| Health Violations: |
| Category: |
Date: |
Specific Violation: |
Scope: |
Level of Harm Caused: |
| Administration Deficiencies |
06/20/2003 |
Get services outside the nursing home that meet professional standards. |
Isolated |
Minimal harm or potential for actual harm |
| Quality Care Deficiencies |
06/20/2003 |
Give professional services that meet a professional standard of quality. |
Isolated |
Minimal harm or potential for actual harm |
| Resident Assessment Deficiencies |
06/20/2003 |
Make a complete assessment that covers all questions for areas that are listed in official regulations. |
Isolated |
Minimal harm or potential for actual harm |
| Resident Assessment Deficiencies |
06/20/2003 |
Provide a final summary of the resident's health status and a summary of the resident's stay, when the resident is ready to leave the nursing home. |
Widespread |
Potential for minimal harm |
| Resident Assessment Deficiencies |
06/20/2003 |
Keep assessments completed in the preceding 15 months in the resident's active record. |
Widespread |
Potential for minimal harm |
| Resident Rights Deficiencies |
06/20/2003 |
Provide services to meet the needs and preferences of each resident. |
Pattern |
Minimal harm or potential for actual harm |
| Administration Deficiencies |
06/24/2004 |
Keep accurate and appropriate medical records. |
Isolated |
Minimal harm or potential for actual harm |
| Environmental Deficiencies |
06/24/2004 |
Have a program to keep infection from spreading. |
Widespread |
Minimal harm or potential for actual harm |
| Environmental Deficiencies |
06/24/2004 |
Make sure that staff members wash their hands when needed. |
Isolated |
Minimal harm or potential for actual harm |
| Environmental Deficiencies |
06/24/2004 |
Move, clean and store sheets, towels and other linens in a way that prevents the spread of infection. |
Isolated |
Minimal harm or potential for actual harm |
| Environmental Deficiencies |
06/24/2004 |
Make sure that a working call system is available in each resident's room or bathroom and bathing area. |
Widespread |
Minimal harm or potential for actual harm |
| Mistreatment Deficiencies |
06/24/2004 |
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. |
Isolated |
Minimal harm or potential for actual harm |
| Nutrition and Dietary Deficiencies |
06/24/2004 |
Store, cook, and give out food in a safe and clean way. |
Widespread |
Minimal harm or potential for actual harm |
| Quality Care Deficiencies |
06/24/2004 |
Give professional services that follow each resident's written care plan. |
Isolated |
Minimal harm or potential for actual harm |
| Quality Care Deficiencies |
06/24/2004 |
Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene. |
Isolated |
Minimal harm or potential for actual harm |
| Quality Care Deficiencies |
06/24/2004 |
Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. |
Isolated |
Actual harm |
| Quality Care Deficiencies |
06/24/2004 |
Make sure that each resident who enters the nursing home without a catheter is not given a catheter, unless it is necessary. |
Isolated |
Minimal harm or potential for actual harm |
| Quality Care Deficiencies |
06/24/2004 |
Give proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible. |
Isolated |
Minimal harm or potential for actual harm |
| Quality Care Deficiencies |
06/24/2004 |
Make sure each resident is being watched and has assistance devices when needed, to prevent accidents. |
Isolated |
Minimal harm or potential for actual harm |
| Quality Care Deficiencies |
06/24/2004 |
Have enough nurses to care for every resident in a way that maximizes the resident's well being. |
Widespread |
Minimal harm or potential for actual harm |
| Resident Assessment Deficiencies |
06/24/2004 |
Make a complete assessment that covers all questions for areas that are listed in official regulations. |
Isolated |
Minimal harm or potential for actual harm |
| Resident Assessment Deficiencies |
06/24/2004 |
Check and update (if needed) each resident's assessment every 3 months. |
Isolated |
Minimal harm or potential for actual harm |
| Resident Assessment Deficiencies |
06/24/2004 |
Make sure all assessments are accurate, coordinated by an RN, done by the right professional, and are signed by the person completing them. |
Isolated |
Minimal harm or potential for actual harm |
| Resident Assessment Deficiencies |
06/24/2004 |
Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured. |
Isolated |
Minimal harm or potential for actual harm |
| Resident Rights Deficiencies |
06/24/2004 |
Quickly give a resident's personal money to the heads of his or her estate after the resident's death. |
Isolated |
Minimal harm or potential for actual harm |
| Resident Rights Deficiencies |
06/24/2004 |
Provide services to meet the needs and preferences of each resident. |
Isolated |
Minimal harm or potential for actual harm |
| Administration Deficiencies |
09/01/2005 |
Get services outside the nursing home that meet professional standards. |
Widespread |
Potential for minimal harm |
| Environmental Deficiencies |
09/01/2005 |
Have a program to keep infection from spreading. |
Widespread |
Minimal harm or potential for actual harm |
| Environmental Deficiencies |
09/01/2005 |
Make sure that a working call system is available in each resident's room or bathroom and bathing area. |
Isolated |
Minimal harm or potential for actual harm |
| Mistreatment Deficiencies |
09/01/2005 |
Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property. |
Isolated |
Minimal harm or potential for actual harm |
| Nutrition and Dietary Deficiencies |
09/01/2005 |
Store, cook, and give out food in a safe and clean way. |
Isolated |
Minimal harm or potential for actual harm |
| Quality Care Deficiencies |
09/01/2005 |
Give professional services that follow each resident's written care plan. |
Isolated |
Minimal harm or potential for actual harm |
| Resident Assessment Deficiencies |
09/01/2005 |
Make a complete assessment that covers all questions for areas that are listed in official regulations. |
Isolated |
Minimal harm or potential for actual harm |
| Resident Assessment Deficiencies |
09/01/2005 |
Do an assessment of the resident every year. |
Isolated |
Minimal harm or potential for actual harm |
| Resident Assessment Deficiencies |
09/01/2005 |
Keep assessments completed in the preceding 15 months in the resident's active record. |
Isolated |
Minimal harm or potential for actual harm |
| Resident Rights Deficiencies |
09/01/2005 |
Keep each resident's personal and medical records private and confidential. |
Isolated |
Minimal harm or potential for actual harm |
| Resident Rights Deficiencies |
09/01/2005 |
Try to resolve each resident's complaints quickly. |
Widespread |
Minimal harm or potential for actual harm |
| Fire Safety Violations: |
| Category: |
Date: |
Specific Violation: |
Scope: |
Level of Harm Caused: |
| Automatic Sprinkler Systems Deficiencies |
06/25/2003 |
an approved automatic sprinkler system connected to the fire alarm system. |
Pattern |
Potential for minimal harm |
| Automatic Sprinkler Systems Deficiencies |
06/25/2003 |
automatic sprinkler systems that have been maintained in working order. |
Pattern |
Potential for minimal harm |
| Corridor Walls and Doors Deficiencies |
06/25/2003 |
corridor and hallway doors that block smoke. |
Widespread |
Potential for minimal harm |
| Emergency Plans and Fire Drills Deficiencies |
06/25/2003 |
record of quarterly fire drills for each shift under varying conditions. |
Widespread |
Potential for minimal harm |
| Fire Alarm Systems Deficiencies |
06/25/2003 |
a fire alarm system that can be heard throughout the facility. |
Isolated |
Minimal harm or potential for actual harm |
| Fire Alarm Systems Deficiencies |
06/25/2003 |
an approved installation, maintenance and testing program for fire alarm systems. |
Pattern |
Potential for minimal harm |
| Fire Alarm Systems Deficiencies |
06/25/2003 |
properly maintained smoke detectors. |
Isolated |
Minimal harm or potential for actual harm |
| Hazardous Area Deficiencies |
06/25/2003 |
construction that can resist fire for one hour or an approved fire extinguishing system. |
Isolated |
Minimal harm or potential for actual harm |
| Illumination and Emergency Power Deficiencies |
06/25/2003 |
emergency lighting that can last at least 1 1/2 hours. |
Pattern |
Minimal harm or potential for actual harm |
| Medical Gases and Anesthetizing Areas Deficiencies |
06/25/2003 |
proper medical gas storage and administration areas. |
Isolated |
Minimal harm or potential for actual harm |
| Electrical Deficiencies |
06/29/2004 |
properly installed electrical wiring and equipment. |
Widespread |
Potential for minimal harm |
| Emergency Plans and Fire Drills Deficiencies |
06/29/2004 |
record of quarterly fire drills for each shift under varying conditions. |
Widespread |
Potential for minimal harm |
| Hazardous Area Deficiencies |
06/29/2004 |
construction that can resist fire for one hour or an approved fire extinguishing system. |
Isolated |
Minimal harm or potential for actual harm |
| Automatic Sprinkler Systems Deficiencies |
09/09/2005 |
automatic sprinkler systems that have been maintained in working order. |
Isolated |
Minimal harm or potential for actual harm |
| Electrical Deficiencies |
09/09/2005 |
weekly inspections and monthly testing of generators. |
Isolated |
Minimal harm or potential for actual harm |
| Electrical Deficiencies |
09/09/2005 |
properly installed electrical wiring and equipment. |
Isolated |
Minimal harm or potential for actual harm |
| Fire Alarm Systems Deficiencies |
09/09/2005 |
an approved installation, maintenance and testing program for fire alarm systems. |
Widespread |
Minimal harm or potential for actual harm |
| Smoke Compartmentation and Control Deficiencies |
09/09/2005 |
walls or barriers that prevent smoke from passing through and would resist fire for at least one hour. |
Pattern |
Minimal harm or potential for actual harm |
| Smoking Regulations Deficiencies |
09/09/2005 |
posted No-smoking signs in areas where smoking is not permitted or did not provide ashtrays where smoking was allowed. |
Isolated |
Minimal harm or potential for actual harm |