Members of the public and welcome to the San Francisco health San FranciscoHealth Mission meeting, july 182023. A quick note on the agenda, well be moving item 9 the Conference Committee report to before, item 8 which is the consent calendar to allow for some discussion. To please make a note of that and we will proceed with calling to order, secretary please call the roll. Commissioner christian. Present. Commissioner chung. Present. Commissioner jer ard o. Present. Commissioner bern al. Present. Commission chow. Present. Present. Just a remind tore please turn off or silence your phones. Thank you, secretary. Now i go to commissioner to acknowledge the Ramaytush Ohlone indigenous stewards of this land and in accordance with their traditions, the ra ma tuber ohlone have never seeded lands as well as all people who reside in these territories. As guests, we recognize that we benefit from living and working on homeland. We wish to pay their respect by acknowledging the relatives of the Ramaytush Ohlone. Thank you commissioner chung. Our next item is approval of Health Commission meeting on july 20, 2023. If there are no amendments, do we have a motion to approve. So moved. Second. Any discussion, any Public Comment. Folks on the line, lets see. For each agenda items, each will have an opportunity to make Public Comment for up to three comments. However, the process does not allow questions to be answered in the meeting or more members nft possible to engage back and forth conversation with the commissioners. The commissioners do consider items when discussing items. Each individuals allow one opportunity to speak per agenda items. Individuals may not return more than once. Written Public Comment may be sent to the Health Commission at the following address, health. Commission. Dph, if you wish to spell your name, you may but it will be part of your allotted time. Against City Employees and will not be tolerated. We will first take Public Comment from individuals attaining the meeting inperson and then from individuals who receive accommodation for disability. Ive given these individuals a code to speak. Finally we will hear from remote Public Comment from other other individuals. There will be a total of 20 minutes that can be heard on each item for individuals who have not received an accommodation, can you please unmute the one person who has their hand up. Speaker hi, code a a. Please begin. Speaker thank you, june 28th minutes, noted that chow and green requested an update of the Organization Chart kind enough to provide a coffee, he never monitored upgraded because the funds are again, too small thats due in part to being prepared again, on at that lloyd size, by senting, the minutes were is chow is concerned about the Research Timeline on expect this charges from laguna honda which is now, 60 days from today. Will be permitted in the near future. End quote, i think pick ins told him the same thing about a formal sustainability plan. What is the delay in presenting it. Thank you. That is the only comment. Any further comment from commissioners before we go to the votes. Those in favor of approving minutes, say aye. Aye. Opposed . The minutes are approved. Thank you. Next item is general Public Comment. I have a short script to read, members may address the commission on items that within subject matter jurisdiction of the commission. Each member of the public may address the commission for up to three minutes. The brown act forbids from taking action including those raised during Public Comment. So again, this would mean that folks who are making comment now would not be speaking on a topic that is listed on the agenda. I see, is there anyone in the room that would like to make a comment . I see no one, please unmute mr. Minuteshaw. Speaker thank you, about the comment on description on the todays agenda has been cleared for a long time. One issue is the deather of treatment, and facilities, the San Francisco is towards the kham approximately and the lack of commissioner involvement in 2016 study had said San Francisco would be 700, facility bed sort. Hes wrong, that sort of order of 1700 beds or worse, that this commission has taken no action proactively, explore building out additional Skilled Nursing capacity in our city and instead, san franciscans are being dumped in the Skilled Nursing facilities. This commission should conduct another study since the 2016 of 7 years old and sadly out of date, before, another Committee Exploring whether to convert laguna hondas patient towers into behavioral out beds is undertaken or released in august of september or october, so the commissioner fully en formed of just how severe the bed shortage is and whether laguna honda beds for some of the population will only worsen the Skilled Nursing bed shortage in the city. Thank you. All right, that was the only Public Comment, the only hand raised. All right action the next item is laguna, closure plan and cms recertification update. Can you please bring up the presentation. Good afternoon, commissioners its my pleasure to provide you on the recertification process. Next slide. So im very pleased to share with you some of our most resent hires and we have hired a new, nursing home administrator and chief executive officer, sandrau simon, she is with us remotely on the, on the computer and, was actually able to meet with the joint Conference Committee of Health Commission at our last meeting, and similar would pause and give an opportunity if the chair so chooses for ms. Simon to say a few words, if thats your pleasure. Yes, please. Welcome ms. Simon. Hello, can you hear me. Yes, hello. Hello. Im happy to be here, filling my fourth week and learning a lot and doing all of my orientations and really looking forward to helping laguna honda on the path to recertification and working in conjunction with rowland and the team and the folks here for a new path for laguna honda and i dont know if you have any questions, of the nursing home administrator, ive been ive been administrator for over 20 years and formerly as the jewish home of San Francisco for 11 years, the single administer and chief administrative officer. So i do have experience here in San Francisco and then, in multi levels of care and multiple type Skilled Nursing facilities. Im just happy to be here. Thank you, ms. Simon, welcome to the Commission Meeting, were happy to have you on board. We know that filling this commission has been a priority and were pleased to have somebody in your caliber along with some of the other new members of the team that i know mr. Pickens will be telling us about. Thank you. We also have two assistant home administrators, we have joining the team, mr. Dill sid who also a long time license home add mr or who comes to us from a facility in the east bay. And weve also hired our assistant administrator who will focus on all aspects for our residents and staff, and na is jennifer carton wayed and were happy to have jennifer in this newly created position. And we are happy to fire the director of facilities, engineering and this is a new position for lag no honda and puts it in par for several years and now laguna, will have the same level of expertise in facilities and engineering. Next slide. So as we bring on these new leaders, were still opinioning the ache for three additional position thats will make up the team in laguna. Were continuing with that search process, the executive search were using is outsourcing new, candidates for consideration and we hope to have another round of interviews within the next coming weeks. The same applies for the medical position, there were a series of interviews last week and were still waiting on the search firm to present additional candidates for interview. And again the desire is to move forward with a hire as soon as we find the right candidate to meet the unique needs at this point in history. And then finally, were also recruiting for management and disaster preparedness, you were that in the root cause analysis for decertification, there were several deficiencies in this area so thus, this position was created to address those findings. So the leaders along with these remaining ones, that were recruiting for will align laguna honda and fulfill the recommendation thats were made to us several months ago by both of the consultant firms that have been of consulting on the laguna honda recertification, next slide. For our path of remains the same as it has been since april of last year, when the decertification, occured, we continued to work hard and to make the Rapid Improvement to prepare for recertification. This includes, both long term operational institution and more importantly cultural changes within the environment at lag no nard to achieve both our recertification and also long term success for the hospital. Were confident that between our own staff and the expert consultants, we have brought in and continue to bring in as circumstances require, that we will have the team in place to ensure a success recertification survey within the coming months. Next slide. So you recall the history of where we are in terms of the federal for medicaid and medicare and services in California Department of Public Health. Back in november of last year, there was a Settlement Agreement reached in order to continue the pause and residents out of laguna and also continued funding. That pause was reinstituted and approved in may of this year. That continues that pause in transferred at least through september 19th and funding through march of 2024 and that also assumes that we are not recertified before that september 19th date, and well address that towards the enter of this presentation in terms of our timeline for certification. Next slide. A maij yor component settlement are the 90 days survey. You recall we had the first survey of november and december of last yae, second of march of this year and most recently had the third june 5th through the 9th. Since then, we received what is called the 2567 which is the statement outlining regulatory findings that was received about two weeks ago, we had required a tenday turn around to work with the cms Quality Improvement expert to for them to do a root cause analysis and for them to develop an action plan to address those deficiencies. That action plan was submitted to cms last week on july 12th and we are waiting their review and approval and hope that they will do to in an expeditious matter so they can stay on track by the end of before the end of this summer. Next slide. Actually, can we go back to the previous slide. I want today also mention in terms of a mild stone with this new, action plan, the several mild stone, i think the good news is the mild stones are there for the most part are not a surprise, they basically encompass those areas that have been previously identified. But for where, we have not had enough time to do the full fixes of those areas. We are confident that all the mild stones in this last plan have completion date by september 1, that that aligns with the plan for recertification by the end of the summer and well be ready for any recertification sometime after september. Next slide. Again, this is a pictorial of a time line of the rewhole recertification going back to april of last year, talks about the readiness activity that we engaged in this makes it look simple but to consulting engagement from two different firms, the 90monitoring surveys, all the action plans of mild stones that have been developed and submitted and that were all reached 100 . And again our timeline for submission for is he certification bit end of this year as indicated here. And next slide. So that concludes my brief overview of update of where we are and im happy to take any questions or comments at the appropriate time. Thank you, mr. Pickens, secretary moore . Were on item 4 and lets take the folks who have received accommodations first, so if you received an accommodation, please raise your hand or hold your hands. Okay, jamie, please unmute the first caller. Mr. Mefpshaw youve got three minutes. Caller thanks. This agenda items claims mr. Pickens from laguna absence, it should not been on this agenda, its wrong. [indiscernible] who distributed the report number sets the other day to the lhh stakeholders email list. A 126 survey report, for inception from between march 14th and 17th and on april 4th and april 19th, uncovered another deficiencies including two citations, where its represent isolated harm, quote unquote substandard tear, belongs to harm patients of fact, being able to application and become recertified. Report number 6 also reported that the root cause analysis reports number 5 and number 6 along with the additional action plan mild stones were submitted as indicated on when this will release, both the robert number, the chants are on page 7, should start indicating at the bottom third of the page what the projected date certain date, on when application per certification will be submitted, obviously not going to be submitted before september 15th, if it moves to pickens, there are new mild stones with due dates in september first. You may have to start discharging patients on september 19th, because theyre not going to get recertified between september 1 and september 19th. Finally as a asked over and over, the mock adams contact was closer than presented to the Health Commission, that commissioners asked for it last april and still have no clear idea why. Finally please mute. Thank you. And please unmute the next caller, caller 4. Hi caller. Please begin. Caller hi, this is dr. Palmer, can you hear me . Yes. Please begin. Caller okay, time is growing short and by july 31, a closure plan which is going to include a Crisis Response team, state hire management stalled at the facilities and partnership with other facilities, to temporarily expand so that more than 100 residents can be distributed and disbursed state wide. I would like to know if current recertification will make that closure plan unnecessary or if it will go forward. And the other thing is youre talking about a survey that is going to occur in Early September and you keep vaguely saying, i really appreciate all of mr. Pickens efforts but there is a vague statement by the end of the summer, we need to know how that will affect December September 19th, eviction closures and disbursal of resident that we know will result in deaths because wlag no honda at its worse is a better than a lot of Nursing Homes at their best and people will die if they are forced to leave laguna honda, thank you. May mute. Those are the only two callers, commissioners. All right, thank you callers. Commissioners any comments or questions on the laguna honda update . Commissioner chow . Yes, thank you mr. Pickens. I was interested in first, a time line of the recertification, now that youve sort of said that by september 1, then the mild stones that were discussing or under way, so, the second thing would be or maybe its actually the first, i was caught by the september 1, do you see, the difference between our very first full survey and then the third survey that was full so then, it came with a, a different set of mild stones so that preassumably some of the first ones were repeated and the volume have come down. I think it will would be nice for the commission to understand what that difference is now and how you then feel that you are able to meet or recertification deadline, if you think that its close to september because youve been talking about prior to the end of the summer, and the opportunities that also then, there is a closure plan from the state that is coming, how we believe that that closure plan that you believe is closure plan is or is not one na, you know, going to, be one that youre, youre looking at not having to use. So, does that make some sense . Yeah. We can discuss the, the comparison between the two full surveys, youre recertification time frame again and then this last issue of the where is the closure plan, what does it do with or without us. Thank you, dr. Chow, and keep me honest and make sure i cover all of those terms in my response. In terms of the first two survey, the most resent stur have a, those were full cms certification surveys. Youre correct in that the first survey, there were 126 findings of non compliance to federal regulations. The second survey yielded 33 findings so a significant decrease. In terms of findings that were repeated from either the first or the second survey and the third survey, and example could be individualized health plans. You know that will be a finding in laguna even before. So there were findings in the first survey, in the first state. Back in december, we had about 600 residents at laguna honda. During that time, we had moved with staff to move forward. At the time only 25 percent of those plans had been vetted. Contrast that to the most resent report that koim outlast week. Now were at 440 of the care plans of residents at laguna that have been certified by external consultants. So the is he vert fickation, which where well be, the third survey did continue to have some findings of care plans but again thats something that has been worked on and almost fixed but there was a finding in the third. Thats an example. In terms of the timeline for certification, as i shared in the presentation, we submitted the new route cause analysis and action plan to see a message on july 12th. We need for them to review that pl