.l.f. and c.l.f. receives referrals from skilled nursing facility within san francisco. within san francisco county. so, we wouldn't necessarily know that there is a san francisco resident living in -- outside of this county unless they're refered to c.l.f. >> but that wasn't my question. my question was we have a declining number of skilled nursing facilities in san francisco. hospitals are getting out of that business. it is sa declining business. so if we have fewer facilities and the same number or greater need of people needing the services, they will be sent to skilled nurses facilitis in other areas of the bay area. so, would that affect their eligibility to equal fill for this programme if they've been in a skilled nursing facility in daly city for six months? >> so, upon referral to c.l.f., if they can establish they are

qualified in c.l.f. and the residency for san francisco, then they are qualified to be refered to this programme. >> so, it is all determined by c.l.f. >> yes. >> ok. thank you. any other comments or questions? as you see, we all did our homework. >> i just wanted to go back to the early comment about monitoring and it is a large granltsz. the sxwier time that d.p.h. had the contract 12i7bs000, we have received the monitoring points and they've passed exceeding over 95% of all of them with no demerits and we did a monitoring last year in the spring and they met all their requirements. so, there is no concerns in terms of monitoring. >> ok. thank you. >> thank you. that is encouraging as well. any comments for the public?

>> good morning. patty clement and i'm with catholic charities and we have been a partner of the c.l.f. programme since its inception and i can tell you that working with brilliant corners and the complexity of the clients we serve in c.l.f. and having scattered site housing has been a huge benefit for the clients that we serve and they do so much better in the community than they would if they had to go to single room occupancy because there's support through the case management answer they've done thing and brilliant corners has been a part of it where they see a client might be struggling a little bit moving out of the nursing home and you have that instant dmounlts your own home and then how do you look at support beyond that. i think they've gone above and beyond in some cases with what they've done to help make this successful and i would recommend that you go ahead and approve. this it has been working really well for all these years and i understand your concern, commissioner lang. but this is really complex and it's really hard when you have master leases to do something with lots of different agencies. thank you.

>> thank you, patty. any other comments or questions from the public? any final comments or questions from the commission? >> the only comment i have is i'd like to schedule time to see this programme upfront, you know? so i will work with whoever i need to in order to make that happen. >> ok. we will make that happen, commissioner. thank you. >> thank you. >> and i'm not sure what the regular review schedule would be, but i certainly hope that it's at least annual and that we -- because this is new to us. and it is as admittedly complex and certainly has a very, very good reputation and there is no reason to think that that will change. i still think it would be beneficial for members of the public if we have an annual report on how it is working with any specific measurements as possible. >> and i think that one of the

things that carrie wong will be doing is to report to you on the community living fund, which she does every six months. and that also she includes this as part -- she will include this as part of it because it goes along with community living fund. so, you will definitely be hearing every six months a report on community living fund and it will include brilliant corners since that is part of our approach to the community living fund service. >> great and we have a specific report on this programme and this agency. >> we can add that. >> that would be great. that would be very helpful. >> since there are one or two reports from the public health department, maybe we can get a copy of that. >> thank you. >> we do have those so we can make sure that you get those. >> commissioner? >> i would like to also -- i would love the chance to be able to visit and see how the programme works on the ground as well as i'm sure -- >> maybe bridgette can afford that and as many commissioners can make it would go. >> sure. >> fantastic. the other question i have is

just -- this new programme, obviously it is very important and so just wondering what portion of the community living fund that this now occupies. the greater pie. >> i would say it is at $3 million and the total c.l.f. is at $9. so, one-third. >> ok. thank you. >> thank you. ok. call to question. all in favour? >> aye. >> any opposed? [laughter] ok. thank you. item passes. thank you very much. >> thank you, commissioners. >> the next item on the agenda is item 7b, requesting authorization to enter into a new grant agreement with self-help for the elderly for the provision of a residential

care facility for telds earley during the period of july 1, 2018 through june 30, 2023 in the amount of $728,210, pluss a 10% contingency for a total grant amount not to exceed $801, 031. welcome back. >> thank you. i'm seeking authorization to enter into a grant for self-help for the elderly at autumn grow, alzheimer's care home. auto glow is a residential care facility for the elderly or rcfe in san francisco for the cognitively impaired seniors 60 and older who have been diagnosed with alzheimer's, park kinsons or other-related types of dementia. it is currently owned and operated by self-help for the elderly. autumn glow provides assistance in a unique nonmedical facility

in the hayes valley located at 654 glow street. it has nine rooms with 15 beds. six of the rooms are double october pan siz and three of the rooms are single occupancy. services include room and board, supervision by professionally trained staff and dementia care, personal assistance, full house keeping and laundry services, medication management, individual designed personal care plans, three nutritious meals daily and between-meal snacks and wide range of daily activities and programmes. all services are provided 24 hours a day, seven days a week. excuse me. but residents may join daycare services proud off site by self-help for the elderly adult daycare. they are provided by multilingual staff which includes cultural and language needs. to be eligible for autumn glow,

individual must be seniors who have been diagnosed with alzheimer's, park kinsons or other types of dementia and qualify as tenants based on the u.s. department of housing and urban health or h.u.d. criteria. and be eligible for admission as determined by titlele 22 regulations governing rcfe. autumn glow will consider individuals referred by laguna honda hospital or other service agencies, provided such individuals meet all the mentioned criteria and that they do not have any health conditions or care needs that will require an intensive or high level of care. this specific health condition or care needs detailed in the appendixa of the scope of the contract. staffing currently at awe tome glow includes the director of housing services, the assistant administrator, the work shift rotations, providing the personal care services for the residents around-the-clock and

they also have two full-time kaox on work shift rotations preparing the meals and snacks daily. in the daytime their ratio of direct care residents 1-to-5 san in the evening it is 1-to-7.5. it will provide residents that will include new and existing residents and they will also provide a minimum of 5200 units of service. it's per resident and includes all the services to be provided by the grant as mentioned. during the grant term, the resident's level of care assessment satisfaction with services and physical wellessness all be evaluated to assess programme impact. and i'm happy to answer any question the commissioners may have at this time. >> thank you. any comments or questions for the -- commissioner lang? >> why is this one sole sourced? [laughter] >> very much the same --

similar to what brilliant corners was transfered from the department of public health. autumn glow is a project initiated and sponsored by the elderly in 1996 when i was incorp rated as a nonprofit public corporation. it was funded by a capital advance financing and the mayor's office of housing to require the 15-bed alzheimer's care facility. and the facility opened in 2001. autumn glow is card separate legal facility. and it is because legal arrangement for out of necessity for the h.u.d. funding, only self-help for the elderly will provide it without any interruption to the service. so it was also a d.p.h.

contract, again, like a realignment where it better fits within the department of services because of our mission statement. >> ok. >> senator loo? >> uh-uh. >> commissioner wallenberg? >> i had a couple. thank you for continuing to stay in the hotseat. [laughter] so in terms of service delivery, there's nine rooms, 15 beds. and i just was wondering during the -- it says -- sorry, it says provided off site by self-help for the elderly daycare services at additional cost. i guess what type of service levels are you getting for that additional cost, how much is that? how much are these programmes being stressed during the intake process that these are available? these are the types of services. and then, i guess, how much additional cost. what types of services? is it being stressed at intake process and what's the breakdown of off site and on site?

>> so, when we say additional costs to the resident, that's actually a separate service. the adult day services for the elderly is not part of as tum glow. -- autumn glow. >> in that sent, what are those additional services and how much is that being stressed that these are available during the intake process? >> sure. the additional services would be the types of services they would receive when they go to the day services. they have the social activities, they have meals. they have -- some specific programmes, specific to that adult day service. >> it clear to them and their networks when they sign up or -- >> yes. that would be clearly explained to the residents and their family. >> ok. and then i just had two other quick questions if that's all right. one on page four, appendix a. we're talking about notifications to families and other appropriate parties of residents going forward.

i'm just curious on what the frequency of that communication is. i guess how often in terms of residents' ongoing needs do the staff and the programme coordinators reach out to family members or that individual's -- >> yeah. to get a definitive answer, i'd like to welcome the director of services at autumn glow. he would have that answer. >> thank you. >> good morning, commissioners. the frequency actually depends on individual residents there. we monitor the health conditions on a daily basis, actually. so our -- on average, we notify their families approximately once every three months to -- once every three weeks.

>> and i guess i had a follow-up question that's similar on those lines. in terms of documentation, we were talking about the staff assesses each resident's tiebltz perform activities of dayly living. every six months. and then skipping down a couple of lines that the staff completes an annual appraisal and service plan for each resident. for me, to determine the activity's daily living ability and also just a general plan for each resident, on an annual basis seems a bit long. >> ok. >> certainly when you already -- when you're talking about a daily check. >> like i mentioned earlier, it's actually a daily check and then on the -- we actually have a more in-depths reveal every six months from that. >> ok. thank you. >> thank you. commissioner loo? >> yeah. i have a question actually on the salary and benefits and i'm looking at it.

every year is the same. how are you going to maintain the staff? >> oh, the budget? yeah. >> because there is no cola, there's no cost of living increase at all. every year the rate is the same. i'm just kind of concerned how can you maintain staff? >> it's difficult. [laughter] in addition to grants -- you know, the residents themselves or family members have to pay the fees and then we actually have a little bit of an increase every year for the service fee. in addition to if there is any increase for funding as well. >> can i -- >> and the -- >> good morning again. john sitikawa, director of contracts. but the other part of it for

the city is that periodically the city applies colas to contracts and that is the opportunity. but the city policy is to apply that as a whole across the set of contracts. this is a general fund contract that would be eligible to receive colas and cogbies as the city granltzes them. as you know the ones from this year and last year, they were 2.5% cola. so, when the next cola comes out, we adjust this contract with the cola that is provided to the city. >> and the other question i have maybe for the -- for james, i know some of the residents may go to adult day health. so, what kind of activities do you have for the residents? >> there are daycare centres, which is about two to three times a week. they engage with the residents in club activities. >> ok. such as?

>> such as exercises that they work together to strengthen the physical as well as mental well-being. and then they are actually nurses, p.t.o. there on site to monitor individual's health, condition. and some of the residents have a mild-to-moderate dementia. they are closely monitored by special staff on site. as well. and so usually the activities are in a group basis and they usually last for about three, four hours during the whole period of about six hours when they are there. so that includes activities such as chair exercise as well

and games for the residents. yeah. >> just out of curiosity, i know that we gave you folks just kind of -- $801,000. what percentage is that of your whole budget? i'm just curious. >> ok. the whole budget is about $650,000. >> how much? >> $650,000 for the -- so you are talking about the $800,000 for five years, right? >> yeah. >> per year is about $140,000. so our annual budgets is about $650,000. >> ok. thank you. >> i have a couple of questions as well. the requirements include individuals suffering from dementia, parkinsons and other

forms of dementia. but do the patients with park kinsons, many of them don't have dementia. it often affects parkinson's patients. so are they parkinson's patients with dementia or parkinsons in general? >> dementia is a general term for us and parkinsons is one of the disorder of dementia and they're very closely -- they're very similar, actually. so with mostly memory loss and the disabilities of performing some of daily activities by themselves. >> certainly the activities, i understand. but i've known and know several people with parkinsons who have had it for many years and they have no memory impairment. it's separate. it does eventually affect their memory. but they can go for long period of times with very long period of time.

does the ombudsman programme visit, does the ombudsman visit your facility on a regular basis? >> they do. >> ok. great. and finally, what happens is the dementia grows greater? becomes more than you can handle? what happens to that patient? >> it gets more severe, if they require hospitalization, you know, we transfer out to the hospital and from there, either they will be transferred out to a long-term skew nursing facility. >> ok. >> yeah. >> ok. all right. thank you. any other comments or questions? commissioner lang. >> the $145,000 yearly amount, is that similar to what you were getting before? >> yes. >> thank you. >> ok. any comments or questions from the public? hearing none, call the question -- all in favour? >> aye. >> any opposed? >> thank you. the motion carris can. >> thank you, commissioners.

>> any announcements? any additional public -- oh. commissioner, sorry. >> i was really glad that, as part of director's report, she spoke about reimagine. and especially the conversation sabbath in response to commissioner loo's question about how about promotion. i'll take this opportunity to extend an invitation to my colleagues and certainly to the members of the public to come tomorrow morning at 8:00. it's an ungodly hour. to the interfaith council's monthly breakfast where reimagine will be presenting. and i'm guessing that their out reach to so many community agencies like ours, you will see -- you will see these sort of presentations throughout the city. so i think on a grassroots level, that's happening. so thank you, director mcspadden. >> any other announcements? any final public comment?

hearing none, motion to adjourn. >> so move. >> second. >> by rising vote.

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