| Date of Violation |
Date Corrected |
Type of Violation |
Deficiency |
Scope |
Level of Harm |
| 2001-05-25 |
2001-08-14 |
Resident Rights Deficiencies |
Immediately tell the resident, doctor, and a family member if: the resident is injured, there is a major change in resident's physical/mental health, there is a need to alter treatment significantly, or the resident must be transferred or discharged. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-05-25 |
2001-08-14 |
Mistreatment Deficiencies |
Keep each resident free from physical restraints, unless needed for medical treatment. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-05-25 |
2001-08-14 |
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 |
| 2001-05-25 |
2001-08-14 |
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 |
| 2001-05-25 |
2001-08-14 |
Resident Assessment Deficiencies |
Make a complete assessment that covers all questions for areas that are listed in official regulations. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-05-25 |
2001-08-14 |
Resident Assessment Deficiencies |
Assess the resident when the resident enters the nursing home, in a timely manner. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-05-25 |
2001-08-14 |
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 |
| 2001-05-25 |
2001-08-14 |
Resident Assessment Deficiencies |
Check and update (if needed) each resident's assessment every 3 months. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-05-25 |
2001-08-14 |
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 |
| 2001-05-25 |
2001-08-14 |
Quality Care Deficiencies |
Give professional services that meet a professional standard of quality. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-05-25 |
2001-08-14 |
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 |
| 2001-05-25 |
2001-08-14 |
Quality Care Deficiencies |
Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-05-25 |
2001-08-14 |
Quality Care Deficiencies |
Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. |
Isolated |
Actual harm |
| 2001-05-25 |
2001-08-14 |
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 |
| 2001-05-25 |
2001-08-14 |
Quality Care Deficiencies |
Make sure that residents with reduced range of motion get proper treatment and services to increase range of motion. |
Isolated |
Actual harm |
| 2001-05-25 |
2001-08-14 |
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 |
| 2001-05-25 |
2001-08-14 |
Environmental Deficiencies |
Make sure that the nursing home area is free of dangers that cause accidents. |
Pattern |
Minimal harm or potential for actual harm |
| 2001-05-25 |
2001-08-14 |
Quality Care Deficiencies |
Make sure each resident is being watched and has assistance devices when needed, to prevent accidents. |
Isolated |
Actual harm |
| 2001-05-25 |
2001-08-14 |
Quality Care Deficiencies |
Make sure that each resident's nutritional needs were met. |
Isolated |
Actual harm |
| 2001-05-25 |
2001-08-14 |
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 |
| 2001-05-25 |
2001-08-14 |
Pharmacy Service Deficiencies |
Make sure that the pharmacist reports anything unusual to the doctor on duty and the director of nursing. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-06-06 |
2002-07-05 |
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 |
Minimal harm or potential for actual harm |
| 2002-06-06 |
2002-07-05 |
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 |
| 2002-06-06 |
2002-07-05 |
Quality Care Deficiencies |
Give professional services that meet a professional standard of quality. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-06-06 |
2002-07-05 |
Quality Care Deficiencies |
Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-06-06 |
2002-07-05 |
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 |
| 2002-06-06 |
2002-07-05 |
Quality Care Deficiencies |
Make sure that residents with reduced range of motion get proper treatment and services to increase range of motion. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-06-06 |
2002-08-28 |
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 |
| 2002-06-06 |
2002-07-05 |
Quality Care Deficiencies |
Make sure that each resident's nutritional needs were met. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-06-06 |
2002-07-05 |
Pharmacy Service Deficiencies |
Make sure that residents who have not taken antipsychotic drugs are not given these drugs, unless they are used to treat a problem that is diagnosed and noted in the medical record. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-06-06 |
2002-07-05 |
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 |
| 2002-06-06 |
2002-07-05 |
Nutrition and Dietary Deficiencies |
Store, cook, and give out food in a safe and clean way. |
Widespread |
Potential for minimal harm |
| 2002-06-06 |
2002-07-05 |
Pharmacy Service Deficiencies |
Make sure that the pharmacist reports anything unusual to the doctor on duty and the director of nursing. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-05-15 |
2003-06-14 |
Resident Assessment Deficiencies |
Keep assessments completed in the preceding 15 months in the resident's active record. |
Widespread |
Potential for minimal harm |
| 2003-05-15 |
2003-06-14 |
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 |
| 2003-05-15 |
2003-06-14 |
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 |
| 2003-05-15 |
2003-06-14 |
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 |
| 2003-05-15 |
2003-06-14 |
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 |
Minimal harm or potential for actual harm |
| 2003-05-15 |
2003-06-14 |
Environmental Deficiencies |
Move, clean and store sheets, towels and other linens in a way that prevents the spread of infection. |
Isolated |
Minimal harm or potential for actual harm |
*** All violations listed are based on federal government records.