Syringa Chalet Nursing Facility

Total Number of Beds: 30	Percent of Occupied Beds: 77%
Total Number of Residents: 23	Located Within a Hospital: No
Type of Ownership: Government - State	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Family & Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 11/07/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.83

Number of LPN/LVN Hours per Nursing Home Resident per Day: 1.23

Number of CNA Hours per Nursing Home Resident per Day: 4.98

Number of Staff Hours per Nursing Home Resident per Day: 7.04

Nursing Home Resident Information**:

** Details Last Reported on: 11/7/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-07-26	2001-08-30	Mistreatment Deficiencies	Protect residents from mistreatment, neglect, and/or theft of personal property.	Pattern	Minimal harm or potential for actual harm
2001-07-26	2001-08-30	Mistreatment Deficiencies	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.	Pattern	Minimal harm or potential for actual harm
2001-07-26	2001-08-30	Resident Rights Deficiencies	Provide care in a way that keeps or builds each resident's dignity and self respect.	Pattern	Potential for minimal harm
2001-07-26	2001-08-30	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Widespread	Potential for minimal harm
2002-08-16	2002-09-20	Resident Rights Deficiencies	Provide care in a way that keeps or builds each resident's dignity and self respect.	Isolated	Minimal harm or potential for actual harm
2002-08-16	2002-09-20	Environmental Deficiencies	Keep safe, clean and homelike surroundings.	Pattern	Potential for minimal harm
2002-08-16	2002-09-20	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Pattern	Potential for minimal harm
2002-08-16	2002-09-20	Resident Assessment Deficiencies	Do a new assessment after any major change in a resident's physical or mental health.	Isolated	Minimal harm or potential for actual harm
2002-08-16	2002-09-20	Resident Assessment Deficiencies	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.	Pattern	Minimal harm or potential for actual harm
2002-08-16	2002-09-20	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Actual harm
2002-08-16	2002-09-20	Quality Care Deficiencies	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
2002-08-16	2002-09-20	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Isolated	Minimal harm or potential for actual harm
2003-11-07	2003-12-01	Mistreatment Deficiencies	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
2003-11-07	2003-12-01	Quality Care Deficiencies	Provide social services for related medical problems to help each resident achieve the highest possible quality of life.	Pattern	Minimal harm or potential for actual harm
2003-11-07	2003-12-01	Resident Assessment Deficiencies	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
2003-11-07	2003-12-01	Pharmacy Service Deficiencies	Act when the pharmacist reports something unusual.	Isolated	Minimal harm or potential for actual harm

*** All violations listed are based on federal government records.