Tahoe Forest Hospital Extended Care

Total Number of Beds: 37	Percent of Occupied Beds: 84%
Total Number of Residents: 31	Located Within a Hospital: Yes
Type of Ownership: Government - Hospital district	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 10/30/2003

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**:

** Details Last Reported on: 10/30/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-11-08	2001-12-23	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
2001-11-08	2001-11-29	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
2001-11-08	2001-12-23	Mistreatment Deficiencies	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Pattern	Potential for minimal harm
2001-11-08	2001-12-23	Environmental Deficiencies	Provide needed housekeeping and maintenance.	Pattern	Potential for minimal harm
2001-11-08	2001-11-26	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
2001-11-08	2001-12-23	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
2001-11-08	2001-11-27	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
2001-11-08	2001-12-23	Nutrition and Dietary Deficiencies	Provide food in a way that meets a resident's needs.	Pattern	Potential for minimal harm
2001-11-08	2001-12-23	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Potential for minimal harm
2001-11-08	2001-11-08	Pharmacy Service Deficiencies	Use the services of a licensed pharmacist.	Pattern	Potential for minimal harm
2001-11-08	2001-11-26	Pharmacy Service Deficiencies	Keep drugs and other similar products locked safely and properly stored.	Pattern	Potential for minimal harm
2001-11-08	2001-12-23	Administration Deficiencies	Have a detailed, written plan for disasters and emergencies.	Pattern	Potential for minimal harm
2001-11-08	2001-12-13	Administration Deficiencies	Train all employees on what to do in an emergency.	Isolated	Minimal harm or potential for actual harm
2002-12-06	2003-01-08	Resident Rights Deficiencies	Provide services to meet the needs and preferences of each resident.	Pattern	Potential for minimal harm
2002-12-06	2003-01-08	Pharmacy Service Deficiencies	Provide drugs and related services needed by each resident.	Isolated	Minimal harm or potential for actual harm
2002-12-06	2003-01-08	Pharmacy Service Deficiencies	At least once a month, have a licensed pharmacist check the drugs that each resident takes.	Pattern	Minimal harm or potential for actual harm
2002-12-06	2003-01-08	Pharmacy Service Deficiencies	Act when the pharmacist reports something unusual.	Pattern	Minimal harm or potential for actual harm
2003-10-30	2003-12-14	Quality Care Deficiencies	Give professional services that follow each resident's written care plan.	Isolated	Minimal harm or potential for actual harm
2003-10-30	2003-12-14	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Potential for minimal harm
2003-10-30	2003-12-14	Pharmacy Service Deficiencies	Act when the pharmacist reports something unusual.	Isolated	Minimal harm or potential for actual harm
2003-10-30	2003-12-14	Environmental Deficiencies	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Isolated	Minimal harm or potential for actual harm
2003-10-30	2003-12-14	Administration Deficiencies	Follow all laws and professional standards.	Pattern	Potential for minimal harm

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