Laguna Honda staff say Medicare survey could arrive any day as leadership hires and discharges continue

San Francisco Department of Public Health leaders told the Health Commission that Laguna Honda Hospital is steadily preparing for a Medicare provider certification survey and has taken steps to strengthen leadership and discharge planning.

Acting CEO Mark Pickens said the hospital has onboarded two directors of nursing, Tracy Brown and Michael Collins, and is close to hiring a chief medical officer. "We are now then in the window awaiting the actual survey process to ensue," Pickens said, describing a CMS-directed change-of-information application and a new Medicare application filed in mid-September.

Pickens told commissioners the hospital paused milestone submissions briefly to prioritize survey readiness but will resume work on remaining items. "There are a total of 119 milestones that remain in progress that have dates of completion between today and the last indicated date of November 3," he said.

On resident placement, Pickens said Laguna Honda has discharged 15 residents since April who no longer meet the skilled nursing level-of-care criteria; most moved to board-and-care homes or supportive housing and a few returned home. He said 10 additional residents are on a priority list for imminent discharge and that, as of the latest report, 75 residents in total had been identified as not meeting skilled-nursing criteria. "We do our due diligence to make sure they're being cared for at the appropriate level in a safe and effective manner," Pickens said.

Public commenters pressed for clarity on the numbers and the status of the settlement oversight. Caller Patrick Manachar asked about discrepancies across past reports and whether required monitoring reports and root-cause analyses remain active; he said, "It doesn't appear that the numbers add up and that all of the people identified as no longer needing skilled care have been accounted for." Pickens and commissioners acknowledged the numbers are fluid and emphasized collaboration with state partners and local placement teams to find safe options.

Commissioners noted work on behavioral health improvements at Laguna Honda, including three work groups to identify staff training needs and a pilot six-person behavioral unit. The commission also discussed the use of robotic pet therapy and the recently approved admissions policy excluding individuals whose behavioral health needs exceed skilled nursing capability.

The Health Commission said it will monitor progress and expects to be notified when CMS or California Department of Public Health survey teams arrive.