Laguna Honda says it has submitted 500 milestones; DPH asks CMS to extend pause on involuntary transfers

Baljit Sangha, presenting on behalf of Laguna Honda, told the San Francisco Health Commission on May 16 that the hospital has submitted all 500 milestones in its action plan intended to secure recertification by state and federal regulators.

"An extension would allow us the time needed to recertify without having to transfer anyone," Sangha said, summarizing the departments formal request to the Centers for Medicare & Medicaid Services (CMS) for a pause on involuntary discharges beyond the current deadline.

The update traced the settlement and monitoring timeline the hospital is working under. Sangha said the city and County of San Francisco signed a settlement and systems agreement with CMS and the California Department of Public Health (CDPH) on Nov. 10, 2022, and that the agreement included payments to the city through Nov. 13, 2023. He said CMS agreed to pause involuntary discharges and transfers through at least May 19, 2023, and that DPH has asked CMS, in writing and verbally, to extend that pause while Laguna Honda completes recertification steps.

Sangha described the monitoring regime spelled out in the settlement: CMS will conduct monitoring surveys roughly every 90 days and has teams on site; CDPH surveyors visit regularly as well. He said Laguna Honda has hosted two 90-day monitoring surveys and that the second showed "much more progress" than the first. He also said CDPH identified a self-reported incident in which a resident care plan was not followed; Laguna Honda submitted a plan of correction that was accepted.

The milestone submission was presented as the central accomplishment of the last months. Sangha said the action plan grew to roughly 500 milestones as a result of a root-cause analysis and quality-improvement work. "All 500 of the action plan milestones have been submitted," he told the commission, calling it a "facility-wide accomplishment."

Sangha also gave an update on key leadership hires: the hospital has extended a conditional offer to a candidate for nursing home administrator and is in second-round interviews for the director of nursing role. He said those hires require background checks and other clearances before being finalized and that leadership onboarding is a priority before summer.

Public commenters pushed DPH and regulators to move cautiously. Caller Patrick Manachal urged Laguna Honda to demand CDPH release a third component of a recent extended survey, identified in the record as CDPH form 25-67, which he said had not been provided within the ten-day period the public expects. "Without seeing the third form 25-67 ... we have no real proof about what progress has been made," he said, and he referenced pending lawsuits arising from earlier transfers.

Clinical commenters echoed the worry that transfers would harm the frail residents. "Eviction equals abuse, neglect and abandonment," Dr. Palmer said during public comment, urging Laguna Honda management and the city attorney to refuse discharges deemed unsafe. Another caller, Norman Daigleman, said eviction "would be a certain death sentence" for some residents.

Commissioners pressed staff on how the department is communicating the harms and anxiety caused by uncertainty to CMS, CDPH and HHS. Sangha said DPH has been candid in both written and verbal communications and is using resident letters, translated materials, resident council meetings, ombudsman engagement and direct outreach through the care-experience team to keep residents and families informed and involved.

What happens next: DPH said it has formally requested an extension of the pause and is awaiting CMSs decision. The commission expressed support for staff work toward recertification and urged continued outreach to residents and families. The next procedural step is a regulator decision on the pause; Laguna Honda and DPH will report back to the commission on recertification progress and any CMS action.