Was this hospital in operation at any time during the year?
Yes
10.
Operation Open From:
1/1/2014
11.
Operation Open To:
12/31/2014
12.
Name of Parent Corporation:
none
13.
Corporate Business Address:
15400 Foothill Boulevard Reimbursement Dept., Bldg A, QIC 40501
14.
City:
San Leandro
15.
State:
CA
16.
Zip:
94578 -
17.
Person Completing Report:
Sonny Fong
18.
Report Preparer's Phone No.:
510-535-7608
19.
Fax No.:
510-437-4588
20.
E-mail Address:
sfong@acmedctr.org
30.
Submitted by:
sofong
31.
Submitted Date and Time:
1/30/2015 2:12:28 PM
32.
Corrected by:
denarduy
33.
Corrected Date and Time:
5/27/2015 2:53:48 PM
Section 2 - Hospital Description
LICENSE CATEGORY (TYPE) (Completed by OSHPD.)
Line No.
(1)
1.
License Category:
General Acute Care Hospital
LICENSEE TYPE OF CONTROL
Line No.
(1)
5.
Select the category that best describes the licensee type of control of your hospital (the type of organization that owns the license) from the list below:
City or County
PRINCIPAL SERVICE TYPE
Line No.
(1)
25.
Select the category that best describes the type of service provided to the majority of your patients. (The type or service is usually consistant with majority of, or mix of reported patient days.)
General Medical / Surgical
Section 3 - Inpatient Services
INPATIENT BED UTILIZATION - DO NOT INCLUDE NORMAL NEWBORNS IN BED UTILIZATION DATA
Line No.
Bed Classification and Bed Designation
(1)
Licensed Beds as of 12/31
(2)
Licensed Bed Days
(3)
Hospital Discharges (including deaths)
(4) Intra-hospital Transfers
(5)
Patient (Census) Days
GAC Bed Designations
1.
Medical / Surgical (include GYN)
161
67,885
8,990
35,658
2.
Perinatal (exclude Newborn / GYN)
17
6,205
1,507
3,721
3.
Pediatric
0
0
0
0
4.
Intensive Care
20
7,300
398
1,242
6,098
5.
Coronary Care
0
0
0
0
0
6.
Acute Respiratory Care
0
0
0
0
0
7.
Burn
0
0
0
0
0
8.
Intensive Care Newborn Nursery
8
2,920
305
80
1,206
9.
Rehabilitation Center
0
0
0
0
15.
Subtotal - GAC
206
84,310
11,200
46,683
16.
Chemical Dependency Recovery Hospital
0
0
0
0
17.
Acute Psychiatric
80
29,200
3,014
25,005
18.
Skilled Nursing
0
0
0
0
0
19.
Intermediate Care
0
0
0
0
20.
Intermediate Care / Developmentally Disabled
0
0
0
0
25.
Total (Sum of lines 15 thru 20)
286
113,510
14,214
71,688
Chemical Dependency Recovery Services In Licensed GAC and Acute Psychiatric Beds*
Line No.
Bed Classification
(1)
Licensed Beds
(3)
Hospital Discharges
(5) Patient (Census) Days
30.
GAC - Chemical Dep Recovery Services
0
0
0
31.
Acute Psych - Chemical Dep Recovery Svcs
0
0
0
* The licensed services data for these CDRS are to be included in lines 1 through 25 above.
Newborn Nursery Information
Line No.
(1) Nursery Bassinets
(3) *Nursery Infants
(5) Nursery Days
35.
Newborn Nursery
20
1,135
1,902
* Nursery Infants are the "normal" newborn nursery equivalent to discharges from licensed beds.
Skilled Nursing Swing Beds (Completed by OSHPD.)
Line No.
(1)
40.
Number of licensed General Acute Care beds approved for Skilled Nursing Care:
0
Complete lines 43 through 70 only if your hospital has licensed Acute Psychiatric or PHF beds. Include Chemical Dependency Recovery Services provided in licensed Acute Psychiatric beds.
Acute Psychiatric Patients By Unit on December 31
Line No.
(1) Number of Patients
43.
Locked
69
44.
Open
0
45.
Acute Psychiatric Total*
69
Acute Psychiatric Patients By Age Category on December 31
Line No.
(1) Number of Patients
46.
0 - 17 Years
0
47.
18 - 64 Years
65
49.
65 Years and Older
4
50.
Acute Psychiatric Total*
69
Acute Psychiatric Patients By Primary Payer on December 31
Line No.
(1) Number of Patients
51.
Medicare - Traditional
17
52.
Medicare - Managed Care
1
53.
Medi-Cal - Traditional
0
54.
Medi-Cal - Managed Care
29
55.
County Indigent Programs
0
56.
Other Third Parties - Traditional
6
57.
Other Third Parties - Managed Care
3
58.
Short-Doyle (includes Short-Doyle Medi-Cal)
13
59.
Other Indigent
0
64.
Other Payers
0
65.
Acute Psychiatric Total*
69
* Acute Psychiatric Total on lines 45, 50 and 65 must agree.
Short Doyle Contract Services
Line No.
(1)
70.
During the reporting period, did you provide any acute psychiatric care under a Short-Doyle contract?
Yes
Inpatient Hospice Program
Line No.
(1)
71.
Did your hospital offer an inpatient hospice program during the report period?
No
If 'yes' on line 71, what type of bed classification is used for this service? (Check all that apply.)
Line No.
Bed Classification
(1)
72.
General Acute Care
No
73.
Skilled Nursing (SN)
No
74.
Intermediate Care (IC)
No
PALLIATIVE CARE PROGRAM
Line No.
(1)
80.
Did your hospital have an inpatient palliative care program during the report period?
Yes
PALLIATIVE CARE PROGRAM - An interdisciplinary team that sees patient, identifies needs, makes treatment recommendations, facilitaties patient and /or family decision making, and/or directly provides palliative care for patients with serious illness and their families.
If 'yes' on line 80, Please answer the questions below.
Line No.
(1)
81.
How many Advanced Practice Nurses(APN)Registered Nurses(RN) are on the inpatient palliative care team?
0
82.
How many of these APN/RNs are board certified by the National Board for Certification for Hospice and Palliative Nursing?
0
83.
How many Physicians are on the inpatient palliative care team?
0
84.
How many of these Physicians are board certified by the American Board of Medical Specialties?
0
85.
How many Social Workers are on the inpatient palliative care team?
1
86.
How many of these Social Workers hold an Advanced Certified Hospice and Palliative Social Worker credential from the National Association of Social Worker?
0
87.
How many Chaplains are on the inpatient palliative care team?
0
*Staffing data should only reflect inpatient palliative care team.
Line No.
(1)
90.
Did your hospital have outpatient palliative care services during the report period?
No
Section 4 - Emergency Department Services (EDS)
EMSA Trauma Center Designation on December 31
(Completed by OSHPD from EMSA data.)
Line No.
(1) Designation
(2) Pediatric
1.
Level II
Licensed Emergency Department Level
(Completed by OSHPD from DHS Data.)
Line No.
(1) January 1
(2) December 31
2.
Basic
Basic
Services Available on Premises
(Check all that apply.)
Line No.
Services Available
(1) 24 Hour
(2) On-Call
11.
Anesthesiologist
Yes
No
12.
Laboratory Services
Yes
No
13.
Operating Room
Yes
No
14.
Pharmacist
Yes
No
15.
Physician
Yes
No
16.
Psychiatric ER
Yes
No
17.
Radiology Services
Yes
No
Emergency Department Services
Line No.
EDS Visit Type
CPT Codes
(1)
Visits not Resulting in Admission*
(2) Admitted from ED (Enter Total Only if Details not Available)
(3)
Total ED Traffic (1) + (2)
21.
Minor
99281
36,079
39
22.
Low/Moderate
99282
10,823
48
23.
Moderate
99283
11,910
59
24.
Severe without threat
99284
17,218
354
25.
Severe with threat
99285
5,297
8,989
30.
TOTAL
81,327
9,489
90,816
* DO NOT INCLUDE patients who register but left without being seen, employee physicals and scheduled Clinic-type visits.
Emergency Medical Treatment Stations on December 31
Line No.
(1)
35.
Enter the number of emergency medical treatment stations.
52
Treatment Station - A specific place within the emergency department adequate to treat one patient at a time. Do not count holding or observation beds.
Non-Emergency (Clinic) Visits Seen in Emergency Department
Line No.
(1)
40.
Enter the number of non-emergency (clinic) visits seen in ED.
0
Emergency Registrations, But Patient Leaves Without Being Seen*
Line No.
(1)
45.
Enter the number of EDS registrations that did NOT result in treatment.
2,870
* Include patients who arrived at ED, but did not register and left without being seen (if available)
Emergency Department Ambulance Diversion Hours
Line No.
(1)
50.
Were there periods when the ED was unable to receive any and all ambulance patients during the year and as a result ambulances were diverted to other hospitals? If 'yes' fill out lines 51 through 62 below. Count only those hours in which the ED was unavailable TO ALL PATIENTS (see instructions).
Yes
Number of Ambulance Diversion Hours that occurred at Emergency Department
Line No.
Month
(1) Hours
51.
January
20
52.
February
25
53.
March
30
54.
April
21
55.
May
19
56.
June
31
57.
July
38
58.
August
32
59.
September
26
60.
October
32
61.
November
23
62.
December
18
65.
Total Hours
315
Section 5 - Surgery and Related Services
Surgical Services
Line No.
Surgical Services
(1) Surgical Operations
(2) Operating Room Minutes
1.
Inpatient
2,888
482,286
2.
Outpatient
2,663
320,643
Operating Rooms On December 31
Line No.
Operating Room Type
(1) Number
7.
Inpatient Only
0
8.
Outpatient Only
0
9.
Inpatient and Outpatient
6
10.
Total Operating Rooms
6
Ambulatory Surgical Program
Line No.
(1)
15.
Did your hospital have an organized ambulatory surgical program?
Yes
Live Births
Line No.
(1) Number
20.
Total Live Births (Count multiple births separately)*
1,122
21.
Live Births with Birth Weight Less Than 2500 grams (5 lbs. 8 oz.)
66
22.
Live Births with Birth Weight Less Than 1500 grams (3 lbs. 5 oz)
2
* TOTAL LIVE BIRTHS on line 20 should approximate the number of Perinatal discharges shown in Section 3, line 2, column 3. Include LDR or LDRP births and C-Section deliveries.
Alternate Birthing (Outpatient) Center Information
Line No.
(1)
31.
Did your hospital have an approved alternate birthing (outpatient) program?
No
32.
Was your alternate setting was approved as LDR
No
33.
Was your alternate setting was approved as LDRP
No
Other Live Birth Data
Line No.
(1) Number
36.
How many of the live births reported on line 20 occurred in your alternative (outpatient) setting? Do not include C-Section deliveries.
0
37.
How many of the live births reported on line 20 were C-Section deliveries?
316
Licensed Cardiology and Cardiovascular Surgery Services (Completed by OSHPD.)
Line No.
(1) Licensure
41.
Cardiac Catheterization Only
Note: Complete lines 42 to 85 if licensed for Cardiovascular Surgery Services. Complete lines 55 to 85 if licensed for Cardiac Catheterization only.
Licensed Cardiovascular Operating Rooms
Line No.
(1)
42.
Number of operating rooms licensed to perform cardiovascular surgery on December 31.
0
Cardiovascular Surgical Operations (with and without the HEART/LUNG MACHINE*)
Line No.
(1) Cardio-Pulmonary Bypass USED*
(2) Cardio-Pulmonary Bypass NOT USED
43.
Pediatric
0
0
44.
Adult
0
0
45.
Total Cardiovascular Surgical Operations
0
0
* Also refered to as Extracorporeal Bypass or "on-the-pump" (heart/lung machine).
Coronary Artery Bypass Graft (CABG) Surgeries*
Line No.
(1)
50.
Number of Coronary Artery Bypass Graft (CABG) surgeries performed.
0
* Subset of cardiovascular surgeries reported on line 45 above.
Cardiac Catheterization Lab Rooms
Line No.
(1)
55.
Number of rooms equipped to perform cardiac catheterizations on December 31.
1
Cardiac Catheterization Visits
Line No.
(1) Diagnostic
(2) Therapeutic
56.
Pediatric - Inpatient
0
0
57.
Pediatric - Outpatient
0
0
58.
Adult - Inpatient
78
41
59.
Adult - Outpatient
143
93
60.
Total Cardiac Catheterization Visits
221
134
Distribution of Procedures Performed in Catheterization Laboratory
Line No.
(1) Procedures
65.
Diagnostic Cardiac Catheterization Procedures (LHC, R & LHC)
221
66.
Myocardial Biopsy
0
71.
Permanent Pacemaker Implantation
0
711.
Other Permanent Pacemaker Procedures (Generator or Lead Replacement)
All other catheterization procedures performed in the lab
93
85.
Total Catheterization Procedures
539
Percutaneous Transluminal Balloon Valvuloplasty(PTBV) is very rarely done in these times. Those that are done are generally on pediatric patients.
AICD procedures are frequently done in the cath lab and are very similar to permanent pacemaker implants.
NOTE: Do Not Include Any Of The Following As A Cardiac Catheterization:
Defibrillation
Temporary Pacemaker Insertion
Cardioversion
Pericardiocentesis
Section 6 - Major Capital Expenditures
Section 127285(3) of the Health and Safety Code requires each hospital 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 hospital 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 hospital 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 hospital 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:
Correction submitted to reflect correct bed count.