>> tuesday, september 19, 2023. secretary please call the roll, please. >> i'll call the roll and read the raymond. >> president bernal present. >> commissioner giraudo present. >> commissioner green present. >> commissioner chow present and commissioner chow the and commissioner chow the ramaytush unceded ancestral homeland of the ramaytush (rah-my-toosh) ohlone (o-lon-ee) who are the original inhabitants of the san francisco peninsula. irresponsibilities as the caretakers of this place, as well as for all peoples who

reside in their traditional territory. elders, and relatives of the ramaytush ohlone community and by affirming their sovereign rights as first peoples. >> okay. >> 2. proposed action: approval of the minutes of the health commission meeting of september 5, 2023. commissioners you had the minutes upon reviewing them, no amendments make a motion. >> make a motion. >> second. >> and if i may offer a motion i'm hoping you can include a

provision from commissioner chow on the up-to-date i incremental said he gave the update that was commissioner green that gave that. >> that amendment a first and the segmented. >> all right. >> any other amendments if none any public comment. >> i have a script to read. for the process didn't allow questions for answered or the public to engage with the commissioners any members of the public when discussing an item please note each individual has one opportunity to speak to an agenda item. where i know sent

to the health commission meeting will also be broadcast on sfgovtv. everyone attending the meeting in person is encouraged to wear a mask throughout the meeting. spell your name for the public comments and please note the federal, state, and local law prohibit harassment and will not be tolerated first public comment from invented in-person. and then take remote public comment from those for accomodation for disabilities. finally we'll hear promote public comment from all individual a time limit of 20 minutes for the public comment and each individuals - anyone in the room like to make public comment on the minutes? >> all right. so let's see - we have one hand, please unmute

that caller limited to 3 minutes per speaker. >> michael please unmute the caller. >> can you hear me? >> yes you've enrollment 3 minutes. >> okay. great. my code is aa and the minutes of this commissioners september the application was submitted and to why the board of supervisors and legislative analysts had his report on september 6th about the e emergency repairs in which the b o a and the certification

application for september 17th. those minutes with dr. terry palmerer and at mukilteo are concerned when the laguna honda hospital and rehabilitation center with resume the missions admonitions and it sounds distinctly that laguna honda hospital and rehabilitation center may have granted authority for the services are now detailing the redissension of admonition despite laguna honda hospital and rehabilitation center has retained staffing with only new residents as of august 22nd.

fewer residents in from april 2022 will be the same number of employees. laguna honda hospital and rehabilitation center obviously needs fewer activity and fewer food service workers to handle two hundred and 22 patients admonitions should resume any not after. >> hire more theorists. thank you. >> that's the only caller for this item. >> no other comments commissioners questions or comments. >> all right. >> all in favor, say "aye." >> aye. >> as amended. >> aye. >> >> opposed? the minutes are approved and next is the director's report.

>> well, i have another script to respect to agenda items, your opportunity to address the commission will be afforded when the item is reached in the meeting. commission from taking action or discussing any item not appearing on the posted agenda, including those items raised at public comment. and the same information around the brown act and any discriminatory harassing statements are not permitted and let's see - the hands. anyone in the room like to make general public comment i see machine in the room and no hands for general public comment we can move on. >> next is is the director's report grant colfax md, dph,

director of health. >> good afternoon, commissioners and with the director's report. >> i want to start offer on one not written item this is september 19th, tuesday, september 19, 2023, which the commission will rarely laguna honda hospital and rehabilitation center voluntary transferred patients getting care we extensions and i'm delighted and laguna honda hospital and rehabilitation center later in the meeting i want to acknowledge that because of of the work because of everybody pulling together with the partnership across the city the work of the workers in the hospital the work will be certified for for medicaid a day of celebration. and really wanted to acknowledge that and we'll get more details on the

medicare application. and in addition, i want to call your attention the new covid vacant will be available for the fall and winter. and this is a for last technically we're calling this a vacant that is for a different variant prior to that and encouraging everyone 6 months and older to get the vacant and people should soon be able to or actually depending on where you are accessing that we'll be distributing at dph in august and go to different pharmacies for the additional

vacancies and very importantly we're seeing an increase in covid case nationwide and across the city so many of us are tired of thinking about covid but here to stay we have the vacancies vaccines and work we really want to make sure that - with regards to the number of situations in san francisco our 7 day positive activities is 7.7 percent. and there are 58 people across the city hospitalized with covid and again, that number is not necessarily rising for the conditions but important to say www the increases the city has a positivity rate we're not seen a burden on our

healthcare system but courage people that toast positive to talk to they're healthcare procedure about educating in particular which is a medication to prevent serious complications due to covid. in addition highlighting a couple of other items in the director's report. >>. two workforce opportunity for the professional development of this professional development for staff that is the bloomberg philip sponsor at the john hopkins public health and diverse executive an initiative with the editorial and the constitute school of medicine is pleased to present this and our staff to look at those

opportunities and potentially apply. really pleased to the next item to call out one of our it's been a long time coming. leaders. by the california homeland that was awarded to dr. tenner for anyone with their essential skills and join me in this great achievement and link in the report and i'll stop there and answer any questions. or any questions?. thank you. >> before commissioners questions or comments any public comment. >> hi any public comment in the room? >> seeing none, folks we're on

item 4 if i want to make comments please press star three now. >> i see no hands commissioners for this item. >> commissioners questions or comments? >> commissioner green. >> yes. and want to lend my voice and congratulate the doctor for everything she's done a that's a humble individual and been recognized really wonderful and for the quality of people about the dpa we appreciate the she of the recognized this way. all right. thank you commissioner green any other questions or comments? >> director. >> i have one other piece

yesterday, we got the new overdose numbers up for the month of august. we - those are data from the office and unfortunately, had a high number we know from prior data due to fentanyl is part of our drug supply needs to be an issue and people know that treatment is available and dpw is doing everything we can to make sure that is vaccine is available and yesterday, we launched a pubically available dashed which tracks the covid deaths and provides context around the number of people seeking treatment. and just want to acknowledge three we'll provide more details in the next

director's report. >> but yesterday, we also know how important databases can be to doing everything we can with the data point to strive toward a better um, and that is a dashboard around those serious issues and in the director's report and ask commissioners to avail themselves of this information and under the leadership of the doctor working extremely hard to get this dashed out and want to acknowledge that work and dashed will continue to be romantic to the situation during this terrible epidemic.

>> i took the opportunity to visit the dashboard and hoping that the trend - and commissioner any other questions or comments? >> yes. commissioner chow. >> i just wanted to reenthuses was so many discussion with the covid recommendation and that simple and clear as it says here six months everyone is encouraged to - stop by a cohort i'm sorry that is done by a cohort the elder everyone should be getting a 6 month of less (unintelligible). >> we're encouraging everyone to get that. >> thank you. >> not that complicated. >> right. not limited or not. >> a nuance recommendation;

right? >> thank you. >> thank you, commissioner chow and director i was able to schedule an appointment for a vaccination so i'll let you all know how it goes. >> our next item on the agenda is resolution is resolution is resolution accept and expend a gift of $57,264 from the san francisco public health foundation (gregory wong, administrative analyst). >> thank you very much. commissioners. >> we would like to ask approval for accept and expend a gift of $57,264. from the san francisco public health foundation and an organizational activity to assist the on and

off with the physical and administrative budget and the city and county of san francisco. if you have any questions please ask. >> thank you very much. >> thank you gregory wong, administrative analyst do we have motion to approve. >> second. >> any public comment? >> is there public comment in the room? >> and i see no hands at this time folks we're on item 5 if you want to i'm sorry three no hands commissioners. >> all right. commissioners any questions or comments stern. >> all in favor, say "aye." >> aye. >> opposed? all right. the resolution passes thank you, gregory wong, administrative analyst and the next recertification update (roland pickens, director and ceo, sf health network & executive sponsor lhh recertification

incident command)) welcome. >> good afternoon, commissioners thank you for allowing me to present own on behalf of roland pickens, director and ceo, sf health network & executive sponsor. next slide, please. so the recertification statistics first, i'll point out good afternoon and so nice to meet you. >> thank you. >> i'm here to present the recertification program. the agency you know more than 95 percent are certified by medicaid this certification is a

direct result of improving in surveys we met the highest standards for the safety for life and fire safety and the operational program. laguna honda hospital and rehabilitation center is made tremendous progress to achieve the recertification and to secure our future but our journey is not over them we're working with the recertification in the medicaid with the the centers for medicare and medicaid services known and cms next slide, please. laguna honda hospital and rehabilitation center submit a change of information proclamation for medicare on august 5th m and cm directed another proclaims and laguna honda hospital and rehabilitation center actually has submitted that application

so we need the so to submit an application because the work and zoning text amendment and commitment needs improvement we are succinct by cms can happen any time and also to determine strait we met the highest standards 6 public health for fire and operations. so a few notes for the recertification timeline. first to achieve the recertification cms we submitted an application and submitted this change of information application at the direction of cms leadership. a change of information operations utilities existing laguna honda hospital and rehabilitation center information. however, cms later informed laguna honda hospital and rehabilitation center to submit a change application was

incorrect and the cms hired us for a new application. so laguna honda hospital and rehabilitation center now has submitted that application as i mentioned earlier with the application as of september 15th. and as i mentioned we wait the recertification secondly, for recertification the medicaid on august 16th the california public health notified laguna honda hospital and rehabilitation center to recertify the medicaid property and congressmen's amended that date to september 5th. and important to note cms is not questioning not questioning are the recertification on 5 the change for the recertification date six the fire life safety

and specifically cms determined the fire life safety was originally due and asked for further documentation we provided and they determined we were in sub anal compliance for the life and fire safety on september 5th. so which was the date certified by the california department of health and healthcare services. so has laguna honda hospital and rehabilitation center has been reserved isn't medicaid procedure program and dr. colfax was saying not moving forward today but, however, laguna honda hospital and rehabilitation center will continue to transfer residents to lower levels of care. or to their homes they no longer are required to have a certain level of care. so for

the entire laguna honda hospital and rehabilitation center hole community. vdz we are dedicated for the height and safety we remain confident that laguna honda hospital and rehabilitation center is the best place for residents to get care and continue to demonstrate we are a different laguna honda hospital and rehabilitation center hospital i'll say that and has made improvements and the progress of two it's been a long time coming. questions when laguna honda hospital and rehabilitation center will begin to add admit those patients and new residents and while we are eager to do so we'll only submit when we demonstrate the improvement we have made are

sustained and staying for a long term this will help us at laguna honda hospital and rehabilitation center. when we do begin new admonition for the laguna honda hospital and rehabilitation center patients transferred will be open and for now they'll be first priority for now patients. providing they still require this level of care. and also like to take a moment to address the 120 beds waiver timelines as cms said that laguna honda hospital and rehabilitation center should be in full compliance so a minimum medicare and medicaid. and if we have the certification before the of waiver and laguna honda hospital and rehabilitation center has maintained that 120 beds and we will reactivate the room in the waiver is granted

and board of supervisors approved the work and it is necessary for the recertification and capital improvement and maintenance work and are the result of adopting to update regulatory requirements and the modernization at the facilities around the country. those are prior to the recertification. and the benefit of the board resolution allows the work for the city guidelines and in has provided manner and at provided completion of those projects help demonstrate the commitment for the immediate compliance and laguna honda hospital and rehabilitation center will continue to spread that for a successful survey. next slide, please.

for our action plan update. go through this forking for the medicaid and cms 90 days monitors in july submitted the proposed action plan and in response to the june service as well as other non-monitoring survey finding. the proposed action plan includes three hundred monitoring for survey three and also the one hundred and fifty milestones for non-monitoring survey finding and this submitted 200 and 57 milestones for this and one hundred and 9 milestones for non-monitoring survey finding. so i'd like to take a moment to and in collaboration and partnerships with the quality improvement experts or two i d laguna honda hospital and rehabilitation center and the two id continue the improvement

work. so in conclusion, throughout the row certification process remained dedicated to the residents for the health and safety and wellness are the top priorities and for laguna honda hospital and rehabilitation center is the best place for the patient to get care our goal to demonstrate about cms and the california department of public health cd ph we need the higher responsibility so fire and operations coordination corporation for the full certification and as i mentioned your journey is not over we must continue to demonstrate everyday that we are the new laguna honda hospital and rehabilitation center hospital and by meeting the high standards required of us every single day 33 day in and out so laguna honda hospital and rehabilitation center is not facing a situation. thank you.

>> thank you for that excellent presentation and for the update any public comment? >> anyone in the room like to make public comment on this item. >> okay. step down so everyone has three minutes when the timer goes oh, your time is up laguna honda hospital and rehabilitation center. >> yes. >> okay. please begin. >> hi, i'm ann san francisco gray panthers and laguna honda hospital and rehabilitation center is a core issue as nursing health service and work in a nursing home it is important. and nursing care that is the only thing will do and people get out of nursing care, you know, and see that final that, you know. we need to um,

soft form for san francisco we have appreciate you keeping this and your report and also prioritizing franciscans for that and making sure the care and housing care in an appropriate setting but it is a nursing home for san francisco and continue to advocate for those in a healthy way. thank you. >> thank you. >> all right. enemy anyone else so, please we can get that comment. >> yeah. you, you mark fitzpatrick can you hear me? >> please begin limited to 3 minutes per speaker. >> hearing the report that laguna honda hospital and rehabilitation center submitted a raw application for

recertification. it seems inken acceptable if laguna honda hospital and rehabilitation center will have a change of information and quote application instead of a probably much more detailed application (microphone distorted) and more servicing that jc c told them last week that laguna honda hospital and rehabilitation center is a two id and mutual to pause milestones august 23rd, this during the app medicare survey window. and the medicare survey

upon completion of the cms medicare certifications survey the milestone will result unquote those milestone applications should be ongoing. after all the analysis report and each subsequent status for each month laguna honda hospital and rehabilitation center failed to adhere to the 3450i8z have been underway since january of this year. particularly

non-compliant control plans or corrections underway ever since laguna honda hospital and rehabilitation center was resisted in april of 2022. those milestones should not be paused but ongoing own while you wait for the survey (microphone distorted) will begin. thank you. >> this is the only public comment on the remote do. >> thank you secretary. before we go to commissioners questions or comments i wanted to clarify first of all, i want to start by acknowledging your hard work and hard work of roland pickens, director and ceo, sf health network & executive sponsor and i see deputy director in the audience and were engaged not even a year and a half ago so

many hard work with all the staff in laguna honda hospital and rehabilitation center to make sure we address the concerns and met on the recertifications made great progress in the row certification and now submission of an application to cms for medicare recertification. i want to clarify i think i got this but laguna honda hospital and rehabilitation center staff put together the application he they were instructed by cms to submit. and after it was submitted to cms acknowledged though have instructed laguna honda hospital and rehabilitation center to submit the incorrect form and as a matter of fact they set back out one of their own experts over to the laguna honda hospital and rehabilitation center to transfer that information from the incorrect application cms instructed laguna honda hospital and rehabilitation center to the correct application; is that

right? >> i believe commissioner chow. >> may i. >> sure. >> can you hear me? >> yes. >> hi commissioner yes, so they directed united states to do a change of information application they then came back and said that was wrong and that we needed to do a few application we offered to have someone help us transfer to a new application that ended up couldn't do. we yeah, this changed we ended up doing a brand new application last friday and resubmitted that. >> can you introduce yourself. >> sure i'm troy williams the co-commander for laguna honda hospital and rehabilitation center cms recertification journey and for the network. >> thank you troy at the at the

l g and to acknowledge there was additional work required by laguna honda hospital and rehabilitation center in order to anytime the correct information after being instructed to submit the wrong application must have been frustrating and appreciate the extra work you all did and to echo september 19th earlier in the year march or april we thought we have to be resuming involuntary discharges but here we go. thank you. >> commissioner guillermo. >> thank you president bernal and thank you for your presentation. and welcome to your first official presentation lots of work that you've being able to pickup for this hit the

ground running so appreciate all of that and appreciate and want to acknowledge as well the september 19th date i don't want to understate how important um, it is for us to not have to worry about trafrgz and hoping never have to do that. again. i have a question i believe i asked this at the jcc meeting with with regards to the service team we are seeing from medicare two questions one do you have a sense of is from oar experience sort of a standard time we mitigate expect it to occur and two, tux.

>> regarding the timeframe i have to to um, reserve but i know that maybe troy or others can talk about the timeline i don't know if there is a fixed timeline open to um, any time you but troy correct me if i am wrong a few weeks or longer. >> yeah. so we don't know. and just the second question- >> (multiple voices). >> cms lhh? >> go ahead. >> i was going to say that is something we don't know for sure, you know. throughout the process combining the team cms team. so we'll - we don't know for sure and they have not

shared three with us. >> just because the surveys are announce at any time. so we wouldn't know. >> thank you for those answers and hoping that it wouldn't be too much lower than we have milestones that we want to make sure continue to be um, achieved. and know - speaking to all the work that has been - through the kinds of mode of operation we know as we put in place the news of laguna honda hospital and rehabilitation center hoping not having to have any slippage in moving forward in the hospital and again not necessarily the fault of anything that took place at laguna honda hospital and rehabilitation center but waiting for the survey, you know. not in our control. but

maybe, you know. several messing up there are for that survey to help it is really important. thank you. >> any other questions or comments commissioners? >> commissioner chow. >> yes. thank you for your presentation and for the listening of the chronology a lot data put forth or floating around and as september 19th is a key date for us and today in the sense we will have to have resumed involuntary transfers. i think perhaps because you're saying we're doing continuous quality improvement and really being prepared for a cms survey maybe we wish to understand

better i know you presented before about the milestone that pausing the milestone is not really pausing the continuous improvement but if i recall from the past, we had things we are producing milestone progress during the preparations for or in the course of a survey occurring. and we therefore were not able to have some of the um, i guess sheets you're using to show our progress. but if the milestones are continued to be critical for us to continue to improve at the excellence then how do you envision we do this i don't think you mean we're not working on the issues maybe clarify this statement means

that, you know. we're discontinuing the milestones at that point. >> that's a great question. pausing the milestones didn't mean we stopped the quality assurance that means many of the projects we are working on through our program that includes the topics for the milestones. so it allows us to focus on the continuous quality improvement in the program so we can maintain retain maintain and survey ready and continuing continuous the quality assurance didn't mean we stopped. in assessing the milestones for many of them in the program and don't know in troy have anything to add hope that answers your question. and not effecting our quality work.

>> okay. >> yes. >> it to understand a difference between following a milestone incorporate a lot of the survey, areas that we are still working own and continuing to work own for the cms survey; right? so the milestones are internal here to see if we completed certain tasks have put in place a process not just on pilots and whatever you want to call it for that milestone; right? but the milestone is equal to the standards. >> correct. >> so i think that is very helpful for all to understand we are continuing to do the work to respond to the areas of survey and that are key and important. and that it's the agency gas

station on the milestone some technically as you continue to do this by not formally working on the milestones at this time. >> right. >> yeah. >> that is will be helpful. >> j.t. c putting in systems daily and monitoring monthly monitoring the new system in the care process and monitoring many of the topics that - >> (multiple voices.) >> milestones. >> right. >> putting it into a sunnyvale operation plan to check it and continual improvement and subsequent. >> okay. >> no - and i think that is helpful to be sure we are looking for the survey. >> right have the continuous survey to sustain as consistently trying to emphasis sustain the progress we have

made i present that very much. >> thank you. >> yeah. >> i wanted to talk about your point and understand to reemphasize over as laguna honda hospital and rehabilitation center understand the clear importance of continuing to improve quality that is a clear thing from the department and department leadership and - all really understand that is incredible important we continue this work and i have to share a recent visit to laguna honda hospital and rehabilitation center and oubtsdz the

disciplinary motorist office and it was important to see a multiple different teams from different parts and working together and setting up a structure and identifying the medics improved setting up that in that work. i want to emphasize this work continues to drive the change that the motorist emphasized about the laguna honda hospital and rehabilitation center team into the future and finally wanted to pubically acknowledge and thank you. the health commission it is in this challenging time and we will continue to have the guidance and leadership thank you for making sure that laguna honda hospital and rehabilitation center is here for san francisco residents. >> sniff of the future i like that. and if not other questions

or comments move on to the next item and thank you, mr. williams and all and i wanted to say what you're saying about thanking the staff for the hard work. i know it is everybody with c n a and others pulling together to decade themselves with the changes that needed to be made it continues the psyche. thank you for acknowledging us. >> thank you i'm in wholehearted agreement. >> we have next reports for the following related items commissioner giraudo the chair of the laguna honda hospital and rehabilitation center committee. >> commissioner giraudo.

>> the laguna honda hospital and rehabilitation center member committee reviewed the standard report. the executive team report. and h.r. report and early version of today's meeting for the full commission and had extensive discussion at that time we reviewed as we have several months we do on, on annual base the policies that reviews and comments recommended for the fuel commission as in the past asked for clarification and some rewording on some of the revisions to the policies that were presented and got lhh

and responses reciting those and appreciate the work that you did my understanding is that there have been in addition questions or comments for concerns so we are fully prepared to recommend to the full commission approval. for the policies that were presented today. >> thank you commissioner giraudo do we have any public comment on the joint committee report. >> we do anyone in the room like to make public comment on this item? i see two hands let take caller two first please. um, hi that is dr. palmer can you hear me? >> yeah my main um, question about um, about the agendas items the joint joint conference

committee and one before are has they've been in discussion and needs to occur citywide not just with with the health commission how we can give oversight for laguna honda hospital and rehabilitation center that is happening again and need (microphone distorted) how to run a nursing home and not just a county hospital. and who do not use laguna honda hospital and rehabilitation center for the purposes unrelated to providing to provide urgent care for disabled san franciscans that is a traffic at the and kind of like

9 and will be intense political pressure to use the laguna honda hospital and rehabilitation center beds for other nursing home care. and because of um, the expense of delivering the nursing home care and the lack of other services in the city and um, while we should care - plenty of services the city needs to care but needs nursing home beds. this mission must not be interfered when i ask for a larger discussion about oversight to prevent this terrible episode from reoccurring again, thank you. >> great. thank you and let's go to the last call. >> yeah. it is can you hear me?

mark. >> limited to 3 minutes per speaker. >> missing from commissioner giraudo update report any mention for the trend the september 12th um, jcc executive team report i see signatures collected during that.org on petition are peskin and others. signatures demonstrated broad community port to submit the waiver application now including part of 10 collected from san franciscans at the greater area and 5 hundred and 74 or 35 percent across all i went back

to check according to the technical 483.9 it is clear that waiver application for nursing facilities and tents for dead medi-cal beds are a distinct part of nursing beds the correct place to submit that um, waiver application is to argon and - and once again getting incorrect information on the p f f and wait for the medicare kirgs and

roland pickens, director and ceo, sf health network & executive sponsor said on may 9th at the board of supervisors he said laguna honda hospital and rehabilitation center meets the requirements so i think the jcc should direct my simon to look at the requests and with the language in 42 cf r says that in the case of nursing faculties that the waiver application came back submitted to the agency in a language very clear comes from the agencies that would be dr. a con. thank you very much. >> that's it on the public comment. >> commissioners any questions or comments before we move on to

the scent calendar next back to the chair of the joint conference committee. >> a motion to approve recommendation policy presented. for the laguna honda hospital and rehabilitation center jcc. >> second. >> a motion and second. do we have public comment. >> yes. anyone in the room like to make a public comment. i see one hand on remote. >> hi. i forgot it's okay i don't have a comment. >> okay. thank you, dr. palmer. >> no further comments. >> all right. any questions or comments from commissioners, commissioner green. >> yes. commissioner guillermo

thank you for you all the roundabout and with the comments some were detailed i do not tell you how pleased what you did in the kribltd attendance to detail with the 25 recorders field you highlighted this really is a testament to the diligence that your pacing so this really is a testament to how and see the progress you've made. thank you very much. >> any other questions or comments? >> all right. echo commissioner green comment about the sheer amount of work they put into the policy changes and have necessary not only for recertification but provide excellent care that our resident

at laguna honda hospital and rehabilitation center receive so thank you for that and no vote questions or comments? we have motion and second on the >> all in favor, say "aye." >> aye. >> opposed? all right. approved. thank you. >> the consent calendar is approved and next. >> 9. for discussion: dph human resources update (luenna kim, dph human resources director) ms. kim welcome. >> thank you very much. ms. kim can you move - yes, thank you the black bar is the microphone. >> okay. >> thank you. is it okay i have to stay on time but of it's. okay. >> that's fine. >> good afternoon,

commissioners. president bernal and commissioner green thank you for me to provide an update and luenna kim, dph human resources director i have with me remotely dr. our employee with the culture team and instrumental in putting those slides together to thank you for that. >> over the next 10 or 15 minutes i'm going to be going on with the final agenda item. next slide, please. . thank you very much.. next slide, please. so the work we've been able to accomplish and continue to do can't happen without the dedication of the dpw staff and thankful for the work today in and out and at the last preservation we expanded the h.r. team compromised you see this this slide and each of the

areas are cruelty they're responsible for inventing h.r. and those are in aligned with the h.r. functions. and to reinvent the decision making. and propel new transformation for the work. though are career opportunity for staff and creating pathways for the staff. so one of the analytics and team i think as we can understand and recognize h.r. has been collecting storing and analyzing data and amazing opportunity to share with the improved equity

through the use of data and streamline the h.r. data to sport the results. though will accomplish and measure outcomes for the services by dpw and we have pleased to have a clinical strategist and candidates and meet the staffing demand we must. so to that end a recruiter who comes from the private sector has many experienced and joined us last week. next slide, please. broadly seeing staffing in two areas and improving the retention. and made progress so we have a way to go in those

areas. and this slide shows some of our accomplishment we appreciate the questions in advance. and some of those. and take the higher staff. so looking at there are two areas the way the city has this available one for the examination and the other is adopted and i'm going to go to the adoption information first and from a list was adopted and both positions were filled in 75 days and dpw we were for all the positions including the ones up above one hundred days. and about thirty days for this filling of this position and health clinician and 67 days to

fill a d n a and just h.r. analysts 69 days to fill that position. this fiscal year the city averages about 8 three days and dpw is 90 days to fulfill a nurse at 77 days for the average for the health commission at one hundred days and c n a so you have a little bit to think about and the eligible list is one hundred and 77 days and dpw one hundred and 66 days for the city average and tried to get information wrong side about the constitution how long it takes to get a list but that information is not available we'll be able to focus better. so i'm not going through all the information but two areas. and

we all know hiring in the city is complicated and we need to work on demystifying is and we met with the 10 three 1 charter and leadership and three, 4 hour sessions to work together from different perspectives on better ways to improve and to provide suggestions to improve the experienced. so i'll talk about some of the suggestions. and another idea to double the training co-hotter a great idea and dr. kim we hired several numbers of people in the training program we need to be - a way to create a piping. next slide, please. traffic is filling positions by

the row tainting the staff and filling all the positions but we are creating and having folks go out we need to deputy our staff. so we have worked on the focus on retention i'd like to talk about three areas and a task force as employees experience issues that need help and may not know where to go to get help we created this help center within the office of help services for whatever questions they may have or an issue in the workplace and dpw and h.r. will help. we'll have a to and from leadership program and research that includes the direct permission level that is they

feel they're part of an organization we've been providing information for supervisors to support staff. and this is um, first ever development program we're proud to have this and lastly, career advancement grateful for the 1021 to the current pipeline and they provide a good portion of this so they have provided 100 intuition for our nurses to move up and at the end 1021 will cover all of that to get there. next slide, please. and a question regarding mandatory online log in. we have a bunch of them i'll go through

them quickly in the workplace and on video that is mandatory and have to strengthen our commitment and training for supervisors introductions for bias for the supervisors and this is a lower program for staff and supervisors and the last prevention for equity in hiring. and then mandatory is practicing culture information about sexual orientation and identify and policies for privacy and other employee statement (unintelligible) those are some of the mandatory trainings we have more staff on track. okay. here's some pictures. next slide, please. forgetting to say. next slide, please. . thank you very much. and some of the sessions we had in the last year and three conferences

hiring and colleagues at h.r. and experience conference an, an manual conference and now for a smart recruiter with d hr and annual h.r. equity conference we work on equity in all the positions. next slide, please. um. okay. so here's a typo it is still 25 hundred positions that is the correct spot. so some of the goals we have i know that some of those are listed. we need the as i mentioned hired a very experienced recruiter from the private segment and across the departments and have

ongoing event and really want to advance our culture and a our history we have a robust program with - and expanding to the registered nurses. we heard that some of the pipeline issues and so they're not able to actually train physicians so we will increase our social have a social media campaign. and in the referral program it is in government in which we can really figuring out why people - don't accept our jobs and recently trying to find a way to bring others back and people that decline jobs and having

ambassadors and things like that. we are really focusing own hiring are permanent civil service. the departments that have hired permanent a couple of things i know that helps bring in staff. >> but we really train them we are looking at prioritizing the hiring and what i talked about the work with them for dph has special benefits. and while on one end that helped bring in nurses. but it is challenging for people to manage 19 positions. so either experienced or not experienced and really urging to look at the applications to those in nursing leadership are familiar with the

work and reach out and meet with all the candidates we want to under that and continue have the recruitment for jobs we wanted to also have a selection so people apply we want to reach out to them right away. and they can start the process which is what we've done in the city a lot of time this is constantly having a vacancy and select and we'll go from there we have done a lot of work on the only broad medical evaluation process. and done a lot of deeper dive and staff coming in to help us

streamline the process and we're used to having this in the department everyone for more 65 months has to get a physical evaluation. and require medical evaluation for my employment. this is necessary for that. we have worked on getting out we don't need medical evaluation to and we're looking to evaluate and my angela's my colleagues in the city we have worked on prioritizing the appointment and making sure that our part (unintelligible) we are a good partner. and i talked about the team data team director. next slide, please. so those are some of the

challenges that are before us. i don't think any of those are a spriep by to have difficult times to healthcare i talked about nurses and it is challenging to hire positions and tough to hire a health commission so we'll focus on those other positions and continue to work with our clinical strategist and nearly 16 percent vacancies own our end throughout the staff we are at 11.5 and make sure we fill up that number over one hundred thousand in 20/20 and doing

things differently i think i believe and we know you do as well have an important mission and will bring people to us bring people back we need to demonstrate and do more active and lots of work in the mission and more outreach so people thinks that we are a great place to work and our mission to work on strategically that. and we recognize the next budget year may be difficult and challenging we are working to fill as many position as possible and fill many positions a month. it is three hundred and month and that's a lot i don't know what the three hundred will get there but striving for that goal. and

bargaining this is bargaining that is coming up we have our teams getting our data together to be um, contributors to the negotiateers. thank you. for giving me an opportunity to provide an up-to-date and the dedicated team as well as all the support we rove from dhr and my colleagues through the the city and also recognition the interpretation support we receive from dr. colfax and others so we need to be better everyday for our staff and patient. thank you very much for listening. this presentation for your questions and because they really help us and improve our work. thank you very much.

>> thank you, ms. kim before commissioners questions or comments. >> any public comment. >> i'd like to thank you for up and running this presentation remotely anyone in the room online no hands and like to make comments on star 3. and no hands. >> commissioner guillermo. >> thank you very much for your presentation appreciate the update. and it seems there is a tremendous progress i'd like to see the effort you and our team bring to san francisco. and the brightist and most dedicated least for the department. hopefully for all the departments in san francisco but certainly for our department. and appreciate all of that work and hoping it comes to meet our goals fire station as you expect. i had a question about

the particularly the license and sifrtsd positions that you seem to be focusing on. is that more difficult to bring in experienced licensed clinicians certified professionals or newly i guess licensed and certified professionals and does that matter that much? >> in this scheme of trying to fill all those vacancies? >> for the nursing we need the get a lot of applicants what are new to the role. um, for example, in perspective we have two new krurments recently had about within two or three months 200 experienced and seven hundred who are new to nursing.

so we do have a greater bunch of individuals i think we have a number of challenges one is the way that um - i don't think this is new to dpw. >> new to the organizations with clinicians so part of this challenge you might have enough seniority we want to change to a different organization you have to change over night that is a challenge and others wants to change specialists bring experience and need to be trained for the new position. for behavorial health commission i think that we do have folks new i think part of it we have such a evacuee list this is

challenge is difficult for the staff to bring in someone new and have to train them and it it becomes i have a lot of work i have a - i need someone but no time to train so part of that is really get a training program in place we can bring in more people who are new. because i think that is - we need to create our own pipeline so we really need to work on being the first employer bringing them boarding some of the things we're finding and . >> what about the competition from the private sector? >> for the nurses there is a

shortage and it - the salaries by the charter is about the working conditions and a lot of things i think and um, i think that is about really getting the commission driven nurses to come to the department of public health and they're not enough clinicians we look at competing with other county and other nonprofits. so we are doing a drilled down for the clinicians and have positions maybe the services are not needed so look for for those licensed and looking at creating our own pipeline i know in the state of washington i read that though have much such a shortage of clinicians they address the

demand and fixing the pipeline we to have no conversation to see if we can have - in order to expand the population. >> appreciate all the efforts you've been putting in and also, because san francisco is just a difficult place for folks to come and live earn a living that is overarching not just for the licensed and certificate positions but for all positions so thank you, thank you for all you do. >> commissioner green. >> thank you for the real crucial for and training for urgent care i have a question i guess one leads to what commissioner guillermo do we

have a sense for our hiring nurses and health clinicians kaiser permanente i think we have tried to - and i was surprised we lost a lot of nurses to kaiser permanente and kaiser permanente is more generous with the education. i'm all for it i never thought of that but enlightening i think i'm wondering how we're trying to do due diligence. >> when our recruiters started

i found out what organization health organization kaiser permanente maybe is different from others and their numbers and how long it has taken. so um, she'll be able to find that information. >> and did create and group 6 bayview county public hospitals that gets together and shares idea but what their conditions are and experiences and how they're hiring and learning from them. i think a number of the public hospitals in the bayview and the time to hire and fill the vacancies as opposed to getting that information and giving an update i'm happy to do that i say we're not competing with the other cities departments like kaiser

permanente and uc sf but and my thing for this year i want all the nurses to have dpw though, pickup shifts in other places but primarily working with us, we have a lot of have a lot of things to offer. thank you. >> i guess the other question the other commissioner mentioned what kind of latitude in terms of a social working can do something otherwise that dpw can do and utilize everyone has a peer what are the barriers through the system who might be

able to do that where are we on that? >> i think my initiative response everyone needs to work in their classification and find out the general duties. um, many operate at that level. i think we need to evaluate for the clinicians for example, what kind of job and the regulations it requires licensed if not should we look at many other - and it is in the interest of time so - we have one you have to work them your classification i think we want to pivot. >> change that and with the classification will involve h.r.

that could involve a service commission and i'm in discussion on the level of conversations but potentially a level of a specialist and a lot of work in the 1980s and 70s some we need to modernize with that kind of work that didn't work today. and provide the social workers classification and what classes and have been and not do that but - we continue to work on stuff. >> now the question is on for the covid questions. >> just. >> please next slide, please. this is for the subsequent billing certain

licenses to for example, q h c has to be w and or any licensed psychologist not on m f p but again looking at the sustainability what if that helps a little bit at least i know what we are dealing with in that stage um, but i have a couple of questions too. are you connecting general health internally pipeline that in the pipeline you're recruiting more positions they will have been been d c h trained? so something

that is connected with um, that pipeline? within the behavorial health? >> it is really tense and simple for those in graduate schools, etc. i've been really pleased with the efficiency in b h f pipeline for people to get on board but i see we're doing in our philip in data pipeline at that time here for you but i think in behavorial health one i know you're trying with the timeline but i know the timelines here phillip coffin, md mia dph for behavorial health for the licenses clinicians or almost licensed moving on along 0 that is one of the reasons i

know some of our fellows have gone to other places want to stay in community health but had to pay their rent so three months of that process just a little bit too much. that's why i'm suggesting some more integration with that pipeline. as well. do whatever you can do within the behavorial health 100 percent right everybody in the bay i mean everywhere nationwide very, very difficult but that's right think that um, it might be helpful to have the timeline and what you're requirements are as well as the pipeline. >> thank you and i completely agree with you had a conversation with the individuals and the people want

to work for dph because of the time it takes to fill the position and chg have builds to pay go something else so we are looking at having a student internship program and they will stay if we don't hire them at the student level we'll lose them and they'll not come back for a while. >> yeah. i - i mean in the last presentation that we had on the dph pipeline so it was their continued outreach for school so partner with them they help out with the practical level and the

staff level. >> thank you i'll speak with them. >> and chair, i oriented kim the name of person that made the presentation that you're talking about. >> great. thank you very much. >> all right. kim thank you for your presentation and certainly appreciate all of the progress you showed in the presentation and the priorities of the commission to streamline not only protecting the health of san franciscans but alleviate the members on the staff and cover the work in the positions so very good progress and thank you for the update and look forward to the next update. >> yes, sir. >> i also want to thank the team you've seen things that provide during the pandemic

multiple challenges and innovation and hiring a team that um, is focused on problem solving and really not allowing to drop the city but easier to get the workforce and hire the very best workforce for public health so, thank you. >> thank you, director colfax and kim. >> our next item is. >> 10. community and public health committee update >> susan. >> we had very, very interesting and wonderful presentation at the committee. the first was the hiv update and it was most interesting to a few facts of the data which is what i like is 82 percent of funding

is there bryan white general fund the group manages 79 programs and uc sf dph and the hiv epidemic going forward their target work is four areas of people experiencing homelessness and people have a recent history of incarceration for people with high substance and gave us excellent attorney information and focus within the hiv. the data in 20/20 the black target

they achieved for depression that was within two years is quite city manager and in 2022, persons experiencing unstable housing which is the other goal. dollars a target of 87 percent depression and unstable housing is 74 percent of the day just excellent program and it was a lot of back and forth education and conversation that led this of the great. the second presentation was the current resources and epidemiology with their focus on reach. though are

currently having three studies for the area and the stimulant more or the other study it was interesting in the beginning data that the stimulant mortality age group was age 50 to 60 and the data showed older and more, more abilities - within the sros and to make a difference the other program the alcoholic program which is to take a drug when needed prior to

taking that and also looking at substance abuse trends we saw the dashboard sent us to fentanyl is the highest with the substance use but not - the alcohol is very high not because we're focusing on um, all sort of opioids as well. and it was noted that right now 90 percent fentanyl involved. so there is lots of great research that is going on with that with the staff. and noted in the

presentation or the slide i mentioned to mark and so i have lots of questions and their presentation is the application of the slide excellent and again, we had a lot of um, conversation and education for back and forth so that was really, you know. successful and to active at the committee meeting because also the exchange to further form of their great work. that's the end of my report. >> thank you commissioner guillermo. >> do we have any public comment on this item. >> anyone would like to comment. >> i don't see any hands. i'm

sorry? this is the community and health committee what commissioner guillermo just - that's okay i see one hand and again, this is own the public health committee update. >> yes. >> caller are you there? >> hi this is dr. palmer. >> there is an interesting discussion at one of the last health commission what the community of putting committee could be doing and should be doing and especially in terms of advocating for people who are affected by the toxins i would like to hear more about that and

know how um, up and running how the community is going on to helped and protected by this committee. >> thank you. >> all right. thank you. >> looks like a person in the room would like to make a public comment. >> so - has to be about the committee of you're talking about an issue. >> yes. >>. thank you very much. the opportunity okay. i'm wording what is the health commission can do to help the jobs such practical solutions as dr. offered on the mining at the last meeting. you know. the

(microphone distorted) for the task force needs represent like the water board, etc. and helpful but they have such limited jurisdiction and um, stricter and the pollution in the air and groundwater so all this stuff really hard to - i've been attending those meetings and in between and in between space you can hear stories of people family and friends and worried about their lifespan and also and their fearful for the children. for the community. i'm wondering with the san francisco health

commission might have a broader influence in this subject and we would appreciate your continued look at it from that community and one other question. i think i said. thank you. >> thank you very much. that's the last comment. >> all right. commissioners any questions or comments? >> seeing none, move on to our item the next item the next item which event the matter shall be removed from the consent agenda and considered as a separate agenda item. approval is requested. >> with the spook in the air i like to call on director colfax with the air quality. >> thank you as we noted the air is not clear out there and as we have had during other bad air events. in close collaboration with the department monitoring the

situation. our public health ranch is sending out e-mails as we speak and alert for when necessary the air quality reaches the level of poor qualify for a specific population i want to make sure that everyone is aware we're monitoring that and really people will get notified. thank you, dr. colfax and commissioner giraudo. >> yes. my other business is san francisco general hospital foundation is having their manual retreat on thursday at the attending as represent sent

and dr. hillary will be participating on a panel i think two other physicians from san francisco general and uc sf and breakdown into two groups but the group well, i think that is interesting and good for them to have doctors in attendance for the challenge that's this thursday. >> thank you, councilors. thank you for your service on the board as well and all right. any other other business. >> this is a follow-up to dr. colfax. and i was wondering about the air quality and this is reading one hundred and 56 is a nice red i'm not sure when

you're criteria are and come down here with the traffic report never mentioned this horrible haze and what is kind of the critical point that we have all to be aware of. this is probably some of the highest i've seen since the fires. >> commissioner chow from you're public health responses the air is a standard was at 1 hundred and 44 warrant the sensitive population to have an alert to that effect. >> our public health emergency response team is standing but as necessary if that level will have an activation.

>> and including the wildfires. >> apparently the fires are not orange in california. >> commissioner guillermo. >> it's what i was going to share that information. >> okay. any other new business so the next item is. >> 12. closed session. do we have a motion to go into closed session. >> so moved. >> to go into closed session. >> any public comment. >> anyone in the room like to comment on this item and first of all, remotely? >> press star three. >> no hands commissioners >> all in favor, say "aye." >> aye. >> opposed? all right. we're no closed session.

>> everyone in the room pleas >> all in favor, say "aye." >> aye. >> opposed? all right. for the disclosing what was discussed in closed session. >> and last item adjourn. >> all in favor, say "aye." >> aye. >> opposed? all right. we're adjourned thank you, everyone. >> thank you. [meeting adjourned]

>> (indiscernible) i just know it. excuse me boys, but does anybody have sun block to block this skin from the sun? >> yes. that's right, i need to get my (indiscernible) >> many of us last summer

(indiscernible) reapplying sun screen is like getting the second dose of mpox vaccine. >> wait, two doses- (indiscernible) >> isn't it too late to get my second dose? >> girl, it is like sun screen, never too late to put more sun screen on. >> that's right, i need to get my second dose of mpox vaccine before the summer starts. >> let's (indiscernible) 21201 to find the closest location to get the vaccine or go to sf.gov/mpox. >> thank you for the information (indiscernible) >> excuse me boys, do you mind checking please? >> sure. >> that doesn't look like a sun burn, you might want to getd it checked out. >> what do you mean clecked out?

>> checked out. i was told if i got my second m pox vaccine i would have less severe symptoms. (indiscernible) >> maybe i schedule the second dose just to be safe from mpox. >> most vackeens offer you a level of protections, just like sun block. sometimes you need to reapply for more protection. the m pox vaccine is based on two shots several weeks apart to provide the strongest level of protection. visit sf.gov/mpox to get yours. >> thank you boys for that reminder! make sure your are fully vaccinated for m pox this summer. text summer vibes to 21201, to get

[music] welcome to this over vow of san francisco ethic's commission. we are excited introduce to you our work and serve as a resource for city employees and officials. the ethicky commission created by san francisco voters in 1993.

to impartial low over see rowel and guidelines for i cleaner government. we help those work nothing or with local gentleman follow the rules through education, support and enforcement the commission shapes the rules to make them strong, practical and enforceable. the public expects and deserves the government this serves them. this means serving the public without improper influence or seeking personal gain. the government's decisions made fairly and open low. however, this is not always the case. for this reason, rules and guide lines exist to steer people away from violating the law or engage nothing unethical behavior. the ethicky commission provides education and assistness for

people working with local government includes city employees, officers, candidates, lobbyists and others engaged in or with government. here are examples of our work. we create new ethic's policies. help officials avoid conflicts of interest. manage public disclosures, over see campaign finances and including recordkeeping and the administration of campaign financing and aid the registration and reporting of lobbyists, campaign and permit consultants and mirj developers. audit campaign, lobbyist and city filers. we investigate complaints of violation and it is commission's

jurisdiction and fines for violation. the san francisco ethic's commission is lead boy 5 voluntary commissioners. who each serve a single 6 year term. the ethic's commission is here for you. we welcome to you engage with us by phone, on line or in person. thank you for watching. >> for us, we wish we had our queue

and we created spaces that are active. >> food and drinks. there is a lot for a lot of folks and community. for us, it started back in 1966 and it was a diner and where our ancestors gathered to connect. i think coffee and food is the very fabric of our community as well as we take care of each other. to have a pop-up in the tenderloin gives it so much meaning. >> we are always creating impactful meaning of the lives of the people, and once we create a space and focus on the most marginalized, you really include a space for everyone. coffee is so cultural for many

communities and we have coffee of maria inspired by my grandmother from mexico. i have many many memories of sharing coffee with her late at night. so we carry that into everything we do. currently we are on a journey that is going to open up the first brick and mortar in san francisco specifically in the tenderloin. we want to stay true to our ancestors in the tenderloin. so we are getting ready for that and getting ready for celebrating our anniversary. >> it has been well supported and well talked about in our community. that's why we are pushing it so much because

that's how we started. very active community members. they give back to the community. support trends and give back and give a safe space for all. >> we also want to let folks know that if they want to be in a safe space, we have a pay it forward program that allows 20% to get some funds for someone in need can come and get a cup of coffee, pastry and feel welcomed in our community. to be among our community, you are always welcome here. you don't have to buy anything or get anything, just be here and express yourself and be your authentic self and we will always take care of you.

5 o'clock. >> (music).

>> co-founder. we started in 2008 and with the intent of making the ice cream with grown up flavors and with like and with tons of accessible freshens and so we this is - many people will like it and other people will like you my name is alice my husband we're the owners of you won't see ice cream in san francisco and really makes fishing that we are always going together and we - we provide the job opportunity for high school students and i hired them every year and . >> fun community hubble in san

francisco is my district i hope we can keep that going for many years. >> and i'm alexander the owner of ice cream and in san francisco and in the outer sunset in since 1955 we have a vast of flavors liar choke o'clock but the flavors more than three hundred flavors available and i am the owner of the ice cream. and my aunt used to take us out to eat ice cream all the time and what can i do why not bring this ice cream shop and (unintelligible) joy a banana split or a great environment for people to come and enjoy.

>> we're the ordinances of the hometown and our new locations in pink valley when i finished law school we should open up a store and, and, and made everybody from scrap the first ice cream shop any ice cream we do our own culture background and a lot of interaction and we're fortunate we can get feedback and serve to the king of ending and also

>> good morning, every one. is this the morning? yes. >> close enough? well thank you so much for being here today to celebrate the official launch of landing at lat us store. [applause] my name is robby silver and i'm the executive director of the downtown sf partnership. wore the community benefit district that serves the financial district and jackson square doing everything we can to create a more vibrant downtown to support economic recovery and the growth of san francisco. we're thrilled to experience today's moment with all of you and if officially welcome to sf newest social destination and the start of a reimagine downtown. ju