CITRUS NURSING CENTER CA DEFICIENCY REPORT

	Nursing Home Deficiency Report current as of November 25, 2009
Date	Deficiency	Scope	Level of Harm
02/02/2010	Try to resolve each resident's complaints quickly.	Isolated	Minimal harm or potential for actual harm
02/02/2010	Provide activities to meet the needs of each resident.	Isolated	Minimal harm or potential for actual harm
02/02/2010	Provide needed housekeeping and maintenance.	Pattern	Minimal harm or potential for actual harm
02/02/2010	Keep sound levels comfortable.	Isolated	Minimal harm or potential for actual harm
02/02/2010	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
02/02/2010	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Actual harm
02/02/2010	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
02/02/2010	Properly mark drugs and other similar products.	Pattern	Minimal harm or potential for actual harm
02/02/2010	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm
02/02/2010	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Isolated	Minimal harm or potential for actual harm
02/02/2010	Be administered in a way that leads to the highest possible level of well being for each resident.	Widespread	Minimal harm or potential for actual harm
02/02/2010	Keep accurate and appropriate medical records.	Pattern	Minimal harm or potential for actual harm
01/28/2010	approved construction type or materials.	Pattern	Minimal harm or potential for actual harm
01/28/2010	corridor and hallway doors that block smoke.	Isolated	Minimal harm or potential for actual harm
01/28/2010	record of quarterly fire drills for each shift under varying conditions.	Widespread	Potential for minimal harm
01/28/2010	portable fire extinguishers.	Isolated	Minimal harm or potential for actual harm
01/28/2010	proper medical gas storage and administration areas.	Pattern	Minimal harm or potential for actual harm
01/28/2010	properly installed electrical wiring and equipment.	Isolated	Minimal harm or potential for actual harm
11/07/2008	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
11/07/2008	Keep each resident's personal and medical records private and confidential.	Isolated	Minimal harm or potential for actual harm
11/07/2008	Keep each resident free from physical restraints, unless needed for medical treatment.	Pattern	Minimal harm or potential for actual harm
11/07/2008	Keep each resident free from drugs that restrain them, unless needed for medical treatment.	Isolated	Minimal harm or potential for actual harm
11/07/2008	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.	Pattern	Minimal harm or potential for actual harm
11/07/2008	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Pattern	Minimal harm or potential for actual harm
11/07/2008	Provide needed housekeeping and maintenance.	Isolated	Minimal harm or potential for actual harm
11/07/2008	Make sure all assessments are accurate, coordinated by an RN, done by the right professional, and are signed by the person completing them.	Pattern	Minimal harm or potential for actual harm
11/07/2008	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
11/07/2008	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
11/07/2008	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Pattern	Minimal harm or potential for actual harm
11/07/2008	Develop/implement required procedures for the administration of immunizations.	Isolated	Minimal harm or potential for actual harm
11/07/2008	Have a program to keep infection from spreading.	Pattern	Minimal harm or potential for actual harm
11/07/2008	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Minimal harm or potential for actual harm
11/07/2008	a two-hour-resistant firewall in common walls.	Isolated	Minimal harm or potential for actual harm
11/07/2008	smoke barrier doors that can resist smoke for at least 20 minutes.	Widespread	Minimal harm or potential for actual harm
11/07/2008	construction that can resist fire for one hour or an approved fire extinguishing system.	Pattern	Minimal harm or potential for actual harm
11/07/2008	properly located and lighted "Exit" signs.	Pattern	Minimal harm or potential for actual harm
11/07/2008	did not have a written emergency evacuation plan.	Widespread	Potential for minimal harm
11/07/2008	record of quarterly fire drills for each shift under varying conditions.	Widespread	Potential for minimal harm
11/07/2008	an approved installation, maintenance and testing program for fire alarm systems.	Widespread	Potential for minimal harm
11/07/2008	properly maintained smoke detectors.	Widespread	Minimal harm or potential for actual harm
11/07/2008	automatic sprinkler systems that have been maintained in working order.	Pattern	Minimal harm or potential for actual harm
11/07/2008	corridors that are separated from common areas by walls constructed to limit the passage of smoke.	Pattern	Minimal harm or potential for actual harm
11/07/2008	corridor and hallway doors that block smoke.	Pattern	Minimal harm or potential for actual harm
11/07/2008	approved construction type or materials.	Pattern	Minimal harm or potential for actual harm
11/07/2008	portable fire extinguishers.	Pattern	Minimal harm or potential for actual harm
11/07/2008	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
11/07/2008	heating and ventilation systems that have been properly installed according to the manufacturer's instructions.	Widespread	Minimal harm or potential for actual harm
11/07/2008	properly sized and located linen or trash receptacles.	Pattern	Minimal harm or potential for actual harm
11/07/2008	proper medical gas storage and administration areas.	Isolated	Minimal harm or potential for actual harm
11/07/2008	weekly inspections and monthly testing of generators.	Pattern	Minimal harm or potential for actual harm
11/07/2008	properly installed electrical wiring and equipment.	Isolated	Minimal harm or potential for actual harm
10/25/2007	Provide needed housekeeping and maintenance.	Isolated	Minimal harm or potential for actual harm
10/25/2007	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
10/25/2007	Provide bedrooms that don't allow residents to see each other when privacy is needed.	Isolated	Minimal harm or potential for actual harm
10/25/2007	corridor and hallway doors that block smoke.	Pattern	Minimal harm or potential for actual harm
10/25/2007	smoke barrier doors that can resist smoke for at least 20 minutes.	Pattern	Minimal harm or potential for actual harm
10/25/2007	construction that can resist fire for one hour or an approved fire extinguishing system.	Isolated	Minimal harm or potential for actual harm
10/25/2007	did not have a written emergency evacuation plan.	Pattern	Minimal harm or potential for actual harm
10/25/2007	portable fire extinguishers.	Pattern	Minimal harm or potential for actual harm
10/25/2007	exits that are free from obstructions and can be used at all times.	Widespread	Potential for minimal harm
10/25/2007	properly installed hallway dispensers for alcohol-based hand rub.	Widespread	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