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Windsor Gardens

Details

Type of Ownership For profit - Corporation
Participates in Medicare? Yes
Participates in Medicaid? Yes
Certified Beds 150
Continuing Care? No
Resident Council? Yes
Family Council? Yes
Multi-Home Chain? No
Located in a Hospital? No
Special Focus Facility? No

View:    Health Inspections  |  Quality Measures  |  Staffing  |  Fire Inspections

Health Inspections  

Most Recent Inspection: 03/25/2011

Date of last standard health inspection: 03/25/2011
Quality Indicator Survey No
Dates of Complaint Investigations: 04/01/2011 - 03/31/2012
Total number of Health Deficiencies for this nursing home: 1
Average number of Health Deficiencies in TX: 3
Average number of Health Deficiencies in US: 3
Range of Health Deficiencies in TX: 0 - 19
Quality Care Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Assist those residents who need help with eating/drinking 02/02/2012 01/00/2001 Few grooming and personal and oral hygiene.

Inspection, 02/00/2004

Nutrition and Dietary Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Provide food in a way that meets a resident's needs. 02/00/2004 02/03/2004 2 Some
Provide food in a way that meets a resident's needs. 02/00/2004 01/08/2005 2 Some

Inspection, 00/01/2004

Administration Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Keep accurate, complete and organized clinical records on each resident that meet professional standards. 00/01/2004 00/03/2005 2 Some
Keep accurate 00/01/2004 00/03/2005 Some complete and organized clinical records on each re
Nutrition and Dietary Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Store, cook, and serve food in a safe and clean way. 00/01/2004 00/03/2005 2 Some
Pharmacy Service Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. 00/01/2004 00/03/2005 2 Some
Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. 00/01/2004 00/03/2005 2 Some
Quality Care Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Assist those residents who need help with eating/drinking, grooming and personal and oral hygiene. 00/01/2004 00/03/2005 2 Few
Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses. 00/01/2004 00/03/2005 2 Few
Assist those residents who need help with eating/drinking 00/01/2004 00/03/2005 Few grooming and personal and oral hygiene.
Properly care for residents needing special services 00/01/2004 00/03/2005 colostomy including: injections

Inspection, 02/05/2003

Administration Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Make sure that nurse aides show they have the skills and techniques to be able to care for residents' needs. 02/05/2003 02/02/2004 2 Some
Environmental Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. 02/05/2003 02/02/2004 2 Some
Have a program that investigates, controls and keeps infection from spreading. 02/05/2003 02/02/2004 2 Some
Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. 02/05/2003 02/02/2004 2 Some
Pharmacy Service Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%. 02/05/2003 02/02/2004 2 Some
Provide routine and emergency drugs through a licensed pharmacist and only under the general supervision of a licensed nurse. 02/05/2003 02/02/2004 2 Few

Inspection, 01/07/2003

Administration Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Keep accurate 01/07/2003 01/08/2003 Some complete and organized clinical records on each re

Inspection, 00/04/2003

Environmental Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Have a program that investigates 00/04/2003 00/05/2003 Few controls and keeps infection from spreading.

Inspection, 00/07/2001

Administration Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Make sure that the facility is administered in an acceptable way that maintains the well-being of each resident. 00/07/2001 00/09/2001 2 Few
Mistreatment Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
1) Hire only people with no legal history of abusing 00/07/2001 00/09/2001 neglect or mistreatment of residents. neglecting or mistreating residents; or 2) report
Develop and implement policies for 1) screening and training employees; and the 2) prevention 00/07/2001 00/09/2001 investigation identification
Quality Care Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Ensure services provided by the nursing facility meet professional standards of quality. 00/07/2001 00/09/2001 2 Few

Nursing Home Staffing  

Information comes from data that the nursing home reports to its state agency. It contains the nursing home staffing hours for a two-week period prior to the time of the state inspection. CMS receives this data and converts it into the number of staff hours per resident per day.

National Average Average in TX Golden Living Center, Asheville
RN Staff Only1 N/A N/A 2 out of 5 stars
Total Number of Residents 86 72 120
Total, Licensed Nurse Staff Hours
per Resident per Day
16 hours 51 minutes 29 hours 19 minutes 2 hours 3 minutes
RN Hours
per Resident per Day
16 hours 3 minutes 28 hours 29 minutes 40 minutes
LPN/LVN Hours
per Resident per Day
16 hours 17 minutes 29 hours 31 minutes 1 hour 22 minutes
CNA Hours
per Resident per Day
17 hours 46 minutes 30 hours 19 minutes 2 hours 21 minutes

1 The star rating a nursing home received for the information it provided about its Registered Nurse (RN) staffing. RNs have between 2 and 6 years of education.

Quality Measures  

Information comes from data that the nursing home reports to its state agency. It contains the nursing home staffing hours for a two-week period prior to the time of the state inspection. CMS receives this data and converts it into the number of staff hours per resident per day.

Long-Term Residents

Short-Term Residents

Fire Safety Inspections

Lists the fire safety requirements that the nursing home failed to meet. Fire safety results are not included in the nursing home's Overall Rating.

Most Recent Inspection: 03/23/2011

Automatic Sprinkler Systems in all required areas Yes
Date of last standard fire safety inspection: 03/23/2011
Dates of Complaint Investigations: 04/01/2011 - 03/31/2012
Total number of Fire Safety Deficiencies for this nursing home: 0
Average number of Fire Safety Deficiencies in TX: 1
Average number of Fire Safety Deficiencies in US: 2
Range of Fire Safety Deficiencies in TX: 0 - 1

Inspection, 01/08/2004

Electrical Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
The appropriate emergency electrical system. 01/08/2004 02/03/2004 2 Some
Vertical Openings Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. 01/08/2004 02/03/2004 2 Some

Inspection, 00/01/2004

Automatic Sprinkler Systems Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
An approved automatic sprinkler system connected to the fire alarm system. 00/01/2004 03/00/2004 1 Many
Building Construction Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Approved construction type or materials. 00/01/2004 03/00/2004 1 Many
Corridor Walls and Doors Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Signs that state that exit doors are to be kept closed. 00/01/2004 03/00/2004 1 Many
Hazardous Area Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Special areas constructed so that walls can resist fire for one hour or an approved fire extinguishing system. 00/01/2004 03/00/2004 1 Many

Inspection, 02/03/2003

Hazardous Area Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Special areas constructed so that walls can resist fire for one hour or an approved fire extinguishing system. 02/03/2003 02/04/2003 2 Few
Smoke Compartmentation and Control Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Smoke barrier doors that can resist smoke for at least 20 minutes. 02/03/2003 02/04/2003 2 Few
Smoking Regulations Deficiencies
Deficiency Inspection Date Correction Date Level of Harm Residents Affected
Posted No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed." 02/03/2003 02/04/2003 2 Many
 

2535 W Pleasant Run
Lancaster, TX 75146

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