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NORTHWAY HEALTH AND REHABILITATION, LLC

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NORTHWAY HEALTH AND REHABILITATION, LLC VS
All other Nursing Homes USA
General
City Birmingham  vs 0.1% Nursing Homes USA have Birmingham
State attribute explanation AL   vs 1.5% Nursing Homes USA have AL
Street 1424 NORTH 25TH STREET  
Zip Code 35234  
Phone 2053285870  
Overall Star Rating
(0.11 lower than average)
vs
3.11

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

Nurse Staffing Star Rating
(0.83 higher 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
113  (4.06 higher than average)
vs
108.94

Total Number of Residents
92  (0.75 higher than average)
vs
91.25

Percent of Occupied Beds
81 % (2.65 % lower than average)
vs
83.65 %

Health Survey Date 5/3/2012  
Fire Survey Date 5/9/2012  
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
Type of Ownership For Profit - Corporation  vs 56.7% Nursing Homes USA have For profit - Corporation
Located Within a Hospital? No  vs 93.6% Nursing Homes USA 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? 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 20  
Staff Information
Number of Residents
92  (0.62 higher than average)
vs
91.38

Number of RN Hours Per Resident Per Day
0.4  (0.37 lower than average)
vs
0.77

Number of LPN/LVN Hours Per Resident Per Day
1.29  (0.45 higher than average)
vs
0.84

Total Number of Licensed Staff Hours Per Resident Per Day
1.69  (0.1 higher than average)
vs
1.59

Number of CNA Hours Per Resident Per Day
0.06  (5.43 lower than average)
vs
5.49

Number Therapy Hours Per Resident Per Day
0.06  (0.04 lower than 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: 05/03/2012
date Of Correction: Not Available 

Deficiency #2 Scope: Some
level Of Harm: 2
deficiency: Provide Housekeeping And Maintenance Services.
survey Date: 05/03/2012
date Of Correction: Not Available 

Deficiency #3 Scope: Few
level Of Harm: 2
deficiency: Have A Program That Investigates, Controls And Keeps Infection From Spreading.
survey Date: 12/16/2011
date Of Correction: 01/20/2012 

Deficiency #4 Scope: Some
level Of Harm: 2
deficiency: Provide Housekeeping And Maintenance Services.
survey Date: 09/10/2010
date Of Correction: 09/13/2010 

Deficiency #5 Scope: Few
level Of Harm: 2
deficiency: Make Sure That The Nursing Home Area Is Free From Accident Hazards And Risks And Provides Supervision To Prevent Avoidable Accidents.
survey Date: 12/16/2009
date Of Correction: 01/20/2010 

Mistreatment Deficiencies
Deficiency #1 Scope: Few
level Of Harm: 4
deficiency: Keep Each Resident Free From Physical Restraints, Unless Needed For Medical Treatment.
survey Date: 09/01/2011
date Of Correction: 08/26/2011 

Resident Rights Deficiencies
Deficiency #1 Scope: Few
level Of Harm: 2
deficiency: Properly Hold, Secure And Manage Each Resident's Personal Money Which Is Deposited With The Nursing Home.
survey Date: 05/03/2012
date Of Correction: Not Available 

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: 12/16/2011
date Of Correction: 01/20/2012 

Deficiency #3 Scope: Few
level Of Harm: 2
deficiency: Try To Resolve Each Resident's Complaints Quickly.
survey Date: 07/21/2011
date Of Correction: 08/04/2011 

Deficiency #4 Scope: Many
level Of Harm: 1
deficiency: Provide Access To A Telephone For Resident To Use In Private.
survey Date: 06/30/2011
date Of Correction: 07/18/2011 

Deficiency #5 Scope: Few
level Of Harm: 2
deficiency: Keep Each Resident's Personal And Medical Records Private And Confidential.
survey Date: 06/30/2011
date Of Correction: 07/01/2011 

Deficiency #6 Scope: Few
level Of Harm: 2
deficiency: Properly Hold, Secure And Manage Each Resident's Personal Money Which Is Deposited With The Nursing Home.
survey Date: 06/30/2011
date Of Correction: 07/22/2011 

Deficiency #7 Scope: Some
level Of Harm: 2
deficiency: Give Each Resident A Notice Of Rights, Rules, Services And Charges. Tell Each Resident Who Can Get Medicaid Benefits About 1) Which Items And Services Medicaid Covers And Which The Resident Must Pay For.
survey Date: 09/10/2010
date Of Correction: 10/15/2010 

Deficiency #8 Scope: Few
level Of Harm: 2
deficiency: Reasonably Accommodate The Needs And Preferences Of Each Resident.
survey Date: 12/16/2009
date Of Correction: 01/20/2010 

Quality Care Deficiencies
Deficiency #1 Scope: Few
level Of Harm: 2
deficiency: Provide Care By Qualified Persons According To Each Resident's Written Plan Of Care.
survey Date: 12/16/2009
date Of Correction: 01/20/2010 

Resident Assessment Deficiencies
Deficiency #1 Scope: Few
level Of Harm: 2
deficiency: Coordinate Assessments With The Pre-admission Screening And Resident Review Program For Mentally-ill And Mentally-retarded Patients.
survey Date: 06/30/2011
date Of Correction: 07/18/2011 

Pharmacy Service Deficiencies
Deficiency #1 Scope: Few
level Of Harm: 2
deficiency: Safely Provide Drugs And Other Similar Products Available, Which Are Needed Every Day And In Emergencies, By A Licensed Pharmacist.
survey Date: 05/03/2012
date Of Correction: Not Available 

Deficiency #2 Scope: Some
level Of Harm: 2
deficiency: Maintain Drug Records And Properly Mark/label Drugs And Other Similar Products According To Accepted Professional Standards.
survey Date: 12/16/2009
date Of Correction: 01/20/2010 

Deficiency #3 Scope: Some
level Of Harm: 2
deficiency: Safely Provide Drugs And Other Similar Products Available, Which Are Needed Every Day And In Emergencies, By A Licensed Pharmacist.
survey Date: 12/16/2009
date Of Correction: 01/20/2010 

Nutrition and Dietary Deficiencies
Deficiency #1 Scope: Many
level Of Harm: 2
deficiency: Store, Cook, And Serve Food In A Safe And Clean Way.
survey Date: 06/30/2011
date Of Correction: 07/21/2011 

Quality Measures Q1
Percent of long-stay residents who received an antipsychotic medication
52.4 % (27.31 % higher 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
6.4 % (10.26 % lower than average)
vs
16.66 %

Percent of long-stay high-risk residents with pressure ulcers
12.2 % (0.38 % lower than average)
vs
12.58 %

Percent of long-stay residents who lose too much weight
17.6 % (5.77 % higher than average)
vs
11.83 %

Percent of long-stay low-risk residents who lose control of their bowels or bladder
27.8 (82.0) % (16.74 % lower than average)
vs
44.54 %

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
1.1 % (12.36 % lower than average)
vs
13.46 %

Percent of long-stay residents who have depressive symptoms
75.2 % (46.82 % higher 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
3.4 % (21.62 % lower than average)
vs
25.02 %

Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine
77.1 % (7.54 % lower than average)
vs
84.64 %

Percent of short-stay residents with Pressure ulcers that are new or worsened
74.4 % (9.54 % lower 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
53.3 % (27.91 % higher than average)
vs
25.39 %

Percent of long-stay residents whose need for help with daily activities has increased
75.2 % (51.5 % higher than average)
vs
23.70 %

Percent of long-stay residents who self-report moderate to severe pain
4.1 % (10 % lower than average)
vs
14.10 %

Percent of long-stay high-risk residents with pressure ulcers 12.3:1 % 
Percent of long-stay residents who lose too much weight
16.8 % (8.3 % higher than average)
vs
8.50 %

Percent of long-stay low-risk residents who lose control of their bowels or bladder
26.6 (79.9) % (16.78 % lower than average)
vs
43.38 %

Percent of long-stay residents who have had a catheter inserted and left in their bladder
4.1 % (6.55 % lower than average)
vs
10.65 %

Percent of long-stay residents with a urinary tract infection
0.7 % (8.88 % lower than average)
vs
9.58 %

Percent of long-stay residents who have depressive symptoms
75.2 % (55.34 % higher 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
5 % (5.73 % lower than average)
vs
10.73 %

Percent of short-stay residents who self-report moderate to severe pain
4.3 % (20.46 % lower than average)
vs
24.76 %

Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine
40.2 % (41.24 % lower than average)
vs
81.44 %

Percent of short-stay residents with Pressure ulcers that are new or worsened
37.6 % (37.15 % lower than average)
vs
74.75 %

Percent of short-stay residents who newly received an antipsychotic medication
2.1 % (15.24 % lower than average)
vs
17.34 %



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