Reallocate beds for Navigation Center purposes leaves a psychiatric medical need unmet. There will be a percentage of patients that need this level of care. Rather than further reducing we need to provide a comprehensive system of Behavioral Healthcare. We needed this yesterday. We need it more today. Thank you for your consideration. Is there any more Public Comment . I just want to say the arf is anything but unsafe. The staff deserve consideration for their jobs. Thank you. I am a gay man that i hate. I will put this in the hands of the commission. Mr. Pickens will you come back up, before we get into the commissions questions and comments i would like to give doctor colfax an opportunity to respond to the things he has heard. We will come back to you during the course of the dialogue up here. Thank you. I want to thank everybody for coming out today and expressing your opinion. It is incredibly important. I apologize on the part of the department for not getting input earlier and hearing your concerns. I do think that we also need to be clear that with regard to people who turned out today the residents, front line staff, members of the public, that you hold a collective wisdom that as director of health i am committed to getting your input as we make decisions Going Forward. It is very important that the department has a shared accountability for the problems of arf and having visited with some of the staff here today i want to assure you while i do think there is severe problems with the arf and the history of the past five years, that i also recognize and i think the leadership recognizes the incredible work that people do every day at the arf and a cross the dph facilities. I want to express my perspective your work is valued by me. I think when i visited many of you described the members of family and some of you have worked there for 19 years. Not to say there are not issues and concerns. When you see problems consistently in the arf, i want it not to be either other. You can have good staff caring for patients kept safely and providing good care and there can be some problems and those need to be a shared responsibility across the leadership and management and front line staff. To express that Going Forward. Whether the arf stays at 32 beds, whatever hatches i am committed to fix happens i am committed that we can fix these problems together. Thank you. It is in the hands of the commission. Commissioners. Thank you, doctor pickens and supervisor ronen. I wrote down names but there are too many to mention. Thank you for turning out to show how much you care about the Services Provided at the a rf and caring for those in need. I did have a question if you refer to i am not sure if the pages are numbered. Actions taken for Resident Safety where you discussed staffing concerns. There were weekly meetings with hr since 2017 to look at the staffing shortages and how those might be addressed. I believe supervisor ronen said there are 12 positions currently unfilled. I am not sure i if that is the number. What are the barriers to filling those positions if there are weekly meetings and why havent beds been addressed . As i said in the presentation, we got down to three vacancies at the arf but we still continue to have the operational issues and concerns that were affecting the unit. Therefore because we were already on heightened alert from the state, we felt in the best interest of care we could not bring additional patients into the system until we figured out what was going on and try to correct those to open up the beds in a safe manner. Follow up. The Unfilled Positions at the current level of 32 . No there are more vacancies. I think there are actually i dont have it in front of me. At least nine vacancies if not more. What are the barriers to filling those . Hr continues to work towards those. We are filling positions on the third floor. There are no barriers to filling positions for the arf other than the plan to use that space for the hummingbirds program. That is why we are in a pause situation. If the decision is to reopen the arf beds we will have to bring hr to the table and work full steam ahead to fill those vacancies. Thank you for your History Lesson on the Behavioral Health center and thanks to everyon everyoneluso passionately has spoken on behalf of the residents of a rf, the staff and the care and wellbeing of the San Francisco residents. Being a native san franciscan and whose immediate family has had to deal with Many Mental Health problems described here, i want to assure you that at least from my sense of my colleagues that we do want to work very, very closely to correct the concerns and to put it into larger context of the lack of facilities and the decreasing lack of facilities that we have to deal within San Francisco and in the bay area for what is actually a growing problem and more complex set of problems that if we can find a way to Work Together in a larger context and systematically, it wont happen quickly but maybe it will happen in the right way. I wanted to ask about the humming bird place expansion. There was a suggestion by one of the speakers, and i apologize i dont remember which one, that one of the things that dph could do is think about the expansion of hummingbirds not necessarily by taking beds away from arf but in other locations and to other facilities within San Francisco. Is that something that the department has looked into . What is the status of that . Thank you for the question. You are absolutely right. I was at a hearing of the board of supervisors last week. I believe it was supervisor fewer who said it shouldnt beep one or the other, it should be and. The department is actively pursuing opening hummingbirds sites around the city. Those investigations are Going Forward and we hope to have those facilities online. I just want to ask mr. Pickens several questions to clarify the presentation. When you say that our changes at the Behavioral Health center are on hold, what is hold . Which scenario are we holding at. We are holding on moving patients in the arf up to the rcfe. Holding on opening a new hummingbird at the bhc building. So those numbers in terms of the additional 14 that would have occurred becoming part of hummingbirds does not happen at this point . No, that happened over a year ago. That happened already . Over a year ago. We are talking about current number at the arf . The current number at the arf will remain. The proposal was only 14. That is on hold. Exactly how many then are at the arf right now . I believe it is 32. So at the moment at the arf we have 32 . At the merf, we have a capacity for a number 50 something . On the third floor . Yes. Yes. There are vacancies there at this point . Yes, i think there are two vacancies. It could be more. We will get you that data. We are not going to fill those either at this point . That is the departments plan right now. Which ones are you referring to . On the third floor . No, we are filling vacancies on the fired floor. That has never been at question. The third floor is the locked ward. It is the second floor the rcfe and first floor is the arf. So the patients from arf are going to the second floor and not third floor, is that correct . Yes. So what the vacancy on the second floor in the residential area . The r. C. F. E. . Kelly, can you help me out . 36. 34 bed vacancy . Lets wait. I am trying to find what the landscape really is when we talk about holding. Where are we then . I am kelly hiramoto, manager of special projects. We now have a census of 36, capacity for 59. How many . 36, capacity for 59. We have 36 out of 59 at the moment. Yes. At the arf we have . 32. Capacity of 55. The capacity still at 55. Then upstairs we have what . On the third floor currently 36. Capacity of 47. Okay. To get back to understanding what we are holding. This is what we are holding . What we are on target for is consolidating the second and first floor. Our plan was to take clients from the first floor to the second floor, 18 clients, 11 of whom are older adults. We will leave 14 as residents of the arf so we can bring the census to 59. We will be four short, but we would be bringing people in from new referals when we got the staffing completed. On the third floor, the locked floor, the reason the census is down is because we had two nurses retire, and we have two senior Behavioral Health clinicians that left, and we are trying to fill all of those vacancies. Our census can only go up when we have those positions filled. We have two Behavioral Health clinicians going through the hiring process currently. We recently finished interviews for the nurses. The third flourish shoes of vacancies flouris floor has b vacancies. We would take those who qualify for locked facility at that point. Until that you dont have the staffing to do it . Thats correct. You anticipate staffing to be filled in what period of time are we talking about now . It sounds like they are through the hiring process. For the Behavioral Health, with the beginning of the process for nurses. Next is background check clearance. That is variable. For some people it can take several months. For others it can happen relatively quickly. People with common names had been often will often take longer. You are saying the third floor is filled based upon your staffing right now and that the additional beds could not really be used until about two months from now when you have done all of the clearances . Yes, hopefully sooner than that. The Behavioral Health clinicians were made offers awhile ago. We hope background clearance comes soon. Sticking with the merf it sounds like the problem is staffing. Did we not at general improve the hiring process to move it along faster. Does that not apply for this . Is this a different process going on . We followed the process hr has for us. Nurses is one of the challenging positions to fillanticly psychiatric nurses. For the Behavioral Health we went through the process quick quickly. Getting to your question, the Human Resource department at San Francisco general also does the hiring for the Behavioral Health center. It is the same staff and tame lines applied to any position at San Francisco general. We are talking about looking at vacancies and beds in different areas right now, including the arf. This is all kinds of related to all of the capacity that we have and the problem of getting into the mrf. Is there not away that if we felt it important to staff up the beds to take patients waiting to get into the her of that we found a way into the merf. I want to make sure we are talking about the mrf on the third floor . The capacity. I am trying to understand the vacancies, what they are relating to. If we are freezing our configuration. Part of the point on the whole issue raised about the capacities within our Mental Healthsehealth system is how wee trying to be able to handle this. It is similar to trying to if one of the problems is filling the slots and we have problems filling the slots and part of the problem is bureaucracy, several years ago we went through that with general and improved the system. If we went back you would say six to nine months. It sounded like it would take a year to get somebody hired. If, in fact, we are having this Mental Health crisis in terms of extra beds that i am wondering if there are other ways of trying if the problem was staffing the issue would be how to handle the staffing. I will leave it there and move to the next question about the capacity and the reason for the arf beds we have spoken about and the information you have provided for us and to the public has been all of the different citations. We can read them in different ways. They are public. They do relate to staff but also as we understand from our citations, some are important and some arent. Certainly citation as are. Part of that related to staff. Where are we talking about . I heard two or three different stories on. There that freeze us from having additional beds beyond what we currently have at 32. At the current moment we would have to hire additional staff. We are about nine staff short to come to full census. Is that full capacity. That is full 55. We have enough for how many right now . If we take what we use for other parts of the building floats, we could open to somewhere around 41 or so. 41 or 42 . Depends on it. I mean just okay. What is needed or what can we afford between the different parts of the city . If you had an overall plan what should be the size of the arf . If you dont want to answer now, you can answer in the third hearing we are having because there is a lot of discussion we shouldnt be closing the arf. What that says is that we have a need for this level of service in our system. What is that level of service we need . Are we able to get to that answer in our presentation . I can answer that question. We would want to staff to the full license capacity of 55. That is what you feel the city really needs is the 55 . Absolutely. So if we are presenting a plan in several meetings, then the plan should be able to then describe what division is, right . The supervisor described a vision what they think would work and what Mental HealthSan Francisco or Something Like that. It would sound like the department should be able to be somewhat more specific what we think should be a plan or what we believe could be a plan, which maybe elements of theirs and elements of the city looking at Mental Health. Your belief is that orf should be arf should be 55. We have 32. We are nine short to get to 55 . Yes, nine staff short. So if we go to 55, so the answer is we need nine staff. We also need to have certain corrections and i think perhaps you might want to explain later how that might be, but that is working with the state again. We have done that in various elements all the way from the courts and jails many years ago to many other instances of working. If we are looking at that and it seems to me that this meeting two sessions from now should help us describe what we believe should be sort of the integrated system and what sorts of types of services are needed, right . That would include hummingbird. Commissioner, with regard to mr. Pickens comment around 55, one of the things that i think is part of the reason we are having this discussion now and i think you are right on the point here. The 32 to 55, we always intended to go back to expand the arf as we were able to build capacity and staffing but correct underlying performance issues with regard to saytations. In citations. In the interim have hummingbird have capacity to take care of the people as we solve for the 55. That is where it is confusing to many because we do think the 55 is where we need to be with the arf. We already have challenges with regard to managing 32 as regard to the citations. This is not about any one person or a judgment, it is just the fact the state has given us a number of citations. The plan was rather than leaving the excess capacity we would turn that into hummingbird. I understand there is disagreement about that. That was the plan. We are holding the idea of hummingbirds and fix to go to 55 for the arf. Again, to be really clear from what was that, that is what we put on hold at this point. As we are able to work that out and where those other beds go, i think that your note to us was quite explicit, to the public that we received and i am hoping people would understand that the department is trying to come up with what should be the areas that we are able to have to serve the public that will meet nose needs. It sounds that the department is not saying we dont need an arf capacity. The question is how to get to that and that there is perhaps not that the current way of trying, i think as director colfax was saying to meet part of our need while trying to get to the 55 was running into problems not only communication but implementation. People are being moved out of areas and at the same time while it sounded like we are going to just stop, you know, that particular level of service at this smaller level while we are also, but i think you are right. Technically you said you were not taking away the 55. We only wanted to put them in to try to deal with the current idea of using empty beds you would then have in order to fulfill a need that hummingbird also has, but that currently we are all saying how to work a hummingbird solution and possibly be able, also, to maintain a different configuration for arf, is that right . Yes. And that work is ongoing at this time with the offices across the street there, both the city hall board and the mayor to try to find a way in which the public will be properly served and that all i am doing is paraphrasing what you are saying, if that is correct. I am sure city hall does, too, the supervisor and mayor do not want to short other needed beds, simply to have a bed count under hummingbird or navigation or anything that we would try to see if we can accommodate all of this. This is nice if you could actually start coming to that accommodation within the third meeting. We might be able to look at a solution. It would seem to me at least that it would be very appropriate that the commission hear an overall broad plan as to the types of services felt to be needed in the city and how we cant reach all of them. Clearly the original intent of the building has sort of been changed by urgent needs otherwise in which we were supposed to be bringing back those who were housed outside on a chronic basis to San Francisco. The needs of the city that has been expressed hearsay if those people at the moment are there still, wherever they are, we cant bring them back because we cant solve our more immediate problems right now. That is the reason for the changes, i believe, at the Behavioral Health center to try to meet the immediate contingencies not forgetting that we have people outside. I