| Date of Violation |
Date Corrected |
Type of Violation |
Deficiency |
Scope |
Level of Harm |
| 2001-03-14 |
2001-04-26 |
Resident Rights Deficiencies |
Let residents give themselves their drugs if they are able. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-07-02 |
Mistreatment Deficiencies |
Keep each resident free from physical restraints, unless needed for medical treatment. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-04-26 |
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 |
| 2001-03-14 |
2001-04-26 |
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 |
| 2001-03-14 |
2001-07-02 |
Environmental Deficiencies |
Provide needed housekeeping and maintenance. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-06-06 |
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 |
| 2001-03-14 |
2001-07-02 |
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 |
| 2001-03-14 |
2001-04-26 |
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 |
| 2001-03-14 |
2001-04-26 |
Quality Care Deficiencies |
Give professional services that meet a professional standard of quality. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-04-26 |
Quality Care Deficiencies |
Make sure that each resident gets help to keep vision and hearing. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-07-02 |
Environmental Deficiencies |
Make sure that the nursing home area is free of dangers that cause accidents. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-04-26 |
Quality Care Deficiencies |
Make sure each resident is being watched and has assistance devices when needed, to prevent accidents. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-04-26 |
Quality Care Deficiencies |
Make sure that each resident's nutritional needs were met. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-04-26 |
Quality Care Deficiencies |
Give each resident enough fluids to keep them healthy and prevent dehydration. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-04-26 |
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. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-04-26 |
Pharmacy Service Deficiencies |
Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-04-26 |
Resident Assessment Deficiencies |
Make sure that doctors see a resident's plan of care at every visit and make notes about progress and orders in writing. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-04-26 |
Pharmacy Service Deficiencies |
Provide drugs and related services needed by each resident. |
Widespread |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-04-26 |
Pharmacy Service Deficiencies |
Use the services of a licensed pharmacist. |
Widespread |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-04-26 |
Pharmacy Service Deficiencies |
Act when the pharmacist reports something unusual. |
Widespread |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-07-02 |
Pharmacy Service Deficiencies |
Keep drugs and other similar products locked safely and properly stored. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-03-14 |
2001-07-02 |
Environmental Deficiencies |
Make sure that the nursing home area is safe, easy to use, clean and comfortable. |
Pattern |
Potential for minimal harm |
| 2001-03-14 |
2001-04-26 |
Administration Deficiencies |
Keep accurate and appropriate medical records. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-08-19 |
Resident Rights Deficiencies |
Honor all of the resident's rights as a resident of the nursing home and as a citizen or resident of the United States. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Resident Rights Deficiencies |
Quickly give a resident's personal money to the heads of his or her estate after the resident's death. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Resident Rights Deficiencies |
Have a private telephone available for use. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Mistreatment Deficiencies |
Protect residents from mistreatment, neglect, and/or theft of personal property. |
Isolated |
Actual harm |
| 2002-05-16 |
2002-06-24 |
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 |
| 2002-05-16 |
2002-08-19 |
Resident Rights Deficiencies |
Provide care in a way that keeps or builds each resident's dignity and self respect. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Resident Rights Deficiencies |
Provide services to meet the needs and preferences of each resident. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Quality Care Deficiencies |
Provide social services for related medical problems to help each resident achieve the highest possible quality of life. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-08-19 |
Environmental Deficiencies |
Provide needed housekeeping and maintenance. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
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 |
| 2002-05-16 |
2002-06-24 |
Quality Care Deficiencies |
Give professional services that meet a professional standard of quality. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Quality Care Deficiencies |
Give professional services that follow each resident's written care plan. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Resident Assessment Deficiencies |
Keep assessments completed in the preceding 15 months in the resident's active record. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-08-19 |
Quality Care Deficiencies |
Give each resident care and services to get or keep the highest quality of life possible. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Quality Care Deficiencies |
Make sure that each residents' abilities to take care of themselves does not lessen, unless a change cannot be avoided. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-08-19 |
Quality Care Deficiencies |
Make sure that each resident who enters the nursing home without a catheter is not given a catheter, unless it is necessary. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-08-19 |
Environmental Deficiencies |
Make sure that the nursing home area is free of dangers that cause accidents. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
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 |
| 2002-05-16 |
2002-06-24 |
Quality Care Deficiencies |
Have enough nurses to care for every resident in a way that maximizes the resident's well being. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Nutrition and Dietary Deficiencies |
Provide food in a way that meets a resident's needs. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-08-19 |
Nutrition and Dietary Deficiencies |
Make sure that the attending doctor orders special diets. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Nutrition and Dietary Deficiencies |
Store, cook, and give out food in a safe and clean way. |
Widespread |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Pharmacy Service Deficiencies |
Provide drugs and related services needed by each resident. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Pharmacy Service Deficiencies |
Keep drugs and other similar products locked safely and properly stored. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-08-19 |
Environmental Deficiencies |
Have a program to keep infection from spreading. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-05-16 |
2002-06-24 |
Administration Deficiencies |
Keep accurate and appropriate medical records. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-04-23 |
2003-05-29 |
Environmental Deficiencies |
Provide needed housekeeping and maintenance. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-04-23 |
2003-05-29 |
Environmental Deficiencies |
Provide clean bed and bath linens that are in good condition. |
Widespread |
Potential for minimal harm |
| 2003-04-23 |
2003-05-29 |
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 |
| 2003-04-23 |
2003-05-29 |
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 |
| 2003-04-23 |
2003-05-29 |
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 |
| 2003-04-23 |
2003-05-29 |
Quality Care Deficiencies |
Give professional services that meet a professional standard of quality. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-04-23 |
2003-05-29 |
Quality Care Deficiencies |
Give professional services that follow each resident's written care plan. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-04-23 |
2003-05-29 |
Quality Care Deficiencies |
Make sure each resident is being watched and has assistance devices when needed, to prevent accidents. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-04-23 |
2003-07-10 |
Quality Care Deficiencies |
Make sure that each resident's nutritional needs were met. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-04-23 |
2003-05-29 |
Nutrition and Dietary Deficiencies |
Make sure that residents are well nourished. |
Widespread |
Potential for minimal harm |
| 2003-04-23 |
2003-05-29 |
Nutrition and Dietary Deficiencies |
Provide special eating equipment and utensils for each resident who needs them. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-04-23 |
2003-07-10 |
Nutrition and Dietary Deficiencies |
Store, cook, and give out food in a safe and clean way. |
Widespread |
Minimal harm or potential for actual harm |
| 2003-04-23 |
2003-05-29 |
Environmental Deficiencies |
Get rid of garbage properly. |
Widespread |
Potential for minimal harm |
| 2003-04-23 |
2003-07-10 |
Pharmacy Service Deficiencies |
Provide drugs and related services needed by each resident. |
Isolated |
Minimal harm or potential for actual harm |
*** All violations listed are based on federal government records.