|
Date of Survey
|
2007/01/31 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Make sure that the nursing home area is free of dangers that cause accidents.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/01/31 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Resident Assessment Deficiencies
|
|
Deficiency
|
Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/01/31 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Provide needed housekeeping and maintenance.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/01/30 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Automatic Sprinkler Systems Deficiencies
|
|
Deficiency
|
an approved automatic sprinkler system connected to the fire alarm system.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/01/30 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Emergency Plans and Fire Drills Deficiencies
|
|
Deficiency
|
record of quarterly fire drills for each shift under varying conditions.
|
|
Level of Harm
|
Potential for minimal harm
|
|
|
Date of Survey
|
2006/02/14 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Corridor Walls and Doors Deficiencies
|
|
Deficiency
|
corridor and hallway doors that block smoke.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/02/14 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Hazardous Area Deficiencies
|
|
Deficiency
|
construction that can resist fire for one hour or an approved fire extinguishing system.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/02/09 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Resident Rights Deficiencies
|
|
Deficiency
|
Provide care in a way that keeps or builds each resident's dignity and self respect.
|
|
Level of Harm
|
Actual harm
|
|
|
Date of Survey
|
2005/04/11 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Medical Gases and Anesthetizing Areas Deficiencies
|
|
Deficiency
|
proper fire barriers, ventilation and signs for the transport of oxygen.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Administration Deficiencies
|
|
Deficiency
|
Keep accurate and appropriate medical records.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Have enough backup water supply for important areas of the nursing home.
|
|
Level of Harm
|
Potential for minimal harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Move, clean and store sheets, towels and other linens in a way that prevents the spread of infection.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Make sure that staff members wash their hands when needed.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Have a program to keep infection from spreading.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Mistreatment Deficiencies
|
|
Deficiency
|
Keep each resident free from physical restraints, unless needed for medical treatment.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Mistreatment Deficiencies
|
|
Deficiency
|
1) Hire only people who have no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Provide needed housekeeping and maintenance.
|
|
Level of Harm
|
Potential for minimal harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Resident Assessment Deficiencies
|
|
Deficiency
|
Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Resident Assessment Deficiencies
|
|
Deficiency
|
1) Develop a complete care plan within 7 days of each resident's admission; 2) prepare a care plan with the care team, including the primary nurse, doctor, resident or resident's family or representative; or 3) check and update the care plan.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Quality Care Deficiencies
|
|
Deficiency
|
Give each resident care and services to get or keep the highest quality of life possible.
|
|
Level of Harm
|
Actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Quality Care Deficiencies
|
|
Deficiency
|
Make sure that residents receive treatment/services to continue to be able to care for themselves, unless a change is unavoidable.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Make sure that the nursing home area is free of dangers that cause accidents.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Pharmacy Service Deficiencies
|
|
Deficiency
|
1) Make sure that residents who take drugs are not given too many doses or for too long; 2) make sure that the use of drugs is carefully watched; or 3) stop or change drugs that cause unwanted effects.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Nutrition and Dietary Deficiencies
|
|
Deficiency
|
Store, cook, and give out food in a safe and clean way.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Pharmacy Service Deficiencies
|
|
Deficiency
|
At least once a month, have a licensed pharmacist check the drugs that each resident takes.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Resident Rights Deficiencies
|
|
Deficiency
|
Let the resident refuse treatment or refuse to take part in an experiment.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|