CARMEL HILLS CARE CENTER CA DEFICIENCY REPORT

	Nursing Home Deficiency Report current as of November 25, 2009
Date	Deficiency	Scope	Level of Harm
08/11/2010	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
08/11/2010	Let residents give themselves their drugs if they are able.	Isolated	Minimal harm or potential for actual harm
08/11/2010	Keep each resident free from physical restraints, unless needed for medical treatment.	Pattern	Minimal harm or potential for actual harm
08/11/2010	Provide care in a way that keeps or builds each resident's dignity and self respect.	Isolated	Minimal harm or potential for actual harm
08/11/2010	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
08/11/2010	Provide needed housekeeping and maintenance.	Isolated	Minimal harm or potential for actual harm
08/11/2010	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
08/11/2010	Give professional services that meet a professional standard of quality.	Pattern	Minimal harm or potential for actual harm
08/11/2010	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Minimal harm or potential for actual harm
08/11/2010	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
08/11/2010	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
08/11/2010	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Pattern	Minimal harm or potential for actual harm
08/11/2010	Provide food in a way that meets a resident's needs.	Isolated	Minimal harm or potential for actual harm
08/11/2010	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
08/11/2010	Have drugs and other similar products available, which are needed every day and in emergencies, and give them out properly.	Pattern	Minimal harm or potential for actual harm
08/11/2010	Properly mark drugs and other similar products.	Isolated	Minimal harm or potential for actual harm
08/11/2010	Have a program to keep infection from spreading.	Widespread	Minimal harm or potential for actual harm
08/11/2010	Keep all essential equipment working safely.	Isolated	Minimal harm or potential for actual harm
08/11/2010	Have enough backup water supply for important areas of the nursing home.	Isolated	Minimal harm or potential for actual harm
08/11/2010	Train all employees on what to do in an emergency.	Isolated	Minimal harm or potential for actual harm
08/11/2010	approved construction type or materials.	Pattern	Minimal harm or potential for actual harm
08/11/2010	corridors that are separated from common areas by walls constructed to limit the passage of smoke.	Isolated	Minimal harm or potential for actual harm
08/11/2010	corridor and hallway doors that block smoke.	Pattern	Minimal harm or potential for actual harm
08/11/2010	smoke barrier doors that can resist smoke for at least 20 minutes.	Isolated	Minimal harm or potential for actual harm
08/11/2010	construction that can resist fire for one hour or an approved fire extinguishing system.	Isolated	Minimal harm or potential for actual harm
08/11/2010	record of quarterly fire drills for each shift under varying conditions.	Widespread	Potential for minimal harm
08/11/2010	automatic sprinkler systems that have been maintained in working order.	Isolated	Minimal harm or potential for actual harm
08/11/2010	portable fire extinguishers.	Isolated	Minimal harm or potential for actual harm
08/11/2010	posted "No-smoking" signs in areas where smoking is not permitted or did not provide ashtrays where smoking was allowed.	Isolated	Minimal harm or potential for actual harm
08/11/2010	restrictions on the use of flammable curtains.	Isolated	Minimal harm or potential for actual harm
08/11/2010	proper medical gas storage and administration areas.	Isolated	Minimal harm or potential for actual harm
08/11/2010	properly installed electrical wiring and equipment.	Pattern	Minimal harm or potential for actual harm
08/11/2010	properly installed hallway dispensers for alcohol-based hand rub.	Isolated	Minimal harm or potential for actual harm
08/27/2009	properly working sprinkler alarm system.	Widespread	Minimal harm or potential for actual harm
08/27/2009	automatic sprinkler systems that have been maintained in working order.	Widespread	Minimal harm or potential for actual harm
08/27/2009	construction that can resist fire for one hour or an approved fire extinguishing system.	Pattern	Minimal harm or potential for actual harm
08/27/2009	properly located and lighted "Exit" signs.	Pattern	Minimal harm or potential for actual harm
08/27/2009	did not have a written emergency evacuation plan.	Isolated	Minimal harm or potential for actual harm
08/27/2009	record of quarterly fire drills for each shift under varying conditions.	Pattern	Minimal harm or potential for actual harm
08/27/2009	an approved installation, maintenance and testing program for fire alarm systems.	Widespread	Minimal harm or potential for actual harm
08/27/2009	proper medical gas storage and administration areas.	Isolated	Minimal harm or potential for actual harm
08/27/2009	proper power supply for life support equipment.	Isolated	Minimal harm or potential for actual harm
08/27/2009	properly installed electrical wiring and equipment.	Pattern	Minimal harm or potential for actual harm
08/20/2009	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
08/20/2009	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
08/20/2009	Let residents give themselves their drugs if they are able.	Pattern	Minimal harm or potential for actual harm
08/20/2009	Keep each resident free from physical restraints, unless needed for medical treatment.	Isolated	Minimal harm or potential for actual harm
08/20/2009	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
08/20/2009	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Isolated	Minimal harm or potential for actual harm
08/20/2009	Provide care in a way that keeps or builds each resident's dignity and self respect.	Pattern	Minimal harm or potential for actual harm
08/20/2009	Provide activities to meet the needs of each resident.	Pattern	Minimal harm or potential for actual harm
08/20/2009	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
08/20/2009	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
08/20/2009	Give professional services that meet a professional standard of quality.	Pattern	Minimal harm or potential for actual harm
08/20/2009	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Minimal harm or potential for actual harm
08/20/2009	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
08/20/2009	Make sure that each resident's nutritional needs were met.	Pattern	Minimal harm or potential for actual harm
08/20/2009	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
08/20/2009	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Isolated	Minimal harm or potential for actual harm
08/20/2009	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
08/20/2009	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
08/20/2009	Properly mark drugs and other similar products.	Isolated	Minimal harm or potential for actual harm
08/20/2009	Have a program to keep infection from spreading.	Widespread	Minimal harm or potential for actual harm
08/20/2009	Make sure that a working call system is available in each resident's room or bathroom and bathing area.	Pattern	Minimal harm or potential for actual harm
08/20/2009	Have enough backup water supply for important areas of the nursing home.	Pattern	Minimal harm or potential for actual harm
08/20/2009	Give or get lab tests to meet the needs of residents.	Isolated	Minimal harm or potential for actual harm
08/20/2009	Quickly tell the resident's doctor the results of lab tests.	Isolated	Minimal harm or potential for actual harm
08/20/2009	Keep complete, dated lab records in the resident's file.	Isolated	Minimal harm or potential for actual harm
08/20/2009	Keep accurate and appropriate medical records.	Pattern	Minimal harm or potential for actual harm
08/20/2009	Have a detailed, written plan for disasters and emergencies.	Pattern	Minimal harm or potential for actual harm
08/20/2009	Train all employees on what to do in an emergency.	Isolated	Minimal harm or potential for actual harm
10/15/2008	exits that are accessible at all times.	Isolated	Minimal harm or potential for actual harm
10/15/2008	posted "No-smoking" signs in areas where smoking is not permitted or did not provide ashtrays where smoking was allowed.	Isolated	Minimal harm or potential for actual harm
10/09/2008	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.	Isolated	Minimal harm or potential for actual harm
10/09/2008	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
10/09/2008	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
10/09/2008	Have enough nurses to care for every resident in a way that maximizes the resident's well being.	Isolated	Minimal harm or potential for actual harm
10/09/2008	Provide food in a way that meets a resident's needs.	Isolated	Minimal harm or potential for actual harm
10/09/2008	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
10/09/2008	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
10/09/2008	Have a program to keep infection from spreading.	Pattern	Minimal harm or potential for actual harm
10/09/2008	Keep all essential equipment working safely.	Isolated	Minimal harm or potential for actual harm
10/09/2008	Have a detailed, written plan for disasters and emergencies.	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