| Total Number of Beds: 125 | Percent of Occupied Beds: 96% |
| Total Number of Residents: 120 | 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: 07/25/2003 |
| Date of Violation |
Date Corrected |
Type of Violation |
Deficiency |
Scope |
Level of Harm |
| 2001-09-28 |
2001-10-15 |
Environmental Deficiencies |
Provide needed housekeeping and maintenance. |
Pattern |
Potential for minimal harm |
| 2002-08-23 |
2002-10-11 |
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 |
| 2002-08-23 |
2002-10-11 |
Resident Rights Deficiencies |
Provide care in a way that keeps or builds each resident's dignity and self respect. |
Pattern |
Potential for minimal harm |
| 2002-08-23 |
2002-10-11 |
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 |
| 2002-08-23 |
2002-10-11 |
Quality Care Deficiencies |
Make sure that each resident's nutritional needs were met. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-08-23 |
2002-10-11 |
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 |
| 2002-08-23 |
2002-10-11 |
Nutrition and Dietary Deficiencies |
Hire enough skilled workers to carry out dietary service. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-08-23 |
2002-10-11 |
Environmental Deficiencies |
Make sure that staff members wash their hands when needed. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-08-23 |
2002-10-11 |
Environmental Deficiencies |
Keep all essential equipment working safely. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-07-25 |
2003-09-24 |
Environmental Deficiencies |
Keep safe, clean and homelike surroundings. |
Pattern |
Potential for minimal harm |
| 2003-07-25 |
2003-09-24 |
Environmental Deficiencies |
Make sure that the nursing home area is free of dangers that cause accidents. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-07-25 |
2003-09-24 |
Nutrition and Dietary Deficiencies |
Store, cook, and give out food in a safe and clean way. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-07-25 |
2003-09-24 |
Administration Deficiencies |
Keep accurate and appropriate medical records. |
Isolated |
Minimal harm or potential for actual harm |
*** All violations listed are based on federal government records.