>> from the cantonese to the hypomania and we have hot pots we have all of the cuisines of china in our chinatown you don't have to go far. >> small business is important to our neighborhood because if we really make a lot of people lives better more people get a job here not just a big firm. >> you don't have to go anywhere else we have pocketed of great neighborhoods haul have all have their own uniqueness. >> san francisco has to all

president green >> present yoch commissioner chow. >> present >> commissioner guggenhime. >> present. >> thank you. the next item is land acknowledgment. president green. the san francisco health commission acknowledges on the unceded home land of the ramaytush ohlone who are the original inhabitants of the san finish peninsula. as the stewards of this land, and in accordance with their traditions the ramaytush ohlone never forgotten responsibilities as the caretakers of this place as well as for all in their tr territory. as guests, we rescue noise that we benefit from living and wing

on their traditional home land. wish to pay respects acknowledging the ancestors, elders and relatives. ramaytush ohlone community and affirmingly their sovereign rights as first peoples. >> thank you. >> the next item is the approval of minutes of the health commission meeting of january 6, 2025. commissioners you have before you the minutes are there any additions or corrections? >> if i may. commissioner chow. noted on page 7 at the top of the page. first and sentence should say commissioner christian asked if state funds are available. not stated there was an extra, d. >> is there a motion to approve the minutes? >> i so move. >> second. >> and is there public comment. why is there public comment on the minutes.

>> i don't seep hands and i will check the remote comment. two this received per commission. i see no hands. >> all in favor of minutes approval. >> aye >> thank you. >> the next is general public comment. and there is a statement to read. >> at this time members of public address the commission on items of into to the public in the subject matter in the commission not on today's agenda. may address up to throw minutes the brown act forbids from taking action or discussing an item not on the agenda. including those raised during public comment. each individual is allowed 1 opportunity to speak. may not return more then and there once to read for others unable to attend the meeting. written comment sent to the health commission at the word health. commission.. if you wish to spell your name

you may during your comments. note this city policies with federal, state and low law prohibit harassing conduct against city employees and others during public meetings will not be tolerated. >> thank you i don't see request forms. is there anyone in the room? jim mc kay turn in the a form. i'm sorry. mac afee. everyone has 3 minutes when the buzzer guess your time is up. >> you got to be kidding why am i not surprised. i want to thank the commission for changing meetings to monday so it did not collide with the

board of supervisors that was upon convenient for the board of supervisors and the commission. not for the public. >> i'm jim [inaudible] ranltdy walsh a resident laguna honda hospital. city attorney subpoena u.s. news documents concerning methodology which they ranged california hospitals. flawed because bias. and fostered on unsuspecting public. because the city attorney was curiously silent as to the methodology being used to recertify laguna honda. i asked at a board meeting if they would inquire whether the city attorney had an opinion >> if so to make it public. they declined. from reports from the press.

i understands how it work system that the state of california does random surveys of employees only. of laguna honda hospital. the san francisco department of public health hired unnamed consultants to do mock surveys with employees of the hospital to coach them how to respond. the state department of public health informs the government. as to whether or not to certify. cms does not decide that on their own. not through their own surveys. well is no reporting of any surveys done for residents. come to find out cms did do surveys with residents of laguna honda and families and friends. they were kept secret as to when they were taking place. in order to be fair.

they were kept secret as to when they were taking fair in order to be fair. this is important to note the cms did surveys they had no affect on the recertification because the state public health to recertify surveying only hospital employees. thank you. i like to give these to the -- thank you. [inaudible]. is there anyone not guilty room who would like to comment? all right. and remotely. i will check again.

i see one hand. >> let us know you are there, caller? >> you got 3 minutes. this is patrick regard something not on the agenda. don't cut me off. this health commission not explained how received internal promotion. begin he liked the minimal requirement of 10 years experience in the governing by laws the health commission revised in the last 30 days. this commission wave the 10 year minimum experience requirement or do coal fax who granted that wafsh. either way why was that minimum requirement waved. importantly, has the [inaudible] assistant nursing home administrator for support services filled yet.

if so, by whom and when. payment nothing its medicare reimbursement program. this is another stain on the compliance with requirements. and may be derail the you shouldy receiving a higher rating. thank you. >> that's the only other public comment for this item. >> thank you. >> then the next item is the director's report and director colfax has the floor. i have a verbal director's report to give you today. few items but important items. so. item one is the fact that mayor lurie was inaugurated on january eighth.

and the mayor has made his priorities very clear. with regard to the city including dph priority. and i want to report to the commission this dph is focused on implementing the mayor's priorities. this includes realizing a vision of seamless behavioral health system gets people care they need wherever and they need it. and we will continue to drive change, foster collaboration and hold ourselves accountable for this work. item two. is on friday, we reported the first case of bird flu in the city. it was detected part of background surveillance that we do with our in our testing and laboratory. the index patient had mild symptoms and fully recovered. at this time there , is no major

public health threat regards to bird flu in san francisco. we continue to recommend that people avoid interactions with birds poultry and birds avoid dead birds and continue to recommend people don't eat or drink unpasteurized dairy. no changed in our recommendations. and if the commission has questions on the h5n1n1 case. 2 important updates i wanted to share. thank you. anymoring items on the director's report? >> any public comment? public comment on item 4 in the room?

the director's report? no hands here and i see no remote hands. >> thank you. any commissioner questions or comments on the director's property. >> yes, thank you. i'm glad you mentioned the case. if there were spread to family or friends or it is an isolated case. and was this a resident who had left the upon country or think that this was acquired here in the city? >> so we have our dph leadership here to provide more information. thank you. >> thank you for the question. doctor george hawn. with regard to travel there was no travel. so this answers that question. and with the regard to whether or not other people have become sick who were exposed this individual the answer, we begin

our investigation late last week. answer so far is, no. and of course, if we find anything different that will be forth coming. >> thank you. >> no other questions or comments. we will go to the next item. which is the first hearing on the fiscal year 25/26 and 27 budget. jen louie or coo and our cfo are presenting in advance thank you for this complex and hard work you have done. we appreciate how much pressure you have been under and what stellar reports you share with us. thank you. >> thank you. am chief operating officer for d. public health. prior to the presentation on the first budget there are things i want to under score about this budget process that are unusual. first, we note the severity of

the budget the shacht deficit has not changed have you revenues not -- expend tours out pacing the revenues the shape and the distance in between are more significant than commissioners have seen in previous years. and also note the i think this budget process will be more dynamic will note the budget instructions we have were issued by then mayor breed. . in am december of the and while they have in the changed was the lurie registration coming on last week we expect that after our submission there will be additional back and forth in ways we have not seen in previous years. this is you know our first charter mandated step to make our budget submission by february 21 vnl i expect there will be continuing conversations

beyond just these two months i will turn that over to mr. morale for presentation. >> good afternoon. commissioners. thank you. cfo for dph glad to be here to present our first hearing for the dph engage for 25-26 and 26-27. first slide. so. firequest say. sfgovtv we ever not seeing the slides can we see a split screen or a slide is? i agree. so for the agenda today. we mraj to give an over view of the dph budget by division.

and then an information on our current projected salary spend in 24-25 for admin code throw.throw. second over view of the 5 year financial projection and core spondzing mayor's budget instructions planning preparing the 25-26 and 26-27 budget. and last how we are approaching that next steps and additional considerations while we plan the budget. >> two more slides. dph budget 3.2 billion. 7700 budgeted ft e split with the lion share of budget authority and ft e authority. and then followed after while laguna honda and behavioral healing divisions. in the pie chart you will see 1.3 billion for san francisco

general represents 39% and the other divisions following thereafter. one question from the commissioners about the break down of cbo contracts by spending category. so specifically, roughly across the divisions there is throw 50 million dollars in general fund supports contract authority. may be lower then and there i'm giving credit. 2 thirds of that are bhs which draw down some medical. the remainder is spread through hiv health services and other communities health programs. >> so. an important part of our approach for all budget is that we are maximizing our revenue opportunity. we look to any opportunity we

have to draw down revenue and maximize it. you can see we have i track record since 1920. the amount of our the dph budget grown near 32.5 to over 3.2 billion. at the same time our reliance of general fund support decrease said from 31% to 25.7%. so, it has gone down. really, as a gross amount staid stead 800 million. so, by division, about the lion share of the 800 million of general fund subsidy public health add tragzs and the remainder behavioral healing 130

million. general hospital, 130 million and smaller remaining amounts happy to provide a chart after the meeting. >> so, administrative code 3.3 asked for cost projections dph operating for personnel spending salary and fringe benefits within. 5 billion in the current year. as of the september 21st, 2024 period projected have 8 million dollars expend tour savings in our personnel spend. half percent on budget. due to continued ramp up and hiring to match growth in new positions and population health and behavioral healing we are trying to hire the authority we keep catch up and hire as fast

as we can. that savings is partial leave off set by higher than budgets levels of spending on certain times of nursing and holiday and premium pay and temp refer staffing we ramp up hiring and operations. similar to the q1 report. so, late breaking effective january ninth, the citywide hiring freeze will impact on the projections that we expect to show in q2. we are still grappling with what the impact will be and expect to have updates as numbers prosecute seed. and as pursuant the quarterly financial reports to health commission will update the numbers and provide our projections that are updated. so. next section goes through the 5 year financial projections as appropriated by the mayor's office and controller's office. and the corresponding mayor's

instructions. i turned on the closed captions there is an echo it is hard to hear you can look at screen and listen and not what is being said. >> apologies. so, budget development follows 4 phases. in december mayor's office and controller's office prepare the 5 year financial projection. in this case, running 25 that core sponldzs to the mayor's budget preparation instructions bringing ulc to the current phase departmental planning we prepare our budget in response to the mayor's budget instructions. closing whatever gaps as shown. mayor takes the budget in march-may to prepare the administration priority and adjust the budget.

board begins hearings in june. makes adjustments and cuts and add backs to the budget in this period. next slide. so, when we prepare the budget, we strife to follow the true north principles. including financial stewardship responsible with public dollars. safety and security for staff and our the folks receiving services. strive to maintain the health impact for our community. maintaining update to date effective workforce. having a view to equity for everything we do. and making sure that we attends to the service experience of the folks receiving services. so. the 5 year owled look for the city is as was referenced. significant. the rate of expenditure growth

exceeds our revenues. the mayor's office and controller's office is not projecting recession revenues are growing but not the pace expend tours grow 836 million dollars deficit in the two years of the budget period. the out years i am show in slides to come more than a billion dollars. and as faded expend tour growth is faster than the revenues are growing. the budget instruction for departments was to find on going permanent spending reductions of 15% start nothing 25-26 for dph thshg 150 million dollars. this slide really shows graphically what the bullets in the previous slide went through. in the first two years 25-26,

26-27 the red line there sort of similar to an alligator mouth is opening wider. that's the 876 in the 2 yeesh budget grow to more then and there a billion dollars in the out years. this is the city's largest deficit the city faced. this guess through some of the specifics on the where the sources of the expenditure growth are coming from. specifically, the is the personnel spend. there are more slides that describe this you see going from relative to budget, what is largely expected about 400,000 of expend tour change to incremental change in the out years 350 million dollars accelerate to 943 million dollars in 29-30. a lot of what is happening is

accel brating pen spend the mayor's office instructed find solutions and proposals to address. and -- you can see where the 876 million dollars deficit projected there source from another point to note there on the top line i skipped over, part of the deficit is that 203 million dollars decline in revenues relative to budget. sourced roughly equally by assumption of prior year savings spread to out years and decline in citywide revenue. and one note just to emphasize on the salaies and fringe estimates close contact mou's already agreed to and incorporate cpi growth for all open contracts they are bake in the assumptions but not a suggestion what the city is offering prudent financial

planning y. cpi? >> consummer price index. they use i think that's san francisco's san jose msa area from it is detailored in the 5 year financial plan the consumer price index. next slide. this slide provides the detail it is of the salary and benefit historical growth. looking since 1819. it lays clear where how fast these costs are accelerating in the last 6 years they have gren by a billion dollars. close to a third and -- this is the lion share where we are trying to close the deficit. and this is describing gfs only. prior year look you get a sense of where the accelerating costs

come from. specific notes for the budget. 25-26 the 250 million dollars deficit is learningly driven from a reduction to revenues assumed in the budget. that includes 118 million dollars from fund balance or prior year savings that were assumed and really the savings are spread for the future years. and then 132 million dollars in expected general fund revenue reductions. that's spread with this business tax shifts. excess property tax. hotel tax receipt reductions and prop m, which is waiver of certain types of fees assessod businesses that affects dph. as well as dpw. note that the 253 million dollars is net of an expected increase in dph revenue of 53

million dollars. this is a theme that will come, we are emphasizing and making sure we are grabbing revenue opportunity for the department where we can to off set the needed reductions. this is one area where we have and -- see revenue improvement. 26-20, we expect 623 million dollars deficit learningly driven by expenditure increases. include the throw00 million dollars in salary and fringe and personnel costs as well as increases in baseline contributions. 55 million dollars in assumed back fill to one time funding received for on going shelter and opioid programming. inflation assumptions for contracts, materials and supplies and 50 million dollars cost increase related to november 24 ballot measures. so, just to highlight some of

the ballot measures the big one for impacting dph is prop m. which made significant reforms to the business taxes. because of the adjusted revenues the measure will produce the 40 million dollars revenue decline for dph this is a lot about small businesses no longer need to pay the fees and general fund back filling. we have to do the licensing reviews for environmental healing but in a lot of case the businesses are exempted pursuant to prop m. other costings include proposition c, g, hii, j, m. so, these are all costs to the city but not directly impacting dph the major one is prop j which limited or set up gates urined student success fund to not allow it to be used to meet other baseline spending for the city that cost the general fund

23 million dollars. proposition i in there expansion defense for registered nurse. estimated by the controltory have a 4 million dollars impact on the general fund a cost born by the retirement system. has impacts to staff but it is a cost in the elsewhere in the city's funds. so, while we prepare the numbers, one thing we are aware of and diligent are external risks to numbers we know are there. so, late break news as well as the hiring freeze, state budget is projected be slightly i read

300 million dollars surplus. as we know, state fiscal outlooks are volatile. and so this is wherewe are monand very, wear that revenue fortunes could change leading to education related property tax declines. federal policies are fronts of mind. we are cautious of of the current economic policy in the federal climate. that have unknown future impacts to the city and economies. risks to medicare funding and medicate funding could strain our local resource. as we can see, we are emphasizing revenue solutions where we can. they account be at risk if the federal policies change something we are aware of. further federal policy risk city fema reimburse ams 240 million dollars are outstanding. not directly related dph,

partially. as well as uncertain federal grant dispursements. risk of federal grants continued to be released in the schedule. assessment appeals. more local risks but declining property tax vowels risk lowering tax revenue and business tax risks related to pending business tax appeals. >> so, in light of those and the numbers and the risks, budget instructions from the mir were for permanent on going sucuts from departments. reducing general fund passport by 15% on going. beginning 25-26. a large focus is on assessing cbo grant allegations and contract awards to make sure we get when we are paying for and

getting the most of every dollar we spends efficiently achieving out come we want. only upon funding community based organizations that demonstrate strong out come and cost effectiveness focused on direct service declines. reexamine all contractual services for effectiveness. and no new ft e's but proposals are instructed to be neutral look to e eliminate vacancies where possible. and finally effective january ninth institute a city institute mayor announced citywide hiring freeze. along the lineups we are working out detail it is of how this is impacting the city and dph. pursuant to instructions layoffs are not referred but if necessary target there we should identify the specifics of the budget instructions. dph is looking at our vacancies

with a hard eye pavements meeting our needs that way temperature say volatile and changing situation dynamic and we have to adjust as the time come. year two only, looking for opportunity to reduce and eliminate redundancies something the mayor's office mayor's budget office is focused on and engaged with us on. a bit few more specifics. city travel for city employees is instructed stop. there are case where there are exceptions but for the most part city staff are instructed to not travel and similar to the assessing contracts for efficiencies, we are preparing contract review and performance data. anticipating it will be an even closer look during make sure we are alined the purpose of the

contract and the dollar. is alined with out come and show the out come we are achieving. so, this is the first hearing. we, sorry, next slide. the first hearing high level. this gives an indication of where we think we are now. we do we are under way in planning to meet and will meet the mayor's budget instructions both 15% reductions, newtal ft e proposal while keep nothing mind mayor's priorities. right now this , shows 149 million dollars reduction target. we identified some increases to medical waiver revenue at the time of the 5 year. and so that -- helps us revenue solutions. to bring our total savings target down as displayed here

113 min and 76 million. it is important it note dph in a fortunate position we have revenue tools available. these will help significantly as we meet our target its is a point of emphasis on this review. so additional considerations mayor instituted the citywide hiring freeze on january 9. exempted positions that are challenging to staff. and that directly support public safety and health. we are actively working through the details of this and expect to as well updates as the time allows for that as we got more information. 25-26 budget includes a reduction of 5% or 10 million dollars of funds contracts to cbo's not funding supported from external sources or use to match

external funds that layers on to solutions we need to incorporate the 10 mission of cutos top of the 150 million dollars we plan through be it through cuts or opportunity for efficiencies. over the next month on going. this sackively busy. as we go dph developing a plan to address the targets. including the previously budgeted contract reductions and as i say that dph is fortunate to have revenue tools available to off set some cuts. that is a point we are looking at. it will not be enough. there will be reductions that are needed we are looking through and finding the ways to achieve the most efficiently possible. finally layoffs are not preferred. and only if necessary. begin our current vacancies we don't expect we need to e eliminate positions. we are focused on finding

vacancies and efficiencies. where we can. finally, time lines. so, we v had a briefing for managers last friday. shortly thereafter briefed cbo's on the instructions and on our approach similar to our conversation this afternoon. we are here meeting for the first over view of our budget and instructions. and participate having our plan meeting target by ready by the third for your review. and have a department submission dead line by friday february 21st. mayor will submit his budget to the board of supervisors friday, may 30th for hearing in june and final adoption of the budget by july. couple of other points to

respond to your questions. so, we reached out and we started briefing c bo's on friday. to discuss the instruction. as we go through this process, there will be lets of communication public low to commission and to the board. these -- now we near a planning phase. mayor will put his final stamp on it. there are a lot of steps to come and do it in full transparency. so, and specifically about how we are looking at performance in the contracts to make sure it is aligned with the way we spend and the intent. the new administration is focussed on accountability. we are looking carefully how we

prioritize funds and how we prove and measure performance. when opportunity there are in our budget plan to maximize that. just -- and then -- so, the expenditure reduction plan will be completed by the third. we think we are confident that this is we are deep in the planning and do anticipate we will have a plan that is ready for commission review and approval on the third. that really is the beginning or middle stage of the process after that, we go back through and anticipate more briefings to come to the health commission as the situation is dynamic and we adopt to the mayor's priorities. so, the -- you know pacific to the question about -- the first

hearing around our budget proposal. we participate anticipate we meet the third and there will be many steps this is a dynamic press that is adapting quickly. we think there will be updates we provide to -- health commission throughout the spring. much more information to come. ultimately, we do ask we will ask for your approval at the time you feel comfortable. appreciate your review and diligence with the questions and with that i'm happy to get to additionaling questions i missed or hand it over. >> thank you so much for the clear presentation and again for the diligence of you and the entire team and the office the budget office. we have quite a few public comments. call people up. i think that may be if throw could lineup at once we have submit will read your names.

the hiv advocacy. david count from thes advocacy network and william dean. so you can come up and again each of have you 3 minutes we welcome your comments >> hi. i'm mark the health commission second at 30 second tells do a ding and you got the final at throw minutes >> thank you. >> hi. i'm eve chu. i'm a san francisco resident and community member i worked for castro mission health center and mission neighborhood health center. i work wor for upon community health center. i'm a transgender man, i'm hiv period diagnosed in the last year. for me i -- dealt with hard times and this city caught me due to the the opinion health program here. i responsiblesed homelessness in the city and addiction in the

city that is why i'm here to urge you all to keep a healthy budget for hiv. health care in the city temperature is important. for me i am not honest low sure fiwould be here i urge to you consider the transgender people residents of the city because many of us are dealing with hiv the fastest rising populations in our [inaudible] not only that many of my siblings in my transgender family also may. we -- fluid we have sec with hetero~ sexual people and concerned about rising rate in our population and the transgender women. transgender mental that are hetero~ sexual and this is just

not the end of the issue. today i read supreme court of the united states is looking to revoke funding for prep. which is something that -- had i not relapsed in my addiction and becaming hiv positive this would have like low saved my life it saved a lot from contracting hiv. something i'd like to say is -- yea. itself still not still a concern of mine. were sorry i did lose my train of thought it is important for my population to have this funding.

i'm womeniam dean a member of the san francisco aid foundation leadership team. upon given this is national mental wellness month my concern is to appeal to you not having cuts to this year's budget. regarding hiv services. i encourage to you provide as much funding as possible for those living with hiv and aids. such as i am. the funding will help to end hiv/aids and improve the life of people impacted. hiv advocacy network has health,

justice, harm reduction, hiv and aging. housing and homelessness and intersectional solidarity. with suitable funds to address these issues many hiv folks will have a secured mental health wellness status enabling them to think, feel and act in daily activities. it is all the action one takes to encourage one's mental wellness needs met and maintained. please provide funds to support communities this rely on your agency to have a successful year as this month celebrates. thank you for listening. thank you. david counts.

>> thank you very much. i'm david counts. a san francisco citizen lived vaness and eddie for over 30 years. i consider the tenderloin my neighborhood. and i'm also a harm reduction activist and one thing i do as a citizen i go throughout my neighborhood and i take harm reduction supplies to used be encampments there are people using on the streets. i will take harm reduction supplies and wound care supplies to them. and my experience with harm reduction is this it -- saves lives. period. and while we have seen a decrease in over dose deaths, reasonable nationwide and in san francisco, we still are in the midst of an over dose epidemic

and i want to urge you folks to stay the course. first, i applaud your measures you take with harm reduction and -- but i urge to you stay the course and not cut any funding from this. one aspect of -- harm reduction is -- that i hand out molook thin is the reason why we seen a decline in the over dose deaths because we inundated and informed and educated people on the streets using. and so and they made it accessible. i found as an individual and talking to people i w with, that -- the users themselves have been quite important in

terms of reversing an over dose. buzz they have it and taught how to use temperature given masks breathing masks they can -- give do mouth to mouth. and -- it is a personal thing for me because i carry it with me i have my dozage now the reason why i carry it i have a friend that i was in a recovery group with. and -- high was in recovery -- for his son to get his son back and renew his rep with his son, which he did. it was i wonderful thing to see him grow in sobriety and his son grow. and the relationship grow. but what happened is my friends's son smoked pot this was lipsed with fentanyl and

died of an over dose he was by himself. anyway it saved -- hi. i'm justice i'm a member of the hiv advocacy network sfaf member at aids foundation. and safe friends coalition. i am living with hiv and here to urge you as we look forward in the budget to not make cuts to hiv prevention, care and treatment for care of our aging folks living with hiv and lived

through multiple pandemics. they are critical for communities and as we look at a political landscape at best shaky people look to san francisco if san francisco deprioritizes these it being create a domino affect in places that don't see this issue as serious. i hope you all think ever us when you are at the table thinking about the budge proposals. and make sure or community is cared for the way san francisco done over many years. hope that you all don't cut our critical services and program this is our community needs, thank you very much. >> good afternoon. i am a volunteer with hiv add rokaes network i echo comments made before me. we as a community at the brink

of a difficult political time. with the tax on civil rights guaranteed we need leadership to step and up provide us with tools of empower am. among the tools services to take care of our aging folks living with hiv and drugs that transformed the battle comprehend the supreme court taken up a case that could end the affordable chairman act no cost provisions the provisions helped clear people across the country access medication at no costs including myself. are under threat. the out of pocket costs of med i guess caguarantee will get wirfs. in livon slot the vital work of the commission becomes more importantful san francisco and the commission have sloen global

leadership. i encourage to you keep in mind vitality of hiv programs and vibrancy of communities and maintaining the lerredship in combating the hiv crisis. thank you for your time. >> good afternoon. . i'm annualy stone. i'm with the hiv advocacy network. i have a few point its share. a lot of my friends and activists have share friday a personal perspective. way in which the care system in the city impacted their lives and how much that mean for them. i have a couple other things want to highlight. i want to acknowledge how difficult the budget situation we are in is. and i understands this is a very

difficult situation for us to be in. i want to applaud dph for the w they are doing and trying to bridge the gaps find a funding and be able it ensure our public health care system maintains the wholeness. i want to say this our hiv system of care are a crowned jowl in our public health system. we have fought from the beginning of crisis in the 80s. we showed up when so many folks who were impacted were stigmatized. dies and had no one and built this robust world class sufficiency care for people to turn to folk in our community and around the world to turn to and look to in difficult times and replicate. i want to say part of this our service and programs serve vulnerable populations folks unhoused. seeing them continue. to exist especially among

unhoused folks. as we are being effective in decreasing the number of new hiv transmissions our system is working and now we are in the last mile piece where we reach those that are the most vulnerable to support them. we are providing sexual healing service. social support to break down isolation for our long-term survivors and we are providing over dose prevention through evidence based harm reduction programs. i want to say nonprofits are cost fest in the way they serve communities. they are trusted and they deliver service at a fraction of the cost. nonprofits are incredible partners in the community. i urge you as commissioners as your reviewing the budget with the role you play in oversight for the community to hold that line and ensure our services and

programs for vulnerable community maintain and keep this in mind as you are reviewing the budget. thank you very much. >> thank you. >> next person is car lito gabriel.

i have many articles about laguna honda i'm sure you have articles or read them. the articles you will read laguna honda gets most of its revenue most of its revenue why will they not tell you where than i get all of their revenue? i will tell you where they get more this they don't tell you

about. it is share of cost. was there a mention of share of cost in about revenue? in the budget? share of cost is from the residents and from the residents he gave the budget report i was wondering. okay. let me tell what you can happen to share of cost had than i play loose with your diagnose. father could have 6 thousand dollars worth of it. that's what could happen. not only that monthegets sent to loug loug for your personal account which they do no transaction registers and havenlt disappearing. i have do you means here in my dag bag if you like to see. hear about share of cost of residence dens and do oddiding. thank you.

any other commenters in the room. and remote public comment. no hands i will give one more shout out we are on budget item 5. no hands. i think we should note we are grateful to the people for their service and advocacy for testifying today and for sharing their personal stories. it is moving. are there commissioner questions or comments on the budget? commissioner chow. yes, i appreciate the break down on the general funds for different sections. it would be a noise if we get in in writing it was hard to pick it all up from this. it would help us understand. i know this general funds by departments we have them inner quarterly report if you place them in one position or else,

and -- i than it is difficult from the instructions to try to picture that is going to be happening in specific instances. healing is an your which there might be exceptions so -- i'm not -- so i'm really more interested in how we are really going to carry this out. understanding that the city's fiscal situation is -- described as you put it, reminds me of a decade or two ago when we have gone through this before. doctor colfax is here. i hear the same needs for efficiency and reduction of services and and in the --

without reduction of service. we -- you know have the same buzz words. it does concern me that if the fact this we are not going to hear this specifics until february third. or this they will not be visible for us -- that i'm concerned that as in our past we have been able to understand some of the public issues and -- sometimes the nuances that then start coming out. that there have been an opportunity for the commission to be able to ask for either a review or variation before submitting to the mayor's office. i recognize because of the timing and the holidays there has been a problem in try to get closer to the mayor's submission. and able to answer the needs oft public. i think as you were say nothing

the entered transparency, being on which and on top of which commissioners might like to be able to express where they might like to behalf the public view a different approach or -- modification and -- department with come back and say they can or can't be done or this was done. that we are not going to have this opportunity. we only have one hearing on february third of your specifics. usually come a large and detailed book. its well worth our review. but then if our comments are not going to being seen and we are asked on this first hearing of the budget, itself. that we are going to be submitting this or take that in

consideration but you know trust us. we will get it done. i don't see that as being transparent as if we were able if there are significant changes coming up from the testimony on february third. that we have an opportunity to look at that before you submit it o february 21st. also because of the largeness of the department have often under different mayor administrations not just one mayor. had a consideration submitted late because of the approach of being able to refine it, before submitting to the mayor. once it is at the mayor's office that is it is the mayor's budget. so -- as the commission that was put in place by the people to be able to reflect the people's interests. it would seem that when we talk about budget changes and

deficits -- that the commission have an opportunity to try to -- reflect and work with the department to see what could be our best budget that we submit to the mayor's office. and that's when i'm looking at whether or not if -- the february third hearing becomes -- well, brings up substantial, that there be schedule another meeting to come back with response its this so we feel comfortable about when we submit. >> thank you. i'm asking -- what your consideration is. i did submit this to you can you think about it. >> absolutely. commissioner chow. i apologize if i missed hiting question on the presentation. we need your approval of our

submission that is a truth in the charter. and that's the intent of the february third meeting. absolutely if there is anything in there that -- it is your discretion to approve or deny or ask for more information. the charter driven requirement. absolutely if you receive it and need more information that is part of the dynamic. one of the points i would want to emphasize, too, is how dynamic the currently situation is. we learned of a hiring freeze we are working throughout administration policy and priorities for the upcoming budget cycle what we submit in february is likely subject to significant change during the spring. and we have a commitment to keep this healing commission and body updated. as far as the third it is an action that we are seeking

approval on. so if there is denial or need to more information that is a given. that we valid to bring it. >> could you describe work you will be doing with the cbo's and beyond having the meeting that you did have last week. how are you going to be working with them to out reach? and first. may be describe -- the -- mood not the mood. but where you are understanding of their understanding of what you were trying to say. these slides we have seen and we are prepared to understand the problems the city is fitsing that's not true of the nonprofit level. which of course has its own challenges. and feels they do the work. how did this meeting go? what other meetings are you going to have?

are you going on have individual meetings with different groups? are you going to tell them we have dhn before, where we did an absolute 10% cut across the board or whatever the percent was we did. and you know another approach or -- we took a listing and put them in priorities and cut a line. we did this. back about 2 decades ago. so -- what -- what do you get from the feeling of the meeting you had with the k cbo's? how are you feeling you will have follow up before february third? >> if i may commissioner in terms of our goal the cbo's to update them in a way they heard the same message around mayor's instructions and the current state. it is also clear when mayor lurie's priorities are.

in terms of the thing this is need to be done including where the expectations with regard to behavioral health. so as part of the budgeting process. the priorities will be prioritized. in terms of resources and -- begin the challenge this is we have and the rapidly changing environment. i asked madea clear that you met the priorities need to be emphasized in our budget process. this this is a very a situation what continues to change. based on the thing this is you are talking about. and we will come become to the commission on february third with a proposal will that reflects mayor's priorities and also reflects the changes that we have been required make according to the mayor's directive and that deadline is very important that we meet.

so i will let you talk about the other details but that first cbo was ensure they heard the same message. they understood we will continue to community with them and transparent to remind the cbo's of the process. one goal was to this meeting you heard feedback about occurrence we wanted to make sure people knew the time line and remind them of the process going through to july first. what that will look like. >> absolutely. thank you. i think exactly -- that is the intent for the cbo meeting introduction, preparation for when we anticipate will be a lot of working in partnership to make surety data that is clear both we are get when we want. and they are produce and demonstrating when they have

contracted for and anticipating this there will be a lot of review in the month to xhchlt for now we are not anticipating across the board blanket reduction. we are being guided looking for opportunity and look for example efficiencies. want to maximize the way we spend and anticipate a department budget submission this reflects that. contracted sfendz maximize out come and look to that to achieve the general fund saving reduction. >> you hear about 3 weeks. and -- this has been a balance -- that we had in terms of building out the cbo net w this included therefore, those who are realist small -- in terms of numbers of people but important in terms of equities

you say. and then there are the very large issues and in the mayor's own priorities some of which are in line with when we are talking about in terms of subtans abuse and the homelessness and problem of supporting them and all. all which is complex and very challenging. so, still back to how we are going to be looking at you know the large organizations which have the large budgets. and yet, trying not to -- affect too much then the very small out reaches small in the sense the population. although often forgotten. let's take the pacific islanders as an example. one that is always forgotten.

they are so small. and yet you know they need and some are going to have to balance what that is. how do you propose doing that in the next several weeks? >> we and i will pause here i think through specifics. we have enengage in the a process that really -- pushes the mayoral instructions to find contract efficiencies. we don't want to do it across the board we know we will impact certain contracts disproportionate that produce what we are paying for in the most optimal way. instead. we are work actively with all divisions to identify those areas where there being be efficiencies and savings. in the intent is t do this with a program lens and say, where are we not getting the most

dollars for our effectiveness for our dollars. we are trying not to do across the board it does result in doubts efficient and infortunate programs. we are working with the programs that the people than the services the best to find where there are opportunity. >> okay. all right. so. i -- understand the task you have. regrettablely it is probably more complicate third degree year then and there in the past because the budget deficit is so great in the city. and -- we have more robust network than we had before. we have more people doing more things. we really out reaches over the decade over or 2. it is not hiv now it is many areas that we are touching. and so becomes more complex. than before am so i hope we will

hear that has been that out reach that -- you know -- can't satisfy obviously. everybody where they are. i know in reading the very extensive reports we have been getting in the left year in the regards to contract date. that there is a lot of work there. and almost there are efficiencies to be done. upon there -- it is detailed. that its -- i would have to give you great credit for being able to find how we will get down to each of the individuals because it is? different yours they all seem tom have you know, an area they can help with and another area where they are so strong in work. >> agree. i would only add that the efficiencies are acrossed board

finding anywhere dp heart attack offer services we expect in the proposal to have a number of vacancies that we think we can reduce and repurpose as well as contract savings and it is really a global look and trying to do it not with a malon the and find the areas where we have opportunity for efficiency. not limited to contract. >> okay. so -- i want to thank you for the work you are going to be doing. and -- ask that you submit this information the general funds and the you are bricking out for us. so we can sort of know where we are looking at and i -- understand -- of course, [inaudible]. your -- consensus report you will come up with, with the --

budget that you will be proposing. thank you. >> other commissioner questions? >> comments? if i'm hearing it would be helpful if may be your group with work with the secretary to see if the presentation or at least when you have on the table for february third is available to us. not more than a few days before if there are really serious occurrence they can be discussed and managed before the third does this sound recently. >> i apologize for the late sharing of these materials. we were holding all we could to make sure we captured all of the updates from last week. we intends to follow the normal commissioner presentation deadlines for the february third meeting. >> we appreciate how difficult this is with the respectid change and uncertainties.

thank you for work you are doing and i know director colfaxmented to say something >> i want to thank drew and the budget team for the incredible work. and to emphasize that we are committed to being trans parent as we can be. with regard to the process. and commissioner you brought up things changed but i think one thing in the big picture a couple things dph has a large budget of 70% is from funds outside the general fund. almost 3 quarters of the budget is in the general fund budget. other thing in terms of official stewardship i think is important to emphasize is that as we expanded service, in the left 5 years, as more work invest in the public health, our general fund contribution of our budget

is actually rimaintenance stable. so that the growth of dph and the w we do the general fund level remained stabling because we have strong financial leadership in the department that is -- aware in times of of strong resource and strong budget we were still -- fiscally conservative in a way i think is helpful at this point as we focus on the mayor's priorities and focus on strengthening our behavioral health work.

item 6 laguna honda report and who is in the our inter~im chief executive officer. will present. good afternoon. i'm the nursing add administrator and ceo for loug loug it is an honor and privilege to serve in the role and i thank you for your warm

welcome. i joined laguna honda in june of 23 as an assistant nursing only administration since august the interim ceo for laguna honda. i'm committed to the mission of laguna honda and to the care for each residents. before we begin i would like to share the [inaudible] arrived for the second organizational assessment. we are in mocks as of this morning. these access ams a part of our sustainable plan. partnering with -- to serve cms experts for the assessments. as you may recall, served as the quality improve am expert this is assisted in recertification process. the mocks unannounced as to

prepare for the real thing. the first -- when they came this time we did not anounts when they would be on site to mimic the process as close as possible. we want to thank the staff for hard work and engagement with the process. i'm confident after recertification survey the mocks will show sustained improvement. sfgovtv show the slides, thank you. updateod 120 beds laguna honda is committed to. that would require to move based on federal cms regulations. doctor colfax shared we

submitted the waiver application to cms toollow for triple rooms city attorney recommendation. we are also the possibility of path way to obtaining certification for 120 beds. keep inform a position to do this thanks to a certification and robust plan. when laguna honda was built in 2010 permitted throw beds to a room. however, since 2016 they changed and only two beds per room are permitted. part of recertification process, we would require to decommission the 120 beds transition from triple to double. we recognize what laguna honda play in safety net heck system

and need for quality and skilled nursing beds. >> i want to share update regarding m hicks he had an even on january 6 we had a contractor work outside of laguna honda campus. and damaged a gas line. luke luge activated nursing home incidents command system. and staff and the administration building safely evacuated. i want to emphasize that the hospital building was not impacted. nor evacuated and no impact to resident care or the hospital new hospital building. i want to thank the staff for quick response and to our am department for management of the situation.

>> covid-19 update we deactivated [inaudible] likely long standing in laguna honda history. our covid-19 hospital command system was first activate in the march of 2020 before our first case of covid. we thank everyone who participated which included near low every departmentful laguna honda illness response is part of regular prescriptions and pleased have zero reds residents with covid-19 currently. further on covid-19 we now able to get for covid-19 resident in our acute unit. you may know loug loug offered

on sight acute care. last among covid residents require hospitalization can be cared at laguna honda. if a resident is positive and requires isolation they will be trashed to dedicated 5 reporting to existing practice. this change supports residents to receive care in a familiar place with familiar staff. and means less disruptive transfers. illnesses vaccines it is focus for us. it continues to be encouraged and available to staff and residents. our vaccination rates are higher than the general public. we continue to work. our population is vulnerable.

teams of doctors, nurses, social w sxirs pharmacists provide ejsz to increase vaccination. . i'm excited say that laguna honda under going a nursing staff shift bed to support care. shift bedding will result in all tower nursing staff. who work on unit assigned home unit. the nursing bid ensures we have a consistent care at bedside. this is an industry best practice. proposal we had many floor staff and after this process they will be assigned home unit providing consistent chairman i want to share gratitude on our nursing leadership and partners for their collaboration to working

with us and makeing important change. on admissions i wanted end with i brief admission's update. laguna honda is open for both skill nursing and acute rehab admissions there is no waiting list for laguna honda. we are reviewing and accepting applications as we receive them. work to ensure that community and entities know who our know that we are again open for admission and understands our admission's processes. this included proactive out reach to community groups. we have hosted many. them. on our campus for facility tours and many cases there has been this has been the first individual to laguna honda in addition to campus tours hosted webinars. . this includes ucsf, setter va,

sfhp. jewish family service and staff in other parts of of sf dph. left week we hosted st. ann's nursing home. last week they announced the facility will be closing. representative from the facility they were on site and meeting with our leaders. and are working with to see if reds denneds will be a good fit. our goal for 25 is to increase the number of referrals and the rate acceptance.

so for we denied 35 applications. out of the 35, 16 applications were denied due to complexity of behavioral healing needs. some were denied they had no level of care needs. or they were too complex to be cared at laguna honda. no applications have been denied doing to insurance reasons. we participate operator denying applications to continue to decline as we work with our partners. to community our adding mission criteria. and finally our slide that shows

the state of the hospital. and in december of 2024. had 14 new admissions the highest to date. we had 2 discharges. our -- average daily census climb in the december. to 428. from 419 in november. we look forward to welcoming more san franciscans to our community as they get overwhelm census. thank you for your time we are available for questions you may have. thank you very much. i we is jim mc fee here on public comment. i'm sorry people hide nothing here. all right. all right and then -- what about remote public comment? yes we do give me a moment to

pull up a slide for one of the people making comment. doctor palmer >> yes, thank you. throw minutes. >> i um this is gn going to be the same i gave you in writing. i just the rate of admission remains slow. especially looking at rate of deaths and discharges. and the reason for denials are not elucidated and they are not broken down monthly which we have asked for multiple times not only me but the health [inaudible]. commission and i remain concern

third degree people are suffering in the community this should be in laguna honda. scared and care givers and patients being turned away because they don't have the right insurance? and are not receiving counciling or referrals insurance barriers can be rectirectified. i know a family that at least the hospital social worker was told no beds at laguna honda because she did not have the right insurance. and the family received no counciling. as to possible ways to get her covered for transfer to laguna honda such as a one time contract with her medicare or emergency disenrollment. but you can't it does not make sense for disenroll in the

current insurance and unless they know when than i will be admitted otherwise they will be uncovered. so, is counciling an effective out reach occurring at the community level? are the admissions coordinators welcoming in kind to people that need to stay in their communities and need a bed at laguna honda to not go to exile? and going to have a lot of residents they are closing and how many are going to be sent out of county to god knows wear they have the wrong insurance? this -- the work needs to start now for folks and the counciling. and there need to out roach to all of potential seniors in need in san francisco. when they contact laguna honda about who can work with them around insurance barriers.

thank you. we have one more. >> yea. >> give me a second to pull up your slide. >> begin. thank you. 120 referrals july 21st and december 21 of 24 denied category total pen. 5% of the 120 the 53 admitted category referral it is across all priority categories total 4 front 2 percent of all referrals there are more denials than admissions. presented 1 in october stratification of reasons for denials. lhh needs to present an updated

strat ifkdz reasons for denials and post referrals to provide a detailed understanding why many referrals are rejectd that would help facilities and families understands why they are rejected. low are rejekel rate of denials.

this commission should require lhh provide reports showing reasons for denotices in closed case. lhh should inform the commission how long it takes between receipt of a referral the day the decision is made and actual time to admission. wonder whether the 26 among decertification period caused harm to lhh and parents are refusing to be admitted. how many of the 22 cases closed saying iingly not go there. thank you. are there commissioner questions or comments on the report in commissioner giraudo. >> i want to thank you for

answering all of the questions this i had submitted. very thoroughly. and i really appreciated it and obviously saved a lot of time. to be able to know this ahead of time. my comment is, thank you for the report and thank you for the quick response to -- the questions. thank you. why thank you. commissioner. commissioner guggenhime. i'm wondering -- i'm a newby here. what is the -- what is your total capacity and when do you think you will reach it? >> skilled nursing total is 769 bed. 120 are when we don't have available that brings town to 649 that is our concern capacity. .

humight get there? we can provide that you informing we have information that we have developed projections when we may roach that. this is moving target and we are making every effort to increase the speed of admissions so we can budgetary contrablts revenue helps. we want to follow processes at the same time and meeting the needs of health network and the community as well. commissioner chow. yes. thank you. for your i'm wondering -- what the tower nursing did. does. we had a large pool of nursing staff that was floor staff not

assigned a unit. which monies they could be to assignments. what that does it is poses challenges and staffing. and also residents in the having consistent staff. with -- this bid, all thefullying staff, signed a home unit. so this way the reds debts have consistent staff providing care. >> now everybody is assigned to

a service. a home unit. >> i guess my other question -- sort of related when the discussion here has been. which is -- what do we think is -- sort of the pace that we should be going at. you say we don't have any backlog? has not been in out reach and -- generally hear there is i need to find people to find places now some of this could be insurance reported because we don't have contracts with some of insurers. the other hand, most general is government and medical. at 1 time walk talking about slowly pacing admissions. which i garth you are not doing now you are say willing is no

backlog. is it that -- you think we are not out reaching? or that -- our criteria issue difficult to meet? >> i mention in the my update we continued to make the out roach to different community partners. and for example, when i don't heard st.ans was closing we enengage said with them than i have 30 residents. which are skilled nursing appropriate. so -- you know, laguna honda went through this we had to discharge some and they go all over the state. so we want to make sure we meet the need of the community. and if we could get them in the city. we are looking at every tune we have and continue to communicate. this we are open with the

admission criteria. hosting tours to make sure they visit and look at the facility as well. >> we are feeling we are able to take people if they apply and it is -- open. >> yes not with the initial slowing of taking only several per week or something. we are -- don't have a quota? >> that's correct. >> okay. thank you. >> thank you. >> thank you. and you know upon the reasons for both people going out as well as the reasons than i might not be in your answers to the questions. very thorough. i wonder wlp the others said would be helpful to get near more granular on this. the public made about helping people understand when than i motive not qualify to begin with. which would save everyone work

and delay. as well as those who might qualify or may not care givers may not frame the need in a way that are clear to you. the more information we can receive the helpful tell be to us and to potential residents at laguna honda we appreciate that. >> i think the point about insurance is a challenge. because -- i have patients who's family members thought they could go somewhere and couldn't. don't get we start with aboutate nait is confusing. i don't know when we can do about this if if you could shir with the commission the out reach and more information what you are doing we have a better understandsing will be helpful. why no rush on any of this. i think it would be useful for everyone. >> we will, thank you. >> great.

thank you. >> other questions or comments? the next item is these are things we do as a jcc i appreciate the other commissioners participating. it is the laguna honda hospital hiring and vacancy report. >> good afternoon. . i'm pleased present the report drawn from the december data on laguna honda vacancies. laguna honda vacancy are at 7.4%. as we look back at the year that ended, it is worth mentioning how hr made significant progress with hiring. thanks in appreciation to all

the hiring teams and unions that partners to decrease vacancies over 12% to the current 7.4%. we hired 16 employees. across the classifications between december 1 and december 31st. and we had 2 separations during the same period with no over time. we continue to prioritize and support hiring of register nurse the 2320 classification. no vacancy rate at 2.51% for december. which translates to 5 vacanies and of those we are working with hiring teams to move candidates throughout selection process. we hired a total of one registered nurse left among. with regards to manager, the 23-22 classification we filled

all the 5 place. throw nurse managers, started last month and two are moving through the on boarding phase. of there are 4 openings for the 2012 or licensed vocational nurse we are in the on boarding process with two vacancies. the h r team continuing to process vacancies through an fortunate batch hiring process. we are processing sick batches we have 31 vacancies in the 2430 of medical evaluation assistant all moving throughout selection process. the seem is working with hiring teams across dph to support and fill thirty-four vacancies in the 2586. or the medical health worker two classification. we are moving people throughout

selection process for 29 of the positions including re, sign am for 4 positions. we have 9 vacancies across dph health program cord narrator two 8 are on boarding. and one has already started. healing program court nayed three the 2593 classification. have currently 47 vacancies which 10 are not guilty on boarding phase. 4 moving throughout selection process. as we look to fill vacancies across dph the process has shown alots of promise to not will identifying efficiencies but to ensure better outcome for both candidates and managers. the hr team continues to hold

planning meetings with executive lead and hiring managers and to go over vacancy information and discuss hiring plans. across the last month, hiring, the highlight include one 2320 registers nurse started left month. 423 or throw's or patient care assistance started last month and two licensed vocational nurses in the 2312 classification this started left month. thank you, >> thank you for your report. any public comment on this item >> there is a hand. doctor palmer, are you have there? i was westerning and i don't i think this is asked before. are the number of vacancies what

census is the number based on. 769 in or the concern census of 428? thank you. >> the only public comment. >> all right. any commissioner questions on the hiring and vacancy report? mr. chow. i was wonder nothing aline am with the mayor's hiring freeze where did we stand in terms of trying to fill positions? as you are now trying to do? s >> >> good evening. director of the san francisco health network. similar to what you heard earlier and comments we are following the major's directive. as drew mentioned they are trying to get clarification on

those positions for public safety and health that are exempt. we believe that many of those positions as a clarification come through will include the nursing classifications at laguna honda. and so -- as we get clarity we will be better informed. laguna honda like all within the network and the dph does have targets that it has to meet and we are working collaborative low to look at targets and we ever balancing it among all division the network. we are coming together leadership team for laguna honda, san francisco general, primary care >> general healing looking at priorities and letting gets the mayor's priorities and then will be putting forth our targets and proposals for efficiencies,

consolidations, we are looking at everything to minimize reductions but some positions are have been for awhile and we managed deliver services so that is part of the things we are looking atteen though is shows up as a vacancy if we have other ways to provide the service we are not filling and contributes to the mayor's targets we'll did that. >> thank you. we will go to the next item. which is laguna honda affair's report and director will present this evening. >> folks just to give a head's up i sent an e mail on new year's eve because of our tight time line today if the folks going to present the rest hope session items could be present

for questions and deposit present information unless there is something vital you need toy woor trying to get the commissioners in and out and able to cover all items. item >> absolutely. good evening i'm going to present. she is supporting the mock they are still on site. i will also be doing the next item as well. we have the affair's report for two months november and december. and i'm happy to answer questions i want to highlight and celebrate did close 97th reported incidents with laguna honda without deefficiencies which is excellent. >> thank you. i believe a lot of questions were answered is there public comment. ? in the room? this is a regular affairs item.

>> randley calf walsh is a residents at laguna honda report. am i to understand that she is not going to give a report we are not going to hear about it. but you guys will be able to ask questions. so could i is there a way i could attain a coup of the report? >> it is in the binder and i'm happy to give it to you and you can come dot office. >> used to be we got copies of all that stuff. not a back and forth i'm happy to talk do to you after the item is over >> see if there are other remote public comment. i see a hand. are you there in yes. >> you got throw minutes. >> thank you. >> hard regarding the affairs

>> reporter: in the the survey update section during lhh certification turbing 2 arrestings [inaudible]. sanitary and 925 effective pest control program. the scope rating is for no actual harm. with potential for minimal harm giving a scope efficiency ready raing for inadequate pest control. of more concerning lhh received deefficiency 684, quality and care involved a substandard quality and care violation. wirfs lhh received isolated deefficiency for 656. comprehensive care plan free throw medication error rate. all throw of the violations occurred during the surveys

during the 26 month decertification 22 and 24. why is lhh continuing to have care plans, medication error and quality of care violations following reinstatements. all 60's deefficiencies received during of the certification can affect lhh120 bed waiver question denied. all 6 credibilitying factors why people referred to lhh voluntary not to be admitted. thank you. >> the only public comment and the last. >> i believe the commissioners questions were answered. so we can go on to the next agenda item. which is the laguna honda hospital policies and trainings director of performance and improvement. i don't know if she wants say.

this will be. i want to note the commissioner behind me that usually the jcc action is to vote to approve to move these policies on to the consent. because this is a committee meeting you will do the same. today is a chance to ask questions or get comments and the action would be to vote to put this on consent for february third meeting. >> thank you for that clarification. and >> thank you. present with the mock surveyors there are 34 policies for review. nursing policy had a minor change. thank you to commissioner chow's review to ensure throughout the policy 72 hours not 96 hours outside of this i request for approval for the items to be on the february consent agenda

>> is there any public comment. there is a hand up. would you like to comment on this item? he disappeared. no comment on this item >> great. in this case i believe the questions were answered i believe we need to hear a motion to approve that we submit the policies for approval to the commission at large. is there a motion? >> i move. to move that lh heart attack policy to the february third, 2025 consent. >> and a second? all in favor? >> aye. >> wonderful. thank you very much. we did this very professionally and efficient low. the next item is other business. is there other business. >> public comment.

>> the next is entertain a mowing to go in closed session. >> any public comment on this. >> none and no hands remote low. why great. >> i move to go to closed session. second. >> all in favor. >> air >> thank you. those of you watching remote know we will not be seen or heard in closed session and will be back after. sfgovtv i will move you over to attendee and everyone in the meeting does in the need to be in make a motion to first note this you approved the credentials report. and make a motion to disclose or not further discussions in closed session. >> move not to disclose discussions in closed session.

>> second >> all in favor? >> aye. >> great. now the adjournment, please? >> motion to adjourn. >> motion to adjourn. >> second. >> all in favor. >> aye >> 6. . 29 >> thank you guggenhime for making quorum and attending. >> thank you. clear clear