Annual Utilization Report of Long Term Care Facilities
Facility Name:	KAISER PERMANENTE POST ACUTE CARE CENTER
OSHPD ID:	206010914	Report Status:	Submitted
License Category:	Skilled Nursing Facility	Report Year:	2004

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, Assistant Administrator
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:	1/1/2004
11.	Operation Open To:	12/31/2004
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:	2/2/2005 2:24:25 PM

Section 2 - Facility Description

LICENSE CATEGORY (TYPE)

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

LICENSE TYPE OF CONTROL

Line No. (1) 5. Select the category that best describes the licensee type of control of your Long Term Care facility from drop down list: 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 Yes 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. (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, 2003 Census 133 0 0 0 0 133 2. + Admissions 2,316 0 0 0 0 2,316 3. - Discharges 2,323 0 0 0 0 2,323 4. Dec. 31, 2004 Census (Total) 126 0 0 0 0 126 5. Patient Days for 2004 47,726 0 0 0 0 47,726 7. Licensed Beds 176 0 0 0 0 176 8. Licensed Bed Days 64,416 0 0 0 0 64,416

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 12 1,275 12. Hospital 2,294 534 13. State Hospital 0 0 14. Other LTC 10 209 15. Residential Board & Care 0 185 16. Other 0 60 17. AWOL 0 18. Death 60 20. Total 2,316 2,323

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 7 22. Medi-Cal 0 23. Managed Care* 117 24. Private Insurance 0 25. Self-Pay 0 29. All Other 2 30. Total 126

* 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 697 32. 2 weeks to less than 1 month 929 33. 1 month to less than 3 months 581 34. 3 months to less than 7 months 70 35. 7 months to less than 1 year 44 36. 1 year to less than 2 years 0 37. 2 years to less than 3 years 2 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 2,323

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. 92

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 4 4 9 21 5 0 43 2. Black 0 1 0 1 1 0 0 3 3. Asian / Pac. Islander 0 0 0 0 1 0 0 1 4. Native American 0 0 0 0 0 0 0 0 5. Other / Unknown 0 0 1 1 2 0 0 4 6. Total Males 0 5 5 11 25 5 0 51

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. White 1 5 6 12 29 6 0 59 12. Black 0 1 1 1 2 1 0 6 13. Asian / Pac. Islander 0 1 1 1 1 0 0 4 14. Native American 0 0 0 0 0 0 0 0 15. Other / Unknown 0 1 1 1 3 0 0 6 16. Total Females 1 8 9 15 35 7 0 75

Ethnicity of Patients on December 31.

Line No. (1) Male* (2) Female** (3) Total 21. Hispanic 3 4 7 22. Non-Hispanic 47 70 117 23. Unknown 1 1 2 25. Total Patients 51 75 126

*  Total male patients in column 1, line 25 must agree with column 8, line 6.

** Total female patients in column 2, line 25 must agree with column 8, line 16.

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

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)."

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.) Yes

Detail of Capital Expenditures

Line No. (1) Description of Project (2) Projected Total Capital Expenditure (3) OSHPD Project No. (if applicable) 26. Replace HVAC Units $1,400,000 SS023013-01 27. 28. 29. 30.

General Comments:

Errors and Warnings