this is the san francisco health commission. this the is tuesday, january 5, mark, please call the roll. commissioner guillermo. >> present. >> commissioner green. >> present. >> commissioner chow. >> spent. >> commissioner christian. >> present. >> commissioner bernal. >> present. >> okay. our next item is approval of the minutes of the health commission meeting of december 15th, 2020. commissioners, we have had an opportunity to review the minutes. thank you for preparing them,

mark. upon reviewing the minutes if there are no further amendments do we have a motion to approve. >> move to approve. >> second. >> mark. roll call vote. commissioner guillermo. >> yes. >> commissioner christian. >> yes. >> commissioner giraudo. >> yes. >> commissioner chow. >> yes. >> commissioner green. >> yes. >> commissioner bernal. >> yes. >> that passes. >> next item. general public comment. for those listening on the line. mark would you read those instructions? >> clerk: if you would like to comment during general comment on an item on the agenda press star 3 to raise your hand. on something not on the agenda press star 3 to raise your hand.

i do not see any hands commissioners. >> we can move on to the next item, which is the resolution honoring all lhh staff and residents. before i hand it over to commissioner guillermo, who is chair for the committee for the hospital i want to send my thanks to everybody, staff and residents. if you look around the country at the state of long-term care facilities, skilled nursing facilities, they have experienced tragic outbreaks. we have seen the majority of the people lost to covid-19 are people in skilled nursing facilities. for the response at the lhh in

san francisco to have done so welcome pairtively and i know that we recently suffered the loss of residents which we are very sad and our condolences to family and loved ones, it is accomplishment we have not seen more. we are pleased we have been able to start vaccinating residents. i know there is a lot more great work to come. on behalf of the entire commission, thank you for your leadership, commitment, hard work and sacrifice and the excellent care you provide to the residents at laguna honda. i would like to hand it over to commissioner guillermo. >> thank you, commissioner bernal. i just want to say i echo everything that was said on our

behalf, and it is my pleasure to be able to be in a position to lead this resolution because it does encapsulate with those of us on the jcc have experienced in the past year, even though we have not been able to be with you all in person, we have certainly been able to feel the dedicated commitment and your ability to meet the challenges with regard to covid-19 and all of the associated issues that you have been able to overcome in order to be able to address this and to deal with as much success as you have over the past year. i also want to have the opportunity to read this

resolution on behalf of dr. david sanchez, who was the chair of the jcc for many years and who i succeeded and wanted to honor him in his passing a month ago, less than a month ago. i know that he would have loved to be able to do what i am doing and read this resolution and share with everyone the history as he would tell it of laguna honda leading up to your ability to make the kind of adjustments in an achievement that you have. in his honor i would like to read this resolution honoring all of you. honoring all laguna hospital and rehab centers, staff members and residents. the hospital and rehabilitation center is one of the largest

skilled nursing and rehabilitation centers in the country owned and operated by the san francisco department of public health. whereas laguna hospital hospital was founded in 1866 with a commitment by any city or county to provide therapeutic care for seniors and ad difficulties with disabilities. the clinicians and support staff dedicate themselves to care for the 780 residents, whereas the lhhh includes physical occupational and speech and offers the only dedicated skilled nursing facility for people with h.i.v. and aids in the san francisco bay area. whereas, lhh offers other services such as nationally

recognized program for people with alzheimer's and dementia, treatment for parkinson's decisions, multiple sclerosis and other diseases. therapeutic services for brain injuries and stroke and support for individuals with multiple physical and psychological diagnoses. whereas lhh offers pain management and end of life care within healthcare and whereas lhh is part of a larger central medical electronic medical record system in 2019 which required an enormous amount of change for all staff members, 2020 was the year to fine tune and make necessary adjustments in the complex data system.

whereas, on february 25, 2020 mayor london breed and doctor colfax -- [indiscernable] covid-19 and whereas lhh discovered the first covid-19 case on march 22, 2020. whereas, lhh visited with the usual operations to prevent covid-19. daily health checks for staff, limiting entrance points to the facility to only two, requiring universal masking for all staff and encouraging residents to wear mask, testing for staff and residents, implements alternative dining spaces for staff to promote social

distancing, whereas lhh had an outbreak control system on protocols and response testing. [indiscernable] the positive residents in a dedicated unit and investigation team. whereas human resource staff worked tirelessly to adjust processes and priorities to meet hiring needs to respond to the pandemic including. [indiscernable] the environmental health services added 24 hour cleaning protocols to the facility services department, plexiglass barriers throughout the campus. whereas the lhh instituted hospital wide training for

prevention and control and personal protective equipment. whereas lhh initiated a robust covid-19 communications strategy to provide daily updates to staff, residents and families. whereas lhh provided alternative activities for residents and celebrations with the intention of raising moral. more recently developed protocols for outdoor visits with loved ones with staff and volunteers. whereas lhh received a 2020 association of public hospital safety quality leaders award for the covid-19 outbreak management and prevention.

[indiscernable] the hardworking and dedicated lhh staff kept the number of resident afternoon staff covid-19 patients at a low amount in comparison with other skilled nursing facilities in the country. be it resolved the san francisco health commission expresses deep gratitude to every lhh hospital employee and volunteer for their work and vital contributions made each day during the covid-19 pandemic. to the benefit of the residents. further resolved the san francisco health commission honors the lhh residents during the stressful period and acknowledges the hardship of being isolated from loved ones and the community during this

pandemic. on behalf of mark, i hereby setter fithe san francisco health commission on january 5, 2021 adopt the foregoing resolution. >> thank you, commissioner guillermo. before comments. do we have public comments on the resolution? >> if you are on the line and would like to speak press star 3 so we can recognize you. star 3. i do not see any hands raised, commissioners. >> okay. fellow commissioners, would you please raise your hand if you have any comments you would like to make with regard to this resolution.

i do not see additional communities. we will have opportunities over the course of the meeting to acknowledge and express gratitude. thank you to commissioner guillermo for reading the resolution. we need a motion and a second, correct, mark? >> correct. >> i move adoption. >> second. >> roll call vote. >> commissioner guillermo. >> yes. >> commissioner giraudo. >> yes. >> commissioner green. >> yes. >> commissioner chow. >> yes. >> commissioner christian. >> yes. >> commissioner bernal. >> yes, enthusiastically. >> thank you, mark. now we get to go to what is one of my favorite activities of the

commission. the privilege to engage in over the course of the year the bow recognition awards. mark, would you like to get us started on that? yes, we are taking turns to read these allowed. these are on the public line. they are not in the room with you all. give me a second to show the screen. >> for everybody on the comment line, lhh staff we are waving knowing you are on the phone with us.

>> give me continues for making it larger. >> i think we can proceed, mark. >> okay. >> commissioner guillermo has the first three. >> four south 5, th the covid-19 unit. since the start of the covid-19 plan, the south side team has been on the front lines to slow the spread of covid-19 at lhh. the covid-19 unit staff passionate resident care

contributed to th to the full fl resuccessful recovery of 19 residents. they embodied the values of high-quality passionate care for residents in their approach to the whole person, not just the diagnosis. congratulations south five covid-19 unit. >> respiratory therapy care practitioners provide ongoing services to residents' health. the lhh response they have

continued to provide services while conducting all covid-19 tests of the residents to provide additional care to those showing symptoms or signs. the dedicated resident focus services continued throughout the year despite the staffing challenges. they have gone above and beyond at this crucial time. congratulations and thank you to the respiratory therapy department. next is the activity therapy

department. >> the high-quality of life for our residents. it changed significantly due to covid-19. they didn't stop providing services. they develop an innovative programming utilizing wide range of activities for quality of life and cognitive and emotional and cultural and leisure areas. additionally, the therapists are key in connecting the residents to families and friends digitally. thanks to the team the cognitive, emotional, social and reactional well-being is supported despite the quarantine. congratulations and thanks to the activity therapy department.

thank you. it is my pleasure to introduce and congratulate the three departments. first environmental services department. what a wonderful department in our very large campus. environmental services department work to maintain hospital cleanliness increased when covid-19 arrived at laguna. the team initiated a 24 hour cleaning service identifying alternative cleaning solutions in conjunction within affection prevention and control. increasing the frequency of high touch surface disinfection and expediting hiring of additional staff for around the clock coverage.

under the leadership of chelsea jackson who served as planning chief from hics team. the team's role is especially vital to disinfect the departments exposed to covid-19 or positive cases. their tire less efforts are crucial in mitigating the spread of covid-19 and keeping the laguna community safe. congratulations to environmental services department. this department is vital during this period of time. contact investigations team. especially as our work is challenged during the last several weeks. the contact investigations team has supported laguna since the beginning of the pandemic. it is one of the primary reasons the covid-19 response has been

as effective as it is today. this team conducts staff and resident contact investigations, also known as contact tracing. the team is also responsible for weekly staff testing. the team is led by irin who displayed leadership and initiative throughout the response. since march. the team has completed over 1500 laguna honda staff interviews associated with positive cases and staff symptoms. over 37800 covid-19 tests for the laguna staff. the c i-team has assisted to minimize the spread of covid-19 at laguna honda. thank you for your very hard work.

congratulations. the last department and one of my favorite is. the food and nutrition services at laguna. this department serves three meals per day for up to 780 residents while running a bustling cafeteria. they have done a remarkable job of adapting food service during the pandemic despite facing unique challenges. the team has navigated p.p.e. protocols and working in the kitchen including eye protection, social distances is not always possible. the leadership provided support and compliance updates, in service training and infection control measures, increased cleaning and disinfecting practices to ensure the team's health and safety.

the team leader does exemplary work and serves as continuity of operations chief for the hics team. congratulations to the nutrition services department. thank you, commissioner chung. i am congratulating the health checkers and screeners. the lhh health checkers conduct symptom screening for playing a vital role in the community. they ensure all that enter comply with the covid-19 symptom screening recommendations for the centers for disease control and prevention.

they screen 800 or more staff per day with a positive and friendly attitude. they have been adaptive in the commitment to keeping the lhh safe and uninterrupted. they are a crucial component of the successful pandemic response. as someone who meets and greets these individuals going to the hospital every day this is a tough job. the fact you do it with such great spirit, we are very grateful to you. thank you so much. next is the rehabilitation department. the lhh rehabilitation department provides various services to residents key to successful recovery. they work with residents recovering from injuries or illnesses, the disability prevents them from doing every

day task to improve independence, dressing, bathing, toileting, strengthening, balance answer cognition. since the onset of covid-19. they worked to ensure residents continue to receive most of the previous services. the team created the first lhh telehealth program to continue providing outpatient services to residents in need. despite the changes in service delivery and staffing. the teams are positive and focused on delivering excellent resident centered care. thank you so much and congratulations. my last privilege is to thank the facility services. the facility services team ensured that lhh's design protects the safety of the staff and residents. in the pandemic response they

installed plexiglass barriers for health checkers at the entrances and were praised for inmovative solutions during the pandemic response and set up alternative din dining spaces. the team has worked under the leadership of diane kenyon who served as logistics chief for the hics team and central command center logistics team. thanthank you so much to diane r such critical work in preventing the spread of the virus through the institution. thank you so much. next up is commissioner bernal for the next three.

>> the clinic. it is my privilege to present this recognition to the clinic staff who have been invaluable in the lhh implementation of the vaccination clinic for staff. the efforts in the vaccine rollout are protecting staff, residents and community. they vaccined more than 700 employees in a short few days. the charge news in the outpatient cleanic for -- clinic. in preparation for vaccinations, she worked closely to develop the work flow for the smoothly run vaccination clinics. she remained calm and is

instrumental in this undertaking. please join me in thanking. next is the admission observation unit. they commit patients at lhh and cares during the 14 day operation period. this team provides care for residents at skilled nursing and rehabilitation level of care which require different care processes and documentation. furthermore the patients are tested for covid prior to admission where the potential risk post admission. the team lives in enhanced p.p.e. and ad heres t to infectn control guidelines to steve -- to keep everyone safe.

[indiscernable] please join me in congratulating them. infection control team ipc team is the foundation of the lhh covid response. under guidance of jennifer, the infection control nurse they provided each discipline with a standard work to provide safe resident care during this global pandemic. the team rounds on each unit working with front line staff t ensure p.p.e. usage and hygiene, masks and social distancing. in the beginning of the pandemic they responded to each case in person, no matter the hour. they supported the unit staff with the needs and questions and concerns and had a listening

ear. they have utilized the skilled nursing facilities in san francisco and across the nation. congratulations to the infection control team. commissioner christian has the next three awards. >> it is my great honor to read the award for the hospital command system or hics team for leadership. the lhh team comprised of hospital leadership has been the lifeblood of lhh covid response. since february 2020 they assembled seven days each we're to guide the hospital during the challenging time. during collaborations and cdc

consultants they implemented practices instrumental in limiting the spread of covid at lhh. the team continues to anticipate and respond to the ever changing circumstances associated with covid. the team has served lhh with distinction, great distinction throughout the pandemic. every effort to pro -- protect residents and staff from physical, emotional and psychological impact. thank you for the work that protected and preserved the lives and health of the residents at lhh. thank you so much. >> next is the social services team. since the start of lhh's protective quarantine order in march 2020. the social services team provided the support for lhh

residents and families and caregivers. to communicate all updates with families and caregivers and maintain extraordinary level of professionalism through the difficult questions in the cdc bag. the team is on the front lines of coordinating virtual and outdoor visits which is very time consuming. while their work flow pivoted substantially, the team let each change and challenge with fortitude and grace. we are so grateful for dedication to residents, families and the institution. i would like to add that i have some personal insight into the work that you do for the residents and families and how difficult and challenging it can be. thank you on behalf of families who have people in the nursing facilities suffering from covid. thank you so much.

>> i have the pleasure of congratulating the it procurement team. they have managed and distributed p.p.e. throughout the covid-19 response. they work with the central command center to support the p.p.e. needs of lhh. they provide excellent customer service, maintain professionalism and are dependable. when lhh began testing alternative respirators, the it team mobilized quickly to provide data to determine which would be the most effective for our staff. this team maintains a positive and friendly attitude and are always more than happy to

assist. thank you foreign abling the staff to stay safe. >> i am going to stand in for the next award. i have the pleasure to congratulate tone near w un g to make sure that staff have the new respirators, the fittings are up-to-date, nursing departments have an adequate supply of n95 respirators. throughout the pandemic response this is crucial to ensure the healthcare providers are fitted

annually to protect themselves and the lhh community. tony created a comprehensive xl database and respirator database. supports without hesitation and day-to-day work of supporting administration and the leadership. clearly without a properly fitted n95 respirator the staff would not be able to do their work. thank you so much for your work. we are going to spread the love a little bit. commissioner green will take over. >> i get to thank the plans analyst team. the man's analyst team is -- plans analyst team is vital to

the covid response. the dedication to data tracks allowed lhh to respond to covid outbreaks and spread within the facility. developed the dashboard to track data on staff and resident testing cases and recoveries. they created a dashboard to review staffing needs and trends of symptoms spread within lhh. they developed the form and help check tools. each member of the team responded to data needs without hesitation. they supported various sections of the covid response including the investigation team, logistics team, ipc team and plans team. i would add the data we see as commissioners is excellent and it really we are so grateful to

you important putting this together with the detail involved and the accuracy is impressive. we benefited from your work in addition to residents and staff that you are protecting. thank you so much. >> i have the privilege of recognizing the volunteer services. we all know how critical volunteers are and their commitment and generosity. the volunteer coordinators have be key in the implementation of the lhh outdoor visitation program. which provided the protective quarantine order to keep residents connected to family and friends and everyone else in the outside world as we deal with this, too. mike ford organized volunteers to assist with visitation observations. volunteers are trained on infection control practices and

are tested weekly to assist as observers and keep outdoor visits safe. in addition to this program development the quick action preserved the holiday program for residents working closely with finance and the activity therapy department to make sure they received gifts during december. thank you for your dedication to the residents and volunteers. >> it is my privilege to honor the next group which has a very tough job. it is the risk management group. risk management team has continued daily operations of responding to facility reported incidents, california department of public health, documentation

requests, cdph site visits and supporting plan of corrections. geraldine has reported cases daily since the onsets of the pandemic. the team for the first few months of the effort supporting the staff in learning appropriate p.p.e. usage and hygiene and as assistance. a constant support to the risk management team responding to regulatory needs in response to covid and daily lhh regulatory requirements. thank you and congratulations to the risk management team. >> it is my privilege on the

next to recognize dr. lisa who an exceptional physician who worked here for 25 years. she is very knowledgeable in all aspects of care and always acts in a cuttertyious and professional -- turcourteous manner. a practice lost by many physicians in towed's health arena. since the initiation of the covid response, doctor who worked nearly every day. she worked alongside medical leadership as acting chief of staff, covid-19, hics leadership, deputy chief of medical operations and hospital executive leaders. she completes all projects, tasks and assignments without breaking a sweat. thank you, doctor who.

my last is to honor and thank bridgett, a charge nurse on south two displaying leadership in support of neighborhood and hospital at-large. she will often offer staff to be footed when hearing of staffing challenges on other units during the day shift. we all share the workload as we are in this together. this is the essence of selfless leadership and one of the qualities that may beings lhh a special place to work. many thanks to you.

>> thank you, commissioner. before we go to comments. mark, do we have public comment on this item? >> thank you. if you would like to comment press star 3 to raise your hands. i don't see any hands, commissioners. >> i would like to recognize dph director dr. grant colfax. >> hi. good afternoon, commissioners. i just want be to add my gratitude and thanks to the commission for recognizing the outstanding laguna honda team, especially during this unprecedented year. as the mayor said this morning lhh is a model for skilled nursing facilities. i think what shines through this year in terms of attendance.

it is a community of people who care for each other no matter what it takes. i think you see that shining through in the recognitions that has been shown today. i want to thank everyone at laguna honda for work and care of the residents. of course, acknowledge the residents and their families who have had a difficult year. vaccines have been given to almost a thousand lhh staff and we expect residents to be offered covid-19 first dose vaccines by tomorrow. i will have more update about that later. we are continuing to make progress. i want to thank everyone for their work. >> thank you, director colfax. commissioners, any other

comments? >> i would like to quickly also thank the commission secretary and the c.e.o. michael phillips and leadership for putting together this awards presentation. to see everybody's face in the slides was something special for us. we missing everybody and we wish we could be there in person. going through and hearing all of the awards and reading about the extraordinary work reminds us of ththe enormity of the task and challenge and the dedication and care. we are grateful to not just our honorees but everybody at laguna honda, both staff and residents for everything you are doing for your hard work, perseverevens, thank you. >> if i may jump in.

i want to give credit to the staff. i had nothing to do with the presentation. i won't take anything away from the glory of the wonderful work they do every day. >> thank you for letting us see the faces of our honorees today in the presentation. it is something special for the commission. thank you. we can move to the next item. mark. >> item 6 is the annual report. you have permission to share your screen. that is how we will do this.

>> can you hear me okay? >> yes, we can. >> good evening, thank you for joining us today. thank you for taking the time for our staff and as well as the recognition we appreciate it. i want to take a quick second to say thank you to. [indiscernable] i have the best team in the world. it may beings all of the difference with the hard work every day. not only did we have a great leadership team as you have indicated in the recognition. we have a tremendous staff and the work they do every day makes this a special place that it is. we could not do this great work without all of our staff.

we really appreciate all of their efforts. as i it i i sit here. we were focused on keeping all of our residents safe and al live. as we all know, unfortunately, we lost five residents recently. they were our only five that we lost. they were five too many. thinking about the families and work of the staff trying to keep the residents safe. we feel that we come up short in that area. at the same time i am so

thankful for all that we have been able to do with such extraordinary circumstances. this is a long and difficult pandemic. during the month of december this is the most dangerous and difficult month during the pandemic. we certainly have at lhh as well. all in all, it is unfortunate that we have been able to now vaccinate the vast majority of our staff. right now we are close to completing all of the units with the regular vaccinations. we have a few more to complete during the follow-up day. all in all, we will be close to completing all of the first round.

that is a wonderful accomplishment. >> this chart indicates the size, magnitude and importance of the department of public health to the city of san francisco. laguna honda is a small portion of this chart. they play an important role in the department. our mission and values represent our identity of the organization. it is our commitment to provide residents care. we have had a busy year, as i

have indicated, despite that we are operating in the middle of a pandemic. we maintain extremely high volumes. 294,000 total resident days. we continued to do admissions. we have completed more than 354 new admissions. 94% of the staff have received the flu vaccination. that is a tremendous achievement as well. [indiscernable] we cared for some of the most vulnerable and underserved residents in the city.

2020 has been a very challenging year as we responded to covid-19. we are very fortunate to have gotten a increase in our operating revenues. that helps us to weather the storm because we also had an associated high number of expenses as well. our total operating expenses increased by 9.5% during the year and on the staff salary fringe benefits we saw an increase of 9.6% in those expenses as well. we did take a 9% decrease in our job fund. that was more of a function of

offsetting the 9% increase we were able to obtain in our increased revenue. this indicates that our main source of revenue is government and 90% of the revenues. [indiscernable] this reinforces our commitment to resident-centered care. it indicates our mission as well

as our metrics of the base of the pyramid. the metrics and the vision is delivering on the commitment to patient centered care. thithisthis ithis isthis is the. we have working at laguna honda which is near and dear to everyone. we are implementing strategy around trying to impact that metric. we also will be doing work in

the area of improving efforts around equity. this is a huge goal for the entire department. 2020 to make that possible. good evening. happy new year. the next slides dive to the true north metrics. i will share about the quality of care. this is focused on improving the health of the people we serve. they chose to focus on calls of major injury.

laguna honda has a falls management tool in the neighborhoods. this allows units to easily see which residents are at risk for fall, who suffered from a fall, who suffered from a fall with major injuries. it provides ability to speak daily in terms of actions to support residents. another item that has been reinstated is the multi-disciplinary falls committee. this team is to come together monthly to review falls throughout the facility, focus on units with patterns in terms of residents falling frequently and discuss actions as a team. they are tasked with working with resident care team to ensure their part of the care plans that we can improve efforts to keep residents safe.

we have new pus by 23% target was 10% reduction. we surpassed that. there is a committee in one of the clinical nurse specialists who partners with the resident care teams throughout the facility. the metric focuses on the safe environment for residents and visitors and safe and safe medication administration we were able to develop and implement the medication administration system. this is very instrumental and very use full in terms of implementation as well. our next item is the care experience metric. this is focused on the best experience for the people we serve. this past fiscal year lhh

maintained recommending lhh. it was collected through discharge survey over the phone and inquiring about experience while they were at the facility. we are proud that we were able to maintain over 85% scores each quarter. big thank you to the social services department who does this great work to collect this data. our work force metric focuses on creating environment that respects values and invests in people. the lhh staff. this year the team focused on improving the likelihood to recommend working here at lhh. in this effort we implements cultural safety survey during the fiscal year and will continue in the next year. we have three surveys and over each survey we were able to gather a larger sample size.

[please stand by]

>> and to support the critical and initial teams of go live and this staff was available to us 24/7 during the first month of supporting users across all the from nursing that quality management to our medical records team. it shift today our response in covid pandemic. shadow units were built to clean our swedes anduring this pandem. i want to share just a few highlights. you know, our fun events from the past fiscal year of course since march, we've not been able to have as many in-person but some of those before.

the service events he have every year that are fun to plan. our laguna honda staff that reach five to 30 years of service are recognized during a special dinner. the event celebrated more than 100 staff members from across multiple departments, they were provided a certificate recognizing the number of years at the hospital as well as a special pen to commemorate the memory. our annual resident holiday gift program, spearheaded by our two volunteer coordinators worked hard during the holiday season to ensure that all residents receive a gift from the hospital. for over two months, michael ford and (inaudible) collaborated with the activity therapy department to identify resident wish list. they also organized a volunteer days with volunteer support to package items that were gifted to residents during each party. this is the pre pandemic not

this past holiday. >> we had a wonderful week whether staff celebration week. after more than three months of trying to slow the spread of covid-19 with laguna honda hospital, we celebrated our staff by hosting a week long series of events. to kicks things off, the hospital received 5,000 bouquets of lilly through the again race donation from the council general of the netherlands. staff were treated to light snacks, that promoted wellness and healthy living. the weekended with a town hall with our new c.e.o. michael phillips and provided participants with an opportunity to ask open and honest questions about the present and future of

the hospital. i'm going to switch gears to our covid response. before i pass it our. >> toni-marie: our acting c.m.o., at the beginning the pandemic we knew laguna honda would be vulnerable to covid-19 due to our sign and population. we implemented actions that have protected our communities to date and dramatically slowed the spread of the virus. at laguna honda hospital, one of the largest skilled nursing facilities in the country and the largely publicly run, we have worked to catch places and during fiscal year 19-20, this

team was able to meet and say that we had no covid-19 deaths. some of our covid-19 response is that we were able to continue a strong covid culture in a sense of community. a lot of the this came from our culture and safety works and partnership with the department leaders and front-line staff. additionally, we did great communication to our staff and residents and resident families and loved ones and the early days of the pandemic, there were many of us here to the we hours of the morning and ensuring that letters were printed and delivered to every resident and every family member. our social services team called to ensure they were up-to-date and all our protocols.

additionally we made sure we were recognizing our staff as much and as often as we could and celebrating the contributions of our resident and resident families. >> good evening, everyone. i wish i can write down everything we did. these are the highlights of all we can remember. our covid response was fast and hard but we succeeded. we started with daily health checks. we limited entrances to two and that is one through the new hospital building, one to the old hospital building. we implemented masking, which is mandatory for staff and we highly encourage masking for the residents. we started screening testing for staff and residents. we formulated outbreaks and controls post any covid positive

cases. we also designated a covid unit. we launched our contact investigation team. we also beefed up our evs department and had a cleaning shift which allows us 24 hour coverage for the whole hospital. we have cleaning protocols for disinfecting youth. we have a thousand staff and there's always changes and and what ppe usings and we change that to this day and plexiglass and we also have stickers and social distance stickers on the

floor on the wall and also, most importantly, planning. planning, planning, planning. planning for reopening and for visitations and services and as well as planning for resident activities, next slide. the next couple of rides is timeline and if this is to look what we've done there's a lot of picks and marks there so we highlight the most important one and march 14th, we started screening for everyone entering the building. this is before we were told to do it by the heath or the. we restricted non-essential personal and visitors so when the was activated and on the tenth we started to have to have protocols and shelter in place

was required and when we received a health order for protective quarantine and this restricts residents from leaving the hospital. cdc and cdph came our way on march 30th to help further improve our protocols and give us more recommendations and from then on it was just what to say. next slide, please. this side i want to focus on may fifth. this is a very monumental moment for the whole staff and for the residents. this is a time we implemented universal now known as screening testing. i remember when i delivered this news to the medical staff they were thrilled a few folks actually got teary-eyed because this gives us hope and prior to this it was a big question mark as to who has the virus and what are we going to do if we test a positive resident. and after that, may eighth, we

designate the covid unit and they have flourished and ex celled since then. all of the implementations and mitigations ex control and disease were able to open up new admissions and june 29th or 30th we started setting it back into our aou. next slide, please. despite the pandemic, laguna honda prioritizes our initiative for advancing equity and we've hosted monthly equity lending series in conjunction with bahi begin north may of 2019. we've had our first cohort of equity champions who have harmed in the health equity champions program and they have enter

department 58 group and they are in charge of open operationsizing our equity this includes give aways and starbucks cups and classes and we have shout outs and some of the prizes and of course most importantly we've increased the communication. that includes our dsf which is our daily situation status. we have a weekly info sheet that includes the ler from michael phillips and we hold monthly town hall meetings and

leadership forums and lastly, it was a very busy year as you all can see. this is a year that we had changes for our institution and we have michael phillips and despite our efforts and laguna lon don't has full compliance and we have flourished and shown we can come together and meet the challenge of covid-19. we decide nation wide trends and that response is a model for so so this is grateful and we are grateful for a staff and resident and our many collaborating partners.

>> thank you so much mr. phillips and dr. hathaway for your presentation. before we -- there you are, hi, you are big on our screen now. before we go into commissioner comments or questions, do we have any public comment? >> >> if you would like to make a comment on this item, press star 3 so you can raise your hand and we can acknowledge you. star 3. i do not see any hands, commissioners. >> all right. thank you. well, before we go to commissioner comments, i just want to acknowledge again, that the hard work and leadership of everybody not at laguna hospital but also at the department of public-health and the leadership of mayor breed as well. i recall at very beginning of the pandemic, it was recognized immediately that one of the keys to our effectively containing covid-19 to the extent possible was having a robust response at laguna honda in order to ensure

that we didn't have the kinds of outbreaks that were seen around the county and the mayor and the leadership within the department of laguna honda engage with the cdc to put together a program that was a model for the nation. some of you may have seen it came out last night or today, a piece in the new yorker, describing some of the efforts that took place in san francisco in order to address the pandemic and looking just at the timeline in your presentations, so many of those steps and actions taken have been highlighted as very effective means to help contain the pandemic and protect operations as a model for the nation so again we're just so proud of your hard work. we understand that as required a lot of sacrifice and a lot of difficult days but it is certainly showing in the results we've seen and while we are very sad to have recently lost some of our residents. there's light at end of the

tunnel with vaccinations, which i know have just begun. i'd like to ask my fellow commissioners if they have any comments for and if he has any comments he would like to share as well. i see commissioner chow. >> yes, thank you. i echo and second everything that you have said in regards to the work that laguna has been doing and especially in regards to our covid challenge. i know that several of us on the joint conference have been also more into the details as to what they've done and we've been also able to get additional information on the work that the hostile has been doing in face of the recent challenges as throughout the city and the state. we've had a raging epidemic even

worse. our third phase, i guess, and we'll probably hear more of that. i want to note, i think the work that laguna has been doing and the way that they have been trying to handle the infections in-house and with staff are really co commendable. if we look at the detail, they've taken advantage of the fact understand our new design and our hospital isn't that new, but certainly if we have had the old design with the large wards, we would have had a lot greater problem. with the design that we have and which people are somewhat in semi private and isolated and being able to have neighborhoods rather than large areas, i think that the staff has taken advantage of that as they have worked the different scenarios and the schemes they're currently using to hold down the

number of infections as well as they have. and considering that so much is coming in from the outside, just to avoid the type of tragedy that mr. phillips, kit that we already have done the first wave for most of -- for almost the entire staff and a good number of our residents. i think that just shows the way that laguna's aggressively trying to protect all our

residents and i want to also express my thanks for the work that they're doing on behalf of our residents and the city. thank you. if. >> thank you commissioner chow. >> thank you. i would like to emphasize and really in particular given that this was a year where there was so much transition going on, that wasn't even covid related, at laguna honda and yet we've had a couple of tough years these last couple of years and i'm so just really glad to hear now that we have a full compliment and the executive team together so i can imagine

how much better we're going to be seeing the la luna hospital perform with a full compliment and permanent folks in place especially given how well you've done with folks serving on an interim basis so i want to congratulate all the leadership there for bringing it all together and continuing to challenge yourself and not using the excuse of covid and transition for not getting to many of the goals and for not -- as i said, making excuses and continuing to challenge yourselves to improve and to always keeping the residents of san francisco first and foremost. so i just want to congratulate you.

i want to -- and i don't know if maggie is on the line but also the role that she played and folks that came in from the network and came in from dsfg and it's been a unique year and a great deal of satisfaction in being part of watching it all come together. and supporting not only the executive team but all of the -- all of the workforce -- >> thank you. commissioner green. >> yes, well, i don't think we can heap enough praise on everyone who works at laguna,

everyone who supports the organization within the health system. of course, the mayor's office for helping facilitate all of the actions you've taken and to have done so so rapidly. but you know, what strikes me in all of this is that there have been so many transitions that all of you have had to face and so many pivots that have been made so suddenly. so many organizations fail when leadership has to shift, never mind, a pandemic that hit in the middle of all of these other things you were dealing with. i think it's a real testament to the creativity, to the commitment, and to the teamwork. it's unusual for you to have been able to accomplish what you did, given all the changes that were thrown your way in such short order. on top of that to hit every single mark in all of the other work that was involved in keeping laguna running and doing so so well.

i was thinking, you read a lot about covid fatigue, there's not a sign of it among those of you who are supporting the residents and the work that you do. it's row marketable how you maintained your momentum. how you maintain your commitment, even as you and your families are vulnerable and you come to work, really, it's hazard pay. everyone deserves to be working in an environment that is so changing and so many threats when we think we've got this pandemic under control. the new variant comes along and i think the way you are able to respond, we all have such faith that no matter what comes our way with this pandemic going forward, that we have great trust in you and faith in you and knowledge that your commitment and your ability to face whatever comes along will be exemplary. and you continue to lead the country in the work that you do and others will look to you to

determine best practices and best way both from a psychological perspective for residents and skilled nursing facilities, as well as the employees and these facilities to handle both the physical as well as the mental well-being of people who are being -- [please stand by]

>> director colfax. >> good afternoon, again, commissioners. extending my gratitude to laguna honda and everything they have done and will continue to do there. just a few things to highlight on the director's report which you have in front of you. as was mentioned earlier in the meeting i wanted to acknowledge the passing of dr. david sanchez. on the board for more than two decades, a true leader at

u.c.s.f. i didn't have a chance to work with him as long or closely as i think that would have benefited me and the department, his legacy is represented in what we have today both at the health department and in terms of health wellness in the city to acknowledge his passing. our condolences to his wife and three children and four grandchildren. i also want to mention i will go into deeper covid-19 update on the next section, but i just with regard to where things stand with health orders. we are still under the state shelter-in-place. regional shelter-in-place. recall the state implements that when ic capacity in the region is less than 15% across the region. at this time as of today the i c.u. capacity in the region is down to 5.9%.

that is a low number we are watching carefully. with regard to our increasing number of cases and hospitalizations in the region, mayor breed and i announced and the health director dr. susan phillips issued an extension of public health quarantine order on new year's eve to expire on january 4th. it is now extended. it requires people traveling outside of the bay area with few exceptions to quarantine for 10 days when they return and if people are coming into san francisco from outside they are required to quarantine for 10 days.

it is important for us to hopefully slow the spread of this virus. we are also extended the local stay-at-home order that was issued december 6th before the state stay-at-home order. right now the state stay-at-home order takes precedence. if and when that state stay-at-home order expires, the local order will have precedence. we will watch cases and hospitalizations in i c.u. capacity to determine when we can hopefully start adelin berrat and careful re-opening. that is not at that point today, but as we continue to work to slow the spread of the virus, as we continue to monitor what is happening post holiday and look at the situation in the central and southern part of the state,

we are watching that to hopefully be able to reopen as quickly and safely as possible. again, given the circumstances we have some ways to go until we are able to do that. i just we will have a vaccine update. our executive sponsor for the covid-19 vaccine will be giving an update on that. i will not go into that in the director's report. i want to welcome our new director of public and governmental affairs to the department, katie cane. in this role she will read the department external affairs work. she joined dph as disaster service worker during the past summer and fall, and we were fortunate to have her agree to join the department in this

position now on a permanent basis. the commission may know her in her former role as san francisco supervisor. we are delighted to have her wisdom and commitment here at the department now and she will continue to play a vital role in the covid-19 response. in broader work in terms of health equity, community engagement and health policy she will continue to make major contributions. i wanted to acknowledge and award a dph employee who has done an outstanding job. worked as our focus on the health network supply chain materials. she was acknowledged as a woman

leader in supply chain. supply chain doesn't get a lot of acknowledgment and attention sometimes in our commission meetings and narrative. i am so grateful for her work. she was so pivotal to makings sure in covid-19 when there were major supply chain issues with masking and other equipment she did a master full job. i want to acknowledge her work and recognition is very much merited and i want to thank her for that. you also have in your summary a number of dph in the news. there is quite a lot of activity. you can review the links there. i am happy to answer additional questions. thank you, commissioners. >> before we move to commissioner questions. any public comment?

>> if you would like to comment press star 3. comment on the director's report press star 3. i do not see any hands up, commissioners. >> any comments or questions for director colfax before his covid-19 update? commissioner chow. >> yes, thank you, dr. colfax for your comments concerning dr. he would have been pleased to see your response that laguna has performed so well over this past year. let me just ask that knowing that the mayor had indicated there were budgetary guidelines

released. when would the commission actually be receiving information and be able to work with you on the new budget? it seems like we just finished the old one. the new budget for the coming fiscal year. >> yes, i will have chief operating officer provide some more specifics on when that timing might be. also, to emphasize the mayor's budgetary priorities this year include covid-19 behavioral health and equity so certainly some key issues that the department is dealing with and supporting. i will let mr. wagner provide comments on timing of when proposals may come before the

commission. >> thank you. greg wagner chief operating chig officer. we are planning the first hearing at the next commission meeting in two weeks. then we will have a series. we are later in the schedule due to the timing of when the mayor's budget instructions were released. we are pushing forward to bring you that information at the next hearing. i can tell you very high level which some of this you probably saw through public documents but the projected budget deficit is about $653.3 million over the next two years. that is a significant deficit, although less than it was in the prior years five year plan. projection mayor's office issued targets of 7.5% with two .5%

contingencies. we started internally and are preparing documents to bring you up-to-date. >> commissioners any other questions before we move forward to the covid-19 update? thank you, mr. wagner. okay. next item. covid-19 update. >> thank you, commissioners. grant colfax, director of health, i will provide a brief update with regard to covid-19. commissioners, currently 24,564 cases of covid-19 reported in the city. we have had 198 deaths. this is looking at the

characteristics of the covid-19 cases. you can see here that pandemic shifted in terms of concentration of covid-19, distribution of the dye agnosed cases -- byagnosed cases. it is a disproportionate share it has dropped. it was slightly above 50% number of months ago. you can see with regard to our age groups. the majority of the covid-19 infections are in people 49 years or younger. smaller proportions in older populations. we call it the older populations at greatest risk for serious illnesses. then with regard to sexual

orientation, you can see distribution. quite a bit of missing data that we are continuing to collect data bisexual orientation as required by the state. with regard to gender. male consistent with the biology of the virus. this is the characteristics of the deaths. again, with regard to race, ethnicity, we see a higher percentage of deaths among asians. we believe it is confounded by place of residence and older age. we presented those data to the commission previously. age groups.

almost three-quarters of deaths are in people over the age of 70. with regard to the gender again, we are seeing national trends predominancmale over female 2-1. these are key health indicators. we have seen a movement of rate of hospitalization. the rate of hospitalization of covid-19 patients has come down from high red alert to yellow. 13% there. that indicates right now things are moving in a better direction. however, i must emphasize to the commission that we have not seen in terms of hospitalizations in moving cases we have not seen potential effects of end of

december or new year's holiday surge. in november with thanksgiving surge we had great rates of increases in cases which we saw in the december surge that we are currently experiencing. we are waiting 7 to 10 days that will be pivotal to understand and determine if there is another surge of cases on top of the surge we are already experiencing which would result in more hospitalizations. our hospital capacity, bed capacity remains robust. you can see our acute bed capacity and icu bed available capacity. icu bed capacity is 34%. i just told you regionally it is down to only 5.9%. this is due to the fact compared to neighboring counties we do not have as high percentage of

covid-19 patients in i c.u. this is also due to hospital capacity overall is influenced by the holidays. a number of people may not go to the hospital for so-called elective surgeries. with regard to acute care bed capacity that 31% is influenced by that as well. case rates per 100,000 is still in the red zone. 27.2. that has been going up over the last few days. unclear if that is due to an actual increase in cases or decrease in testing that happened over the holiday period. we are watching that number very carefully. to put that in some perspective. this is higher than where we were in the summer and fall per 100,000. about a third lower than the

state overall number which has been about 100 to 120 per 100,000. we hope we don't get there. testing numbers far above the target. this number has come down on average because this does reflect the holiday period. we expect our testing numbers to go back up to the 8,000 average soon. contact tracing, partner notification, slight improvements there to reflect that we have had such a large increase in cases over this past month in december. then our ppu is strong at 100%. this shows hospitalization trend. we are now nearly double hospitalizations compared to the summer surge or the spring surge. you can see just at that very end the last four or five days the numbers are high.

they appear to have leveled off. the next 7 to 10 days will tell us a lot more whether this leveling off represents the peak of the surge or if we see numbers climbing higher. this is our reproductive rates. estimate. remember this is a modeling calculation based on thousands of data points. not a number that we can esderm precisely. we can estimate. that follows the blue line through the graph. the solid is average of the reproductive rate. the blue wish purple lines are the estimates how low or high the actual rate is. our current reproductive rate

january 3rd is estimated 1.11. that is somewhat down from where we were in late november, early december, where we had gone up to 1.45. that is good. we are continuing to watch to see if this number goes lower. we really need this to go below one to ensure the pandemic is really slowing down. you can see that with our efforts of masking to cover our nose and mouths physically distancing, not gathering during holidays or now with members of other than with our immediate households we can make a huge change. 40% decrease starting today would dramatically reduce deaths, and we would have reduction in death and

hospitalizations even if we achieve this in a matter of two weeks from now. continuing to reduce this reproductive number is key to slowing the surge, being able to resoaable toreopen to a new nore push out a vaccine as quickly as we receive it. that is my update. our executive sponsor for the vaccine rollout can give a vaccine update now or if the commission has questions about what i just showed, i leave it to the commission if they would like mr. pickens to go. >> it looks like we do have a few questions. mark, is it all right to do commissioner questions now? >> make sure the folks on the public comment know after the

vaccine presentation we will take your questions. let's go to commissioners. >> commissioner green. >> thank you so much director colfax for this update. i have two questions. one, whether there is any ability to predicter what the variant and potential entry in our community might due to the numbers and extra changes to anticipate. the other is i wonder if you have any data about trends in house systems in terms of where our patients are hospitalized? i know in the other system the volume is up. do you have any information about the keyser system or -- kaiser system that might i form us if it might be a pressure point. kaiser is an example.

do you have any lines to help inform more than just what we know from our population distributions, which systems might be under most stress at this time? >> what we know about the u.k. variant is concerning. it is significantly more transmissible. we haven't done any modeling on those dynamics, certainly it reinforces the need to continue the prevention efforts to slow the spread. from what we know now, the prevention efforts, the physical distancing, masking of nose and mouth, avoiding gatherings and all but most essential travel should slow the spread. reinforces the need to respect the travel quarantine order because it is very key for us

especially when we look at the situation in central and southern california to slow the spread of the virus and not to travel except for exceptional circumstances. i guess with regard to the u.k. variant. no indication at this time it is a more fatal virus. mortality doesn't appear to be unchanged. if somebody is infected with this variants versus the nor natural -- most prevalent strain circulating in the community now. there is also no indication the u.k. variant will be resistant to the vaccine. that is where things stand in regard to that. with regard to hospitalization

capacity, we have data on the very large number of covid-19 patients. the doctor is on the line to provide more details. we have a high proportion of covid-19 patients compared to out care burden across the city. i will say that after a number of efforts, our advance planning team has been able to receive data, characteristics of covid-19 patients hospitalized. they are analyzing that. i am happy to come back with the key findings at the next commission meeting. >> thank you, commissioner chow. >> thank you, doctor colfax. i was wondering as part of the

covid linking issue of school openings, where we are since it appears that not only did the governor, as you said in your director's report, indicate he would like schools open, we know the mayor did. it looks like since i know that public health has put out advice is there an effort being made so the school district really does open pretty soon? >> so we have kept the schools open that opened before the surge. we are deeply committed with regard to elementary schools staying open. we have been working with the school district since march to reopen schools especially elementary schools at this time. we are continuing to support the school district with regard to safety precautions, with regard

to availing themselves of testing resources. we are pleased to see the governor's announcement. hopefully those resources will help the school district open more quickly. as you know, the opening of public schools is determined by the school district. we are here and have been helping and are ready to continue to assist. we believe re-opening the elementary schools is pivotal. what we have seen with the private schools that have been open in the city at this time, we believe the benefits out weigh the risks. >> thank you very much. i am hoping that your efforts will continue to encourage them to feel more safe. i think that the example of the schools already open would seem

to say that the public schools could really emulate that. >> thank you, commissioner chow. i see no other comments or questions from commissioners. we can move on to the vaccine update. mr. pickens. >> thank you, commissioner. thank you for allowing me to come before you and just share very brief update on covid vaccine. my colleague, doctor julie came to your previous meeting to provide an in depth update. i am here to give you a brief update of things that progressed since her last update to you. as dr. colfax mentioned, i am the executive sponsor for the

city's covid command center vaccine team. i stepped into this role two and a half weeks ago when dr. susan phillips was the acting health officer. she had this role. we partner in the network on all of the work dph does. thithis is a small part of my contribution to the effort. in terms of the covid command center, c-3. the city's coordinated response. there is a vaccine team and i want to acbeing the leaders. doctor julie stotley is the health division dph director of communitdirector ofdecisions. dr. mary has been deployed with

covid command for the past year. and also i want to recognize dr. i am the -- at the mass coney. i am here to share the heavy work with the vaccine. next slide. when doctor stotley came before you. she shared this. this shows how we envision implements the vaccine rollout in the city. this is really more long-term approach. not only what is going on right now, phase one, where we still have limited doses available.

we are concentrating on key populations determined by the cdc and the state. they have established the priority of which populations we vaccinate. in the next few weeks and months phase two and then phase three on a more sustained basis for several months in the future. again, we are still in phase one. we will hopefully move to phases 2 and 3 as vaccine becomes more readily available and as we increase ability to get people vaccinated. >> a little more time on this slide to give you an update of the current state of where things are in san francisco. as i mentioned, both in terms of our own dph rollout of the

vaccine but importantly phase 1a is the state's plan for covid 19 vaccination. that represents the top tier of healthcare and emergency workers who are at greatest risk of exposure to the virus. as of today a little more than 6,000 san francisco healthcare workers -- healthcare workers have been vaccinated. the majority of those 6,000 employees are employees of the city and county of san francisco. that may beings sense when you think about the work force that san francisco general, firefighter, e.m.t., paramedics deleverring front line services. all of them have received the first doses. second doses are administered this week.

the other thing i would like to highlight. you will hear mce multi county entities. those hospitals and health systems in an area like our county that are part of larger statewide regional or national changes. cutter, pfizer and dignity. it is important to note that initially both facilities received their first allocations of vaccine through the local health department. they are about to receive the second dose to vaccinate employees. after that the role of the health department in terms of allocating vaccine will go away. they will we getting vaccine

directly from the state. they have begun to receive vaccines directly from the state not through the local health department. that is the way the state planned this rollout to be. another key update is that you heard this a little bit the laguna honda report. vaccinations in long-term care facilities in the county. that is accomplished primarily through federal cdc partnership for long-term care. after today we know that we will have 90% of the residents at laguna honda that received the first dose of vaccine. they may be there now. we may be at that point already, fingers crossed. we will definitely have all residents done by tomorrow if not already done. the time point i want to leave

you with. during the tradition of san francisco, we have a great collaboration with the san francisco hospital system through the san francisco hospital council. in addition we have great relationships with the community clinic consortium and other not for profit clinical systems in the city. we have initiated discussions with those groups. we are actively planning to collaborate together. what is very clear from the ways the operation warp speed is designed federal and state level, the vast majority of vaccinations will occur within those mces, the large systems that will be receiving the vaccine directly from the state. it is important that we as the local health jurisdiction work with them because that is where

most of the vaccinations will occur. for us as part of the city and county of san francisco. the hotel systems is where the employees receive healthcare. we want to make sure the city employees who are essential workers will be given vaccines expeditiously. this is my final slide. i have mentioned a couple times that the state has its rollout plan for covid-19 vaccination. i mentioned we are in that very first phase 1a of three phases. phase 1a has three tiers. we are currently in tiers 1 and 2. we are about to begin tier 3. it is our desire and plan that

we should be through all of these tiers within the month of january, if not sooner than the end of the month sona we can be prepared to move to the next phase. speaking of the next phase, the state has not defined all of the categories in there. we are still waiting on direction from the state. that is the brief update i wanted to provide tonight. to let you know we will continue to come back as we learn more, as we get more data. again, as i mentioned, the vaccine is handled at the state level. we are working with the state to better understand the data they have that they can share with us so we can share with you and the public the best available reliable data. that ends my presentation. i will be happy to try to answer any questions you may have.

>> commissioners, any questions for mr. pickens? >> i know there was somebody with a hand up. public comment press star three. you have got two minutes. speak so we know yo you are her. [roll call] yes, can you hea -- >> caller: i am michelle i work with older adults. my comment has to do with the presentation on the lhh and the commissioners. i was extremely impressed to hear how well they are doing with covid response. i heard that it was a model. i can't help but wonder if there is a way for lhh to put together a model given to other areas that work with older adults,

specifically residential living. also, i was thinking of commissioner green's comment about having flexible and creative. this is unprecedented. is there a way to include someone from lhh or familiar with the system going to different facilities for training that includes areas to have more dynamic thinking to be prepared for whatever is around the bend. that was my comment. thank you. >> one more comment. to let the folk know from the public comment line. the commissioners don't respond to the things you suggest or questions because it is not on the agenda. they hear you and i am taking

notes. know that because it is not interaction doesn't mean they are not paying attention. diana morales i will unmute you. you have two minutes. okay. >> she just popped off. commissioners. that is all the questions. let's give her time. maybe something happened on the technical side. is that okay? >> great. commissionecommissioner guiller. >> thank you, dr. colfax and mrr presentations. i had a question about the cooperation that you are having

with the other multi county entities. given that my understanding is that these vaccines cannot be shared amongst even hospitals much less systems. how might the coordination work in terms of some hospitals or systems having supply of vaccines that could go to tier 1 population or tier 2 or 3 if the county does not have sufficient vaccinations but the other entities do? is that something that is able to be coordinated or something that you cannot do? >> thank you for the question. that is something that can be

coordinated. there is a process called redistribution that is allowed through the cdc and the state rules whereby one entity can go through the local health jurisdiction to redistribute the vaccine so it doesn't go unused or wasted. that is one of the main things we are already doing working with health systems to make sure that they do have the supply coming in from the state. we are definitely there to work with them if they have shortfalls, advocate on their behalf and to try to help really level load around the city, particularly as we try to vaccinate those priority populations. >> thank you. we hear these reports about certain entities are going beyond their priority population

if they have excess vaccines and sharing within the larger -- [indiscernable] i wonder if that might occur in san francisco given the need that we have with our population? >> absolutely. we have been on guard for that very thing which is why we have started those discussions with the health systems. they have all committed that we are going to go through this journey together in san francisco, that we are not going to move to one phase until all of the other partners are also on board so that we have equity on a city-county wide basis. >> thank you. >> commissioner chow. >> thank you for bringing us

up-to-date where we are and the complicated systems that we seem to be trying to navigate. within that, our private practitioners and staff are still wondering and i know that the department has said in the next several weeks they hope to put out advice as to how they or in their offices they could be protected and receiving the vaccine. not the patients which is another question that they also have and that is because the patients are asking, they don't have an answer to that. the question is they are part of the staff. not necessarily part of one of the systems like kaiser, but in the private offices. i know you are working with the medical society. do you have insight for us right now as to wha when they would et to be able to work? i am getting questions from our

colleagues. >> sure. i can try to answer this as best i know. they are definitely in phase 1a in that phase. the group working on vaccination has issued preliminary information to private providers and are working with them to see which of them are interested and able to meet the criteria for receiving the vaccine. as you know there is a process. you have got to have the right cold storage and those types of things. you have to be registered with the state in the system called covid ready the teams at the covid command center is providing resources to private providers to assist and support them signing up and covid ready also, in our discussions with

the health systems even for private providers, many have relationships with some of those health systems. the health systems have already stepped up to the table and said they are willing to vaccinate the staff of those private providers. that will be part of the continued planning that we are doing with the health systems. >> thank you. i do know that the board of medical society is meeting on monday. i am sure that question will come up again. working with conrad at the medical society who has been actually putting out a lot of good information to the practitioners. it might be helpful because the last that we got was that we are waiting for the health department. what you are telling me the health department did give guidance.

that doesn't seem to have gotten portrayed yet. since their meeting is next monday, it would be quite use full if somebody could address that or be willing to work with conrad to see that information is there. i think that is where the individual practitioners are trying to figure out how they work within their own system or medical groups who have affiliations. some are medical groups, not part of the dignity or the system. >> i will follow up with the team in terms of the ones who are doing outreach to get an update where we are on the specific outreach with the san francisco medical society and make sure that they have the latest and greatest information to support them getting access to the vaccines for their staff.

>> if it is possible to help copy me on that because now that dr. aragon was the li staff are membermembers of the society. at the board meeting if i understood what was happening we could help answer those questions. >> happy to. >> thank you. >> commissioner green. >> thank you so much for this information. i would echo what commissioner chow mentioned because not only are there several thousands of patients that don't have a direct affiliation with the system just as one example of independent practice organization with a large san francisco based information. there is tremendous numbers of

questions from medicare patients who are on medicare advantage. over 75 should be early receivers of vaccine because there is a cascade that involves hospital beds and i c.u. capacity and that is their population living independently ends up contracting the cities. it would be helpful for information beyond just individual offices not having the capacity to keep these vaccines at proper temperature. there is the issue of administration. there can be nerve damage if the vaccine is not injected properly and training to inject the vaccines an an hour long. i know we talked about enough individuals to administer the vaccine. that is another question that comes in the distribution chain that would be useful to address.

the last comment i would make is many of the private offices including my own provide vital services take care of several hundred pregnant women. if my office had to quarantine because a place in the office there would be no place for these individuals to go to receive time sensitive care. this is fragile. it applies across the city. i worry this disease outbreaks in the clinics will have the providers and the ability to give urgent care to individuals in need. i want to make those comments. thank you for recognizing we are a system that we have to look at every corner to make sure we have accounted for all patients across the city. >> thank you very much, commissioner green. i will make sure that we

coordinate with mark to get you an update on the outreach activities and planning we have done with the independent providers and what the plans are. >> commissioner christian. >> good evening, mr. pickens, thank you for your presentation. could you help me understand where community mental health workers in private practice fall in terms of being vaccinated themselves? i am not sure that the continuation of the discussion about medical doctors and their practices, probably a separate question. i am thinking about psychologists who are not part of kaiser or any other medical group, multi county medical group to provide vaccines.

do these very vital mental health workers, where do they fall in terms of priority? >> thank you for the question, commissioner christian. phase 1a, tier 1 includes healthcare workers, emergency providers and those supporting critical healthcare infrastructure. behavioral health providers are part of that. while they were not in the very first tier of emergency room, i c.u. nurses, e.m.t. we will get quickly to that tier and should be having those folks signed up very quickly. because i don't have dr. stoatly here with me, i don't know which

tier they are in. i am hesitant to give an answer that may be incorrect. i can assure you the behavioral health providers. in some settings we coup pro anotheproducehe -- we do providy care. they are definitely in the prioritized tier, just not the first tier. >> thank you. i know this is a process developing situation, but as soon as there can be labels to specify behavioral health workers are considered to be essential workers. i know that we think about it we realize that is true. as soon as there is information in the community to make that clear would be helpful. >> thank you for the feedback. we will incorporate that. >> this is hally hammer.

>> please do, hally. >> commissioner, christian. we have included our contracted behavioral health providers with our civil service employees in the chain and in the administration plans for the vaccine. i can't speak specifically to our private provider network like the individual providers. our contracted health providers are all included. they will be vaccinated alongside the other behavioral health clinicians. that is the next tier. 1b. we can let you know exactly where that is. >> thank you. i appreciate it. >> i want to add that similarly we have behavioral health

services representation on the sfhm patient task force and thinking hard to make sure the clients receive the vaccination and if they touch the behavioral health or primary healthcare elsewhere. we are working on that as well. >> one thing i think is worth noting since we are virtually at laguna honda is that 90% of the residents have been vaccinated which is a tremendous accomplishment since it just started yesterday. thank you for the update as well. mr. pickenss i have two brief questions. first i understand that the state is responsible for the phasing. i would be interested to see where we would see people living in congregate settings such as

sros in those phases. my question today is with regard to special populations. i know there was not enough data or participation in the clinical trials to indicate whether or not it is advisable for people with weakened immune systems such as h.i.v., women who are pregnant should receive the vaccination. is there any new information in that regard or some feedback that we will get more data as more vaccines are administered to determine whether or not it is advisable for these groups to receive the vaccine? >> thank you very much, commissioner bernal for the important question. i don't be have that information. i know that the team does. we will coordinate with doctor

mercy and get an answer to that question. >> thank you, mr. pickens. >> just to emphasize that many of the question we have questions to the state and we are following the state guidelines. those guidelines will be refined, particularly with regard to specific, we hope specifically to the populations that were brought forward and mentioned here. i want to emphasize to the commission that we are going to follow those state guidelines. if we cannot fine the answers to your questions we will consult with the state. i want to thank mr. pickens for his work. he obviously has a massive job

and stepped up to this role across the city to help us coordinate the vaccine efforts. to reiterate we expect that most vaccine will be delivered by these multi county agencies. we are working to cooberate with them and we expect they will be receiving most of the vaccines, most of those in san francisco since over 95% of san franciscans have healthcare coverage. >> thank you, director colfax. i do not see any other questions or comments from commissioners. thank you, mr. pickens, thank you for your hard work and leadership and excellent presentation. >> may we go back to public comment. ms. moral less got bumped. >> hello. two minutes on the clock.

>> hi. i have comments currently i am a student at college of san francisco and perform x-rays at hospital. we will be an at the hospital for five days a week for eight hours per day perform the same level of care as licensed technologies but not offered covid vaccine. we feel like we fall into the population since we work in direct healthcare. the attention gathered over 200 signatures over people who agree with us. we just had a question why we weren't considered phase 1. we are also in direct contact with covid patients, you know. it is patient safety as much as

our safety. >> thank you. just to repeat commissioners don't respond to direct questions or comments because they only talk about things on the agenda. we have heard your question. i am hoping mr. pickens and the other folks can take that into consideration with the other commissioners input and can bring back information to the commission. >> thank you. >> thank you very much. seeing no other comments or questions we can move to the next topic which is for discussion finance and planning committee update.

>> thank you. i want to thank the commissioners who came later in the meeting so we would have a quorum to make recommendations. the agenda shows we had two contracts one with an extension for walgreens to help to administer the 350b pharmacy program which is the low cost acquisition program that the city uses. we use walgreens with 30 points of service so that our patients will have read de-access in the neighborhood. this is an extension of the contract for three more years or a total of eight years because of the wonderful work that they are doing. they have received very good ratings from our patient

experience. the other contract that we also looked at was from felton institute. they are working on the repeats in the population. they have been able to receive or they are going to have a new grant added to their contract if we then approve the addition to the contract. i forget what it was exactly. increase of $1.6 million for the term of 6.5 years. it is a grant that the institute has found to be very appropriate to carry out. we had for me contracts. one was actually an administrative one for the

medical administrative management programs. it manages these for the 50 counties in the state. received these funds. up until recently it was okay to actually work a relationship with the host county doing that without a formal contract. however the city policy changed and required a formal contract. what we have before us is retroactive contract going back to july 2019 in order to have them administrator this. there is a contract amount of $561,000 for about three years. it includes about $200,000 which is -- because the fees are based upon what the draw is, i am not

sure exactly what that is. the recommendation was add $200,000 over the 150 or $160,000 annually to be sure over the three year period we don't run out of funs to pay them. since they are based upon the ability to actually bill and get funding this is basically an administrative fee paid in order to do it. there is no general fund as well. the latter three are new contracts for the sugary drink distribution tax community program. in that program we have heard two of the contracts and the commission already passed them last november. these are three more that take on three different populations of central american population, southeast asian and the tenderloin neighborhood development corporation working within their populations

including the mission bay. i felt also that we wanted to be sure that while the contracts are for a community program planning process in the first phase of the logic models they put out they did pivot their contractors in order to help bring food or allow healthy choices of food up to the populations they were serving. we felt that that work and the work of doing some of the hands on was really important and noted that there was quite a bit of money put in for planning and research and perhaps in towed's context they want to help continue some direct services for that population.

so these populations as one of the grants that we did recommend the approval of the contracts and the staff took that advice to be under consideration. we also asked that there be a report back to the commission on the results of the work they are doing either at an annual basis for which there is an annual report submitted from the five providers so we could have an overview at the health commission distribution tax progress. that ends my report. if the commissioners want to add anything or answer questions for the commission. >> thank you, commissioner chow

for stepping in to chair and commissioner giraudo for participating in the meeting. it is a great example of work done in the committees. members of the public are available to view and participate in over web ex. not all of the work happens at commission level there is significant work at the committees as well. do we have public comment, mark, on this? >> no hands up. >> any questions or comments from commissioners before we move to the next item which is an action item to approve the consent calendar? all right. seeing none. next item. consent calendar. >> i would move concept

calendar. >> i second it. >> any public comments? no hands up, commissioners. roll call vote. commissioner chow. >> yes. >> commissioner giraudo. >> yes. >> commissioner christian. >> yes. >> commissioner green. >> yes. >> commissioner guillermo. >> yes. >> commissioner bernal. >> yes. >> that passes. >> next item other business. any other business? or public comment on this item? >> press star three for comments on this item. >> no hands up, commissioners. >> next item for discussion is joint conference committee report. brief update on the decembe

december 22zsfg joint conference committee meeting. >> at the meeting the j cc review the standard reports. human resources and medical staff report. ththe appointment of the chief f community primary care and approved the psychiatry rules and regulations. we approved credential also report and the minutes report. that is our report. >> any questions or public comment. any questions or comments from the commission? >> i would likno hands, commiss. >> our next item is closed session. in order to have a closed session we need a motion to go into that closed session.

do we have a motion from the commission? >> so moved. >> so moved. >> i will second it. >> commissioner christian. >> commissioner girardeau. >> yes. >> commissioner green. >> yes. >> commissioner guillermo. >> yes. >> commissioner chow. >> yes. >> commissioner bernal. >> yes. >> if you will give me 30 seconds or so. thank you so much. don't feel like you need to wait for us to come back out of closed session. i am going

>> there's a new holiday shopping tradition, and shop and dine in the 49 is inviting everyone to join and buy black friday. now more than ever, ever dollar that you spend locally supports small businesses and helps entrepreneurs and the community to thrive.

this holiday season and year-round, make your dollar matter and buy black. >> i went through a lot of struggles in my life, and i am blessed to be part of this. i am familiar with what people are going through to relate and empathy and compassion to their struggle so they can see i came out of the struggle, it gives them hope to come up and do something positive. ♪ ♪ i am a community ambassador.

we work a lot with homeless, visitors, a lot of people in the area. >> what i like doing is posting up at hotspots to let people see visibility. they ask you questions, ask you directions, they might have a question about what services are available. checking in, you guys. >> wellness check. we walk by to see any individual, you know may be sitting on the sidewalk, we make sure they are okay, alive.

you never know. somebody might walk by and they are laying there for hours. you never know if they are alive. we let them know we are in the area and we are here to promote safety, and if they have somebody that is, you know, hanging around that they don't want to call the police on, they don't have to call the police. they can call us. we can direct them to the services they might need. >> we do the three one one to keep the city neighborhoods clean. there are people dumping, waste on the ground and needles on the ground. it is unsafe for children and adults to commute through the streets. when we see them we take a picture dispatch to 311. they give us a tracking number and they come later on to pick it up. we take pride. when we come back later in the day and we see the loose trash

or debris is picked up it makes you feel good about what you are doing. >> it makes you feel did about escorting kids and having them feel safe walking to the play area and back. the stuff we do as ambassadors makes us feel proud to help keep the city clean, helping the residents. >> you can see the community ambassadors. i used to be on the streets. i didn't think i could become a community ambassador. it was too far out there for me to grab, you know. doing this job makes me feel good. because i came from where a lot of them are, homeless and on the street, i feel like i can give them hope because i was once there. i am not afraid to tell them i used to be here.

i used to be like this, you know. i have compassion for people that are on the streets like the homeless and people that are caught up with their addiction because now, i feel like i can give them hope. it reminds you every day of where i used to be and where i am at now.

>> hi.ow. my name is carmen chiu, san francisco's elected assessor. buying your first home is a big deal. for many of us, it's the single largest asset that we'll own. that's why it's really important to plan ahead for property taxes so that there are no surprises. a typical question new homeowners ask is what is a supplemental tax. so understand supplemental tax, we need to start with proposition 13. under california's prop 13 law, the value we use to calculate your property tax is limited to a 2% growth peryear, but when ownership changes, prop 13 requires that we set a properties assessed value to market value. the difference in value between the previous owner's value and the new value is the supplemental assessment. how does the supplemental assessment translate to the tax you need to pay?

supplemental tax is calculated by applying the tax rate to the value and then prorating it for the amount of time that you owned it in that tax year. in generale, the tax rate is roughly 1%. let's walk-through an example together. here dan is the original owner of a home with a prop 13 protected value of $400,000. with a tax rate of 1%, he pays $4,000. dan sells his home to jennie at a market rate of $700,000. in this case, jennie's home will be reassessed to $700,000, and jennie is responsible for paying property taxes at that level from the time she first owns it. many times, people might have already paid their property taxes in full by the time they sell their home. in that case, dan has paid $4,000 in taxes already for the full year. jennie would likely payback dan through escrow for her share of the $4,000, depending on the

proportion of the tax year she owns the home. however, she's also responsible for paying taxes at the higher market value from when she begins to own the home. how does that work? let's say jennie owns the property for nine months of the first tax year, which is approximately 75% of the year. during the escrow process, she'd pay dan back 75% of the $4,000 he already paid, which is $3,000. on top of that, she would owe taxes at the higher rate for the proportion of the year she owned the house. in this case, she owes the amount not already billed through dan or $700,000 minus $400,000, multiplied by a tax rate of 1%, and multiplied again by 75% to reflect the time she owned the home in that tax year. here, jennie's supplemental tax is roughly $2,250.

going forward, jennie will be billed at her new reset prop 13 value. are you still with us? if this isn't complicated enough, some new owners might receive two supplemental tax bills, and this has to do with the date that you transfer property. but before we get to that, you first need to understand two concepts. first, what is a fiscal year? in california, local government runs on a fiscal year. unlike the calendar year, where the year begins on january 1, a fiscal year begins in the middle of the year, on july 1. property tax follows the fiscal year cycle. second, state law requires property be valued as of january 1 every year, in other words, new year's day. the value as of january 1 is used to calculate property taxes for the upcoming fiscal year. this means property value as of january 1, 2018 will be usedtor fiscal year 18 -- used

for fiscal year 18-19 covering july 2018 through june 2019. similarly, the value of january 1, 2019 will be used for the fiscal year covering july 2019 through june 2020. now back to whether you should expect to receive one or two supplemental tax bills. the rule of thumb is that if the property transfers happens in the first half of the fiscal year, in other words between july and december, then you should expect only one supplemental tax fill. if the transfer happens in the second half of the fiscal year or between january and june, you should expect two supplemental tax bills. here's the reason why. using dan and jennie's example again, dan's $400,000 value as of january 1 is used to set the tax bill for the following fiscal year beginning july through june of the next year. jennie buys the property from dan in october. the taxable value is reset to

$700,000 as of october, but the bill issued still reflects dan's lower value. in this case, jennie would expect to receive one supplemental or catch-up bill to capture the difference between her assessed value and began's fr began's -- dan's from october through june. because of january 1 we already know of the sale, we would have used the following year to set jennie's property taxes and no other supplemental bill should be received. however, if dan sells the property to jennie in march, instead, jennie should expect two supplemental bills. like before, jennie would receive one supplemental bill to cover the time in which she owned the home in the current tax year from march to june. but because as of the next january used to set the tax base for the following tax year, dan still owned the home, the following year's entire bill still reflects the values not updated for jennie. in this instance, jennie

receives a second supplemental for the following year covering july through june. after the supplemental tax bills, new owners should receive only one regular tax bill peryear going forward. remember our office values the properties, but billing and collections are handled by another organization called the treasurer and tax collector's office. if you'd like to learn more, please visit our website at sfassessor.org. thank you for watching.

if january 8, 2021 regular meeting of the san francisco ethics commission to be held by teleconference pursuant to the governor's executive order declaring a local emergency dated february 25, 2020. before we proceed further i would like to ask commission staff member who is acting as