| Date of Violation |
Date Corrected |
Type of Violation |
Deficiency |
Scope |
Level of Harm |
| 2001-01-16 |
2001-02-28 |
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 |
| 2001-01-16 |
2001-02-28 |
Resident Rights Deficiencies |
Properly hold, secure and manage each resident's personal money which is deposited with the nursing home. |
Widespread |
Potential for minimal harm |
| 2001-01-16 |
2001-02-28 |
Mistreatment Deficiencies |
Keep each resident free from physical restraints, unless needed for medical treatment. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-01-16 |
2001-02-28 |
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 |
| 2001-01-16 |
2001-02-28 |
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 |
| 2001-01-16 |
2001-02-28 |
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 |
| 2001-01-16 |
2001-02-28 |
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 |
| 2001-01-16 |
2001-02-28 |
Quality Care Deficiencies |
Give professional services that meet a professional standard of quality. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-01-16 |
2001-02-28 |
Quality Care Deficiencies |
Give each resident care and services to get or keep the highest quality of life possible. |
Isolated |
Actual harm |
| 2001-01-16 |
2001-02-28 |
Quality Care Deficiencies |
Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. |
Isolated |
Actual harm |
| 2001-01-16 |
2001-02-28 |
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 |
| 2001-01-16 |
2001-02-28 |
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 |
| 2001-01-16 |
2001-02-28 |
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 |
| 2001-01-16 |
2001-02-28 |
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 |
| 2001-01-16 |
2001-02-28 |
Quality Care Deficiencies |
Make sure that each resident's nutritional needs were met. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-01-16 |
2001-02-28 |
Quality Care Deficiencies |
Give each resident enough fluids to keep them healthy and prevent dehydration. |
Isolated |
Minimal harm or potential for actual harm |
| 2001-01-16 |
2001-02-28 |
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 |
| 2001-01-16 |
2001-02-28 |
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 |
| 2001-01-16 |
2001-02-28 |
Pharmacy Service Deficiencies |
Make sure that residents are safe from serious medication errors. |
Isolated |
Actual harm |
| 2001-01-16 |
2001-02-28 |
Pharmacy Service Deficiencies |
Act when the pharmacist reports something unusual. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
Resident Rights Deficiencies |
Properly hold, secure and manage each resident's personal money which is deposited with the nursing home. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
Resident Rights Deficiencies |
Provide enough notice before discharging or transferring a resident. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
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. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
Mistreatment Deficiencies |
Keep each resident free from physical restraints, unless needed for medical treatment. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
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 |
| 2002-02-06 |
2002-04-01 |
Resident Rights Deficiencies |
Provide services to meet the needs and preferences of each resident. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
Quality Care Deficiencies |
Provide activities to meet the needs of each resident. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
Environmental Deficiencies |
Provide needed housekeeping and maintenance. |
Widespread |
Potential for minimal harm |
| 2002-02-06 |
2002-04-01 |
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 |
| 2002-02-06 |
2002-04-01 |
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 |
| 2002-02-06 |
2002-04-01 |
Quality Care Deficiencies |
Give professional services that meet a professional standard of quality. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
Quality Care Deficiencies |
Give each resident care and services to get or keep the highest quality of life possible. |
Isolated |
Actual harm |
| 2002-02-06 |
2002-04-01 |
Quality Care Deficiencies |
Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. |
Isolated |
Actual harm |
| 2002-02-06 |
2002-04-01 |
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 |
| 2002-02-06 |
2002-05-14 |
Quality Care Deficiencies |
Make sure that residents with reduced range of motion get proper treatment and services to increase range of motion. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
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 |
| 2002-02-06 |
2002-04-01 |
Environmental Deficiencies |
Make sure that the nursing home area is free of dangers that cause accidents. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-05-14 |
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 |
| 2002-02-06 |
2002-05-14 |
Quality Care Deficiencies |
Make sure that each resident's nutritional needs were met. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
Quality Care Deficiencies |
Give each resident enough fluids to keep them healthy and prevent dehydration. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
Pharmacy Service Deficiencies |
Gradually lower the dose of residents' antipsychotic drugs, unless this causes negative medical effects. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-05-14 |
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 |
| 2002-02-06 |
2002-04-01 |
Quality Care Deficiencies |
Use a registered nurse at least 8 hours a day, 7 days a week. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
Nutrition and Dietary Deficiencies |
Make sure that residents are well nourished. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
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 |
| 2002-02-06 |
2002-04-01 |
Environmental Deficiencies |
Get rid of garbage properly. |
Widespread |
Potential for minimal harm |
| 2002-02-06 |
2002-04-01 |
Resident Assessment Deficiencies |
Make sure that all needed doctor visits are made personally by a doctor, as required. |
Isolated |
Minimal harm or potential for actual harm |
| 2002-02-06 |
2002-04-01 |
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 |
| 2002-02-06 |
2002-04-01 |
Environmental Deficiencies |
Put firmly secured handrails on each side of hallways. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-01-21 |
2003-02-07 |
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. |
Widespread |
Potential for minimal harm |
| 2003-01-21 |
2003-02-07 |
Resident Rights Deficiencies |
Keep each resident's personal and medical records private and confidential. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-01-21 |
2003-02-07 |
Mistreatment Deficiencies |
Keep each resident free from physical restraints, unless needed for medical treatment. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-01-21 |
2003-02-07 |
Environmental Deficiencies |
Provide needed housekeeping and maintenance. |
Widespread |
Potential for minimal harm |
| 2003-01-21 |
2003-02-07 |
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 |
| 2003-01-21 |
2003-02-07 |
Quality Care Deficiencies |
Give professional services that meet a professional standard of quality. |
Isolated |
Minimal harm or potential for actual harm |
| 2003-01-21 |
2003-02-07 |
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 |
| 2003-01-21 |
2003-02-07 |
Quality Care Deficiencies |
Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-01-21 |
2003-02-07 |
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 |
| 2003-01-21 |
2003-02-07 |
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 |
| 2003-01-21 |
2003-02-07 |
Environmental Deficiencies |
Make sure that the nursing home area is free of dangers that cause accidents. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-01-21 |
2003-02-07 |
Quality Care Deficiencies |
Make sure each resident is being watched and has assistance devices when needed, to prevent accidents. |
Isolated |
Actual harm |
| 2003-01-21 |
2003-02-07 |
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 |
| 2003-01-21 |
2003-02-07 |
Nutrition and Dietary Deficiencies |
Make sure that residents are well nourished. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-01-21 |
2003-02-07 |
Nutrition and Dietary Deficiencies |
Store, cook, and give out food in a safe and clean way. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-01-21 |
2003-02-07 |
Environmental Deficiencies |
Get rid of garbage properly. |
Widespread |
Potential for minimal harm |
| 2003-01-21 |
2003-02-07 |
Environmental Deficiencies |
Move, clean and store sheets, towels and other linens in a way that prevents the spread of infection. |
Widespread |
Potential for minimal harm |
*** All violations listed are based on federal government records.