| Total Number of Beds: 124 | Percent of Occupied Beds: 94% |
| Total Number of Residents: 117 | Located Within a Hospital: No |
| Type of Ownership: Non profit - Church related | Multiple Nursing Homes by Same Owner: Yes |
| Councils the Nursing Home Participates in: Family & Resident | Medicare/Medicaid: Participating in Medicare and Medicaid |
| * Details Last Reported on: 03/21/2003 |
| Date of Violation |
Date Corrected |
Type of Violation |
Deficiency |
Scope |
Level of Harm |
| 2002-01-11 |
2002-02-01 |
Quality Care Deficiencies |
Give each resident a special diet to help when there is a nutritional problem. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-01-11 |
2002-02-01 |
Nutrition and Dietary Deficiencies |
Store, cook, and give out food in a safe and clean way. |
Pattern |
Minimal harm or potential for actual harm |
| 2002-01-11 |
2002-02-15 |
Environmental Deficiencies |
Keep all essential equipment working safely. |
Pattern |
Potential for minimal harm |
| 2002-01-11 |
2002-02-15 |
Environmental Deficiencies |
Provide at least one room to use as a dining room and for activities, that is a good size, with good lighting, airflow and furniture. |
Pattern |
Potential for minimal harm |
| 2003-03-21 |
2003-04-28 |
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. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-03-21 |
2003-04-28 |
Mistreatment Deficiencies |
Keep each resident free from physical restraints, unless needed for medical treatment. |
Pattern |
Minimal harm or potential for actual harm |
| 2003-03-21 |
2003-04-21 |
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 |
| 2003-03-21 |
2003-04-28 |
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 |
| 2003-03-21 |
2003-05-01 |
Nutrition and Dietary Deficiencies |
Store, cook, and give out food in a safe and clean way. |
Isolated |
Minimal harm or potential for actual harm |
*** All violations listed are based on federal government records.