we believe the needs of black youth are strengthened. i will talk in the next minute or so. we found the system for obtaining the cards is inequitable leading to true and see and harassment. the clipper card is easy to fill out. it asks for nothing but verification of age and signature. it is still difficult to access assuming they know about it. particularly for the newcomer families they don't know this the an option. it takes weeks for the cards to be approved and mailed to their addresses. they have to choose to not go to school or risk getting ticketed by sfmta. i get calls stating families are

worried about free clipper and public charge. caregivers keep little ones home because they have no bus fare for school. if you don't have bus fare you can get a ticketed. undocumented families are afraid they are on a list when they hand over their passports to sfmta. i have heard about sfmta officials. while i am sure it is rare but it happened. asking for immigration paperwork and searching back pats. some encourage people to carry red cards to school to give it to officials. it is traditionally for ice agents. i have suggestions. to get the clipper cardses that we distribute and hand the paperwork over for approval.

for the sfmta officials not to be able to question without a caregiver. caregivers get passes when transporting young people. make muni free-for-all. thank you. >> james johnson. >> i am james johns sana regular guy. i have a quick story. i will start with and i have a video of something that is horrible i was assaulted by a muni bus driver multiple times. i was coming from my drug program which was requirement for me. under insurance if you had any prior substance abuse and you need something orthopedic or serious surgery you have to do a vetting process, a drug program and stay clean and sober six

months or a year. i had to do a year. i was coming from the drug program would not be allowed to get on the bus. the bus driver pulled in front of two poles. she seen me coming out of the building i am rolling up. you have to catch up with the bus there is no place to stop. when i said can i get on? she would have to power down and let the ramp down she said, no, you can't. >> a week later at 1:30 p.m. she zook off. i called three one one. i field with the 311 process. it has to be flawed. i called, told them i was just assaulted by a bus driver.

the bus driver took off and did not wait for a supervisor. i have four instances where i called and i have the reports right here. >> same bus line and same everything, then this happens. >> it is only 47 seconds. >> can i ride the bus, ma'am? i am handicapped. >> that is assault, ma'am, ma'am, that is an assault. i am not moving my arms to take this bus out of commission. >> so anyway now this is a video

prior to it so you know it wasn't phony. it has been happening. >> the bus will be coming at 1:30 p.m. the driver will allow me on the bus and i will have to report it. >> i am asking you a question. i am handicapped, you have no reason to deny me. are you going to allow me on the bus, ma'am? i am handicapped. i need to go home. can i get on the bus, yes or no? can i get on the bus, ma'am? >> you have handicapped seats available. yes or no? can i get on the bus, ma'am?

[ inaudible ] >> this went on for another minute. she did not allow me on the bus. she had to take it out of service because she closed it on my arm. this is all of those people they got off the bus and i was spat upon by three people. she heard the people in the back gettingetting royaled up. she said get your bus out of the way and spat on me. i waited. i filed a report. i have seen her since. that is what they did and that is what happened to me. i would say the 311 does not work. they should have immediately contacted me. i was assaulted.

the door was closed on my arm. i did file charges on this officer. i have that report, too. >> i am not sure if you shared them. >> everybody has got them. >> thank you. i have lisa lynn cost. >> thank you, commissioners. i am a san francisco resident and daily municipal neap rider. during the day i ran b magic. we serve the community of bayview hunters point. i am not a transportation expert. we worked on two occasions with the two transportation authorities in san francisco. that is the sfmta on a project that was an 18 month project and

most recently with the bayview community-based transportation project. specifically, the participator rebudget process recently. >> that being shade, bayview has five main lines 19, 54 and 29 and t line. for the four bus lines bayview happens to be the end of the line for those four bus lines. as up mentioned, commissioner sweet when you are at the end of the line most lightly it is not on time. we experience that a lot on the bayview particularly on the 19, 54 and the 29. also was mentioned similar to the hill it is photography

issues which creates isolated community. the shuttle program was targets seniors and young people. as well as unreliability of muni on the evenings starting as early as 43. if i need to come downtown to get here by 530 i have to leave before 430. you have to wait half an hour to 45 minutes. this happens on most of the bus lines. the project we are involved with is infrastructure. we the house community meetings throughout the last fiscal year about the service issues. unfortunately, the part we were part of did not address the service issues, it was not part of the grant for that yo budget.

some solutions more bus shelters to have the arrival times for muni. also, at the very least improving service, not having people wait 45 minutes to half hour. you might have to wait five or 10 minutes. if they were on time they wouldn't need the waits because they would follow the schedule that is provided. thank you very much. >> robin crop. >> if you want to leave your recommendations, we can take them directly.

certainly, we do want to get that information to the right place. thank you. go ahead. restart the clock, please. >> san francisco resident and now with save muni. i want to talk about two issues tonight. first is julie's discussion of drivings. i want to say i had a driver on the bus who told us he had no break for 8 hours. the bus wanted to bring food. he says i am on camera i can't eat. >> i spoke with someone and he said wrong the driver could have taken a break to get food. i want to ask julie. i want to know if the drivers are getting communication about rights that they could take a brace. the whole bus was concerned he was heavy. they are not getting bathroom

breaks and not enough time to eat food. are the labor laws being nolled or if this is a deterrent. i know you were concerned about having enough drivers for your force. thank you for your report. >> i want to do my other feedback. for my second issue, i am a disabled person using paratransit and mini rail. some of us do use the muni also. it has not been accessible to me because i can't ride on the bench. i can't ride half of the buses there is no forward faces seat in the boarding area. there is no accessible seat for me. i would like a representtro

fitting of all is the buses so we have a shirt for them. second we are looking at railcar design for the next 30 years. it is important to have enough seats for the disabilities or the plans as they stand with only a couple of seats planned for the next 50 cars. they are going to eliminate us and injury us because i can a survey of 100 people last fall and 400 last month in muni station and i heard a lot of disabilities. these folks are going side ways. many are comfortable. i heard about 30 reasons from disabled people why they need

the forward seat. >> this is a very important issue about access for our city. i would like your help. they all need to approach the city together. >> edward right. >> i want to thank the members of the public here today and sharing their insights and thoughts on this issue. i am primarily here to listen. i wasn't planning on speaking. i did want to share our thinking on this. for transportation we are thrilled to see this discussion with this commission and i would like to thank the commission for doing that. it is not a public good. it is also a human right.

we see that in our district. our constituents are diverse. we have the highest portion of seniors and schools in the city in our district. we know that we have the largest section of above ground light rail service in our dippings triact that experiences the highest number of switch backs of any line in the system. to shed light on this, the number one topic we hear about from constituents is muni. that is because people rely on pit. that is how they get to their jobs and access their livelihoods. when we talk about equity, reliability and service, it is important to keep in context

what that means to people. it is the difference to making it to work on time. it is sometimes the difference between deeping your job or not. it is really does make a difference in people's lives. i wanted to share be that with you and i want to highlight a topic brought up by cat carter of did he havof the effort to ae support. supervisor mar is a father. he has a 13 year-old daughter. she tried to take the 29 to school but after repeated attempts to get on the bus she found out it was too crowded

every time she tries. thank you. >> edna james and michael perkins. if you want to speak, we have another card. that is great. owe are near the end of the car. >> i am president of my community action organization. i am a nurse at the community center. i wrote this in may of 2014. to the transportation. it hasn't changed. i want to say that the young man who witnessed leaving him at the sign. they did this to another handicapped individual. i was sitting in my car and he had gotten up on the ramp at

arch and randolph street. he was turned this way not in front of the car. the bus man just speeded across him and left him there. it was cold and everything. i felt so bad for that senior who was in the wheelchair that he had to it is up there for the next 15 minutes. i said in my car until the next bus came. she moved so fast and i made a complaint. they don't respond. you call 311 and get a message, a voice message. we looked at the message and blaugh blaugh blaugh and that is it. this is a complaint i really made on behalf of this mantanting there.

the other thing we had a problem going under ground with the m train and eliminating the symptom for an overhead bridge. don't think about it. we have to fight that. the small houses around there was not built to go to the foundation. you would put a lot of homes would be shaken, you know, for that. it wasn't built for you to go undergrounds. we could not stand the vibration there. stop for the intersection at beverly. when it comes across 19th avenue. you have the seniors tieing to

come from the timber church were there. other bega school then they are coming for sergeant. it is three ways and that is the muni stop and that is not good. it provides sitting benches at lake view and mount vernon. this is not done. i am saying that is all i want to say. thank you very much. >> thank you. >> i want to encourage ms. james to give her list to the transit director to give it to ms.kerish

ball if you could do that, that would be great. i want to thank the members of the public for all of the community work and effort that you are doing. thank you. >> next is michael perkins. then we will take a break. i work with the community cent center. everybody has mitt most of my list i will cut this short. i do have some seniors that used to visit the center. basically they do not have the transportation to get there. most of them live on the hit also. -- the hills. the buses can't get up the hills because of the steep grades on

the streep. if it is possible maybe you want to look into purchasing paratransit type vehicles to clear the corners so those seniors living on the steam grades can make it on down to their appointments or anything eselse they may need to do. thank you for your time. >> thank you for being here tonight. the last cashed is david hooper. >> good evening. i serve as did president of the new mission terrace improvement association and on district 11 council with ms. jameses who is right 99% of the time. there was an extended outreach to bring the information to the

community if district 11 and to talk about the transit equity. my immediate neighborhood does okay. it depends on the j, k, m. and the 49, 49 and what i see is district sheila. people mu don't have smartphones who are not in that world, who don't twit are knots included in any of this. it is apparent if supervisor moore can take his daughter to lowell because the 29 line is not working that is great. that is the exception people have to take their children to school on public transit. we have has as many as we did 50

years ago. it is for people raised somewhere went away to college. they ride the schoolters, too uber and take lift. they have no experience at muni. their kids will not have a customer base. unless we do something and figure out a way to address the new apartments near the reservoy other side of the freeway. wwe will be raised. i work for the post office i started working as an paymentter. i retired at central control. it is apparent that some things

can be excluded when the huge metal down happened. these have dressable. when i started it took me what three months before i got full pay. that was a great contract. they got rid of had it expended to five years. it is difficult to get operators. you charge them $3 per day near the division, that is $700 each year out of their pocket. i think we can do better. it is realizing some people are not connected to this vibrant economy.

>> that is all the cards i have. we will not end the meeting as we usually do, however, i will note at this point there is a note that the next discussion of transit at the hrc meeting might be october 10th. i am thing. i think everyone for staying here and to the staff for staffing this. maybe we should have time for more robust discussion. as evidenced by the fact we have muni through the whole meeting. let's discuss that offline and do this in a way that is going to yield th to improve equity in transit in san francisco. i know for some people they

would look forward to join us on the tenth. i suspect it won't be a meeting focused on transit is. we will get back through the same channels when staff figures that out. >> i want to acknowledge and thank s.f.m.t.a. i appreciate that brittany and cathy. i want to thank kathy for her out reach and engagement. we will follow up to see what is the best daytime for the next meeting. thank you all. >> thank you everyone. good night. go.

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>> good morning and welcome to the san francisco planning commission and health commission special joint hearing for thursday, october 3rd, 2019. i will remember you that we do not tolerate disruptions or outbursts. please silence cell phones. please state your name for the record. i will take roll for the planning commission. (roll call) we expect commissioners moore and richards to be absent today. >> i will take roll for the health commission. (roll call).

>> commissioners, we have one item on the special calendar item one 2012-0403w. california pacific medical center annual compliance statement. this is an informational hearing. >> good morning, commissioners, i am planning department staff. the item before you is an informational presentation on the california pacific medical center's compliance with their development agreement for the 2018 reporting period. this is the sixth annual reporting period. i am joined by ken, marina from the health services service and the department of public health and elizabeth pearl of the planning department. today's hearing is part of the annual review process required by the development agreement

foresee see. for c.p.m.c. it requires a public hearing. following today's hearing the directors of planning and public health will derm whether c.p.m.c. is in compliance. a third-party monitor will inform the board of supervisors if they agree with the directors' determinations. c.p.m.c.'s development agreement allowed them to build a new hospital and medical office building at the vanness and geary campus with a requirement they build a new hospital to replace st. luke's. the development agreement required replacement of st. luke's hospital within two years of opening the vanness hospital. they met this with the owning of the -- opening of the commission

hospital. they required payments for range of public benefits and improvements. they completed the payment requirements with a total payment of over $73 million. for the 2018 reporting period there are 11 main actions up for compliance t.these include payments, hiring commitments, public improvement and community outreach. my colleagues will go into these. in one reporting area the local hiring period has a reporting period corresponding to the fiscal year rather than calendar year. that means for recent information on hiring. ken will help explain how the c.p.m.c. overall hiring record compares to the goals of the overall development agreement. construction of the vanness hospital is complete, and the

associated medical office building also opened this year. future construction includes the new medical office building omission and improve mends around the -- improvements around the mission area. one other obligation is the limit on fees for servicen creases by c.p.m.c. as the provider for the city health service system. annual increases must be no more than 5%. actual analysis finds they met the requirement through 2017. the most recent year for which this analysis has been complet completed. they are working on the 2018 data now. with that we will turn to ken nem from the oawd work force

division. >> welcome. >> thank you, good morning. i am the director of city build of the office of economic work force development. thank you for the hearing to give us the opportunity for feedback on the report and i would like to thank the public to serve the residents seeking employment for this great opportunity for the hospital. first, i would like to start with the construction. we are putting it as cumulative since it started in august of 2013. the first topic is hiring for internship. as you know, the majority of the construction work has ended. st. luke's opened in august 2018. the vanness hospital opened in march this year. a lot of construction has been completed. when we generated these hours for the last program year, not a

lot of hours were added. for example, for the 50% entry level positions for non-union administrative engineering candidates, new hires in the office we had requests for 38 of the new entry level positions. we filled 32 with folks out of our program. city build have the construction hands-on training and have the professional services so people coming through our program administrative type of professional training at city college. we work with contractors to get them into these administrative positions. 32 of those were from our program and some include lead document, document coordinators, project administrators and project manager. from the next slide, which is very similar, but this is really

focusing on the internship program. we work with the san francisco unified school district and san francisco state through the mesa program, mathematics, engineer and science achievement. they are disadvantaged residents. we got 30 interns on this project. goal was 50%. we achieved 57%. i spoke with the contractors. 10 of the hires are on the company working with projects outside of the hospital once it was completed. that is a good success. we want retention and people sustaining to work. the next slide is our entry level positions for construction and most of these are focused on apprentice ship programs.

city build we offer the academy which is 18 weeks. people who graduate from the program we pay for the initiation fees to get them in the union and to work. early are the challenges not having enough ironworkers. we have presented that in the past. one of the toughest trades to convince people to work in, and with that there was still a good amount of ironworkers. during one of the events a graduate spoke and highlighted success in working on the project. the last four years, we have experienced a big construction boom. in city build we manage other compliance programs, mandatory hire the city public works contract we increased for the last year 3 million work hours. this has mandatory requirements. if the contractors do not meet that there are penalties. it is going to local residents on the projects but the other

projects are taking them to avoid penalties. we had the opening of chase center. they increased the program year about 1.5 to 2 million work hours. they also had the office of community investment goals that was drags and pulling on local residents to work on those projects. some of the challenges we had difficulties in fulling. drywalllers during the chase center. sheet metal workers and operating engineers were some of the entry level positions we could not fill to get people working on the project. we had 175 apprentices on the project. these are individuals that did not be have experience or could not get an opportunity to work construction due to this project brought them on, started a career in construction and they are union members. that is the success of that.

then the fourth compliance is the overall work hours. overall workout is 30%. the first three years we met the goal. with all of the construction happening and other projects, we have seen decline especially the last year the major work was the medical office building. a lot of exteriors were done. what caught us off guard a special interior modular system, prefab wall to use for that system in canada, and the carpenters that needed to do the work had to have special certification. we pulled in the contractors, we could not get it from the union because of the special certification. we did not have people trained for that. even with that we were able to get some employment opportunities, not the bulk of the prefab work. that gave us a challenge in a drop in numbers.

they did the best to work with us to hire folks outside of those specific classifications. we still convinced them to hire people from the community working in the cleanup work, laborers and whatever opportunity was available that didn't need the special certifications. to date we 432 -- 322 residents hired to meet the 30% goal. these are just some statistics. this is a piechart of where the hours went. we have reported roughly a little over 5.6 million work hours, of that 1.15 for apprentices. 35% of those were local. these are new individuals coming into the system to help them retain them and successful journey level workers. now here is a demographic where the workers were coming from,

from the different neighborhoods. these are the key neighborhoods that had the san francisco work hours. four biggest neighborhoods we were targeting and which the da put a special reference for. four of these neighborhoods represented 60% of the work hours. workers were coming from the neighborhoods we wanted to impact through the development agreement. now, i will focus on the lb eg egos. 14%. we have reached 16% of the dollars were going to l.b.e. that is equivalent to $227 million to l.b.e.s. each of the bullets focused on the projects and where the money was coming from. the ti work was not significant

compared to other major work. lower amount and we were able to reach 16% to the l.b.e. community. l.b.e. is monitored by the contractor monitoring division. they provided me that data. now, we are looking at the first source hiring. to focus first is the program year's goals. in addition to construction we have a business services team that works with c.p.m.c., the employer and they submit to us job notices. we work with the community to provide referrals. i convinced them to give opportunities for people coming to the program. we have hospitality and healthcare that a lot of graduates go to the post construction work. the goal is 40% of the new hires entry level positions referred. in the program year we were able

to hit 52%, 48 out of the 92 employees were referred through our system. we 432 -- 326 placements since the program started. i have statistics on the next slide. for the program year, i think a big question where are the individuals coming from? based on our analysis all of the qatathekey neighborhoods. 65% from the tenderloin, outer mission, chinatown and southeast neighborhoods. cumulative data we looked at since we started the program with 81% retention rate. these are individuals hired that stayed for 180 days or more. we had 263 hires retained over 180 days.

the last slide is just a work force fundings. those are provided to help fund the agencies doing the work in recruiting the neighborhoods, non-profits to do job training or employment opportunities. a lot did case management to make sure people are successful. life skills to prepare them before they come to our office for training. the current grantees this program year $375,000, and the agencies were jds, self-help for the elderly, success center, co-tenderloin is a new agency. as of this may of 2019, there is $935,000 in the account. the program year they are looking at new scopes of work and what else needs to be done to prepare individuals for the

post-construction and operation of the hospital and those are my updates. >> thank you very much. we may have questions. >> good morning. i am from the department of public health. for this section of the presentation i will provide an overview of compliance related to the healthcare commitments and the da. so first i would like to provide a summary of the healthcare commitments. there are multiple commitments to ensure that c.p.m.c. provides high-quality care to all san franciscans, especially low income, uninsured. each contain multiple provisions. at the top five baseline commitments to maintain the same

level of commitment. three to increase care to medical and low income individuals. two on the innovation fund for $8.6 million to fund community-based services and programs. the last two commitments are specific to the mission burnell campus in effect for the open of the new hospital in august of 2018. they are reported in the compliance review. these additional commitments include key provisions related to the number and type of bed space available and four provisions to ensure specific services and programs are provided at the mission burnell campus. there are five additional healthcare provisions that range various topics. sub-acute services.

these provisions help to ensure seamless and accessible care to those in san francisco. over the next several lieds i will provide more details on the healthcare provisions and the compliance on each. this slide provides details on each of the five baseline healthcare commitments. the c.p.m.c. compliance and if they are compliant. c.p.m.c. exceeded the requirement of caring for the charity care patients. it is for those without expectation of reimbursement. they cared for 38,210 charity patients. second is community benefit unreimbursed costs to provide or improve community health.

in 2018, c.p.m.c. exceeded the $8 million community benefit requirement providing $15.1 million. they met this by providing grants, community health programs and community outreach. it is important to note that the first two provisions on the slide are verified as part of a third-party audit. third and fourth are related to charity care policies. third required easy to maintain the charity policies through 2015 which they met. it requires charity care policies compliant with state law. that is the case. as of 2018, c.p.m.c., charity care was the same as 2015. the last provision i is for the easy to support the bayview child care center. they have provided an operations

grant for five years, invested over $1 million, transferred assets, is still the specialty and hospital partner. so the next three provisions focus on medical. the first provision, c.p.m.c. continued to participate with the san francisco health plan. next requires easy to assume responsibility for 5400 new beneficiaries. this was met in 2014. in 2018, c.p.m.c. had. they are required to serve the new medical beneficiaries through a partnership with the tenderloin serving provider.

currently there is no such provider. to meet this c.p.m.c. partnered with northeast medical services to bring st. anthony's clinic as primary care provider in tenderloin. they are accepting enrollees. in may 2019 there were 174 members in the partnership. they have reported several barriers to increasing enrollment. if you include patient choice. new enrollees can choose which hospital to go to for specialty referrals. these may be more familiar with the csfg and opt for that instepped of c.p.m.c. another barrier is follow up with potential enrollees. they may have unstable housing or have outdated contact information. clinic staff have been unable to reach them to complete

enrollment. another barrier is staffing challenges. they have experienced staff turnover. c.p.m.c. has reported that it is partnership with three-inch dependent primary care providers. they collectively serve 2600 tenderloin residents. c.p.m.c. continues to work with the st. anthonys for outreach efforts. the next two provisions pertain to innovation fund. c.p.m.c. is required to make payments between 2013 to 2017 totaling $8.6 million. the final payment of $1.25 million was made in 2017 and completed the payment obligation to the innovation fund. this describes how they are used

administered by the san francisco foundation. c.p.m.c. and the public health and foundation it is on a committee to support community clinics and community based programs. these awards will support community based programs for african-american and pacifi pacc island communities, healthy living and services for seniors. so the da includes two provisions related to the number and type of bed space available. the first provision on this slide requires the mission be 120 beds general acute care with

comprehensive emergency services, must open within 24 months of the vanness hospital. they have opened the hospital as described in august 2018 abearlier this year opened the vanness hospital in march of 2019. this second provision is conditions on the operation of 30 additional shell bed spaces at the vanness hospital. c.p.m.c. may not build out or place into operation this shelled space until after the mission burnell is open and has a 75% for a full fiscal year as in the compliance report. this provision is not yet applicable but subject to the mission burnell campus hospitalization utilization. the follows four provisions

ensure c.p.m.c. provides specific programs at the campus. they require comprehensive inpatient and out patient and urgent care services. c.p.m.c. is compliant offering all services outlined in the development agreement. for the second and third. c.p.m.c. is established to establish and maintain a center of excellence in senior health. this center is named health first at the mission bernel campus and integrates community health workers to the healthcare team. c.p.m.c. reported the following in 2018. it provided care to 717 unique

patients and over 1400 encounters. staffing includes three bilingual community health workers bilingual in stannish and english and the program is fully staffed adding patients regularly. they require easy to create a community advisory board to provide input to the operation of the center. c.p.m.c. convened the first board meeting in october 2018. in review we noted the advisory board could have additional membership. we recommend c.p.m.c. recruit and engage additional community organizations into the body. next is center of excellence in senior health to provide care to approximately 600 seniors over 70 to live successfully in the community and reduce unnecessary hospitalizations. it is comprised of three programs. the first is acute care for

elderly or ace, it is a 34 bed unit at the mission bernal campus providing care to older adults. physical and occupational therapy and rehabilitation and group activities to encourage socialization. second is the hospital elder life which develops personal care to help each patient stay mobile and social and prevent functional decline. third is the san francisco village partnership, which is a nonprofits that provides a care navigator to access needed community services to ease transition from hospital to home. c.p.m.c. reported 70 patients each month and has conducted outreach to community partners to promote as a potential resource. for the last provision on the

slide, c.p.m.c. has a proposal for the office building within five years of opening the new hospital. they are within the five year window. they have until august 2023 to submit a proposal. so the remaining healthcare divisions are stand a stand alo. the first requires easy to develop specific for sub-acute care services. it is skilled nurses in which patients require a higher level of care such as ventilator care. the requirement was to present the health commission. this was completed in 2016 through presentation of the post-acute care to the health commission. c.p.m.c. is currently engaged in the project to a assess and

develop strategies in the city. second is integration of staff across the c.p.m.c. campuses. in 2016 they completed integration of st. luke's to a single integrated staff. they have maintained this with opening of the new mission bernal hospital. the third provision requires the participation in a community benefits partnership. they continued to participate in the san francisco health improvement partnership which is a nonprofit hospital and community-based organizations to improve the health and wellness of san franciscans. the next commitment i is for the easy to continue partnership. they maintained the current

agreement during 2018. there are concerns regarding the agreements. c.p.m.c. and chinese hospital are negotiating contracts. we will provide update next year in the compliance report. so for the last provision, the last provision touches on national culturally appropriate services or class standards. c.p.m.c. has reported it is their policy to deliver in accordance with mandates with the national standards. they are compliant be with this provision. commissioners and community members expressed concerns regarding the cultural appropriateness of the services. particularly, around the st. luke's diabetes center. they met in april 2016 and the meeting resulted in specific recommendations to increase spanish speaking sta,