| Date of Violation |
Date Corrected |
Type of Violation |
Deficiency |
Scope |
Level of Harm |
| 2001-07-12 |
2001-09-05 |
Quality Care Deficiencies |
Provide activities to meet the needs of each resident. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-07-12 |
2001-09-05 |
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. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-07-12 |
2001-09-05 |
Resident Assessment Deficiencies |
Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-07-12 |
2001-09-05 |
Quality Care Deficiencies |
Give professional services that meet a professional standard of quality. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-07-12 |
2001-09-05 |
Quality Care Deficiencies |
Give each resident care and services to get or keep the highest quality of life possible. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-07-12 |
2001-09-05 |
Quality Care Deficiencies |
Make sure that each resident's nutritional needs were met. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-07-12 |
2001-09-05 |
Pharmacy Service Deficiencies |
Make sure that residents are safe from serious medication errors. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-07-12 |
2001-09-05 |
Pharmacy Service Deficiencies |
Have drugs and other similar products available, which are needed every day and in emergencies, and give them out properly. |
Isolated |
Actual harm |
| 2001-07-12 |
2001-09-05 |
Administration Deficiencies |
Keep accurate and appropriate medical records. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-10-25 |
2002-11-25 |
Quality Care Deficiencies |
Give professional services that meet a professional standard of quality. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-10-25 |
2002-11-25 |
Pharmacy Service Deficiencies |
Gradually lower the dose of residents' antipsychotic drugs, unless this causes negative medical effects. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-10-25 |
2002-11-25 |
Pharmacy Service Deficiencies |
Act when the pharmacist reports something unusual. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-10-25 |
2002-11-25 |
Administration Deficiencies |
Choose a doctor to be the medical director. |
Widespread |
Minimal harm or potential for actual harm |
| 2002-10-25 |
2002-11-25 |
Administration Deficiencies |
Keep accurate and appropriate medical records. |
Widespread |
Minimal harm or potential for actual harm |
| 2003-10-31 |
2003-12-05 |
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. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-10-31 |
2003-12-05 |
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 |
| 2003-10-31 |
2003-12-05 |
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 |
| 2003-10-31 |
2003-12-05 |
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 |
| 2003-10-31 |
2003-12-05 |
Resident Assessment Deficiencies |
Check and update (if needed) each resident's assessment every 3 months. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-10-31 |
2003-12-05 |
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. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-10-31 |
2003-12-05 |
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 |
| 2003-10-31 |
2003-12-05 |
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 |
| 2003-10-31 |
2003-12-05 |
Quality Care Deficiencies |
Give professional services that meet a professional standard of quality. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-10-31 |
2003-12-05 |
Quality Care Deficiencies |
Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene. |
Widespread |
Potential for minimal harm |
| 2003-10-31 |
2003-12-05 |
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 |
Actual harm |
| 2003-10-31 |
2003-12-05 |
Environmental Deficiencies |
Make sure that the nursing home area is free of dangers that cause accidents. |
Pattern |
Potential for minimal harm |
| 2003-10-31 |
2003-12-05 |
Quality Care Deficiencies |
Make sure that each resident's nutritional needs were met. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-10-31 |
2003-12-05 |
Quality Care Deficiencies |
Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses. |
Pattern |
Potential for minimal harm |
| 2003-10-31 |
2003-12-05 |
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 |
| 2003-10-31 |
2003-12-05 |
Pharmacy Service Deficiencies |
Make sure that residents who have not taken antipsychotic drugs are not given these drugs, unless they are used to treat a problem that is diagnosed and noted in the medical record. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-10-31 |
2003-12-05 |
Pharmacy Service Deficiencies |
Act when the pharmacist reports something unusual. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-10-31 |
2003-12-05 |
Administration Deficiencies |
1) Review the work of each nurse aide every year; or 2) give regular training for the nurse aides. |
Widespread |
Potential for minimal harm |
| 2003-10-31 |
2003-12-05 |
Administration Deficiencies |
Give or get lab tests to meet the needs of residents. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-10-31 |
2003-12-05 |
Administration Deficiencies |
Keep accurate and appropriate medical records. |
Widespread |
Minimal harm or potential for actual harm |
*** All violations listed are based on federal government records.