That we benefit from living and working on their traditional homeland. We wish to pay our respects by acknowledging the ancestors, elders, and relatives of the Ramaytush Ohlone community and by affirming their sovereign rights as first peoples. Our first item is a discussion item. Laguna honda hospital and Rehabilitation Hospital closure plan and cms recertification update. I would like to welcome roland pick inns to the microphone. Speak into the microphone but you dont have to get that close. Thank you, president bernal. Good afternoon, commissioners. Its a pleasure to be with you to provide this update on the status of laguna honda hospital in our recertification efforts. Im joined by Senior Leaders of the hospital who are attending remotely and they are here to support me in the event that there may be questions that i may not be able to answer on my own. They were they were there to help back me up. Well start. Next slide. As we have shared before, we all remember back in april of 2022, a little over a year ago, the centers for medicare and Medicaid Services terminated laguna hospitals participation and the medical provider program. Since then, we have and continued to work hard to meet all regulatory requirements and make rapid improvements to prepare for recertification. Next slide. As weve discussed here previously, november 10th of last year, the city and county signed a Settlement Agreement with cms and the California Department of Public Health. Under the terms of that agreement, cms agreed to continue paying for care karat laguna hospital to 2023 and pause discharges to the community and in the voluntary transfers to Skilled Nursing facilities and i emphasize involuntary because its important to note and remember that under the terms of this Settlement Agreement, residents have the right to initiate them receives if they wanted to either themselves if they want to be discharged to the community or be transferred to another sniff. Theres been 16 resident initiated discharges that occurred over the last year. Its also important to note that while that pause was extended in early may of this year, on both the discharges and the transfers, a little over a week ago, we were directed by cms while the pause and transfers to other Skilled Nursing facilities will remain at least through may 19th, they directed us to begin the process of doing communitybased discharges for laguna hospital residents who no longer meet Skilled Nursing facility care as defined by cms in the medicaid program. That represents approximately 40 of the current 530 residents at laguna honda. Youll appreciate that this represents individuals who when they first came to laguna hospital, actually did meet the Skilled Nursing level of requirements when they were first admitted but due to the great care that theyve received at laguna, at some point in time, they recovered and then no longer needed assistance with what is known as adl or activities of daily living so for example, help with feeding, bathing, toileting, personal grooming so those individuals then fallout side of the perimeters for which cms will pay for care and they have instructed us to proceed with identifying Community Based for those individuals and our team is actively working on that. Next slide. That Settlement Agreement that was reached in november of last year had many, many requirements, mostly on the part of the city of dph and laguna honda. One of the key components of that Settlement Agreement was requirement that a cms approved Quality Improvement expert conduct a root cause analysis on the operations of laguna honda over the past two and a half years, looking at the results of previous surveys and findings, in order to identify where their key themes or trends that may have led to the circumstances, which led to the decertification. That Quality Improvement expert is a firm called, Health ServicesAdvisory Group, as you know, Health ServicesAdvisory Group has been onboard at laguna well before the Settlement Agreement. They actually came to laguna may of last year, so they have been with us for a year, already working with us to improve our processes and our Regulatory Compliance. So, to date, after undergoing that root cause analysis in developing an action plan that initially had 330 milestones that had, that have to be met and completed by may 19th of this year, theres also another component to the Settlement Agreement which is 90day Monitoring Surveys, so every 90 days since november of last year, weve been in a survey window process. Weve already undergone two of those Monitoring Surveys and the first occurred november early last year and the second survey, just concluded in march of this year. During that survey process, teams from both cns and California Department of Public Health have come in and reviewed our operations. We note that there was significant improvement in the second survey compared to the first survey and we anticipate that the next, the third Monitoring Survey will occur between a window starting the end of this month, may through some time in june. Were expecting that third survey. Next slide. So, that action plan that was that came out of the root cause analysis has served as our Guiding Light and our path toward recertification since january of this year. It truly serves as our blueprint for how well accomplish cms recertification. Remember, this action plan was developed with the cms Quality Improvement expert along with our Leadership Team and represents from their opinion, all of those important improvements that corrective actions that need to be made in order for laguna to be ready to be successful with its cms recertification survey that will occur later this year. One of the components of that Settlement Agreement is that every month, the cms Quality Improvement expert submits a report to cms on the tenth of the month. That shows our progress towards meeting the action plan and our overall improvement being ready for recertification. As we have reported previously, we have been 102 successful 100 successful every month completing all milestone in january. There were 126 in february and 133 in march. There were 77 and for the month of april and early may, there are approximately 120 and were on track for successfully completing all of those. So from our perspective, we feel we are very much complying with the terms of that Settlement Agreement and are setting the stage to definitively prove to cms that we are making improvements towards our path towards recertification. As ive mentioned that initial action plan had 330 milestones, those are on track to be completed by may 13th, which is the date listed. And its important to remember that those were from the original root cause analysis and the action plan. With those two additional 90day Monitoring Surveys, there have been subsequent followuproot cause analysis on those individual findings and there have been new milestones that had been developed, so while we originally started with 330 milestones, at the end of this last survey that ended in march, were now up to a total of 500 milestones. So, two weeks from now, we would have completed the 330, but there are approximately another couple of hundred that will be completed after the 13th day in order that the qie has time to validate that we have made the improvements and that those improvements are going to be long lasting and were not window dressing but it has been baked into our organizational processes. In terms of some of the timing for all of these various moving parts, the action plans and the milestones, once were successful in completing that third Monitoring Survey, again, which we think will be some time between the end of this month, may and june and then there will be another mini root cause analysis on whatever findings there might be, and knock on wood, it would be great if there were zero findings and in an institution as large as laguna honda, thats unlikely, so hopefully, there will few findings but whatever those are, the Quality Improvement expert is then required to work with our Leadership Team to develop an action plan and potentially new milestones, have those implemented over a period of time, probably two to four weeks and then probably based upon that timeframe, july august, we feel we will be in a better position to have the assurance that we really have fixed those items from all of the Monitoring Surveys and the root cause analysis and then be prepared to submit and apply for our recertification survey. Next slide. So, that Settlement Agreement, again, had many, many requirements that were put upon the city and dph and laguna. One of them was the production of a closure plan. One would say why would you do a closure plan when, you know, you fully expect to have continued operations . And the answer to that is, it was it was and remains to be a requirement for the continued funding from cms. In order for cms to continue funding, while were not certified, they are required the pro tux of this closure plan and the original closure plan was approved last summer and you will recall, it wasnt the closure plan that we wanted, but it was the one that cms was willing to approve that had an initial four months for us to do transfers. We know what happened when that was implemented, that led to the pause and the settlement back in november. In terms of the closure plan, because of the Settlement Agreement, it had to be updated to reflect the new requirements under the Settlement Agreement. That updated closure plan was recently approved about a month ago and as weve said before, its our desire that we never to implement that closure plan but that would require us to resume transfers of residence and we feel that we have demonstrated to cms and hopefully others that we truly are making long lasting improvements at laguna and were meeting every metric that they have asked us to meet in terms of these monthly milestones and we are anticipating a successful third Monitoring Survey. So, again, we think weve made the case for why this closure plan should never be implemented, but at the same time, we fulfilled our requirement to have a closure plan to ensure our ongoing funding. Next slide. So, throughout this process, we always want to and we always do keep residents at the center of all that we do and part of that residentcentered care is making sure we respect and protect our residents rights and one of those rights is the right to appeal. Its laid at statutory requirements in the state of california, medicaid Operations Manual and gives our residents quite a big role in terms of how their care is delivered in terms of where its delivered. Obviously, as ive said, were making sure were doing everything we can not to have to implement the closure plan, but and in fact, we have, in our Ongoing Communications with cms and also with hhs, we have requested that they continue the pause that is now set to expire on may 19th for transfers to other facilities and we are waiting their response to our request that they continue that pause. Dr. Colfax and i have regular discussions with c mr. S and hhs. They have indicated they are considering our request. We had discussion that when they extended the pause the last time, we were only given 24 hours notice and that created a lot of strain, particularly for our residents with their families, other Health Systems in the city who depend on laguna honda. They have indicated they are appreciative of what happened the last time and that they are confident they can give us a response well in advance of the may 19th date. However, they didnt give us a particular date, but they just said it would be much sooner than the previous notification and i have to say, based upon the discussions that dr. Colfax and i have been a part with the Senior Leadership at cms and hhs, it is, i think, a much better relationship than it was six months ago and they seem to be much more collaborative and responsive to our needs so im very hopeful that they will be true to their words and give us some relief on that pause sooner rather than later. Next slide. So, that concludes my brief overview and im sure you have questions and comments and i will do my best to try and address them at the appropriate time. Thank you, mr. Pickens to your team for this excellent presentation. Secretary morewitz, will you let us know if theres Public Comment with instructions. I want to clarify the number to call for Public Comment is 4156550001. Again, 4156550001 and access code is 25978442164. Pound. I have a script to read about Public Comment. For each agenda item, members of the public will have an opportunity to make comment for up to three minutes. The public process is designed to invite input and feedback from individuals in the community. However, process doesnt allow questions to be answered in the meeting or for members in the public to engage in pack and forth conversation with the commissioners. The commissioners do consider comments from members of the public when discussing an item and making request to the ph. Please note each individual is allowed one opportunity to speak per agenda item. Individuals may not return more than once to read statements from other individuals unable to attend the meeting. Written Public Comment may be sent to the Health Commission at the following e. Dress, health Dot Commission dot dhp at sfdph dot org. If you wish to spell your name for the minutes, you may do so without taking your allotted time. City policies along with federal state and local law prohibit discriminatory comments against well take Public Comment from individuals attending in person and take remote Public Comment from individuals who have received an accommodation for disability. For the meeting today, i have given accommodation to three people. Note, the first folks that we will call will be the three people. Others, please do not raise your hand until your category is called. I have given each individuals a code to speak when they begin their comments to prevent others from speaking during this time. Well hear remote Public Comment from all other individuals and theres a time limit of 20 minutes on the total remote comment to be heard on each item. Because of the new remote Public Comment procedures recommended by the office of city administrator and City Attorneys office, please do not raise your hand to make remote Public Comment on item until your category is called. Okay. So, please unmute the first person. I have a timer in my hand. Everybody gets three minutes and when the buzzer goes off, know your time is off. Call you are, youre unmuted. Less you know youre there. Thank you, this is michael, of the San Francisco great panthers. This closure plan is something that you should be ashamed of being a part of. Let me read a little bit of it. This is called the intent. The intent of this revised closure plan is ensure the safe ordering and clinically appropriate transfer or discharge of each patient with a minimum amount of stress for patients, families, guard januarys and legal representatives. All medicare and medicaid beneficiary patients will be discharged or transferred to the most appropriate setting possible, in terms of quality, services and location available and determines, and determined to be appropriate for each resident. About expeditions and safe of a matter as possible. People should not ashamed of this, of having signed onto this. I looked to see what was talked about at the, before the daily transfers took place and there really basically, its the same thing was that nearly you have a plan that said residents seems completing the patient Placement Associates for the following, current level of care, risks for transfer trauma, discharge options. Its the same stuff. This is an insult to the 12 people who died on the first goaround and i dont see anything in this that indicates that another one would be any different. Theres no theres still no places in San Francisco that are going to be able to take we have yet to have any proof that the legal discharge notices thats going to be given have any kind of backing and if push comes to shove, residents will rebel. The