CADIA REHABILITATION RENAISSANCE

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General
Percent of short-stay residents with Pressure ulcers that are new or worsened	2 %
City	MILLSBORO	vs	0% Nursing Homes USA have MILLSBORO
State attribute explanation	DE	vs	0.3% Nursing Homes USA have DE	compare DE Nursing Homes USA
Street	26002 JOHN J WILLIAMS HIGHWAY
Zip Code	19966
Phone	3029474200
Overall Star Rating	3 (0.11 lower than average)	vs	3.11	Compare similar Overall Star Rating (3)
Health Inspections Star Rating	2 (0.83 lower than average)	vs	2.83	Compare similar Health Inspections Star Rating (2)
Nurse Staffing Star Rating	4 (0.83 higher than average)	vs	3.17	Compare similar Nurse Staffing Star Rating (4)
Quality Measures Star Rating	4 (0.69 higher than average)	vs	3.31	Compare similar Quality Measures Star Rating (4)
RN Only Star Rating	5 (1.83 higher than average)	vs	3.17	Compare similar RN Only Star Rating (5)
Number of Certified Beds	120 (11.06 higher than average)	vs	108.94	Compare similar Number of Certified Beds (120)
Total Number of Residents	116 (24.75 higher than average)	vs	91.25	Compare similar Total Number of Residents (116)
Percent of Occupied Beds	97 % (13.35 % higher than average)	vs	83.65 %	Compare similar Percent of Occupied Beds (97) %
Health Survey Date	3/23/2012
Fire Survey Date	3/26/2012
Sprinkler Status	Fully Sprinklered	vs	90.2% Nursing Homes USA have Fully Sprinklered
Program Participation	Medicare And Medicaid	vs	91.5% Nursing Homes USA have Medicare and Medicaid	compare Medicare and Medicaid Nursing Homes USA
Type of Ownership	For Profit - Corporation	vs	56.7% Nursing Homes USA have For profit - Corporation	compare For profit - Corporation Nursing Homes USA
Located Within a Hospital?	No	vs	93.6% Nursing Homes USA don't have Located Within a Hospital?	Compare similar don't have Located Within a Hospital?
Multi Nursing Home Ownership?	Yes	vs	54.9% Nursing Homes USA have Multi Nursing Home Ownership?
Resident and Family Councils	RESIDENT	vs	66% Nursing Homes USA have RESIDENT
Continuing Care Retirement Community?	No	vs	90.9% Nursing Homes USA don't have Continuing Care Retirement Community?
Quality Indicator Survey?	Yes	vs	31.3% Nursing Homes USA have Quality Indicator Survey?
Special Focus Facility?	No	vs	99% Nursing Homes USA don't have Special Focus Facility?
Civil Money Penalty Count	75.2 (17.04 higher than average)	vs	58.16
Total Enforcement Actions Count	2 (54.31 lower than average)	vs	56.31
# of deficiencies	23

Staff Information
Number of Residents	116 (24.62 higher than average)	vs	91.38
Number of RN Hours Per Resident Per Day	1 (0.23 higher than average)	vs	0.77
Number of LPN/LVN Hours Per Resident Per Day	0.96 (0.12 higher than average)	vs	0.84
Total Number of Licensed Staff Hours Per Resident Per Day	1.96 (0.37 higher than average)	vs	1.59
Number of CNA Hours Per Resident Per Day	0.1 (5.39 lower than average)	vs	5.49
Number Therapy Hours Per Resident Per Day	0.1 (equals average)	vs	0.10

Environmental Deficiencies
Deficiency #1		Scope: Few level Of Harm: 2 deficiency: Have A Program That Investigates, Controls And Keeps Infection From Spreading. survey Date: 02/27/2012 date Of Correction: 05/25/2012
Deficiency #2		Scope: Few level Of Harm: 2 deficiency: Have A Program That Investigates, Controls And Keeps Infection From Spreading. survey Date: 11/10/2011 date Of Correction: 02/03/2012
Deficiency #3		Scope: Few level Of Harm: 3 deficiency: Make Sure That The Nursing Home Area Is Free From Accident Hazards And Risks And Provides Supervision To Prevent Avoidable Accidents. survey Date: 11/10/2011 date Of Correction: 02/03/2012

Mistreatment Deficiencies
Deficiency #1		Scope: Some level Of Harm: 2 deficiency: Develop Policies That Prevent Mistreatment, Neglect, Or Abuse Of Residents Or Theft Of Resident Property. survey Date: 03/24/2012 date Of Correction: 05/25/2012
Deficiency #2		Scope: Few level Of Harm: 2 deficiency: 1) Hire Only People With 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. survey Date: 03/24/2012 date Of Correction: 05/25/2012
Deficiency #3		Scope: Few level Of Harm: 2 deficiency: 1) Hire Only People With 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. survey Date: 07/22/2010 date Of Correction: 10/15/2010

Resident Rights Deficiencies
Deficiency #1		Scope: Few level Of Harm: 2 deficiency: Provide Written Records When A Resident Is Transferred Or Discharged. survey Date: 03/23/2012 date Of Correction: 05/25/2012
Deficiency #2		Scope: Few level Of Harm: 2 deficiency: Immediately Tell The Resident, The Resident's Doctor And A Family Member Of The Resident Of Situations (injury/decline/room, Etc.) That Affect The Resident. survey Date: 03/23/2012 date Of Correction: 05/25/2012
Deficiency #3		Scope: Few level Of Harm: 2 deficiency: Immediately Tell The Resident, The Resident's Doctor And A Family Member Of The Resident Of Situations (injury/decline/room, Etc.) That Affect The Resident. survey Date: 11/10/2011 date Of Correction: 02/03/2012
Deficiency #4		Scope: Few level Of Harm: 2 deficiency: Tell The Resident Completely About His Or Her Health Status, Care And Treatments. survey Date: 11/10/2011 date Of Correction: 02/03/2012

Quality Care Deficiencies
Deficiency #1		Scope: Few level Of Harm: 2 deficiency: Provide Necessary Care And Services To Maintain The Highest Well Being Of Each Resident . survey Date: 02/27/2012 date Of Correction: 05/25/2012
Deficiency #2		Scope: Few level Of Harm: 2 deficiency: Provide Necessary Care And Services To Maintain The Highest Well Being Of Each Resident . survey Date: 11/10/2011 date Of Correction: 02/14/2012
Deficiency #3		Scope: Few level Of Harm: 2 deficiency: Provide Medically-related Social Services To Help Each Resident Achieve The Highest Possible Quality Of Life. survey Date: 11/10/2011 date Of Correction: 02/03/2012
Deficiency #4		Scope: Few level Of Harm: 2 deficiency: Assist Those Residents Who Need Total Help With Eating/drinking, Grooming And Personal And Oral Hygiene. survey Date: 07/22/2010 date Of Correction: 10/15/2010

Resident Assessment Deficiencies
Deficiency #1		Scope: Few level Of Harm: 2 deficiency: Make Sure That A Doctor Approves A Resident's Admission In Writing And That Each Resident Remains Under The Care Of A Doctor. survey Date: 02/27/2012 date Of Correction: 06/08/2012
Deficiency #2		Scope: Few level Of Harm: 2 deficiency: Develop A Complete Care Plan That Meets All Of A Resident's Needs, With Timetables And Actions That Can Be Measured. survey Date: 02/27/2012 date Of Correction: 05/25/2012
Deficiency #3		Scope: Few level Of Harm: 2 deficiency: Develop A Complete Care Plan That Meets All Of A Resident's Needs, With Timetables And Actions That Can Be Measured. survey Date: 11/10/2011 date Of Correction: 02/03/2012
Deficiency #4		Scope: Few level Of Harm: 2 deficiency: Develop A Post-discharge Plan With The Resident And Family For The Resident's Care After Leaving The Nursing Home. survey Date: 08/11/2009 date Of Correction: 08/31/2009

Administration Deficiencies
Deficiency #1		Scope: Few level Of Harm: 2 deficiency: Keep Accurate, Complete And Organized Clinical Records On Each Resident That Meet Professional Standards. survey Date: 02/27/2012 date Of Correction: 05/25/2012
Deficiency #2		Scope: Few level Of Harm: 2 deficiency: Keep Accurate, Complete And Organized Clinical Records On Each Resident That Meet Professional Standards. survey Date: 11/10/2011 date Of Correction: 02/03/2012
Deficiency #3		Scope: Few level Of Harm: 2 deficiency: Give Or Get Quality Lab Services/tests In A Timely Manner To Meet The Needs Of Residents. survey Date: 11/10/2011 date Of Correction: 02/14/2012

Pharmacy Service Deficiencies
Deficiency #1		Scope: Few level Of Harm: 2 deficiency: Maintain Drug Records And Properly Mark/label Drugs And Other Similar Products According To Accepted Professional Standards. survey Date: 02/27/2012 date Of Correction: 05/25/2012
Deficiency #2		Scope: Few level Of Harm: 3 deficiency: Make Sure That Residents Are Safe From Serious Medication Errors. survey Date: 02/27/2012 date Of Correction: 07/10/2012

Quality Measures Q1
Percent of long-stay residents who received an antipsychotic medication	28.9 % (3.81 % higher than average)	vs	25.09 %
Percent of long-stay residents whose need for help with daily activities has increased	2.4 % (30.55 % lower than average)	vs	32.95 %
Percent of long-stay residents who self-report moderate to severe pain	15.6 % (1.06 % lower than average)	vs	16.66 %
Percent of long-stay high-risk residents with pressure ulcers	8.6:1 %
Percent of long-stay residents who lose too much weight	7.6 % (4.23 % lower than average)	vs	11.83 %
Percent of long-stay residents who have had a catheter inserted and left in their bladder	3.5 % (12.13 % lower than average)	vs	15.63 %
Percent of long-stay residents with a urinary tract infection	75.2 % (61.74 % higher than average)	vs	13.46 %
Percent of long-stay residents who have depressive symptoms	7.2 % (21.18 % lower than average)	vs	28.38 %
Percent of long-stay residents who were physically restrained	75.2 % (31.52 % higher than average)	vs	43.68 %
Percent of short-stay residents who self-report moderate to severe pain	32.6 % (7.58 % higher than average)	vs	25.02 %
Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine	87.4 % (2.76 % higher than average)	vs	84.64 %
Percent of short-stay residents with Pressure ulcers that are new or worsened	95.3 % (11.36 % higher than average)	vs	83.94 %
Percent of short-stay residents who newly received an antipsychotic medication	3.7 % (42.2 % lower than average)	vs	45.90 %
Percent of long-stay residents experiencing one or more falls with major injury	3.6 % (11.92 % lower than average)	vs	15.52 %

Quality Measures Q3
Percent of long-stay residents who received an antipsychotic medication	30.1 % (4.71 % higher than average)	vs	25.39 %
Percent of long-stay residents whose need for help with daily activities has increased	1.3 % (22.4 % lower than average)	vs	23.70 %
Percent of long-stay residents who self-report moderate to severe pain	15.6 % (1.5 % higher than average)	vs	14.10 %
Percent of long-stay high-risk residents with pressure ulcers	9.1 % (0.12 % lower than average)	vs	9.22 %
Percent of long-stay residents who lose too much weight	6 % (2.5 % lower than average)	vs	8.50 %
Percent of long-stay low-risk residents who lose control of their bowels or bladder	32.4 (90.3) % (10.98 % lower than average)	vs	43.38 %
Percent of long-stay residents who have had a catheter inserted and left in their bladder	3.8 % (6.85 % lower than average)	vs	10.65 %
Percent of long-stay residents with a urinary tract infection	2 % (7.58 % lower than average)	vs	9.58 %
Percent of long-stay residents who have depressive symptoms	6.4 % (13.46 % lower than average)	vs	19.86 %
Percent of long-stay residents who were physically restrained	75.2 % (36.67 % higher than average)	vs	38.53 %
Percent of long-stay residents experiencing one or more falls with major injury	2.4 % (8.33 % lower than average)	vs	10.73 %
Percent of short-stay residents who self-report moderate to severe pain	32 % (7.24 % higher than average)	vs	24.76 %
Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine	86.6 % (5.16 % higher than average)	vs	81.44 %
Percent of short-stay residents with Pressure ulcers that are new or worsened	95.8 % (21.05 % higher than average)	vs	74.75 %
Percent of short-stay residents who newly received an antipsychotic medication	16.1 % (1.24 % lower than average)	vs	17.34 %