SIGNATURE HEALTHCARE OF PALM BEACH FL DEFICIENCY REPORT

	Nursing Home Deficiency Report current as of November 25, 2009
Date	Deficiency	Scope	Level of Harm
01/15/2010	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
01/15/2010	Provide needed housekeeping and maintenance.	Pattern	Minimal harm or potential for actual harm
01/15/2010	Give professional services that meet a professional standard of quality.	Isolated	Minimal harm or potential for actual harm
01/15/2010	Give professional services that follow each resident's written care plan.	Isolated	Minimal harm or potential for actual harm
01/15/2010	Develop/implement required procedures for the administration of immunizations.	Isolated	Minimal harm or potential for actual harm
01/15/2010	Give or get dental care for each resident.	Isolated	Minimal harm or potential for actual harm
01/15/2010	Properly mark drugs and other similar products.	Isolated	Minimal harm or potential for actual harm
01/15/2010	Provide at least one room to use as a dining room and for activities, that is a good size, with good lighting, airflow and furniture.	Isolated	Minimal harm or potential for actual harm
12/11/2008	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
12/10/2008	Honor all of the resident's rights as a resident of the nursing home and as a citizen or resident of the United States.	Isolated	Minimal harm or potential for actual harm
12/10/2008	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.	Widespread	Potential for minimal harm
12/10/2008	Provide services to meet the needs and preferences of each resident.	Pattern	Minimal harm or potential for actual harm
12/10/2008	Provide needed housekeeping and maintenance.	Pattern	Minimal harm or potential for actual harm
12/10/2008	Make a complete assessment that covers all questions for areas that are listed in official regulations.	Isolated	Minimal harm or potential for actual harm
12/10/2008	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
12/10/2008	Give professional services that meet a professional standard of quality.	Pattern	Minimal harm or potential for actual harm
12/10/2008	Give professional services that follow each resident's written care plan.	Isolated	Minimal harm or potential for actual harm
12/10/2008	Make sure that residents receive treatment/services to continue to be able to care for themselves, unless a change is unavoidable.	Isolated	Minimal harm or potential for actual harm
12/10/2008	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
12/10/2008	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
12/10/2008	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
12/10/2008	Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%.	Pattern	Minimal harm or potential for actual harm
12/10/2008	Develop/implement required procedures for the administration of immunizations.	Isolated	Minimal harm or potential for actual harm
12/10/2008	Provide food in a way that meets a resident's needs.	Pattern	Minimal harm or potential for actual harm
12/10/2008	Store, cook, and give out food in a safe and clean way.	Widespread	Minimal harm or potential for actual harm
12/10/2008	At least once a month, have a licensed pharmacist check the drugs that each resident takes.	Widespread	Minimal harm or potential for actual harm
12/10/2008	Properly mark drugs and other similar products.	Isolated	Minimal harm or potential for actual harm
12/10/2008	Make sure that a working call system is available in each resident's room or bathroom and bathing area.	Isolated	Minimal harm or potential for actual harm
12/10/2008	Keep accurate and appropriate medical records.	Isolated	Minimal harm or potential for actual harm
11/29/2007	Give the resident's legal representative the same rights as the resident.	Isolated	Minimal harm or potential for actual harm
11/29/2007	Properly hold, secure and manage each resident's personal money which is deposited with the nursing home.	Isolated	Minimal harm or potential for actual harm
11/29/2007	Allow residents to easily see the results of the nursing home's most recent survey.	Pattern	Potential for minimal harm
11/29/2007	Let residents give themselves their drugs if they are able.	Isolated	Minimal harm or potential for actual harm
11/29/2007	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
11/29/2007	Provide needed housekeeping and maintenance.	Pattern	Minimal harm or potential for actual harm
11/29/2007	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
11/29/2007	Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.	Isolated	Actual harm
11/29/2007	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
11/29/2007	Make sure that each resident's nutritional needs were met.	Isolated	Minimal harm or potential for actual harm
11/29/2007	Have a program to keep infection from spreading.	Isolated	Minimal harm or potential for actual harm
11/27/2007	record of quarterly fire drills for each shift under varying conditions.	Widespread	Minimal harm or potential for actual harm
11/27/2007	weekly inspections and monthly testing of generators.	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