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. Good morning and welcome to the street scape project and muni project. I certainly as the public works director for the city and county here and i want to thank you for all coming out to celebrate this very exciting project that will improve the lives of the many people who use this inner sunset corridor. The project which spans all the way from aguelo to 19th avenue will improve the quality of life and Transit Services of this diverse neighborhood, which serves families, students, merchants and tourists alike president the street scape improvement is a collaborative project with the ms works and the utilitys commission. For the past two years, theyve been working together to make crucial improvements to the inner sunset street scape and nearby Transit Services that not only make the area more vibrant and more accessible, safe and reliable. When you look around the surrounding streets, you see the vibrant landscapes that add to the neighborhoods charm, improve seating, as you can see, visitor striving, new street trees. All of this creates a healthy environment and a great carbon footprint. What many do not see are the upgraded traffic signals, the repaved roads and all of the help to improve thed safety and transit service. Theres many components to this project that has not been seen. We have improvements to the underground sewer line and improvements to our water lines, our firefightings were upgraded or replaced, all to increase capacity and to minimize any destructions that will provide more Reliable Service to the community. Also, as a part of this project, theres more than 3,000 feet of pipe that was installed for the department of technology for future fiber optic cables and this is a great partnership. As we do many projects on patrero were installing pipe and well have the pipes electric in and, of course, less destruction to the neighbor while the projects happen. With all of that said, it brings me great joy to see the work that all of these agencies are doing together and how we come together to improve the quality of life of this diverse neighborhood in San Francisco. San francisco. I want to thank john thomas and our project manager, johnny farm, harlin kelly and his team from the puc and mr. Maguire and, of course, our contractor, who was out here everyday making sure that we got this job done. And now, the person who helps to make all of these projects happen, the person who makes our neighborhoods better for everyone, the person looking out for the future of San Francisco, without future delay, let me introduce our mayor, london breed. [cheers and applause] its so good to be back. I remember when we first set on the path to do this project for this neighborhood, andrea, i just noticed you were over there and its great to see you and martha and so many folks from the community. You all did the work because you wanted Something Better for this community. We have kids everywhere and these kids from stepping stone preschool are joining us today. And youll get your snacks in just a minute, so dont worry. [cheers and applause] we have kids, we have families, seniors, people who, basically, love this community and so many amazing restaurants, so many amazing places to shop. This is like really a jewel in San Francisco and, in fact, when improve was supervisor, i came to this community a lot to hideout and relax. And it was great. What was so important was to make it a lot offer annua and dl with safety and Public Infrastructure improvements. One of the things that i spent time with some of the neighbors doing is standing on the corner of ninth and irving and many of you know the familiar sound of some of the onl old muni trains which still come through this way, how loud and heavy they are. Remember i said the new trains will be much quieter. Did you just hear how much quieter the new trains are . A loa lot of the promises to ths community are finally happening and it was because of your patience. We know that it was very challenging to come in and the construction and the loss of parking and tearing up the streets and digging in and you all, through this whole challenge, you were very patient and we really appreciate that, because now we are here realizing just really a dream for community, an improvement to the sidewalks, an improvement to the infrastructure and an improvement to our water pressure system so that when there is a fire or emergency, the pressure i know this is not probably that interesting, but it makes all the difference when dealing with any emergency that water suppression and our equipment and the systems actually work when we need it the most. The fiber optic cables, improvements to the sidewalks, all of the Amazing Things that will make this community not just safer but more boost and sobeautiful. I want to thank thet park neighbors, at the time of the leadership of andrea yaguin, that you pushed us to give some attention to this community and shine a light on the challenges that exist here is why were here, as well as the inner sunset merchants association. The merchants here who serve the community, this is really not just a place where so many neighbors enjoy and eat and go to the Hardware Stores and pick up glasses. People from ucfs spend a lot of time here during lunch and people from the park spend a lot of time here and this community has come together as a force to make amazing projects like this happen. So im really excited. Looking forward to doing even more, because i have not forgotten about the wires over on ninth and irving and what we need to do to underground those wires. I know thats important and were talking about right down the street, the gateway on gaten lincoln and ninth and to really transform this community because its a jewel in our community. Thank you to the department of public works, to mta, all of the contractors, all of incredible workers who basically not only worked in this community but spent money at the restaurants and this was definitely a great effort and took time and here we are, a celebration of just really an amazing project that is going to change the quality of life for the residents who live here. So enjoy it and next up, i want to take the opportunity to introduce your supervisor, valley brown, who as you remember was out here on a regular basis working with you all to move this project forward. She drove me a little crazy because she was running out of patience with the city bureaucracy and trying to get it done. And now she gets to enjoy the fruits of her labor. Ladies and gentlemen, your supervisor, valley brown [cheers and applause] you know what they say what doesnt kill us makes us stronger and thats how i feel about this project. I want to say im sorry to everyone. It was her fault. She started it and then i had to come in and finish it, right . [ laughter ] yeah, im not going go over everything weve done because i know mohamed nurue gave you all of the sexy details. But what i see is this neighborhood coming together and saying, ok, this is painful and especially the merchants, but we know once its finished, it will be amazing and 21 million later, yeah, it looks pretty amazing, id say. I want to thank people and i have to read this because i always forget one person and then i get in trouble after wars. Afterwards. So thank you, mayor, breed for starting it, city administrator, naomi kelly and mohamed nurue from public works. I mean, this is something i have to say was he really jumped in and said, lets make this happen and lets make it as less painful as we can. Acting director for sfmta, tom mcguire and San Franciscos puc. I would call everyone on this list and said if there was a pile of dirt and they couldnt park their car at 7 00 at night. So the responsiveness of their teams were amazing. I want to thank all of their teams because every week we had an issue, whether it was the veterinarian or people getting dirt in their driveway and couldnt park their car. Park driveway, this is all things that they really stepped up. I put 75k into budget so we could do