| Total Number of Beds: 100 | Percent of Occupied Beds: 98% |
| Total Number of Residents: 98 | Located Within a Hospital: No |
| Type of Ownership: Non profit - Church related | 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: 09/11/2003 |
| Date of Violation |
Date Corrected |
Type of Violation |
Deficiency |
Scope |
Level of Harm |
| 2001-09-06 |
2001-10-26 |
Resident Rights Deficiencies |
Tell each resident who can get Medicaid benefits about 1) which items and services Medicaid covers and which the resident must pay for; or 2) how to apply for Medicaid, along with the names and addresses of State groups that can help. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-09-06 |
2001-10-26 |
Mistreatment Deficiencies |
Keep each resident free from physical restraints, unless needed for medical treatment. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-09-06 |
2001-10-26 |
Mistreatment Deficiencies |
Keep each resident free from drugs that restrain them, unless needed for medical treatment. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-09-06 |
2001-10-26 |
Environmental Deficiencies |
Make sure that the nursing home area is free of dangers that cause accidents. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-09-06 |
2001-10-26 |
Nutrition and Dietary Deficiencies |
Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-09-06 |
2001-10-26 |
Nutrition and Dietary Deficiencies |
Store, cook, and give out food in a safe and clean way. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-07-25 |
2002-08-30 |
Mistreatment Deficiencies |
Protect residents from mistreatment, neglect, and/or theft of personal property. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-07-25 |
2002-08-30 |
Mistreatment Deficiencies |
Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-09-11 |
2003-10-31 |
Resident Rights Deficiencies |
Let residents give themselves their drugs if they are able. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-09-11 |
2003-10-31 |
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 |
| 2003-09-11 |
2003-10-31 |
Quality Care Deficiencies |
Make sure each resident is being watched and has assistance devices when needed, to prevent accidents. |
Isolated |
Actual harm |
*** All violations listed are based on federal government records.