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CARRIAGE HOUSE MANOR

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CARRIAGE HOUSE MANOR VS
All other Nursing Homes USA
General
City SULPHUR SPRINGS   vs 0% Nursing Homes USA have SULPHUR SPRINGS
State attribute explanation TX   vs 7.6% Nursing Homes USA have TX
Street 210 PIPELINE RD  
Zip Code 75482  
Phone 9038853589  
Overall Star Rating
(2.11 lower than average)
vs
3.11

Health Inspections Star Rating
(1.83 lower than average)
vs
2.83

Nurse Staffing Star Rating
(1.17 lower than average)
vs
3.17

Quality Measures Star Rating
(0.69 higher than average)
vs
3.31

RN Only Star Rating
(1.17 lower than average)
vs
3.17

Number of Certified Beds
120  (11.06 higher than average)
vs
108.94

Total Number of Residents
102  (10.75 higher than average)
vs
91.25

Percent of Occupied Beds
85 % (1.35 % higher than average)
vs
83.65 %

Health Survey Date 12/2/2011  
Fire Survey Date 11/29/2011  
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
Type of Ownership For Profit - Individual  vs 3.5% Nursing Homes USA have For profit - Individual
Located Within a Hospital? No  vs 93.6% Nursing Homes USA don't have Located Within a Hospital?
Multi Nursing Home Ownership? No  vs 45.1% Nursing Homes USA don't have Multi Nursing Home Ownership?
Resident and Family Councils Both  vs 29.8% Nursing Homes USA have Both
Continuing Care Retirement Community? No  vs 90.9% Nursing Homes USA don't have Continuing Care Retirement Community?
Quality Indicator Survey? No  vs 68.7% Nursing Homes USA don't have Quality Indicator Survey?
Special Focus Facility? No  vs 99% Nursing Homes USA don't have Special Focus Facility?
Civil Money Penalty Count
(57.16 lower than average)
vs
58.16

Total Enforcement Actions Count
(55.31 lower than average)
vs
56.31

# of deficiencies
(3.48 lower than average)
vs
7.48

Staff Information
Number of Residents
102  (10.62 higher than average)
vs
91.38

Number of RN Hours Per Resident Per Day
0.36  (0.41 lower than average)
vs
0.77

Number of LPN/LVN Hours Per Resident Per Day
0.54  (0.3 lower than average)
vs
0.84

Total Number of Licensed Staff Hours Per Resident Per Day
0.89  (0.7 lower than average)
vs
1.59

Number of CNA Hours Per Resident Per Day
0.01  (5.48 lower than average)
vs
5.49

Number Therapy Hours Per Resident Per Day
0.01  (0.09 lower than average)
vs
0.10

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: 02/09/2010
date Of Correction: 03/01/2010 

Deficiency #2 Scope: Some
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: 02/09/2010
date Of Correction: 03/01/2010 

Administration Deficiencies
Deficiency #1 Scope: Some
level Of Harm: 2
deficiency: Make Sure That Nurse Aides Show They Have The Skills And Techniques To Be Able To Care For Residents' Needs.
survey Date: 12/02/2011
date Of Correction: 01/09/2012 

Pharmacy Service Deficiencies
Deficiency #1 Scope: Many
level Of Harm: 2
deficiency: Maintain Drug Records And Properly Mark/label Drugs And Other Similar Products According To Accepted Professional Standards.
survey Date: 12/02/2011
date Of Correction: 01/09/2012 

Quality Measures Q1
Percent of long-stay residents who received an antipsychotic medication
21.3 % (3.79 % lower than average)
vs
25.09 %

Percent of long-stay residents whose need for help with daily activities has increased
75.2 % (42.25 % higher than average)
vs
32.95 %

Percent of long-stay residents who self-report moderate to severe pain
5.9 % (10.76 % lower than average)
vs
16.66 %

Percent of long-stay high-risk residents with pressure ulcers
5.9 % (6.68 % lower than average)
vs
12.58 %

Percent of long-stay residents who lose too much weight
4.4 % (7.43 % lower than average)
vs
11.83 %

Percent of long-stay low-risk residents who lose control of their bowels or bladder
32.5 % (12.04 % lower than average)
vs
44.54 %

Percent of long-stay residents who have had a catheter inserted and left in their bladder
5.2 % (10.43 % lower than average)
vs
15.63 %

Percent of long-stay residents with a urinary tract infection 9.9:1 % 
Percent of long-stay residents who have depressive symptoms 9.4 / 10.4 % 
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
22.9 % (2.12 % lower than average)
vs
25.02 %

Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine
94.4 % (9.76 % higher than average)
vs
84.64 %

Percent of short-stay residents with Pressure ulcers that are new or worsened
95.8 % (11.86 % higher than average)
vs
83.94 %

Percent of short-stay residents who newly received an antipsychotic medication
75.2  (29.3 higher than average)
vs
45.90

Percent of long-stay residents experiencing one or more falls with major injury
2.20 % (13.32 % lower than average)
vs
15.52 %

Quality Measures Q3
Percent of long-stay residents who received an antipsychotic medication
21.6 % (3.79 % lower than average)
vs
25.39 %

Percent of long-stay residents whose need for help with daily activities has increased
0.6 % (23.1 % lower than average)
vs
23.70 %

Percent of long-stay residents who self-report moderate to severe pain
13.3 % (0.8 % lower than average)
vs
14.10 %

Percent of long-stay high-risk residents with pressure ulcers
5 % (4.22 % lower than average)
vs
9.22 %

Percent of long-stay residents who lose too much weight
4.2 % (4.3 % lower than average)
vs
8.50 %

Percent of long-stay low-risk residents who lose control of their bowels or bladder
33.3 % (10.08 % lower than average)
vs
43.38 %

Percent of long-stay residents who have had a catheter inserted and left in their bladder
6.4 % (4.25 % lower than average)
vs
10.65 %

Percent of long-stay residents with a urinary tract infection
11.4 % (1.82 % higher than average)
vs
9.58 %

Percent of long-stay residents who have depressive symptoms
6.3 % (13.56 % 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 2.6 / 3 % 
Percent of short-stay residents who self-report moderate to severe pain
24.4 % (0.36 % lower than average)
vs
24.76 %

Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine
94.5 % (13.06 % higher than average)
vs
81.44 %

Percent of short-stay residents with Pressure ulcers that are new or worsened
97 % (22.25 % higher than average)
vs
74.75 %

Percent of short-stay residents who newly received an antipsychotic medication
16.7 % (0.64 % lower than average)
vs
17.34 %



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