C M Tucker Nursing Care Center / Stone & Fewell
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- General
- Medicaid Data
- Medicare Cost Report
- Staff
- Quality Measures
- Health Survey
- Fire Safety Survey
- Definitions
- Overall Facility Star Rating:
- Address:
-
2200 Harden Street
Columbia, SC 29203, Richland County - Phone:
- (803)737-5305
- Medicare Cost Reports Available from:
- 1996-07-01 To 2010-06-30
- Health Survey Star Rating:
- Health Survey:
- 59 Deficiencies Listed | 2010-01-20
- Fire Survey:
- 3 Deficiencies Listed | 2010-01-21 | Sprinkler Status: fully sprinklered
- Ownership Type:
- Government - State
- A Multi-Nursing home (chain) Ownership:
- No
- Resident and Family Councils:
- Both
- Continuing Care Retirement Community:
- No
- Special Focus Facility:
- No
- Program Participation:
- Medicare and Medicaid
- Located in a Hospital?
- No
- Certified Beds:
- 252
- Residents:
- 66
- Occupancy:
- 26%
There is no cost report data available currently for this facility.
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Other Cost Report Years:
Fiscal Year Begin: 2009-07-01 | Fiscal Year End: 2010-06-30
| Worksheet | Description |
|---|---|
| Worksheet S, Part 1 & 2 | Certification and Settlement Summary |
| Worksheet S-2 | Complex Identification Data |
| Worksheet S-3 | Statistical Data |
| Worksheet S-3, Part 2 & 3 | SNF Wage Index Information |
| Worksheet S-7, Part 4 | Prospective Payment for SNF Statistical Data (RUGs) |
| Worksheet A | Reclassification and Adjustment of Trial Balance of Expenses |
| Worksheet A-7 | Analysis of Changes During Cost Reporting Period in Capital Asset Balances |
| Worksheet A-8 | Adjustments to Expenses |
| Worksheet A-8-1 | Statement of Costs of Services from Related Organizations |
| Worksheet A-8-2 | Provider-Based Physicians Adjustments |
| Worksheet B, Part 1 | Cost Allocation - General Service Costs |
| Worksheet B, Part 2 | Allocation of Capital - Related Costs |
| Worksheet B-1, Part 1 | Cost Allocation - General Service Costs |
| Worksheet C | Ratio of Cost to Charges for Ancillary and Outpatient Cost Centers |
| Worksheet D, Part 2 & 3 (Title XVIII) SNF Facility Type | Apportionment of Ancillary and Outpatient Cost and Reduction of Therapy Costs for Title XVIII (SNF) |
| Worksheet D-1, Part 1 & 2 (Title XVIII) SNF Facility Type | Computation of Inpatient Routine Costs |
| Worksheet E, Part 3 (Title XVIII) SNF Facility Type | Calculation of Reimbursement Settlement (SNF, Title XVIII) |
| Worksheet E-1 (Title XVIII) SNF Facility Type | Analysis of Payments to Providers for Services Rendered (SNF, Title XVIII) |
| Worksheet G | Balance Sheet |
| Worksheet G-2, Part 1 & 2 | Statement of Patient Revenues and Operating Expenses |
| Worksheet G-3 | Statement of Revenues and Expenses |
| National Average | South Carolina Average | C M Tucker Nursing Care Center / Stone & Fewell | |
|---|---|---|---|
| Nurse Staffing Star Rating | |||
| Total Number of Residents | 88.90 | 95.80 | 66.0 |
| Total Number of Licensed Nurse Staff Hours per Resident per Day | 1 hour and 34 minutes | 1 hour and 45 minutes | 1 hour and 50 minutes |
| RN Hours per Resident per Day | 44 minutes | 48 minutes | 59 minutes |
| RN Staff Only Star Rating | |||
| LPN/LVN Hours per Resident per Day | 50 minutes | 59 minutes | 52 minutes |
| CNA Hours per Resident per Day | 2 hours and 28 minutes | 2 hours and 32 minutes | 1 hour and 28 minutes |
| Quality Measures | National Average | South Carolina Average | C M Tucker Nursing Care Center / Stone & Fewell |
|---|---|---|---|
| Quality Measures Star Rating | |||
| Long-Stay Residents | |||
| NOTE: For the following Measures, Higher Percentages are better. | |||
| Percent of long-stay residents given influenza vaccination during the flu season | 86.96% | 86.96% | 93% |
| Percent of long-stay residents who were assessed and given pneumococcal vaccination | 85.82% | 85.82% | 98% |
| NOTE: for the following measures, lower percentages are better. | |||
| Percent of long-stay residents whose need for help with daily activities has increased | 13.41% | 13.41% | 14% |
| Percent of long-stay residents who have moderate to severe pain | 3.08% | 3.08% | 0% |
| Percent of high-risk long-stay residents who have pressure sores | 9.79% | 9.79% | 16% |
| Percent of low-risk long-stay residents who have pressure sores | 1.52% | 1.52% | 5% |
| Percent of long-stay residents who were physically restrained | 2.62% | 2.62% | 4% |
| Percent of long-stay residents who are more depressed or anxious | 13.72% | 13.72% | 18% |
| Percent of low-risk long-stay residents who lose control of their bowels or bladder | 47.77% | 47.77% | 83% |
| Percent of long-stay residents who have/had a catheter inserted and left in their bladder | 4.79% | 4.79% | 6% |
| Percent of long-stay residents who spend most of their time in bed or in a chair | 3.84% | 3.84% | 2% |
| Percent of long-stay residents whose ability to move about in and around their room got worse | 10.29% | 10.29% | 8% |
| Percent of long-stay residents who had a urinary tract infection | 8.48% | 8.48% | 10% |
| Percent of long-stay residents who lose too much weight | 7.25% | 7.25% | 10% |
| Short-Stay Residents | |||
| NOTE: For the following Measures, Higher Percentages are better. | |||
| Percent of short-stay residents given influenza vaccination during the flu season | 78.26% | 78.26% | 98% |
| Percent of short-stay residents who were assessed and given pneumococcal vaccination | 77.32% | 77.32% | 100% |
| NOTE: For the following Measures, Lower Percentages are better. | |||
| Percent of short-stay residents who have delirium | 1.31% | 1.31% | Not Available |
| Percent of short-stay residents who had moderate to severe pain | 17.26% | 17.26% | Not Available |
| Percent of short-stay residents who have pressure sores | 10.85% | 10.85% | Not Available |
Mistreatment Deficiencies
| Inspectors determined that the nursing home failed to: | Inspection Date | Correction Date | Level of Harm | Scope |
|---|---|---|---|---|
| 1. 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. | 2010-11-30 | 2010-12-27 | Minimal harm or potential for actual harm | Isolated |
| 2. 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. | 2010-01-20 | 2010-02-23 | Minimal harm or potential for actual harm | Pattern |
| 3. Write and use policies that forbid mistreatment, neglect and abuse of residents and theft of residents' property. | 2010-01-20 | 2010-02-23 | Minimal harm or potential for actual harm | Pattern |
| 4. Keep each resident free from physical restraints, unless needed for medical treatment. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
| 5. 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. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
| 6. 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. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Isolated |
Pharmacy Service Deficiencies
| Inspectors determined that the nursing home failed to: | Inspection Date | Correction Date | Level of Harm | Scope |
|---|---|---|---|---|
| 1. 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. | 2010-01-20 | 2010-02-21 | Minimal harm or potential for actual harm | Isolated |
| 2. Have drugs and other similar products available, which are needed every day and in emergencies, and give them out properly. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
| 3. Have drugs and other similar products available, which are needed every day and in emergencies, and give them out properly. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Pattern |
| 4. At least once a month, have a licensed pharmacist check the drugs that each resident takes. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Isolated |
Quality Care Deficiencies
| Inspectors determined that the nursing home failed to: | Inspection Date | Correction Date | Level of Harm | Scope |
|---|---|---|---|---|
| 1. Give professional services that follow each resident's written care plan. | 2010-11-30 | 2010-12-27 | Actual harm | Isolated |
| 2. Make sure that each resident's nutritional needs were met. | 2010-01-20 | 2010-02-05 | Minimal harm or potential for actual harm | Isolated |
| 3. Make sure that each resident who enters the nursing home without a catheter is not given a catheter, unless it is necessary. | 2010-01-20 | 2010-02-21 | Minimal harm or potential for actual harm | Isolated |
| 4. Give each resident care and services to get or keep the highest quality of life possible. | 2008-12-04 | 2008-12-18 | Actual harm | Isolated |
| 5. Provide activities to meet the needs of each resident. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Pattern |
| 6. Make sure that each resident who enters the nursing home without a catheter is not given a catheter, unless it is necessary. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
| 7. Give proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
| 8. Give professional services that follow each resident's written care plan. | 2008-12-04 | 2008-12-18 | Actual harm | Isolated |
| 9. Provide social services for related medical problems to help each resident achieve the highest possible quality of life. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
| 10. Give the right treatment and services to residents who have mental or social problems adjusting. | 2008-08-11 | 2008-08-25 | Immediate jeopardy to resident health or safety | Isolated |
| 11. Provide social services for related medical problems to help each resident achieve the highest possible quality of life. | 2008-08-11 | 2008-08-25 | Immediate jeopardy to resident health or safety | Isolated |
| 12. Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. | 2008-05-20 | 2008-07-14 | Minimal harm or potential for actual harm | Isolated |
| 13. Make sure that each resident who enters the nursing home without a catheter is not given a catheter, unless it is necessary. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Isolated |
| 14. Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Isolated |
| 15. Give proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Isolated |
| 16. Give professional services that meet a professional standard of quality. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Isolated |
| 17. Give each resident care and services to get or keep the highest quality of life possible. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Pattern |
Environmental Deficiencies
| Inspectors determined that the nursing home failed to: | Inspection Date | Correction Date | Level of Harm | Scope |
|---|---|---|---|---|
| 1. Make sure that the nursing home area is free of dangers that cause accidents. | 2010-11-30 | 2010-12-27 | Actual harm | Isolated |
| 2. Make sure that the nursing home area is free of dangers that cause accidents. | 2010-01-20 | 2010-02-21 | Minimal harm or potential for actual harm | Pattern |
| 3. Make sure that a working call system is available in each resident's room or bathroom and bathing area. | 2010-01-20 | 2010-02-21 | Minimal harm or potential for actual harm | Pattern |
| 4. Have a program to keep infection from spreading. | 2010-01-20 | 2010-02-21 | Minimal harm or potential for actual harm | Widespread |
| 5. Make sure that the nursing home area is safe, easy to use, clean and comfortable. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
| 6. Make sure that the nursing home area is free of dangers that cause accidents. | 2008-12-04 | 2008-12-18 | Immediate jeopardy to resident health or safety | Pattern |
| 7. Provide needed housekeeping and maintenance. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Pattern |
| 8. Make sure that the nursing home area is free of dangers that cause accidents. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Isolated |
| 9. Have a program to keep infection from spreading. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Isolated |
Resident Rights Deficiencies
| Inspectors determined that the nursing home failed to: | Inspection Date | Correction Date | Level of Harm | Scope |
|---|---|---|---|---|
| 1. 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. | 2010-01-20 | 2010-02-21 | Potential for minimal harm | Widespread |
| 2. Provide services to meet the needs and preferences of each resident. | 2010-01-20 | 2010-02-21 | Minimal harm or potential for actual harm | Pattern |
| 3. Provide care in a way that keeps or builds each resident's dignity and self respect. | 2010-01-20 | 2010-02-21 | Minimal harm or potential for actual harm | Isolated |
| 4. Keep each resident's personal and medical records private and confidential. | 2010-01-20 | 2010-02-21 | Minimal harm or potential for actual harm | Isolated |
| 5. Quickly give a resident's personal money to the heads of his or her estate after the resident's death. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
| 6. Provide care in a way that keeps or builds each resident's dignity and self respect. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Pattern |
| 7. Allow residents to easily see the results of the nursing home's most recent survey. | 2008-12-04 | 2008-12-18 | Potential for minimal harm | Widespread |
| 8. 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. | 2008-05-20 | 2008-07-14 | Minimal harm or potential for actual harm | Isolated |
| 9. Quickly give a resident's personal money to the heads of his or her estate after the resident's death. | 2007-10-31 | 2007-11-29 | Potential for minimal harm | Pattern |
| 10. 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. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Isolated |
Administration Deficiencies
| Inspectors determined that the nursing home failed to: | Inspection Date | Correction Date | Level of Harm | Scope |
|---|---|---|---|---|
| 1. Give or get lab tests to meet the needs of residents. | 2010-01-20 | 2010-02-21 | Minimal harm or potential for actual harm | Pattern |
| 2. Give lab tests only when the attending doctor ordered them. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
| 3. Give or get x-rays and other tests to meet the needs of residents. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
| 4. Give or get lab tests to meet the needs of residents. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
| 5. Set up or keep a group of people to review and ensure quality. | 2008-12-04 | 2008-12-18 | Immediate jeopardy to resident health or safety | Pattern |
| 6. Be administered in a way that leads to the highest possible level of well being for each resident. | 2008-12-04 | 2008-12-18 | Immediate jeopardy to resident health or safety | Pattern |
| 7. Choose a doctor to be the medical director. | 2008-12-04 | 2008-12-18 | Immediate jeopardy to resident health or safety | Pattern |
| 8. Be administered in a way that leads to the highest possible level of well being for each resident. | 2008-08-11 | 2008-08-25 | Immediate jeopardy to resident health or safety | Isolated |
| 9. Keep accurate and appropriate medical records. | 2007-10-31 | 2007-11-29 | Minimal harm or potential for actual harm | Isolated |
Resident Assessment Deficiencies
| Inspectors determined that the nursing home failed to: | Inspection Date | Correction Date | Level of Harm | Scope |
|---|---|---|---|---|
| 1. Make a complete assessment that covers all questions for areas that are listed in official regulations. | 2008-12-04 | 2008-12-18 | Immediate jeopardy to resident health or safety | Pattern |
| 2. 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. | 2008-12-04 | 2008-12-18 | Immediate jeopardy to resident health or safety | Pattern |
| 3. Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured. | 2008-05-20 | 2008-07-14 | Minimal harm or potential for actual harm | Isolated |
Nutrition and Dietary Deficiencies
| Inspectors determined that the nursing home failed to: | Inspection Date | Correction Date | Level of Harm | Scope |
|---|---|---|---|---|
| 1. Make sure that the attending doctor orders special diets. | 2008-12-04 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
Hazardous Area Deficiencies
| Inspectors determined that the building did not have: | Inspection Date | Correction Date | Level of Harm | Scope |
|---|---|---|---|---|
| 1. Construction that can resist fire for one hour or an approved fire extinguishing system. | 2007-10-30 | 2007-11-29 | Minimal harm or potential for actual harm | Isolated |
Interior Finish Deficiencies
| Inspectors determined that the building did not have: | Inspection Date | Correction Date | Level of Harm | Scope |
|---|---|---|---|---|
| 1. Fire-resistant room wall surfaces. | 2007-10-30 | 2007-11-29 | Minimal harm or potential for actual harm | Isolated |
Exits and Egress Deficiencies
| Inspectors determined that the building did not have: | Inspection Date | Correction Date | Level of Harm | Scope |
|---|---|---|---|---|
| 1. Exits that are accessible at all times. | 2008-12-03 | 2008-12-18 | Minimal harm or potential for actual harm | Isolated |
Resident Councils
The law requires nursing homes to allow councils to be set up by residents and families. Resident and family councils can facilitate communications with staff. If a nursing home does not have a resident and family council, ask the administrator why. If there is a council, ask to talk with council presidents to get a sense of how the nursing home has acted on their concerns.
Ownership Type
Nursing homes can be run by private for-profit corporations, non-profit corporations, religious affiliated organizations, or government entities. Quality of nursing homes can vary within each of these different types of ownership. Each nursing home needs to be judged on its own merits.
Multiple Nursing Home Ownership
Multi-nursing home chains have two or more homes under one ownership or operation.
Registered Nurse
Registered nurses (RNs) have between 2 and 6 years of education
Licensed Practical and Vocational Nurse
Licensed practical and vocational nurses (LPNs/LVNs) generally have 1 year of training. By law, RNs must assess residents' needs. RNs and LPNs/LVNs work together to plan care, implement care and treatment, and evaluate residents' outcomes. Nurses must be licensed in the state and are on site to provide care to residents twenty-four hours per day, seven days a week.
Certified Nursing Assistant
Certified nursing assistants (CNAs) provide care on a twenty-four hour basis. They work under the direction of a licensed nurse to assist residents with activities of daily living, i.e., eating, grooming, hygiene, dressing, transferring, and toileting. To become a full time certified nursing assistants (CNAs) one must have completed a competency evaluation program or nurse assistant training within 4 months of their permanent employment. They must also pursue continuing education each year.
On Site Services
On site services provide insight into the actual services that the Nursing Home offers. These services include dental service, dietary service, mental health service and others. This information will allow you to see if the Nursing Home provides these services or if they contract with an outside agency for these services.
Percentage of Residents Whose Ability to Move about in and around Their Room Got Worse
This measure indicates the percentage of residents whose ability to move about, either by walking or using a wheelchair, in their room and the hallway near their room, got worse since their last assessment. (Lower percentages are better.)
A decline in physical activity may come with age due to muscle loss, joint stiffness, worsening illness, fear of injury, or depression. Residents who lose mobility may also lose the ability to perform other activities of daily living, like eating, dressing, or getting to the bathroom. In some cases, however, the decline measured may be temporary and due to a short-term illness the resident is experiencing at the time of the assessment.
A lack of movement affects the resident in many ways. It becomes difficult to participate in physical and social activities. Sleep quality can suffer. The risk of heart disease, stroke, diabetes, or blood clots can increase. Depression and anxiety can worsen. Staying in one position and constant pressure on the skin can increase the chance of pressure sores. It is important for residents to be as active as possible.
Nursing home staff can help residents move around more. For instance, they can encourage residents to take part in physical and social activities or take them for regular walks if they need help. Most residents value being able to move about on their own and take care of themselves. It is important that nursing home staff encourage residents to do as much as they can for themselves and stay as active as physically possible. Some residents will decline in their ability to move about, even though the nursing home staff makes a good effort to keep them more active
Percentage of High Risk Residents Who Have Pressure Sores
This measure indicates the percent of residents, among all residents at high risk for getting pressure sores, who get a pressure sore in the nursing home. (Lower percentages are better.) A resident is at high risk for getting pressure sores if he or she is in a coma, doesn't get the nutrients they need (like water, vitamins, and minerals), or can't move or change position on their own.
A pressure sore is a skin wound. Pressure sores are sometimes called bedsores. These sores can be caused by pressure on the skin from chairs, wheelchairs, or beds. Pressure sores usually develop on bony parts of the body such as the tailbone, hip, ankle, or heel. They are usually caused by constant pressure on one part of the skin.
Pressure sores may:
- be painful
- take a long time to heal
- cause other complications such as skin and bone infections
Percentage of Residents Who Spend Most of Their Time in Bed or in a Chair
This measure indicates the percentage of residents who spent most of their time in bed or in a chair in their room during the 7-day assessment period. (Lower percentages are better.)
A decline in physical activity may come with age due to muscle loss, joint stiffness, fear of injury, worsening illness, or depression. Residents who spend too much time in bed or a chair may lose the ability to perform activities of daily living, like eating, dressing, or getting to the bathroom.
Staying in a bed or chair affects the resident in many ways. Unused muscles get weaker. It becomes difficult to participate in physical and social activities. Sleep quality can suffer. The risk of heart disease, stroke, diabetes, or blood clots can increase. Depression and anxiety can worsen. Staying in one position, and constant pressure on the skin can increase the chance of pressure sores. It is important for residents to be as active as possible.
Nursing home staff can help residents be more active. For instance, they can encourage residents to take part in physical activities or take them for regular walks if they need help. Most residents value being able to take care of themselves. It is important that nursing home staff encourage residents to do as much as they can for themselves and stay as active as physically possible. Some residents will choose to remain in bed or in a chair even though the nursing home staff makes a good effort to keep them more active. It is also important to note that some residents may be counted in this measure if their assessment period occurs when they are temporarily ill and are remaining in bed due to a short-term problem.
Percentage of Residents Who Were Physically Restrained
This measure indicates the percent of residents in the nursing home who were physically restrained daily during the 7-day assessment period. (Lower percentages are better.)
A physical restraint is any device, material, or equipment attached or adjacent to a resident's body, which the individual cannot remove easily, that keeps a resident from moving freely or prevents them normal access to their body. Examples of physical restraints include special types of vests, chairs with lap trays, lap belts, and enclosed walkers. Bed rails (side rails) are also considered restraints in certain situations, but they are not used in the calculation of this measure.
Restraints should only be used when they are necessary as part of the treatment of a resident's medical condition. Only a doctor can order a restraint. Restraints should never be used to punish a resident or to make things easier for the staff. Facilities are not allowed to use restraints based solely on a family's request, unless there is a documented medical need and a doctor's order. A resident who is restrained daily can become weak, lose the ability to go to the bathroom by themselves, and develop pressure sores or other medical complications.
Percentage of Residents Whose Need for Help with Daily Activities Has Increased
The daily activities that this measure counts include:
- feeding oneself
- moving from one chair to another
- changing positions while in bed
- going to the bathroom alone
Residents are checked routinely to see how they function doing these basic daily activities. Some loss of function may be expected in the elderly. If they are in poor health or if they are ill (for example, if they have pneumonia, an infection, a recent injury, or a chronic problem like asthma that has flared up), they may have a temporary loss of function. Sudden or rapid loss of one or more of these basic daily tasks could mean the resident needs medical attention.
Most residents value being able to take care of themselves. It is important that nursing home staff encourage residents to do as much as they can for themselves. In some cases, it may take more staff time to allow residents to do these tasks than to do the tasks for them. Residents who still do these basic daily activities with little help may feel better about themselves and stay more active. This can affect their health in a good way. When people stop taking care of themselves, it may mean that their health has gotten worse. The resident's ability to perform daily functions is important in maintaining their current health status and quality of life. Some residents will lose function in their basic daily activities even though the nursing home provides good care.
Percentage of Low Risk Residents Who Lose Control of Their Bowels and Bladder
This measure indicates the percent of residents who often lose control of their bowels or bladder. (Lower percentages are better.) This information is only based on residents who have a low risk for losing control of their bowel or bladder. Residents have a low risk for losing bowel and bladder control if they do not have either severe dementia (memory loss) or a very limited ability to move on their own.
Loss of bowel or bladder control is not a normal sign of aging and can often be successfully treated. Loss of bowel and bladder control can be caused by:
- physical problems (like constipation, muscle weakness, or a bladder infection)
- location problems (like the bathroom being too far away)
- reaction to medication
- limited ability to walk or move around
- diet and fluid intake
- toilet routine (timing trips to the bathroom)
- whether someone can provide assistance when needed
- certain medical conditions, such as diabetes, dementia, spinal cord injury, or neurological disease
Finding the cause and treating a problem with bowel or bladder control is important for many reasons. Physically, it can help prevent infections and pressure sores. Mentally, treatment can help the well being of the resident by restoring dignity and social interaction. Having fewer residents with bowel and bladder control problems can give the nursing home staff more time to provide other care.
Five Star Quality Rating
Much Above Avg. 5 out of 5 stars
Above Avg. 4 out of 5 stars
Average 3 out of 5 stars
Below Avg. 2 out of 5 stars
Much Below Avg. 1 out of 5 stars
Percentage of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder
This measure indicates the percent of residents who had a catheter inserted and left in their bladder for a period of time during the 14-day assessment period. (Lower percentages are better.)
A catheter is a thin, soft tube that is inserted into the bladder and attached to a bag that collects the urine. It may be inserted into the bladder of a patient who has lost control of their bladder or cannot use a toilet (for instance, someone in a coma). Catheters may be used because there is a physical reason the urine cannot drain naturally, to keep a patient with pressure sores that are not healing clean and dry, or to measure the amount of urine being produced.
A catheter should only be used when it is medically necessary. Residents may need a lot of help to get to the toilet, or they may have to go frequently. A catheter should not be used for the convenience of the nursing home staff. Using a catheter may result in complications like urinary tract or blood infections, physical injury, skin problems, bladder stones, or blood in the urine. Some studies have shown that long-term use of indwelling catheters (over many years) may increase the rates of bladder cancer in patients with spinal cord injuries.
Percentage of Residents with a Urinary Tract Infection
This measure indicates the percentage of residents who had an infection in their urinary tract at any time during the 30 days before their most recent assessment. (Lower percentages are better.)
A urinary tract infection (UTI) is an infection in the urethra that, if left untreated, can spread to the bladder (bladder infection) and kidney (kidney infection).
If the area where waste (urine and bowel movements) leaves the body is not kept clean, bacteria from the colon may multiply and enter the urethra (the tube that passes urine from the bladder to outside the body), causing a UTI. A UTI may also be caused by bacteria on a catheter (a soft tube) being used to drain urine from the bladder.
Most urinary tract infections can be prevented by keeping the area clean, emptying the bladder regularly, and drinking enough fluid. Nursing home staff should make sure the resident has good hygiene. Finding the cause and getting early treatment of a UTI can prevent the infection from spreading and becoming more serious or causing complications like delirium. It is important to find out whether the UTI is caused by a physical problem, like an enlarged prostate, so proper medical treatment can be given.
Percentage of Residents Who Are More Depressed or Anxious
This measure indicates the percentage of residents who have become more depressed or anxious in the nursing home since the last time they were checked. (Lower percentages are better.)
Depression is a medical problem of the brain that can affect how a person thinks, feels, and behaves. Signs of depression may include fatigue, a loss of interest in normal activities, poor appetite, and problems with concentration and sleeping.
Anxiety is excessive worry. Signs of anxiety can include trembling, muscle aches, problems sleeping, stomach pain, dizziness, and irritability.
Feeling depressed or anxious can lessen one's quality of life and lead to other health problems. Nursing home residents are at a high risk for developing depression and anxiety for many reasons, such as loss of a spouse, family members, or friends; chronic pain and illness; difficulty adjusting to the nursing home; and frustration with memory loss. Identifying depression and anxiety can be difficult in elderly patients because the signs may be confused with the normal aging process, a side effect of a medication, or the result of a medical condition. Proper treatment may include medication, therapy, or an increase in social support.
Percentage of Residents Who Lose Too Much Weight
This measure indicates the percentage of residents who have lost too much weight. (Lower percentages are better.)
A loss of 5% or more of body weight in one month is usually considered unhealthy (for example, a 150 pound person should not lose more than 7.5 pounds in one month). Too much weight loss can make a person weak, change how medicine works in the body, or cause the skin to break down, which can lead to pressure sores. Too much weight loss may mean that the resident is ill, refuses to eat, is depressed, or has a medical problem that makes eating difficult (like weakness caused by a stroke). It could also mean that the resident is not being fed properly, their medical care is not being properly managed, or that the nursing home's nutrition program is poor. To help prevent unhealthy weight loss, it is important that the resident's diet is balanced and nutritious, and that staff spend enough time feeding people who can't feed themselves. Sometimes it may be necessary for a person to lose weight for medical reasons. In these cases, the medical staff may plan in advance for the resident to lose weight on a special weight loss program, but the person should not lose more than 5% of body weight in one month.
Percentage of Residents Who Have Moderate to Severe Pain
This indicates the percentage of residents who are reported to have moderate to severe pain during the 7-day assessment period. This measure is shown to encourage you to talk to the nursing home staff about how they check and manage pain, and to make you aware of how important it is. Pain can be caused by a variety of medical conditions. Checking for pain and pain management are very complex.
Comparing these percentages is different from the other measures because the percentages may mean different things. Generally, a lower percentage on this measure is better. However, this isn't always true. For example, two nursing homes could provide the same quality of care and have the same number of residents with pain. However, if one of the nursing homes does a better job checking the residents for pain, they could have a higher percentage on this measure. Or, if for personal or cultural reasons, more residents in one of the nursing homes refuse to take pain medication, that nursing home's percentage would be higher. In these examples, although the percentage for one nursing home is higher, it does not mean they are not providing good care.
Residents should always be checked regularly by nursing home staff to see if they are having pain. Residents (or someone on their behalf) should let staff know if they are in pain so efforts can be made to find the cause and make the resident more comfortable. If pain is not treated, a resident may not be able to perform daily routines, may become depressed, or may have an overall poor quality of life. This percentage may include some residents who are getting or have been prescribed treatment for their pain but who refuse pain medicines or choose to take less. Some residents may choose to accept a certain level of pain so they can stay more alert.
Percentage of Long-Stay Residents Who Were Assessed and Given Pneumococcal Vaccination
A pneumococcal vaccination otherwise known as pneumococcal shot may help you prevent, or lower the risk of becoming seriously ill from pneumonia caused by bacteria. It may also help you prevent future infections.
Residents of nursing homes should be asked if they have been vaccinated for pneumonia, and if not, you should be given the pneumococcal shot unless there is a medical reason why you should not receive it.
Percentage of Long-Stay Residents Given Influenza Vaccination During the Flu Season
Influenza is also known as the "flu" and is a contagious form of a respiratory infection. The flu is easily transmitted from person to person. The most common form of spreading this condition is when a person coughs or sneezes.
Receiving an immunization (influenza vaccination or flu shot) can prevent you from getting the flu or at the least help to reduce your risk of becoming seriously ill from the flu. People 65 years of age and older tend to be at a higher risk of becoming seriously ill from the flu. These illnesses can develop into serious and sometime life threatening medical complications. It is recommended that if you are 65 or older you should get a flu shot once a year if no medical condition would preclude you from receiving one.
The flu season is between October and March of each year. Residents of nursing homes should have a flu shot once every year during the flu season. You doctor will explain to you if you have a medical condition or situation that would not allow you to receive a flu shot.
Overall Rating
The overall rating is a combination of the health inspection rating, the staffing rating, and the quality measures rating. Analysis was conducted on these three data sources and each of these ratings were combined into one overall rating.
When looking at the five-star ratings, more stars are better. Five (5) stars are the most a nursing home can get. One (1) star is the fewest.
Health Inspection Result Rating
Strengths:
- Comprehensive: The nursing home health inspection process looks at all major aspects of care in a nursing home (about 180 different items).
- Onsite Visits by Trained Inspectors: It is the only source of information that comes from a trained team of objective surveyors who visit each nursing home to check on the quality of care, inspect medical records, and talk with residents about their care.
- Federal Quality Checks: Federal surveyors check on the state surveyors' work to make sure they are following the national process and that any differences between states stay within reasonable bounds.
Limits:
- Variation between States: There are some differences in how different states carry out the inspection process, even though the standards are the same across the country.
- Medicaid Program Differences: There are also differences in state licensing requirements that affect quality, and in state Medicaid programs that pay for much of the care in nursing homes
Staffing Rating
Strengths:
- Overall Staffing: The quality ratings look at the overall number of staff compared to the number of residents and how many of the staff are trained nurses.
- Adjusted for the Population: The ratings consider differences in how sick the nursing home residents are in each nursing home, since that will make a difference in how many staff are needed.
Limits:
- Self-Reported: The staffing data are self-reported by the nursing home, rather than collected and reported by an independent agency.
- Snap-Shot in Time: Staffing data are reported just once a year and reflect staffing over a 2 week period of time.
Quality Measures Rating
Strengths:
- In-Depth Look: The quality measures provide an important in-depth look at how well each nursing home performs on ten important aspects of care. For example, these measures show how well the nursing home helps people keep their ability to dress and eat, or how well the nursing home prevents and treats skin ulcers.
- National Measures: The ten quality measures we use in the Five-Star rating are used in all nursing homes.
Limits:
- Self-Reported Data: The quality measures are self-reported by the nursing home, rather than collected and reported by an independent agency.
- Just a Few Aspects of Care: The quality measures represent only a few of the many aspects of care that may be important to you.
