>> all right. hello and welcome to the healing commission meeting tuesday, september 20 of 22. for those members may be watching we are trying something different given importance of the laguna honda hospital matter. taking our presentation regarding laguna honda first on the agenda after roll call after which we will go in a closed session. that closed session will last for exactly 45 minutes. that is a closed session on laguna honda. and after which time you are welcome to come back and join us for the rest of the meeting. secretary morewitz? >> commissioner chung. >> present.

>> commissioner giraudo. >> present. >> commissioner guillermo. >> commissioner chow. >> present >> commissioner green. >> present. >> welcome to the september 20 san francisco health commission is hybrid format in person room 300 broadcast live on sfgovtv and available web ex. we are listen by call nothing 415-655-0001. the code is on the agenda. before we begin i like to reminds individuals present approximate in person all health and safety and building rules adhered to. wear a mask, covering your nose and mouth during the meeting and when you speak. failure to add hering will result in removal in the room.

also note that hand sanitize are stations are set up at the event real of the room in room 3 huh human. welcome the public's participation during public comment an opportunity for general public comment toward the beginning after the closed session and be an opportunity to comment on each action item. each is limited to 3 minutes. public comment will be taken in person and lucall in. for each item first from people in person. then from people attending remote. those in person submit a card to me. just a tip for those of you participating remote, if you would like to make public comment it is more efficient to view the meeting on web ex well is no delay if there is an issue you can press star 3 the minutes or moment that an item is called to make sure you get in line in time. those are 2 tips. that i offer to you.

to access closed captioning hover over the live stroll a pop up with a logo will show and you click on that on the cc. >> note that city policies with federal, state and local law prohibit harassment during meetings. public comment is permitted on matters within the jurisdiction of the healing commission. thank you for joining us. >> thank you secretary morewitz i like to offer guillermo to offer the ramaytush ohlone. >> thank you. ramaytush oholone land acknowledgement the san francisco health commission acknowledges that we are on the unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. as the indigenous stewards of this land, and in accordance with their traditions, the ramaytush ohlone have never ceded, lost, nor forgotten their responsibilities as the caretakers of this place, as well as for all peoples who reside in their traditional territory. as

guests, we recognize that we benefit from living and working on their traditional homeland. we wish to pay our respects by acknowledging the ancestors, elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> thank you. being signature guillermo. now the laguna honda hospital and rehab center closure plan and cms recertification update. welcome. rolfe around director of the health network exacting laguna honda ceo. >> thank you. commissioner bernal and other commissioners. good afternoon. it is my pleasure to be before you today to present this update on laguna honda hospital closure

plan and cms recertification process. i'm joined by members of the laguna honda executive staff and the laguna honda recertification incident command staff who can help to answer questions that might come up after or during the presentation. >> we will move forward. >> as you are aware laguna honda is the largest public run skilled nursing facility in the country been around for miles an hour than 150 years. some noted, when laguna honda first opened, president abraham lincoln was the chief executive of the united states. we have been around for awhile. laguna honda cares for people

coping with many different conplex and chronic conscience stroke, traumatic brain injury and other degenerative diseases. like multicull sclerosis. we offer a wide variety of therapeutic modalities including rehab services, physical therapy. speech and other specialities. >> we are proud to offer specialized care that you will not finds in any other skilled nursing facility including special units that provide monolingual care in spanish, chinese and have a unit in paltive care and the only san francisco bay area unit on positive care for aids or hiv and memory care. and in addition, we also have

the most robust behavioral health service of any skilled nursing facility in the country providing specialized care for individuals with mental health and substance use disorder conscience. conscience. to recap what brought us here. you recall that back in the summer of 2020, one laguna honda reported 2 nonfatal over doses to the california department of public health as required through our participation as a licensed facility and cms provider at that time. that self report involved 2 patients whoef exercised their rights as skilled nursing

residents to leave laguna honda and go out to the community and who came back to laguna honda several hours later and unfortunately suffered a nonfatal substance over dose. luckily, the staff were traind and had the tools and medication to reverse the over doses and the patient resident survived. because of this self report of this incident, cdph exercised their responsibility both on behalf of the state and cms to conduct an initial survey of that incident. which they did a month later and subkwenlt follow up surveys and that lead to a final survey in

april of 2022. that really showed while laguna honda was able to correct many of the issues related to those over dozes and some of the subscent findings new findings made at the last visit and the time e lapsed and laguna honda not able to rectify those. cms instituted its requirement to end cm circumstance participation after 6 months of noncompliance status. am immediately upon the dessertification in april of this year, laguna honda and the department of public health made recertification our top prior. and in order to do that, we immediately searched out and secured the service of 2

external experts who had experienced both in skilled nursing care and over all public health care operations. we worked immediately with the consultants. they hit the ground rung during an initial assess am of laguna honda and have implemented many corrective actions to improve the safety of the facility and the operations. in addition to those assessments and we will talk more about as we go through the presentation, there was also an initial mock survey. we will talk about that in findings. and there is also planned it is the work kicked off in terms of a top to bottom assessment of laguna that will also look at the structure of the hospital how it is organized. how it is staffed.

clinical programs it operates. and will make recommendations in terms of the ideal in state of laguna for the future. those recommendations come to the health commission and d ph for consideration and targeting the first quarter of a now year to have that assessment. another update in terms of where we are today here in september of this year. when recertification when dessertification occurred in april we were required go through a press required of decertified skilled nursing facility. draftd and submitted a cms required patient transfer

discharge enclosure plan. you will recall the plan we submitted to cms shows that the size of the laguna population and the cox mrementity of patient population to safely implement a closure plan it would take laguna honda 18 months from april in order to do that. that plan was rejected by cms and cms skournted staying laguna needed to have that enclosure within an initial 4 month period through september 13th with a two month extension. that's where we were the first 4 months of this process from april through august. . on july 28 after implemented

that closure plan for two months during which time 57 laguna residents were transferred or discharged. cms agreed to a repress bite city to pause all of those transfers and discharges so there could be a further assessment and evaluation. and then a couple weeks later on august 15th, cms and the city on behalf of laguna honda reached an agreement with cms to extend those needed medicare and medicaid payments through november 13th of this year of 22. and to also continue that -- initial pause of transfers and discharged until november 13th. >> we saw that as a great

temporary reprieve from the closure plan. and thought of the opportunity to refocus efforts on our primary goal, which was and conditions to be recertification in the medical, medicare programs. as i said before the number one priority is recertification. we talked about the fact we brought on the consultants and they helped us put together a road map to recertification we shared with this commission and in others and is available on our laguna honda recertification website. but the first mile stones on boarding of consultants. second mile stone was the consultants to do initial analysis and assess ams of laguna they

completed and a first and major mile stone was a mock survey number one. and as you recall you described it a consultant actually simulate the cms process and put laguna through a mock survey against the cms certifications. >> this mock survey first mechanic survey commolestod july 21st of this year. and as a result of that survey, there were 101 standards of cms that were found laguna needed to show improvement to meet the requirement. and for those 101cms standards,

the team at laguna and our consultants came together working with frontline staff and managers to develop 344 corrective actions in order to remedy the gaps in compliance. i'm happy to report all of the plans of correction have been implemented and are in the process of being monitored and evaluated. and -- we are already seeing the results of those improvements which we will share later on. >> it important to than these corrective actions monitored daily, we have the laguna honda hospital executive plan correction huddle. occurs every day at 10 a.m. at

laguna honda. and this is where we bring executives and any of our staff including our leadership they are able to see where we are. in correcting approximate implementing the plans of correction. as we said from the beginning we wanted this to be a transparent process so all stake holders could see that laguna honda took that cms dessertification seriously and committed to make the improvements to keep laguna honda a safe operational place for skilled nursing in san francisco. this plan of correction press is monitoring process is the way by which we do it. we mentioned that in our mile stones toward recertification, we have indicated a need for a second box survey that mock

survey is still on our plan and we are assessing the appropriate time to have that survey conducted. so in addition to that first mock survey. the second mile stone was an among long training and reeducation process for the 1200 staff at laguna honda. that first mock survey showed those on going areas of gaps in compliance. so our consultants took those gaps and developed a laguna honda specific curriculum geared at educating and training staff on how to become compliant with those findings.

this was not a cookie cutter available, off the shelf training this was tailored to laguna honda and taylored to the areas of noncompliance. we are happy to report that we are well on our way to having almost 100% of staff to have gone through that process and reported to the upon conference committee. there are staff who are on leave and are who were sick and make those up. but we are well over the 95% compliance of that and hope to expect to be 100% very soon. that was a massive under take. but worth it. why? because we have been able to show through what we are calling our key performance indicators, a dash board of all of the

essential elements to recertification in terms of compliance with cms standards. we'll share with you and show you that by monitoring these plan of correction key performance ind indicators we are actually seeing great improvement in compliance and well on our way to being appropriated for cms recertification survey. so i have the next company slides to give you a brief sum row of what appears on that k pi dash board. this is a report that come out every monday. and -- it it is made available and it is -- to all at laguna and other stake holders and gives us an idea of where we are in terms of improving our

performance and meeting regular compliance. this particular slide shows where we are in terms of the area of environment of care. and environment of care covers a lot but it encompass the physical environment of laguna honda. and our nursing units are the units well maintained? are they operating in a regular compliant manner. and the environment of care looks at about use a tool for monitoring the compliance and look at 144 different items including looking at the utility room. looking at laundry and medication stored appropriately. being administer the presently. looking at the food galleys.

monitoring isolation rooms to make sure they have the required negative pressure. looking at waste management within the facility. so again over 144 different areas. what we have seen the past 6 weeks that you will see at the top line is we -- are goal is to have 90% or more compliance in terms of the 144 areas of environment of care. and you can see the last 2 weeks we met that goal special have exceeded it. so -- and we know that one of the reasons we got this compliance is that tailor made training in august specifically addressed environment of care. hands hygiene the training occur in the august had an emphasis on

hand hygiene. as you have seen that was an area that cms found in that last survey in april, where laguna honda was not able to show comcompliance we are you now 99% on this measure. these are this data come from rounding observations and rounds on units at laguna every day 7 days a week on are across all shifts. so again we are constantly out there benching our staff. befshg the residents and when observers see deviation from standard they are able to do real time coaching and teaching with staff and as a result of that, we see between that the observations and training i think the this these data show

we are making progress toward compliance. and the -- the final slide shoes where we are in terms of inspection control and prevention. this is an area highlighted during the last survey in april. our goal is 90 percent. on hand hi joan and environment of care. we are not at this target but i will be getting to get there. this has to do with presently wearing ppe. the masks like i have on now. goggles and face shield when is you are in patient care areas. making sure that food is stored at the correct temperature. making sure that refrigerator in which the food is stored has on

going monitoring so you assure that the food never dropped below an unsafe temperature. so, again while we are not at the 90% we had a bounce the last 3 weeks but confident we are moving in the right direction. next slide. with all this work occurred the last few months, how do we what are we doing to make sure that we are susstaining these improve ams? again i mentioned we are doing observational just in time teaching rounds 24 hours a day, 7 days a week. we establish what we called a severe finding strike steam. in the midst of the rounds, look pat different elements if the observer finds there is is

something really grossly wrong that potentially could result and in cms terms jeppard and he something that can cause harm to a patient. we have a strike team. and it is a team that goes to a unit and may say, we saw -- something on the floor that should not have been there. and it was a hazzard to the parent. they work with the staff and the management of that unit or that department in order to find out what caused the situation. dp how we can remedy it and make sure it does not happen again? had is our strike team. the another way we make sure we susstain the correction system use of the huddle boards. for those of out commission for arc while. huddle boards are a tool that we learnd and used during the lean

process improve am management system process. but the data that i shared with you in terms of k pi that information is published and pushed out to the unitos a weekly basis. and at the way it works is we have 3 shifts day shift, evening and night shift there everhuddles that occur at each of the shifts. the staff on the shifts review the latest information from rounding. they get to see their own unit performance, are they meading the are target? they see their peers and see what the areas of concern are. you know they get to see we are having issues with clutter in the hallway. and so -- it is a great communication tool. so that frontline staff getting

immediate feedback in terms of the compliance data that is collected. next slide. wanted to updatedow this issue. the triplet issue. a by product of losing certification in april. cms indicated that whenever we get ready to submit for recertification or what they see as a new certification, we will be required to certify under rowels that remember adopted in 2016. as you know the current laguna honda hospital open in the 2010 and built to the cms standards in place at this time. at that time cms allowed to you have up to 3 resident patient in

one room had shared a bedroom. the new regulations cms in 2016 changed that. you can have no more than 2 patients in a room that share one bedroom. what does this money for laguna? it means that there are 120 beds affected by this change in cms rules. which means, if we were to be surveyed under those new standards, we -- could only be surveyed for a total of 649 skilled nursing beds compared to the -- that number is wrong. we would be 120 beds less than when we have now. so,mented give you an update while initially we were under the impression we take the 120

beds off our license now that is not the case. in fact, we are resubmitting our license application for the full compliment of current beds. however, the question what will cms in california department of public health cert foil when they come out for the visit? it is not clear and would be dem pending on the decision how many of the beds will they survey and how many will they certify and how many will they license upon a successful cms survey. we are in the discussions with cms and cdph on this sxsh keep you informed. again i want to reiterate that we are not removing the 120 beds

from the license. >> also give an update -- of a covid-19 surge that occurred at laguna in august. on august 25th after a week of seeing an increasing number of case, we topped out a total of 55 residents who were tested and found to be covid positive. now the good thing is that over 90% of our residents at lagowna are vaccinated and fully boosted that meant despite tested positive, many of those residents were nonasymptomatic and the ones who were had mild symptoms. i believe that initially 4 were

transferred to other acute hospitals. all all returned back to laguna. as of today i think we are down to 2 covid positive patients at laguna. so, you know we immediately took issues to go in covid surge. reimplemented the measures that were enacted at the beginning of the covid pandemic and we reinstituted the requirement all visitors had to be tested uponent row in laguna whether they had proof of vaccination or not. we instituted enhanced ppe observations. to make sure that staff visited and everyone else in the hospital were presently taking

precautions. we also temporarily suspended in person gatherings or meeting. closed the cafeteria and continued with twice weekly testing of all staff at laguna. and requirement for n95 and eye protection in patient areas. we are confident boy taking the aggressive measures we were able to, again, abate that rise in case. and again we gone from 55 on august 25th down to 2 as of today. also an update that as you know the new covid-19 vaccine just

became available and we have started rolling it out at laguna to staff and residents last week. so again we want to make sure we are able to keep our residence upon debts vaccination numbers in the 90's % and higher. and -- we will the same enrolling the previous boosters the same with this new booster. and wanted share this, a slide that gives you an over view, discharges and expirations at laguna from june of last year 2021 through august 202. they represent the fact that we ceased doing new admissions as a

result of the dessertification process. . that concludes this formal presentation of an update of where we are at laguna and happy to try to answer questions of the commission you may have. >> theshth director before we go to comments or questions do we have anyone in public comment. yes. folks on the line if you like to comment on item 2 the laguna honda hospital center closure plan and recertification update press star 3 now. i will read a statementism want to acknowledge early on in mr. picken's presentation the graphics may have been whacky the folks from sfgovtv replaced a cable hopefully that made it easy ear. members of the public have an

opportunity to comment for ump to 3 minutes the public comment process is designed to invite input and feedback from the community. the process does not allow questions to are answered in the meeting or members to engage in back and forth conversation with the commissioners. commissioners consider comments when discussing items and making requests. each individual is allowed one opportunity to speak per item and not return more than once to are theed other statements from individuals not attention. written comment may be sent at this time health commission. if you wish to spell your name you may do so. you each get 3 minuteings i see one hand now. let us know you are there. >> hi. this is doctor palmer can you hear me. >> loud and clear.

go ahead you have 3 minutes. >> i'm speaking as usual a retired laguna honda doctor and as an aging person in san francisco some day need a rehab or bed at laguna honda. i very much appreciate the efforts that the city is funding to save laguna honda and keep the left lanesed beds. but it is very difficult for me to hear mr. pickence at different meetings tell us over and over how incompetent managers at laguna honda had to learn to get out of offices and miss meetings and go to the word to make sure proper care suspect given. this reminds us all that management neglect lead to this mess and this implicates the health commission and department of public health and the mayor. my questions are how willure

prevent inappropriate and fatal discharge of patients from resuming the closure plan was generated by laguna honda and the department of public health in the state. it needs to not go forward. nodes to be uncouple friday recertification. what are your plans to prevent this? number 2, if poor training of management and staff is so severe they delay the admission in funding how will you protect the beds and the current and future residents of laguna honda? as you see there is over lap in the questions. >> number 3. if staff trainod discharges of people that can be discharged to a lower level of care so they will not die. we are talking a lot about staff training but not talking about training in discharge rights and safe discharges and follow up after discharges.

which -- was royally screwed up. when 9 people out of 57 died. why should the in the sea and county pay the bills to bridge existing residents recertification is delayed? the city broke laguna honda the city noteds to take responsibility. and fix it. thank you very much. >> thank you for your comments. why commissioners this is the only hand i see. >> thank you caller. commissioners did we have comments or questions? secretary morewitz. >> i see commissioner guillermo. >> okay, commissioner guillermo. >> thank you president bernal and thank you mr. pickens for the update, which does show the improvement and the effort that is being put in by all at laguna honda and i'm glad to see those

numbers moving up and -- hoping that we are able to continue as you say and sustain. the progress. i did have a question on staffing. given that there is increased need for training, and monitoring and keeping in mind the new regulations and such, are we confident there is sufficient and appropriate staffing in order to continue the forward progress. not just through recertification press but on going? begin that we may end up restructuring laguna honda in the future? >> so, thank you for that question. commissioner guillermo. yes, we are confident that we have sufficient staffing at

laguna. always in any health care organization we would love to have more. seems when you do your work more hands are always needed. we meet the hppd the -- patient -- patient to staff ratios required in the skilled nursing facility we meet and exceed those. now having said that, we know we have cases often time when is staff are out on leave or call in sick and that is why we have per dium and registry staff to fill any last minute gaps. as you can imagine with covid our ability to get registry staff is much restrained

compared to prior to covid. there are times when registry staff are not available upon even though we put out a call to which we contract. that top to bottom assessm that will be coming forwardful include a staffing analysis based upon current and any proposed future options that consultants deem appropriate and so that will be included in the top to bottom analysis a more current staffing analysis and external third party. thank you, and a related question if i may, just wondering if you give us a bit of insight in how the staff moral is fairing during the

period it would seem that given the come pliance numbers going up there is, there is -- cooperation and enthusiasm for that. but if you could give us flavor i think that would be helpful, thank you. why certainly. for lagowna colleagues from the group on the line, you know after i finish, jump in. as you imagine, staff moral took an immediate hit to an all time low right after the dessertification. i think remained for several months staff felt demoralized. a few months prior they were hailed a success story for how they managed covid pandemic. and then a few months later to come back and told is that you are out of compliance with cms rowel and don't have a safe

environment for parents that took a negative affect on the staff. we laguna had a care experience team. we immediately brought in other resources, the chief medical officer from zukerberg. chief care experience experience came over to work with the existing laguna upon honda an care experience team. brought in resources through the city employee assistance program. and brought on other contractors to really help figure out when can we do to help ensure that staff felt supported in the process. i would say from april up to we did the trin nothing august that moral was not good. i can say that i think that training was a good sign to many

of the staff that we are on our way toward compliance. you can feel excitement throughout lagowna that month of august as staff like people were back in high school and college. class to class. seeing friends in the hallway. you know exchanging a stories. so the time of excitement and we received great feedback in terms of the surveys from staff about that training. of they said, we want to do this every yearch had this discussion with our budget director says okay we have to include that line item in the budget to do this intense training every year for staff. i also with the fact that we are now getting the kpi and other compliance information back to staff, so they can see, are we

improving or not. so now that we established the huddle boards in the units, we are that rolled out the last couple weeks. already we are getting feedback from staff. we appreciate having this information. you know we knew a lot of things going on but not how we were doing. now you know how you are doing. here is a report for your area. so i would say and we recently assigned one of our staff to be 100% devoted to care experience organizational change and management. we are bringing in additional resources to support both on short term and long-term investment in how do we change at laguna recognize and provide

safe, compliant care. we are not where we want to be but the last month moral has increased and the last few week when is we seen the increase in compliance you hear the chatter, people the units are being competitive with each other. okay, we beat to you compliance when you are getting on board? i think we are on the right track. >> thank you. for that we all aware of the synergy that happens between staff that is confident and enthusiastic about their work. and the quality and safety of service to the residents and parents. i hope we are able to continue to hear that good news as we go forward. >> thank you. >> commissioners other comments or questions.

>> commissioner green and shaul have hands up. vice president green? >> thank you for this really clear and excellent presentation and -- i am impressed bite acceleration of the bench marks meeting the bench marks, the presentation that we got a few days ago did not include data that show real improvements and i realize that is dated you have been able to obtain the last few day its is impressive. what you said about the moral and the enthusiasm is really impressivech i think that most of us those of us on the committee are remember [inaudible] witnessing a profound change and grateful to you and the leadership and the

staff for affecting changes with the huge number of items you had to address and doing it efficiently, i'm encouraged and did not know what to think before now. i really compliment you and everyone for the work you are doing. the other questions i had was about the moral of the patient the residents and families. good morals are infection. do they feel stable? are they feeling threatened about the november deadline? and the last question i had is in relationship to the rable progress you med when you spoke to cms you quoted 18 month period of time. that sounds like this is much faster track than 18 months. i wonder if you can um -- help us understand is it the resources put in the direction

and that's the reason or um -- how do we interpret it [inaudible] our sense is they remain concerned and just unclear as to the final outcome. we did share immediately the information about the pause. the agreements to pause through november 13th shared that with residents, families and ombuds persons. that information went out. and it is reviewed with the residents and resident care teen and council. having said this. you know the resident its is confusing. we xheenlted we got of break

disconnected... >> and that hopefully we can -- perhaps get an extension beyond that time. but -- we are -- definitely making every effort we can to make sure residents and families are kept as much up to speed as we are keeping our staff and, stake holders up to speed. our communication's team make sure that whenever we are communicating that residents and families and decision makers are included in the communication process. in terms of the speed. you know nothing like a good crisis to speed things along.

we did our due diligence and philidelphia instructions to formulate a plan that would be safe and effective and came up with 18 months they did not dictate that. we were told 4 months with possible 2 month extension. that's what we went with. we invented everything we could to expedite that time toward recertification and the improvements needed. we were fortunate we brought on the best consultants. that helped. having people who know what they are doing and expertise in skilled nursing facility and in terms of health care operations and public health care operations not every consultant is used to working within a large public health system with all the bureaucracies and requirements. that's when we have.

that also i think contributed to the escalation in our improvement efforts. >> thank you. so much and i think what you said about the huddle and bring the information to the staff also is so important and -- why success leads to success. thank you so much. >> thank you vice president green. commissioner chow. >> and i would like to thank mr. pickens for a clear and very promising [inaudible] to date i finds gratifying surprising we are doing and glad you add last week's report that shows there was acceleration in the progress being made on the 3 major factors. and we are looking at. i was wondering to follow up

of -- commissioner green's question about patients whether or not we are seeing that patients actually using more of the ombuds person or actually working with our own staff in trying to understand their needs and perhaps to also more important we understand not just parents but families. how they have been making use of these services and getting clear answers. the second question -- that i thought might be helpful for the public seems to be some need to understand how the initial transfers were made that it was not just one or two people signing off saying that somebody looks stable. there was a protocol agreed on worked out with the state and

including professionalful and other staff. so -- thought it might be good to briefly describe who was part of that team that would then determine the level of the -- patient who or could not be transferred. so -- again. those are my 2 questions. >> thank you doctor chow. so starting with the question of the assessments that lead to the discharges and transfers. so as you being correctly point out, all those assessments done based upon the closure, transfer, discharge plan approved by cms and california department of public healing. laguna had to submit the screening tools, processes by which we would undertake the assessments. they approved those and loo lagown a philidelphia those in

doing this assessment process. the term assessment process rolls off the tongue it is not a simple process it is thorough a multidisciplinary process involved physicians, nurses, social workers, dieticians therapists anyone involve in the care had to be involved in the assessment process to tomorrow what are the needs of this resident. what are the concerns including transfer trauma of might contribute to the success of this person being discharged or transferred. so those teams had to come together, review the information and data and make a final

decision as to the level care condition skilled nursing care or potential discharge to the community. and even so in the decisions what are the special needs of this person versus another. and can that facility to which this person referred prosecute vise those things that is on the lagowna side. the other side the facility that which is than i were referred had to review that information through their regular admission process. than i had to determine this they had the facilities and the programs to meet the needs out lines. >> and basically interviewed patients to make sure they were appropriate thap it is the process went through in terms of assessments for referral and discharge.

>> in terms of the question about oh. are patients utilizing the ombuds person or staff. if any if any folks on the team are on who. to comment, i can they they are doing both. and we have hosted i know -- with the state ombuds person and the local ombuds person's office 2 in which laguna leadership made itself available with the staff to meet with stake holders and patients and residentses and families. i know that the opbud's person staff are active. i see them as they are out on the units. i seen them in the resident council meeting. they communicated with us when they felt that will they 98 our signage was not appropriate.

we took their fee back and made changes to their satisfaction and improve signage. the cooperation between the internal and the ombuds person's office. why thank you. i would like to say i had the opportunity to visit laguna honda last month and the seeing the huddling and rounding and training mod useless commends the staff of laguna honda for the tremendous improvements this we have seen in the last few weeks. you look at the keeper forms there is an improvement and that is a testament to our staff and how committed they are to ensure

laguna honda remains open and able to serve residents. i wanted to make sure that is on the record and knowing the progress that has been made. thank you for your leadership and sharing this with us today. i know that director colfact would like to say a few words. >> thank you president bernal. i wanted to reiterate appreciation for the w that has been done. mr. pickens and your team and to people at the neighborhoods. i had the pleasure of walking the neighborhoods in the halls of laguna honda and the improvement is tangible and i think the improvement in people's perspective and attitudes is irrelevant impressive. you see this in people problem solving and supporting each other including at huddle boards. one can tell quickly that they

are utilized there are suggestion notes on the board and or appreciation notes. and again to emphasize in the last couple of weeks we have seen improvements in all yours that is because in the i think that is because the staff are really solving issues in role time and performing good work and seen as a tool to improve patient health. i think that we are ensuring that the culture of on going improvement is taking root. so thank you, commissioners for your support and want to thank the laguna honda team for making this progress and cautiously optimistic tell move forward in the right direction. thanks. >> thank you director colfax. thank you very much mr. pickens the next is a closed session regarding laguna honda.

this closed session will take place for exactly 45 minutes. 45 minutes from now is when we will return to open session if required we will have another closed session in order to finish up business that was not handled during the 45 minutes. so at this point do we have a motion to enter closed session? >> i move to move it to closed session. >> i second. >> and commissioners i will take public comment on this item. on the line you can comment on item 3 the closed session pressing story 3 to raise your hand. again star 3 to comment on the closed session and as president bernal mentioned we will return at approximately 5:50 after 45 minutes. until then you will in the see or hear us but we will be back. i don't see hands. i will do a vote.

commissioner guillermo. >> yes. >> commissioner chung. >> yes. >> commissioner giraudo. >> yes. >> commissioner chow. >> yes. >> commissioner green. >> yes. >> and commissioner bernal. >> yes. >> thank you, give us a few minutes to switch over and again are we good to go? the i will reread the statement. the health commission completed the closed session and address the items under reconvene in open session. commissioner this is is the time to consider whether you would loishg to disclose discussions held in closing session. >> do we have a motion to disclose or not disclose. why move to not disclose. >> second. >> roll call vote. commissioner chung. >> yes. >> guillermo. >> yes. >> commissioner giraudo. >> yes. >> commissioner chow. >> yes. >> commissioner green. >> yes. >> and commissioner bernal. >> yes and welcome back to the

public we were able to conclude our closed session in the time. with a few more minutes to get us back up and running on sfgovtv we welcome feedback from the public about the sequence of the agenda on days we have laguna honda. we have dedicated laguna honda updates and now move on to our next item which is approval of the minutes of of september 6, 2022. commissioners you have the minutes before you if there are no amendmented we have a motion to approve. >> i approve. >> second. >> >> second. folks on the line if you like to comment on item 4 the prove of the september 6 of 22 minutes please press star 3 now. star 3 to comment on the minutes. no hands issue commissioners i will do a vote.

commissioner chung. >> yes. commissioner chow. >> yes. >> commissioner giraudo. >> yes. >> commissioner guillermo. >> yes. why commissioner green. >> yes. >> and commissioner bernal. why yes. the item passes >> the item is the director's report for this we have doctor grant colfax, director of health >> thank you president bernal and good afternoon health commissioners. i will go through the director's report sum rising the items here and provide an update with slides with regard to covid. the covid slide in a minute if first i will read through other items you had before nut director's report. so one really delighted to join mayor breed and other city officials in the opening of the new renovated castro/mission health center last week. i think you know the castro mission neighborhood center was the stele's first primary care

clinic welcomed the community for the past 57 years. opened as healing center one in 1965. and the center patients connect primary care services from checkups, pharmacy consults. behavioral health and hiv/aids and services for lbgtq + youth. genter health sf program will move there this fall access to quality gender affirming care. the capitol improvements in juvenile 22 includes total upgraded exam rooms, 4 consultation rooms and remodel seismic upgrades, fire protection upgrades and air conditioning and plans around the facility renovates.

and how we are improving the infrastructure to care for san francisco residents. next item is with regard to the release of the 2021 hiv epidemiology reports this out line san francisco's progress toward getting to zero new hiv infections and highlighting the changes faced by people in homelessness and people who inject drugs with hiv care and prevention treatment. number of new hiv diagnose was 160 case in 2021. a 16% increase from 2020. number of new diagnoses is lower than the 173 in 2019. it is unclear whether the rise from the 2020 is the result of rise in transmission or more access testing as the covid-19 pandemic subsided in tests of

the lower number in 2020 under estimate of new infection in that year of we are continued to ensuring people understand that hiv is still here. revention issue care and treatment is important as ever. d ph provides food safety toejz the communities as an example of that, we partnered with the chinese chamber reaches out to vipiral healing grant for food safety presentation for the community. the environmental health branch provided the food safety presentation last month covering food temperatures, rapid cooling and sanitation. public engagement are opportunity for us to connect with xhounlts we serve to educate organizations about food safety practices. and in terms of the next item with monkeypox update, pleased to say that the number of new

cases diagnosed every week slowed down. we are at 779 total infection in san francisco. that compared to 4, 453 in california and over 23,000 in across the country. and our robust response includes the need for people in high risk groups to get vaccinated. we have adequate vaccine supply including with partners so people it is recommended to get air vaccine have access. we are getting second doses. we are collaborating with the state and cdc to secure additional 10,000 dose for events. including the folsom street fair and castro street fair. we are reaching out and focus our efforts in reaching communities equal impacted by

monkeypox. part of the efforts where implementing mull prong community strategy for vaccinating communes impacted by monkeypox and may have health care. we will seek out opportunity to leverage resources to reduce desparities. and as an example of that, one of the things we are doing is a pop up event at club hopy the night club at market from 8-11 p.m. on wednesday, september 21st. again i will go in events work nothing off the business hours to ensure that we are reaching people most at risk and again will advocate for reducing the desparities in monkeypox cases mainly through driving the vaccine education and vaccine in communities we have a number of

monkeypox cases compared to vaccine recipients. i can stop or go on to the covid-19 update slides and take questions after. president bernal? what is your preference. >> director colfact. theed to mention we will have doctor scott at the next meeting on october 40 to gift hiv epidemiology report. we look forward to getting the full presentation and appreciate you sharing the progress today. with monkeypox we are receiving allocation this weekend. is well a quick thumb nail of the activities d ph will be engaged in to ensure people have access to vaccinations? >> certainly there , is out reach and preparation lead by one of our key monkeypox

coordinator. frank is connected with the community working and done a lot of that in the past for other out reach effort it is. i don't know if doctor philip is on to provide more we can provide that to the commission as a follow up. >> thank you. seat levelling off of monkeypox case in san francisco. thank you to the department for great work there. >> you are welcome. commissioners anything else before the covid-19 update? i think we can go ahead. >> great. had a few slides to provide an update where we stand with regard to covid. so, in terms of our cases per 100,000 the slide got cut off i

apologize this shows the case count continues to decline. we are actually lower than upon 27.3 at this time. i will make sure i have -- yes. for some reason the version i have. i don't know if you have the slide in your packet the packet i have shoes the data shows that from -- toward the end of -- of -- the middle of september, excuse me, we are 5 cases per 100,000. we are doing, we are seeing a sharp decline in cases now and are at level it is equal to where we were before the omicron surge. we make sure this slide gets corrected or if it was cut off we make sure this we get the correct slide there. the good news the cases have

declined substantially, this does not represent cases thatter detected through home testing butt other pes that gives us confidence in the fact that we are in a good place is demonstrated on the next slide. the next slide. somehow our versions of hai don't know if you have these slides in -- can i excuse me i of course the slighteds that are run are an incorrect version. can we take an assess am of that. because this looks like it is an old version. there should be -- um -- few are slides a total of -- 5 slides.

can we take a moment and get the right version up. why director colfact i'm looking at the e mill and i think the wrong set was sentien if we have the right ones to present. can you go through what you have? il show the slides using my camera. can you see it. we have focus issues. >> run through and make sure the commissioners get the right versions. 5 case per 100,000. our total cases are 176,000 and cumulative are 1,000 unfortunately regard to the deaths. because we are vaccinated and

boosted, we are preventing deaths every day. the worse of our [inaudible] is over and moving in the right direction is as of of september 15th we had a total of 56 individuals in the hospital. that includes 9 in icu with covid compares to peek of about 150 during the last surge. and our hospital capacity remains g. remember that number of people in the hospital with covid includes people hospitalized and hospitalized for other continue who is test positive for can vitd and includes transfers to our san francisco hospitals. in terms of our vaccine booster administration, 85% of all residents have completed their

initial vaccine. 75% of residents have been boosted. and in terms of zero to 4 year old that is the last group eligible for vaccine. we are aware as we have seen across the country and the state in terms that up tick. 30% of the population has a doze and 17% completed the series. in terms of the vaccine roll out exciting news. continue to focus on that roll out. and -- and are ensuring people have access to boost ins the network that are health care system partners providing the boosters we are continuing to a limed degree to provide covid boosters that pop up clinics through the covid task force.

ure heard mr. pickens state we rolled out boosters at laguna honda hospital. so as far as the up tick may be good. pharmacies are offering boosters and same day appointments across the staechl i expect i will have we are arc waiting data from the state to have numbers for percentage of among people who are already received the series. we are doing a live education to ensure people understands. that while we are in good shape here people need that booster which the commission knows confers will conifer the additional protection against the variants that are most circulating now. happy to take questions on kwo i haved or items on the director's

report and i apologize for the if version mix and up make surety commission has correct slides for this meeting and going forward. >> to the public the covid-19 data and reports are available on line as well. commissioners comments or questions. >> we have public comment. >> personal on the line if you like to make public comment on the director's report. which is item 5. press star 3. star 3 for item 5. no hand. commissioners. >> commissioners, comments or questions? >> i want to thank you for the covid-19 encouraging update. and we have gone down to 5 [hard to understand] i was struck by your -- article on the food

safety education and i think a great public service -- i am wondering in the past, the environmental inspectors had regular series of meetings with the restaurants. and i wander if this is still continuing? that was very helpful for upon restaurants and sanitation and compliance. >> thank you. commissioner chow. and it it is a -- i don't have the information about whether to continue or not we can circle back in terms of the whether that program has been able to maintain to what degree given the pandemic. i will certain ask the female and get you this answer. >> sure. thank you very much and again, thank you for the update. i'm wondering when the monkeypox

we could have kind of a line of progress in terms of the number of case coming down that could be helpful in terms of the chronology. >> i will take that back to the team and see when we can provide there. >> thank you. >> other upon comments or questions? >> commissioners, thank you, thank you director colfact we will go on to the next item which is general public comment. secretary morewitz. >> actually govern that doctor philip rejoin and you had asked a question about appropriation for folsom. would you like that answered >> yes, i did have a quick question on the director's report about preparation for folsom street and castro street fair in regard to m-pox and what

activities with the additional allocation that was secure friday the federal government. why good afternoon. apologies for being away i met with the data team to talk about tables we would like to put out for you m-pox. yes, we are excited about the allocation for folsom and castro street. fair season and a variety of events are going to be before, during and after this. this kicked off the past weekend. and upon even despite the winds and rain, there were community events that vaccinated a couple handled people. that was really exciting. they had to cansel the saturday event because of winds. despite rainom sunday we vaccinated quite a few people. next 2 weeks there are events planned. some in the evening, at clubs.

commune events and focusing on equity and he understanding we have this latin x destairity with says numbers and vaccine recipients. we will have teams at folsom street and at the castro street fairs to vaccinate there. teams have been work hard and looking forward to a good 2 weeks of the fair season late summer early fall. as we try to use up as much the 10,000 doses as we can. >> thank you, doctor philip. >> and thank you secretary morewitz move on to general

public comment. >> if you like to comment about something not on the agenda this is the time. general public comment is for public comment about things not on the agenda. please press star 3 if you would like to make general public comment. i dent see a hands, one person on the line >> next item is discussion a community and public health committee update. we have commissioner giraudo chair of the committee >> thank you very much. and our first presentation was the center on substance abuse and health. of the department they focus on 4 areas of sip lances, alcohol, hiv and over dose opioids. so the first one of the presentations was the focus on methamphetamine use data.

it was interesting that with their data there has been a decrease in the use with the prescribing of prop rion and [inaudible] and that continues and was a very positive [inaudible]. than i have a new study this will hopefully begin in november on -- injectables for the methamphetamine use and for cocaine use. i'm sorry. and the injectables will last a month. which is -- much easier and hopefully much more user friendly. one of the things that i think with most exciting, too, is in

the um -- in the studies that the department had done, there has been repcasion of the use on a national level and helped influence national policy. on methamphetamine use. the next per on the over dose report. 91% of opioid deaths are linked to fentanyl and the data showed in 2021 there has been an increase in black, african-american deaths due to opioid use, fentanyl. it is one only one of only

substance research within the d ph. went country. most substance use data research is through medical centers and d ph is the only one in the thauz is within the department of public health. what i have asked is for doctor coughin or staff to come back. it was notable that much of their work -- has been translated into national policy as well as various trainings and adopted by many locals across the country. i asked him to very simple low come become or sends a data sheet. i think it is irrelevant important for the commission to know what this department does. and what the impact is on the

national basis. which i finds was extremely impressive. that will be to come. our next presentation was learn and innovation group. and their focuses are the for the one is internal workforce development. in the areas of accreditation, they do a formal need's assess:significant racial equity plan and public health care for [inaudible] translate into training priorities. another area is external capacity building assistance. one is the cdc funded capacity build nothing hiv prevention. one of the next items is learning portal. i thought it was exciting because it is trainings that

partners for other partners throughout the city on various issues as opioid over dose training. it is innovative. presented the theory of actions program what they are doing with pipelines and the path ways to health. professional development staff engagement and promotive appointments. project interests, invest is another program that hopeful lite cdc will fund in november. the path ways program upon, which has been presented to our committee before with the summer hiv/aids research program has been around for 10 years and again the data was impressivech and as well as their population

health scholars. both presentations i thought were -- very good very informative of different work of the d ph that is really an essential to our department going forward. i don't know if commissioner chow has anything else you would like to add? >> no , i think you were really througho in your report. thank you so much commissioner. >> okay. >> thank you. >> all right. that's my report. why thank you commissioner giraudo. no public comment y. any comments or questions? >> our next is other business. do we have other business? there is no other. >> commissioner giraudo. thank you. >> you are on mute.

on thursday, san francisco general hospital foundation will have their annual board retreat the first in person and 2 envelope or 3 years. as your representative, i will be attending as well as doctor colfax will be presenting. information as well as a question and answer period for um -- the board. i think you i -- made -- communicated before i present at every meeting. in the last meeting was the over dose new street over dose team and the short video. so that is thursday. that doctor colfax and i will be there. >> thank you commissioner giraudo for your leadership with

the foundation. the next item is the joint conference committee report from the laguna honda jcc meeting on september 13th. commissioner guillermo. >> thank you, president bernal. very short report given mr. pickence provided in his on laguna honda a comprehensive sum row of what was also presented at the jcc in their executive report. i do want to note that one of the items we normally have on the agenda is the regular affairs report. and i think it is worth noting given you know all we hearted and learning about the laguna honda and the, around the

transparency and reporting of events that -- we have pending or we have pending, open items for facility related reported events as far as 2019. and these are events that have are open and have either not yet investigated or are pending -- information so that when things are reported, we don't have plans of correction or -- a closure or a report of nodeficiencies in many of the fri's as far as 2019. alternate majority of the open inpending fri's from upon even 2021. lag between upon an

incident is reported whether a unanimous or self reported; and an ability to correct and monitor any changes, has a significant impact. i think on all of the things we are hearing about in terms of when we need to monitor the plans of correction and need to correct and so on moving toward recertification but on going care at laguna honda there are 161 in total facility reported incidents that are pending without a document request or call or visit from either d ph or cms. that is an indication of the difficulties just on a daily basis. that laguna honda has to contends with in addition to all of the other things we heard today. going on at laguna honda.

i wanted to make sure that is something we are aware of as a commission. other than that we want in closed session. and as you as i noted the majority of the report was already shared through mr. picken's report to the full commission. thank you. >> all right. thank you, commissioner guillermo. is there public comment? no one. commissioners any questions? next item is unnecessary as we completed our closed session at the top of the agenda. so our next is consideration for motion to adjourn. >> move to adjourn. >> well is no public comment commissioner guillermo >> yes >> commissioner giraudo. >> yes. >> chung. >> yes. >> chow.

>> yes. >> and commissioner bernal. >> yes, thank you commissioners and d ph staff and the public we will see you in 2 weeks. thank you director colfax >> thank you. take care, everyone.

>> my name is sylvia and i'm the owner of the mexican bistro. we have been in business for 18 years and we first opened on garry street in san francisco, and now we are located in a beautiful historic building. and we are part of the historical building founded in 1776. at the same time as the mission delores in san francisco. (♪♪) our specialty food is food from central mexico. it's a high-end mexican food based on quality and fresh ingredients. we have an amazing chef from yucatán and we specialize on

molotov, that are made with pumpkin seeds. and we're also known for handmade tortillas and we make our own fresh salsa. and we have cocktails, and we have many in the bar. we have specialty drinks and they are very flavorrable and very authentic. some of them are spicy, some are sour, but, again, we offer high-quality ingredients on our drinks as well. (♪♪) we have been in san francisco for 27 years, and our hearts are here. we are from mexico, but after 27 years, we feel part of the community of san francisco. it is very important for us to be the change, the positive

change that is happening in san francisco. the presidio in particular, they're doing great efforts to bring back san francisco, what it was. a lot of tourism and a lot of new restaurants and the new companies. san francisco is international and has a lot of potential. (♪♪) so you want to try authentic mexican food and i invite you to come to our bistro located on 50 moroo avenue in presidio. and i'll wait here with my open arms and giving you a welcome to try my food. (♪♪)

>> roughly five years, i was working as a high school teacher, and i decided to take my students on a surfing field trip. the light bulb went off in my head, and i realized i could do much more for my students taking them surfing than i could as their classroom teacher, and that is when the idea for the city surf project was born. >> working with kids in the ocean that aren't familiar with this space is really special because you're dealing with a lot of fear and apprehension but at the same time, a lot of excitement. >> when i first did it, i was,

like, really scared, but then, i did it again, and i liked it. >> we'll get a group of kids who have just never been to the beach, are terrified of the idea, who don't like the beach. it's too cold out, and it's those kid that are impossible to get back out of the water at the end of the day. >> over the last few years, i think we've had at least 40 of our students participate in the city surf project. >> surfing helped me with, like, how to swim. >> we've start off with about two to four sessions in the pool before actually going out and surfing. >> swimming at the pool just helps us with, like, being, like, comfortable in the water and being calm and not being all -- not being anxious. >> so when we started the city surf project, one of the things we did was to say hey, this is

the way to earn your p.e. credits. just getting kids to go try it was one of our initial challenges for the first year or two. but now that we've been doing it three or four years, we have a group of kids that's consistent, and the word has spread, that it's super fun, that you learn about the ocean. >> starting in the morning, you know, i get the vehicles ready, and then, i get all the gear together, and then, i drive and go get the kids, and we take them to a local beach. >> we usually go to linda mar, and then occasionally ocean beach. we once did a special trip. we were in capitola last year, and it was really fun. >> we get in a circle and group stretch, and we talk about specific safety for the day,

and then, we go down to the water. >> once we go to the beach, i don't want to go home. i can't change my circumstances at home, but i can change the way i approach them. >> our program has definitely been a way for our students to find community and build friends. >> i don't really talk to friends, so i guess when i started doing city surf, i started to, like, get to know people more than i did before, and people that i didn't think i'd like, like, ended up being my best friends. >> it's a group sport the way we do it, and with, like, close camaraderie, but everybody's doing it for themselves. >> it's great, surfing around, finding new people and making new friendships with people throughout surfing. >> it can be highly developmental for students to have this time where they can learn a lot about themselves while negotiating the waves. >> i feel significantly, like,

calmer. it definitely helps if i'm, like, feeling really stressed or, like, feeling really anxious about surfing, and i go surfing, and then, i just feel, like, i'm going to be okay. >> it gives them resiliency skills and helps them build self-confidence. and with that, they can use that in other parts of their lives. >> i went to bring my family to the beach and tell them what i did. >> i saw kids open up in the ocean, and i got to see them connect with other students, and i got to see them fail, you know, and get up and get back on the board and experience success, and really enjoy themselves and make a connection to nature at the same time. >> for some kids that are, like, resistant to, like, being

in a mentorship program like this, it's they want to surf, and then later, they'll find out that they've, like, made this community connection. >> i think they provided level playing fields for kids to be themselves in an open environment. >> for kids to feel like i can go for it and take a chance that i might not have been willing to do on my own is really special. >> we go on 150 surf outings a year. that's year-round programming. we've seen a tremendous amount of youth face their fears through surfing, and that has translated to growth in other facets of their lives. >> i just think the biggest thing is, like, that they feel like that they have something that is really cool, that they're engaged in, and that we, like, care about them and how they're doing, like, in general.

>> what i like best is they really care about me, like, i'm not alone, and i have a group of people that i can go to, and, also, surfing is fun. >> we're creating surfers, and we're changing the face of surfing. >> the feeling is definitely akin to being on a roller coaster. it's definitely faster than i think you expect it to be, but it's definitely fun. >> it leaves you feeling really, really positive about what that kid's going to go out and do. >> i think it's really magical almost. at least it was for me. >> it was really exciting when i caught my first wave. >> i felt like i was, like -- it was, like, magical, really. >> when they catch that first wave, and their first lights up, you know -- their face lights up, you know you have them hooked. >> i was on top of the world.

it's amazing. i felt like i was on top of the world even though i was probably going two miles an hour. it was, like, the scariest thing i'd ever done, and i think it was when i got hooked on surfing after >> we are providing breakfast, lunch, and supper for the kids. >> say hi. hi. what's your favorite? the carrots. >> the pizza? >> i'm not going to eat the pizza. >> you like the pizza? >> they will eat anything. >> yeah, well, okay.

>> sfusd's meal program right now is passing out five days worth of meals for monday through friday. the program came about when the shelter in place order came about for san francisco. we have a lot of students that depend on school lunches to meet their daily nutritional requirement. we have families that can't take a hit like that because they have to make three meals instead of one meal. >> for the lunch, we have turkey sandwiches. right now, we have spaghetti

and meat balls, we have chicken enchiladas, and then, we have cereals and fruits and crackers, and then we have the milk. >> we heard about the school districts, that they didn't know if they were going to be able to provide it, so we've been successful in going to the stores and providing some things. they've been helpful, pointing out making sure everybody is wearing masks, making sure they're staying distant, and everybody is doing their jobs, so that's a great thing when you're working with many kid does.

>> the feedback has been really good. everybody seems really appreciative. they do request a little bit more variety, which has been hard, trying to find different types of food, but for the most part, everyone seems appreciative. growing up, i depended on them, as well, so it reminds me of myself growing up. >> i have kids at home. i have six kids. i'm a mother first, so i'm just so glad to be here. it's so great to be able to help them in such a way because some families have lost their job, some families don't have access to this food, and we're just really glad to be

>> each has their own areas of concern. the renaissance with the paint chipping and is not containing trash. the why the that we need to have a trash can that works for the city of san francisco came from seeing how the front cans are not working. so we wanted something that is able to enclose and willing to sloarn when they come to pick up a trash can, they can just put it into their trucks and reduce accidents. we need to have a recycling exchange and nots to have large

pieces of contents in twhr. we need to have everything clear and look good while we're doing it. we wanted it to be compatible with the surroundings as well as not draw too much attention to it there isn't a lot that is available to meet this requirement. then we thought this idea of designing our own trash cans. we need to go to a professional industrial designer that has the experience do a design. they came up with 15 or 20 different ideas. we picked three that we think would work best for the city. we have a total of three custom design trash cans and three off the shelf cans. we'll put 26 into the program strategically across the city. we're trying to come up with one

design. if the trash can is able to perform the way it's designed, it will save us in the long term because we're spending a lot of money to maintain the trash cancel. we want a solution to minimize the long term maintenance. >> we're trying to pick materials that will last a long time. that is variable depending on whether it's a beach. we're losing stainless steel. the coding that we pick is about a sen-year coating. it's pretty durable. we're confident that the materials we're picking will have longevity. the designs are attractive and i think the materials are durable. people that come to san francisco or live in san francisco, these will be things you won't see in any other

place. that's going to be a san francisco thing. >> i think the project itself is not a complicated one. it's going through all of this process, get us to properly do our outreach so everyone is aware of the project and gathering the agency approvals is the most challenging part of the project. there will be an on-line survey for the public and include qr code stickers. we'll analyze the data and provide a recommendation to our executive leadership team to make a final. >> i cann. [♪♪] ann.

fisherman's wharf, this is a working wharf and it's part of the beauty of the san francisco area. >> before the restaurant, before the t-shirt shops. >> at first the fishermen would go out and do the harvesting. they process the crab. >> it really is industrial. it is fish processors. >> it's a working, living, breathing place. and it's a great place to visit and there's a lot of history. >> i'm a third generation italian fisherman. we're one of the oldest fishing families at fishermen's wharf. my family's been working here since 1908. my boat's called the lovely martha. sport fishing means when you

come out and catch your own fish on the boat. commercial fishermen come out, catch fish, it gets processed and they sell it to a store. they're selling crab off the boat. there's nothing more fresh than a crab. our crab are sweeter and better tasting. the meat is firmer. >> more crab. >> we love crab. we love the people out on the boats. they're awesome. >> what a good meal tonight. >> we just barely got down here in time. we would have come earlier if we knew how much fun it was. >> this is the place to get crab if you're looking for it. >> some of these boats have salmon permits. so every boat kind of does a different thing. you can come down here and have wild caught salmon that was just caught that morning or the night before and there's nothing fresher than that. >> that's the whole thing of coming out on a party boat. you can catch your own crab, lock cod, halibut, salmon, you

can't get that kind of fish. >> now the consumer can just buy here if they want to and take it home which is great. or they can buy it here and take it to one of the restaurants and they can have a glass of wine and enjoy the crab we just brought in for them. >> come on over. it's great. nice and beautiful here in san francisco and the port. definitely come. >> our fishermen are super excited. it's great to have the public come down here and interact. >> it's a whole experience for the family, where they bring the kids and interact and say wow, the crab's alive. it's going to claw me and everything. >> they really get excited they're coming down here and posting their recipes or pictures of the food. or their kids picking up the crab. they're making a whole experience out of it. >> it is going to give the locals a part of san francisco that was taken away from them. >> now i have a reason to come back. >> i had a guy the other day come and say he hasn't been

down to fisherman's wharf in 10 years. he said i'm going to come down here every weekend. i forgotfor tuesday september 20, 2022. i like to welcome the members of the public listening in to us live and the staff and others who will be participating in today's meeting. following the guidelines set forth the members of this commission are meeting remotely to insure the safety of everybody including members of the public. thank you all for joining us. madam secretary, please call the first item. >> thank you mr. chair. the first order of business is item 1, roll call. commission members please respond when i call your