Today. We used to have was it 40 licensed or 60 licensed sub acute . They were the only one. This conversation is narrowly focused on cpmc sutter. Some of that is decisions far before we as policymakers were here. They were made in the overall city. This is something the department of Public Health and there is a move, i guess, in the last 20 years to get out of the business of subacute care. It doesnt seem to make sense to me. Those patients are not going away. Those patients will need care. What we are saying in our Decision Making is, yes, but someone else is going to take care of them so we are going to send them to sacramento and san jose and to los angeles. To me that just seems it might seem costeffective in terms of just the bottom line, but in terms of just decency and humanity, if that were your Family Member that you wanted to go visit and you live here, how are you going to go visit them . It causes a lot of pain and discomfort for everyone involved in this conversation. I want to say for the record i did say this to the doctor yesterday, i understand we dont want to narrowly focus on cpmc. I do think cpmc should reconsider and do everything they can to be part of the solution. The facility itself is licensed and built out for sub acute care and sniff, and i think they should continue to do that. They should find a way to do that. Also importantly and this is why i want her to come back up to talk more about this is that we have other partners willing to step up and expand the number of subacute. Myself and supervisor peskin spoke with the doctor yesterday. We want to invite the Hospital Council and cpmc because you are the only ones with current sub acute beds to set down with myself and first and more most supervisor peskin. Chinese hospital is ready to step up to do this. We want to take advantage of that and we want to move. Chinese hospital is having its own problems. I want to say for the record we want to invite cpmc to sit down with myself and supervisor peskin and Chinese Hospital to solve that and move to get those beds filled. Can you come up and talk more about some of the more immediate plans to expand this care . What i want you to do in light of that is and i asked this before. What is the right number of subacute beds we should have in the city and county of San Francisco . It is hard to pinpoint a right number so ballpark we are landing around 49 to 80 beds would be a starting place number. People remember last year director garcia had reference to 70 beds that year. The number of discharges in the year that we were doing the survey that was closer to 49, but we acknowledged that number is deflated because you cant just count people who went to subacute because a lot of people go to alternate destinations that might have gone there had it existed. That is why the number is placed in that range. Can you speak a little more about the immediate plans with dignity and Chinese Hospital . I know that was referenced. I definitely want to dig in on that. We have been having ongoing conversations with chinese around the 23 bed unit originally outfitted to be Skilled Nursing facility. We asked if they would convert that. Those conversations have continued to take place, we accompanied them to cdph when they were working with them around some of the barriers to opening the unit, which is predominantly around having food access. The kitchen as currently constructed is smaller than what can serve those 23 beds. We were trying to be collaborative to problem solve that and we have that conversation with them. We asked for an active proposal from them with operating costs and capital cost to do the opening of the subacute. We put in that request for the proposal before the hearing today to give you something concrete. It was not forthcoming. The department is continuing to meet with the leadership. Of Chinese Hospital . Of Chinese Hospital. Now we have had the hearing we hope that gives it more traction to move forward. I understand there is leadership change at dph and a bit of turnover and we have gone through a transition period. Respectfully, as you said we had this conversation with doctor garcia. I know that we made some serious progress with dignity, and that got paused because of change in leadership over there. We have gone through a change in leadership in a couple of different places. I want to say myself and supervisor peskin want to invite to sit down. We want to move to get this done. That would be very helpful. We look forward to participating. I want to say for the record. Can you speak a little bit about the kent field. I will ask the chair to continue this so we can come back to say where we are in terms of numbers of subacute. We want to hold the department accountable and ask the Hospital Council to step up so we can come back with concrete numbers. We are continuing to have conversations with dignity. They are currently having conversations internally and with other external partners about what will happen with the st. Marys space. It was our first go to because they have a Space Available that could be converted. Consent field is provide consent field is pro kent field is doing the subacute. The conversations were moving to proposal stage when the leadership change occurred. The message from dignity now is the conversation is on pause and they anticipate coming back to the department in november with the status if they are willing to move forward or pursue other options. Does it mean the department is done with the conversations with dignity . We have conversations about why it would be helpful for the city and county of San Francisco to keep subacute as an option. It would be important to have a timeline. Can you talk about the conversation . There is a conversation between Residential Care versus acute care and hospital care. Can you talk a little bit about that. For the department . Just in general to get to the 50 to 80 subacute beds are these all hospital based . No, because the department doesnt have any authority over hospitals to say you have to put in a subacute. We are currently looking at all options how we could bring it into the city. The next opportunity that we can see happening most quickly would be by talking to freestanding Skilled Nursing facilities as in the report. We had them and the department outreached all providers doing prestanding Skilled Nursing skill in the city about willingness to open new beds or if they have facilities struggling, which will are in the city some Skilled Nursing facilities having issues, whether they could become sniff subacute. In that conversation does the city and county, are we involved in reimbursement, hoping them . Are we doing subsidy for the care . We have just begun having outreach conversations. Initial feedback that was not preferred choice. The choices for hospital based dwindled we opened up lines of communication at the same time so we would be able to explore all options rather than no options. The expectations is likely we will enter Public Private partnership. The structure is open for discussion. We havent had sit downs with those partners yet. I think if we were to say in 90 days, if you were to come back at some point we will continue this at call of the chair. We want an update on that and need to move aggressively with conversations with dignity and Chinese Hospital. The outline was that we want clear proposals to bring back to the board by november and then hopefully have a decision by december to begin implementation. That would be 60 days. October november. We will try to get something to you by november and have Implementation Plan by december. We will try to stay on track. We appreciate how important this is to to city and to the board. Thank you. I wanted to ask you two more questions. Supervisor stephanie, did you have questions . We will wait. We have a couple questions. Just trying to wrap my head around what to do as policymakers to provide subacute beds or ask the hospitals to partner to do that. Why doesnt Southern California have the same shortag shortage e and what are they doing to have this care readily available . I am trying to understand why we have a lack of beds here. One thinks financial, of course, but you can help me understand that, that would be great. I think it is real to state when you look at Southern California, there is a great deal more acreage of land to build these kinds of facilities. The other thing is the bay area has Free StandingSkilled Nursing facilities offering this level of care, but i think that the bay area struggles very much with many competing care vulnerable populations that need support and care and that is true for the department of Public Health, particularly over the last 11 years that i have been with them. It is selfish who are you going to serve with the limited resources we have available to us, and i think it is a constant struggle to prioritize. We are at a point where it is clear that sniff subacute is one of the population we need to put the time and energy to. What are the implications on the acute bed population if the patients arent able to be discharged to subaccute beds. Do those patients stay longer than necessary in acute care . Absolutely. Have we looked at the cost of that . I think getting cost of care the cost of care in a hospital the hard. We have some sort of projected numbers. We didnt want to put that into a presentation when it was such a soft number. We want to spend time to give it validity. We will be working towards that. Thank you. Thank you, supervisor. My question is what is the plan for the space at davies . It is licensed for smithsub acute now . What is the plan. Well, through the regulatory bodies, those beds are sub acute is a sub designation of sniff so they are licensed for sniff now. They go through a process by which they are termed active Skilled Nursing beds versus subacute. Wwe currently have nine beds remaining for subacute. Holding one available in the event there is a need for one of the patients to develop respiratory infection and needs a room by themselves. The ones not sub acute are just remaining sniff. Correct. That is your longterm plan currently . Yes. The floor is licensed for 17 sniff sub acute or are the rest not licensed as subacute. You said nine are. You converted them back to sniff . Correct. So what i want to ask, and i said this to doctor brown yesterday, i would like at a minimum to reconsider keeping the nine that you have as subacute to be part of the larger conversation to get us to 80 citywide beds. I know there are other hospitals. I am not just asking this today of cpmc. We are asking the entire Hospital Council to step up, st. Marys, Chinese Hospital, dignity, kaiser, everyone in San Francisco needs to be part of this solution. It wouldnt be on cpmcs shoulders at some point we made a decision to move away from it. Now we realize that was a mistake. You are not obligated legally as part of the Development Agreement to maintain these beds, but you are obligated to be part of the solution so we would like you to reconsider that, if you would take that back to your leadership, if you could. Of course. Would you also since you are the only one speaking today, would you commit to being part of this conversation to work with Chinese Hospital and dignity and others to come up with a longer Term Solution . Yes, of course. That is it. Thank you so much for answering the questions today. I will close by saying quickly, chair, thank you for taking the time today to speak about a very important topic. It is something that i felt compelled to be a part of, as i said in my opening statement. St. Lukes is a lifeline for my district and neighborhood. So many people come across like supervisor stephanie with a Family Member with a correction or born in st. Lukes or have a personal relationship with someone working there. I am thankful that cpmc committed to keeping the hospital open. It is important for our community. We then transferred the conversation to cpmc davies. Now this is where we are. We do take responsibility as a city as well because we made mistakes in this conversation, and the decisions made have impacts on peoples lives. We have to figure out a way to get to 80. I am glad she is here to say in 60 days we will get an update. We are looking for dignity, Chinese Hospital, cpmc, kaiser, everyone that is part of this system in San Francisco to be part of the solution to get us to the right number of subacutes beds, and 50 to 80 is a starting point. I am hopeful we will get a better idea what that needs to be in the overall conversation. This was not a comfortable conversation. It was very uncomfortable and personal to visit the families in their current state, and i appreciate the families for inviting us down, and i appreciate all of the folks that come out here from cpmc and add row advocates. We want everyone to be part of this conversation. We think it is that important for our county. Thank you, mr. Chair, for giving me leeway in this conversation. I would continue this to the call of the chair, probably in about 60 days we will come back for an update, not as long of a hearing. We will get a quick update and engage with the different hospitals to move this conversation forward. Thank you. You have made a motion to continue to the call of the chair and we will take that without objection. Mr. Clerk any more items before us today. Clerk no further business. All right, then we are adjourned. The teams really, really went above and beyond and is continuing to do that today. This past year, the San FranciscoPublic Utilities commission Water Quality division started receiving many more requests to test for lead in the Public School system here in San Francisco as a result of legislation that had passed from the state requiring all of the Public Schools to do lead testing. And so as a result, the Public Utilities commission and the Water Quality team in particular was asked to meet with the San FranciscoUnified School District to begin to prioritize which schools to test to meet that state mandate. The team that tests, were a full Service Environmental laboratory, and we take care of both the needs of the Water Quality division and the waste water enter price. And on the Water Quality enterprise, we have to also have Drinking Water that meets all federal and state quality regulations. And lead in schools, were playing a problem in remediating this problem of lead in schools. Our role here in communications is being able to take the data that we have that we know is protective of Public Health and safety and transmit it, give it to the public in a way they understand we are really doing our jobs well and making sure that they are safe always. The public learned very quickly all the accurate facts and all the critical information that they needed to know, and its up to these individuals and their agencies and their commitment to the city. I enjoy the work because i can help people, and i can help the utilities to provide a better Water Quality, make sure that people feel that drinking hetch hetchy water is actually a pride. Hats off to the Water Quality team because between them working on late nights, working on the weekends when the schools are closed, and working as a partner in the School District for the times they found a higher lead sample, they worked through to address that, so the team went above and beyond and is continuing to do that today. Today we are going to talk about fire safety. We are here at the urban center on Mission Street in San Francisco. Its a wonderful display. A little house in the urban Center Exhibition center that shows what its like in a home in San Francisco after an earthquake. One of the major issues that we are going to face after earthquakes are fire hazard. We are happy to have the fire marshall join us today. Thank you. My pleasure. We talk about the San Francisco earthquake that was a fire that mostly devastated the city. How do we avoid that kind of problem. How can we reduce fire hazard . The construction was a lot different. We dont expect what we had then. We want to make sure with the gas heaters that the gas is shut off. If you shut it off you are going to have no hot water or heat. Be careful not to shut it off unless you smell gas. Absolutely because once you do shut it off you should have the Utility Company come in and turn it back on. Here is a mock up of a gas hear the on a house. Where would we find the gas meter . It should be in your garage.