>> good afternoon everyone welcome to the december 17th, 2024 health commission. as you know this is the last meeting of the year and we're going to concentrate on the accomplishment, and at this time the commissioner would like to acknowledge the exceptional work as a department of a whole under the director colfax's leadership,

we're so grateful and everything that has been done to advance the health and well being of san franciscans this is an amazing department that does really ground breaking and national work so we're grateful this department. i also have a bittersweet news as commissioner chung is going to leave us, she being spearing in for another department as we speak. and you know, for all of this time has really been such a strong and advocate and voice for the under marginized

committees. i think we will all miss her and the vas contributions. can you please call the roll. >> yes, thank you, i'll start with you commissioner green. >> present. >> christian. >> present. >> bernard. >> present. gi rand o. >> present. >> chow. >> gi lermo. >> present. >> and commissioner guillermo will read the land acknowledgment. >> the raman --ramaytush ohlone have never seeded this land. as guests we recognize that we benefit from working and

working on their homeland. we wish to pay our respects by acknowledging the elders and relatives of the ramaytush alone' community and by affirming their soverne rights. >> thank you, the next item on the januaried is approval of minutes of december 3, 2024. you have the minutes, are there any additional additions or corrections? >> i do have a correction to my comments. whether there was a way for us to get lawful in a way that could spark additional ideas without, creating a seiad of

meetings, that is my correction. >> thank you. how should we proceed in terms of motion to approve? do you need more details? >> that's okay and that's a correction of what she wrote. i think there is no need to vote on an amendment or revision. >> all right, we need a motion to approve the minutes. >> so moved. >> is there a second. >> second. >> there any public comment on this item? is there any public comment in the room in the on this item. there is none. and two people that received permission on public comment, this is your chance. >> all in favor say aye. >> aye. >> perfect, thank you so much. the next agenda is general public comment and secretarying has a statement to read. >> at this time membersed of the public may address the commission on items within the jurisdiction of the commission but not on the meeting agenda.

individuals may not return more than one to read statements to attend the meeting. written public comment the word health. commission.dph. if you wish to spell your name for the minutes you may do during robo comments. city policies along local law permit misconduct against employees and will not be tolerated. >> thank you, so i have one request from chris ward klein, general public comment, please come forward. >> as you know i've got a timer, perfect. >> thank you, health commission, director colfax for

allowing me to speak. i want today thank everybody for giving me a platform to speak but also to get the stakeholders and the community the confidence to speak up as well. and we are make ing a lot of communication. the drones in new york are related to. we're going into a period that we have not seen since 1979, welfare change and we went into a different direction with our healthcare. there is a lot going on, there is a new administration coming in and a lot of people are worried. i would suggest that we focus on our circle in front of us and we'll be fine, we'll be okay. there is been great improvement with the overdoses, we're finding out the information system. information system was being used by causing the stress

levels and everybody didn't understand what the base level was for a person. so you're giving people person but they're up here and they stay up here. sol that was driving the overdoses, some of you spoke up and i know that, spoke up to the right people so thank you, especially thank you to director colfax he took some of the brunt from my angriness, for that, i apologize, but i don't apologize for my message because it was needed. we've got the right stakeholders, again you will not be seeing much more i'm going to focus on my non violence and i'll go from there. thank you everybody. >> thank you. dr. palmer is here with us, thank you for being here. >> nice to see you and thank you for your work here and your patience. i would like about laguna

honda, i would like to see restated commitment and on going commitment to getting those 120 beds. so we can get patients into those beds and i would like transparent information in as many meetings as possible about any barriers to doing that. in our days of penny pinching, i'm afraid that those beds will be compromised and we need to get them back. sorry. and i, yeah, i really would like to transparency about what is going on with the regulatory agencies at laguna honda. okay, thanks a lot.

>> thank you, and for general public comment, i hope i don't say your name wrong, it looks like benson net nsu. >> mr. nadel. >> i apologize. >> that's okay, i have a typed copy and you have the handwritten. >> a couple of different items on the agenda. >> so this is general public comment. >> this item, this particular item is for topic. >> okay, for agenda items and then comments after each. my apologize. --apologies. >> no worries, is there anyone else in the room? and what about remote for general public comment? >> yes, we have one hand. >> hi, you're unmuted please let us know you're there. >> hi this is patrick.

>> please begin, you have three minutes. >> i am speaking on a toing not on any other right on today's meeting agenda. mr. worwick don't cut me off. as commissioners know, cdph has a required administrator in training curriculum. on july 15th, 2023, i placed a cph record request and received a response on october 4, 2023. six months later i placed a follow-up request and received a response april 5th, 2024. both times, they found no records ever having involved in the program, required as a in national exams to become a licensed norm administrator. i placed another follow-up record request for december 15th, 2024, they have not obtained the license between 12 months of her june 23 higher.

mhs posting for assistant home add or was a required minimum qualification where candidates had to pass exams for nhl. we should be term natured as you know qualified. after all, in order to regain zen sure, and coincidence may have lead into believing recruiting candidates for openings was a signal to cms/dph and leadership were sincere about hiring knowledgeable experience and appropriately and cms regulations. with this just debate and pull the wool over cms's wise it was to be abandoned ar recertification.

as a matter of fairness and equity between february and june 2023, believing the minimum qualifications for apply to everybody, to posses the nhs license. des ignee to now creatively mote fie the assistant moan home administrator to not obtain nh a license within 12 months of hire. bar this in mind when you consider passing agenda item number 7 today. thank you. >> that's the last remote public comment. >> then we'll go to the next agenda which is the employee recognition awards. we have the privilege of

celebrating some exceptional teams that have made such progress at laguna honda this year and before, and each commissioner will have the opportunity to discuss a little bit about each view to we'll start with the therapy team and this will be commissioner kho*u. >> thank you, it's my pleasure to recognize on behalf of the commission the work of the activity therapy department. this department provides various programming to promote enriched quality of life. the families changed significantly during covid-19 and much of the hospital programming was stopped as residents were not able to gather in social groups. this past year, the programming has expanded and includes socially enriching experiences such as mini concerts, outside

of the art studio, parade for pride and juneteenth celebrations. as a festival and outing off site. they continue to offer creative and innovative programming utilizing a wide range of activities to help residents maintain quality of life in the physician con cognitive. our residents physical social and relational well being continues to be supported. our congratulations to the activities therapy department and their work. thank you. >> give them all a round of applause. [applause] >> wonderful, the next team is rehabilitation services and

commissioner guillermo. >> thank you, president green. again, also very happy to be able to acknowledge this team this year. the team is comprised of physical and speech therapist who epitomize selfless behavior and underscore the true meaning of service. this group understand that a job well done includes the tangible and intangible elements of what matters most. because the needs of each residents is unique, they collaborate with colleagues for improved send off and care are completed to further enhance functional mobility of life. the health workers have been instrumental in supporting and have done a fabulous job in

patients scheduling fellower both operations. thteam with wheelchair needs while maining 100 percent compliance for our department along with prompt submission and follow-up work order. this group has been extremely supportive of the ex time team and dedication to improving laguna honda department and its commitment to equitable public health. >> give this team a round of applause. >> thank you and now commissioner salgado will honor the services group. >> thank you, madam president, president green. it is our honor to give this award to the environment al service at laguna honda, made of team utilities workers and porterrs, the evs team works

together to ensure that laguna honda is a clean and safe and home life for our residents. the evs team played integral part in the recertification process helping to achieve various mild stones and survey results. they are also an integral part of our on going response ensuring that we met cdph guidelines and in turn keeping transition base low. the team has adapted to many changes create a new process and become a core member of the inter disciplinary team at laguna hand a. they have become a central part of the infection control committee, the team members also interact with the residents with their daily work. they're truly behind the scene staff who help things happen. and we're grateful to have them

at an integral part of laguna honda team. >> thank you. and the next recognition is commissioner christian on the quality management grao* group. >> thank you, president green. it's my privilege to read the award for the quality team in laguna honda. it's made up of risk management regulatory affairs, performance improvement data analytic and patient safety. these teams facilitate the program to continuously prepare for federal and state surveys. so that we continue to be data driven and make informed improvement decisions, to facilitating the annual review of hundreds of hospital policies to meeting regulatory compliance, to reviewing safety

events. the team works closely with all debt in particular with nursing pharmacy food and nutrition services and executive leadership. the regular tore affairs teams has investigated 1159 complaints from present. supported route cause analysis. the improve team supports each quality assurance and performance improvement special and readily available for all. the quality management readiness incredibly important.

audits and recommendation [applause]. >> thank you. and now commissioner girando will recognize journey. >> in 2023 laguna hand a became the restraint free fashionity, such as bedside rails, seat belt and bed alarms, a team helped a facilitate working closely with staff resident sxz families. to reduce restraint use and maintain a restraint free environment. this is no small feat as overtime, they have become reliant on certain restraints to feel safe and they required a great deal of collaboration

and trailing alternative. the laguna hand a restraint free journey involved many people together. they helped laguna reduce restraints by over 660 percent over the past year and transition more residents to alternative. the retrain free work is so important because it's so focused on resident safety and dignity and regulatory compliance. we thank our laguna staff members for leaving this important work as well as our residents and their loved one who work together with us to find alternatives. thank you. >> graduations. >>--congratulations. >> and i have the privilege to honor the nursing department in particular the wound care champions and we've seen amazing progress in this area. so this is dedicated team that has created a robust waound

care program thanks to their dedication, we're seeing results in both preventing as well as bet we are identification and stage of wounds and clearly it has a huge impact on the quality of life for our residents. so over the past three years, this inter discipline disciplinary team this has included establishing performance improvement subcommittee putting into places new policies and procedures as well as epic optimization so that documentation is clarified and in compliance. we've also included training in the pleasure injuries and other top ixz to support wound care and skin integrity. weekly head to toe skin assessments. in addition, we have new state-of-the-art and devices to promote and optimize a healing environment.

the wound care champions are critical in bringing wound care best practices to the frontline. wound champions use their expertise to support their colleagues to deliver great care. heal and prevent wounds. thank you so much. and i know director would like to say something. >> as we reach 192024, i'm so grateful for the work of these teams. as the as the commissioner's read these accomplished, i heard so many key components of laguna honda's journey first to recertification for medicaid

and for medicare, and that journey is continuing as we continue to change as we continue to be forward to be the skilled newsinger facility and rehabilitation center of the future. and i just, i'm so appreciative if you go to laguna hand a and visit the teams, the change is very evidence. the change is very evident in terms of being focused and resident center and innovative. i want recertify to continued improvement and ensuring the laguna honda is the best it can be for the residents their families and the staff. thank you. >> thank you, there any public comment on the awards?

dr. palmer? >> yeah, i just wanted say that worked at laguna hand a for 15 years and when i went into the private sector, i assume that things were done in the private sector, the way that they were done at lag no hand a that i would have an inter disciplinary team na was highly functional that cared about the patients and unfortunately, it was not quite like that. and i'm so glad that you're continuing to push for it to be the best that it can be. and that we're in this mode of reinvention and it's the bottom of the safety net in san francisco and it's one of the things that makes things beautiful in san francisco that we have this. and and i hope the new mayor and the new board of supervisors really understand

how important it is and i will personally do my best to educate them if there is any doubt. so thanks a lot. >> thank you so much, is there any public comment in the room? and what about remote public comment? >> i see a hand, i will unmute, your hand is up. >> sorry. >> no problem at all. and just to finish off, those listen from laguna hand a, i've given certificates that will be distributed to the teams. that's how we distributed. >> i think we would love to echo director's colfax's comment as he so eloquently made them and how much we appreciate and honor all the work you've done.

i guess we go to the next item hon a fiscal report and administrator and ceo and he's going to begin with our report. >> and kenya tomas is running the slides remotely. >> thank you, for recognizing all the laguna honda staff and all the different teams and thairt reason we are here today presenting this annual police report to you. i serve as nursing home administrator and ceo for laguna hand a, i'm joined with jennifer the jennifer and she is assistant. it has been a great honor to serve the residents and families for this past fiscal

year. and i'm grateful for the continued flexibility during the time of change and for continuing to interest us with our care. it's also been a pleasure to serve a language the staff of laguna hand a. they're the true result their dedication. i'm proud and honored to be part of this team and all that we've achieved together this past year including the resiter fickation. next slide. we're one of the largest nursing facility in california and in the country and one of the oldest.

we represent commitment by any county for, and adults with disable. i really believe that laguna honda reflects the best of san francisco and excellent services for those who need the most. next slide. as i talk about the mission and vision and values for me, i think we really need to ground ourselves in the why we're here. so mean the mission for laguna hand a is to provide a welcoming therapeutic and healing environment that promotes the individuals well health and well being. our vision is to build healthier lifes as a laeter and post acute care. as we carry out the vision and

mission, with compassion, professionalism and competency and team work and integrity and collaboration. in the post landscape, we gain focus on the vision being the best in the field and to me, i think recognizing what the vision, mission and values are really recognizing why we're here is what guides us to continue with the best of who we are and where we want to be. and now i'll go to jen for the next slides. >> next slide, please. so we're nothing without our residents at laguna hand a. and the reason that we show up everyday and the reason why we are the number one nursing

nation in the nation. next slide. we are raishly and ethnickly diverse with two-thirds identifying as people or what i like to say bodies of color, humans of klar. --color. we lingwish many languages which include our spanish and chinese language units and we serve residents at different ages of life from early 20s up to the sent centenarianses.

this is a lot of numbers but it demonstrate the year and what we've done. we've served 510 people and that's over, has a lot of resident days, right? we've successfully transitioned 23 residents to the community who no longer require skilled nursing scare. our goal is to help resident as chief their high level as independentes. we care for residents with a wide range of diagnosis many of them in the neurological realm and also dementia nuero cognitive the majority of where we serve. is would now like to highlight a number of residents, next slide. first slide is formerly known

as emma but some of us get to call her mama. mama emma, she was born in new orleans and turned 100 this year. one of our centenarians, first lived in sil vaer and then bay view where she raised her family. on her birthday she was surrounded by dozens family members, four generations of her family and then a couple months later, the mayor came and was able to give her a certificate. it was a really nice day. next slide. roy is an incredible artist. when you walk in the hallway, you can see some of his unique vibrant colorful creations.

he was inspired by watching jacque haoufto, and he's got amazing jewelry and he made it and really really happy to show you all of his work and what his inspirations are. roy was born in houston and came to san francisco during his maou trising. he played with archie bell. we are grateful to have them--now we'll take a moment to share highlights from our true quality and safety and financial stewardship and equity. together they support our mission and vision of residents

centered care. first, let me introduce terry director of nursing. who will be joining us online. >> good morning, please get a lot closer to the microphone, terry, i'm sorry. >> sure. >> it's like a whisper, thank you yell and see how it goes. >> thank you hear me now.

i'm talking louder. >> commissioner green, can you--okay, yes go ahead. >> okay, actually we're getting a headset and hopefully that will be better because it has a mic attached. sorry about that. >> it's okay. is that better? >> much bert. that sounds great. >> okay, sorry about that. good evening. okay, next slide, please. the quality metrics focuses on improving the health of the people we serve and producing positive health outcomes through resident centered care. we continue to focus on pleasure resolve with major injuries. we issued a stand up meeting with reporting with the key

topics including file and pleasure injuries and ensuring the propofol up. we decreases a number of residents with pleasure injury by 31 percent. and also achieved the 100 percent compliance and our fall rate remains below the national average at 3.5 percent. finally increasing the accuracy of pleasure injury staging, identifying wounds more quickly to stop progression and prevention of pressure injuries as well. reducing injury and falls remains our main injury. let me introduce to neal director of pharmacy. >> good evening, i'm director of pharmacy at laguna honda

hospital. this year laguna honda has made team investments in improving safety and collaboration of safety of life. we hired our first medication officer, this role is engaged in all safety efforts including coordinating the investigation of medication related error and improving changes to address them. we're proud to average a 3.8 percent medication error rate. we took on many important projects this year. we installed new state-of-the-art medication and we also begun construction on a new room and hazardous meant raol. let me introduce chief experience officer. >> hi good afternoon. so next slide, please.

the care experience metric focuses on provieeding the best experience for everyone who comes through our doors including resident, family members, staff and the broader community. this past fiscal year, restrengthened the program with a dedicated staff to support the program. we expanded our response team which collaborate with nurse anding psychiatry to foster a care activity. the behavior response team, supports the case load of about 150 residents and i want to share today that today i had the pleasure of seeing them in action as they worked closely to provide capacity building and concrete tools in the moment for learning how to do better deescalation and person informed care. and it was pretty impressive to see the care that they're providing not just our

residents but our staff. we resident council which is now a hybrid in-person and zoom. this is allowing more of our residents to attend whether they want to join remotely. we also resume conducting surveys with their resident sxz families and the residents shared experiencing improvement in all of the areas that we surveyed including quite significant improvement and courtesy respect and timely call-in response. and lastly, just outside of the fiscal year, i began a new role as chief experience officer. very excited for the growth that we continue to do in this area. next slide, please. thanks to hr, we have reduced our staff vacancy rates from

11.4 percent to 5.4 percent with laguna honda now. has used new hiring processes that redudes our declassification to 67 days. which is a huge improvement and we have 582 employ others which participated the strengths that were identified by our staff including supervisor of communication and ratio equity and fair and feelings of a lack of pride in the job, staffing khalenssing and opportunities for professional growth. and i think it's important to just name the back to back experience of the years of covid and all the changes that we had to make to address it as well recertification has been challenging. so it's been important for us to work hard and make sure that

we're listening to what they share with us so we can address these impacts and ensure that staff have opportunities and support. in partnership with hr, we look forward to focus to create a strong culture and belonging and mutual respect. and now i'm going to turn it over to lilly who is our chief financial officer. >> good afternoon, xhaoef financial officer, good to see everyone. so the stewardship metric, this focus on stewardship of resources. we focus this year on measuring our spending rate of growth and having not exceed of the growth of the general fund and we're able to achieve this goal in fiscal 24.

other accomplishments decreasing from prior year and general management including 6 months of resolution of resolving funding gaps and doing transparent for all of our stakeholders. next slide, please. the next two slides we always include the report. i'll start with revenue, our total operating revenue is down year after year because of the lower zen seses during the recertification. on the expenditure side, total decrease year over year, due to a reduction in register cost. the general fund was increased to coster revenue.

sxl salary and fringe slight in reduction in our vacancies. this gives an overview. which continue to rely on medi-cal and we don't see much and flat year over year and shift to the mix due to a decrease in overall patient visits. although census has decreased that mix has remained highly consistent and we expect to see the same in fiscal 25. and now i turn it over. thank you. >> good afternoon, commissioners, chief quality officer, thank you for your

time today and it's an honor to share with you some highlights from our fiscal year. and what a fiscal year it has been for laguna honda, we retrieved recertification major mild stone. more than 95 percent of our residents as you may know rely on medicaid for their care. this was a as a result of a lot of hard work as you know and several regular russ surveys. and not to mention, we also submitted the application for medi care shortly there after. next slide. in april of 2024, the san francisco department of public health and our partners at the city attorney's office wouldn't

award, i was honored to be recognized with tory williams from laguna honda and city attorney's office. and while this is a leadership award, it truly is a pure reflection of the tireless work that they have done at laguna honda. and finally in june of 2024, the moment we've all been working since april of 2022, medicare recertification and full certification in the cms program, this provieed ufp relief and joy and of course the larger community because they would know laguna honda could be here to stay. it was as a result of improvement work, and dozens

and dozens of milestones as you all know. next slide, please. so it's to celebrate the fiscal year including the resident and staff celebration. next slide. and with that, i'll pass it back to jennifer. >> thanks, naz. >> so of course a effort, we would not have done it without every single one of us up there. next slide. for more than two years, laguna hand a staff, put forth a here i can and historic effort--historic effort. while we don't have the time to highlight aep team take a look at your screen and just to

acknowledge the many many teams that have contributed to where we are today and we continue to thank them. thank to everyone at laguna honda for distributing to everything that we've done this past year. next slide, please. this was at our recertification celebration, it was a really nice event, next slide. our volunteers, we have 111 active volunteers for many many years, they've been at laguna honda before you may have passed one of these folks in the hallway. they're part of our contribution and contribute a lot to our community especially our residents.

>> thank you, jennifer. i just want to acknowledge again all the hard work that laguna hand a team has put in. this is just a snap shot that of all the work that has been put into all of these achievements. and i'm extremely honored to be part of this exceptional team. so 2023, 24 was a momentum year. we a received not only full recertification, we also prepared and resumed administration. --admission, we began to implement that we maintain and maintain all the improvements that we have implemented in the last year and a half. and we continue to be better and become a class facility.

so as we come to an end of this year and look forward with optimism and excitement, we'll continue to build on the improve work. we'll continue to work our staff and continue to grow resident and community and provide excellent care. we'll continue to work toward our goal of being the world class 5-star facility. so on behalf of the laguna honda team, i want to thank our dedicated staff for all of their hard work as i've said, this is just a fraction of their work and as it's reflected on the annual report. truly thank you and from the bottom of my heart, happy holidays. and i want to thank san

francisco health network, who has been a great time as i spent my 18 months in the laguna honda. and finally, we thank our health commission, and health commission under dedicated members under laguna honda b.c. c and president green, thank you, your dedication to san francisco health network as well. truly appreciate all of you. >> thank you and thank you for acknowledging the members of the department who are here, we appreciate all they've done. but it's been our privileged to stand witness for what you said is in deed a tier i can effort

and to see the dedication and commitment and really dill against of everyone at laguna. all corrective action plans and all the efforts that were made, you're still obviously doing this, you get these reports and the commitment to sustainability of all the accomplishments that you've also made, is really exemplary. and we'll be the top stilled nursing facility and you're headed to be leaders in the field so we're very appreciative. is there any public comment on the annual report, there is a lot of granulearity. is this available online? >> everything is available online.

>> yes, and everything that wants to hear more can read this, it's well done and beautiful document. is there any remote public comment on the report. >> there is one hand? did you raise and lower your hand? >> i did, i lowered it. >> great. no remote public comment. >> is there any commissioner comments or questions on the report. commissioner guillermo. >> i just wanted associate myself on president green's comments and congratulations on the completion of some very difficult objectives and goals. that has well position approximated us for achieving that vision for being the

highest quality nursing facility post acute care all the definition that's we want to name for laguna honda hospital in the country and as an example. are for what others can achieve, not just in terms of what is necessary to achieve regulatory compliance but as both of you and others that have presented, really, the care of residents that find themselves at laguna honda now and hope to you know, if needed, find themselves at laguna honda for the best of care representing what is possible to protect and sf respect the dignity of all those that need it. i wanted to congratulate you on

that but we know that achieving recertification, going through corid all the things that have happened over the last five years, with new leadership and then the new processes and innovation, the test are still yet to come. but, i have full confidence that those tests r&b met and exceeded with again, the commitment that you all have shown and have proven to us and the public that commitment. so thank you very much and at thank you very much, i look forward to hearing more in the years to come. >> thank you president green. and i certainly associate myself with the, the accolades

that both the president vice president of the commission have. have given in regards to the work over the past year. it seems to me that our report does not really capture the amount of work that you all did. this is not just that there were 1,000 points to be resolved, but that it took i think scores of people to actually respond to each of these. and if you know how surveys go and how surveyers look at things and you're looking at the individual and subjective understanding of what, you have written or have done to do.

to get medical recertification and then a cms recertification as we all live through that period of time as part of your during conference committee and i guess i didn't realize we must have read hundreds of the policies and work through with you to work smith them through, we recognize that there was an enormous amount of work that these pages don't really express. and i want to, you know, for years, and before i came on to this commission, so you understand how long ago, that was. laguna has moved light years ahead. it does not reflect on our report, because it reads like hey, this is something that we

do, but it isn't, it comes a long way. and only part of the what the challenges have been in order to to have, and to continue the sfshses that we offer at laguna. so while i recognize that it's a nice annual report i'm sorry it's so hard that we cannot reflect all the work that your teams have done and entire network and dr. colfax central office and all have really put in in order over the last two years to have accomplished this and to put us on a path to a better, a greater, and to move

it forward, we look forward to the coming year where we'll see more metrics because now we don't have to deal with the thousands, you know, corrective action things but we can now, also get on to the work of really moving as dr. colfax said to be the best in the nation. so thank you. >> thank you. >> thank you. all right, seeing no other, sorry, commissioner christian. >> thank you, i just want to say thank you so much for the tremendous amount of work that you have done over the last couple of years. it is, i think unless a person somehow witnessed to to some degree, it's unphantomable

where you brought the institution today. and as a san franciscan, i thank you, because i've learned how much this institution means to people here how important how critical it is and, with your work, we've saved it and with your work we will preserve it and continue to enhance it. so i want to say thank you as a member of the commission and also a san franciscan, and i appreciate everything that you came together and everything that you're going to do going forward, thank you so much. i think there are two bookings with the neighborhood that sum it up. one is when you go to laguna

now and every neighborhood in the, in the nursing station back room, there is a key metrics board that everybody looks at reshifts and every shift they go through that port. and also place for staff to put suggestions on how to improve. that's the accountability the metrics and the other thing is, when you walk into laguna honda, it may seem like a small thing but to have table cloth and centerpieces where people are eating and dining, the focus on patients, it's a focus on home liken vierment. i want today share that and thank the team on importantly the resident experience, thanks.

thank you so much for all you've done and doing the best medical area and the humanity you demonstrate ready. i'm sure that there were moment that's everybody felt so demoralized yet the spirit was to positive and committed. i want today mention that, we're impressed by all the aspects for what you do. thank you so much. >> can we give them a round of applause. [applause] >> i fwes we'll go to the next agenda item. and our cmo is going to present this item. >> hi good aong. i'm pleased to present on behalf of our entire teams,

good afternoon, commissioners, my name is albert lamb i serve as the medical doctor and i'm looking forward to providing a brief update on how our admissions are going to laguna honda, on behalf of a large team. next slide. so we're thrilled that we're able to resume new admission earlier this year. it's been a two nf year pause. and first resumed admissions on july 211, we anticipate an exciting mild stone. 50 new admissions to date and this is made possible through the hard work of many staff, many local advocate and you health commission, we have so

pleased with all of this equipment that we received. and we are also so pleased to be able to not oj admit formal residents and we were able to contact all the former resident sxz none of them chose to return to laguna honda. next slide. with the priority one as being former lag no laguna honda. the five groups that we have which is part of the policy. this had been previously presented and let me, i'm going to go to the next slide, if there are any questions i'll be happy to answer again later. as we resume, new admissions, i

just want to state that we're open for skilled nursing and rehabilitation. there is currently no wait list for laguna honda and we're reviewing and accepting application we receive them. so we're committed to meeting admission criteria and it's critical that we provide the best care to every resident so. for that action, we remain in regulatory compliance. we're working to ensure that the community know that we are open for admission, we continue to hold community town halls to get the word out. and we understand that, our admission criteria and process, we continue to educate our community on. we're also working to ensure that we provide excellent care. we would like lag no honda to be the top choice for san

franciscans. next slide, this slide shows an index view of admissions with data broken down by priority group. as you can see, san francisco zuckerberg general. we have admitted ten more residents of december 12th that is currently 8 in process down from 10 and we've denied 27 applications. the applications that have been denied and i know there was request for information on this as well. were for one of three reasons, first, sometimes there is not there is no sniff level of care identified. the second, sometimes the behavior health needs cannot be met at laguna honda.

and the third reason, sometimes the complexity means that this person is not appropriate for laguna honda either. this is sometimes that still requires acute care management. and we anticipate the rate of applications are going to continue to deny, and as we clearly communicate our admissions criteria. next slide. this slide shows our average monthly census, which continues to increase month after month and we look forward to welcoming more and continue to grow our census in 2025. we know after a pause it's going to take time to community. we're also working tirelessly to increase the referrals and

ensure the best care for laguna residents. thank you for your time. >> ye, i believe we have public comment in this room. >> yes. i've got three minutes when the timer goes off, know your time is up. >> i want to congratulate for laguna for pulling out of the trenches and for a good annual report. my comments are about the policy. i'm asking if there is possible to add demographic presentation. how many individuals were admitted for long term care? how many for rehab? secondly, can we stratify to

admit elderly throughout the city and i also, wonder whether two additional components in admission screening can be introduced. the hole of medi-cal plans and secondly, to talk about the tool that utilization review is use to go screen residents for admission or not admission. i think it's part of the discussion around who gets admitted into the future. thank you. >> thank you and dr. palmer. >> yeah, i'm woe worried about people who are in the community and suffering that need a bed at laguna honda and that there is not enough information and out reach. and there is a number, i actually went through the experience of applying to

laguna honda for my father in 2017 and i was shocked by the amount of paperwork that i got no help with. luckily i knew what to do, but, and also, that i was met with kind of a grudging ing attitude because she needed long term care she did not need rehab and i was reminded, we don't have that much care beds. but if you're a san franciscan and you know long term care and qualify for it, you should be admitted. you've got 120 beds to fill. and there is a number, if there was a no wrong doer approach to ally to laguna honda, which is used as a concept in other ways and there is a number of places

where, you know, phone numbers and counseling about getting into lag no honda, could be publicized each member sends out a weekly or monthly letter of with resources. laguna honda should be in there and what the criteria are. services are they being regularly documented. elderly disabled people know other disabled and elderly people. and there may be you can get a volunteers to do this but you need to create the material and the references and the counseling and, i mean, we want those to be utilized and we want the people that need to get into them. and i would like to hear more

about that. i also need, i would like to see the admissions broken down and for the admission to be not so agonizing slow, i would like to see more. and fast per, there is people that need them. you don't want them dying of infected beds at home. and this is what happens, it's a regular thing where somebody will go to a regular room and infected and send them home and the whole thing continues. this is very common and we want everybody to know that, a person like this, this is a, you know, there is beds open at lag no honda. >> time is up. >> thanks a lot. >> is there any public comment on the room on admissions policy? and how about remote public comment?

>> i have one hand up. mr. nesha, you've got two minutes. >> thank you. it used awe deaccept tip y access of just five with each increment. creating a misleading illusion after daily appeared as double between july and november. i recreated this slide using a more interval of 50 on the y access. it's an increase of just 12 patients more on a daily average. stop lying with statistics. similarly, flight number 5 is deceptive hides the die nominater. the november 12, 2024 report

showed 28 admissions showing by 24 discharges. today's report claiming 28 admissions. also, supplies data contains two math errors. don't add up correctly. nag number 5 lose the reported pole ghost. the number 12, covered 93 days, 3 months, 1 day, july 31, to october 31, 2024. today's report skipped the reporting period, covering 123 days four months and 20 days. to december 12, 2024. the admissions represent just 42.6 percent of the 100 referrals since admission. by contract the 27 referral that's were denied by patient

not totals 46, 42.2 percent of the referrals l.a. h received. reports that of the 5 admission priority levels, only 58.3 percent have come from priority number 3 and other affiliated facilities with just 7, 14.5 percent. and 13, 56.5 percent of the 23 referrals were either denied or closed. this places other nhn facilities if part when they may or may not become to become medi-cal eligible. this reduce the application denies and quotes. finally this commission if the 120 waiver request now.

thank you. >> i believe that's the only hand. let me just go back. that ising the only hand. all right, commissioner questions and comments on the admissions policy? all right i see you nodding during the public comment about trying to reach out to local hospitals as well as the community to let them know that laguna honda is very much available and we look forward to hearing more about that and the efforts being made in subsequent meetings at our jcc, we would also be interested to know the timeline for the waiver submission and i gather that maybe discussed at the jc cin january. i'm not sure if you had any comments about the two topics,

specialty effort to find of make more comment the the availability of laguna honda. >> thank you, happy to identify that the team has identified this as a critical need. this is on going work. just putting out an announcement is not going to do it to be able to have people choose us as their top choice for a nursing facility. we are taking steps to publicize and make note of the great team that we have here and to be able to connect in the many ways. >> thank you so much. commissioner chow. >> thank you very much, i was

reminded and it would take some sense to really look again in the break down in terms of what is being requested on the acute rehab? and what our initiatives are. this has been an issue that goes back to the blue ribbon committee, 30 plus years ago. and i, i recognize the the environment and how the health plans work. we've spoken about trying to see if the acute rehab unit could become parts of the network of other health plans in terms of broadening this. approach for plans, since we have a very fine rehab unit.

this also requires not just sending to hospitals but working with the other health plans to see if we can be part of the acute rehab network. so just looking at areas where we can serve the city. and it may be useful how the unit is our out reach is going in terms of just looking at the ated mission by priority and from i understand, we need to also work with the health plans. it's just a work in progress but i think an additional area in which we could then have more out reach and also then,

fulfill our desire to be a trusted place for rehab for experiences for example. okay, thank you. >> okay. income the next item on the agenda is governing bylaw. last meeting, we asked for modification sxz you have they them before you. the propoeds revision right side highlighted in yellow. so, at this moment, i think it would be helpful. >> i think we have an introduction. >> oh sorry, go ahead, please. and then i'll talk about procedure. >> good evening, once again i'm ceo and nursing home administrative in lag no honda,

an action for item today, you have otherwise laguna honda before you. so based on the comments and discussions from the last health commission meeting on the third, we would ask to update the bylaw based on the feedback that was provided by the commissioners and yourself and as well as the public as well. so we updated by law as requested bit deadline of december 6th and we also made additional revisions based on the comments of the individuals. so we followed the process in sharing, the vision we have followed the process sharing grounds timely and clearly review and we're asking that you review and approve these

bylaws. we're happy to answer any question you may have. >> and we want to thank your team for responding so rapidly. thanks to all. so now all of them have these documents before them and i believe we need to entertain a motion to approve. >> i so moved to approve the bylaws. >> i second is there and any public comment on this item. i believe we have some in the room. if i'm reading the numbers right. dr. palmer. >> please wait until you get up there. >> that you listen to all of us. one of the things and this is for the future, one thing that

honda is sub servient is one of the way that you got in trouble. they don't understand how nursing homes work, it was a trial by fire. i think you and have to figure out where it went wrong before you figure out how to fix it. it just makes me nervous that you cannot go straight to dr. colfax, you can't go straight to the top. laguna hand a is equal is a separate facility from san francisco general, it's equal it's a totally different mission. and so, i mean i'm not, i don't really know how to fix it but, we, we need to make sure that there is a deep understanding

by the administration of how different a nursing home is, than in an acute hospital in the future and bylaw and the laws of command should reflect that. so there is huge economic incentive to use to balance the budget of other entities and at laguna honda has s own mission that has to be respected. thank you. and mr. nadel. >> benjamin nadel. i would like to, say thanks to the revision of the bylaw from a couple of years ago to include long term care. the experience and other

nursing homes is there is a separate track of emissions. they discourage flipping over to medi-cal because it does not accept the rate of reimbursement. there are individuals that 20 years, they would be admitted as long term care. and that terminology is no longer used. so i'm concerned about the inclusive of acute care. i know what it means in the vir knack lar vernacular. and if you go to the dwi, building healthier lives at the leader and post acute care.

am i making any sense? and all the small board all the facilities and what we're finding is in smaller particularly behavior health clients their level of care, how do they get admitted to a place like laguna hand a? --honda, that is a big way. they just can't meet the increasing medical needs of those individuals. are they admitted if they have rehab potential or admitted because of increased core morbidity. how about remote public comment? >> we have one hand.

mr.menshaw would you like to comment on this? >> yes. today's bylaw remain trouble some. states lhs should report to the san francisco ceo. this is a major mistake. it may well have contributed torres i go nation--resignation. previously, lhs and ceo reported for decades to the directer of private health. to report which was not initially informed to oversee.

second, article 7, in a healthcare setting and posses an in home administrator license. this is sharable this is caca nonsense, does not appear to be qualified to hold the position. his linkedin profile, first job at nhs after completing administrator in training program, lasted just ten months. [indiscernible] first 8 months should be dis qualifying towards lhs reducing him to under 7 years nursing

home experience. this commission should remove today's bylaw to allow you to qualify ceo's position. what is next? removing the qualification and requirement that lahs administer license and director of public health to modify minimum job qualification without this health commission, don't become lah by relaxing. remove this cacachange today before adopting bylaws changes. after all, altering the job qualifications for l.a. year may affect patients and they

may hang in the ballots. thank you. >> that's the only public comment on this item. >> all right, commissioners questions and comments. commissioner guillermo. >> yes, i want to appreciate the swift action on the concerns and questions that were raised at the last meeting and the changes in response to those comments that were made so that they can be done in a timely way for this meeting. thank you. i'll wait until commissioner chow has any comments. did you have any comments on the bylaw. >> on the bylaw, i believe they

captured, at the meeting, but it incorporated my issues. so i'm pleased to support the by laws as written. >> thank you, president green. i would like to make a motion to add several amendments. i believe they are in front of the commissioners. so first add the word all, a.l.l.where as all these bylaw apply to its entire facility including acute and newssering beds as well as, the addition proposed word all other services provided by the facilities. the next paragraph word as the

word off to appoint appoint and where appropriate removed members of the medical staff consistent with the medical staff bylaw including appointment and rea appointment of one or more dentists, pediatrist and/or clinical psychologist to the medical staff respectively, dental and pediatric and/or other and/or clinical services are provided. the next proposed amendment is on page 8, regarding the director of health. add the word below, to the following sentence, ensuring the existence of systemic and

affective mechanism for goshing body. hospital admission and medical staff and governing bodies and management of any healthcare organizations in parenthesis that are related to the hospital term is defined below, that is proposed amendment. hospital term is defined by low by these bylaw. in medical staff through meetings of governing body, joint conference committee and hospital administration. page 16 article 10, conflict of interest, adding the following clause. any person who is, subject of or has an ownership or financial interest in the subject of a governmental division being made by the member where as a result of the relationship the ability to act for the benefit of the public

could reasonably be added. i'll now add the clause. members should obtain from voting on any matter as defined by applicable state and local law. in itn,where a member as a personal or professional or business relationship with any person who is the subject of or has an ownership or financial interest in the trf governmental decision being made by the member where as the as a result of relationship the abilitying of the member to act for the benefit of the public could be questioned. the member shall disclose the relation publicly prior to acting on the matter. and that concludes my proposed amendment.

>> proposed amendment from commissioner christian before you. is there a second to the motion? >> i second the motion. >> and then, is there any commissioner discussion on the proposed amendment to the bylaws? >> i will just say that i suggested these proposed amendments in order to try to make it a little more clear to somebody who is a lay person with respect to the medical profession like myself so it's as clear as possible and there are a lot of things that are not common in our common have venacular. but that's the focus of my recommendation. and we appreciate you being a

attorney the extra eye. so i'm going to give this a try. i'm going to take a all in favor of adding the proposed. >> madam president, i would i would suggest some of these are easy understand, and several in my mind are not as easy to understand. and i'm reading the comments that have come from staff also, which might lend to some further discussion and i guess i would actually move that we separate the question and vote on each of the amendments separately. are you looking at the first page where there is blue highlighted showing the amendment, not the questions

that commissioner christian asked but the actual amendment that she just proposed. >> i'm looking at the first page and the second page. >> okay. thank you. so i would like to separate and divide the question so we can discuss, i guess it's the fourth actually separately the fourth amendment. you know, personally i don't have an issue with first three. so we can extract, i would move that we would then divide the question and extract item number 4, page 6. >> could you make your comments commissioners so it's clear what your issue is and that would help you vote on this? >> my issue is i would like to discuss the fourth amendment a little further.

>> i believe procedure alley, you're all allowed to discuss all the amendments. >> yes, you can discuss all the amendment and we can accept them all but as a moabsinger the motion has four amendments you can separate out and remove like in a consent calendar and remove one amendment for further discussion to better understand it. in my mind the first three are not an issue but the fourth i would like bert explanation. you have the right to discuss all thed amendments, she made one. >> what i was suggesting is that we separate so we can vote on those that i think are con controversial so we can discuss the fourth. >> all right. i'm p sure how to separate out, do you have to separate it?

>> right now there is a motion and a second to help these. >> i will make a motion on top of the motion which is sektd airy motion to divide the motion and to make simple and remove it number the fourth amendment labeled for page 16 conflict of interest. >> all right, i need to get city attorney, sorry commissioners, anne are you on just procedure alley? i'm not sure how to follow this? can you all help? >> [indiscernible]

and then, the last amendment, and then approve the if those were amendments were added to third motion for the final one. >> so under the current first and second, first and second the first three, and then amendment right side covered. so there now needs to be a new motion and second to discuss the fourth? >> all right so making sure that procedure alley that we remove the fourth clause as a second thing to discuss. >> i'll second that. >> so you can all now discuss the fourth. >> well we should vote on 3 and then discuss the fourth. so we can get that off the table and really then, i just want an explanation of the fourth better and just focus on discussion of that.

so all you do is vote on the first three. >> all those in favor. >> aye. >> aye. >> so now you can discuss the fourth. >> okay, so in the fourth, i would like to commissioner christian to give better explanation just trying to understand because as i read it, it may be a little ambiguous that if there is any relationship that should be disclosed. what i'm not sure is what we're trying to address, the initial statements seem to be within the range of what the city has.

or helped clarify for us something that might be missing in the official definition that was already in the original bylaws. >> thank you. >> or in this bylaw. >> thank you for the question dr. chow. so looking at article 10 conflict of interest and reading it as it stands in the original documents members should obtain from voting on any manner where they have a legal conflict of interest. until addition where i member has a personal professional comma or business relationship, the member should disclose that relationship prior to acting on the matter. so when i read that, the text after or business relationship,

for personal, member has a personal or business relationship whether it would be useful to explain the type of personal relationship at issue. and that was a question that i proposed and the answer came back as amended. so when i said that, my question was, they have a conflict of interest as applicable where a member has a personal or business relationship, the member shall disclose that relationship prior to acting on the matter. as i read it now, as it is

stated, it may be fine and when i read it, originally, the personal part seemed to be hanging for me whether there was any need to add additional detail to the kind of personal relationship at issue but, and you know, i was thinking of our many hours of training by the city attorney about your commissioner chow and your sister has this and that kind of thing. so perhaps, as it is, if it's, seems to be enough, for people i would certainly go with that. >> i personally favor a shorter and cleaner statement.

and it just zooms to me that i had wanted to accept a cleaner shorter, version that was really quite clear and seem to be the one that our city attorney helped us draft. i appreciate that you're saying that really as we reread it, it could be clearer, so i would speak against the motion and and leave it as, it was written by the original as written by the city attorney. that's my own.

something that could be perceived as a conflict and that's what i was focused on but if we were happy to disclose that may just take care of it. >> commissioner girando. >> i personally like how it's spelled out with the ownership for financial interest and this is what for a number of organizations including the one i'm employed for, that very specific language is included in what you sign. it's important in light of things that may have been services in our city et cetera.

and that is the language that i have signed for a number of organizations. so i think it makes it a little bit more clear. >> commissioner? >> i agree it does make it a little bit more clear because it may be an indirect conflict of interest. if we're voting of something and my brother owns stock, it is a conflict of interest because i can still benefit from it indirectly. i understand where this change is coming from. especially with things that have happened in the city prior. >> and thank you for jogging my memory about this a little bit. so leave iting it up to the

person i think is problematic. there are people that i know, let's say in my democratic club who i don't, i've never had a cup of coffee of them, i would not say that i have a personal relationship with them but under certain circumstances i should have to disclose that i know this person who i only said two words to over the last two years and you may perceive that this is a conflict of interest because we're in a club together but for me it does not feel like it is. actual, it's an an actual beinger because there is nothing that they can do for me or that i care about them, but commissioner salgado may say, they've been in the board for three years, that's the granular level that i was coming from. given what i do day-to-day and

the many times i've had to take these trainings. >> i'm wondering if our city attorney did have an opinion as to whether this addition would be appropriate from their stand point? >> city attorney worked with the laguna honda staff. >> no, i mean the proposed amendment. i think there are some arguments here, does the city attorney have an opinion as to whether or not this helps clarify or you know, is consistent? >> harry can you get on or anne? >> and maybe some of the things that they can answer is whether personal relationship is defined anywhere or is it

subjective analysis. >> good evening, again. city attorney, so just to set the context, this bylaw is not creating any conflict of interest policy for you but really just restates, the city's conflict of interest policy to which you're already subject to. the proposed amendment is directly from section 3.214 of the san francisco campaign and conduct code. so it elaborates on there. if you want to adopt the full sentence from that section 3.214, you could. if you choose not to, you can do that either one with the, you know if you have that

amendment because it's only stating what is in the law. if you're looking to make any other changes that you need to take a look at what specifically whether defining other terms or getting any sort of additional clarification. >> so, i think henry, you're saying that this is already consistent with what is the policy. it does not add to it or, and it may help clarify, is that what you would think? >> what i was saying is this conflict of interest section simply restates the city's conflict of interest laws. so it does not nothing other

than that, so the commissioner is already, even if the section was not in the document. ?fm all right, so does the amendment does not add a greater confusion that would just be clarifying as commissioner christian was speaking? >> so it sounds like consensus that more clarity would be preferred bit commissioner. shall we take a vote? >> and it does not have to be unanimous. >> can we make a motion first. >> commissioner chow made a motion. you had the motion and it's been separated out and we can vote on it. >> but you need to make a motion to add it.

because you separated. >> i'll move to add the amendment. >> i'll second. >> all in favor. >> aye. >> aye. >> opposed? all right, the amendment is articulated by commissioner christian has passed. >> so all the amendments that she proposed are all in the document and you still need to vote on the final amendment which contain the final amendments. >> all in favor say aye. >> aye. >> thank you very much for guiding us through this and again to laguna team for being so diligent to work with the city attorney and everyone to get this document finished in time and to be so clear. all right 9 next item on the agenda is director's report. director colfax. >> good evening, just want to share a couple of things that are not in the director's

report. i had the pleasure of joining members of the community and key dph staff this weekend on saturday morning. at the seating 5,000 event. this is and annual event that provide healthy food to people most in need and it was really inspiring to have so many community members working with the dph and community leaders to make sure that people got the healthy food needed noert holiday season. so just to share that. the other piece of information that i want to share with you is, today we had a possibility to talk about the on going decline in our overdose death in san francisco. one of the things we emphasize is we continue to focus on getting people off the street and into treatment. was the fact that we now have injectable morphine available

for people as an option to get to on their journey to recovery. so this is an exciting innovation and in terms of for people who may not be able or want to go to say a methadone clinic on a daily basis to get medications or take a daily pill, that there is injectable alternative. so i want today share that information. our overdose deaths are down overall approximately 20 percent this year. and we will continue to focus on innovating changing folks accountable to get them off the streets and into treatment. in terms of other areas in the report to highlight, really pleased that multi dis plain disciplinary team recognizing their innovative efforts to

deliver high-quality care for heart failure patients for behavioral health. this was the team's received the 2024j tyson award for excellence in pursuit of and kaiser permanente and the quality leader award for the quality of hospitals and health systems in california. so these are very prestigious awards and i want to congratulate the dph teams for receiving them and for the great work that they do. next item is more than 200 nurse anding other staff attended an all day symposium hospitals call auditorium to address substance use disorder. valuable into best practices and huge dis ordinary

treatment, communicate withing patients effectively, and other key areas ensuring that when, people need care for their, their substance use dis records that dph is there. when people need that assistance. next item, dph health emergency, and principal received the emergency planning work for her work during the 8 pack summit and the other employees was honored with the emergency responder of the a year award. jonathan is a certified hygienist that was assigned to hazardous material program.

public health bho provides personal information such as prenatal and signs of post partum depression and finally, starting where i ended with injectables, the sf s*f health

network is providing cutting edge hiv care and as we commemorated december 1, we reflected on the incredible strides that have been made towards managing this disease. more than 450 hiv patients receive the latest in hiv therapy across ten medical sites. this is another innovation, dph was key partners has been a leader in getting injectable viral therapy to patients, going from the research to on the ground clinical availability and just want to thank the team's for that and you see the arc of innovation and clinical deliverable systems getting injectable or where people are living with hiv of world of addressing and

meeting people to reach their needs who are ready to go into substance use disorder treatment. thank you for that and i will answer any questions you may have. >> thank you for highlighting all the awards and also this incredible work with injector as well as the overdose falling and thank you for all the work that you've done for your career and hiv space. we're so happy to have you. is there any public comment on the director's report. is there any in the room? okay, there is a hand up, remotely. do you have your hand up for this item? mr. min ?nd shaw. okay, that may have been a mistake. >> any comments from the director's report. commissioner christian, i would say thank you for sharing this

great news with us, it is, truly in line what we hear with the department several times a month. so please do think your staff for their work and it is it's really outstanding, thank you so much commissioner. i will do that. >> commissioner chow. >> yes, dr. colfax, i'm wondering if there is any follow-up in terms of the resent directive, well i should say advise to doctors to really be checking for avian flu, whether either at the state or federal level we're having more activities in regards to being more alert as to what we should be doing.

continue to get questions. >> they've been following this closely and i believe is online available to provide you with the most resent update in that regard. >> so unfortunately, dr. philip is not available at this time. there is limited surveillance for 51 it's a national level state level and local level. ensure that providers in the city if there are, if there is reasonable suspicious for that they test for it and there is

limited testing of fentanyl samples being able and they will be able to come back and report. to be testing for it in cases that could be suspicious. i'm just wondering, and that would be fun if we can get an update in the next meeting. >> to emphasize there is not been a case of hiv11 reported in san francisco and at this time, the risk to the general public in san francisco remains slow.

commissioner chow, oh yes. thank you. at the december 129ing meeting, the committee approved the environment of care report which details the vas amount of work that has been done and you heard about it today at laguna honda, it's more complicate asked very robust environmental care. and it is online and worth reviewing. the committee also reviewed and recommended approval of the provision of care policy which we look at every year. in will be done brought at the full commission. we also then reviewed the ceo report we're changing its

format to be narrative and then to have a statistical area that then tracks the knew north progress over each month rather than simile on a quarterly basis and it's helpful in understanding the work that the hospital is doing in its quality journey. they also reviewed the regulatory staff report, represented that the full commission approved the items on the consent calendar that is going to be before us. in close session, we approved the minutes report. thank you. >> thank you, is there any public comment on this item? >> any public comment in the room? all right and i don't see any hands, actually, let me make sure. yes, i see no hands. >> okay, any commissioner questions or comments on this report? i can echo what commissioner

said, the reports are really excellent as we're seeing the true north over the months and the presentation on the environment of care was very well done by mr. jackson, so it was an excellent meeting. all right, we'll go to the next item is a consent calendar and jcc has recommended that the full commission approve the items the service rules and psychiatry rules and regulation. is there a motion to approve. >> so moved. >> second. >> all in favor. >> no, i need to check. any public comment in the room. there is no remote public comment. >> all in favor. >> aye. >> wonderful. >> the next is, commissioner girado giving us a report. >> thank you. >> thank you, we had excellent report and full of information

and data, it was very very impressive. the couple of updates hiv diagnosis in 133 new diagnosed from 2022 which is a 20 percent decline. and since 2013 it's a 67 percent decline. the highest are highest against black and latino men. link to go care, 95 percent within one month of diagnosis, versus 82 percent that is across the u.s. in data. the second part was on sexually transmitted diseases and the report between 2019 and 2023 all rates decreased. increases continues since 2014

female syphilis which is a big focus right now of the department group. the disparity among age and race, young african-american females, are have the highest increase. m pox, 25 cases in 2024 through 10-31 which is a very significant handle on the issue. we also had information on four sti prevention and post release of the cases for example in november 2023. there was a 50 percent in chlamydia cases and 511 percent in syphilis which are both lower than the model projections have been. in hiv, sti prevention with the

city clinic and direct services within the prevention, one as well as other items are research and training and tech assistance as well links and radar. gent focus is eliminating congenital syphilis which remains the program priority. in community out reach and they, the department is funded 7 health access points which are focused with different agencies, who are focusing on addressing hiv and sti within their i umbrella of agency and they've been funded to specific do so in these two areas and

they have seen in the past year, 8442 clients in 9030 visits. we also had an excellent report on getting to zero which which there is multiple accomplishment which as dr. colfax had alluded to. has increases with men who has sex with men. it was a very, it was an excellent report with a lot of information to process. but that s their presentation. but, also included in the commissioner having their packet too.

the back up information is very extensive and really significant and remarkable of what >> any commissioner comments on this report? commissioner christian. >> just want to say to commissioner girarndo for giving a son size but full report. and the teams are doing excellent work and looking to look for ways to reach more people particularly more youth, as the numbers of infections are way too high.

>> thank you. the next item on the agenda are other business, is there any other business? all right, seeing none, and public. >> any public comment on new business? >> not in the room and none remotely. >> so the next item is to go into closed session. is there a motion to go into closed session? >> so moved. >> second. >> is there any public comment. >> any public comment? i see none. all right. all in favor of going into closed session, please say aye. >> aye. >> so for those of you who are going to leave, we will come back but for those who need to depart, happy holidays for everyone and thank you members of the public for attending, we >> okay. so we need a motion to disclose?

>> i make a motion not to disclose and to move our recommendations to the board of supervisors for full approval. >> and is there a second. >> i second. >> and all in favor, i guess there is no public comment. so all in favor. >> aye. >> aye. >> great. >> okay, the next item, on this robert's rules of order challenge meeting. >> actually, before you move to consider for adjournment, director colfax noted this is the last time that this body will meet as a full body in this room. as of january 6, most of the meetings will be moving to city hall until the auditorium is ready. take a moment. this is almost 40 years here and commissioner chow has been here for many of those decades. >> i've watched it all. >> yes.

so just note and it's important to thank all the people in the chairs before you and all the people who presented. just remember that. >> thank you so much for bringing that up and it's a beautiful praom and a lot of history in this room. so, i guess, >> it's a little smaller. so please consider a motion to adjourn. >> second. >> all in favor. >> aye. >> thank you everyone and have a wonderful holiday.

>> i never met anyone who recovered from the drugs i was using. i know i was not living the life i wanted to lichb, but didn't know how to get back on track. buprenorphine gave me the life and space to take life one step at a time. i have a life, a life beyond what i could ever dream. a life that includes a relationship with my son. i know anyone can recover. i'm living proof

>> my name is andrew england the owner and collector at real old paper. i'm a native to the bay areaismt grew up in oakland, spent high school years here and lived in hawaii about 10 years. moved back shortly. been in san francisco proper now for about 8 years. when i realized i wasn't a dealer anymore in san francisco, i found openings and decided to opening my own store in north beach in 2016. north beach was a great place to start. i got a neighborhood feel from it. i got involved in the community, but as far as business turnover, fisherman's wharf is 2 fold, 3 fold because there are so many more people here. we have been here going on 3 and a half years. i started as a hobbyist. i started collecting movie posters in high school.

not originals. just favorite. when i mouved to hawaii there was a gallery that specialized in viptage posters and that taught me about the variables beyond movies and that is where this is my career path and what iment to do. i with irked for them for 8 years, took a portion of pay in store credit so i built a collection basically and turned it into a brz. business. hobby turns business and forch int. i got bitten by the poster bug it spiraled out of control and i needed to a store to outlet my collection. san francisco has always had a viptage poster dating with 1970 with chicago new york and paris san francisco is a city with a area to buy vintage posters so people appreciate the time

capsule and history. all are vintage. most in the store is at least 40 plus years old, some back to the 1800s so we have some 140 years old. they are advertisement,b war propaganda from world war 1 and 2. movie and with travel posters and alcohol and tobaccos. thin pieces of paper meant to last maybe a mujt or 6 weeks. the lowest point was the pandemic. having to close the gallery so i didsant have a web store biltd or outlet and barely a instagram and told all the customers don't buy on line. can't be sure they are authentic or true colors or size or condition. it was very frustrating. it was a struggle until this opportunity presented itself and when i moved into this location on the wharf, there was still nobody here yet. we hadn't officially reopened but i

rolled the dice, spent everything i had left to build this place out, and give it one last shot. it worked out very well. it worked out very well. >> here we have the 1971 for the fight. ali and frazier first meeting. the one first professional loss. there is a lot that appreciate the story and understand the esthetic and message and nuances within the graphic. the champagne [indiscernible] wonderful piece. it carries both styles. it has the [indiscernible] in his garb. he has shoes and fits the earlier periods, but done in the style of art deco and that is what we offer and part of the experience knhing into the store. we will walk through the purchase and explain how we preserved it, what are the imperfections and what does the imagery mean. you have the older story and the newer story, pasted over the top. we will give you all that

information. about everything. it may not be your favorite piece until you heard the story. i are think i always had in the back of my mind a second location outside the state. i dream is tokyo, but i do a lot of consulting in las vegas with pon stars group so thought about opening a shop in las vegas. we like to branch out at some point. we are from here and where the company started and where we'll stay, we may just also open another store. i love being here. this is where my family is, this is where i was raised and not ready to leave that behind cht yes, people are looking for this store and there are fewer and fewer store fronts, brick and mortar like ours that outlet this thing. we offer the experience. i think it is very desirable collective subject matter because we are less and less acustoms. you can pick it while looking at it. examining the flaws and scale and color. you know what you are getting because you get that exact one.

poster art is my area of expertise and i have affinity for. poster art especially they are not meant to last are under appreciateated. real paper, the vintage gallery is 777 beach street, tuesday-saturday 11-5 and monday 12-5. >> brainchild the executive director 6 housing clinic in the neighborhood for it 90 years and talking about the history like the first web about family history and a lot of the clinicians found with a group of the community members. with the

owner of cadillac the housing on the west coast and the tenderloin is a permanent climax of history of the neighborhood and the community art gorilla for whatever reason artists in the neighborhood. and we do public events as well as walk in (unintelligible) for residents we have been known for has nothing to do with historically artist surveys and that makes us very unique and work producing about the cafe and a riot happened in the neighborhood in 1966 helping us on market street year-round indefinitely we think

that the arts is an incredible way of experiencing history and really helps people think of themselves as history persons and especially for the house play really a part of the - and think that is generates for the - we are aware the art is important for people and important for the community mba and can be a really assessable and engaging way to see history well. >> those are the ways as the art and history you're not going to see emotionally in the

[music] hi, my maim is judy seeber and owner and bier for emily joubert my-my husband and i own the store together and i started 20 years ago. my husband always thought we should open more doors, and we had two middle school age children and were waiting for them to get older. once they left for college we opened more doors andf is was a natural for me because my grand mother raised my mom in the city on california. emily joubert is my mother's mother and when i original bought the store in woodside it was named in any event and wanted to make it more personal so my inspiration for my whole life

has been by grand mother. she was really into fashion and sewing and cooking and all things that make a home and i love the thought my grand mother strolled up and down the street and i feel it is perfect location for the store with her namesake and i want to be a source of inspirational things and something convenient for the neighbors. and the community at large. in the neighborhood i like to think of it as a wonderful place that if you need a gift we have a lot of hostess gifts. if you need table pillows. we have everything for the home. it is like a mini-general store. i don't know there is a lot of home and garden stores in the area. i know there is dedicated garden stores rchlt what sets me apart i think is just my dedication to doing things that i think my grand mother would

love what inspires me and i find in her home if she were ivtoday and things again, that make a house a home. i take great pride in really discovering and sourcing things that you can't easily find at the store down the street. we want to welcome everyone in the neighborhood and in the city and in the greater bay area to come and discover emily joubert. [music]

>> long it was in fashion, o'shaughnessy water system has been sustainable. in addition to providing water for the bay area, it also generates clean hydroelectric power to run city buildings and services. and more recently, some san francisco homes and businesses. >> satellite electricity is greenhouse gas free, so we see a tremendous benefit from that. we really are proud of the fact that, we've put our water to work. >> even with the system as well coon received as hetch hetchy, climate change has made the supply of water from the sierra vulnerable. and requires new thinking about where and how we use water. >> we have five hundred million gallons a day of wastewater being dumped out into san francisco bay and the ocean from the bay area alone. and that water could be recycled and should be recycled for reuse through out the bay area.

>> we're looking at taking wastewater and reading it to drink watering standards. we're also looking at our generation and looking at onsite water reuse looking at the technology and strategies we have available to us today. >> the very first recycling plant in the state of california for landscape irrigation was built in san francisco. we've just developed a new recycled water plant in the ocean side wastewater facility for irrigation purposes in golden gate park, lincoln park and the panhandle. >> a century ago, san francisco built a dam to create bunched znswer of fresh water to ensure the future and ensure the taps will flow for future generations, it will take as much vision when it reflects a fundamental change about how we think about water. >> i think we recognize there's going to be change in the future. so we're going to have to have the flexibility and the

creativity to deal with that future as it's presented to us, it's a matter of how to see it and say, okay, let's make wise use of everything we have. >> this o'shaughnessy centennial moment is made possibculture. >> well to c h f a the society of america here on a chinatown the district preserved and the history of chinatown with any person of any background is sketch plan or accepted for all people the founder help to create the studies and with a major collection on the objects that tell the material history of chinatown and so much is offend in chinatown incredible all the texture of the design a

way to get from the east to the west and beyond that have an amazing institution like c h f a to [pledge of allegiance] >> fire commission regular meeting december 11, 2024. 9 a.m. to 12 p.m. this meeting will be in person at city hall room 416. members attends nothing personville an opportunity to provide public comment members