AGAPE NURSING AND REHABILIATION CENTER, LLC

Nursing Home Inspector

505 N ROAN STREET
JOHNSON CITY, TN 37604
Washington County
Phone: 423-975-2000
Provider Number: 445162
Last Inspection: 03/22/2017

About the Nursing Home

Number of Beds: 84
Number of Residents: 59
Beds Available: 25
Percent Occupancy: 70%
Insurance Accepted: Medicare & Medicaid
Types of Councils: Both
Ownership: For profit - Partnership
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

 

0

Facility
17

County
14

TN
20

USA

Deficiency Ratings
By Year

Lower Numbers Are Better

 

0

2017
0

2016
20

2015

Medicare Ratings

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

 

Details by Inspection Date

1/14/2015 Inspection

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. Isolated : Actual 4 2/13/2015
 
Failed To: Make sure that the facility is administered in an acceptable way that maintains the well-being of each resident . Isolated : Actual 4 2/13/2015
 
Failed To: Provide care by qualified persons according to each resident's written plan of care. Isolated : Actual 4 2/13/2015
 
Failed To: Protect each resident from mistreatment, neglect and misappropriation of personal property. Isolated : Actual 4 2/13/2015
 
Failed To: Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Isolated : Actual 4 2/13/2015
 

Complaint Investigation Deficiencies

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

12/22/2016 Investigation

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Help and prepare each resident for a safe and easy discharge or transfer from the nursing home. Isolated : Minimal 3 1/27/2017
 
Failed To: Provide necessary care and services to maintain or improve the highest well being of each resident . Isolated : Minimal 3 1/27/2017
 

About The Staff

(Higher Numbers Are Better)

Staffing Hours Per Day Per Resident... This Facility County Avg TN State Avg
Number of Residents 59 81.88 85.33
Registered Nurses 0.58 0.87 0.75
Licensed Practical / Vocational Nurses 0.92 1.01 1.05
Certified Nursing Assistants 2.05 2.10 2.17
Total Staff Hours 3.55 3.98 3.97

 


About the Residents

(Lower Numbers Are Better)

Percent of Residents... This Facility% County Avg% TN State Avg%
of high risk long-stay residents with pressure ulcers 6 4 5
of long-stay residents assessed and appropriately given the pneumococcal vaccine 99 98 92
of long-stay residents assessed and appropriately given the seasonal influenza vaccine 100 96 93
of long-stay residents experiencing one or more falls with major injury 2 3 3
of long-stay residents who have depressive symptoms 0 1 2
of long-stay residents who lose too much weight 5 7 7
of long-stay residents who received an antianxiety or hypnotic medication 34 42 36
of long-stay residents who received an antipsychotic medication 10 16 17
of long-stay residents who self-report moderate to severe pain 5 3 4
of long-stay residents who were physically restrained 3 6 1
of long-stay residents whose ability to move independently worsened 16 22 21
of long-stay residents whose need for help with daily activities has increased 8 13 15
of long-stay residents with a catheter inserted and left in their bladder 1 2 2
of long-stay residents with a urinary tract infection 10 4 4
of low risk long-stay residents who lose control of their bowels or bladder 83 65 56
of short-stay residents assessed and appropriately given the pneumococcal vaccine 95 95 83
of short-stay residents who had an outpatient emergency department visit 17 10 13
of short-stay residents who made improvements in function 64 57 64
of short-stay residents who newly received an antipsychotic medication 3 2 2
of short-stay residents who self-report moderate to severe pain 9 11 12
of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine 89 90 81
of short-stay residents who were rehospitalized after a nursing home admission 25 21 21
of short-stay residents who were successfully discharged to the community 46 50 48
of short-stay residents with pressure ulcers that are new or worsened 5 1 0