Survey Info.

Annual Utilization Report of Long Term Care Facilities
Facility Name:	FALLBROOK SKILLED NURSING
OSHPD ID:	206370704	Report Status:	Submitted
License Category:	Skilled Nursing Facility	Report Year:	2017

Table of Contents

Click on any of the links listed below to view the corresponding section.

Section 1 - General Information

Section 2 - Facility Description

Section 3 - Census and Utilization

Section 4 - Patient Demographics

Section 5 - Major Capital Expenditures

Errors and Warnings

Section 1 - General Information

Facility Name:

FALLBROOK SKILLED NURSING

OSHPD ID Number:

206370704

Street Address:

325 POTTER ST

City:

FALLBROOK

Zip:

92028

Facility Phone No.:

(760) 728 - 2330 ext.

Administrator Name:

Robert Durbin

Administrator E-mail Addr:

b.durbinfb@progressivehealthcare.com

Was this facility in operation at any time during the year?

Yes

10.

Operation Open From:

1/1/2017

11.

Operation Open To:

12/31/2017

12.

Name of Parent Corporation:

13.

Corporate Business Address:

14.

City:

15.

State:

16.

Zip:

17.

Person Completing Report:

Robert Castaneda

18.

Report Preparer's Phone No.:

909-796-2595

19.

Fax No.:

909-796-8797

20.

E-mail Address:

r.castaneda@progressivecarecenters.com

30.

Submitted by:

rcastanedafb

31.

Submitted Date and Time:

2/15/2018 5:25:24 PM

Section 2 - Facility Description

LICENSE CATEGORY (Completed by OSHPD.)

Line No.		(1)
1.	License Category	Skilled Nursing Facility

LICENSE TYPE OF CONTROL

Line No.		(1)
5.	From the list below, select the ONE category that best describes the licensee type of control of your long-term care facility, i.e. the type of organization that owns the license. (There will be a drop down box in ALIRTS - see list of choices below.)	Investor - Limited Liability Company

Facility Certifications

From the certification categories below, check those categories for which your facility was certified or contracted during the year (Check all that apply.)

Line No.		(1)
21.	Medicare Skilled Nursing	Yes
22.	Medi-Cal Skilled Nursing	Yes
23.	Medi-Cal Skilled Nursing/Mentally Disordered (Special Treatment Program)	No
24.	Medi-Cal Intermediate Care (General)	No
25.	Medi-Cal Intermediate Care / Developmentally Disabled	No
26.	Medi-Cal Subacute or Subacute - Pediatric	No

Section 3 - Census and Utilization

Census and Patient Days

For each licensed bed category (columns 1 through 5), enter prior year ending census (line 1), admissions (line 2), discharges (line 3), current year ending census, and patient days (line5).

Line No.		(1) Skilled Nursing	(7) Total
1.	Dec 31, 2016 Census	70	70
2.	+ Admissions	442	442
3.	- Discharges	444	444
4.	Dec. 31, 2017 Census (Total)	68	68
5.	Patient Days for 2017	25,662	25,662
7.	Licensed Beds	93	93
8.	Licensed Bed Days	33,945	33,945

Patients Admitted From and Discharged To

LTC Patients admitted from and discharged to each place shown.

Line No.		(1) Admitted From	(2) Discharged To
11.	Home	11	261
12.	Hospital	422	98
13.	State Hospital	0	0
14.	Other LTC	6	15
15.	Residential Board & Care*	2	21
16.	Other	1	3
17.	AWOL / AMA		10
18.	Death		36
20.	Total	442	444

*Include RCFE, ARF, Other Assisted Living Facilities, or a secured facility such as an Alzheimer's unit, jail or prison.

Patients By Payment Source On December 31

Number of patients in the facility on December 31, whose principal source of payment was from the sources shown.

Line No.		(1) Patients
21.	Medicare	9
22.	Medi-Cal	18
23.	Managed Care*	37
24.	Private Insurance	3
25.	Self-Pay	0
29.	All Other	1
30.	Total	68

* Include patients enrolled in Medicare and Medi-Cal managed care health plans.

Discharges By Length Of Stay

Number of discharges for each of the ranges of length of stay below.

Line No.	Time in Facility	(1) Patients
31.	Less than 2 weeks	217
32.	2 weeks to less than 1 month	123
33.	1 month to less than 3 months	70
34.	3 months to less than 7 months	18
35.	7 months to less than 1 year	4
36.	1 year to less than 2 years	5
37.	2 years to less than 3 years	1
38.	3 years to less than 5 years	4
39.	5 years to less than 7 years	2
40.	7 years to less than 10 years	0
41.	10 years or longer	0
45.	Total	444

Hospice Program

Line No.		(1)
51.	Did your facility offer a hospice program during the report period?	No

Special Programs

Line No.		(1) Patients
52.	Number of patients diagnosed as having AIDS, ARC, prodromal AIDS or HIV-related diseases and illness (HTLV-III / LAV).	1

Line No.		(1)
53.	Does your facility offer a specialized program for Alzheimer's patients?	No

Line No.		(1) Patients
54.	Number of patients who had a primary or secondary diagnosis of Alzheimer's Disease.	6

Section 4 - Patient Demographics

Males - Race and Age of Male LTC Patients on December 31.

Line No.		(3) 55-64	(4) 65-74	(5) 75-84	(6) 85-94	(8) Total
1.	White	2	5	10	4	21
2.	Black	0	0	0	0	0
3.	Asian / Pac. Islander	0	0	0	0	0
4.	Native American	0	0	0	0	0
5.	Other / Unknown	0	1	0	0	1
6.	Total Males	2	6	10	4	22

Females - Race and Age of Female LTC Patients on December 31.

Line No.		(3) 55-64	(4) 65-74	(5) 75-84	(6) 85-94	(7) 95+	(8) Total
11.	White	1	8	20	14	3	46
12.	Black	0	0	0	0	0	0
13.	Asian / Pac. Islander	0	0	0	0	0	0
14.	Native American	0	0	0	0	0	0
15.	Other / Unknown	0	0	0	0	0	0
16.	Total Females	1	8	20	14	3	46

Ethnicity of Patients on December 31.

Line No.		(1) Male*	(2) Female**	(3) Total
21.	Hispanic	6	5	11
22.	Non-Hispanic	16	41	57
23.	Unknown	0	0	0
25.	Total Patients	22	46	68

* Total male patients in line 25, column 1 must be the same as reported in line 6, column 8.

** Total female patients in line 25, column 2 must be the same as reported in line 16, column 8.

Section 5 - Major Capital Expenditures

Section 127285(3) of the Health and Safety Code requires each facility to report "acquisitions of diagnostic or therapeutic equipment during the reporting period with a value in excess of five hundred thousand dollars ($500,000)."

Diagnostic and Therapeutic Equipment Acquired During The Report Period

Line No.		(1)
1.	Did your facility acquire any diagnostic or therapeutic equipment that had a value in excess of $500,000? (If 'Yes', fill out lines 2 through 11, as necessary, below.)	No

Diagnostic and Therapeutic Equipment Detail

Line No.	(1) Description of Equipment	(2) Value	(3) Date of Aquisition MM/DD/YYYY	(4) Means of Acquisition
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Building Projects Commenced During Report Period Costing Over $1,000,000

Section 127285(4) of the Health and Safety Code requires each facility to report the "commencement of projects during the reporting period that require a capital expenditure for the facility or clinic in excess of one million dollars ($1,000,000)."

Line No.		(1)
25.	Did your facility commence any building projects during the report period which will require an aggregate capital expenditure exceeding $1,000,000? (If 'Yes', fill out lines 26 through 30, as necessary, below.)	No

Detail of Capital Expenditures

Line No.	(1) Description of Project	(2) Projected Total Capital Expenditure	(3) OSHPD Project No. (if applicable)
26.
27.
28.
29.
30.

General Comments:

Errors and Warnings