PRESBYTERIAN COMMUNITY CARE CE

Nursing Home Inspector

1085 N. OREGON STREET
ONTARIO, OR 97914
Malheur County
Phone: 541-889-9133
Provider Number: 385008
Last Inspection: 06/18/2016

About the Nursing Home

Number of Beds: 96
Number of Residents: 26
Beds Available: 70
Percent Occupancy: 27%
Insurance Accepted: Medicare & Medicaid
Types of Councils: Resident
Ownership: Non profit - Corporation
Within Hospital?: NO

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

 

57

Facility
34

County
24

OR
20

USA

Deficiency Ratings
By Year

Lower Numbers Are Better

 

57

2016
25

2015
15

2014

Medicare Ratings

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

 

Details by Inspection Date

6/18/2016 Inspection

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Isolated : Minimal 3 8/7/2016
 
Failed To: Conduct initial and periodic assessments of each resident's functional capacity. Isolated : Minimal 3 8/7/2016
 
Failed To: Ensure each resident receives an accurate assessment by a qualified health professional. Isolated : Minimal 3 8/7/2016
 
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 8/7/2016
 
Failed To: Allow residents the right to participate in the planning or revision of care and treatment. Isolated : Actual 4 9/18/2016
 
Failed To: Provide care by qualified persons according to each resident's written plan of care. Isolated : Minimal 3 8/7/2016
 
Failed To: Provide necessary care and services to maintain or improve the highest well being of each resident . Isolated : Minimal 3 8/7/2016
 
Failed To: Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. Isolated : Actual 4 9/18/2016
 
Failed To: Ensure that each resident who enters the nursing home without a catheter is not given a catheter, unless medically necessary, and that incontinent patients receive proper services to prevent urinary tract infections and restore normal bladder functions. Isolated : Minimal 3 8/7/2016
 
Failed To: Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Isolated : Minimal 3 8/7/2016
 
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. Pattern : Minimal 4 8/7/2016
 
Failed To: Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%. Isolated : Minimal 3 8/7/2016
 
Failed To: Store, cook, and serve food in a safe and clean way. Widespread : Minimal 5 8/7/2016
 
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 8/7/2016
 
Failed To: Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. Isolated : Minimal 3 8/7/2016
 
Failed To: Have a program that investigates, controls and keeps infection from spreading. Pattern : Minimal 4 8/7/2016
 
Failed To: Keep accurate, complete and organized clinical records on each resident that meet professional standards. Isolated : Minimal 3 8/7/2016
 

5/15/2015 Inspection

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Conduct initial and periodic assessments of each resident's functional capacity. Isolated : Minimal 3 7/3/2015
 
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 7/3/2015
 
Failed To: Maintain 15 months of resident assessments in the resident's active clinical record. Pattern : Minimal 4 7/3/2015
 
Failed To: Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Pattern : Potential 3 7/3/2015
 
Failed To: Provide necessary care and services to maintain or improve the highest well being of each resident . Isolated : Minimal 3 7/3/2015
 
Failed To: Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Isolated : Minimal 3 7/3/2015
 
Failed To: Ensure residents maintain acceptable nutritional status. Isolated : Minimal 3 7/3/2015
 
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 7/3/2015
 

4/3/2014 Inspection

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Conduct initial and periodic assessments of each resident's functional capacity. Isolated : Minimal 3 5/31/2014
 
Failed To: Review or revise the resident's care plan after any major change in physical or mental health. Isolated : Minimal 3 5/31/2014
 
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 5/31/2014
 
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 5/31/2014
 
Failed To: Store, cook, and serve food in a safe and clean way. Isolated : Minimal 3 5/31/2014
 

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 OR State Avg
Number of Residents 26 21.00 53.13
Registered Nurses 1.66 0.83 0.86
Licensed Practical / Vocational Nurses 1.51 0.76 0.75
Certified Nursing Assistants 4.41 2.20 3.13
Total Staff Hours 7.58 3.79 4.75

 


About the Residents

(Lower Numbers Are Better)

Percent of Residents... This Facility% County Avg% OR State Avg%
of high risk long-stay residents with pressure ulcers 24 12 5
of long-stay residents assessed and appropriately given the pneumococcal vaccine 89 94 92
of long-stay residents assessed and appropriately given the seasonal influenza vaccine 90 95 92
of long-stay residents experiencing one or more falls with major injury 0 0 3
of long-stay residents who have depressive symptoms 0 1 3
of long-stay residents who lose too much weight 12 10 7
of long-stay residents who received an antianxiety or hypnotic medication 7 5 15
of long-stay residents who received an antipsychotic medication 7 13 14
of long-stay residents who self-report moderate to severe pain 24 13 11
of long-stay residents who were physically restrained 2 1 0
of long-stay residents whose ability to move independently worsened 27 23 18
of long-stay residents whose need for help with daily activities has increased 13 13 12
of long-stay residents with a catheter inserted and left in their bladder 16 12 3
of long-stay residents with a urinary tract infection 2 2 4
of short-stay residents assessed and appropriately given the pneumococcal vaccine 88 Not Available   51
of short-stay residents who had an outpatient emergency department visit 10 94 80
of short-stay residents who made improvements in function 87 11 14
of short-stay residents who newly received an antipsychotic medication 3 84 70
of short-stay residents who self-report moderate to severe pain 26 1 1
of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine 87 17 19
of short-stay residents who were rehospitalized after a nursing home admission 13 92 78
of short-stay residents who were successfully discharged to the community 81 11 19
of short-stay residents with pressure ulcers that are new or worsened 1 81 67