Report Year:
Memorial Hospital of Gardena

Gardena

Page:1 of 9
Provide the Hospital Owner and Year of Report per Section 130061(e)
Facility Number: Facility Name: Address: City: 11843 Memorial Hospital of Gardena 1145 W. Redondo Beach Blvd. Gardena
Hospital Owner/Licensee: Year of Reporting: Contact 1 e-mail Address: Contact 2 e-mail Address: Contact 3 e-mail Address:: Name of Submitter: Submission Date:
Avanti Health System 2010
Memorial Hospital of Gardena 1/25/2011 3:00:00 PM
Report Status: Data Last Update: 01/11/2011

Submission Date:

01/25/2011

Print Date:

1/26/2011 8:38 AM

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Page:3 of 9

Page:4 of 9

Provide the number of inpaient beds and patient days per type of service per building per Section 130061(c)(1)(F) Building Number: 1 Type of Service Provided X Nursing Inpatient Beds Inpatient Beds Inpatient Beds 70 Inpatient Days 10 Inpatient Days 0 Inpatient Days 17391 X Surgical X Obstetrical Recovery Newborn/ WellBaby Emergency Building Name: Hospital
IntensiveCare Pediatric/Adol escent

3768 0

X Anesthesia X Clinical Lab

Psychiatric Nursing

Inpatient Beds

Inpatient Days

X Radiological/ Imaging

Nuclear Medicine

X Pharmaceutical X Obstetrical Ante/Postprtum Intermediate Care X Skilled Nursing Inpatient Beds Inpatient Beds Inpatient Beds 23 Inpatient Days 3221 X Dietetic X Administration X Support Services 69 Inpatient Days X Obstetrical Cesarean/Deliv Central Plant X Rehabilitation Therapy Renal Dialysis Outpatient Surgery

Total Beds this Building

Page:5 of 9
Provide the number of Inpatient beds and patient days per type of unit per building per Section 130061(c)(1)(F)

Building Number:

Building Name:
Hospital Acute Psychiatric 0 Inpatient Bed 0 Inpatient Days 0
Medical / Surgical (Include GYN) Inpatient Bed 70 Inpatient Days 1739 1
Acute Respiratory Care Inpatient Bed 0 Inpatient Days
Perinatal (excluse Newborn / GYN) Inpatient Bed Pediatric 23 Inpatient Days 3221
Burn Inpatient Bed 0 Inpatient Days 0
Skilled Nursing Inpatient Bed 69 Inpatient Days 2411 7
intensive Care Newborn Nursery 0 Inpatient Days 0 Inpatient Bed Rehabilitation Center Inpatient Days 1884 Inpatient Bed Chemical Dependency Inpatient Days 1884 Inpatient Bed 0 Inpatient Days Inpatient Days Inpatient Days 0

Intermediate Card

Inpatient Bed
Intensive Care Inpatient Bed 5
Int. Care / development Disabled Inpatient Bed 0 Inpatient Days 0

Coronary Care

Total Beds this Building Per Unit 172
Total Beds this Building Per Service 172

Page:6 of 9

For all buildings at the facility, indicate which ones are scheduled for general acute service removal. Building Number 1 Building Name Hospital Building to be Removed

Page:7 of 9

Page:8 of 9
Report any general acute care hospital inpatient service that is provided in any genaral acute care hospital building that is rated SPC-1 per Section 130061(c)(4)

Hospital

Type of Service Provided X X Nursing X IntensiveCare X Pediatric/Adol escent X Psychiatric Nursing X X Obstetrical Ante/Postprtum X Intermediate Care Dietetic Clinical Lab X Radiological/ Imaging Pharmaceutical X Newborn/ WellBaby X Outpatient Surgery Anesthesia X Obstetrical Recovery Renal Dialysis Surgical X Obstetrical Cesarean/Deliv Rehabilitation Therapy
Emergency Nuclear Medicine
Central Plant Support Services

Administration

Skilled Nursing

Page:9 of 9

Report the final configuration of all buildings on the hospital campus showing how each building will comply with the SPC-5/NPC-4 or 5 requirements whether by retrofit or by replacement and the type of service that will be provided in each general actue care hospital building per Section 130061(c)(5)

Building Number: Configuration :
Retrofit Non-Conforming building to SPC 2 and NPC 3 and remove from service by 2030
Type of Service Provided X Surgical X Obstetrical Cesarean/Deliv Rehabilitation Therapy

Nursing IntensiveCare

Anesthesia X Obstetrical Recovery Renal Dialysis
Pediatric/Adol escent Psychiatric Nursing
Clinical Lab Radiological/ Imaging Pharmaceutical X Emergency X Central Plant X Newborn/ WellBaby X Outpatient Surgery
Obstetrical Ante/Postprtum
X Intermediate Care X X Skilled Nursing
Dietetic Nuclear Medicine Administration X Support Services

Report Year:

Vista Hospital of South Bay

Gardena

Page:1 of 18
Provide the Hospital Owner and Year of Report per Section 130061(e)
Facility Number: Facility Name: Address: City: 11547 Vista Hospital of South Bay 1246 W. 155th St. Gardena
Hospital Owner/Licensee: Year of Reporting: Contact 1 e-mail Address: Contact 2 e-mail Address: Contact 3 e-mail Address:: Name of Submitter: Submission Date:
Vista Hospital of South Bay, LP 2010
Kevin Chavez 1/19/2011 3:59:57 PM
Report Status: Data Last Update: 01/19/2011

Submission Date:

01/19/2011

Print Date:

1/20/2011 8:38 AM

Page:2 of 18

For buildings which are planned for retrofit or replacement the report shall identify: Whether the hospital owner intends to retrofit or replace the building to SPC 2 or SPC 5 per section 130061(c)(1)(A). The deadline, as described in Section 130060 or 130061.5, for retrofit or replacement of the bulding that the hospital owner intends to meet, and the applicable extension for which the hospital owner has been approved per Section 130061(c)(1)(B) Bldg. No. 01 Building Name Original Building Alternate Building Address Building Resolution Retrofit Final SPC Rating If Required SPC2 Extension Date 01/01/2013 Anticipated Completion Date 07/01/2011

1246 W. 155th St.

Page:3 of 18

Page:4 of 18

Provide the number of inpaient beds and patient days per type of service per building per Section 130061(c)(1)(F) Building Number: 01 Type of Service Provided X Nursing Inpatient Beds Inpatient Beds Inpatient Beds 39 Inpatient Days 4 Inpatient Days 0 Inpatient Days 12874 X Surgical Obstetrical Recovery Newborn/ WellBaby Emergency Building Name: Original Building
IntensiveCare Pediatric/Adol escent

1432 0

X Anesthesia Clinical Lab

Psychiatric Nursing

Inpatient Beds

Inpatient Days

Radiological/ Imaging

Nuclear Medicine

X Pharmaceutical Obstetrical Ante/Postprtum Intermediate Care Skilled Nursing Inpatient Beds Inpatient Beds Inpatient Beds 0 Inpatient Days 0 X Dietetic Administration Support Services 0 Inpatient Days Obstetrical Cesarean/Deliv Central Plant X X Rehabilitation Therapy Renal Dialysis Outpatient Surgery

Total Beds this Building

Page:5 of 18
Provide the number of Inpatient beds and patient days per type of unit per building per Section 130061(c)(1)(F)

Building Number:

Building Name:
Original Building Acute Psychiatric 0 Inpatient Bed 0 Inpatient Days 0
Medical / Surgical (Include GYN) Inpatient Bed 39 Inpatient Days 1287 4
Acute Respiratory Care Inpatient Bed 0 Inpatient Days
Perinatal (excluse Newborn / GYN) Inpatient Bed Pediatric 0 Inpatient Days 0
Burn Inpatient Bed 0 Inpatient Days 0
Skilled Nursing Inpatient Bed 0 Inpatient Days 0
intensive Care Newborn Nursery 0 Inpatient Days 0 Inpatient Bed Rehabilitation Center Inpatient Days 1432 Inpatient Bed Chemical Dependency Inpatient Days 0 Inpatient Bed 0 Inpatient Days Inpatient Days Inpatient Days 0

Intermediate Card

Inpatient Bed
Intensive Care Inpatient Bed 4
Int. Care / development Disabled Inpatient Bed 0 Inpatient Days 0

Coronary Care

Total Beds this Building Per Unit 43
Total Beds this Building Per Service 43

Page:6 of 18

For all buildings at the facility, indicate which ones are scheduled for general acute service removal. Building Number Building Name Original Building South Addition North Addition Laboratory Addition Building to be Removed

Page:7 of 18

Page:8 of 18
Report any general acute care hospital inpatient service that is provided in any genaral acute care hospital building that is rated SPC-1 per Section 130061(c)(4)

Original Building

Type of Service Provided X X Nursing X IntensiveCare Pediatric/Adol escent Psychiatric Nursing X Obstetrical Ante/Postprtum X Intermediate Care Dietetic Clinical Lab Newborn/ WellBaby X Outpatient Surgery Anesthesia Obstetrical Recovery X Renal Dialysis Surgical Obstetrical Cesarean/Deliv Rehabilitation Therapy
Radiological/ Imaging Pharmaceutical
Emergency Nuclear Medicine
Central Plant Support Services

Administration

Skilled Nursing

Page:9 of 18

Report the final configuration of all buildings on the hospital campus showing how each building will comply with the SPC-5/NPC-4 or 5 requirements whether by retrofit or by replacement and the type of service that will be provided in each general actue care hospital building per Section 130061(c)(5)
Building Number: Configuration :
Retrofit Non-Conforming building to SPC 2 and NPC 3 and remove from service by 2030
Type of Service Provided X Surgical Obstetrical Cesarean/Deliv Rehabilitation Therapy

Nursing IntensiveCare

Anesthesia Obstetrical Recovery X Renal Dialysis
Pediatric/Adol escent Psychiatric Nursing X
Clinical Lab Radiological/ Imaging Pharmaceutical Emergency X Dietetic Nuclear Medicine Administration Support Services X Central Plant Newborn/ WellBaby X Outpatient Surgery

Obstetrical Ante/Postprtum

Intermediate Care

Page:10 of 18

South Addition

Retrofit Conforming building to NPC 4 or NPC 5
Type of Service Provided Surgical Obstetrical Cesarean/Deliv X Rehabilitation Therapy
Pediatric/Adol escent Psychiatric Nursing
Clinical Lab Radiological/ Imaging Pharmaceutical Newborn/ WellBaby Outpatient Surgery
Obstetrical Ante/Postprtum Dietetic Intermediate Care Administration Skilled Nursing

Emergency

Central Plant

Support Services

Page:11 of 18

North Addition

Type of Service Provided Surgical Obstetrical Cesarean/Deliv Rehabilitation Therapy
Anesthesia Obstetrical Recovery Renal Dialysis
Obstetrical Ante/Postprtum Dietetic Intermediate Care Administration Skilled Nursing X

Page:12 of 18

Laboratory Addition

Page:13 of 18

Include information on the number of inpatient beds by type of Service provided by buildings that are classified as SPC-2, SPC-3, SPC-4, and SPC-5 per Section 130061(e)

Building Number: 02

Type of Service Provided X Nursing IntensiveCare Inpatient Beds Inpatient Beds Surgical Anesthesia Obstetrical Recovery X Renal Dialysis Obstetrical Cesarean/Deliv X Rehabilitation Therapy
Pediatric/Adol escent Psychiatric Nursing Obstetrical Ante/Postprtum
Inpatient Beds Inpatient Beds Inpatient Beds

Clinical Lab

Newborn/ WellBaby

Outpatient Surgery

Emergency Dietetic Nuclear Medicine
Intermediate Care Skilled Nursing

0 Administration

Inpatient Beds Total Beds this Building 11

Page:14 of 18

Building Number: 03
Type of Service Provided Nursing IntensiveCare Inpatient Beds Inpatient Beds Surgical Anesthesia Obstetrical Recovery Renal Dialysis Obstetrical Cesarean/Deliv Rehabilitation Therapy
Emergency Dietetic X Nuclear Medicine
Inpatient Beds Total Beds this Building 0

Page:15 of 18

Building Number: 04

Page:16 of 18

Include information on the number of inpatient beds by type of unit provided by buildings that are classified as SPC-2, SPC-3, SPC-4, and SPC-5 per Section 130061(e)
South Addition Acute Psychiatric 0 Inpatient Bed 0 Inpatient Days 0
Medical / Surgical (Include GYN) Inpatient Bed 11 Inpatient Days 3630
Perinatal (excluse Newborn / GYN) Inpatient Bed 0 Inpatient Days 0

Pediatric

intensive Care Newborn Nursery 0 Inpatient Days 0 Inpatient Bed Rehabilitation Center 0 Inpatient Days 0 Inpatient Bed Chemical Dependency 0 Inpatient Days 0 Inpatient Bed 0 Inpatient Days Inpatient Days Inpatient Days 0
Inpatient Bed Intensive Care Inpatient Bed Coronary Care
Total Beds this Building Per Unit 11
Total Beds this Building Per Service 0

Page:17 of 18

North Addition Acute Psychiatric 0 Inpatient Bed 0 Inpatient Days 0
Medical / Surgical (Include GYN) Inpatient Bed 0 Inpatient Days 0
Total Beds this Building Per Unit 0

Page:18 of 18

Laboratory Addition Acute Psychiatric 0 Inpatient Bed 0 Inpatient Days 0