Adult Care Home Rating Worksheet
Facility Name:
Springview - Crouse Building
County: Alamance
License #: HAL-001-025
FID: 980775
This facility is rated: * Facilities must obtain two |
Star Rating Score Key | ||
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Four Stars | = 100 points or greater | ||
Three Stars | = 90.9 - 99.9 points | ||
Two Stars | = 80.0 - 89.9 points | ||
One Star | = 70.00 - 79.9 points | ||
Zero Stars | = 69.9 and lower |
Total Merit Points | Total Demerit Points | Base Points | Facility Rating Score |
---|---|---|---|
Base Points - Total Demerits + Total Merits = Rating Score | |||
2.00 | 2.00 | 100.00 | 100.00 |
Reason for Rating Issuance:
Annual Inspection Date: 10-Nov-16 |
Merit Points Earned | Demerit Points Issued | Statute or Rule Category | Measurement Evaluated |
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13F/G.0300 - Physical Plant Requirements | For each citation of noncompliance with the rules related to physical plant, the facility will receive a demerit of 2 points. (citation(s): _ x 2.0 = _ ) | ||
13F/G.0700 - Admission & Discharge Requirements | For each citation of noncompliance with the rules related to admission and discharge, the facility will receive a demerit of 2 points. (citation(s): _ x 2.0 = _ ) |
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13F/G.0800 - Resident Assessment & Care Plan | For each citation of noncompliance with the rules related to resident assessment & care plan, the facility will receive a demerit of 2 points. (citiation(s): _ x 2.0 = _ ) |
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2.00 | 13F/G.0900 - Resident Care & Services | For each citation of noncompliance with the rules related to resident care & services, the facility will receive a demerit of 2 points. (citation(s): 1 x 2.0 = 2.00) |
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13F/G.1000 - Medication Management | For each citation of noncompliance with the rules related to medication management, the facility will receive a demerit of 2 points. (citation(s): _ x 2.0 = _ ) |
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13F.1300 - Special Care Units for Alzheimer's & Related Disorders (ACH Only) | For each citation of noncompliance with the rules related to special care units for Alzheimer's & related disorders, the facility will receive a demerit of 2 points. (citation(s): _ x 2.0 = _ ) |
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13F.1400 - Special Care Units for Mental Health Disorders (ACH Only) | For each citation of noncompliance with the rules related to special care units for mental health disorders, the facility will receive a demerit of 2 points. (citation(s): _ x 2.0 = _ ) |
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13F/G.1500 - Use of Physical Restraints & Alternatives | For each citation of noncompliance with the rules related to physical restraints and alternatives, the facility will receive a demerit of 2 points. (citation(s): _ x 2.0 = _ ) |
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G.S.131D-21 - Residents' Rights | For each citation of noncompliance with the statutes related to residents' rights, the facility will receive a demerit of 2 points. (citation(s): _ x 2.0 = _ ) |
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13F/G.0215 - Type A Violation | For each citation of noncompliance, which results in a Type A violation, the facility will receive a demerit of 10 points. (citation(s): _ x 10.0 = _ ) |
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13F/G.0215 - Type B Violation | For each citation of noncompliance, which results in a Type B violation, the facility will receive a demerit of 3.5 points. (citation(s): _ x 3.5 = _ ) |
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13F/G.0215 - Type B Violation Uncorrected | For each Type B violation that is uncorrected, the facility will receive a demerit of 3.5 points. (Type B violations uncorrected: _ x 3.5 = _ ) |
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13F/G.0214 Suspension of Admissions | If the facility's admissions are suspended, the facility will receive a demerit of 10 points. | ||
13F/G.0212 Notice of Revocation of License Issued | If a notice of revocation of license is issued, the facility will receive a demerit of 31 points. | ||
13F/G.1603 - Citation of noncompliance corrected or Type B Violation correction | For each citation of non-compliance of Type B Violation correction with rules related to 10A NCAC 13F .1603, which is corrected, the facility will receive a merit of 1.25 points. (citation(s): _ x 1.25 = _ ) |
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13F/G.0215 - Type A Violation corrected | For each citation, which is corrected, which previously resulted in a Type A violation, the facility will receive a merit of 2.5 points. (citation(s): _ x 2.5 = _ ) |
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13F/G.0215 - Uncorrected Type B Violation corrected | For each uncorrected Type B violation that is corrected, the facility will receive a merit of 1.25 points. (Type B violations corrected: _ x 1.25 = _ ) |
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Removal of Suspension of Admissions | If the facility has a Suspension of Admissions removed, the facility will receive a merit of 5 points. | ||
G.S.131D-10(d)(2) - Participation in a Quality Improvement Program | If the facility participates in a quality improvement program approved by DHHS, it will receive a merit of 2.5 points. | ||
G.S.131E - NC NOVA designation awarded | If the facility has been awarded NC NOVA designation, it will receive a merit of 2.5 points. | ||
Emergency power back-up | The facility will receive 2 merit point for new (On or after 07/03/2008) emergency power arrangements and 1 point for existing power arrangements. | ||
2.00 | Automatic sprinklers | The facility will receive 3 merit points for newly (On or after 07/03/2008) installed sprinklers and 2 points for existing sprinklers. |