GRANDVIEW MANOR CARE CENTER MO DEFICIENCY REPORT

	Nursing Home Deficiency Report current as of November 25, 2009
Date	Deficiency	Scope	Level of Harm
09/14/2009	Provide care in a way that keeps or builds each resident's dignity and self respect.	Isolated	Minimal harm or potential for actual harm
09/14/2009	Bill properly: Charged resident for items that Medicare or Medicaid pays for.	Isolated	Minimal harm or potential for actual harm
09/14/2009	Quickly give a resident's personal money to the heads of his or her estate after the resident's death.	Pattern	Minimal harm or potential for actual harm
09/14/2009	Properly hold, secure and manage each resident's personal money which is deposited with the nursing home.	Pattern	Minimal harm or potential for actual harm
09/14/2009	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.	Isolated	Minimal harm or potential for actual harm
09/14/2009	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.	Isolated	Minimal harm or potential for actual harm
09/14/2009	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
09/14/2009	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
09/14/2009	Check and update (if needed) each resident's assessment every 3 months.	Pattern	Minimal harm or potential for actual harm
09/14/2009	Do an assessment of the resident every year.	Isolated	Minimal harm or potential for actual harm
09/14/2009	Electronically record and report resident status assessments in a timely manner as required in order to monitor resident health and progress.	Isolated	Minimal harm or potential for actual harm
09/14/2009	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Pattern	Immediate jeopardy to resident health or safety
09/14/2009	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
09/14/2009	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
09/14/2009	Give or get dental care for each resident.	Pattern	Minimal harm or potential for actual harm
09/14/2009	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Isolated	Minimal harm or potential for actual harm
09/14/2009	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
09/14/2009	Make sure that the attending doctor orders special diets.	Isolated	Minimal harm or potential for actual harm
09/14/2009	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Pattern	Minimal harm or potential for actual harm
09/14/2009	Provide needed housekeeping and maintenance.	Pattern	Minimal harm or potential for actual harm
09/14/2009	Keep safe, clean and homelike surroundings.	Pattern	Minimal harm or potential for actual harm
09/14/2009	Make sure there is a program to prevent/deal with mice, insects, or other pests.	Widespread	Minimal harm or potential for actual harm
09/14/2009	Have enough outside airflow.	Widespread	Minimal harm or potential for actual harm
09/14/2009	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm
09/14/2009	Choose a doctor to be the medical director.	Pattern	Minimal harm or potential for actual harm
09/14/2009	Follow all laws and professional standards.	Isolated	Minimal harm or potential for actual harm
09/14/2009	walls or barriers that prevent smoke from passing through and would resist fire for at least one hour.	Pattern	Minimal harm or potential for actual harm
09/14/2009	fire safety features required by current fire safety codes.	Pattern	Minimal harm or potential for actual harm
09/14/2009	emergency lighting that can last at least 1 1/2 hours.	Widespread	Minimal harm or potential for actual harm
09/14/2009	construction that can resist fire for one hour or an approved fire extinguishing system.	Pattern	Minimal harm or potential for actual harm
09/14/2009	properly installed electrical wiring and equipment.	Pattern	Minimal harm or potential for actual harm
09/14/2009	corridor and hallway doors that block smoke.	Pattern	Minimal harm or potential for actual harm
09/14/2009	an approved automatic sprinkler system connected to the fire alarm system.	Pattern	Minimal harm or potential for actual harm
07/25/2008	Protect the resident from a transfer or discharge that is not wanted or needed.	Isolated	Minimal harm or potential for actual harm
07/25/2008	Properly hold, secure and manage each resident's personal money which is deposited with the nursing home.	Pattern	Minimal harm or potential for actual harm
07/25/2008	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
07/25/2008	Tell the resident completely about his or her health status.	Isolated	Minimal harm or potential for actual harm
07/25/2008	Provide a final summary of the resident's health status and a summary of the resident's stay, when the resident is ready to leave the nursing home.	Isolated	Minimal harm or potential for actual harm
07/25/2008	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
07/25/2008	Give the right treatment and services to residents who have mental or social problems adjusting.	Isolated	Actual harm
07/25/2008	Make sure that each resident who enters the nursing home without a catheter is not given a catheter, unless it is necessary.	Pattern	Minimal harm or potential for actual harm
07/25/2008	Make sure that residents are safe from serious medication errors.	Isolated	Minimal harm or potential for actual harm
07/25/2008	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
07/25/2008	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
07/25/2008	Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property.	Widespread	Minimal harm or potential for actual harm
07/25/2008	Protect residents from mistreatment, neglect, and/or theft of personal property.	Pattern	Actual harm
07/25/2008	Protect each resident from all abuse, physical punishment, and being separated from others.	Isolated	Actual harm
07/25/2008	Keep each resident free from physical restraints, unless needed for medical treatment.	Isolated	Minimal harm or potential for actual harm
07/25/2008	Provide clean bed and bath linens that are in good condition.	Pattern	Minimal harm or potential for actual harm
07/25/2008	Provide needed housekeeping and maintenance.	Pattern	Minimal harm or potential for actual harm
07/25/2008	Have enough outside airflow.	Pattern	Minimal harm or potential for actual harm
07/25/2008	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Minimal harm or potential for actual harm
07/25/2008	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm
07/25/2008	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Actual harm
07/25/2008	Have a detailed, written plan for disasters and emergencies.	Widespread	Minimal harm or potential for actual harm
07/25/2008	Follow all laws and professional standards.	Isolated	Minimal harm or potential for actual harm
07/25/2008	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
07/25/2008	smoke barrier doors that can resist smoke for at least 20 minutes.	Pattern	Minimal harm or potential for actual harm
07/25/2008	emergency showers.	Isolated	Minimal harm or potential for actual harm
07/25/2008	construction that can resist fire for one hour or an approved fire extinguishing system.	Isolated	Minimal harm or potential for actual harm
07/25/2008	exits that are free from obstructions and can be used at all times.	Pattern	Minimal harm or potential for actual harm
07/25/2008	exits that are accessible at all times.	Pattern	Minimal harm or potential for actual harm
07/25/2008	properly installed electrical wiring and equipment.	Pattern	Minimal harm or potential for actual harm
07/25/2008	signs that state that exit doors are to be kept closed.	Isolated	Minimal harm or potential for actual harm
07/25/2008	corridor and hallway doors that block smoke.	Pattern	Minimal harm or potential for actual harm
07/25/2008	properly protected cooking facilities.	Isolated	Minimal harm or potential for actual harm
07/25/2008	approved construction type or materials.	Isolated	Minimal harm or potential for actual harm
07/25/2008	automatic sprinkler systems that have been maintained in working order.	Widespread	Minimal harm or potential for actual harm
12/03/2007	Keep each resident's personal and medical records private and confidential.	Isolated	Minimal harm or potential for actual harm
12/03/2007	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
12/03/2007	Electronically record and report resident status assessments in a timely manner as required in order to monitor resident health and progress.	Pattern	Minimal harm or potential for actual harm
12/03/2007	Make sure that each resident who enters the nursing home without a catheter is not given a catheter, unless it is necessary.	Isolated	Minimal harm or potential for actual harm
12/03/2007	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Actual harm
12/03/2007	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
12/03/2007	Make sure that each resident's nutritional needs were met.	Isolated	Minimal harm or potential for actual harm
12/03/2007	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Pattern	Minimal harm or potential for actual harm
12/03/2007	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
12/03/2007	Provide food in a way that meets a resident's needs.	Isolated	Minimal harm or potential for actual harm
12/03/2007	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
12/03/2007	Keep each resident free from physical restraints, unless needed for medical treatment.	Pattern	Minimal harm or potential for actual harm
12/03/2007	Make sure that the nursing home area is free of dangers that cause accidents.	Isolated	Minimal harm or potential for actual harm
12/03/2007	Provide needed housekeeping and maintenance.	Pattern	Minimal harm or potential for actual harm
12/03/2007	Make sure that staff members wash their hands when needed.	Isolated	Minimal harm or potential for actual harm
12/03/2007	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm
12/03/2007	Follow all laws and professional standards.	Pattern	Minimal harm or potential for actual harm
12/03/2007	properly located and lighted "Exit" signs.	Pattern	Minimal harm or potential for actual harm
12/03/2007	emergency lighting that can last at least 1 1/2 hours.	Widespread	Minimal harm or potential for actual harm
12/03/2007	properly installed electrical wiring and equipment.	Isolated	Minimal harm or potential for actual harm
12/03/2007	automatic sprinkler systems that have been maintained in working order.	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