>> meeting of the san francisco health commission. president bernal is on a well deserved vacation, so i will be chairing the meeting today and secretary morewitz, willia call the roll? >> sure. i'll start with you. [roll call] >> two very quick announcements. the first is, this will be our last virtual meeting. starting in march we will be at 1 (inaudible) for the meetings but we will have public comment continue to be available remotely and i know secretary morewitz and the audio visual team are working very hard right now to

make sure this happens accurately and smoothly so hopefully next meeting members who wish to comment remotely will continue to be able to do so. the other is we may lose quorum as the meeting progresss so there may be action items we won't be able to complete but do our best to get through everything and complete the agenda today. i have the privilege of reading the land acknowledgment today. 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. the next agenda item will be general public comment. for this members of the public can make comment on items not on the agend a. >> thank you. i have a statement to read. this is just a tip, please press star 3 to raise your hand for any agenda item you like to make comment for, and encourage you it do so at the beginning of the item as it is called to make sure your hand is recognized. at this time, members of the public may address the commission on items of interest to the public that are within the subject matter jurisdiction of the

commission that are not on this meeting agenda. with respect to agenda items, your opportunity to address the commission will be afforded when the item is reached in the meeting. each member of the public may address the commission for up to three minutes. the brown act forbids the commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at public comment. this is for items not on the agenda. for general public comment there is already a item for laguna honda update so if you are planning to make a laguna honda comment this is not the time to do so. caller, i'm unmuting you. please let us know you are there. caller. >> can you hear me? >> yes, i can hear you. >> okay. i am going to

asking for a reasonable accommodation. i'm not sure i can stay on the line, but as far as the second root cause analysis following the 90 day monitoring- >> this is not the time for laguna honda comment. it will come at the next item. you are the only hand, and if you just wait a few minutes you are able to make comment at the correct time. alright. we can move on. commissioners, that was the only hand. >> alright. the next item is indeed the report from commissioner guillermo and joint conference committee and report from the last meeting of the laguna honda jcc.

>> i'm sorry, was that me? >> yes. >> okay. sorry. so, i will make a brief report on the jcc meeting of last week on february 14. at the meeting, the committee reviewed and discussed standard open session reports including the executive team report, the regulatory affairs report, human resources hiring and vacancies and we also reviewed the autopsy policy and procedure and making a recommendation to the full health commission, which will come soon after my full report. during the executive team update, mr. pickens shared that laguna honda is still waiting for cms approval of the draft action plan that it has submitted in regard to

current vacancies. works closely with human resources to hire qualified candidates. terry acting chief nursing officer shared laguna honda continued to provide higher then required staff to patient ratios for its skilled nursing and acute clinic units and are during the regulatory report the committee was given clarity as the state (inaudible) the related plans of correction do not directly relate or correlate with the recertification work, but there are cross-overs. there was quite a bit of discussion, q & a throughout both the executive team report, the hiring and vacancy report and the regulatory affairs report. some of which will be repeated and reported at

the-mr. pickens presentation today. the committee was also happy to hear the news dr. (inaudible) was hired as a new laguna honda chief medical officer and apologize if i mispronounced the name dr. (inaudible) also wanted to report that recruitment efforts continue in ernest for other vacant executive positions and also part of the discussion was the difficulty in some of the recruitment efforts because of the unsure status of the recertification, but that has not deterred the department and human resources from continuing with those recruitment efforts, so that is the extent of my report for now and as

i said, some will be repeated in mr. pickens report i think next. >> thank you so much commissioner guillermo. any public comments? >> yes, i see two hands. folks we are on item 3, joint conference committee and other committee reports. press star 3 if you like to make comment. i see two hands. you are unmuted caller, please let us know you are there. >> yeah, it is patrick again. >> okay, you have 3 minutes. >> regarding the update from the jcc, (inaudible) root cause analysis following the 90 day monitoring survey still (inaudible) cms approval? in reviewing cdgh form 25 (inaudible) inspection reports, back to the july 12, 2019 (inaudible) at laguna

honda, a separate november 2019 survey rca1, and rca2 across patient care items, laguna honda received 88 (inaudible) from d to l, including 9 immediate (inaudible) regarding patient care issues, and you add the 96 alpha to lima scoping ratings, including an additional 13 immediate (inaudible) you need

to expedite hiring a nursing home administrator well versed how to prevent patient care violations and (inaudible) transplanted from elsewhere and the san francisco health network and (inaudible) versed in acute care hospital regulations, not (inaudible) i find it shocking you are hiring dr. (inaudible) to be the chief medical officer, because she had been i believe the medical (inaudible) suggesting she also does not have experience in skilled nursing facility settings. again, the laguna honda restorative care policy for nursing

restorative care remains (inaudible) i had helped senior occupational physical therapist working (inaudible) at laguna honda developed a restorative care program at laguna honda august of 2009 and it was a well-run program until nursing got their hands on it and claimed it the rehab department didn't know what it was doing and so nursing is taking over the program which has now been run into the ground. >> next caller. you are unmuted. >> hi. this is dr. theresa palmer. i wanted to again ask about the statement roland pickens made on january 31 at the board of supervisors that there is a code or law

to allow laguna honda to grandfather in a rooms so the 120 bed count would not be necessary. despite request the public received no useful information about this, and we would like to at least see what the law says and where and if we can help support that law to prevent the loss of 120 beds. the other thing is another week has passed. has the action plan for the root cause analysis been accepted yet by cms and if not why not? we need to know if things are happening the way they should be happening for the facility to be saved and in fact and recertified. thank you very much. >> those are the only two hands commissioners. >> thank you. what

about questions or comments from the commissioners? i don't see any hands. >> i don't either, commissioner. >> sorry, i did want to make one additional comment. i wanted to thank zoe harris before pitch hitting for mark morewitz. she did a excellent job and wanted to make sure she was recognized for doing so. >> she did indeed. she did wonderful with very little preparation, she was great. we will now go to the laguna honda hospital closeier plan recertification update. >> good evening commissioners. roland pickens, interim chief executive officer here at laguna honda hospital. thank you for the opportunity to present. my monthly update to

the commission on the status of laguna honda hospital. next slide. i think we are all familiar with the circumstances surrounding the decertification back in april of last year that resulted after several surveys of non compliance, but i think what is most important is the fact we have been on a road of continuous improvement and moving forward as regulatory compliance since april last year. next slide. you recall that part of the cms requirements of decertified facilities is that they generate a patient transfer and closure plan, which we did. there were issues with

the plan, this was not the plan we originally put together. there was challenges in the implementation of the plan and lawsuit by the city and settlement agreement between the city attorney and cms that set up new terms for ongoing financing of laguna at least through november of this year, 2023, and it also required a revision of the original closure plan and also the establishment of a new process to lead laguna towards recertification. next slide. that new process to lead laguna towards recertification, at the heart of it was the requirement that a quality improvement expert skilled in cms skilled nursing facility regulations had to be identified by laguna and then approved by cms to come in and do a

retrospective root cause analysis looking at the monitoring activity survey prior to the decertification april last year. health service advisory group was approved by cms as the quality improvement expert. they constructed a root cause analysis, shared that root cause analysis with cms, cms approved it and then instructed the health service advisory group to work with laguna handsa for a action plan to address the areas of concern identified in the root cause analysis. next slide. there are many components to that settlement agreement. one of those components in addition to the root cause analysis and the

action plan is actually a every 90 day monitoring survey by cms. you recall we had the first survey the end of last november, december. that resulted in a series of findings and again under the terms of the settlement agreement, when there is a 9 o# day survey and there are findings, then the qie must conduct an additional root cause analysis on those new findings and then work with laguna to add those to our action plan and milestones. we in the window for our second 90 day monitoring survey, which can occur any time between now and through the month of march. next slide. so, as i mentioned, the action plan that

addresses the areas of concern identified in the rca is the new blue print how we attain a cms regulatory compliance. the settlement agreement requires that all of the corrective actions and milestones that are identified in the action plan and there are some 460 individual milestones that have been identified that have to be completed between january and may 13 of this year. we have a huge infrastructure that has been set up to help facilitate achievement of the milestones and monitoring of progress towards meeting those milestones. next slide. in addition, each month again another requirement of the settlement agreement. the

quality improvement expert health service advisory group must submit a progress report to cms outlining the previous month activities. the qie submitted their first report on february 10 as required by the settlement agreement to cms, and we are pleased to report that all 126 milestones for the month of january were met, so that means of the 460 total milestones we knocked off 126 and i believe for this current month of february we have roughly 130 milestones that have to be met in order to show continued compliance towards recertification. we meet several times during the week internally to monitor our progress. we met today and as of now we are on target to again completing all of our

monthly milestones for february so we watched this very closely and so that we can try to get on top of any concerns early so we can be hundred percent compliant by the end of the month. next slide. and this is meant to give a one page just timeline in terms of the many activities surrounding towards recertification. the top of this chart talks about survey readiness-it is every 90 day monitoring surveys, to see how they are stretched out over the every 90 day period, and so this is layered on top of every day routine operations that go on at laguna honda and

the fact that we are always on a daily basis required to be regulatory compliant, so when you look at the bottom of this chart, it really represents the activities of the action plan. the fact that we submitted the action plan on january 6, we then received some initial feedback from cms and then we were required to incorporate the results of the second root cause analysis that came out of the first monitoring survey and so we revised our responsive action plan and resubmitted that to cms on january 31. we still are awaiting their subsequent additional feedback on this revised plan,

and similarly, we are also waiting for additional comments back from cms on the revised closure plan, which we submitted to cms february 2, and are waiting to get their response as to whether or not both of those documents will be approved. i think it is important to note that we are not letting lack of response from cms deter our work. we are moving forward as if both of these documents are going to be accepted without any major substantial changes, because time is of the essence and we needed to move forward and so i want to assure you the work is continuing and that we are making-doing our due diligence to show that

we are making progress towards cms regulatory compliance. next slide. as i mentioned, the settlement agreement required that we update the closure plan based upon the extension of funding through november this year and update the closure plan based upon feedback we received from the california department of public health, particularly around some of the early transfers and discharges that occurred. we submitted our revised closure plan to cms february 2. again, it is our understanding they are still reviewing our comments and we are looking forward to getting their response any day now, but again, our work-we are still doing all of our internal due diligence so that if the closure plan were ever required to be implemented,

which we hope will never be the case, we will at least be ready. again, we've done our due diligence and are just waiting on our colleagues at cms to come back to us with their final comments and hopefully approval on both of these documents. it is important to just reiterate again that on february 1, we received notice that cms agreed to the city request through the city attorney office to continue the pause of involuntary dist charges and transfers from laguna. we welcomed that approval from cms, again because it allows us to focus hundred percent of our efforts on recertification and not having to divert resources towards doing any kind of transfer or discharge for our

residents. next slide. as i close this a couple thoughts. just want to leave you with is that the work is still continuing. staff have been real troopers throughout this process in that every time we implement new changes or implement phase 3 requirements or just improvements to our regular processes, all of those have people attached to them. people, meaning both our residents and our staff and so, as much as we are pushing towards making these needed improvements, we always have to keep in mind that we must address the personal aspect of how we are engaging our staff to make these in some

cases pretty significant changes in the way in which we all work together here at laguna. i also want to mention that in terms of the recruitment of our permanent leadership at laguna, we are moving full speed ahead with that. in speaking with (inaudible) kim our dph director of human resources, her most recent update to me is that she and dph, cfo greg lazner are working with the city department of human resources to get access to one of the two executive search firms that are on their approved list of city vendors, and the goal is to secure one of those firms by march 15 so that they can start the national-nation wide search. it is also important to note that all sides of the

top leadership positions, the nursing home administrator, the two assistant home nursing administrators, the director of nursing, the medical director, they have all been listed on the city's recruitment website, so the posting is already out there. there are applicants and as the search firm is identified and brought on-board, anyone who is applied for those positions already just through the regular city process will be referred to the search firm for the search firm to do their due diligence in vetting candidates andprinting -presenting the only most qualified to fill those spots. the goal is to secure the search firm by march 15, have the search firm start their nation wide search march 15 through april and begin to review and interview

candidates starting as early as may 1 with the goal of having a selection as close to that may 1 deadline as possible. of course, that assumes we will get quality candidate pool, which is still questionable given where we are. the fact we are currently a decertified facility, but we are hopeful that through the use of an executive search firm we will get sufficient quality pool to allow us to make a hire sooner rather then later. we will not sacrifice quality of individual for speedyness and time. we would do all the resident staff and all disservice if we rush a hire and not hire the best person for the job, and so we are confident that the executive search firm will help us do that. and also just

wanted to leave by saying that you know, we have made sure that while those of who are here in interim leadership positions, we are being supported by skilled nursing facility experts certified individuals through our consultant engagement and they are working hand in hand with us in the leadership to make sure that until we get our permanent leaders on-board, that we have the expertise in skilled nursing and we are also utilizing staff from other parts of dph and the network who also bring expertise in areas that are essential to skilled nursing. for example, the wound keep leadership team from zuckerberg to assist in the wound care

improvements at laguna. want to make sure you are aware of these important updates in terms of where we are and happy to try and answer any questions you might have. >> thank you so much for that thorough and concise report. it was very helpful to get the update on the search as well as mentioning that all this had such a impact on the staff and on the residents. thank you so much. is there any public comment on this item? >> i will check. i see one hand. folks on the line, we are on item 4, the laguna honda update, please press star 3 if you like to make a comment. i will unmute the person who has their hand up already. hi, caller, you are unmuted. >> i disappointed in seeing mr. pickens powerpoint presentation because it didn't

mention anything about the number of milestones had reached 454 by my count, not 300 milestones he had been previously telling you. it would be interesting to know how many of the 460 milestones were scheduled for completion in february and since it is all most the end of february, how many of them do you really expect to achieve? on page 9, he mentioned in pass ing the revised closure plan. cms complained february 1 that they had not received any response to their suggestions

since laguna honda on january 13 and january 18, and yet now hearing mr. (inaudible) cms complaint letter resubmitted the closure plan apparently incorporating the changes cms, cvgh and california department of healthcare services had provided that in the middle of january. i find it strange though that you submitted the revised closure plan belatedly and now to believe 19 days later cms has still not approved it. we need to know what is going on with that. commissioner chow and listened

to my testify at the jcc recently about the job description and job recruiting, and commissioner chow specifically asked for a updated lah organization chart. has that been done and can you provide it to the public record now, please? thank you. >> only hand that is raised for this from the public for this item. >> any commissioner questions or comments on this item? >> commissioner chow. >> commissioner chow. >> yes. thank you. and thank you mr. pickens for the additional information beyond what the jcc concerning the update in terms of the rapid movement on the search firm process for the

administrator. i think that's a chance in order to get qualified executives to understand what the job is and challenge and the assignment to take such a position. i was very pleased with that. if you can help describe-you are talking about the 400 milestones. how do they really relate to those tags that cms gives us because not all tags have the same value, and certain tags are actually critical and some are immediate and other tags are really within the realm of these are compliance issues and documentation issues, very important, but are not those that might cause an immediate (inaudible) could you tell us how many of the 400

represent whatever these other tags are and that as obviously they all have to be answered and i think your timeframe to clarify that, is you are talking about the 400 and we have gotten hundred something and expecting another hundred something in february and expecting to complete all 400 by the deadline in may in terms of responding? >> thank you dr. chow. hopefully i can answer your questions. so, yes, there are approximately 460 total milestones. it is important to note that initially with the initial or the first root cause analysis that was done prior to the first 90 day monitoring survey, there were 330 milestones that were developed. when the first monitoring survey occurred as required

under the settlement agreement, the qie conducted a additional root cause analysis based upon the 90 day survey. work with laguna and we added an additional hundred plus milestones to come up to 460, so originally end of december, january there were 330 milestones, now there are 460. one would anticipate that when we have the second 90 day survey some time over the next 30 or 40 days, there might be additional findings and additional root cause analysis and then potentially some more milestones. we would expect it to be significantly less then what occurred with the first 90 day survey, but just want to make sure you know that that is a potential outcome. there still may be more

milestones. we are as mentioned in the presentation as late as the check-in meeting today on track to meet all our 130 odd milestone frz the month of february and my message to staff is that we have no room for error. the settlement agreement clearly says laguna must convince cms that we are making progress and the best way we can do that is have hundred percent compliance of meeting all the milestones so that is what we are-that is our goal and we are at this point on track to meeting that goal. in terms of the different cms regulatory tags, you are correct that tags range from alphabet a up to j, k, l, and there is a point or a

scoring that cms ascribes to the various regulatory tags or j tag, a tags whatever that may be. that is really focused on the 90 day surveys, because when they did the first 90 day survey they actually-when they had findings they had to attribute it to a specific cms regulatory tag. unlike the root cause analysis when the quality improvement expert went back and looked at all the regulatory surveys 18 months prior to april 2022, they did not ascribe specific regulatory tags with the scoring value. in fact, instead they looked at what were the themes

of the areas of non compliance? was it patient's rights? medication management? a illicit substances? those were the general themes of care opposed to individual cms prescribed f tags. so, the root cause analysis and the action plan, those 460 milestones themselves don't have a point score, but it is the 66 tags that were cited in the first 90 day monitoring survey that actually do have a total risk score which is 796, so when you look at all 66 of those tags that were cited in the 90 day monitoring

survey, when you ascribe them the various points, they total 796, so between now and may 13, our goal is to document to the qie and then cms that we have fixed and addressed each those tags and as we do the score will go down from 796 to the goal of being at zero by may 13. >> thank you very much. i appreciate that clarification that actually it is really important that we are going to be judged also on the tags as we go along. that's the final report card that cms gives us, but milestones help in collecting the tags, which now there appear to be two. that's

all very helpful to me. >> thank you so much for that. that really helped clarify things. i don't see any other commissioner hands. i believe director colfax had some comments. >> thank you commissioner green and commissioners. i just want to take a moment to acknowledge roland pickens leadership and the work that has continued at laguna honda and i expanded in response to the cms requirements and i think the fact that cms made the decision to delay any transfers of patients, which we know was the right decision, indicative how far mr. pickens has brought the team and will continue to support the team and the work, and just to say that with the 460 milestones, addressing the tags and aggregate scores that mr. pickens just brought up, all these actions are in response and continue to be in

response to hundreds, actually thousands of observations every day in the hospital and bringing that data driven approach and then having the laguna honda team implement, create and implement a structure to hold the hospital and the teams accountable for meeting the goals and the action plan, is really indicative how far laguna honda continues to grow and change in response to what we know needs to be done. just to boil down further, in the neighborhoods having the boards that directly address some of these key metric mr. pickens is focused on so everybody at the hospital has ownership in the success of recertification and i'm optimistic that we continue to go in the right direction and just want to thank mr. pickens and the entire team at laguna

honda because there is a lot of work behind every milestone and every tag and the team is really shown that they are up to the task and there is still a lot more work to do. i think you are clear around vuliabilities we continue to have, but again, the path is challenging, i think the team is just done a remarkable job. thank you. >> thank you for saying that and i think the entire commission would associate with your comments. it is quite remarkable that this team has been able to continue with such commitment and such passion in the face of all of these changes, and i think they really have rallied and are doing a terrific job in working together in a exemplary way so thank you so much. if there is nothing else on this item, the consent calendar involves one policy for the laguna honda policy which is the

autopsy policy and procedures. >> jcc recommended the full commission approve this policy after discussing it last week at the jcc meeting. >> yeah. >> so, commissioners, as with any consent calendar item, all we look for is a motion to approve and second then i go through with the roll call vote. there isn't discussion unless you pick the item out for discussion. >> if there is no discussion is there a motion to approve? >> i will make a motion to approve the policy for the laguna honda regarding autopsy. >> i second. >> folks online if you like to comment on item 5, consent calendar this is the time to do it. i see one hand and will unmute you. you got three minutes. >> thank you. again,

i want to keep beating on the drum about the nursing policy. (inaudible) why has this commission not- >> (inaudible) >> in a meeting about the policies and procedures that you are considering on their consent calendar, when are you going to put that restorative nursing program on your consent calendar? it is long overdue. that program has been shut down from my understanding for going on three years, which is ridiculous because it its residents at risk of further functional decline when they are not getting

restorative care. why isn't this being made a priority to bring that policy and procedure to the attention of the full health commission and get the thing considered and approved kwr and the program restarted? it is not enough to just get recertification. yes, that's the ultimate goal, but part of becoming recertified must include resuming that restorative care nursing program for the benefit of elderly and disabled residents at laguna honda. you have to stop stalling on getting that program resumed. that's starts with getting the policy and procedure reapproved just as

dr. lisa pasqual (inaudible) centralized rehab that restorative level two that was supposed to be ward based that nursing never really implemented to begin with. the doj in 1998 was very concerned about it being a civil rights violation and you are dragging your feet on this far too long. thank you. >> okay. roll call vote. [roll call] >> the item passes. thank you very much. >> the next item is approval of the minutes of the health commission meeting of february 7, 2023. are there any additions or corrections to the minutes? i don't see

any hands. is there a motion to approve? >> so move. >> i'll second. >> alright. folks on the line, if you like to make comment on item 6, the approval of the minutes of february 7, 2023. i see one hand. mr. shaw, you have three minutes. >> thank you mr. morewitz. i did not sit through mr. (inaudible) presentation, but reading these meeting minutes, i am absolutely shocked that she has (inaudible) to claim that prior to (inaudible) laguna honda was "not using electronic healthcare records system". what is he

thinking? (inaudible) corporation was an electronic healthcare records system. yes, you migrated to epic, it is not known when you migrated the previous medical records contained in the seeman's lcr/envision electronic healthcare records system, but these ongoing delays and reoccurring problems with epic are just-no punt intended, they are epic in scope. you have a epic failure to implement that ehr

system which you have been trying to do every since it was rolled out in august 2019. how long is the roll out going to take? you have been at it for all most four years. you're having to develop a system within epic because apparently nurses can't get into patient's medical records to see md chart notes and progress notes from the various clinical disciplines like physical therapy and occupational therapy. it is just astounding. i remind you, i put in a records request to find out how many (inaudible) referrals are being made for

the restorative care program versus physician referrals to the (inaudible) program, (inaudible) rotten epic team is saying that you can't provide that information just like epic can't couldn't tell you how many discharges were being made to out of county facilities, which is just ludicrous because envision-- >> so, commissioner green, i know there is a motion. not sure if commissioners have comment s. looks like there is not so will do a roll call vote. [roll call] the minutes have passed. thank you so much. >> the next item is the director's report.

director colfax. >> hello. good afternoon commissioners. frank colfax health director and have the director's report here. a lot to cover, and so i'll get right to it. just with regard to covid-19 pandemic, just about at the three year anniversary of the first case reported in san francisco, and our health officer dr. susan phillip announced that san francisco will end the covid-19 public health emergency declaration and health orders, so dph announced the city covid-19 public health emergency declaration and health officer order safer return together along with additional health orders will end february 28 in alignment with the end of california covid-19 stay of emergency. while the threat from covid-19 is not over as both the virus and tools to respond evolved over

the past few years, san francisco is now in a significantly better position then any time prior in the pandemic due to the city high vaccination and booster rates and availability of effective covid-19 treatment. while the san francisco health officer will resend the safer return together order intends to issue two orders which effect hospitals skilled nursing facilities and other healthcare and jail sites. under the first order staff will still be required to wear a mask when interacting with patients clients or people incarcerated. masking requirements for the general public in these settings will end. masking requirements for the general public and staff will end. these changes go into effect march 1. the safer return together order masking reermts will be remuchbed for patients, clients or people incarcerated those who operate the facility can choose to be

more restrictive and implement their own requirements. people can choose to wear a mask around others and people should respect other's choices around this issue. the covid-19 landscape continues to change our commitment to community most impacted by the virus stands firm. we will continue our vital partnerships to insure lower barrier covid-19 resources including testing and vaccinations remain available to those most in need even as we shift from emergency response to ongoing recovery. next item wanted to bring the commission attention to the fact that the health department issued a health alert on the dangers of (inaudible) also known as trank. in this record, the san francisco office of the chief medical examiner determined four individuals who died of overdoses have low level of trank in their systems. testing overdoses who

died between mid-december 2022 and mid-january 2023, the office of the chief medical examiner found so far to date four individuals who died of drug overdose had low levels of (inaudible) in the system. the ocme including (inaudible) as part of a 2022 retesting effort and incorporated into surveillance program for 2023 and onward. zile zeen is a non opioid veterinary trank not used for human use and mixed with heroin and other illicit drugs. (inaudible) san francisco is concerning. the office of the chief medical examiner has not seen related wounds or (inaudible) to date, dph has not receive a report of skin wounds nor

intoxication or withdrawl. these facts suggest the drug may not be wide-spread but dph and community partners are working to learn more, share information and prepare street response impacts and respond appropriately. dph is working with public health and colleagues to assess the impacts and developing supportive care options including treatment. in the next item, wanted to highlight zuckerberg san francisco hospital celebrated 150 years through the san francisco general hospital foundation. through two sold out events at city hall. a tribute to the strong support for all of us and our work. at these events mayor breed welcomed hundreds of supporters and speaker nancy

pelosi received a life time achievement award for decades support at the gala and proud also health and human service secretary basarah was the key note speaker. the showcased the to the region the significance of zuckerberg san francisco general and the place in san francisco's history as we reach this major milestone. it was a great evening to celebrate and so pleased the foundation recognized three sfg heroes. (inaudible) the breast cancer survivor and advocate spreading awareness about the service and care available to help others. and two nurse leaders. joan torres project manager for the emergency response team honored for groundbreaking work in leading implementing the team

that provides thousands of consultation to prevent and reduce violence and safety on campus. (inaudible) urgent care clinical nurse manager honored for extraordinary work in launching managing the covid-19 and m pox vaccine clinic. this clinic provided more then 214 thousand covid and 21 thousand m pox vaccinations to the patients and community. i want to thank the foundation for hosting this event and event chair and the cofounders ann bare and judy (inaudible) and then on a more regulatory note also really delighted to announce the joint commission will recertify advance primary stroke program after conducting a two day survey of the

regulatory affairs and neuro science teams on february 14 and 15. as you know, these surveys are very intense, they go through a number of procedures, review many aspects of our care, and the commission concluded the survey and relate several positive observations about the program. congratulations to our stroke program staff for their exceptional team work and work. next item, the 2023 employment engagement survey. so important that we consistently and comprehensively survey dph employees, so this is being done and the survey is conducted by nrc health. it is brief, meaningful, confinancial and web based and have many strategies for maximum par ticipation and employee feedback will inform future workforce development

at the department of public health so thank the team including the team in the human resources department and at the department of health equity who partnered-the division of health equity who partnered to develop and move the survey forward and again encourage all employees across the department to respond to the survey. finally, in terms of the covid update, wanted to update you on our covid numbers. i'll give you a few more up to date numbers then what are in the director's report. as of february 15, noted on the public tracker, we had -sorry-i will read these numbers and will get the commission more updated numbers. as of 2-8,

the san francisco 7 day average of covid cases per day is 76 and 61 people are hospitalized, including 5 in intensive care unit. we are seeing some increases in the covid hospitalizations. this is expected with the new variants increasing the health hospital capacity remains adequate to care for people, and then in terms of our vaccination, 86 percent of all san francisco residents have been vaccinated and 65 percent received a booster dosage that also includes 38 percent who received a bivalent booster. 38 percent, we like to see that percentage be higher, it much higher then the state or national averages so comparatively san francisco continues to do well. that's my director's report. happy to answer any questions from the commissioners. thank

you. >> thank you very much. is there any public comment on the item? >> folks on the line, if you like to comment on the director's report, item 7, press star 3 now. i see no hands, commissioners. >> any commissioner questions or comments on the director's report? >> i did just in terms of my notes going back to updated covid numbers as of 2-15 the number of covid cases per day is 83, so that's updated. as of 2-16, we had 75 people in the hospital including 9 in icu. just i had a hard time reading my handwriting while looking at the report but that is the updated numbers for the commission. thank you. >> i bet you are a doctor. [laughter] i think commissioner chow has his hand up.

>> yes. dr. colfax thank you and thank you for actually telling us about how well this year's 150 anniversary with the san francisco foundation (inaudible) that must have been a really wonderful event and both as you know (inaudible) have been really dedicated people and i am glad they are noted here and acknowledged. i know it is a typo, i wanted to point that out to the commission and the public that either there is a extra 1 or the numbers are moved where we are describing the san francisco (inaudible) [difficulty hearing speaker] as it is reading it reads 1 million 9-

>> thank you. we'll make that correction. >> i think for the record that might be useful. i also note that dr. phillip is away and thought she might give us a explanation-her logic and the logic of the health officer regarding the national requirements and general public have been sort of questioned about that, and we recognize she's not here today, but would be very nice if she gave us the logic behind allowing general public when going into-especially when going into -well, i say inpatients where we are requiring our hospital personnel to mask, but we are not requiring the public which may have just as high risk of carrying covid as them. i just wanted to know her thoughts about that. and i

appreciate your final report in terms of the covid that we are also then able to also report the bivalent numbers because i think that continues to try to encourage that it is really a important booster we should all be having, and have appreciated certainly the reports on covid and i'm assuming that our commission will continue to receive our daily reports. thank you. >> thank you. i don't- >> sorry, i don't know how to raise my hand on the ipad. i did have a question for dr. colfax and first thank you for your report. i had a question about the employee survey. canned could you tell us when was the last time the survey was held and is it an

annual survey that-i think there was probably because of covid some interruption in that if i recall correctly, but just curious about- >> there was a interruption due to covid and i can return to the commission with the date about the last employee survey. i think this year or this cycle we are taking somewhat different tact where we insure we are asking fewer questions that are really from what we have gotten feedback from employees the most meaningful and establish a roadmap how to respond to the issues employees bring up and bring forward so that's why we are going in this direction for this round, and i think we will review and making sure that we balance the need to do surveys on a regular basis with actually responding to the surveys and doing the work that will

hopefully turn a cycle of improvement. a cycle where we do the survey, get the responses and then are able to respond and then with a follow-up survey hopefully start to see changes and if we dont see changes then redirect. happy to have those the team come and present to the commission at another date in more detail about the survey and the plans for conducting the survey, responding--analyzing the survey results and to your question about how frequently we will plan to do the surveys, they can certainly provide more information on that. >> great. thank you. another sort of curious thing about the survey itself. there is such a wide variant in the type of employee that would be responding and you have inpatient, laguna

honda folks and administrative and technology people so just curious to see when the results come out or based on the changes you are making, what kinds of differences are different workforce populations targets and how they are responding based on the work they do and in fact whether this-i dont know what the survey looks like but whether there needs to be some i guess targeted types of survey or questions or assessment based on the type again of work category and employee population and where they happen to be placed. it is just such a large workforce population, i think larger then the city so think it is important for us to have a sense of how that large employee population is

really being impacted. and what suggestions they have, what concerns they have about their work and how it relates to the department and the services the department is providing to the public as well as in terms of servicing its own internal constituencies. >> thank you, i appreciate that and will take that back to the team. >> commissioner the last survey was done in 2019 and brief follow up of 2020 but covid stopped from there. >> thank you mark. >> i don't see any other commissioner questions or comments, so i think thank you for the report and we can no gow go to community public health update i believe commissioner chung will make. >> actually commissioner chung and commissioner chow both attended but there wasn't agreement who would

report. if i may, i'll just say the committee reviewed two presentations and the commissioner chow and chung can you all chime in? the two prezen sentations for the (inaudible) from june to december 2022. and thren the whole person integrated care update intersections of behavioral health. commissioners, any other details you- >> i think chime in with to include with the national behavioral health survey, there is a shift in terms of the demographic and we actually see an increase in women and the sample size, so 50 percent for women and 50 percent were heterosexual and there is (inaudible) african

americans. so, i think that the discussions we had is like if we need to continue to pay attention to that or is it caused by covid and i think dr. wilson is saying that it is significant because even a small number of increased, it changes the whole--the percentage and it is percentage that we really trying to get to. in terms of the whole person care, it is great to hear that the marie x martinez clinic has been (inaudible) very well, and there are currently actually i forgot how many patients they are serving. (inaudible) have

other medical issues. frequent flier that have a high access of emergency services, so it sounds like right now the program is doing what is necessary and then the newest programs that are part of the whole person care program is the managed alcohol housing-managed alcohol-what's the word? managed alcohol --program. so, currently i think they have about 10 members that they are providing support to and they are trying to increase that to 20 and also find a permanent home for them. that is all i have that i think is the

highlight. >> thank you. that was very thorough. commissioner chow, did you have anything to add? >> i think that-i thought the wellness program did show and i think you all read the extensiveness of the network that is being put out now for the whole person program under not just the city, but with cal aim and all the integration may actually be helpful. the staff presented they are looking at milestones and report cards and should be able to come back in the coming year to tell us what the exact work was. the alcohol program was quite interesting. there is 10 beds people go through and apparently they stay for less then a day but trying to increase to 20 beds and finding a location so that

sounds like that is a very important service also on a acrut level for people who have serious needs for detox. that was really quite interesting also. i appreciate the opportunity to have been part of the committee today. >> thank you. is there any public comment on this item? >> we are on item 8. report back from the community public health committee from today. press star 3 if you like to make a comment. i see no hands commissioners. >> any other commissioner questions or comments? it doesn't look it. thank you so much. the next item on the agenda is other business. do any of the commissioners have any other business they like to bring up? i don't see any hands. is there any pubplic comment? >> nokes folks on the line, we are on item 9, other

business. press star 3 if you like to comment on this item. no hands, commissioners. >> well then, if i read right, the next item is adjournment. is there a motion to adjourn? >> i will move adjournment. >> second? >> second. >> i will do roll call vote. [roll call] >> thank you is r all very much for the wonderful presentations. a lot of really positive news and all the hard work all the staff at dph is doing and we'll see you in person in a few weeks. >> take care everyone. >> thanks everybody. thank you commissioners. [meeting adjourned] >>

>> shared spaces have transformed san francisco's streets and sidewalks. local business communities are more resilient and our neighborhood centers are more vibrant and lively. fire blocks and parking lanes can be for seating and merchandising and other community activities. we're counting on operators of shared spaces to ensure their sites are safe and accessible for all. when pair mets, firefighters and other first responders arrive at a scene, they need clear visual

access to see the building entrances, exits and storefront windows from the street. that means parklets should be transfer in the areas above inches above the sidewalk level. it's best if these areas are totally unobstructed by transparent materials may be okay. you can check with fire department staff to make sure your site meets visibility requirements. emergency response crews and their equipment need to be move easily between streets, sidewalks and buildings, especially when they are using medical gurneys, ladders and other fire fighting tools. that means that parklet structures need a three foot wide emergency feet every 20 feet and 3 feet from marked parking spaces and emergency access gaps need to be open to the sky, without obstructions, like canopies, roofs, or cables and should always be clear of tables, chairs, planters and

other furnishings. emergency responders need to use ladders to reach windows and roofs to buildings and the ladders need unobstructed overhead clearance and room to be placed at a 72-degree angle against the building. clearances needed around the ladders to move equipment and people safely up and down. so not all parklets can have roofs ask canopies depending on the width of the sidewalk in your area. please make sure that your electric cables are hung so they are out of the way and (indiscernible) to the structure, they can be pulled down by firefighters. cable connections need to be powered from an outdoor reciprocal in the building facade because hard wire connections are much more difficult to disconnect quickly. these updates to the shared spaces program will ensure safety and accessibility for everyone, so we can all enjoy these public spaces. more

information is available at sf dot gov slash shared spaces.

is r. my name is debra alvarez rodriguez. i'm the deputy director in san francisco. my background is one in which i have spent the entirety of my life committed to finding solution to poverty and addressing the issues of inequity so people and communities can have accesses to resources and financial freedom. one thing true anode dear to my heart was the power of business ownership in creating pathways to financial freedom. we have still in infancy. we had over 100 entrepreneurs

come and start their businesses. some are food trucks. some are restaurants. some are in farmer's markets and so farther. that's an incredible legacy and record to build upon. this was the perfect opportunity for me to come back home, you know, come back to the neighborhood and take my skills and networks and resources and put it backseat in service of the community. given everything with racial reckoning and pandemic it was time for me and everyone else that had the opportunity to leave and get educated to come back home. we have a opportunity to grow our impact in terms of the number of people we serve and how we serve them. we grow our impact in taking the money we make with our entrepreneurs and circulate those resources back interview the community for community development. the third thing is we have a

opportunity to have an impact on public policy in terms of the policies and practices the district has been notorious about interms of inequities. all of those are just the beginning of what is possible in terms of growth and impact. ♪ [ music ] ♪♪ [music] >> san francisco is known as yerba buena, good herb after a mint that used to grow here.

at this time there were 3 settlements one was mission delores. one the presidio and one was yerba buena which was urban center. there were 800 people in 1848 it was small. a lot of historic buildings were here including pony express headquarters. wells fargo. hudson bay trading company and famous early settlers one of whom william leaderdorph who lived blocks from here a successful business person. african-american decent and the first million airin california. >> wilwoman was the founders of san francisco. here during the gold rush came in the early 1840s. he spent time stake himself as a merchant seaman and a business person. his father and brother in new

orleans. we know him for san francisco's history. establishing himself here arnold 18 twoochl he did one of many things the first to do in yerba buena. was not california yet and was not fully san francisco yet. >> because he was an american citizen but spoke spanish he was able to during the time when america was taking over california from mexico, there was annexations that happened and conflict emerging and war, of course. he was part of the peek deliberations and am bas doorship to create the state of california a vice council to mexico. mexico granted him citizenship. he loaned the government of san francisco money. to funds some of the war efforts to establish the city itself and the state, of course.

he established the first hotel here the person people turned to often to receive dignitaries or hold large gatherings established the first public school here and helped start the public school system. he piloted the first steam ship on the bay. a big event for san francisco and depict instead state seal the ship was the sitk a. there is a small 4 block long length of street, owned much of that runs essentially where the transamerica building is to it ends at california. i walk today before am a cute side street. at this point t is the center what was all his property. he was the person entrusted to be the city's first treasurer. that is i big deal of itself to

have that legacy part of an african-american the city's first banker. he was not only a forefather of the establishment of san francisco and california as a state but a leader in industry. he had a direct hahn in so many things that we look at in san francisco. part of our dna. you know you don't hear his anymore in the context of those. representation matters. you need to uplift this so people know him but people like him like me. like you. like anyone who looks like him to be, i can do this, too. to have the city's first banker and a street in the middle of financial district. that alone is powerful. [music]

is >> the meeting will come to order. welcome to upon monday february 27, 2023 meeting of the rules committee of the board of supervisors i'm mat dorsey chair of the committee