Avanti Health System, LLC; CHHP Holding II, LLC; and CHHP Management, LLC

National Labor Relations Board - Administrative Judge Opinions

Jun 14, 2011

21-CA-039268 (N.L.R.B. Jun. 14, 2011)

JD(SF)-12-11
Los Angeles, CA
UNITED STATES OF AMERICA
BEFORE THE NATIONAL LABOR RELATIONS BOARD
DIVISION OF JUDGES
SAN FRANCISCO BRANCH OFFICE
AVANTI HEALTH SYSTEM, LLC;
CHHP HOLDINGS II, LLC;
AND CHHP MANAGEMENT, LLC
and Case 21–CA–39264
SERVICE EMPLOYEES INTERNATIONAL
UNION, UNITED HEALTHCARE
WORKERS-WEST
and Case 21–CA–39268
CALIFORNIA NURSES ASSOCIATION/
NATIONAL NURSES ORGANIZING COMMITTEE,
NATIONAL NURSES UNITED, AFL–CIO
Lisa McNeil, Esq.,
for the General Counsel.
Jane Lawhon, Esq., of Oakland, California,
for the Union.
Richard W. Kopenhefer, Esq., and
Paul Berkowitz, Esq., of Sheppard
Mullin Richter & Hampton LLP, of Los
Angeles, California, for the Respondents.
DECISION
Statement of the Case
Gerald A. Wacknov, Administrative Law Judge: Pursuant to notice a hearing in this
matter was held before me in Los Angeles, California, on March 14, 15, 16, and 17, 2011. The
captioned charge in Case 21–CA–39264 was filed by Service Employees International Union,
United Healthcare Workers-West on March 9, 2010.1 The captioned charge in Case 21–CA–
39268 was filed by California Nurses Association/National Nurses Organizing Committee,

1 Prior to the hearing in this matter those portions of the consolidated complaint pertaining to
Case 21–CA–32964 were withdrawn; therefore the remaining complaint allegations pertain only
to Case 21–CA–39268 filed by the Union.
JD(SF)-12-11
2
National Nurses United, AFL–CIO (Union) on March 11, 2010. On December 27, 2010, the 5
Regional Director for Region 21 of the National Labor Relations Board (Board) issued a
complaint and notice of hearing alleging violations by Avanti Health System, LLC; CHPP
Holdings II, LLC; and CHHP Management, LLC (Respondents) of Section 8(a)(1) and (5) of the
National Labor Relations Act, as amended (the Act). The Respondents, in their answer to the
complaint, duly filed, deny that they have violated the Act as alleged.10
The parties were afforded a full opportunity to be heard, to call, examine, and cross-
examine witnesses, and to introduce relevant evidence. Since the close of the hearing, briefs
have been received from counsel for the General Counsel (the General Counsel) and counsel for
the Respondent; and the Union filed a statement adopting in full the General Counsel’s brief. 15
Upon the entire record, and based upon my observation of the witnesses and consideration of the
briefs submitted, I make the following.
Findings of Fact
20
I. Jurisdiction
The Respondent CHHP Holdings II, LLC, admits that CHHP Management, LLC is its
wholly owned subsidiary, and that the two entities own, and operate, respectively, the
Community Hospital of Huntington Park, an acute care hospital, located in Los Angeles, 25
California. It is admitted that CHHP Management, LLC, in operating the hospital, derives gross
revenues in excess of $250,000 and purchases and receives at the hospital goods valued in excess
of $5000 directly from points outside the State of California. It is further admitted, and I find,
that CHHP Management, LLC is an employer engaged in commerce within the meaning of
Section 2(2), (6) and (7) of the Act, and, as the operator of the hospital, is a health care 30
institution within the meaning of Section 2(14) of the Act.
II. The Labor Organization Involved
I find that the Union is, and at all times material herein has been, a labor organization 35
within the meaning of Section 2(5) of the Act,
III. Alleged Unfair Labor Practices
A. Issues40
The principal issues in this proceeding are whether the three named Respondents
conduct the business operations of the hospital as a single or, in the alternative, as joint
employers; and whether all or any of them have violated Section 8(a)(5) and (1) of the Act by
refusing to recognize and bargain with the Union in accordance with established Board 45
successorship principles.
JD(SF)-12-11
3
B. Facts, Analysis, Conclusions5
1. Status of Avanti Health System, LLC
Avanti Health System, LLC (Avanti) intended to purchase, own and operate Community
Hospital of Huntington Park (CHHP), owned by an entity named Karykeion, Inc., through a 10
bankruptcy sale. However, due to the last-minute refusal of Avanti’s lender to provide financing,
various investors of Avanti established CHHP Holdings II, LLC, and that entity, in turn,
established CHHP Management, its wholly owned subsidiary. While Avanti was therefore no
longer the legal purchaser of CHHP, it became the guarantor of certain loans to CCHP Holdings
II, LLC, thus enabling that entity to purchase CHHP. Thereupon, CHHP Holdings II, LLC 15
purchased CHHP. Because, according to the Respondents, CHHP Holdings II, LLC currently
owns CHHP, and CHHP Management, LLC currently operates CHHP, it is argued that Avanti
should therefore not be a party to this proceeding as it is neither the owner nor manager of
CHHP, and is only tangentially involved as the guarantor of the aforementioned loans.
20
The printout of Avanti’s website, www.avantihospitals.com, under various home-page
headings, introduced into evidence in this proceeding, states, inter alia:
Avanti Health System owns and operates acute care hospitals.
25
Through our subsidiaries, we own and operate acute care hospitals and related
healthcare businesses.
Avanti and its’ affiliates currently own and operate three acute care hospitals,
East Los Angeles Doctors Hospital, Memorial Hospital of Gardena, and our sister 30
hospital, Community Hospital of Huntington Park, all located near Los Angeles,
California.
The Respondents provided no evidence to explain the apparent inconsistency between Avanti’s
purported tangential relationship simply as loan guarantor of CHHP Holdings II, LLC, and the 35
degree of its ownership and control of CHHP as set forth in its website.
East Los Angeles Doctors Hospital (Doctors Hospital) is located some seven miles from
CHHP, and is considered a sister hospital to CHHP. Araceli Lonergan is CEO of Doctors
Hospital. Doctors Hospital is owned and operated by Avanti; there is no separate management 40
entity that operates the hospital. Lonergan testified that Steve Dixon, then CEO of Avanti, told
her that her Doctors Hospital management group would be going to go over to CHHP and run it.
Thus, at all times material herein, Lonergan and her Doctors Hospital management team have
been in charge of the daily operations of Doctors Hospital as well as of CHHP, and divide their
time between the two hospitals. Lonergan and her management team receive their paychecks 45
from Doctors Hospital, but Lonergan testified she signs the payroll checks “and things like that”
on behalf of CHHP Management, LLC. The management team applied the Doctors Hospital
policies, practices and employee rules to the CHHP employees from the time of the acquisition
of CHHP.
50
Carmelo James is chief nursing officer (CNO) at both Doctors Hospital and CHHP. He is
responsible for all nursing care and staffing. He and his staff of Doctors Hospital managers who
report to him were responsible for hiring the RNs at CHHP both prior to and after the acquisition
of CHHP. James agreed that upon the acquisition of CHHP the Doctors Hospital policies
regarding wages, all employment rules, sick leave, vacation, and benefit packages and all other 55
JD(SF)-12-11
4
rules and policies were instituted at CHHP as a result of instructions from “Steve” (apparently 5
Avanti CEO Steve Dixon) “that we had to mirror [at CHHP] what we have at East LA [Doctors
Hospital] . . . It’s just fair.”
Steve Lopez is chief financial officer (CFO) of both Doctors Hospital and CHHP and
spend his time at both locations. Lopez testified that he was involved in setting wage rates for 10
the employees who were to be hired at CHHP. The rates are the same for employees at both
hospitals because, as Lopez testified, “we can’t disenfranchise employees at East LA (Doctors
Hospital), so I wanted to make sure that comparable jobs were paid equally.”
On the basis of the foregoing I find, that Avanti, CHHP Holding II, LLC and CHHP 15
Management, LLC constitute a single employer under well established Board precedent as set
forth in the cases cited by the General Counsel in her brief: Radio & Television Broadcast
Technicians Local Union v. Broadcast Service of Mobile, Inc., 380 U.S 255, 256 (1965); Proctor
Express, Inc., 322 NLRB 281, 289–290 (1996); NLRB v. Browning, 691 F2d 1117 (3d Cir. 1982);
Hydrolines, Inc., 305 NLRB 416, 417 (1991). Centralized control of labor relations is “critical” 20
and “a single-employer relationship will be found only if one of the companies exercises actual
or active control over the day-to-day operations or labor relations of the other.” (Original
emphasis; footnote omitted.) Dow Chemical Co., 326 NLRB 288 (1998). There is common
overlapping ownership between the entities, and, most importantly, it is clear that Avanti,
through its Doctors Hospital management staff, exercises actual and active day-to-day control 25
over CHHP.
2. Successorship
Prior to the acquisition of CHHP by the Respondents the Union had been the collective 30
bargaining representative of certain CHHP employees in the following unit as set forth in the
January 1, 2007 to June 30, 2010 collecive-bargaining agreement between the Union and
CHHP:
Included: All full-time and per diem Registered Nurses, including those35
who serve as relief charge nurses;
Excluded: All other Registered Nurses, including confidential Registered Nurses,
office clerical Registered Nurses, all other professional Registered Nurses
(including without limitation physicians and residents), registry nurses, 40
Registered Nurses of outside registries and other agencies supplying labor to the
Employer, traveling nurses, regularly assigned charge nurses, guards,
managers, supervisors, as defined in the Act, and already represented
Registered Nurses.
45
On March 6, 2010,2 prior to the acquisition, during a time when the Respondents’
Doctors Hospital managers were interviewing and preparing to hire a new complement of
employees for the operation of CHHP, the Union, by letter, requested recognition as the
collective-bargaining representative of the Respondents’ RNs in the aforementioned bargaining
unit. The Respondents’ operation of CHHP commenced at 12:01 a.m. on March 26. On 50
March 27, Respondents’ counsel replied to the Union’s letter acknowledging that the demand
for recognition was a continuing one, and further stating that the Union “does not presently
represent a majority of our employees in an appropriate bargaining unit under the principles

2 All dates or time periods hereinafter are within the year 2010 unless otherwise indicated.
JD(SF)-12-11
5
established by the U.S. Supreme Court in NLRB v. Burns Int’l Security Services, 406 U.S. 272 5
(1972)”; the Respondents declined to recognize the Union until such time as it was certified
pursuant to an NLRB election.
The Respondents continue to refuse to recognize the Union, maintaining that the Union
has never represented a majority of RNs at CHHP at any time subsequent to the acquisition of 10
the hospital.
The Respondents in their brief assert, “This is a simple case involving dueling Burns
“headcounts” under NLRB v. Burns Security Services, 406 U.S. 272, 280–281 (1972), and Fall
River Dyeing Corp. v. NLRB, 482 U.S. 27 (1987). The General Counsel and Union agree. 15
What the parties do not agree upon, however, is the date on which the Respondents first
employed a “substantial and representative complement” of RNs, and whether, on and after that
date, the Respondents employed a majority of the predecessors’ RNs (sometimes referred to as
“incumbents”).
20
Steve Lopez, CFO of both Doctors Hospital and CHHP testified that as of March 26,
when the Respondents began operating CHHP, it was fully staffed and there was adequate
staffing level to run the hospital successfully.3 Further, Lopez testified that about a week after
the initial takeover of operations, CHHP received a California Health Department review
including the auditing of staffing levels. CHPP passed the audit and it was found the hospital 25
was adequately staffed.
A comparison of record evidence from the General Counsel and the Respondents shows
that on March 26 there were a total of 47 nonsupervisory RNs employed by CHHP, and that of
this number 30 nonsupervisory RNs had been employed by the predecessor on March 25;30
accordingly, the Union represented a majority of 63.8 percent of unit employees.4 The
Respondents contend, however, that although Lopez stated there were enough RNs initially
employed to run the hospital, the complement of 47 RN’s did not constitute a “substantial and
representative” complement of RNs sufficient to run the hospital; rather, it had been determined
that a staff of 65 nonsupervisory RNs would have reasonably met contemplated staffing 35
requirements. Indeed, as Respondent’s witnesses testified, offers of employment were made to
65 RNs. Further, Lopez testified that what he meant by his assertions that the hospital was fully
or adequately staffed as of March 26, is not that it was fully and adequately staffed with 47 RNs,
but that it was fully and adequately staffed because on and after March 26 some 10 RNs were
“borrowed” or “migrated” or “floated” from Doctors Hospital to CHHP, and many other RN 40
registry nurses, who worked for outside agencies, had to be brought on board to supplement the
inadequate RN staffing.
The Respondents agree 65 nonsupervisory RNs would constitute adequate staffing, and
that 47 RNs were employed on March 26. It follows that 72.3 percent of the contemplated RN 45

3 Lopez also makes this same statement both in a Board affidavit and in a sworn declaration
submitted by the Respondents to the District Court in a related 10(j) proceeding.
4 The Respondents maintain that two of these 30 RNs were in fact supervisors, infra; therefore,
although they were hired by CHHP as nonsupervisory RNs, they were not formerly bargaining
unit employees and may not be counted in determining the Union’s majority under Burns.
However, even if these two individuals were excluded and 28 rather than 30 of the predecessor’s
nonsupervisory RNs began working for CHHP on March 26, the Union’s majority support, 56.2
percent is nevertheless established.
JD(SF)-12-11
6
work force was employed on March 26. This percentage would, I believe, under the 5
circumstances, constitute a substantial and representative complement of employees under
Burns. However, the Respondents also maintains that the aforementioned presumptively
appropriate RN unit5 set forth in the collective-agreement between the Union and successor
employer is not appropriate in that it includes per diem RNs who, because of their limited
benefits and sporadic employment, have an insufficient community of interest with the other 10
RNs.
In this regard, the aforementioned collective-agreement specifies as follows:
C. Per Diem Registered Nurse15
A Per Diem Registered Nurse is a Registered Nurse who has executed the
Facility’s Per Diem Agreement and who is not a regular full-time or regular part-
time1 Registered Nurse. Per Diem Registered Nurses do not receive any
insurance, retirement or other fringe benefits under this agreement . . . except
that Per Diem nurses shall be eligible for participation in the 401(k) Retirement 20
Savings Plan as allowed under the Plan. Per Diem nurses shall be eligible for
the new Retiree Medical Benefit contained in Article 15B, subject to the
eligibility requirements set forth in Article 15B.
The Per Diem Agreement referred to in the above paragraph is a one-page agreement, 25
signed by the RN, and specifies the following criteria: Per Diem nurses must be available to
work at least one day per week; must be available to work a minimum of one weekend per
month; must submit their available days to Nursing Administration prior to the posting of the next
work schedule; and must work at least one of five specified holidays.
30
Union Representative Dinorah Williams testified she was involved in negotiating the
aforementioned contract and the terms of the per diem agreement with the predecessor
employer, Karykeion, Inc. Williams testified that per diem nurses enjoyed various contract
benefits: weekend, evening, and nightshift differential rates; and bonuses. Regarding work
schedules, Williams testified that under certain circumstances per diem RNs who were on the 35
schedule to work would be called in to take the place of a full-time RN who was on overtime.
Regarding discipline of per diem nurses, Williams testified that if a per diem nurse did not meet
the requisite requirements spelled out in the per diem agreement prior to the posting of each
staffing schedule, that is, by submitting their availability, they would be automatically “plugged
in” to a date, and if they did not show up to work on that date they would be subject to discipline 40
including termination.
On the basis of the foregoing, and in the absence of any case authority to the contrary, I
find that per diem RNs were appropriately included within the RN bargaining unit under the
contract between the Union and the predecessor.45
The Respondents in their brief assert that a substantial and representative complement of
RNs was working for CHPP as of April 19, the ending date of the Respondents first full 2-week
pay period, April 5 to 19, after its takeover, and that the Burns successorship count should be
conducted during or after, but not before, that pay period. According to a detailed chart 50
constructed by the Respondents in their brief, the Respondents conclude that there were a total of

5 See Sec.103.30, Appropriate Bargaining Units, of the Boards Rules and Regulations.
JD(SF)-12-11
7
63 nonsupervisory RNs6 employed during that pay period, 31 of whom were unit employees of 5
the predecessor; thus, according to the Respondents, the Union represented only 49.2 percent of
the CHHP RNs, and therefore did not enjoy majority support.
In order to arrive at this number of 63 RNs the Respondents included 6 individuals,
allegedly RNs, infra, who are not customarily considered staff nurses. The Respondents 10
maintain that the predecessors’ bargaining unit would have included such individuals had the
predecessor employed them. In this regard, the Respondents elicited from Juliet Miranda, chief
nursing officer and chief operating officer for the predecessor, the following response to a
hypothetical question:
15
Q. By Respondent’s counsel: If you had an individual who was a licensed RN
working in another non-supervisory classification, they would have been included
in the unit?
A. Yes.20
While this appears to be Miranda’s opinion, whether an employee who is not an RN staff nurse,
but who happens to have RN licensure, would or would not be included in the RN unit is not a
decision for Miranda alone to make. Rather, inclusion or exclusion of such individuals would be
subject to agreement of the parties, or, if no agreement could be reached, to Board determination. 25
It appears that Miranda’s testimony on this point is mere speculation. In fact, this was never an
issue between the predecessor and Union as the predecessor, insofar as the record shows, had
employed no such individuals; further, the unit description, as set for above, directly contradicts
Miranda’s testimony as it specifically excludes, “All other Registered Nurses . . . .”
Accordingly. I find no merit to the Respondents’ contention.30
Carmelo James, chief nursing officer (CNO) at both Doctors Hospital and CHHP, is
responsible for all nursing care and staffing. James testified that utilization review employees,
also known as case management employees, are responsible for the “constant movement of the
patients.” While it is not required that utilization review personnel be RNs, and while LVNs 35
were initially doing this work at CHHP both before and shortly after its takeover by the
Respondents, James testified it is his preference to hire RNs for such positions as RN training for
utilization review personnel, who act as “middlemen” between the nurses and the physicians,”
lends itself to better, more accurate, communication and therefore is more expedient. These
individuals work with the nursing staff, including RNs, to determine what is needed for the well 40
being of the patient according to accepted standards of practice for treating each particular
patient. According to James, these case managers “will basically ask our nurses on the floor
what’s going on with this patient, things like that.” They also work with the social worker for
discharge planning, including financial classes for patients to help them cope with financial
difficulties after they are discharged.45

6 In this regard, given the fact the Respondents agree that 63 RNs, rather than 65, comprised a
substantial and representative complement of RNs necessary to run the hospital, the complement
of RNs on March 26, 2010 (47) would be 74.6 percent of the RN employee complement needed
to run the hospital.
JD(SF)-12-11
8
James testified that CHHP hired two RNs to perform this work, namely Maggie Vargas5
and Arturo Ponce. However, while the Respondents’ payroll records do list Ponce as a “RN
Case Manager” in the Utilization Review department, these records do not contain the name of
Vargas. Therefore, I find that Vargas was not on the payroll of CHHP during that April 5 to 19
payroll period. Moreover, it is the Board’s practice to exclude case managers from a RN unit,
even if the case managers are RNs, in the “absence of a [hospital] requirement for RN licensure 10
for the Employer’s case manager position.” Salem Hospital, 333 NLRB 560 (2001). Here,
neither James’ testimony nor the Respondents’ payroll records show that Marisela Gonzalez,
lead case manager in utilization review,7 has RN licensure. Therefore, I find that the
Respondents have not demonstrated that individuals occupying the case manager position are
required to be licensed RNs; accordingly, I find that Ponce should not be included within the RN 15
unit.
Further, the chart in Respondents brief lists Erika Ramirez as a unit member with the title
“RN Utilization Review Coordinator.” James did not discuss Ramirez, her name was not
mentioned at the hearing, and Respondents’ payroll lists her as “UR Coordinator,” rather than, 20
“RN Utilization Review Coordinator.” Therefore, there is no record evidence showing she is a
RN.
James testified that an individual, Jeremias Azuela, who is no longer employed by the
Respondents, was a RN whose job description was Performance Improvement/Risk Management 25
(PI/RM) in the Risk Management department. This position falls under the jurisdiction of the
chief operating officer (COO) rather than James’ jurisdiction. Azuela occupied the same
position or Karykeion, Inc., the predecessor, but was not included in the predecessors’ RN
bargaining unit. James testified that Azuela:
30
[W]orks with us related to performance improvement.
We look at certain indicators that we would like to improvement [sic] and with
[sic] gather data and analyze it as a team to see how we can come up with
interventions to correct or to make things much smoother . . . within the 35
regulations as well.
He did a lot of great things for us with core measures and everything else. He
worked hand in hand with my nurses to try to change our basically our habit and
to make it more compliant with the joint commission and AOA standards.40
There is no documentary evidence that Azuela was in fact a RN, his duties do not appear
to be closely related to the direct, daily care of patients, and, most significantly, he was not under
the supervision of Chief Nursing Officer James. I find he should not be included in the RN unit.
45
James testified that Suzanne Zemer is an RN educator. She educates all staff employees,
including the nursing staff, as follows:

7 Marisela Gonzalez is not listed in the chart in the Respondents brief as a unit member.
JD(SF)-12-11
9
. . . get into compliance and any standards that change she’s in charge of that or 5
we have other schools. There’s schools of nursing that actually come and do that.
She’s in charge of making sure those students fall within the guidelines that we
set forth.
Suzanne Zemer is not listed in the Respondents’ April 5 to 19 payroll records. Therefore she 10
was not employed during the relevant time period in question.
James testified that Barbara Edmonds is “a contract person” who occupies the position of an RN
infection control nurse.
15
She predominantly deals with all of the bugs that come around and work
diligently with the ID doctor, Dr. McNamara and with the committee and comes
up with all of this—the plan to make sure that infection in the hospital is
minimized.
20
Barbara Edmonds, a contract person, is not listed in the Respondents’ April 5 to 19 payroll
records. Therefore she was not employed during the relevant time period in question.
The Respondents maintain that Judith Morgan and Bozena Owens, both charge nurses,
should be included in the unit as James’ rather lengthy testimony on this point demonstrates that 25
they are not supervisors. I agree. Further, the General Counsel appears to agree that these
individuals are properly within the unit. They will be included.
The Respondents maintain that two RNs, Ki Kim and Lillian Pascua, who are claimed by
the Union and General Counsel to be incumbents, are in fact not incumbents as they were RN 30
clinical supervisors while working for the predecessor and therefore should not have been
included in the predecessor’s RN unit. In support of this contention, the Respondents introduced
a Personnel Change Notice for Ki Kim, dated March 17, 2006, showing that she had been a
current clinical supervisor and received an incentive salary increase; and that Lillian Pascua
apparently was promoted to the position of clinical supervisor on January 6, 2006.835
However, the predecessor’s payroll document, introduced into evidence by the General
Counsel, shows that on March 25, the day preceding the takeover of CHHP by the Respondents,
neither Kim nor Pascua are listed as clinical supervisors; rather they are listed as RNs in the
surgery unit and the emergency room, respectively, and are included in the RN unit. Further, 40
eight other individuals who are identified in the predecessor’s payroll document as “clinical
supervisors” are not included in the RN unit. Accordingly, I conclude that the most current
documentary evidence shows that Kim and Pascua are appropriately included in the RN unit as
incumbents.
45

8 The Respondents subpoenaed these files from the predecessor sometime prior to the hearing
herein, and were permitted to look through the files and copy documents from the files, but not
retain the files. Therefore, the files were not available at the hearing.
JD(SF)-12-11
10
The Respondents maintain that an all-RN unit is not appropriate and that 7 non-RN 5
healthcare professionals should also be included in the unit. Thus, the Respondents would
include two social workers, four pharmacists, and the registered dietician, who, according to the
Respondents, all hold bachelor degrees and state licenses, and share a close community of
interest with the RNs. It is argued that the exclusion of this “small residual unit of 7 non-RN
healthcare professionals” would likely cause them to remain unrepresented for the purposes of 10
collective bargaining, or, in the alternative, if they sought union representation, would conflict
with Board policy to minimize the undue proliferation of bargaining units in the healthcare
industry. The problem with this argument is that, according to the Respondents’ payroll
information, the Respondents employed during the April 5 to 19 payroll period many other
individuals who could likely be included in a separate unit of healthcare professionals such as 15
case managers, utilization review employees, lab assistants, phlebotomists, radiology
technicians, pharmacy technicians, surgical technicians, ultrasound technicians, licensed
vocational nurses (LVNs), and perhaps others, numbering, roughly, in the neighborhood of 100
or more individuals. The record evidence does not support the Respondents’ argument that the
seven individuals selected by the Respondents would not be appropriately included in a larger 20
unit. I find no merit to the Respondents’ argument.
From the foregoing, I conclude that the RN unit on April 19 consisted of a total
complement of 59 RNs, 33 of whom were incumbents. Therefore, on that date, the Union
represented a majority of 55.9 percent of the bargaining unit.925
The Respondents agree that a sufficient number of RNs to run the hospital were
employed during the April 5 to 19 pay period, and I have found that 59 RNs were employed
during that period. The complement of 47 RNs on March 26 constitutes 79.6 percent of that
number. Clearly this significant percentage, particularly given the fact that, as Respondents 30
managers testified, the number of RNs required at any given time is a difficult number to
accurately assess as a result of the ever-changing daily patient population, constitutes a
substantial and representative complement of RNs. I so find.
I therefore find that the Union has represented a majority of unit employees beginning on 35
March 26 and continuing thereafter, as alleged in the complaint, and that the Respondents have
violated and are violating Section 8(a)(5) and (1) of the Act as alleged by failing and refusing to
bargain with the Union as the representative of the unit RNs on and after March 26.
Conclusions of Law and Recommendations40
1. The Respondents Avanti Health Systems, LLC, CHHP Holdings II, LLC and CHHP
Management, LLC constitute a single employer engaged in commerce within the meaning of

9 The arithmetic is as follows: The Respondents list a total unit complement of 63 individuals. I
have found, for reasons set forth above, that six of these individuals should be excluded from the
unit (Maggie Vargas, Arturo Ponce, Erika Ramirez, Jeremias Azuela, Suzanne Zemer, and
Barbara Edmonds), and two RNs should be added (Judith Morgan and Bozena Owens). Further,
the Respondents list a total of 31 incumbent RNs. I have found that two RNs (Ki Kim and
Lillian Pascua) were nonsupervisory incumbents of the predecessor and should be counted as
such.
JD(SF)-12-11
11
Section 2(2), (6) and (7) of the Act, and a health care institution within the meaning of Section 5
2(14) of the Act.
2. The Union is a labor organization within the meaning of Section 2(5) of the Act.
3. The Respondents have violated Section 8(a)(5) and (1) of the Act as alleged in the 10
complaint.
The Remedy
Having found that the Respondents have violated and are violating Section 8(a)(5) and 15
(1) of the Act, I recommend that they be required to recognize and bargain with the Union
in the collective-bargaining unit described below, and, on request of the Union, rescind
and retroactively restore any departures from terms and conditions of employment,
including wages, that existed on March 26, 2010.
20
I shall also recommend that the Respondents be required to cease and desist from in
any other like or related manner interfering with, restraining, or coercing its employees in the
exercise of their rights under Section 7 of the Act. Finally, I shall recommend the posting of an
appropriate notice, attached hereto as “Appendix.”
25
ORDER10
The Respondents Avanti Health Systems, LLC, CHHP Holdings II, LLC and CHHP
Management, LLC, their officers, agents, successors, and assigns, shall
30
1. Cease and desist from
(a) Failing and refusing to bargain with the Union as the exclusive collective-bargaining
representative of employees in the unit described below.
35
(b) In any like or related manner interfering with, restraining, or coercing employees in
the exercise of the rights guaranteed them by Section 7 of the Act.
2. Take the following affirmative action, which is necessary to effectuate the purposes of
the Act40
(a) Bargain with the Union as the exclusive representative of the employees in the
following appropriate unit concerning terms and conditions of employment and, if an
understanding is reached, embody the understanding in a signed agreement:
45

10 If no exceptions are filed as provided by Section 102.46 of the Board’s Rules and Regulations,
the findings, conclusions, and recommended Order shall, as provided in Section 102.48 of the
Rules, be adopted by the Board and all objections to them shall be deemed waived for all
purposes.
JD(SF)-12-11
12
Included: All full-time and per diem Registered Nurses, including those who 5
serve as relief charge nurses;
Excluded: All other Registered Nurses, including confidential Registered
Nurses, office clerical Registered Nurses, all other professional Registered Nurses
(including without limitation physicians and residents), registry nurses, Registered 10
Nurses of outside registries and other agencies supplying labor to the Employer,
traveling nurses, regularly assigned charge nurses, guards, managers, supervisors,
as defined in the Act, and already represented Registered Nurses.
(b) On request of the Union, rescind any departures from terms and conditions of 15
employment that existed on March 26, 2010, and retroactively restore terms and
conditions of employment that existed on March 26, 2010.
(c) Within 14 days after service by the Region, post at its CHHP facility copies of the
attached notice marked “Appendix.”11 Copies of the notice, on forms provided by the Regional 20
Director for Region 21, after being duly signed by Respondents’ representative, shall be posted
immediately upon receipt thereof, and shall remain posted by Respondents for 60 consecutive
days thereafter, in conspicuous places, including all places where notices to employees are
customarily posted. Reasonable steps shall be taken by the Respondents to ensure that the
notices are not altered, defaced, or covered by any other material.25
(d) Within 21 days after service by the Regional Office, file with the Regional Director
for Region 21 a sworn certification of a responsible official on a form provided by the Region
attesting to the steps that the Respondent has taken to comply.
30
Dated: Washington, D.C. June 14, 2011
_______________________
Gerald A. Wacknov35
Administrative Law Judge

11 If this Order is enforced by a judgment of the United States Court of Appeals, the wording in
the notice reading, “Posted by Order of the National Labor Relations Board,” shall read, “Posted
Pursuant to a Judgment of the United States Court of Appeals Enforcing and Order of the
National Labor Relations Board.”
APPENDIX
NOTICE TO EMPLOYEES
POSTED BY ORDER OF THE
NATIONAL LABOR RELATIONS BOARD
AN AGENCY OF THE UNITED STATES GOVERNMENT
The National Labor Relations Board has found that we violated Federal labor law and has
ordered us to post and obey this notice.
FEDERAL LAW GIVES YOU THE RIGHT TO:
Form, join, or assist a union
Choose representatives to bargain with us on your behalf
Act together with other employees for your benefit and protection
Choose not to engage in any of these protected activities
WE WILL NOT refuse to bargain with California Nurses Association/National Nurses
Organizing Committee, National Nurses United, AFL–CIO as the exclusive representative of the
employees in the following appropriate unit concerning terms and conditions of employment:
Included: All full-time and per diem Registered Nurses,
including those who serve as relief charge nurses;
Excluded: All other Registered Nurses, including confidential
Registered Nurses, office clerical Registered Nurses, all other
professional Registered Nurses (including without limitation
physicians and residents), registry nurses, Registered Nurses of
outside registries and other agencies supplying labor to the
Employer, traveling nurses, regularly assigned charge nurses,
guards, managers, supervisors, as defined in the Act, and already
represented Registered Nurses.
WE WILL, on request of the Union, bargain collectively with the Union as the exclusive
representative of the employees in the unit described above with respect to rates of pay, wages,
hours, and other terms and conditions of employment and, if agreement is reached, embody such
agreement in a signed document.
WE WILL, on request of the Union, rescind any departures from terms and conditions of
employment that existed on March 26, 2010, and retroactively restore terms and conditions of
employment, including wages, that existed on March 26, 2010.
WE WILL NOT in any like or related manner interfere with, restrain, or coerce employees in the
exercise of the rights guaranteed them by Section 7 of the Act.
AVANTI HEALTH SYSTEMS, LLC,
CHHP HOLDING II, LLC and
CHHP MANAGEMENT, LLC
(Employer)
Dated: _________________________ By:_____________________________
(Representative) (Title)
This is an official notice and must not be defaced by anyone.
This notice must remain posted for 60 consecutive days from the date of posting and must not be
altered, defaced, or covered with any other material. Any questions concerning this notice or
compliance with its provisions may be referred to the Board’s office, 888 South Figueroa Street,
9th Floor, Los Angeles, CA 90017-5449. Phone 213.894.5200.