Annual Utilization Report of Long Term Care Facilities
Facility Name:KAISER PERMANENTE POST ACUTE CARE CENTER
OSHPD ID:206010914Report Status:Submitted
License Category:Skilled Nursing FacilityReport Year:2013
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
1.Facility Name:KAISER PERMANENTE POST ACUTE CARE CENTER
2.OSHPD ID Number:206010914
3.Street Address:1440 - 168TH AVENUE
4.City:SAN LEANDRO
5.Zip:94578
6.Facility Phone No.:(510) 481 - 8575 ext.
7.Administrator Name:Christopher Cherney
8.Administrator E-mail Addr:Christopher.Cherney@kp.org
9.Was this facility in operation at any time during the year?Yes
10.Operation Open From:1/1/2013
11.Operation Open To:12/31/2013
12.Name of Parent Corporation:Kaiser Foundation Hospitals, Inc.
13.Corporate Business Address:1950 Franklin Street
14.City:Oakland
15.State:CA
16.Zip:94612 -
17.Person Completing Report:Christopher Cherney
18.Report Preparer's Phone No.:510-481-6312
19.Fax No.:510-481-6310
20.E-mail Address:Christopher.Cherney@kp.org
30.Submitted by:206010914
31.Submitted Date and Time:2/13/2014 2:59:01 PM
Section 2 - Facility Description
LICENSE CATEGORY (Completed by OSHPD.)
Line
No.		(1)
1.License CategorySkilled 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.)Non-profit 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 NursingYes
22.Medi-Cal Skilled NursingNo
23.Medi-Cal Skilled Nursing/Mentally Disordered (Special Treatment Program)No
24.Medi-Cal Intermediate Care (General)No
25.Medi-Cal Intermediate Care / Developmentally DisabledNo
26.Medi-Cal Subacute or Subacute - PediatricNo
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
(2)

Skilled Nursing Mentally Disordered
(3)



Intermediate Care		(4)
Intermediate Care Develop-
mentally Disabled
(5)


Congregate Living Health Facility
(6)




Total
1.Dec 31, 2012 Census1110000111
2.+ Admissions1,56500001,565
3.- Discharges1,55800001,558
4.Dec. 31, 2013 Census
(Total)		1180000118
5.Patient Days for 201341,714000041,714
7.Licensed Beds1760000176
8.Licensed Bed Days64,240000064,240

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.Home6965
12.Hospital1,559250
13.State Hospital00
14.Other LTC097
15.Residential Board & Care*0151
16.Other00
17.AWOL / AMA15
18.Death80
20.Total1,5651,558
*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.Medicare3
22.Medi-Cal0
23.Managed Care*85
24.Private Insurance0
25.Self-Pay1
29.All Other29
30.Total118
* 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 weeks521
32.2 weeks to less than 1 month760
33.1 month to less than 3 months160
34.3 months to less than 7 months61
35.7 months to less than 1 year52
36.1 year to less than 2 years3
37.2 years to less than 3 years1
38.3 years to less than 5 years0
39.5 years to less than 7 years0
40.7 years to less than 10 years0
41.10 years or longer0
45.Total1,558

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).20

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.275
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.White346672028
2.Black124332015
3.Asian / Pac. Islander00233008
4.Native American00000000
5.Other / Unknown00000000
6.Total Males461212134051
Females - Race and Age of Female 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
11.White23312103033
12.Black0434113025
13.Asian / Pac. Islander01233009
14.Native American00000000
15.Other / Unknown00000000
16.Total Females28819246067
Ethnicity of Patients on December 31.
Line
No.		(1)
Male*		(2)
Female**		(3)
Total
21.Hispanic4610
22.Non-Hispanic4761108
23.Unknown000
25.Total Patients5167118
*  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