| 11% | Percent of Residents Who are More Depressed or Anxious |
| 10% | Percent of Residents Whose Ability to Move About in and Around Their Room Got Worse |
| 1% | Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder |
| 8% | Percent of Residents Whose Need for Help With Daily Activities Has Increased |
| 0% | Percent of Low-Risk Residents Who Have Pressure Sores |
| 2% | Percent of Short-Stay Residents With Delirium |
| 9% | Percent of Residents Who Were Physically Restrained |
| 29% | Percent of Short-Stay Residents With Pressure Sores |
| 7% | Percent of Residents Who Spend Most of Their Time in Bed or in a Chair |
| 3% | Percent of Residents Who Have Moderate to Severe Pain |
| 4% | Percent of Residents Who Lose Too Much Weight |
| 4% | Percent of Short-Stay Residents Who Had Moderate to Severe Pain |
| 17% | Percent of High-Risk Residents Who Have Pressure Sores |
| 9% | Percent of Residents With a Urinary Tract Infection |
| 53% | Percent of Low-Risk Residents Who Lose Control of Their Bowels or Bladder |
7
1...12
|
Quality Care: Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.
| Level of Harm: | Actual harm | Scope: | Isolated |
| Survey Date: | 20060123 | Corrected By: | 20060328 |
|
7
1...12
|
Quality Care: Give each resident care and services to get or keep the highest quality of life possible.
| Level of Harm: | Actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20050130 |
|
7
1...12
|
Quality Care: Give each resident enough fluids to keep them healthy and prevent dehydration.
| Level of Harm: | Actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20050130 |
|
7
1...12
|
Quality Care: Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.
| Level of Harm: | Actual harm | Scope: | Isolated |
| Survey Date: | 20030925 | Corrected By: | 20031109 |
|
6
1...12
|
Pharmacy Service: Properly mark drugs and other similar products.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Widespread |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
6
1...12
|
Environmental: Have a program to keep infection from spreading.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Widespread |
| Survey Date: | 20041001 | Corrected By: | 20050130 |
|
5
1...12
|
Resident Rights: Provide care in a way that keeps or builds each resident's dignity and self respect.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Pattern |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
5
1...12
|
Environmental: Keep safe, clean and homelike surroundings.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Pattern |
| Survey Date: | 20030925 | Corrected By: | 20031109 |
|
5
1...12
|
Resident Rights: Try to resolve each resident's complaints quickly.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Pattern |
| Survey Date: | 20041001 | Corrected By: | 20050130 |
|
5
1...12
|
Nutrition and Diet: 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.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Pattern |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Environmental: Provide needed housekeeping and maintenance.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20060123 | Corrected By: | 20060328 |
|
4
1...12
|
Pharmacy Service: Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Nutrition and Diet: Make sure that the attending doctor orders special diets.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Environmental: Make sure that staff members wash their hands when needed.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Administration: Keep accurate and appropriate medical records.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20050130 |
|
4
1...12
|
Administration: Get services outside the nursing home that meet professional standards.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Resident Assessment: Make a complete assessment that covers all questions for areas that are listed in official regulations.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Environmental: Provide needed housekeeping and maintenance.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Environmental: Keep adequate and comfortable lighting in all areas.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20030925 | Corrected By: | 20031109 |
|
4
1...12
|
Resident Assessment: 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.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20030925 | Corrected By: | 20031109 |
|
4
1...12
|
Environmental: Make sure that staff members wash their hands when needed.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20030925 | Corrected By: | 20031109 |
|
4
1...12
|
Resident Rights: 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.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Resident Rights: Properly hold, secure and manage each resident's personal money which is deposited with the nursing home.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Resident Rights: Provide proof that all residents' personal money which is deposited with the nursing home, is secure.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Resident Rights: Let residents give themselves their drugs if they are able.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Resident Rights: Provide services to meet the needs and preferences of each resident.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Quality Care: Provide social services for related medical problems to help each resident achieve the highest possible quality of life.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
4
1...12
|
Resident Rights: Provide services to meet the needs and preferences of each resident.
| Level of Harm: | Minimal harm or potential for actual harm | Scope: | Isolated |
| Survey Date: | 20030925 | Corrected By: | 20031109 |
|
3
1...12
|
Administration: Hire a qualified activities director.
| Level of Harm: | Potential for minimal harm | Scope: | Widespread |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
3
1...12
|
Administration: Hire a qualified social worker; or in homes with more than 120 beds, hire a qualified full-time social worker.
| Level of Harm: | Potential for minimal harm | Scope: | Widespread |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|
2
1...12
|
Environmental: Move, clean and store sheets, towels and other linens in a way that prevents the spread of infection.
| Level of Harm: | Potential for minimal harm | Scope: | Pattern |
| Survey Date: | 20041001 | Corrected By: | 20041115 |
|