Contract Nursing Home Exclusion Review

Part of the initial review for contracting and part of the annual review.

Name of Nursing Home WAYNESBORO HEALTH AND REHABILITATION CENTER
Address 104 J V MANGUBAT DRIVE, PO BOX 510
WAYNESBORO TN, 38485
Telephone
Six Digit Provider Number 445518

A. Deficiencies

Rating (G-L) Program Requirements Corrected Date Current Survey Date
G Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. 07/27/2018 06/27/2018
G Provide appropriate pressure ulcer care and prevent new ulcers from developing. 07/27/2018 06/27/2018
G Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. 07/27/2018 06/27/2018
G Administer the facility in a manner that enables it to use its resources effectively and efficiently. 07/27/2018 06/27/2018
G Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. 07/27/2018 06/27/2018
G Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. 07/27/2018 06/27/2018
Deficiency Count: 6
Section Rating: FAIL

*Facility fails if there are three level "G" or worse deficiencies in the current survey.

B. Health Requirement Deficiencies

Current Number at Facility State Average
Total Health Requirement Deficiencies: 8 3.9
Section Rating: FAIL

Health Requirement Deficiencies: (The total number of health requirements deficiencies cannot be more than twice the State average in the current survey.)

C. RN Hours

RN Hours Current Average at Facility State Average
RN Hours per Resident Day: 0.45 0.59
Section Rating: FAIL

* Program requirement: Fail if less than state average

D. Total Nursing Staff

Total Nursing Staff Current Average at Facility State Average
Total Nursing Staff Hours per resident Day: 3.9 3.84
Section Rating: PASS

* Program requirement: Fail if less than state average

E. Quality Measures

NOTE:

Although the Centers for Medicare and Medicaid Services (CMS) has released 24 Quality Measures, current VHA guidelines indicate that the following 18 Quality Measures be used to determine Pass/Fail for Section G of the review.

Quality Measures Facility Percent State Average Flagged
Percentage of high risk long-stay residents with pressure ulcers 0% 4.5%
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine 0% 84.2%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine 0% 86.7%
Percentage of long-stay residents experiencing one or more falls with major injury 0% 3.2%
Percentage of long-stay residents who have depressive symptoms 0% 1.5%
Percentage of long-stay residents who lose too much weight 0% 6.8%
Percentage of long-stay residents who received an antipsychotic medication 0% 15.2%
Percentage of long-stay residents who self-report moderate to severe pain 0% 3.8%
Percentage of long-stay residents who were physically restrained 0% 0.7%
Percentage of long-stay residents whose need for help with daily activities has increased 0% 13.6%
Percentage of long-stay residents with a catheter inserted and left in their bladder 0% 1.6%
Percentage of long-stay residents with a urinary tract infection 0% 3.6%

* A facility fails when six or more of the CMS Quality Measures listed below in Nursing Home Compare fall above the state average.
N.A.= contact home, data not submitted N.S. = contact home, numbers too small