|
Date of Survey
|
2007/01/18 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Nutrition and Dietary Deficiencies
|
|
Deficiency
|
Provide special eating equipment and utensils for each resident who needs them.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/01/18 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Resident Rights Deficiencies
|
|
Deficiency
|
Keep each resident's personal and medical records private and confidential.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/01/18 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Resident Rights Deficiencies
|
|
Deficiency
|
Let residents give themselves their drugs if they are able.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/01/18 (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
|
2007/01/18 (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
|
2007/01/18 (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
|
2007/01/18 (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
|
2007/01/16 (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
|
2007/01/16 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Fire Alarm Systems Deficiencies
|
|
Deficiency
|
properly maintained smoke detectors.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2007/01/16 (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
|
2007/01/16 (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
|
2007/01/16 (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
|
2007/01/16 (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
|
2007/01/16 (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
|
2007/01/16 (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
|
2007/01/16 (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
|
2007/01/16 (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
|
2007/01/16 (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
|
2005/11/03 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Resident Rights Deficiencies
|
|
Deficiency
|
Let residents give themselves their drugs if they are able.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/11/03 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Resident Assessment Deficiencies
|
|
Deficiency
|
Make sure all assessments are accurate, coordinated by an RN, done by the right professional, and are signed by the person completing them.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/11/03 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Quality Care Deficiencies
|
|
Deficiency
|
Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/11/03 (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
|
2005/11/03 (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
|
2005/11/03 (YYYY/MM/DD)
|
|
Deficiency Type
|
Health
|
|
Category
|
Administration Deficiencies
|
|
Deficiency
|
Make sure that nurse aides show they have the skills to be able to care for residents.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/11/02 (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
|
2005/11/02 (YYYY/MM/DD)
|
|
Deficiency Type
|
Fire Safety
|
|
Category
|
Exit and Exit Access Deficiencies
|
|
Deficiency
|
at least two remote exits on each floor or fire section of the building.
|
|
Level of Harm
|
Minimal harm or potential for actual harm
|
|
|
Date of Survey
|
2005/11/02 (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
|
2005/11/02 (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
|
2005/11/02 (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
|
2005/11/02 (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
|
2005/11/02 (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
|
2004/12/06 (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
|
|