|
Date of Survey
|
2007/09/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Fire Alarm Systems Deficiencies
|
|
Deficiency
|
an approved back-up procedure for a faulty fire alarm system.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/09/10 (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
|
2007/09/10 (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
|
2007/09/10 (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
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/09/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Furnishings and Decorations Deficiencies
|
|
Deficiency
|
restrictions on the use of flammable curtains.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/09/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Electrical Deficiencies
|
|
Deficiency
|
properly installed electrical wiring and equipment.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/09/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Automatic Sprinkler Systems Deficiencies
|
|
Deficiency
|
back-up procedures in place for a faulty automatic sprinkler system.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/09/07 (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
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/09/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Quality Care Deficiencies
|
|
Deficiency
|
Provide activities to meet the needs of each resident.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/09/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Resident Assessment Deficiencies
|
|
Deficiency
|
Make a complete assessment that covers all questions for areas that are listed in official regulations.
|
|
Level of Harm
|
Potential for minimal harm
|
|
|
Date of Survey
|
2007/09/07 (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
|
2007/09/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Quality Care Deficiencies
|
|
Deficiency
|
Give professional services that meet a professional standard of quality.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/09/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Quality Care Deficiencies
|
|
Deficiency
|
Give professional services that follow each resident's written care plan.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/09/07 (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
|
2007/09/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Get rid of garbage properly.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/09/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Resident Assessment Deficiencies
|
|
Deficiency
|
Make sure that doctors see a resident's plan of care at every visit and make notes about progress and orders in writing.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/09/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Make sure there is a program to prevent/deal with mice, insects, or other pests.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/09/07 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Administration Deficiencies
|
|
Deficiency
|
Set up or keep a group of people to review and ensure quality.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Fire Alarm Systems Deficiencies
|
|
Deficiency
|
an approved installation, maintenance and testing program for fire alarm systems.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (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
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Illumination and Emergency Power Deficiencies
|
|
Deficiency
|
emergency lighting that can last at least 1 1/2 hours.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (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
|
2006/07/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Vertical Openings Deficiencies
|
|
Deficiency
|
exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detectors.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (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
|
2006/07/10 (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
|
2006/07/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Smoking Regulations Deficiencies
|
|
Deficiency
|
posted "No-smoking" signs in areas where smoking is not permitted or did not provide ashtrays where smoking was allowed.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Building Service Equipment Deficiencies
|
|
Deficiency
|
properly protected cooking facilities.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Furnishings and Decorations Deficiencies
|
|
Deficiency
|
exits that are free from obstructions and can be used at all times.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Furnishings and Decorations Deficiencies
|
|
Deficiency
|
restrictions on the use of flammable curtains.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Medical Gases and Anesthetizing Areas Deficiencies
|
|
Deficiency
|
proper medical gas storage and administration areas.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Electrical Deficiencies
|
|
Deficiency
|
weekly inspections and monthly testing of generators.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Electrical Deficiencies
|
|
Deficiency
|
properly installed electrical wiring and equipment.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Building Contruction Deficiencies
|
|
Deficiency
|
approved construction type or materials.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/07/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Automatic Sprinkler Systems Deficiencies
|
|
Deficiency
|
portable fire extinguishers.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/06/29 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Make sure there is a program to prevent/deal with mice, insects, or other pests.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/06/29 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Resident Rights Deficiencies
|
|
Deficiency
|
Immediately tell the resident, doctor, and a family member if: the resident is injured, there is a major change in resident's physical/mental health, there is a need to alter treatment significantly, or the resident must be transferred or discharged.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/06/29 (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
|
2006/06/29 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Keep sound levels comfortable.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/06/29 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Quality Care Deficiencies
|
|
Deficiency
|
Give professional services that meet a professional standard of quality.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/06/29 (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
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2006/06/29 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Pharmacy Service Deficiencies
|
|
Deficiency
|
Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Illumination and Emergency Power Deficiencies
|
|
Deficiency
|
emergency lighting that can last at least 1 1/2 hours.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (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
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Smoke Compartmentation and Control Deficiencies
|
|
Deficiency
|
smoke barrier doors that can resist smoke for at least 20 minutes.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Smoke Compartmentation and Control Deficiencies
|
|
Deficiency
|
walls or barriers that prevent smoke from passing through and would resist fire for at least one hour.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Vertical Openings Deficiencies
|
|
Deficiency
|
exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detectors.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (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
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Building Contruction Deficiencies
|
|
Deficiency
|
approved construction type or materials.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Emergency Plans and Fire Drills Deficiencies
|
|
Deficiency
|
did not have a written emergency evacuation plan.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Fire Alarm Systems Deficiencies
|
|
Deficiency
|
a fire alarm system that can be heard throughout the facility.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (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
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Electrical Deficiencies
|
|
Deficiency
|
properly installed electrical wiring and equipment.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Electrical Deficiencies
|
|
Deficiency
|
weekly inspections and monthly testing of generators.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Furnishings and Decorations Deficiencies
|
|
Deficiency
|
restrictions on the use of highly flammable materials.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Furnishings and Decorations Deficiencies
|
|
Deficiency
|
exits that are free from obstructions and can be used at all times.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Building Service Equipment Deficiencies
|
|
Deficiency
|
properly protected cooking facilities.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Smoking Regulations Deficiencies
|
|
Deficiency
|
posted "No-smoking" signs in areas where smoking is not permitted or did not provide ashtrays where smoking was allowed.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/05/10 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Automatic Sprinkler Systems Deficiencies
|
|
Deficiency
|
portable fire extinguishers.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/29 (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
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/29 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Quality Care Deficiencies
|
|
Deficiency
|
Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.
|
|
Level of Harm
|
Actual harm
|
|
|
Date of Survey
|
2005/04/29 (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
|
Actual harm
|
|
|
Date of Survey
|
2005/04/29 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Quality Care Deficiencies
|
|
Deficiency
|
Give each resident a special diet to help when there is a nutritional problem.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/29 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Quality Care Deficiencies
|
|
Deficiency
|
Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/29 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Nutrition and Dietary Deficiencies
|
|
Deficiency
|
1) Provide 3 meals daily at regular times; or 2) serve breakfast within 14 hours after dinner; or 3) offer a snack at bedtime each day.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/04/29 (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
|
Potential for minimal harm
|
|
|
Date of Survey
|
2005/04/29 (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
|
2005/04/29 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Environmental Deficiencies
|
|
Deficiency
|
Provide needed housekeeping and maintenance.
|
|
Level of Harm
|
Potential for minimal harm
|
|