Kingsley Manor Care Center

Total Number of Beds: 51	Percent of Occupied Beds: 92%
Total Number of Residents: 47	Located Within a Hospital: No
Type of Ownership: Non profit - Corporation	Multiple Nursing Homes by Same Owner: Yes
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 01/13/2004

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**:

Percent of Residents Who Have Moderate to Severe Pain: 2%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 0%
Percent of Residents Whose Need for Help With Daily Activities Has Increased: 0%
Percent of Residents Who are More Depressed or Anxious: 9%
Percent of Residents Who Were Physically Restrained: 9%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 9%
Percent of Residents With a Urinary Tract Infection: 3%
** Details Last Reported on: 1/13/2004

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2002-01-28	2002-03-18	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.	Pattern	Potential for minimal harm
2002-01-28	2002-03-18	Mistreatment Deficiencies	Keep each resident free from physical restraints, unless needed for medical treatment.	Isolated	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	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.	Pattern	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	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
2002-01-28	2002-03-18	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Isolated	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	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
2002-01-28	2002-03-18	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
2002-01-28	2002-03-18	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	Potential for minimal harm
2002-01-28	2002-03-18	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
2002-01-28	2002-03-18	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	Quality Care Deficiencies	Make sure that residents with loss of bladder control receive treatment or service to prevent infections and help get normal bladder control.	Isolated	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Pattern	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	Quality Care Deficiencies	Give each resident enough fluids to keep them healthy and prevent dehydration.	Isolated	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	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.	Isolated	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	Pharmacy Service Deficiencies	Make sure that residents are safe from serious medication errors.	Isolated	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	Nutrition and Dietary Deficiencies	Make sure that the attending doctor orders special diets.	Isolated	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	Nutrition and Dietary Deficiencies	Provide special eating equipment and utensils for each resident who needs them.	Pattern	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	Administration Deficiencies	Get services outside the nursing home that meet professional standards.	Isolated	Minimal harm or potential for actual harm
2002-01-28	2002-03-18	Administration Deficiencies	Keep accurate and appropriate medical records.	Pattern	Potential for minimal harm
2003-03-09	2003-04-09	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.	Pattern	Potential for minimal harm
2003-03-09	2003-04-09	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.	Pattern	Potential for minimal harm
2003-03-09	2003-04-09	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Pattern	Potential for minimal harm
2003-03-09	2003-04-09	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
2003-03-09	2003-04-09	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
2003-03-09	2003-04-09	Nutrition and Dietary Deficiencies	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Isolated	Minimal harm or potential for actual harm
2003-03-09	2003-04-09	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Isolated	Minimal harm or potential for actual harm
2003-03-09	2003-04-09	Environmental Deficiencies	Have a program to keep infection from spreading.	Pattern	Potential for minimal harm
2003-03-09	2003-04-09	Environmental Deficiencies	Be designed, built, equipped, or well kept to protect the health and safety of residents, workers, and the public.	Pattern	Potential for minimal harm
2003-03-09	2003-04-09	Environmental Deficiencies	Keep all essential equipment working safely.	Isolated	Minimal harm or potential for actual harm
2003-03-09	2003-04-09	Environmental Deficiencies	Provide bedrooms that hold no more than 4 residents per room.	Pattern	Potential for minimal harm
2003-03-09	2003-04-09	Environmental Deficiencies	Make sure that a working call system is available in each resident's room or bathroom and bathing area.	Pattern	Potential for minimal harm
2003-03-09	2003-04-09	Administration Deficiencies	Follow all laws and professional standards.	Pattern	Potential for minimal harm
2004-01-13	2004-02-06	Resident Rights Deficiencies	Keep each resident's personal and medical records private and confidential.	Isolated	Minimal harm or potential for actual harm
2004-01-13	2004-02-06	Resident Rights Deficiencies	Allow residents to easily see the results of the nursing home's most recent survey.	Pattern	Potential for minimal harm
2004-01-13	2004-02-06	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
2004-01-13	2004-02-06	Resident Rights Deficiencies	Provide care in a way that keeps or builds each resident's dignity and self respect.	Pattern	Potential for minimal harm
2004-01-13	2004-02-06	Quality Care Deficiencies	Give each resident care and services to get or keep the highest quality of life possible.	Pattern	Potential for minimal harm
2004-01-13	2004-02-06	Quality Care Deficiencies	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Minimal harm or potential for actual harm
2004-01-13	2004-02-06	Pharmacy Service Deficiencies	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Pattern	Minimal harm or potential for actual harm
2004-01-13	2004-02-06	Nutrition and Dietary Deficiencies	1) Provide 3 meals daily at regular times; or 2) serve breakfast within 14 hours after dinner; or 3) offer a snack at bedtime each day.	Pattern	Potential for minimal harm
2004-01-13	2004-02-06	Environmental Deficiencies	Keep all essential equipment working safely.	Widespread	Potential for minimal harm
2004-01-13	2004-02-06	Environmental Deficiencies	Make sure there is a program to prevent/deal with mice, insects, or other pests.	Widespread	Potential for minimal harm

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