HORIZON WEST - SIERRA HILLS CA DEFICIENCY REPORT

	Nursing Home Deficiency Report current as of November 25, 2009
Date	Deficiency	Scope	Level of Harm
01/18/2011	approved construction type or materials.	Isolated	Minimal harm or potential for actual harm
01/18/2011	emergency lighting that can last at least 1 1/2 hours.	Isolated	Minimal harm or potential for actual harm
01/18/2011	properly located and lighted "Exit" signs.	Pattern	Minimal harm or potential for actual harm
01/18/2011	properly maintained smoke detectors.	Isolated	Minimal harm or potential for actual harm
01/18/2011	properly working alarms on sprinkler valves.	Isolated	Minimal harm or potential for actual harm
01/18/2011	automatic sprinkler systems that have been maintained in working order.	Isolated	Minimal harm or potential for actual harm
01/18/2011	portable fire extinguishers.	Isolated	Minimal harm or potential for actual harm
01/18/2011	heating and ventilation systems that have been properly installed according to the manufacturer's instructions.	Pattern	Minimal harm or potential for actual harm
01/18/2011	proper medical gas storage and administration areas.	Isolated	Minimal harm or potential for actual harm
01/18/2011	properly installed electrical wiring and equipment.	Pattern	Minimal harm or potential for actual harm
01/13/2011	Properly hold, secure and manage each resident's personal money which is deposited with the nursing home.	Widespread	Potential for minimal harm
01/13/2011	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
01/13/2011	Send and promptly deliver unopened mail to residents.	Isolated	Minimal harm or potential for actual harm
01/13/2011	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
01/13/2011	Provide care in a way that keeps or builds each resident's dignity and self respect.	Pattern	Minimal harm or potential for actual harm
01/13/2011	Keep safe, clean and homelike surroundings.	Pattern	Minimal harm or potential for actual harm
01/13/2011	Assess the resident when the resident enters the nursing home, in a timely manner.	Isolated	Minimal harm or potential for actual harm
01/13/2011	Check and update (if needed) each resident's assessment every 3 months.	Isolated	Minimal harm or potential for actual harm
01/13/2011	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
01/13/2011	Give professional services that meet a professional standard of quality.	Widespread	Minimal harm or potential for actual harm
01/13/2011	Screen residents when they are first admitted to send them to an area with special care for people with developmental disabilities or mental illness, if needed.	Pattern	Minimal harm or potential for actual harm
01/13/2011	Keep assessments completed in the preceding 15 months in the resident's active record.	Pattern	Minimal harm or potential for actual harm
01/13/2011	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Minimal harm or potential for actual harm
01/13/2011	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
01/13/2011	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Widespread	Potential for minimal harm
01/13/2011	Provide food in a way that meets a resident's needs.	Isolated	Minimal harm or potential for actual harm
01/13/2011	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
01/13/2011	Make sure that doctors visit residents regularly, as required.	Isolated	Minimal harm or potential for actual harm
01/13/2011	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
01/13/2011	Properly mark drugs and other similar products.	Widespread	Minimal harm or potential for actual harm
01/13/2011	Have a program to keep infection from spreading.	Widespread	Minimal harm or potential for actual harm
01/13/2011	Keep accurate and appropriate medical records.	Isolated	Minimal harm or potential for actual harm
01/13/2011	Have an agreement with at least one hospital certified by Medicare or Medicaid to make sure residents can be moved quickly to the hospital when they need medical care.	Widespread	Potential for minimal harm
10/07/2009	corridor and hallway doors that block smoke.	Isolated	Minimal harm or potential for actual harm
10/07/2009	approved construction type or materials.	Isolated	Minimal harm or potential for actual harm
10/07/2009	automatic sprinkler systems that have been maintained in working order.	Pattern	Minimal harm or potential for actual harm
10/07/2009	portable fire extinguishers.	Isolated	Minimal harm or potential for actual harm
10/07/2009	properly protected cooking facilities.	Pattern	Minimal harm or potential for actual harm
10/07/2009	properly installed electrical wiring and equipment.	Pattern	Minimal harm or potential for actual harm
10/05/2009	Provide activities to meet the needs of each resident.	Pattern	Potential for minimal harm
10/05/2009	Do an assessment of the resident every year.	Isolated	Minimal harm or potential for actual harm
10/05/2009	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
10/05/2009	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
10/05/2009	Give each resident care and services to get or keep the highest quality of life possible.	Isolated	Minimal harm or potential for actual harm
10/05/2009	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
10/05/2009	Make sure that the nursing home area is free of dangers that cause accidents.	Widespread	Potential for minimal harm
10/05/2009	Make sure that each resident's nutritional needs were met.	Isolated	Minimal harm or potential for actual harm
10/05/2009	Make sure that residents are well nourished.	Pattern	Potential for minimal harm
10/05/2009	Store, cook, and give out food in a safe and clean way.	Pattern	Minimal harm or potential for actual harm
10/05/2009	Get rid of garbage properly.	Pattern	Potential for minimal harm
10/05/2009	Make sure that the nursing home area is safe, easy to use, clean and comfortable.	Pattern	Potential for minimal harm
10/05/2009	Have a detailed, written plan for disasters and emergencies.	Widespread	Minimal harm or potential for actual harm
10/05/2009	Train all employees on what to do in an emergency.	Widespread	Minimal harm or potential for actual harm
10/05/2009	Let residents give themselves their drugs if they are able.	Isolated	Minimal harm or potential for actual harm
10/05/2009	Protect residents from mistreatment, neglect, and/or theft of personal property.	Isolated	Actual harm
10/05/2009	Provide care in a way that keeps or builds each resident's dignity and self respect.	Isolated	Minimal harm or potential for actual harm
07/09/2008	smoke barrier doors that can resist smoke for at least 20 minutes.	Isolated	Minimal harm or potential for actual harm
07/09/2008	construction that can resist fire for one hour or an approved fire extinguishing system.	Isolated	Minimal harm or potential for actual harm
07/09/2008	properly located and lighted "Exit" signs.	Isolated	Minimal harm or potential for actual harm
07/09/2008	a fire alarm system that can be heard throughout the facility.	Widespread	Potential for minimal harm
07/09/2008	restrictions on the use of highly flammable materials.	Isolated	Minimal harm or potential for actual harm
07/09/2008	proper medical gas storage and administration areas.	Isolated	Minimal harm or potential for actual harm
07/03/2008	Try to resolve each resident's complaints quickly.	Pattern	Minimal harm or potential for actual harm
07/03/2008	Provide care in a way that keeps or builds each resident's dignity and self respect.	Pattern	Minimal harm or potential for actual harm
07/03/2008	Provide services to meet the needs and preferences of each resident.	Isolated	Minimal harm or potential for actual harm
07/03/2008	Assess the resident when the resident enters the nursing home, in a timely manner.	Isolated	Minimal harm or potential for actual harm
07/03/2008	Check and update (if needed) each resident's assessment every 3 months.	Isolated	Minimal harm or potential for actual harm
07/03/2008	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
07/03/2008	Give professional services that meet a professional standard of quality.	Pattern	Minimal harm or potential for actual harm
07/03/2008	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
07/03/2008	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Pattern	Minimal harm or potential for actual harm
07/03/2008	Make sure that residents are safe from serious medication errors.	Isolated	Minimal harm or potential for actual harm
07/03/2008	Hire enough skilled workers to carry out dietary service.	Pattern	Minimal harm or potential for actual harm
07/03/2008	Make sure that residents are well nourished.	Pattern	Minimal harm or potential for actual harm
07/03/2008	Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.	Pattern	Minimal harm or potential for actual harm
07/03/2008	Make sure that the attending doctor orders special diets.	Pattern	Minimal harm or potential for actual harm
07/03/2008	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
07/03/2008	Have a program to keep infection from spreading.	Pattern	Minimal harm or potential for actual harm
07/03/2008	Be designed, built, equipped, or well kept to protect the health and safety of residents, workers, and the public.	Pattern	Minimal harm or potential for actual harm
07/03/2008	Follow all laws and professional standards.	Pattern	Potential for minimal harm
07/03/2008	Keep accurate and appropriate medical records.	Pattern	Potential for minimal harm
07/03/2008	Have a detailed, written plan for disasters and emergencies.	Widespread	Minimal harm or potential for actual harm
07/03/2008	Train all employees on what to do in an emergency.	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