| Total Number of Beds: 100 | Percent of Occupied Beds: 82% |
| Total Number of Residents: 82 | Located Within a Hospital: No |
| Type of Ownership: Non profit - Corporation | Multiple Nursing Homes by Same Owner: No |
| Councils the Nursing Home Participates in: Family & Resident | Medicare/Medicaid: Participating in Medicare and Medicaid |
| * Details Last Reported on: 04/24/2003 |
| Date of Violation |
Date Corrected |
Type of Violation |
Deficiency |
Scope |
Level of Harm |
| 2002-04-12 |
2002-05-30 |
Resident Rights Deficiencies |
Keep each resident's personal and medical records private and confidential. |
Pattern |
Potential for minimal harm |
| 2002-04-12 |
2002-05-30 |
Environmental Deficiencies |
Provide needed housekeeping and maintenance. |
Pattern |
Potential for minimal harm |
| 2002-04-12 |
2002-05-30 |
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 |
| 2002-04-12 |
2002-05-30 |
Nutrition and Dietary Deficiencies |
Make sure that residents are well nourished. |
Widespread |
Potential for minimal harm |
| 2002-04-12 |
2002-05-30 |
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. |
Widespread |
Potential for minimal harm |
| 2002-04-12 |
2002-05-30 |
Nutrition and Dietary Deficiencies |
Store, cook, and give out food in a safe and clean way. |
Widespread |
Potential for minimal harm |
| 2002-04-12 |
2002-05-30 |
Resident Assessment Deficiencies |
Make sure that a doctor approves a resident's admission in writing and that each resident has a doctor. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-04-12 |
2002-05-30 |
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. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-04-12 |
2002-05-30 |
Resident Assessment Deficiencies |
Make sure that doctors visit residents regularly, as required. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-04-12 |
2002-05-30 |
Pharmacy Service Deficiencies |
Use the services of a licensed pharmacist. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-04-12 |
2002-05-30 |
Environmental Deficiencies |
Have a program to keep infection from spreading. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-04-12 |
2002-05-30 |
Administration Deficiencies |
Give or get lab tests to meet the needs of residents. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-04-12 |
2002-05-30 |
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.