NORTHERN SURRY SNF

Nursing Home Inspector

830 ROCKFORD STREET
MOUNT AIRY, NC 27030
Surry County
Phone: 336-719-7000
Provider Number: 345278
Last Inspection: 02/10/2017

About the Nursing Home

Number of Beds: 33
Number of Residents: 31
Beds Available: 2
Percent Occupancy: 94%
Insurance Accepted: Medicare & Medicaid
Types of Councils: Resident
Ownership: Government - Hospital district
Within Hospital?: YES

About State Inspection Deficiencies

Nursing Homes that are Medicare and/or Medicaid certified are licensed by the state and are required to comply with rigid standards enforced by regular facility inspections and extensive evaluations.

The state inspection deficiencies provided here are accounts reported by state inspectors of every discrepancy found where the home failed to meet the minimum standards set forth by state and federal regulations. If a home does not show any deficiencies, it has met the minimum standards required.

Please note: Findings in these inspections do not present a complete picture of the quality of care provided. Information in this database should be interpreted carefully and used in conjunction with other sources, as well as a visit to the nursing home.


Deficiency Ratings

Our nursing home inspector tool compares the severity of deficiences rather than the number of deficiences. We calculate the severity of each deficiency using the formula:

Severity Rating = Scope + Level of Harm.

Deficiency Rating= Sum of ALL Severity Ratings

Severity Scope Level of Harm
2 1-Isolated 1-Potential for minimal harm
3 2-Pattern 1-Potential for minimal harm
3 1-Isolated 2-Minimal harm or potential for actual harm
4 3-Widespread 1-Potential for minimal harm
4 2-Pattern 2-Minimal harm or potential for actual harm
4 1-Isolated 3-Actual harm
5 3-Widespread 2-Minimal harm or potential for actual harm
5 2-Pattern 3-Actual harm
5 1-Isolated 4-Immediate jeopardy to resident health or safety
6 3-Widespread 3-Actual harm
6 2-Pattern 4-Immediate jeopardy to resident health or safety
7 3-Widespread 4-Immediate jeopardy to resident health or safety

Deficiency Ratings
By Region

Lower Numbers Are Better

 

44

Facility
20

County
14

NC
20

USA

Deficiency Ratings
By Year

Lower Numbers Are Better

 

44

2017
18

2016
27

2015

Medicare Ratings

Overall Rating: Overall Rating
Health Rating: Health Rating
Staff Rating: Staff Rating
Quality Rating: Quality Rating

 

Details by Inspection Date

2/10/2017 Inspection

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Store, cook, and serve food in a safe and clean way. Widespread : Minimal 5 3/9/2017
 
Failed To: Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. Isolated : Minimal 3 3/9/2017
 
Failed To: Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. Isolated : Minimal 3 3/9/2017
 
Failed To: Provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality. Pattern : Minimal 4 3/9/2017
 
Failed To: Allow residents the right to participate in the planning or revision of care and treatment. Isolated : Minimal 3 3/9/2017
 
Failed To: Post nurse staffing information/data on a daily basis. Widespread : Potential 4 2/10/2017
 
Failed To: Ensure each resident receives an accurate assessment by a qualified health professional. Pattern : Minimal 4 3/9/2017
 
Failed To: Ensure that residents are safe from serious medication errors. Pattern : Minimal 4 3/9/2017
 
Failed To: Set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action. Pattern : Minimal 4 3/9/2017
 
Failed To: At least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor. Isolated : Minimal 3 3/9/2017
 
Failed To: Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Pattern : Minimal 4 3/9/2017
 
Failed To: Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%. Isolated : Minimal 3 3/9/2017
 

2/19/2016 Inspection

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Isolated : Minimal 3 3/10/2016
 
Failed To: At least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor. Isolated : Minimal 3 3/10/2016
 
Failed To: Set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action. Isolated : Minimal 3 3/10/2016
 
Failed To: Allow residents the right to participate in the planning or revision of care and treatment. Isolated : Minimal 3 3/10/2016
 
Failed To: Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. Isolated : Minimal 3 3/10/2016
 
Failed To: Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. Isolated : Minimal 3 3/10/2016
 

4/23/2015 Inspection

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. Isolated : Minimal 3 5/18/2015
 
Failed To: Provide necessary care and services to maintain or improve the highest well being of each resident . Isolated : Minimal 3 5/18/2015
 
Failed To: Keep each resident free from physical restraints, unless needed for medical treatment. Isolated : Minimal 3 5/18/2015
 
Failed To: Ensure that residents with limited range of motion receive appropriate treatment and services to increase range of motion or prevent further decrease in range of motion. Isolated : Minimal 3 5/18/2015
 
Failed To: Keep residents' personal and medical records private and confidential. Isolated : Minimal 3 5/18/2015
 
Failed To: Allow residents the right to participate in the planning or revision of care and treatment. Isolated : Minimal 3 5/18/2015
 
Failed To: Develop policies and procedures for influenza and pneumococcal immunizations. Isolated : Minimal 3 5/18/2015
 
Failed To: At least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor. Isolated : Minimal 3 5/18/2015
 
Failed To: Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Isolated : Minimal 3 5/18/2015
 

Complaint Investigation Deficiencies

These deficiencies resulted from complaints investigated by the state inspectors and substantiated.

No Complaint Deficiencies Reported

About The Staff

(Higher Numbers Are Better)

Staffing Hours Per Day Per Resident... This Facility County Avg NC State Avg
Number of Residents 31 83.00 84.96
Registered Nurses 0.64 0.58 0.72
Licensed Practical / Vocational Nurses 0.78 0.70 0.87
Certified Nursing Assistants 1.94 2.28 2.33
Total Staff Hours 3.36 3.55 3.91

 


About the Residents

(Lower Numbers Are Better)

Percent of Residents... This Facility% County Avg% NC State Avg%
of high risk long-stay residents with pressure ulcers 2 4 7
of long-stay residents assessed and appropriately given the pneumococcal vaccine 98 98 93
of long-stay residents assessed and appropriately given the seasonal influenza vaccine 96 97 93
of long-stay residents experiencing one or more falls with major injury 8 5 3
of long-stay residents who have depressive symptoms 17 4 2
of long-stay residents who lose too much weight 8 9 8
of long-stay residents who received an antianxiety or hypnotic medication 49 41 29
of long-stay residents who received an antipsychotic medication 12 9 13
of long-stay residents who self-report moderate to severe pain 2 4 6
of long-stay residents who were physically restrained 0 0 0
of long-stay residents whose ability to move independently worsened 55 26 23
of long-stay residents whose need for help with daily activities has increased 26 16 18
of long-stay residents with a catheter inserted and left in their bladder 3 1 1
of long-stay residents with a urinary tract infection 4 8 4
of low risk long-stay residents who lose control of their bowels or bladder 40 54 55
of short-stay residents assessed and appropriately given the pneumococcal vaccine 87 92 83
of short-stay residents who had an outpatient emergency department visit 11 15 13
of short-stay residents who made improvements in function 54 61 64
of short-stay residents who newly received an antipsychotic medication 1 1 1
of short-stay residents who self-report moderate to severe pain 6 8 14
of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine 88 91 81
of short-stay residents who were rehospitalized after a nursing home admission 11 18 20
of short-stay residents who were successfully discharged to the community 76 58 55
of short-stay residents with pressure ulcers that are new or worsened 0 0 0