Survey Info.

Annual Utilization Report of Long Term Care Facilities
Facility Name:	SHARP HOSPICECARE PARKVIEW HOME
OSHPD ID:	206374431	Report Status:	Submitted
License Category:	Congregate Living Health Facility	Report 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

Facility Name:

SHARP HOSPICECARE PARKVIEW HOME

OSHPD ID Number:

206374431

Street Address:

5788 LYDEN WAY

City:

SAN DIEGO

Zip:

92120

Facility Phone No.:

(619) 286 - 2503 ext.

Administrator Name:

Suzanne K Johnson

Administrator E-mail Addr:

suzanne.johnson@sharp.com

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:

Sharp Grossmont Hospital

13.

Corporate Business Address:

5555 Grossmont Center Drive

14.

City:

La Mesa

15.

State:

16.

Zip:

91942 -

17.

Person Completing Report:

Pat Salmon

18.

Report Preparer's Phone No.:

619-667-1980

19.

Fax No.:

619-667-1940

20.

E-mail Address:

patricia.salmon@sharp.com

30.

Submitted by:

psalmon1

31.

Submitted Date and Time:

2/18/2014 4:17:26 PM

Section 2 - Facility Description

LICENSE CATEGORY (Completed by OSHPD.)

Line No.		(1)
1.	License Category	Congregate Living Health 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 Nursing	No
22.	Medi-Cal Skilled Nursing	No
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.		(5) Congregate Living Health Facility	(6) Total
1.	Dec 31, 2012 Census	3	3
2.	+ Admissions	254	254
3.	- Discharges	253	253
4.	Dec. 31, 2013 Census (Total)	4	4
5.	Patient Days for 2013	1,264	1,264
7.	Licensed Beds	4	4
8.	Licensed Bed Days	1,460	1,460

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	109	6
12.	Hospital	105	0
13.	State Hospital	0	0
14.	Other LTC	32	3
15.	Residential Board & Care*	8	0
16.	Other	0	0
17.	AWOL / AMA		0
18.	Death		244
20.	Total	254	253

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

* 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	245
32.	2 weeks to less than 1 month	7
33.	1 month to less than 3 months	1
34.	3 months to less than 7 months	0
35.	7 months to less than 1 year	0
36.	1 year to less than 2 years	0
37.	2 years to less than 3 years	0
38.	3 years to less than 5 years	0
39.	5 years to less than 7 years	0
40.	7 years to less than 10 years	0
41.	10 years or longer	0
45.	Total	253

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).	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.	4

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	0	0	0	0	0	0	0	0
2.	Black	0	0	0	0	0	0	0	0
3.	Asian / Pac. Islander	0	0	0	0	0	0	0	0
4.	Native American	0	0	0	0	0	0	0	0
5.	Other / Unknown	0	0	0	0	0	0	0	0
6.	Total Males	0	0	0	0	0	0	0	0

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

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

Ethnicity of Patients on December 31.

Line No.		(2) Female**	(3) Total
21.	Hispanic	0	0
22.	Non-Hispanic	4	4
23.	Unknown	0	0
25.	Total Patients	4	4

* 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