Covington Manor Health and Rehabilitation Center


Address: 5700 Wilkie Drive


Phone: 432-7556


Owner: Covenant Care Indiana Inc., Aliso Viejo, Calif.


Officers: Robert Levin, Christine Sims, Mary Evans and Andrew Torok


Most recent change in ownership: June 1998; former owner NCS Inc.


Most recent name change: was Covington Manor Nursing Center before Feb. 23


Status: For profit


Administrator: Linda Towns


Hire date: Oct. 13


Sprinkler system: Full


Resident rooms with smoke alarm: 0


Facility fire safety violations in past year: 4


Average fire violations in Indiana: 4


Medicare/Medicaid beds: 149


Census: 109 as Feb. 6


Most recent annual survey:



Date: Jan. 11


In substantial compliance?: No


When compliance met: April 16


Deficiencies found in Levels D-L**: 8 D; 3 E; 1 G


D Level:


♦Notification of changes - failure to inform the doctor of a resident's abnormal blood sugars, which reached 434 (normal is 70-110).

♦Comprehensive assessments - failure to ensure followup assessment done for a resident treated for a urinary tract infection; failure to accurately assess and document involuntary movements of a resident on psychiatric medication; failure to assess a resident following dialysis treatments.

♦Quality of care - failure to ensure two diabetic residents were assessed and monitored after abnormal blood sugar levels. One resident's blood sugar ranged from 350 to 574 (normal is 70-110). No record the doctor was called; the other resident was not given insulin at the dosage ordered by the doctor.

Another resident was treated with an antibiotic for a urinary tract infection, but nurses did not record the urine color, clarity or odor after treatment, and the resident's infection either did not clear up or she had another one.

♦Accidents and supervision - failure to ensure safe water temperatures were maintained in two residents' bathroom and a shower room; surveyors found a sharp, jagged edge on a hall railing.

♦Unnecessary drugs - failure to ensure a resident was not given too high dosage of a drug because the facility did not follow the doctor's orders for the resident's weekly blood tests.

♦Medication errors - relating to the resident who was not given 81 1/2 pills of her antipsychotic drug due to pharmacy error.

♦Pharmacy services - The facility pharmacist dispensed one month's supply of a psychiatric drug for a resident, but protocol called for a one-week prescription because the pharmacy was to ensure the patient's blood levels were checked biweekly before refilling the drug. The assistant director of nursing admitted there was no record that the blood test was done for four weeks.

♦Lab services - failure to follow doctor's orders for two residents who were to have blood tests due to the psychiatric drugs they were prescribed.


E Level:


♦Care plans - failure to monitor intake/output of two residents, resulting in one resident's 10-day hospitalization. The resident had a feeding tube and surveyors could not find documentation of intake/output for 10 days in November 2007 and 13 days in December 2007.

Facility also failed to follow the care plan of a resident who was to have weekly blood pressure checks. Another resident with psychiatric illness was to have blood checks every two weeks but no testing done between Nov. 6, 2007, and Jan. 10. Later the assistant director of nursing found four of five missing blood tests in a bin of unfilled clinical records.

Another resident was to be prompted at specific times to use the bathroom, but January records showed she was not being prompted and was now wearing incontinent briefs.

One resident was given the wrong dosage of an antipsychotic drug due to a pharmacy error. The resident missed getting 81 1/2 tablets between Dec. 7, 2007, and Jan. 10.

Another resident was to have continual feeding through a tube in the resident's stomach and given a prescribed amount of liquids, but the resident became dehydrated on two occasions that required hospitalization. Records showed no documentation was made or the resident's intake/output for 10 days in November 2007 and 13 days in December 2007.

♦Flu/pneumonia shots - failure to get proper documentation from the resident or resident's family regarding the immunizations. One resident's consent form was more than a year old, and records showing the shots were given were missing for some residents. A nurse said she had given the shots but that the documentation had not yet been filed.

♦Clinical records - failure to ensure that medical records were maintained, complete and organized for four residents.

No records were found from a hospice agency nurse who came to the facility to provide care for the resident. The facility administrators said they were unaware the hospice agency had not provided nursing notes.

Issues also related to the missing record for immunizations, missing records of weekly blood tests for one resident and missing X-ray report for a resident.


G Level:


♦Hydration - failure to ensure of receipt of adequate hydration, which led to the resident's hospitalization. Surveyors later observed a nurse giving fluids to the resident and flushing the resident's stomach feeding tube, but the nurse said she was not able to determine exactly how much fluid she had administered. Nursing administrators said the dehydration that led to hospitalization was due to the resident's congestive heart failure and kidney failure, not due to inadequate liquids given the resident.


Substantiated complaints in 2008: 3


Previous year: 2

Substandard quality of care designations in 2008: None

Immediate jeopardy designations in 2008: None


Federal Quality Initiative scores:



Staffing hours per resident per day for licensed nursing staff:


Covington Manor: 1 hour, 26 minutes

Statewide average: 1 hour, 24 minutes

National average: 1 hour, 18 minutes


For nursing assistants:


Covington Manor: 1 hour, 55 minutes

State average: 2 hours

National average: 2 hours, 18 minutes


National Nursing Home Compare Score (based on three years of data):



(the lower the score, the better)


Covington Manor: 199

Statewide average: 192


State licensure actions: None


Federal actions imposed: Denial of payment for new admissions imposed April 11-16; civil money penalty of $100/day imposed Jan. 11-Feb. 27; civil money penalty of $200/day imposed March 14 -April 15.

Glenbrook Rehabilitation and Skilled Nursing Center


Address: 3811 Parnell Ave.


Phone: 482-4651


Owner: Indiana Health and Rehabilitation Centers/Extendicare Inc., Milwaukee


Officers: Roch Carter, Jillian Fountain, Philip Small and Douglas Harris


Most recent change in ownership: Extendicare Homes before July 1, 1994


Status: For profit


Administrator: Carol McGuigan


Hire date: Dec. 20, 2007


Sprinkler system: Full


Resident rooms with smoke alarm: 0


Facility fire safety violations in past year: 6


Average fire violations in Indiana: 4


Beds: 90


Census: 60 as of April 22


Most recent annual survey:


Date: March 28


In substantial compliance?: No


When compliance met: April 30


Deficiencies found in Levels D-L**: 6 D; 1 G


D Level:


♦Protection of residents' funds - failure to ensure one resident was receiving her monthly Medicaid personal allowance and failure to ensure the allowance was deposited into her account. The resident had mental retardation, was blind and had a personality disorder. A bank account for her was opened Feb. 9, 2006. On Nov. 1, 2007, there was $360.87 in the account. But since she had transferred to Glenbrook more than two years ago from a group home, she had never received her $52/month personal allowance from Medicaid.

♦Environment - A resident whose primary language was Burmese and whose care plan called for her to have a homelike atmosphere that would meet her cultural, social and religious needs had no personal belongings in her room to meet those needs.

♦Comprehensive care plans - failure to obtain the lab report for a resident who was anemic. The resident was to have a blood test every six months, but records showed no blood test had been done since Aug. 1, 2007.

♦Nutrition - failure to ensure a resident was given increased protein to promote healing of a pressure sore and prevent weight loss. Her care plan called for three scoops of protein powder four times a day in her drink when her blood protein levels were at a specific low level, but staff gave her just two scoops.

♦Specialized rehabilitation services - related to the woman who came to the facility from a group home and who was not provided her rocking chair and other services to maintain the highest quality of living.

♦Failure to ensure lab tests were ordered for the above-mentioned resident who had low protein levels.


G Level:


Social services - failure to get specialized health care services for one blind resident with mental retardation. The resident was to have a health care representative. Her records showed she also had a glider rocker that she enjoyed using and that would “be sent with her wherever she goes.” Records showed she also read Braille books that staff at her previous residence worked with her on identifying Braille numbers and reading and helped her with range of motion exercises. Records showed she also liked group and recreational activities appropriate for a person with mild mental retardation. Her plan of care included recommendations for her listening to books on tape and to have one-on-one specialized services.

Surveyors noted she had no rocking chair in her room and that she spent hours in bed with no music, radio or TV and was observed rocking herself back and forth in her wheelchair at times. Several books on tape were in her room but not made available for her. Records dated Dec. 27, 2006, stated, “Still awaiting services - funding,” but no documentation was made of any follow-up on the issue between Nov. 9, 2006, and Feb. 26, 2008.

One notation in her chart stated: “Resident will have services in place prior to September 2007,” but no further documentation was available except a note, dated February 2008, stating: “Budget approved, but needed re-submitted.” A health care representative had not been found.

Staff from the group home where the woman lived previously told the facility's social services director that the woman's personal items “may not have followed her.”

The facility also failed to meet the toileting assistance needs for the resident mentioned above who was Burmese and spoke no English and whose religion was Buddhism. There was no documentation her language barriers or religious needs and preferences were addressed.


Substantiated complaints in 2008: 2


Previous year: 3


Immediate jeopardy designations in 2008: None


Substandard quality of care designations in 2008: None


Federal Quality Initiative scores:



Staffing hours per resident per day for licensed nursing staff:



Glenbrook: Not available


Statewide average: 1 hour, 24 minutes


National average: 1 hour, 18 minutes


For nursing assistants:


Glenbrook: Not available

State average: 2 hours


National average: 2 hours, 18 minutes


National Nursing Home Compare Score (based on three years of data):



(the lower the score, the better)


Glenbrook: 345

Statewide Average: 192


State licensure actions in 2008: None


Federal actions imposed: None

Harborside Healthcare


Address: 1201 Daly Drive, New Haven


Phone: 749-0413


Owner: HHCI Limited Partnership, Albuquerque, N.M.


Officers: Stephen Guillard, Bruce Beardsley and William Stephan


Most recent change in ownership: Before Jan 1, 1996, Krupp Yield Plus Limited Partnership


Status: For profit


Administrator: Sally Sharp


Hire date: Jan. 7


Sprinkler system: Full


Resident rooms with smoke alarm: 0


Facility fire safety violations in past year: 0


Average fire violations in Indiana: 4


Beds: 120


Census: 115 as of April 17


Most recent annual survey:



Date: Feb. 15


In substantial compliance?: Yes


Deficiencies found in Levels D-L**: 0


Substantiated complaints in 2008: 3, with 2 rating no deficiencies


Previous year: 4


Substandard quality of care designations in 2008: None


Immediate jeopardy designations in 2008: None


Federal Quality Initiative scores:



Staffing hours per resident per day for licensed nursing staff:


Harborside: 1 hour, 11 minutes

Statewide average: 1 hour, 24 minutes

National average: 1 hour, 18 minutes


For nursing assistants:


Harborside: 2 hours, 4 minutes

State average: 2 hours

National average: 2 hours, 18 minutes


National Nursing Home Compare Score (based on three years of data):



(the lower the score, the better)


Harborside: 30

Statewide average: 192


State licensure actions in 2008: None

Federal actions imposed: Federal civil money penalty of $200/day

imposed March 10-April 7 and related to the above complaint.

Heritage Park


Address: 2001 Hobson Road


Phone: 484-9557


Owner: Health & Hospital Corporation of Marion County, Indianapolis


Officers: Matthew Gutwein, Patricia Hebenstreit, Greg Porter and Daniel Sellers


Most recent change in ownership: Eaglecare Inc. before Jan 1, 2003


Status: For profit


Administrator: Craig Kollen


Hire date: Oct. 2, 2006


Sprinkler system: Full


Resident rooms with smoke alarms: 19


Facility fire safety violations in past year: 1


Average fire violations in Indiana: 4

Beds: 180, 40 certified for Medicare


Census: 171 as of March 7


Most recent annual survey:


Date: Feb. 22


In substantial compliance?: No


When compliance met: March 19


Deficiencies found in Levels D-L**: 2 E


E Level:


♦Sanitary conditions of food preparation/service - failure to ensure opened packages of food were properly sealed; failure to prevent contamination of food transported through hallways; failure to ensure dining tables were sanitized correctly after meals and to ensure hot food was kept at proper temperatures prior to serving the food. Ten of 11 residents queried said hot food was cold by the time it was served. Pork chops, for example, tested at 120 degrees, but safe temperature is above 140 degrees.

Dietary staff cleaned tables using a solution that was not tested for meeting concentration levels to kill bacteria; food taken from the kitchen to residents' rooms was not covered while in transport.

♦Infection control - failure to follow manufacturer's instruction for cleaning/disinfecting showers, shower chairs bedside tables and other hard surfaces. When questioned by surveyors on how long the disinfectant was to be left on the surface before wiping off, some staff said a couple of seconds while others said a couple of minutes; the correct time is at least 10 minutes.


Substantiated complaints in 2008: 1

Previous year: 1


Substandard quality of care designations in 2008: None


Immediate jeopardy designations in 2008: None


Federal Quality Initiative scores:



Staffing hours per resident per day for licensed nursing staff:


Heritage Park: 1 hour, 15 minutes

Statewide average: 1 hour, 24 minutes

National average: 1 hour, 18 minutes


For nursing assistants:


Heritage Park: 2 hours, 1 minute

State average: 2 hours

National average: 2 hours, 42 minutes


National Nursing Home Compare Score (based on three years of data):



(the lower the score, the better)


Heritage Park: 62

Statewide average: 192


State licensure actions in 2008: None


Federal actions imposed: None

Miller's Merry Manor


Address: 5544 E. State Blvd.


Phone: 749-9506


Owner: Miller's Health System Inc., Warsaw


Officers: V. Richard Miller, R. James Miller, Barbara Miller, Tina Robinson, Patrick Boyle, Lori Haug and Beverly Miller


Most recent change in ownership: none


Statu
s: For profit


Administrator: Kenneth Pflumm


Hire date: March 10


Beds: 77


Census: 70 as of Jan. 11


Sprinkler system: full



Resident rooms with smoke alarms: 41 of 77


Facility fire safety violations in past year: 2


Average fire safety violations in Indiana: 4


Most recent annual survey:


Date: Jan. 11


Note: This facility was surveyed in October, but findings not yet available


In substantial compliance to January survey?: No


When compliance met: Feb. 13


Deficiencies found in Levels D-L**: 2 D


D Level:


♦Care plan - failure to follow the care plan of a resident who had difficulty swallowing. The resident was to be prompted to tuck his chin and drink liquids with each bite of food. He was observed eating and coughing throughout several meals, with no prompting. His face would turn bright red due to his difficulty eating.

Another resident with dementia and swallowing difficulty was to have a diet with food softened mechanically and was to be monitored throughout the meal.

♦Quality of care - issues related to above situation with residents who had difficulty swallowing


Substantiated complaints in 2008: 1


Previous year: 0


Substandard quality of care designations in 2008: None


Immediate jeopardy designations in 2008: None


Federal Quality Initiative scores:



Staffing hours per resident per day for licensed nursing staff:


Miller's: 1 hour, 29 minutes

Statewide average: 1 hour, 24 minutes

National average: 1 hour, 18 minutes


For nursing assistants:


Miller's: 2 hours, 26 minutes

State average: 2 hours

National average: 2 hours, 18 minutes


National Nursing Home Compare Score (based on three years of data):



(the lower the score, the better)


Miller's: 60

Statewide average: 192


State licensure actions in 2008: None


Federal actions imposed: None

Woodview Healthcare Inc.


Address: 3420 E. State Blvd.


Phone: 484-3120


Most recent change in ownership: None


Status: For profit


Administrator/owner: John August/Woodview Healthcare Inc., Fort Wayne


Hire date: Jan. 1, 1981


Sprinkler system: Full


Resident rooms with smoke alarms: 0


Facility fire safety violations in past year: 1


Average fire violations in Indiana: 4


Beds: 128


Census: 95 as of Feb. 22


Most recent annual survey:


Date: Feb. 1


In substantial compliance?: No


When compliance met: March 8


Deficiencies found in Levels D-L**: 1 D; 2 E


D Level:


♦Assessment - failure to assess a resident who had a significant change in health status and ability to feed herself. The clinical record of the resident dated March 25, 2007, stated the woman had a urinary catheter and could feed herself, yet summary review of the woman's status, dated Dec. 14, 2007, showed she no longer had a catheter and required full assistance to eat. Yet records contained no documentation on details of the significant changes, as is required.


E Level:


♦Assessments - failure to ensure thorough skin assessments were completed for four residents with skin infections. The four residents developed skin rashes, itching and raised bumps that eventually were diagnosed as scabies. Scabies is caused by a microscopic mite that affects the skin. While the rashes were treated in various ways, there was no documentation that the infection control nurse thoroughly inspected residents' skin to ensure an accurate diagnosis was made in a timely manner. One resident, who was eventually prescribed a medication that kills scabies, had no skin assessment for more than four months, even though records showed documentation of an ongoing rash and where on the body the rash was located. Lack of assessment delayed effective treatment for some residents.

The infection-control nurse said she usually tried to assess skin rashes “if she could locate the resident,” surveyors noted in their report. She also said she depended on other nursing care staff to do the assessments.

♦Infection control - issues pertaining to the facility failing to follow policies and procedures for analyzing, assessing and tracking skin infections in four residents who had scabies. The facility failed to implement infection control measures according to facility policy to prevent spread of scabies. Eight residents developed scabies between October 2007 and January.


Substantiated complaints in 2008: 3


Previous year: 0


Substandard quality of care designations in 2008: None


Immediate jeopardy designations in 2008: None


Federal Quality Initiative scores:



Staffing hours per resident per day for licensed nursing staff:


Woodview: 1 hour, 33 minutes

Statewide average: 1 hour, 24 minutes

National average: 1 hour, 18 minutes


For nursing assistants:


Woodview: 2 hours, 48 minutes

State average: 2 hours

National average: 2 hours, 18 minutes


National Nursing Home Compare Score (based on three years of data):



(the lower the score, the better)


Woodview: 55

Statewide average: 192


State licensure actions in 2008: None


Federal actions imposed: None

Riverbend Health Care Center


Address: 7519 Winchester Road


Phone: 747-7435


Owner: Riverbend Healthcare LLC, Fort Wayne


Officers: Unavailable


Most recent change in ownership: Transitional Health Partners before August 2004


Status: For profit


Administrator: Lodene Yaney


Hire date: Feb. 18


Sprinkler system: Full


Resident rooms with smoke alarms: 0


Facility fire safety violations in past year: 7


Average fire violations in Indiana: 4


Beds: 66


Census: 62 as of Jan. 18


Most recent annual survey:


Date: Jan. 18


In substantial compliance?: No


When compliance met: Feb. 17


Deficiencies found in Levels D-L**: 18 D


D Level:


♦Privacy - failure to provide privacy for two residents. One resident was observed getting a blood sugar check while in the hallway in view of others. The other resident received an insulin injection in her abdomen within view of her roommate and with the window blinds open.

♦Social services - failure to ensure resident with broken, decayed teeth received needed dental services; facility had no policy for ensuring dental needs are met.

♦Housekeeping/maintenance - failure to ensure one drinking fountain was in good condition.

♦Assessments - failure to do a thorough, quarterly assessment of one resident's needs; also failure to document assessment of the aforementioned resident who had decreased oxygen levels and elevated pulse and who was at risk of pressure sores. The resident required hospitalization when her oxygen levels dropped and her pulse was nearly 200 beats a minute.

♦Assessments - failure to ensure one resident's incontinence status and height were accurately documented. The resident's chart stated she was continent because she had a urinary catheter and listed her height as 5 feet, 3 inches. Yet a later quarterly review said she was 5 feet tall and that she was incontinent but there was no further documentation as to the changes and a new plan of care.

♦Care plans - When a problem was noted in a resident, the care plan was not changed to address the issue, as is required. One resident who was in hospice care at the facility had specific foods that she liked and tolerated. She was not offered those foods. Staff was to set up the resident's meal trays and assist her with eating to prevent weight loss.

♦Care plans - failure to ensure one resident's tube feeding was administered continuously as per doctor's orders. Another resident was to wear therapeutic hosiery but surveyors observed the resident not wearing them on multiple occasions. A third resident was to wear a hand/wrist brace to prevent contractures, but over several days, surveyors did not see the resident wearing them.

A resident had requested hospice care and the doctor gave an order for hospice involvement on Nov. 23, 2007, yet on Jan. 14, no documentation was found that hospice had been called.

♦Activities of daily living - failure to assist a resident with eating. The resident had significant weight loss.

♦Range of motion - failure to ensure restorative therapy staff did 10-minute, three-times-a-day stretching of a resident's leg, according to doctor's orders.

♦Nasogastric feeding tube - failure to ensure continuous pumping of nutrient-rich food occurred for a resident with a feeding tube.

♦Sanitary conditions of food prep/service - failure to properly seal and label opened package of food in storage; dietary staff also failed to wash their hands during food preparation/service.

♦Dental service - failure to ensure routine dental services were provided for a resident with decayed and broken teeth.

♦Pharmacy services - failure to ensure expired and unlabeled meds were removed from the emergency medication cart.

♦Infection control - failure of a nurse to wash her hands for at least 10 seconds after dropping her keys on the floor, then giving medications. In three of eight observations, one nurse did not do proper hand-washing.

♦Resident call system - failure to ensure one resident had access to the bedside call light.

♦Environmental conditions - failure to ensure one handrail did not have sharp, jagged edges.

♦Clinical records - failure to ensure the resident with the feeding tube had documentation of nutritional intake. Staff also failed to document care of one resident's urinary catheter.


Substantiated complaints in 2008: 3


Previous year: 3


Substandard quality of care designations in 2008: None


Immediate jeopardy designations in 2008: None


Federal Quality Initiative scores:



Staffing hours per resident per day for licensed nursing staff:


Riverbend: 1 hour, 35 minutes

Statewide average: 1 hour, 24 minutes

National average: 1 hour, 18 minutes


For nursing assistants:


Riverbend: 1 hour, 40 minutes

State average: 2 hours

National average: 2 hours, 18 minutes


National Nursing Home Compare Score (based on three years of data):



(the lower the score, the better)


Riverbend: 485

Statewide average: 181


State licensure actions in 2008: None


Federal actions imposed: None

Village of Heritage


Address: 12011 Whittern Road, Monroeville


Phone: 623-6440


Owner: Adams County Memorial Hospital, Decatur


Officers: Marvin Baird, Stan Mosser, John Kintz and Dr. Robert Judge


Most recent change in ownership: N/A


Status: Nonprofit


Administrator: Rosina Thatcher


Hire date: May 21, 2007


Sprinkler system: Full


Resident rooms with smoke alarms: All


Facility fire safety violations in past year: 1


Average fire deficiencies in Indiana: 4


Beds: 61


Census: 58 as of Feb. 21


Most recent annual survey:


Date: Jan. 31


In substantial compliance?: No


When compliance met: Feb. 25


Deficiencies found in Levels D-L**: 6 D; 1 G


D Level:


♦Assessments - failure to accurately assess and calculate fluid requirements of three residents based on their weight; the dietary staff calculated fluid intake based on medium weight for all females rather than on resident's actual weight.

♦Care plans - failure to ensure meal consumption for one resident, at risk for weight loss, was accurately recorded; 64 meals had no documentation. One resident was to have high-protein supplement four times a day, but facility failed to provide it according to doctor's orders.

♦Food - failure to provide food substitutes for a resident who did not care for many of the regular menu items. The resident was also observed sitting 18 inches away from the table, which made it difficult for the resident to reach her food; 64 meals had no documentation of what the resident ate.

♦Drug regimen review - failure to ensure timely followup of pharmacy recommendations for one resident. The pharmacist said duplication was occurring in some meds ordered by the doctor, but it was five months before the orders were changed.

♦Lab services - failure to follow doctor's orders for a resident who was to have blood tests.

♦Clinical records - failure to document all meal consumption for one resident with significant weight loss; failure to ensure nutritional intake was accurately recorded for one resident and fluid intake accurately recorded for another resident


G Level:


♦Nutrition - Related to aforementioned residents whose food intake was not consistently recorded. One resident lost 13 pounds in one month. The dietary care plan stated if a weight loss of 5 or more pounds occurred in a resident, dietary was to be notified by nursing staff but no documentation was made that dietary had addressed the issue. The resident's care plan stated snacks were to be given at bedtime to increase calories and protein, but the cook said bedtime snacks were either an individual pack of crackers or cookies, plus a drink such as lemonade.


Substantiated complaints in 2008: None


Previous year: 1


Substandard quality of care designations in 2008: None


Immediate jeopardy designations in 2008: None


Federal Quality Initiative scores:



Staffing hours per resident per day for licensed nursing staff:


Village of Heritage: 58 minutes

Statewide average: 1 hour, 24 minutes

National average: 1 hour, 18 minutes


For nursing assistants:


Village of Heritage: 55 minutes

State average: 2 hours

National average: 2 hours, 18 minutes


National Nursing Home Compare Score (based on three years of data):



(the lower the score, the better)


Village of Heritage: 165

Statewide average: 192


State licensure actions in 2008: None


Federal actions imposed: None

Explanation

Nursing homes are given deficiencies according to ratings set by the federal government. Although there are A-C ratings, they are the least serious deficiencies and are not tracked in News-Sentinel reports. Levels D-L have the following meanings, with D being less severe and L indicating the most serious deficiency. Levels G-L are particularly cause for concern:



D: Isolated/minimal harm or potential for actual harm - A less serious deficiency and isolated to the fewest number of individuals; results in minimal discomfort or has the potential to negatively affect a resident's ability to achieve his/her highest level of functioning.


E: Pattern/minimal harm or potential for actual harm - A less serious deficiency affecting more than a limited number of individuals; results in minimal discomfort or has the potential to negatively affect residents.


F: Widespread/minimal harm or potential for actual harm - A less serious deficiency that is widespread; results in minimal discomfort or has the potential to negatively affect residents.


G: Isolated/actual harm - A more serious deficiency isolated to the fewest number of individuals; negatively affects the resident's ability to achieve his/her highest functioning.


H. Pattern/actual harm - A more serious deficiency affecting more than a limited number of individuals; negatively affects residents.


I. Widespread/actual harm - A more serious deficiency that is widespread and/or has the potential to affect a large number of residents.


J. Isolated/immediate jeopardy - The most serious deficiency, although isolated to the fewest number of residents, staff or occurrences; has caused or is likely to cause serious injury, harm, impairment or death: immediate corrective action required.


K. Pattern/immediate jeopardy - The most serious deficiency affecting more than a limited number of individuals; has caused or is likely to cause serious injury, harm impairment or death; immediate corrective action required.


L. Widespread/immediate jeopardy - the most serious deficiency and widespread throughout the facility; places residents in immediate jeopardy, causing or likely to cause serious injury, harm, impairment or death; immediate corrective action required.