BRIGHTON PLACE SAN DIEGO CA DEFICIENCY REPORT

	Nursing Home Deficiency Report current as of November 25, 2009
Date	Deficiency	Scope	Level of Harm
04/27/2010	approved construction type or materials.	Isolated	Minimal harm or potential for actual harm
04/27/2010	smoke barrier doors that can resist smoke for at least 20 minutes.	Pattern	Minimal harm or potential for actual harm
04/27/2010	automatic sprinkler systems that have been maintained in working order.	Isolated	Minimal harm or potential for actual harm
04/27/2010	restrictions on the use of flammable curtains.	Widespread	Potential for minimal harm
04/23/2010	Provide care in a way that keeps or builds each resident's dignity and self respect.	Isolated	Minimal harm or potential for actual harm
04/23/2010	Provide services to meet the needs and preferences of each resident.	Isolated	Minimal harm or potential for actual harm
04/23/2010	Check and update (if needed) each resident's assessment every 3 months.	Isolated	Minimal harm or potential for actual harm
04/23/2010	Make sure that each residents' abilities to take care of themselves does not lessen, unless a change cannot be avoided.	Isolated	Minimal harm or potential for actual harm
04/23/2010	Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses.	Isolated	Minimal harm or potential for actual harm
04/23/2010	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm
04/23/2010	Give lab tests only when the attending doctor ordered them.	Isolated	Minimal harm or potential for actual harm
04/23/2010	Keep accurate and appropriate medical records.	Isolated	Minimal harm or potential for actual harm
04/14/2009	exits that are free from obstructions and can be used at all times.	Isolated	Minimal harm or potential for actual harm
04/14/2009	portable fire extinguishers.	Isolated	Minimal harm or potential for actual harm
04/14/2009	smoke barrier doors that can resist smoke for at least 20 minutes.	Isolated	Minimal harm or potential for actual harm
04/14/2009	automatic sprinkler systems that have been maintained in working order.	Isolated	Minimal harm or potential for actual harm
04/09/2009	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
04/09/2009	post nurse staffing information.	Widespread	Potential for minimal harm
04/09/2009	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Widespread	Potential for minimal harm
04/09/2009	Store, cook, and give out food in a safe and clean way.	Isolated	Minimal harm or potential for actual harm
04/09/2009	Have drugs and other similar products available, which are needed every day and in emergencies, and give them out properly.	Isolated	Minimal harm or potential for actual harm
04/09/2009	Properly mark drugs and other similar products.	Isolated	Minimal harm or potential for actual harm
04/09/2009	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm
04/09/2009	Train all employees on what to do in an emergency.	Isolated	Minimal harm or potential for actual harm
04/15/2008	signs that state that exit doors are to be kept closed.	Isolated	Minimal harm or potential for actual harm
04/15/2008	construction that can resist fire for one hour or an approved fire extinguishing system.	Isolated	Minimal harm or potential for actual harm
04/15/2008	rooms that can be unlocked from inside without a key.	Isolated	Minimal harm or potential for actual harm
04/15/2008	properly working alarms on sprinkler valves.	Widespread	Potential for minimal harm
04/15/2008	exits that are free from obstructions and can be used at all times.	Isolated	Minimal harm or potential for actual harm
04/15/2008	proper medical gas storage and administration areas.	Isolated	Minimal harm or potential for actual harm
04/15/2008	a separate and independent backup electrical power source.	Widespread	Potential for minimal harm
04/10/2008	Provide care in a way that keeps or builds each resident's dignity and self respect.	Widespread	Potential for minimal harm
04/10/2008	Provide activities to meet the needs of each resident.	Pattern	Potential for minimal harm
04/10/2008	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Minimal harm or potential for actual harm
04/10/2008	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
04/10/2008	Have drugs and other similar products available, which are needed every day and in emergencies, and give them out properly.	Isolated	Minimal harm or potential for actual harm
04/10/2008	Have a program to keep infection from spreading.	Widespread	Potential for minimal harm
04/10/2008	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Potential for minimal harm
04/10/2008	Keep accurate and appropriate medical records.	Pattern	Potential for minimal harm
04/10/2008	Train all employees on what to do in an emergency.	Isolated	Minimal harm or potential for actual harm

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Where does this data come from?

The data on this website describes nursing home characteristics, quality measures, inspection results, and nursing staff information.

The data come from 2 sources:

1. Centers for Medicare & Medicaid Services (CMS) have an Online Survey, Certification, and Reporting (OSCAR) database - Includes the nursing home characteristics and health deficiencies issued during the three most recent state inspections and recent complaint investigations.

   The survey inspection results are collected by the state survey agencies, who perform onsite visits to nursing homes . The inspections occur at least once during a 15-month period, or any time in between as a result of a complaint received by the state. The inspections ensure that the nursing home residents receive quality care and services in a safe and comfortable environment in accordance with rules established by CMS. Complaints may be reported and inspected during the year (outside of the 9-15 month survey cycle). Inspections about a complaint that result in the citation of a health deficiency are reported to CMS and included in this website. Sometimes the inspection finds a problem that the nursing home identified and corrected before the inspection occurred. The fact and the nature of these prior problems (deficiencies) may be included in this website.

   The information on the nursing homes' characteristics derived from OSCAR are prepared by each nursing home at the beginning of the regular State inspection. This information is reported by the nursing homes themselves. It is reviewed by nursing home inspectors, but not formally audited to ensure data accuracy. In addition, this information changes frequently as residents are discharged and admitted, or resident conditions change.

2. National database known as the Minimum Data Set (MDS) Repository

   The data for the quality measures come from the MDS Repository. The MDS is collected on regular intervals for every resident in a Medicare or Medicaid certified nursing home. Information is collected on the resident's health, physical functioning, mental status, and general well-being. These data are used by the nursing home to access the needs and develop a plan of care unique to each resident.

   Regulations require that a MDS assessment be performed at admission, quarterly, annually, and whenever the resident experiences a significant change in status. For residents in a Medicare Part A stay, the MDS is also used to determine the Medicare reimbursement rate. These assessments are performed on the 5th, 14th, 30th, 60th and 90th day of admission.

   All of this data is reported by the nursing homes themselves. It is reviewed by nursing home inspectors, but not formally audited to ensure that it is accurate. Every attempt is made to assure the accuracy and timeliness of this information. However, this information changes frequently as residents are discharged and admitted, or resident conditions change. We advise interpreting this information cautiously and supplementing it with information from the Ombudsman's office, the State Survey Agency, or other sources.

   Some MDS items used to calculate the quality measures consider the resident's condition during previous days prior to the assessment date. The following table provides these "observation" or "look back" time frames.

Signs of Nursing Home Abuse:

• Unexplained injuries or bruises
• Over or under medication
• Visible cuts, bruises, or welts
• Rapid weight loss or weight gain
• Dehydration, malnutrition, and bedsores
• Unsanitary living conditions
• Infections
• Broken bones
• Sudden death