CHHP Management, LLC dba Community Hospital of Huntington Park

Training Proposal for: CHHP Management, LLC dba Community Hospital of Huntington Park Agreement Number: ET13-0394 Panel Meeting of: May 23, 2013 ETP Regional Office: North Hollywood Analyst: J. Romero PROJECT PROFILE Contract Attributes: Counties Served: Retrainee SET Priority Rate Medical Skills Training Job Creation Initiative HUA Los Angeles County Industry Sector(s): Healthcare Priority Industry: Yes No Repeat Contractor: Yes No Union(s): Yes No Number of Employees in: CA: 1,400 U.S.: 1,400 Worldwide: 1,400 Turnover Rate: 12% Managers/Supervisors: (% of total trainees) FUNDING DETAIL 0% Program Costs - (Substantial Contribution) (High Earner Reduction) = Total ETP Funding $248,554 $0 $0 $248,554 In-Kind Contribution: 100% of Total ETP Funding Required $275,796 ETP 130 - Single (08/16/12) 1 of 5

Community Hospital of Huntington Park May 23, 2013 ET13-0394 TRAINING PLAN TABLE Job No. Job Description 1 Retrainee SET Priority Rate Medical Skills Training HUA 2 SET Job Creation Initiative Medical Skills Training HUA Type of Training MS Didactic, MS Clinical with Preceptor, Continuous Impr., Computer Skills MS Didactic, MS Clinical with Preceptor, Continuous Impr., Computer Skills Estimated Range of No. of Hours Trainees Class / CBT Lab 163 24-200 0 53 Weighted Avg: 41 24-260 0 Weighted Avg: 121 Average Cost per Trainee Post- Retention Wage $738 $20.03 $2,420 $13.34 Minimum Wage by County: $20.03 per hour for Job Number 1 and $13.34 per hour for Job Number 2, both in Los Angeles County. Health Benefits: Yes No This is employer share of cost for healthcare premiums medical, dental, vision. Used to meet the Post-Retention Wage?: Yes No Maybe Up to $3.25 per hour may be used to meet the Post-Retention Wage. Wage Range by Occupation Estimated # of Occupation Titles Wage Range Trainees Registered Nurse 115 Licensed Vocational Nurse 30 New Graduate Nurse 20 Radiology Technician 15 Respiratory Therapist 7 Laboratory Technician 17 Surgical Technician 6 Certified Nursing Assistant 6 INTRODUCTION This will be the second Agreement between ETP and CHHP Management, LLC dba Community Hospital of Huntington Park (CHHP). CHHP (www.chhplax.com) is a for-profit, 81-bed general medical and surgical hospital accredited by the Healthcare Facility Accreditation Program. The hospital has provided services to the Huntington Park area (including the cities of Walnut Park, Vernon, Florence-Graham, Maywood, Bell, Cudahy, South Gate, and Bell Gardens) since being established in 1966. In 2005, Karykeion Inc. was acquired from Tenet Healthcare and subsequently purchased by Avanti Health Systems, LLC (Avanti Health) in March of 2010. CHHP provides outpatient and inpatient services including: ETP 130 - Single (08/16/12) 2 of 5

Community Hospital of Huntington Park May 23, 2013 ET13-0394 pediatric care, specialized emergency room, telemetry, ICU, and surgical service. Ancillary services include radiology, laboratory, cardio/pulmonary and physical therapy. As an acute hospital, CHHP provides medical treatment for both brief- and long-term illnesses. Since the acquisition by Avanti Health, the hospital has focused primarily on rebuilding community relations after years of financial difficulty with the prior ownership. Training received under the prior ETP Agreement has improved the hospital s overall performance. CHHP is expanding its emergency-bed capacity and capabilities to accept paramedic service and more acute patients. PROJECT DETAILS In January of 2013, CHHP started the conversion to a full-service Emergency Department. This expansion features eight additional treatment bays which can accommodate local residents and neighboring communities requiring 911 services to have prompt access to care. The expansion of the Emergency Department has transformed the hospital and has increased its average daily census of patients almost two-fold. The increase in admissions has also resulted in an increase in patients requiring care by more highly-skilled staff with triage techniques training in emergency nursing skills, emergency severity index skills, and training on new Emergency Department monitoring equipment. CHHP will recruit, hire and train up to 46 full-time nurses and 7 allied medical professionals to allow for expanded services and to fill available slots for the move to significantly reduce Registry and contract staff. CHHP will hire and train relatively inexperienced nurses (including new graduate nurses) to meet legislated nurse-patient ratios. Inexperienced nurses are typically not prepared to assume responsibility for patient care and require extensive theory and practical clinical knowledge transfer from an experienced and trained preceptor. Commitment to Training CHHP represents that ETP funds will not displace the existing financial commitment to training. Safety training is, and will continue to be, provided in accordance with all pertinent requirements under state and federal law. Training Infrastructure Training will commence immediately. CHHP has prepared a tentative training schedule based on their proposed curriculum, and they have identified qualified employees who are experts in their fields to provide training. Administration will be provided by an outside vendor who assisted CHHP during development. Training Plan Continuous Improvement (10%) - Training will be given to all occupations. Topics include customer service, documentation skills, crisis prevention & intervention, preceptor skills (train-thetrainer), charge nurse training/frontline leadership skills, and performance & quality improvement. Computer Skills (10%) - All occupations will receive electronic medical records (EMR) application skills training. The hospital is currently in phase II of the EMR rollout, which is the meaningful use phase. There are two more phases of rollout that are required to take place over the next 18 months, which will entail additional training. ETP 130 - Single (08/16/12) 3 of 5

Community Hospital of Huntington Park May 23, 2013 ET13-0394 Medical Skills Training The Panel has established a $22 reimbursement rate for nurse upgrade training, recognizing the higher cost of delivery for the Clinical Preceptor model. Medical Skills Training Didactic (35%): All occupations will receive classroom training. Medical Skills Training Clinical with Preceptor (45%): All occupations will receive medical skills training in their specific units with a Preceptor. All new hires, regardless of occupation, will receive two to ten shifts to validate skills and become familiar with patient acuity levels and the level of care that the hospital requires. New Graduate Nurses and novice skilled employees will participate in an extended preceptorship that will range from 160-400 hours (only up to 200 hours for Job Number 1 and up to 260 hours for Job Number 2 may be reimbursed), depending on skill level. Existing staff may receive clinical preceptor hours to validate new skills learned in the classroom and/or when cross-training to a new department with a higher level of patient acuity. High Unemployment Area The hospital s location in the City of Huntington Park is in a high unemployment area of the State. Special Employment Training Under Special Employment Training (SET), the participating employer is not required to demonstrate out-of-state competition. To qualify under SET, trainees must earn at least the statewide average hourly wage at the end of the retention period. Wage and Retention Modifications SET Priority Industry For trainees employed in a priority industry, the Panel may modify the wage up to 25% below the statewide average hourly wage (from $26.71 to $20.03). This wage modification is requested for trainees in Job Number 1 in order to serve workers in lower-wage occupations. SET Retrainee - Job Creation Under the Retrainee-Job Creation program, training for newly-hired employees is reimbursed at a higher rate and trainees are subject to a lower post-retention wage (standard new hire minimum wage of $13.34 instead of the state average hourly wage of $26.71). CHHP has committed to hiring 53 new employees (Job Number 2). To be eligible for reimbursement, these trainees must be hired within the three-month period prior to Panel approval or during the term of contract. Training Hours Limitation Retraining hours are capped at 200 per trainee, except for New Graduate Registered Nurses where the range of hours is capped at 300 per trainee. CHHP is asking for a modification of the cap to 260 hours for trainees in Job Number 2. New Graduate Registered Nurses and newlyhired allied health staff are typically not prepared to assume responsibility for patient care and must receive extensive theory and practical clinical knowledge from an experienced and trained preceptor. ETP 130 - Single (08/16/12) 4 of 5

Community Hospital of Huntington Park May 23, 2013 ET13-0394 RECOMMENDATION Staff recommends approval of this proposal with all wage modifications and modification to cap on training hours for New Graduate Registered Nurses. PRIOR PROJECTS The following table summarizes performance by CHHP under an ETP Agreement that was completed within the last five years: Agreement No. Location (City) Term Approved Amount ET11-0339 $79,650 DEVELOPMENT SERVICES 05/27/11-05/26/13 Payment Earned $ % $79,650 $79,650 (100%) The company retained National Training Systems, Inc. (NTSI) in Ladera Ranch to assist with development of this proposal for a flat fee of $14,939. ADMINISTRATIVE SERVICES NTSI will also perform administrative services in connection with this proposal for a fee not to exceed 13% of payment earned. TRAINING VENDORS To Be Determined ETP 130 - Single (08/16/12) 5 of 5

Community Hospital of Huntington Park ET13-0394 Exhibit B: Menu Curriculum Class/Lab Hours 24 200 (Job Number 1) 24 260 (Job Number 2) Trainees may receive any of the following: MEDICAL SKILLS TRAINING CLINICAL PRECEPTOR Emergency Department Training o Patient Assessment & Care o Triage Nursing Skills o Emergency Care of the Burn Patient o Intravenous (IV) Insertion & Therapy o Emergency Room Nursing Skills Intensive Care Unit/Critical Care Unit Training o Critical Care Nursing Skills o Patient Assessment & Care o Hemodynamic Monitoring o Pre and Post-Operative Care o Care of Trauma Patient o Ventilator & Tracheotomy Care Laboratory Services Unit o Urine Specimen Testing o Blood Specimen Testing o Bloodborne Pathogens o Cerebrospinal Fluid Testing o Direct Wet Preparations o Concentration Techniques for Lab Specimens o Blood Grouping o Equipment Skills Medical/Surgical Unit Training o Patient Assessment & Care o Medical/Surgical Nursing Skills o Pre and Post Operative Care o Orthopedic Nursing Skills o Oncology Nursing Skills Operating Room and Post-Anesthesia Care Unit (PACU) Training o Patient Assessment & Care o Care of the Burn Patient o Peri-Operative Nursing Skills o Pre- and Post-Operative Care Radiology Services Unit o Ultrasound o Computed Tomography Scan o X-Ray o Care of Orthopedic Patients o Care of the Cardiac Patient o Equipment Skills ETP 100 Exhibit B Menu Curriculum (02/13/12) 1 of 3

Community Hospital of Huntington Park ET13-0394 Respiratory Services o Chronic Obstructive Pulmonary Disease o Asthma o Respiratory Disorders o Code Blue Response and Procedures o Care of the Cardiac Patient o Equipment Skills Telemetry Unit Training o Care of the Cardiac Patient o EKG & Cardiac Monitoring o Dysrhythmia Interpretation o Telemetry Nursing Skills o Pre and Post Operative Care o Care if the Neurosurgical Patient o Intravenous (IV) Therapy o Oncology Nursing Skills MEDICAL SKILLS TRAINING DIDACTIC Acute Psychiatric Care Acute Myocardial Infarction Advanced Cardiac Life Support (ACLS) Arterial Blood Gas (ABG) Interpretation Basic Life Support (BLS) Body Mechanics Care of the Cardiac Patient Care of the Burn Patient Care of the Stroke Patient Central Lines Management Chest Tube Care & Management Code Blue Response & Procedures Critical Care Nursing Skills Decontamination Procedures Diabetes Care & Management Dysrhythmia Recognition & Interpretation Educating the Patient & Family EKG & Cardiac Monitoring Electronic Fetal Monitoring (Beginning & Advanced) Emergency Room Nursing Skills Equipment Skills (IV pumps, cardiac telemetry, vital signs, pulse-oximeter, ventilators, specialty beds, etc.) Evidence Based Practices Gastrointestinal Assessment and Management Hemodynamic Monitoring Infection Control Intravenous (IV) Insertion & Therapy Laboratory Services Training Medical/Surgical Nursing Skills Medication Administration & Management Moderate Sedation New Graduate Nursing Skills ETP 100 Exhibit B Menu Curriculum (02/13/12) 2 of 3

Community Hospital of Huntington Park ET13-0394 Nurse Orientation Training Nursing Diagnosis Skills Nursing Process Skills Oncology Nursing Skills Orthopedic Nursing Skills Ostomy & Continence Care Pain Management (Acute & Chronic) Patient Assessment & Care Patient Fall Prevention Pediatric Advanced Life Support (PALS) Peri-Operative Nursing Skills PICC Line Insertion Pre and Post-Operative Care Radiology Services Training Rapid Response Skills Renal Assessment & Management Respiratory Assessment & Care Restraints S.T.A.B.L.E. Telemetry Nursing Skills Total Parenteral Nutrition (TPN) Transfer Techniques Triage Nursing Skills Ventilator and Tracheotomy Care Wound & Skin Care CONTINUOUS IMPROVEMENT Case Management/Discharge Planning Charge Nurse Training/Frontline Leadership Skills Communications Skills Conflict Resolution Skills CORE Measures Crisis Prevention Intervention (CPI) Critical Thinking Skills Culturally Appropriate Care Customer Service Skills Documentation Skills Organization and Time Management Skills Patient and Family Centered Care Skills Preceptor Skills (Train-The-Trainer) Performance and Quality Improvement and Procedures Team Building Skills Utilization Review COMPUTER SKILLS Microsoft Office/Excel Skills (Intermediate & Advanced) Electronic Medical Records Application Skills Note: Reimbursement is capped at 200 total training hours per-trainee for Job Number 1 and 260 total training hours per-trainee for Job Number 2, regardless of method of delivery. ETP 100 Exhibit B Menu Curriculum (02/13/12) 3 of 3