Survey Info.

Annual Utilization Report of Long Term Care Facilities
Facility Name:	ROYAL OAKS CONVALESCENT HOSPITAL
OSHPD ID:	206190665	Report Status:	Revised
License Category:	Skilled Nursing Facility	Report Year:	2011

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:

ROYAL OAKS CONVALESCENT HOSPITAL

OSHPD ID Number:

206190665

Street Address:

250 NORTH VERDUGO ROAD

City:

GLENDALE

Zip:

91206

Facility Phone No.:

(818) 244 - 1133 ext.

Administrator Name:

LILIA LIMCACO

Administrator E-mail Addr:

nursingtrinity@yahoo.com

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

Yes

10.

Operation Open From:

1/1/2011

11.

Operation Open To:

12/31/2011

12.

Name of Parent Corporation:

ROYAL OAKS CONVALESCENT HOSPITAL INC

13.

Corporate Business Address:

250 N VERDUGO RD

14.

City:

GLENDALE

15.

State:

16.

Zip:

91206 -

17.

Person Completing Report:

nelson rivera

18.

Report Preparer's Phone No.:

818-244-1133

19.

Fax No.:

818-246-1149

20.

E-mail Address:

riveranels4@aol.com

30.

Submitted by:

nelson

31.

Submitted Date and Time:

5/23/2012 2:45:11 PM

32.

Corrected by:

cindythom

33.

Corrected Date and Time:

5/14/2012 9:38:34 AM

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- Corporation

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	(3) Intermediate Care	(6) Total
1.	Dec 31, 2010 Census	112	0	112
2.	+ Admissions	350	0	350
3.	- Discharges	344	0	344
4.	Dec. 31, 2011 Census (Total)	118	0	118
5.	Patient Days for 2011	42,697	0	42,697
7.	Licensed Beds	133	3	136
8.	Licensed Bed Days	48,545	1,095	49,640

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	15	49
12.	Hospital	316	225
13.	State Hospital	0	0
14.	Other LTC	16	11
15.	Residential Board & Care*	2	9
16.	Other	1	0
17.	AWOL / AMA		5
18.	Death		45
20.	Total	350	344

*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	13
22.	Medi-Cal	95
23.	Managed Care*	5
24.	Private Insurance	1
25.	Self-Pay	4
29.	All Other	0
30.	Total	118

* 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	71
32.	2 weeks to less than 1 month	150
33.	1 month to less than 3 months	53
34.	3 months to less than 7 months	29
35.	7 months to less than 1 year	18
36.	1 year to less than 2 years	14
37.	2 years to less than 3 years	5
38.	3 years to less than 5 years	3
39.	5 years to less than 7 years	0
40.	7 years to less than 10 years	1
41.	10 years or longer	0
45.	Total	344

Hospice Program

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

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).	0

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.	0

Section 4 - Patient Demographics

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

Line No.		(1) < 45	(2) 45-54	(3) 55-64	(4) 65-74	(5) 75-84	(6) 85-94	(7) 95+	(8) Total
1.	White	1	2	3	2	8	9	2	27
2.	Black	1	1	1	0	2	0	0	5
3.	Asian / Pac. Islander	0	0	1	2	1	1	0	5
4.	Native American	0	0	0	0	0	0	0	0
5.	Other / Unknown	0	0	2	2	3	0	1	8
6.	Total Males	2	3	7	6	14	10	3	45

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

Line No.		(2) 45-54	(3) 55-64	(4) 65-74	(5) 75-84	(6) 85-94	(7) 95+	(8) Total
11.	White	0	2	7	18	17	1	45
12.	Black	2	1	0	1	0	0	4
13.	Asian / Pac. Islander	2	1	3	3	2	0	11
14.	Native American	0	0	0	0	0	0	0
15.	Other / Unknown	1	1	3	6	2	0	13
16.	Total Females	5	5	13	28	21	1	73

Ethnicity of Patients on December 31.

Line No.		(1) Male*	(2) Female**	(3) Total
21.	Hispanic	8	13	21
22.	Non-Hispanic	37	60	97
23.	Unknown	0	0	0
25.	Total Patients	45	73	118

* 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