Resolution approving Amendment No. 1 to the agreement between the City and County of San Francisco, acting by and through, the Department of Public Health (DPH), and Community Forward SF, to provide medical respite and sobering center services, to extend the term by three years and six months from December 31, 2025, for a total term of July 1, 2024, through June 30, 2029, and to increase the amount by $22,263,326 for a total not to exceed amount of $32,262,830; and to authorize DPH to enter into amendments or modifications to the agreement that do not materially increase the obligations or liabilities to the City and are necessary to effectuate the purposes of the agreement or this Resolution.

This resolution approves Amendment No. 1 to an agreement between the Department of Public Health (DPH) and Community Forward SF (CFSF) for medical respite and sobering center services. The amendment extends the contract term by three years and six months, from December 31, 2025, to June 30, 2029, for a total term of five years (July 1, 2024, through June 30, 2029). It also increases the funding by $22,263,326, bringing the total not-to-exceed amount to $32,262,830. Services are provided at 1171, 1179, and 1185 Mission Street in San Francisco.

Key programs and changes include:

• Medical Respite: Provides 75 beds for medically frail homeless individuals recovering from illness or injury, focusing on chronic health management and social services. The average stay is 46-60 days.
• Sobering Center: Offers 14 beds for individuals intoxicated on alcohol or opioids to safely sober up, diverting them from emergency departments and jails. Its scope has expanded to include opioid overdose recovery and is formalized as an alternate destination for emergency medical services.
• Managed Alcohol Program (MAP): Previously a standalone program, it is now consolidated into the Medical Respite facility, reducing its capacity from 20 to 10 beds due to a shift in primary substance addictions from alcohol to opioids/stimulants. This consolidation resulted in $1.20 million (17.3%) in budget savings and a 17.6% reduction in FTEs from FY 2024-25 to FY 2025-26.

New operational requirements enhance safety, including mandatory searches for weapons upon entry, regular bathroom checks (every 30 minutes with call-and-response), and strict protocols for handling non-compliance, implemented due to escalating safety incidents involving weapons. The total budget for FY 2025-26 is $5.76 million, primarily funded by the General Fund (93%), Proposition C revenues (7%), and the Opioid Settlement Fund (less than 1%). Program performance in FY 2023-24 was rated as "commendable/exceeds standards" by DPH.

This agreement directly impacts San Francisco residents, particularly homeless individuals struggling with health issues and substance use disorders, by providing crucial temporary shelter, medical respite, and safe sobering services. The expansion of the Sobering Center to include opioid recovery and its formalization as an alternate EMS destination means more efficient and appropriate care for those in crisis, potentially reducing strain on emergency services and jails. New safety protocols aim to create safer environments within these facilities, though they introduce stricter entry requirements for clients.

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