Surrey Place Health & Rehab Center

Total Number of Beds: 120	Percent of Occupied Beds: 94%
Total Number of Residents: 113	Located Within a Hospital: No
Type of Ownership: Non profit - Other	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: 09/12/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.34

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.9

Number of CNA Hours per Nursing Home Resident per Day: 2.82

Number of Staff Hours per Nursing Home Resident per Day: 4.06

Nursing Home Resident Information**:

Percent of Low-Risk Residents Who Have Pressure Sores: 2%
Percent of Short-Stay Residents With Pressure Sores: 15%
Percent of High-Risk Residents Who Have Pressure Sores: 16%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain: 13%
Percent of Residents Who Have Moderate to Severe Pain: 4%
Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse: 11%
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: 9%
Percent of Residents Who are More Depressed or Anxious: 19%
Percent of Short-Stay Residents With Delirium: 0%
Percent of Residents Who Were Physically Restrained: 18%
Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder: 44%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 5%
Percent of Residents With a Urinary Tract Infection: 7%
** Details Last Reported on: 9/12/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-06-01	2001-07-01	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
2001-06-01	2001-07-01	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
2001-06-01	2001-07-01	Quality Care Deficiencies	Give professional services that follow each resident's written care plan.	Isolated	Minimal harm or potential for actual harm
2001-06-01	2001-07-01	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	Minimal harm or potential for actual harm
2001-06-01	2001-07-01	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
2001-06-01	2001-07-01	Pharmacy Service Deficiencies	Make sure that residents are safe from serious medication errors.	Isolated	Minimal harm or potential for actual harm
2001-06-01	2001-07-01	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Isolated	Minimal harm or potential for actual harm
2001-06-01	2001-07-01	Pharmacy Service Deficiencies	Have drugs and other similar products available, which are needed every day and in emergencies, and give them out properly.	Isolated	Minimal harm or potential for actual harm
2001-06-01	2001-07-01	Pharmacy Service Deficiencies	Properly mark drugs and other similar products.	Isolated	Minimal harm or potential for actual harm
2001-06-01	2001-07-01	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Pattern	Minimal harm or potential for actual harm
2001-06-01	2001-07-01	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Isolated	Minimal harm or potential for actual harm
2001-06-01	2001-07-01	Administration Deficiencies	Keep accurate and appropriate medical records.	Isolated	Minimal harm or potential for actual harm
2002-07-25	2002-09-16	Resident Rights Deficiencies	Keep each resident's personal and medical records private and confidential.	Isolated	Minimal harm or potential for actual harm
2002-07-25	2002-09-16	Resident Rights Deficiencies	Tell the resident or the resident's representative in writing how long the nursing home will hold the resident's bed when the resident temporarily leaves the facility.	Widespread	Potential for minimal harm
2002-07-25	2002-09-16	Quality Care Deficiencies	Make sure that residents receive treatment/services to continue to be able to care for themselves, unless a change is unavoidable.	Isolated	Minimal harm or potential for actual harm
2002-07-25	2002-09-16	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
2002-07-25	2002-09-16	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
2002-07-25	2002-09-16	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Isolated	Minimal harm or potential for actual harm
2002-07-25	2002-09-16	Environmental Deficiencies	Put firmly secured handrails on each side of hallways.	Pattern	Minimal harm or potential for actual harm
2003-09-12	2003-10-20	Resident Assessment Deficiencies	Check and update (if needed) each resident's assessment every 3 months.	Isolated	Minimal harm or potential for actual harm
2003-09-12	2003-10-20	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm

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