Surprise Valley

Total Number of Beds: 22	Percent of Occupied Beds: 100%
Total Number of Residents: 22	Located Within a Hospital: Yes
Type of Ownership: Government - Hospital district	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 08/13/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day:

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

Number of CNA Hours per Nursing Home Resident per Day:

Number of Staff Hours per Nursing Home Resident per Day:

Nursing Home Resident Information**:

** Details Last Reported on: 8/13/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-05-04	2001-06-30	Mistreatment Deficiencies	Keep each resident free from physical restraints, unless needed for medical treatment.	Pattern	Potential for minimal harm
2001-05-04	2001-05-07	Resident Assessment Deficiencies	Make sure all assessments are accurate, coordinated by an RN, done by the right professional, and are signed by the person completing them.	Pattern	Potential for minimal harm
2001-05-04	2001-05-22	Pharmacy Service Deficiencies	Make sure that the pharmacist reports anything unusual to the doctor on duty and the director of nursing.	Isolated	Minimal harm or potential for actual harm
2001-05-04	2001-05-25	Administration Deficiencies	Give or get lab tests to meet the needs of residents.	Isolated	Minimal harm or potential for actual harm
2002-07-11	2002-08-12	Resident Rights Deficiencies	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.	Pattern	Potential for minimal harm
2002-07-11	2002-08-12	Resident Rights Deficiencies	Help and prepare each resident for a safe and easy discharge and transfer from the nursing home.	Isolated	Minimal harm or potential for actual harm
2002-07-11	2002-08-12	Quality Care Deficiencies	Provide social services for related medical problems to help each resident achieve the highest possible quality of life.	Pattern	Potential for minimal harm
2002-07-11	2002-08-12	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Widespread	Potential for minimal harm
2002-07-11	2002-08-12	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.	Isolated	Minimal harm or potential for actual harm
2002-07-11	2002-08-12	Resident Assessment Deficiencies	Electronically record and report resident status assessments in a timely manner as required in order to monitor resident health and progress.	Widespread	Potential for minimal harm
2002-07-11	2002-08-12	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
2002-07-11	2002-08-12	Pharmacy Service Deficiencies	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.	Isolated	Minimal harm or potential for actual harm
2002-07-11	2002-08-12	Nutrition and Dietary Deficiencies	Provide food in a way that meets a resident's needs.	Isolated	Minimal harm or potential for actual harm
2002-07-11	2002-08-12	Pharmacy Service Deficiencies	Make sure that the pharmacist reports anything unusual to the doctor on duty and the director of nursing.	Isolated	Minimal harm or potential for actual harm
2002-07-11	2002-08-12	Pharmacy Service Deficiencies	Properly mark drugs and other similar products.	Isolated	Minimal harm or potential for actual harm
2002-07-11	2002-08-12	Environmental Deficiencies	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm
2002-07-11	2002-08-12	Administration Deficiencies	Keep accurate and appropriate medical records.	Pattern	Potential for minimal harm
2003-08-13	2003-08-14	Mistreatment Deficiencies	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
2003-08-13	2003-08-19	Resident Assessment Deficiencies	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Pattern	Potential for minimal harm
2003-08-13	2003-09-09	Nutrition and Dietary Deficiencies	Make sure that residents are well nourished.	Pattern	Minimal harm or potential for actual harm
2003-08-13	2003-09-09	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
2003-08-13	2003-08-25	Pharmacy Service Deficiencies	Provide drugs and related services needed by each resident.	Pattern	Potential for minimal harm
2003-08-13	2003-08-15	Pharmacy Service Deficiencies	Use the services of a licensed pharmacist.	Isolated	Minimal harm or potential for actual harm
2003-08-13	2003-08-13	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Isolated	Minimal harm or potential for actual harm
2003-08-13	2003-08-18	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Widespread	Potential for minimal harm

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